Efficacy of Cone-Beam CT for the treatment of cerebral aneurysms with flow diverter

Abstract

Cone beam computed tomography (CBCT) has evolved to provide details of implanted devices such as flow diverters when they are used for treatment of cerebral aneurysms. The aim of the study is to present our experience in using CBCT with intra-arterial injection and provide a step-by-step approach for postprocessing in a practical protocol for daily use. IRB approval was obtained, and the neuro-interventional database of the year 2022 was retrospectively reviewed for patients who were treated for cerebral aneurysms with flow diverters. Patient demographics, aneurysm location (internal carotid artery [ICA]-ophthalmic artery [OphA], posterior communicating artery [PCoA], anterior communicating artery [ACoA]), type (regular, bilobed or fusiform), size, device, injection technique (contrast dilution, rate, and volume), and reconstruction protocol were recorded. Acquired images were postprocessed using a Philips Xtravision workstation. Five patients (three women and two men) met the criteria of our study. One patient was treated for two aneurysm simultaneously. Age range was 50-80 years old. Treated aneurysms were located in the ICA-ophtalmic artery in four cases, PCoA in one case, ACoA in one case. Four were bilobed aneurysms, one regular and one fusiform. PED-Vantage (two cases), Silk-Vista (two cases), Surpass-Evolve (one case), Derivo-Mini (one case) were the devices used during the procedures. One injection technique was used: 1.5 ml/s for a total volume of 38ml with a 4-s imaging delay. Contrast (Iomeron 300 mg/mL) dilution was 10%. The device’s landing zones, wall apposition and neck-coverage were successfully visualized in all cases. After six months a complete aneurysm exclusion was obtained in two cases.