FRED Italian Registry: a multicenter experience with the flow re-direction endoluminal device for intracranial aneurysms

J Neurosurg. 2019 May 10;1-8. doi: 10.3171/2019.1.JNS183005. Online ahead of print.

Abstract

Objective: The introduction of flow-diverter devices (FDDs) has revolutionized the endovascular treatment of intracranial aneurysms. Here the authors present their Italian multicenter experience using the flow re-direction endoluminal device (FRED) in the treatment of cerebral aneurysms, evaluating both short- and long-term safety and efficacy of this device.

Methods: Between February 2013 and December 2014, 169 consecutive aneurysms treated using FRED in 166 patients were entered into this study across 30 Italian centers. Data collected included patient demographics, aneurysm location and characteristics, baseline angiography, adverse event and serious adverse event information, morbidity and mortality rates, and pre- and posttreatment modified Rankin Scale scores, as well as angiographic and cross-sectional CT/MRI follow-up at 3-6 months and/or 12-24 months per institutional standard of care. All images were reviewed and adjudicated by an independent core lab.

Results: Of the 169 lesions initially entered into the study, 4 were later determined to be extracranial or nonaneurysmal by the core lab and were excluded, leaving 165 aneurysms in 162 patients treated in 163 procedures. Ninety-one (56.2%) patients were asymptomatic with aneurysms found incidentally. Of the 165 aneurysms, 150 (90.9%) were unruptured. One hundred thirty-four (81.2%) were saccular, 27 (16.4%) were fusiform/dissecting, and the remaining 4 (2.4%) were blister-like. One hundred thirty-seven (83.0%) arose from the anterior circulation.FRED deployment was impossible in 2/163 (1.2%) cases, and in an additional 4 cases (2.5%) the device was misdeployed. Overall mortality and morbidity rates were 4.3% and 7.3%, respectively, with rates of mortality and morbidity potentially related to FRED of up to 2.4% and 6.2%, respectively. Neuroimaging follow-up at 3-6 months showed complete or nearly complete occlusion of the aneurysm in 94% of cases, increasing to 96% at 12-24 months' follow-up. Aneurysmal sac shrinkage was observed in 78% of assessable aneurysms.

Conclusions: This preliminary experience using FRED for endovascular treatment of complex unruptured and ruptured aneurysms showed a high safety and efficacy profile that is comparable to those of other FDDs currently in use.

Keywords: AChA = anterior choroidal artery; AE = adverse event; AsE = asymptomatic event; BA = basilar artery; DSA = digital subtraction angiography; FDD = flow diverter device; FRED; FRED = flow re-direction endoluminal device; GDC = Guglielmi detachable coil; ICA = internal carotid artery; ICH = intracerebral hemorrhage; MCA = middle cerebral artery; OKM = O’Kelly-Marotta; PCoA = posterior communicating artery; PICA = posterior inferior cerebellar artery; RROC = Raymond-Roy occlusion classification; SAE = serious AE; SAH = subarachnoid hemorrhage; TIA = transient ischemic attack; VA = vertebral artery; endovascular procedures; interventional neurosurgery; intracranial aneurysm; mRS = modified Rankin Scale; new device; vascular disorders.