Purpose

Flow diverter stents are gaining wider use in the treatment of complex intracranial aneurysms; however, there are limited data on occlusion and complication rates of flow diverters in very large and giant aneurysms. This study assessed the safety and efficacy of flow redirection endoluminal device (FRED) and FRED Jr. stents in aneurysms ≥ 20 mm.

Methods

We retrospectively analyzed all aneurysms ≥ 20 mm treated with FRED/FRED Jr. between January 2010 and June 2020 from three centers. Endpoints for clinical safety were absence of major stroke, aneurysmal rupture, or death and complete or near-complete occlusion for efficacy.

Results

A total of 45 patients with very large (28 cases) and giant aneurysms (17 cases) were treated with FRED (41 cases), and FRED Jr. (4 cases) stents. The majority of the aneurysms (40/45, 88.9%) were in the anterior circulation. Adjunctive aneurysm coiling was performed in 21 aneurysms (46.7%).

Technical complications were encountered in 4 procedures (8.9%). Ischemic and hemorrhagic complication rates were 6.7% and 8.9%, respectively. There was no case with major stroke. The mortality rate was 8.9%, and all cases were due to hemorrhagic complications from aneurysmal rupture.

Median angiographic follow-up was 21.5 months (range 3–60 months). Complete occlusion was achieved in 32 aneurysms (71.1%), and near-complete occlusion in 5 cases (11.1%).

Conclusion

The use of FRED/FRED Jr. for the treatment of aneurysms ≥ 20 mm achieved a long-term aneurysm occlusion rate and a safety profile comparable to the large series reported with other flow diverter stents.

中文翻译：

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带或不带辅助盘绕的流量重定向腔内装置 (FRED) 治疗非常大和巨大的脑动脉瘤

目的

分流支架在复杂颅内动脉瘤的治疗中得到更广泛的应用；然而，关于非常大和巨大动脉瘤中分流器的闭塞和并发症发生率的数据有限。本研究评估了流重定向腔内装置 (FRED) 和 FRED Jr. 支架在 ≥ 20 mm 动脉瘤中的安全性和有效性。

方法

我们回顾性分析了 2010 年 1 月至 2020 年 6 月期间在三个中心接受 FRED/FRED Jr. 治疗的所有 ≥ 20 mm 的动脉瘤。临床安全性的终点是没有大卒中、动脉瘤破裂或死亡，以及完全或接近完全闭塞的疗效。

结果

共 45 例特大（28 例）和巨大动脉瘤（17 例）患者接受了 FRED（41 例）和 FRED Jr.（4 例）支架治疗。大多数动脉瘤（40/45，88.9%）位于前循环。对 21 个动脉瘤 (46.7%) 进行了辅助动脉瘤栓塞。

4 个手术（8.9%）出现技术并发症。缺血性和出血性并发症的发生率分别为 6.7% 和 8.9%。没有发生严重中风的病例。死亡率为8.9%，所有病例均因动脉瘤破裂出血并发症所致。

中位血管造影随访时间为 21.5 个月（范围 3-60 个月）。完全闭塞32例（71.1%），接近完全闭塞5例（11.1%）。

结论

使用 FRED/FRED Jr. 治疗 ≥ 20 mm 的动脉瘤实现了长期动脉瘤闭塞率和与其他分流器支架报道的大型系列相当的安全性。