Treatment outcomes and effectiveness of FRED for fusiform vertebral artery aneurysms

BackgroundAt our hospital, we use the flow re-direction endoluminal device (FRED) to treat vertebral artery (VA) aneurysms. Some reports suggest that the treatment efficacy of FRED may be lower in patients with fusiform-type aneurysms. At our hospital, we compared the treatment outcomes of FRED for both fusiform- and saccular-type aneurysms occurring at the posterior inferior cerebellar artery bifurcation.MethodsWe included 29 of 245 patients treated with FRED for VA aneurysms (9 saccular and 20 fusiform) between June 2020 and November 2022. We assessed occlusion rates and background factors, including age, sex, hypertension, diabetes, dyslipidemia, and smoking history. Patients received 100 mg aspirin and 3.75 mg prasugrel for at least 7 days prior to surgery. Non-responders received a loading dose of aspirin or prasugrel before surgery. Follow-up evaluations included magnetic resonance angiography (MRA) at 3 and 9 months and digital subtraction angiography (DSA) at 6 and 12 months. For patients with contradictions to DSA, MRI was used for follow-up if the aneurysm was visible. Additional FRED procedures were considered for patients with poor occlusion evidence at 6 months.ResultsPatients with fusiform type were younger (P = 0.025), and their aneurysms were larger (P = 0.036) and had better obliteration rates (P = 0.007), compared with the saccular type. In the fusiform group, 18 out of 20 cases (90%) achieved good obliteration, whereas only 2 out of 9 cases (34%) in the saccular group did. Multivariate analysis indicated that fusiform aneurysm type was a significant predictor of good obliteration.ConclusionsThe treatment effect of FRED on the fusiform VA aneurysm appears to differ from the outcomes based on the pipeline device, suggesting the potential for achieving favorable results earlier in fusiform cases.