Healing process after flow diverting device treatment of cerebral aneurysms: current research and clinical progress

Abstract

The treatment of intracranial aneurysms (IAs) has undergone dramatic changes over the past few decades, from external obliteration of the sac by microsurgery to minimally invasive endovascular embolization. To overcome the high recurrence rates after endovascular treatment, many novel therapies have been developed. One therapy involves placing a flow diverter (FD) in the parent artery, causing the blood to bypass the aneurysm sac in addition to promoting hemostasis, occlusion, and neointima formation. Safety and efficacy have been tested in several well-designed clinical trials and numerous clinical studies with low complication rates and high aneurysm occlusion rates. However, one significant drawback of FDs is that the aneurysm is not immediately occluded after treatment and neointima formation at the aneurysm neck can take up to 2 years after treatment, during which time the patient is still susceptible to rupture. FDs have now been utilized for over 10 years. It is thus necessary to analyze the mechanisms underlying this procedure and comparative outcomes of different methods to ensure high long-term efficacy. In this article, we perform an overview of the current understanding of the flow diversion mechanism of aneurysm occlusion, highlighting the biological and mechanical effects of stent design, hemodynamics, and deployment. [Am J Transl Med 2021. 5 (2): 63-75].