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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleNeurointervention

Treatment of Intra- and Extracranial Aneurysms Using the Flow-Redirection Endoluminal Device: Multicenter Experience and Follow-Up Results

F. Drescher, W. Weber, A. Berlis, S. Rohde, A. Carolus and S. Fischer
American Journal of Neuroradiology January 2017, 38 (1) 105-112; DOI: https://doi.org/10.3174/ajnr.A4964
F. Drescher
aFrom the Knappschaftskrankenhaus Bochum (F.D., W.W., S.F.), Universitätsklinik, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, Bochum, Germany
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W. Weber
aFrom the Knappschaftskrankenhaus Bochum (F.D., W.W., S.F.), Universitätsklinik, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, Bochum, Germany
bKnappschaftskrankenhaus Recklinghausen Klinik für Radiologie Neuroradiologie und Nuklearmedizin (W.W.), Recklinghausen, Germany
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A. Berlis
cKlinikum Augsburg (A.B.), Klinik für Diagnostiche Radiologie und Neuroradiologie, Augsburg, Germany
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S. Rohde
dKlinikum Dortmund (S.R.), Klinik für Radiologie und Neuroradiologie, Dortmund, Germany
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A. Carolus
eKnappschaftskrankenhaus Bochum (A.C.), Universitätsklinik, Klinik für Neurochirurgie, Bochum, Germany.
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S. Fischer
aFrom the Knappschaftskrankenhaus Bochum (F.D., W.W., S.F.), Universitätsklinik, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, Bochum, Germany
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  • Fig 1.
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    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.

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    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.

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    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.

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    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

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    Table 1:

    Inclusion and exclusion criteria for treatment with FRED

    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
    • View popup
    Table 2:

    Summary of the locations of the treated aneurysms

    LocationAneurysms (No.)Ratio
    Anterior circulation (n = 39; 75.0%)
        ICA cervical815.4%
        ICA cavernous35.8%
        ICA paraophthalmic2140.5%
        ICA Pcom35.8%
        ACA23.8%
        MCA23.8%
    Posterior circulation (n = 13; 25.0%)
        BA23.8%
        VA V4917.3%
        PCA23.8%
    Total52100.0%
    • Note:—ACA indicates anterior cerebral artery; BA, basilar artery; VA, vertebral artery; PCA, posterior cerebral artery; Pcom, posterior communicating; MCA, middle cerebral artery.

    • View popup
    Table 3:

    Occlusion rates at 3- and 12-month follow-up

    Occlusion3-Month Follow-UpRatio12-Month Follow-UpRatio
    Complete occlusion2558.1%2775.0%
    Minor neck remnant1125.6%822.2%
    Major residual filling37.0%12.8%
    Unchanged filling49.3%00.0%
    Total43100.0%36100.0%
    • View popup
    Table 4:

    Summary of complications during the follow-up period

    Adverse EventsAt Discharge (n = 52 cases)Ratio3-Month Follow-Up (n = 43 cases)Ratio12-Month Follow-Up (n = 36 cases)Ratio
    Hemorrhagic00.0%12.3%00.0%
    Thromboembolic, symptomatic11.9%00.0%12.8%
    Thromboembolic, asymptomatic35.7%24.7%12.8%
    Total47.6%37.0%25.6%
    • View popup
    Table 5:

    Morbidity and mortality during the follow-up period

    At Discharge (n = 50 patients)Ratio3-Month Follow-Up (n = 41 patients)Ratio12-Month Follow-Up (n = 34 patients)Ratio
    Morbidity12.0%00.0%12.0%
    Mortality00.0%12.0%00.0
    • View popup
    Table 6:

    Complication rates with different flow diverters including the period under review

    AuthorYearFlow DiverterNo. of PatientsThromboembolic ComplicationsHemorrhagic ComplicationsMedian Follow-Up Time (mo)
    Möhlenbruch et al82015FRED2914.0%3.0%6
    Poncyljusz et al112013FRED617.0%0.0%3
    Briganti et al122016FRED200.0%0.0%12
    Lubicz et al132015Silk2623.1%11.5%6
    Briganti et al42012Silk + Pipeline2734.8%5.5%3
    Colby et al72016Pipeline Flex442.0%0.0%Not applicable
    De Vries et al142013Surpass3713.5%5.4%12
    Fischer et al152015p641303.0%0.0%9
    Our data2016FRED4815.4%1.9%12
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American Journal of Neuroradiology: 38 (1)
American Journal of Neuroradiology
Vol. 38, Issue 1
1 Jan 2017
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Cite this article
F. Drescher, W. Weber, A. Berlis, S. Rohde, A. Carolus, S. Fischer
Treatment of Intra- and Extracranial Aneurysms Using the Flow-Redirection Endoluminal Device: Multicenter Experience and Follow-Up Results
American Journal of Neuroradiology Jan 2017, 38 (1) 105-112; DOI: 10.3174/ajnr.A4964

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Treatment of Intra- and Extracranial Aneurysms Using the Flow-Redirection Endoluminal Device: Multicenter Experience and Follow-Up Results
F. Drescher, W. Weber, A. Berlis, S. Rohde, A. Carolus, S. Fischer
American Journal of Neuroradiology Jan 2017, 38 (1) 105-112; DOI: 10.3174/ajnr.A4964
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