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Flow diverter OR flow diverting OR flow diversion AND aneurysm

Min S Park, Marcus D Mazur, Karam Moon, Michael J Nanaszko, John R W Kestle, Lubdha M Shah, Blair Winegar, Felipe C Albuquerque, Philipp Taussky, Cameron G McDougall
OBJECT: Despite the popularity of flow-diverting stents for the treatment of cerebral aneurysms, there is no widely accepted scale for the characterization of results. We present an outcomes-based grading scale that considers factors related to failure of flow diversion. METHODS: The grading scale was developed using the results from consecutive patients at two institutions who were treated with flow diversion for a cerebral aneurysm. The initial treatment results were graded on patient, aneurysm, and treatment characteristics...
October 19, 2016: Journal of Neurointerventional Surgery
Marcus D Mazur, Philipp Taussky, Joel D MacDonald, Min S Park
BACKGROUND AND IMPORTANCE: As the use of flow-diverting stents (FDSs) for intracranial aneurysms expands, a small number of case reports have described the successful treatment of blister aneurysms of the internal carotid artery with flow diversion. Blister aneurysms are uncommon and fragile lesions that historically have high rates of morbidity and mortality despite multiple treatment strategies. We report a case of rebleeding after treatment of a ruptured blister aneurysm with deployment of a single FDS...
November 2016: Neurosurgery
Tibor Becske, Matthew B Potts, Maksim Shapiro, David F Kallmes, Waleed Brinjikji, Isil Saatci, Cameron G McDougall, István Szikora, Giuseppe Lanzino, Christopher J Moran, Henry H Woo, Demetrius K Lopes, Aaron L Berez, Daniel J Cher, Adnan H Siddiqui, Elad I Levy, Felipe C Albuquerque, David J Fiorella, Zsolt Berentei, Miklós Marosföi, Saruhan H Cekirge, Peter K Nelson
OBJECTIVE The long-term effectiveness of endovascular treatment of large and giant wide-neck aneurysms using traditional endovascular techniques has been disappointing, with high recanalization and re-treatment rates. Flow diversion with the Pipeline Embolization Device (PED) has been recently used as a stand-alone therapy for complex aneurysms, showing significant improvement in effectiveness while demonstrating a similar safety profile to stent-supported coil treatment. However, relatively little is known about its long-term safety and effectiveness...
October 14, 2016: Journal of Neurosurgery
Sophia F Shakur, Victor A Aletich, Sepideh Amin-Hanjani, Ahmed E Hussein, Fady T Charbel, Ali Alaraj
BACKGROUND: Pipeline embolization devices (PEDs) are commonly used for endovascular treatment of cerebral aneurysms but can be associated with delayed ipsilateral intraparenchymal hemorrhage. Although intra-aneurysmal hemodynamic changes have been studied, parent vessel and intracranial hemodynamics after PED use are unknown. We examine the impact of flow diversion on parent artery and distal intracranial hemodynamics. METHOD: Patients with internal carotid cerebral aneurysms treated with PED who had flow volume rate, flow velocities, pulsatility index, resistance index, Lindegaard ratio, and wall shear stress (WSS) obtained after treatment using quantitative magnetic resonance angiography were reviewed...
October 4, 2016: Interventional Neuroradiology
Jay Vachhani, Christopher Nickele, Lucas Elijovich, Paul Klimo, Adam S Arthur
Intracranial flow diversion has gained increasing popularity since the approval of the Pipeline Embolization Device (PED). Although it is only approved for use in adult patients, the PED has been used to treat aneurysms in pediatric patients. We present the first reported case of the use of a PED in a pediatric patient to treat an unusual fusiform distal anterior cerebral artery aneurysm. A 12-year-old female presented with new onset seizures and was found to have an incidental distal left anterior cerebral artery aneurysm...
September 29, 2016: World Neurosurgery
Albert Ho Yuen Chiu, Rajalakshmi Ramesh, Jason Wenderoth, Mark Davies, Andrew Cheung
Subarachnoid hemorrhage secondary to rupture of a circumferential dissecting aneurysm continues to be a treatment dilemma. Vessel sacrifice, when possible, continues to be the safest option but in certain cases this is not possible due to lack of collateral supply. In such cases, coil assisted endovascular flow diversion has become a potential option but the requirement for dual antiplatelet therapy in an unsecured intracranial aneurysm continues to raise concern.We present a 48-year-old man with a World Federation of Neurological Surgeons grade 5 subarachnoid hemorrhage, secondary to a ruptured intradural left vertebral artery dissecting aneurysm, who was treated successfully with a pipeline embolization device with Shield technology using aspirin and a single intravenous loading dose of abciximab...
September 28, 2016: Journal of Neurointerventional Surgery
Bradley A Gross, Karam Moon, Andrew F Ducruet, Felipe C Albuquerque
BACKGROUND/OBJECTIVE: The rarity of petrous internal carotid artery (ICA) aneurysms has largely precluded analyses of their presentation and management in case series format. METHODS: We performed a retrospective analysis of our endovascular database of patients treated from January 2001 to May 2016 to identify patients with petrous ICA aneurysms. We evaluated the treatment approach and results for patients managed in the era of dedicated intracranial stents and flow diverters, noting clinical and angiographic results...
September 26, 2016: Journal of Neurointerventional Surgery
Pedro Aguilar-Salinas, Leonardo B C Brasiliense, Douglas Gonsales, Bartley Mitchell, Andrey Lima, Eric Sauvageau, Ricardo Hanel
Refinements in endovascular technology have revolutionized the treatment of intracranial aneurysms (IAs) with the development of flow-diversion technology. The first generation of the Pipelin Embolization Device (PED) has demonstrated its safety and efficacy. However, the deployment technique was a difficult task that often led to complex maneuvers. The Pipeline Flex Embolization Device (PED Flex) is the second generation and its introduction has arrived with high expectations due to a completely redesigned delivery system that intends to overcome deployment difficulties seen in the previous generation...
October 2016: Expert Review of Medical Devices
Takashi Suzuki, Hiroyuki Takao, Soichiro Fujimura, Chihebeddine Dahmani, Toshihiro Ishibashi, Hiroya Mamori, Naoya Fukushima, Makoto Yamamoto, Yuichi Murayama
BACKGROUND: Although flow diversion is a promising procedure for the treatment of aneurysms, complications have been reported and it remains poorly understood. The occurrence of adverse outcomes is known to depend on both the mechanical properties and flow reduction effects of the flow diverter stent. OBJECTIVE: To clarify the possibility of designing a flow diverter stent considering both hemodynamic performance and mechanical properties. MATERIALS AND METHODS: Computational fluid dynamics (CFD) simulations were conducted based on an ideal aneurysm model with flow diverters...
September 19, 2016: Journal of Neurointerventional Surgery
Raghav Gupta, Justin M Moore, Christoph J Griessenauer, Nimer Adeeb, Apar S Patel, Roy Youn, Karen Poliskey, Ajith J Thomas, Christopher S Ogilvy
INTRODUCTION: Flow diversion with the Pipeline Embolization Device (PED) is currently adopted for treatment of a variety of intracranial aneurysms. The elevated risk of thromboembolic complications associated with the device necessitates the need for administration of antiplatelet agents. We sought to assess current dual antiplatelet therapy practices patterns and their associated costs, following PED placement. MATERIALS AND METHODS: An online questionnaire assessing dual antiplatelet regimens following flow diversion for treatment of intracranial aneurysms was developed and disseminated to 80 neurosurgeons at major academic cerebrovascular centers...
September 15, 2016: World Neurosurgery
Christopher J Stapleton, Collin M Torok, Aman B Patel
BACKGROUND: Penumbra SMART coils differ from traditional microcoils used for endovascular coil embolization of intracranial aneurysms (IAs) in that they (1) become progressively softer from their distal to proximal end, rather than being of uniform stiffness, (2) have a tight conformational structure, and (3) have a more robust stretch-resistance platform. These properties aid in preventing microcatheter prolapse and coil herniation during coil deployment and in filling small pockets of the aneurysm sac...
September 8, 2016: Interventional Neuroradiology
Bradley A Gross, Felipe C Albuquerque, Karam Moon, Andrew F Ducruet, Cameron G McDougall
BACKGROUND/OBJECTIVE: The optimal management of residual or recurrent clipped aneurysms is infrequently addressed in the literature. METHODS: We reviewed our endovascular database from January 1998 to May 2016 to identify patients with clipped aneurysms undergoing subsequent endovascular treatment, evaluating treatment approach, and clinical and angiographic outcomes. RESULTS: 60 patients underwent endovascular treatment of residual/recurrent clipped aneurysms; 7 rebled prior to endovascular therapy...
August 8, 2016: Journal of Neurointerventional Surgery
Daniel Raper, Dale Ding, Eric C Peterson, Richard W Crowley, Kenneth C Liu, Nohra Chalouhi, David M Hasan, Aaron S Dumont, Pascal Jabbour, Robert M Starke
INTRODUCTION: Cavernous carotid aneurysms can cause significant symptomatology through mass effect and may rupture, resulting in carotid-cavernous fistula or epistaxis. Traditional treatment options included endovascular or surgical parent vessel occlusion, or embolization; in the last decade, the development of flow-diverting stents has changed the management paradigm for these lesions. AREAS COVERED: In this review, we summarize the natural history, clinical presentation, and evolution of treatment options for cavernous carotid aneurysms and discuss developments likely to influence treatment strategies in the future...
July 22, 2016: Expert Review of Neurotherapeutics
Loyola V Gressot, Akash J Patel, Visish M Srinivasan, Adam Arthur, Peter Kan, Edward A M Duckworth
BACKGROUND: The pipeline embolization device (PED) is a flow-diverting stent that provides an additional treatment modality in the management of intracranial aneurysms. An aneurysm treated with a flow diverter is expected to involute over time, contrary to the immediate obliteration expected by surgical clipping or coiling. Yet, which aneurysms will respond to PED therapy and the time frame to expect full obliteration remain unclear. CASE DESCRIPTION: We report the unusual case of a 50-year-old woman with multiple (4 total) intracranial aneurysms who underwent multimodality treatment...
September 2016: World Neurosurgery
A Rouchaud, C Ramana, W Brinjikji, Y-H Ding, D Dai, T Gunderson, J Cebral, D F Kallmes, R Kadirvel
BACKGROUND AND PURPOSE: Robust wall apposition for flow-diverter stents may be important for endothelialization. Using a large series of experimental aneurysms treated with the Pipeline Embolization Device, the objectives of this study were to 1) assess interobserver agreement for the evaluation of wall apposition on posttreatment DSA and evaluate its association with aneurysm occlusion, and 2) measure the relationship between wall apposition assessed with histology and aneurysm occlusion rate after treatment...
July 7, 2016: AJNR. American Journal of Neuroradiology
Guilherme Dabus, Jonathan A Grossberg, C Michael Cawley, Jacques E Dion, Ajit S Puri, Ajay K Wakhloo, Douglas Gonsales, Pedro Aguilar-Salinas, Eric Sauvageau, Italo Linfante, Ricardo A Hanel
BACKGROUND: The off-label use of flow diverters in the treatment of distal aneurysms continues to be debated. OBJECTIVE: To report our multicenter experience in the treatment of complex anterior cerebral artery aneurysms with the Pipeline embolization device (PED). METHODS: The neurointerventional databases of the four participating institutions were retrospectively reviewed for aneurysms treated with PED between October 2011 and January of 2016...
July 5, 2016: Journal of Neurointerventional Surgery
Biagia La Pira, Waleed Brinjikji, Christopher Hunt, John J Chen, Giuseppe Lanzino
Aneurysmal volume expansion after endovascular treatment is caused by intra-aneurysmal thrombosis in the early postembolization period. Although postembolization mass effect on cranial nerves and other adjacent structures has been previously reported, we are unaware of reports involving the anterior visual pathway. A 66-year-old woman with a 2-week history of blurred vision without headache was found to have a large, unruptured anterior communicating artery aneurysm. One month after endovascular treatment of the aneurysm with coiling and flow diversion, the patient developed decreased vision in her right eye and a left homonymous hemianopia...
June 23, 2016: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
Krishna Amuluru, Fawaz Al-Mufti, Chirag D Gandhi, Charles J Prestigiacomo, I Paul Singh
Direct carotid-cavernous fistulas (CCFs) are rare complications of flow diversion and have typically been documented in a subacute time frame after treatment. We present the first reported case of an intraprocedural direct CCF that developed immediately after flow diversion for treatment of a symptomatic paraclinoid right internal carotid artery aneurysm with a neck involving the cavernous segment. Endovascular treatment of such direct fistulas typically involves either transarterial obliteration of the fistulous site or transvenous embolization of the cavernous sinus...
October 2016: Interventional Neuroradiology
Brian P Walcott, Christopher J Stapleton, Omar Choudhri, Aman B Patel
IMPORTANCE: Brain aneurysms have traditionally been treated with surgical clipping or endovascular coiling techniques. With these modalities, many large or complex aneurysms remain difficult to treat. A new option, flow diversion, is now available to treat aneurysms. OBJECTIVE: To summarize the clinical progression of flow diversion technology, from an experimental treatment to a commonly used method to treat large or complex aneurysms. EVIDENCE REVIEW: References for this topical review were identified by searches of PubMed and GoogleScholar between January 2000 and January 2016...
August 1, 2016: JAMA Neurology
Seby John, Mark D Bain, M Shazam Hussain, Andrew M Bauer, Gabor Toth
BACKGROUND: The long-term effect of flow diversion (FD) on aneurysms has not been well studied. OBJECTIVE: We aimed to assess the effect of the Pipeline embolization device (Covidien, Irvine, California, USA) on large and giant intracranial aneurysms with magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) and then correlate with clinical follow-up. METHODS: We conducted a retrospective analysis of aneurysms treated solely with Pipeline without adjunctive therapy...
September 2016: World Neurosurgery
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