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Flow diverter OR flow diverting OR flow diversion AND aneurysm

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https://www.readbyqxmd.com/read/28279774/conscious-sedation-versus-general-anesthesia-for-the-treatment-of-cerebral-aneurysms-with-flow-diversion-a-matched-cohort-study
#1
Christoph J Griessenauer, Hussain Shallwani, Nimer Adeeb, Raghav Gupta, Leonardo Rangel-Castilla, Adnan H Siddiqui, Elad I Levy, Myles D Boone, Ajith J Thomas, Christopher S Ogilvy
INTRODUCTION: Flow diversion has become a popular treatment option for a variety of cerebral aneurysms. We sought to compare conscious sedation and general anesthesia for flow diverter placement in a matched cohort study. MATERIALS AND METHODS: Patients who underwent flow diverter placement under conscious sedation were matched on the basis of age, sex, American Society of Anesthesiologists (ASA) classification, aneurysm location, and aneurysm size with patients who received general anesthesia...
March 6, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28265011/tourniquet-parent-artery-occlusion-after-flow-diversion
#2
Visish M Srinivasan, Maxim Mokin, Edward A M Duckworth, Stephen Chen, Ajit Puri, Peter Kan
BACKGROUND: The Pipeline Embolization Device (PED) is increasingly used for both on- and off-label purposes for treatment of intracranial aneurysms. The device gradually slows flow of blood into the aneurysm, but the high metal coverage of PED promotes endothelialization of the device. Occasionally, this leads to in-stent stenosis that is clinically well tolerated. We present a multi-institutional Pipeline series that includes three cases of gradual asymptomatic occlusion within the PED and parent vessel...
March 6, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28246277/ischemic-stroke-after-treatment-of-intraprocedural-thrombosis-during-stent-assisted-coiling-and-flow-diversion
#3
Nimer Adeeb, Christoph J Griessenauer, Justin M Moore, Paul M Foreman, Hussain Shallwani, Rouzbeh Motiei-Langroudi, Raghav Gupta, Carlos E Baccin, Abdulrahman Alturki, Mark R Harrigan, Adnan H Siddiqui, Elad I Levy, Christopher S Ogilvy, Ajith J Thomas
BACKGROUND AND PURPOSE: Intraprocedural thrombosis poses a formidable challenge during neuroendovascular procedures because the risks of aggressive thromboembolic treatment must be balanced against the risk of postprocedural hemorrhage. The aim of this study was to identify predictors of ischemic stroke after intraprocedural thrombosis after stent-assisted coiling and pipeline embolization device placement. METHODS: A retrospective analysis of intracranial aneurysms treated with stent-assisted coiling or pipeline embolization device placement between 2007 and 2016 at 4 major academic institutions was performed to identify procedures that were complicated by intraprocedural thrombosis...
February 28, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28243686/flow-diversion-what-can-clinicians-learn-from-animal-models
#4
Robert Fahed, Tim E Darsaut, Jean-Christophe Gentric, Behzad Farzin, Igor Salazkin, Guylaine Gevry, Jean Raymond
INTRODUCTION: Flow diversion is increasingly used for treating intracranial aneurysms. This article aims to review the evidence obtained from animal models and summarizes the findings that might be of clinical interest. METHODS: From a systematic review of studies published between 2000 and 2016, we extracted the data on the following questions: What roles do aneurysm dimension, morphology, and vascular geometry have on success of flow diversion? What characteristics of a flow diverter can influence aneurysm occlusion? What are the risk factors for jailed branch occlusion? RESULTS: Flow diversion has been shown to be less effective in occluding large aneurysms with wide or undefined necks, as compared to smaller aneurysms with narrower necks...
February 27, 2017: Neuroradiology
https://www.readbyqxmd.com/read/28210239/flow-diversion-for-the-treatment-of-mca-bifurcation-aneurysms-a-single-centre-experience
#5
Pervinder Bhogal, Muhammad AlMatter, Hansjörg Bäzner, Oliver Ganslandt, Hans Henkes, Marta Aguilar Pérez
BACKGROUND: Intracranial aneurysms located at the bifurcation of the middle cerebral artery (MCA) can often be challenging for the neurointerventionalist. We aimed to evaluate the efficacy and safety of flow diverting stents (FDS) in the treatment of these aneurysms. MATERIALS AND METHODS: We retrospectively reviewed our prospectively maintained database to collect information for all patients with unruptured saccular bifurcation MCA aneurysms treated with FDS between January 2010 and January 2016...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28184003/a-survey-of-intracranial-aneurysm-treatment-practices-among-united-states-physicians
#6
Kyle M Fargen, Hector E Soriano-Baron, Julia T Rushing, William Mack, J Mocco, Felipe Albuquerque, Andrew F Ducruet, Maxim Mokin, Italo Linfante, Stacey Q Wolfe, John A Wilson, Joshua A Hirsch
BACKGROUND: Recent surveys have failed to examine cerebrovascular aneurysm treatment practices among US physicians. OBJECTIVE: To survey physicians who are actively involved in the care of patients with cerebrovascular aneurysms to determine current aneurysm treatment preferences. METHODS: A 25-question SurveyMonkey online survey was designed and distributed electronically to members of the Society of NeuroInterventional Surgery, Society of Vascular and Interventional Neurology, and the American Association of Neurological Surgeons/Congress of Neurological Surgeons Combined Cerebrovascular Section...
February 9, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28163518/double-barrel-y-configuration-stenting-for-flow-diversion-of-a-giant-recurrent-basilar-apex-aneurysm-with-the-pipeline-flex-embolization-device
#7
Dale Ding, Robert M Starke, Ben McGuinness, Stefan Brew
Giant basilar apex aneurysms are extremely challenging to successfully manage. The Pipeline Flex embolization device (PFED) is a new generation flow-diverting stent with a modified delivery system which allows resheathing of the stent after partial deployment. We describe a case of double-barrel Y-configuration stenting of a giant, recurrent basilar apex aneurysm using the PFED. A 73-year-old male was previously treated for an unruptured 11-mm basilar apex aneurysm with stent-assisted coiling using a Neuroform stent...
December 2016: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/28155683/towards-the-patient-specific-design-of-flow-diverters-made-from-helix-like-wires-an-optimization-study
#8
Mingzi Zhang, Hitomi Anzai, Bastien Chopard, Makoto Ohta
BACKGROUND: Flow diverter (FD) intervention is an emerging endovascular technique for treating intracranial aneurysms. High flow-diversion efficiency is desired to accelerate thrombotic occlusion inside the aneurysm; however, the risk of post-stenting stenosis in the parent artery is posed when flow-diversion efficiency is pursued by simply decreasing device porosity. For improving the prognosis of FD intervention, we develop an optimization method for the design of patient-specific FD devices that maintain high levels of porosity...
December 28, 2016: Biomedical Engineering Online
https://www.readbyqxmd.com/read/28130501/endovascular-flow-diversion-for-treatment-of-anterior-communicating-artery-region-cerebral-aneurysms-a-single-center-cohort-of-50-cases
#9
Geoffrey P Colby, Matthew T Bender, Li-Mei Lin, Narlin Beaty, Judy Huang, Rafael Tamargo, Alexander Coon
BACKGROUND: Flow diversion represents a novel but definitive treatment for recurrent and difficult-to-coil aneurysms of the anterior communicating artery (ACoA) region, of which reports are limited. OBJECTIVE: To determine the effectiveness of the Pipeline embolization device (PED) in treating aneurysms in the ACoA region. METHODS: We retrospectively reviewed an IRB-approved database of patients with an aneurysm at a single institution for patients with ACoA or A1-A2 aneurysms treated with PED...
January 27, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28056454/collar-sign-in-incompletely-occluded-aneurysms-after-pipeline-embolization-evaluation-with-angiography-and-optical-coherence-tomography
#10
C J Griessenauer, R Gupta, S Shi, A Alturki, R Motiei-Langroudi, N Adeeb, C S Ogilvy, A J Thomas
BACKGROUND AND PURPOSE: Flow diversion with the Pipeline Embolization Device has emerged as an attractive treatment for cerebral aneurysms. Processes involved in aneurysm occlusion include changes in intra-aneurysmal hemodynamics and endothelialization of the device. Here, we call attention to a radiographic sign not previously reported that is detected in incompletely occluded aneurysms after treatment with the Pipeline Embolization Device at angiographic follow-up and referred to as the "collar sign...
November 10, 2016: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28029187/off-label-uses-for-flow-diversion-in-intracranial-aneurysm-management
#11
Fawaz Al-Mufti, Krishna Amuluru, Gomez Francisco, Vincent Dodson, Mohammad El-Ghanem, Charles J Prestigiacomo, Chirag D Gandhi
Treatment of complex aneurysms using microsurgical and other conventional neuroendovascular techniques remains challenging. As a result, stent- and balloon-assisted coiling are instead performed to treat morphologically complex aneurysms, which include giant, wide-necked, and fusiform aneurysms. While these techniques have had success in treating these complex aneurysms, recanalization rates associated with these techniques are still problematic. In the constant effort to improve the outcome of complex aneurysm treatment, flow-diverting stents (FDSs) have emerged in recent years as the preferred treatment...
December 28, 2016: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
https://www.readbyqxmd.com/read/28017223/parent-vessel-occlusion-for-treatment-of-cerebral-aneurysms-is-there-still-an-indication-a-series-of-17-patients
#12
Nishant Ganesh Kumar, Travis R Ladner, Imad S Kahn, Scott L Zuckerman, Christopher B Baker, Marybess Skaletsky, Deborah Cushing, Matthew R Sanborn, J Mocco, Robert D Ecker
INTRODUCTION/PURPOSE: Flow diversion has allowed cerebrovascular neurosurgeons and neurointerventionalists to treat complex, large aneurysms, previously treated with trapping, bypass, and/or parent vessel sacrifice. However, a minority of aneurysms remain that cannot be treated endovascularly, and microsurgical treatment is too dangerous. However, balloon test occlusion (macro and micro), micro WADA testing, ICG, intra-angiography and intra-operative monitoring are all available to clinically test the hypothesis that vessel sacrifice is safe...
January 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28007770/flow-diversion-in-ruptured-intracranial-aneurysms-a-meta-analysis
#13
T P Madaelil, C J Moran, D T Cross, A P Kansagra
BACKGROUND: Flow diversion is now an established technique to treat unruptured intracranial aneurysms not readily amenable to endovascular coil embolization or open microsurgical occlusion. The role of flow-diverting devices in treating ruptured aneurysms is less clear. PURPOSE: To estimate rates of angiographic occlusion and good clinical outcome in patients with ruptured intracranial aneurysms treated with flow-diverting devices. DATA SOURCES: Systematic review of Ovid MEDLINE, PubMed, Cochrane databases, and EMBASE from inception to December 2015 for articles that included ruptured aneurysms treated with flow diversion...
December 22, 2016: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/27956252/clinical-features-management-considerations-and-outcomes-in-case-series-of-patients-with-parasellar-intracranial-aneurysms-undergoing-anterior-skull-base-surgery
#14
Daniel M Raper, Dale Ding, Elizabeth Evans, Robert M Starke, R Webster Crowley, Kenneth C Liu, Edward H Oldfield, John A Jane
BACKGROUND: The coincidence of parasellar aneurysms (IAs) and anterior skull base (ASB) lesions, while rare, presents a management challenge. IAs embedded within, or adjacent to, ASB lesions are at risk in the perioperative period and may have unique presentations, natural histories, and outcomes. The objective of this study was to outline management options and nuances in patients with coexisting IAs and ASB lesions. METHODS: We retrospectively evaluated all patients who presented for management of IAs and ASB lesions from January 2006 to January 2014...
March 2017: World Neurosurgery
https://www.readbyqxmd.com/read/27942770/management-of-unruptured-saccular-aneurysms-of-the-m1%C3%A2-segment-with-flow-diversion-a%C3%A2-single-centre-experience
#15
Pervinder Bhogal, Rosa Martinez, Oliver Gansladt, Hansjörg Bäzner, Hans Henkes, Marta Aguilar
PURPOSE: The optimal strategy for the treatment of M1 segment aneurysms has not yet been determined as both standard microneurosurgical and endovascular techniques can pose challenges. We sought to determine the efficacy of flow diverting stents to treat small, unruptured aneurysms of the M1 segment. METHODS: We retrospectively reviewed our database of prospectively collected information for all patients treated with flow diversion for an unruptured saccular aneurysm of the middle cerebral artery (MCA) between February 2009 and February 2016...
December 11, 2016: Clinical Neuroradiology
https://www.readbyqxmd.com/read/27884881/testing-stenting-and-flow-diversion-using-a-surgical-elastase-induced-complex-fusiform-aneurysm-model
#16
R Fahed, T E Darsaut, I Salazkin, J-C Gentric, M Mazighi, J Raymond
BACKGROUND AND PURPOSE: Rabbit elastase-induced saccular aneurysms have been commonly used for preclinical testing of endovascular devices, including flow diverters. However, all tested devices have been shown to be capable of aneurysm occlusion with this model. We aimed to create a more challenging model to test and discriminate among neurovascular devices of varying efficacies. MATERIALS AND METHODS: With a surgical approach that included elastase infusion and balloon dilation, we attempted the creation of complex fusiform aneurysms in 16 rabbits, with standard saccular carotid aneurysms created in 15 other animals...
November 24, 2016: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/27864325/a-technical-consideration-when-using-flow-diversion-for-recurrent-aneurysms-following-stent-assisted-coiling
#17
Justin R Mascitelli, Daniel Wei, Thomas J Oxley, Christopher P Kellner, Hazem Shoirah, Reade A De Leacy, J Mocco, Johanna T Fifi
Flow diversion (FD) is a treatment option for recurrent aneurysms including following stent-assisted coiling (SAC), although this approach is both 'off-label' and unproven. A technical challenge of FD placement may involve the microwire catching on the tines of the previously placed stent or potentially going 'in-out-in' from the central axis of the stent. We report a case and technique that assures the wire has safely remained within the central axis of the stent. The procedure was performed in standard fashion except that the intermediate catheter was passed completely through the previously placed stent after the microwire/microcatheter had crossed...
November 18, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27856436/diffusion-weighted-imaging-detected-ischemic-lesions-following-endovascular-treatment-of-cerebral-aneurysms-a-systematic-review-and-meta-analysis
#18
K M Bond, W Brinjikji, M H Murad, D F Kallmes, H J Cloft, G Lanzino
BACKGROUND AND PURPOSE: Endovascular treatment of intracranial aneurysms is associated with the risk of thromboembolic ischemic complications. Many of these events are asymptomatic and identified only on diffusion-weighted imaging. We performed a systematic review and meta-analysis to study the incidence of DWI positive for thromboembolic events following endovascular treatment of intracranial aneurysms. MATERIALS AND METHODS: A comprehensive literature search identified studies published between 2000 and April 2016 that reported postprocedural DWI findings in patients undergoing endovascular treatment of intracranial aneurysms...
November 17, 2016: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/27852655/a-technical-consideration-when-using-flow-diversion-for-recurrent-aneurysms-following-stent-assisted-coiling
#19
Justin R Mascitelli, Daniel Wei, Thomas J Oxley, Christopher P Kellner, Hazem Shoirah, Reade A De Leacy, J Mocco, Johanna T Fifi
Flow diversion (FD) is a treatment option for recurrent aneurysms including following stent-assisted coiling (SAC), although this approach is both 'off-label' and unproven. A technical challenge of FD placement may involve the microwire catching on the tines of the previously placed stent or potentially going 'in-out-in' from the central axis of the stent. We report a case and technique that assures the wire has safely remained within the central axis of the stent. The procedure was performed in standard fashion except that the intermediate catheter was passed completely through the previously placed stent after the microwire/microcatheter had crossed...
November 15, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27844465/blood-flow-diversion-as-a-primary-treatment-method-for-ruptured-brain-aneurysms-concerns-controversy-and-future-directions
#20
Brian P Walcott, Matthew J Koch, Christopher J Stapleton, Aman B Patel
Flow diversion is a novel treatment for brain aneurysms that works by redirecting blood flow away from the aneurysm. Immediately after placement of the stent, blood flow stagnates within the aneurysm dome and it undergoes thrombosis. Over time, a new endothelium develops across the neck, thereby reconstructing the parent vessel and curing the aneurysm. The use of this treatment method for ruptured aneurysms has two specific concerns: 1) risk of hemorrhage from the aneurysm after treatment because of potential delayed aneurysm occlusion; and 2) hemorrhagic complications from antiplatelet use, which is required to prevent thromboembolic complications from the device...
November 14, 2016: Neurocritical Care
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