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Flow diverter OR flow diverting OR flow diversion AND aneurysm

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https://www.readbyqxmd.com/read/29327999/declining-complication-rates-with-flow-diversion-of-anterior-circulation-aneurysms-after-introduction-of-the-pipeline-flex-analysis-of-a-single-institution-series-of-568-cases
#1
Geoffrey P Colby, Matthew T Bender, Li-Mei Lin, Narlin Beaty, Justin M Caplan, Bowen Jiang, Erick M Westbroek, Bijan Varjavand, Jessica K Campos, Judy Huang, Rafael J Tamargo, Alexander L Coon
OBJECTIVE The second-generation Pipeline embolization device (PED), Flex, has several design upgrades, including improved opening and the ability to be resheathed, in comparison with the original device (PED classic). The authors hypothesized that Flex is associated with a lower rate of major complications. METHODS A prospective, IRB-approved, single-institution database was analyzed for all patients with anterior circulation aneurysms treated by flow diversion. The PED classic was used from August 2011 to January 2015, and the Pipeline Flex has been used since February 2015...
January 12, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29239685/in%C3%A2-vitro-angiographic-comparison-of-the-flow-diversion-performance-of-five-neurovascular-stents
#2
Ronak J Dholakia, Ari D Kappel, Andrew Pagano, Henry H Woo, Baruch B Lieber, David J Fiorella, Chander Sadasivan
Background and purpose Data differentiating flow diversion properties of commercially available low- and high-porosity stents are limited. This in vitro study applies angiographic analysis of intra-aneurysmal flow to compare the flow-diversion performance of five neurovascular devices in idealized sidewall and bifurcation aneurysm models. Methods Five commercial devices (Enterprise, Neuroform, LVIS, FRED, and Pipeline) were implanted in silicone sidewall and bifurcation aneurysm models under physiological average flow of blood analog fluid...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/29219758/the-use-of-alternatives-to-clopidogrel-in-flow-diversion-treatment-with-the-pipeline-embolization-device
#3
Elias Atallah, Hassan Saad, Kimon Bekelis, Nohra Chalouhi, Stavropoula Tjoumakaris, David Hasan, Jorge Eller, David Stidd, Robert H Rosenwasser, Pascal Jabbour
OBJECTIVE Thromboembolic complications continue to be encountered with Pipeline embolization devices (PEDs) despite routine clopidogrel/aspirin antiplatelet therapy. This study examined the safety and efficacy of prasugrel in the management of clopidogrel-resistant patients treated for cerebral aneurysms. METHODS Four hundred thirty-seven consecutive patients were identified between January 2011 and May 2016. Patients allergic, or having less than 30% platelet inhibition, to a daily 75-mg dose of clopidogrel received 10 mg of prasugrel daily (n = 20) or 90 mg of ticagrelor twice daily (n = 2)...
December 8, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29211861/spontaneous-microguidewire-extrusion-from-the-foot-following-cerebral-aneurysm-treatment-first-case-report
#4
Kurdow Nader, Saleh Lamin, Joseph Leyon, Swarupsinh Chavda, Allan Thomas, Sarin Kuruvath
BACKGROUND AND IMPORTANCE: Microguidewire entrapment and failure related to endovascular therapy is a rare complication with limited case reports available, most of which are from cardiac endovascular intervention. Migration of the microguidewire has been reported in coronary intervention with some resulting in severe complications, but there are no reported cases of spontaneous extrusion of wire fragment following a neurointerventional procedure. We report the first case of a microguidewire entrapment with subsequent fracture, followed by spontaneous extrusion of the wire fragment...
November 29, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29204037/staged-multimodality-treatment-of-a-large-ruptured-fusiform-supraclinoid-internal-carotid-artery-aneurysm-microsurgical-clip-assisted-endovascular-coiling
#5
Dale Ding, Thomas J Buell, Ching-Jen Chen, Daniel M Raper, Kenneth C Liu, Dennis G Vollmer
In the contemporary era of aneurysm management, large fusiform aneurysms presenting with subarachnoid hemorrhage (SAH) remain particularly challenging lesions to successfully manage. We describe a staged, multimodal treatment strategy for a 71-year-old patient who presented with a large ruptured fusiform aneurysm of the supraclinoid internal carotid artery (ICA) and a fetal posterior communicating artery which originated from the inferomedial aspect of the aneurysm. In the first stage, we performed a partial microsurgical clip reconstruction of the fusiform aneurysm and secured its rupture site, which was identified intraoperatively...
October 2017: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/29192856/management-of-antiplatelet-therapy-in-patients-undergoing-neuroendovascular-procedures
#6
Keri S Kim, Justin F Fraser, Stephen Grupke, Aaron M Cook
Neuroendovascular techniques for treating cerebral aneurysms and other cerebrovascular pathology are increasingly becoming the standard of care. Intraluminal stents, aneurysm coils, and other flow diversion devices typically require concomitant antiplatelet therapy to reduce thromboembolic complications. The variability inherent with the pharmacodynamic response to common antiplatelet agents such as aspirin and clopidogrel complicates optimal selection of antiplatelet agents by clinicians. This review serves to discuss the literature related to antiplatelet use in neuroendovascular procedures and provides recommendations for clinicians on how to approach patients with variable response to antiplatelet agents, particularly clopidogrel...
December 1, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29184531/stent-assisted-coiling-of-ruptured-and-incidental-aneurysms-of-the-intracranial-circulation-using-moderately-flow-redirecting-braided-leo-stents-initial-experience-in-39-patients
#7
Peter Voigt, Stefan Schob, Robert Jantschke, Ulf Nestler, Matthias Krause, David Weise, Donald Lobsien, Karl-Titus Hoffmann, Ulf Quäschling
Background: Flow diversion (FD)-a young technique using stents with highly increased surface coverage-was introduced to treat complex aneurysms without intra-aneurysmal material placement and has amended the spectrum of endovascular techniques such as stent-assisted coil occlusion considerably. However, ischemic complications, a common side effect in FD, occur more frequently compared with the conventional endovascular approaches and certainly limit the indication of this technique. Our study aimed to investigate the feasibility and efficacy of stent-assisted coiling using low profile self-expandable stents, which exhibit only moderate flow-redirecting properties and therefore represent a combination of hemodynamic endovascular and occlusive endosaccular therapy...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29163748/transradial-approach-for-deployment-of-a-flow-diverter-for-an-intracranial-aneurysm-in-a-patient-with-a-type-3-aortic-arch
#8
Geoffrey W Peitz, Bhavani Kura, Jeremiah N Johnson, Ramesh Grandhi
Background: Flow diversion with the Pipeline embolization device (PED) is an effective treatment for giant and wide-neck intracranial aneurysms, but the standard transfemoral approach may not be feasible in patients with Type-3 aortic arches. Case Report: An 84-year-old woman presented with a right internal carotid artery (ICA) giant aneurysm and a Type-3 aortic arch, necessitating a transradial approach for access to the right common carotid artery. A triaxial catheter system made for a stable platform for the deployment of two telescoping PEDs to treat the patient's right ICA giant aneurysm...
October 2017: Journal of Vascular and Interventional Neurology
https://www.readbyqxmd.com/read/29140523/sequential-coiling-assisted-deployment-of-flow-diverter-for-treatment-of-fusiform-middle-cerebral-artery-aneurysms
#9
Abdulrahman Y Alturki, Philip G R Schmalz, Christopher S Ogilvy, Ajith J Thomas
BACKGROUND AND IMPORTANCE: Fusiform intracranial aneurysms remain challenging lesions to treat. These aneurysms have historically required bypass procedures or clip remodeling constructs for cure. Recently, endovascular specialists have reported experience with flow diversion for complex fusiform aneurysms of the vertebrobasilar system, with mixed results. Vascular anatomy for anterior circulation fusiform aneurysms may make these lesions more amenable to flow diversion and embolization procedures; however, published experience with these techniques is lacking...
November 11, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29125410/hemorrhage-associated-with-ventriculoperitoneal-shunt-placement-in-aneurysmal-subarachnoid-hemorrhage-patients-on-a-regimen-of-dual-antiplatelet-therapy-a-retrospective-analysis
#10
Joseph S Hudson, Yasunori Nagahama, Daichi Nakagawa, Robert M Starke, Brian J Dlouhy, James C Torner, Pascal Jabbour, Lauren Allan, Colin P Derdeyn, Jeremy D W Greenlee, David Hasan
OBJECTIVE Intracranial stenting and flow diversion require the use of dual antiplatelet therapy (DAPT) to prevent in-stent thrombosis. DAPT may significantly increase the risk of hemorrhagic complications in patients who require subsequent surgical interventions. In this study, the authors sought to investigate whether DAPT is a risk factor for hemorrhagic complications associated with ventriculoperitoneal (VP) shunt placement in patients with aneurysmal subarachnoid hemorrhage (aSAH). Moreover, the authors sought to compare VP shunt complication rates with respect to the shunt's location from the initial external ventricular drain (EVD) site...
November 10, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29118790/rescue-treatment-with-pipeline-embolization-for-postsurgical-clipping-recurrences-of-anterior-communicating-artery-region-aneurysms
#11
Li-Mei Lin, Rajiv R Iyer, Matthew T Bender, Thomas Monarch, Geoffrey P Colby, Judy Huang, Rafael J Tamargo, Alexander L Coon
Background: Postsurgical clipping aneurysm recurrences or residuals can be difficult to manage with either traditional open microsurgical approaches or endosaccular coiling. Endoluminal parent vessel reconstruction with flow diversion may be an ideal method for treating these recurrences by avoiding reoperative surgery or intraprocedural aneurysm rupture with aneurysm access. Method: We retrospectively reviewed a single-center aneurysm database identifying all anterior communicating artery (ACom) region aneurysms with recurrences after microsurgical clipping...
October 2017: Interventional Neurology
https://www.readbyqxmd.com/read/29089414/flow-diversion-for-anterior-choroidal-artery-acha-aneurysms-a-multi-institutional-experience
#12
Visish M Srinivasan, Michael George Zaki Ghali, Jacob Cherian, Maxim Mokin, Ajit S Puri, Ramesh Grandhi, Stephen R Chen, Jeremiah N Johnson, Peter Kan
BACKGROUND: Anterior choroidal artery (AChA) aneurysms represent a small subset of cerebral aneurysms. The Pipeline Embolization Device (PED) has been successfully applied to various aneurysms of the supraclinoid internal carotid artery (ICA). The treatment of these aneurysms requires special attention due to the eloquent territory supplied by the AChA. We report the largest and first dedicated series of flow diversion treatment of AChA aneurysms. METHODS: Four institutional neurointerventional databases were reviewed for cases of intracranial aneurysms treated with PED...
October 31, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29060623/applying-computer-simulation-to-the-design-of-flow-diversion-treatment-for-intracranial-aneurysms
#13
Mingzi Zhang, Yujie Li, David I Verrelli, Winston Chong, Makoto Ohta, Yi Qian
Although flow-diversion (FD) treatment has been proven to be able to induce intracranial aneurysm (IA) occlusion, clinical follow-ups reported that a number of patients may still suffer from delayed IA rupture or incomplete aneurysm occlusion post-treatment. Complete aneurysm occlusion is believed to be associated with favourable haemodynamic alteration post-treatment, which may be greatly affected by the selection of device size and quantity, as well as the FD deployment procedure. However, clinicians have to choose and deploy the FD relying on their experience, since no post-stenting haemodynamic information is generally available to them prior to a specific treatment...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/29054914/flow-diversion-for-the-treatment-of-posterior-inferior-cerebellar-artery-aneurysms-a-novel-classification-and-strategies
#14
Visish M Srinivasan, Michael George Zaki Ghali, Oleg E Reznik, Jacob Cherian, Maxim Mokin, Travis M Dumont, John R Gaughen, Ramesh Grandhi, Ajit S Puri, Stephen R Chen, Jeremiah N Johnson, Peter Kan
BACKGROUND: The pipeline embolization device (PED) is frequently used in the treatment of anterior circulation aneurysms, especially around the carotid siphon, with generally excellent results. However, treatment of posterior inferior cerebellar artery (PICA) aneurysms with flow diversion (FD) has not been specifically described or discussed. While there are reports of treating PICA aneurysms using placement of FD stents in the vertebral artery, there are no reports of treating these lesions by placement of flow diverting stents in the PICA vessel itself...
October 20, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29046918/flow-diverter-treatment-of-cerebral-blister-aneurysms
#15
Russell Cerejo, Mark Bain, Seby John, Julian Hardman, Nina Moore, M Shazam Hussain, Gabor Toth
PURPOSE: Blood blister-like aneurysms (BBA) are small, friable, broad-based aneurysms that represent high risk for rerupture. Treatment of BBA is challenging, and may include surgical wrapping, clipping, multiple overlapping stents, and/or coiling. Flow diversion is a rapidly evolving treatment strategy for intracranial aneurysms, but the evidence for its use in cases of BBA is scarce. METHODS: A retrospective review of flow-diverter-treated, ruptured BBA cases at our tertiary care institution was undertaken...
December 2017: Neuroradiology
https://www.readbyqxmd.com/read/29040765/flow-diversion-for-the-treatment-of-an-unruptured-paraclinoid-carotid-artery-aneurysm
#16
(no author information available yet)
No abstract text is available yet for this article.
October 11, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29030499/unexpected-early-radiographic-findings-associated-with-a-ruptured-blister-like-carotid-wall-aneurysm
#17
James West, Jasmeet Singh, Stacey Q Wolfe, Kyle M Fargen
A 33-year-old man presented with aneurysmal subarachnoid hemorrhage from a ruptured, blister-type sidewall internal carotid artery (ICA) aneurysm. Balloon-assisted coiling was performed with residual neck. He subsequently developed severe vasospasm requiring intra-arterial therapies on multiple occasions, during which it was noted that despite widespread vasospasm, a focal segment of the ICA at the site of the aneurysm showed no significant spasm, suggesting underlying vessel abnormality. He was discharged without deficit and scheduled for flow diversion given concern over this potentially pathologic segment of vessel...
October 13, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29027870/flow-diversion-of-a-recurrent-iatrogenic-basilar-tip-aneurysm-in-a-pediatric-patient-case-report
#18
Rahul A Sastry, Matthew J Koch, Benjamin L Grannan, Christopher J Stapleton, William E Butler, Aman B Patel
Endoscopic third ventriculostomy (ETV) is a common treatment for noncommunicating hydrocephalus. Although rare, vascular injury and traumatic pseudoaneurysm development during ETV have been reported. The authors present the case of a 13-year-old boy who underwent repeat ETV (rETV) for shunt and ETV failure, and who suffered an intraoperative subarachnoid hemorrhage due to iatrogenic injury to the basilar tip, with subsequent development of a pseudoaneurysm. Despite initial primary coil embolization, the aneurysm recurred and was definitively treated with flow diversion...
October 13, 2017: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/29025918/contemporary-endovascular-and-open-aneurysm-treatment-in-the-era-of-flow-diversion
#19
REVIEW
Marcus D Mazur, Philipp Taussky, Min S Park, William T Couldwell
Clinical outcomes have improved considerably over the last decade for patients with ruptured and unruptured aneurysms. Modern endovascular techniques, such as flow diversion, are associated with high aneurysm occlusion rates and have become a popular treatment modality for many types of aneurysms. However, the safety and effectiveness of flow diversion has not yet been established in trials comparing it with traditional aneurysm treatments. Moreover, there are some types of aneurysms that may not be appropriate for endovascular coiling, such as wide-necked aneurysms located at branch points of major vessels, large saccular aneurysms with multiple efferent arteries, dolichoectatic aneurysms, large aneurysms with mass effect, when there are technical complications with endovascular treatment, when patients cannot tolerate or have contraindications to antiplatelet therapy or in the setting of a subarachnoid haemorrhage...
October 12, 2017: Journal of Neurology, Neurosurgery, and Psychiatry
https://www.readbyqxmd.com/read/28987840/endovascular-treatment-of-ruptured-vertebrobasilar-dissecting-aneurysms-using-flow-diversion-embolization-devices-single-institution-experience
#20
Waldo R Guerrero, Santiago Ortega-Gutierrez, Minako Hayakawa, Colin P Derdeyn, James D Rossen, David Hasan, Edgar A Samaniego
OBJECTIVE: Treatment of ruptured posterior circulation dissecting aneurysms is technically challenging with potentially high morbidity and mortality. We sought to assess the safety and feasibility of using a flow diversion devices (FDD) and a specific acute antiplatelet aggregation protocol in the management of ruptured dissecting aneurysms. METHODS: Subjects with ruptured dissecting aneurysms treated during a three-year period were retrospectively identified from a prospective registry...
October 5, 2017: World Neurosurgery
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