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Flow diverter stent

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https://www.readbyqxmd.com/read/28611831/salvage-of-herniated-flow-diverters-using-stent-and-balloon-anchoring-techniques-a-technical-note
#1
Bharathi D Jagadeesan, Divyajot Sandhu, Kim Jae Hong, Sara Roshan Khanipour, Andrew W Grande, Ramachandra P Tummala
BACKGROUND: The pipeline embolization device (PED; Medtronic, MN, USA) can sometimes herniate into the aneurysmal sac in an unexpected manner during or shortly after its deployment due to device foreshortening. In this report, we describe 2 endovascular techniques, which can be used to reposition a herniated PED construct into a more favorable alignment. SUMMARY: In a 67-year-old patient who had an intraprocedural herniation of a PED device into a giant cavernous aneurysm, a stent anchor technique was used to reverse the herniation, reorient the PED construct, and achieve successful flow diversion...
March 2017: Interventional Neurology
https://www.readbyqxmd.com/read/28604183/treatment-of-an-internal-carotid-artery-aneurysm-with-a-flow-diverter-through-a-double-lumen-balloon-catheter
#2
José M Amorim, Santiago Rosati, Ronit Agid, Vítor Mendes Pereira, Timo Krings
Background Double lumen balloon catheters (DLBCs) are currently used in the treatment of intracranial aneurysms, especially when involving balloon or stent-assisted coiling. The existing DLBCs allow the delivery of self-expandable stents but do not offer the possibility to deploy flow-diverters. Despite the increasing use and success of flow-diverters, there have been numerous reports of procedural complications such as early in-stent thrombosis or delayed distal embolization. It seems that these complications can be avoided by correct stent positioning and adequate wall apposition, achieved either by manoeuvres with the microguidewire and/or microcatheter or by performing balloon angioplasty following an exchange guidewire manoeuvre...
June 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/28598274/evaluation-of-ischemic-lesion-prevalence-after-endovascular-treatment-of-intracranial-aneurysms-as-documented-by-3-t-diffusion-weighted-imaging-a-2-year-single-center-cohort-study
#3
Christina Iosif, Jean-Christophe Lecomte, Eduardo Pedrolo-Silveira, George Mendes, Marie-Paule Boncoeur Martel, Suzana Saleme, Charbel Mounayer
OBJECTIVE Even though published data exist concerning the prevalence of ischemic lesions detected by diffusion-weighted imaging (DWI) following endovascular treatment of intracranial aneurysms, a single-center cross-evaluation of the different endovascular techniques has been lacking. The authors sought to prospectively evaluate the prevalence and clinical significance of ischemic lesions occurring after endovascular treatment of intracranial aneurysms and to compare the safety and effectiveness of a broad spectrum of currently accepted endovascular techniques in a single-center setting...
June 9, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28595811/acute-distal-migration-of-a-flow-diverting-stent
#4
David Dornbos, Ciarán J Powers
The introduction of flow diverting stents, particularly for treatment of petrous to supraclinoid internal carotid artery aneurysms, has greatly impacted endovascular treatment of intracranial aneurysms. Despite their high efficacy, complications, such as ischemic events, distal hemorrhage, or problems with stent deployment, remain a significant concern. We present the first reported case of acute distal migration of a Pipeline Embolization Device (PED). A 24-year old female underwent elective placement of a PED for treatment of a left paraclinoid internal carotid artery aneurysm...
June 5, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28592484/analysis-of-neointima-development-in-flow-diverters-using-optical-coherence-tomography-imaging
#5
Yoshikazu Matsuda, Joonho Chung, Demetrius K Lopes
BACKGROUND: Flow diverters are used for the treatment of intracranial aneurysms. Surface modification may decrease the thrombogenicity of flow diverters but the details are unknown. Optical coherence tomography (OCT) is an intravascular imaging test with high resolution which identifies neointimal growth over stents. We compared the development of neointima in a flow diverter and stents with and without surface modification in a swine model. METHODS: In this study we implanted four devices (two in each carotid artery) in four pigs...
June 7, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28576622/haemodynamic-effects-of-stent-diameter-and-compaction-ratio-on-flow-diversion-treatment-of-intracranial-aneurysms-a-numerical-study-of-a-successful-and-an-unsuccessful-case
#6
Mingzi Zhang, Yujie Li, Xi Zhao, David I Verrelli, Winston Chong, Makoto Ohta, Yi Qian
BACKGROUND: Compacting a flow-diverting (FD) stent is an emerging technique to create a denser configuration of wires across the aneurysm ostium. However, quantitative analyses of post-stenting haemodynamics affected by the compaction level of different stent sizes remain inconclusive. OBJECTIVE: To compare the aneurysmal haemodynamic alterations after virtual FD treatments with different device diameters at different compaction ratios. METHODS: We virtually implanted three sizes of FD stent, with each size deployed at four compaction ratios, into two patient aneurysms previously treated with the Silk+FD-one successful case and the other unsuccessful...
May 16, 2017: Journal of Biomechanics
https://www.readbyqxmd.com/read/28565993/use-of-the-pipeline-embolization-device-in-the-treatment-of-iatrogenic-intracranial-vascular-injuries-a-bi-institutional-experience
#7
Julius Griauzde, Vijay M Ravindra, Neeraj Chaudhary, Joseph J Gemmete, Marcus D Mazur, Christopher D Roark, William T Couldwell, Min S Park, Philipp Taussky, Aditya S Pandey
OBJECTIVE Flow-diverting devices have been used for the treatment of complex intracranial vascular pathology with success, but the role of these devices in treating iatrogenic intracranial vascular injuries has yet to be clearly defined. Here, the authors report their bi-institutional experience with the use of the Pipeline embolization device (PED) for the treatment of iatrogenic intracranial vascular injuries. METHODS The authors reviewed a retrospective cohort of patients with iatrogenic injuries to the intracranial vasculature that were treated with the PED between 2012 and 2016...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565984/novel-use-of-flow-diversion-for-the-treatment-of-aneurysms-associated-with-arteriovenous-malformations
#8
Craig Kilburg, Philipp Taussky, M Yashar S Kalani, Min S Park
The use of flow-diverting stents for intracranial aneurysms has become more prevalent, and flow diverters are now routinely used beyond their initial scope of approval at the proximal internal carotid artery. Although flow diversion for the treatment of cerebral aneurysms is becoming more commonplace, there have been no reports of its use to treat flow-related cerebral aneurysms associated with arteriovenous malformations (AVMs). The authors report the cases of 2 patients whose AVM-associated aneurysms were managed with flow diversion...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28565977/endovascular-treatment-of-blister-aneurysms
#9
Geoffrey W Peitz, Christopher A Sy, Ramesh Grandhi
Blister aneurysms are rare cerebrovascular lesions for which the treatment methods are reviewed here, with a focus on endovascular options. The reported pathogenesis of blister aneurysms varies, and hemodynamic stress, arterial dissection, and arteriosclerotic ulceration have all been described. There is consensus on the excessive fragility of blister aneurysms and their parent vessels, which makes clipping technically difficult. Open surgical treatment is associated with high rates of complications, morbidity, and mortality; endovascular treatment is a promising alternative...
June 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28553172/current-status-of-the-treatment-of-blood-blister-like-aneurysms-of-the-supraclinoid-internal-carotid-artery-a-review
#10
REVIEW
Tiefeng Ji, Yunbao Guo, Xiuying Huang, Baofeng Xu, Kan Xu, Jinlu Yu
Currently, the treatment of blood blister-like aneurysms (BBAs) of the supraclinoid internal carotid artery (ICA) is challenging and utilizes many therapeutic methods, including direct clipping and suturing, clipping after wrapping, clipping after suturing, coil embolization, stent-assisted coil embolization, multiple overlapping stents, flow-diverting stents, covered stents, and trapping with or without bypass. In these therapeutic approaches, the optimal treatment method for BBAs has not yet been defined based on the current understanding of BBAs of the supraclinoid ICA...
2017: International Journal of Medical Sciences
https://www.readbyqxmd.com/read/28531340/in-reply-rerupture-of-a-blister-aneurysm-after-treatment-with-a-single-flow-diverting-stent
#11
Marcus D Mazur, Philipp Taussky, Joel D MacDonald, Min S Park
No abstract text is available yet for this article.
May 22, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28521024/pipeline-embolization-device-for-pericallosal-artery-aneurysms-a-retrospective-single-center-safety-and-efficacy-study
#12
Katyucia De Macedo Rodrigues, Anna Luisa Kühn, Takamitsu Tamura, Guilherme Dabus, Peter Kan, Miklos G Marosfoi, J Diego Lozano, Mary Perras, Christopher Brooks, Mary C Howk, Samuel Y Hou, David E Rex, Francesco Massari, Matthew J Gounis, Ajay K Wakhloo, Ajit S Puri
BACKGROUND: Pericallosal artery aneurysm treatment may be challenging using traditional endovascular techniques. OBJECTIVE: To demonstrate the feasibility, efficacy, and safety of endovascular treatment of pericallosal artery aneurysm using flow diverters. METHODS: We performed a retrospective review of our institutional database from July 2013 through July 2016 and identified 7 subjects with a pericallosal artery aneurysm treated with the Pipeline embolization device (ev3 Neurovascular, Medtronic, Dublin, Ireland) and at least 1 follow-up angiogram...
May 17, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/28515570/association-between-hemodynamic-modifications-and-clinical-outcome-of-intracranial-aneurysms-treated-using-flow-diverters
#13
Nikhil Paliwal, Robert J Damiano, Jason M Davies, Adnan H Siddiqui, Hui Meng
Treatment of intracranial aneurysms (IAs) has been revolutionized by the advent of endovascular Flow Diverters (FDs), which disrupt blood flow within the aneurysm to induce pro-thrombotic conditions, and serves as a scaffold for endothelial ingrowth and arterial remodeling. Despite good clinical success of FDs, complications like incomplete occlusion and post-treatment rupture leading to subarachnoid hemorrhage have been reported. In silico computational fluid dynamic analysis of the pre- and post-treated geometries of IA patients can shed light on the contrasting blood hemodynamics associated with different clinical outcomes...
February 11, 2017: Proceedings of SPIE
https://www.readbyqxmd.com/read/28506004/relationships-between-geometrical-parameters-and-mechanical-properties-for-a-helical-braided-flow-diverter-stent
#14
Takashi Suzuki, Hiroyuki Takao, Soichiro Fujimura, Chihebeddine Dahmani, Toshihiro Ishibashi, Hiroya Mamori, Naoya Fukushima, Yuichi Murayama, Makoto Yamamoto
BACKGROUND: Although flow diversion is a promising procedure for aneurysm treatment, the safety and efficacy of this strategy have not been sufficiently characterized. Both mechanical properties and flow reduction effects are important factors in the design of an optimal stent. OBJECTIVE: We aimed to clarify the contributions of strut size and pitch to the mechanical properties (radial stiffness and longitudinal flexibility) and geometric characteristics (porosity and pore density) related to flow reduction effects...
May 1, 2017: Technology and Health Care: Official Journal of the European Society for Engineering and Medicine
https://www.readbyqxmd.com/read/28499020/letter-rerupture-of-a-blister-aneurysm-after-treatment-with-a-single-flow-diverting-stent
#15
Leonardo B C Brasiliense, Christina M Walter, Mauricio J Avila, Travis M Dumont
No abstract text is available yet for this article.
May 11, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28488025/in-stent-stenosis-after-p64-flow-diverter-treatment
#16
M Aguilar Pérez, P Bhogal, E Henkes, O Ganslandt, H Bäzner, H Henkes
PURPOSE: There is limited information available on the incidence of in-stent stenosis (ISS) secondary to the use of flow-diverting stents in the intracranial vasculature. We sought to determine the incidence, severity, and clinical course of ISS on angiographic follow-up after treatment of saccular aneurysms with p64. METHODS: We retrospectively reviewed all patients who underwent treatment of a saccular (ruptured and unruptured) intracranial aneurysm with ≥1 p64 between 2011 and 2015...
May 9, 2017: Clinical Neuroradiology
https://www.readbyqxmd.com/read/28487360/ultrasound-for-the-evaluation-of-stenosis-after-flow-diversion
#17
Cameron M McDougall, Khurshid Khan, Maher Saqqur, Andrew Jack, Jeremy Rempel, Carol Derksen, Yin Xi, Michael Chow
BACKGROUND AND PURPOSE: Flow diversion is a relatively new strategy used to treat complex cerebral aneurysms. The optimal method for radiographic follow-up of patients treated with flow diverters has not been established. The rate and clinical implications of in-stent stenosis for these devices is unclear. We evaluate the use of transcranial Doppler ultrasound (TCD) for follow-up of in-stent stenosis. MATERIALS AND METHODS: We analyzed 28 patients treated with the Pipeline embolization device (PED) over the course of 42 months from January 2009 to June 2012...
May 9, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28477214/the-new-double-layer-micromesh-stent-roadsaver-%C3%A2-use-in-endovascular-treatment-of-supraaortic-and-visceral-artery-aneurysms-and-pseudoaneurysms
#18
Koray Akkan, Erhan Ilgit, Kutlay Karaman, Baran Onal, Murat Dökdök, Elif Ersöz, Abdullah Özer, Bijen Nazliel
PURPOSE: This study was designed to present our preliminary experience with the Roadsaver(®) double-layer micromesh (DLM) stent in the endovascular treatment of supra-aortic and visceral aneurysms and to utilize the flow-diverting effect of this new design in the treatment of these aneurysms. METHODS: DLM stent (Roadsaver(®), Terumo, Tokyo, Japan) was used in five patients (median age 61.8 years; three men) for treating arterial aneurysms (one common carotid artery, one vertebral artery V1 segment, one superior mesenteric artery, and two renal artery aneurysms)...
May 5, 2017: Cardiovascular and Interventional Radiology
https://www.readbyqxmd.com/read/28472526/glycoprotein-iib-iiia-inhibitors-in-prevention-and-rescue-treatment-of-thromboembolic-complications-during-endovascular-embolization-of-intracranial-aneurysms
#19
David Dornbos, Joel S Katz, Patrick Youssef, Ciarán J Powers, Shahid M Nimjee
Thromboembolic complications remain a major risk of endovascular neurosurgery during the treatment of intracranial aneurysms, despite the use of therapeutic heparinization and oral antiplatelet therapy when indicated. Glycoprotein (GP) IIb/IIIa inhibitors target a nonredundant pathway of platelet aggregation following adhesion and activation. Initially established and implemented in the cardiovascular arena, this drug class has provided a new tool in the neurovascular armamentarium as well. Numerous case reports, case series, and retrospective reviews have evaluated the safety and efficacy of abciximab, eptifibatide, and tirofiban in the treatment of acute thromboembolic complications during the endovascular treatment of intracranial aneurysms...
May 3, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28458385/recent-trends-in-neuro-endovascular-treatment-for-acute-ischemic-stroke-cerebral-aneurysms-carotid-stenosis-and-brain-arteriovenous-malformations
#20
Yuji Matsumaru, Eiichi Ishikawa, Tetsuya Yamamoto, Akira Matsumura
The efficacy of mechanical thrombectomy with stent retrievers for emergent large vessel occlusion has been proved by randomized trials. Mechanical thrombectomy is increasingly being adopted in Japan since stent retrievers were first approved in 2014. An urgent clinical task is to offer structured systems of care to provide this treatment in a timely fashion to all patients with emergent large vessel occlusion. Treatment with flow-diverting stents is currently a preferred treatment option worldwide for large and giant unruptured aneurysms...
May 1, 2017: Neurologia Medico-chirurgica
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