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Pipeline OR flow diverter OR flow diverting OR flow divertion AND aneurysm

M Killer-Oberpfalzer, N Kocer, C J Griessenauer, H Janssen, T Engelhorn, M Holtmannspötter, J H Buhk, T Finkenzeller, G Fesl, J Trenkler, W Reith, A Berlis, K Hausegger, M Augustin, C Islak, B Minnich, M Möhlenbruch
BACKGROUND AND PURPOSE: Endoluminal reconstruction with flow-diverting stents represents a widely accepted technique for the treatment of complex intracranial aneurysms. This European registry study analyzed the initial experience of 15 neurovascular centers with the Flow-Redirection Intraluminal Device (FRED) system. MATERIALS AND METHODS: Consecutive patients with intracranial aneurysms treated with the FRED between February 2012 and March 2015 were retrospectively reviewed...
March 15, 2018: AJNR. American Journal of Neuroradiology
F Cagnazzo, D Mantilla, A Rouchaud, W Brinjikji, P-H Lefevre, C Dargazanli, G Gascou, C Riquelme, P Perrini, D di Carlo, A Bonafe, V Costalat
BACKGROUND: The safety and efficacy of reconstructive and deconstructive endovascular treatments of very large/giant intracranial aneurysms are not completely clear. PURPOSE: Our aim was to compare treatment-related outcomes between these 2 techniques. DATA SOURCES: A systematic search of 3 data bases was performed for studies published from 1990 to 2017. STUDY SELECTION: We selected series of reconstructive and deconstructive treatments with >10 patients...
March 15, 2018: AJNR. American Journal of Neuroradiology
Soumik Das, Arun Kumar Gupta, Arvinda Hanumathapura Ramalingiah
We report here a rare complication in the form of kinking of flow diverter in a case of giant wide-necked supraclinoid internal carotid artery (ICA) aneurysm 48 hours after the procedure. This 28-year female presented with giant wide-necked right supraclinoid ICA aneurysm which was managed by flow diversion. On 2nd post-op day, patient developed weakness of left side with altered sensorium - angiography and CT showed kinking of flow diverter at the neck of the aneurysm with poor distal flow. Eventually, the patient developed right middle cerebral artery infarct for which decompressive hemicraniectomy was done...
March 2018: Neurointervention
Pervinder Bhogal, Muhammad AlMatter, Victoria Hellstern, Oliver Ganslandt, Hansjörg Bäzner, Hans Henkes, Marta Aguilar-Pérez
Purpose: The Medina Embolic Device (MED) is a new intrasaccular device with promising early results. Previously we documented our initial experience of this device both alone and in combination with other devices including flow diverter stents (FDS). We sought to determine the effect of the MED + FDS strategy for the treatment of selected aneurysms. Materials and Methods: We performed a retrospective analysis of prospectively collected data to identify all patients with aneurysms treated using both the MED and intraluminal FDS...
March 2018: Neurointervention
Adam A Dmytriw, Nimer Adeeb, Ashish Kumar, Christoph J Griessenauer, Kevin Phan, Christopher S Ogilvy, Paul M Foreman, Hussain Shallwani, Nicola Limbucci, Salvatore Mangiafico, Caterina Michelozzi, Timo Krings, Vitor Mendes Pereira, Charles C Matouk, Yuchen Zhang, Mark R Harrigan, Hakeem J Shakir, Adnan H Siddiqui, Elad I Levy, Leonardo Renieri, Christophe Cognard, Ajith J Thomas, Thomas R Marotta
BACKGROUND: Flow diversion for basilar apex aneurysms has rarely been reported. OBJECTIVE: To assess flow diversion for basilar apex aneurysms in a multicenter cohort. METHODS: Retrospective review of prospectively maintained databases at 8 academic institutions was performed from 2009 to 2016 to identify patients with basilar apex aneurysms treated with flow diversion. Clinical and radiographic data were analyzed. RESULTS: Sixteen consecutive patients (median age 54...
February 26, 2018: Neurosurgery
Adam N Wallace, Jonathan A Grossberg, Josser E Delgado Almandoz, Mudassar Kamran, Anil K Roy, Yasha Kayan, Matthew J Austin, Brian M Howard, Christopher J Moran, C Michael Cawley, DeWitte T Cross, Jacques E Dion, Akash P Kansagra, Joshua W Osbun
BACKGROUND: Flow diversion of posterior cerebral artery (PCA) aneurysms has not been widely reported, possibly owing to concerns regarding parent vessel size and branch vessel coverage. OBJECTIVE: To examine the safety and effectiveness of PCA aneurysm flow diverter treatment. METHODS: Retrospective review of PCA aneurysms treated with the Pipeline Embolization Device (PED; Medtronic Inc, Dublin, Ireland) at 3 neurovascular centers, including periprocedural complications and clinical and angiographic outcomes...
March 8, 2018: Neurosurgery
Tackeun Kim, O-Ki Kwon, Heeyoung Lee, Min Jai Cho, Hyun Jean Jeong, Seung Pil Ban
OBJECTIVE: To investigate nationwide statistics on flow-diverting stent usage for cerebral aneurysm treatment and related mortality data. METHODS: We requested data extraction from the National Health Insurance Service claims database using electronic data interchange codes (J3207064, J3207073). Patient and hospital information as well as death statistics were collected from the database. RESULTS: A total of 169 procedures were performed using flow-diverting stents for cerebral aneurysm treatment from November 2014 to December 2016 in Korea...
March 2018: Journal of Korean Neurosurgical Society
Wonsoo Son, Dong-Hun Kang, Byung Moon Kim, Jaechan Park, Yong-Sun Kim
BACKGROUND: The pipeline embolization device (PED; ev3, Irvine, California, USA) has been used to divert flow away from an aneurysm sac. The risk of complications may increase for flow diversion with giant aneurysms, since these cases may require multiple overlapping PEDs, which makes the technique highly complex. CASE DESCRIPTION: We report a rescue technical strategy for lost access during multiple overlapping PED placement for a giant, fusiform cavernous aneurysm...
March 7, 2018: World Neurosurgery
P Bhogal, O Ganslandt, H Bäzner, H Henkes, M Aguilar Perez
BACKGROUND: The region of the brain supplied by the anterior choroidal artery (AChoA) is exquisitely eloquent. Aneurysms arising at or close to the origin of the vessel are not uncommon and damage or occlusion to the vessel can result in devastating consequences. The optimal treatment strategy is yet to be determined. OBJECTIVE: We sought to determine the efficacy of flow diversion for the treatment of unruptured AChoA aneurysms. METHOD: A retrospective review of our prospectively maintained database was performed to identify all patients with unruptured aneurysms of the AChoA between March 2009 and May 2017...
March 7, 2018: Clinical Neuroradiology
Robert Fahed, Tim E Darsaut, Marc Kotowski, Igor Salazkin, Jean Raymond
Aim Flow diverters are increasingly used to treat aneurysms, but treatment is not always effective. The management of aneurysms that fail to occlude following flow diversion is problematic. We aimed to reproduce failures in an animal model and study re-treatment with additional flow diverters alone or with flow diverters and liquid embolic agent. Material and methods Twenty wide-necked aneurysms were created at the carotid-lingual bifurcation in 10 dogs, and were treated with flow diverters 4-6 weeks later...
January 1, 2018: Neuroradiology Journal
Jildaz Caroff, Takamitsu Tamura, Robert M King, Pedro N Lylyk, Erin T Langan, Olivia W Brooks, Frédéric Clarençon, John Michael Wainwright, Laurent Spelle, Miklos Marosfoi, Matthew J Gounis, Ajit S Puri
BACKGROUND: Optical coherence tomography (OCT) is a high-resolution, intra-vascular diagnostic technique widely used for the characterization of vascular pathologies and optimization of stent implantation during percutaneous coronary intervention. OCT was used to investigate the in vivo vascular response to a new phosphorylcholine surface modified flow diverter (sPED). METHODS: In an in vivo rabbit aneurysmal model, we used two different types of flow diverters (classic Pipeline - cPED; and sPED) with or without dual antiplatelet therapy (four groups, n=10 per group)...
March 6, 2018: Journal of Neurointerventional Surgery
Rajsrinivas Parthasarathy, Vipul Gupta, Aditya Gupta
OBJECTIVES: Blister like aneurysm (BLA) is extremely challenging to treat; endoluminal reconstruction has emerged as the most promising treatment method. When to treat after the ictus, the timing of administration of antiplatelet and causal relationship between platelet function testing results and thromboembolism is unclear. We theorized that Prasugrel with a lower incidence of resistance may be a safe suitable alternative to clopidogrel in patients treated with a flow diverter. METHODS: Prospectively collected data from consecutive patients treated for a ruptured blister with a flow diverter was reviewed...
March 6, 2018: British Journal of Radiology
Ana Paula Narata, Aymeric Amelot, Richard Bibi, Denis Herbreteau, Denis Angoulvant, Yves Gruel, Kevin Janot
BACKGROUND: Dual antiplatelet therapy (DAPT) associating aspirin + clopidogrel is commonly utilized in neurovascular interventions despite unpredictable clopidogrel efficacy with 4% to 50% of patients considered nonresponders. Ticagrelor is an antiplatelet agent with low resistance rates but unknown efficacy and safety in neurovascular patients. OBJECTIVE: To evaluate frequency of ischemic and hemorrhagic events in patients treated with aspirin and ticagrelor when associated with perioperative heparin bolus for unruptured aneurysms treated with intracranial stents...
February 26, 2018: Neurosurgery
Johanna Clauser, Marius S Knieps, Martin Büsen, Andreas Ding, Thomas Schmitz-Rode, Ulrich Steinseifer, Jutta Arens, Giorgio Cattaneo
Particle image velocimetry (PIV) is a commonly used method for in vitro investigation of fluid dynamics in biomedical devices, such as flow diverters for intracranial aneurysm treatment. Since it is limited to transparent blood substituting fluids like water-glycerol mixture, the influence of coagulation and platelet aggregation is neglected. We aimed at the development and the application of a modified platelet rich plasma as a new PIV fluid with blood-like rheological and coagulation properties. In standardized intracranial aneurysm silicone models, the effect of this new PIV plasma on the fluid dynamics before and after flow diverter implantation was evaluated and compared with water-glycerol measurements...
February 27, 2018: Annals of Biomedical Engineering
Daniel L Faden, Marion A Hughes, Philippe Lavigne, Brian T Jankowitz, Eric W Wang, Juan C Fernandez-Miranda, Paul A Gardner, Carl H Snyderman
BACKGROUND: Nontraumatic pseudoaneurysms of the cranial base are rare and present unique diagnostic and treatment dilemmas compared with both true aneurysms and pseudoaneurysms outside of the cranial base. There is a dearth of knowledge regarding the management of these complicated lesions. METHODS: Nontraumatic pseudoaneurysms of the cranial base internal carotid artery (ICA) were retrospectively identified at the University of Pittsburgh Medical Center through a key word search of cranial base cases from 2010 to 2017...
February 27, 2018: International Forum of Allergy & Rhinology
Philippe Dodier, Josa M Frischer, Wei-Te Wang, Thomas Auzinger, Ammar Mallouhi, Wolfgang Serles, Andreas Gruber, Engelbert Knosp, Gerhard Bavinzski
OBJECTIVE: The authors report long-term results after PED implantation, characterize complex and standard aneurysms comprehensively and introduce a modified flow disruption scale. METHODS: The authors retrospectively reviewed a consecutive series of 40 patients, harboring 59 aneurysms treated with 54 PEDs. Aneurysm complexity was assessed using our proposed classification. Immediate angiographic results were analyzed using previously published grading scales and our novel flow disruption scale (BD scale)...
February 22, 2018: World Neurosurgery
Anna Luisa Kühn, Guilherme Dabus, Peter Kan, Ajay K Wakhloo, Ajit S Puri
Background Use of flow-diversion technology in the treatment of incidental and recanalized posterior communicating artery (PComA) aneurysms. Methods Patients treated with the Pipeline embolization device (PED) for PComA aneurysms were identified and included in our retrospective analysis. We evaluated aneurysm characteristics, modified Rankin Scale score (mRS) on admission, angiography follow-up, and patient clinical outcome at discharge, at three to nine months, and at 12-18 months. Results We included 56 patients with a mean age of 56 years...
January 1, 2018: Interventional Neuroradiology
Yon Kwon Ihn, Shang Hun Shin, Seung Kug Baik, In Sup Choi
Endovascular coiling for intracranial aneurysms has become an accepted treatment with good clinical results and provides adequate protection against rebleeding and rupture of aneurysms. However, despite the experience, preparation, or skill of the physician, complications during endovascular treatment still occur. The main complications of endovascular coiling are: procedural aneurysmal perforations by the microcatheter, micro-guidewire, or coil, and thromboembolic events. Such situations are unexpected, complex, and can have devastating consequences...
January 1, 2018: Interventional Neuroradiology
Eduardo Waihrich, Pierre Clavel, George Mendes, Christina Iosif, Iruena Moraes Kessler, Charbel Mounayer
BACKGROUND: Flow-diverter stent (FDS) deployment can cause morphological and hemodynamic changes in the carotid siphon (CS), influencing the occlusion rate of aneurysms in this location. OBJECTIVE: To evaluate morphological changes to the CS after FDS deployment and their relationship with the rate of occlusion of intracranial aneurysms. METHODS: A cohort of 183 patients with CS aneurysms were treated by deployment of Pipeline® FDS (Medtronic Inc, Dublin, Ireland)...
February 10, 2018: Neurosurgery
Zhen Yu Jia, Hai Bin Shi, Shigeru Miyachi, Sun Moon Hwang, Jae Jon Sheen, Yun Sun Song, Joong Goo Kim, Deok Hee Lee, Dae Chul Suh
Since the first use of the Guglielmi detachable coil system for cerebral aneurysm embolization in 1990, various endovascular methods have been developed to treat large numbers of aneurysms. The main strategic and technical modifications introduced to date include balloon-assisted coil embolization, stent-assisted coil embolization, flow diverters, and flow disrupters. The development and introduction of such devices have been so persistent and rapid that new devices are being approved worldwide even before the earlier ones become available in some countries...
January 2018: Journal of Stroke
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