Endovascular treatment of unruptured intracranial aneurysms with flow diverters: A retrospective long-term single center analysis

Abstract

Purpose The introduction of flow diverters (FDs) in 2007 greatly enhanced the treatment of intracranial aneurysms. Here, we present our long-term clinical experience in treating unruptured intracranial aneurysms with FDs. Methods 107 patients with unruptured aneurysms and treated with an FD between 2010 and 2019 were retrospectively reviewed. Aneurysm occlusion, procedural complications, and clinical outcome were evaluated. Results Angiographic follow-up was available for 93 patients with a mean long-term follow-up time of 28.4 ± 21.6 months. Additional coiling was performed in 15.1% of patients ( n = 14). Adequate aneurysm occlusion (Kamran grades 3 and 4) at long-term follow-up was achieved in 94.6% of patients ( n = 88). 3.2% ( n = 3) required endovascular retreatment since the last follow-up showed a lack of aneurysm occlusion (Kamran grade 0) due to a foreshortening of the FD. Incomplete opening of the FD and parent vessel occlusion was seen in 1.1% ( n = 1) and 3.2% ( n = 3) of patients, respectively. In-stent stenosis was observed in 57% ( n = 53) of cases at short-term follow-up and 22.6% ( n = 21) at long-term, which were moderate and asymptomatic overall. In-stent stenosis decreased significantly between short- and long-term follow-ups (31.4 ± 17.0% vs 9.7 ± 13.6%, respectively; p ≤ 0.001). Thromboembolic and hemorrhagic events occurred in 7.5% ( n = 7) and 1.1% ( n = 1) of patients, respectively. Good clinical outcome (modified Rankin scale: 0–2) was obtained in 97.8% ( n = 91) leading to an overall treatment-related morbidity of 2.2% ( n = 2). There was no procedural mortality. Conclusion Our study shows that FD treatment of unruptured intracranial aneurysms is effective and safe with high occlusion rates and low rates of permanent morbidity at long-term follow-up.