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Kim M, Kim J, Chang C, Jung Y. Resubmission Addressing the "Hook-in" Problem in Accero Stent-Assisted Coil Embolization: Understanding Cases and Solutions. World Neurosurg 2024; 189:42-46. [PMID: 38821402 DOI: 10.1016/j.wneu.2024.05.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/02/2024]
Affiliation(s)
- Minseok Kim
- Department of Neurosurgery, Yeungnam University Medical Center and Medical School, Namgu, Daegu, South Korea
| | - Jonghoon Kim
- Department of Neurosurgery, Yeungnam University Medical Center and Medical School, Namgu, Daegu, South Korea
| | - Chulhoon Chang
- Department of Neurosurgery, Yeungnam University Medical Center and Medical School, Namgu, Daegu, South Korea
| | - Youngjin Jung
- Department of Neurosurgery, Yeungnam University Medical Center and Medical School, Namgu, Daegu, South Korea.
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Goertz L, Zopfs D, Pennig L, Zaeske C, Timmer M, Turowski B, Kaschner M, Borggrefe J, Schönfeld M, Schlamann M, Kabbasch C. Comparative Analysis of the Low-Profile Acclino Stent and the Enterprise Stent for the Treatment of Unruptured Intracranial Aneurysms. World Neurosurg 2024; 182:e517-e524. [PMID: 38043742 DOI: 10.1016/j.wneu.2023.11.138] [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: 09/29/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE In preliminary studies, advanced intracranial stents appear to have a favorable safety profile for intracranial aneurysm treatment. This dual-center study is a head-to-head comparison of the low-profile Acandis Acclino stent (a third-generation stent) and the first- and second-generation Enterprise stent. METHODS Patients who underwent stent-assisted coiling with either the Enterprise or the Acclino stent for unruptured aneurysms during an 8-year period were enrolled and compared for complications, clinical outcomes, and angiographic results. Primary outcome measures were ischemic stroke rate and mid-term complete occlusion rate. Propensity score adjustment was performed to account for small differences between the groups. RESULTS Enterprise and Acclino stents were used in 48 cases each. The overall rate of thrombotic complications was higher in the Enterprise group than in the Acclino group (20.8% vs. 4.2%, HR: 6.6, 95%CI: 2.2-20.0, P = 0.01, adjusted P < 0.01), which translated into a higher rate of major ischemic stroke after Enterprise treatment (6.3% vs. 0%, HR: 2.1, 95%CI: 1.8-2.4, P = 0.08, adjusted P < 0.01). Mid-term and long-term angiographic follow-up showed complete occlusion rates of 83.3% and 75.0% for Enterprise and 89.2% and 75.9% for Acclino (both P > 0.05). Retreatment rates were 10.4% in the Enterprise group and 4.2% in the Acclino group (P = 0.42, adjusted P = 0.10). CONCLUSIONS The results indicate a favorable safety profile of the Acclino over the Enterprise, justifying the use of advanced stent systems in clinical practice. However, further comparative studies of the Acclino and other competing stent systems are needed to draw a definitive conclusion on the state of stent-assisted coiling.
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Affiliation(s)
- Lukas Goertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - David Zopfs
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Charlotte Zaeske
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marco Timmer
- Department of General Neurosurgery, Center for Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Bernd Turowski
- Department of Neuroradiology, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Marius Kaschner
- Department of Neuroradiology, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Michael Schönfeld
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marc Schlamann
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christoph Kabbasch
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Nabizadeh F, Valizadeh P, Balabandian M. Stent-assistant versus non-stent-assistant coiling for ruptured and unruptured intracranial aneurysms: A meta-analysis and systematic review. World Neurosurg X 2024; 21:100243. [PMID: 38221954 PMCID: PMC10787302 DOI: 10.1016/j.wnsx.2023.100243] [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: 10/12/2022] [Accepted: 10/04/2023] [Indexed: 01/16/2024] Open
Abstract
Background Several different endovascular and non-invasive treatment methods are suggested for the various types of intracranial aneurysms including simple, balloon-assisted, and stent-assisted coiling (SAC). Previous studies investigated the safety and efficacy of SAC versus non-stent-assisted coiling (non-SAC) but the results were controversial. We aim to perform a systematic review and meta-analysis to compare the efficacy and safety of SAC with non-SAC technique in stratifying by the ruptured and unruptured aneurysms. Methods PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were searched in April 2022 for studies investigated the efficacy and safety of SAC versus non-SAC. Results Overall, 26 studies entered into our qualitative and quantitative synthesis. We found that there was overall lower recurrence rate in SAC versus non-SAC significant (RR: 0.43, 95%CI: 0.33, 0.53). Furthermore, the comparisons were significant in unruptured (RR: 0.63, 95%CI: 0.40, 0.86), ruptured (RR: 0.29, 95%CI), and combination aneurysms (RR: 0.42, 95%CI: 0.30, 0.54). Also, we found higher risk of intraprocedural rupture for SAC versus non-SAC in unruptured aneurysms (RR: 1.40, 95%CI: 1.31, 1.50). Investigating hemorrhagic events risk showed that there was significant difference in ruptured (RR: 1.73, 95%CI: 1.12, 2.34) and combination aneurysms (RR: 0.60, 95%CI: 0.37, 0.82). There was no significant difference in immediate occlusion rate, complete occlusion, and risk of ischemic events in our analysis. Conclusion Overall, our findings demonstrated that SAC may have higher efficacy in term of recurrence rate, but also may have a higher risk of complications in the treatment of intracranial aneurysms. As there are several factors affecting the outcomes and safety of these interventions, further RCTs controlled for multiple factors are required better guide the neurointerventionists choose the best strategy.
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Affiliation(s)
- Fardin Nabizadeh
- Neuroscience Research Group (NRG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Parya Valizadeh
- School of Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Balabandian
- Neuroscience Research Group (NRG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Mosimann PJ, Yamac E, Wallocha M, Ayad A, Chapot R. LVIS EVO stent-through-balloon after hydrocoil embolization of intracranial aneurysms: One-year results. Interv Neuroradiol 2022:15910199221138151. [PMID: 36377272 DOI: 10.1177/15910199221138151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND AND PURPOSE To evaluate the durability and safety of complete intracranial aneurysm occlusion at one year using the low-profile braided intracranial LVIS EVO stent. MATERIALS AND METHODS This is a retrospective, monocentric, observational study of unruptured wide-necked intracranial aneurysms treated with the LVIS EVO stent-through-balloon technique after balloon-assisted hydrocoil embolization. Imaging and clinical data were assessed by two blinded independent neuroradiologists and neurologists, respectively. Primary endpoint was complete angiographic occlusion on day 0 and at 12 months. Secondary endpoints included clinical safety using the modified Rankin scale (mRS), ischemic and hemorrhagic adverse events, parent vessel stenosis > 50% or occlusion and retreatment rate. RESULTS 103 aneurysms in 103 patients were included (53 years-old, 77% women). Mean aneurysm size and neck were 7 and 4 mm, respectively. Complete occlusion was 97% initially and 90% at 12 months, with pending follow up in 17.5% patients. Five patients (5%) with partially stented necks were retreated with a second stent in a T-configuration. Two stents failed to open initially and were immediately retrieved. Asymptomatic parent vessel occlusion and severe in-stent stenosis occurred in 1% and 3%, respectively. The 12-month procedure-related permanent neurological deficit and mortality rates (mRS 3-6) were 2% and 1%, respectively. There was one fatal bleeding but no large ischemic complications. CONCLUSION Delivering the LVIS EVO stent through a dual lumen balloon after balloon-assisted hydrocoil embolization yields a high and stable rate of complete aneurysm occlusion at one year with a reasonable immediate and delayed complication rate.
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Affiliation(s)
- Pascal J Mosimann
- Department of intracranial endovascular therapy, Neuroradiology, Alfried-Krupp-Krankenhaus, Essen, Germany
| | - Elif Yamac
- Department of intracranial endovascular therapy, Neuroradiology, Alfried-Krupp-Krankenhaus, Essen, Germany
| | - Marta Wallocha
- Department of intracranial endovascular therapy, Neuroradiology, Alfried-Krupp-Krankenhaus, Essen, Germany
| | - Ahmed Ayad
- Department of intracranial endovascular therapy, Neuroradiology, Alfried-Krupp-Krankenhaus, Essen, Germany
| | - René Chapot
- Department of intracranial endovascular therapy, Neuroradiology, Alfried-Krupp-Krankenhaus, Essen, Germany
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Letter to the Editor: The Role of Modern Simulation Techniques in Neurovascular Surgery Training. World Neurosurg 2021; 148:233. [PMID: 33770840 DOI: 10.1016/j.wneu.2021.01.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 11/20/2022]
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Sayin B, Karaman A, Balci S, Akmangit İ, Daglioglu E, Arat A. Dual Stenting with New-Generation Stents for Aneurysm Embolization in Acute Subarachnoid Hemorrhage. World Neurosurg 2021; 154:e102-e108. [PMID: 34229098 DOI: 10.1016/j.wneu.2021.06.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Endosaccular treatment is the backbone of endovascular treatment for acutely ruptured aneurysms. Stent-assisted coiling is a niche technique in this context. Data on X-stenting or Y-stenting (dual crossing stenting, DCS) in the acute phase after subarachnoid hemorrhage (aSAH) are scarce, and the impact of stent properties on the outcome is unknown. We retrospectively evaluated the clinical and imaging results of DCS in patients treated for aSAH. METHODS Patients with aSAH treated with DCS were evaluated retrospectively. Patient and procedural characteristics were evaluated to determine clinical outcomes, associated complications, and follow-up imaging findings. RESULTS Sixteen procedures (16 patients; 10 women, mean age 55.8) were performed within 3.2 ± 2.6 days (range 1-10 days) of aSAH. Only the latest generation of intracranial stents (dual Neuroform Atlas-12 cases, dual Leo Baby-2 cases, Neuroform Atlas with Acclino Flex, or Leo Baby-2 cases) were used. Technical success rate was 100%; however, 25% of the procedures were complicated, leading to adverse events in 3 procedures (18.8%; 2 stent thrombosis, 1aneurysm rupture). Procedure-related morbidity and mortality and overall permanent morbidity and mortality were 6.3%, none, 6.3%, and 12.5%, respectively. No additional neurologic events were noted on a mean clinical follow-up of 160 ± 156 (range: 1-540) days. CONCLUSIONS Our findings and the patient-by-patient data we extracted from the literature suggest that DCS can be performed with new-generation, low-profile stents in aSAH if a definite procedural risk is acceptable for a specific patient. New-generation open-cell stent combinations appear as a viable choice for DCS in aSAH.
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Affiliation(s)
- Bige Sayin
- Department of Interventional Radiology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Ayberk Karaman
- Department of Neurosurgery, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Sinan Balci
- Department of Interventional Radiology, Ankara Hacettepe University, Ankara, Turkey
| | - İlkay Akmangit
- Department of Interventional Radiology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Ergun Daglioglu
- Department of Neurosurgery, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Anil Arat
- Department of Interventional Radiology, Ankara Hacettepe University, Ankara, Turkey.
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Al-Abdulwahhab AH, Lee DH, Song Y, Suh DC. Staged Approach for Stent-Assisted Coiling of Cerebral Aneurysms after Failure of Initial Intra-Saccular Catheterization. Neurointervention 2021; 16:46-51. [PMID: 33618505 PMCID: PMC7946552 DOI: 10.5469/neuroint.2020.00374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/03/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose Microcatheter navigation into an aneurysm sac can present difficulties through negative interactions between the deployed stent mesh and microcatheter. We hypothesized that endothelialization of the stent mesh would minimize these interactions. We aimed to assess the feasibility of staged coiling after stenting by reviewing our experiences with unavoidably staged embolization cases. Materials and Methods Between 2011 and 2019, 7 patients (mean age 57.2 years, range 49–76 years) including 5 females, experienced 9 unruptured aneurysms treated with staged stenting and coiling due to unstable microcatheter navigation into the aneurysm after stent placement. The aneurysms were in the paraclinoid internal carotid artery (ICA) (n=3), ophthalmic origin ICA (n=1), superior cerebellar artery origin (n=2), basilar tip (n=2), and the middle cerebral artery bifurcation (n=1). The stents used were the Neuroform Atlas (n=4), Neuroform EZ (n=2), and Low-profile Visualized Intraluminal Support Blue (n=1). Results The mean interval between stenting and coiling was 15 weeks (range, 12–21 weeks). The average navigation time between the first roadmap imaging and microcatheter insertion in the sac was 14 minutes (range, 8–20 minutes). One aneurysm was occluded without further coiling on follow-up. Staged coiling successfully treated the remaining aneurysms (n=8). No complications were identified. Conclusion In cases of difficult intra-saccular catheterization, intentional staged coiling may be a feasible option for stent-assisted coiling of the cerebral aneurysms.
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Affiliation(s)
- Abdulrahman Hamad Al-Abdulwahhab
- Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar City, Saudi Arabia
| | - Deok Hee Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yunsun Song
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Chul Suh
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Zaeske C, Hickethier T, Borggrefe J, Goertz L, Dettmeyer R, Schlamann M, Abdullayev N, Kabbasch C. Postinterventional Assessment after Stent and Flow-Diverter Implantation Using CT: Influence of Spectral Image Reconstructions and Different Device Types. AJNR Am J Neuroradiol 2020; 42:516-523. [PMID: 33384288 DOI: 10.3174/ajnr.a6952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/12/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE CTA provides a noninvasive alternative technique to DSA in the follow-up after endovascular aneurysm treatment to evaluate aneurysm occlusion and exclude intraluminal narrowing after stent or flow-diverter implantation; however, assessability may be impeded by stent material artifacts. The objective of this in vitro study was to compare the visual assessability of different conventional stents and flow diverters as well as different reconstructions of dual-layer CT images. MATERIALS AND METHODS Four conventional intracranial stents and 4 flow diverters were implanted in identical aneurysm phantoms. Conventional and monoenergetic images (40, 50, 60, 90, 120, 180 keV) were acquired to evaluate attenuation alteration, visible lumen diameter, and SNR. Image quality was rated subjectively by 2 independent radiologists using a 4-point Likert scale. RESULTS Low kiloelectron volt (40-60 keV) monoenergetic reconstructions showed an improved SNR and an improved lumen density ratio compared with high kiloelectron volt reconstructions (90-180 keV) and conventional reconstructions, however without reaching significance compared with the latter. Assessment of the adjacent aneurysm and subjective evaluation was not affected by the imaging technique and stent type. Artifact susceptibility varied with the device used and increased among flow diverters. CONCLUSIONS Low kiloelectron volt reconstructions improved the assessment of the stent lumen in comparison with high kiloelectron volt reconstructions. No significant improvement in image quality could be shown compared with conventional images. For some devices, iodine-specific reconstructions led to severe artifacts and are therefore not recommended. There was no relevant improvement in the assessability of the adjacent aneurysm.
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Affiliation(s)
- C Zaeske
- From the Institute for Diagnostic and Interventional Radiology (C.Z., T.H., J.B., L.G., M.S., N.A., C.K.)
| | - T Hickethier
- From the Institute for Diagnostic and Interventional Radiology (C.Z., T.H., J.B., L.G., M.S., N.A., C.K.)
| | - J Borggrefe
- From the Institute for Diagnostic and Interventional Radiology (C.Z., T.H., J.B., L.G., M.S., N.A., C.K.)
| | - L Goertz
- From the Institute for Diagnostic and Interventional Radiology (C.Z., T.H., J.B., L.G., M.S., N.A., C.K.).,Center for Neurosurgery (L.G.), Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - R Dettmeyer
- Institute of Forensic Medicine (R.D.), Justus-Liebig-University, Giessen, Germany
| | - M Schlamann
- From the Institute for Diagnostic and Interventional Radiology (C.Z., T.H., J.B., L.G., M.S., N.A., C.K.)
| | - N Abdullayev
- From the Institute for Diagnostic and Interventional Radiology (C.Z., T.H., J.B., L.G., M.S., N.A., C.K.)
| | - C Kabbasch
- From the Institute for Diagnostic and Interventional Radiology (C.Z., T.H., J.B., L.G., M.S., N.A., C.K.)
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Evaluation of the Accero Stent for Stent-Assisted Coiling of Unruptured Wide-Necked Intracranial Aneurysm Treatment with Short-Term Follow-Up. J Clin Med 2020; 9:jcm9092808. [PMID: 32877984 PMCID: PMC7564441 DOI: 10.3390/jcm9092808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Stent-assisted coiling is an effective method of treating intracranial aneurysms. The aim of the study was to assess the safety and efficacy of the new Accero stent for the treatment of intracranial aneurysms. MATERIALS AND METHODS It was a retrospective, single-center study. Eighteen unruptured intracranial aneurysms were treated using the stent-assisted coiling method with the Accero stent. Patient demographics, aneurysm characteristics, procedural parameters, grade of occlusion, complications, and clinical results were analyzed. Follow-up magnetic resonance (MR) was performed 6 months after intervention. RESULTS Seventeen patients with 18 incidental unruptured aneurysms were electively treated with coiling and the Accero stent. The aneurysms were located on internal carotid artery (ICA), middle cerebral artery (MCA) and basilar artery (BA). All stents were deployed successfully. Immediate complete occlusion rate Raymond-Roy occlusion classification (RROC) class I was achieved in 13 cases and class II in 4 cases. Complications occurred in 2/17 treatments and included guidewire stent perforation with subarachnoid hemorrhage (SAH) and stent deformation. Vascular spasm in the subarachnoid hemorrhage (SAH) patient subsided before discharge. Ninety days after intervention, the modified Rankin Scale (mRS) value was 0. RROC class I was observed in 88.23% of cases in follow-up. CONCLUSION The Accero stent provides excellent support for coil mass. It constitutes an efficacious device with good initial occlusion rate for treating wide-necked unruptured intracranial aneurysms.
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