PATIENTS
We retrospectively reviewed patients with unruptured intracranial aneurysms who underwent endovascular treatment with flow diverters between April 2013 and August 2015 at our institution.
We identified 25 patients (16 asymptomatic and 9 symptomatic).
Nine patients (mean age 55 ± 10 years; 6 females,
3 males) with specific neurologic symptoms and unruptured aneurysms (mean size 21 ± 7 mm) were treated; 3 patients referred progressive visual loss,
4 symptoms related to compression of cranial nerves (III-IV-VI deficit),
2 suffered of multiple TIA episodes,
followed by a disorder of speech and vertigo.
The aneurysms were located in the cavernous or ophtalmic segment of the internal carotid artery (6),
in the basilar tip (2),
and in vertebral artery (1).
All the aneurysms had a high probability of recurrence with traditional endovascular technique.
Therapeutic alternatives were discussed between neurosurgeons and interventional neuroradiologists multidisciplinary meetings.
DEVICES AND TECHNIQUE
3D rotational angiography was performed to determine the best working projections.
All treatments were performed under general anesthesia.
Endovascular access was obtained by a standard transfemoral approach; following access,
patients were heparinized with an intravenous bolus of 5000 UI.
A 6-French ENVOY catheter was then placed within the introducer to reach proximal internal carotid artery or in the vertebral artery as distal as possible,
allowing navigation with microcatheters.
Flow Re-Direction Endoluminal Device (FRED) was positioned in 4 patients,
Pipeline embolization device (PED) in 3 patients,
Silk flow Diverter (SFD) in 2 patients.
In 6 patients,
1 or more coils was placed in the aneurysm’s sac before the positioning of the flow diverter or with “jailing” technique.
MEDICAL TREATMENT
All patients were premedicated with 75 mg of clopidogrel and 75 or 150 mg of aspirin daily for at least 5 days before the procedure.
Dual antiplatelet therapy was mantained for at least 3 months for all patients,
and discontinued if the follow-up magnetic resonance imaging (MRI) study did not demonstrate recurrence or complications.
Single antiplatelet therapy was continued 6-12 months after the procedure.
With the aim of relieving mass-related symptoms,
4 patients received 4 mg of dexamethasone daily for 1 week,
and then for another week the dose was tapered and discontinued.
FOLLOW-UP AND CLINICAL OUTCOME
All patients underwent MRI examination 1-3 months after the procedure,
and a conventional angiography after 3-6 months if any unaspected finding was observed.
Another MRI study was performed 12 months after the intervention.
A senior neurosurgeon or neurointerventionalist recorded the clinical course and the evolution of symptoms.