Flow diversion is a game changer

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At the Carotid Challenge session, which took place at the Charing Cross Symposium (CX35) on 9 April in London, UK, 62% of delegates said that they believed flow diversion was a “game changer” after Andrew Platts, London, UK, spoke to them about the intervention for the anterior cerebral circulation.

Platts said that a flow diverting stent was designed to redirect flow forces away from vulnerable arterial lesions and aneurysms. He reviewed information that was derived from early cases using flow diverters, and reported that: anticoagulation alone would not prevent acute stent thrombosis; that verified platelet inhibition is mandatory before or immediately after flow diverting stents are placed; and that typically both aspirin and clopidogrel (Plavix; Bristol-Myers Squibb and Sanofi Aventis) should be administered from six weeks to three months after implantation and that after this timeframe, just one of the agents should be continued. Platts added that new devices were due to enter the market soon, including intra-aneurysmal flow diverters.

He then presented updates from the UK Flow Diverter Registry. The devices used in the registry were Silk (42 patients) and Pipeline (161 patients). In terms of deployment, the flow diverters that were deployed successfully were 171. To date, according to the registry, 174 aneurysms (of 216 aneurysms overall; 87%) had not ruptured.

Platts noted that these were only preliminary data and that the characteristics (including the aneurysms) of the patients in the registry were diverse. However, he did add that the registry reflected “real-world practice and outcomes” and emphasised that complication rates observed with the devices were not insignificant.

According to Platts, flow diverting stents can remodel flow and the vessel and preserve flow in covered branches. He also noted that flow diverting stents require a validated platelet inhibition but they “add a new tool in the management of aneurysmal disease.”

In the discussion after his talk, Platts said that flow diverters, in his opinion, were a safe way of managing fusiform aneurysms which are rare. In acute subacharanoid haemorrhage, he said that putting a patient on dual-antiplatelet agents in the presence of an aneurysm that has not been excluded from the circulation (flow diverter does not control the flow within the aneurysm) was ill-advised.

In the vote at the end of the session that asked the question: “Is intracranial flow diversion a game changer?”, 62% of the audience voted yes. 

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