Flow Diverter Performance for the Treatment of Intracranial Aneurysms: An International Multicenter Comparative Study
Background Current evidence comparing flow diverters (FDs) for the treatment of intracranial aneurysms is limited to single‐arm head‐to‐head retrospective and prospective studies. Herein, we aimed to compare the efficacy and safety of four FDs for the treatment of intracranial aneurysms. Methods We...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-03-01
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| Series: | Stroke: Vascular and Interventional Neurology |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.122.000696 |
| _version_ | 1797346875265777664 |
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| author | Juan Vivanco‐Suarez Juan E. Basilio Flores Aaron Rodriguez‐Calienes Juan Carlos Miranda Gustavo Foa David Altschul Joel A. Aguilar‐Melgar Andres Dajles Milagros Galecio‐Castillo Cynthia B. Zevallos Mudassir Farooqui Ajit S. Puri Henry Pacheco‐Fernandez Baca Santiago Ortega‐Gutierrez |
| author_facet | Juan Vivanco‐Suarez Juan E. Basilio Flores Aaron Rodriguez‐Calienes Juan Carlos Miranda Gustavo Foa David Altschul Joel A. Aguilar‐Melgar Andres Dajles Milagros Galecio‐Castillo Cynthia B. Zevallos Mudassir Farooqui Ajit S. Puri Henry Pacheco‐Fernandez Baca Santiago Ortega‐Gutierrez |
| author_sort | Juan Vivanco‐Suarez |
| collection | DOAJ |
| description | Background Current evidence comparing flow diverters (FDs) for the treatment of intracranial aneurysms is limited to single‐arm head‐to‐head retrospective and prospective studies. Herein, we aimed to compare the efficacy and safety of four FDs for the treatment of intracranial aneurysms. Methods We performed a retrospective, multicenter international cohort study of adult patients treated with FDs (Pipeline embolization device, Surpass Streamline, Flow Redirection Endoluminal Device, and Silk) for intracranial aneurysms between 2015 and 2021. Efficacy was determined by aneurysm occlusion at final follow‐up. Safety was determined by ischemic/hemorrhagic events and mortality. Secondary safety was assessed by technical complications. A mixed‐effect multivariable ordinal and logistic regression were performed to evaluate variables that predicted the outcomes of interest. Results We included 235 patients with 274 aneurysms. Treatment was performed with either the Pipeline embolization device (92), Surpass Streamline (56), Flow Redirection Endoluminal Device (47), and Silk (40). Median age was 57 (47–65) years. Most patients were asymptomatic (76%), and 8% had previous rupture. Most aneurysms were saccular (85%) and anterior (94%). The Pipeline embolization device subgroup had the largest aneurysms (6 mm, P=0.005). Median follow‐up time was 9 (6–14) months. Final overall complete occlusion was 72% without significant differences between FDs (P=0.5). Total ischemic (5%) and hemorrhagic (3%) events were also similar (P=0.1 and P=0.06). One patient expired (0.4%, P=0.6). In multivariable analysis, device diameter predicted aneurysm persistence and ≥50% in‐stent stenosis predicted ischemic/hemorrhagic complications. Conclusions Our findings comparing 4commonly used FDs in a heterogeneous population with mainly small‐sized aneurysms confirmed a similar safety and efficacy profile between devices. |
| first_indexed | 2024-03-08T11:39:32Z |
| format | Article |
| id | doaj.art-882e17261cf84954b39af7670bd8b2d1 |
| institution | Directory Open Access Journal |
| issn | 2694-5746 |
| language | English |
| last_indexed | 2024-03-08T11:39:32Z |
| publishDate | 2023-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj.art-882e17261cf84954b39af7670bd8b2d12024-01-25T09:28:49ZengWileyStroke: Vascular and Interventional Neurology2694-57462023-03-013210.1161/SVIN.122.000696Flow Diverter Performance for the Treatment of Intracranial Aneurysms: An International Multicenter Comparative StudyJuan Vivanco‐Suarez0Juan E. Basilio Flores1Aaron Rodriguez‐Calienes2Juan Carlos Miranda3Gustavo Foa4David Altschul5Joel A. Aguilar‐Melgar6Andres Dajles7Milagros Galecio‐Castillo8Cynthia B. Zevallos9Mudassir Farooqui10Ajit S. Puri11Henry Pacheco‐Fernandez Baca12Santiago Ortega‐Gutierrez13Department of Neurology Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City IowaDepartment of Neurosurgery Hospital Nacional Daniel Alcides Carrion Callao PeruDepartment of Neurology Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City IowaDepartment of Neuroradiology Sanatorio Sagrado Corazon Buenos Aires ArgentinaDepartment of Neuroradiology Instituto Oulton Cordoba ArgentinaDepartment of Neurosurgery Montefiore Medical Center Bronx NYDepartment of Neurosurgery Hospital Nacional Daniel Alcides Carrion Callao PeruDepartment of Neurology Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City IowaDepartment of Neurology Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City IowaDepartment of Neurology Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City IowaDepartment of Neurology Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City IowaDepartment of Radiology University of Massachusetts Medical School Worcester MADepartment of Neurosurgery Hospital Nacional Daniel Alcides Carrion Callao PeruDepartment of Neurology Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City IowaBackground Current evidence comparing flow diverters (FDs) for the treatment of intracranial aneurysms is limited to single‐arm head‐to‐head retrospective and prospective studies. Herein, we aimed to compare the efficacy and safety of four FDs for the treatment of intracranial aneurysms. Methods We performed a retrospective, multicenter international cohort study of adult patients treated with FDs (Pipeline embolization device, Surpass Streamline, Flow Redirection Endoluminal Device, and Silk) for intracranial aneurysms between 2015 and 2021. Efficacy was determined by aneurysm occlusion at final follow‐up. Safety was determined by ischemic/hemorrhagic events and mortality. Secondary safety was assessed by technical complications. A mixed‐effect multivariable ordinal and logistic regression were performed to evaluate variables that predicted the outcomes of interest. Results We included 235 patients with 274 aneurysms. Treatment was performed with either the Pipeline embolization device (92), Surpass Streamline (56), Flow Redirection Endoluminal Device (47), and Silk (40). Median age was 57 (47–65) years. Most patients were asymptomatic (76%), and 8% had previous rupture. Most aneurysms were saccular (85%) and anterior (94%). The Pipeline embolization device subgroup had the largest aneurysms (6 mm, P=0.005). Median follow‐up time was 9 (6–14) months. Final overall complete occlusion was 72% without significant differences between FDs (P=0.5). Total ischemic (5%) and hemorrhagic (3%) events were also similar (P=0.1 and P=0.06). One patient expired (0.4%, P=0.6). In multivariable analysis, device diameter predicted aneurysm persistence and ≥50% in‐stent stenosis predicted ischemic/hemorrhagic complications. Conclusions Our findings comparing 4commonly used FDs in a heterogeneous population with mainly small‐sized aneurysms confirmed a similar safety and efficacy profile between devices.https://www.ahajournals.org/doi/10.1161/SVIN.122.000696embolizationflow diversionintracranial aneurysmssubarachnoid hemorrhage |
| spellingShingle | Juan Vivanco‐Suarez Juan E. Basilio Flores Aaron Rodriguez‐Calienes Juan Carlos Miranda Gustavo Foa David Altschul Joel A. Aguilar‐Melgar Andres Dajles Milagros Galecio‐Castillo Cynthia B. Zevallos Mudassir Farooqui Ajit S. Puri Henry Pacheco‐Fernandez Baca Santiago Ortega‐Gutierrez Flow Diverter Performance for the Treatment of Intracranial Aneurysms: An International Multicenter Comparative Study Stroke: Vascular and Interventional Neurology embolization flow diversion intracranial aneurysms subarachnoid hemorrhage |
| title | Flow Diverter Performance for the Treatment of Intracranial Aneurysms: An International Multicenter Comparative Study |
| title_full | Flow Diverter Performance for the Treatment of Intracranial Aneurysms: An International Multicenter Comparative Study |
| title_fullStr | Flow Diverter Performance for the Treatment of Intracranial Aneurysms: An International Multicenter Comparative Study |
| title_full_unstemmed | Flow Diverter Performance for the Treatment of Intracranial Aneurysms: An International Multicenter Comparative Study |
| title_short | Flow Diverter Performance for the Treatment of Intracranial Aneurysms: An International Multicenter Comparative Study |
| title_sort | flow diverter performance for the treatment of intracranial aneurysms an international multicenter comparative study |
| topic | embolization flow diversion intracranial aneurysms subarachnoid hemorrhage |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.122.000696 |
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