1
|
Piñana C, Remollo S, Zamarro J, Werner M, Espinosa de Rueda M, Vega P, Hernandez D, Murias E, Rivera E, Olier J, San Roman L, Páez-Carpio A, Requena M, Aixut S, de Dios Lascuevas M, Moreu M, Rosati S, Gramegna LL, Castaño C, Tomasello A. Derivo embolization device for intracranial aneurysms: a Spanish multicenter retrospective study. J Neurointerv Surg 2023; 15:871-875. [PMID: 35999049 DOI: 10.1136/jnis-2022-019220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/15/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Flow diverters have emerged in recent years as a safe and effective treatment for intracranial aneurysms, with expanding indications. The Derivo embolization device (DED) is a second-generation flow diverter with a surface finish that may reduce thrombogenicity. We report our multicenter experience evaluating its safety and efficacy. METHODS We retrospectively analyzed all patients treated with the DED in eight centers in Spain between 2016 and 2020. Demographics, clinical data, procedural complications, morbidity and aneurysm occlusion rates were collected. RESULTS A total of 209 patients with 250 aneurysms were treated (77.5% women). The majority of aneurysms were located in the internal carotid artery (86.8%) and most (69.2%) were small (<10 mm) with a median maximum diameter of 5.85 mm and median neck size of 4 mm. DED deployment was successful in all cases, despite two malfunctioning devices (1%). Major complications occurred in nine patients (4.3%), while mild neurologic clinical events were registered in 23 (11%); four patients died (1.9%). A total of 194 aneurysms had an angiographic follow-up at 6 months and showed complete aneurysm occlusion in 75% of cases. Twelve-month follow-up was available for 112 of the treated aneurysms, with a total occlusion rate of 83%. CONCLUSION The DED is a second-generation surface-modified flow diverter that presents an option for treatment of intracranial aneurysms with comparable safety and efficacy to other available flow diverter devices. Nonetheless, risks are not negligible, and must be balanced against the natural history risk of cerebral aneurysms, considering the tendency to widen indications for treatment of smaller and less complex lesions in day-to-day use.
Collapse
Affiliation(s)
- Carlos Piñana
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sebastian Remollo
- Interventional Neuroradiology Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Joaquín Zamarro
- Interventional Neuroradiology, Radiology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Mariano Werner
- Interventional Neuroradiology, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Mariano Espinosa de Rueda
- Interventional Neuroradiology, Radiology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Pedro Vega
- Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - David Hernandez
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Eduardo Murias
- Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Eila Rivera
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jorge Olier
- Interventional Neuroradiology, Hospital de Navarra, Pamplona, Spain
| | - Luis San Roman
- Interventional Neuroradiology, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alfredo Páez-Carpio
- Interventional Neuroradiology, Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Manuel Requena
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sonia Aixut
- Neuroradiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | - Marta de Dios Lascuevas
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Moreu
- Interventional Neuroradiology Unit, Department of Radiology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Santiago Rosati
- Interventional Neuroradiology Unit, Department of Radiology, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Laura Ludovica Gramegna
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Bologna, Italy
- Instituto delle Scienze Neurologiche di Bologna (IRCCS), Bologna, Italy
| | - Carlos Castaño
- Interventional Neuroradiology Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Alejandro Tomasello
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
| |
Collapse
|
2
|
Wu Y, Yu J, Zhang T, Deng JP, Zhao Z. Endovascular treatment of distal internal carotid artery aneurysms and vertebral artery dissecting aneurysms with the Willis covered stent: A single-center, retrospective study. Interv Neuroradiol 2023; 29:63-78. [PMID: 35581717 PMCID: PMC9893231 DOI: 10.1177/15910199211070900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/09/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND More data is needed on the short- and medium-term efficacy and safety of the Willis covered stent in treating distal internal carotid artery (DICA) aneurysms and vertebral artery dissecting aneurysms (VADAs). METHODS Records of all 42 patients with DICA aneurysms or VADAs treated with the Willis covered stents at our institute between July 2014 and January 2019 were retrospectively examined. The patients' demographic information, symptoms, diagnosis, treatment procedure, immediate and follow-up clinical and angiographic outcomes were extracted. RESULTS 46 Willis covered stents were successfully implanted in all of the 42 patients (total 43 aneurysms). Immediate complete aneurysm occlusion was achieved in 37 patients (38 aneurysms) (88.4%), and endoleak occurred to 5 patients (5 aneurysms) (11.6%). 2 patients died post-operatively from procedure-related complications, another one died from reasons unrelated to the procedure. Among the remaining 39 patients, non-lethal complications occurred in 4 patients including ptosis and diplopia of the right eye, intra-operative hemorrhage and carotid cavernous fistulas (CCF). Angiographic and clinical follow-ups (means ± standard deviation: 8.8 ± 5.3 months) were done for 32 patients (33 aneurysms). Complete occlusion was maintained in all of the 33 aneurysms. 2 of the 32 patients had significant though asymptomatic parent artery (PA) occlusion. No ischemic or hemorrhagic event occurred during the follow-up period. The modified Rankin Scale (mRS) score was 0 in 31 patients and 1 in the remaining 1 patient. CONCLUSIONS The Willis covered stent could be a safe and effective treatment for complex DICA aneurysms with excellent durability. In addition, the Willis covered stent treated all of the 3 cases of VADAs in the study with complete success without any complications, however, as the number of the VADA cases was small, more cases are needed to further confirm the efficacy and safety of the Willis covered stent in treating VADAs.
Collapse
Affiliation(s)
| | | | - Tao Zhang
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University (The Fourth Military Medical
University), Xi’an, China
| | - Jian-Ping Deng
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University (The Fourth Military Medical
University), Xi’an, China
| | - Zhenwei Zhao
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University (The Fourth Military Medical
University), Xi’an, China
| |
Collapse
|
3
|
Thormann M, Sillis N, Thoma T, Altenbernd J, Berger B, Cioltan A, Loehr C, Bohner G, Siebert E, Nordmeyer H, Mpotsaris A, Behme D. The DERIVO®2 Embolization Device in the treatment of ruptured and unruptured intracranial aneurysms: A multicenter analysis. Interv Neuroradiol 2022:15910199221142643. [PMID: 36567499 DOI: 10.1177/15910199221142643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Flow diverters are an increasingly used treatment option for intracranial aneurysms. A recent addition to the European market is the DERIVO®2 Embolization Device (DED2), promising improved radiopacity. We aimed to assess the safety and efficacy of the DED2 regarding angiographic and clinical outcomes in ruptured and unruptured cerebral aneurysms. METHODS We performed a multicenter trial at six interventional centers. Data were prospectively collected and all patients treated with the DED2 were included. The primary endpoint was angiographic aneurysm occlusion at 6 months as assessed by the O'Kelly Marotta (OKM) grading scale with a favorable outcome definition of OKM C + D. Clinical outcome was evaluated according to the modified Rankin scale (mRS). RESULTS Between August 2020 and July 2021, 37 patients were treated with the DED2 and were included in our analysis. Five patients presented with ruptured aneurysms. Median age was 60 years, 27 patients were female, and 10 male. Median mRS was 0 (range 0-4). Mean aneurysm size was 8.9 ± 7.1 mm with a mean neck size of 6.5 ± 6.1. The DED2 fully opened at deployment in all cases. Clinical follow-up was available for 30 patients (81%). Twenty-five (83%) had an mRS of 0 or 1. Three patients with ruptured aneurysms died during the follow-up period. No treatment-related major morbidity was observed. Follow-up imaging was available in 27 (90%) patients, with 23 patients (85%) showing satisfactory aneurysm occlusion OKM grade C-D. CONCLUSION In this small cohort, the DED2 provided safe and effective treatment of ruptured and unruptured intracranial aneurysms.
Collapse
Affiliation(s)
- Maximilian Thormann
- University Clinic for Neuroradiology, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Nele Sillis
- University Clinic for Neuroradiology, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Taina Thoma
- University Clinic for Neuroradiology, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Jens Altenbernd
- Department of Radiology and Neuroradiology, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Björn Berger
- Department of Neuroradiology, Evangelisches Klinikum Bethel, Universitätsklinikum OWL, Bielefeld, Germany
| | - Andrea Cioltan
- Department of Radiology and Neuroradiology, 39546Klinikum Vest GmbH Behandlungszentrum Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
| | - Christian Loehr
- Department of Radiology and Neuroradiology, Klinikum Vest Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
| | - Georg Bohner
- Institute of Neuroradiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eberhard Siebert
- Institute of Neuroradiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hannes Nordmeyer
- Department of Interventional Neuroradiology Radprax, 39655St Lukas Klinik, Solingen, Germany
- School of Medicine, Department of Health, 12263Witten/Herdecke University, Witten, Germany
| | - Anastasios Mpotsaris
- Department for Diagnostic and Interventional Radiology and Neuroradiology, Munich Clinic Harlaching, Munich, Germany
| | - Daniel Behme
- University Clinic for Neuroradiology, 39067University Hospital Magdeburg, Magdeburg, Germany
- Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| |
Collapse
|
4
|
Alkhars H, Haq W, Al-Tayeb A, Sigounas D. Feasibility and Safety of Transradial Aneurysm Embolization: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 165:e110-e127. [PMID: 35654332 DOI: 10.1016/j.wneu.2022.05.112] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Use of the transradial access (TRA) approach for neuroendovascular procedures has been increasing in recent years. Our aim is to assess the feasibility, success rate, and complications associated with TRA for intracranial aneurysm embolization. METHODS PubMed, Scopus, and Embase were systematically searched for studies using TRA for intracranial aneurysm embolization. Random-effects models were used to obtain pooled rates of procedural success and complications. RESULTS Twenty-four studies comprising 1283 (85.9%) TRA and 122 (8.2%) distal TRA aneurysm embolization procedures were included. The pooled success rate of the 18 studies in the meta-analysis was 93.5% (95% confidence interval [CI], 91.1%-95.8%). The pooled thromboembolic complication rate was 0.5% (95% CI, 0.1%-0.9%), the hemorrhagic complication rate was 0.5% (95% CI, 0.1%-0.9%), and the access site complication rate was 0.8% (95% CI, 0.3%-1.3%). One study (4.3%) used exclusively a 7-French guide catheter, and most used a 6-French guide catheter (22 of 23 studies, 95.7%), which was further incorporated as part of a triaxial configuration through a sheathless 8-French system in 4 studies (17.4%), 7-French guide catheter in 2 studies (8.7%), and 8-French sheath in 1 study (4.3%). The embolization techniques used were flow diverter placement in 451 cases (39.1%), coiling in 376 (32.6%), stent-assisted coiling in 127 (11.0%), balloon-assisted coiling in 104 (9.0%), Woven EndoBridge system in 50 (4.3%), and flow diverter placement plus coiling in 42 (3.6%). CONCLUSIONS Treating intracranial aneurysms using various embolization techniques through TRA is feasible and associated with low access site and intraoperative complications.
Collapse
Affiliation(s)
- Hussain Alkhars
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Waqas Haq
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ahmed Al-Tayeb
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Dimitri Sigounas
- Department of Neurosurgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
| |
Collapse
|
5
|
Choi JH, Sim SY, Shin YS, Chung J. A Single Flow Re-direction Endoluminal Device for the Treatment of Large and Giant Anterior Circulation Intracranial Aneurysms. Yonsei Med J 2022; 63:349-356. [PMID: 35352886 PMCID: PMC8965426 DOI: 10.3349/ymj.2022.63.4.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The purpose of this study was to report the author's experiences in treating large (10-25 mm) and giant (>25 mm) intracranial aneurysms (IAs) using a single Flow Re-direction Endoluminal Device (FRED) without assistant coiling, with a focus on procedure-related complications. MATERIALS AND METHODS A total of 33 patients who were treated with FRED between January 2018 and July 2020 were retrospectively reviewed. The timing of procedure-related complications was chronologically categorized as acute (within 7 days), subacute (8 to 21 days), and delayed (after 21 days) periods. Follow-up angiography was performed at 2 to 27 months (mean 9.7 months), and clinical follow-up was performed at 1 to 31 months (mean 14.1 months) in all patients. RESULTS Six (18.2%) patients experienced procedure-related complications, including 2 (6.1%) in acute period, 1 (3.0%) in subacute period, and 3 (9.1%) in delayed period. Thromboembolic complications occurred in 5 (15.2%) patients and hemorrhagic complications in 1 (3.0%). Permanent morbidity and mortality rates were 3.0% each. Non-internal carotid artery (ICA) location of IAs (odds ratio 6.532; 95% confidence interval, 1.335-17.816; p=0.034) was the only independent risk factor for procedure-related complications on multivariate logistic regression analysis. CONCLUSION The procedure-related complication rate was 18.2% in this study. Procedure-related complications might increase when treating large and giant IAs located on a non-ICA, especially on the middle cerebral artery. Therefore, it may be suggested that neurointerventionists and endovascular neurosurgeons should pay attention to the location of IAs when treating large and giant IAs with a single FRED.
Collapse
Affiliation(s)
- Jai Ho Choi
- Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sook Young Sim
- Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
| | - Yong Sam Shin
- Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joonho Chung
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
6
|
De Beule T, Boulanger T, Heye S, van Rooij WJ, van Zwam W, Stockx L. The Woven EndoBridge for unruptured intracranial aneurysms: Results in 95 aneurysms from a single center. Interv Neuroradiol 2021; 27:594-601. [PMID: 33745363 PMCID: PMC8493345 DOI: 10.1177/15910199211003428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/10/2021] [Accepted: 02/19/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND PURPOSE The Woven EndoBridge (WEB) is an intrasaccular flowdisruptor that is increasingly used for the treatment of (wide-necked) aneurysms. We present our experience with the WEB for unruptured aneurysms. MATERIALS AND METHODS Between April 2014 and August 2019, 93 patients with 95 unruptured aneurysms were primarily treated with the WEB. There were 69 women and 24 men, mean age 61 years (median 58, range 37-80). RESULTS Of 95 aneurysms, 86 had been discovered incidentally, 3 were symptomatic and 6 were additional to another ruptured aneurysm. Location was anterior communicating artery 33, middle cerebral artery 29, basilar tip 19, carotid tip 8, posterior communicating artery 4, posterior inferior cerebellar artery 1, superior cerebellar artery 1. Mean aneurysm size was 6 mm (median 6, range 3-13 mm).In one aneurysm additional coils were used and in another, a stent was placed. There was one procedural rupture without clinical sequelae. There were two thrombo-embolic complications leading to permanent deficit in one patient (mRS 2). Morbidity rate was 1.0% (1 of 93, 95%CI 0.01-6.5%) and mortality was 0% (0 of 93, 95%CI 0.0-4.8%). Angiographic follow-up at six months was available in 85 patients with 87 aneurysms (91%). Of 87 aneurysms, 68 (78%) were completely occluded, 14 (16%) had a neck remnant and 5 were incompletely occluded. Four aneurysms were retreated. Retreatment rate was 4.5% (4 of 87, 95%CI 1.7-13.6%). CONCLUSION WEB treatment of unruptured aneurysms is safe and effective. Additional devices are needed only rarely and retreatment at follow-up is infrequent.
Collapse
Affiliation(s)
- Tom De Beule
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Sam Heye
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - Wim van Zwam
- Department of Radiology, Maastricht Universiteit Medisch Centrum, Maastricht, the Netherlands
| | - Luc Stockx
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Simgen A, Mayer C, Kettner M, Mühl-Benninghaus R, Reith W, Yilmaz U. Retrospective analysis of intracranial aneurysms after flow diverter treatment including color-coded imaging (syngo iFlow) as a predictor of aneurysm occlusion. Interv Neuroradiol 2021; 28:190-200. [PMID: 34107790 DOI: 10.1177/15910199211024056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Flow Diverters (FD) have immensely extended the treatment of cerebral aneurysms in the past years. Complete aneurysm occlusion is a process that often takes a certain amount of time and is usually difficult to predict. Our aim was to investigate different syngo iFlow parameters in order to predict aneurysm occlusion. METHODS Between 2014 and 2018 patients with unruptured cerebral aneurysms treated with a FD were reviewed. Aneurysm occlusion and complication rates have been assessed.In addition, various quantitative criteria were assessed using syngo iFlow before, after the intervention, and after short and long-term digital subtraction angiography (DSA). RESULTS A total of 66 patients hosting 66 cerebral aneurysms were included in this study. 87.9% (n = 58) aneurysms in the anterior and 12.1% (n = 8) in the posterior circulation were treated. Adequate aneurysm occlusion at long-term follow-up (19.05 ± 15.1 months) was achieved in 90.9% (n = 60). Adequately occluded aneurysm revealed a significantly greater peak intensity delay (PI-D, p = 0.008) and intensity decrease ratio (ID-R, p < 0.001) compared to insufficiently occluded aneurysms. Increased intra-aneurysmal contrast agent intensity (>100%) after FD implantation resulted in an ID-R < 1, which was associated with aneurysm growth during follow-up DSA. Retreatment with another FD due to foreshortening and/or aneurysm growth was performed in 10.6% (n = 7). Overall morbidity and mortality rates were 1.5% (n = 1) and 0%. CONCLUSION The applied syngo iFlow parameters were found to be useful in predicting adequate aneurysm occlusion and foresee aneurysm growth, which might indicate the implantation of another FD.
Collapse
Affiliation(s)
- Andreas Simgen
- Departments of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Christine Mayer
- Departments of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Michael Kettner
- Departments of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | | | - Wolfgang Reith
- Departments of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| | - Umut Yilmaz
- Departments of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany
| |
Collapse
|
9
|
den Bergh FRAV, De Beule T, van Rooij WJ, Voormolen MH, Van der Zijden T, Stockx L, van Zwam WH, Fransen H. The p48 flow diverter: First clinical results in 25 aneurysms in three centers. Interv Neuroradiol 2021; 27:339-345. [PMID: 33164617 PMCID: PMC8190948 DOI: 10.1177/1591019920972213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The novel low-profile p48 flow diverter has been designed to treat aneurysms on small vessels of 1.75-3mm. We report our first clinical experiences. METHODS Between March 2018-January 2020, 22 patients with 25 aneurysms were treated with the p48 in 3 centers. One patient had 3 aneurysms covered by one p48 and one patient had 2 aneurysms. There were 5 men, 17 women, with a mean age of 55 years (median 59, range 29-73 years). RESULTS In 25 aneurysms, 24 p48 flow diverters were placed. In 1 patient additional coils were placed in the aneurysm. Procedural vessel rupture by the micro guidewire occurred in 2 patients and vessel rupture during p48 balloon dilatation occurred in 1 patient. Overall, the permanent morbidity rate was 13.6% (3 of 22, 95%CI 3.9-34.2%) and mortality was 4.5% (1 of 22, 95%CI <0.01-23.5%). Most complications were procedure-related and not device-specific. Of 22 patients with 25 aneurysms treated with p48, 18 patients with 20 aneurysms had angiographic follow-up after 5-18 months. Of 19 aneurysms, 10 were occluded and 7 showed a remnant. Two aneurysms were open after 6 months. Three aneurysms were still not occluded after 12, 14, and 18 months and these 3 were retreated. Retreatment rate was 16% (3 of 19) and the adequate occlusion rate was 90% (17 of 19). CONCLUSIONS Treatment of aneurysms in small-caliber vessels with the p48 is feasible and effective but is not without complications. More data is needed to establish indications, safety, and efficacy more accurately.
Collapse
Affiliation(s)
- FRA Van den Bergh
- Department of Radiology, Algemeen Ziekenhuis St Lucas, Gent, Belgium
| | - T De Beule
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - WJ van Rooij
- Department of Radiology, Algemeen Ziekenhuis Turnhout, Turnhout, Belgium
| | - MH Voormolen
- Department of Radiology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | - T Van der Zijden
- Department of Radiology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | - L Stockx
- Department of Radiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - WH van Zwam
- Department of Radiology, Maastricht Universiteit Medisch Centrum, Maastricht, the Netherlands
| | - H Fransen
- Department of Radiology, Algemeen Ziekenhuis St Lucas, Gent, Belgium
| |
Collapse
|
10
|
Link TW, Carnevale JA, Goldberg JL, Jones C, Kocharian G, Boddu SR, Lin N, Patsalides A, Gobin YP, Knopman J. Multiple pipeline embolization devices improves aneurysm occlusion without increasing morbidity: A single center experience of 140 cases. J Clin Neurosci 2021; 86:129-135. [PMID: 33775316 DOI: 10.1016/j.jocn.2021.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/29/2020] [Accepted: 01/11/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Rates of aneurysm occlusion with the pipeline embolization device (PED) has varied widely in the literature from 55.7% to 93.3% at 6 months, which may reflect a difference in technique including sizing and number of devices used. METHODS 140 cases at our institution were retrospectively reviewed, and aneurysms treated with a single PED vs. multiple were compared. RESULTS Complete aneurysm occlusion was achieved in 86.9% at 6 months, 91.8% at 1 year, and 97.6% at longest follow-up. Retreatment with an additional device was required in 7 (5.1%). Major and minor complication rate within 30 days was 1.4% and 5.0%, and at greater than 30 days was 0.8% and 3.1%. Patients treated with multiple PEDs had significantly higher rates of aneurysm occlusion at 6 months (92.9% vs. 75.6%, p = 0.017) and 12 months (98.4% vs. 81.1%, p = 0.014), with no difference in complications. The two groups were similar aside from a higher number of ophthalmic and paraophthalmic aneurysms treated with multiple PEDs (23.4% vs. 6.5%, p = 0.004; and 35.1% vs. 17.4%, p = 0.020), and more posterior communicating artery and recurrent aneurysms treated with a single PED (28.3% vs. 3.2%, p = 0.001; 23.9% vs. 8.5%, p = 0.031). The use of multiple PEDs was found to be an independent predictor of aneurysm occlusion in a multivariate analysis (p = 0.015). CONCLUSIONS The use of multiple PEDs for intracranial aneurysms leads to significantly higher occlusion rates without added morbidity. This benefit is particularly appropriate for ophthalmic segment aneurysms, while more distal segments with eloquent perforating branches should be managed with caution.
Collapse
Affiliation(s)
- Thomas W Link
- Department of Neurosurgery, Weill Cornell Medical Institution New York Presbyterian Hospital, New York, NY, USA
| | - Joseph A Carnevale
- Department of Neurosurgery, Weill Cornell Medical Institution New York Presbyterian Hospital, New York, NY, USA.
| | - Jacob L Goldberg
- Department of Neurosurgery, Weill Cornell Medical Institution New York Presbyterian Hospital, New York, NY, USA
| | - Conor Jones
- Department of Neurosurgery, Weill Cornell Medical Institution New York Presbyterian Hospital, New York, NY, USA
| | - Gary Kocharian
- Department of Neurosurgery, Weill Cornell Medical Institution New York Presbyterian Hospital, New York, NY, USA
| | - Srikanth R Boddu
- Department of Neurosurgery, Weill Cornell Medical Institution New York Presbyterian Hospital, New York, NY, USA
| | - Ning Lin
- Department of Neurosurgery, Weill Cornell Medical Institution New York Presbyterian Hospital, New York, NY, USA
| | - Athos Patsalides
- Department of Neurosurgery, Weill Cornell Medical Institution New York Presbyterian Hospital, New York, NY, USA
| | - Y Pierre Gobin
- Department of Neurosurgery, Weill Cornell Medical Institution New York Presbyterian Hospital, New York, NY, USA
| | - Jared Knopman
- Department of Neurosurgery, Weill Cornell Medical Institution New York Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
11
|
Safety and efficacy of stent-assisted coiling for acutely ruptured wide-necked intracranial aneurysms: comparison of LVIS stents with laser-cut stents. Chin Neurosurg J 2021; 7:19. [PMID: 33653398 PMCID: PMC7927374 DOI: 10.1186/s41016-021-00237-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 02/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background To compare the safety and efficacy of LVIS stent-assisted coiling with those of laser-cut stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms. Methods Patients with acutely ruptured wide-necked intracranial aneurysms treated with LVIS stent-assisted coiling (LVIS stent group) and laser-cut stent-assisted coiling (laser-cut stent group) were retrospectively reviewed from January 2014 to December 2017. Propensity score matching was used to adjust for potential differences in age, sex, aneurysm location, aneurysm size, neck width, Hunt-Hess grade, and modified Fisher grade. Perioperative procedure-related complications and clinical and angiographic follow-up outcomes were compared. Univariate and multivariate analyses were performed to determine the associations between procedure-related complications and potential risk factors. Results A total of 142 patients who underwent LVIS stent-assisted coiling and 93 patients who underwent laser-cut stent-assisted coiling were enrolled after 1:2 propensity score matching. The angiographic follow-up outcomes showed that the LVIS stent group had a slightly higher complete occlusion rate and lower recurrence rate than the laser-cut stent group (92.7% vs 80.6%; 3.7% vs 9.7%, P = 0.078). The clinical outcomes at discharge and follow-up between the two groups demonstrated no significant differences (P = 0.495 and P = 0.875, respectively). The rates of intraprocedural thrombosis, postprocedural thrombosis, postoperative early rebleeding, and procedure-related death were 0.7% (1/142), 1.4% (2/142), 2.8% (4/142), and 2.1% (3/142) in the LVIS stent group, respectively, and 4.3% (4/93), 2.2% (2/93), 1.1% (1/93), and 3.2% (3/93) in the laser-cut stent group, respectively (P = 0.082, 0.649, 0.651, and 0.683). Nevertheless, the rates of overall procedure-related complications and intraprocedural rupture in the LVIS stent group were significantly lower than those in the laser-cut stent group (5.6% vs 14.0%, P = 0.028; 0.7% vs 6.5%, P = 0.016). Multivariate analysis showed that laser-cut stent-assisted coiling was an independent predictor for overall procedure-related complications (OR = 2.727, P = 0.037); a history of diabetes (OR = 7.275, P = 0.027) and other cerebrovascular diseases (OR = 8.083, P = 0.022) were independent predictors for ischemic complications, whereas none of the factors were predictors for hemorrhagic complications. Conclusions Compared with laser-cut stent-assisted coiling, LVIS stent-assisted coiling for the treatment of acutely ruptured wide-necked intracranial aneurysms could reduce the rates of overall procedure-related complications and intraprocedural rupture.
Collapse
|
12
|
Ocal O, Arat A. The Exchange-Free Technique: A Novel Technique for Enhancing Surpass Flow Diverter Placement. Asian J Neurosurg 2020; 15:620-626. [PMID: 33145216 PMCID: PMC7591168 DOI: 10.4103/ajns.ajns_374_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/26/2020] [Accepted: 04/18/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Following flow diverter placement, approximately 20% of intracranial aneurysms remain as residual aneurysms at 1 year. Device malapposition is a cause of residual aneurysms after flow diversion. We present a new and straightforward technique (exchange-free technique [EFT]) to enhance apposition of the surpass flow diverter (SFD), the only over-the-wire flow diverter currently available. Materials and Methods: We deployed laser-cut mini stents through the inner deployment catheter of the SFD. This maneuver was performed simply by withdrawing the micro-guidewire from its lumen and replacing it with a mini-stent (stents deliverable through microcatheters with inner diameter of 0.0165 inches), without a need to re-cross the deployed SFD or an exchange maneuver. All aneurysms in which this technique was utilized were retrospectively reviewed. Results: Twenty-eight patients (20 females) with 30 treated aneurysms were identified. The mean aneurysm diameter was 10.2 ± 6.6 mm. Technical success rate was 96.6% (29/30 aneurysms). There was no mortality or permanent morbidity related to the procedures. Except for the patient treated for an iatrogenic, surgery-related internal carotid artery pseudoaneurysm who died secondary to consequences of multiple surgeries, no cases of mortality or permanent morbidity were noted. Complete aneurysm occlusion rates were 78.2%, 82.1%, and 95.2% at 0–3, 3–6, and 9–12 months, respectively. None of the patients were re-treated. Conclusion: EFT is a simple and fast technique which was not associated with adverse effects in our series. The higher aneurysm obliteration rate obtained with EFT is probably the result of better wall apposition of the SFD.
Collapse
Affiliation(s)
- Osman Ocal
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Anıl Arat
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| |
Collapse
|
13
|
Choi JH, Lee KS, Kim BS, Shin YS. Treatment outcomes of large and giant intracranial aneurysms according to various treatment modalities. Acta Neurochir (Wien) 2020; 162:2745-2752. [PMID: 32827268 DOI: 10.1007/s00701-020-04540-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/16/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE This study aimed to compare the treatment outcomes of large (15-25 mm) and giant (> 25 mm) intracranial aneurysms (IAs), according to different treatment modalities. METHODS In total, 112 patients with large and giant IAs treated with various treatment modalities between January 2009 and December 2018 were retrospectively reviewed. Clinical and radiological parameters were analyzed and correlated with the treatment modality. RESULTS A total of 141 procedures were performed on 112 patients. We initially treated 47 cases with coil embolization, 39 with flow diverter (FD), 13 with direct clipping, and 13 with parent artery occlusion (PAO). Recurrence (46.8%) and retreatment (31.9%) rates were significantly higher in the coiling group (p < 0.001). Complete occlusion rate (36.3%) was significantly lower in the coiling group (p = 0.027). PAO could achieve a high complete occlusion rate (90.9%) with low complication rate (12.5%). The total complication rate was 17%. In the multivariate logistic regression analysis, FD (OR 3.406, p = 0.036) and direct clipping (OR 5.732, p = 0.017) showed a significantly higher complication rate than coiling. The overall mortality rate was 8% (8/139 procedures). At the last follow-up (mean 30.6 ± 26.4 months), 70 of 96 patients (72.9%) showed complete or near-complete occlusion. Good functional outcome (mRS ≤ 2) was observed in 90 of 112 (80.3%) patients at the last follow-up (mean 33.2 ± 30.5 months). CONCLUSIONS Good clinical and radiologic outcomes with acceptable complication and mortality rates can be achieved by various treatment modalities. The selection of appropriate modality should be individualized based on the angiographic findings and clinical symptoms.
Collapse
Affiliation(s)
- Jai Ho Choi
- Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu,, Seoul, Korea
| | - Kwan Sung Lee
- Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu,, Seoul, Korea
| | - Bum-Soo Kim
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, Korea
| | - Yong Sam Shin
- Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu,, Seoul, Korea.
| |
Collapse
|
14
|
Sindeev S, Kirschke JS, Prothmann S, Frolov S, Liepsch D, Berg P, Zimmer C, Friedrich B. Evaluation of flow changes after telescopic stenting of a giant fusiform aneurysm of the vertebrobasilar junction. Biomed Eng Online 2019; 18:82. [PMID: 31340820 PMCID: PMC6657177 DOI: 10.1186/s12938-019-0699-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of flow-diverters for non-saccular cerebral posterior circulation aneurysms requires complex deployment techniques and is associated with high mortality and morbidity. Therefore, further studies are required to clarify the effect of stenting on post-treatment hemodynamics in such aneurysms. In this study, we evaluated flow alterations in a treated giant fusiform aneurysm of the vertebrobasilar junction and correlated them with the clinical outcome. METHODS A patient-specific aneurysm model was acquired by rotational angiography, and three SILK flow-diverters (4.5 × 40, 5 × 40 and 5.5 × 40 mm) were virtually deployed in series along the basilar and right vertebral arteries. Image-based blood flow simulations before and after the treatment were performed under realistic pulsatile flow conditions. The flow reduction, velocity and wall shear stress (WSS) distribution, streamlines and WSS-derived parameters were evaluated before and after the treatment. RESULTS The computed velocity streamlines showed substantial alterations of the flow pattern in the aneurysm and successful redirection of blood flow along the series of flow-diverters with no flow through the overlapping stents. The obtained flow reduction of 86% was sufficient to create thrombogenic flow conditions. Moreover, a 6.2-fold increase in relative residence time and a decrease by 87% of time-averaged WSS contributed to a successful treatment outcome observed during the follow-up. CONCLUSIONS We found a correlation between the numerically predicted flow alterations and the available treatment outcome. This shows the potential of image-based simulations to be used in clinical practice for treatment planning and estimation of possible risk factors associated with a complex stent deployment in fusiform aneurysms of the posterior circulation.
Collapse
Affiliation(s)
- Sergey Sindeev
- Department of Biomedical Engineering, Tambov State Technical University, Tambov, Russia
| | - Jan Stephan Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Sascha Prothmann
- Department of Neuroradiology, Helios Klinikum München West, Munich, Germany
| | - Sergey Frolov
- Department of Biomedical Engineering, Tambov State Technical University, Tambov, Russia
| | - Dieter Liepsch
- Department of Building Services Engineering, Munich University of Applied Sciences, Munich, Germany
| | - Philipp Berg
- Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Benjamin Friedrich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| |
Collapse
|
15
|
Touzé R, Gravellier B, Rolla-Bigliani C, Touitou V, Shotar E, Lenck S, Boch AL, Degos V, Sourour NA, Clarençon F. Occlusion Rate and Visual Complications With Flow-Diverter Stent Placed Across the Ophthalmic Artery's Origin for Carotid-Ophthalmic Aneurysms: A Meta-Analysis. Neurosurgery 2019; 86:455-463. [DOI: 10.1093/neuros/nyz202] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/11/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Romain Touzé
- Interventional Neuroradiology Unit, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
- Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France
| | - Bastien Gravellier
- Advanced Scientific Statistics Unit, University of Paris-Saclay, Paris, France
| | - Claudia Rolla-Bigliani
- Interventional Neuroradiology Unit, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Valérie Touitou
- Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne University of Paris 6, Paris, France
| | - Eimad Shotar
- Interventional Neuroradiology Unit, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne University of Paris 6, Paris, France
| | - Stéphanie Lenck
- Interventional Neuroradiology Unit, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Anne-Laure Boch
- Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France
| | - Vincent Degos
- Department of Anesthesiology, Pitié-Salpêtrère Hospital, Paris, France
- Neuro-Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Nader-Antoine Sourour
- Interventional Neuroradiology Unit, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Frédéric Clarençon
- Interventional Neuroradiology Unit, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne University of Paris 6, Paris, France
| |
Collapse
|
16
|
Kim BM, Park KY, Lee JW, Chung J, Kim DJ, Kim DI. A Newly-Developed Flow Diverter (FloWise) for Internal Carotid Artery Aneurysm: Results of a Pilot Clinical Study. Korean J Radiol 2019; 20:505-512. [PMID: 30799582 PMCID: PMC6389806 DOI: 10.3348/kjr.2018.0421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/17/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Byung Moon Kim
- Department of Radiology, Yonsei University College of Medicine, Severance Stroke Center, Severance Hospital, Seoul, Korea.
| | - Keun Young Park
- Department of Neurosurgery, Yonsei University College of Medicine, Severance Stroke Center, Severance Hospital, Seoul, Korea
| | - Jae Whan Lee
- Department of Neurosurgery, Yonsei University College of Medicine, Severance Stroke Center, Severance Hospital, Seoul, Korea
| | - Joonho Chung
- Department of Neurosurgery, Yonsei University College of Medicine, Severance Stroke Center, Severance Hospital, Seoul, Korea
| | - Dong Joon Kim
- Department of Radiology, Yonsei University College of Medicine, Severance Stroke Center, Severance Hospital, Seoul, Korea
| | - Dong Ik Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| |
Collapse
|
17
|
Maingard J, Lamanna A, Kok HK, Thijs V, Hirsch JA, Lee MJ, Chandra RV, Brooks M, Asadi H. Endovascular Treatment of Intracranial Aneurysms: What Does Bibliographic Analysis Tell Us About Treatment Paradigms and Predictions for the Future? World Neurosurg 2018; 121:259-260. [PMID: 30347296 DOI: 10.1016/j.wneu.2018.10.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Julian Maingard
- Interventional Radiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia; Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Australia; School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - Anthony Lamanna
- Interventional Radiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia; Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Australia
| | - Hong Kuan Kok
- Interventional Radiology Service-Department of Radiology, Northern Hospital, Melbourne, Australia; School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - Vincent Thijs
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; The University of Melbourne, Melbourne, Australia; Department of Neurology, Austin Health, Melbourne, Australia
| | - Joshua A Hirsch
- NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael J Lee
- Interventional Radiology Service-Department of Radiology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ronil V Chandra
- Department of Imaging, Monash University, Melbourne, Australia; Interventional Neuroradiology Unit-Monash Imaging, Monash Health, Melbourne, Australia
| | - Mark Brooks
- Interventional Radiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia; Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Australia; Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - Hamed Asadi
- Interventional Radiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia; Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Australia; Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; Interventional Neuroradiology Unit-Monash Imaging, Monash Health, Melbourne, Australia; School of Medicine-Faculty of Health, Deakin University, Waurn Ponds, Australia
| |
Collapse
|
18
|
Beydoun HA, Azarbaijani Y, Cheng H, Anderson-Smits C, Marinac-Dabic D. Predicting Successful Treatment of Intracranial Aneurysms with the Pipeline Embolization Device Through Meta-Regression. World Neurosurg 2018; 114:e938-e958. [DOI: 10.1016/j.wneu.2018.03.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/17/2018] [Accepted: 03/17/2018] [Indexed: 10/17/2022]
|
19
|
Rajah G, Narayanan S, Rangel-Castilla L. Update on flow diverters for the endovascular management of cerebral aneurysms. Neurosurg Focus 2018; 42:E2. [PMID: 28565980 DOI: 10.3171/2017.3.focus16427] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Flow diversion has become a well-accepted option for the treatment of cerebral aneurysms. Given the significant treatment effect of flow diverters, numerous options have emerged since the initial Pipeline embolization device studies. In this review, the authors describe the available flow diverters, both endoluminal and intrasaccular, addressing nuances of device design and function and presenting data on complications and outcomes, where available. They also discuss possible future directions of flow diversion.
Collapse
Affiliation(s)
- Gary Rajah
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Sandra Narayanan
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
| | | |
Collapse
|
20
|
Walcott BP, Koch MJ, Stapleton CJ, Patel AB. Blood Flow Diversion as a Primary Treatment Method for Ruptured Brain Aneurysms-Concerns, Controversy, and Future Directions. Neurocrit Care 2018; 26:465-473. [PMID: 27844465 DOI: 10.1007/s12028-016-0318-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Flow diversion is a novel treatment for brain aneurysms that works by redirecting blood flow away from the aneurysm. Immediately after placement of the stent, blood flow stagnates within the aneurysm dome and it undergoes thrombosis. Over time, a new endothelium develops across the neck, thereby reconstructing the parent vessel and curing the aneurysm. The use of this treatment method for ruptured aneurysms has two specific concerns: 1) risk of hemorrhage from the aneurysm after treatment because of potential delayed aneurysm occlusion; and 2) hemorrhagic complications from antiplatelet use, which is required to prevent thromboembolic complications from the device. In this review, we explore these two concerns based on the emerging published literature. Optimal peri-procedural management of these issues in the neurocritical care setting is vital to improving outcomes. We also identify ongoing clinical trials of flow diversion for the treatment of ruptured aneurysms. Flow diversion is an alternative to clipping or coiling for many ruptured aneurysms and may be potentially more efficacious in certain aneurysm subtypes.
Collapse
Affiliation(s)
- Brian P Walcott
- Department of Neurological Surgery, University of Southern California, USC Healthcare Center II, 1520 San Pablo St #3800, Los Angeles, CA, 90033, USA.
| | - Matthew J Koch
- Department of Neurological Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA
| | - Christopher J Stapleton
- Department of Neurological Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA
| | - Aman B Patel
- Department of Neurological Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA
| |
Collapse
|
21
|
Touzé R, Touitou V, Shotar E, Gabrieli J, Drir M, Mathon B, Sourour NA, Clarençon F. Long-term visual outcome in patients treated by flow diversion for carotid-ophthalmic aneurysms. J Neurointerv Surg 2018; 10:1067-1073. [PMID: 29572267 DOI: 10.1136/neurintsurg-2017-013684] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/12/2018] [Accepted: 02/20/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Flow-diverter stents (FDSs) are an upgrade in the treatment of intracranial aneurysms. However, complications concerning covered branches have been reported, especially the ophthalmic artery (OA). The purpose of our study was to evaluate the long-term ophthalmic complication rate of carotid-ophthalmic aneurysms (COA) without visual pathways compression, treated by a FDS covering the OA by performing an exhaustive ophthalmic examination. MATERIAL AND METHODS Retrospective analysis of a single-center database screening the patients treated from October 2009 to April 2015 for an intracranial aneurysm with a FDS. The patients treated for a non-compressive COA with coverage of the OA by the device were studied (n=30). Among these patients, 15 (50%) were excluded. The remaining 15 patients underwent a systematic and extensive ophthalmic examination at least 2 years after the stent placement by two ophthalmologists. RESULTS Fifteen patients with 16 COAs treated with a FDS were included. Mean follow-up was 4.1±2 years. Six patients (40%), presented ophthalmic complications, including three fugax amauroses (18.8%) and four significant visual field defects (25%). After comparing each eye's visual field's patients, we observed a significant difference between the eye on the FDS side compared with the contralateral eye, with a mean deviation of -1.58 dB versus -0.67 dB respectively (P=0.003). Visual acuity was preserved in all patients. CONCLUSION Patients treated by FDS for COA have a good long-term clinical ophthalmic outcome. However, extensive ophthalmic examination shows a high percentage of minor ophthalmic modifications. Interventional neuroradiologists should be aware of these possible complications when choosing to treat these aneurysms with FDS.
Collapse
Affiliation(s)
- Romain Touzé
- Departement of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.,Departement of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France
| | - Valérie Touitou
- Departement of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France.,Paris VI University, Pierre et Marie Curie, Paris, France
| | - Eimad Shotar
- Departement of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.,Paris VI University, Pierre et Marie Curie, Paris, France
| | - Joseph Gabrieli
- Departement of Interventional Neuroradiology, Padova University Hospital, Padova, Italy
| | - Mehdi Drir
- Departement of Anesthesiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Bertrand Mathon
- Paris VI University, Pierre et Marie Curie, Paris, France.,Departement of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France.,Paris VI University, Pierre et Marie Curie, Paris, France
| | | | - Frédéric Clarençon
- Departement of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.,Paris VI University, Pierre et Marie Curie, Paris, France
| |
Collapse
|
22
|
Bhogal P, AlMatter M, Hellstern V, Ganslandt O, Bäzner H, Henkes H, Aguilar-Pérez M. The Combined Use of Intraluminal and Intrasaccular Flow Diversion for the Treatment of Intracranial Aneurysms: Report of 25 Cases. Neurointervention 2018; 13:20-31. [PMID: 29535895 PMCID: PMC5847887 DOI: 10.5469/neuroint.2018.13.1.20] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 02/23/2018] [Accepted: 02/26/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The Medina Embolic Device (MED) is a new intrasaccular device with promising early results. Previously we documented our initial experience of this device both alone and in combination with other devices including flow diverter stents (FDS). We sought to determine the effect of the MED + FDS strategy for the treatment of selected aneurysms. MATERIALS AND METHODS We performed a retrospective analysis of prospectively collected data to identify all patients with aneurysms treated using both the MED and intraluminal FDS. We present our technical success rate, early and mid-term angiographic follow-up, and clinical outcome data. RESULTS We identified 25 non-consecutive patients. The treatment was staged in 9 patients and in a single session 16 patients. The average age was 61±12.8 years (range 40-82). The average fundus height was 11±3.6 mm and average fundus width was 10.1±3.4 mm. In the staged cohort (n=9) at delayed angiography (mean 10 mths) 8 aneurysms (89%) showed complete exclusion (mRRC 1) and in one patient there was a parent vessel occlusion. In the simultaneous cohort delayed angiography (n=10, mean 8.1 months) demonstrated complete occlusion (mRRC 1) in 6 aneurysms (60%), 3 neck remnants (mRRC 2) (30%) and 1 patient (10%) showed persistent aneurysmal filling (mRRC 3a). There were 5 complications with permanent morbidity (mRS >2) in two patients. There were no mortalities. CONCLUSION The MED can be successfully used in combination with intraluminal FDS and in selected aneurysms this may represent an alternative to FDS and adjunctive coiling.
Collapse
Affiliation(s)
- Pervinder Bhogal
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Germany
| | | | | | | | - Hansjörg Bäzner
- Neurological Clinic, Neurocenter, Klinikum Stuttgart, Germany
| | - Hans Henkes
- Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Germany
- Medical Faculty, University Duisburg-Essen, Germany
| | | |
Collapse
|
23
|
Pierot L, Gawlitza M, Soize S. Unruptured intracranial aneurysms: management strategy and current endovascular treatment options. Expert Rev Neurother 2017; 17:977-986. [DOI: 10.1080/14737175.2017.1371593] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Laurent Pierot
- Department of Neuroradiology, CHU Reims, University Reims-Champagne-Ardenne, Reims, France
| | - Matthias Gawlitza
- Department of Neuroradiology, CHU Reims, University Reims-Champagne-Ardenne, Reims, France
| | - Sébastien Soize
- Department of Neuroradiology, CHU Reims, University Reims-Champagne-Ardenne, Reims, France
| |
Collapse
|
24
|
Abstract
BACKGROUND Intracranial saccular aneurysms are acquired lesions that often present with neuro-ophthalmologic symptoms and signs. Recent advances in neurosurgical techniques, endovascular treatments, and neurocritical care have improved the optimal management of symptomatic unruptured aneurysms, but whether the chosen treatment has an impact on neuro-ophthalmologic outcomes remains debated. EVIDENCE ACQUISITION A review of the literature focused on neuro-ophthalmic manifestations and treatment of intracranial aneurysms with specific relevance to neuro-ophthalmologic outcomes was conducted using Ovid MEDLINE and EMBASE databases. Cavernous sinus aneurysms were not included in this review. RESULTS Surgical clipping vs endovascular coiling for aneurysms causing third nerve palsies was compared in 13 retrospective studies representing 447 patients. Complete recovery was achieved in 78% of surgical patients compared with 44% of patients treated with endovascular coiling. However, the complication rate, hospital costs, and days spent in intensive care were reported as higher in surgically treated patients. Retrospective reviews of surgical clipping and endovascular coiling for all ocular motor nerve palsies (third, fourth, or sixth cranial nerves) revealed similar results of complete resolution in 76% and 49%, respectively. Improvement in visual deficits related to aneurysmal compression of the anterior visual pathways was also better among patients treated with clipping than with coiling. The time to treatment from onset of visual symptoms was a predictive factor of visual recovery in several studies. Few reports have specifically assessed the improvement of visual deficits after treatment with flow diverters. CONCLUSIONS Decisions regarding the choice of therapy for intracranial aneurysms causing neuro-ophthalmologic signs ideally should be made at high-volume centers with access to both surgical and endovascular treatments. The status of the patient, location of the aneurysm, and experience of the treating physicians are important factors to consider. Although a higher rate of visual recovery was reported with neurosurgical clipping, this must be weighed against the potentially longer intensive care stays and increased early morbidity.
Collapse
|
25
|
Zhou G, Su M, Yin YL, Li MH. Complications associated with the use of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis. Neurosurg Focus 2017; 42:E17. [DOI: 10.3171/2017.3.focus16450] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe objective of this study was to review the literature on the use of flow-diverting devices (FDDs) to treat intracranial aneurysms (IAs) and to investigate the safety and complications related to FDD treatment for IAs by performing a meta-analysis of published studies.METHODSA systematic electronic database search was conducted using the Springer, EBSCO, PubMed, Medline, and Cochrane databases on all accessible articles published up to January 2016, with no restriction on the publication year. Abstracts, full-text manuscripts, and the reference lists of retrieved articles were analyzed. Random-effects meta-analysis was used to pool the complication rates across studies.RESULTSSixty studies were included, which involved retrospectively collected data on 3125 patients. The use of FDDs was associated with an overall complication rate of 17.0% (95% confidence interval [CI] 13.6%–20.5%) and a low mortality rate of 2.8% (95% CI 1.2%–4.4%). The neurological morbidity rate was 4.5% (95% CI 3.2%–5.8%). No significant difference in the complication or mortality rate was observed between 2 commonly used devices (the Pipeline embolization device and the Silk flow-diverter device). A significantly higher overall complication rate was found in the case of ruptured IAs than in unruptured IA (odds ratio 2.3, 95% CI 1.2–4.3).CONCLUSIONSThe use of FDDs in the treatment of IAs yielded satisfactory results with regard to complications and the mortality rate. The risk of complications should be considered when deciding on treatment with FDDs. Further studies on the mechanism underlying the occurrence of adverse events are required.
Collapse
Affiliation(s)
- Geng Zhou
- 1Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai
| | - Ming Su
- 2Shandong Academy of Chinese Medicine, Lixia, Jinan; and
| | - Yan-Ling Yin
- 3Department of Anesthesiology, The Military General Hospital of Beijing PLA, Beijing, China
| | - Ming-Hua Li
- 1Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai
| |
Collapse
|
26
|
Letter Regarding Article, “Efficacy of Flow-Diverting Devices for Cerebral Aneurysms: A Systematic Review and Meta-analysis” ∗. World Neurosurg 2016; 94:578. [DOI: 10.1016/j.wneu.2016.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 11/18/2022]
|
27
|
Zhou G, Yin Y, Li M. Flow Diversion for Cerebral Aneurysms: A Promising Therapy Needs Full Evaluation. World Neurosurg 2016; 91:626-7. [PMID: 27083132 DOI: 10.1016/j.wneu.2016.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Geng Zhou
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - YanLing Yin
- Department of Anesthesiology, The Military General Hospital of Beijing PLA, Beijing, China
| | - MingHua Li
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| |
Collapse
|
28
|
Meta-Analysis of the Efficiency and Prognosis of Intracranial Aneurysm Treated with Flow Diverter Devices. J Mol Neurosci 2016; 59:158-67. [DOI: 10.1007/s12031-016-0723-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 01/19/2016] [Indexed: 11/29/2022]
|