Treatment of Unruptured, Tandem Aneurysms of the ICA with a Single Flow Diverter.

Background And Purpose: Intracranial adjacent tandem lesions of the internal carotid artery (ICA) are rare and the optimal treatment strategy is unknown. This study was carried out to determine whether a single flow diverter stent (FDS) could be successfully used to treat these lesions.

Methods: The prospectively maintained database was retrospectively carried out to identify patients treated between February 2009 and February 2018 with multiple unruptured, tandem ICA aneurysms and treated with a single FDS. Demographic data, clinical presentation, aneurysm characteristics, treatment data, clinical result and clinical and radiological follow-up information were recorded.

Results: A total of 69 patients (62 female, 89.8%) with average age 55 ± 14.8 years were identified. In total there were 169 aneurysms and the majority of patients (n = 47, 68.1%) had only 2 tandem aneurysms. The largest aneurysms measured 7.69 ± 5.3 mm (range 1.5-26 mm) in height, 6.64 ± 4.71 mm (range 1.5-23 mm) in width and the smaller aneurysm measured 2.61 ± 1.32 mm (range 0.8-9.5 mm) in height and 2.32 ± 1.12 mm (range 0.7-8 mm) in width. In 36 patients the p64 was used, the PED in 28 patients and Surpass in 5 patients. Follow-up was available in 54 patients (130 aneurysms). At initial follow-up (7.2 ± 4.2 months) 45 (83.3%) of the larger aneurysms and 66 (86.8%) of the smaller aneurysms were satisfactorily occluded (Raymond-Roy classification RRC 1 or 2). At delayed follow-up (18 ± 14.6 months) 48 of the larger aneurysms (88.9%) and 71 of the smaller aneurysms (93.4%) were satisfactorily occluded. There were three complications including one death.

Conclusion: A single FDS can be used to successfully treat multiple tandem aneurysms of the ICA with a high rate of aneurysm exclusion and an acceptable risk profile.