• Seby John, Mark Bain, Russell Cerejo, Andrew Bauer, Thomas Masaryk, Muhammad S Hussain, Peter Rasmussen, and Gabor Toth.
• Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
• World Neurosurg. 2017 Nov 1; 107: 142-147.

ObjectiveTo assess technical success and clinical and imaging outcomes of flow diversion (FD) treatment of multiple, tandem intracranial aneurysms.MethodsRetrospective analysis was performed of patients treated with FD for tandem intracranial aneurysms.ResultsTwenty female patients with a mean (±SD) age of 60 (±12) years were included. One patient was treated after subarachnoid hemorrhage. In 22 separate procedures, 47 aneurysms, all located in the intracranial internal carotid artery, were treated. In 3 cases, treatment was performed for aneurysm recurrence after previous endovascular treatment. All aneurysms were successfully treated in 1 session. A single stent was used in most (82%) cases, with no adjunctive coiling. There were no intraprocedural complications. Three patients experienced mild, transient neurologic symptoms after the procedure with no long-term neurologic deficits. Follow-up imaging with digital subtraction angiography and/or contrast-enhanced magnetic resonance angiography was available in 18/20 (90%) patients at an average (±SD) of 18.8 (±11.2) months. Of 40 aneurysms with follow-up imaging, 34 (85%) were completely occluded. Clinical follow-up, available in 20/20 (100%) patients, showed that 19/20 (95%) achieved a modified Rankin Scale score of 0-2. There were no cases of aneurysm rupture after treatment, and no patients required retreatment at last available follow-up.ConclusionsFD appears technically feasible, safe, and effective for treatment of tandem intracranial aneurysms, with potential advantages over traditional endovascular or surgical treatment modalities. Larger studies are needed to confirm these findings.Copyright © 2017 Elsevier Inc. All rights reserved.

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