Fortschrittliche Techniken und klinische Anwendungen in der Behandlung intrakranieller Aneurysmen: Ein Fokus auf Flow Diverter und selbstexpandierenden Stents
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Abstract
Objective of the study: The objective of this cumulative dissertation was to clinically evaluate innovative endovascular treatment strategies for intracranial aneurysms—specifically using modern fourth-generation flow diverters with Shield technology and HPC-coated, self-expanding stents.The study focused on unruptured aneurysms treated with shortened dual antiplatelet therapy (DAPT), as well as acutely ruptured aneurysms treated with stent-assisted coiling (SAC) or flow diversion (FD) using prasugrel monotherapy.
Methods: This dissertation is based on two retrospective studies:
(1) A single-center analysis conducted in Hanover evaluated the Pipeline Vantage flow diverter therapy in 30 patients with unruptured aneurysms.
(2) A multicenter case series involving 46 patients from four neurovascular centers analyzed the treatment of ruptured aneurysms using HPC-coated devices in combination with prasugrel single-agent antiplatelet therapy, directly comparing SAC and FD. The study assessed peri- and post-procedural complications, angiographic occlusion rates, and
functional outcomes according to the modified Rankin Scale (mRS).
Results: In the Pipeline Vantage cohort, implantation was successful in 100% of cases with no periprocedural complications. Complete aneurysm occlusion was achieved in 65.6% of cases after three months and in 75% after an average of 9.9 months. In the multicenter analysis of ruptured aneurysms, technical success was also achieved in 100% of cases.SAC showed a significantly higher immediate occlusion rate (96%) compared to FD (17%). At 12 months, the occlusion rates were comparable (SAC: 100%, FD: 95%). The overall complication rate was low (2%), while 84% of patients had a favorable functional outcome (mRS ≤ 2).
Conclusion: The available data show that both modern flow-diverting systems used with shortened DAPT and HPC-coated stents used with prasugrel monotherapy represent safe and effective treatment options for ruptured aneurysms. Of particular note is the clinical feasibility of reduced antiplatelet therapy, without compromising safety or occlusion success. These strategies offer valuable approaches to personalizing aneurysm treatment and suggest a potential reduction in drug-related side effects.
Keywords: Intracranial aneurysm, flow diverter, stent-assisted coiling, prasugrel, DAPT, SAPT, HPC coating, Pipeline Vantage, endovascular therapy, neuroradiological intervention.
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Issued: 2026-05-19
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Is based on: (DOI) 10.1177/15910199231205047 DOI: 10.1007/s00234-025-03715-w
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FB20:Medizin
Language
de
Keywords
Intrakranielles AneurysmaFlow DiverterStent-assistiertes CoilingPrasugrelDAPTSAPTHPC-BeschichtungPipeline Vantageendovaskuläre Therapieneuroradiologische Intervention.
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Aburub, Abdallah: Fortschrittliche Techniken und klinische Anwendungen in der Behandlung intrakranieller Aneurysmen: Ein Fokus auf Flow Diverter und selbstexpandierenden Stents. : 2026-05-19. DOI: https://doi.org/10.17192/openumr/754.
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Except where otherwised noted, this item's license is described as Attribution 4.0 International