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Liu C, Cai Y, Zang C, Guo K, Hu X. Innovations in intracranial aneurysm treatment: a pilot study on the Choydar flow diverter. Front Neurol 2024; 15:1413681. [PMID: 39026585 PMCID: PMC11254627 DOI: 10.3389/fneur.2024.1413681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024] Open
Abstract
Background The flow diverter (FD) has emerged as a promising treatment option for intracranial aneurysms. Recently, a novel flow-diverting stent, the Choydar FD device, has been developed within our nation. Objective To introduce the newly developed Choydar FD device and present our preliminary clinical experience with its application in the treatment of intracranial aneurysms. Methods A total of 23 patients with 23 unruptured intracranial aneurysms, comprising 20 (87.0%) aneurysms located at the internal carotid artery and 3 (13.0%) at the vertebral artery, were treated with the Choydar FD device between December 2021 and April 2022. Patient baseline data, clinical and angiographic outcomes were collected and analyzed. Results The Choydar FD device was successfully deployed in all patients (100%), with 18 aneurysms (78.3%) additionally treated with coils. One patient experienced an ischemic event with sensory disturbance during the perioperative period. At the 1-year follow-up, all patients demonstrated good clinical outcomes. Of the 23 aneurysms with available angiographic follow-up, 22 (95.7%) achieved complete occlusion, and one patient exhibited in-stent stenosis without neurological deficits. Conclusion The initial clinical results of the Choydar FD device are encouraging, and it appears to be a useful option for treating intracranial aneurysms with acceptable efficacy and safety. Future studies with larger sample sizes and longer follow-up durations are warranted to validate these findings.
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Affiliation(s)
- Changya Liu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yike Cai
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chunguang Zang
- Department of Neurosurgery, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Kaikai Guo
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuebin Hu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Forestier G, Cortese J, Bardet SM, Baudouin M, Janot K, Ratsimbazafy V, Perrin ML, Mounier J, Couquet C, Yardin C, Larragneguy Y, Souhaut F, Chauvet R, Belgacem A, Brischoux S, Magne J, Mounayer C, Terro F, Rouchaud A. Comparison of arterial wall integration of different flow diverters in rabbits: The CICAFLOW study. J Neuroradiol 2023:S0150-9861(23)00235-3. [PMID: 37634579 DOI: 10.1016/j.neurad.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND AND PURPOSE New coated flow diverters (FDs) claim antithrombotic properties and increased arterial wall integration. The aim of this study is to compare in vivo endothelial coverage of coated and uncoated FD in the context of different antiplatelet regimens. METHODS Different FDs (Silk Vista - SV, Pipeline with Shield technology - PED shield and Surpass Evolve - SE) were implanted in the aorta of rabbits, all 3 in each animal with 3 different antiplatelet regimens: no antiplatelet therapy, aspirin alone, or aspirin and ticagrelor. Four weeks after FD implantation, angiography, flat-panel CT, and optical coherence tomography (OCT) were performed before harvesting the aorta. Extensive histopathology analyses were performed including environmental scanning electron microscopy (ESEM), multiphoton microscopy (MPM) and histological staining with qualitative and/or quantitative assessment of device coverage. RESULTS All 23 FDs that were implanted remained patent without hyperplasia. Qualitative stent coverage assessment revealed that there were no statistically significant differences between the FD groups (p = 0.19, p = 0.45, p = 0.40, and p = 0.84 for OCT, ESEM, MPM and histology, respectively). Quantitative neointimal measurement of histological sections also showed similar results in all 3 FD groups (p = 0.70). However, there were significant differences between the 3 groups of antiplatelet regimens (p = 0.07) with a higher rate in the no antiplatelet group (p = 0.05 versus aspirin alone and p = 0.03 versus aspirin and ticagrelor). CONCLUSION Our study provides evidence that FD integration into the arterial wall is similar with coated (PED shield) and uncoated devices (SV, SE), regardless of the antiplatelet regimen. FD integration with specific surface coverage should be promoted. TRIAL REGISTRATION APAFIS #2022011215518538.
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Affiliation(s)
- Géraud Forestier
- University Hospital of Limoges, Neuroradiology Department, 2 avenue Martin Luther-King, Dupuytren, Limoges 87042, France; University of Limoges, XLIM UMR CNRS, Limoges 7252, France.
| | - Jonathan Cortese
- University of Limoges, XLIM UMR CNRS, Limoges 7252, France; NEURI Brain Vascular Center, Interventional Neuroradiology, Bicêtre University-Hospital, Le Kremlin-Bicêtre, France
| | | | - Maxime Baudouin
- University Hospital of Limoges, Neuroradiology Department, 2 avenue Martin Luther-King, Dupuytren, Limoges 87042, France
| | - Kévin Janot
- University of Limoges, XLIM UMR CNRS, Limoges 7252, France; Regional University Hospital Center Tours, Radiology, Diagnostic and Interventional Neuroradiology, France
| | - Voahirana Ratsimbazafy
- Service de Pharmacie, CHU de Limoges, Limoges, France; Université de Limoges, IFR 145 GEIST, Institut d'Epidémiologie Neurologique et de Neurologie Tropicale, INSERM, UMR, Limoges 1094, France
| | | | - Jérémy Mounier
- University of Limoges, XLIM UMR CNRS, Limoges 7252, France
| | - Claude Couquet
- University of Limoges, XLIM UMR CNRS, Limoges 7252, France
| | - Catherine Yardin
- University of Limoges, XLIM UMR CNRS, Limoges 7252, France; Cytology Department, Dupuytren Limoges University Hospital, France
| | | | - Flavie Souhaut
- University of Limoges, XLIM UMR CNRS, Limoges 7252, France
| | - Romain Chauvet
- University of Limoges, XLIM UMR CNRS, Limoges 7252, France
| | | | - Sonia Brischoux
- Service de pharmacie centrale, CHU Dupuytren, Limoges, France
| | - Julien Magne
- Department of Cardiology and CEBIMER, Limoges University Hospital, France; INSERM U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidémiologie des maladies chroniques en zone tropicale, OmegaHealth, Institut d'Epidémiologie et de Neurologie Tropicale, Limoges, France
| | - Charbel Mounayer
- University Hospital of Limoges, Neuroradiology Department, 2 avenue Martin Luther-King, Dupuytren, Limoges 87042, France; University of Limoges, XLIM UMR CNRS, Limoges 7252, France
| | - Faraj Terro
- University of Limoges, XLIM UMR CNRS, Limoges 7252, France
| | - Aymeric Rouchaud
- University Hospital of Limoges, Neuroradiology Department, 2 avenue Martin Luther-King, Dupuytren, Limoges 87042, France; University of Limoges, XLIM UMR CNRS, Limoges 7252, France
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Wu ZP, Yin JL, Liu SK, Ji S, Liu JY, Wang HL, Zhang YS, Zhang DZ. Enterprise stents versus low-profile visualized intraluminal support stents for stent-assisted coiling of unruptured paraclinoid aneurysms. Technol Health Care 2023; 31:1855-1865. [PMID: 37125582 DOI: 10.3233/thc-220697] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND The microsurgical treatment of paraclinoid aneurysms can be challenging due to the anatomical structures that surround them. OBJECTIVE This study compared the clinical and angiographic outcomes of unruptured paraclinoid aneurysms treated with enterprise (EP) stents and low-profile visualized intraluminal support (LVIS) stents. METHODS A retrospective analysis of the clinical and radiological data from 133 patients with 139 unruptured paraclinoid aneurysms, who received an EP or an LVIS stent between January 2017 and June 2021 at Taizhou People's Hospital, was performed. Immediate postoperative and follow-up angiographic results were analyzed retrospectively using the Raymond-Roy occlusion classification (RROC). Any complications following the procedure and the patients' clinical outcomes were noted. RESULTS Enterprise stents were used for stent-assisted coiling in 64 patients with 68 aneurysms and LVIS stents were used in 69 patients with 71 aneurysms. Both groups exhibited an increase in the proportion of aneurysms meeting the criteria for RROC class I, but the LVIS group demonstrated a higher rate of aneurysms meeting the class I criteria compared with the EP group, both on immediate postoperative angiography (45.1% vs. 11.8%, p< 0.001) and on follow-up angiography (94.9% vs. 80.6%, p= 0.025). Procedure-related complications were experienced by 9.4% of patients in the EP group (one coil prolapse, two parent artery occlusions, and three thromboembolic events), and 8.7% of patients in the LVIS group (three stent-related thrombosis and three thromboembolic events). There were no statistically significant differences between the two groups in relation to perioperative complications (p= 0.746) or favorable clinical outcomes (p= 0.492). CONCLUSION A greater proportion of aneurysms in the LVIS group met the criteria for RROC class I compared with the EP group. There is no significant difference in procedural complications or clinical outcomes between EP and LVIS stents. Although no aneurysm recurrence was observed during the short follow-up period, continued monitoring is required.
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Florez WA, Garcia-Ballestas E, Quiñones-Ossa GA, Janjua T, Konar S, Agrawal A, Moscote-Salazar LR. Silk® Flow Diverter Device for Intracranial Aneurysm Treatment: A Systematic Review and Meta-Analysis. Neurointervention 2021; 16:222-231. [PMID: 34517469 PMCID: PMC8561040 DOI: 10.5469/neuroint.2021.00234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/06/2021] [Indexed: 11/24/2022] Open
Abstract
Flow diverters have become a critical instrument for complex aneurysms treatment. However, limited data are currently available regarding short and long-term outcomes for the Silk flow diverter. The objective of the study is to determine neurological prognosis and mortality rates for the Silk flow diversion device used in intracranial aneurysms. A systematic review with meta-analysis was performed using databases. The following descriptors were used for the search: “SILK”, “Flow Diverter”, “Mortality”, and “Prognosis”. The following data were extracted: mortality, good functional outcome, Glasgow outcome scale, complete or near-complete occlusion rates, rate of retreatment, and complications (thromboembolic and hemorrhagic complications). A total of 14 studies were selected. Among the 14 studies, 13 were retrospective observational cohort studies and 1 was a prospective observational cohort study. The mortality rate was 2.84%. The clinical good outcomes rate was 93.3%. The poor outcome rate was 6.6%. The overall thromboembolic complication rate was 6.06% (95% confidence interval [CI] 0.00–6.37, P=0.12, I2=3.13%). The total hemorrhagic complication rate was 1.62% (95% CI 0.00–5.34, P=0.28, I2=1.56%). The complete aneurysm occlusion rate was 80.4% (95% CI 8.65–9.38, P<0.0001, I2=9.09%). The Silk diverter device has a good safety and efficacy profile for treating intracranial aneurysms with high complete occlusion rates.
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Affiliation(s)
- William A Florez
- Latin American Council of Neurocritical Care (CLaNi), Cartagena, Colombia
| | - Ezequiel Garcia-Ballestas
- Latin American Council of Neurocritical Care (CLaNi), Cartagena, Colombia.,Center of Biomedical Research (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | - Gabriel Alexander Quiñones-Ossa
- Latin American Council of Neurocritical Care (CLaNi), Cartagena, Colombia.,Faculty of Medicine, University El Bosque, Bogota, Colombia
| | - Tariq Janjua
- Department of Neurology and Critical Care Medicine, Regions Hospital, Saint Paul, MN, USA
| | - Subhas Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Madhya Pradesh, India
| | - Luis Rafael Moscote-Salazar
- Latin American Council of Neurocritical Care (CLaNi), Cartagena, Colombia.,RED LATINO, Latin American Organization of Trauma and Neurocritical Care, Bogota, Colombia
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