Isil Saatci
Flow diverters are the recent hot topic in the endovascular treatment of cerebral aneurysms. They enable the treatment of so-called “unfavorable” aneurysms, especially sidewall aneurysms with wide necks, large or giant aneurysms with mass effect, fusiform aneurysms, blister aneurysms, dissecting aneurysms, or recurrent aneurysms. But, moreover, as we anticipated based on the positive feedback from colleagues, worldwide, following our publication, this concept has also changed the policy of many neurointerventionalists who without taking the risk of sac catheterization and coil placement, place a single flow-diverter device considered to cure the “coilable” aneurysms as well, with much shorter operation times. The 6-month occlusion rate of 91.2% increasing to 94.6% in the following control, associated with permanent morbi-mortality rates of 1% and 0.5%, respectively, further promotes this technique. It is likely that especially in the patients with unruptured aneurysms, where double antiaggregating drug administration is not a concern, the treatment of any sidewall aneurysm is likely to shift to the flow-diversion technique.
We are collecting data regarding the patency of vessels that come directly off from the sac where no other techniques, either endovascular or surgical, are likely to save the relevant branch. It seems revolutionary that in such aneurysms, following the placement of a flow diverter at the neck, while the aneurysm is becoming occluded, the branch arising from the sac is kept patent, if there is a demand for flow.