Flow Diversion for Cerebral Aneurysms: A Decade-Long Experience with Improved Outcomes and Predictors of Success

Abstract

Background: Flow diversion has significantly improved the management of cerebral aneurysms. Technological advancements and increased clinical experience over the past decade have led to better outcomes and fewer complications. This study provides updated results and examines the factors that influence the success of flow diversion. Methods: We reviewed records of 115 patients with 121 intracranial aneurysms treated from July 2014 to August 2023. All patients had unruptured aneurysms in the anterior and posterior circulation. Results: Complete aneurysm occlusion was achieved in 72.7% of cases, with a complication rate of 9.1%. Significant predictors of complete occlusion included aneurysm diameter (OR = 0.89, 95% CI 0.82–0.97, p = 0.009) and the presence of incorporated branches (OR = 0.22, 95% CI 0.08–0.59, p = 0.003). Cox analysis identified neck diameter (HR = 0.92, 95% CI 0.87–0.98, p = 0.009) and incorporated branch (HR = 0.40, 95% CI 0.24–0.69, p = 0.001) as significant for occlusion. Multivariable analysis identified aneurysm diameter (OR = 1.21, 95% CI 1.09–1.37, p = 0.001) as significant for safety outcomes. Improved outcomes were observed in recent treatments, with higher occlusion rates (79.7% vs. 61.7%, p = 0.050) and lower complication rates (4.1% vs. 14.9%, p = 0.011). Conclusions: Enhanced technical proficiency, better devices, and refined patient selection have significantly improved the efficacy and safety of flow diversion for cerebral aneurysms. Identifying significant predictors for treatment success and safety outcomes can inform clinical practice, aiding in patient selection.

Keywords

• flow diversion
• cerebral aneurysm
• aneurysm occlusion
• long-term outcomes
• safety outcomes