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Xie D, Zhao L, Liu H, Wang J, Lu P, Ye X, Yang S. Tubridge Flow Diverter for the Treatment of Unruptured Dissecting Cerebral Aneurysms. World Neurosurg 2023; 172:e343-e348. [PMID: 36639100 DOI: 10.1016/j.wneu.2023.01.024] [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] [Received: 11/29/2022] [Accepted: 01/07/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND The Tubridge flow diverter is a device widely used in China aimed at reconstructing parent artery and occluding complex aneurysm. The experience of the Tubridge in treating unruptured vertebrobasilar artery dissecting aneurysms is still limited. In this study, we aimed to evaluate the safety and efficacy of the Tubridge flow diverter for the treatment of vertebrobasilar artery dissecting aneurysms. METHODS We reviewed the clinical records of aneurysms treated with the Tubridge flow diverter between 2019 and 2021 in a national cerebrovascular disease center. Therapeutic process, occlusion rate, and clinical outcome were compared. RESULTS Twenty-three patients with 23 vertebrobasilar artery aneurysms were identified. The results showed that the mean length and mean maximal width were 15.14 and 9.14 mm, respectively, in the vertebrobasilar artery. Twenty-four Tubridge flow diverters were successfully implanted without unfold failure. A complete occlusion rate at the last angiographic follow-up was achieved in 78.26% of vertebrobasilar artery aneurysms. Fifteen branch arteries were covered, and only 1 branch artery disappeared at follow-up. Mild asymptomatic cerebral infarction occurred in 3 patients (13.04%); intracranial hemorrhage was not found in the patients. CONCLUSIONS Our preliminary experience suggests that the Tubridge flow diverter might be a safe and effective tool for dissecting cerebral aneurysms. Branch arteries were well protected and mild asymptomatic cerebral infarction occurred in some patients. Adequate evidence is required to clear the definite indications and complications in a multicenter randomized controlled trial with a long-term follow-up.
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Affiliation(s)
- Dajiang Xie
- Department of Neurosurgery, Sir Run Run Shaw Hospital, College of Medical Sciences, Zhejiang University, Hangzhou, China
| | - Li Zhao
- Department of Gastroenterology, Hangzhou Red Cross Hospital/Integrated Traditional Chinese and Western Medicine Hospital of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, China
| | - Hailong Liu
- Department of Neurosurgery, Jiashan Hospital of Traditional Chinese Medicine, Jiaxing, China
| | - Jiaxiong Wang
- Department of Neurosurgery, South Yunnan Central Hospital of Yunnan Province (The First People's Hospital of HongHe Prefecture), Mengzi, China
| | - Peng Lu
- Department of Neurosurgery, Sir Run Run Shaw Hospital, College of Medical Sciences, Zhejiang University, Hangzhou, China
| | - Xin Ye
- Department of Neurosurgery, Sir Run Run Shaw Hospital, College of Medical Sciences, Zhejiang University, Hangzhou, China
| | - Shuxu Yang
- Department of Neurosurgery, Sir Run Run Shaw Hospital, College of Medical Sciences, Zhejiang University, Hangzhou, China.
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Wei D, Deng D, Gui S, You W, Feng J, Meng X, Chen X, Lv J, Tang Y, Chen T, Liu P. Machine learning to predict in-stent stenosis after Pipeline embolization device placement. Front Neurol 2022; 13:912984. [PMID: 36147044 PMCID: PMC9486156 DOI: 10.3389/fneur.2022.912984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background The Pipeline embolization device (PED) is a flow diverter used to treat intracranial aneurysms. In-stent stenosis (ISS) is a common complication of PED placement that can affect long-term outcome. This study aimed to establish a feasible, effective, and reliable model to predict ISS using machine learning methodology. Methods We retrospectively examined clinical, laboratory, and imaging data obtained from 435 patients with intracranial aneurysms who underwent PED placement in our center. Aneurysm morphological measurements were manually measured on pre- and posttreatment imaging studies by three experienced neurointerventionalists. ISS was defined as stenosis rate >50% within the PED. We compared the performance of five machine learning algorithms (elastic net (ENT), support vector machine, Xgboost, Gaussian Naïve Bayes, and random forest) in predicting ISS. Shapley additive explanation was applied to provide an explanation for the predictions. Results A total of 69 ISS cases (15.2%) were identified. Six predictors of ISS (age, obesity, balloon angioplasty, internal carotid artery location, neck ratio, and coefficient of variation of red cell volume distribution width) were identified. The ENT model had the best predictive performance with a mean area under the receiver operating characteristic curve of 0.709 (95% confidence interval [CI], 0.697–0.721), mean sensitivity of 77.9% (95% CI, 75.1–80.6%), and mean specificity of 63.4% (95% CI, 60.8–65.9%) in Monte Carlo cross-validation. Shapley additive explanation analysis showed that internal carotid artery location was the most important predictor of ISS. Conclusion Our machine learning model can predict ISS after PED placement for treatment of intracranial aneurysms and has the potential to improve patient outcomes.
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Affiliation(s)
- Dachao Wei
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Dingwei Deng
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Siming Gui
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Wei You
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Junqiang Feng
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiangyu Meng
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiheng Chen
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jian Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yudi Tang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Ting Chen
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Peng Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
- *Correspondence: Peng Liu
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Abouelleil M, Chehab A, Nabulsi O, Singer J, Mazaris P. Use of Pipeline Flex Flow Diverter in the Treatment of an Internal Carotid Artery Dissection: A Case Report. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Wang G, Li C, Piao J, Xu B, Yu J. Endovascular treatment of blunt injury of the extracranial internal carotid artery: the prospect and dilemma. Int J Med Sci 2021; 18:944-952. [PMID: 33456352 PMCID: PMC7807178 DOI: 10.7150/ijms.50275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/18/2020] [Indexed: 11/15/2022] Open
Abstract
The extracranial internal carotid artery (ICA) refers to the anatomic location that reaches from the common carotid artery proximally to the skull base distally. The extracranial ICA belongs to the C1 segment of the Bouthillier classification and is at considerable risk for injury. Currently, the understanding of endovascular treatment (EVT) for blunt injury of the extracranial ICA is limited, and a comprehensive review is therefore important. In this review, we found that extracranial ICA blunt injury should be identified in patients presenting after blunt trauma, including classical dissection, pseudoaneurysm, and stenosis/occlusion. Computed tomography angiography (CTA) is the first-line method for screening for extracranial ICA blunt injury, although digital subtraction angiography (DSA) remains the "gold standard" in imaging. Antithrombotic treatment is effective for stroke prevention. However, routine EVT in the form of stenting should be reserved for patients with prolonged neurological symptoms from arterial stenosis or considerably enlarged pseudoaneurysm. Endovascular repair is now emerging as a favored therapeutic option given its demonstrated safety and positive clinical and radiographic outcomes.
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Affiliation(s)
- Guangming Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Chao Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, China
| | - Jianmin Piao
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Baofeng Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
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