Article Figures & Data
Figures
- Fig 1.
Dual-layer structure of the FRED. The fluoroscopic visibility results from 2 interwoven helical marker strands delineating the dual-layer section (working length) and 4 radiopaque markers at the flared ends.
- Fig 2.
A, A male patient with multiple asymptomatic intracranial aneurysms with a small proximal aneurysm of the A1 segment status post stent-assisted coil occlusion of a distal ICA aneurysm, right oblique and cranial views. B, Placement of a 3.5-/13/7-mm FRED with its flared ends extending toward the ICA bifurcation to cover the aneurysm with the dual-layer part of the device, right oblique and cranial views. C, Stasis of contrast material up to the venous phase, right oblique and cranial views. D, 4-month follow-up angiography with complete occlusion of the aneurysm, right oblique and cranial views.
- Fig 3.
A, Finding of a large irregularly shaped aneurysm of the right ICA (posterior communicating segment) in a woman, causing symptoms of mass effect, 3D rotational angiography. B, Placement of a 4.0-/18/12-mm FRED after jailing of a microcatheter. Intra-aneurysmal stasis of contrast material, lateral view. C, Loose coil occlusion of the aneurysm, lateral view. D, Complete occlusion of the aneurysm on 3-month follow-up angiography, lateral view.
- Fig 4.
A, Incidental finding of a cavernous ICA aneurysm in a female patient, 3D rotational angiography. B, Placement of a 3.5-/22/16-mm FRED with incomplete expansion in the midsection of the flow diverter, recorded with fluoroscopy. C, Acute thrombotic occlusion of the ICA caused by the incompletely expanded flow diverter, right anterior oblique view. D, Status post dilation of the FRED with a coronary percutaneous transarterial angioplasty balloon (Sequent Medical, 2.75 × 10 mm), right anterior oblique view. E, 3-month follow-up angiography demonstrates complete occlusion of the cavernous aneurysm with regular opacification of the ICA, lateral view.
Tables
Criteria In favor of treatment with FRED Intradural incidental aneurysm Intradural or extradural symptomatic aneurysm (mass effect) Supposed difficulty for coil treatment alone (dome-to-neck ratio of <1.2, broad-based aneurysm, fusiform morphology, blisterlike shape) Difficulty or impossibility of neurosurgical clip placement due to aneurysm morphology or anatomic location Acutely ruptured aneurysms without any alternative neurosurgical or endovascular treatment option Aneurysm remnant or reperfusion after endovascular or microsurgical treatment Documented response to medicamentous platelet function inhibition Exclusion for treatment with FRED Intradural aneurysm with a definable neck Intradural bifurcation aneurysm Documented nonresponse to medicamentous platelet function inhibition Patient preference for alternative treatment options Patient preference against any treatment Location Aneurysms (No.) Ratio Anterior circulation (n = 39; 75.0%) ICA cervical 8 15.4% ICA cavernous 3 5.8% ICA paraophthalmic 21 40.5% ICA Pcom 3 5.8% ACA 2 3.8% MCA 2 3.8% Posterior circulation (n = 13; 25.0%) BA 2 3.8% VA V4 9 17.3% PCA 2 3.8% Total 52 100.0% Note:—ACA indicates anterior cerebral artery; BA, basilar artery; VA, vertebral artery; PCA, posterior cerebral artery; Pcom, posterior communicating; MCA, middle cerebral artery.
Occlusion 3-Month Follow-Up Ratio 12-Month Follow-Up Ratio Complete occlusion 25 58.1% 27 75.0% Minor neck remnant 11 25.6% 8 22.2% Major residual filling 3 7.0% 1 2.8% Unchanged filling 4 9.3% 0 0.0% Total 43 100.0% 36 100.0% Adverse Events At Discharge (n = 52 cases) Ratio 3-Month Follow-Up (n = 43 cases) Ratio 12-Month Follow-Up (n = 36 cases) Ratio Hemorrhagic 0 0.0% 1 2.3% 0 0.0% Thromboembolic, symptomatic 1 1.9% 0 0.0% 1 2.8% Thromboembolic, asymptomatic 3 5.7% 2 4.7% 1 2.8% Total 4 7.6% 3 7.0% 2 5.6% At Discharge (n = 50 patients) Ratio 3-Month Follow-Up (n = 41 patients) Ratio 12-Month Follow-Up (n = 34 patients) Ratio Morbidity 1 2.0% 0 0.0% 1 2.0% Mortality 0 0.0% 1 2.0% 0 0.0 - Table 6:
Complication rates with different flow diverters including the period under review
Author Year Flow Diverter No. of Patients Thromboembolic Complications Hemorrhagic Complications Median Follow-Up Time (mo) Möhlenbruch et al8 2015 FRED 29 14.0% 3.0% 6 Poncyljusz et al11 2013 FRED 6 17.0% 0.0% 3 Briganti et al12 2016 FRED 20 0.0% 0.0% 12 Lubicz et al13 2015 Silk 26 23.1% 11.5% 6 Briganti et al4 2012 Silk + Pipeline 273 4.8% 5.5% 3 Colby et al7 2016 Pipeline Flex 44 2.0% 0.0% Not applicable De Vries et al14 2013 Surpass 37 13.5% 5.4% 12 Fischer et al15 2015 p64 130 3.0% 0.0% 9 Our data 2016 FRED 48 15.4% 1.9% 12
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