1
|
D Vera D, Cardenas SA, Ortiz AF, Rodriguez AM, Ferreira CA, Serrano S, Reyes A, Galvis M, Vargas O, Mantilla DE. Safety and Efficacy of Endovascular Coils and Non-Flow-Diverting Stents for Management of Unruptured Intracranial Aneurysms: A Location-Specific Outcomes Analysis. World Neurosurg 2024; 182:e734-e741. [PMID: 38081582 DOI: 10.1016/j.wneu.2023.12.028] [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: 11/15/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 01/07/2024]
Abstract
INTRODUCTION The relationship between the anatomical location of an unruptured saccular aneurysm, the efficacy, and the potential complications associated with coil and non-flow-diverting stents remains poorly documented. Therefore, the aim of this study is to evaluate the efficacy and safety of endovascular treatment based on the anatomical position of the unruptured intracranial aneurysm (UIA). METHODS A retrospective cohort study was conducted using an anonymized database of patients who underwent endovascular therapy for UIAs between 2014 and 2021. RESULTS A total of 138 patients with 147 UIAs were included. Immediate Raymond-Roy occlusion class I or II was achieved in 99.2% of patients in all anatomical locations, with a 96.2% occlusion rate at the 12-month follow-up. Complications occurred more frequently in the anterior cerebral artery (35%) and internal carotid artery in its ophthalmic segment (25%). However, the difference was not statistically significant. CONCLUSIONS Our study shows that endovascular treatment with stents and coils is effective and safe for managing UIAs in various anatomical locations. The incidence of thromboembolic complications was significantly higher for UIAs located in the anterior cerebral artery.
Collapse
Affiliation(s)
- Daniela D Vera
- Interventional Radiology Department, Fundación Oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia.
| | - Sauder A Cardenas
- Interventional Radiology Department, Fundación Oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia; Interventional Radiology Department, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Andrés F Ortiz
- Interventional Radiology Department, Fundación Oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia; Interventional Radiology Department, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Adriana M Rodriguez
- Interventional Radiology Department, Fundación Oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia
| | - Carlos A Ferreira
- Interventional Radiology Department, Fundación Oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia
| | - Sergio Serrano
- Research Group-UNAB, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Adriana Reyes
- Research Group-UNAB, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Melquizidel Galvis
- Interventional Radiology Department, Fundación Oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia; Interventional Radiology Department, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Oliverio Vargas
- Interventional Radiology Department, Fundación Oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia; Interventional Radiology Department, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Daniel E Mantilla
- Interventional Radiology Department, Fundación Oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia; Interventional Radiology Department, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| |
Collapse
|
2
|
Chatterjee A, Mahajan A, Banga V, Ojha P, Goel G. Y Stenting in Wide-Necked Bifurcation Aneurysms: A Single-Center Experience. INDIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1055/s-0041-1730103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractStent-assisted coiling is an endovascular means of managing wide-necked bifurcation aneurysms. In spite of the wide availability of various newer devices in managing such difficult aneurysms, the Y stenting offers a safe and cost-effective alternative to treat such cases in resource poor settings. This article provides an insight of our initial six cases of Y stent-assisted coiling along with their follow-up over a period of 6 months with no recanalization in any case. It also highlights the various technical aspects involved in such cases. One case had recurrent subdural hematoma probably due to use of antiplatelets and another patient had sudden dip in level of consciousness probably due to hematoma expansion that might also have been due to antiplatelet usage. However, none of the cases had any issues regarding stent migration, malapposition, and dissection. In our experience, Neuroform Atlas stent used for Y stenting offers a safe and technically easy alternative to various newer bifurcation devices.
Collapse
Affiliation(s)
- Apratim Chatterjee
- Department of Neurointervention, Medanta, The Medicity, Gurugram, Haryana, India
| | - Anshu Mahajan
- Department of Neurointervention, Medanta, The Medicity, Gurugram, Haryana, India
| | - Vinit Banga
- Department of Neurointervention, Medanta, The Medicity, Gurugram, Haryana, India
| | - Piyush Ojha
- Department of Neurointervention, Medanta, The Medicity, Gurugram, Haryana, India
| | - Gaurav Goel
- Department of Neurointervention, Medanta, The Medicity, Gurugram, Haryana, India
| |
Collapse
|
3
|
Lv X, Zhang W, Zhao X, Zhang H, Wang J. Endovascular Treatment of Small Wide-Neck Bifurcation Aneurysms with Single Solitaire AB Stent Technique. Neurol India 2021; 69:879-882. [PMID: 34507405 DOI: 10.4103/0028-3886.323897] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE We present our experience in using the single Solitaire AB stent for small wide-neck bifurcation aneurysms (WNBAs). MATERIALS AND METHODS During 18 months, 20 small (the largest width <10 mm) WNBAs were treated with the single Solitaire AB stent-assisted coiling. The patients were 12 women and 8 men, with a mean age of 52 years (range: 36-66 years). The mean aneurysm size was 4.2 mm (2-9 mm) and mean neck size was 3.9 mm (2-9 mm). Results at follow-up were graded as complete occlusion, neck remnant, or residual aneurysm. RESULTS All 20 small WNBAs were adequately occluded after a single Solitaire AB stent placement. There were no procedural ruptures and no thromboembolic complications occurred. Two patients developed a transient neurological deficit. In 20 patients with angiographic follow-up at 6 months, 16 (80%) aneurysms remained adequately occluded. Clinical follow-up in the 20 patients revealed mRS 0-2 in all. CONCLUSIONS Single Solitaire AB stent-assisted coil embolization for small WNBAs was safe and effective.
Collapse
Affiliation(s)
- Xianli Lv
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wei Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xuelian Zhao
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Huifang Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - James Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| |
Collapse
|
4
|
Granja MF, Cortez GM, Aguilar-Salinas P, Agnoletto GJ, Imbarrato G, Jaume A, Aghaebrahim A, Sauvageau E, Hanel RA. Stent-assisted coiling of cerebral aneurysms using the Y-stenting technique: a systematic review and meta-analysis. J Neurointerv Surg 2019; 11:683-689. [PMID: 30610070 DOI: 10.1136/neurintsurg-2018-014517] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/08/2018] [Accepted: 11/26/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Bifurcation aneurysms can be treated with stent-assisted coiling using two stents in a Y-configuration. We aim to investigate the angiographic and clinical outcomes of Y-stent constructs for the treatment of intracranial aneurysms. METHODS A systematic review of PubMed, Ovid MEDLINE, and Ovid EMBASE databases was conducted based on PRISMA guidelines. The study selection was performed using the 'Ryyan' application. Our analysis included 18 studies with 327 patients. Inclusion criteria were: articles published from January 2000 to November 2017, English language, including cerebral aneurysms treated via Y-stenting, and ≥5 cases with radiographic/clinical outcomes. Technical notes, editorials, reviews, and animal studies were excluded. A random-effect meta-analysis was performed on angiographic and clinical outcomes, including aneurysm occlusion, modified Rankin Scale, neurological outcome, and procedure-related mortality. 95% CIs and event rates were estimated. Statistical heterogeneity was assessed using I2 statistics. RESULTS The procedure-related good outcome rate was 92% and complete occlusion rate was 91%. The permanent neurological deficit rate was 4% and procedure-related mortality was 2%. The procedure-related stroke rate was 12%. A total of 28/146 (19%) patients had ruptured aneurysms. At long-term follow-up, overall stroke rate was 9% in patients with unruptured aneurysm. The mortality rate was higher in cases with ruptured aneurysms than in those with unruptured aneurysms (18% vs 0.8%; p<0.001). CONCLUSIONS Y-stenting for bifurcation aneurysms yields a high rate of complete occlusion and low rates of mortality and stroke. Careful patient selection is needed.
Collapse
Affiliation(s)
- Manuel F Granja
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Gustavo M Cortez
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | | | | | - Gregory Imbarrato
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | | | - Amin Aghaebrahim
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Eric Sauvageau
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Ricardo A Hanel
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| |
Collapse
|
5
|
Samaniego EA, Mendez AA, Nguyen TN, Kalousek V, Guerrero WR, Dandapat S, Dabus G, Linfante I, Hassan AE, Drofa A, Kouznetsov E, Leedahl D, Hasan D, Maud A, Ortega-Gutierrez S. LVIS Jr Device for Y-Stent-Assisted Coil Embolization of Wide-Neck Intracranial Aneurysms: A Multicenter Experience. INTERVENTIONAL NEUROLOGY 2018; 7:271-283. [PMID: 29765397 DOI: 10.1159/000487545] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/09/2018] [Indexed: 01/19/2023]
Abstract
Background and Purpose Complex wide-neck intracranial aneurysms are challenging to treat. We report a multicenter experience using the LVIS Jr stent for "Y-stent"-assisted coiling embolization of wide-neck bifurcation aneurysms. Methods Seven centers provided retrospective data on patients who underwent Y-stenting. Technical complications, immediate posttreatment angiographic results, clinical outcomes, and imaging follow-up were assessed. Results Thirty patients/aneurysms were treated: 15 basilar tip, 8 middle cerebral artery, 4 anterior communicating artery, 1 pericallosal, and 2 posterior inferior cerebellar artery aneurysms. The mean aneurysm size was 11 mm and the mean dome-to-neck ratio was 1.3 mm. Twenty-four aneurysms were unruptured and treated electively, and 6 were acutely ruptured. Fifty-eight LVIS Jr stents were successfully deployed without any technical issue. One pro-cedural and transient in-stent thrombosis resolved with the intravenous infusion of a glycoprotein IIb/IIIa inhibitor. Five periprocedural complications (within 30 days) occurred: 2 periprocedural neurological complications (1 small temporal stroke that presented with transient aphasia and 1 posterior cerebral artery infarct) and 3 nonneurological periprocedural complications (2 retroperitoneal hematomas, and 1 patient developed a disseminated intravascular coagulopathy). One permanent complication (3.3%) directly related to Y-stenting was reported in the patient who suffered the posterior cerebral artery infarct. Immediate complete obliteration (Raymond-Roy Occlusion Classification [RROC] I-II) was achieved in 26 cases (89.6%). Twenty-four patients had clinical and imaging follow-up (mean 5.2 months). Complete angiographic occlusion (RROC I-II) was observed in 23 patients (96%). A good functional outcome with a modified Rankin Scale score ≤2 was achieved in 26 cases. Conclusions In this multicenter case series, Y-stent-assisted coiling of wide-neck aneurysms with the LVIS Jr device was feasible and relatively safe. Follow-up imaging demonstrated very low recanalization rates.
Collapse
Affiliation(s)
- Edgar A Samaniego
- Department of Neurology, Neurosurgery and Radiology, University of Iowa, Iowa, Iowa, USA
| | - Aldo A Mendez
- Department of Neurology, Neurosurgery and Radiology, University of Iowa, Iowa, Iowa, USA
| | - Thanh N Nguyen
- Department of Neurology, Neurosurgery and Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Vladimir Kalousek
- Department of Radiology, Clinical Hospital Center "Sestre Milosrdnice,", Zagreb, Croatia
| | - Waldo R Guerrero
- Department of Neurology, Neurosurgery and Radiology, University of Iowa, Iowa, Iowa, USA
| | - Sudeepta Dandapat
- Department of Neurology, Neurosurgery and Radiology, University of Iowa, Iowa, Iowa, USA
| | - Guilherme Dabus
- Miami Cardiac and Vascular Institute and Baptist Neuroscience Center, Miami, Florida, USA
| | - Italo Linfante
- Miami Cardiac and Vascular Institute and Baptist Neuroscience Center, Miami, Florida, USA
| | | | - Alexander Drofa
- Department of Neurosurgery, Sanford Brain & Spine Center, Fargo, North Dakota, USA
| | - Evgueni Kouznetsov
- Department of Neurosurgery, Sanford Brain & Spine Center, Fargo, North Dakota, USA
| | - David Leedahl
- Pharmacy Services, Sanford Medical Center, Fargo, North Dakota, USA
| | - David Hasan
- Department of Neurosurgery, University of Iowa, Iowa, Iowa, USA
| | - Alberto Maud
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | | |
Collapse
|
6
|
Spiotta AM, Chaudry MI, Turner RD, Turk AS, Derdeyn CP, Mocco J, Tateshima S. An Update on the Adjunctive Neurovascular Support of Wide-Neck Aneurysm Embolization and Reconstruction Trial: 1-Year Safety and Angiographic Results. AJNR Am J Neuroradiol 2018; 39:848-851. [PMID: 29599174 DOI: 10.3174/ajnr.a5599] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/10/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE The safety and efficacy of the PulseRider for the treatment of wide-neck, bifurcation aneurysms at the basilar and carotid terminus locations were studied in a prospective trial, the Adjunctive Neurovascular Support of Wide-Neck Aneurysm Embolization and Reconstruction (ANSWER) trial, reporting on initial 6-month angiographic and clinical results. This report provides insight into the longer term durability and safety with 12-month data. MATERIALS AND METHODS Aneurysms treated with the PulseRider among enrolled sites were prospectively studied. Updated 12-month data on clinical and imaging end points are included. RESULTS Thirty-four patients were enrolled (29 women, 5 men) with a mean age of 60.9 years. The mean aneurysm height ranged from 2.4 to 15.9 mm with a mean neck size of 5.2 mm (range, 2.3-11.6 mm). At 1 year, there were no device migrations or symptomatic in-stent stenoses. Raymond-Roy I occlusion was achieved in 53% of cases at the time of treatment and progressed to 61% and 67% at 6 and 12 months, respectively. Adequate occlusion (Raymond-Roy I/II) progressed from 88% at 6 months to 90% at 12 months. No recanalizations were observed. There was 1 delayed ischemic event. Good outcome (mRS 0-2) was achieved in 90% of patients. CONCLUSIONS The updated 1-year results from the ANSWER trial demonstrate aneurysm stability and an acceptable safety profile for aneurysms treated at the basilar apex and carotid terminus. Prospective data from a larger set of aneurysms treated at other locations are required to assess how treatment with PulseRider compares with alternatives for treating wide-neck bifurcation aneurysms.
Collapse
Affiliation(s)
- A M Spiotta
- From the Department of Neurosurgery (A.M.S., M.I.C., R.D.T., A.S.T.), Medical University of South Carolina, Charleston, South Carolina
| | - M I Chaudry
- From the Department of Neurosurgery (A.M.S., M.I.C., R.D.T., A.S.T.), Medical University of South Carolina, Charleston, South Carolina
| | - R D Turner
- From the Department of Neurosurgery (A.M.S., M.I.C., R.D.T., A.S.T.), Medical University of South Carolina, Charleston, South Carolina
| | - A S Turk
- From the Department of Neurosurgery (A.M.S., M.I.C., R.D.T., A.S.T.), Medical University of South Carolina, Charleston, South Carolina
| | - C P Derdeyn
- Department of Radiology (C.P.D.), University of Iowa, Iowa City, Iowa
| | - J Mocco
- Department of Neurosurgery (J.M.), Mount Sinai Hospital, New York, New York
| | - S Tateshima
- Department of Radiology (S.T.), University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
7
|
Mokhtar NH, Abas A, Razak NA, Hamid MNA, Teong SL. Effect of different stent configurations using Lattice Boltzmann method and particles image velocimetry on artery bifurcation aneurysm problem. J Theor Biol 2017; 433:73-84. [PMID: 28844907 DOI: 10.1016/j.jtbi.2017.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 08/10/2017] [Accepted: 08/15/2017] [Indexed: 12/15/2022]
Abstract
Proper design of stent for application at specific aneurysm effect arteries could help to reduce the issues with thrombosis and aneurysm. In this paper, four types of stent configuration namely half-Y (6 mm), half-Y (4 mm), cross-bar, and full-Y configuration will implanted on real 3D artery bifurcation aneurysm effected arteries. Comparisons were then conducted based on the flow patterns after stent placement using both LBM-based solver and PIV experimental findings. According to the data obtained from all 4 stent designs, the flow profiles and the computed velocity from both methods were in agreement with each other. Both methods found that half-Y (6 mm) stent configuration is by far the best configuration in reducing the blood velocity at the vicinity of the aneurysm sac. The analysis also show that the half-Y (6 mm) stent configuration recorded the highest percentage of velocity reduction and managed to substantially reduce the pressure at the bifurcation region. This high flow velocity reduction through the use of half-Y stent could consequently promote the formation of thrombus thereby reducing the risk of rupture in the aneurysm sac.
Collapse
Affiliation(s)
- N Hafizah Mokhtar
- School of Mechanical Engineering, Universiti Sains Malaysia, Engineering Campus, Nibong Tebal, Penang 14300, Malaysia
| | - Aizat Abas
- School of Mechanical Engineering, Universiti Sains Malaysia, Engineering Campus, Nibong Tebal, Penang 14300, Malaysia.
| | - N A Razak
- School of Aerospace Engineering, Universiti Sains Malaysia, Engineering Campus, Nibong Tebal, Penang 14300, Malaysia
| | | | - Soon Lay Teong
- School of Mechanical Engineering, Universiti Sains Malaysia, Engineering Campus, Nibong Tebal, Penang 14300, Malaysia
| |
Collapse
|
8
|
Spiotta AM, Derdeyn CP, Tateshima S, Mocco J, Crowley RW, Liu KC, Jensen L, Ebersole K, Reeves A, Lopes DK, Hanel RA, Sauvageau E, Duckwiler G, Siddiqui A, Levy E, Puri A, Pride L, Novakovic R, Chaudry MI, Turner RD, Turk AS. Results of the ANSWER Trial Using the PulseRider for the Treatment of Broad-Necked, Bifurcation Aneurysms. Neurosurgery 2017; 81:56-65. [DOI: 10.1093/neuros/nyx085] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 04/05/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: The safety and probable benefit of the PulseRider (Pulsar Vascular, Los Gatos, California) for the treatment of broad-necked, bifurcation aneurysms was studied in the context of the prospective, nonrandomized, single arm clinical trial—the Adjunctive Neurovascular Support of Wide-neck aneurysm Embolization and Reconstruction (ANSWER) Trial.
OBJECTIVE: To present the results of the United States cases employing the PulseRider device as part of the ANSWER clinical trial.
METHODS: Aneurysms treated with the PulseRider device among sites enrolling in the ANSWER trial were prospectively studied and the results are summarized. Aneurysms arising at either the carotid terminus or basilar apex that were relatively broad necked were considered candidates for inclusion into the ANSWER study.
RESULTS: Thirty-four patients were enrolled (29 female and 5 male) with a mean age of 60.9 years (27 basilar apex and 7 carotid terminus). Mean aneurysm height ranged from 2.4 to 15.9 mm with a mean neck size of 5.2 mm (range 2.3-11.6 mm). In all patients, the device was delivered and deployed. Immediate Raymond I or II occlusion was achieved in 82.4% and progressed to 87.9% at 6-month follow-up. A modified Rankin Score of 2 or less was seen in 94% of patients at 6 months.
CONCLUSION: The results from the ANSWER trial demonstrate that the PulseRider device is safe and offers probable benefit as for the treatment of bifurcation aneurysms arising at the basilar apex or carotid terminus. As such, it represents a useful addition to the armamentarium of the neuroendovascular specialist.
Collapse
Affiliation(s)
- Alejandro M. Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Colin P. Derdeyn
- Department of Radiolo-gy, Neurology and Neurosurgery, Univer-sity of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Satoshi Tateshima
- Department of Radiology, UCLA Medical Center, Santa Monica, Cali-fornia
| | - Jay Mocco
- Department of Neurosurgery, Mount Sinai Medical Center, Miami Beach, Florida
| | - R. Webster Crowley
- Department of Neuro-surgery, Rush University Medical Center, Chicago, Illinois
| | - Kenneth C. Liu
- Department of Neuro-surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Lee Jensen
- De-partment of Radiology, University of Vir-ginia School of Medicine, Charlottesville, Virginia
| | - Koji Ebersole
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Alan Reeves
- Department of Ra-diology, University of Kansas Medical Center, Kansas City, Kansas
| | - Demetrius K. Lopes
- Department of Neuro-surgery, Rush University Medical Center, Chicago, Illinois
| | - Ricardo A. Hanel
- Depart-ment of Neurosurgery, Baptist Health, Jacksonville, Florida
| | - Eric Sauvageau
- Depart-ment of Neurosurgery, Baptist Health, Jacksonville, Florida
| | - Gary Duckwiler
- Department of Radiology, UCLA Medical Center, Santa Monica, Cali-fornia
| | - Adnan Siddiqui
- Department of Neurosurgery, University at Buffalo, Buf-falo, New York
| | - Elad Levy
- Department of Neurosurgery, University at Buffalo, Buf-falo, New York
| | - Ajit Puri
- Department of Ra-diology, UMass Memorial Medical Cen-ter, Worcester, Massachusetts
| | - Lee Pride
- Depart-ment of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Roberta Novakovic
- Depart-ment of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - M. Imran Chaudry
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Raymond D. Turner
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Aquilla S. Turk
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
9
|
Ge H, Jin H, Li Y, Lv X. Extraction of a migrated coil from the Enterprise stent strut using a Solitaire AB stent. Neuroradiol J 2016; 29:470-472. [PMID: 27558991 PMCID: PMC5131764 DOI: 10.1177/1971400916666556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A 56-year-old woman was admitted to stent-assisted coiling for a 2-mm A1 aneurysm of the left anterior cerebral artery and a left 3-mm internal carotid artery aneurysm. While coiling the A1 aneurysm, the first 2 mm × 20 mm coil migrated through the 4.5 mm × 37 mm Enterprise stent struts, lodging at the distal anterior cerebral artery. A 4 mm × 15 mm Solitaire AB stent was used successfully in this case to remove the displaced coil. The A1 aneurysm was re-treated with a 2 mm × 40 mm coil after placement of the Enterprise stent, and the ophthalmic ICA aneurysm was also coiled through the stent struts. The patient was neurologically intact after treatment.
Collapse
Affiliation(s)
- Huijian Ge
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, China
| | - Hengwei Jin
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, China
| | - Youxiang Li
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, China
| | - Xianli Lv
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, China
| |
Collapse
|
10
|
Mukherjee S, Chandran A, Gopinathan A, Putharan M, Goddard T, Eldridge PR, Patankar T, Nahser HC. PulseRider-assisted treatment of wide-necked intracranial bifurcation aneurysms: safety and feasibility study. J Neurosurg 2016; 127:61-68. [PMID: 27689454 DOI: 10.3171/2016.2.jns152334] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The goal of this study was to assess the safety and feasibility of PulseRider, a novel endovascular stent, in the treatment of intracranial bifurcation aneurysms with wide necks. The authors present the initial results of the first 10 cases in which the PulseRider device was used. METHODS Patients whose aneurysms were intended to be treated with the PulseRider device at 2 institutions in the United Kingdom were identified prospectively. Patient demographics, procedural details, immediate neurological and clinical status, and immediate angiographic outcomes and 6-month clinical and imaging follow-up were recorded prospectively. RESULTS At the end of the procedure, all 10 patients showed complete aneurysm occlusion (Raymond Class 1). There were no significant intraprocedural complications except for an occurrence of thromboembolism without clinical sequelae. There was no occurrence of aneurysm rupture or vessel dissection. At 6-month follow-up, 7 and 3 patients had modified Rankin Scale scores of 0 and 1, respectively. All 10 patients had stable aneurysm occlusion (Raymond Class 1) and daughter vessel intraluminal patency on 6-month follow-up catheter angiography. CONCLUSIONS The authors' early experience with the PulseRider device demonstrates that it is a safe and effective adjunct in the treatment of bifurcation aneurysms with wide necks arising at the middle cerebral artery bifurcation, anterior cerebral artery, basilar apex, and carotid terminus. It works by providing a scaffold at the neck of the bifurcation aneurysm, enabling neck remodeling and coil support while maintaining parent vessel intraluminal patency. Early clinical and radiological follow-up showed good functional outcome and stable occlusion rates, respectively. Further data are needed to assess medium- and long-term outcomes with PulseRider.
Collapse
Affiliation(s)
| | | | - Anil Gopinathan
- Interventional Neuroradiology, Leeds General Infirmary, Leeds;,Departments of 2 Neuroradiology and
| | | | - Tony Goddard
- Interventional Neuroradiology, Leeds General Infirmary, Leeds
| | - Paul R Eldridge
- Neurosurgery, The Walton Centre, Lower Lane, Fazakerley, Liverpool, United Kingdom
| | - Tufail Patankar
- Interventional Neuroradiology, Leeds General Infirmary, Leeds
| | | |
Collapse
|
11
|
Jeong HW, Seung WB. Outcomes of Stent-assisted Coil Embolization of Wide-necked Intracranial Aneurysms Using the Solitaire™ AB Neurovascular Remodeling Device. J Cerebrovasc Endovasc Neurosurg 2016; 17:301-12. [PMID: 27066440 PMCID: PMC4823427 DOI: 10.7461/jcen.2015.17.4.301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 11/12/2015] [Accepted: 12/19/2015] [Indexed: 11/27/2022] Open
Abstract
Objective This retrospective study presents our experience with respect to the clinical and angiographic outcomes of patients treated with stent-assisted coil embolization using Solitaire™ AB stents. Materials and Methods From March 2011 to December 2014, 50 patients with 55 wide-necked and/or complex intracranial aneurysms were evaluated. Four patients presented with an acute subarachnoid hemorrhage. Stent deployment was performed with a standard coiling procedure in 49 aneurysms. Three patients underwent bailout stenting, 2 patients were treated by temporary stenting and one patient was treated only by stenting without coiling for dissecting aneurysm. Results Successful placement of the Solitaire AB stent was achieved in all the cases. Based on the postprocedural angiographic results, a Raymond 1 was obtained in 32 (59%) of 54 aneurysms, excluded by one case of dissecting aneurysm, and a Raymond 2 in 13 (24%), and a Raymond 3 in 9 (17%). There was one thromboembolic (2%) and three hemorrhagic complications (6%). However, procedure-related morbidity or mortality was not found. Annual follow-up angiographic results from the embolization were obtained in 40 (74.1%) of 54 cases. These results were represented as Raymond 1 in 27 (67.5%), class 2 in 9 (22.5%), and class 3 in 4 (10%) cases. Angiographic improvement associated with progressive thrombosis of the aneurysm was obtained in 10 aneurysms. Four aneurysms were recanalized without requiring additional treatment. In-stent stenosis was found in one aneurysm, but stent migration was not seen on follow-up angiography. Conclusion Stent-assisted coil embolization using the Solitaire AB stent for treating wide-necked and/or complex intracranial aneurysms was found to be safe and effective immediately post-embolization and after follow-up. Long-term follow-up will be required to identify the effect of the Solitaire AB stent on recanalization rates.
Collapse
Affiliation(s)
- Hae Woong Jeong
- Department of Diagnostic Radiology, Busan Baik Hospital, Inje University, Busan, Korea
| | - Won-Bae Seung
- Department of Neurosurgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| |
Collapse
|
12
|
Zhang J, Wang D, Li X. Solitaire AB stent-assisted coiling embolization for the treatment of ruptured very small intracranial aneurysms. Exp Ther Med 2015; 10:2239-2244. [PMID: 26668623 DOI: 10.3892/etm.2015.2826] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 03/16/2015] [Indexed: 11/05/2022] Open
Abstract
Recent advances in neuroradiological techniques have increasingly improved the diagnosis rate for very small aneurysms, particularly with the widespread use of three-dimensional cerebral angiography. However, the treatment of very small aneurysms remains a considerable challenge for neurosurgeons. Endovascular coiling has emerged as a potential treatment option for intracranial aneurysms. The aim of the present study was to evaluate the safety and efficacy of Solitaire AB stent-assisted coiling embolization for the treatment of ruptured very small intracranial aneurysms. This retrospective study included nine consecutive patients with ruptured very small intracranial aneurysms (≤3 mm) that underwent Solitaire AB stent-assisted coiling embolization. The aneurysms were located in the ophthalmic branch of the internal carotid artery (n=2), the posterior communicating branch of the internal carotid artery (n=4), the top of the basilar artery (n=1) and the middle cerebral artery (n=2). Solitaire AB stents were successfully implanted in all nine patients. Of the nice individuals, six patients exhibited complete occlusion at Raymond grade I and three patients exhibited occlusion at Raymond grade II. No aneurysm rupture was observed during the surgery. During the follow-up period of 8-13 months, no intracranial hemorrhage occurred. A total of seven patients underwent follow-up digital subtraction angiography at 5-10 months post-intervention. No recurrence of the aneurysms and no stenosis or occlusion of the parent arteries was observed. Therefore, Solitaire AB stent-assisted coil embolization was demonstrated to be a safe and effective treatment for ruptured very small intracranial aneurysms. The long-term efficacy of this technique may be improved by increasing the packing density around the aneurysmal neck and improving the hemodynamics.
Collapse
Affiliation(s)
- Jifang Zhang
- Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China ; Department of Neurosurgery, Qingdao Municipal Hospital, Qingdao, Shandong 266071, P.R. China
| | - Donghai Wang
- Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xingang Li
- Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| |
Collapse
|
13
|
Brassel F, Melber K, Schlunz-Hendann M, Meila D. Kissing-Y stenting for endovascular treatment of complex wide necked bifurcation aneurysms using Acandis Acclino stents: results and literature review. J Neurointerv Surg 2015; 8:386-95. [DOI: 10.1136/neurintsurg-2015-011691] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/23/2015] [Indexed: 11/04/2022]
Abstract
IntroductionY-configured stent assisted coiling is a promising therapeutic option to ensure safe coil embolization and preserve the affected arteries in complex wide necked aneurysms. We present our experience with self-expanding Acandis Acclino stents for the treatment of complex aneurysms using the kissing-Y technique.MethodsWe retrospectively reviewed seven patients with seven complex aneurysms (three anterior communicating artery (AcomA), two middle cerebral artery, one basilar artery/superior cerebellar artery, and one vertebral artery/posterior inferior cerebellar artery) who were treated with the kissing-Y technique by stent assisted coiling from June 2013 to July 2014, with follow-up until January 2015. DSA follow-up was up to 17 months, with a mean follow-up period of 10 months. Six patients were treated electively and one in the acute phase of a subarachnoid hemorrhage. In all cases, closed cell Acandis Acclino stents were used. We evaluated procedural complications, clinical outcomes, and mid term angiographic follow-up. Additionally, a literature review is provided.ResultsIn all patients, stents were successfully placed and implanted. One patient developed a periprocedural thromboembolic complication not directly related to the stents. No other periprocedural or postprocedural complications were encountered. Follow-up examinations showed stable and total occlusion of all coiled aneurysms.ConclusionsThe results of our study show that the kissing-Y technique using closed cell Acandis Acclino stents followed by coil embolization is a feasible treatment option for selected complex bifurcation aneurysms.
Collapse
|
14
|
Crossing Y-stent technique with dual open-cell stents for coiling of wide-necked bifurcation aneurysms. Clin Neurol Neurosurg 2015; 132:54-60. [PMID: 25777137 DOI: 10.1016/j.clineuro.2015.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 01/24/2015] [Accepted: 02/03/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Double stenting in a Y-configuration is a promising therapeutic option for wide-necked cerebral aneurysms not amenable to reconstruction with a single stent. We retrospectively evaluated the efficacy and safety of the crossing Y-stent technique for coiling of wide-necked bifurcation aneurysms. METHODS By collecting clinical and radiological data we evaluated from January 2007 through December 2013, 20 wide-necked bifurcation aneurysms. RESULTS Twelve unruptured and eight ruptured aneurysms in 20 patients were treated with crossing Y-stent-assisted coiling. Aneurysm size and neck size ranged from 3.2 to 28.2mm (mean 7.5mm) and from 1.9 to 9.1mm (mean 4.5mm). A Y-configuration was established successfully in all 20 patients. All aneurysms were treated with a pair of Neuroform stents. The immediate angiographic results were total occlusion in 17 aneurysms, residual neck in two, and residual sac in one. Peri-operative morbidity was only 5%. Fifteen of 18 surviving patients underwent follow-up conventional angiography (mean, 10.9 months). The result showed stable occlusion in all 15 aneurysms and asymptomatic in-stent occlusion in one branch artery. At the end of the observation period (mean, 33.5 months), all 12 patients without subarachnoid hemorrhage had excellent clinical outcomes (mRS 0), except one (mRS 2). Of eight patients with subarachnoid hemorrhage, four remained symptom free (mRS 0), while the other four had were dependent or dead (mRS score, 3-6). CONCLUSION In this report on 20 patients, crossing Y-stent technique for coiling of wide-necked bifurcation aneurysms showed a good technical safety and favorable clinical and angiographic outcome.
Collapse
|
15
|
Akgul E, Balli T, Aksungur EH. Hybrid, Y-configured, dual stent-assisted coil embolization in the treatment of wide-necked bifurcation aneurysms. Interv Neuroradiol 2015; 21:29-39. [PMID: 25934772 PMCID: PMC4757200 DOI: 10.1177/1591019915575436] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In Y-stenting, stabilization of the first stent may be problematic as in some cases it migrates during second stent insertion. This report evaluates the safety and effectiveness of the technique and presents the long-term results of hybrid, Y-configured, dual stent-assisted coil embolization in the treatment of wide-necked bifurcation aneurysms. We retrospectively evaluated the patients treated endovascularly due to cerebral aneurysms. Twenty patients treated with hybrid Y-stent-assisted coil embolization were enrolled in the study. In hybrid stenting, an open-cell intracranial stent (Neuroform) was used as a first stent to prevent stent migration. A closed-cell stent (Enterprise or Acclino) was used as a second stent and the aneurysm was embolized with coils between the stent struts. In all patients, hybrid Y-stenting and coil embolization were accomplished successfully. No stent migration occurred. Clinically, neither symptomatic neurologic complication nor death was seen. Of 20 wide-necked bifurcation aneurysms, nine were at the basilar tip, while seven were at the middle cerebral artery and three at the anterior communicating artery. In one patient, the aneurysm was at the A2-3 junction of the anterior cerebral artery. One of the patients had a subarachnoid hemorrhage. The mean angiographic follow-up was 25.6 months. No in-stent stenosis was seen in any of the patients and recanalization in only one. Hybrid, Y-configured, dual stent-assisted coil embolization is a safe and effective method in the treatment of wide-necked bifurcation aneurysms to prevent stent migration and aneurysm recanalization, and is a viable alternative to microsurgery.
Collapse
Affiliation(s)
- Erol Akgul
- Radiology Department, Medical Faculty, Cukurova University, Adana, Turkey
| | - Tugsan Balli
- Radiology Department, Medical Faculty, Cukurova University, Adana, Turkey
| | - Erol H Aksungur
- Radiology Department, Medical Faculty, Cukurova University, Adana, Turkey
| |
Collapse
|
16
|
Spiotta AM, Chaudry MI, Turk AS, Turner RD. Initial experience with the PulseRider for the treatment of bifurcation aneurysms: report of first three cases in the USA. J Neurointerv Surg 2015; 8:186-9. [DOI: 10.1136/neurintsurg-2014-011531] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 12/12/2014] [Indexed: 12/21/2022]
Abstract
IntroductionThe PulseRider is a novel device intended for use in the treatment of aneurysms arising at bifurcations. We present the initial results of the first three cases in the USA employing the PulseRider device.MethodsAneurysms intended to be treated with the PulseRider device at a single institution were identified prospectively. Aneurysms arising at either the carotid terminus or basilar apex that were relatively broad-necked were considered candidates for treatment with the novel device.ResultsPatients were pretreated with dual antiplatelet therapy. All cases were performed under general endotracheal anesthesia. An appropriately sized PulseRider device was deployed across the neck of the aneurysm. A microcatheter was then navigated over a 0.014 inch microwire through the device into the aneurysm. Complete occlusion of the aneurysm was achieved in all cases without intraprocedural complications.ConclusionsWe have found in our early experience with the Pulse Rider device that its use is safe and effective as an adjunct in the treatment of bifurcation aneurysms arising at the basilar apex or carotid terminus. As such, it represents a useful addition to the armamentarium of the neuroendovascular specialist.
Collapse
|
17
|
Akgul E, Balli T, Aksungur EH. Hybrid, Y-Configured, Dual Stent-Assisted Coil Embolization in the Treatment of Wide-Necked Bifurcation Aneurysms. Interv Neuroradiol 2015. [DOI: 10.15274/inr-2015-10107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
18
|
Limbucci N, Renieri L, Nappini S, Consoli A, Rosi A, Mangiafico S. Y-stent assisted coiling of bifurcation aneurysms with Enterprise stent: long-term follow-up. J Neurointerv Surg 2014; 8:158-62. [PMID: 25501447 DOI: 10.1136/neurintsurg-2014-011483] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/24/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND Y-stent assisted coiling has been proposed for the treatment of wide-neck bifurcation aneurysms, but there are many technical variations. We report our single-center experience of Y-stent assisted coiling of bifurcation aneurysms with the closed cell Enterprise stent in order to evaluate the safety and long-term results of this technique. The literature on Y-stenting and its hemodynamic effects are reviewed. METHODS Fifty-two consecutive patients with wide-neck bifurcation aneurysms underwent Y-stent assisted coiling with two Enterprise stents. The procedure was completed in 48 cases (92.3%) and technical failure occurred in 4 cases (7.3%). Cases performed with other stents were excluded. All procedures were performed under double antiplatelet therapy. Periodic clinical and neuroradiological follow-up was performed. RESULTS Mean neuroradiological follow-up time was 26 months. Complete immediate occlusion was obtained in 87.5% of patients. Two remnants had regrown at follow-up and were recoiled, achieving complete occlusion. The late neuroradiological occlusion rate was: complete occlusion 93.6%, neck remnant 4.3%, sac remnant 2.1%. No in-stent stenosis was detected at follow-up. Among the 48 procedures, two complications occurred (4.2%). Mortality was 2.1%. No delayed ischemic stroke occurred. CONCLUSIONS Y-stent assisted coiling has a high immediate occlusion rate and very good long-term stability. The procedure is relatively safe, although the complication and mortality rates are not negligible. Two Enterprise stents can be safely used for Y-stenting and, indeed, offer the advantage of easier catheterization, delivery and deployment into distal and tortuous vessels than open cell stents.
Collapse
Affiliation(s)
- Nicola Limbucci
- Interventional Neuroradiology Unit, Careggi University Hospital, Florence, Italy
| | - Leonardo Renieri
- Interventional Neuroradiology Unit, Careggi University Hospital, Florence, Italy
| | - Sergio Nappini
- Interventional Neuroradiology Unit, Careggi University Hospital, Florence, Italy
| | - Arturo Consoli
- Interventional Neuroradiology Unit, Careggi University Hospital, Florence, Italy
| | - Andrea Rosi
- Interventional Neuroradiology Unit, Careggi University Hospital, Florence, Italy
| | - Salvatore Mangiafico
- Interventional Neuroradiology Unit, Careggi University Hospital, Florence, Italy
| |
Collapse
|
19
|
Y-Stent embolization technique for intracranial bifurcation aneurysms. J Clin Neurosci 2014; 21:1368-72. [DOI: 10.1016/j.jocn.2013.11.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 11/13/2013] [Indexed: 11/18/2022]
|
20
|
Y-Stenting for Bifurcation Aneurysm Coil Embolization: What is the Risk? Stroke Res Treat 2014; 2014:762389. [PMID: 25120940 PMCID: PMC4121189 DOI: 10.1155/2014/762389] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 04/29/2014] [Indexed: 11/17/2022] Open
Abstract
The use of two stents in a “Y” configuration (Y-stenting) to assist with coil embolization of complex bifurcation aneurysms has been accepted as an alternative to clip reconstruction of a select subset of challenging aneurysms. We review the risks associated with Y-stenting, including its procedural complication rates, angiographic occlusion rates, rerupture, and retreatment rates.
Collapse
|
21
|
Ikeda DS, Marlin ES, Shaw A, Sauvageau E, Powers CJ. Endovascular Management of Anterior Communicating Artery Aneurysms. Neurosurg Clin N Am 2014; 25:437-54. [DOI: 10.1016/j.nec.2014.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
22
|
Guo XB, Yan BJ, Guan S. Waffle-Cone Technique Using Solitaire AB Stent for Endovascular Treatment of Complex and Wide-Necked Bifurcation Cerebral Aneurysms. J Neuroimaging 2014; 24:599-602. [PMID: 24708043 DOI: 10.1111/jon.12121] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 02/15/2014] [Accepted: 03/02/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Xin-bin Guo
- Department of Interventional Radiology; The First Affiliated Hospital of Zhengzhou University; 1 Jianshe Road Zhengzhou 450052 China
| | - Bao-jun Yan
- Department of Interventional Radiology; The First Affiliated Hospital of Zhengzhou University; 1 Jianshe Road Zhengzhou 450052 China
| | - Sheng Guan
- Department of Interventional Radiology; The First Affiliated Hospital of Zhengzhou University; 1 Jianshe Road Zhengzhou 450052 China
| |
Collapse
|
23
|
Kono K, Terada T. Feasibility of insertion of a microcatheter through a Y-stent in coil embolization of cerebral aneurysms and its detailed geometry by micro-computed tomography. Acta Neurochir (Wien) 2014; 156:39-43. [PMID: 24190455 DOI: 10.1007/s00701-013-1925-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 10/15/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Y-stent-assisted coil embolization for cerebral aneurysms, open or closed cell stents are used. Different microcatheters for coil insertion are available. We investigated which microcatheter could be navigated into an aneurysm through a Y-stent with different stents. METHODS Double Neuroform open-cell stents or double Enterprise closed-cell stents were deployed in Y-configuration in a silicon model of a bifurcation aneurysm. Two endovascular neurosurgeons independently tried to navigate an SL-10 microcatheter for 0.010" coils or a PX Slim microcatheter for 0.020" Penumbra coils into the aneurysm through the Y-stent. In addition, we measured lengths of stent pores of the Y-stents with double Enterprise stents deployed in the model by micro-computed tomography. RESULTS It was feasible to navigate an SL-10 microcatheter into the aneurysm through the Y-stent with Enterprise or Neuroform stents. Navigation of a PX Slim microcatheter was feasible in the Y-stents only with Neuroform stents. In the Y-stent with double Enterprise stents, the lengths of the second stent pores were significantly smaller than those of the first stent (0.41 ± 0.18 mm vs 0.69 ± 0.20 mm; P = 0.008). The SL-10 microcatheter was smaller than approximately 80% of the stent pores of the first stent and 30% of those of the second stent. The PX Slim microcatheter was smaller than 20% of the stent pores of the first stent and 0% of those of the second stent. CONCLUSIONS It was feasible to insert an SL-10 microcatheter into the aneurysm through Y-stents with Enterprise or Neuroform stents. Navigation of a PX Slim microcatheter for 0.020" Penumbra coils was feasible in Y-stents with Neuroform stents, but not with double Enterprise stents. The measurements of stent pores by micro-computed tomography supported this feasibility study. These results may be helpful to select appropriate stents and microcatheters in Y-stent-assisted coil embolization, especially in case of retreatments.
Collapse
Affiliation(s)
- Kenichi Kono
- Department of Neurosurgery, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama, 640-8505, Japan,
| | | |
Collapse
|
24
|
Fargen KM, Mocco J, Neal D, Dewan MC, Reavey-Cantwell J, Woo HH, Fiorella DJ, Mokin M, Siddiqui AH, Turk AS, Turner RD, Chaudry I, Kalani MYS, Albuquerque F, Hoh BL. A Multicenter Study of Stent-Assisted Coiling of Cerebral Aneurysms With a Y Configuration. Neurosurgery 2013; 73:466-72. [PMID: 23756744 DOI: 10.1227/neu.0000000000000015] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract
BACKGROUND:
Stent-assisted coiling with 2 stents in a Y configuration is a technique for coiling complex wide-neck bifurcation aneurysms.
OBJECTIVE:
We sought to provide long-term clinical and angiographic outcomes with Y-stent coiling, which are not currently established.
METHODS:
Seven centers provided deidentified, retrospective data on all consecutive patients who underwent stent-assisted coiling for an intracranial aneurysm with a Y-stent configuration.
RESULTS:
Forty-five patients underwent treatment by Y-stent coiling. Their mean age was 57.9 years. Most aneurysms were basilar apex (87%), and 89% of aneurysms were unruptured. Mean size was 9.9 mm. Most aneurysms were treated with 1 open-cell and 1 closed-cell stent (51%), with 29% treated with open-open stents and 16% treated with 2 closed-cell stents. Initial aneurysm occlusion was excellent (84% in Raymond grade I or II). Procedural complications occurred in 11% of patients. Mean clinical follow-up was 7.8 months, and 93% of patients had a modified Rankin Scale score of 0 to 2 at last follow-up. Mean angiographic follow-up was 9.8 months, and 92% of patients had Raymond grade I or II occlusion on follow-up imaging. Of those patients with initial Raymond grade III occlusion and follow-up imaging, all but 1 patient progressed to a better occlusion grade (83%; P < .05). Three aneurysms required retreatment because of recanalization (10%). There was no difference in initial or follow-up angiographic occlusion, clinical outcomes, incidence of aneurysm retreatment, or in-stent stenosis among open-open, open-closed, or closed-closed stent groups.
CONCLUSION:
In a large multicenter series of Y-stent coiling for bifurcation aneurysms, there were low complication rates and excellent clinical and angiographic outcomes.
Collapse
Affiliation(s)
- Kyle M. Fargen
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - J Mocco
- Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee
| | - Dan Neal
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Michael C. Dewan
- Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee
| | - John Reavey-Cantwell
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia
| | - Henry H. Woo
- Departments of Neurosurgery and Radiology, Stony Brook University Medical Center, Stony Brook, New York
| | - David J. Fiorella
- Departments of Neurosurgery and Radiology, Stony Brook University Medical Center, Stony Brook, New York
| | - Maxim Mokin
- Department of Neurosurgery, University at Buffalo, Buffalo, New York
| | - Adnan H. Siddiqui
- Department of Neurosurgery, University at Buffalo, Buffalo, New York
| | - Aquilla S. Turk
- Departments of Neurosurgery and Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Raymond D. Turner
- Departments of Neurosurgery and Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Imran Chaudry
- Departments of Neurosurgery and Radiology, Medical University of South Carolina, Charleston, South Carolina
| | | | - Felipe Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Brian L. Hoh
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| |
Collapse
|
25
|
Sarabia R, Arrese I. Letter to the Editor. Interv Neuroradiol 2012; 18:490. [DOI: 10.1177/159101991201800416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 07/12/2012] [Indexed: 11/15/2022] Open
Affiliation(s)
- Rosario Sarabia
- Rosario Sarabia, MD, PhD, Ignacio Arrese, MD, Unit of Vascular Neurosurgery, Hospital Universitario “Río Hortega”, Valladolid, Spain, Tel.: +34608046363,
| | - Ignacio Arrese
- Rosario Sarabia, MD, PhD, Ignacio Arrese, MD, Unit of Vascular Neurosurgery, Hospital Universitario “Río Hortega”, Valladolid, Spain, Tel.: +34608046363,
| |
Collapse
|