Purpose: Flow Diverters (FD) have dramatically impacted the manner of endovascular treatment (EVT) of carotid siphon sidewall aneurysms. However, the indications remain unclear when compared to conventional coiling and stent-assisted coiling. We conducted herein a retrospective monocentric study in order to evaluate the safety and cost-effectiveness of EVT, comparing treatment with FD versus coiling.
Materials and Methods: Based on a prospectively gathered database we selected unruptured sidewall carotid siphon aneurysms treated in our department since the introduction of FD (2008 to 2016) for which the maximum sac diameter was 15 mm. Patient demographics, aneurysm characteristics (sac and neck sizes, dome-to-neck ratio), treatment options (FD, simple coiling or with balloon-remodeling technique [BRT], stent-assisted-coiling [SAC]), procedural and peri-procedural complications, angiographic results at follow-up were collected. Total procedural costs were also recorded. Both groups of patients and aneurysms were compared.
Results: 226 aneurysms in 211 patients (1.1 aneurysm per patient) during 216 procedures (including 158 BRT and 42 SAC procedures) were coiled. 161 aneurysms in 114 patients (1.4 aneurysm per patient) during 126 procedures were treated with FD (no coils). Aneurysms in the FD group had larger neck and lower dome-to-neck ratio. No mortality occurred in both groups. Complication rates were similar in both groups. Angiographic follow-up was longer in the coiling group. There was no difference in term of total aneurysm circulatory exclusion at follow-up between the 2 groups. FD treatment was twice more expansive than coiling (aggregated costs of simple coiling, BRT and SAC).
Conclusions: In the light of the clinical, angiographic results and costs, there is no rational to consider FD treatment for small and medium sizes carotid siphon aneurysms as the first EVT option. Coiling remains a valid therapeutic alternative in the FD era.