Weiss Daniel, Vach Marius, Ivan Vivien L, Muhammad Sajjad, Hofmann Björn B, Neyazi Milad, Turowski Bernd, Kaschner Marius
Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf, Germany.
Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
J Neuroimaging. 2025 Jan-Feb;35(1):e13253. doi: 10.1111/jon.13253.
Flow diversion has become a key treatment option for complex intracranial aneurysms. Recent advancements include coated flow diverters (FDs), designed to potentially reduce the need for dual antiplatelet therapy, thereby removing the associated secondary risks while maintaining patency and low complication rates. Comparing coated and uncoated FDs may offer insights into long-term outcomes and treatment optimization.
In this retrospective single-center study, we investigated the data of 21 consecutive patients with cerebral aneurysms, treated between 2021 and 2023 with the coated Derivo 2heal Embolization Device and the uncoated Derivo Embolization Device (both Acandis). We described the procedure and analyzed clinical and radiological data, along with long-term outcomes after 18 months of follow-up.
Nine patients (42.9%) had incidental, while 12 (57.1%) had symptomatic aneurysms, including 10 with World Federation of Neurosurgical Societies classification IV subarachnoid hemorrhages. Aneurysm locations included mostly the internal carotid (n = 9) and the vertebral artery (n = 7). All FDs were successfully deployed: 11 patients received the coated and 10 the uncoated device. After 18 months, 73.3% of patients had favorable outcomes (modified Rankin Score 0-2). One coated FD occluded asymptomatically after 6 months, and one uncoated FD occluded immediately but could be recanalized.
We observed favorable occlusion rates for both coated and uncoated FDs. The role of dual antiplatelet therapy remains debated. Large multicenter studies are essential to evaluate the patency of coated compared to uncoated FDs and determine whether they can reduce thrombogenicity, potentially allowing for less or no antiplatelet therapy in emergencies.
血流导向已成为复杂颅内动脉瘤的关键治疗选择。最近的进展包括涂层血流导向装置（FD），其设计目的是可能减少双联抗血小板治疗的需求，从而消除相关的继发性风险，同时保持通畅率和低并发症发生率。比较涂层和未涂层的FD可能有助于了解长期疗效和治疗优化。
在这项回顾性单中心研究中，我们调查了2021年至2023年间连续21例脑动脉瘤患者的数据，这些患者分别接受了涂层Derivo 2heal栓塞装置和未涂层的Derivo栓塞装置（均为Acandis公司产品）治疗。我们描述了手术过程，并分析了临床和放射学数据以及随访18个月后的长期疗效。
9例患者（42.9%）为偶然发现的动脉瘤，12例（57.1%）为有症状的动脉瘤，其中10例为世界神经外科联合会IV级蛛网膜下腔出血。动脉瘤位置主要包括颈内动脉（n = 9）和椎动脉（n = 7）。所有FD均成功植入：11例患者接受了涂层装置，10例接受了未涂层装置。18个月后，73.3%的患者预后良好（改良Rankin评分0 - 2）。1枚涂层FD在6个月后无症状性闭塞，1枚未涂层FD立即闭塞但可再通。
我们观察到涂层和未涂层FD均有良好的闭塞率。双联抗血小板治疗的作用仍存在争议。大型多中心研究对于评估涂层FD与未涂层FD的通畅率以及确定它们是否能降低血栓形成性至关重要，这可能使得在紧急情况下减少或无需抗血小板治疗成为可能。
