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Flow-diverter

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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
#1
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
#2
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
#3
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...
December 7, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/29209136/interaction-between-flow-diverter-and-parent-artery-of-intracranial-aneurysm-a-computational-study
#4
Wenyu Fu, Qixiao Xia
To evaluate the influence of deployment strategy on the mechanical interaction between braided stent and parent artery of intracranial aneurysm (the elasticity of the arterial wall is considered), finite-element analyses are carried out by referring to computational models of flow-diverter device and arterial wall. Two implantation strategies are used to virtually implant the braided stent into the ideal intracranial aneurysm model. One is the noncompacted implantation method, and the other is the implantation method of using push-pull technique...
2017: Applied Bionics and Biomechanics
https://www.readbyqxmd.com/read/29204036/flow-diverting-stent-assisted-coil-embolization-of-a-ruptured-internal-carotid-artery-blister-aneurysm-with-the-pipeline-flex-embolization-device
#5
Dale Ding, Robert M Starke, Ayton Hope, Stefan Brew
Internal carotid artery (ICA) blister aneurysms are rare and challenging to successfully treat, using contemporary surgical or endovascular approaches, without partial or complete compromise of the parent vessel. We describe the use of a resheathable flow diverter, the Pipeline Flex Embolization Device (PFED) to perform stent-assisted coiling of a ruptured supraclinoid ICA blister aneurysm in a 56-year-old female who presented with a high-grade subarachnoid hemorrhage (SAH). The first PFED was deployed across the aneurysm neck to jail a microcatheter within the aneurysm dome, and then, two small coils were delivered into the aneurysm...
October 2017: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/29201581/contrast-enhancement-of-aneurysm-sac-post-pipeline-treatment-interpreted-as-recanalization
#6
Annie J Tsay, Sara Langan, Scott Simon
Multiple imaging modalities are available to evaluate aneurysms post-flow diverter (FD) placement. Though digital subtraction angiography (DSA) is the gold standard imaging modality post-FD placement, it is not perfect, and neither are other techniques, including contrast-enhanced magnetic resonance angiography (CE-MRA) and magnetic resonance imaging (MRI). We present a case of a 73-year-old woman with a right internal carotid artery (ICA) aneurysm treated with a pipeline embolization device (PED). Initial follow-up post-PED placement by three-dimensional time-of-flight (3D-TOF) MRA demonstrated aneurysm occlusion, which was confirmed by computed tomography angiography (CTA) and CE-MRA in subsequent follow-up appointments...
September 29, 2017: Curēus
https://www.readbyqxmd.com/read/29197163/model-for-pressure-drop-and-flow-deflection-in-the-numerical-simulation-of-stents-in-aneurysms
#7
S Li, J Latt, B Chopard
The numerical simulation of flow diverters like stents contributes to the development and improvement of endovascular stenting procedures, leading ultimately to an improved treatment of intracranial aneurysms. Due to the scale difference between the struts of flow diverters and the full artery, it is common to avoid fully resolved simulations at the level of the stent porosity. Instead, the effect of stents on the flow is represented by a heuristic continuum model. However, the commonly used porous media models describe the properties of flow diverters only partially, because they do not explicitly account for the deflection of the flow direction by the stent...
December 1, 2017: International Journal for Numerical Methods in Biomedical Engineering
https://www.readbyqxmd.com/read/29174523/transvenous-coil-embolization-for-the-treatment-of-carotid-cavernous-fistula-after-pipeline-placement-a-case-report
#8
Ryuta Nakae, Masaya Nagaishi, Issei Takano, Yoshihiro Tanaka, Akio Hyodo, Kensuke Suzuki
The Pipeline embolization device (PED), a type of flow diverter, has become an appealing alternative treatment option for large or giant and wide-necked intracranial aneurysms. Carotid cavernous fistula (CCF) resulting from delayed aneurysmal rupture is a rare complication of PED placement with unknown pathophysiology. Here, we describe a case of CCF resulting from aneurysmal rupture following PED placement, and present the details of treatment by transvenous coil embolization. An 81-year-old woman was referred to our hospital for treatment of an 18...
November 22, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29170270/the-role-of-hemodynamics-in-intracranial-bifurcation-arteries-after-aneurysm-treatment-with-flow-diverter-stents
#9
A P Narata, F S de Moura, I Larrabide, C M Perrault, F Patat, R Bibi, S Velasco, A-C Januel, C Cognard, R Chapot, A Bouakaz, C A Sennoga, A Marzo
BACKGROUND AND PURPOSE: Treatment of intracranial bifurcation aneurysms with flow-diverter stents can lead to caliber changes of the distal vessels in a subacute phase. This study aims to evaluate whether local anatomy and flow disruption induced by flow-diverter stents are associated with vessel caliber changes in intracranial bifurcations. MATERIALS AND METHODS: Radiologic images and demographic data were acquired for 25 patients with bifurcation aneurysms treated with flow-diverter stents...
November 23, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/29163748/transradial-approach-for-deployment-of-a-flow-diverter-for-an-intracranial-aneurysm-in-a-patient-with-a-type-3-aortic-arch
#10
Geoffrey W Peitz, Bhavani Kura, Jeremiah N Johnson, Ramesh Grandhi
Background: Flow diversion with the Pipeline embolization device (PED) is an effective treatment for giant and wide-neck intracranial aneurysms, but the standard transfemoral approach may not be feasible in patients with Type-3 aortic arches. Case Report: An 84-year-old woman presented with a right internal carotid artery (ICA) giant aneurysm and a Type-3 aortic arch, necessitating a transradial approach for access to the right common carotid artery. A triaxial catheter system made for a stable platform for the deployment of two telescoping PEDs to treat the patient's right ICA giant aneurysm...
October 2017: Journal of Vascular and Interventional Neurology
https://www.readbyqxmd.com/read/29140523/sequential-coiling-assisted-deployment-of-flow-diverter-for-treatment-of-fusiform-middle-cerebral-artery-aneurysms
#11
Abdulrahman Y Alturki, Philip G R Schmalz, Christopher S Ogilvy, Ajith J Thomas
BACKGROUND AND IMPORTANCE: Fusiform intracranial aneurysms remain challenging lesions to treat. These aneurysms have historically required bypass procedures or clip remodeling constructs for cure. Recently, endovascular specialists have reported experience with flow diversion for complex fusiform aneurysms of the vertebrobasilar system, with mixed results. Vascular anatomy for anterior circulation fusiform aneurysms may make these lesions more amenable to flow diversion and embolization procedures; however, published experience with these techniques is lacking...
November 11, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29127197/communicating-malapposition-of-flow-diverters-assessed-with-optical-coherence-tomography-correlates-with-delayed-aneurysm-occlusion
#12
Robert M King, Olivia W Brooks, Erin T Langan, Jildaz Caroff, Frédéric Clarençon, Takamitsu Tamura, John Michael Wainwright, Matthew J Gounis, Miklós Marosfői, Ajit S Puri
BACKGROUND: Optical coherence tomography (OCT) is a high resolution intravascular imaging method that allows visualization of flow diverter struts and the vessel wall. In this study, malapposition of the flow diverter that continues into the neck of the aneurysm, named communicating malapposition (CM), was investigated as a potential factor for delayed aneurysm healing. METHODS: 40 New Zealand White rabbits underwent elastase induced aneurysm creation, and were subsequently assigned to one of four treatment groups based on flow diverter type and administration of antiplatelet therapy...
November 10, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/29125410/hemorrhage-associated-with-ventriculoperitoneal-shunt-placement-in-aneurysmal-subarachnoid-hemorrhage-patients-on-a-regimen-of-dual-antiplatelet-therapy-a-retrospective-analysis
#13
Joseph S Hudson, Yasunori Nagahama, Daichi Nakagawa, Robert M Starke, Brian J Dlouhy, James C Torner, Pascal Jabbour, Lauren Allan, Colin P Derdeyn, Jeremy D W Greenlee, David Hasan
OBJECTIVE Intracranial stenting and flow diversion require the use of dual antiplatelet therapy (DAPT) to prevent in-stent thrombosis. DAPT may significantly increase the risk of hemorrhagic complications in patients who require subsequent surgical interventions. In this study, the authors sought to investigate whether DAPT is a risk factor for hemorrhagic complications associated with ventriculoperitoneal (VP) shunt placement in patients with aneurysmal subarachnoid hemorrhage (aSAH). Moreover, the authors sought to compare VP shunt complication rates with respect to the shunt's location from the initial external ventricular drain (EVD) site...
November 10, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29118794/safety-and-efficacy-of-low-profile-self-expandable-stents-for-treatment-of-intracranial-aneurysms-initial-and-midterm-results-a-systematic-review-and-meta-analysis
#14
Su-Yeon Park, Jae-Sang Oh, Hyuk-Jin Oh, Seok-Mann Yoon, Hack-Gun Bae
Low-profile stents seem to be associated with a higher incidence of thromboembolic events compared with preexisting stents. We conducted a systematic review of 11 eligible reports and a meta-analysis of 7 reports with respect to the clinical efficacy and safety of low-profile stents. There were 217 intracranial aneurysms reported; 22% were ruptured aneurysms. In all, 72% were treated using single stenting, 19% were treated using overlapping stenting, and 6% were treated using balloon angioplasty followed by stenting; 3% were used to assess the flow diverter effect in a dissecting aneurysm or were treated using unexpected subtotal coil packing...
October 2017: Interventional Neurology
https://www.readbyqxmd.com/read/29118792/anchoring-pipeline-flow-diverter-construct-in-the-treatment-of-traumatic-distal-cervical-carotid-artery-injury
#15
Krishna Amuluru, Fawaz Al-Mufti, William Roth, Charles J Prestigiacomo, Chirag D Gandhi
Background: Traumatic extracranial internal carotid artery (ICA) dissections are uncommon and can be difficult to treat. Thinning of adventitia and dilatation may occur following arterial dissection, thus resulting in a fusiform pseudoaneurysm, which can subsequently cause bleeding, expanding, or pulsatile hematoma. Currently, medical management with anticoagulation remains the first line of treatment and yields good outcomes in 75% of cases with a mortality rate of 3-4%. Endovascular intervention is indicated with failure of medical therapy, progressive enlargement of a traumatic pseudoaneurysm, acute flow-related infarcts due to vessel occlusion, or when anticoagulation is contraindicated due to risk of pseudoaneurysm rupture and hemorrhage...
October 2017: Interventional Neurology
https://www.readbyqxmd.com/read/29099296/dual-antiplatelet-therapy-in-aneurysmal-subarachnoid-hemorrhage-association-with-reduced-risk-of-clinical-vasospasm-and-delayed-cerebral-ischemia
#16
Yasunori Nagahama, Lauren Allan, Daichi Nakagawa, Mario Zanaty, Robert M Starke, Nohra Chalouhi, Pascal Jabbour, Robert D Brown, Colin P Derdeyn, Enrique C Leira, Joseph Broderick, Marc Chimowitz, James C Torner, David Hasan
OBJECTIVE Clinical vasospasm and delayed cerebral ischemia (DCI) are devastating complications of aneurysmal subarachnoid hemorrhage (aSAH). Several theories involving platelet activation have been postulated as potential explanations of the development of clinical vasospasm and DCI. However, the effects of dual antiplatelet therapy (DAPT; aspirin and clopidogrel) on clinical vasospasm and DCI have not been previously investigated. The objective of this study was to evaluate the effects of DAPT on clinical vasospasm and DCI in aSAH patients...
November 3, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29081013/emerging-technologies-in-flow-diverters-and-stents-for-cerebrovascular-diseases
#17
REVIEW
Michael Karsy, Jian Guan, Andrea A Brock, Anubhav Amin, Min S Park
PURPOSE OF REVIEW: Stents and flow diverters have revolutionized the treatment of cerebrovascular disease. Guglielmi coils, flexible microcatheters, and first-generation intracranial stents, such as Neuroform (Stryker Neurovascular) and Enterprise stents (Codman/DePuy-Synthes), have paved the way for the development of the Pipeline Embolization Device (PED) (ev3/Covidien/Medtronic) and other endovascular approaches. RECENT FINDINGS: This review discusses the historical development of flow diverter technologies from the PED to similar devices, such as the Surpass stent (Stryker Neurovascular), the Flow-Redirection Endoluminal Device (FRED; MicroVention, Inc...
October 28, 2017: Current Neurology and Neuroscience Reports
https://www.readbyqxmd.com/read/29065742/balloon-sandwich-technique-for-retrieval-of-fractured-delivery-wire-of-pipeline-stent
#18
Russell Cerejo, Mark Bain, Thomas Masaryk
Delivery wire fracture of flow-diverter stents are rare but have been described. We describe a video case of a successful technique to retrieve such a fractured delivery wire by using a balloon microcatheter and the intermediate catheter when other proven methods may fail.
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/29060624/sensitivity-study-on-modelling-a-flow-diverting-stent-as-a-porous-medium-using-computational-fluid-dynamics
#19
Yujie Li, Mingzi Zhang, David I Verrelli, William Yang, Winston Chong, Makoto Ohta, Yi Qian
The flow-diverting (FD) stent has become a commonly used endovascular device to treat cerebral aneurysms. This discourages blood from entering the aneurysm, thereby reducing the likelihood of aneurysm rupture. Using computational fluid dynamics (CFD) to simulate the aneurysmal haemodynamics after FD treatment could help clinicians predict the stent effectiveness prior to the real procedure in the patient. As an alternative to modelling the stent as a fine wire mesh, modelling the FD stent as a porous medium was established to save computational time, and has also been proved capable of predicting the same haemodynamics as obtained using the real FD stent geometry...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/29054914/flow-diversion-for-the-treatment-of-posterior-inferior-cerebellar-artery-aneurysms-a-novel-classification-and-strategies
#20
Visish M Srinivasan, Michael George Zaki Ghali, Oleg E Reznik, Jacob Cherian, Maxim Mokin, Travis M Dumont, John R Gaughen, Ramesh Grandhi, Ajit S Puri, Stephen R Chen, Jeremiah N Johnson, Peter Kan
BACKGROUND: The pipeline embolization device (PED) is frequently used in the treatment of anterior circulation aneurysms, especially around the carotid siphon, with generally excellent results. However, treatment of posterior inferior cerebellar artery (PICA) aneurysms with flow diversion (FD) has not been specifically described or discussed. While there are reports of treating PICA aneurysms using placement of FD stents in the vertebral artery, there are no reports of treating these lesions by placement of flow diverting stents in the PICA vessel itself...
October 20, 2017: Journal of Neurointerventional Surgery
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