![]() noted, DWI changes occurred at a nearly 6-fold higher rate than clinical symptoms. However, these results should be interpreted with caution, since silent infarcts are a known consequence of diagnostic coronary and cerebral angiography alone. Interestingly, the frequency of asymptomatic ischemic events associated with use of FDS, as detected by postprocedural diffusion-weighted imaging (DWI), was higher than similar events with coiling in two separate cohorts: 63% asymptomatic events according to Brasiliense et al. The incidence of symptomatic thromboembolic complications has been reported in various studies to be between 2 and 8%, similar to reported complication rates experienced with coil embolization. Thromboembolic complications in the setting of flow diversion include acute and hyperacute stent thrombosis, large-vessel occlusion, and perforator or side-branch occlusion. Thromboembolic and Ischemic Complications We categorize these periprocedural complications into four categories: (1) thromboembolic/ischemic events, (2) side branch occlusions, (3) parent artery injury and/or rupture, and (4) malposition or migration of the flow-diverting stent(s). Periprocedural complications increase morbidity and should be identified quickly and even anticipated so that they can be prevented, or at least quickly identified and corrected. ![]() Based on the focus of our review, complications of use of FDS for aneurysm treatment were categorized as (1) periprocedural or (2) postprocedural. Any potential conflict on article selection was mitigated by discussion and mutual consensus with arbitration by the senior authors (F.A. Studies or reports describing the use of FDS for treatment procedures other than intracranial aneurysms were excluded. Further criteria for article selection relied upon the description of complication in the identified publications. All studies including case reports, case series, clinical trials, or observational cohorts were included in this review if they addressed any questions related to the management of FDS. Bibliographies of identified citations and articles citing them were also examined. The search and the retrieved citations were examined in their entirety by 4 authors (FA, E.R.C., K.A., and V.P.) independently by reviewing article title, abstract and full-texts. Electronic databases MEDLINE and Google Scholar were mined using Boolean operators “AND” and “OR” for search terms “flow diverter,” “endovascular,” “aneurysm,” “intracranial,” and “pipeline” in various combinations. MethodsĪ systematic, qualitative review of the literature for relevant, peer-reviewed articles up to May 1, 2017, was performed. Herein, we sought to review these complications and their respective management strategies. Risks associated with FDS may be divided into periprocedural complications, immediate postprocedural complications, and delayed complications. These two actions isolate the aneurysm from the parent artery by causing remodeling or “reconstruction” around the prosthesis while eliminating the aneurysm-parent vessel interface altering flow dynamics both across and within, the cerebral aneurysm, leading to thrombosis. ![]() The mechanism of action of flow-diverting stents is based on two concepts: (1) the disruption of blood flow from the parent artery into the aneurysm and (2) the provision of a scaffold on which endothelial cells can grow. Flow diversion carries a high risk of thromboembolic complications hence, platelet inhibition is recommended to reduce the risk of thromboembolic events. The introduction of flow-diverting stents (FDS) has provided a promising alternative option for the repair of giant-size, wide-neck, and fusiform aneurysms that have historically been challenging.
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