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Pipeline stent

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https://www.readbyqxmd.com/read/28047297/tu-fg-209-05-demonstration-of-the-line-focus-principle-using-the-generalized-measured-relative-object-detectability-gm-rod-metric
#1
M Russ, A Shankar, A Lau, D Bednarek, S Rudin
PURPOSE: Demonstrate and quantify the augmented resolution due to focalspot size decrease in images acquired on the anode side of the field, for both small and medium (0.3 and 0.6mm) focal-spot sizes using the experimental task-based GM-ROD metric. Theoretical calculations have shown that a medium focal-spot can achieve the resolution of a small focal-spot if acquired with a tilted anode, effectively providing a higher-output small focal-spot. METHODS: The MAF-CMOS (micro-angiographic fluoroscopic complementary-metal-oxide semiconductor) detector (75µm pixel pitch) imaged two copper wire segments of different diameter and a pipeline stent at the central axis and on the anode side of the beam, achieved by tilting the x-ray C-arm (Toshiba Infinix) to 6° and realigning the detector with the perpendicular ray to correct for x-ray obliquity...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/27957634/optimal-pediatric-dosing-of-anti-platelet-agents-for-pipeline-stent-embolization-a-case-report-and-review-of-the-literature
#2
Mary In-Ping Huang Cobb, Ali R Zomorodi, Erik F Hauck, Tony P Smith, L Fernando Gonzalez
BACKGROUND: Various strategies are emerging for dosing antiplatelet therapies in preparation for pipeline stent embolization in adults. Hyper-response is associated with hemorrhagic complications. Hypo-response is associated with thromboembolic events. Dosing of antiplatelet agents is highly variable, with little consensus among experts for adults-and even more so for children. To date, pipeline stents have been deployed in 11 pediatric patients, ages 4-15. A variety of clopidogrel and aspirin dosing regimens have been used, with response tested in only three patients, who were all therapeutic...
December 12, 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/27956518/use-of-self-expanding-stents-for-better-intracranial-flow-diverter-wall-apposition
#3
Anna Luisa Kühn, Ajay K Wakhloo, Matthew J Gounis, Peter Kan, Katyucia de Macedo Rodrigues, J Diego Lozano, Miklos G Marosfoi, Mary Perras, Christopher Brooks, Mary C Howk, David E Rex, Francesco Massari, Ajit S Puri
BACKGROUND: Flow diverter (FD) malapposition is associated with stroke-related complications. We document the use of self-expanding nitinol stents to remove/reduce the ledge of a FD deployed for aneurysm treatment. METHODS: We identified five patients who were treated with the Pipeline embolization device (PED) in conjunction with a Neuroform EZ stent for inadequate wall apposition of the ends of the FD at our institution between May 2014 and July 2015. Among other parameters, angiographic results, cone-beam computed tomography assessment of wall apposition and patient clinical outcome were evaluated...
December 12, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27904445/endovascular-treatment-of-unruptured-aneurysms-of-cavernous-and-ophthalmic-segment-of-internal-carotid-artery-with-flow-diverter-device-pipeline
#4
Marko Jevsek, Charbel Mounayer, Tomaz Seruga
BACKGROUND: Intra-arterial treatment of aneurysms by redirecting blood flow is a newer method. The redirection is based on a significantly more densely braided wire stent. The stent wall keeps the blood in the lumen of the stent and slows down the turbulent flow in the aneurysms. Stagnation of blood in the aneurysm sac leads to the formation of thrombus and subsequent exclusion of the aneurysm from the circulation. The aim of the study was to evaluate flow diverter device Pipeline for broad neck and giant aneurysm treatment...
December 1, 2016: Radiology and Oncology
https://www.readbyqxmd.com/read/27799376/thrombogenicity-of-flow-diverters-in-an-ex-vivo-shunt-model-effect-of-phosphorylcholine-surface-modification
#5
Matthew W Hagen, Gaurav Girdhar, John Wainwright, Monica T Hinds
BACKGROUND: Flow diverters offer a promising treatment for cerebral aneurysms. However, they have associated thromboembolic risks, mandating chronic dual antiplatelet therapy (DAPT). Shield Technology is a phosphorylcholine surface modification of the Pipeline Embolization Device (PED) flow diverter, which has shown significant reductions in material thrombogenicity in vitro. OBJECTIVE: To compare the thrombogenicity of PED, PED with Shield Technology (PED+Shield), and the Flow-Redirection Endoluminal Device (FRED)-with and without single antiplatelet therapy and DAPT-under physiological flow...
October 31, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27798327/effects-on-vessel-measurement-accuracy-and-subsequent-occlusion-after-calcium-channel-blocker-infusion-during-treatment-of-cerebral-aneurysms-with-the-pipeline-embolization-device
#6
M D Alexander, A D Nicholson, R J Darflinger, F Settecase, D L Cooke, C F Dowd, M R Amans, R T Higashida, S W Hetts, V V Halbach
INTRODUCTION/PURPOSE: To achieve aneurysm occlusion, flow diverters (FDs) must be accurately sized to maximize coverage over the neck and induce thrombosis. Catheterization for diagnostic angiography can cause vasospasm that may affect vessel measurements. This study evaluates impacts of intra-arterial infusion of a calcium channel blocker (CCB) on angiographic measurements in patients treated with FDs to determine effects on final diameter of the FD and subsequent occlusion. MATERIALS AND METHODS: Pre-treatment measurements were recorded for diameter of the distal and proximal landing zones and maximum and minimum diameters between these segments...
October 26, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27780870/virtual-flow-diverter-treatment-planning-the-effect-of-device-placement-on-bifurcation-aneurysm-haemodynamics
#7
Thomas Peach, Katerina Spranger, Yiannis Ventikos
Bifurcation aneurysms account for a large fraction of cerebral aneurysms and often present morphologies that render traditional endovascular treatments, such as coiling, challenging and problematic. Flow-diverter stents offer a potentially elegant treatment option for such aneurysms, but clinical use of these devices remains controversial. Specifically, the deployment of a flow-diverter device in a bifurcation entails jailing one or more potentially vital vessels with a low-porosity mesh designed to restrict the flow...
October 25, 2016: Proceedings of the Institution of Mechanical Engineers. Part H, Journal of Engineering in Medicine
https://www.readbyqxmd.com/read/27773393/are-all-stents-equal-need-for-scoring-system-to-evaluate-stents
#8
EDITORIAL
Sundeep Mishra
Currently drug eluting stents (DES) have reached a high degree of sophistication where there seems very little scope of improvement. Even so every year or so there is some advancement in technology and a new version is released, which is claimed to be a new generation (rather than pipeline innovation). It is really important to define what pipeline extension is and what is new innovation (generation)? This classification would not only be useful from regulatory perspective but also determining the true value of a product allowing for a correct pricing, which should ideally be able to mark-up for a real innovation...
September 2016: Indian Heart Journal
https://www.readbyqxmd.com/read/27739944/pipeline-for-uncoilable-or-failed-aneurysms-3-year-follow-up-results
#9
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
https://www.readbyqxmd.com/read/27727400/hemodynamics-of-flow-diverters
#10
Ronak Dholakia, Chandramouli Sadasivan, David Fiorella, Henry Woo, B Barry Lieber
Cerebral aneurysms are pathological focal evaginations of the arterial wall at and around the junctions of the circle of Willis. Their tenuous walls predispose aneurysms to leak or rupture leading to hemorrhagic strokes with high morbidity and mortality rates. The endovascular treatment of cerebral aneurysms currently includes the implantation of fine-mesh stents, called flow diverters, within the parent artery bearing the aneurysm. By mitigating flow velocities within the aneurysmal sac, the devices preferentially induce thrombus formation in the aneurysm within hours to days...
October 11, 2016: Journal of Biomechanical Engineering
https://www.readbyqxmd.com/read/27703060/quantitative-assessment-of-parent-vessel-and-distal-intracranial-hemodynamics-following-pipeline-flow-diversion
#11
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
https://www.readbyqxmd.com/read/27530137/reliability-of-dual-vs-single-volume-reconstruction-of-three-dimensional-digital-subtraction-angiography-for-follow-up-evaluation-of-endovascularly-treated-intracranial-aneurysms
#12
Nimer Adeeb, Christoph J Griessenauer, Apar S Patel, Justin Moore, Parviz Dolati-Ardejani, Raghav Gupta, Rouzbeh Motiei-Langroudi, Christopher S Ogilvy, Ajith J Thomas
INTRODUCTION: Single-volume reconstruction of three-dimensional (3D) digital subtraction angiography (DSA) can be effectively used for aneurysm assessment and planning of endovascular embolization. Unfortunately, post-embolization follow-up angiographic images can be obscured by artifact. The dual-volume reconstruction technique was developed in order to reduce artifact and enhance the visualization of the aneurysm, the parent vessel and side branches, and endovascular devices. The purpose of this study was to compare the reliability of dual- vs single-volume reconstruction of 3D DSA in evaluation of follow-up images after endovascular embolization of intracranial aneurysms...
December 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27471186/rapid-delayed-growth-of-ruptured-supraclinoid-blister-aneurysm-after-successful-flow-diverting-stent-treatment
#13
Stefan Thomas Lang, Zarina Assis, John H Wong, William Morrish, Alim P Mitha
A 62-year-old woman presented with a subarachnoid hemorrhage secondary to a ruptured right supraclinoid internal carotid artery blister aneurysm. She was treated in an emergent fashion with two flow diverting pipeline embolization devices (PED) deployed in a telescoping fashion. CT angiography performed for unrelated reasons at 7 months showed successful treatment of the aneurysm without evidence of residual aneurysm. However, a follow-up digital subtraction angiogram performed at 9 months showed a large aneurysm in a modified position compared with the original aneurysm...
July 28, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27436031/rapid-delayed-growth-of-ruptured-supraclinoid-blister-aneurysm-after-successful-flow-diverting-stent-treatment
#14
Stefan Thomas Lang, Zarina Assis, John H Wong, William Morrish, Alim P Mitha
A 62-year-old woman presented with a subarachnoid hemorrhage secondary to a ruptured right supraclinoid internal carotid artery blister aneurysm. She was treated in an emergent fashion with two flow diverting pipeline embolization devices (PED) deployed in a telescoping fashion. CT angiography performed for unrelated reasons at 7 months showed successful treatment of the aneurysm without evidence of residual aneurysm. However, a follow-up digital subtraction angiogram performed at 9 months showed a large aneurysm in a modified position compared with the original aneurysm...
July 19, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27422683/an-intraoperative-look-at-failure-of-flow-diversion-when-additional-or-alternative-treatments-should-be-considered
#15
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
https://www.readbyqxmd.com/read/27399387/107%C3%A2-evaluating-the-costs-of-follow-up-imaging-protocol-for-endovascularly-treated-unruptured-intracranial-aneurysms-a-multicenter-study
#16
Raghav Gupta, Christoph Johannes Griessenauer, Nimer Adeeb, Justin M Moore, Apar S Patel, Michelle Hui Juan Chua, Ajith J Thomas, Christopher S Ogilvy
INTRODUCTION: Unruptured intracranial aneurysms (UIAs) are being detected at a greater rate. Advances in endovascular technologies have reduced procedural morbidity and mortality compared with traditional surgical clipping in a subset of these cases. Little exists in the literature identifying optimal follow-up imaging protocols for these patients. Given recent data that suggest that percent occlusion of the aneurysm at follow-up correlates strongly with the rate of rerupture, the utilization of imaging modalities that are both specific and sensitive for aneurysm detection, at the appropriate time points, is essential...
August 2016: Neurosurgery
https://www.readbyqxmd.com/read/27395807/endovascular-treatment-of-a-complex-renal-artery-aneurysm-using-coils-and-the-pipeline-embolization-device-in-a-patient-with-a-solitary-kidney
#17
Demetri Adrahtas, Patrick Jasinski, George Koullias, David Fiorella, Apostolos K Tassiopoulos
BACKGROUND: We report a case of endovascular treatment of a complex renal artery aneurysm using the Pipeline Embolization Device, a flow diverting stent which is indicated for the treatment of large and giant cerebral aneurysms. METHODS: A forty-year-old female with medically refractory hypertension and congenital agenesis of the right kidney was found to have a 2.8-cm left superior renal artery branch aneurysm. The patient was treated successfully using the Pipeline Embolization Device (Medtronic, Irvine, CA) with coil embolization of the aneurysm and of one outflow vessel...
October 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27390319/wall-apposition-is-a-key-factor-for-aneurysm-occlusion-after-flow-diversion-a-histologic-evaluation-in-41-rabbits
#18
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
https://www.readbyqxmd.com/read/27370946/flow-diverter-effect-of-lvis-stent-on-cerebral-aneurysm-hemodynamics-a-comparison-with-enterprise-stents-and-the-pipeline-device
#19
Chao Wang, Zhongbin Tian, Jian Liu, Linkai Jing, Nikhil Paliwal, Shengzhang Wang, Ying Zhang, Jianping Xiang, Adnan H Siddiqui, Hui Meng, Xinjian Yang
BACKGROUND: The aim of this study was to quantify the effect of the new Low-profile Visualized Intraluminal Support (LVIS®D) device and the difference of fluid diverting effect compared with the Pipeline device and the Enterprise stent using computational fluid dynamics (CFD). METHODS: In this research, we simulated three aneurysms constructed from 3D digital subtraction angiography (DSA). The Enterprise, LVIS and the Pipeline device were virtually conformed to fit into the vessel lumen and placed across the aneurysm orifice...
July 2, 2016: Journal of Translational Medicine
https://www.readbyqxmd.com/read/27365325/virtual-versus-real-implantation-of-flow-diverters-clinical-potential-and-influence-of-vascular-geometry
#20
P Bouillot, O Brina, H Yilmaz, M Farhat, G Erceg, K-O Lovblad, M I Vargas, Z Kulcsar, V M Pereira
BACKGROUND AND PURPOSE: Intracranial stents have become extremely important in the endovascular management of complex intracranial aneurysms. Sizing and landing zone predictions are still very challenging steps in the procedure. Virtual stent deployment may help therapeutic planning, device choice, and hemodynamic simulations. We aimed to assess the predictability of our recently developed virtual deployment model by comparing in vivo and virtual stents implanted in a consecutive series of patients presenting with intracranial aneurysms...
June 30, 2016: AJNR. American Journal of Neuroradiology
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