SILK flow diverter for treatment of intracranial aneurysms: initial experience and cost analysis
Background The flow diverting stent is a new and expansive tool in the endovascular therapy of complex intracranial aneurysms. We present our experience using SILK flow diverter (SFD) in patients with complex intracranial aneurysms, and a cost analysis. Methods Between September 2010 and May 2012, 1...
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| Veröffentlicht in: | Journal of neurointerventional surgery 2013-11, Vol.5 (Suppl 3), p.iii11-iii15 |
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| description | Background The flow diverting stent is a new and expansive tool in the endovascular therapy of complex intracranial aneurysms. We present our experience using SILK flow diverter (SFD) in patients with complex intracranial aneurysms, and a cost analysis. Methods Between September 2010 and May 2012, 19 consecutive patients with 29 complex intracranial aneurysms were treated with SFD without the adjunctive use of coils. We retrospectively evaluated the technical aspects, thromboembolic events, adjunctive therapies, and short term results in patients with complex intracranial aneurysms treated with SFD. A cost analysis of patients who were treated with SFD was performed and compared with similar sized aneurysms coiled with stent assisted coiling. Results The primary technical success rate was 100%. An adjunctive device was required in two of our patients. The technique related complication rate and the 30 day mortality and morbidity rates were 5% (1/20) and 10% (2/20), respectively. We had a total of 263 patient months of clinical and 166 patient months of imaging follow-up. Follow-up imaging revealed two asymptomatic occlusions of the parent artery. Complete occlusion of the aneurysm with fully patent parent artery was observed in 59% of patients where follow-up images were available. The cost analysis showed that the mean cost of treatment with SFD was significantly cheaper compared with the presumed cost of stent assisted coiling (p |
| doi_str_mv | 10.1136/neurintsurg-2012-010590 |
| format | Article |
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We present our experience using SILK flow diverter (SFD) in patients with complex intracranial aneurysms, and a cost analysis. Methods Between September 2010 and May 2012, 19 consecutive patients with 29 complex intracranial aneurysms were treated with SFD without the adjunctive use of coils. We retrospectively evaluated the technical aspects, thromboembolic events, adjunctive therapies, and short term results in patients with complex intracranial aneurysms treated with SFD. A cost analysis of patients who were treated with SFD was performed and compared with similar sized aneurysms coiled with stent assisted coiling. Results The primary technical success rate was 100%. An adjunctive device was required in two of our patients. The technique related complication rate and the 30 day mortality and morbidity rates were 5% (1/20) and 10% (2/20), respectively. We had a total of 263 patient months of clinical and 166 patient months of imaging follow-up. Follow-up imaging revealed two asymptomatic occlusions of the parent artery. Complete occlusion of the aneurysm with fully patent parent artery was observed in 59% of patients where follow-up images were available. The cost analysis showed that the mean cost of treatment with SFD was significantly cheaper compared with the presumed cost of stent assisted coiling (p<0.001). Conclusions The SFD provides a very feasible, efficient, relatively safe, and cost effective method to treat complex intracranial aneurysms without the use of adjunct coiling.</description><identifier>ISSN: 1759-8478</identifier><identifier>EISSN: 1759-8486</identifier><identifier>DOI: 10.1136/neurintsurg-2012-010590</identifier><identifier>PMID: 23424227</identifier><language>eng</language><publisher>BMA House, Tavistock Square, London, WC1H 9JR: BMJ Publishing Group Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Aneurysm ; Aneurysms ; Anti-Inflammatory Agents - therapeutic use ; Aspirin - therapeutic use ; Blood platelets ; Coronary Angiography ; Cost analysis ; Costs and Cost Analysis ; Databases, Factual ; Dexamethasone - therapeutic use ; Embolization, Therapeutic - economics ; Embolization, Therapeutic - instrumentation ; Embolization, Therapeutic - methods ; Female ; Flow Diverter ; Follow-Up Studies ; Humans ; Intracranial Aneurysm - mortality ; Intracranial Aneurysm - therapy ; Magnetic Resonance Angiography ; Male ; Middle Aged ; Patients ; Pipelines ; Platelet Aggregation Inhibitors - therapeutic use ; Retrospective Studies ; Stents ; Stents - adverse effects ; Stents - economics ; Ticlopidine - analogs & derivatives ; Ticlopidine - therapeutic use ; Tomography, X-Ray Computed ; Treatment Outcome ; Veins & arteries ; Young Adult</subject><ispartof>Journal of neurointerventional surgery, 2013-11, Vol.5 (Suppl 3), p.iii11-iii15</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Copyright: 2013 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b422t-f9e1e922eeb4a4e38a07ff1a9847a984dcb8653a50d7e27db1a508f1a8b1ef0c3</citedby><cites>FETCH-LOGICAL-b422t-f9e1e922eeb4a4e38a07ff1a9847a984dcb8653a50d7e27db1a508f1a8b1ef0c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jnis.bmj.com/content/5/Suppl_3/iii11.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttps://jnis.bmj.com/content/5/Suppl_3/iii11.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,776,780,3183,23550,27901,27902,77569,77600</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23424227$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shankar, Jai Jai Shiva</creatorcontrib><creatorcontrib>Vandorpe, Robert</creatorcontrib><creatorcontrib>Pickett, Gwynedd</creatorcontrib><creatorcontrib>Maloney, William</creatorcontrib><title>SILK flow diverter for treatment of intracranial aneurysms: initial experience and cost analysis</title><title>Journal of neurointerventional surgery</title><addtitle>J NeuroIntervent Surg</addtitle><description>Background The flow diverting stent is a new and expansive tool in the endovascular therapy of complex intracranial aneurysms. We present our experience using SILK flow diverter (SFD) in patients with complex intracranial aneurysms, and a cost analysis. Methods Between September 2010 and May 2012, 19 consecutive patients with 29 complex intracranial aneurysms were treated with SFD without the adjunctive use of coils. We retrospectively evaluated the technical aspects, thromboembolic events, adjunctive therapies, and short term results in patients with complex intracranial aneurysms treated with SFD. A cost analysis of patients who were treated with SFD was performed and compared with similar sized aneurysms coiled with stent assisted coiling. Results The primary technical success rate was 100%. An adjunctive device was required in two of our patients. The technique related complication rate and the 30 day mortality and morbidity rates were 5% (1/20) and 10% (2/20), respectively. We had a total of 263 patient months of clinical and 166 patient months of imaging follow-up. Follow-up imaging revealed two asymptomatic occlusions of the parent artery. Complete occlusion of the aneurysm with fully patent parent artery was observed in 59% of patients where follow-up images were available. The cost analysis showed that the mean cost of treatment with SFD was significantly cheaper compared with the presumed cost of stent assisted coiling (p<0.001). Conclusions The SFD provides a very feasible, efficient, relatively safe, and cost effective method to treat complex intracranial aneurysms without the use of adjunct coiling.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aneurysm</subject><subject>Aneurysms</subject><subject>Anti-Inflammatory Agents - therapeutic use</subject><subject>Aspirin - therapeutic use</subject><subject>Blood platelets</subject><subject>Coronary Angiography</subject><subject>Cost analysis</subject><subject>Costs and Cost Analysis</subject><subject>Databases, Factual</subject><subject>Dexamethasone - therapeutic use</subject><subject>Embolization, Therapeutic - economics</subject><subject>Embolization, Therapeutic - instrumentation</subject><subject>Embolization, Therapeutic - methods</subject><subject>Female</subject><subject>Flow Diverter</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Intracranial Aneurysm - mortality</subject><subject>Intracranial Aneurysm - therapy</subject><subject>Magnetic Resonance Angiography</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Pipelines</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Retrospective Studies</subject><subject>Stents</subject><subject>Stents - adverse effects</subject><subject>Stents - economics</subject><subject>Ticlopidine - analogs & derivatives</subject><subject>Ticlopidine - therapeutic use</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><subject>Veins & arteries</subject><subject>Young Adult</subject><issn>1759-8478</issn><issn>1759-8486</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkU1P3DAQhq0K1F22_QsQiUsvAdtJbIcbrFhYsWor0Va9uU4yrrzNx9Z2YPff4yiwQpy42KOZZ2ZezYvQCcFnhCTsvIXemta73v6NKSY0xgRnOf6ApoRneSxSwQ72MRcTdOTcGmPGM559RBOapDSllE_Rn_vl6i7SdfcYVeYBrAcb6c5G3oLyDbQ-6nQUNllVWtUaVUdq2L1zjbsIeeOHFGw3YA20JYRqFZWd8yFQ9c4Z9wkdalU7-Pz8z9DPxfWP-W28-naznF-u4iII8bHOgUBOKUCRqhQSoTDXmqg8yB-eqiwEyxKV4YoD5VVBQigCIAoCGpfJDH0Z525s978H52VjXAl1HfR2vZMkTdMkzzDDAT19g6673ga9geKCCUwYzgPFR6q0nXMWtNxY0yi7kwTLwQT5ygQ5mCBHE0Ln8fP8vmig2ve9XD0A8QgY52G7ryv7TzKe8Ex-_TWXmK4W7Hd-Jb8Hno580azfreIJbA-nOA</recordid><startdate>201311</startdate><enddate>201311</enddate><creator>Shankar, Jai Jai Shiva</creator><creator>Vandorpe, Robert</creator><creator>Pickett, Gwynedd</creator><creator>Maloney, William</creator><general>BMJ Publishing Group Ltd</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>201311</creationdate><title>SILK flow diverter for treatment of intracranial aneurysms: initial experience and cost analysis</title><author>Shankar, Jai Jai Shiva ; Vandorpe, Robert ; Pickett, Gwynedd ; Maloney, William</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b422t-f9e1e922eeb4a4e38a07ff1a9847a984dcb8653a50d7e27db1a508f1a8b1ef0c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aneurysm</topic><topic>Aneurysms</topic><topic>Anti-Inflammatory Agents - therapeutic use</topic><topic>Aspirin - therapeutic use</topic><topic>Blood platelets</topic><topic>Coronary Angiography</topic><topic>Cost analysis</topic><topic>Costs and Cost Analysis</topic><topic>Databases, Factual</topic><topic>Dexamethasone - therapeutic use</topic><topic>Embolization, Therapeutic - economics</topic><topic>Embolization, Therapeutic - instrumentation</topic><topic>Embolization, Therapeutic - methods</topic><topic>Female</topic><topic>Flow Diverter</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Intracranial Aneurysm - mortality</topic><topic>Intracranial Aneurysm - therapy</topic><topic>Magnetic Resonance Angiography</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Pipelines</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Retrospective Studies</topic><topic>Stents</topic><topic>Stents - adverse effects</topic><topic>Stents - economics</topic><topic>Ticlopidine - analogs & derivatives</topic><topic>Ticlopidine - therapeutic use</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><topic>Veins & arteries</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shankar, Jai Jai Shiva</creatorcontrib><creatorcontrib>Vandorpe, Robert</creatorcontrib><creatorcontrib>Pickett, Gwynedd</creatorcontrib><creatorcontrib>Maloney, William</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of neurointerventional surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shankar, Jai Jai Shiva</au><au>Vandorpe, Robert</au><au>Pickett, Gwynedd</au><au>Maloney, William</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>SILK flow diverter for treatment of intracranial aneurysms: initial experience and cost analysis</atitle><jtitle>Journal of neurointerventional surgery</jtitle><addtitle>J NeuroIntervent Surg</addtitle><date>2013-11</date><risdate>2013</risdate><volume>5</volume><issue>Suppl 3</issue><spage>iii11</spage><epage>iii15</epage><pages>iii11-iii15</pages><issn>1759-8478</issn><eissn>1759-8486</eissn><abstract>Background The flow diverting stent is a new and expansive tool in the endovascular therapy of complex intracranial aneurysms. We present our experience using SILK flow diverter (SFD) in patients with complex intracranial aneurysms, and a cost analysis. Methods Between September 2010 and May 2012, 19 consecutive patients with 29 complex intracranial aneurysms were treated with SFD without the adjunctive use of coils. We retrospectively evaluated the technical aspects, thromboembolic events, adjunctive therapies, and short term results in patients with complex intracranial aneurysms treated with SFD. A cost analysis of patients who were treated with SFD was performed and compared with similar sized aneurysms coiled with stent assisted coiling. Results The primary technical success rate was 100%. An adjunctive device was required in two of our patients. The technique related complication rate and the 30 day mortality and morbidity rates were 5% (1/20) and 10% (2/20), respectively. We had a total of 263 patient months of clinical and 166 patient months of imaging follow-up. Follow-up imaging revealed two asymptomatic occlusions of the parent artery. Complete occlusion of the aneurysm with fully patent parent artery was observed in 59% of patients where follow-up images were available. The cost analysis showed that the mean cost of treatment with SFD was significantly cheaper compared with the presumed cost of stent assisted coiling (p<0.001). Conclusions The SFD provides a very feasible, efficient, relatively safe, and cost effective method to treat complex intracranial aneurysms without the use of adjunct coiling.</abstract><cop>BMA House, Tavistock Square, London, WC1H 9JR</cop><pub>BMJ Publishing Group Ltd</pub><pmid>23424227</pmid><doi>10.1136/neurintsurg-2012-010590</doi></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Aneurysm Aneurysms Anti-Inflammatory Agents - therapeutic use Aspirin - therapeutic use Blood platelets Coronary Angiography Cost analysis Costs and Cost Analysis Databases, Factual Dexamethasone - therapeutic use Embolization, Therapeutic - economics Embolization, Therapeutic - instrumentation Embolization, Therapeutic - methods Female Flow Diverter Follow-Up Studies Humans Intracranial Aneurysm - mortality Intracranial Aneurysm - therapy Magnetic Resonance Angiography Male Middle Aged Patients Pipelines Platelet Aggregation Inhibitors - therapeutic use Retrospective Studies Stents Stents - adverse effects Stents - economics Ticlopidine - analogs & derivatives Ticlopidine - therapeutic use Tomography, X-Ray Computed Treatment Outcome Veins & arteries Young Adult |
| title | SILK flow diverter for treatment of intracranial aneurysms: initial experience and cost analysis |
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