====== Intracranial aneurysm Flow Diversion complications ====== see [[Intracranial aneurysm clipping complications]]. see [[Intracranial aneurysm coiling complications]]. [[Complication]]s associated with [[Flow Diversion]] may be divided into [[periprocedural]] complications, immediate [[postprocedural]] complications, and delayed [[complication]]s. Al-Mufti et al. sought to review these complications and novel [[management]] strategies that have been reported in the [[literature]] ((Al-Mufti F, Cohen ER, Amuluru K, Patel V, El-Ghanem M, Nuoman R, Majmundar N, Dangayach NS, Meyers PM. Bailout Strategies and Complications Associated with the Use of Flow-Diverting Stents for Treating Intracranial Aneurysms. Interv Neurol. 2020 Feb;8(1):38-54. doi: 10.1159/000489016. Epub 2018 Oct 16. PMID: 32231694; PMCID: PMC7098281.)). The risks includeng in-[[stent thrombosis]], [[perianeurysmal edema]], distant and delayed [[hemorrhage]]s, and perforator occlusions. Comparative efficacy and safety against other therapies are being studied in ongoing [[trial]]s. [[Antiplatelet therapy]] is mandatory with flow diverters, which has highlighted the need for better evidence for monitoring and tailoring antiplatelet therapy ((Alderazi YJ, Shastri D, Kass-Hout T, Prestigiacomo CJ, Gandhi CD. Flow diverters for intracranial aneurysms. Stroke Res Treat. 2014;2014:415653. doi: 10.1155/2014/415653. Epub 2014 May 20. Review. PubMed PMID: 24967131.)). Symptomatic modifications of side branches after flow diverter treatment depend on the extent and type of collateral supply ((Saleme S, Iosif C, Ponomarjova S, Mendes G, Camilleri Y, Caire F, Boncoeur MP, Mounayer C. Flow-diverting stents for intracranial bifurcation aneurysm treatment. Neurosurgery. 2014 Dec;75(6):623-31. doi: 10.1227/NEU.0000000000000522. PubMed PMID: 25121791. )). ---- Preliminary clinical series document effective treatment of wide-neck and/or large and [[giant aneurysm]]s with acceptable complication rates. However, several questions remain unanswered related to the [[incidence]] and mechanisms of aneurysm rupture after treatment with flow diverters, fate of small perforating vessels, and long-term patency rates ((D'Urso PI, Lanzino G, Cloft HJ, Kallmes DF. Flow diversion for intracranial aneurysms: a review. Stroke. 2011 Aug;42(8):2363-8. doi: 10.1161/STROKEAHA.111.620328. Epub 2011 Jul 7. PMID: 21737793.)) ---- ---- The objective of a study was to review the literature on the use of [[flow-diverting device]]s (FDDs) to treat [[intracranial aneurysm]]s (IAs) and to investigate the safety and complications related to FDD treatment for IAs by performing a [[meta-analysis]] of published studies. A systematic electronic database search was conducted using the Springer, EBSCO, PubMed, Medline, and Cochrane databases on all accessible articles published up to January 2016, with no restriction on the publication year. Abstracts, full-text manuscripts, and the reference lists of retrieved articles were analyzed. Random-effects meta-analysis was used to pool the complication rates across studies. RESULTS Sixty studies were included, which involved retrospectively collected data on 3125 patients. The use of FDDs was associated with an overall complication rate of 17.0% (95% confidence interval [CI] 13.6%-20.5%) and a low mortality rate of 2.8% (95% CI 1.2%-4.4%). The neurological morbidity rate was 4.5% (95% CI 3.2%-5.8%). No significant difference in the complication or mortality rate was observed between 2 commonly used devices (the Pipeline embolization device and the Silk flow-diverter device). A significantly higher overall complication rate was found in the case of ruptured IAs than in unruptured IA (odds ratio 2.3, 95% CI 1.2-4.3). The use of FDDs in the treatment of IAs yielded satisfactory results with regard to complications and the mortality rate. The risk of complications should be considered when deciding on treatment with FDDs. Further studies on the mechanism underlying the occurrence of adverse events are required ((Zhou G, Su M, Yin YL, Li MH. Complications associated with the use of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis. Neurosurg Focus. 2017 Jun;42(6):E17. doi: 10.3171/2017.3.FOCUS16450. PMID: 28565981.)). ===== Antiplatelet Therapy in Flow Diversion ===== [[Antiplatelet Therapy in Flow Diversion]]. ===== Case series ===== Unruptured and recanalized aneurysms located in the anterior circulation treated with FRED and FRED Jr were prospectively included. Adverse events were independently evaluated by a Clinical Event Committee with a vascular neurosurgeon and an interventional neuroradiologist. Primary safety outcome measures were morbidity and mortality rates at 6 months after treatment. Results: A total of 103 patients/aneurysms were included in 13 interventional neuroradiology (INR) centers. Aneurysm locations were supraclinoid internal carotid artery (ICA) in 71 (68.9%), cavernous ICA in 15 (14.6%), anterior cerebral artery or anterior communicating artery in nine (8.7%), and middle cerebral artery in eight (7.8%). Aneurysms were small (<10 mm) in 71 patients (68.9%). Treatment was successfully performed in 98/103 patients (95.1%). Thromboembolic (TE) complications occurred in 5/103 patients (4.9%), intraoperative rupture in 2/103 patients (1.9%), delayed aneurysm rupture in 1/103 patient (1.0%), and delayed hematoma occurred in 1/103 patient (1.0%). Six-months' mortality and morbidity rates were 1/102 (1.0%) and 2/102 (2.0%), respectively. Conclusions: Aneurysm treatment with the FRED device is safe with low mortality (1.0%) and morbidity (2.0%) ((Pierot L, Spelle L, Berge J, Januel AC, Herbreteau D, Aggour M, Piotin M, Biondi A, Barreau X, Mounayer C, Papagiannaki C, Lejeune JP, Gauvrit JY, Costalat V. Feasibility, complications, morbidity, and mortality results at 6 months for aneurysm treatment with the Flow Re-Direction Endoluminal Device: report of SAFE study. J Neurointerv Surg. 2018 Aug;10(8):765-770. doi: 10.1136/neurintsurg-2017-013559. Epub 2018 Jan 19. PMID: 29352057; PMCID: PMC6204937.)). ===== References =====