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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2021.tde-05072021-154241
Document
Author
Full name
Lucas Eduardo Bonadio
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2021
Supervisor
Committee
Abud, Daniel Giansante (President)
Gardenghi, Leandro Augusto
Szejnfeld, Denis
Title in Portuguese
Eficácia e segurança no tratamento de aneurismas cerebrais paraclinoideos com uso do stent redirecionador de fluxo Derivo
Keywords in Portuguese
Aneurismas cerebrais
Derivo embolization device
Eficácia
Segurança
Abstract in Portuguese
Introdução: Poucas publicações trataram exclusivamente do uso do stent redirecionador de fluxo (RF) para o tratamento de aneurismas paraclinoideos. Procuramos determinar a eficácia do stent RF Derivo (DED) para tratar aneurismas neste local específico. Métodos: Revisamos retrospectivamente 126 pacientes com 159 aneurismas não rotos tratados com o stent Derivo entre dezembro de 2016 e dezembro de 2019 exclusivamente nesse segmento carotídeo. Resultados: Sexo feminino correspondeu 87%, com idade média de 54 anos. Dos 159 aneurismas, 138 foram descobertos incidentalmente, 21 eram sintomáticos, 13 foram tratados anteriormente. Todos da topografia paraclinoidea, 97,4% eram saculares e 2,6% eram fusiformes ou blister. O tamanho médio do aneurisma foi 5,8 mm (DP 3,53). Taxa de sucesso de colocação do stent foi de 98,7%. Controle angiográfico em 146 pacientes aos 6 meses e 131 aos 12 meses mostrou oclusão completa de 79,5% e 88,5%, respectivamente. Média de 1,1 dispositivo por paciente. Angioplastia com balão foi necessária em 16,5%. Estenose intra-stent moderada (25-50%) ocorreu em 3,9% com regressão em todos casos aos 12 meses, sem nenhuma progressão para oclusão completa. Morbidade precoce em 4 procedimentos (3%) (tromboembólica ou hemorrágica); desses, um paciente evoluiu para óbito e os outros 3 não tiveram repercussão neurológica. Durante o seguimento não houve complicações hemorrágicas tardias. Conclusão: O stent Derivo oferece uma opção de tratamento eficaz e segura para aneurismas paraclinoideos. A taxa de oclusão do aneurisma foi de 88,5% no seguimento, alcançada com um único dispositivo e alta taxa de sucesso técnico.
Title in English
Efficacy and safety in the treatment of paraclininoid brain aneurysms using Derivo flow diversor stent
Keywords in English
Cerebral aneurysms
Derive embolization device
Efficiency
Safety
Abstract in English
Introduction: Few publications have dealt exclusively with the use of flow diverter stents for the treatment of paraclininoid aneurysms. We sought to determine the efficacy and the safety of the flow diverter Derivo embolization device® (DED) to treat aneurysms in this specific location. Methods: We retrospectively reviewed 126 patients harboring 159 unruptured aneurysms treated with the DED between December 2016 and December 2019 exclusively in this carotid segment. Results: Female sex corresponded to 87%, with an average age of 54 years. Of the 159 aneurysms, 138 were discovered incidentally, 21 were symptomatic, 13 were treated previously. All aneurysms belonged to the paraclinoid topography, 97.4% were saccular and 2.6% were fusiform or blister. The mean size of the aneurysm was 5.8 mm (SD 3.53). Success rate for stent placement was 98.7%. Angiographic control in 146 patients at 6 months and 131 at 12 months showed complete occlusion of 79.5% and 88.5%, respectively. Average of 1.1 devices per patient. Balloon angioplasty was necessary in 16.5%. Moderate in-stent stenosis (25-50%) occurred in 3.9% with regression in all cases at 12 months, with any progression to complete occlusion. Early morbidity in 4 procedures (3%) (thromboembolic or hemorrhagic), of which one patient died and the others 3 had no neurological repercussion. During follow-up, there were no late bleeding complications. Conclusion: Derivo offers an effective and safe treatment option for paraclininoid aneurysms. The aneurysm occlusion rate was 88.5% in the follow-up, achieved with a single device and a high technical success rate.
 
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Publishing Date
2021-07-08
 
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