Ignazio Divenuto

Mid-term and long-term follow-up of intracranial aneurysms treated by the p64 Flow Modulation Device: a multicenter experience

Background Experience with the endovascular treatment of cerebral aneurysms using the p64 Flow Modulation Device is still limited. This study discusses the results and complications of this new flow diverter device. Methods 40 patients (30 women, 10 men) with 50 cerebral aneurysms treated in six Italian neurointerventional centers with the p64 Flow Modulation Device between April 2013 and September 2015 were retrospectively reviewed. Results Complete occlusion was obtained in 44/50 aneurysms (88%) and partial occlusion in 3 (6%). In the other three aneurysms (6%), two cases of asymptomatic in-stent thrombosis and one intraprocedural occlusion of the parent vessel occurred. Technical complications were observed in eight procedures (16%). Permanent morbidity due to acute in-stent thrombosis and consequent ischemic stroke occurred in one patient (2.5%). No delayed aneurysm rupture, subarachnoid or intraparenchymal hemorrhage, or ischemic complications occurred and there were no deaths. Conclusions Endovascular treatment with the p64 Flow Modulation Device is a safe treatment for unruptured cerebral aneurysms, resulting in a high rate of occlusion. As with other flow diverter devices, we recommend this treatment mainly for large-necked aneurysms of the internal carotid artery siphon. However, endovascular treatment with the p64 device should also be encouraged in difficult cases such as aneurysms of the posterior circulation and beyond the circle of Willis.

Endovascular treatment of intracranial aneurysms with flow-diverter stents: preliminary single-centre experience

PurposeThis paper reports our preliminary experience with the endovascular treatment of intracranial aneurysms using flow-diverter stents (FDs) and compares it with the literature data.Materials and methodsFrom May 2009 to April 2012, 28 patients (6 men and 22 women; mean age, 54 years) with a total of 35 aneurysms were treated with FDs. We evaluated postprocedural technical success and long-term efficacy, with follow-up examinations performed at 3–7 days [computed tomography (CT)/magnetic resonance (MR) angiography] and at 3, 6 and 12 months (digital subtraction angiography, DSA). A total of 43 FDs were placed, 36 Pipeline and 7 Silk.ResultsA total of 30 procedures were performed (two patients were treated twice). Technical success was 96.6%, with one case of postprocedural death; the aneurysm exclusion rate at 3, 6 and 12 months was 60%, 73% and 89%, respectively. There was no case of acute stent thrombosis, and only two cases of nonsignificant stenosis. All covered side branches were patent, except one case of steno-occlusion of the ophthalmic artery.ConclusionsOur results are consistent with the literature and demonstrate the effectiveness and safety of FDs in selected cases of cerebral aneurysm (wide neck, fusiform, blister-like).RiassuntoObiettivoScopo del presente lavoro è riportare la nostra esperienza nel trattamento endovascolare degli aneurismi cerebrali mediante stent a diversione di flusso (FD), confrontandola con i dati della letteratura.Materiali e metodiDa maggio 2009 ad aprile 2012 sono stati trattati mediante FD 28 pazienti (6 maschi e 22 femmine; età media 54 anni) portatori di 35 aneurismi cerebrali. Abbiamo valutato il successo tecnico procedurale e l’efficacia a distanza mediante angiotomografia computerizzata (TC) o angio-risonanza magnetica (RM) a 3–7 giorni, quindi angiografia digitale a sottrazione (DSA) a 3, 6 e 12 mesi. Sono stati posizionati complessivamente 43 FD, 36 Pipeline e 7 Silk.RisultatiComplessivamente sono stati eseguiti 30 interventi (due ritrattamenti a 3 mesi per copertura parziale del colletto aneurismatico). Abbiamo ottenuto il successo tecnico nel 96,6% dei casi, con un caso (3,4%) di insuccesso esitato in decesso post-operatorio. L’esclusione dal circolo dell’aneurisma è stata a 3, 6 e 12 mesi rispettivamente del 60%, 73% ed 89%. Non abbiamo osservato nessun caso di trombosi intra-stent, solo due casi di stenosi lieve intra-stent, risoltesi poi al followup; in tutti i casi i vasi collaterali ricoperti dagli stent sono risultati pervi, eccetto un caso di steno-occlusione dell’arteria oftalmica.ConclusioniI risultati da noi ottenuti, in linea con i dati della letteratura, documentano che il trattamento degli aneurismi cerebrali mediante FD rappresenta un’opzione sicura ed efficace in casi selezionati (aneurismi a largo colletto, fusiformi, blister-like), con buoni risultati nel tempo.

High-grade Residual Tumor

71-year-old patient affected by right parietal gemistocytic astrocytoma treated with subtotal resection and subsequent combined radiation therapy-chemotherapy Morphofunctional MR follow-up performed with morphologic study, perfusion and spectroscopy preoperatively and at 3 months after surgery and radiation therapy-chemotherapy

Tumor Progression/Recurrence

53-year-old patient affected by right temporal glioblastoma multiforme treated with subtotal surgery, combined radiation therapy-chemotherapy, and second- and third-line adjuvant chemotherapy Multimodal CT/MR follow-up with morphologic and perfusion studies performed preoperatively and at 1, 4 and 8 months after surgery and combined radiation therapy-chemotherapy