Article Figures & Data
Figures
- FIG 1.
Treatment of an incidental aneurysm of the ICA with the FRED X. The preinterventional angiography including 3D reconstructions (A–C) showed a saccular sidewall aneurysm of the right ICA in an asymptomatic patient. A FRED X FD was placed in the parent artery, covering the aneurysm neck (D–F). On the angiography 13 months after the treatment (G–I), the aneurysm was completely occluded.
- FIG 2.
Treatment of an incidental PcomA aneurysm with the FRED X and coiling with intra- and postprocedural thrombosis. This patient, who had an incidental BA aneurysm treated with a Woven EndoBridge device (WEB; MicroVention) previously, presented with an incidental, irregularly shaped aneurysm of the ICA adjacent to the PcomA (A and B). After an uneventful treatment with FRED X implantation and coiling with a jailing technique (C), intraprocedural thrombus formation at the proximal part of the flow-diverting section of the stent was observed (white arrow in D). Tirofiban was instantly administered for 30 minutes, which led to a complete resolution of the thrombosis (E). Seven days after the treatment, after discontinuation of her ticagrelor medication, the patient presented with complete occlusion of the FD (F and G) with good collateralization via the contralateral side. Recanalization of the stent was achieved by tirofiban administration for 48 hours (H and I). The patient was neurologically asymptomatic the entire time.
Tables
Characteristics Patient age (mean) (range) (yr) 55 (SD, 12) (27–79) Clinical presentation Incidental Regrowth/persistent aneurysmb SAH Headache Co-incidentalc Diplopia Other 100 (62.1%) 20 (12.4%) 18 (11.2%) 9 (5.6%) 6 (3.7%) 3 (1.9%) 5 (3.1%) Aneurysm location ICA BA MCA VA Other 117 (72.7%) 13 (8.1%) 10 (6.2%) 9 (5.6%) 12 (7.5%) Aneurysm sized (mean) (range) (mm) 7.8 (SD, 6.3) (1.0–46.0) Neck diameter (mean) (range) (mm) 4.7 (SD, 3.8) (1.0–36.0) Dome-to-neck ratio (mean) (range) 1.7 (SD, 0.9) (0.4–7.5) Diameter of the parent artery proximal and distal to the aneurysm mean) (range) (mm) Proximal Distal 3.5 (SD, 0.8) (1.5–7.0) 3.1 (SD, 0.7) (1.2–5.2) Aneurysm type Saccular Blister-like Fusiform Dissecting 131 (81.4%) 14 (8.7%) 11 (6.8%) 5 (3.1%) Sidewall or bifurcation aneurysm Sidewall Bifurcation 136 (84.5%) 25 (15.5%) Parameters Aneurysms treated in the respective treatment session 1 2 3 4 144 (89.4%) 13 (8.1%) 2 (1.2%) 2 (1.2%) Ease of deploymentb Very poor Poor Intermediate Good Very good 0 (0%) 1 (0.6%) 1 (0.6%) 12 (7.5%) 147 (91.3%) Vessel wall appositionb Very poor Poor Intermediate Good Very good 0 (0%) 0 (0%) 2 (1.2%) 8 (5.0%) 151 (93.8%) Radiopacityb Very poor Poor Intermediate Good Very good 0 (0%) 0 (0%) 0 (0%) 59 (36.7%) 102 (63.4%) Performance compared with FRED/FRED Jrb Worse Slightly worse Equivalent Slightly better Better 0 (0%) 0 (0%) 154 (96.3%) 6 (3.8%) 0 (0%) Additional coiling 48 (29.8%) In-stent balloon angioplasty 4 (2.5%) Adverse events/complications Adverse event Technical periprocedural adverse event Minor adverse event Major adverse event Neurological morbidity Mortality 5 (3.1%) 21 (13.0%) 5 (3.1%) 3 (1.9%) 2 (1.2%) ↵a Data are absolute number of cases (relative frequency in %).
Occlusion rates Occlusion at latest follow-upb I: Complete occlusion II: Residual neck III: Residual aneurysm 94 (66.2%) 24 (16.9%) 24 (16.9%)
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