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Ghozy S, Ramzan A, Kobeissi H, Motawei AS, Abdelghaffar M, Dmytriw AA, Kallmes DF, Kadirvel R. eCLIPs bifurcation remodeling system for treatment of wide-neck bifurcation aneurysms: A systematic review and meta-analysis of safety and efficacy. Neuroradiol J 2024:19714009241247463. [PMID: 38621366 DOI: 10.1177/19714009241247463] [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: 04/17/2024] Open
Abstract
BACKGROUND Wide neck bifurcation aneurysms (WNBAs) are a subtype of aneurysms that are especially complex to treat. We aim to conduct a systematic review and meta-analysis to synthesize the available literature on the safety and efficacy of employing endovascular clip system (eCLIPs) in the treatment of WNBAs. METHODS We report this study in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. PubMed, Embase, Web of Science, and Scopus were queried for this review. Screening and extraction were performed by at least two authors to ensure accuracy and completeness, and a senior author arbitrated any discrepancies. All data were analyzed using R software version 4.3.0. and random-effects model. RESULTS Four studies were finally included, of which three were prospective and one was retrospective. Successful adjunctive coiling occurred in 91.38% (95% CI = 70.71-97.9) of cases and overall technical success was achieved in 88.61% (95 CI = 75.54-95.15) of cases. The pooled complete occlusion (Raymond-Roy Class I) was 50.65% (95% CI = 39.63-61.60) and adequate occlusion (Raymond-Roy Class I/II) was 84.42% (95% CI = 74.53-90.93). Thrombo-embolic complication had a pooled rate of 1.22% (95% CI = 0.17-8.15), retreatment rate was 6.10% (95% CI = 2.56-13.83), and mortality reported in 3.66% (95% CI = 1.18-10.74) of patients. CONCLUSION The use of eCLIPs may be a safe and efficacious treatment for WNBAs. Future randomized controlled trials are needed for further validation of the findings.
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Affiliation(s)
- Sherief Ghozy
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA
- Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St Michael's Hospital, Toronto, ON, Canada
| | | | - Ramanathan Kadirvel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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2
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Gunkan A, Ferreira MY, Batista S, Fouad MEM, Ciccio G. Efficacy and safety of low profile stents in Y-stent assisted coil embolization of wide-necked bifurcation aneurysms: a systematic review and meta-analysis. Neurosurg Rev 2024; 47:123. [PMID: 38503965 DOI: 10.1007/s10143-024-02343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/23/2024] [Accepted: 03/03/2024] [Indexed: 03/21/2024]
Abstract
Low-profile stents may provide significant advantages in Y-stent-assisted coiling due to their miniaturized design and capability to be delivered through a 0.0165-inch microcatheter. We aim to investigate the safety and efficacy of using these newer versions of stents in Y-stent-assisted coiling for the treatment of wide-necked bifurcation aneurysms. We conducted a systematic review of the PubMed, Embase, Cochrane Library, and Web of Science databases up to September 2023, following the PRISMA guidelines. Eligible studies included ≥ 5 patients with intracranial wide-necked bifurcation aneurysms treated with Y-stent-assisted coiling using low-profile stents, providing angiographic and clinical outcomes. Two authors independently handled the search and selection. Primary outcomes were immediate and follow-up aneurysm occlusion, procedure-related complications, aneurysm recanalization, and retreatment. Secondary outcomes included technical success, procedure-related morbidity, procedure-related mortality, procedure-related stroke, and in-stent stenosis at follow-up. We analyzed the data using random-effects meta-analysis. In total, 19 studies including 507 patients with 509 aneurysms were included. 95% of the treated aneurysms were managed using the crossing Y-configuration. Technical success rate was 99%. Immediate adequate aneurysm occlusion was 90%. Follow-up angiographies were available for 443 aneurysms. The mean angiographic follow-up duration was 15.6 ± 1.9 months. The rates for follow-up adequate aneurysm occlusion and complete occlusion were 98% and 89%, respectively. After a mean clinical follow-up of 15 ± 2.4 months, a good clinical outcome was observed in 98% of patients. Overall, procedure-related morbidity and mortality rates were 1.3%, and 0.4%, respectively. Low-profile stents in Y-stent-assisted coiling outperform previous stent versions in terms of safety, efficacy, and technical success rates.
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Affiliation(s)
- Ahmet Gunkan
- Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
| | | | - Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Mohamed E M Fouad
- Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - Gabriele Ciccio
- Department of Radiology, CHU de Saint Etienne, Saint Etienne, France
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3
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Consoli A, Nishi H, Diouf A, Charbonnier G, Araújo A, Marotta TR. Endovascular treatment of wide-neck bifurcation aneurysms: the eCLIPs device. J Neurointerv Surg 2024; 16:229. [PMID: 38171614 DOI: 10.1136/jnis-2023-020442] [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: 04/15/2023] [Accepted: 06/21/2023] [Indexed: 01/05/2024]
Abstract
The endovascular clip system device, eCLIPs (eVasc, Vancouver, British Columbia, Canada), was introduced almost a decade ago for the treatment of wide-neck bifurcation aneurysms,1-3 which represent a challenge for both endovascular and surgical approaches. Several techniques and devices (intrasaccular or intra-arterial) have been introduced and are currently available in order to improve the technical and clinical outcomes of aneurysm embolization. Flow diversion and flow disruption have shown controversial results in this subtype of aneurysm. In this video we present the use of the eCLIPs device to treat a ruptured, wide-neck aneurysm of the top of the basilar artery. The decisional approach, technical details, and the different steps of the endovascular treatment are described. The final part of the video is dedicated to the characteristics of the device for re-endothelialization4 and flow diversion (video 1).5 neurintsurg;16/3/229/V1F1V1Video 1 .
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Affiliation(s)
- Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Hospital Foch Department of Therapeutic and Interventional Neuroradiology, Suresnes, France
- RADIS Laboratory, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Hidehisa Nishi
- Department of Neurosurgery, Division of Surgery, St Michael's Hospital Neurosurgery Service, Toronto, Ontario, Canada
| | - Ange Diouf
- Department of Medical Imaging, St Michael's Hospital Medical Imaging Department, Toronto, Ontario, Canada
| | - Guillaume Charbonnier
- RADIS Laboratory, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Department of Interventional Neuroradiology, Besançon Regional University Hospital Center, Besancon, Bourgogne-Franche-Comté, France
| | - André Araújo
- RADIS Laboratory, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Department of Imagiology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Thomas R Marotta
- RADIS Laboratory, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Department of Interventional Neuroradiology, St Michael's Hospital, Toronto, Ontario, Canada
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4
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Jahandardoost M, Ricci D, Milani AS, Jahandardoost M, Grecov D. A comprehensive simulation framework for predicting the eCLIPs implant crimping into a catheter and its deployment mechanisms. J Mech Behav Biomed Mater 2024; 150:106227. [PMID: 37995603 DOI: 10.1016/j.jmbbm.2023.106227] [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: 01/09/2023] [Revised: 10/25/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
Tubular flow diverters (FDs) represent an important subset of the endovascular treatment of cerebral aneurysms (CAs), acting to reduce aneurysm inflow, eventually resulting in aneurysm thrombosis and occlusion. eCLIPs (product of Evasc Neurovascular Enterprises, Vancouver, Canada), an innovative non-tubular implant causes flow diversion by bridging the neck of bifurcation CAs. However, in a small subset of challenging bifurcation aneurysms with fusiform pathology, the currently available eCLIPs models do not provide sufficient neck bridging resulting in a gap created between the device structure and the aneurysm/artery wall. To overcome this challenge, a new design of the eCLIPs (VR-eCLIPs) was developed by varying the rib length to cover such an inflow gap. To optimize the new product development process, and avoiding expensive and time-consuming iterative manufacture of prototype devices, we have developed a new finite element model to simulate the crimping and expansion processes of the VR-eCLIPs implant, and assess the possibility of plastic deformation. Results indicated that neither eCLIPs nor VR-eCLIPs experience plastic deformation during the crimping process. Upon full expansion, the ribs of VR-eCLIPs interact with the aneurysm and artery wall to cover the inflow gap that exists in certain challenging anatomies. This process serves as a basis to expedite design development prior to prototype manufacturing.
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Affiliation(s)
- Mehdi Jahandardoost
- Industrial and Biological Multiphysics Research Lab, Department of Mechanical Engineering, University of British Columbia, Vancouver, BC, Canada; Materials and Manufacturing Research Institute, University of British Columbia, Kelowna, BC, Canada.
| | - Donald Ricci
- eVasc Neurovascular Enterprise, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Abbas S Milani
- Materials and Manufacturing Research Institute, University of British Columbia, Kelowna, BC, Canada; Composites Research Network-Okanagan Laboratory, School of Engineering, University of British Columbia, Kelowna, BC, Canada.
| | - Mohsen Jahandardoost
- Department of Mechanical Engineering, University of Pittsburgh, Johnstown, PA, USA.
| | - Dana Grecov
- Industrial and Biological Multiphysics Research Lab, Department of Mechanical Engineering, University of British Columbia, Vancouver, BC, Canada.
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Haryu S, Sakata H, Matsumoto Y, Niizuma K, Endo H. Endovascular Treatment of Wide-Neck Bifurcation Aneurysm: Recent Trends in Coil Embolization with Adjunctive Technique. JOURNAL OF NEUROENDOVASCULAR THERAPY 2024; 18:75-83. [PMID: 38559450 PMCID: PMC10973563 DOI: 10.5797/jnet.ra.2023-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/11/2023] [Indexed: 04/04/2024]
Abstract
Wide-neck bifurcation aneurysms (WNBAs) are sometimes challenging to treat. During endovascular treatment, it is important to prevent coil deviation and preserve normal vessels. Adjunctive balloon- and stent-assisted techniques have been developed. A meta-analysis of endovascular treatments of WNBAs revealed that only 40% of patients had complete occlusion. Recently, novel devices have been developed to expand the range of treatment options. Flow-diverter stents and intra-aneurysmal flow disruption devices do not require coils; however, coil embolization remains the standard procedure used by many neurointerventionists. This review describes the recent trends in adjunctive techniques for supporting coil embolization for WNBAs. We referred to literature on balloon-assisted techniques, stent-assisted techniques, Y-stenting, PulseRider, Barrel stents, Comaneci temporary stents, pCONUS, and eCLIPs. These reports showed that adequate embolization rates were generally greater than 80%, and the complete occlusion rate was as high as 94.6%. All devices had a relatively high occlusion rate; however, it may be inaccurate to simply compare each device because of the heterogeneity of the studies. It is important to select the best treatment for each individual case by considering not only literature-based efficacy and safety but also patient background, aneurysm characteristics, and operator experience.
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Affiliation(s)
- Shinya Haryu
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Hiroyuki Sakata
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Miyagi, Japan
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Yasushi Matsumoto
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Abouei Mehrizi MA, Habibi MA, Keykhosravi E, Eazi SM, Minaee P, Mirjani MS. The Safety and Efficacy of eCLIPs for Treatment of Wide-Necked Bifurcation Aneurysms: A Systematic Review and Meta-Analysis. World Neurosurg 2023; 180:213-223.e7. [PMID: 37813336 DOI: 10.1016/j.wneu.2023.10.011] [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: 09/04/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Wide-necked bifurcation aneurysms (WNBAs) are challenging intracranial aneurysms. Several device and treatment approaches have been proposed for the treatment of WNBAs. The endovascular clip system (eCLIPs) is a newly developed endovascular device with flow diverter and flow disruptor features. This study aims to investigate the safety and efficacy of the eCLIPs for treatment of patients with WNBAs. METHODS This is a systematic review and meta-analysis study conducted in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. The electronic databases of PubMed, Embase, Scopus, and Web of Science were systematically reviewed from inception to June 19, 2023. The rate of complete and near-complete occlusion, successful device implantation, and serious adverse events were pooled using STATA, version 17. RESULTS A total of 5 studies with 110 patients with WNBAs were systematically investigated. Our findings show that the immediate successful implantation rate of eCLIPs was 0.93 (95% confidence interval [CI], 0.88-0.97). Moreover, the immediate postoperative complete occlusion rate was 0.34 (95% CI, 0.10-0.58), and the immediate postoperative near-complete occlusion rate was 0.35 (95% CI, 0.24-0.45). Also, the near-complete occlusion rate at the latest follow-up was 0.3 (95% CI, 0.16-0.44). The serious adverse event rate was 0.14 (95% CI, 0.05-0.22). Stroke was also reported in 2 studies, with 1 study reporting 1 patient who experienced stroke within the first 24 hours and 1 study reporting no patients with stroke. CONCLUSIONS Our findings document that the eCLIPs is a safe and effective device for treating patients with WNBAs and associated with favorable outcomes.
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Affiliation(s)
| | - Mohammad Amin Habibi
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ehsan Keykhosravi
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Seyed Mohammad Eazi
- Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran
| | - Poriya Minaee
- Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran
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7
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Zhou Z, Lan W, Yu J. Endovascular treatment of middle cerebral artery aneurysms: current status and future prospects. Front Neurol 2023; 14:1239199. [PMID: 38033773 PMCID: PMC10684741 DOI: 10.3389/fneur.2023.1239199] [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] [Received: 06/13/2023] [Accepted: 10/20/2023] [Indexed: 12/02/2023] Open
Abstract
Middle cerebral artery (MCA) aneurysms are complex and widely distributed throughout the course of the MCA. Various types of aneurysms can occur in the MCA. Ruptured as well as unruptured MCA aneurysms may require treatment to avoid bleeding or rebleeding. Currently, clipping is regarded as the first-line choice for the treatment of MCA aneurysms. However, endovascular treatment (EVT) is emerging as an alternative treatment in selected cases. EVT techniques vary. Therefore, it is necessary to review EVT for MCA aneurysms. In this review, the following issues were discussed: MCA anatomy and anomalies, classifications of MCA aneurysms, the natural history of MCA aneurysms, EVT status and principle, deployments of traditional coiling techniques and flow diverters (FDs), and deployments and prospects of intrasaccular flow disruptors and stent-like devices. According to the review and our experience, traditional coiling EVT is still the preferred therapy for most MCA aneurysms. FD deployment can be used in selective MCA aneurysms. Parent artery occlusion (PAO) can be used to treat distal MCA aneurysms. In addition, new devices can be used to treat MCA aneurysms, such as intrasaccular flow disruptors and stent-like devices. In general, EVT is gaining popularity as an alternative treatment option; however, there is still a lack of evidence regarding EVT, and longer-term data are not currently available for most EVT devices.
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Affiliation(s)
- Zibo Zhou
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Wenjing Lan
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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8
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Diestro JDB, Dibas M, Adeeb N, Regenhardt RW, Vranic JE, Guenego A, Lay SV, Renieri L, Al Balushi A, Shotar E, Premat K, El Naamani K, Saliou G, Möhlenbruch MA, Lylyk I, Foreman PM, Vachhani JA, Župančić V, Hafeez MU, Rutledge C, Rai H, Tutino VM, Mirshani S, Ghozy S, Harker P, Alotaibi NM, Rabinov JD, Ren Y, Schirmer CM, Goren O, Piano M, Kuhn AL, Michelozzi C, Elens S, Starke RM, Hassan A, Salehani A, Nguyen A, Jones J, Psychogios M, Spears J, Parra-Fariñas C, Bres Bullrich M, Mayich M, Salem MM, Burkhardt JK, Jankowitz BT, Domingo RA, Huynh T, Tawk R, Ulfert C, Lubicz B, Panni P, Puri AS, Pero G, Griessenauer CJ, Asadi H, Siddiqui A, Ducruet AF, Albuquerque FC, Du R, Kan P, Kalousek V, Lylyk P, Boddu SR, Stapleton CJ, Knopman J, Jabbour P, Tjoumakaris S, Clarençon F, Limbucci N, Aziz-Sultan MA, Cuellar-Saenz HH, Cognard C, Patel AB, Dmytriw AA. Intrasaccular flow disruption for ruptured aneurysms: an international multicenter study. J Neurointerv Surg 2023; 15:844-850. [PMID: 35868856 DOI: 10.1136/jnis-2022-019153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/01/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Woven EndoBridge (WEB) device is a novel intrasaccular flow disruptor tailored for bifurcation aneurysms. We aim to describe the degree of aneurysm occlusion at the latest follow-up, and the rate of complications of aneurysms treated with the WEB device stratified according to rupture status. METHODS Our data were taken from the WorldWideWeb Consortium, an international multicenter cohort including patients treated with the WEB device. Aneurysms were classified into two groups: ruptured and unruptured. We compared clinical and radiologic outcomes of both groups. Propensity score matching (PSM) was done to match according to age, gender, bifurcation, location, prior treatment, neck, height, dome width, daughter sac, incorporated branch, pretreatment antiplatelets, and last imaging follow-up. RESULTS The study included 676 patients with 691 intracranial aneurysms (529 unruptured and 162 ruptured) treated with the WEB device. The PSM analysis had 55 pairs. In both the unmatched (85.8% vs 84.3%, p=0.692) and matched (94.4% vs 83.3%, p=0.066) cohorts there was no significant difference in the adequate occlusion rate at the last follow-up. Likewise, there were no significant differences in both ischemic and hemorrhagic complications between the two groups. There was no documented aneurysm rebleeding after WEB device implantation. CONCLUSION There was no significant difference in both the radiologic outcomes and complications between unruptured and ruptured aneurysms. Our findings support the feasibility of treatment of ruptured aneurysms with the WEB device.
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Affiliation(s)
- Jose Danilo Bengzon Diestro
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mahmoud Dibas
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nimer Adeeb
- Department of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, Louisiana, USA
| | - Robert W Regenhardt
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin E Vranic
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adrien Guenego
- Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Bruxelles, Belgique
| | - Sovann V Lay
- Service de Neuroradiologie Diagnostique et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France
| | - Leonardo Renieri
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Ali Al Balushi
- Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York, USA
| | - Eimad Shotar
- Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France
| | - Kevin Premat
- Department of Interventional Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Guillaume Saliou
- Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier Vaudois de Lausanne, Lausanne, Switzerland
| | | | - Ivan Lylyk
- Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Paul M Foreman
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, Florida, USA
| | - Jay A Vachhani
- Neurosurgery Department, Orlando Health Neuroscience and Rehabilitation Institute, Orlando, Florida, USA
| | - Vedran Župančić
- Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Muhammad U Hafeez
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, Texas, USA
| | - Caleb Rutledge
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Hamid Rai
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York, USA
| | - Vincent M Tutino
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York, USA
| | - Shervin Mirshani
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sherief Ghozy
- Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pablo Harker
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Naif M Alotaibi
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - James D Rabinov
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yifan Ren
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Melbourne, Victoria, Australia
| | | | - Oded Goren
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA
| | - Mariangela Piano
- Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Anna Luisa Kuhn
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, Massachusetts, USA
| | | | - Stephanie Elens
- Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Bruxelles, Belgique
| | - Robert M Starke
- Deparment of Neurosurgery, University of Miami, Miami, Florida, USA
| | - Ameer Hassan
- Deparment of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, Texas, USA
| | - Arsalaan Salehani
- Deparments of Neurosurgery and Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anh Nguyen
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Jesse Jones
- Deparments of Neurosurgery and Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marios Psychogios
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
| | - Julian Spears
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Division of Neurosurgery, University of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Carmen Parra-Fariñas
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Maria Bres Bullrich
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Michael Mayich
- Departments of Medical Imaging, and Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mohamed M Salem
- Department of Neurosurgery, University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Ricardo A Domingo
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Thien Huynh
- Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Rabih Tawk
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Christian Ulfert
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Boris Lubicz
- Service de Neuroradiologie Interventionnelle, Hôpital Universitaire Erasme, Bruxelles, Belgique
| | - Pietro Panni
- Interventistica Neurovascolare, Ospedale San Raffaele, Milano, Italy
| | - Ajit S Puri
- Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, Massachusetts, USA
| | - Guglielmo Pero
- Interventistica Neurovascolare, Ospedale Niguarda Cà Granda, Milano, Italy
| | - Christoph J Griessenauer
- Department of Neurosurgery, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria, Salzburg, Austria
- Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Hamed Asadi
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Melbourne, Victoria, Australia
| | - Adnan Siddiqui
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Rose Du
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, Canada
| | - Peter Kan
- Department of Neurosurgery, UTMB and Baylor School of Medicine, Houston, Texas, USA
| | - Vladimir Kalousek
- Subdivision of Interventional Neuroradiology, Department of Radiology, Clinical Hospital Center 'Sisters of Mercy', Zagreb, Croatia
| | - Pedro Lylyk
- Equipo de Neurocirugía Endovascular y Radiología Intervencionista, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Srikanth Reddy Boddu
- Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York, USA
| | - Christopher J Stapleton
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jared Knopman
- Neurosurgery & Interventional Neuroradiology, New York Presbyterian Hospital, Weill Cornell School of Medicine, New York, New York, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Frédéric Clarençon
- Department of Interventional Neuroradiology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Nicola Limbucci
- Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy
| | - Mohammad A Aziz-Sultan
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hugo H Cuellar-Saenz
- Department of Neurosurgery and Neurointerventional Surgery, Louisiana State University, Shreveport, Louisiana, USA
| | - Christophe Cognard
- Service de Neuroradiologie Diagnostique et Thérapeutique, Centre Hospitalier de Toulouse, Hôpital Purpan, Toulouse, France
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Adam A Dmytriw
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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9
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Morales-Caba L, Lylyk I, Vázquez-Añón V, Bleise C, Scrivano E, Perez N, Lylyk PN, Lundquist J, Bhogal P, Lylyk P. The pCONUS2 and pCONUS2 HPC Neck Bridging Devices : Results from an International Multicenter Retrospective Study. Clin Neuroradiol 2023; 33:129-136. [PMID: 35819477 PMCID: PMC10014770 DOI: 10.1007/s00062-022-01191-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 06/16/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Bifurcation aneurysms represent an ongoing endovascular challenge with a variety of techniques and devices designed to address them. We present our multicenter series of the pCONUS2 and pCONUS2 HPC devices when treating bifurcation aneurysms. METHODS We performed a retrospective review of our prospectively maintained databases at 3 tertiary neurointerventional centers to identify all patients who underwent coil embolization with the pCONUS2 or pCONUS2 HPC device between February 2015 and August 2021. We recorded baseline demographics, aneurysm data, complications, immediate and delayed angiographic results. RESULTS We identified 55 patients with 56 aneurysms, median age 63 years (range 42-78 years), 67.3% female (n = 37). The commonest aneurysm location was the MCA bifurcation (n = 40, 71.4%). Average dome height was 8.9 ± 4.2 mm (range 3.2-21.5 mm), average neck width 6.4 ± 2.5 mm (range 2.6-14 mm), and average aspect ratio 1.3 ± 0.6 (range 0.5-3.3). The pCONUS2 was used in 64.3% and the pCONUS2 HPC in 35.7%. The procedural technical success rate was 98.2%. Intraoperative complications occurred in 5 cases (8.9%), 4 of which were related to the coils with partial thrombus formation on the pCONUS2 HPC seen in 1 case that was resolved with heparin. In relation to the procedure and treatment of the aneurysm the overall permanent morbidity was 1.8% (n = 1/55) and mortality 0%. Delayed angiographic follow-up (48 aneurysms) at median 12 months postprocedure (range 3-36 months) demonstrated adequate occlusion of 83.4% of aneurysms. CONCLUSION The pCONUS2 and pCONUS2 HPC devices carry a high technical success rate, low complication and retreatment rate, and good rates of adequate occlusion. Larger prospective confirmatory studies are required.
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Affiliation(s)
- L Morales-Caba
- Department of Neuroradiology, Hospital Universitari i Politècnic La Fe, València, Spain
- Department of Radiology, Hospital Universitari La Ribera, Alzira, Spain
| | - I Lylyk
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - V Vázquez-Añón
- Department of Neuroradiology, Hospital Universitari i Politècnic La Fe, València, Spain
- Department of Radiology, Hospital Universitari La Ribera, Alzira, Spain
| | - C Bleise
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - E Scrivano
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - N Perez
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - P N Lylyk
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - J Lundquist
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - P Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, Whitechapel Road, E1 1BB, London, UK.
| | - P Lylyk
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
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de Vries J, Aquarius R, Sørensen L, Boogaarts HD, Turowski B, van Zwam WH, Marotta TR, Bartels RHMA. Safety and efficacy of the eCLIPs bifurcation remodelling system for the treatment of wide necked bifurcation aneurysms: 1 year results from the European eCLIPs Safety, Feasibility, and Efficacy Study (EESIS). J Neurointerv Surg 2023; 15:163-171. [PMID: 35393338 DOI: 10.1136/neurintsurg-2021-018460] [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: 11/19/2021] [Accepted: 03/07/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND The eCLIPs bifurcation remodelling system is a non-circumferential implant that bridges the neck from outside of a bifurcation aneurysm. The goal of the multicenter, post-marketing European eCLIPs Safety, FeasIbility, and Efficacy Study (EESIS), was to present the efficacy and safety results of the eCLIPs device after 365 days of follow-up. METHODS All patients were to receive an eCLIPs in conjunction with coils. The study was conducted according to good clinical practices and included independent adjudication of safety and efficacy outcomes. RESULTS Twenty patients were enrolled at four European centers. Mean age was 60 years (range 41-74) and aneurysms were located at the basilar tip (n=19) and carotid tip (n=1). Average aneurysm dome height was 6.0 mm (range 2.0-15.0). Mean neck length was 5.1 mm (range 2.6-8.5). The technical success rate was 90% (18 of 20). No major territorial strokes or deaths occurred between the index procedure and after 365 days of follow-up. Complete occlusion was achieved in 60% of patients (12 of 20 patients) and 67% of patients with an eCLIPs device (12 of 18) after 365 days of follow-up. Adequate occlusion (complete occlusion and neck remnant) was achieved in 80% of patients (16 of 20 patients) and 89% of patients with an eCLIPs device (16 of 18 patients) after 365 days of follow-up. CONCLUSION In this small series, treatment with eCLIPs was feasible, safe, and efficacious, considering the challenging nature of the aneurysms. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT02607501.
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Affiliation(s)
- Joost de Vries
- Neurosurgery, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - René Aquarius
- Neurosurgery, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Leif Sørensen
- Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bernd Turowski
- Radiology, Universitätsklinikum Düsseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
| | - Wim H van Zwam
- Radiology and Nuclear Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, The Netherlands
| | - Thomas R Marotta
- Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, Toronto, Ontario, Canada
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Wodarg F, Ozpeynirci Y, Hensler J, Jansen O, Liebig T. Contour-Assisted coiling with jailed microcatheter May result in better occlusion (CoCoJaMBO) in wide-necked intracranial aneurysms: Proof of principle and immediate angiographic results. Interv Neuroradiol 2023; 29:79-87. [PMID: 35014885 PMCID: PMC9893242 DOI: 10.1177/15910199211069782] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Wide-necked bifurcation aneurysms, partially thrombosed, and recurrences of large and giant aneurysms are challenging to treat. We report our preliminary experience with a Contour-assisted coiling technique and discuss the periprocedural safety, feasibility, and effectiveness of the approach. METHODS We retrospectively reviewed consecutive patients who received endovascular treatment for intracranial aneurysms with an intra-aneurysmal flow disruptor (Contour) at two neurovascular centres between October 2018 and December 2020 and identified patients treated with a combination of Contour and platinum coils. Clinical and procedural data were recorded. RESULTS For this analysis, 8 patients (5 female) aged 60.1 ± 9.2 years on average were identified. Three of 8 aneurysms were associated with previous acute subarachnoid hemorrhage (SAH). The mean average dome height was 12.8 ± 7.6 mm, mean maximum dome width 10.3 ± 5.4 mm, and neck width 5.5 ± 2.5 mm. The mean dome-to-neck ratio was 1.9 ± 1.0. Immediate complete occlusion of the aneurysm was seen in 5 of 8 cases. In one SAH patient, a parent vessel was temporarily occluded but could be reopened rapidly. One device detached prematurely without any sequelae. No other procedural adverse events were recorded. CONCLUSION From this initial experience, Contour with adjunctive coiling is a safe and technically feasible method for endovascular treatment of large, wide-necked, partially thrombosed, recurrent, or ruptured bifurcation aneurysms. Further studies with larger numbers of patients and longer follow-up are needed to confirm our results.
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Affiliation(s)
- Fritz Wodarg
- Department of Radiology and Neuroradiology, University Hospital
Schleswig-Holstein, Campus Kiel, Christian-Albrechts University, Germany
| | - Yigit Ozpeynirci
- Institute of Neuroradiology, LMU-University Hospital,
Ludwig-Maximilians-University, Munich, Germany
| | - Johannes Hensler
- Department of Radiology and Neuroradiology, University Hospital
Schleswig-Holstein, Campus Kiel, Christian-Albrechts University, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital
Schleswig-Holstein, Campus Kiel, Christian-Albrechts University, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, LMU-University Hospital,
Ludwig-Maximilians-University, Munich, Germany
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12
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Yeomans J, Gatt S, Habeeb Mohamed E, Crossley R, Keston P, Minks D, Dobbs N, Mortimer A, Downer J, Sastry A. pCONUS 2 and pCONUS 2-HPC in the treatment of wide-necked intracranial aneurysms: Multicentre UK experience. Interv Neuroradiol 2023:15910199221150467. [PMID: 36617807 DOI: 10.1177/15910199221150467] [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: 01/10/2023] Open
Abstract
BACKGROUND/PURPOSE pCONUS 2 and pCONUS 2-HPC are neck-bridging devices that provide coiling support in the endovascular treatment of wide-necked intracranial aneurysms. To date, limited multicentre data has been published. This study provides the first pooled data from multiple UK centres regarding outcomes for these devices covering the periprocedural period to 6-month follow-up. MATERIALS/METHODS This retrospective, single-arm study assessed 65 patients treated over 3 years from the time of procedure to 6 months post-procedure across four UK centres. Data collected included patient demographics, aneurysm characteristics and antiplatelet regimens. Outcome measures were angiographic results and procedure-related complications from the immediate periprocedural period to 6-month follow-up. RESULTS Fifty-four unruptured (83.1%) and 11 ruptured (16.9%) aneurysms were treated. Fifty-five aneurysms were located in the anterior circulation (87.7%). There were four device-related intraprocedural complications: three cases of asymptomatic, temporary thrombus formation and one mortality associated with branch vessel occlusion and aneurysm re-bleeding in a ruptured case. There were no post-procedural device-related complications. Satisfactory occlusion was achieved in 58/65 procedures (89.2%) at time of treatment and in 44/60 (73.3%) at 6 months. Satisfactory occlusion correlated with aneurysm size and coiling packing density. Retreatment was required for five unruptured cases (7.7%) and was straightforward with the device in situ. CONCLUSION pCONUS 2 and pCONUS 2-HPC have good short-term safety profiles. The use of pCONUS 2-HPC in the acute treatment of ruptured aneurysms with postprocedural SAPT is feasible. The devices have an intraprocedural complication rate of 4/65 (6.2%) across multiple UK centres, including a single death (1.5%).
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Affiliation(s)
- James Yeomans
- Radiology Department, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, Wales, UK
| | - Simon Gatt
- Radiology Department, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, Scotland, UK
| | - Ezaz Habeeb Mohamed
- Radiology Department, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, Scotland, UK
| | - Robert Crossley
- 159003Radiology Department, Southmead Hospital, North Bristol NHS Trust, Bristol, England, UK
| | - Peter Keston
- Radiology Department, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, Scotland, UK
| | - David Minks
- 105563Radiology Department, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, England, UK
| | - Nicholas Dobbs
- 159003Radiology Department, Southmead Hospital, North Bristol NHS Trust, Bristol, England, UK
| | - Alexander Mortimer
- 159003Radiology Department, Southmead Hospital, North Bristol NHS Trust, Bristol, England, UK
| | - Jonathan Downer
- Radiology Department, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, Scotland, UK
| | - Anand Sastry
- Radiology Department, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, Wales, UK
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13
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Shaban S, Huasen B, Haridas A, Killingsworth M, Worthington J, Jabbour P, Bhaskar SMM. Digital subtraction angiography in cerebrovascular disease: current practice and perspectives on diagnosis, acute treatment and prognosis. Acta Neurol Belg 2022; 122:763-780. [PMID: 34553337 DOI: 10.1007/s13760-021-01805-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022]
Abstract
Digital Subtraction Angiography (DSA) is the gold-standard imaging modality in acute cerebrovascular diagnosis. The role of DSA has become increasingly prominent since the incorporation of endovascular therapy in standards of care for acute ischemic stroke. It is used in the assessment of cerebral vessel patency; however, the therapeutic role of DSA from a prognostic standpoint merits further investigation. The current paper provides an update on current practice on diagnostic, therapeutic and prognostic use of DSA in acute cerebrovascular diseases and various indications and perspectives that may apply, or limit its use, in ongoing surveillance or prognosis. Pre-clinical and clinical studies on the aspects, including but not limited to the morphology of cerebrovasculature in acute ischaemic stroke, are required to delineate and inform its prognostic role.
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Affiliation(s)
- Shirin Shaban
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, NSW, Australia
| | - Bella Huasen
- Department of Interventional Radiology, Lancashire University Teaching Hospitals, Lancashire Care NHS Foundation Trust, Preston, UK
| | - Abilash Haridas
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- Baycare Medical Group, Pediatric Neurosurgery, Cerebrovascular and Skull Base Neurosurgery, St Joseph's Hospital, Tampa, FL, USA
| | - Murray Killingsworth
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, NSW, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, Australia
- Department of Anatomical Pathology, Correlative Microscopy Facility, NSW Health Pathology, Sydney, Australia
| | - John Worthington
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- RPA Comprehensive Stroke Service and Department of Neurology, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Pascal Jabbour
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Sonu Menachem Maimonides Bhaskar
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia.
- University of New South Wales (UNSW), South Western Sydney Clinical School, Liverpool, NSW, Australia.
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, Australia.
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, Australia.
- Department of Neurology and Neurophysiology, Clinical Sciences Building, Liverpool Hospital, Elizabeth St, Liverpool, NSW, 2170, Australia.
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14
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Diestro JDB, Keough MB, Ashforth RA, Chow MM, Rempel JL, Marotta TR, O'Kelly C. Treatment of wide-necked bifurcation aneurysms with the eCLIPs device: 5-year experience of a single center. J Neurointerv Surg 2022; 15:461-464. [PMID: 35545426 DOI: 10.1136/neurintsurg-2022-018731] [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: 01/26/2022] [Accepted: 04/08/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The endovascular clip system (eCLIPs) is a novel device with both neck bridging and flow-diversion properties that make it suitable for the treatment of wide-necked bifurcation aneurysms. OBJECTIVE To describe the clinical and radiologic outcomes of the eCLIPs device, including the first-in-man use of the latest version of the device. METHODS This is a retrospective case series on all the wide-necked bifurcation aneurysms treated with the eCLIPs device in our center. The immediate and latest radiologic and clinical outcomes were assessed. RESULTS The device was successfully implanted in 12 of 13 patients. After a median follow-up period of 19 months (range 3-64 months), all patients with available data (11/12) had a good radiologic outcome (modified Raymond-Roy classification scores of 1 or 2). Two patients (18.2%) underwent re-treatment with simple coiling through the device. One of these had a subarachnoid hemorrhage prior to re-treatment. There were no major complications (death or permanent neurologic deficits) associated with use of the device. CONCLUSION Our series demonstrates occlusion rates that are similar to those of standard stent-assisted coiling and intrasaccular flow diversion for wide-necked bifurcation aneurysms. Larger registry-based studies are necessary to support our findings.
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Affiliation(s)
- Jose Danilo Bengzon Diestro
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael B Keough
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Robert A Ashforth
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Michael M Chow
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jeremy L Rempel
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas R Marotta
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Cian O'Kelly
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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15
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Dmytriw AA, Patel AB, Roy D, Spears J, Marotta TR, Diestro JDB. In Reply: Flow Diversion for Middle Cerebral Artery Aneurysms: An International Cohort Study. Neurosurgery 2022; 90:e178. [PMID: 35333206 DOI: 10.1227/neu.0000000000001934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/08/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aman B Patel
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Roy
- Département de Radiologie, Radio-oncologie et Médecine Nucléaire, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Julian Spears
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital (Unity Health), University of Toronto, Toronto, Ontario, Canada
| | - Thomas R Marotta
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital (Unity Health), University of Toronto, Toronto, Ontario, Canada
| | - Jose Danilo B Diestro
- Département de Radiologie, Radio-oncologie et Médecine Nucléaire, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Québec, Canada.,Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital (Unity Health), University of Toronto, Toronto, Ontario, Canada
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16
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Results of the pToWin Study: Using the pCONUS Device for the Treatment of Wide-Neck Intracranial Aneurysms. J Clin Med 2022; 11:jcm11030884. [PMID: 35160333 PMCID: PMC8836830 DOI: 10.3390/jcm11030884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/03/2022] Open
Abstract
Coil embolization has become a well-established option for the treatment of intracranial aneurysms. Yet, wide-neck bifurcation aneurysms (WNBAs) remain a challenge. The pCONUS is the first generation of a stent-like implant for the bridging of WNBAs to enable coiling. The pToWin study was a prospective, single-arm, multicenter study conducted to analyze the safety and efficacy of the pCONUS in the treatment of WNBAs. The primary effectiveness endpoint was the rate of adequate occlusion of the aneurysm at 3–6 and 7–12 months. The primary safety endpoint was the occurrence of major ipsilateral stroke or neurological death during the follow-up. A total of 115 patients were included. Aneurysm locations were the middle cerebral artery in 52 (45.2%), the anterior communicating artery in 35 (30.4%), the basilar artery in 23 (20%), the internal carotid artery terminus in three (2.6%), and the pericallosal artery in two (1.7%) patients. Treatment was successfully performed in all but one patient. The morbi-mortality rate was 1.9% and 2.3% at 3–6 and 7–12 months, respectively. Of the aneurysms, 75.0% and 65.6% showed adequate occlusion at 3–6 and 7–12 months, respectively. pCONUS offers a safe and reasonably effective treatment of WNBAs, demonstrated by acceptable adequate aneurysm occlusion and low rates of adverse neurologic events.
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Propensity score-adjusted analysis on stent-assisted coiling versus coiling alone for ruptured intracranial aneurysms. Sci Rep 2021; 11:21742. [PMID: 34741073 PMCID: PMC8571381 DOI: 10.1038/s41598-021-01156-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/14/2021] [Indexed: 11/08/2022] Open
Abstract
Stent-assisted coiling (SAC) for ruptured intracranial aneurysms (RIAs) remains controversial due to an inherent risk of potential thromboembolic and hemorrhagic complications. We compared SAC and coiling alone for the management of RIAs using propensity score-adjustment. Sixty-four patients treated by SAC and 220 by stand-alone coiling were retrospectively reviewed and compared using inverse probability of treatment weighting (IPTW) with propensity scores. Functional outcome, procedure-related and overall complications and angiographic results were analyzed. Aneurysms treated by SAC had a larger diameter, a wider neck and were more frequently located at the posterior circulation. SAC had a higher risk for thromboembolic complications (17.2% vs. 7.7%, p = 0.025), however, this difference did not persist in the IPTW analysis (OR 1.2, 95% CI 0.7-2.3, adjusted p = 0.458). In the adjusted analysis, rates of procedural cerebral infarction (p = 0.188), ventriculostomy-related hemorrhage (p = 0.584), in-hospital mortality (p = 0.786) and 6-month favorable functional outcome (p = 0.471) were not significantly different between the two groups. SAC yielded a higher complete occlusion (80.0% vs. 67.2%, OR 3.2, 95% CI 1.9-5.4, p < 0.001) and a lower recanalization rate (17.5% vs. 26.1%, OR 0.3, 95% CI 0.2-0.6, p < 0.001) than stand-alone coiling at 6-month follow-up. In conclusion, SAC of large and wide-necked RIAs provided higher aneurysm occlusion and similar clinical outcome, when compared to stand-alone coiling.
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18
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Yeomans J, Sastry A. pCONUS 2 and pCONUS 2-HPC for the treatment of wide-necked intracranial aneurysms: Periprocedural, 6-month, and early 2-year follow-up outcomes. Interv Neuroradiol 2021; 27:805-814. [PMID: 33887974 DOI: 10.1177/15910199211011887] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/PURPOSE pCONUS 2 and pCONUS 2-HPC are novel neck-bridging devices designed to support endovascular coil occlusion of wide-necked intracranial bifurcation aneurysms. This study summarises periprocedural outcomes, 6-month, and early 2-year follow-up results following its introduction in an interventional neuroradiology centre. MATERIALS/METHODS This prospective, single-arm study assessed 20 aneurysms treated over a 40 month time period from time of procedure to 2 years post-procedure. Data collected included patient demographics, aneurysm features, and intraprocedural, 6-month, and 2-year post-procedural complications and angiographic features. RESULTS The mean age of the cohort was 59+-SD 7.7 years. 16 unruptured aneurysms were treated (pCONUS 2 13/16, pCONUS 2-HPC 3/16) and 4 ruptured aneurysms were treated with pCONUS 2-HPC. Unruptured cases received dual antiplatelet therapy pre- and post-procedure while ruptured cases received single antiplatelet therapy. 9/20 aneurysms were located at the MCA bifurcation and 7/20 at the basilar tip. The remaining 4 aneurysms were at various bifurcations in the anterior circulation. 11/20 were small (<10mm) and 9/20 were large (10-25mm). There was one periprocedural complication: a retroperitoneal bleed. There were no post-procedural intracranial complications or at 6-months follow-up. At 6 months, satisfactory occlusion was achieved in 94% of cases (15/16). There was one delayed death at 2-year follow-up from an unrelated cause. CONCLUSION pCONUS 2 and pCONUS 2-HPC have excellent short and medium-term safety profiles and clinical outcomes with no procedure-related mortality or morbidity and good occlusion rates at 6-month follow-up. The use of pCONUS 2-HPC with single antiplatelet therapy is feasible and did not cause any complications.
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Affiliation(s)
- J Yeomans
- University Hospital of Wales, Cardiff, UK
| | - A Sastry
- University Hospital of Wales, Cardiff, UK
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Larson AS, Mehta T, Grande AW. Neurosurgical management of aneurysms of the vertebrobasilar system: increasing indications for endovascular therapy with a continued role for open microneurosurgery. Neurosurg Rev 2021; 44:2469-2476. [PMID: 33409762 DOI: 10.1007/s10143-020-01460-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/16/2020] [Accepted: 12/09/2020] [Indexed: 11/26/2022]
Abstract
Aneurysms of the vertebrobasilar system remain among the most challenging subsets of aneurysms to treat with an open surgical approach. Since Charles Drake's pioneering work in the 1960s, several advances in microsurgical techniques have improved outcomes and feasibility in the open surgical management of these aneurysms. In parallel, the field of endovascular neurosurgery has provided several safe and effective treatment options. Multiple trials have suggested that endovascular therapy for aneurysms of the vertebrobasilar system is superior to open surgical management in most cases. In some instances, however, open surgical management likely represents a more effective and durable option relative to endovascular therapy. Therefore, continued training of future cerebrovascular specialists in open surgery of vertebrobasilar aneurysms remains crucial. With widespread utilization of endovascular techniques, however, proper exposure of trainees to such aneurysms is growing increasingly difficult. In this review, we discuss the recent advances in the endovascular management of vertebrobasilar aneurysms while also emphasizing the continued importance of open microneurosurgery in such cases.
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Affiliation(s)
- Anthony S Larson
- Department of Neurosurgery, University of Minnesota Medical School, 420 Delaware St SE., Minneapolis, MN, 55455, USA.
| | - Tapan Mehta
- Department of Neurosurgery, University of Minnesota Medical School, 420 Delaware St SE., Minneapolis, MN, 55455, USA
- Department of Interventional Neuroradiology and Neurology, Ayer Neuroscience Institute, Hartford Healthcare, West Hartford, CT, USA
| | - Andrew W Grande
- Department of Neurosurgery, University of Minnesota Medical School, 420 Delaware St SE., Minneapolis, MN, 55455, USA
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Narsinh KH, Caton MT, Mahmood NF, Higashida RT, Halbach VV, Hetts SW, Amans MR, Dowd CF, Cooke DL. Intrasaccular flow disruption (WEB) of a large wide-necked basilar apex aneurysm using PulseRider-assistance. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2020; 24. [PMID: 33816125 PMCID: PMC8018600 DOI: 10.1016/j.inat.2020.101072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Large, wide-necked basilar apex aneurysms are difficult to treat. Microsurgical clipping can result in neurologic morbidity and mortality. Endovascular treatment often leaves remnants that need retreatment and/or stent placement with dual antiplatelet therapy. The Woven EndoBridge (WEB) is an intrasaccular flow disruption device that can be used without dual antiplatelet therapy. However, the WEB cannot typically be used in large or giant aneurysms > 10 mm because the largest diameter device is the 11 × 9.6 mm single layer sphere (SLS). We present a case in which we use a PulseRider aneurysm neck reconstruction device in the basilar artery to assist in WEB deployment within a 22 mm basilar apex aneurysm with 14 mm neck, thereby permitting aspirin monotherapy postoperatively.
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Affiliation(s)
- Kazim H Narsinh
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
| | - M Travis Caton
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
| | - Nausheen F Mahmood
- Department of Neurology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Randall T Higashida
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
| | - Van V Halbach
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
| | - Steven W Hetts
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
| | - Matthew R Amans
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
| | - Christopher F Dowd
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
| | - Daniel L Cooke
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
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Particle Image Velocimetry Measurements of the Flow-Diverting Effects of a New Generation of the eCLIPs Implant for the Treatment of Intracranial Bifurcation Aneurysms. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10238639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Flow diverters (FDs) for the endovascular treatment of intracranial aneurysms are effective for sidewall aneurysms, but their use at a bifurcation is problematic because FDs only partially cover the aneurysm neck and impede flow into a daughter branch; they are thus not employed routinely in this anatomy. eCLIPs was developed as a non-tubular implant to completely cover the neck of an aneurysm and serve as a coil retention device necessary for the adequate treatment of wide-neck bifurcation aneurysms. eCLIPs has shown some flow diversion effects in bifurcation anatomy but not equal to those exhibited by clinically accepted flow diverters in sidewall anatomy. A new generation of eCLIPs implant, the eCLIPs bifurcation flow diverter (eBFD), with higher metal coverage, was developed to achieve a similar flow diversion as a Pipeline Embolization Device (PED), a prototypical FD. Particle image velocimetry was used to capture the fluid dynamics and velocity reduction within silicone aneurysm replicas. A circulatory mimicking loop was developed to circulate the flow through the silicone models. All generations of eCLIPs implants had some flow-diverting effect, with increasing metal coverage density of the implant proportionately increasing the flow diversion effect. The eBFD, with a metal density of 35%, showed greater flow diversion than PED, with 30% metal density, for bifurcation anatomy. The eBFD showed similar reduction of flow in a bifurcation anatomy to PED in a sidewall, both sufficient to permit early thrombosis of the aneurysm. Thus, the eBFD can potentially provide sufficient flow diversion for the treatment of bifurcation aneurysms to avoid adjunctive coiling.
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