الفهرس 
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Abstract
Endovascular treatment (EVT) is more considered as first-intention treatment of intracranial aneurysms. However, wide-necked and fusiform aneurysms remain technically challenging to treat by the endovascular approach. Stent-assisted coiling and balloon-assisted coiling are alternative techniques to treat such complex aneurysms, but studies have shown less than expected efficacy, as suggested by their high rate of recanalization. The management of complex aneurysms via microsurgery or conventional neuroendovascular strategies has traditionally been poor. However, over the last few years, flow diverting stents (FDS) have revolutionized the treatment of such aneurysms.
Aneurysms are vascular abnormality of extreme importance in the group of cerebrovascular diseases, given that they represent the most common cause of spontaneous subarachnoid hemorrhage and are responsible for nearly a quarter of all intra cranial hemorrhages.
The treatment of intracranial aneurysms may be performed by microsurgical clipping or endovascular managements. Surgical management of intracranial aneurysms consists of the exclusion of the aneurysmal sac from the circulation. Clipping of aneurysm neck has been the method of choice for aneurysm obliteration. For decades it was the only option in treatment of ruptured and unruptured aneurysms.
A study published in 1991 became one of the major references in the evolution of endovascular treatment for intracranial aneurysms. Guglielmi developed a system of soft platinum coil soldered to a stainless steel delivery wire that was detachable by electrolysis. The system called GDC (Guglielmi detachable coil) began to be employed initially for aneurysms with difficult surgical access, such as in the vertebrobasilar system, or in patients with unfavorable clinical conditions. Soon, the indications were expanded and endovascular treatment became a very good option in the management of intracranial aneurysms.
The endovascular treatment of intracranial aneurysms demonstrates low morbidity and mortality. However, aneurysms with complex form and wide neck still remain a therapeutic challenge with a greater risk of recurrence and complication
Because endovascular treatment is now considered the first line of treatment in the management of most intracranial aneurysms, whether ruptured or unruptured, the need for appropriate and efficacious adjunctive tools is crucial. The introduction of flow diverting stents (FDS) represented a paradigm shift in the way intracranial aneurysms were treated and for the first time a treatment option that allowed reconstruction of the diseased parent artery became available
FDS are implanted within the parent artery rather than the aneurysm sac. By modifying intra-aneurysmal and parent-vessel flow dynamics at the aneurysm/parent vessel interface, FDS trigger a cascade of gradual intra-aneurysmal thrombosis.
As endothelialization of the FDS is complete, the parent vessel reconstructs while preserving the patency of normal perforators and side branch vessels. As with any intervention, the practice and application of flow diversion technology is inherent, with risks that include vessel rupture or perforation, in-stent thrombosis, perforator occlusion, procedural and delayed hemorrhages, and perianeurysmal edema.
We aimed to describe and show the safety and efficiency of the flow diverter stents and its role as an adjunct in endovascular management of intracranial aneurysms.
This prospective interventional study was conducted on 15 patients, no -patients proved to have intracranial wide neck aneurysms (neck to dome ratio of 1 or more), either recanalized aneurysm or newly diagnosed during a diagnostic angiography or incidentally discovered in CT or MR cerebral angiography for any reason. No age predilection. Summary of our results:
• In the present study, the age ranged from 15.0 – 62.0 years old with a mean (±SD) of 52.07 ± 11.83 years. There was 6(40%) male and 9(60%) females.
• All cases had underlying comorbidity. Regarding presentation 7(46.7%) of patients had ruptured aneurysms.
• Regarding size of aneurysms, 2 (13.3%) of patients had small size (<15), 5(33.3%) of patients had large size (15 – 25) and 8(53.3%) of patients had Giant size (≥25). The size of aneurysms ranged from 1.50 – 30.0 mm with a mean (±SD) value of19.60 ± 8.66 mm.
• Regarding the type of device used, 12 (80%) of patients used Pipeline and 3(20.0%) of patients used Bbvista. Regarding the stent-assisted coiling, 4(26.7%) of patients used Stent-assisted coiling. According to technical problem occurred in 1(6.7%) patient.
• According to immediate post-operative occlusion (Raymond - Roy classification), 9 (60.0%) of patients were class I, 3(20.0%) of patients were class II, 3(20.0%) of patients were class III.
• According to complication in 48hrs, rupture occurred in 2 (13.3%) of patients, acute stent thrombosis occurred in 4 (26.7%) of patients.
• As regard mortality, only 2 (13.3%) of patients were dead.
• According to 6 months follow up, Occlusion occurred in 12 (92.3%) of patients and Delayed complication occurred in 1(7.7%) patient.