Search

Objective: Flow diversion is increasingly used as an endovascular treatment for intracranial aneurysms. FRED-EPI is a prospective, multicenter, French study, conducted to analyze the safety and efficacy of aneurysm treatment with FRED/FRED Jr (Microvention, AlisoViejo, CA, USA) in current clinical practice., Patients and Methods: Patients with intracranial aneurysms treated with FRED and FRED Jr who agreed to participate were prospectively and consecutively included in all French centers using these devices., Results: From June 2020 to January 2022, 135 patients (110 females, 81.5%, and 25 males, 18.5%) with 154 aneurysms were included in 13 French interventional neuroradiology centers. The mean age was 53.9 ± 12.2 years (range: 20 - 77 years). Aneurysm was unruptured in 123 cases (79.9%), ruptured in 4 cases (2.6%), and recanalized in 27 cases (17.5%). Most aneurysms were small (135/154, 87.7%). Aneurysm locations were supraclinoid ICA in 83 (53.9%), cavernous and petrous ICA in 25 (16.2%), anterior cerebral artery or anterior communicating artery in 19 (12.3%), MCA in 7 (4.5%), and posterior circulation in 20 (13.0%). Three patients (2.2%) had hemorrhagic complications (1 delayed aneurysm rupture and 2 delayed remote hematoma) and 3 (2.2%) ischemic complications (2 intrastent thrombosis and 1 stroke related to atherosclerosis) leading to 1-year morbimortality of 4.4%. Complete aneurysm occlusion was reported in 105/139 aneurysms (75.5%)., Conclusions: FRED-EPI confirms good safety of aneurysm treatment with FRED/FRED Jr in current clinical practice with 4.4% 1-year morbimortality., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial or personal relationships that could be viewed as influencing the work reported in this paper. The authors declare the following financial or personal relationships that could be viewed as influencing the work reported in this paper:, (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Background: The Low profile visualized intraluminal support (LVIS)/LVIS Jr is a self-expanding braiding stent for the treatment of intracranial aneurysm. This study is to determine the safety and effectiveness of the LVIS/LVIS Jr for the treatment of intracranial aneurysms in a real-world setting., Methods: This prospective, observational, multicenter study enrolled patients with unruptured, ruptured and recanalized intracranial aneurysms treated with the LVIS stents, between February 2018 to December 2019. Primary endpoint was the cumulative morbidity and mortality rate (CMMR) assessed at 12 months follow-up (FU)., Results: A total of 130 patients were included (62.3 % women, mean age 55.9 ± 11.4) on an intention-to-treat basis. Four patients (3.1 %) had 2 target aneurysms; 134 total aneurysms were treated. The aneurysms were mainly located on the middle cerebral artery (41/134; 30.6 %) and the anterior communicating artery (31/134; 23.1 %). The CMMR at 1 year linked to the procedure and/or device was 4.6 % (6/130). The overall mortality was 1.5 % (2/130), none of these deaths adjudged as being linked to the procedure and/or device. All aneurysms (134/134, 100 %) were successfully treated with LVIS stent and/or other devices. At a mean FU of 16.8 months post-procedure, complete/nearly complete occlusion was achieved in 112 aneurysms (92.6 %), and only 3 patients (2.5 %) required aneurysm retreatment., Conclusion: This study provides evidence that the LVIS/LVIS Jr devices are safe and effective in the treatment of complex intracranial aneurysms, with very high rates of adequate occlusion at FU. These angiographic results are stable over time with an acceptable complication rate., Trial Registration: ClinicalTrial.gov under NCT03553771., Competing Interests: Declaration of Competing Interest MP reports support for attending meetings and/or travel from Balt, and stock or stock options (Basecamp Vascular, Synchron, Radical Catheter, Vastrax, Intradys). LP reports consulting fees from Balt, Microvention, Phenox. FC reports consulting fees from Balt, Medtronic, Microvention, Stryker, stock or stock options (Collavidance, Intradys), and leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid (Artedrone). PM reports consulting fees from Medtronic, Stryker, Artiria, payment to his institution (Codman), and served as chairman of the adverse events monitoring committee for this study, sponsored by Microvention. GM reports consulting fees from Microvention, Balt, Stryker, honoraria for lectures (Medtronic, Johnson & Jonhson). AR reports consulting fees from Balt. The other authors report no conflicts., (Copyright © 2023 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

The authors report on 3 rare cases of ruptured lenticulostriate artery (LSA) aneurysms that were heralded by deep cerebral hematomas. The hematomas were unilateral in 2 cases and bilateral in 1; in the bilateral case, only a single LSA aneurysm could be identified on the right side of the brain. Because of their small size (≤ 2 mm), fusiform aspect, and deep location within the brain, all of the aneurysms were treated conservatively. There was no hemorrhage recurrence, and follow-up angiography demonstrated spontaneous thrombosis in 2 of the 3 cases. The clinical course was favorable in 2 of the 3 patients. The course in the patient with the bilateral hematoma was marked by an ischemic event after the initial episode, resulting in an aggravation of deficits. The cause of this second event was uncertain. Because our knowledge about the natural history of LSA aneurysms is incomplete, there is no consensus concerning a therapeutic strategy. The authors' experience in 3 reported cases leads them to think that a conservative approach involving close angiographic monitoring may be proposed as first-line treatment. If the monitored aneurysm then persists or grows in size, its occlusion should be considered. Nonetheless, other studies are needed to further strengthen the legitimacy of this strategy.