Tubridge Flow Diverter Study For Intracranial Aneurysms

A cerebral aneurysm (also known as an intracranial or intracerebral aneurysm) is a weak or thin spot on a blood vessel in the brain that balloons out and fills and intermixes with parent artery blood. Incidence of intracranial aneurysms varies by country, with reports of prevalence ranging from 5.1 to 19.6 cases per 100,000 persons. The most devastating presentation of an intracranial aneurysm is subarachnoid hemorrhage (SAH). It is estimated that, on average, five percent of the population is afflicted and the incidence of aneurysm rupture (SAH) is between 6 and 9 per 1000 000 individuals .Mortality can approach 50%, with fewer than 60% of survivors returning to independent living.

Invasive treatment of aneurysms began with an open surgical procedure referred to as 'surgical clipping'. This treatment was once considered the gold standard treatment for aneurysms. Traditional surgery requires craniotomy to reach the aneurysm in the brain and place the clip on the neck (opening) of the aneurysm to block the blood flow into the aneurysm. It usually has a higher complication rate and mortality rate. In contrast to the surgery, endovascular treatment via a minimally invasive procedure Endovascular treatment has become the mainstream treatment of intracranial aneurysms, which consists of coiling, stent-assisted coiling, and flow diversion.

Flow diverter is a stent-like device with low-porosity and higher metal coverage would significantly change the direction of the blood flow, reduce the hemodynamic impact on the aneurysmal necks, and further induce intra-saccular thrombogenesis; also, they would serve as scaffolds to promote intima formation, which has a distinct effect on the healing of aneurysmal necks. Meanwhile, due to the pressure gradient between the main trunk and perforators, those perforators would keep patent. The emergence of the flow diverter shows the treatment of the brain aneurysm changed from the concept of aneurysm sac packing to the hemodynamic reconstruction of the parent vessel.

In recent years, commercialized flow diverter represented as pipeline embolization device (Medtronic, Irvine, California, USA) which is braided strands of cobalt chromium and platinum, and Silk Flow Diverter (Balt Extrusion, Montmorency, France) which is braided from nitinol wires. One potential technical concern with different material or design for FD is that of may lead to different flow reduction effects or mechanical properties, which can result in neurologic complications. Tubridge flow diverter is a self-expended stent which is braided of nickel-titanium microfilaments with two platinum-iridium microfilaments through the entire stent. It has been in commercial clinical use in China since April 2018. Here, the investigator conducted a post market, nationwide, multicenter registry research on embolization of intracranial aneurysms with tubridge flow diverter in China, to evaluate the important clinical outcomes in real-world use.