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https://www.readbyqxmd.com/read/29466903/complications-of-endovascular-treatment-for-intracranial-aneurysms-management-and-prevention
#1
Yon Kwon Ihn, Shang Hun Shin, Seung Kug Baik, In Sup Choi
Endovascular coiling for intracranial aneurysms has become an accepted treatment with good clinical results and provides adequate protection against rebleeding and rupture of aneurysms. However, despite the experience, preparation, or skill of the physician, complications during endovascular treatment still occur. The main complications of endovascular coiling are: procedural aneurysmal perforations by the microcatheter, micro-guidewire, or coil, and thromboembolic events. Such situations are unexpected, complex, and can have devastating consequences...
January 1, 2018: Interventional Neuroradiology
https://www.readbyqxmd.com/read/29444328/influence-of-anatomic-changes-on-the-outcomes-of-carotid-siphon-aneurysms-after-deployment-of-flow-diverter-stents
#2
Eduardo Waihrich, Pierre Clavel, George Mendes, Christina Iosif, Iruena Moraes Kessler, Charbel Mounayer
BACKGROUND: Flow-diverter stent (FDS) deployment can cause morphological and hemodynamic changes in the carotid siphon (CS), influencing the occlusion rate of aneurysms in this location. OBJECTIVE: To evaluate morphological changes to the CS after FDS deployment and their relationship with the rate of occlusion of intracranial aneurysms. METHODS: A cohort of 183 patients with CS aneurysms were treated by deployment of Pipeline® FDS (Medtronic Inc, Dublin, Ireland)...
February 10, 2018: Neurosurgery
https://www.readbyqxmd.com/read/29402066/development-of-new-endovascular-devices-for-aneurysm-treatment
#3
REVIEW
Zhen Yu Jia, Hai Bin Shi, Shigeru Miyachi, Sun Moon Hwang, Jae Jon Sheen, Yun Sun Song, Joong Goo Kim, Deok Hee Lee, Dae Chul Suh
Since the first use of the Guglielmi detachable coil system for cerebral aneurysm embolization in 1990, various endovascular methods have been developed to treat large numbers of aneurysms. The main strategic and technical modifications introduced to date include balloon-assisted coil embolization, stent-assisted coil embolization, flow diverters, and flow disrupters. The development and introduction of such devices have been so persistent and rapid that new devices are being approved worldwide even before the earlier ones become available in some countries...
January 2018: Journal of Stroke
https://www.readbyqxmd.com/read/29380260/long-term-follow-up-in-the-endovascular-treatment-of-intracranial-aneurysms-with-flow-diverter-stents-update-of-a-single-centre-experience
#4
Giuseppe Guzzardi, Carmelo Stanca, Paolo Cerini, Bruno Del Sette, Ignazio Divenuto, Emanuele Malatesta, Alessandro Carriero, Alessandro Stecco
INTRODUCTION: Flow-diverter stents are becoming a useful tool in treating patients with intracranial aneurysms with suitable anatomical feature. Purpose of this study was to evaluate effectiveness and safety of endovascular treatment with flow-diverting stents (FD) in unruptured intracranial aneurysms. METHODS: From May 2009 and May 2014, we treated 49 patients with a total of 58 aneurysms, with FD technique. All patients were treated electively, under general anesthesia and were administered single antiplatelet drug 5 days before the procedure and double antiplatelet therapy for 3 months afterwards...
January 30, 2018: La Radiologia Medica
https://www.readbyqxmd.com/read/29378449/experience-using-pipeline-embolization-device-with-shield-technology-in-a-patient-lacking-a-full-postoperative-dual-antiplatelet-therapy-regimen
#5
Kirill Orlov, Dmitry Kislitsin, Nikolay Strelnikov, Vadim Berestov, Anton Gorbatykh, Timur Shayakhmetov, Pavel Seleznev, Anton Tasenko
Utilization of flow diverting devices is accompanied with dual antiplatelet therapy to reduce the risk of thromboembolic events, even though this increases the risk of hemorrhagic complications. The updated Pipeline Flex embolization device with Shield Technology has been created using a phosphorylcholine coating that reduces thrombogenicity and possibly reduces the need for dual antiplatelet therapy. However, because of the potential risk to patients of utilizing a pipeline embolization device without dual antiplatelet therapy, the pipeline embolization device with Shield Technology has not been tested in human subjects without dual antiplatelet therapy, and its contribution to preventing thromboembolic events is therefore unknown...
January 1, 2018: Interventional Neuroradiology
https://www.readbyqxmd.com/read/29377486/liver-atrophy-and-regeneration-in-non-cirrhotic-portal-vein-thrombosis-effect-of-surgical-shunts
#6
Abdulrhman S Elnaggar, Adam D Griesemer, Stuart Bentley-Hibbert, Robert S Brown, Mercedes Martinez, Steven J Lobritto, Tomoaki Kato, Jean C Emond
OBJECTIVE: To characterize the relationship between portal vein thrombosis (PVT) and hepatic atrophy in the non-cirrhotic patients and the effect of various types of surgical shunts on liver regeneration and splenomegaly. BACKGROUND: Non-cirrhotic patients with PVT suffer from presinusoidal portal hypertension and often hepatic atrophy, a topic that has received little attention. We hypothesized that patients with PVT have decreased liver volumes, and shunts that preserve intrahepatic portal flow enhance liver regeneration...
January 29, 2018: Liver Transplantation
https://www.readbyqxmd.com/read/29372879/microsurgical-clipping-of-ophthalmic-artery-aneurysms-surgical-results-and-visual-outcomes-with-208-aneurysms
#7
Tomoya Kamide, Halima Tabani, Michael M Safaee, Jan-Karl Burkhardt, Michael T Lawton
OBJECTIVE While most paraclinoid aneurysms can be clipped with excellent results, new postoperative visual deficits are a concern. New technology, including flow diverters, has increased the popularity of endovascular therapy. However, endovascular treatment of paraclinoid aneurysms is not without procedural risks, is associated with higher rates of incomplete aneurysm occlusion and recurrence, and may not address optic nerve compression symptoms that surgical debulking can. The increasing endovascular management of paraclinoid aneurysms should be justified by comparisons to surgical benchmarks...
January 26, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29362153/endovascular-treatment-of-intracranial-vertebrobasilar-artery-dissecting-aneurysms-parent-artery-occlusion-versus-flow-diverter
#8
Yi-Bin Fang, Amy Lin, Alex Kostynskyy, Ronit Agid, Mike Tymianski, Ivan Radovanovic, Timo Krings, Vitor Mendes Pereira
PURPOSE: To compare the safety and efficacy of endovascular parent artery occlusion (PAO) and flow diverter (FD) treatment in treating vertebrobasilar dissecting aneurysms (VBDAs). METHODS: A review of a prospective aneurysm database at our institution was performed to identify all consecutive patients with intracranial VBDAs managed with endovascular treatment, which were either PAO or FD. Clinical and imaging findings were compared between the two groups. RESULTS: A total of 25 consecutive patients with 27 VBDAs were included...
February 2018: European Journal of Radiology
https://www.readbyqxmd.com/read/29354333/transvenous-aneurysm-sac-and-rupture-point-coil-embolization-of-direct-carotid-cavernous-fistula-after-pipeline-embolization
#9
Hidenori Oishi, Kosuke Teranishi, Kenji Yatomi, Munetaka Yamamoto, Hajime Arai
A delayed aneurysm rupture after flow diverter therapy is a rare but serious complication. Due to the anatomical specificity, a delayed rupture of a carotid cavernous aneurysm may cause a direct carotid cavernous fistula (dCCF). We present a novel therapeutic approach for treatment of dCCF after flow diverter therapy using the Pipeline embolization device (PED). An 86-year-old woman suffered from dCCF after PED embolization. A microcatheter was advanced through the transvenous approach into the cavernous sinus (CS) and further inserted into the aneurysm sac via the rupture point...
January 2018: NMC Case Report Journal
https://www.readbyqxmd.com/read/29352057/feasibility-complications-morbidity-and-mortality-results-at-6-months-for-aneurysm-treatment-with-the-flow-re-direction-endoluminal-device-report-of-safe-study
#10
Laurent Pierot, Laurent Spelle, Jérôme Berge, Anne-Christine Januel, Denis Herbreteau, Mohamed Aggour, Michel Piotin, Alessandra Biondi, Xavier Barreau, Charbel Mounayer, Chrisanthi Papagiannaki, Jean-Paul Lejeune, Jean-Yves Gauvrit, Vincent Costalat
BACKGROUND AND PURPOSE: Flow diverters are increasingly used for the treatment of intracranial aneurysms. Evaluation of the first devices available for clinical use showed high efficacy of this treatment although safety results were worse compared with coiling or balloon-assisted coiling. The Safety and Efficacy Analysis of FRED Embolic Device in Aneurysm Treatment (SAFE) trial is a single-arm, multicenter, prospective study conducted to precisely analyze the safety and efficacy of the FRED and FRED Jr devices...
January 19, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29351652/early-results-in-flow-diverter-sizing-by-computational-simulation-quantification-of-size-change-and-simulation-error-assessment
#11
Ana Paula Narata, Jordi Blasco, Luis San Roman, Juan Miguel Macho, Hector Fernandez, Raquel Kale Moyano, Renaud Winzenrieth, Ignacio Larrabide
BACKGROUND: Sizing of flow diverters (FDs) stent in the treatment of intracranial aneurysms is a challenging task due to the change of stent length after implantation. OBJECTIVE: To quantify the size change and assess the error in length prediction in 82 simulated FD deployments. METHODS: Eighty-two consecutive patients treated with FDs were retrospectively analyzed. Implanted FD length was measured from angiographic images and compared to the nominal sizes of the implanted device...
January 17, 2018: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29349370/endovascular-treatment-with-flow-diverting-stents-of-symptomatic-superior-mesenteric-artery-after-dissection-aneurysm
#12
Giuseppe Baldino, Paolo Mortola, Marta Cambiaso, Alessandro Valdata, Amerigo Gori
Isolated and spontaneous superior mesenteric artery dissection is a rare cause of acute abdominal pain. Whereas there is widespread consensus on conservative treatment of asymptomatic forms, revascularization would seem indicated in symptomatic complicated cases. A 73-year-old man presented with worsening epigastric pain. A computed tomography scan revealed an isolated and spontaneous superior mesenteric artery dissection with aneurysmal evolution of the false lumen, involving multiple side branches. The postdissection aneurysm was treated by endovascular exclusion with flow-diverting stents...
March 2017: Journal of Vascular Surgery Cases and Innovative Techniques
https://www.readbyqxmd.com/read/29331948/lvis-blue-as-a-low-porosity-stent-and-coil-adjuvant
#13
Matthew J Koch, Christopher J Stapleton, Scott B Raymond, Susan Williams, Thabele M Leslie-Mazwi, James David Rabinov, Aman B Patel
INTRODUCTION: The LVIS Blue is an FDA-approved stent with 28% metallic coverage that is indicated for use in conjunction with coil embolization for the treatment of intracranial aneurysms. Given a porosity similar to approved flow diverters and higher than currently available intracranial stents, we sought to evaluate the effectiveness of this device for the treatment of intracranial aneurysms. METHODS: We performed an observational single-center study to evaluate initial occlusion and occlusion at 6-month follow-up for patients treated with the LVIS Blue in conjunction with coil embolization at our institution using the modified Raymond-Roy classification (mRRC), where mRRC 1 indicates complete embolization, mRRC 2 persistent opacification of the aneurysm neck, mRRC 3a filling of the aneurysm dome within coil interstices, and mRRC 3b filling of the aneurysm dome...
January 13, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29317468/radiation-exposure-and-procedure-and-fluoroscopy-times-in-endovascular-treatment-of-intracranial-aneurysms-a-methodological-comparison
#14
Nicholas K Cheung, Michelle Boutchard, Michael W Carr, Jens J Froelich
BACKGROUND: Limited data are available for radiation exposure, and procedure and fluoroscopy times in neuroendovascular treatment (NET) strategies. OBJECTIVE: This study establishes and compares related parameters between coil embolization (COIL), balloon assisted coil embolization (BAC), stent assisted coil embolization (SAC), and flow diverting technology (FDT) in NET of intracranial aneurysms. MATERIALS AND METHODS: Between 2010 and 2017, 249 consecutive intracranial aneurysms underwent NET at a single center, all performed by the same operator...
January 9, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29304062/phase-contrast-mri-versus-numerical-simulation-to-quantify-hemodynamical-changes-in-cerebral-aneurysms-after-flow-diverter-treatment
#15
Sergey Sindeev, Philipp Georg Arnold, Sergey Frolov, Sascha Prothmann, Dieter Liepsch, Andrea Balasso, Philipp Berg, Stephan Kaczmarz, Jan Stefan Kirschke
Cerebral aneurysms are a major risk factor for intracranial bleeding with devastating consequences for the patient. One recently established treatment is the implantation of flow-diverters (FD). Methods to predict their treatment success before or directly after implantation are not well investigated yet. The aim of this work was to quantitatively study hemodynamic parameters in patient-specific models of treated cerebral aneurysms and its correlation with the clinical outcome. Hemodynamics were evaluated using both computational fluid dynamics (CFD) and phase contrast (PC) MRI...
2018: PloS One
https://www.readbyqxmd.com/read/29298859/fast-acquisition-cone-beam-computed-tomography-initial-experience-with-a-10-s-protocol
#16
Visish M Srinivasan, Gouthami Chintalapani, Kevin Matthew Camstra, Sabih T Effendi, Jacob Cherian, Jeremiah N Johnson, Stephen R Chen, Peter Kan
BACKGROUND: Cone-beam computed tomography (CBCT) facilitates the acquisition of cross-sectional imaging in angiography suites using a rotational C-arm and digital flat panel detectors. The applications are numerous, including evaluation of implanted devices and localization of cerebrovascular lesions. We present and validate the clinical utility of an alternative fast CBCT acquisition protocol in the context of neurovascular device imaging. METHODS: Contrast-enhanced (CE)-CBCT images were acquired using a new 10 s protocol in a phantom head model, swine model, and in patients...
January 3, 2018: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29277587/the-use-of-flow-diverter-in-ruptured-dissecting-intracranial-aneurysms-of-the-posterior-circulation
#17
Volker Maus, Anastasios Mpotsaris, Franziska Dorn, Markus Möhlenbruch, Jan Borggrefe, Pantelis Stavrinou, Nuran Abdullayev, Utako Birgit Barnikol, Thomas Liebig, Christoph Kabbasch
OBJECTIVE: Acute dissecting aneurysms of the posterior circulation are a rare cause of SAH. Established endovascular treatment options include PAO and stent-assisted coiling, but appear to be associated with an increased risk of ischemic stroke. Vessel reconstruction with flow-diverters is an alternative treatment option, however, its safety and efficacy in the acute stage remains unclear. METHODS: Multi-centric retrospective analysis of 15 consecutive acutely ruptured dissecting posterior circulation aneurysms treated with flow-diverters...
December 22, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29239687/open-cell-stent-and-use-of-cone-beam-ct-enables-a-safe-and-effective-coil-embolization-of-true-ophthalmic-artery-and-anterior-choroidal-artery-aneurysms-with-preservation-of-parent-vessel-clinical-and-angiographic-results
#18
Samuel Y Hou, Anna Luisa Kühn, Ajit S Puri, Ajay K Wakhloo
Background Treatment of true ophthalmic artery (OA) or anterior choroidal artery (AChA) aneurysms with preservation of the parent vessel may be challenging. Flow diverters have limitations when dealing with branch vessels arising from the aneurysm sac. Visual loss or AChA territory infarcts have been reported both for surgical and endovascular treatment. Methods We evaluated the safety and efficacy of an open-cell design, laser-cut, self-expanding Nitinol stent, and use of cone-beam computed tomography (CBCT) for stent-assisted coil embolization...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/29239685/in%C3%A2-vitro-angiographic-comparison-of-the-flow-diversion-performance-of-five-neurovascular-stents
#19
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
https://www.readbyqxmd.com/read/29214402/decision-making-and-neurosurgeons-agreement-in-the-management-of-aneurysmal-subarachnoid-haemorrhage-based-on-computed-tomography-angiography
#20
Nicolai Maldaner, Jan-Karl Burkhardt, Martin Nikolaus Stienen, Johannes Goldberg, David Bervini, Philippe Bijlenga, Davide Croci, Daniel Zumofen, Donato D'Alonzo, Serge Marbacher, Rodolfo Maduri, Roy Thomas Daniel, Carlo Serra, Giuseppe Esposito, Marian C Neidert, Oliver Bozinov, Luca Regli
BACKGROUND: To determine the neurosurgeon's agreement in aneurysmal subarachnoid haemorrhage (aSAH) management with special emphasis on the rater's level of experience. A secondary aim was to analyse potential aneurysm variables associated with the therapeutic recommendation. METHOD: Basic clinical information and admission computed tomography angiography (CTA) images of 30 consecutive aSAH patients were provided. Twelve neurosurgeons independently evaluated aneurysm characteristics and gave recommendations regarding the emergency management and aneurysm occlusion therapy...
February 2018: Acta Neurochirurgica
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