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Flow diverter

Michael A Silva, Alfred P See, Priyank Khandelwal, Ashutosh Mahapatra, Kai U Frerichs, Rose Du, Nirav J Patel, Mohammad A Aziz-Sultan
OBJECTIVE Paraclinoid aneurysms represent approximately 5% of intracranial aneurysms (Drake et al. [1968]). Visual impairment, which occurs in 16%-40% of patients, is among the most common presentations of these aneurysms (Day [1990], Lai and Morgan [2013], Sahlein et al. [2015], and Silva et al. [2017]). Flow-diverting stents, such as the Pipeline Embolization Device (PED), are increasingly used to treat these aneurysms, in part because of their theoretical reduction of mass effect (Fiorella et al. [2009])...
June 22, 2018: Journal of Neurosurgery
Christine F Dow, Won Sang Lee, Jamin S Greenbaum, Chad A Greene, Donald D Blankenship, Kristin Poinar, Alexander L Forrest, Duncan A Young, Christopher J Zappa
Ice shelves control sea-level rise through frictional resistance, which slows the seaward flow of grounded glacial ice. Evidence from around Antarctica indicates that ice shelves are thinning and weakening, primarily driven by warm ocean water entering into the shelf cavities. We have identified a mechanism for ice shelf destabilization where basal channels underneath the shelves cause ice thinning that drives fracture perpendicular to flow. These channels also result in ice surface deformation, which diverts supraglacial rivers into the transverse fractures...
June 2018: Science Advances
L Eichhorn, J Doerner, J A Luetkens, J M Lunkenheimer, R C Dolscheid-Pommerich, F Erdfelder, R Fimmers, J Nadal, B Stoffel-Wagner, H H Schild, A Hoeft, B Zur, C P Naehle
BACKGROUND: Prolonged breath holding results in hypoxemia and hypercapnia. Compensatory mechanisms help maintain adequate oxygen supply to hypoxia sensitive organs, but burden the cardiovascular system. The aim was to investigate human compensatory mechanisms and their effects on the cardiovascular system with regard to cardiac function and morphology, blood flow redistribution, serum biomarkers of the adrenergic system and myocardial injury markers following prolonged apnoea. METHODS: Seventeen elite apnoea divers performed maximal breath-hold during cardiovascular magnetic resonance imaging (CMR)...
June 18, 2018: Journal of Cardiovascular Magnetic Resonance
Murillo Cunegatto-Braga, Brian Hogan, Pedro Aguilar-Salinas, Alexandra D Beier, Ricardo A Hanel
BACKGROUND: Intracranial aneurysms(IAs) are rare in the pediatric population and are usually considered difficult to treat with traditional microsurgery due to their complex morphology. Endovascular techniques have become the standard option for treating IAs in adults. More recently, flow diverters such as the Pipeline Embolization Device(PED) are being widely adopted for unruptured IAs with safety and efficacy in adults, yet their use in the pediatric population is not well defined. In this paper we present a pediatric patient with a ruptured PCA aneurysm successfully treated with a PED and a review of the literature of the current status of PED use in this subset of patients...
June 14, 2018: World Neurosurgery
Yong Cheol Lim, Yong Sam Shin, Joonho Chung
A new Low-profile Visualized Intraluminal Support device (LVIS Blue) is a braided stent that provides a higher degree of metal coverage. This stent may be beneficial for complete obliteration of an aneurysm due not only to its support of a higher occlusion rate using coils inside of the aneurysm but also to its flow diverting effect. We introduce and describe a new flow diversion technique using an LVIS Blue-within-an-Enterprise for patients with vertebral artery (VA) dissecting aneurysms. A 6-Fr guiding catheter was positioned in the ipsilateral VA...
June 14, 2018: World Neurosurgery
Pierre Bouillot, Olivier Brina, Bénédicte M A Delattre, Rafik Ouared, Alain Pellaton, Hasan Yilmaz, Paolo Machi, Karl-Olof Lovblad, Mohamed Farhat, Vitor Mendes Pereira, Maria Isabel Vargas
PURPOSE: The morphological and hemodynamic evaluations of neurovascular diseases treated with stents would benefit from noninvasive imaging techniques such as 3D time-of-flight MRI (3D-TOF) and 3D phase contrast MRI (3D-PCMRI). For this purpose, a comprehensive evaluation of the stent artifacts and their impact on the flow measurement is critical. METHODS: The artifacts of a representative sample of neurovascular stents were evaluated in vitro with 3D-TOF and 3D-PCMRI sequences...
June 12, 2018: Magnetic Resonance in Medicine: Official Journal of the Society of Magnetic Resonance in Medicine
M Akli Zetchi, Adam A Dmytriw, Albert H Chiu, Brian J Drake, Niki V Alizadeh, Aditya Bharatha, Abhaya V Kulkarni, Thomas R Marotta
Objective Numerous studies have suggested a relationship between delayed occlusion of intracranial aneurysms treated with the Pipeline Embolization Device (PED) and the presence of an incorporated branch. However, in some cases, flow diversion may still be the preferred treatment option. This study sought to determine whether geometric factors pertaining to relative size and angulation of branch vessel(s) can be measured in a reliable fashion and whether they are related to occlusion rates. Methods Eighty aneurysms treated at a single neurovascular center from November 2008 to June 2014 were identified...
January 1, 2018: Interventional Neuroradiology
Ryuta Nakae, Tomoji Takigawa, Koji Hirata, Masaya Nagaishi, Akio Hyodo, Kensuke Suzuki
BACKGROUND: Inflow into an aneurysm sac immediately following flow diverter (FD) treatment is an assumed cause of delayed aneurysmal rupture. The significance of delayed post-treatment residual flow occurring months after FD treatment is unknown. CASE DESCRIPTION: A 76-year-old woman with a large intracranial aneurysm measuring 23.0 × 18.1 mm in the cavernous segment of the right internal carotid artery was treated with placement of a single FD (Pipeline Embolization Device [PED]®, Covidien, Irvine, CA, USA)...
May 28, 2018: World Neurosurgery
Visish M Srinivasan, Ascher Kaufmann, Peter Kan, Edward A Duckworth
Giant cavernous aneurysms of the internal carotid artery (ICA) are challenging lesions associated with high surgical morbidity. Prior to the past several years, these were treated by surgical reconstruction, proximal ligation, or stent-assisted coiling techniques. Flow diversion has become the standard of care for these lesions, providing a high rate of obliteration with a much better safety profile. However, flow diverters rely upon a navigable vasculature and, usually, a tri-axial support system. Cases in which such access is difficult require unique approaches to combine the strengths of both surgical and endovascular therapy...
March 28, 2018: Curēus
Bastian Kraus, Lukas Goertz, Bernd Turowski, Jan Borggrefe, Marc Schlamann, Franziska Dorn, Christoph Kabbasch
BACKGROUND: The Derivo Embolization Device (DED) is a novel flow diverter stent that provides increased x-ray visibility, an improved delivery system, and potentially reduced thrombogenicity. The objective of this study was to evaluate the early safety and efficacy of the second-generation DED. METHODS: We retrospectively analyzed all patients with unruptured intracranial aneurysms (UIAs) treated with the DED between November 2015 and December 2017 in three German tertiary care centers...
May 30, 2018: Journal of Neurointerventional Surgery
Pervinder Bhogal, Jorge Chudyk, Carlos Bleise, Ivan Lylyk, Hans Henkes, Pedro Lylyk
Objective The objective of this study was to report our experience on the use of flow diverting stents placed within the posterior inferior cerebellar artery (PICA) as a treatment option for aneurysms of the PICA. Methods Three patients with aneurysms of the PICA, both ruptured and unruptured, underwent treatment of their aneurysms with placement of a single flow diverter in the PICA across the neck of the aneurysm. Adjunctive techniques such as coiling were not used. We present the angiographic and clinical follow-up data...
January 1, 2018: Interventional Neuroradiology
Clément Portois, Elyess Essouayed, Michael D Annable, Nathalie Guiserix, Antoine Joubert, Olivier Atteia
A novel approach using foam to manage hazardous waste was successfully demonstrated under active site conditions. The purpose of the foam was to divert groundwater flow, that would normally enter the source zone area, to reduce dissolved contaminant release to the aquifer. During the demonstration, foam was pre generated and directly injected surrounding the chlorinated solvent source zone. Despite the constraints related to the industrial activities and non-optimal position of the injection points, the applicability and effectiveness of the approach have been highlighted using multiple metrics...
May 1, 2018: Journal of Contaminant Hydrology
Yoshikazu Matsuda, Dong-Kyu Jang, Joonho Chung, John Michael Wainwright, Demetrius Lopes
OBJECTIVE: To evaluate the rate of neointimal development and thrombus formation of surface-modified flow diverters in single antiplatelet therapy (SAPT) using optical coherence tomography (OCT) in a porcine model. METHODS: We divided 10 experimental pigs into two groups. One group (n=6) received dual antiplatelet therapy (DAPT) and the other group (n=4) received SAPT. Four stents (two per carotid artery) were implanted in both groups. The stents used were the Pipeline Flex embolization device (PED Flex), Pipeline Flex with Shield technology (PED Shield), and the Solitaire AB stent...
May 26, 2018: Journal of Neurointerventional Surgery
D Yu Usachev, V A Lukshin, K G Mikeladze, S B Yakovlev
The article reports a clinical case of endovascular treatment of a female patient with a giant aneurysm of the cavernous internal carotid artery complicated by gross ipsilateral bending of the proximal third of the common carotid artery. To ensure an adequate endovascular approach to the aneurysm, open repair of the common carotid artery and elimination of its bending were performed at the first stage. This enabled successful placement of a flow-diverting stent into the internal carotid artery at the aneurysm level at the second stage, resulting in good technical and clinical outcomes...
2018: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
Philipp Berg, Sylvia Saalfeld, Gábor Janiga, Olivier Brina, Nicole M Cancelliere, Paolo Machi, Vitor M Pereira
Endovascular treatment of intracranial aneurysms using flow-diverting devices has revolutionized the treatment of large and complex lesions due to its minimally invasive nature and potential clinical outcomes. However, incomplete or delayed occlusion and persistent intracranial aneurysm growth are still an issue for up to one-third of the patients. We evaluated two patients with intracranial aneurysm located at the internal carotid artery who were treated with flow-diverting devices and had opposite outcomes...
May 1, 2018: International Journal of Artificial Organs
José E Cohen, J Moshe Gomori, Ronen R Leker, Sergey Spektor, Hosni Abu El Hassan, Eyal Itshayek
OBJECTIVE: We present our experience with stent techniques in the management of acutely ruptured aneurysms, focusing on aneurysm occlusion rates, intraprocedural complications, and late outcomes. METHODS: We retrospectively reviewed the clinical records of patients treated by stent techniques during the early acute phase of aneurysmal rupture, from June 2011 to June 2016. Patients who underwent stenting for the management of unruptured aneurysms, or in a delayed fashion for a ruptured lesion, were excluded...
May 19, 2018: Journal of Neurointerventional Surgery
G Foa Torres, F Roca, A Noguera, J Godes, S Petrocelli, I Aznar, S Ales, P Muszynski, R Maehara, M Vicente, J M Pumar
Background Flow-diverter stents have been successfully used in the treatment of complex aneurysms with limited therapeutic alternatives. We report our experience using the Silk flow diverter (SFD; Balt Extrusion, Montmorency, France) for the treatment of complex aneurysms in four Argentine centers. Methods We conducted a retrospective review of 246 consecutive patients who were treated with the SFD at four Argentine centers between January 2009 and January 2017. The patient and aneurysm characteristics, as well as the details of the procedure, were analyzed...
January 1, 2018: Interventional Neuroradiology
Narlin B Beaty, Jessica K Campos, Geoffrey P Colby, Li-Mei Lin, Matthew T Bender, Risheng Xu, Alexander L Coon
Background: An estimated 0.1% of the population harbors brain arteriovenous malformations (AVMs). Diagnosis and workup of AVMs include thorough evaluation for characterization of AVM angioarchitecture and careful assessment for concomitant aneurysms. The presence of coexisting aneurysms is associated with an increased risk of intracranial hemorrhage, with a published risk of 7% per year compared to patients with AVMs alone with a risk of 3%. Comprehensive AVM management requires recognition of concomitant aneurysms and prioritizes treatment strategies to mitigate the aggregate risk of intracranial hemorrhage associated with AVM rupture in patients with coexisting aneurysms...
April 2018: Interventional Neurology
Spencer Twitchell, Hussam Abou-Al-Shaar, Jared Reese, Michael Karsy, Ilyas M Eli, Jian Guan, Philipp Taussky, William T Couldwell
OBJECTIVE With the continuous rise of health care costs, hospitals and health care providers must find ways to reduce costs while maintaining high-quality care. Comparing surgical and endovascular treatment of intracranial aneurysms may offer direction in reducing health care costs. The Value-Driven Outcomes (VDO) database at the University of Utah identifies cost drivers and tracks changes over time. In this study, the authors evaluate specific cost drivers for surgical clipping and endovascular management (i...
May 2018: Neurosurgical Focus
Ignacio Polti, Benoît Martin, Virginie van Wassenhove
Psychological models of time perception involve attention and memory: while attention typically regulates the flow of events, memory maintains timed events or intervals. The precise, and possibly distinct, roles of attention and memory in time perception remain debated. In this behavioral study, we tested 48 participants in a prospective duration estimation task while they fully attended to time or performed a working memory (WM) task. We report that paying attention to time lengthened perceived duration in the range of seconds to minutes, whereas diverting attention away from time shortened perceived duration...
April 27, 2018: Scientific Reports
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