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Digital archive of theses discussed at the University of Pisa

 

Thesis etd-12222021-165123


Thesis type
Tesi di specializzazione (4 anni)
Author
D'AMELIO, CLAUDIO
URN
etd-12222021-165123
Thesis title
Endovascular treatment of intracranial aneurysms with flow diverter devices
Department
RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA
Course of study
RADIODIAGNOSTICA
Supervisors
relatore Prof. Neri, Emanuele
relatore Prof. Cosottini, Mirco
Keywords
  • neurovascular
  • intracranial aneurysms
  • flow diverters
Graduation session start date
10/01/2022
Availability
Withheld
Release date
10/01/2092
Summary
Purpose
To retrospectively evaluate the clinical and neuroradiological outcome of patients with intracranial aneurysms treated with flow-diversion in a single center and to find significant variables as predictors of outcome.

Material and methods
Clinical and radiological data from a retrospective database were analyzed for all patients with intracranial aneurysms treated by flow diversion at the OU of Neuroradiology of the Pisa University Hospital from May 2014 to October 2020. A restricted cohort of patients was selected based on the completeness of radiological data and the absence of previous attempts to aneurysm treatment. Follow-up consisted of catheter cerebral angiography, CT or MRI angiography at 1-2, 6 and 12-18 months post-procedure to verify the grade of occlusion and post-procedural complications. Univariate analysis and multivariate logistic regression were performed to identify predictors of aneurysm persistence.

Results
Complete occlusion was obtained in 43 aneurysms (74%) out of 58. Among the occluded aneurysms, 19 were completely occluded at 1-2 months (44%), 21 at 6 months (49%) and 3 at 1-1.5 years (7%). A neck remnant was identified in 7 aneurysms (12%) while partial filling of the aneurysmal sac persisted in 4 aneurysms (7%). In three cases an increase of the treated aneurysm was observed at the 1-1.5 years follow-up.
The mortality rate was 2%. Clinical conditions were stable with no variations in mRS in the other patients.
Occluded aneurysms differed from persisted aneurysms for size (p=0.01514) and location (p=0.01658). At multivariate analysis aneurysm location (p=0.00175) was an independent predictor of occlusion while size (0.01019) was an independent predictor of aneurysm persistence.

Conclusions
Flow diverter devices (FDDs) can be employed with good clinical and radiological outcome in treatment of saccular intracranial aneurysm with complex morphology and fusiform, dissecting and blister-like aneurysms of internal carotid artery (ICA) and posterior circulation (PC).
Aneurysms affecting smaller and more distal arteries carry later occlusion rates and higher risk of aneurysm persistence.
FDs may also assist coiling in treatment of ruptured saccular aneurysms to ensure a complete aneurysm occlusion.
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