Distal Aneurysms Are Amenable To Selective Treatment With Flow Diverters

In short

MedWire News has released an article based on an advance online publication from “Stroke” in which a French study has found patients who present with distal aneurysms at and beyond the circle of Willis can be effectively treated with flow diverters (FD) without experiencing significant complications.

Background

Distally located aneurysms can be difficult to treat with endovascular techniques that spare the parent artery, due to the potential risk for ischemia.

The flow diverting stent is a new option in endovascular therapy specifically designed for the endovascular reconstruction of a segmentally diseased artery, forming a high-coverage mesh on the neck of the aneurysm to reduce blood flow into the sac and subsequently induce thrombosis while preserving the patency of adjacent small vessels. Studies have concluded that FD can be a successful treatment option, but the associated risk of thromboembolic events means some will justify it only if conventional endovascular or surgical treatment options are not applicable.

Application of flow diversion therefore remains in clinical question and this study deal specifically with its use in small peripheral aneurysms where its clinical advantages could theoretically be most significant.

The study

A more full treatment of the methodology and results can be found in the Medwire article or the Stroke paper (abstract) itself.

In summary, 30 aneurysms at and beyond the circle of Willis from 26 patients (aged 49 years on average) were treated with FD alone in 73.3% of cases and with additional coils in 23.3% of cases. Clinical findings were that immediate angiographic occlusion was achieved in 18.2% of patients treated with FD alone, while this was not achieved among those treated with FD plus coils. No angiographic recurrence of initially totally occluded aneurysms was observed.

Data from 13 months’ follow up showed that in the group of patients with aneurysms treated by FD alone, 78.9% achieved complete occlusion compared with 100% in all four aneurysms treated by FDs and coils.

The paper concludes that aneurysms at and beyond the circle of Willis are amenable to selective treatment with FDs.

Investigator comments

Michel Piotin (Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild, Paris) and colleagues caution that because that FD does not elicit complete aneurysm occlusion at the time of placement, it may not provide the immediate protection from re-bleeding offered by coiling or surgical clipping. However, they say that surgical or conventional endovascular treatment of blister-like and very small aneurysms remains challenging.

“In this context, FD that provides redirection of blood flow and aneurysm thrombosis, without taking the risk of aneurysm sac perforation by catheterisation, might be an alternative and a simpler therapeutic option,” says the team.

“Our limited series carries the inherent restrictions of a small retrospective study, and larger series with longer follow-up are mandatory to draw definitive conclusions,” write the authors in Stroke.

Source: Medwire News, Stroke