O-013 Intra-aneurysmal Flow Disruption: a New Approach for the Endovascular Treatment of Intracranial Aneurysms. French Clinical Experience

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Abstract

Purpose

Standard coiling is now the first line approach for the treatment of intracranial aneurysms. However, this technique has some limitations, including treatment of wide-neck and large and giant aneurysms and recanalisations. Therefore, new techniques and devices are needed. The objective of intra-saccular flow disruption is the modification of aneurysmal flow by placing a device in the aneurysm sac. Preliminary clinical experience in French centres is presented.

Materials and Methods

Computational fluid dynamics and pre-clinical testing (canine cross-over carotid bifurcation model) were used to develop an intra-saccular flow disrupter design, designated as WEB (Sequent, Aliso Viejo, CA).The WEB is a self-expanding, oblate, braided nitinol mesh, composed of an inner and outer braid held together by proximal, middle, and distal radio-opaque markers and creating two compartments: one distal and one proximal.Clinically, 39 patients (27F/12M, age: 37–75 years) harbouring ruptured, unruptured or recanalised aneurysms were treated between June 2011 and January 2013 in 7 French centres, using an intra-aneurysmal flow-disrupter (WEB).

Materials and Methods

Aneurysm location was middle cerebral artery (23 aneurysms), basilar artery (8), internal carotid artery (5), and anterior communicating artery (3). Aneurysm size was 10mm in 5 aneurysms. Neck size was > 4mm in 5 aneurysms and <4mm in 35 cases.

Results

Clinically, the device was successfully deployed in all but 2 cases. Three thromboembolic events were observed with favourable outcome in both cases (mRS ≤2). No intraoperative rupture was observed. No delayed rupture or remote haematoma was observed. Additional coiling was performed in 4 cases. Mid-term follow-up results are presented.

Conclusion

Intra-saccular flow disruption using WEB is a completely new endovascular approach to treat some types of aneurysm, particularly wide-neck bifurcation aneurysms. This preliminary clinical experience shows the safety and efficacy of the device when used in appropriately selected cases.

Disclosures

L. Pierot: 2; C; Sequent. A. Januel: None. H. Raoult: None. L. Spelle: None. C. Papagiannaki: None. H. Desal: None. P. Courtheoux: None. K. Krzysztof Kadziolka1: None. J. Gauvrit: None. J. Moret: None. D. Herbreteau: None. C. Cognard: None.

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