Treatment of Unruptured, Tandem Aneurysms of the ICA with a Single Flow Diverter

Intracranial adjacent tandem lesions of the internal carotid artery (ICA) are rare and the optimal treatment strategy is unknown. This study was carried out to determine whether a single flow diverter stent (FDS) could be successfully used to treat these lesions.

The prospectively maintained database was retrospectively carried out to identify patients treated between February 2009 and February 2018 with multiple unruptured, tandem ICA aneurysms and treated with a single FDS. Demographic data, clinical presentation, aneurysm characteristics, treatment data, clinical result and clinical and radiological follow-up information were recorded.

A total of 69 patients (62 female, 89.8%) with average age 55 ± 14.8 years were identified. In total there were 169 aneurysms and the majority of patients (n = 47, 68.1%) had only 2 tandem aneurysms. The largest aneurysms measured 7.69 ± 5.3 mm (range 1.5-26 mm) in height, 6.64 ± 4.71 mm (range 1.5-23 mm) in width and the smaller aneurysm measured 2.61 ± 1.32 mm (range 0.8-9.5 mm) in height and 2.32 ± 1.12 mm (range 0.7-8 mm) in width. In 36 patients the p64 was used, the PED in 28 patients and Surpass in 5 patients. Follow-up was available in 54 patients (130 aneurysms). At initial follow-up (7.2 ± 4.2 months) 45 (83.3%) of the larger aneurysms and 66 (86.8%) of the smaller aneurysms were satisfactorily occluded (Raymond-Roy classification RRC 1 or 2). At delayed follow-up (18 ± 14.6 months) 48 of the larger aneurysms (88.9%) and 71 of the smaller aneurysms (93.4%) were satisfactorily occluded. There were three complications including one death.

A single FDS can be used to successfully treat multiple tandem aneurysms of the ICA with a high rate of aneurysm exclusion and an acceptable risk profile.