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Published on: September 25, 2009
Angiographic Occlusion After Flow Diversion of Ruptured and Unruptured Intracranial Aneurysms Using the Flow
Joanna M Roy1, Arbaz Momin1, Basel Musmar1
1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.
Insights
Flow diversion with FRED-X effectively occludes intracranial aneurysms. Larger distal parent artery diameter predicts lower occlusion rates, highlighting the importance of device sizing for successful flow diversion treatment.
Area of Science:
- Endovascular neurosurgery
- Cerebrovascular disease management
- Medical device technology
Background:
- Flow diversion is a key endovascular technique for treating intracranial aneurysms.
- Factors influencing flow diversion success include patient comorbidities, aneurysm morphology, and stent design.
- The Flow Redirection Endoluminal Device with X-technology (FRED-X) is a specific flow diverter used in this study.
Purpose of the Study:
- To identify predictors of angiographic occlusion after intracranial aneurysm treatment with the FRED-X flow diverter.
- To analyze the impact of patient-specific and aneurysm-related factors on treatment outcomes.
- To evaluate the efficacy of FRED-X in achieving progressive aneurysm occlusion.
Main Methods:
- A multicenter retrospective study involving 144 patients with 152 intracranial aneurysms treated with FRED-X.
- Data collection included patient demographics, aneurysm characteristics, and procedural details.
- Angiographic occlusion was assessed using the Raymond Roy Occlusion Classification, with multivariate logistic regression analyzing predictors of complete occlusion at 6- or 12-month follow-up.
Main Results:
- Complete angiographic occlusion was achieved in 69.4% of patients.
- Univariate analysis revealed associations between occlusion and aneurysm laterality, partial sac thrombosis, parent artery diameters, and procedure time.
- Multivariate analysis identified that a larger parent artery diameter distal to the aneurysm was significantly associated with decreased odds of complete occlusion (OR 0.46, P < .002).
Conclusions:
- Distal parent artery diameter is a significant predictor of reduced aneurysm occlusion rates following flow diversion with FRED-X.
- These findings underscore the critical role of appropriate device sizing in optimizing flow diversion outcomes.
- Further prospective research is recommended to validate these results and refine treatment strategies.
Background And Objectives:
Flow diversion induces progressive aneurysm occlusion by reducing blood flow across the aneurysm neck over time. Various factors, including comorbid conditions, aneurysm characteristics, and stent design, have been shown to affect occlusion rates after flow diversion. Our study analyzed predictors of angiographic occlusion after flow diversion of intracranial aneurysms using the Flow Redirection Endoluminal Device with X-technology (FRED-X).
Methods:
This was a multicenter study of ruptured and unruptured aneurysms treated at 6 participating institutions across the United States. Data were collected on patient-specific factors and aneurysm characteristics. Angiographic occlusion was assessed using the Raymond Roy Occlusion Classification. Multivariate logistic regression was used to analyze predictors of complete angiographic occlusion at either the 6- or 12-month follow-up.
Results:
One hundred forty-four patients with 152 aneurysms met criteria for inclusion. A total of 69.4% of patients (n = 100) achieved complete occlusion. The average age of the cohort that achieved complete occlusion was 56.2 years, and 84% (n = 84) was female. On univariate analysis, aneurysm laterality, partial thrombosis of the aneurysm sac, proximal and distal diameters of the parent artery, and procedure time were significantly associated with complete angiographic occlusion. On multivariate analysis, parent artery diameter distal to the aneurysm was associated with 0.46-fold decreased odds of complete occlusion (95% CI: 0.26-0.78, P < .002). One patient in the incompletely occluded cohort underwent retreatment using the Pipeline Shield at 7 months after the initial flow diversion procedure using the FRED-X.
Conclusion:
Our study identified that parent artery diameter distal to the aneurysm was associated with decreased odds of aneurysm occlusion after flow diversion using the FRED-X. This adds to the literature on the importance of device sizing during flow diversion. Further prospective studies could help validate these findings.
