Repeat Flow Diversion for Cerebral Aneurysms Failing Prior Flow Diversion: Safety and Feasibility From Multicenter Experience.
Publication/Presentation Date
4-1-2022
Abstract
BACKGROUND: Aneurysmal persistence after flow diversion (FD) occurs in 5% to 25% of aneurysms, which may necessitate retreatment. There are limited data on safety/efficacy of repeat FD-a frequently utilized strategy in such cases.
METHODS: A series of consecutive patients undergoing FD retreatment from 15 centers were reviewed (2011-2019), with inclusion criteria of repeat FD for the same aneurysm at least 6 months after initial treatment, with minimum of 6 months post-retreatment imaging. The primary outcome was aneurysmal occlusion, and secondary outcome was safety. A multivariable logistic regression model was constructed to identify predictors of incomplete occlusion (90%-99% and < 90% occlusion) versus complete occlusion (100%) after retreatment.
RESULTS: Ninety-five patients (median age, 57 years; 81% women) harboring 95 aneurysms underwent 198 treatment procedures. Majority of aneurysms were unruptured (87.4%), saccular (74.7%), and located in the internal carotid artery (79%; median size, 9 mm). Median elapsed time between the first and second treatment was 12.2 months. Last available follow-up was at median 12.8 months after retreatment, and median 30.6 months after the initial treatment, showing complete occlusion in 46.2% and near-complete occlusion (90%-99%) in 20.4% of aneurysms. There was no difference in ischemic complications following initial treatment and retreatment (4.2% versus 4.2%;
CONCLUSIONS: Repeat FD for persistent aneurysms carries a reasonable success/safety profile. Satisfactory occlusion (100% and 90%-99% occlusion) was encountered in two-thirds of patients, with similar complications between the initial and subsequent retreatments. Fusiform morphology was the strongest predictor of retreatment failure.
Volume
53
Issue
4
First Page
1178
Last Page
1189
ISSN
1524-4628
Published In/Presented At
Salem, M. M., Sweid, A., Kuhn, A. L., Dmytriw, A. A., Gomez-Paz, S., Maragkos, G. A., Waqas, M., Parra-Farinas, C., Salehani, A., Adeeb, N., Brouwer, P., Pickett, G., Ku, J., X D Yang, V., Weill, A., Radovanovic, I., Cognard, C., Spears, J., Cuellar-Saenz, H. H., Renieri, L., … Thomas, A. J. (2022). Repeat Flow Diversion for Cerebral Aneurysms Failing Prior Flow Diversion: Safety and Feasibility From Multicenter Experience. Stroke, 53(4), 1178–1189. https://doi.org/10.1161/STROKEAHA.120.033555
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
34634924
Department(s)
Administration and Leadership
Document Type
Article