1
|
Saei HM, Miller SE, Pope HM, Hassan AE. Fubuki XF Long Sheath guide catheter use in neuroendovascular procedures: Institutional experience in 60 cases. Interv Neuroradiol 2024:15910199241245601. [PMID: 38592015 DOI: 10.1177/15910199241245601] [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: 04/10/2024] Open
Abstract
BACKGROUND Endovascular treatment devices require compatible guide catheters to navigate complex vessels and anatomy. The Fubuki XF Long Sheath guide catheter (Fubuki XF) was developed with a 0.090-inch internal diameter with hydrophilic coating, an atraumatic rounded tip, and enhanced trackability and support with gradual shaft transition zones. METHODS We retrospectively analyzed a prospectively maintained database of neuroendovascular patients treated using Fubuki XF at our center (July 2022─May 2023). Baseline/procedural characteristics were collected. Outcomes of interest included technical success (procedure completion with Fubuki XF without alternative guide catheter use) and peri-procedural complications. RESULTS This study included 60 patients (43.3% [26/60] female; mean age: 69.6 ± 9.7) presenting with stenosis (45.0% [27/60]), unruptured aneurysms (31.7% [19/60]), ruptured aneurysm (1.7% [1/60]), arteriovenous fistula (5.0% [3/60]), arteriovenous malformation (3.3% [2/60]), chronic subdural hematoma (3.3% [2/60]), stroke/emboli (6.7% [4/60]), vasospasm (1.7% [1/60]), or carotid web (5.0% [1/60]). Fubuki XF was used to deliver endovascular treatment devices for stenting (43.3% [26/60]), flow diversion (23.3% [14/60]), embolization (11.7% [7/60]), coiling (10.0% [6/60]), balloon angioplasty (10.0% [6/60]), and mechanical thrombectomy (1.7% [1/60]). The Fubuki XF tip was placed in the internal carotid artery in 38.3% (23/60) of cases. Technical success was achieved in all cases. One V1 non-flow-limiting dissection (not related to Fubuki XF) and one failed closure occurred (1.7% [1/60] each). No iatrogenic strokes or intraprocedural ruptures occurred. CONCLUSION We used Fubuki XF to safely and effectively deliver a variety of compatible neuroendovascular devices. Fubuki XF was stable in all cases and locations, and there were no device-related complications or dissections.
Collapse
Affiliation(s)
- Hamzah M Saei
- Department of Vascular Neurology, Rio Grande Regional Hospital, McAllen, TX, USA
| | - Samantha E Miller
- Department of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, TX, USA
| | | | - Ameer E Hassan
- Department of Neuroscience, Valley Baptist Neuroscience Institute, Harlingen, TX, USA
| |
Collapse
|
2
|
Liang W, Yin J, Lu C, Yang J, Ma X, Zhang X, Turhon M, Yang X. Treatment of intracranial aneurysms with pipeline embolization device: a single-center experience. Quant Imaging Med Surg 2024; 14:2916-2926. [PMID: 38617176 PMCID: PMC11007493 DOI: 10.21037/qims-23-1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/25/2024] [Indexed: 04/16/2024]
Abstract
Background Endovascular therapy is the primary treatment modality for intracranial aneurysms (IA). The objective of this study was to assess the effectiveness and safety of a pipeline embolization device (PED) for the treatment of IA. Methods This retrospective study was conducted at a single center. Data were collected for all patients who underwent PED treatment at the Fourth Affiliated Hospital of Xinjiang Medical University between December 2018 and January 2022. Clinical characteristics, aneurysm-related characteristics, treatment details, and clinical and imaging outcomes were collected and analyzed. Results A total of 60 consecutive patients with 60 IAs were treated with a PED. The mean age of the participants was 61.8 years, with 53% being female. The average size of the aneurysms was 14.7 mm, with 54 located in the anterior circulation and six in the posterior circulation. The median last follow-up time was 13.0 months (range, 11-24 months). All patients underwent final digital subtraction angiography (DSA) for angiographic follow-up, and 50 aneurysms (83.3%) were completely occluded. The overall complication rate was 3.3%, and there were no reported mortalities. Among the 12 cases of ruptured aneurysms, all of which underwent adjunctive coil embolization, the complete occlusion rate was 91.7% with a complication rate of 16.6% [ischemic complication and modified Rankin scale (mRS) deteriorated]. In the 6 cases of posterior circulation aneurysms (2 in the basilar artery), 5 cases achieved complete occlusion and 1 case achieved near-complete occlusion, with no reported complications or mortality. Conclusions The use of PEDs appears to be an effective treatment option for IA, demonstrating high occlusion rates and low complication rates. While the application of PEDs for the treatment of ruptured aneurysms did not increase the risk of secondary aneurysm rupture, caution is still warranted due to a higher complication rate. In the treatment of aneurysms of the vertebrobasilar artery using PEDs, this study achieved favorable efficacy outcomes without complications nor patient mortality. However, further studies are needed to validate these findings.
Collapse
Affiliation(s)
- Wenbao Liang
- Department of Neurology, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Neurology, The Fourth Affiliated Hospital of Xinjiang Medical University (Xinjiang Uyhgur Autonomous Region Hospital of Traditional Chinese Medicine), Urumqi, China
- Department of Neurosurgery, The Fourth Affiliated Hospital of Xinjiang Medical University (Xinjiang Uyhgur Autonomous Region Hospital of Traditional Chinese Medicine), Urumqi, China
| | - Jiaqi Yin
- Department of Cardiology three, The Fourth Affiliated Hospital of Xinjiang Medical University (Xinjiang Uyhgur Autonomous Region Hospital of Traditional Chinese Medicine), Urumqi, China
| | - Chenyu Lu
- Department of Neurosurgery, The Fourth Affiliated Hospital of Xinjiang Medical University (Xinjiang Uyhgur Autonomous Region Hospital of Traditional Chinese Medicine), Urumqi, China
| | - Jianbo Yang
- Department of Neurology, The Fourth Affiliated Hospital of Xinjiang Medical University (Xinjiang Uyhgur Autonomous Region Hospital of Traditional Chinese Medicine), Urumqi, China
| | - Xiaoqiang Ma
- Department of Neurosurgery, The Fourth Affiliated Hospital of Xinjiang Medical University (Xinjiang Uyhgur Autonomous Region Hospital of Traditional Chinese Medicine), Urumqi, China
| | - Xin Zhang
- Department of Neurosurgery, The Fourth Affiliated Hospital of Xinjiang Medical University (Xinjiang Uyhgur Autonomous Region Hospital of Traditional Chinese Medicine), Urumqi, China
| | - Mirzat Turhon
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xinling Yang
- Department of Neurology, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Department of Neurology, Xinjiang Medical University, Urumqi, China
| |
Collapse
|
3
|
Ma W, Deng X, Chen J, Guo X. Risk factor analysis of changes in blood flow in the A1 segment of the anterior cerebral artery after flow-diverter coverage of it. Neurosurg Rev 2024; 47:74. [PMID: 38315259 DOI: 10.1007/s10143-024-02306-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/14/2024] [Accepted: 01/17/2024] [Indexed: 02/07/2024]
Abstract
Few studies have explored the effect of a flow-diverter device (FD) on blood flow in the A1 segment of the anterior cerebral artery (ACA), after treatment of intracranial aneurysms in the bifurcation region of the internal carotid artery (ICA). The main objective of this article is to investigate the factors that affect A1 blood flow after FD covers the A1 artery. This is a single-center, retrospective study. Data were collected retrospectively from our center, and patients whose FDs were placed for treatment from the terminal of the ICA to the M1 segment were analyzed. A total of 42 patients were included in the study. Immediate post-procedural angiography following device placement revealed decreased blood flow in the A1 of 15 (35.7%) patients and complete occlusion of the A1 segment in 11 (26.2%) patients. During an average follow-up period of 9.8 months, the A1 segment was ultimately occluded in 25 patients (59.5%) and decreased blood flow in 4 patients (9.5%). When using FD to cover the A1 artery for the treatment of intracranial aneurysms, patients with preoperative opening of the anterior communicating artery (AcomA) are more prone to occlusion or decreased blood flow of the A1 artery, compared to patients without opening.
Collapse
Affiliation(s)
- WuLin Ma
- Department of Neurointervention, Erqi District, The First Affiliated Hospital of Zhengzhou University, No.1, East Construction Road, Zhengzhou City, 450052, Henan Province, China
| | - Xin Deng
- Department of Neurointervention, Erqi District, The First Affiliated Hospital of Zhengzhou University, No.1, East Construction Road, Zhengzhou City, 450052, Henan Province, China
| | - JunFan Chen
- Department of Neurointervention, Erqi District, The First Affiliated Hospital of Zhengzhou University, No.1, East Construction Road, Zhengzhou City, 450052, Henan Province, China
| | - XinBin Guo
- Department of Neurointervention, Erqi District, The First Affiliated Hospital of Zhengzhou University, No.1, East Construction Road, Zhengzhou City, 450052, Henan Province, China.
| |
Collapse
|
4
|
Nasra M, Maingard JT, Hall J, Mitreski G, Kuan Kok H, Smith PD, Russell JH, Jhamb A, Brooks DM, Asadi H. Clipping versus coiling: A critical re-examination of a decades old controversy. Interv Neuroradiol 2024; 30:86-93. [PMID: 36017537 PMCID: PMC10956463 DOI: 10.1177/15910199221122854] [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: 05/22/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Two major studies, The International Subarachnoid Aneurysm Trial and the Barrow Ruptured Aneurysm Trial, compare the long-term outcomes of clipping and coiling. Although these demonstrated coiling's initial benefits, rebleeding and retreatment rates as well as converging patient outcomes sparked controversy regarding its durability. This article will critically examine the available evidence for and against clipping and coiling of intracranial aneurysms. Critics of endovascular treatment state that the initial benefit seen with endovascular coiling decreases over the duration of follow-up and eventually functional outcomes of both treatment modalities are similar. Combined with the increased rate of retreatment and rebleeding, these trials reveal that coiling is not as durable and not as effective as a long-term treatment compared to clipping. Also, due to the cost of devices following endovascular treatment and prolonged hospitalization following clipping, the financial burden has been considered controversial. SUMMARY/KEY MESSAGES Short-term outcomes reveal better morbidity and mortality outcomes following coiling. Despite the higher rates of retreatment and rebleeding with coiling, there was no significant change in functional outcomes following retreatment. Furthermore, examining more recent trials reveals a decreased rate of recurrence and rebleeding with improved technology and expertise. Functional outcomes deteriorate for both cohorts over time while recent results revealed improved long-term cognitive outcomes and levels of health-related quality of life after coiling in comparison to clipping. The expense of longer hospital stays following clipping must be balanced against the expense of endovascular devices in coiling.
Collapse
Affiliation(s)
| | - Julian Tam Maingard
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia
- Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia
| | - Jonathan Hall
- Department of Interventional Radiology, St Vincent's Health Australia, Fitzroy, Victoria, Australia
| | - Goran Mitreski
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia
| | - Hong Kuan Kok
- Interventional Radiology Service, Northern Hospital, Epping, Victoria, Australia
| | - Paul D. Smith
- Department of Neurosurgery, St Vincent's Hospital, Fitzroy, Victoria, Melbourne, Australia
- Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Jeremy H. Russell
- Department of Neurosurgery, Austin Health, Heidelberg, Victoria, Australia
| | - Ashu Jhamb
- Department of Interventional Radiology, St Vincent's Health Australia, Fitzroy, Victoria, Australia
| | - Duncan Mark Brooks
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia
- School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia
| | - Hamed Asadi
- Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Clayton, Victoria, Australia
- Department of Radiology, Interventional Neuroradiology Service, Austin Health, Heidelberg, Victoria, Australia
- School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| |
Collapse
|
5
|
Korte J, Marsh LMM, Saalfeld S, Behme D, Aliseda A, Berg P. Fusiform versus Saccular Intracranial Aneurysms-Hemodynamic Evaluation of the Pre-Aneurysmal, Pathological, and Post-Interventional State. J Clin Med 2024; 13:551. [PMID: 38256685 DOI: 10.3390/jcm13020551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Minimally-invasive therapies are well-established treatment methods for saccular intracranial aneurysms (SIAs). Knowledge concerning fusiform IAs (FIAs) is low, due to their wide and alternating lumen and their infrequent occurrence. However, FIAs carry risks like ischemia and thus require further in-depth investigation. Six patient-specific IAs, comprising three position-identical FIAs and SIAs, with the FIAs showing a non-typical FIA shape, were compared, respectively. For each model, a healthy counterpart and a treated version with a flow diverting stent were created. Eighteen time-dependent simulations were performed to analyze morphological and hemodynamic parameters focusing on the treatment effect (TE). The stent expansion is higher for FIAs than SIAs. For FIAs, the reduction in vorticity is higher (Δ35-75% case 2/3) and the reduction in the oscillatory velocity index is lower (Δ15-68% case 2/3). Velocity is reduced equally for FIAs and SIAs with a TE of 37-60% in FIAs and of 41-72% in SIAs. Time-averaged wall shear stress (TAWSS) is less reduced within FIAs than SIAs (Δ30-105%). Within this study, the positive TE of FDS deployed in FIAs is shown and a similarity in parameters found due to the non-typical FIA shape. Despite the higher stent expansion, velocity and vorticity are equally reduced compared to identically located SIAs.
Collapse
Affiliation(s)
- Jana Korte
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, 39106 Magdeburg, Germany
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany
| | - Laurel M M Marsh
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany
- Department of Mechanical Engineering, George Mason University, Fairfax, VA 22030, USA
| | - Sylvia Saalfeld
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany
- Department of Computer Science and Automation, Ilmenau University of Technology, 98693 Ilmenau, Germany
| | - Daniel Behme
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany
- University Hospital Magdeburg, University of Magdeburg, 39106 Magdeburg, Germany
| | - Alberto Aliseda
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
| | - Philipp Berg
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany
- Department of Medical Engineering, University of Magdeburg, 39106 Magdeburg, Germany
| |
Collapse
|
6
|
Rogers PS, Volders D, Pickett G, Vandorpe R. Coil migration through two flow-diverting stents. BMJ Case Rep 2024; 17:e256863. [PMID: 38238159 PMCID: PMC10806980 DOI: 10.1136/bcr-2023-256863] [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] [Accepted: 12/24/2023] [Indexed: 01/23/2024] Open
Abstract
We report a case of a patient who initially presented with a subarachnoid haemorrhage secondary to a ruptured supraclinoid internal carotid artery (ICA) blister aneurysm. The patient was treated successfully with a flow diverter stent (FD) and coiling; however, a large aneurysm recurrence via a feeding posterior communicating artery (PCOM) was noted on the 1-year follow-up angiogram. During the retreatment, a second FD in the ICA resulted in insufficient aneurysm stasis. Therefore, the decision was made to coil sacrifice the PCOM via posterior circulation access. During the first coil deployment, the distal coil end migrated through the mesh of two overlapping FD into the middle cerebral artery. This complication was a previously unrecognised possibility given the composition of the FD. This case report aims to discuss this process as a potential complication during neurointerventional procedures using these devices.
Collapse
Affiliation(s)
- Patrick Scott Rogers
- Diagnostic Imaging, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - David Volders
- Diagnostic Imaging, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gwynedd Pickett
- Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert Vandorpe
- Diagnostic Imaging, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
7
|
Deshmukh AS, Priola SM, Katsanos AH, Scalia G, Costa Alves A, Srivastava A, Hawkes C. The Management of Intracranial Aneurysms: Current Trends and Future Directions. Neurol Int 2024; 16:74-94. [PMID: 38251053 PMCID: PMC10801587 DOI: 10.3390/neurolint16010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/14/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Intracranial aneurysms represent a major global health burden. Rupture of an intracranial aneurysm is a catastrophic event. Without access to treatment, the fatality rate is 50% in the first 30 days. Over the last three decades, treatment approaches for intracranial aneurysms have changed dramatically. There have been improvements in the medical management of aneurysmal subarachnoid haemorrhage, and there has been an evolution of treatment strategies. Endovascular therapy is now the mainstay of the treatment of ruptured intracranial aneurysms based on robust randomised controlled trial data. There is now an expansion of treatment indications for unruptured intracranial aneurysms to prevent rupture with both microsurgical clipping and endovascular treatment. Both microsurgical and endovascular treatment modalities have evolved, in particular with the introduction of innovative endovascular treatment options including flow diversion and intra-saccular flow disruption. These novel therapies allow clinicians to treat more complex and previously untreatable aneurysms. We aim to review the evolution of treatment strategies for intracranial aneurysms over time, and discuss emerging technologies that could further improve treatment safety and functional outcomes for patients with an intracranial aneurysm.
Collapse
Affiliation(s)
- Aviraj S. Deshmukh
- Division of Clinical Sciences, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, ON P3E 2C6, Canada;
| | - Stefano M. Priola
- Division of Neurosurgery, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, ON P3E 2C6, Canada;
| | - Aris H. Katsanos
- Division of Neurology, Hamilton General Hospital, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital of National Importance “Garibaldi”, 95126 Catania, Italy;
| | - Aderaldo Costa Alves
- Division of Neurosurgery, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, ON P3E 2C6, Canada;
| | - Abhilekh Srivastava
- Division of Neurology, Hamilton General Hospital, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Christine Hawkes
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M5S 1A1, Canada;
| |
Collapse
|
8
|
Ku JC, Chavda V, Palmisciano P, Pasarikovski CR, Yang VX, Kiwan R, Priola SM, Chaurasia B. Endovascular treatment for anterior inferior cerebellar artery-posterior inferior cerebellar artery (AICA-PICA) common trunk variant aneurysms: Technical note and literature review. J Cerebrovasc Endovasc Neurosurg 2023; 25:452-461. [PMID: 37041684 PMCID: PMC10774679 DOI: 10.7461/jcen.2023.e2022.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/27/2022] [Accepted: 02/26/2023] [Indexed: 04/13/2023] Open
Abstract
The Anterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery (AICA-PICA) common trunk is a rare variant of cerebral posterior circulation in which a single vessel originating from either the basilar or vertebral arteries supplies both cerebellum and brainstem territories. We present the first case of an unruptured right AICA-PICA aneurysm treated with flow diversion using a Shield-enhanced pipeline endovascular device (PED, VANTAGE Embolization Device with Shield Technology, Medtronic, Canada). We expand on this anatomic variant and review the relevant literature. A 39-year-old man presented to our treatment center with vertigo and right hypoacusis. The initial head CT/CTA was negative, but a 4-month follow-up MRI revealed a 9 mm fusiform dissecting aneurysm of the right AICA. The patient underwent a repeat head CTA and cerebral angiogram, which demonstrated the presence of an aneurysm on the proximal portion of an AICA-PICA anatomical variant. This was treated with an endovascular approach that included flow diversion via a PED equipped with Shield Technology. The patient's post-procedure period was uneventful, and he was discharged home after two days with an intact neurological status. The patient is still asymptomatic after a 7-month follow-up, with MR angiogram evidence of stable aneurysm obliteration and no ischemic lesions. Aneurysms of the AICA-PICA common trunk variants have a high morbidity risk due to the importance and extent of the territory vascularized by a single vessel. Endovascular treatment with flow diversion proved to be both safe and effective in obliterating unruptured cases.
Collapse
Affiliation(s)
- Jerry C. Ku
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Vishal Chavda
- Department of Pathology, Stanford School of Medicine, Stanford University Medical Centre, Stanford, CA, USA
| | - Paolo Palmisciano
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | | | - Victor X.D. Yang
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Ruba Kiwan
- Department of Radiology, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - Stefano M. Priola
- Division of Neurosurgery, Health Sciences North, Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| |
Collapse
|
9
|
Solis F, Plasencia A, Wahlster S, Walker M, Levitt MR, Ecos R. Flow Diversion for the Treatment of Intracranial Aneurysms in a Peruvian Cohort: Experiences from a Limited-Resource Setting and Barriers to Implementation. World Neurosurg 2023; 180:79-85. [PMID: 37742718 DOI: 10.1016/j.wneu.2023.09.058] [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: 09/05/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Stenting with flow diverter devices (FDDs) has increasingly emerged as a treatment for intracranial aneurysms. The use of FDDs in the developing world has not been described. METHODS A retrospective review was performed of a cohort of patients who underwent flow diversion at 4 tertiary-care centers in Lima, Peru between January 2017 and June 2021. Demographics, clinical features, and aneurysm morphology were evaluated. Clinical outcomes were observed 3 months after discharge and occlusion rates were assessed 12 months after treatment. RESULTS Sixty-nine patients (mean age, 46 ±14.5 years; 17% female) were treated with FDDs; 4% (n = 3) of the treated aneurysms were ruptured. Most aneurysms were saccular (n = 65; 94%), <10 mm in maximum size (n = 60; 87%), and located in the anterior circulation (n = 67; 97%). Minor complications, such as groin hematoma, occurred in 7 cases. No serious complications or deaths occurred. Patients' functional status was excellent (modified Rankin Scale score 0-1) in 99% (n = 66) at discharge and 100% (n = 67) at 3 months. Although some patients were lost to follow-up, complete occlusion was seen in 76% (n = 31) of 41 treated patients at 12 months. CONCLUSIONS We report the largest multicenter experience of FDDs for cerebral aneurysm treatment in Peru, with reasonable outcomes that are comparable to other settings despite various challenges, suboptimal circumstances, and lack of resources.
Collapse
Affiliation(s)
- Frank Solis
- Neurological Surgery and Endovascular Neurosurgery, Clínica Internacional San Borja, Lima, Peru; Endovascular Neurosurgery Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.
| | - Andres Plasencia
- Neurological Surgery and Endovascular Neurosurgery, Clínica Internacional San Borja, Lima, Peru
| | - Sarah Wahlster
- Neurology, Neurosurgery, and Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Melanie Walker
- Neurological Surgery and Stroke & Applied Neuroscience Center, University of Washington, Seattle, Washington, USA
| | - Michael R Levitt
- Neurological Surgery, Radiology, Mechanical Engineering, and Stroke & Applied Neuroscience Center, University of Washington, Seattle, Washington, USA
| | - Rosa Ecos
- Vascular Neurology, Instituto Nacional de Ciencias Neurológicas, Lima, Peru; Medicine Faculty, Universidad Nacional Federico Villarreal, Lima, Peru
| |
Collapse
|
10
|
Korte J, Gaidzik F, Larsen N, Schütz E, Damm T, Wodarg F, Hövener JB, Jansen O, Janiga G, Berg P, Pravdivtseva MS. In vitro and in silico assessment of flow modulation after deploying the Contour Neurovascular System in intracranial aneurysm models. J Neurointerv Surg 2023:jnis-2023-020403. [PMID: 37852752 DOI: 10.1136/jnis-2023-020403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/15/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The novel Contour Neurovascular System (Contour) has been reported to be efficient and safe for the treatment of intracranial, wide-necked bifurcation aneurysms. Flow in the aneurysm and posterior cerebral arteries (PCAs) after Contour deployment has not been analyzed in detail yet. However, this information is crucial for predicting aneurysm treatment outcomes. METHODS Time-resolved three-dimensional velocity maps in 14 combinations of patient-based basilar tip aneurysm models with and without Contour devices (sizes between 5 and 14 mm) were analyzed using four-dimensionsal (4D) flow MRI and numerical/image-based flow simulations. A complex virtual processing pipeline was developed to mimic the experimental shape and position of the Contour together with the simulations. RESULTS On average, the Contour significantly reduced intra-aneurysmal flow velocity by 67% (mean w/ = 0.03m/s; mean w/o = 0.12m/s; p-value=0.002), and the time-averaged wall shear stress by more than 87% (mean w/ = 0.17Pa; mean w/o = 1.35Pa; p-value=0.002), as observed by numerical simulations. Furthermore, a significant reduction in flow (P<0.01) was confirmed by the neck inflow rate, kinetic energy, and inflow concentration index after Contour deployment. Notably, device size has a stronger effect on reducing flow than device positioning. However, positioning affected flow in the PCAs, while being robust in effectively reducing flow. CONCLUSIONS This study showed the high efficacy of the Contour device in reducing flow within aneurysms regardless of the exact position. However, we observed an effect on the flow in PCAs, which needs to be investigated further.
Collapse
Affiliation(s)
- Jana Korte
- Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
- Research campus STIMULATE, University of Magdeburg, Magdeburg, Germany
| | - Franziska Gaidzik
- Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
- Research campus STIMULATE, University of Magdeburg, Magdeburg, Germany
| | - Naomi Larsen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Erik Schütz
- Research campus STIMULATE, University of Magdeburg, Magdeburg, Germany
| | - Timo Damm
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
| | - Fritz Wodarg
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Jan-Bernd Hövener
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Gábor Janiga
- Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
- Research campus STIMULATE, University of Magdeburg, Magdeburg, Germany
| | - Philipp Berg
- Research campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Healthcare Telematics and Medical Engineering, University of Magdeburg, Magdeburg, Germany
| | - Mariya S Pravdivtseva
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
| |
Collapse
|
11
|
Javed K, Fortunel A, Holland R, Khatri D, Ahmad S, Haranhalli N, Altschul D. Identifying risk factors for perioperative thromboembolic complications in patients treated with the Woven EndoBridge device. Interv Neuroradiol 2023; 29:561-569. [PMID: 35837721 PMCID: PMC10549708 DOI: 10.1177/15910199221113907] [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: 04/30/2022] [Accepted: 06/27/2022] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Woven EndoBridge (WEB) is a new endovascular treatment option for wide necked bifurcation aneurysms. Results from the WEB-IT trial showed a 0% risk of thromboembolic complications within 30 days post-op but the rate reported in the literature is as high as 10%. We are exploring potential risk factors associated with immediate thromboembolic complications in patients treated with the WEB device. METHODS Retrospective study of forty-two patients with intracranial aneurysms who were treated with WEB at a single center from 2019-2021. Data was collected on patient demographics, comorbidities, aneurysm characteristics, procedural details, and hospital course. Bivariate analyses were performed to compare patients who experienced a periprocedural ischemic stroke to those who did not. Multiple logistic regression modeling was performed to identify independent risk factors for thromboembolic complications. RESULTS Of the 42 patients that were treated with WEB, 6 suffered an ischemic stroke (AIS). These patients were more likely to have an underlying diagnosis of arrythmias (p value = 0.007). Furthermore, they had a median angle of 32.0° in the true neck view on diagnostic angiogram compared to 19.5° (p value = 0.046). Lastly, they had a longer procedure length of 228 min compared to 178 min (p value = 0.002). Patients with thromboembolic complications had a longer length of stay in the hospital and worse outcomes at three months follow up. On logistic regression modeling, these risk factors did not reach statistical significance. CONCLUSION Risk factors of thromboembolic complications after WEB placement include cardiac arrythmias, acute aneurysmal angle in the true neck view and a longer procedure length.
Collapse
Affiliation(s)
- Kainaat Javed
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Adisson Fortunel
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Ryan Holland
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Deepak Khatri
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Samuel Ahmad
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Neil Haranhalli
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - David Altschul
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| |
Collapse
|
12
|
Jaha L, Ademi B, Rudari H, Vokrri L, Gjikolli B, Koshi A, Kuçi A, Jaha A. Surgical management of extracranial internal carotid artery aneurysm-Case report and literature review. Clin Case Rep 2023; 11:e8015. [PMID: 37799567 PMCID: PMC10547859 DOI: 10.1002/ccr3.8015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023] Open
Abstract
Key Clinical Message Extracranial internal carotid artery aneurysms (EICAAs) can lead to serious medical conditions, such as stroke or compression over cranial nerves. In very few cases, there may be hemorrhagic complications due to the rupture. Although rare, they should be suspected cause in every patient with transitory ischemic attack or stroke, especially in the presence of pain, palpable mass or bruit in the neck. Abstract Extracranial internal carotid artery aneurysms (EICAAs) are rare arterial aneurysms, with a prevalence of less than 1%. Although they are not common, these aneurysms can lead to serious medical conditions, such as stroke or compression over cranial nerves. In very few cases, there may be hemorrhagic complications due to the rupture of the aneurysm. This report presents a case of a successful surgical intervention for EICAA, and an overview of symptoms, risk factors, causes, diagnostic procedures, treatments, and potential postoperative complications. A 70-year-old Albanian lady had been experiencing pain due to a pulsating mass in her neck for many years. Physical examination did not reveal any signs of infection, injury, or previous surgery. A palpable thrill and a carotid bruit were detected over an evident pulsating mass on the left side of her neck. Her past medical history was consistent with three transitory ischemic attacks in recent months and a stroke 5 years earlier. Comorbidities included hypercholesterolemia, hypertension, and long-standing coronary artery disease. Imaging investigation in terms of ultrasound and CT-scan confirmed the presence of an aneurysm of the proximal tract of the internal carotid artery measuring 42 × 31 mm. Surgery was indicated on symptomatic and anatomical grounds. The procedure was carried out under general anesthesia. After proximal and distal clamping, the aneurysm was excised followed by end-to-end anastomosis of the internal carotid artery. The postoperative course was uneventful, and the patient was discharged home on the fifth postoperative day. Despite the growing number of reported cases of successful endovascular treatment for internal carotid artery aneurysms, open surgery remains a safe and effective treatment option. However, it is crucial to provide customized treatment plans for each patient based on their individual characteristics and the particularities of their aneurysm.
Collapse
Affiliation(s)
- Luan Jaha
- Department of Vascular SurgeryUniversity Clinical Center of KosovoPrishtinaKosovo
| | - Bekim Ademi
- Department of Vascular SurgeryUniversity Clinical Center of KosovoPrishtinaKosovo
| | - Hajriz Rudari
- Department of Vascular SurgeryUniversity Clinical Center of KosovoPrishtinaKosovo
| | - Lulzim Vokrri
- Department of Vascular SurgeryUniversity Clinical Center of KosovoPrishtinaKosovo
| | - Bujar Gjikolli
- Department of RadiologyUniversity Clinical Center of KosovoPrishtinaKosovo
| | - Adhurim Koshi
- Department of Vascular SurgeryUniversity Clinical Center of KosovoPrishtinaKosovo
| | - Astrit Kuçi
- Department of DentistryUniversity Dentistry Clinical Center of KosovoPrishtinaKosovo
| | - Art Jaha
- Department of Vascular SurgeryUniversity Clinical Center of KosovoPrishtinaKosovo
- Department of RadiologyUniversity Clinical Center of KosovoPrishtinaKosovo
- Department of DentistryUniversity Dentistry Clinical Center of KosovoPrishtinaKosovo
| |
Collapse
|
13
|
Kaydu NE, Cindil E, Asfuroglu BB, Onal B, Oner AY. Comparative evaluation of brain perfusion with ASL and DSC MRI following intracranial vascular flow diverter stent replacement. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1390-1396. [PMID: 37530531 DOI: 10.1002/jcu.23530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/09/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE The objective of this study was to asses brain perfusion parameters and ischemic changes following treatment of aneurysm with flow diverters with two different perfusion MRI technique (Arterial spin labeling and DSC MRI), and to compare the results and effectiveness of these two methods. METHODS The prospective data was collected from patients with aneurysm who treated with flow diverters. MR examinations, including diffusion-weighted imaging (DWI), ASL, and DSC perfusion MRI, were conducted before and after treatment within the first week and at 6 months. Perfusion parameters of territory area and contralateral side were measured and analyzed by statistically. The relationships between ASL and DSC parameters were analyzed by using Sperman's correlation analysis. RESULTS A total of 14 cases of aneurysms in 11 patients treated successfully with endovascular flow diverter stent placement. Pretreatment and post treatment (within first week and 6 months) MRI images were evaluated. Asymptomatic randomly distributed millimetric restricted diffusion foci were observed in 8 of all patients. There was no statistically difference between pre and post treatment perfusion parameters (p > 0.05). A statistically significant correlation was found between variable ASL CBF, and the variables of DSC CBF and TTP. CONCLUSIONS Notwithstanding the fact that flow diverters change flow dynamics in aneurysm sac, there is no any perfusion abnormality in the territory area. Asymptomatic randomly distributed diffusion restricted foci in the both cerebral hemisphere can be observed. ASL and DSC MRI are effective for evaluation of brain perfusion.
Collapse
Affiliation(s)
| | - Emetullah Cindil
- Department of Radiology, Gazi University, School of Medicine, Ankara, Turkey
| | | | - Baran Onal
- Department of Radiology, Gazi University, School of Medicine, Ankara, Turkey
| | - Ali Yusuf Oner
- Department of Radiology, Gazi University, School of Medicine, Ankara, Turkey
| |
Collapse
|
14
|
Iwata N, Sakamoto M, Sakou T, Uno T, Kurosaki M. Utility of follow-up ultra-high-resolution CT angiography with model-based iterative reconstruction after flow diverter treatment for cerebral aneurysms. LA RADIOLOGIA MEDICA 2023; 128:1262-1270. [PMID: 37658197 DOI: 10.1007/s11547-023-01692-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/27/2023] [Indexed: 09/03/2023]
Abstract
PURPOSE Follow-up examinations after flow diverter (FD) treatment for cerebral aneurysms typically involve magnetic resonance imaging (MRI) or digital subtraction angiography (DSA). However, MRI is prone to vascular defects due to metal artifacts from FD, and DSA carries a risk of ischemic complications. In the context of computed tomography angiography (CTA), this study compares the efficacy of ultra-high-resolution CT (UHRCT) and novel reconstruction techniques, such as model-based iterative reconstruction (MBIR), against conventional methods such as filtered back projection (FBP) and hybrid iterative reconstruction (IR), to determine if they are a viable alternative to DSA in clinical settings. MATERIALS AND METHODS A phantom study was conducted with the full-width half-maximum considered as the FD thickness. This study compared three reconstruction methods: MBIR, FBP, and hybrid IR. A clinical study was also conducted with 21 patients who underwent follow-up CTA after FD treatment. The FD's visibility was assessed using a 4-point scale in FBP, hybrid IR, and MBIR compared to cone-beam CT (CBCT) with angiographic systems. RESULTS In the phantom study, FBP, hybrid IR, and MBIR visualized thinner FD thicknesses and improved detail rendering in that order. MBIR proved to be significantly superior in both the phantom and clinical study. CONCLUSION UHRCT with MBIR is highly effective for follow-up evaluations after FD treatment and may become the first-choice modality in the future.
Collapse
Affiliation(s)
- Naoki Iwata
- Department of Clinical Radiology, Tottori University Hospital, Tottori, Japan.
| | - Makoto Sakamoto
- Department of Clinical Radiology, Tottori University Hospital, Tottori, Japan
| | - Toshio Sakou
- Department of Clinical Radiology, Tottori University Hospital, Tottori, Japan
| | - Tetsuji Uno
- Department of Clinical Radiology, Tottori University Hospital, Tottori, Japan
| | - Masamichi Kurosaki
- Department of Clinical Radiology, Tottori University Hospital, Tottori, Japan
| |
Collapse
|
15
|
Piñana C, Remollo S, Zamarro J, Werner M, Espinosa de Rueda M, Vega P, Hernandez D, Murias E, Rivera E, Olier J, San Roman L, Páez-Carpio A, Requena M, Aixut S, de Dios Lascuevas M, Moreu M, Rosati S, Gramegna LL, Castaño C, Tomasello A. Derivo embolization device for intracranial aneurysms: a Spanish multicenter retrospective study. J Neurointerv Surg 2023; 15:871-875. [PMID: 35999049 DOI: 10.1136/jnis-2022-019220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/15/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Flow diverters have emerged in recent years as a safe and effective treatment for intracranial aneurysms, with expanding indications. The Derivo embolization device (DED) is a second-generation flow diverter with a surface finish that may reduce thrombogenicity. We report our multicenter experience evaluating its safety and efficacy. METHODS We retrospectively analyzed all patients treated with the DED in eight centers in Spain between 2016 and 2020. Demographics, clinical data, procedural complications, morbidity and aneurysm occlusion rates were collected. RESULTS A total of 209 patients with 250 aneurysms were treated (77.5% women). The majority of aneurysms were located in the internal carotid artery (86.8%) and most (69.2%) were small (<10 mm) with a median maximum diameter of 5.85 mm and median neck size of 4 mm. DED deployment was successful in all cases, despite two malfunctioning devices (1%). Major complications occurred in nine patients (4.3%), while mild neurologic clinical events were registered in 23 (11%); four patients died (1.9%). A total of 194 aneurysms had an angiographic follow-up at 6 months and showed complete aneurysm occlusion in 75% of cases. Twelve-month follow-up was available for 112 of the treated aneurysms, with a total occlusion rate of 83%. CONCLUSION The DED is a second-generation surface-modified flow diverter that presents an option for treatment of intracranial aneurysms with comparable safety and efficacy to other available flow diverter devices. Nonetheless, risks are not negligible, and must be balanced against the natural history risk of cerebral aneurysms, considering the tendency to widen indications for treatment of smaller and less complex lesions in day-to-day use.
Collapse
Affiliation(s)
- Carlos Piñana
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sebastian Remollo
- Interventional Neuroradiology Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Joaquín Zamarro
- Interventional Neuroradiology, Radiology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Mariano Werner
- Interventional Neuroradiology, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Mariano Espinosa de Rueda
- Interventional Neuroradiology, Radiology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Pedro Vega
- Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - David Hernandez
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Eduardo Murias
- Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Eila Rivera
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jorge Olier
- Interventional Neuroradiology, Hospital de Navarra, Pamplona, Spain
| | - Luis San Roman
- Interventional Neuroradiology, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alfredo Páez-Carpio
- Interventional Neuroradiology, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Manuel Requena
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sonia Aixut
- Neuroradiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Marta de Dios Lascuevas
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Moreu
- Interventional Neuroradiology Unit, Department of Radiology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Santiago Rosati
- Interventional Neuroradiology Unit, Department of Radiology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Laura Ludovica Gramegna
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Bologna, Italy
- Instituto delle Scienze Neurologiche di Bologna (IRCCS), Bologna, Italy
| | - Carlos Castaño
- Interventional Neuroradiology Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Alejandro Tomasello
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
| |
Collapse
|
16
|
Fan Y, Lei J, Fei F, Liu J, Liu Y. A novel flow diverter device (Tubridge) for the treatment of intracranial aneurysms: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:198. [PMID: 37561213 DOI: 10.1007/s10143-023-02100-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023]
Abstract
The flow diverter (FD) device has become a feasible and effective option for treating intracranial aneurysms. This study aimed to evaluate the efficacy and safety of Tubridge FD (TFD) in treating intracranial aneurysms and provide evidence for further research and clinical application. Electronic databases, including PubMed, Web of Science, Embase, and the Cochrane Library from inception to July 31, 2022, were searched. The eligible studies should include TFD investigations in treating intracranial aneurysms. Pooled technical success rate, complete occlusion rate, improvement rate, stable rate, symptom elimination rate, and adverse events rate were calculated with either the fixed-effects model or the random-effects model, depending on the results of tests for heterogeneity. Egger's tests were performed to assess the potential publication bias. A total of 7 studies (145 patients) were included in this study. The pooled technical success rate was 0.98, the complete occlusion rate was 0.79, the improvement rate was 0.21, and the stable rate was 0.05. One included study reported that the surgery-related mortality rate in the Tubridge group was higher than that in the control group (3.66% vs. 1.61%), while the surgery-related morbidity rate in the Tubridge group was 2.4% and that in the control group was 0. Findings of this meta-analysis indicate that TFD manifests promising and effective performance with acceptable adverse events in the treatment of intracranial aneurysms.
Collapse
Affiliation(s)
- Yingjun Fan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jun Lei
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Fan Fei
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jun Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yanhui Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
| |
Collapse
|
17
|
Suzuki Y, Toma N, Inoue K, Ichikawa T, Nishikawa H, Miura Y, Fujimoto M, Yasuda R, Maeda M, Suzuki H. Evaluation of Intra-Aneurysmal Residual Blood Flow with the iMSDE T1-Black Blood Imaging after Flow Diverter Treatment. JOURNAL OF NEUROENDOVASCULAR THERAPY 2023; 17:159-166. [PMID: 37609573 PMCID: PMC10442175 DOI: 10.5797/jnet.oa.2023-0016] [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: 03/27/2023] [Accepted: 05/25/2023] [Indexed: 08/24/2023]
Abstract
Objective We aimed to evaluate the efficacy of the "improved motion-sensitized driven-equilibrium (iMSDE)"-prepared T1-weighted black blood (T1-BB) MRI for monitoring treatment effect with a flow diverter (FD) for cerebral aneurysms. Methods Following the exclusion of concomitant coiling and retreatment cases from 60 consecutive cases of cerebral aneurysms treated with FDs at our institution, 32 with imaging data were included in the analysis. Detectability of residual blood flow within the aneurysms was validated as follows: 1) comparison of MRI sequences (iMSDE-prepared T1-BB images, T1-weighted images [ T1WI], and time-of-flight [ TOF]-MRA) in cases of incompletely occluded aneurysms and 2) comparison of angiography and MRI sequences in the same period. Results 1) The probability of diagnosing intra-aneurysmal blood flow was significantly higher with iMSDE-prepared T1-BB (iMSDE-prepared T1-BB vs. T1WI, p <0.001; iMSDE-prepared T1-BB vs. TOF-MRA, p <0.001). 2) The diagnostic accuracy of residual aneurysmal blood flow was significantly higher with iMSDE-prepared T1-BB than that with T1WI (p = 0.032). Furthermore, in cases of incomplete occlusion, the probability of detecting intra-aneurysmal blood flow was significantly higher with iMSDE-prepared T1-BB (iMSDE-prepared T1-BB vs. T1WI, p <0.001; iMSDE-prepared T1-BB vs. TOF-MRA, p = 0.023). Conclusion Our results demonstrated that iMSDE-prepared T1-BB could help distinguish between blood flow and thrombus within the aneurysms after FD treatment, especially in the early stages of FD treatment.
Collapse
Affiliation(s)
- Yume Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Naoki Toma
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Katsuhiro Inoue
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | - Tomonori Ichikawa
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hirofumi Nishikawa
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yoichi Miura
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masashi Fujimoto
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Ryuta Yasuda
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masayuki Maeda
- Department of Neuroradiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| |
Collapse
|
18
|
Nariai Y, Takigawa T, Hyodo A, Suzuki K. Acute Distal Migration and Shortening of the Flow-Redirection Endoluminal Device: A Case Report. JOURNAL OF NEUROENDOVASCULAR THERAPY 2023; 17:132-138. [PMID: 37546345 PMCID: PMC10400909 DOI: 10.5797/jnet.cr.2023-0011] [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: 02/24/2023] [Accepted: 05/08/2023] [Indexed: 08/08/2023]
Abstract
Objective The flow diverter (FD) is a promising device. Apart from two main complications, hemorrhagic and ischemic ones, stent migration is reportedly an unusual complication. In particular, distal migration of the FD has rarely been reported. We report a case of asymptomatic acute distal migration of the flow-redirection endoluminal device (FRED). Case Presentation A 50-year-old woman was incidentally diagnosed with an unruptured right internal carotid-ophthalmic artery aneurysm with a maximum diameter of 8.0 mm, and she subsequently underwent endovascular treatment with FRED. Based on the vessel diameter (3.8 mm proximal and 3.6 mm distal to the aneurysm), a 4.0-mm-diameter and 18-mm-long FRED was deployed without postoperative complications. However, on MRA 12 months after treatment, the aneurysm was not occluded; angiography showed distal migration of the FRED. The postoperative MRA and skull X-ray images were retrospectively reviewed to determine the period of the migration. The skull X-ray images and the signal loss area due to the FRED on MRA 1 day after the treatment had already demonstrated the migration of the FRED. In the second treatment, a 4.0-mm-diameter and 23-mm-long FRED was deployed in an overlapping fashion up to the proximal part of the carotid siphon. Prompt identification of distal migration of the FD without neurologic signs could be challenging. Conclusion It is important to follow up meticulously with MRA and skull X-ray images after FD treatment for detecting stent migrations as early as possible.
Collapse
Affiliation(s)
- Yasuhiko Nariai
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Tomoji Takigawa
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Akio Hyodo
- Department of Neurosurgery, Kamagaya General Hospital, Kamagaya, Chiba, Japan
| | - Kensuke Suzuki
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| |
Collapse
|
19
|
Meyerovitz C, Colwell L, Jeng-Miller K. Paracentral acute middle maculopathy immediately following internal carotid endovascular repair. Digit J Ophthalmol 2023; 29:58-60. [PMID: 37727463 PMCID: PMC10506615 DOI: 10.5693/djo.02.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Paracentral acute middle maculopathy (PAMM) can result from decreased perfusion to retinal and choroidal circulations meeting in the inner nuclear layer (INL) and outer plexiform layer (OPL). Although ischemia in these layers is rare, certain procedures place patients at risk for possible events, such as cardiopulmonary bypass, coronary angiography, and endovascular coil embolization. We report the case of a 70-year-old woman with a sudden-onset left paracentral scotoma following internal carotid endovascular repair. Currently no treatment or preventive technique is available. Additional ischemic events can occur if a preventable cause is not identified.
Collapse
|
20
|
Naylor RM, Abbasi M, Brinjikji W, Cloft HJ, Kallmes DF, Lanzino G. Long-term outcomes following pipeline embolization of unruptured aneurysms. Acta Neurochir (Wien) 2023:10.1007/s00701-023-05619-1. [PMID: 37191722 DOI: 10.1007/s00701-023-05619-1] [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: 01/18/2023] [Accepted: 05/05/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Flow diversion using the pipeline embolization device (PED) for unruptured aneurysms is associated with high occlusion and low morbidity and mortality. However, most reports have limited follow-up of 1-2 years. Therefore, we sought to report our outcomes after PED for unruptured aneurysms in patients with at least 5-years of follow-up. METHODS Review of patients undergoing PED for unruptured aneurysms from 2009 to 2016. RESULTS Overall, 135 patients with 138 aneurysms were included for analysis. Seventy-eight percent of aneurysms (n=107) over a median radiographic follow-up of 5.0 years underwent complete occlusion. Among aneurysms with at least 5-years of radiographic follow-up (n=71), 79% (n=56) achieved complete obliteration. No aneurysm recanalized after radiographic obliteration. Furthermore, over a median clinical follow-up period of 4.9 years, 84% of patients (n=115) self-reported mRS scores between 0 and 2. For patients with at least 5-years of clinical follow-up, 88% (n=61) reported mRS between 0 and 2. In total, 3% (n=4) of patients experienced a major, non-fatal neurologic complication related to the PED, 5% (n=7) of patients experienced a minor neurologic complication related to PED placement, and 2% (n=3) died from either delayed aneurysm rupture, delayed ipsilateral hemorrhage after PED placement, or delayed (9 months after treatment) neural compression after progressive thrombosis of a PED-treated dolichoectactic vertebrobasilar aneurysm. CONCLUSIONS Treatment of unruptured aneurysms with the PED is associated with high rates of long-term angiographic occlusion and low, albeit clinically important, rates of major neurologic morbidity and mortality. Thus, flow diversion via PED placement is safe, effective, and durable.
Collapse
Affiliation(s)
- Ryan M Naylor
- Department of Neurosurgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Mehdi Abbasi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Yale University, New Haven, CT, USA
| | | | - Harry J Cloft
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| |
Collapse
|
21
|
Soydemir E, Gündoğmuş CA, Türeli D, Andaç Baltacıoğlu N, Bayri Y, Baltacıoğlu F. Safety and efficacy of flow diverter stents in the treatment of middle cerebral artery aneurysms: a single-center experience and follow-up data. Diagn Interv Radiol 2023; 29:350-358. [PMID: 36988000 PMCID: PMC10679704 DOI: 10.4274/dir.2022.211050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/04/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE This study aims to evaluate the safety and efficacy of flow diverters (FDs) in the treatment of middle cerebral artery (MCA) aneurysms and share the follow-up (F/U) results. METHODS The treatment and F/U results of 76 MCA aneurysms treated with the flow re-direction endoluminal device (FRED), FRED Jr., and pipeline embolization device (PED) FD stents were evaluated retrospectively. The aneurysm occlusion rates were compared between FDs, and the integrated and jailed branches were evaluated through follow-ups. The oversizing of the stent was compared between occluded/non-occluded aneurysms and integrated branches. RESULTS The mean F/U duration was 32 ± 6.3 months, and the mean aneurysm diameter was 4.45 mm. A total of 61 (80.3%) aneurysms were wide-necked; 73 (96.1%) were saccular; 52 (68.4%) were located at the M1 segment; and 36 (45.6%) FREDs, 23 (29.1%) FRED Jr.s, and 19 (24.1%) PEDs were used for treatment. The overall occlusion rates for the 6-, 12-, 24-, 36-, and 60-month digital subtraction angiographies were 43.8%, 63.5%, 73.3%, 85.7%, and 87.5% respectively. The last F/U occlusion rates were 67.6% for FRED, 66.7% for PED, and 60.6% for FRED Jr. (P = 0.863). An integrated branch was covered with an FD during the treatment of 63 (82.8%) aneurysms. A total of six (10%) of the integrated branches were occluded without any symptoms at the last F/U appointment. The median oversizing was 0.45 (0-1.30) for occluded aneurysms, and 0.50 (0-1.40) for non-occluded aneurysms (P = 0.323). The median oversizing was 0.70 (0.45-1.10) in occluded integrated branches and 0.50 (0-1.40) in non-occluded branches (P = 0.131). In-stent stenosis was seen in 22 (30.1%) of the stents at the 6-month F/U and in only 2 (4.7%) at the 24-month F/U. Thus, none of the patients had any neurological deficits because of the in-stent stenosis. Severe in-stent stenosis was seen in two stents. CONCLUSION MCA aneurysms tend to be complex, with integrated branches and potentially wide necks. FD stents are safe and effective in the treatment of MCA aneurysms, and the patency of the side and jailed branches is preserved in most cases. Higher occlusion and lower in-stent stenosis rates are seen with longer F/U durations.
Collapse
Affiliation(s)
- Efe Soydemir
- Department of Radiology, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Cemal Aydın Gündoğmuş
- Department of Radiology, Marmara University Faculty of Medicine, İstanbul, Turkey
- Department of Radiology, Koç University Hospital, İstanbul, Turkey
| | - Derya Türeli
- Department of Radiology, Marmara University Faculty of Medicine, İstanbul, Turkey
| | | | - Yaşar Bayri
- Department of Neurosurgery, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Feyyaz Baltacıoğlu
- Department of Radiology, Marmara University Faculty of Medicine, İstanbul, Turkey
- Department of Radiology, VKV Amerikan Hospital, İstanbul, Turkey
| |
Collapse
|
22
|
Kitamura T, Fujii T, Yatomi K, Teranishi K, Mitome-Mishima Y, Oishi H. Safety and efficacy of pipeline embolization device treatments for intradural internal carotid artery aneurysms in a single center in a Japanese population. Surg Neurol Int 2023; 14:92. [PMID: 37025526 PMCID: PMC10070317 DOI: 10.25259/sni_1165_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/25/2023] [Indexed: 03/19/2023] Open
Abstract
Background:
The pipeline embolization device (PED) is the most common flow diverter device in the world. To date, there have been no reports of treatment outcomes specific to intradural internal carotid artery (ICA) aneurysms. The safety and efficacy of the PED treatments for intradural ICA aneurysms are reported.
Methods:
131 patients with 133 aneurysms underwent PED treatments for intradural ICA aneurysms. The mean aneurysm dome size and neck length were 12.7 ± 4.3 mm and 6.1 ± 2.2 mm, respectively. We used adjunctive endosaccular coil embolization for 88 aneurysms (66.2%). A total of 113 aneurysms (85%) were angiographically followed up 6 months following the procedure, and 93 aneurysms (69.9%) were followed up for 1 year.
Results:
The angiographic outcome at 6 months showed that 94 (83.2%) aneurysms had O’Kelly-Marotta (OKM) grade D, 6 (5.3%) had C, 10 (8.8%) had B, and 3 (2.7%) had A. At 1 year, 82 (88.2%) aneurysms had OKM grade D, 6 (6.5%) had C, 3 (3.2%) had B, and 2 (2.2%) had A. Multivariate analysis showed that aneurysm neck size and adjunctive coiling were statistically significant in aneurysm occlusion status. Major morbidity modified Rankin Scale >2 and mortality rates related to procedures were 3.0% and 0%, respectively. Delayed aneurysm ruptures were not observed.
Conclusion:
These results reveal that PED treatment of intradural ICA aneurysms is safe and efficacious. The combined use of adjunctive coil embolization not only prevents delayed aneurysm ruptures but also contributes to an increase in the rate of complete occlusion.
Collapse
Affiliation(s)
- Takayuki Kitamura
- Department of Neuroendovascular Therapy and Neurosurgery, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Takashi Fujii
- Department of Neuroendovascular Therapy, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kenji Yatomi
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kohsuke Teranishi
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yumiko Mitome-Mishima
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hidenori Oishi
- Department of Neuroendovascular Therapy and Neurosurgery, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
23
|
Utility of flow diverters in treatment of acutely ruptured uncoilable aneurysms of the posterior circulation of the brain. Jpn J Radiol 2023:10.1007/s11604-023-01409-y. [PMID: 36920731 DOI: 10.1007/s11604-023-01409-y] [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: 09/13/2022] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE Aim of this study is to evaluate safety and efficacy of flow diverters (FDs) in treatment of acutely ruptured posterior circulation aneurysms MATERIALS AND METHODS: Databases of three participating institutions were retrospectively scanned for patients in whom FD placement was attempted for treatment of acutely ruptured vertebrobasilar aneurysms. An interval of 14 days or fewer between the latest ictus and treatment was used as inclusion criterion. Patients with dolichoectasia of vertebrobasilar arteries were excluded. If necessary, adjunctive techniques including coiling or stenting were utilized. Clinical outcomes were graded using mWFNS (modified World Federation of Neurosurgical Societies Scale) and mRS (modified Rankin Scale). Aneurysmal occlusion was defined as Raymond-Roy Class 1. Spearman's (ρ) test was used to assess the correlation between variables. Univariate and multivariate logistic regression were used to assess outcomes. RESULTS 31 patients (25 women, mean age: 52.7 ± 15.2) harboring 32 aneurysms (16 non-saccular, mean size: 11.4 ± 7 mm) were included. Mean number of FDs used was 1.22 ± 0.42. In six cases, adjunctive coiling and in five cases, apposing stent placement were used. Overall mortality rate and procedure-related mortality rates were 22.5% (7/31) and 9.6% (3/31), respectively. At a mean imaging follow-up of 17.2 ± 12.6 months, total occlusion was achieved in 22 aneurysms (91.6%). Univariate analysis showed that mortality was positively correlated with vasospasm (ρ = 0.600, p < 0.05), higher mWFNS Scale (ρ = 0.685, p < 0.05), higher modified Fischer Score (ρ = 0.609, p < 0.05), higher mRS (ρ = 0.594, p < 0.05) on admission and negatively correlated with saccular morphology (ρ = -0.529, p < 0.05). Multivariate logistic regression identified mWFNS on admission as a significant predictor. (OR: 7.148, 95% CI 1.777-28.758, p: 0.01). Adjunctive coiling positively correlated with aneurysm occlusion. (ρ = 0.522, p < 0.05). CONCLUSION The procedure-related morbidity and mortality is not negligible. However, the risks and efficacy associated with FDs are acceptable, especially when adjunctive coiling is possible, given the lack of treatment alternatives.
Collapse
|
24
|
Inci S, Karakaya D. Microsurgical Treatment of Previously Coiled Giant Aneurysms: Experience with 6 Cases and Literature Review. World Neurosurg 2023; 171:e336-e348. [PMID: 36513298 DOI: 10.1016/j.wneu.2022.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Surgical treatment of insufficiently embolized (coiled) or recurrent giant aneurysms has not been well established in the literature. The aim of this study is to bring up the surgical difficulties of these rare aneurysms and to offer solutions. METHODS A database was queried for giant aneurysms that had been previously embolized and subsequently required surgical treatment. We only found 29 aneurysms in the literature and here, we report 6 more surgical cases with patient characteristics, radiological studies, applied surgical techniques, and outcomes which were reviewed retrospectively. RESULTS Four females and 2 males, with a mean age of 45.6 years took part in the study. The most common aneurysm location was the middle cerebral artery. While 5 aneurysms were successfully clipped, 1 was excised and the neck was closed with micro sutures. The coils were compulsorily removed in 3 patients. Postoperative digital subtraction angiography confirmed total occlusion of the aneurysms in all cases. Overall morbidity was 16.6%. There was no mortality. No recurrence was observed in the angiographic follow-up (mean 22.6 months, range 7-47 months). The literature review also determined that 97.1% of 35 previously coiled giant aneurysms (including ours) were occluded using various surgical techniques, with 82.8% good outcome. CONCLUSIONS Surgical clipping is a safe and effective procedure for the treatment of insufficiently embolized or recurrent giant aneurysms after coiling. If possible, the coils should not be removed. However, if safe clipping is not possible due to the coils, the removal of the coils should not be avoided.
Collapse
Affiliation(s)
- Servet Inci
- Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey.
| | - Dicle Karakaya
- Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey
| |
Collapse
|
25
|
Flow Diverting Stents in Cerebral Small Caliber Vessels (< 2 mm) for Aneurysm Treatment : A Three Center Retrospective Study. Clin Neuroradiol 2023; 33:99-105. [PMID: 35768696 DOI: 10.1007/s00062-022-01187-6] [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: 04/12/2022] [Accepted: 06/08/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The off-label use of flow diverting stents (FDS) for treating cerebral aneurysms in small distal vessels is increasing in clinical practice with encouraging results; however, data directly addressing the parent vessel size are still scarce. Our aim was to evaluate the safety and efficacy of FDS placement in anterior and posterior circulation aneurysms with parent arteries ≤ 2 mm in a real-world representative setting. METHODS We retrospectively reviewed patients treated with FDS at the three participating university hospitals between 2009 and 2021. The inclusion criteria were the placement of at least one FDS in a parent vessel with a maximum diameter of 2 mm or less. The primary clinical safety endpoint was the absence of death, major or minor symptomatic stroke, transient ischemic attack and procedure-related intracranial hemorrhage. Clinical outcome was assessed using the modified Rankin Scale (mRS) score at the follow-up visit at 1 year. The primary efficacy endpoint was defined as complete and near-complete occlusion at the 1‑year follow-up. RESULTS We identified 55 patients harboring 56 aneurysms. The primary clinical safety endpoint was obtained in 93% of cases. The hemorrhagic and thromboembolic complication rates were 4% and 9%, respectively. No patient died or had a relevant discrepancy (> 1 point) at the pre-mRS and post-mRS. The primary efficacy endpoint was reached in 80% of cases. CONCLUSION The use of FDS in vessels < 2 mm is technically feasible with good aneurysm occlusion rates and an acceptable safety profile. Nevertheless, it is essential to be aware of the of the main complications associated when operating in small diameter vessels.
Collapse
|
26
|
López-Callejas O, Ortiz-Giraldo AF, Vera DD, Ramirez-Rojas DA, Villamizar-Barahona AB, Ferreira-Prada CA, Galvis M, Vargas-Pérez O, Serrano-Gómez S, Reyes-Gonzalez A, Mantilla D. Flow Diverter Treatment for Non-Ruptured Carotid Aneurysms: Efficacy and Safety. Neurointervention 2023; 18:23-29. [PMID: 36809874 PMCID: PMC9986347 DOI: 10.5469/neuroint.2022.00458] [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: 12/01/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
PURPOSE Internal carotid artery (ICA) aneurysm treatment with a flow diverter (FD) has shown an adequate efficacy and safety profile, presenting high complete occlusion or near occlusion rates with low complications during follow-up. The purpose of this study was to evaluate the efficacy and safety of FD treatment in non-ruptured internal carotid aneurysms. MATERIALS AND METHODS This is a retrospective, single-center, observational study evaluating patients diagnosed with unruptured ICA aneurysms treated with an FD between January 1, 2014, and January 1, 2020. We analyzed an anonymized database. The primary effectiveness endpoint was complete occlusion (O'Kelly-Marotta D, OKM-D) of the target aneurysm through 1-year follow-up. The safety endpoint was the evaluation of modified Rankin Scale (mRS) 90 days after treatment, considering a favorable outcome an mRS 0-2. RESULTS A total of 106 patients were treated with an FD, 91.5% were women; the mean follow- up was 427.2±144.8 days. Technical success was achieved in 105 cases (99.1%). All patients included had 1-year follow-up digital subtraction angiography control; 78 patients (73.6%) completed the primary efficacy endpoint by achieving total occlusion (OKM-D). Giant aneurysms had a higher risk of not achieving complete occlusion (risk ratio, 3.07; 95% confidence interval, 1.70 - 5.54]). The safety endpoint of mRS 0-2 at 90 days was accomplished in 103 patients (97.2%). CONCLUSION Treatment of unruptured ICA aneurysms with an FD showed high 1-year total occlusion results, with very low morbidity and mortality complications.
Collapse
Affiliation(s)
- Orlando López-Callejas
- Department of Interventional Radiology, Fundación Oftalmológica de Santander-Clínica Ardila Lülle, Floridablanca, Colombia.,Department of Radiology, Clínica Medicadiz, Ibagué, Colombia
| | - Andres F Ortiz-Giraldo
- Department of Interventional Radiology, Fundación Oftalmológica de Santander-Clínica Ardila Lülle, Floridablanca, Colombia
| | - Daniela D Vera
- Department of Radiology, Fundación Oftalmológica de Santander-Clínica Ardila Lülle, Floridablanca, Colombia
| | | | - Ana B Villamizar-Barahona
- Department of Interventional Radiology, Fundación Oftalmológica de Santander-Clínica Ardila Lülle, Floridablanca, Colombia
| | - Carlos A Ferreira-Prada
- Department of Interventional Radiology, Fundación Oftalmológica de Santander-Clínica Ardila Lülle, Floridablanca, Colombia.,Department of Interventional Radiology, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Melquizidel Galvis
- Department of Interventional Radiology, Fundación Oftalmológica de Santander-Clínica Ardila Lülle, Floridablanca, Colombia.,Department of Interventional Radiology, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Oliverio Vargas-Pérez
- Department of Interventional Radiology, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.,Department of Radiology, Fundación Oftalmológica de Santander-Clínica Ardila Lülle, Floridablanca, Colombia
| | - Sergio Serrano-Gómez
- Clinical Research Group-UNAB, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Adriana Reyes-Gonzalez
- Clinical Research Group-UNAB, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Daniel Mantilla
- Department of Interventional Radiology, Fundación Oftalmológica de Santander-Clínica Ardila Lülle, Floridablanca, Colombia.,Department of Interventional Radiology, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| |
Collapse
|
27
|
Wu Y, Yu J, Zhang T, Deng JP, Zhao Z. Endovascular treatment of distal internal carotid artery aneurysms and vertebral artery dissecting aneurysms with the Willis covered stent: A single-center, retrospective study. Interv Neuroradiol 2023; 29:63-78. [PMID: 35581717 PMCID: PMC9893231 DOI: 10.1177/15910199211070900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/09/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND More data is needed on the short- and medium-term efficacy and safety of the Willis covered stent in treating distal internal carotid artery (DICA) aneurysms and vertebral artery dissecting aneurysms (VADAs). METHODS Records of all 42 patients with DICA aneurysms or VADAs treated with the Willis covered stents at our institute between July 2014 and January 2019 were retrospectively examined. The patients' demographic information, symptoms, diagnosis, treatment procedure, immediate and follow-up clinical and angiographic outcomes were extracted. RESULTS 46 Willis covered stents were successfully implanted in all of the 42 patients (total 43 aneurysms). Immediate complete aneurysm occlusion was achieved in 37 patients (38 aneurysms) (88.4%), and endoleak occurred to 5 patients (5 aneurysms) (11.6%). 2 patients died post-operatively from procedure-related complications, another one died from reasons unrelated to the procedure. Among the remaining 39 patients, non-lethal complications occurred in 4 patients including ptosis and diplopia of the right eye, intra-operative hemorrhage and carotid cavernous fistulas (CCF). Angiographic and clinical follow-ups (means ± standard deviation: 8.8 ± 5.3 months) were done for 32 patients (33 aneurysms). Complete occlusion was maintained in all of the 33 aneurysms. 2 of the 32 patients had significant though asymptomatic parent artery (PA) occlusion. No ischemic or hemorrhagic event occurred during the follow-up period. The modified Rankin Scale (mRS) score was 0 in 31 patients and 1 in the remaining 1 patient. CONCLUSIONS The Willis covered stent could be a safe and effective treatment for complex DICA aneurysms with excellent durability. In addition, the Willis covered stent treated all of the 3 cases of VADAs in the study with complete success without any complications, however, as the number of the VADA cases was small, more cases are needed to further confirm the efficacy and safety of the Willis covered stent in treating VADAs.
Collapse
Affiliation(s)
| | | | - Tao Zhang
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University (The Fourth Military Medical
University), Xi’an, China
| | - Jian-Ping Deng
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University (The Fourth Military Medical
University), Xi’an, China
| | - Zhenwei Zhao
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University (The Fourth Military Medical
University), Xi’an, China
| |
Collapse
|
28
|
Kashkoush A, El-Abtah ME, Achey R, Hussain MS, Toth G, Moore NZ, Bain M. Flow Diversion as Destination Treatment of Intracranial Mycotic Aneurysms: A Retrospective Case Series. Oper Neurosurg (Hagerstown) 2023; 24:492-498. [PMID: 36715979 DOI: 10.1227/ons.0000000000000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/21/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Mycotic aneurysms represent a rare type of intracranial aneurysm. Treatment options usually consist of coiling, clipping, or liquid embolization. Data regarding outcomes after flow diversion of mycotic aneurysms are sparse. OBJECTIVE To present a single-center case series regarding our experience with FD as definitive treatment for ruptured mycotic aneurysms initially treated with coil embolization. METHODS We retrospectively reviewed a prospectively maintained database of all cerebrovascular procedures performed at a single institution between 2017 and 2021 for cases that used FD for the management of intracranial mycotic aneurysms. Prospectively collected data included patient demographics, medical history, rupture status, aneurysm morphology, aneurysm location, and periprocedural complications. The main outcomes included neurological examination and radiographic occlusion rate on cerebral digital subtraction angiography. RESULTS Three patients with 4 ruptured mycotic aneurysms that were initially treated with coil embolization were identified that required retreatment. The aneurysms were located along the middle cerebral artery bifurcation (n = 2), posterior cerebral artery P1/2 junction (n = 1), and basilar artery apex (n = 1), which all demonstrated recurrence after initial coil embolization. Successful retreatment using flow diverting stents was performed in all 3 patients. At the last angiographic follow-up, all aneurysms demonstrated complete occlusion. No patients suffered new periprocedural complications or neurological deficits after FD. CONCLUSION Flow-diverting stents may be an effective treatment option for intracranial mycotic aneurysms that are refractory to previous endovascular coiling. Future studies are warranted to establish the associated long-term safety and clinical efficacy.
Collapse
Affiliation(s)
- Ahmed Kashkoush
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed E El-Abtah
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Rebecca Achey
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Gabor Toth
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nina Z Moore
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA.,Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mark Bain
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA.,Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
29
|
Endovascular treatment of challenging aneurysms with FRED Jr flow diverter stents: a single-center experience. Jpn J Radiol 2023; 41:322-334. [PMID: 36315360 PMCID: PMC9619020 DOI: 10.1007/s11604-022-01354-2] [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: 05/08/2022] [Accepted: 10/20/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE To analyze clinical safety and efficacy of flow re-direction endoluminal device (FRED) Jr flow diverter for treatment of unruptured, ruptured, or recanalyzed aneurysms. MATERIALS AND METHODS Between October 2019 and February 2022, 25 patients with 31 aneurysms treated with FRED Jr were included in the study. Clinical and radiological records, procedural details, and follow-up outcomes were retrospectively evaluated. Eighteen (72%) patients were female. Median age was 48.8 (age range 9-85). Mean follow-up was 21 months (6-28 months). Location of the aneurysms were as follows; 13 in middle cerebral artery (MCA), 7 in anterior cerebral artery (ACA), 4 in posterior cerebral artery (PCA), 3 in true posterior communicating artery (PCom), 2 in anterior communicating artery (ACom), 1 in superior cerebellar artery (SCA), 1 in true ophthalmic artery. Five patients (20%) presented with acute subarachnoid hemorrhage (aSAH). RESULTS In all procedures, FRED Jr was successfully deployed. Three true Pcom aneurysms and a true ophthalmic aneurysm were treated with FRED Jr. Three patients with two adjacent aneurysms were treated with a single FRED Jr. In two (8%) patients in-stent thrombosis occurred intraoperatively, they were treated with iv tirofiban and thrombectomy without any sequelae. Post-discharge 2 weeks later, intraparenchymal hemorrhage occurred in a patient. He was treated with surgical drainage, the clinical course was modified Rankin score (mRS) 2. Digital subtraction angiography (DSA) was performed on 16 (64%) patients with 21 (67%) aneurysms. Near complete-complete occlusion (O'Kelly-Morata grading scale (OKM C-D) was documented in 15/16 (93.7%) patients, 20/21 (95.2%) aneurysms. In nine (36%) patients, no residual filling was observed in the magnetic resonance angiography (MRA). Good clinical outcome (mRS 0-1) was achieved in 24/25 (96%) of patients. CONCLUSION Endovascular treatment of small cerebral aneurysms with FRED Jr is safe and effective even in complex and challenging morphologies allowing high rates of aneurysm occlusion with low periprocedural complications. Our cohort, consisting of a rate 20% acute ruptured aneurysms, is the major additive data to the published literature.
Collapse
|
30
|
Lauzier DC, Huguenard AL, Srienc AI, Cler SJ, Osbun JW, Chatterjee AR, Vellimana AK, Kansagra AP, Derdeyn CP, Cross DT, Moran CJ. A review of technological innovations leading to modern endovascular brain aneurysm treatment. Front Neurol 2023; 14:1156887. [PMID: 37114225 PMCID: PMC10126349 DOI: 10.3389/fneur.2023.1156887] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
Tools and techniques utilized in endovascular brain aneurysm treatment have undergone rapid evolution in recent decades. These technique and device-level innovations have allowed for treatment of highly complex intracranial aneurysms and improved patient outcomes. We review the major innovations within neurointervention that have led to the current state of brain aneurysm treatment.
Collapse
Affiliation(s)
- David C. Lauzier
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- *Correspondence: David C. Lauzier ;
| | - Anna L. Huguenard
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Anja I. Srienc
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Samuel J. Cler
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Joshua W. Osbun
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Arindam R. Chatterjee
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Ananth K. Vellimana
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Akash P. Kansagra
- Department of Neurointerventional Surgery, California Center of Neurointerventional Surgery, San Diego, CA, United States
| | - Colin P. Derdeyn
- Department of Radiology, University of Iowa School of Medicine, Iowa City, IA, United States
| | - Dewitte T. Cross
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Christopher J. Moran
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| |
Collapse
|
31
|
Gozal YM, Abou-Al-Shaar H, Alzhrani G, Taussky P, Couldwell WT. Complications of Endovascular and Open Aneurysm Surgery in the Era of Flow Diversion. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 130:85-94. [PMID: 37548727 DOI: 10.1007/978-3-030-12887-6_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
The techniques used for treatment of intracranial aneurysms have progressed dramatically over the decades. The introduction of modern endovascular techniques and the continued refinement of progressively less invasive neurosurgical approaches have contributed to steadily improving clinical outcomes. Moreover, innovations such as flow-diverting stents have achieved dramatic success and have gained rapid widespread adoption. Particularly in lesions for which the application of conventional treatment techniques is difficult, flow diversion technology has revolutionized aneurysm management. This review provides a discussion on the morbidity and mortality encountered in the treatment of intracranial aneurysms in the modern era. Common adverse events faced in the management of these lesions with open surgery and various endovascular techniques are highlighted.
Collapse
Affiliation(s)
- Yair M Gozal
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
- Mayfield Clinic, Cincinnati, OH, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gmaan Alzhrani
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Philipp Taussky
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
| |
Collapse
|
32
|
Thormann M, Sillis N, Thoma T, Altenbernd J, Berger B, Cioltan A, Loehr C, Bohner G, Siebert E, Nordmeyer H, Mpotsaris A, Behme D. The DERIVO®2 Embolization Device in the treatment of ruptured and unruptured intracranial aneurysms: A multicenter analysis. Interv Neuroradiol 2022:15910199221142643. [PMID: 36567499 DOI: 10.1177/15910199221142643] [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: 12/27/2022] Open
Abstract
BACKGROUND Flow diverters are an increasingly used treatment option for intracranial aneurysms. A recent addition to the European market is the DERIVO®2 Embolization Device (DED2), promising improved radiopacity. We aimed to assess the safety and efficacy of the DED2 regarding angiographic and clinical outcomes in ruptured and unruptured cerebral aneurysms. METHODS We performed a multicenter trial at six interventional centers. Data were prospectively collected and all patients treated with the DED2 were included. The primary endpoint was angiographic aneurysm occlusion at 6 months as assessed by the O'Kelly Marotta (OKM) grading scale with a favorable outcome definition of OKM C + D. Clinical outcome was evaluated according to the modified Rankin scale (mRS). RESULTS Between August 2020 and July 2021, 37 patients were treated with the DED2 and were included in our analysis. Five patients presented with ruptured aneurysms. Median age was 60 years, 27 patients were female, and 10 male. Median mRS was 0 (range 0-4). Mean aneurysm size was 8.9 ± 7.1 mm with a mean neck size of 6.5 ± 6.1. The DED2 fully opened at deployment in all cases. Clinical follow-up was available for 30 patients (81%). Twenty-five (83%) had an mRS of 0 or 1. Three patients with ruptured aneurysms died during the follow-up period. No treatment-related major morbidity was observed. Follow-up imaging was available in 27 (90%) patients, with 23 patients (85%) showing satisfactory aneurysm occlusion OKM grade C-D. CONCLUSION In this small cohort, the DED2 provided safe and effective treatment of ruptured and unruptured intracranial aneurysms.
Collapse
Affiliation(s)
- Maximilian Thormann
- University Clinic for Neuroradiology, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Nele Sillis
- University Clinic for Neuroradiology, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Taina Thoma
- University Clinic for Neuroradiology, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Jens Altenbernd
- Department of Radiology and Neuroradiology, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Björn Berger
- Department of Neuroradiology, Evangelisches Klinikum Bethel, Universitätsklinikum OWL, Bielefeld, Germany
| | - Andrea Cioltan
- Department of Radiology and Neuroradiology, 39546Klinikum Vest GmbH Behandlungszentrum Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
| | - Christian Loehr
- Department of Radiology and Neuroradiology, Klinikum Vest Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
| | - Georg Bohner
- Institute of Neuroradiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eberhard Siebert
- Institute of Neuroradiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hannes Nordmeyer
- Department of Interventional Neuroradiology Radprax, 39655St Lukas Klinik, Solingen, Germany
- School of Medicine, Department of Health, 12263Witten/Herdecke University, Witten, Germany
| | - Anastasios Mpotsaris
- Department for Diagnostic and Interventional Radiology and Neuroradiology, Munich Clinic Harlaching, Munich, Germany
| | - Daniel Behme
- University Clinic for Neuroradiology, 39067University Hospital Magdeburg, Magdeburg, Germany
- Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| |
Collapse
|
33
|
Carvalho V, Moreira M, Vilarinho A, Cerejo A, Vaz R, Silva PA. Selection bias in patients proposed for neurosurgical versus endovascular treatment of aneurysms of the posterior communicating artery. Interv Neuroradiol 2022; 28:675-681. [PMID: 34787020 PMCID: PMC9706261 DOI: 10.1177/15910199211057738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/25/2021] [Accepted: 10/17/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Microsurgical clipping and endovascular coiling are viable treatment options for posterior communicating artery (PComA) aneurysms, but there are still major limitations to evidence-based decisions regarding standard-of-care treatment. In this study, we aimed at assessing potential selection biases that may influence our ability to extract conclusions about the comparative effectiveness or efficacy of the aneurysm treatment. OBJECTIVE To study the patient/aneurysm characteristics as possible biases in the option for endovascular or neurosurgical treatment of PComA aneurysms. METHODS A single-center, retrospective cohort study was performed, including all patients with treated PComA aneurysms with neurosurgical clipping or endovascular coiling between January 2010 and January 2021. Clinical and morphological data were collected from electronic records, and statistical analysis was performed. RESULTS A total of 64 patients was eligible for inclusion; 24 (37.5%) patients were proposed for neurosurgical treatment, while 40 (62.5%) for endovascular treatment; 10 patients (25%) crossed over to the clipping group whereas none crossed over to the coiling side. Actual treatment analysis showed significantly higher diameters of mother vessel (t-test, p = 0.034) and aneurysm neck (Mann-Whitney, p = 0.029) in the clipping group and higher aspect and dome-to-neck ratios in the endovascular group (Mann-Whitney, p = 0.008). A significantly higher vasospasm frequency was found in the clipping group but only in the intention-to-treat analysis (Chi-square, p = 0.032). CONCLUSION Significant morphological differences between effective endovascular and surgical groups and differences in intention-to-treat analysis may limit the validity of a direct comparison between treatment options and suggest the presence of a possible selection bias.
Collapse
Affiliation(s)
- Vasco Carvalho
- Department of Neurosurgery, Centro Hospitalar Universitário São
João, Porto, Portugal
- Faculty of Medicine of the University of
Porto, Porto, Portugal
| | - Marta Moreira
- Faculty of Medicine of the University of
Porto, Porto, Portugal
| | - António Vilarinho
- Department of Neurosurgery, Centro Hospitalar Universitário São
João, Porto, Portugal
- Faculty of Medicine of the University of
Porto, Porto, Portugal
| | - António Cerejo
- Department of Neurosurgery, Centro Hospitalar Universitário São
João, Porto, Portugal
- Faculty of Medicine of the University of
Porto, Porto, Portugal
| | - Rui Vaz
- Department of Neurosurgery, Centro Hospitalar Universitário São
João, Porto, Portugal
- Faculty of Medicine of the University of
Porto, Porto, Portugal
| | - Pedro Alberto Silva
- Department of Neurosurgery, Centro Hospitalar Universitário São
João, Porto, Portugal
- Faculty of Medicine of the University of
Porto, Porto, Portugal
| |
Collapse
|
34
|
Flores-Milan G, Pressman E, Peto I, Ren Z, Guerrero WR, Mokin M. Factors associated with in-stent stenosis after cerebral aneurysm embolization using a Pipeline embolization device. Interv Neuroradiol 2022; 28:731-736. [PMID: 34894820 PMCID: PMC9706256 DOI: 10.1177/15910199211066368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Flow-diverting (FD) stents, with or without coiling, are a mainstay in endovascular treatment of intracranial aneurysms (IAs). One observed complication from flow diverter stent (FDS) insertion has been in-stent stenosis. Though previously studied in the short-term period, the long-term history of this complication has yet to be described. METHODS We performed a retrospective cohort study of consecutive IAs treated with Pipeline Embolization Device (PED), with or without coiling, at our centre between September 2014 and December 2018 that had at least one digital subtraction angiogram (DSA) during follow-up. In-stent stenosis was measured from DSA images, and associated patient and procedural characteristics were analysed. RESULTS 94 patients treated with PED for IA were identified. On initial DSA during follow-up, 52 patients (55.3%) had in-stent stenosis within the PED. Of these 52 patients, 17 had a second DSA during follow-up. In this 2nd DSA, improvement and/or stable in-stent stenosis was seen 16 patients (94.1%). One patient in this group had worsening in-stent stenosis had a vertebrobasilar junction FD stent. Of the patients without in-stent stenosis on initial DSA, 15 had a second DSA during follow-up. Only one of these patients (6.7%) had new appearance of in-stent stenosis (measuring 5%). Multivariate analysis found statin use to be predictive of in-stent stenosis (p = 0.020, Odds ratio = 0.279 and 95% confidence interval = 0.095-0.821). CONCLUSIONS In-stent stenosis after FDS placement was seen in 53.2% of cases, which had between 1-50% of stenosis. 82.4% had resolution/improvement of their stenosis. Statin use was protective of in-stent stenosis.
Collapse
Affiliation(s)
- Gabriel Flores-Milan
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Elliot Pressman
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Ivo Peto
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Zeguang Ren
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Waldo R. Guerrero
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
- Neurosciences Group, Tampa General Hospital, Tampa, FL, USA
| | - Maxim Mokin
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
- Neurosciences Group, Tampa General Hospital, Tampa, FL, USA
| |
Collapse
|
35
|
Al-Ageely TA, Ismail M, Mohammed SA, Al-Delfi AH, Alshedidi MS, Al-Jaberi MB, Almufadhal MH, Abdulateef AA, Aljuboori Z, Al-Jehani H, Hoz SS. Failure of tandem flow diversion for intracranial aneurysms: Literature review and illustrative case. Surg Neurol Int 2022; 13:518. [DOI: 10.25259/sni_944_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background:
Flow diverters are becoming one of the main endovascular procedures used to treat aneurysms. Flow diverter devices (FDDs) have multiple types approved for endovascular procedure use. Although their indications are not well described, they are usually used for large or giant, wide-necked, and recurrent aneurysms. Multiple FDDs can be deployed to treat giant aneurysms to ensure and accelerate aneurysm occlusion and mitigate complications. We report a case of endovascular treatment of an intracranial aneurysm using three silk FDDs complicated by a delayed migration of the stents along the parent artery, along with a literature review of the related cases.
Methods:
We conducted a PubMed Medline database search by the following combined formula of subjects headings: ((((((intracranial aneurysm[MeSH Terms]) AND (endovascular procedure[MeSH Terms])) OR (endovascular technique[MeSH Terms])) AND (endovascular[Title/Abstract]) AND (Flow diverter[Title/ Abstract])) OR (flow diversion[Title/Abstract])) OR (Pipeline[Title/Abstract])) AND (Multiple[Title/Abstract]).
Results:
The result was eight cases of endovascular treatment of intracranial aneurysms with multiple FDD. The male-to-female ratio in these cases was 5:3, and there is a wide age range from 22 months to 69 years old. The cases differed in the type and number of FDDs used, yet, they all had similar results with aneurysm occlusion and recovery of the patient with no observed complications.
Conclusion:
Tandem flow diverter deployment has technical challenges and complications such as complete obstruction can occur. Planning and learning from experience with those new technologies are the typical way to overcome such complications in the future.
Collapse
Affiliation(s)
- Teeba A. Al-Ageely
- Department of Neurosurgery, University of Baghdad, College of Medicine, Al Risafa, Baghdad, Iraq,
| | - Mustafa Ismail
- Department of Neurosurgery, University of Baghdad, College of Medicine, Al Risafa, Baghdad, Iraq,
| | - Sara A. Mohammed
- Department of Neurosurgery, University of Baghdad, College of Medicine, Al Risafa, Baghdad, Iraq,
| | - Ali H. Al-Delfi
- Department of Neurosurgery, University of Alameed, College of Medicine, Karbala, Iraq,
| | - Muhammed S. Alshedidi
- Department of Neurosurgery, University of Alameed, College of Medicine, Karbala, Iraq,
| | | | - Muntadher H. Almufadhal
- Department of Neurosurgery, University of Baghdad, College of Medicine, Al Risafa, Baghdad, Iraq,
| | | | - Zaid Aljuboori
- Department of Neurosurgery, University of Wisconsin-Madison, Wisconsin, United States,
| | - Hosam Al-Jehani
- Department of Neurosurgery, Imam Abdulrahman Alfaisal University, Dammam, Saudi Arabia,
| | - Samer S. Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States
| |
Collapse
|
36
|
A Mechanical Analysis of Early Aneurysm Rupture following Flow Diversion with Quantification of Stent Motion during Cardiac Cycles. J Vasc Interv Radiol 2022; 33:1435-1437.e3. [PMID: 35922004 DOI: 10.1016/j.jvir.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/13/2022] [Accepted: 07/17/2022] [Indexed: 12/15/2022] Open
|
37
|
Complete Basilar Artery Occlusion Following Ventriculoperitoneal Shunt Placement for Giant Aneurysm Complicated by Concurrent Obstructive Hydrocephalus: A Case Report. BRAIN HEMORRHAGES 2022. [DOI: 10.1016/j.hest.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
38
|
Lazaro T, Vasandani V, Robledo A, Gadgil N, Kan P. Flow diversion of a dissecting PICA aneurysm. NEUROSURGICAL FOCUS: VIDEO 2022; 7:V9. [PMID: 36425264 PMCID: PMC9664496 DOI: 10.3171/2022.7.focvid2247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/26/2022] [Indexed: 06/16/2023]
Abstract
A 47-year-old female with a history of a ruptured left posterior inferior cerebellar artery (PICA) aneurysm, status post coil embolization and retreatment for recurrence, presented with evidence of a recurrent dissecting PICA aneurysm. Given that these aneurysms are considered high risk and have a greater propensity for rupture than anterior circulation aneurysms, retreatment was recommended. With the patient's strong preference for endovascular therapy, flow diversion with a Silk Vista Baby was performed. Given the low-profile design of the device, a radial artery approach and coaxial technique were used to deploy the flow diverter. The device was successfully placed, with complete obliteration of the aneurysm after 1 year. The video can be found here: https://stream.cadmore.media/r10.3171/2022.7.FOCVID2247.
Collapse
Affiliation(s)
- Tyler Lazaro
- Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | - Viren Vasandani
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas
| | - Ariadna Robledo
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas
| | - Nisha Gadgil
- Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | - Peter Kan
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas
| |
Collapse
|
39
|
Restrepo AF, Singer J. Commentary: The Pennsylvania Postmarket Multicenter Experience With Flow Redirection Endoluminal Device. Neurosurgery 2022; 91:e109-e110. [PMID: 36001777 DOI: 10.1227/neu.0000000000002114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Andres F Restrepo
- Neurosurgery Division, Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, Michigan, USA.,Department of Neurosurgery, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Justin Singer
- Neurosurgery Division, Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, Michigan, USA.,Department of Neurosurgery, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| |
Collapse
|
40
|
Eker OF, Lubicz B, Cortese M, Delporte C, Berhouma M, Chopard B, Costalat V, Bonafé A, Alix-Panabières C, Van Anwterpen P, Zouaoui Boudjeltia K. Effects of the flow diversion technique on nucleotide levels in intra-cranial aneurysms: A feasibility study providing new research perspectives. Front Cardiovasc Med 2022; 9:885426. [PMID: 36186973 PMCID: PMC9515454 DOI: 10.3389/fcvm.2022.885426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The flow diverter stent (FDS) has become a first-line treatment for numerous intra-cranial aneurysms (IAs) by promoting aneurysm thrombosis. However, the biological phenomena underlying its efficacy remain unknown. We proposed a method to collect in situ blood samples to explore the flow diversion effect within the aneurysm sac. In this feasibility study, we assessed the plasma levels of nucleotides within the aneurysm sac before and after flow diversion treatment. Materials and methods In total, 14 patients with unruptured IAs who were selected for FDS implantation were prospectively recruited from February 2015 to November 2015. Two catheters dedicated to (1) FDS deployment and (2) the aneurysm sac were used to collect blood samples within the parent artery (P1) and the aneurysm sac before (P2) and after (P3) flow diversion treatment. The plasma levels of adenosine monophosphate (AMP), adenosine diphosphate (ADP), and adenosine triphosphate (ATP) at each collection point were quantified with liquid chromatography and tandem mass spectrometry. Results The aneurysms were extradural in nine (64.3%) patients and intra-dural in five (35.7%) patients. They presented an average diameter of 15.5 ± 7.1 mm, height of 15.8 ± 4.6 mm, and volume of 2,549 ± 2,794 ml. In all patients (100%), 16 FDS implantations and 42 in situ blood collections were performed successfully without any complications associated with the procedure. The ATP, ADP, and AMP concentrations within the aneurysm sac were decreased after flow diversion (p = 0.005, p = 0.03, and p = 0.12, respectively). Only the ATP levels within the aneurysm sac after flow diversion were significantly correlated with aneurysm volume (adjusted R2 = 0.43; p = 0.01). Conclusion In situ blood collection within unruptured IAs during a flow diversion procedure is feasible and safe. Our results suggest that the flow diversion technique is associated with changes in the nucleotide plasma levels within the aneurysm sac.
Collapse
Affiliation(s)
- Omer F. Eker
- Department of Neuroradiology, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- CREATIS Laboratory, UMR 5220, U1206, Université Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, Lyon, France
- *Correspondence: Omer F. Eker,
| | - Boris Lubicz
- Department of Interventional Neuroradiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Melissa Cortese
- RD3–Pharmacognosy, Bioanalysis, and Drug Discovery and Analytical Platform, Faculty of Pharmacy, Université Libre de Bruxelles, Brussels, Belgium
| | - Cedric Delporte
- RD3–Pharmacognosy, Bioanalysis, and Drug Discovery and Analytical Platform, Faculty of Pharmacy, Université Libre de Bruxelles, Brussels, Belgium
| | - Moncef Berhouma
- Department of Vascular Neurosurgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Bastien Chopard
- Scientific and Parallel Computing Group, CUI, University of Geneva, Geneva, Switzerland
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | - Alain Bonafé
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France
| | - Catherine Alix-Panabières
- Laboratory of Rare Human Circulating Cells, University Medical Center of Montpellier, University of Montpellier, Montpellier, France
- CREEC, MIVEGEC, University of Montpellier, CNRS, IRD, Montpellier, France
| | - Pierre Van Anwterpen
- RD3–Pharmacognosy, Bioanalysis, and Drug Discovery and Analytical Platform, Faculty of Pharmacy, Université Libre de Bruxelles, Brussels, Belgium
| | - Karim Zouaoui Boudjeltia
- Laboratory of Experimental Medicine (ULB 222), Medicine Faculty, Université Libre de Bruxelles, CHU de Charleroi, Charleroi, Belgium
| |
Collapse
|
41
|
Ishihara K. Biomimetic materials based on zwitterionic polymers toward human-friendly medical devices. SCIENCE AND TECHNOLOGY OF ADVANCED MATERIALS 2022; 23:498-524. [PMID: 36117516 PMCID: PMC9481090 DOI: 10.1080/14686996.2022.2119883] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 06/01/2023]
Abstract
This review summarizes recent research on the design of polymer material systems based on biomimetic concepts and reports on the medical devices that implement these systems. Biomolecules such as proteins, nucleic acids, and phospholipids, present in living organisms, play important roles in biological activities. These molecules are characterized by heterogenic nature with hydrophilicity and hydrophobicity, and a balance of positive and negative charges, which provide unique reaction fields, interfaces, and functionality. Incorporating these molecules into artificial systems is expected to advance material science considerably. This approach to material design is exceptionally practical for medical devices that are in contact with living organisms. Here, it is focused on zwitterionic polymers with intramolecularly balanced charges and introduce examples of their applications in medical devices. Their unique properties make these polymers potential surface modification materials to enhance the performance and safety of conventional medical devices. This review discusses these devices; moreover, new surface technologies have been summarized for developing human-friendly medical devices using zwitterionic polymers in the cardiovascular, cerebrovascular, orthopedic, and ophthalmology fields.
Collapse
Affiliation(s)
- Kazuhiko Ishihara
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, Osaka, Japan
| |
Collapse
|
42
|
Khorasanizadeh M, Shutran M, Schirmer CM, Salem MM, Ringer AJ, Grandhi R, Mitha AP, Levitt MR, Jankowitz BT, Taussky P, Thomas AJ, Moore JM, Ogilvy CS. North American multicenter experience with the Flow Redirection Endoluminal Device in the treatment of intracranial aneurysms. J Neurosurg 2022; 138:933-943. [PMID: 36087324 DOI: 10.3171/2022.7.jns221371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Flow diverters have revolutionized the endovascular treatment of intracranial aneurysms. Here, the authors present the first large-scale North American multicenter experience using the Flow Redirection Endoluminal Device (FRED) in the treatment of cerebral aneurysms. METHODS Consecutive cerebral aneurysms treated with FRED at 7 North American centers between June 2020 and November 2021 were included. Data collected included patient demographic characteristics, aneurysm characteristics, periprocedural and long-term complications, modified Rankin Scale (mRS) scores, and radiological follow-up. RESULTS In total, 133 aneurysms in 116 patients were treated with 123 FRED deployment procedures and included in this study. One hundred twenty-six aneurysms (94.7%) were unruptured, 117 (88.0%) saccular, and 123 (92.5%) located in anterior circulation. The mean (range) aneurysm maximal width and neck width sizes were 7.2 (1.5-42.5) mm and 4.1 (1.0-15.1) mm, respectively. Successful FRED deployment was achieved in 122 procedures (99.2%). Adjunctive coiling was used in 4 procedures (3.3%). Radiological follow-up was available for 101 aneurysms at a median duration of 7.0 months. At last follow-up, complete occlusion was observed in 55.4% of patients, residual neck in 8.9%, and filling aneurysm in 35.6%; among cases with radiological follow-up duration > 10 months, these values were 21/43 (48.8%), 3/43 (7.0%), and 19/43 (44.2%), respectively. On multivariate regression analysis, age (OR 0.93, p = 0.001) and aneurysm neck size (OR 0.83, p = 0.048) were negatively correlated with odds of complete occlusion at latest follow-up. The retreatment rate was 6/124 (4.8%). The overall complication rate was 31/116 (26.7%). Parent vessel occlusion, covered branch occlusion, and in-stent stenosis were detected in 9/99 (9.1%), 6/63 (9.5%), and 15/99 (15.2%) cases, respectively. The FRED-related, symptomatic, thromboembolic, and hemorrhagic complication rates were 22.4%, 12.9%, 6.9%, and 0.9% respectively. The morbidity rate was 10/116 patients (8.6%). There was 1 death due to massive periprocedural internal carotid artery stroke, and 3.6% of the patients had an mRS score > 2 at the last follow-up (vs 0.9% at baseline). CONCLUSIONS As the first large-scale North American multicenter FRED experience, this study confirmed the ease of successful FRED deployment but suggested lower efficacy and a higher rate of complications than reported by previous European and South American studies on FRED and other flow-diverting devices. The authors recommend judicious use of this device until future studies can better elucidate the long-term outcomes of FRED treatment.
Collapse
Affiliation(s)
- MirHojjat Khorasanizadeh
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Max Shutran
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Mohamed M Salem
- 3Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew J Ringer
- 4Mayfield Clinic, TriHealth Neuroscience Institute, Good Samaritan Hospital, Cincinnati, Ohio
| | - Ramesh Grandhi
- 5Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Alim P Mitha
- 6Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Michael R Levitt
- 7Department of Neurological Surgery, University of Washington, Seattle, Washington; and
| | - Brian T Jankowitz
- 3Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Philipp Taussky
- 5Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Ajith J Thomas
- 8Department of Neurological Surgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Justin M Moore
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christopher S Ogilvy
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
43
|
Jensen MM, Hatlevik Ø, Steinhauff DD, Griswold ED, Wei X, Isaacson KJ, Barber ZB, Huo E, Taussky P, Jedrzkiewicz J, Cappello J, Cheney D, Ghandehari H. Protein-Based Polymer Liquid Embolics for Cerebral Aneurysms. Acta Biomater 2022; 151:174-182. [PMID: 35948175 DOI: 10.1016/j.actbio.2022.08.003] [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: 01/04/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 11/01/2022]
Abstract
Cerebral aneurysms (CA), an abnormal bulge in the arteries that supply blood to the brain, are prone to rupture and can cause hemorrhagic stroke. Physicians can treat CA by blocking blood flow to the aneurysmal sac via clipping of the aneurysm neck via open procedure, or endovascular occlusion of the aneurysm with embolic materials to promote thrombus formation to prevent further inflow of blood into the aneurysm. Endovascular treatment options for CA still have significant limitations in terms of safety, usability in coagulopathic patients, and risks of device migration. Bioactive embolic therapies, consisting of non-toxic bioresorbable materials that encourage the growth of neointima across the aneurysm neck, are needed to improve the healing of CA. In this work, the bioinspired silk-elastinlike protein-based polymer (SELP 815K), was used to embolize aneurysms in a rabbit elastase model. SELP 815K effectively embolized the model aneurysms in vivo, achieving >90% occlusion, using commercial microcatheters. No device-associated adverse effects were observed in any of the animals, and SELP 815K showed no cytotoxicity. SELP embolization did not show any deleterious effects to local tissues, and features consistent with reendothelialization of the aneurysm neck were noted in histological examination one-month post-embolization. SELP 815K shows promise as an embolic treatment for unruptured CA. STATEMENT OF SIGNIFICANCE: : Unruptured cerebral aneurysms are present in approximately 3% of the population, with a fatality rate of up to 65% upon rupture. In this work a silk-elastinlike protein polymer (SELP) is explored as a liquid embolic for occlusion of cerebral aneurysms. This embolic exists as a liquid at room temperature before rapidly forming a gel at physiological temperature. This shape filling property was used to successfully occlude cerebral aneurysms in rabbits, with stable occlusion persisting for over thirty days. SELP occlusions show evidence for reendothelialization of the aneurysm sac and provide an opportunity for delivery of bioactive agents to further improve treatments.
Collapse
Affiliation(s)
- Mark M Jensen
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, Utah, USA
| | | | - D Douglas Steinhauff
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, Utah, USA
| | - Ethan D Griswold
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, Utah, USA
| | - Xiaomei Wei
- TheraTarget, Inc., Salt Lake City, Utah, USA
| | - Kyle J Isaacson
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, Utah, USA
| | - Zachary B Barber
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, Utah, USA
| | - Eugene Huo
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, Utah, USA; Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA
| | - Philipp Taussky
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Jolanta Jedrzkiewicz
- Department of Pathology and ARUP Laboratories, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Joseph Cappello
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, Utah, USA
| | | | - Hamidreza Ghandehari
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA; Utah Center for Nanomedicine, University of Utah, Salt Lake City, Utah, USA; TheraTarget, Inc., Salt Lake City, Utah, USA; Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, Utah, USA.
| |
Collapse
|
44
|
Issa R, Al-Homedi Z, Syed DH, Aziz W, Al-Omari B. Surpass Evolve Flow Diverter for the Treatment of Intracranial Aneurysm: A Systematic Review. Brain Sci 2022; 12:brainsci12060810. [PMID: 35741695 PMCID: PMC9221455 DOI: 10.3390/brainsci12060810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE This systematic review aims to summarize the evidence investigating the effectiveness and safety of the Surpass Evolve-Flow Diverter (SE-FD) to treat brain aneurysms. METHOD We searched MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane Library from January 2019 to 29 March 2022. Terms related to the "intracranial aneurysm" and "surpass evolve flow diverter" concepts were used to search the databases; Medical Subject Headings (MeSH) and reference hand search were also utilized. RESULTS The searches primarily identified 1586 documents. A total of five studies (four case series and one cohort) were included in this review. In the included studies, 192 (74 male and 118 females) patients with 198 aneurysms were involved. In total, 153 SE-FDs were used to treat 145 aneurysms. Complete occlusion was achieved in 69/145 (48%) cases and near-complete occlusion in 24/145 (17%) cases from aneurysms treated with SE-FD. Reported postoperative complications included stent thrombosis (n = 4 patients), hemorrhage (n = 5 patients), ischemia (n = 9 patients), and neurological complications (n = 12 patients). In total, four deaths were reported with only one related to the SE-FD procedure. CONCLUSION The results of this review are based on observational data, due to the absence of clinical trials. The findings of the included studies suggest that the effectiveness of the SE-FD procedure is lower than previous FDs but the safety is similar. The included studies also suggested that SE-FD has navigability and resistance to twisting, which makes the procedure an easier method to treat aneurysms that are proximal and distal to the circle of Willis deployment. This review highlights the urgency to conduct clinical trials to confirm these suggestions.
Collapse
Affiliation(s)
- Rania Issa
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates; (R.I.); (Z.A.-H.); (D.H.S.)
| | - Zahrah Al-Homedi
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates; (R.I.); (Z.A.-H.); (D.H.S.)
| | - Dawood Hasan Syed
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates; (R.I.); (Z.A.-H.); (D.H.S.)
| | - Waseem Aziz
- Department of Neurosurgery, Sheikh Shakhbout Medical City, Abu Dhabi P.O. Box 11001, United Arab Emirates;
- Department of Neurosurgery, Alexandria University School of Medicine, Alexandria 21526, Egypt
| | - Basem Al-Omari
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates; (R.I.); (Z.A.-H.); (D.H.S.)
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates
- KU Research and Data Intelligence Support Center (RDISC) AW 8474000331, Khalifa University of Science and Technology, Abu Dhabi P.O. Box 127788, United Arab Emirates
- Correspondence: ; Tel.: +971-2-312-4452
| |
Collapse
|
45
|
Mezali F, Benmamar S, Naima K, Ameur H, Rafik O. Evaluation of stent effect and thrombosis generation with different blood rheology on an intracranial aneurysm by the Lattice Boltzmann method. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 219:106757. [PMID: 35338884 DOI: 10.1016/j.cmpb.2022.106757] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/07/2022] [Accepted: 03/12/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Treatment of intracranial aneurysms with flow-diverting stents prevents rupture by reducing blood flow and creating thrombosis within the aneurysm. This paper aims to assess the hemodynamic effect of placing stents with different struts (0, 3, 5, 7 struts) on intracranial aneurysms and to propose a simple prediction model of thrombosis zone without any further computational cost. METHOD Lattice Boltzmann method with different rheological models (Newtonian, Carreau-Yasuda, KL) of blood are used to study the hemodynamic effect of flow-diverting stents in the aneurysm. Pulsatile flow boundary conditions were applied in the inlet of the artery. The average Reynolds number was resulting Re = 111. The Lagrangian tracking of the particle was developed to assess the intra-aneurysmal blood stagnation. To predict the probable thrombose zone induced by flow-diverting stents, the shear rate threshold is utilized to determine the nodes of fluid to clot. RESULTS The results show that the flow patterns into the aneurysmal sac develop a vortex, decreasing after stent placement until disappearance for the stent with seven struts (porosity 71.4%). Velocity, shear rate, shear stress, trajectory, path length, and occlusion rate are compared before and after stent placement. These parameters decrease inversely with the porosity of the stent. The three models yield a closes result of the (velocity, shear rate, occlusion rate). Tracking the fluid-particle trajectory shows that the length of the particle paths decreases with the number of struts causing fluid to slow down and increase, consequently, the residence time into the sac. CONCLUSION The flow-diverting stents placement cause the reduction of dynamic flow within aneurysm. The reduction effect is almost the same below five struts (80% of porosity). The results show that, if our objective is restricted to estimating the hemodynamic effect, measured by (velocity, shear rate, occlusion rate), the differences between rheological behavior models are, practically, not significant, and the models can be used indifferently.
Collapse
Affiliation(s)
- Farouk Mezali
- Water Sciences Research laboratory: LRS-Eau, National Polytechnic School, El harrach, Algiers; Hydraulics department, Faculty of Technology-BP 166 M'sila 28000 Algeria.
| | - Saida Benmamar
- Water Sciences Research laboratory: LRS-Eau, National Polytechnic School, El harrach, Algiers.
| | - Khatir Naima
- Department of Technology, University Centre of Naama (Ctr Univ Naama), P.O. Box 66, Naama 45000, Algeria.
| | - Houari Ameur
- Department of Technology, University Centre of Naama (Ctr Univ Naama), P.O. Box 66, Naama 45000, Algeria.
| | - Ouared Rafik
- Water Sciences Research laboratory: LRS-Eau, National Polytechnic School, El harrach, Algiers
| |
Collapse
|
46
|
Feigen CM, Vivanco-Suarez J, Javed K, Dardick JM, Holland R, Mendez-Ruiz A, Ortega-Gutierrez S, Haranhalli N, Altschul DJ. Pipeline Embolization Device and Pipeline Flex Versus Surpass Streamline Flow Diversion in Intracranial Aneurysms: A Retrospective Propensity Score-Matched Study. World Neurosurg 2022; 161:e384-e394. [PMID: 35151920 DOI: 10.1016/j.wneu.2022.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare safety and efficacy profiles in aneurysms treated with Pipeline Embolization Device or Pipeline Flex versus Surpass Streamline flow diverters (FDs). METHODS Patients who underwent flow diversion for aneurysm treatment at 2 centers were included. Covariates comprised patient demographics, comorbidities, and aneurysm characteristics. Metrics included number of devices, adjuvant device use, case duration, and radiation exposure. Outcomes included periprocedural complications and radiographic results at follow-up. Propensity score-matched pairs were generated using demographic and aneurysm characteristics to verify the outcomes in equally sized groups. RESULTS The majority of 141 flow diversion procedures performed on 126 patients were in the anterior circulation (96%) and unruptured (93%). Operators experienced more complications placing Surpass FDs compared with Pipelines (18.2% vs. 3.1%, P = 0.005) but used fewer Surpass devices per case (1 device in all Surpass cases and range for Pipeline cases 1-7; P < 0.001). Ballooning was more frequent for Surpass (29.5% vs. 2.1%, P < 0.001). There were no differences in mortality (2.1% vs. 0, P = 1.00), intracranial hemorrhage (3.1% vs. 0, P = 0.551), or stroke (4.2% vs. 6.8%, P = 0.680). Rates of aneurysm obliteration at follow-up were similar. Propensity-matched pairs had no differences in FD deployment complications or perioperative events, yet the significant differences remained for adjuvant balloon use and number of FDs deployed. CONCLUSIONS While the devices demonstrated similar safety and efficacy profiles, deployment of the Surpass Streamline was more technically challenging than Pipeline Embolization Device or Pipeline Flex. Prospective cohort studies are needed to corroborate these findings.
Collapse
Affiliation(s)
- Chaim M Feigen
- Montefiore Department of Neurological Surgery, Bronx, New York, USA.
| | - Juan Vivanco-Suarez
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Kainaat Javed
- Montefiore Department of Neurological Surgery, Bronx, New York, USA
| | - Joseph M Dardick
- Montefiore Department of Neurological Surgery, Bronx, New York, USA
| | - Ryan Holland
- Montefiore Department of Neurological Surgery, Bronx, New York, USA
| | - Alan Mendez-Ruiz
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Neil Haranhalli
- Montefiore Department of Neurological Surgery, Bronx, New York, USA
| | - David J Altschul
- Montefiore Department of Neurological Surgery, Bronx, New York, USA
| |
Collapse
|
47
|
Achey RL, Winkelman R, Sheikhi L, Davison M, Toth G, Moore N, Bain M. Use of Surpass Streamline Flow Diverter for the Endovascular Treatment of Craniocervical Aneurysms: a Single-Institution Experience. World Neurosurg 2022; 162:e281-e287. [PMID: 35276392 DOI: 10.1016/j.wneu.2022.03.008] [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: 12/21/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Flow diversion has revolutionized endovascular treatment for cerebral aneurysms. Surpass Streamline flow-diverter (SSFD) has shown promise for expanding flow diversion device options for aneurysm treatment. The SSFD differs from earlier stents by maintaining high porosity with increased pore density to ensure appropriate flow disruption. Given the delivery system's increased dimension options, and potential greater flow diverting properties, the SSFD is poised to extend the anatomic/pathologic reaches of flow diversion therapy. METHODS Data pertaining to SSFD-treated aneurysms were gathered retrospectively from 2019 to 2020. Collected information included aneurysm location, size, symptoms, complications, and occlusions rates at follow-up. Size was categorized as small (<10 mm), large (10-25 mm), and giant (>25 mm) according to SCENT trial criteria. Aneurysm occlusion on follow-up imaging was characterized by SMART grading with adequate occlusion defined as grades 3 and 4. Imaging was performed at time of treatment, six-month, and one-year follow-up. RESULTS 42 SSFD-treated aneurysms were treated throughout the cerebrovascular system; 3 cervical, 4 posterior, and 35 intracranial anterior circulation. Complete occlusion rates at six months and one year were 48% and 57% with adequate occlusion achieved in 89.6% and 85.7% respectively. Rates of complete occlusion were higher for small aneurysms (69%) compared to large aneurysms (38%). CONCLUSIONS Our data suggests comparable complete occlusion rates compared to the SCENT trial (66.1% vs 57% in our center) and adequate occlusion rates. Similar occlusion rates to prior studies despite broadened inclusion criteria/diversity of aneurysms treated demonstrates favorable generalizability of flow-diverting technology to a wide array of aneurysmal pathology.
Collapse
Affiliation(s)
- R L Achey
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland OH
| | - R Winkelman
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland OH
| | - L Sheikhi
- University of Kentucky, Kentucky Neuroscience Institute, Lexington KY
| | - M Davison
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland OH
| | - G Toth
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland OH; Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland OH
| | - N Moore
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland OH; Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland OH
| | - M Bain
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland OH; Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland OH.
| |
Collapse
|
48
|
Roloff C, Berg P. Effect of flow diverter stent malposition on intracranial aneurysm hemodynamics—An experimental framework using stereoscopic particle image velocimetry. PLoS One 2022; 17:e0264688. [PMID: 35235597 PMCID: PMC8890739 DOI: 10.1371/journal.pone.0264688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/15/2022] [Indexed: 12/04/2022] Open
Abstract
Background Flow-diverting stents are increasingly used for the minimally-invasive treatment of intracranial aneurysms. However, a correct positioning of such devices can be challenging due to varying vessel diameters as well as the complex anatomy of the neurovasculature. As a consequence, unsuccessful treatment outcomes are increasingly reported requiring an improvement of the understanding of stent-induced flow modification. Methods To evaluate the effect of different degrees of flow diverter stent malposition on intra-aneurysmal hemodynamic changes, a controlled hemodynamic configuration was created using an idealized intracranial aneurysms model. Afterwards, four different treatment scenarios were reproduced comprising of 1) the ideal treatment, 2) an insufficient wall apposition in the region of the ostium, 3) a distorted device migrating into the aneurysm sac and 4) an inaccurately deployed stent due to wrong release location. For the assessment of the individual flow modifications, high-resolution stereoscopic particle image velocimetry (PIV) measurements were carried out. Results The analysis of the precise in-vitro PIV measurements reveals that in all cases a considerable reduction of the cycle-averaged and peak-systolic velocity was obtained. Compared to the untreated aneurysm configuration, the flow reduction ranged from 63% (scenario 4) up to 89% (scenario 3). The ideal treatment reached a reduction of 78%, which is known to be sufficient for a successful therapy. However, inaccurate device positioning leads to increased oscillating flow towards the lateral directions reducing the chances of sufficient thrombus formation. Conclusions High-resolution in-vitro PIV measurements enable an accurate quantification of the treatment efficacy for flow-diverting devices. Furthermore, insufficient treatment outcomes can be reproduces allowing for an assessment of intra-aneurysmal hemodynamic changes.
Collapse
Affiliation(s)
- Christoph Roloff
- Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
| | - Philipp Berg
- Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- * E-mail:
| |
Collapse
|
49
|
Dabhi N, Sarathy D, Snyder MH, Kellogg RT, Park MS. Flow Diverter Devices for Treatment of Intracranial Aneurysms in Small Parent Vessels – A Systematic Review of Literature. World Neurosurg 2022; 162:183-194.e7. [DOI: 10.1016/j.wneu.2022.02.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/08/2022] [Indexed: 11/29/2022]
|
50
|
Chivukula V, White R, Shields A, Davies J, Mokin M, Bednarek DR, Rudin S, Ionita C. Leveraging Patient-Specific Simulated Angiograms to Characterize Cerebral Aneurysm Hemodynamics using Computational Fluid Dynamics. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 12036:120360S. [PMID: 35983495 PMCID: PMC9385184 DOI: 10.1117/12.2611473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Cerebral aneurysms (CA) affect nearly 6% of the US population and its rupture is one of the major causes of hemorrhagic stroke. Neurointerventionalists performing endovascular therapy (ET) to treat CA rely on qualitative image sequences obtained under fluoroscopy guidance alone, and do not have access to crucial quantitative information regarding blood flow before, during and after treatment - partially contributing to a failure rate of up to 30%. Computational fluid dynamics (CFD) is a powerful tool that can provide a wealth of quantitative data; however, CFD has found limited utility in the clinic due to the challenges in obtaining hemodynamic boundary conditions for each patient. In this work, we present a novel CFD-based simulated angiogram approach (SAA) that resolves the blood flow physics and interaction between blood and injected contrast agent to extract quantitative hemodynamic parameters which can be used to design real-time parametric imaging analysis. The SAA enables correlating contrast agent transport to the underlying hemodynamic conditions via time-density curves (TDC) obtained at several points in the region of interest. The ability of the TDC and the SAA to provide critical hemodynamic parameters in and around CA anatomies, such as washout and local flow changes is explored and presented. This provides invaluable quantitative data to the clinician at the time of intervention, since it incorporates the physics of blood flow and correlates the contrast transport to hemodynamic parameters quantitatively - thereby enabling the clinician to take informed decisions that improve treatment outcomes.
Collapse
Affiliation(s)
- V Chivukula
- Biomedical Engineering, Florida Institute of Technology
| | - R White
- Biomedical Engineering, Florida Institute of Technology
| | - A Shields
- Medical Physics, State University of New York at Buffalo
- Canon Stroke and Vascular Research Center, State University of New York at Buffalo
| | - J Davies
- Department of Neurosurgery, State University of New York at Buffalo
| | - M Mokin
- Department of Neurology and Neurosurgery, University of South Florida
| | - D R Bednarek
- Medical Physics, State University of New York at Buffalo
- Canon Stroke and Vascular Research Center, State University of New York at Buffalo
| | - S Rudin
- Medical Physics, State University of New York at Buffalo
- Canon Stroke and Vascular Research Center, State University of New York at Buffalo
- Department of Neurosurgery, State University of New York at Buffalo
| | - C Ionita
- Medical Physics, State University of New York at Buffalo
- Canon Stroke and Vascular Research Center, State University of New York at Buffalo
- Department of Neurosurgery, State University of New York at Buffalo
| |
Collapse
|