Flow Diverting Stents in Cerebral Small Caliber Vessels (< 2 mm) for Aneurysm Treatment: A Three Center Retrospective Study
Purpose The off-label use of flow diverting stents (FDS) for treating cerebral aneurysms in small distal vessels is increasing in clinical practice with encouraging results; however, data directly addressing the parent vessel size are still scarce. Our aim was to evaluate the safety and efficacy of...
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Veröffentlicht in: | Clinical neuroradiology (Munich) 2023-03, Vol.33 (1), p.99-105 |
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creator | Hohenstatt, Sophia Vinci, Sergio L. Vollherbst, Dominik F. Tessitore, Agostino Schmitt, Niclas Pitrone, Antonio Caragliano, Antonio A. Velo, Mariano Möhlenbruch, Markus A. Paolucci, Aldo |
description | Purpose
The off-label use of flow diverting stents (FDS) for treating cerebral aneurysms in small distal vessels is increasing in clinical practice with encouraging results; however, data directly addressing the parent vessel size are still scarce. Our aim was to evaluate the safety and efficacy of FDS placement in anterior and posterior circulation aneurysms with parent arteries ≤ 2 mm in a real-world representative setting.
Methods
We retrospectively reviewed patients treated with FDS at the three participating university hospitals between 2009 and 2021. The inclusion criteria were the placement of at least one FDS in a parent vessel with a maximum diameter of 2 mm or less. The primary clinical safety endpoint was the absence of death, major or minor symptomatic stroke, transient ischemic attack and procedure-related intracranial hemorrhage. Clinical outcome was assessed using the modified Rankin Scale (mRS) score at the follow-up visit at 1 year. The primary efficacy endpoint was defined as complete and near-complete occlusion at the 1‑year follow-up.
Results
We identified 55 patients harboring 56 aneurysms. The primary clinical safety endpoint was obtained in 93% of cases. The hemorrhagic and thromboembolic complication rates were 4% and 9%, respectively. No patient died or had a relevant discrepancy (> 1 point) at the pre-mRS and post-mRS. The primary efficacy endpoint was reached in 80% of cases.
Conclusion
The use of FDS in vessels |
doi_str_mv | 10.1007/s00062-022-01187-6 |
format | Article |
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The off-label use of flow diverting stents (FDS) for treating cerebral aneurysms in small distal vessels is increasing in clinical practice with encouraging results; however, data directly addressing the parent vessel size are still scarce. Our aim was to evaluate the safety and efficacy of FDS placement in anterior and posterior circulation aneurysms with parent arteries ≤ 2 mm in a real-world representative setting.
Methods
We retrospectively reviewed patients treated with FDS at the three participating university hospitals between 2009 and 2021. The inclusion criteria were the placement of at least one FDS in a parent vessel with a maximum diameter of 2 mm or less. The primary clinical safety endpoint was the absence of death, major or minor symptomatic stroke, transient ischemic attack and procedure-related intracranial hemorrhage. Clinical outcome was assessed using the modified Rankin Scale (mRS) score at the follow-up visit at 1 year. The primary efficacy endpoint was defined as complete and near-complete occlusion at the 1‑year follow-up.
Results
We identified 55 patients harboring 56 aneurysms. The primary clinical safety endpoint was obtained in 93% of cases. The hemorrhagic and thromboembolic complication rates were 4% and 9%, respectively. No patient died or had a relevant discrepancy (> 1 point) at the pre-mRS and post-mRS. The primary efficacy endpoint was reached in 80% of cases.
Conclusion
The use of FDS in vessels < 2 mm is technically feasible with good aneurysm occlusion rates and an acceptable safety profile. Nevertheless, it is essential to be aware of the of the main complications associated when operating in small diameter vessels.</description><identifier>ISSN: 1869-1439</identifier><identifier>EISSN: 1869-1447</identifier><identifier>DOI: 10.1007/s00062-022-01187-6</identifier><identifier>PMID: 35768696</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Embolization, Therapeutic - methods ; Endovascular Procedures - methods ; Humans ; Intracranial Aneurysm - diagnostic imaging ; Intracranial Aneurysm - surgery ; Medicine ; Medicine & Public Health ; Neurology ; Neuroradiology ; Neurosurgery ; Original Article ; Retrospective Studies ; Stents - adverse effects ; Stroke - therapy ; Treatment Outcome</subject><ispartof>Clinical neuroradiology (Munich), 2023-03, Vol.33 (1), p.99-105</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2022</rights><rights>2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c298t-58b97f4f88a2bc810e651538485ba5c76d43a7f2baed873ae517947e37d0bea63</cites><orcidid>0000-0002-6163-4328</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00062-022-01187-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00062-022-01187-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35768696$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hohenstatt, Sophia</creatorcontrib><creatorcontrib>Vinci, Sergio L.</creatorcontrib><creatorcontrib>Vollherbst, Dominik F.</creatorcontrib><creatorcontrib>Tessitore, Agostino</creatorcontrib><creatorcontrib>Schmitt, Niclas</creatorcontrib><creatorcontrib>Pitrone, Antonio</creatorcontrib><creatorcontrib>Caragliano, Antonio A.</creatorcontrib><creatorcontrib>Velo, Mariano</creatorcontrib><creatorcontrib>Möhlenbruch, Markus A.</creatorcontrib><creatorcontrib>Paolucci, Aldo</creatorcontrib><title>Flow Diverting Stents in Cerebral Small Caliber Vessels (< 2 mm) for Aneurysm Treatment: A Three Center Retrospective Study</title><title>Clinical neuroradiology (Munich)</title><addtitle>Clin Neuroradiol</addtitle><addtitle>Clin Neuroradiol</addtitle><description>Purpose
The off-label use of flow diverting stents (FDS) for treating cerebral aneurysms in small distal vessels is increasing in clinical practice with encouraging results; however, data directly addressing the parent vessel size are still scarce. Our aim was to evaluate the safety and efficacy of FDS placement in anterior and posterior circulation aneurysms with parent arteries ≤ 2 mm in a real-world representative setting.
Methods
We retrospectively reviewed patients treated with FDS at the three participating university hospitals between 2009 and 2021. The inclusion criteria were the placement of at least one FDS in a parent vessel with a maximum diameter of 2 mm or less. The primary clinical safety endpoint was the absence of death, major or minor symptomatic stroke, transient ischemic attack and procedure-related intracranial hemorrhage. Clinical outcome was assessed using the modified Rankin Scale (mRS) score at the follow-up visit at 1 year. The primary efficacy endpoint was defined as complete and near-complete occlusion at the 1‑year follow-up.
Results
We identified 55 patients harboring 56 aneurysms. The primary clinical safety endpoint was obtained in 93% of cases. The hemorrhagic and thromboembolic complication rates were 4% and 9%, respectively. No patient died or had a relevant discrepancy (> 1 point) at the pre-mRS and post-mRS. The primary efficacy endpoint was reached in 80% of cases.
Conclusion
The use of FDS in vessels < 2 mm is technically feasible with good aneurysm occlusion rates and an acceptable safety profile. Nevertheless, it is essential to be aware of the of the main complications associated when operating in small diameter vessels.</description><subject>Embolization, Therapeutic - methods</subject><subject>Endovascular Procedures - methods</subject><subject>Humans</subject><subject>Intracranial Aneurysm - diagnostic imaging</subject><subject>Intracranial Aneurysm - surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosurgery</subject><subject>Original Article</subject><subject>Retrospective Studies</subject><subject>Stents - adverse effects</subject><subject>Stroke - therapy</subject><subject>Treatment Outcome</subject><issn>1869-1439</issn><issn>1869-1447</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1Kw0AQxxdRbKl9AQ-yRz1E9yP7EfBS6icIHlq9eFg26aRENonuJkpvvpHv5JO4GvXoYZiB-c8P5ofQPiXHlBB1EgghkiWExaJUq0RuoTHVMktomqrtv5lnIzQN4THGCdeZEGoXjbhQMq7lGD1cuPYVn1Uv4LuqWeNFB00XcNXgOXjIvXV4UVvn8Ny6KgeP7yEEcAEfnn68vbNYdX2Ey9bjWQO934QaLz3Yro6YPbRTWhdg-tMn6O7ifDm_Sm5uL6_ns5ukYJnuEqHzTJVpqbVleaEpASmo4DrVIreiUHKVcqtKlltYacUtCKqyVAFXK5KDlXyCDgfuk2-fewidqatQgHO2gbYPhknNlI4_kxhlQ7TwbQgeSvPkq9r6jaHEfHk1g1cTvZpvr-aLf_DD7_MaVn8nvxZjgA-BEFfNGrx5bHvfxJ__w34CtmSEGw</recordid><startdate>20230301</startdate><enddate>20230301</enddate><creator>Hohenstatt, Sophia</creator><creator>Vinci, Sergio L.</creator><creator>Vollherbst, Dominik F.</creator><creator>Tessitore, Agostino</creator><creator>Schmitt, Niclas</creator><creator>Pitrone, Antonio</creator><creator>Caragliano, Antonio A.</creator><creator>Velo, Mariano</creator><creator>Möhlenbruch, Markus A.</creator><creator>Paolucci, Aldo</creator><general>Springer Berlin Heidelberg</general><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>7X8</scope><orcidid>https://orcid.org/0000-0002-6163-4328</orcidid></search><sort><creationdate>20230301</creationdate><title>Flow Diverting Stents in Cerebral Small Caliber Vessels (< 2 mm) for Aneurysm Treatment</title><author>Hohenstatt, Sophia ; Vinci, Sergio L. ; Vollherbst, Dominik F. ; Tessitore, Agostino ; Schmitt, Niclas ; Pitrone, Antonio ; Caragliano, Antonio A. ; Velo, Mariano ; Möhlenbruch, Markus A. ; Paolucci, Aldo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c298t-58b97f4f88a2bc810e651538485ba5c76d43a7f2baed873ae517947e37d0bea63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Embolization, Therapeutic - methods</topic><topic>Endovascular Procedures - methods</topic><topic>Humans</topic><topic>Intracranial Aneurysm - diagnostic imaging</topic><topic>Intracranial Aneurysm - surgery</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosurgery</topic><topic>Original Article</topic><topic>Retrospective Studies</topic><topic>Stents - adverse effects</topic><topic>Stroke - therapy</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hohenstatt, Sophia</creatorcontrib><creatorcontrib>Vinci, Sergio L.</creatorcontrib><creatorcontrib>Vollherbst, Dominik F.</creatorcontrib><creatorcontrib>Tessitore, Agostino</creatorcontrib><creatorcontrib>Schmitt, Niclas</creatorcontrib><creatorcontrib>Pitrone, Antonio</creatorcontrib><creatorcontrib>Caragliano, Antonio A.</creatorcontrib><creatorcontrib>Velo, Mariano</creatorcontrib><creatorcontrib>Möhlenbruch, Markus A.</creatorcontrib><creatorcontrib>Paolucci, Aldo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical neuroradiology (Munich)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hohenstatt, Sophia</au><au>Vinci, Sergio L.</au><au>Vollherbst, Dominik F.</au><au>Tessitore, Agostino</au><au>Schmitt, Niclas</au><au>Pitrone, Antonio</au><au>Caragliano, Antonio A.</au><au>Velo, Mariano</au><au>Möhlenbruch, Markus A.</au><au>Paolucci, Aldo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Flow Diverting Stents in Cerebral Small Caliber Vessels (< 2 mm) for Aneurysm Treatment: A Three Center Retrospective Study</atitle><jtitle>Clinical neuroradiology (Munich)</jtitle><stitle>Clin Neuroradiol</stitle><addtitle>Clin Neuroradiol</addtitle><date>2023-03-01</date><risdate>2023</risdate><volume>33</volume><issue>1</issue><spage>99</spage><epage>105</epage><pages>99-105</pages><issn>1869-1439</issn><eissn>1869-1447</eissn><abstract>Purpose
The off-label use of flow diverting stents (FDS) for treating cerebral aneurysms in small distal vessels is increasing in clinical practice with encouraging results; however, data directly addressing the parent vessel size are still scarce. Our aim was to evaluate the safety and efficacy of FDS placement in anterior and posterior circulation aneurysms with parent arteries ≤ 2 mm in a real-world representative setting.
Methods
We retrospectively reviewed patients treated with FDS at the three participating university hospitals between 2009 and 2021. The inclusion criteria were the placement of at least one FDS in a parent vessel with a maximum diameter of 2 mm or less. The primary clinical safety endpoint was the absence of death, major or minor symptomatic stroke, transient ischemic attack and procedure-related intracranial hemorrhage. Clinical outcome was assessed using the modified Rankin Scale (mRS) score at the follow-up visit at 1 year. The primary efficacy endpoint was defined as complete and near-complete occlusion at the 1‑year follow-up.
Results
We identified 55 patients harboring 56 aneurysms. The primary clinical safety endpoint was obtained in 93% of cases. The hemorrhagic and thromboembolic complication rates were 4% and 9%, respectively. No patient died or had a relevant discrepancy (> 1 point) at the pre-mRS and post-mRS. The primary efficacy endpoint was reached in 80% of cases.
Conclusion
The use of FDS in vessels < 2 mm is technically feasible with good aneurysm occlusion rates and an acceptable safety profile. Nevertheless, it is essential to be aware of the of the main complications associated when operating in small diameter vessels.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>35768696</pmid><doi>10.1007/s00062-022-01187-6</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-6163-4328</orcidid></addata></record> |
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subjects | Embolization, Therapeutic - methods Endovascular Procedures - methods Humans Intracranial Aneurysm - diagnostic imaging Intracranial Aneurysm - surgery Medicine Medicine & Public Health Neurology Neuroradiology Neurosurgery Original Article Retrospective Studies Stents - adverse effects Stroke - therapy Treatment Outcome |
title | Flow Diverting Stents in Cerebral Small Caliber Vessels (< 2 mm) for Aneurysm Treatment: A Three Center Retrospective Study |
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