Telescoping Flow Diverters for the Treatment of Brain Aneurysms: Indications and Outcome

Objective Few studies have reported the impact of telescoping flow diverters in intracranial aneurysm treatment. Our study compared aneurysms treated using telescoping flow diverters to those treated with a single flow diverter and identified predictors of telescoping. Methods This was a single-center retrospective review of a prospectively maintained database of aneurysms treated with flow diverters (FDs) between 2011 and 2023. All patients who were treated with FDs for intracranial aneurysms were included in the study. Results The study comprised 750 patients with 750 aneurysms treated using 871 FDs. The study cohort was divided into 85 patients requiring telescoping FDs and 655 who did not. Rates of hemorrhage (7.1% vs 1.8%, p<0.001), symptomatic stroke (5.9% vs 2.6 p<0.001) and asymptomatic stroke (1.2% vs 0.8%, p<0.001) were significantly higher in the telescoping cohorts. At final follow-up, the rate of non-occlusion (9.8% vs 5.1%, p=0.029) and the rate of complete occlusion (88.5% vs 81.1%, p=0.029) were significantly higher in the telescoping cohort. On multivariate analysis, fusiform morphology (OR: 2.4, 95%CI 1.0-5.0, p=0.03), increasing aneurysm height (OR: 1.0, 95% CI 1.0-1.1, p= 0.034) and the use of the Pipeline Embolization Device (PED) flow diverter (OR: 2.4, 95%CI 1.3-4.4, p=0.005) were independent predictors of telescoping. Conclusion Aneurysms with fusiform morphology and those that underwent flow diversion using PED had higher odds for telescoping. Significantly higher rates of angiographic occlusion with the use of telescoping FD adds to the literature on its efficacy in treating aneurysms of varying morphology.