Controversy surrounding flow diverters in the sylvian artery - Ep.3/4

Flow diverter in the treatment of MCA aneurysms:

During this third episode we begin with some important topics discussed by

Pr. René Chapot:

1) Should we use such a powerful device to treat aneurysms of this type?

2) Would covering a branch using an FD in that region be a high price to treat

an aneurysm?

Furthermore, he recalls that we perform several angioplasties for stenosis of

intracranial arteries and when we evaluate the use of FD we say that we do

not mind sacrificing a branch.

Another discussion raised by Pr. Berenstein is the possibility of doing an

occlusion test to find out which branch of the MCA has the best collateral to

define which branch we should place the FD.

And in addition to this discussion, Pr. Chapot remembers that a great

possibility that is very reproducible anywhere in the world is the surgical

approach. This was corroborated by Pr. Siddiqui who emphasized that in his

service this would have been the option.

And Pr. Chapot treated this MCA aneurysm with two scepter balloons and

emphasized the need to occlude the balloon orifice with heat to avoid blood

entry that could lead to serious complications.

• Further reading:

1) Piano, M. et al. Flow diverter devices in the treatment of complex middle cerebral artery

aneurysms when surgical and endovascular treatments are challenging. J. Stroke Cerebrovasc.

Dis. 31, 106760 (2022)

2) BhogalP,AlMatterM,Ba ̈znerH,etal.Flowdiversionforthetreat- ment of MCA bifurcation

aneurysms: a single centre experience. Front Neurol 2017;8:20 CrossRef Medline

3) BhogalP,MartinezR,GansladtO,etal.Managementofunruptured saccular aneurysms of the M1

segment with flow diversion: a single centre experience. Clin Neuroradiol 2016 Dec 11. [Epub

ahead of print] CrossRef Medline

4) Briganti F, Napoli M, Leone G, et al. Treatment of intracranial an- eurysms by flow diverter

devices: long-term results from a single center. Eur J Radiol 2014;83:1683–90 CrossRef Medline

5) Caroff J, Neki H, Mihalea C, et al. Flow-diverter stents for the treat- ment of saccular middle

cerebral artery bifurcation aneurysms. AJNR Am J Neuroradiol 2016;37:279 – 84 CrossRef

Medline

6) IosifC,MounayerC,YavuzK,etal.Middlecerebralarterybifurca- tion aneurysms treated by

extrasaccular flow diverters: midterm angiographic evolution and clinical outcome. AJNR Am J

Neurora- diol 2017;38:310 –16 CrossRef Medline

7) F. Cagnazzo, D. Mantilla, P.-H. Lefevre, C. Dargazanli, G. Gascou and V. Costalat American

Journal of Neuroradiology December 2017, 38 (12) 2289-2294

8) Diestro JDB, Adeeb N, Dibas M, et al. Flow Diversion for Middle Cerebral Artery Aneurysms: An

International Cohort Study. Neurosurgery. 2021;89(6):1112-1121