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Título

FLOW DIVERTER ENDOLUMINAL DEVICE (FRED) FOR THE TREATMENT OF INTRACRANIAL ANEURYSMS: 6 YEARS CLINICAL RESULTS

Resumo

INTRODUCTION: Flow diverter are one of several models of metallic stents used in intracranial aneurysms (IAs) embolization. They show an advantage over endosaccular coiling since they treat the weakened arterial wall by providing a scaffold for new endo-thelial cell growth to occur. The FRED (Flow Diverter Endoluminal Device) is a model of flow diverter that stands out for being a two-layer braided spiral that helps to reconstruct the blood vessel wall. OBJECTIVE: Report the experience of the use of the FRED dispositive in the endovascular treatment of IAs and evaluate the safety and efficacy of this intervention. METHODS: This retrospective and single-center observational study evaluates the use of FRED or FRED Jr in the endovascular treatment of IAs from July 2016 to April 2022. Patients included were older than 18 years, and treated with a FRED or FRED Jr dispositive; and were excluded if the implant did not occur for some complication or if they didn’t perform a control cerebral angiography after the procedure. Dual antiplatelet therapy (acetylsalicylic acid and clopidogrel) was managed 5 days before and 6 months after the procedure and acetylsalicylic acid was used for another 6 months. Data were collected from the medical records: sex and age, number and location of IAs, complications, morbidity and level of IA occlusion – following the O'Kelly Marotta (OKM) classification scale. All intraprocedural complications were reported. The follow-up of patients was carried out 6 and/or 12 months after the procedure with a digital subtraction angiography. RESULTS: Between July 2016 and April 2022, 191 patients were screened, which 31 met exclusion criteria. 135 patients were female. The mean age was 53 years. A total of 198 AIs were treated – 178 of them in the internal carotid artery, mainly in the ophthalmic segment. Following the OKM scale for occlusion of IAs, 61% fulfilled category D; while C, B and A were observed in, respectively, 11%, 7% and 6%. 28 patients had not undergone control angiography at the time of the study, but were not excluded because there was still time for follow-up. The morbidity rate was 16% (mRS = 1, mainly headache). No deaths were reported. CONCLUSIONS: IAs are more common in females after 50 years old. In this study, the occlusion rate was seen in 70% of the cases, a value that can still increase as follow-ups are concluded. Thus, high efficacy in the use of FRED in the endovascular treat-ment of IAs is suggested.

Palavras Chave

FLOW DIVERTER ENDOLUMINAL DEVICE; INTRACRANIAL ANEURYSMS;