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Flow diverter OR flow diverting OR flow diversion AND aneurysm

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
Stephan A Munich, Marshall C Cress, Leonardo Rangel-Castilla, Ashish Sonig, Christopher S Ogilvy, Giuseppe Lanzino, Ondra Petr, J Mocco, Peter J Morone, Kenneth V Snyder, L Nelson Hopkins, Adnan H Siddiqui, Elad I Levy
BACKGROUND: Neck remnants are not uncommon after endovascular treatment of cerebral aneurysms. Critics of endovascular treatments for cerebral aneurysms cite neck remnants as evidence in favor of microsurgical clipping. However, studies have failed to evaluate the true clinical significance of aneurysm neck remnants following endovascular therapies. OBJECTIVE: To assess the clinical significance of residual aneurysm necks and to determine the rate of subsequent rupture following coiling or stent-assisted coiling of cerebral aneurysms...
March 8, 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
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
Nohra Chalouhi, Purvee D Patel, Elias Atallah, Robert M Starke, Ameet Chitale, Michael Lang, Stavropoula Tjoumakaris, David Hasan, Hekmat Zarzour, Michelle J Smith, Robert Rosenwasser, Pascal Jabbour
BACKGROUND: Flow diversion has emerged as a highly effective treatment for intracranial aneurysms. OBJECTIVE: To assess the yield of further angiographic follow-up in aneurysms that have achieved adequate occlusion after treatment with the Pipeline Embolization Device (PED; Medtronic Inc, Dublin, Ireland). METHODS: This is a single-institution, retrospective study. Inclusion criteria were as follows: (1) patients with 1 or more aneurysms treated with PED, (2) available short-term (<12 mo) follow-up digital subtraction angiography (DSA), (3) complete (100%) or near-complete (>95%) occlusion on short-term follow-up DSA, and (4) available further angiographic follow-up (DSA, Magnetic Resonance Angiography (MRA), or Computed Tomography Angiography (CTA))...
March 5, 2018: 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
Richard A Gray, Pras Pathmanathan
Patient-specific computer models have been developed representing a variety of aspects of the cardiovascular system spanning the disciplines of electrophysiology, electromechanics, solid mechanics, and fluid dynamics. These physiological mechanistic models predict macroscopic phenomena such as electrical impulse propagation and contraction throughout the entire heart as well as flow and pressure dynamics occurring in the ventricular chambers, aorta, and coronary arteries during each heartbeat. Such models have been used to study a variety of clinical scenarios including aortic aneurysms, coronary stenosis, cardiac valvular disease, left ventricular assist devices, cardiac resynchronization therapy, ablation therapy, and risk stratification...
March 6, 2018: Journal of Cardiovascular Translational Research
Jing Yu, Ning Xu, Ying Zhao, Jinlu Yu
The anterior choroidal artery (AChA) is a critical artery in brain physiology and function. The AChA is involved in many diseases, including aneurysm, brain infarct, Moyamoya disease (MMD), brain tumor, arteriovenous malformation (AVM), etc. The AChA is vulnerable to damage during the treatment of these diseases and is thus a very important vessel. However, a comprehensive systematic review of the importance of the AChA is currently lacking. In this study, we used the PUBMED database to perform a literature review of the AChA to increase our understanding of its role in neurophysiology...
2018: International Journal of Medical Sciences
Ali S Haider, Tijani Osumah, Hawk Cambron, Suraj Sulhan, Fariha Murshid, Steven Vayalumkal, Richa Thakur, Umair Khan, Kennith F Layton
The two main treatment modalities of acute intracranial aneurysm rupture are endovascular embolization and surgical clipping, each with its own benefits and risks. Endovascular treatment is associated with better outcomes compared to surgical clipping, but is also associated with high recurrence rates. We present the case of a patient with an acutely ruptured intracranial aneurysm, who subsequently underwent partial endovascular coiling acutely, and later underwent flow diversion therapy with the Pipeline Embolization Device...
November 25, 2017: Curēus
Raluca Pascalau, Vlad Adrian Padurean, Dana BARTOș, Adrian BARTOș, Bianca Aurora Szabo
AIM: Anatomical variants of the circle of Willis are diverse and frequent and, although they are not a direct cause of cerebrovascular diseases, they are risk factors for impaired collateral perfusion and wall shear stress. This study aimed to correlate the anatomical variants with their effects on the hemodynamic and geometrical parameters responsible for the pathogenesis of neurological diseases. MATERIAL AND METHODS: The circle of Willis and the proximal segments of the main arteries were dissected and measured on ten formalin-fixed human brains...
February 7, 2018: Turkish Neurosurgery
Maxim Mokin, Angel Chinea, Christopher T Primiani, Zeguang Ren, Peter Kan, Visish M Srinivasan, Ricardo Hanel, Pedro Aguilar-Salinas, Aquilla S Turk, Raymond D Turner, M Imran Chaudry, Andrew J Ringer, Babu G Welch, Vitor Mendes Pereira, Leonardo Renieri, Mariangela Piano, Lucas Elijovich, Adam S Arthur, Ahmed Cheema, Demetrius Klee Lopes, Ahmed Saied, Blaise W Baxter, Harris Hawk, Ajit S Puri, Ajay K Wakhloo, Hussain Shallwani, Elad I Levy, Adnan H Siddiqui, Guilherme Dabus, Italo Linfante
BACKGROUND: Blood blister aneurysms (BBA) are a rare subset of intracranial aneurysms that represent a therapeutic challenge from both a surgical and endovascular perspective. OBJECTIVE: To report multicenter experience with flow diversion exclusively for BBA, located at non-branching segments along the anteromedial wall of the supraclinoidal internal carotid artery (ICA). METHODS: Consecutive cases of BBA located at non-branching segments along the anteromedial wall of the supraclinoidal ICA treated with flow diversion were included in the final analysis...
February 24, 2018: Journal of Neurointerventional Surgery
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
Anna M Schneider, Justin M Moore, Nimer Adeeb, Raghav Gupta, Christoph J Griessenauer, Peter A Winkler, Sarah Sieber, Abdulrahman Y Alturki, Christopher S Ogilvy, Ajith J Thomas
INTRODUCTION: The objective of this study was to analyze patients' perceptions of their headaches both prior to and following Pipeline flow diversion treatment of their unruptured intracranial aneurysms, with the goal of identifying prognostic factors associated with headache patterns to improve predictions of overall outcomes. MATERIALS AND METHODS: We retrospectively identified 133 patients treated with the PED between January 1 st 2014 and December 31 st 2016 at an academic institution in the United States...
February 14, 2018: World Neurosurgery
Denise Brunozzi, Sophia F Shakur, Fady T Charbel, Ali Alaraj
Objective Pipeline embolization devices (PED) are commonly used for endovascular treatment of cerebral aneurysms but changes in intracranial hemodynamics after PED deployment are poorly understood. Here, we assess middle cerebral artery (MCA) and systemic blood pressure before and after PED treatment. Methods Records of patients with cerebral aneurysms proximal to the internal carotid artery terminus treated with PED at our institution between 2015 and 2017 were retrospectively reviewed. Patients were included if ipsilateral MCA pressure measurements were available...
January 1, 2018: Interventional Neuroradiology
Gabriele Capo, Maria C Vescovi, Giovanni Toniato, Benedetto Petralia, Vladimir Gavrilovic, Miran Skrap
Background: Giant aneurysms (>25 mm) arising from the vertebral artery (VA) often present with slow progression of symptoms and signs because of gradual brainstem and cranial nerve compression. The underlying pathophysiology is not well understood, and treatment, wherever possible, is tailored to each singular case. Endovascular management does not usually solve the problem of mass compression, whereas surgical treatment involves several complications. Case Description: A 58-year-old woman presented with a continuously growing giant right VA aneurysm, partially thrombosed, even after endovascular treatment (placement of two diversion flow stents)...
2018: Surgical Neurology International
Julian Maingard, Kevin Phan, Yifan Ren, Hong Kuan Kok, Vincent Thijs, Joshua A Hirsch, Michael J Lee, Ronil V Chandra, Duncan Mark Brooks, Hamed Asadi
INTRODUCTION: Endovascular interventions for intracranial aneurysms have evolved substantially over the past several decades. A citation rank list is used to measure the scientific and/or clinical impact of an article. Our objective was to identify and analyze the characteristics of the 100 most cited articles in the field of endovascular therapy for intracranial aneurysms. METHODS: We performed a retrospective bibliometric analysis between July and August 2017...
January 19, 2018: Journal of Neurointerventional Surgery
Jiang Xiong, Zhongzhou Hu, Hongpeng Zhang, Huanming Xu, Duanduan Chen, Wei Guo
Surgeon-modified retrograde branched extension limb assembling technique and bridged endografts were successfully used to exclude an asymptomatic pararenal abdominal aortic aneurysm and to reconstruct the superior mesenteric artery and bilateral renal arteries in a case with high-grade celiac artery stenosis, nondilated aorta above the superior mesenteric artery, and large lumen below the renal arteries. In patient-specific models for hemodynamics analysis, enhanced flow diversion to visceral arteries up to 6-month follow-up confirmed treatment feasibility; however, endograft configurations could be improved to avoid sharp corners at bifurcations, thereby ensuring smooth flow transport and possibly reducing risk for endograft narrowing or the development of thrombosis...
June 2017: Journal of Vascular Surgery Cases and Innovative Techniques
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
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
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