IAGS Blogs: Intra-Cranial Intervention: Embolization, Balloons, Stents

Moderator: Tyrone Collins

Panelists:             Nick Hopkins and Gary Roubin

 

What are the treatment options for intracranial aneurysmal and atherosclerotic disease?

Two novel devices to treat intracranial aneurysmal disease are being evaluated by our European colleagues.  These “ flow diverting” devices have demonstrated some encouraging results in aneuryms that are difficult or impossible to treat with surgery or coiling.  Diverters are highly flexible small celled stents that allow placement across an aneurysm while allowing for continued flow into juxtaposed tiny perforator branches and redirecting the flow back into the parent vessel.  There have been reports of technical problems requiring the insertion of multiple diverts to achieve an acceptable result, thrombotic complications and ruptures.

Gaps in current knowledge:  We have a lot to learn about flow diversion to treat aneuryms.  Similarly, the use of intracranial angioplasty and stenting for atherosclerotic disease is controversial regarding who should perform the procedure, the technical performance and what patients should be treated.  A strategy of angioplasty initially for highly symptomatic patients followed by repeat angiography and possible stenting after three months may make this treatment option safer and more effective.

Summary and results:  The flow diverter concept is fascinating, however it is not clear where this technology will progress.  Further research and development is warranted.  The recent SAMPRAS trial that was criticized for design flaws has significantly jeopardized the future of intracranial angioplasty and stenting for atherosclerotic patients.  Well designed and conducted trials should be considered for the future.

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