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Flow-Diverting Stents for Intracranial Bifurcation Aneurysm Treatment

Saleme, Suzana MD*; Iosif, Christina MD, MSc, PhD*; Ponomarjova, Sanita MD*; Mendes, George MD*; Camilleri, Yann MD; Caire, François MD§; Boncoeur, Marie-Paule MD; Mounayer, Charbel MD, PhD*

doi: 10.1227/NEU.0000000000000522
Research-Human-Clinical Studies

BACKGROUND: Although initially considered safe when covering bifurcation sites, flow-diverting stents may provoke thrombosis of side branches that are covered during aneurysm treatment.

OBJECTIVE: To understand the occurrence and clinical expression of side-branch remodeling in distal intracranial arterial sites after flow diverter deployment by means of correlation of imaging and clinical data.

METHODS: We analyzed our prospectively collected data on a series of patients treated with flow diverters for intracranial aneurysms at bifurcation sites. From February 2011 to May 2013, 32 patients with 37 aneurysms (anterior communicating artery, 9 [24.3%]; anterior cerebral artery, 5 [13.5%]; middle cerebral artery, 19 (51.4%); terminal internal carotid artery, 4 [10.8%]) were treated. We divided aneurysms into 2 groups based on the side branches covered by the stent during treatment. Group A consisted of cases with side branches that supplied brain territories also receiving a direct collateral supply. Group B consisted of cases in which side branches supplied territories without direct collateral supply. The 2 groups were compared statistically.

RESULTS: Total exclusion occurred in 97.3% of aneurysms at follow-up. Initial modified Rankin Scale (mRS) score was 0 to 1 for 29 patients (90.6%) and 2 for 3 patients (9.4%). New permanent neurological deficit was reported in 3 patients (9.4%). At the 6-month follow-up, the mRS score was 0 to 1 for 31 patients (96.8%) and 3 for 1 patient (3.2%). Although 78.5% of side branches in group A underwent narrowing or occlusion after 6 months, no new stroke was found on magnetic resonance imaging.

CONCLUSION: Symptomatic modifications of side branches after flow diverter treatment depend on the extent and type of collateral supply.

ABBREVIATIONS: DSA, digital subtraction angiography

DWI, diffusion-weighted imaging

FD, flow-diverter stent

FLAIR, fluid-attenuated inversion recovery

MCA, middle cerebral artery

mRS, modified Rankin Scale

OKM, O'Kelly-Marotta

*Department of Interventional Neuroradiology,

Department of Diagnostic Neuroradiology, and

§Department of Neurosurgery, Dupuytren University Hospital, Limoges, France

Correspondence: Charbel Mounayer, MD, PhD, 2 Avenue Martin Luther King, 87042 Limoges, France. E-mail:

Received March 22, 2014

Accepted July 27, 2014

Copyright © by the Congress of Neurological Surgeons