Single-Center Experience With the Bare p48MW Low-Profile Flow Diverter and Its Hydrophilically Covered Version for Treatment of Bifurcation Aneurysms in Distal Segments of the Anterior and Posterior Circulation
Stefan Schob, Monika Kläver, Cindy Richter, Cordula Scherlach, Jens Maybaum, Simone Mucha, Marie-Sophie Schüngel, Karl‐Titus Hoffmann, Ulf Quaeschling
Abstract
Flow diversion has profoundly changed the way aneurysms are treated. However, it conventionally requires dual anti-platelet medication and has yet been considered off-label-use in the posterior circulation or within peripheral vessels of the anterior circulation. Here we report our experience with the p48MW/p48MW_HPC in the anterior and posterior circulation. This novel low-profile flow-diverter is specifically designed for treatment of small peripheral vessels and the p48MW_HPC has an anti-thrombotic-polymer-coating, which allows application of a single anti-platelet function medication in conditions that expectably require further surgery. 32 patients were prospectively included. 26 treatments were performed with one flow-diverter, four required two overlapping flow-diverters, one case demanded three overlapping flow-diverters and for one extensive dissecting aneurysm telescoping with eight flow-diverters was necessary. 22 complex bifurcation-aneurysms were treated. Three months follow up was available for 14 patients. Deployment was uneventful in all cases. In four cases under-sizing was unavoidable and resulted in significant shortening of the flow-diverter, which demanded implantation of further flow-diverters to sufficiently treat the target aneurysm. Three flow-diverters required balloon-angioplasty for optimal wall-approximation. All parent vessels remained patent. Available three month follow up studies showed decreased influx or delayed washout in all aneurysms, none was occluded completely. There were no device-related clinical complications. Implantation of the p48MW/p48MW_HPC is safe and effective for treatment of distally located cerebral aneurysms. Considering the reported rates of ischemic complications associated with flow-diversion of complex bifurcation-aneurysms, the p48MW/p48MW_HPC potentially provides increased safety for complex bifurcation aneurysms in the anterior and posterior circulation.