and no devices were deployed within it. In the second and third set of tests, aSurpassEvolveflowdiverter(4.5 × 25 mm; Stryker Neurovascular) and the BFDS (4.5 × 36 mm), respectively, were deployed across the aneurysm neck. In similar in vitro studies offlowdiversion, the Evolve stent was shown to have betterflow-divertingproperties compared to the Pipeline device (Medtronic); therefore, the Evolve stent was chosen for the comparison group in our study. 6 , 7 The 3D angio-CT (Siemens Artis) was performed after both the Evolveflowdiverterand the BFDS were

are currently available: the Pipeline embolization device (PED, Medtronic),Surpass(Stryker), FRED (flowredirection endoluminal device, MicroVention), SILK (Balt Extrusion), and p64 (Phenox). A new generation of intraluminal support devices incorporate braided designs with 18%–22% metal coverage and possibleflow-modifying properties. These include: LVIS (low-profile visualized intraluminal support device, MicroVention), LVIS Jr. (MicroVention), and LVIS Blue (MicroVention). Incidentally, 2 overlapping LVIS devices have been reported to create a betterflow-diverting

, and they correlate this with whether or not the aneurysm became occluded over time The PED, along with the SILK andSURPASSflowdiverters(FDs), are intracranial stents made of platinum and cobalt chromium wires (PED andSURPASS) or nickel-titanium alloy (nitinol—SILK) that cover about 30% of the inside of the artery in which they are deployed. For comparison, stents like the Neuroform stent cover less than 10% of the artery wall. 2 The PED was approved by the US FDA in April 2011. This was based on data from 131 patients studied between 2007 and 2009. 1 , 5 The

;Surpass=Surpassflowdiverter; U = unruptured; VBJ = vertebrobasilar junction; WEB = Woven EndoBridge; WP = wire perforation. Complication Rates The overall complication rate was 17.0% (95% CI 13.6%–20.5%). The incidence of procedural technical complications was 9.4% (95% CI 6.6%–12.2%). The specific causes of the technical events were poor stent opening (in 8.6% of the cases, 95% CI 4.6%–12.7%) and wire perforation (in 3.8% of the cases, 95% CI 0.73%–6.87%; Table 1 ). Adverse events were classified and the rates were 14.8% for severe complications, 69.1% for

according to the O’Kelly-Marotta (OKM) Scale forflow分类,基于充填的程度(完全的l filling; B, subtotal filling; C, entry remnant; D, no filling). 20 We strictly analyzed postprocedural, midterm, and long-term results.Flow-DiverterDevices: Technical Considerations Six types of FDDs are currently approved for the treatment of intracranial aneurysms in clinical practice: PEP (Covidien), SILKflowdiverter(Balt Extrusion), FRED (Microvention), the p64flowmodulation device (Phenox),SurpassStreamlineflowdiverter(Stryker), and Derivo

: 2363 – 2368 , 2011 10.1161/STROKEAHA.111.620328 8 De Vries J , Boogaarts J , Van Norden A , Wakhloo AK : New generation ofFlowDiverter(surpass) for unruptured intracranial aneurysms: a prospective single-center study in 37 patients . Stroke 44 : 1567 – 1577 , 2013 10.1161/STROKEAHA.111.000434 9 Deshmukh V , Hu YC , McDougall CG , Barnwell SL , Albuquerque F , Fiorella D : Histopathological assessment of delayed ipsilateral parenchymal hemorrhages after the treatment of paraclinoid aneurysms with the Pipeline Embolization

neurosurgery . J Neurosurg 89 : 865 – 873 , 1998 10.3171/jns.1998.89.5.0865 8 De Vries J , Boogaarts J , Van Norden A , Wakhloo AK : New generation offlowdiverter(Surpass) for unruptured intracranial aneurysms: a prospective single-center study in 37 patients . Stroke 44 : 1567 – 1577 , 2013 10.1161/STROKEAHA.111.000434 9 Decroix JP , Graveleau P , Masson M , Cambier J : Infarction in the territory of the anterior choroidal artery. A clinical and computerized tomographic study of 16 cases . Brain 109 : 1071 – 1085 , 1986 10

search from 2009 to 2014 was performed using the following search terms individually or in combination: pipeline embolization device, aneurysm(s), andflow-diversion, excluding otherflow-diverters. Review of retrieved articles' bibliographies yielded nineteen single and multicenter studies. A statistical meta-analysis between aspirin dose (low dose < 160 mg, high dose < 300 mg), loading doses of APT agents, post-PED APT regimens, and platelet function testing (PFT) with hemorrhagic or thrombotic complications was performed. Results Aspirin therapy for ≤ 6 months

literature and none in infants. 1 , 3 , 12 , 14 , 19 , 20 , 25 , 29 , 31 , 32 , 35 , 41 , 46 , 48 , 49 These studies are summarized in Table 1 and include aneurysms treated with PED, SILK (Balt Extrusion), andSurpass(Stryker Neurovascular)flowdiverters. One case from Crowley et al. in 2009 utilized three telescoping Cordis Enterprise microstents to treat a fusiform basilar aneurysm in a 22-month-old child, who was previously the youngest patient treated with aflowdiversion strategy. 19 Overall, 17 of 23 aneurysms had near-total or total occlusion at the last