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Kraehling H, Akkurt BH, Elsharkawy M, Ayad A, Ergawy M, Celik E, Chapot R, Schwindt W, Stracke CP. A Giant Stent for Giant Cerebral Aneurysms-The Accero ®-Rex-Stent. J Clin Med 2024; 13:388. [PMID: 38256521 PMCID: PMC10816579 DOI: 10.3390/jcm13020388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/14/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE Until now, giant intracranial aneurysms (GIAs) have in many cases been a vascular disease that was difficult or impossible to treat, not least due to the lack of availability of a large-format stent. In this multicentre study, we report on the first five clinical applications of the Accero®-Rex-Stents (Acandis, Pforzheim, Germany) in the successful treatment of fusiform cerebral giant aneurysms. MATERIAL AND METHODS The Accero®-Rex-Stents are self-expanding, braided, fully radiopaque Nitinol stents designed for aneurysm treatment. The stent is available in three different sizes (diameter 7-10 mm, length 30-60 mm) and intended for endovascular implantation in vessels with diameters of 5.5-10 mm. RESULTS Five patients (all male, age 54.4 ± 8.1 years) with large fusiform aneurysms of the posterior circulation were treated endovascularly using the Accero®-Rex-Stents. There were no technical complications. One major ischemic complication occurred. A significant remodeling and reduction in the size of the stent-covered aneurysms was already seen in the short-term post-interventional course. CONCLUSIONS The Accero®-Rex-Stents were successfully and safely implanted in all five patients with fusiform giant aneurysms, showing technical feasibility with promising initial results and significant aneurysm size reduction in already available follow-up imaging. KEY POINT With the Accero-Rex-Stents, a new device is available that offers another treatment option for rare cerebral fusiform giant aneurysms with very large parent vessels.
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Affiliation(s)
- Hermann Kraehling
- University Clinic for Radiology, University of Münster, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
- University Clinic for Radiology, Department for Interventional Neuroradiology, University of Münster, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Burak Han Akkurt
- University Clinic for Radiology, University of Münster, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Mohamed Elsharkawy
- University Clinic for Radiology, Department for Interventional Neuroradiology, University of Münster, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
- Department of Neuroradiology, Alfried-Krupp-Krankenhaus, Alfried-Krupp-Straße 21, 45131 Essen, Germany (R.C.)
| | - Ahmed Ayad
- Department of Neuroradiology, Alfried-Krupp-Krankenhaus, Alfried-Krupp-Straße 21, 45131 Essen, Germany (R.C.)
| | - Mostafa Ergawy
- University Clinic for Radiology, Department for Interventional Neuroradiology, University of Münster, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Ekin Celik
- Department of Radiology and Neuroradiology, Ludmillenstift Hospital, Ludmillenstrasse 4-6, 49716 Meppen, Germany
| | - René Chapot
- Department of Neuroradiology, Alfried-Krupp-Krankenhaus, Alfried-Krupp-Straße 21, 45131 Essen, Germany (R.C.)
| | - Wolfram Schwindt
- University Clinic for Radiology, Department for Interventional Neuroradiology, University of Münster, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Christian Paul Stracke
- University Clinic for Radiology, Department for Interventional Neuroradiology, University of Münster, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
- Clinic and Policlinic for Diagnostic and Interventional Neuroradiology, University Hospital Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Guo Y, Song Y, Hou K, Yu J. Intracranial Fusiform and Circumferential Aneurysms of the Main Trunk: Therapeutic Dilemmas and Prospects. Front Neurol 2021; 12:679134. [PMID: 34305790 PMCID: PMC8299836 DOI: 10.3389/fneur.2021.679134] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022] Open
Abstract
Intracranial fusiform and circumferential aneurysms (IFCAs), especially those located on the main trunk, are uncommon and difficult to manage. Currently, literature focused on IFCAs on the main trunk of cerebral arteries is lacking. The treatment of IFCAs is still under debate. Therefore, in this review, we further explore the treatment of this complicated entity. In addition, we also present some interesting cases. Based on the literature review and our experience, we found that IFCAs are often located in the vertebrobasilar system and that ruptured or large symptomatic IFCAs are associated with increased mortality and higher rebleeding rates. The treatment strategies for IFCAs can be classified as deconstructive and reconstructive methods via open surgery and/or endovascular treatment (EVT). Currently, EVT is a popular method and the main therapeutic choice. In particular, flow diversion has revolutionized the treatment of IFCAs. Parent artery occlusion (PAO) with or without revascularization may still be considered a suitable choice. Complex IFCAs that cannot be resolved by EVT can also be treated via open surgery with or without extracranial–intracranial bypass. Targeted embolization for the weak points of IFCAs is a temporary or palliative choice that is rarely used. In summary, despite complications, both surgical treatment and EVT are effective options for appropriately selected cases. Due to the development of endovascular implants, EVT will have better prospects in the future.
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Affiliation(s)
- Yunbao Guo
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Ying Song
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Kun Hou
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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Li M, Liang H, Wang J. Unfavorable Outcomes Related to Endovascular Treatment of Giant Vertebrobasilar Aneurysms. Front Neurol 2020; 11:748. [PMID: 32849210 PMCID: PMC7431816 DOI: 10.3389/fneur.2020.00748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 06/17/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Giant vertebrobasilar aneurysms (GVBAs) have an unfavorable natural history if left untreated and often pose a sizeable challenge to endovascular treatment. The aim of this study was to analyze the angiographic and clinical outcomes of GVBAs treated by various endovascular procedures. Methods: Between January 2010 and September 2018, 27 patients with 27 GVBAs treated endovascularly were enrolled in this consecutive study. The clinical and angiographic features, treatment modalities, and outcomes were analyzed. Results: The patient cohort comprised 21 men (77.8%) and 6 women (22.2%) of mean age 42.7 ± 18.9 years (range, 6-65 years). The most common presenting symptom was compressive symptoms, present in 15 patients (55.6%). None of the GVBAs was ruptured. Of the 27 GVBAs, 23 aneurysms were dissecting aneurysm with intramural hematoma and 4 aneurysms were saccular. Regarding treatment approach, internal trapping was used in 5 aneurysms, stent-assisted coil embolization in 10, sole stenting in 4, and flow diverters in 8. Overall, 12 patients (44.4%) had an unfavorable angiographic or clinical outcome: 3 patients presented with post-operative complications and subsequent death, and 9 with poor prognosis during follow-up. Conclusions: Patients with GVBAs may not benefit from endovascular treatment. Newer-generation devices are necessary to provide more optimal therapy for the management of these complex lesions.
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Affiliation(s)
- Miao Li
- Department of Neurosurgery, The China-Japan Union Hospital of Jilin University, Changchun, China
| | - Huaxin Liang
- Department of Neurosurgery, The China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jie Wang
- Department of Neurology, The China-Japan Union Hospital of Jilin University, Changchun, China
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Sato K, Endo H, Fujimura M, Endo T, Matsumoto Y, Shimizu H, Tominaga T. Endovascular Treatments in Combination with Extracranial-Intracranial Bypass for Complex Intracranial Aneurysms. World Neurosurg 2018; 113:e747-e760. [DOI: 10.1016/j.wneu.2018.02.143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 02/21/2018] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
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Garg S, Khosroshahi A. A 55-Year-Old Male Presenting With Altered Mental Status: A Complicated Case of Intracranial Aneurysm. Arthritis Care Res (Hoboken) 2017; 69:1915-1919. [DOI: 10.1002/acr.23409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/31/2017] [Indexed: 02/04/2023]
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Wang J, Liu XF, Li BM, Li S, Cao XY, Liang YP, Ge AL, Feng HM. Application of parallel stent placement in the treatment of unruptured vertebrobasilar fusiform aneurysms. J Neurosurg 2017; 126:45-51. [DOI: 10.3171/2015.12.jns151716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Large vertebrobasilar fusiform aneurysms (VFAs) represent a small subset of intracranial aneurysms and are often among the most difficult to treat. Current surgical and endovascular techniques fail to achieve a complete or acceptable result because of complications, including late-onset basilar artery thrombosis and perforator infarction. The parallel-stent placement technique was established in the authors' department, and this study reports the application of this technique in the treatment of unruptured VFAs.
METHODS
Eight patients with 8 unruptured VFAs who underwent parallel stent placement between April 2011 and August 2012 were included. The diameters of the VFAs ranged from 7.9 to 14.0 mm, and the lengths from 27.5 to 54.4 mm. Of the 8 patients with unruptured VFAs, 3 received double or triple parallel stents and 5 patients received a series-connected stent with another 1 or 2 stents deployed parallel to them. Outcomes for these patients were tabulated, based on the modified Rankin Scale (mRS) score and angiographic results.
RESULTS
All of the 25 stents were successfully placed without any treatment-related complications. During follow-up, 5 patients had decreased mRS scores, 2 were unchanged, and 1 was increased for subarachnoid hemorrhage. Immediate and follow-up clinical outcome was completely or partially recovered in most patients. Follow-up angiograms revealed 2 aneurysms were reduced in size and 6 were unchanged after stent placement. No in-stent stenosis, occlusion of the posterior inferior cerebellar artery, or perforators jailed by the stent occurred in any of the aneurysms.
CONCLUSIONS
These results provide encouraging support for the parallel-stent placement technique, which can be envisaged as an alternative strategy against unruptured VFAs. However, testing in more patients is needed.
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Albuquerque FC, Park MS, Abla AA, Crowley RW, Ducruet AF, McDougall CG. A reappraisal of the Pipeline embolization device for the treatment of posterior circulation aneurysms. J Neurointerv Surg 2014; 7:641-5. [DOI: 10.1136/neurintsurg-2014-011340] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 07/25/2014] [Indexed: 11/04/2022]
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Toth G, Bain M, Hussain MS, Moskowitz S, Masaryk T, Rasmussen P, Hui F. Posterior circulation flow diversion: a single-center experience and literature review. J Neurointerv Surg 2014; 7:574-83. [PMID: 24984708 DOI: 10.1136/neurintsurg-2014-011281] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 06/12/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Flow diverters have been used predominantly for large anterior circulation aneurysms. Data on the safety and efficacy of this treatment for posterior circulation aneurysms are limited. OBJECTIVE To present our posterior circulation flow diverter experience, outcomes and morbidity in comparison with recent studies. METHODS A retrospective chart and imaging review of six patients with seven aneurysms in posterior circulation vessels, treated with flow diverter technology was carried out. A literature review was performed using standard online search tools. RESULTS We included five saccular and two fusiform posterior circulation aneurysms. An average of two flow diverters was placed for each patient. Adjunctive coiling was used in three cases. Follow-up at an average of 14.5 months showed complete angiographic occlusion in 4 (57.1%) cases, including one patient with in-stent thrombosis and major brainstem stroke at 4.5 months, a week after self-discontinuing dual antiplatelet therapy. Two other patients developed small periprocedural strokes but had excellent recovery. One death occurred 18 months after the initial procedure. No aneurysm rupture or parenchymal hemorrhage was seen. Overall, 5 (71%) cases, all with saccular aneurysms, had good clinical outcome (modified Rankin score (mRS) 0-1). Fusiform basilar aneurysms had markedly worse outcomes (mRS 5 and 6). Our literature review yielded six other studies with 100 additional patients. Overall, good outcome was seen in 74.3%, with a 12.3% average mortality and 11% permanent neurologic deficit rate. Complete occlusion varied from 43% to 100%. CONCLUSIONS Flow diversion may be a possible treatment in carefully selected patients with high-risk atypical posterior circulation aneurysms, with poor natural history and no optimal treatment strategy. Symptomatic and fusiform large aneurysms appear to carry the highest risk. Further studies are necessary to assess the role of flow diversion in the posterior circulation.
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Affiliation(s)
- Gabor Toth
- Cleveland Clinic, Cerebrovascular Center, Cleveland, Ohio, USA
| | - Mark Bain
- Cleveland Clinic, Cerebrovascular Center, Cleveland, Ohio, USA
| | | | | | - Thomas Masaryk
- Cleveland Clinic, Cerebrovascular Center, Cleveland, Ohio, USA
| | - Peter Rasmussen
- Cleveland Clinic, Cerebrovascular Center, Cleveland, Ohio, USA
| | - Ferdinand Hui
- Cleveland Clinic, Cerebrovascular Center, Cleveland, Ohio, USA
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Yu YP, Zhao HQ, Ren WF, Chi XL. Giant aneurysm of the basilar artery in an 86 year old woman. F1000Res 2013; 2:112. [PMID: 24358886 PMCID: PMC3814923 DOI: 10.12688/f1000research.2-112.v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2013] [Indexed: 11/20/2022] Open
Abstract
In this article we present an 80 year old female patient with an unruptured giant aneurysm of the basilar artery presenting with posterior circulation ischemic symptoms. Angiography and CT revealed giant basilar aneurysmal dilatation with severe and wide intracranial arteriosclerosis. We described the uniqueness of this case. Giant basilar aneurysm is associated with various complications particularly brain stem infarction. It is emphasized that arteriosclerosis plays an important role in the formation of giant basilar aneurysms.
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Affiliation(s)
- Yong peng Yu
- Department of Neurology, Affiliated Wendeng Center Hospital of Weifang Medical College, Weihai, 264400, China
| | - Hong qin Zhao
- Department of Neurology, Affiliated Hospital of Qingdao University Medical College, Qingdao, 266000, China
| | - Wei feng Ren
- Intensive Care Unit, Affiliated Hospital of Qingdao University Medical College, Qingdao, 266000, China
| | - Xiang lin Chi
- Department of Neurology, Affiliated Wendeng Center Hospital of Weifang Medical College, Weihai, 264400, China
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