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Comparative efficacy of flow diverter devices in the treatment of carotid sidewall intracranial aneurysms: a Retrospective, Multicenter Study

Background The comparative efficacy and safety of first-generation flow diverters (FDs), Pipeline Embolization Device (PED) (Medtronic, Irvine, California), Silk (Balt Extrusion, Montmorency, France), Flow Re-direction Endoluminal Device (FRED) (Microvention, Tustin, California), and Surpass Streamline...

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Main Authors: Dmytriw, Adam A. (Author) , Salim, Hamza (Author) , Musmar, Basel (Author) , Cancelliere, Nicole M. (Author) , Griessenauer, Christoph J. (Author) , Regenhardt, Robert W. (Author) , Jones, Jesse (Author) , Tutino, Vincent (Author) , Hasan, Zuha (Author) , Limbucci, Nicola (Author) , Lay, Sovann V. (Author) , Spears, Julian (Author) , Rabinov, James D. (Author) , Harrigan, Mark R. (Author) , Siddiqui, Adnan H. (Author) , Levy, Elad I. (Author) , Stapleton, Christopher J. (Author) , Renieri, Leonardo (Author) , Cognard, Christophe (Author) , Shaikh, Hamza (Author) , Kühn, Anna Luisa (Author) , Möhlenbruch, Markus Alfred (Author) , Tjoumakaris, Stavropoula I. (Author) , Jabbour, Pascal (Author) , Taussky, Philipp (Author) , Settecase, Fabio (Author) , Heran, Manraj K. S. (Author) , Nguyen, Anh (Author) , Volders, David (Author) , Harker, Pablo (Author) , Devia, Diego A. (Author) , Puri, Ajit S. (Author) , Psychogios, Marios (Author) , Puentes, Juan C. (Author) , Leone, Giuseppe (Author) , Buono, Giuseppe (Author) , Tarantino, Margherita (Author) , Muto, Mario (Author) , Briganti, Francesco (Author) , Dalal, Shamsher (Author) , Gontu, Vamsi (Author) , Alcedo Guardia, Rodolfo E. (Author) , Vicenty-Padilla, Juan C. (Author) , Brouwer, Patrick (Author) , Schmidt, Matthias H. (Author) , Schirmer, Clemens (Author) , Pickett, Gwynedd E. (Author) , Andersson, Tommy (Author) , Söderman, Michael (Author) , Marotta, Thomas R. (Author) , Cuellar-Saenz, Hugo (Author) , Thomas, Ajith J. (Author) , Patel, Aman B. (Author) , Mendes Pereira, Vitor (Author) , Adeeb, Nimer (Author)
Format: Article (Journal)
Language:English
Published: 18 July 2024
In: Clinical neuroradiology
Year: 2024, Volume: 34, Issue: 4, Pages: 907-917
ISSN:1869-1447
DOI:10.1007/s00062-024-01435-x
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1007/s00062-024-01435-x
Verlag, lizenzpflichtig, Volltext: https://link.springer.com/10.1007/s00062-024-01435-x
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Author Notes:Adam A. Dmytriw, Hamza Adel Salim, Basel Musmar, Nicole M. Cancelliere, Christoph J. Griessenauer, Robert W. Regenhardt, Jesse Jones, Vincent Tutino, Zuha Hasan, Nicola Limbucci, Sovann V. Lay, Julian Spears, James D. Rabinov, Mark R. Harrigan, Adnan H. Siddiqui, Elad I. Levy, Christopher J. Stapleton, Leonardo Renieri, Christophe Cognard, Hamza Shaikh, Anna Luisa Kühn, Markus A. Möhlenbruch, Stavropoula I. Tjoumakaris, Pascal Jabbour, Philipp Taussky, Fabio Settecase, Manraj K. S. Heran, Anh Nguyen, David Volders, Pablo Harker, Diego A. Devia, Ajit S. Puri, Marios Psychogios, Juan C. Puentes, Giuseppe Leone, Giuseppe Buono, Margherita Tarantino, Mario Muto, Francesco Briganti, Shamsher Dalal, Vamsi Gontu, Rodolfo E. Alcedo Guardia, Juan C. Vicenty-Padilla, Patrick Brouwer, Matthias H. Schmidt, Clemens Schirmer, Gwynedd E. Pickett, Tommy Andersson, Michael Söderman, Thomas R. Marotta, Hugo Cuellar-Saenz, Ajith J. Thomas, Aman B. Patel, Vitor Mendes Pereira, Nimer Adeeb, on behalf Flow diversion Multinational Observational cohort Device comparsion (FlowMOD) Investigators
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Summary:Background The comparative efficacy and safety of first-generation flow diverters (FDs), Pipeline Embolization Device (PED) (Medtronic, Irvine, California), Silk (Balt Extrusion, Montmorency, France), Flow Re-direction Endoluminal Device (FRED) (Microvention, Tustin, California), and Surpass Streamline (Stryker Neurovascular, Fremont, California), is not directly established and largely inferred. - Purpose This study aimed to compare the efficacy of different FDs in treating sidewall ICA intracranial aneurysms. - Methods We conducted a retrospective review of prospectively maintained databases from eighteen academic institutions from 2009-2016, comprising 444 patients treated with one of four devices for sidewall ICA aneurysms. Data on demographics, aneurysm characteristics, treatment outcomes, and complications were analyzed. Angiographic and clinical outcomes were assessed using various imaging modalities and modified Rankin Scale (mRS). Propensity score weighting was employed to balance confounding variables. The data analysis used Kaplan-Meier curves, logistic regression, and Cox proportional-hazards regression. - Results While there were no significant differences in retreatment rates, functional outcomes (mRS 0-1), and thromboembolic complications between the four devices, the probability of achieving adequate occlusion at the last follow-up was highest in Surpass device (HR: 4.59; CI: 2.75-7.66, p < 0.001), followed by FRED (HR: 2.23; CI: 1.44-3.46, p < 0.001), PED (HR: 1.72; CI: 1.10-2.70, p = 0.018), and Silk (HR: 1.0 ref. standard). The only hemorrhagic complications were with Surpass (1%). - Conclusion All the first-generation devices achieved good clinical outcomes and retreatment rates in treating ICA sidewall aneurysms. Prospective studies are needed to explore the nuanced differences between these devices in the long term.
Item Description:Gesehen am 14.04.2025
Physical Description:Online Resource
ISSN:1869-1447
DOI:10.1007/s00062-024-01435-x

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