Introduction The Flow Redirection Endoluminal Device (FRED; MicroVention) is a dual-layered flow diverter used for the treatment of intracranial aneurysms. The objective of this systematic review was to compile device-related safety and effectiveness data. Methods The literature from January 1, 2013 to April 30, 2021 was searched for studies describing use of the FRED for intracranial aneurysm treatment irrespective of aneurysm location and morphology. The review included anterior and posterior circulation ruptured and unruptured saccular, fusiform or dissection, and blister aneurysms. MeSH terms related to “flow re-direction endoluminal device” and “FRED for aneurysms” were used. Data related to indication, complications, and rates of aneurysm occlusion were retrieved and analyzed. Results Twenty-two studies with 1729 intracranial aneurysms were included in this review. Overall reported morbidity was 3.9% (range 0–20%). Overall procedure-related mortality was 1.4% (range 0–6%). Complication rates fell into 5 categories: technical (3.6%), ischemic (3.8%), thrombotic or stenotic (6%), hemorrhagic (1.5%), and non-neurological (0.8%). The aneurysm occlusion rate between 0 and 3 months (reported in 11 studies) was 47.8%. The occlusion rate between 4 and 6 months (reported in 14 studies) was 73.8%. Occlusion rates continued to increase to 75.1% at 7–12 months (reported in 10 studies) and 86.6% for follow-up beyond 1 year (reported in 10 studies). Conclusion This review indicated that the FRED is a safe and effective for the treatment of intracranial aneurysms. Future studies should directly compare the FRED with other flow diverters for a better understanding of comparative safety and effectiveness among the different devices.
The Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo piloted an Asylum Medicine elective to improve medical students’ knowledge, skill, and comfort serving refugee and asylum seeking patient populations. To augment traditional classroom learning, students also participated in community dinners at a local refugee shelter.
Methods:
Prior to and following community dinners, students completed a survey evaluating four primary endpoints: comfort speaking with an individual who self-identifies as a refugee or asylum seeker, comfort speaking to an individual with a language barrier, understanding of refugee and asylum seekers’ pre-arrival experiences, comfort engaging in social conversation with individuals who have different lived experiences. Students rated their responses on a five-point scale where 1 was defined as ‘Not Very Comfortable’ and 5 was defined as ‘Very Comfortable.’
Results:
Respondents’ (n=20) mean self-reported scores prior to and following the community dinner for each endpoint are as follows: comfort speaking with refugees and asylum seekers (pre: 3.55, post: 4.15), comfort speaking to individuals9 with a language barrier (pre: 3.3, post: 3.75), understanding of migrants9 pre-arrival experiences (pre: 2.95, post: 3.70), and comfort speaking about social topics with refugees or asylum seekers (pre: 3.95, post: 4.35).
Conclusion:
Experiential learning experiences are a valuable tool for medical educators to increase medical trainees’ comfort while working with individuals from refugee and asylum-seeking populations.This model may be adopted to increase healthcare trainees9 comfort serving individuals from a diversity of backgrounds and ultimately reduce identity-based healthcare disparities, improve quality of care for traditionally marginalized patients, and promote cultural competence in the clinical setting.
Few studies have explored the association between stroke thrombectomy (ST) volume and hospital accreditation with clinical outcomes.To assess the association of ST case volume and accreditation status with in-hospital mortality and home discharge disposition using the national Medicare Provider Analysis and Review (MEDPAR) database.Rates of hospital mortality, home discharge disposition, and hospital stay were compared between accredited and non-accredited hospitals using 2017-2018 MEDPAR data. The association of annual ST case volume with mortality and home disposition was determined using Pearson's correlation. Median rate of mortality and number of ST cases at hospitals within the central quartiles were estimated.A total of 29 355 cases were performed over 2 years at 847 US centers. Of these, 354 were accredited. There were no significant differences between accredited and non-accredited centers for hospital mortality (14.8% vs 14.5%, p=0.34) and home discharge (12.1% vs 12.0%, p=0.78). A significant positive correlation was observed between thrombectomy volume and home discharge (r=0.88; 95% CI 0.58 to 0.97, p=0.001). A significant negative relationship was found between thrombectomy volume and mortality (r=-0.86; 95% CI -0.97 to -0.49, p=0.002). Within the central quartiles, the median number of ST cases at hospitals with mortality was 24/year, and the median number of ST cases at hospitals with home discharge rate was 23/year.A higher volume of ST cases was associated with lower mortality and higher home discharge rate. No significant differences in mortality and discharge disposition were found between accredited and non-accredited hospitals.
The Flow Redirection Endoluminal Device (FRED; MicroVention) is a dual-layered flow diverter used for the treatment of intracranial aneurysms. The objective of this systematic review was to compile device-related safety and effectiveness data.
Methods
The literature from January 1, 2013 to June 30, 2020 was searched for studies describing use of the FRED for intracranial aneurysm treatment irrespective of aneurysm location and morphology. The review included anterior and posterior circulation ruptured and unruptured saccular, fusiform or dissection, and blister aneurysms. MeSH terms related to "flow re-direction endoluminal device" and "FRED for aneurysms" were used. Data related to indication, complications, and rates of aneurysm occlusion were retrieved and analyzed.
Results
Twenty studies with 1674 intracranial aneurysms were included in this review. The overall reported morbidity was 0-20%. Overall procedure-related mortality was 1.6% (range 0-6%). Complication rates fell into 5 categories: technical (3.8%), ischemic (3.9%), thrombotic orstenotic (5.9%), hemorrhagic (1.5%), and non-neurological (0.8%). The aneurysm occlusion rate between 0 and 3 months (reported in 9 studies) was 47.8%. The occlusion rate between 4 and 6 months (reported in 11 studies) was 73.1%. Occlusion rates continued to increase to 75.1% at7-12 months (reported in 9 studies) and 87.0% for follow up beyond 1 year (reported in 8 studies).
Conclusion
This review indicated that the FRED is a safe and effective for the treatment of intracranial aneurysms. Future studies should directly compare the FRED with other flow diverters for a better understanding of comparative safety and effectiveness among the different devices.
Disclosures
M. Waqas: None. R. Dossani: None. M. Alkhaldi: None. J. Neveu: None. J. Cappuzzo: None. J. Liam: None. A. Khan: None. V. Lazarov: None. A. Monteiro: None. J. Davies: 1; C; National Center for Advancing Translational Sciences of the National Institutes of Health under award number KL2TR001413 to the University at Buffalo. A. Siddiqui: 2; C; Amnis Therapeutics, Boston Scientific, Canon Medical Systems USA Inc., Cerebrotech Medical Systems Inc., Cerenovus, Corindus Inc., Endostream Medical Ltd., Imperative Care, Inc. Integra LifeSciences C. 4; C; Adona Medical, Inc, Amnis Therapeutics, (Purchased by Boston Scientific October 2017), Blink TBI Inc., Buffalo Technology Partners Inc., Cerebrotech Medical Systems, Inc., Cognition Medical, Endostrea. E. Levy: 2; C; Claret Medical, GLG Consulting, Guidepoint Global, Imperative Care, Medtronic, Rebound, StimMed;. 4; C; NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care (formerly the Stroke Project), Rebound Therapeutics, StimMed, Three Rivers Medical.
