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Greco E, Ghaith AKA, Rios-Zermeno J, Ghanem M, Perez-Vega C, Kashyap S, Freeman WD, Miller DA, Huynh TJ, Bydon M, Middlebrooks EH, Sandhu SJS, Tawk RG. Long-Term Safety and Efficacy of Pipeline Embolization Device in Anterior and Posterior Circulation Aneurysms: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 185:103-112. [PMID: 38307200 DOI: 10.1016/j.wneu.2024.01.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Flow diversion using the pipeline embolization device (PED) has been a paradigm shift for anterior circulation (AC) aneurysms. However, only a few studies report the long-term (≥1 year) angiographic and clinical outcomes for posterior circulation (PC) aneurysms. This study aims to compare the long-term safety and efficacy of treatment of AC and PC aneurysms with PED. METHODS The databases included Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane, and Scopus. Studies with at least 10 patients and 1-year follow-up were included. Twenty-four studies met our inclusion criteria. A random effect meta-analysis was performed to estimate the ischemic and hemorrhagic complications. A meta-analysis of proportions was performed to estimate the pooled rates of long-term complete aneurysmal occlusion, symptomatic stroke, aneurysmal rupture, and intracranial hemorrhage. RESULTS There were 1952 aneurysms, of which 1547 (79.25%) were in the AC and 405 (20.75%) in the PC. The 1-year occlusion rate was 78% in AC compared to 73% in PC aneurysms (P < 0.01). The symptomatic infarct rate was 5% in AC compared to 13% in PC (P < 0.01). While the rupture rate was 1% in AC compared to 4% in PC (P = 0.01), the rate of intracranial hemorrhage was 2% for both (P = 0.99). CONCLUSIONS The long-term occlusion rate after PED was higher in AC aneurysms, and the cumulative incidence of stroke and aneurysm rupture was higher in PC aneurysms.
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Affiliation(s)
- Elena Greco
- Research Fellow in the Department of Radiology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA; Research Fellow in the Department of Neurologic Surgery, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA
| | - Abdul Karim A Ghaith
- Research Fellow in the Neuro-Informatics Laboratory, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Jorge Rios-Zermeno
- Research Fellow in the Department of Neurologic Surgery, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA
| | - Marc Ghanem
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Carlos Perez-Vega
- Resident in the Department of Neurologic Surgery, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA
| | - Samir Kashyap
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - W David Freeman
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Neurology, and Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - David A Miller
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Thien J Huynh
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Erik H Middlebrooks
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Rabih G Tawk
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA.
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Ni H, Hang Y, Liu S, Jia ZY, Shi HB, Zhao LB. Stent-assisted coiling of unruptured paraclinoid aneurysms with wide neck or unfavorable dome-to-neck ratio: Results of ventral wall vs dorsal wall with propensity score matching analysis. Interv Neuroradiol 2024; 30:147-153. [PMID: 35538879 PMCID: PMC11095348 DOI: 10.1177/15910199221100966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/28/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the clinical safety and efficacy of stent-assisted coil embolization of unruptured wide-necked paraclinoid aneurysms based on the projection distribution. METHODS Between November 2015 and September 2020, 267 unruptured paraclinod aneurysms in 236 patients were identified with a wide neck or unfavorable dome-to-neck ratio and treated with stent-assisted coiling technique. The classification of this segment aneurysms was simplified to the dorsal group (located on the anterior wall) and ventral group (Non-dorsal). Following propensity score matching analysis, the clinical and radiographic data were compared between the two groups. RESULTS Among 267 aneurysms, 186 were located on the ventral wall and 81 were on the dorsal wall. Dorsal wall aneurysms had a larger size (p < .001), wider neck (p = .001), and higher dome-to-neck ratio (p = .023) compared with ventral wall aneurysms. Propensity score-matched analysis found that dorsal group had a significantly higher likelihood of unfavorable results in immediate (residual sac, 39.4% vs. 18.2%, p = .007) and follow-up angiography (residual sac, 14.8% vs. 1.9%, p = .037) compared with ventral group, with significant difference in recurrence rates (9.3% vs. 0%, p = .028). The rates of procedure-related complications were not significantly different, but one thromboembolic event occurred in the dorsal group with clinical deterioration. CONCLUSIONS Traditional stent-assisted coiling can be given preference in paraclinoid aneurysms located on the ventral wall. The relatively high rate of recurrence in dorsal wall aneurysms with stent assistance may require other treatment options.
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Affiliation(s)
- Heng Ni
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yu Hang
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Sheng Liu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Zhen-Yu Jia
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Lin-Bo Zhao
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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Levy BR, Monteiro A, Raygor KP, Donnelly BM, Davies JM, Snyder KV, Siddiqui AH, Levy EI, Sigounas D. Visual Morbidity in Patients With Ophthalmic Segment Aneurysms Treated With Flow Diverters: A Dual-Center Experience. Neurosurgery 2024; 94:538-544. [PMID: 37721433 DOI: 10.1227/neu.0000000000002694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/27/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Flow diverter (FD) treatment for aneurysms of the ophthalmic segment of the internal carotid artery (ICA) may raise concerns about visual morbidity related to coverage of the ophthalmic artery by the device. Our objective was to evaluate clinical and angiographic outcomes associated with FD treatment of these aneurysms, with particular emphasis on visual morbidity. METHODS We performed a retrospective analysis of the endovascular databases at 2 US centers to identify consecutive patients with aneurysms along the ophthalmic segment of the ICA that were treated with FDs between January 2010 and December 2022. Baseline demographics, aneurysm characteristics, and periprocedural and postprocedural data, including the occurrence of visual complications, were collected. RESULTS One hundred and thirteen patients with 113 aneurysms were identified for inclusion in this study. The mean age of the patients was 59.5 ± 12.4 years, and 103 (91.2%) were women. The ophthalmic artery origin was involved in 40 (35.4%) aneurysms, consisting of a neck origin in 33 (29.2%) and a dome origin in 7 (6.2%). New transient visual morbidity during the hospital stay included impaired visual acuity or blurriness in 1 (0.9%) patient, diplopia in 1 (0.9%), and floaters in 1 (0.9%). New transient visual morbidity during follow-up included impaired visual acuity or blurriness in 5 patients (4.4%), diplopia in 3 (2.7%), ipsilateral visual field defect in 1 (0.9%), and floaters in 6 (5.3%). Permanent visual morbidity occurred in 1 patient (0.9%). Among the 101 patients who had angiographic follow-up, the Raymond-Roy occlusion classifications were I (complete aneurysm occlusion) in 85 (84.2%), II (residual neck) in 11 (10.9%), and III (residual aneurysm) in 5 (4.9%). CONCLUSION In our experience, flow diversion for ICA ophthalmic segment aneurysms resulted in low rates of visual morbidity, which was mostly transient in occurrence.
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Affiliation(s)
- Bennett R Levy
- George Washington University School of Medicine and Health Sciences, Washington , District of Columbia , USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA
| | - Kunal P Raygor
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA
| | - Brianna M Donnelly
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA
- Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo , New York , USA
- Jacobs Institute, Buffalo , New York , USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo , New York , USA
- Jacobs Institute, Buffalo , New York , USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo , New York , USA
- Jacobs Institute, Buffalo , New York , USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo , New York , USA
- Jacobs Institute, Buffalo , New York , USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
| | - Dimitri Sigounas
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington , District of Columbia , USA
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Rodriguez-Calienes A, Borjas-Calderón NF, Vivanco-Suarez J, Zila-Velasque JP, Chavez-Malpartida SS, Terry F, Grados-Espinoza P, Saal-Zapata G. Endovascular Treatment and Microsurgical Clipping for the Management of Paraclinoid Intracranial Aneurysms: A Systematic Review and Meta-Analysis. World Neurosurg 2023; 178:e489-e509. [PMID: 37516140 DOI: 10.1016/j.wneu.2023.07.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE We aimed to compare the efficacy and safety of microsurgical clipping versus endovascular treatment (EVT) for paraclinoid aneurysms. METHODS A systematic search for studies including patients with paraclinoid aneurysms treated with a microsurgical or endovascular technique was conducted in 6 databases from inception to February 2022. Efficacy outcomes included complete angiographic occlusion at last follow-up, favorable functional outcome, and recurrence of the aneurysm. For safety, we assessed a composite of intraoperative and postoperative complications. Data were pooled using a random-effects model. RESULTS A total of 95 studies including 6711 patients, 3029 in the surgical group and 3682 in the EVT group were found. Pooled rates of complete occlusion were 94% (95% CI 91%-96%; I2 = 0%) in the surgical group and 69% (95% CI 63%-74%; I2 = 79%) in the EVT group, respectively. The favorable functional outcome rate was 86% (95% CI 76%-92%; I2 = 72%) with surgical treatment and 95% (95% CI 92%-97%; I2 = 61%) with EVT. The rate of aneurysm recurrence with surgical treatment was 1% (95% CI 0%-4%; I2 = 0%) and 12% (95% CI 9%-16%; I2 = 57%) with EVT. The composite safety outcome rate in the surgical group was 24% (95% CI 18%-30%; I2 = 90%) and 10% (95% CI 8%-13%; I2 = 71%) in the EVT group. CONCLUSIONS Our findings suggest that microsurgical clipping seems to have a higher efficacy than EVT in terms of angiographic occlusion and aneurysm recurrence; however, EVT seems to be safer in terms of intraoperative and postoperative complications. Considering the heterogeneity and low-level evidence of the data available, further prospective randomized studies are warranted to confirm our findings.
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Affiliation(s)
- Aaron Rodriguez-Calienes
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA; Neuroscience, Clinical Effectiveness and Public Health Research Group, Universidad Científica del Sur, Lima, Peru.
| | - Nagheli Fernanda Borjas-Calderón
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima, Peru; Grupo Estudiantil de Investigación en Neurociencias, Sociedad de Estudiantes de Medicina de la Universidad de San Martín de Porres, Lima, Peru; Abdulrauf University of Neurosurgery, Simi Valley, California, USA
| | - Juan Vivanco-Suarez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - J Pierre Zila-Velasque
- Universidad Nacional Daniel Alcides Carrión, Facultad de Medicina Humana, Pasco, Peru; Red Latinoamericana de Medicina en la Altitud e Investigación (REDLAMAI), Pasco, Peru
| | - Sandra S Chavez-Malpartida
- Universidad Nacional Mayor de San Marcos, Lima, Peru; Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru
| | - Fernando Terry
- Department of Neurosurgery, Clínica Internacional, Lima, Peru
| | - Pamela Grados-Espinoza
- Universidad Nacional Daniel Alcides Carrión, Facultad de Medicina Humana, Pasco, Peru; Red Latinoamericana de Medicina en la Altitud e Investigación (REDLAMAI), Pasco, Peru
| | - Giancarlo Saal-Zapata
- Department of Neurosurgery, Endovascular Neurosurgery Service, Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, Lima, Peru; Departament of Neurosurgery, Clinica Angloamericana, Lima, Peru
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5
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Gupta G, Sreenivasan S, Kane I, Salguiero L, Saifuddin A, Sundararajan S, Khandelwal P, Nourallah-Zadeh E, Sun H, Sonig A, Singla A, Nanda A, Roychowdhury S. Surpass embolization of intracranial aneurysms: Perspective from a 2-year longitudinal follow-up study across high volume comprehensive stroke centers. Interv Neuroradiol 2023:15910199231188760. [PMID: 37464776 DOI: 10.1177/15910199231188760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Surpass Streamline (SS; Stryker©) is an over-the-wire first-generation flow diverter (FD). There is a scarcity of data on real-world outcomes and complications of this FD. METHODS A retrospective review of consecutive cases between January 2019 and July 2021 at two high-volume comprehensive stroke centers, involving SS was conducted. RESULTS Fifty-five patients harbored 69 treated aneurysms, of which 96% were in the internal carotid petrous to terminus segments and 88% were <10 mm in size, and 12% measuring 10-24 mm. Raymond Roy Grade 1 occlusion was noted in 55 aneurysms (79.7%) at 1 year. Median follow-up duration was 26 months (mean = 26.06). Major complications were seen in eight patients (14.5%; 95% CI 6.5-26.7) and mortality attributable to SS stenting complications occurred in two (4.3%) patients. Four (7.2%) had ophthalmologic thromboembolic complications and two had (3.6%) ischemic complications. Procedural complications occurred in 10 patients (18.18%; 95% CI 9.1-30.9). Technical complications during procedure (n = 3, 5.3%) were: "confirmed" distal middle cerebral artery (MCA) guidewire perforation; "suspected" distal MCA guidewire perforation causing post-procedural subarachnoid hemorrhage and internal carotid artery dissection causing ischemic stroke. Seizures were seen in 5 (9.09%) and carotid-cavernous fistula in 1 (1.8%). Multivariate regression analysis showed technical challenges significantly predicted occurrence of major complications (p = 0.001; R2 = 0.39, F(13,43) = 2.15, p = 0.029). Univariate analysis showed technical challenges significantly predicted ophthalmological complications (R2 = 0.06, F(1,55) = 4.04, p = 0.049) and major complications (R2 = 0.21, F(1,55) = 15.11, p = 0.0002). CONCLUSION Large-scale future registry should focus on national data regarding SS safety, technical challenges, and procedural complications. We present one of the longest follow-ups for SS in literature.
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Affiliation(s)
- Gaurav Gupta
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Sanjeev Sreenivasan
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Ian Kane
- Department of Radiology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Lauren Salguiero
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Ali Saifuddin
- Department of Radiology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Srihari Sundararajan
- Department of Radiology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Priyank Khandelwal
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Emad Nourallah-Zadeh
- Department of Neurology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Hai Sun
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Ashish Sonig
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Amit Singla
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Anil Nanda
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Sudipta Roychowdhury
- Department of Radiology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
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Islim FI, Saleem N, Patankar T. A review and journey in intrasaccular treatment of intracranial aneurysms. Interv Neuroradiol 2023:15910199231182460. [PMID: 37321652 DOI: 10.1177/15910199231182460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
The invested effort and collaboration of clinicians and medical device companies to improve occlusion rates and clinical outcomes for patients with intracranial aneurysms treated via less invasive endovascular means led to the development of the concept of intrasaccular devices. Intrasaccular devices were introduced to offer simple treatment options, offering easier navigation through difficult anatomy, simpler and quicker deployment into large and wide-neck aneurysms. Additionally, they offer easier sizing, whilst offering a wide range of options suitable for aneurysms of different sizes. The concept of most intrasaccular devices is to occupy the aneurysm neck, however offering better stability than simple coiling, therefore increasing the chance of long-term aneurysm occlusion. This is achieved without a sizable metal content within the parent vessel, contrary to flow diverters, theoretically reducing the risk of thromboembolic events. This review aims to discuss the history and latest developments of intrasaccular intracranial devices, which offer an exciting and potentially successful option for treatment of complex intracranial aneurysms.
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Affiliation(s)
| | - Nayyar Saleem
- Department of Neuroradiology, Leeds General Infirmary, Leeds, UK
| | - Tufail Patankar
- Department of Neuroradiology, Leeds General Infirmary, Leeds, UK
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Montagne W, Lloyd N, Sagalow E, Cox E, Hardman J, Kim JH. Internal Carotid Artery Pseudoaneurysm After Transsphenoidal Pituitary Tumor Resection: A Case Report. Cureus 2023; 15:e36539. [PMID: 37090349 PMCID: PMC10121229 DOI: 10.7759/cureus.36539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 04/25/2023] Open
Abstract
Here, we present a case report on internal carotid artery pseudoaneurysm (ICAP) which highlights a rare but potentially life-threatening complication of transsphenoidal pituitary surgery. A 32-year-old male underwent resection of a pituitary tumor and developed a large cerebrospinal fluid (CSF) leak during surgery, which was reconstructed with a fat graft and nasoseptal flap. Postoperatively, he was recovering well and discharged without complications; however, eight days after surgery he returned with massive epistaxis and hematemesis. This was initially managed with endoscopic exploration, nasal packing, and transfusion of blood products. Imaging revealed a pseudoaneurysm on the right internal carotid artery. The patient was started on aspirin and clopidogrel, and a flow diverter stent was placed without complications. Our case emphasizes the importance of prompt recognition and management of vascular injuries such as an internal carotid pseudoaneurysm after transsphenoidal pituitary surgery to prevent catastrophic outcomes.
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Affiliation(s)
- William Montagne
- Otolaryngology - Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
| | - Nathan Lloyd
- Otolaryngology - Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
| | - Emily Sagalow
- Otolaryngology - Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
| | - Efrem Cox
- Neurosurgery, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
| | - Julian Hardman
- Neurointerventional Radiology, Desert Radiology, Las Vegas, USA
| | - Jee-Hong Kim
- Otolaryngology - Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
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8
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Luzzi S, Giotta Lucifero A, Baldoncini M, Campero A, Galzio R, Lawton MT. Optic Foraminotomy versus Anterior Clinoidectomy for Small Superior-Projecting Paraclinoid Aneurysms: Visual and Angiographic Outcome Evaluation. World Neurosurg 2023; 170:e612-e621. [PMID: 36410704 DOI: 10.1016/j.wneu.2022.11.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Optic foraminotomy (OF) has been recently proposed as an alternative to anterior clinoidectomy (AC) for selected types of paraclinoid aneurysms. In this study, OF and AC were compared for small superior-projecting paraclinoid aneurysms assuming visual and angiographic results as outcome measures. Indications for OF are also discussed. METHODS Data of patients who underwent surgery for a paraclinoid aneurysm in the last 10 years were collected across 3 tertiary hospitals. Small to regular-size and superior projecting aneurysms were sorted. Multiple and complex aneurysms were excluded. Records of patients who went through OF were compared with those of patients who underwent AC. Neurologic outcome was reported as a modified Rankin Scale. Aneurysm complete occlusion rate and rate of approach-related worsened vision were selected as outcome measures of efficacy and safety, respectively, of the OF versus AC. Unpaired t test and χ2 test were used for numerical and categorical variables, respectively. A P value less than 0.05 was considered statistically significant. RESULTS OF and AC groups involved 18 and 25 patients, respectively. Complication rate, overall neurologic outcome, rate of approach-related worsened vision, and complete occlusion rate did not differ between the groups. The average follow-up was 51 ± 34 and 60 ± 41 months in the OF and AC groups, respectively. CONCLUSIONS Compared to AC, OF did not show either a higher rate of approach-related worsened vision or a lower aneurysm complete occlusion rate. OF can be considered a valid alternative to the AC for small superior-projecting dorsal ICA wall paraclinoid aneurysms.
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Affiliation(s)
- Sabino Luzzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Alice Giotta Lucifero
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Matias Baldoncini
- Department of Neurological Surgery, San Fernando Hospital, Buenos Aires, Argentina; Laboratory of Microsurgical Neuroanatomy, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Alvaro Campero
- Department of Neurological Surgery, Padilla Hospital, Tucumán, Argentina
| | - Renato Galzio
- Neurosurgery Unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
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9
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Biberoğlu Çelik E, Haidar H, Eraslan M, Baltacioglu F. Choroidal and retinal anatomical response following treatment of carotid-ophthalmic aneurysms with flow diverter stents. Photodiagnosis Photodyn Ther 2022; 40:103117. [PMID: 36109002 DOI: 10.1016/j.pdpdt.2022.103117] [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: 06/04/2022] [Revised: 08/15/2022] [Accepted: 09/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Flow diverter stents(FDSs) are recent additions to the endovascular armament for treating ophthalmic segment aneurysms(OSA). In our study we evaluated the long-term effect of FDS placement on multiple Optical Coherence Tomography(OCT) findings, best corrected visual acuity(BCVA) and intra-ocular pressure(IOP). METHODS A prospective cohort study was conducted in 35 patients treated with a single FDS placement for OSA, between 2013 and 2018. Spectral-domain OCT was used to measure retinal nerve fiber layer thickness, ganglion cell complex thickness, subfoveal choroidal thickness(SFCT), and other stereometric parameters. Choroidal Vascularity Index(CVI) in a 1.5 mm wide subfoveal choroidal area was calculated. BCVA and IOP were also assessed. These measurements, at final follow up, were compared to the untreated fellow eye to evaluate the long-term effect of FDS placement. RESULTS This study included 70 eyes from 35 patients (100% female) with a mean age of 54.9 ± 9.8 years and mean follow-up period of 37.3 ± 18.9 months. No ophthalmic artery occlusion was encountered. The mean CVI was significantly higher in the stented side compared to the fellow normal eye (66.90±1.95 vs 65.05±1.93, p=.001) while mean SFCT was significantly reduced (251.23±68.54 vs 288.78±78.95, p=.037). Differences in the remaining studied parameters did not reach statistical significance. The difference in BCVA between stented and fellow normal eyes was also not significant (0.057±0.213 vs 0.060±0.214, p=.977 in logMAR). CONCLUSION Treatment with FDSs did not cause permanent visual damage. This study is the first to report a decrease in SFCT with a compensatory increase in CVI following FDS placement for OSA.
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Affiliation(s)
- Esra Biberoğlu Çelik
- Department of Ophthalmology, Marmara University Pendik Educational and Research Hospital, Istanbul, Turkey
| | - Hassan Haidar
- School of Medicine, Marmara University, Istanbul, Turkey
| | - Muhsin Eraslan
- Department of Ophthalmology, School of Medicine, Marmara University, Istanbul, Turkey.
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Wang Y, Yu J. Endovascular treatment of aneurysms of the paraophthalmic segment of the internal carotid artery: Current status. Front Neurol 2022; 13:913704. [PMID: 36188411 PMCID: PMC9523143 DOI: 10.3389/fneur.2022.913704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
The paraophthalmic segment of the internal carotid artery (ICA) originates from the distal border of the cavernous ICA and terminates at the posterior communicating artery. Aneurysms arising from the paraophthalmic segment represent ~5–10% of intradural aneurysms. Due to the advent of endovascular treatment (EVT) techniques, specifically flow-diverting stents (FDSs), EVT has become a good option for these aneurysms. A literature review on EVT for paraophthalmic segment aneurysms is necessary. In this review, we discuss the anatomy of the paraophthalmic segment, classification of the paraophthalmic segment aneurysms, EVT principle and techniques, and prognosis and complications. EVT techniques for paraophthalmic segment aneurysms include coil embolization, FDSs, covered stents, and Woven EndoBridge devices. Currently, coiling embolization remains the best choice for ruptured paraophthalmic segment aneurysms, especially to avoid long-term antiplatelet therapy for young patients. Due to the excessive use of antiplatelet therapy, unruptured paraophthalmic segment aneurysms that are easy to coil should not be treated with FDS. FDS is appropriate for uncoilable or failed aneurysms. Other devices cannot act as the primary choice but can be useful auxiliary tools. Both coiling embolization and FDS deployment can result in a good prognosis for paraophthalmic segment aneurysms. The overall complication rate is low. Therefore, EVT offers promising treatments for paraophthalmic segment aneurysms. In addition, surgical clipping continues to be a good choice for paraophthalmic segment aneurysms in the endovascular era.
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Xu C, Wu P, Sun B, Xu S, Luo B, Yang X, Shi H. Incomplete occlusion and visual symptoms of peri-ophthalmic aneurysm after treatment with a pipeline embolization device: a multi-center cohort study. Acta Neurochir (Wien) 2022; 164:2191-2202. [PMID: 35554695 DOI: 10.1007/s00701-022-05239-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/05/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Peri-ophthalmic aneurysm is a special type of aneurysm. We assessed the relationship between ophthalmic artery (OA) origin and aneurysm and examined the effect of a pipeline embolization device (PED, Covidien/Medtronic) with or without coils on aneurysm occlusion rate and visual outcomes. METHODS We retrospectively analyzed 194 peri-ophthalmic aneurysms in 189 patients among 1171 patients treated with a PED in a Chinese post-market multi-center registry study from November 2014 to October 2019. Peri-ophthalmic aneurysms were defined as carotid-ophthalmic segment aneurysms arising from the internal carotid artery dorsal wall at, or distal to, the OA origin, with a superior or superomedial projection. The relationship between OA origin and the aneurysm was classified as follows: type A, OA originating separate from the aneurysm; type B, OA originating from the aneurysm neck or dome. Patients with aneurysm were divided into the PED-only group and the PED + coils group according to treatment. RESULTS The median follow-up time was 6.8 months (range, 5.3-20.2 months). There were 163 occluded aneurysms (84%) and 31 aneurysms with incomplete occlusion (16%). A multivariate analysis showed that type B aneurysm was a risk factor for incomplete occlusion in the PED-only group (odds ratio [OR] 4.854, 95% confidence interval [CI] 1.878-12.548, P = 0.001). Visual symptoms at final follow-up correlated with preoperative visual symptoms (OR 22.777, 95% CI 3.115-166.555, P = 0.002). CONCLUSIONS Type B aneurysm is associated with a lower occlusion rate after PED-only treatment. Patients with preoperative visual symptoms should be treated promptly to avoid permanent visual symptoms.
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Tanaka Y, Nagatsuka H, Miki Y, Tetsuo Y, Yabuzaki H, Nakayama S, Matsuda Y, Tsumoto T, Terada T. Two patients of visual disturbance and optic perineuritis after placement of a flow diverter. Radiol Case Rep 2022; 17:1487-1490. [PMID: 35265246 PMCID: PMC8899115 DOI: 10.1016/j.radcr.2022.01.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 01/31/2022] [Indexed: 11/12/2022] Open
Abstract
The pathogenesis of new visual symptoms after flow diverter stent placement in the ophthalmic artery for internal carotid artery aneurysms remains unclear. We report two cases of patients who developed visual field disturbance and decreased visual acuity following flow diverter placement. The “doughnut sign” was found around the optic nerve on magnetic resonance imaging. The patients had progressive visual field defects and impairment on the side where the flow diverter was placed. Short tau inversion recovery coronal images showed a doughnut-shaped high-signal around the optic nerve on the affected side. Both patients were treated with steroid pulse therapy, and 1 received endovascular therapy. Their symptoms gradually improved, and the “doughnut sign” disappeared. The “doughnut sign” observed around the optic nerve on magnetic resonance imaging may be found alongside visual disturbance symptoms after paraclinoid aneurysm treatment. It is recommended that short tau inversion recovery sequences be performed preoperatively in patients presenting with visual impairment and in whom the possibility of postoperative exacerbation is suspected.
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Flow diverter modeled as heterogeneous and anisotropic porous medium: Simulation, experimental validation and case analysis. J Biomech 2021; 123:110525. [PMID: 34023757 DOI: 10.1016/j.jbiomech.2021.110525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 04/23/2021] [Accepted: 05/09/2021] [Indexed: 11/22/2022]
Abstract
Simulation of flow diverter (FD) treated aneurysm can evaluate treatment efficacy and aid treatment planning. However, explicit modeling of thin wires of FD impose extremely high demand of computational resources and time, which limit its use in time-sensitive presurgical planning. One alternative approach is to model FD as homogenous porous medium, which saves time but with compromise in accuracy. We proposed a new method to model FD as heterogeneous and anisotropic porous medium whose properties were determined from local porosity. The new method was validated by comparing with PIV measurement from an in-vitro phantom. Simulation result was in good agreement with experimental measurement. Four patient cases were further analyzed to compare the new method with the homogenous porous media method. Results showed that in patient cases with curved artery, new method was preferred over the homogenous method, as the assumption of homogenous porosity led to overpredicted flow reduction effect by as much as 87.9%, which may lead to overoptimistic decision making and poor prognosis. Our new method can provide timely and accurate simulation to aid in the treatment planning of aneurysms.
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Role of the ophthalmic artery in the endovascular treatment for intracranial vascular diseases. Acta Neurol Belg 2021; 121:321-330. [PMID: 33400225 DOI: 10.1007/s13760-020-01576-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
The ophthalmic artery (OA) is a crucial artery. Centered at the OA, there are numerous extracranial-intracranial anastomoses. The OA and its collaterals can be involved in some intracranial vascular diseases. So, it is very important to understand its specific anatomy, variation, and role in different neurovascular diseases. The OA has various anomalies both in the origin and collateral circulation. When performing endovascular treatment (EVT), the OA may suffer unexpected embolization through the numerous dangerous anastomoses. In case of a dural arteriovenous fistula or brain arteriovenous malformation mainly fed by the OA, the OA can be the passage of EVT, during which the central retinal artery could be injured. During interventional recanalization of steno-occlusive diseases of the internal carotid artery, dissection at the cavernous segment could progress to the OA segment and occlude the origin of OA. Under the circumstance of moyamoya disease, the OA can provide collateral flow to the anterior cerebral artery. When performing EVT for OA aneurysm concurrent with moyamoya disease, the parent OA should be preserved. After placement of a flow-diverting device for ophthalmic ICA aneurysm, the covered OA could experience spontaneous occlusion, leading to visual disturbance. Hence, the OA is an extremely important artery in the EVT for intracranial vascular diseases. In this article, we would extensively review the related literature to increase our understanding of the role of OA in intracranial vascular diseases. In addition, some illustrative cases would also be provided.
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Ni H, Zhao LB, Liu S, Jia ZY, Cao YZ, Shi HB. Open-cell stent-assisted coiling for the treatment of paraclinoid aneurysms: traditional endovascular treatment is still not out of date. Neuroradiology 2021; 63:1521-1530. [PMID: 33630124 DOI: 10.1007/s00234-021-02679-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/18/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Before we enter the era of flow diverter stents (FDS), the standard stent-assisted coiling technique is a well-established treatment option for routine paraclinoid aneurysms. We assess the clinical safety and efficacy of stent-assisted coiling with open-cell stent in the treatment of paraclinoid aneurysms and evaluate the association between clinical factors and follow-up aneurysm occlusion. METHODS The clinical and radiographic data of 110 consecutive patients with 122 paraclinoid aneurysms treated with open-cell stent between April 2015 and April 2019 were analyzed retrospectively at our center. We assessed the immediate and progressive occlusion rates, complications, and clinical outcome. Multivariate analysis was performed to investigate the risk factors of angiographic incomplete occlusion. RESULTS Among 110 patients, stent-assisted coiling was successfully performed in all cases. Four (3.6%) thromboembolic events were reported during the procedure, which resulted in transient morbidity. Immediate angiography demonstrated complete occlusion in 64 (52.5%) aneurysms and no occlusion of ophthalmic artery. Angiographic follow-up at 6 months demonstrated an increase in the complete occlusion rate to 92.9%. No delayed in-stent stenosis was observed, and three aneurysms recurred. Clinical follow-up was completed in 102 patients (92.7%), and favorable outcomes were achieved in 101 (99%) patients at 6 months. Multivariate analysis showed that aneurysm size (p < 0.001) was associated with incomplete aneurysm occlusion at follow-up. CONCLUSION Stent-assisted coil embolization with open-cell stents is safe and effective for the treatment of paraclinoid aneurysms and provides progressive occlusion without significant in-stent stenosis events.
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Affiliation(s)
- Heng Ni
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Lin-Bo Zhao
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Zhen-Yu Jia
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Yue-Zhou Cao
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
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Brunozzi D, Alaraj A. Commentary: Treatment of Carotid Ophthalmic Aneurysm With Woven EndoBridge (WEB SL): 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E426-E427. [PMID: 32615584 DOI: 10.1093/ons/opaa183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Denise Brunozzi
- Department of Neurosurgery, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
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Deora H, Martinez-Perez R, Agrawal A, Moscote-Salazar LR. Letter: Occlusion Rate and Visual Complications With Flow-Diverter Stent Placed Across the Ophthalmic Artery's Origin for Carotid-Ophthalmic Aneurysms: A Meta-Analysis. Neurosurgery 2020; 86:E398-E399. [PMID: 31642495 DOI: 10.1093/neuros/nyz482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Harsh Deora
- Department of Neurosurgery National Institute of Mental Health and Neurosciences Bangalore, India
| | - Rafael Martinez-Perez
- Department of Neurological Sciences Wexner Medical Center The Ohio State University Columbus, Ohio.,Division of Neurosurgery Institute of Neurosciences Universidad Austral de Chile Valdivia, Chile
| | - Amit Agrawal
- Department of Neurosurgery Narayana Medical College and Hospital Nellore, India
| | - Luis Rafael Moscote-Salazar
- Neurosurgery-Critical Care Center for Biomedical Research (CIB) Faculty of Medicine-University of Cartagena Cartagena de Indias, Bolivar, Colombia
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Cagnazzo F, Ahmed R, Lefevre PH, Derraz I, Dargazanli C, Gascou G, Riquelme C, Frandon J, Bonafe A, Costalat V. Flow modification on the internal carotid artery bifurcation region and A1 segment after M1-internal carotid artery flow diverter deployment. J Neurointerv Surg 2020; 12:1226-1230. [PMID: 32457221 DOI: 10.1136/neurintsurg-2020-016051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Clinical and hemodynamic consequences of flow diverters extending from the M1 to the internal carotid artery (ICA), covering the A1 segment, have rarely been investigated. We aimed to provide angiographic and clinical data about flow modifications on the covered A1. METHODS Consecutive patients receiving M1-ICA flow diverters for unruptured aneurysms were collected from our prospective database (2014-2020). RESULTS 42 A1 arteries covered with a single device were studied. All patients had an angiographic detected contralateral flow from the anterior communicating artery (AcomA). Immediately after flow diversion, 20 (47.6%) covered A1 showed slow flow. During a mean angiographic follow-up of 14 months, 13 (31%) and 22 (52.3%) A1 arteries were occluded and narrowed, respectively. Flow changes were asymptomatic in all cases. Vascular risk factors, sex, oversized compared with not oversized stents, immediate A1 slow flow, age, diameter of the A1, length of follow-up, and platelet inhibition rate were tested as prognosticators of A1 occlusion. Length of the angiographic follow-up was the only predictor of A1 occlusion (p=0.005, OR=3, CI=1.4 to 6.7). There were two device related ischemic events with a 2.3% rate of morbidity (one basal ganglia infarct after coverage of the M1 perforators and one transient acute instent thrombosis). CONCLUSIONS Covering the A1 segment during M1-ICA flow diversion seems relatively safe, if the contralateral flow is assured by the AcomA. Approximately 31% and 52% of the covered A1 showed asymptomatic occlusions and narrowing, respectively. The likelihood of flow modification was proportional to the length of follow-up. Morbidity associated with flow diversion in the ICA terminus region was 2.3%.
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Affiliation(s)
- Federico Cagnazzo
- Neuroradiology Department, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Raed Ahmed
- Neuroradiology Department, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Pierre-Henri Lefevre
- Neuroradiology Department, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Imad Derraz
- Neuroradiology Department, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Cyril Dargazanli
- Neuroradiology Department, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Gregory Gascou
- Neuroradiology Department, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Carlos Riquelme
- Neuroradiology Department, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Julien Frandon
- Radiologie et Imagerie Médicale, Hôpital Universitaire Carémeau, Nîmes, Nîmes, France
| | - Alain Bonafe
- Neuroradiology Department, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Vincent Costalat
- Neuroradiology Department, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
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Touzé R, Clarençon F. In Reply: Occlusion Rate and Visual Complications With Flow-Diverter Stent Placed Across the Ophthalmic Artery's Origin for Carotid-Ophthalmic Aneurysms: A Meta-Analysis. Neurosurgery 2020; 86:E400-E401. [PMID: 31848613 DOI: 10.1093/neuros/nyz484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Romain Touzé
- Department of Neuroradiology Pitié-Salpêtrière Hospital APHP Paris, France
| | - Frédéric Clarençon
- Department of Neuroradiology Pitié-Salpêtrière Hospital APHP Paris, France.,Sorbonne University Paris, France.,GRC BioFast Paris VI University Paris, France
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Piergallini L, Cagnazzo F, Conte G, Dargazanli C, Derraz I, Lefevre PH, Gascou G, Mantilla D, Riquelme C, Bonafe A, Costalat V. Virtual simulation with Sim&Size software for Pipeline Flex Embolization: evaluation of the technical and clinical impact. J Neurointerv Surg 2020; 12:968-973. [DOI: 10.1136/neurintsurg-2020-015813] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 12/26/2022]
Abstract
IntroductionDuring flow diversion, the choice of the length, diameter, and location of the deployed stent are critical for the success of the procedure. Sim&Size software, based on the three-dimensional rotational angiography (3D-RA) acquisition, simulates the release of the stent, suggesting optimal sizing, and displaying the degree of the wall apposition.ObjectiveTo demonstrate technical and clinical impacts of the Sim&Size simulation during treatment with the Pipeline Flex Embolization Device.MethodsConsecutive patients who underwent aneurysm embolization with Pipeline at our department were retrospectively enrolled (January 2015–December 2017) and divided into two groups: treated with and without simulation. Through univariate and multivariate models, we evaluated: (1) rate of corrective intervention for non-optimal stent placement, (2) duration of intervention, (3) radiation dose, and (4) stent length.Results189 patients, 95 (50.2%) without and 94 (49.7%) with software assistance were analyzed. Age, sex, comorbidities, aneurysm characteristics, and operator’s experience were comparable among the two groups. Procedures performed with the software had a lower rate of corrective intervention (9% vs 20%, p=0.036), a shorter intervention duration (46 min vs 52 min, p=0.002), a lower median radiation dose (1150 mGy vs 1558 mGy, p<0.001), and a shorter stent length (14 mm vs 16 mm, p<0.001).ConclusionsIn our experience, the use of the virtual simulation during Pipeline treatment significantly reduced the need for corrective intervention, the procedural time, the radiation dose, and the length of the stent.
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Bonasia S, Bojanowski M, Robert T. Embryology and anatomical variations of the ophthalmic artery. Neuroradiology 2019; 62:139-152. [PMID: 31863143 DOI: 10.1007/s00234-019-02336-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/04/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE The ophthalmic artery (OA) has one of the most complex anatomy and the most fascinating embryological development. METHODS The complexity of the embryologic development of the OA resides in the implication of three different embryological systems: the carotid system, the stapedial system, and the ventral pharyngeal system. RESULTS This explains very well the numerous variations in origin of the OA and the importance of vascular anastomoses developed with branches of the external carotid artery and with the middle meningeal artery. CONCLUSION In this review, authors propose a comprehensive description of different hypotheses on the embryologic development of the OA and, in a second part, explain all anatomical variations and clinical implications of this artery.
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Affiliation(s)
- Sara Bonasia
- Department of Neurosurgery, Regional Hospital of Lugano, Neurocenter of the Southern Switzerland, Via Tesserete 46, CH-6903, Lugano, Switzerland
| | - Michel Bojanowski
- Department of Neurosurgery, Notre-Dame Hospital, Montreal, Quebec, Canada
| | - Thomas Robert
- Department of Neurosurgery, Regional Hospital of Lugano, Neurocenter of the Southern Switzerland, Via Tesserete 46, CH-6903, Lugano, Switzerland.
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