p64 flow diverter: Results in 108 patients from a single center

Abstract

Background and purpose: Flow diverters are increasingly used to treat intracranial aneurysms. We report the safety and efficacy of the p64 flow diverter, a resheathable and detachable device for intracranial aneurysms.

Materials and methods: We retrospectively reviewed 108 patients with 109 aneurysms treated with the p64 between March 2014 and July 2019. There were 87 women and 21 men, mean age 57 years. Of 109 aneurysms, 74 were discovered incidentally, 12 were symptomatic, 18 were previously treated, and five were ruptured dissection aneurysms. A total of 10 aneurysms were located in the posterior circulation. The mean aneurysm or remnant size was 8.1 mm.

Results: Hemorrhage by perforation with the distal guidewire occurred in two patients with permanent neurological deficits in one. In one patient, acute in-stent occlusion caused infarction with a permanent deficit. Permanent morbidity was 1.9% (2 of 108, 95%CI 0.1-6.9%); there was no mortality. During follow-up, three in-stent occlusions occurred, all asymptomatic. There were no delayed hemorrhagic complications. At six months, 77 of 96 aneurysms (80.2%) were completely occluded, and at last follow-up, this increased to 93 of 96 aneurysms (96.9%). In-stent stenosis at any degree occurred in 11 patients, progressing to asymptomatic complete occlusion in one. In the other patients, stenosis resolved or improved at further follow-up.

Conclusion: The p64 offers an effective and safe treatment option. Aneurysm occlusion rate was 97% at last follow-up, mostly achieved with a single device. There were no delayed hemorrhagic complications. Delayed in-stent stenosis infrequently progresses to occlusion but remains a matter of concern.

Keywords: Flow diversion; flow diverter; interventional radiology; intracranial aneurysm.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.

A 37-year-old woman with an incidental para-ophthalmic aneurysm. 3D (a) and 2D (b) angiogram showing small para-ophthalmic aneurysm. (c) The position of the p64 flow diverter. (d) Angiogram at two weeks made because of intermittent sensibility disturbances shows 50% stenosis at the distal end of the p64. (e) Angiogram at six months demonstrates a normal caliber of the carotid artery. The aneurysm is occluded. (f) MRA at two years is unchanged with six months angiogram.

Figure 2.

A 38-year-old woman with an incidental supraclinoid aneurysm treated with a p64 flow diverter and progressive stenosis and occlusion at follow-up. Initial images of the procedure are lost. The patient remained asymptomatic with good collateral flow. (a) Follow-up angiogram at six months shows severe stenosis at the distal end of the p64. (b) Angiogram at 12 months shows progressive distal stenosis. (c) Angiogram at two years demonstrates complete occlusion. (d) Position of the p64 with deformation at both ends.

Figure 3.

A 72-year-old man with an incidentally found fusiform middle cerebral artery aneurysm. (a) AP carotid angiogram shows a fusiform aneurysm on M1. (b) Position of the p64 flow diverter. (c) Angiogram after six months demonstrates complete occlusion of the aneurysm.

Figure 4.

A 74-year-old man with an incidentally found carotid-ophthalmic aneurysm. Carotid angiogram (a) and 3D angiogram (b) reveals a wide-necked ophthalmic aneurysm. (c) Lateral radiograph shows the position of p64 flow diverter. (d) Complete aneurysm occlusion on 6 months follow-up angiogram.