flow diverters for cerberal aneurysms
TRANSCRIPT
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FLOW DIVERTERS FOR CERBERAL ANEURYSMS
Vipul Gupta
Artemis HospitalsGurgaonIndia
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Endovascular mgt of aneurysms….
Issues..
Large and giant aneurysms
Fusiform/dissecting aneurysms
Blister aneurysms
Small dysplastic aneurysms
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1917
pts.
451
patients
ISUIA Trial
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Large, giant aneurysms
Classically - Surgery treatment of choice -Better occlusion, more permanent, mass effect
Endovascular – safer, issue of residual/recurrences; mass effect of coils
Stents
Flow modification
Intimal growth and healing
Change of angles
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Flow modification/diversion-
Flow diversion with stents- single, overlapping
Further evolution – flow diverters (stents)
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0
1
2
3
4
5
6
7
8
9
10
0 10 20 30 40 50 60 70 80 90 100
Flow index
Ineffective
(clotting)Ineffective
(free flow)
Effective flow
diversion and side
branch patencyOptimizing
flow diversion
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A B
Cavernous aneurysms
26 year old,
Cranial nerve palsy
B
G
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Large ICA aneurysms …
• Complete occlusion – 90 %, no recurrences
• Complication rate – 2-8 %
• Careful placement , avoid overlapping
devices, anti-platelet regime
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Small Blister/dissecting…
Blister aneurysms (BA) are rare lesions characterized by a hemispherical shape and fragile walls
Surgical Options - Direct clipping, clipping plus wrapping, wrapping alone, clipping with Sundtencircling graft clips, encircling silicone clip application, primary suturing of ICA, vascular staple clip closure of ICA and trapping with or without extracranial-intracranial bypass
High risk of premature rupture during surgery, large lacerations
Endovascular- difficult to coil, friable, continued growth, stent needed (issues in SAH), single/overlapping
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Classical blister aneurysm
34-year M, SAH
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D E F
B CA B
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B
C D
A
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Blister Aneurysm
Our experience with FD vs non FDFD – 11 cases
Complete occlusion – 89% vs 71% i.f.o FD
Repeat treatment – none vs 11.7% i.f.o FD
Rebleed resulting in death – none vs 5.8% i.f.o FD
Submitted for publication
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Small ICA aneurysms …
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Dissections with blister
2-overlapping Enterprise stents
Posterior circulation aneurysms …
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Distal bifurcation aneurysms
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Intermediate Flow diverters (FRED junior)
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Is it all easy ….
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Progressive intraaneurysmalpartial thrombosis starts
8th
DAY POST COILING PRESENTED WITH VERTIGO AND HEADACHE
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56 yr old,
ischaemic
stroke
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Flow diverters … Major evolution of EVT of aneurysms
TOC for large/giant ICA aneurysms
Blister/small dysplastic aneurysms
Posterior circulation – more careful use
Evolving – distal aneurysms
Issues – cost, expertise, posterior ciruclationgiant aneurysms …
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For more information on:
STROKE & NEUROVASCULAR INTERVENTIONS:
URL:www.sanif.co.in
Facebook:https://www.facebook.com/strokeawarenessindiahttps://www.facebook.com/vipul.gupta.35175
Twitterhttps://twitter.com/drvipulgupta25
LinkedINhttps://in.linkedin.com/pub/dr-vipul-gupta/51/8a1/25a
YouTubeChannel: Stroke & Neurovascular Interventionswww.youtube.com/c/StrokeNeurovascularInterventionsfoundation
Dr Vipul Gupta
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Thank you ….