Flow diversion versus parent artery occlusion with bypass in the treatment of complex intracranial aneurysms: Immediate and short-term outcomes of the randomized trial

• Published in: Clinical neurology and neurosurgery 2018-09, Vol.172, p.183-189
• Main Authors: Kiselev, Roman, Orlov, Kirill, Dubovoy, Andrey, Berestov, Vadim, Gorbatykh, Anton, Kislitsin, Dmitry, Shayakhmetov, Timur, Tasenko, Anton, Seleznev, Pavel, Strelnikov, Nikolay, Ovsyannikov, Konstantin, Gladkikh, Victor, Moskalev, Andrey
• Format: Article
• Language: English
• Subjects: Age; Aneurysm; Aneurysm, Ruptured - surgery; Aneurysms; Arteries - surgery; Bias; Bypass; Bypasses; Cardiovascular system; Clinical outcomes; Complications; Diversion; Embolization, Therapeutic - methods; Endovascular Procedures - methods; Female; Flow diverter; Gender; Hemorrhage; Humans; Intracranial Aneurysm - surgery; Ischemia; Localization; Male; Medical imaging; Middle Aged; Morbidity; Morphology; Mortality; Neck; Neurological complications; Neurology; Neuropathy; Occlusion; Patients; Propensity Score; Prospective Studies; Randomization; Revascularization; Software; Stents; Surgery; Thrombosis; Time Factors; Treatment Outcome; Veins & arteries
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2018.06.042

•Study showed better clinical outcomes of flow diversion in comparison with bypass.•FD had lower complete obliteration rate in comparison with PAO in 12 months.•Major complications rate was significantly higher in surgical group.•Predictors of uncomplete occlusion and complications were found during study. We performed prospective randomized comparison of clinical and surgical outcomes of flow diversion versus PVO and bypass in patients with complex anterior circulation aneurysms. Open, prospective, randomized, parallel group, multicenter study of complex intracranial aneurysms treatment was conducted. Patients with complex intracranial aneurysms of anterior circulation with neck is more than 4 mm wide, dome/neck ratio is equal or less than 2:1, which is suitable for flow diversion and occlusion with bypass were included in the study. A total of 111 potential participants were enrolled since March 2015. Additional propensity score matching was performed with 40 patients in each group selected for analysis. 39 out of 40 patients (97.5%) from matched FD group reached good clinical outcome. In the matched bypass group acceptable outcome was achieved in 32 (80%) out of 40 patients (difference between groups p = 0.029). The morbidity and mortality rates were 15% and 5%, respectively. Difference in the rates of favorable outcomes, compared by χ2 met statistical significance (p = 0.014). The rate of complete aneurysm occlusion at 6 months was 42.5% in the FD group and 95% in surgical group (p