Brazilian FRED Registry: A Prospective Multicenter Study for Brain Aneurysm Treatment-The BRED Study.

BACKGROUND AND PURPOSE: The development of flow diverters has changed the endovascular approach to intracranial aneurysms. On the basis of good results, the indications for flow diverters have expanded to include aneurysms of different shapes, locations, and sizes. The objective of the study was to report on the performance of the Flow Re-Direction Endoluminal Device (FRED) in intracranial aneurysm treatment at early and medium-term follow-up. MATERIALS AND METHODS: This single-arm, multicentric, prospective, observational study assessed aneurysm treatment with the FRED. The primary outcome was complete aneurysm occlusion at 6 and 12 months, and the secondary outcome was to evaluate the safety of the FRED with respect to stroke and death rates. RESULTS: Between June 2016 and August 2018, a total of 100 consecutive patients with 131 aneurysms were treated in 107 procedures. Total occlusion rates were 91% and 95% at 6 and 12 months. There was 1 death, and the total final morbidity rate was 1.8%. The complication rate was 4.6%. CONCLUSIONS: As reported previously, the FRED has proved to be a safe and effective tool, with high occlusion rates. The design of the stent makes it more difficult to perform balloon angioplasty compared with similar devices. A branch arising from the aneurysm sac was found to be a predictor of nonocclusion at 12 months, though larger series are needed to estimate the magnitude of the association.

Angiographic results in intracranial aneurysms treated with inert platinum coils.

This study was designed in an attempt to identify the risk factors that could be significantly associated with angiographic recurrences after selective endovascular treatment of aneurysms with inert platinum coils. A retrospective analysis of all patients with selective endovascular coil occlusion of intracranial aneurysms was prospectively collected from 1999 to 2003. There were 455 aneurysms treated with inert platinum coils and followed by digital subtraction angiography. Angiographic results were classified according Roy and Raymond's classification. Recurrences were subjectively divided into minor and major. The most significant predictors for angiographic recurrences were determined by ANOVAs logistic regression, Cochran-Mantel-Haenszel test, Fisher exact probability. Short-term (4.3 ± 1.4 months) follow-up angiograms were available in 377 aneurysms, middle-term (14.1 ± 4.0 months) in 327 and long-term (37.4 ± 11.5 months) in 180. Recurrences were found in 26.8% of treated aneurysms with a mean of 21 ± 15.7 months of follow-up. Major recurrences needing retreatment were present in 8.8% during a mean period follow-up of 17.9 ± 12.29 months after the initial endovascular treatment. One patient (0.2%) experienced a bleed during the follow-up period. Recurrences after endovascular treatment of aneurysms with inert platinum coils are frequent, but hemorrhages are unusual. Single aneurysm, ruptured aneurysm, neck greater than 4 mm and time of follow-up were risk factors for recurrence after endovascular treatment. The retreatment of recurrent aneurysm decreases the risk of major recurrences 9.8 times. Long-term angiogram monitoring is necessary for the population with significant recurrence predictors.

Direct vertebral artery access for the endovascular treatment of basilar artery aneurysms.

The femoral approach has been considered the preferred technique for the endovascular treatment of intracranial aneurysms. Occasionally, aneurysms are not amenable to the standard femoral approach. We describe four cases of basilar artery aneurysm that were treated by the direct vertebral artery access of V1 at the cervical region. The direct vertebral artery access technique can provide an alternative route in selected cases for the treatment of basilar artery aneurysms.

[Endovascular treatment of unruptured middle cerebral artery aneurysms]. / Traitement endovasculaire des anévrysmes non rompus de l'artère cérébrale moyenne.

INTRODUCTION: Middle cerebral artery aneurysms (MCA) often present an unusual anatomical feature for the endovascular treatment and are frequently sent to surgery. We report our experience in the endovascular treatment of unruptured MCA aneurysms and compare it with results from the neurosurgical literature. PATIENTS AND METHODS: In this retrospective study were included all patients with unruptured MCA aneurysms treated in our institution between November 1998 and December 2003. 3D imaging was performed in all cases to determine precisely the relationship between aneurysm and parent artery. The degree of occlusion of the aneurysms was estimated according to Raymond's classification. The neurological state was evaluated according to the Rankin scale and was re-evaluated at the time of each follow-up. RESULTS: Eighty four patients with 100 aneurysms were analysed. Ninety aneurysms were treated by endovascular approach. Nine aneurysms were sent to surgery, after 3D imaging analyses or failed endovascular treatment. In one patient, related to the aneurysm configuration, a conservative attitude has been adopted. Four giant aneurysms were treated by parent vessel occlusion and 86 aneurysms were selectively occluded. The remodelling technique with balloon was performed in 58.1% of cases. Eight patients presented a new neurological deficit. The deficit was transient in six cases, and permanent in 2 cases. There was no mortality in this series. In 86 aneurysms selectively treated, there were 87.2% good results (grades A and B). Seventy one aneurysms (82.5%) treated were controlled between 3 and 58 months with a 19.6 months average. Recurrences were observed in 25.3% of cases. They were major in 9.8% and retreatment was performed. CONCLUSION: We report the feasibility of the endovascular treatment of MCA aneurysms previously estimated untreatable. Per procedural 3D imaging and remodelling technique were fundamental tools in the management of these aneurysms.