Neurointervention.  2017 Mar;12(1):11-19. 10.5469/neuroint.2017.12.1.11.

Treatment of Intracranial Aneurysms with Flow Re-direction Endoluminal Device - A Single Centre Experience with Short-term Follow-up Results

• Mahboobani NR
• Chong WH
• Lam SS
• Siu JC
• Tan CB
• Wong YC

• KMID: 2371754
• DOI: http://doi.org/10.5469/neuroint.2017.12.1.11

Abstract

PURPOSE
A flow diverter (FD) is an effective treatment option for intracranial aneurysms. The Flow Re-direction Endoluminal Device (FRED) is a relatively new flow diverter with a unique dual-layer design. We report our experience and short-term results with the FRED.
MATERIALS AND METHODS
We did a retrospective review of all consecutive cases in which the FRED was used to treat intracranial aneurysms at a single institution from March 2014 till December 2015. Clinical parameters, aneurysm characteristics, technical results and short-term outcomes were reviewed.
RESULTS
Eleven intracranial aneurysms were treated with the FRED in 11 patients. The technical device deployment success rate was 100%. Immediate reduction in intra-aneurysmal flow after deployment was noted in 10 cases. The aneurysm occlusion rate at 6 months was 75%. There was 1 complication of in-stent thrombosis immediately after deployment. There was no side branch occlusion, delayed aneurysm rupture, stroke, or intraparenchymal haemorrhage. There was no neurological deficit, morbidity, or mortality.
CONCLUSION
The FRED is a new FD. It has shown to be safe and effective in our series. The unique dual-layer design of the device renders it to have technical advantages over other FDs. The 6-month aneurysm occlusion rate and complication profile of FRED are similar to other FDs.

Keyword

Intracranial aneurysm; stents; flow diversion; flow diverters; FRED; Flow Re-direction Endoluminal Device

MeSH Terms

Aneurysm
Follow-Up Studies*
Humans
Intracranial Aneurysm*
Mortality
Retrospective Studies
Rupture
Stents
Stroke
Thrombosis

Figure

• 

  Fig. 1 The FRED device. Profile view (A) and illustration (B) of the FRED showing dual-layer design. Reproduced with permission from MicroVention, Inc.

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  Fig. 2 A 53-year-old man with large left paraophthalmic internal carotid artery (ICA) aneurysm (case 9). (A) Lateral view of left ICA angiogram showing large paraophthalmic aneurysm. (B, C) Immediate post-deployment lateral view of left ICA angiogram at arterial (B) and venous (C) phases with layering of contrast seen on venous (C) phase. (D) Post-deployment anteroposterior (AP) view of left common carotid artery (CCA) angiogram showing no opacification of left ICA beyond the vertical part of petrous segment (arrow). (E) AP view of left ICA angiogram after intra-arterial thrombolysis with abciximab showing partial recanalization of left intracranial ICA. (F) AP view of right ICA angiogram showing crossflow to left anterior (ACA) and middle (MCA) cerebral arteries via anterior communicating artery. (G) CT angiogram of Circle of Willis acquired 2 weeks after FRED deployment showing occluded left ICA (arrow). (H) CT angiogram of Circle of Willis acquired 2 weeks after FRED deployment showing thrombosed aneurysm (arrow) and patent left ACA and MCA. (I) Non-contrast CT brain done prior to CT angiogram of Circle of Willis with image at level of lentiform nuclei - no infarct is seen.

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  Fig. 3 A 38-year-old man with large ruptured left paraophthalmic internal carotid artery (ICA) aneurysm (case 7). (A) Lateral view of left ICA angiogram showing large paraophthalmic aneurysm. (B, C) Angiogram after deployment of the first FRED showing opacification of aneurysm (B) with contrast washout (C) in sync with ICA indicative of rapid flow within aneurysm. (D, E) Angiogram after deployment of a second FRED in an overlapping manner showing opacification of aneurysm (D) with contrast stasis and layering (E). (F) 6-month follow-up angiogram with illustrated working length (arrowheads) and total length (arrows) of overlapping FREDs. The aneurysm is occluded. Left ophthalmic artery is patent.

• 

  Fig. 4 A 42-year-old woman with dissecting fusiform aneurysm in V4 segment of right vertebral artery (VA; case 4). (A) Lateral view of right VA angiogram showing the aneurysm shortly distal to origin of right posterior inferior cerebellar artery (PICA). (B) Arterial phase of immediate post-FRED deployment angiogram with illustrated working length (short arrows) and total length (long arrows) of the FRED. (C) Venous phase of immediate post-deployment angiogram showing layering of contrast within the aneurysm. (D) 6-month follow-up angiogram showing occluded aneurysm and patent right PICA.

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