Neurointervention.  2021 Nov;16(3):232-239. 10.5469/neuroint.2021.00227.

REtrospective Multicenter INdian Study of Derivo Embolization Device (REMIND): Periprocedural Safety

• Mahajan NP
• Mushtaq M
• Bhatti A
• Purkayastha S
• Dange N
• Cherian M
• Gupta V
• Huded V

• KMID: 2522037
• DOI: http://doi.org/10.5469/neuroint.2021.00227

Abstract

Purpose
The treatment of aneurysms with characteristics such as complex morphology, fusiform, blister-like, wide neck, or large size has been revolutionized with the introduction of flow diverters. Though flow diverters have several advantages over coiling, they also have certain important disadvantages such as the lack of immediate protection against rupture, the risk of ischemic stroke, the need for antiplatelet therapy, and long latency for complete effect. The Derivo Embolization Device (DED) is a second-generation self-expanding device that is claimed to be less thrombogenic than conventional devices. We retrospectively evaluated the periprocedural safety and risks associated with the DED across 5 centers in India.
Materials and Methods
This is a multicentric, retrospective, observational study of DED, conducted at 5 high volume endovascular therapy centers in India from May 2018 to June 2020. Periprocedural demographic, clinical, and angiographic data were collected from a retrospective review of patient charts.
Results
A total of 96 patients, including 56 (58.3%) females, aged between 16–80 years (60±12.7 years) harboring 106 aneurysms were studied. Seven (7.3%) were noted to harbor multiple aneurysms: 6 had 3 aneurysms each, while 1 patient had 5 aneurysms. The following aneurysm characteristics were noted: average size, 9.8±8.2 mm; average neck size, 6.9±8.5 mm; wide-necked (>4 mm), 63 (59.4%); giant (>25 mm), 8 (7.5%); and anterior circulation location, 98 (92.5%). Eighteen (17%) of these were ruptured. Additional balloon angioplasty was performed in 5 (5.2%) patients. Intraprocedural problems were encountered in 3 (3.1%), of which only 1 had clinical implications, the device fish-mouthing with stent thrombosis resulting in a malignant middle cerebral artery territory infarction. The modified Rankin scale at 3 months was worse in 1 patient.
Conclusion
DED is a newer generation flow diverter stent with a low periprocedural complication rate.

Keyword

Aneurysm; Embolism; Hemorrhage; Stents; Thrombosis

Figure

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  Fig. 1. A middle-aged individual who had undergone coiling of anterior communicating artery aneurysm (AComA) 6 months ago for subarachnoid haemorrhage, currently asymptomatic. (A) Regrowth of AComA aneurysm. (B) Derivo 2.5×20 device deployed through Neuroslider 21 microcatheter through 6F Benchmark guiding catheter. (C) Device migrated distally leaving the aneurysm neck unprotected. (D) Derivo 3.5×25 deployed in a telescopic fashion, covering the aneurysm neck. (E) Post-procedure angiogram showed normal distal vasculature and well covered aneurysm neck.

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