İNTRAKRANYAL ANEVRİZMALARIN TEDAVİSİNDE MİNİMAL PROFİLLİ YÜZEY MODİFİKASYONLU AKIM YÖNLENDİRİCİLERİN SONUÇLARININ DEĞERLENDİRİLMESİ

Abstract

Gürler V, Evaluation of the Results of Minimal Profilli Surface Modification Current Diverters in the Treatment of Intracranial Aneurysms, Hacettepe University Faculty of Medicine, Department of Radiology, Residency Thesis, Ankara, 2024.

Flow diverters (FDs) have become a preferred treatment modality in recent years, especially in the treatment of intracranial aneurysms that are difficult to treat. In this study, we aimed to evaluate the efficacy and safety of DERIVO® 2 Embolization Device (DED2), a minimal profile surface-modified flow diverter specifically designed for the treatment of distally located aneurysms.

After obtaining approval for our study by the Health Sciences Ethics Committee of our university, patients with intracranial aneurysms admitted to the Neurointerventional Radiology Unit, Department of Radiology, Hacettepe University Hospitals between January 2021 and February 2024 and intended to be treated endovascularly in our center with the flow diverter named DERIVO® 2 Embolization Device (DED2) with a diameter of ≤3.5 mm (minimal profile) were retrospectively screened. Demographic parameters and clinical-radiological data of the patients before, during and after the procedure were retrospectively evaluated. A total of 33 patients had 36 aneurysms. DED2 was used as salvage therapy in 1 patient and was not included in the statistical evaluations.

Technical success, aneurysm occlusion grades according to the modified Raymond-Roy occlusion classification (mRROC) and device efficacy in proximal and distally located aneurysms were evaluated.

All aneurysms included in the study ranged from 2.5 mm to 26 mm with a mean size of 6.52 mm (SD ±5.09). The mean neck width of the 35 aneurysms in our series was 4.29 mm (SD ± 2.14). Of the 30 aneurysms in which DED2 was implanted, 4 aneurysms (13.3%) underwent coiling in addition to DED2 treatment, while 5 aneurysms (16.7%) underwent stenting in addition to DED2 treatment. In 22 aneurysms (73.4%), DED2 was used alone. Our procedural adverse event rate was 3.1% in one patient, considering the slowing of flow in the superior trunk, which was jailed with a flow diverter during the endovascular procedure. In conclusion, our procedural complication rate is similar to the rates of other minimal profile flow diverter devices in the literature.

The technical success rate on a device basis was 90.6%, and when the number of aneurysms was taken into account, the technical success rate on an aneurysm basis was 90.9%. Our complete occlusion rate (RR 1) in aneurysms was 89.6% at 15.4 ± 8.3 months post-procedure follow-up. No post-procedural permanent neurologic deficit, neurologic mortality or major stroke was observed during follow-up.

Compared to the other minimal profile flow diverter, Silk Vista Baby, the complete occlusion rates were better than the literature, indicating the success of the DED2 device. The fact that there was no significant difference in complete occlusion and complication rates, especially between distal/proximal aneurysms, indicates that the DED2 device is not more risky in terms of thrombosis or bleeding, contrary to expectations, although it is used in more distal thin-small vessels. Compared to the literature, the procedural adverse event rates seen in procedures performed with the DED2 device are also similar. In conclusion, the DED2 device shows promise as an effective and safe treatment modality, especially in the treatment of distally located aneurysms.