Adrian Ringelstein, Essen, Germany, presented the results of a study at the European Congress of Radiology (ECR) in Vienna, Austria, in March which showed a high aneurysm occlusion rate in the mid-term follow-up after treatment of complex aneurysms with flow diverters. The study also revealed a complication rate that was “not low”.
Wide-necked and fusiform aneurysms are a technical challenge for endovascular treatment. Ringelstein noted that flow diverters may occlude the aneurysms by endoluminal reconstruction of the parent artery and reduction of blood flow into the aneurysms.
“The purpose of this study was to assess the rate of intervention-associated complications and the mid-term outcome after Silk stent implantation,” he told delegates.
The investigators retrospectively analysed 17 patients with unruptured aneurysms who were treated using 21 Silk flow diverters between May 2008 and December 2010. Indications for treatment were presence of fusiform aneurysms, circumferential aneurysms and giant aneurysms and presentation of embolic events or a progressive mass effect.
They achieved technical success reached in all 17 patients. “Three aneurysms were immediately occluded, one of these with additional coiling. All aneurysms showed immediately in-flow reduction. After three months, occlusion was observed in all cases except one aneurysm of the internal carotid artery. The overall complication rate including technical, thromboembolic complication or in-stent-thrombosis was 29 % (six out of 21 flow diverters),” said Ringelstein.
He also noted that clinical outcome included two patients with severe neurological deficits and one with neurological deficit that was considered “not severe”. At the one-year follow-up, no reperfusion of any aneurysm was seen, he added.
The investigators concluded that despite a 29% complication rate, flow diverter treatment of complex aneurysms is effective with a high aneurysm occlusion rate at one year follow-up.
Ringelstein also said: “The overall complication rate may be higher than in conventional stent-assisted coiling, but we have to consider that the aneurysms were difficult to treat with conventional endovascular methods, had recurred after previous treatments, or showed a disease progression.”