Treatment of Ruptured Blister-Like Aneurysms with the FRED Flow Diverter: A Multicenter Experience

Fellows’ Journal Club

In a retrospective multicenter study, all patients treated with the FRED for a ruptured intracranial blister-like aneurysm between January 2013 and May 2019 were analyzed. In total, 30 patients with 30 ruptured blister-like aneurysms were treated. Immediate complete aneurysm obliteration with the FRED was achieved in 10 patients (33%). Of the 26 patients with follow-up, complete obliteration was achieved in 21 patients (80%) after 6 months and in 24 patients (92%) in the final follow-up (median, 22 months). The authors conclude that treatment of ruptured blister-like aneurysms with the FRED is safe and effective.

Abstract

Figure from Möhlenbruch et al
A, Nonenhanced head CT of a female patient in her 50s showing subarachnoid hemorrhage, Hunt and Hess grade 4, and Fisher grade 4. B, Angiography reveals a blister-like aneurysm of the right supraclinoid ICA with a maximum neck diameter of 3.3 mm. C, Angiographic result immediately after deployment of FRED 4.0 × 13 mm. D, Follow-up angiography at day 17 shows a residual aneurysm filling. E and F, Follow-up angiography at 3 months demonstrates complete aneurysm obliteration. mRS score at 3 months was 1.

BACKGROUND AND PURPOSE

Treatment of ruptured blister-like aneurysms is technically challenging. This study aimed at analyzing the safety and efficacy of the Flow-Redirection Endoluminal Device (FRED) in the treatment of ruptured blister-like aneurysms.

MATERIALS AND METHODS

In a retrospective multicenter study, all patients treated with the FRED due to a ruptured intracranial blister-like aneurysm between January 2013 and May 2019 were analyzed. The primary end points for clinical safety were mRS 0–2 at 6 months after treatment and the absence of major ipsilateral stroke or death. The primary end points for efficacy were the absence of rebleeding after treatment and complete angiographic occlusion according to the O’Kelly-Marotta classification at 6 months after treatment.

RESULTS

In total, 30 patients with 30 ruptured blister-like aneurysms were treated. Immediate complete aneurysm obliteration (O’Kelly-Marotta classification D) with the FRED was achieved in 10 patients (33%). Of the 26 patients with follow-up, complete obliteration was achieved in 21 patients (80%) after 6 months and in 24 patients (92%) in the final follow-up (median, 22 months). Twenty-three patients (77%) achieved mRS 0–2 at 6 months. Major stroke or death occurred in 17%. Two patients died due to pneumonia, and 2 patients died due to infarction following cerebral vasospasm. There was no case of rebleeding after FRED implantation. There was 1 case of delayed asymptomatic stent occlusion.

CONCLUSIONS

Treatment of ruptured blister-like aneurysms with the FRED is safe and effective.

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Treatment of Ruptured Blister-Like Aneurysms with the FRED Flow Diverter: A Multicenter Experience
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Jeffrey Ross
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