1
|
Ahn HS, Jeon HJ, Cho BM, Park SH. Single Neuroform Atlas stent: a reliable approach for treating complex wide-neck bifurcated aneurysms. Front Neurol 2024; 15:1391799. [PMID: 39099782 PMCID: PMC11295356 DOI: 10.3389/fneur.2024.1391799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/01/2024] [Indexed: 08/06/2024] Open
Abstract
Background Treating wide-neck bifurcated cerebral aneurysms (WNBAs) using various techniques and new devices has shown favorable outcomes. However, endovascular coiling can be technically challenging when the aneurysm neck is incorporated into the parent vessel. Furthermore, although recent research has reported favorable outcomes of Neuroform Atlas stent (NAS)-assisted coiling, broad inclusion criteria have hampered precise evaluations of their effectiveness and safety for treating complex WNBAs. Therefore, this study evaluated whether the use of a single NAS is a safe and effective approach for treating complex WNBAs. Methods We treated 76 complex WNBAs (unruptured, n = 49; ruptured, n = 27) using single NAS-assisted coil embolization and retrospectively analyzed the clinical and angiographic outcomes. Results In a cohort of 68 patients (mean age, 58.3 ± 11.6 years; males n = 20, 29.4%; females, n = 48, 70.6%), 76 stents were successfully delivered to the target aneurysms, yielding a technical success rate of 98.6%. Complete occlusion was evident in 59 (77.6%) of 76 aneurysms, with neck remnants found in 16 (21.1%) and partial occlusion in 1 (1.3%). Treatment-related morbidities comprised one branch occlusion and one parenchymal hemorrhage. However, no new neurological symptoms of unruptured aneurysms were evident at discharge. The outcomes of 20 of the 27 ruptured aneurysms were favorable (Glasgow Outcome Scale scores of 4 or 5) at the final follow-up assessment (mean 12.2 [6-29] months), except for one initial subarachnoid hemorrhage. Post-treatment angiography revealed complete occlusion in 89.1%, neck remnants in 7.8%, and incomplete occlusion in 3.1% of the aneurysms. Approximately 88.2% of the patients were assessed at least once by follow-up diagnostic or magnetic resonance angiography (mean, 12.5 ± 4.3 [range, 6-29] months), with five (7.8%) minor and two (3.1%) major recurrences. Conclusion A single NAS is safe and effective for treating WNBAs incorporated into parent vessels.
Collapse
Affiliation(s)
| | - Hong Jun Jeon
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | | | | |
Collapse
|
2
|
Lim J, Monteiro A, Jacoby WT, Danziger H, Kuo CC, Alkhars H, Donnelly BM, Khawar WI, Lian MX, Iskander J, Davies JM, Snyder KV, Siddiqui AH, Levy EI. Coiling Variations for Treatment of Ruptured Intracranial Aneurysms: A Meta-Analytical Comparison of Comaneci-, Stent-, and Balloon-Coiling Assistance Techniques. World Neurosurg 2023; 175:e1324-e1340. [PMID: 37169072 DOI: 10.1016/j.wneu.2023.05.008] [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: 01/18/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Wide-necked aneurysms represent a challenge for treatment in the setting of acute subarachnoid hemorrhage. Stent-assisted coiling (SAC) and balloon-assisted coiling (BAC) are well-known techniques for treating wide-necked aneurysms. Comaneci-assisted coiling (CAC) is a newer technique involving temporary stent deployment to assist aneurysm coiling. We aim to present the first meta-analysis comparing these treatments of ruptured aneurysms. METHODS Following PRISMA guidelines, PubMed and Embase databases were queried from earliest records to July 2022 for literature reporting SAC, BAC, or CAC of ruptured intracranial aneurysms. A meta-analysis of identified articles was performed. RESULTS Of the 571 articles queried, 64 articles were included. One study reported BAC and SAC, 8 reported BAC, 52 reported SAC, and 3 reported CAC. These studies comprised 3153 patients with 3207 ruptured aneurysms treated with CAC (161 patients and aneurysms), BAC (330 patients and aneurysms), and SAC (2662 patients, 2716 aneurysms). Rates of periprocedural thromboembolic or hemorrhagic complications, overall or procedure-related mortality, immediate complete occlusion, retreatment, and length of angiographic follow-up did not differ significantly between SAC and BAC. Periprocedural thromboembolic (P = 0.03) and hemorrhagic (P = 0.01) complication rates were higher with BAC than CAC. Periprocedural thromboembolic (P = 0.03) and hemorrhagic (P < 0.0001) complication rates were higher with SAC than CAC. Complete aneurysm occlusion rates (P = 0.033) were higher with CAC than BAC. No significant differences were present in CAC versus BAC or SAC retreatment rates. CONCLUSIONS CAC was associated with lower hemorrhagic and thromboembolic complication rates and demonstrated similar complete occlusion and residual retreatment rates to those for BAC and SAC.
Collapse
Affiliation(s)
- Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Wady T Jacoby
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Hannah Danziger
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Hussain Alkhars
- George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Brianna M Donnelly
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Wasiq I Khawar
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Ming X Lian
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Joseph Iskander
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
| |
Collapse
|
3
|
Santos-Franco JA, Cruz-Argüelles CA, Abrego-Salinas AA, Casas-Martínez MR, DeFont-Reaulx Rojas E. [Brain aneurysms treatment with pCONus2 device. Initial experience at IMSS]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:265-273. [PMID: 37216405 PMCID: PMC10437233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/08/2022] [Indexed: 05/24/2023]
Abstract
Background pCONus2 device has been used in some countries as coadyuvant in the treatment of wide-neck bifurcation aneurysms with coils. Objective To present the first series of brain aneurysms treated with pCONus2 in the Mexican Institute for Social Security (IMSS). Material and methods We retrospectively present the first 13 aneurysms treated from October 2019 to February 2022 with pCONus2 device at a third level hospital. Results 6 aneurysms located at anterior communicating artery, 3 at middle cerebral artery bifurcation, 2 at internal carotid artery bifurcatión, and 2 at the tip of basilar artery were treated. Device deployment was performed without complications and it was possible to embolize aneurysms with coils in 12 patients (92%), while on an internal carotid bifurcation aneurysm (8%) there was an incident of a pCONus2 petal migration toward vascular lumen caused by coils mesh pressure, situation that was solved by placing an nitinol self-expandable microstent. In 7 cases (54%) we performed coiling technique after microcatheter passage through pCONus2, while in 6 cases (46%) we used the jailing technique without complications. Conclusions pCONus2 is a useful device for wide-neck bifurcation aneurysms embolization. In Mexico our experience is yet limited; however, the first cases have been successful. Furthermore, we showed the first cases treated using jailing technique. Much more cases are required in order to carry out a statistically conclusive analysis and to establish the effectiveness and safety of the device.
Collapse
Affiliation(s)
- Jorge Arturo Santos-Franco
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Departamento de Neurocirugía y Terapia Endovascular Neurológica. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Carlos Antonio Cruz-Argüelles
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Departamento de Neurocirugía y Terapia Endovascular Neurológica. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Adrián Alejandro Abrego-Salinas
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Departamento de Neurocirugía y Terapia Endovascular Neurológica. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Martín Roberto Casas-Martínez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, Departamento de Neurocirugía y Terapia Endovascular Neurológica. Ciudad de México, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | | |
Collapse
|
4
|
Ban SP, Kwon OK, Kim YD. Long-Term Outcomes of Placement of a Single Transverse Stent through the Anterior Communicating Artery via the Nondominant A1 in Coil Embolization of Wide-Necked Anterior Communicating Artery Aneurysms. J Korean Neurosurg Soc 2021; 65:40-48. [PMID: 34879639 PMCID: PMC8752886 DOI: 10.3340/jkns.2021.0191] [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: 07/23/2021] [Accepted: 10/15/2021] [Indexed: 11/27/2022] Open
Abstract
Objective Placement of a single transverse stent via the nondominant A1 across the anterior communicating artery (AComA) into the contralateral A2 can provide sufficient neck coverage for wide-necked bifurcation AComA aneurysms. The authors described the feasibility, safety and long-term outcomes of this technique.
Methods Between January 2015 and February 2018, placement of a single transverse stent via the nondominant A1 was attempted in 17 wide-necked bifurcation AComA aneurysms. The authors reviewed the medical records and radiological studies.
Results The technical success rate was 94.1% (16/17). Periprocedural thromboembolic complications occurred in one patient (6.3%) without permanent neurological deficits. The mean clinical follow-up duration was 39.9±9.8 months. No deaths or delayed thromboembolic complications occurred. The mean angiographic follow-up duration was 38.9±9.8 months. The immediate and final follow-up complete occlusion rates were 87.4 and 93.7%, respectively. There was no recanalization during the follow-up period.
Conclusion Placement of a single transverse stent via the nondominant A1 across the AComA into the contralateral A2 is a feasible and relatively safe endovascular technique for the treatment of wide-necked bifurcation AComA aneurysms, with good long-term occlusion rates and a reasonable complication rate, if only the nondominant A1 is applicable.
Collapse
Affiliation(s)
- Seung Pil Ban
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - O-Ki Kwon
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Young Deok Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
5
|
Lv X, Zhang W, Zhao X, Zhang H, Wang J. Endovascular Treatment of Small Wide-Neck Bifurcation Aneurysms with Single Solitaire AB Stent Technique. Neurol India 2021; 69:879-882. [PMID: 34507405 DOI: 10.4103/0028-3886.323897] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE We present our experience in using the single Solitaire AB stent for small wide-neck bifurcation aneurysms (WNBAs). MATERIALS AND METHODS During 18 months, 20 small (the largest width <10 mm) WNBAs were treated with the single Solitaire AB stent-assisted coiling. The patients were 12 women and 8 men, with a mean age of 52 years (range: 36-66 years). The mean aneurysm size was 4.2 mm (2-9 mm) and mean neck size was 3.9 mm (2-9 mm). Results at follow-up were graded as complete occlusion, neck remnant, or residual aneurysm. RESULTS All 20 small WNBAs were adequately occluded after a single Solitaire AB stent placement. There were no procedural ruptures and no thromboembolic complications occurred. Two patients developed a transient neurological deficit. In 20 patients with angiographic follow-up at 6 months, 16 (80%) aneurysms remained adequately occluded. Clinical follow-up in the 20 patients revealed mRS 0-2 in all. CONCLUSIONS Single Solitaire AB stent-assisted coil embolization for small WNBAs was safe and effective.
Collapse
Affiliation(s)
- Xianli Lv
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wei Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xuelian Zhao
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Huifang Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - James Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| |
Collapse
|
6
|
Srinivasan VM, Srivatsan A, Spiotta AM, Hendricks BK, Ducruet AF, Albuquerque FC, Puri A, Amans MR, Hetts SW, Cooke DL, Ogilvy CS, Thomas AJ, Enriquez-Marulanda A, Rai A, Boo S, Carlson AP, Crowley RW, Rangel-Castilla L, Lanzino G, Chen PR, Diaz O, Bohnstedt BN, O'Connor KP, Burkhardt JK, Johnson JN, Chen SR, Kan P. Early postmarket results with PulseRider for treatment of wide-necked intracranial aneurysms: a multicenter experience. J Neurosurg 2020; 133:1756-1765. [PMID: 31703202 DOI: 10.3171/2019.5.jns19313] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 05/08/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Traditionally, stent-assisted coiling and balloon remodeling have been the primary endovascular treatments for wide-necked intracranial aneurysms with complex morphologies. PulseRider is an aneurysm neck reconstruction device that provides parent vessel protection for aneurysm coiling. The objective of this study was to report early postmarket results with the PulseRider device. METHODS This study was a prospective registry of patients treated with PulseRider at 13 American neurointerventional centers following FDA approval of this device. Data collected included clinical presentation, aneurysm characteristics, treatment details, and perioperative events. Follow-up data included degree of aneurysm occlusion and delayed (> 30 days after the procedure) complications. RESULTS A total of 54 aneurysms were treated, with the same number of PulseRider devices, across 13 centers. Fourteen cases were in off-label locations (7 anterior communicating artery, 6 middle cerebral artery, and 1 A1 segment anterior cerebral artery aneurysms). The average dome/neck ratio was 1.2. Technical success was achieved in 52 cases (96.2%). Major complications included the following: 3 procedure-related posterior cerebral artery strokes, a device-related intraoperative aneurysm rupture, and a delayed device thrombosis. Immediately postoperative Raymond-Roy occlusion classification (RROC) class 1 was achieved in 21 cases (40.3%), class 2 in 15 (28.8%), and class 3 in 16 cases (30.7%). Additional devices were used in 3 aneurysms. For those patients with 3- or 6-month angiographic follow-up (28 patients), 18 aneurysms (64.2%) were RROC class 1 and 8 (28.5%) were RROC class 2. CONCLUSIONS PulseRider is being used in both on- and off-label cases following FDA approval. The clinical and radiographic outcomes are comparable in real-world experience to the outcomes observed in earlier studies. Further experience is needed with the device to determine its role in the neurointerventionalist's armamentarium, especially with regard to its off-label use.
Collapse
Affiliation(s)
| | | | - Alejandro M Spiotta
- 2Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | | | - Andrew F Ducruet
- 3Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Ajit Puri
- 4Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Matthew R Amans
- 5Department of Radiology, University of California at San Francisco, San Francisco, California
| | - Steven W Hetts
- 5Department of Radiology, University of California at San Francisco, San Francisco, California
| | - Daniel L Cooke
- 5Department of Radiology, University of California at San Francisco, San Francisco, California
| | - Christopher S Ogilvy
- 6Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ajith J Thomas
- 6Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Ansaar Rai
- 7Department of Radiology, West Virginia University Hospital, Morgantown, West Virginia
| | - SoHyun Boo
- 7Department of Radiology, West Virginia University Hospital, Morgantown, West Virginia
| | - Andrew P Carlson
- 8Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - R Webster Crowley
- 9Department of Neurosurgery, Rush Medical College, Chicago, Illinois
| | | | | | - Peng Roc Chen
- 11Department of Neurosurgery, University of Texas Health Science Center, Houston, Texas
| | - Orlando Diaz
- 12The Cerebrovascular Center, Houston Methodist Hospital, Houston, Texas; and
| | - Bradley N Bohnstedt
- 13Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Kyle P O'Connor
- 13Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | | | | | | | | |
Collapse
|
7
|
Krupa K, Brzegowy P, Kucybała I, Łasocha B, Urbanik A, Popiela TJ. Endovascular embolization of wide-necked bifurcation aneurysms with the use of pCONus device: A systematic review and meta-analysis. Clin Imaging 2020; 70:81-88. [PMID: 33130244 DOI: 10.1016/j.clinimag.2020.10.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/24/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The following study aimed to summarize the overall safety and efficacy of the pCONus device in the treatment of wide-necked bifurcation aneurysms. MATERIAL AND METHODS Major electronic medical databases were thoroughly searched to identify relevant studies. Data regarding the type of included studies, type of aneurysm and its location, treatment results measured in Raymond-Roy Occlusion Class (RROC) and its complications, as well as patients' neurological outcome at the discharge were extracted from the eligible studies and included in the meta-analysis. The subgroup analyses dependent on the aneurysm rupture status were also conducted. RESULTS A total of 8 studies (198 patients with 200 aneurysms) were included in this meta-analysis. The most common localization of the treated aneurysms was the middle cerebral artery with its pooled prevalence estimate (PPE) of 44.5%. Immediately after the procedure, RROC I (complete obliteration of the aneurysm) was observed in 46.8%, RROC II in 32.9%, while RROC III (residual aneurysm) in 20.3% of the patients. In a short-term follow-up, PPE of RROC I was 55.0%, RROC II 29.0%, and RROC III 16.1%. The PPE of intraprocedural complications was 17.3%, the most frequent were thromboembolic events, which were observed in 12.1% of all procedures. Poor neurological outcome at the discharge was noted with PPE of 9.6%. CONCLUSIONS The effectiveness and safety of wide-necked bifurcation aneurysm treatment utilizing the pCONus device is moderate. There is still a need for a consensus regarding the effective antiplatelet regimen in furtherance of diminishing the rate of thromboembolic events.
Collapse
Affiliation(s)
- Kamil Krupa
- Department of Radiology, Jagiellonian University Medical College, 19 Kopernika Street, 31-501 Krakow, Poland; International Evidence-Based Anatomy Working Group (iEBA-WG), 12 Kopernika Street, 31-034 Krakow, Poland
| | - Paweł Brzegowy
- Department of Radiology, Jagiellonian University Medical College, 19 Kopernika Street, 31-501 Krakow, Poland
| | - Iwona Kucybała
- Department of Radiology, Jagiellonian University Medical College, 19 Kopernika Street, 31-501 Krakow, Poland.
| | - Bartłomiej Łasocha
- Department of Radiology, Jagiellonian University Medical College, 19 Kopernika Street, 31-501 Krakow, Poland
| | - Andrzej Urbanik
- Department of Radiology, Jagiellonian University Medical College, 19 Kopernika Street, 31-501 Krakow, Poland
| | - Tadeusz J Popiela
- Department of Radiology, Jagiellonian University Medical College, 19 Kopernika Street, 31-501 Krakow, Poland
| |
Collapse
|
8
|
Jeon HJ, Park JH, Lee JY, Jeon HJ, Park SW, Cho BM. Endovascular Coiling for a Wide-neck Bifurcated Aneurysm with Anterograde Horizontal Stenting via Microcatheter Looping: A Technical Case Report. J Cerebrovasc Endovasc Neurosurg 2018; 20:181-186. [PMID: 30397590 PMCID: PMC6199400 DOI: 10.7461/jcen.2018.20.3.181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/05/2018] [Accepted: 09/14/2018] [Indexed: 11/23/2022] Open
Abstract
Technical advances with devices such as catheters, balloons, and stents have widened the indications for endovascular coiling for unfavorable aneurysms. The authors report two cases of coil embolization for a wide-neck bifurcated aneurysm with anterograde horizontal stenting via microcatheter looping. Two women, aged 56 and 38 years, respectively, had an undertall- and overwide-neck aneurysm with bifurcated branches at the basilar bifurcation and middle cerebral bifurcation, respectively. The delivery microcatheter was steamed so that it could be looped deliberately to the opposite vessel. The enterprise stent was first anchored to the vessel of the posterior cerebral artery on one side. The remaining portion was spanned into a looped microcatheter to the opposite branch while pushing the stent. The Neuroform Atlas stent was passed directly through the looped segment of the microcatheter at the M2 branch and spanned horizontally by unsheathing. Under horizontal stenting, complete coil embolization was achieved without immediate or delayed complications in both cases. This novel technique presents a viable option for stent-assisted coiling within an optimal anatomy.
Collapse
Affiliation(s)
- Hyun-Jae Jeon
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jong-Hwa Park
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.,Department of Neurosurgery, Gangwon National University College of Medicine, Chuncheon, Korea
| | - Jong-Young Lee
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hong-Jun Jeon
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.,Department of Neurosurgery, Gangwon National University College of Medicine, Chuncheon, Korea
| | - Seoung-Woo Park
- Department of Neurosurgery, Gangwon National University College of Medicine, Chuncheon, Korea
| | - Byung-Moon Cho
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| |
Collapse
|
9
|
Mine B, Bonnet T, Vazquez-Suarez JC, Iosif C, Lubicz B. Comparison of stents used for endovascular treatment of intracranial aneurysms. Expert Rev Med Devices 2018; 15:793-805. [DOI: 10.1080/17434440.2018.1538779] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Benjamin Mine
- Department of Interventional Neuroradiology, University Hospital Erasme, Brussels, Belgium
| | - Thomas Bonnet
- Department of Interventional Neuroradiology, University Hospital Erasme, Brussels, Belgium
| | | | - Christina Iosif
- Department of Interventional Neuroradiology, University Hospital Erasme, Brussels, Belgium
| | - Boris Lubicz
- Department of Interventional Neuroradiology, University Hospital Erasme, Brussels, Belgium
| |
Collapse
|
10
|
Adeeb N, Griessenauer CJ, Patel AS, Foreman PM, Baccin CE, Moore JM, Gupta R, Alturki A, Harrigan MR, Ogilvy CS, Thomas AJ. The Use of Single Stent-Assisted Coiling in Treatment of Bifurcation Aneurysms: A Multicenter Cohort Study With Proposal of a Scoring System to Predict Complete Occlusion. Neurosurgery 2017; 82:710-718. [DOI: 10.1093/neuros/nyx310] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 05/11/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The development of stent-assisted coiling has allowed for the endovascular treatment of wide-necked bifurcation aneurysms. A variety of options exist, and little is known about the optimal stent configuration in this setting. We report a large multicenter experience of stent-assisted coiling of bifurcations aneurysms using a single stent, with attention to factors predisposing to aneurysm recanalization.
OBJECTIVE
To assess the safety and efficacy of single stent-assisted coiling, in addition to analyzing the factors associated with recanalization, and proposal of a predictive scoring scale.
METHODS
A multicenter retrospective analysis of bifurcation aneurysms treated with a single stent-assisted coiling technique between 2007 and 2015 was performed. Clinical and radiographic data were collected and used to develop a scoring system to predict aneurysm occlusion.
RESULTS
A total of 74 bifurcation aneurysms were treated with single stent-assisted coiling. At a median follow-up of 15.2 mo, complete occlusion or remnant neck was achieved in 90.6% of aneurysms. Aneurysm location, maximal diameter, neck size, and alpha angle were predictive of aneurysm occlusion at last follow-up. A scoring system to predict complete occlusion based on these factors was developed. An increasing score correlated with a higher rate of complete occlusion.
CONCLUSION
The treatment of bifurcation aneurysm using single stent technique for stent-assisted coiling is safe and effective. Complete occlusion or remnant neck occlusion was achieved in 90.6% of cases. Class III aneurysms can be effectively treated using a single stent, while class I may require Y-stent technique.
Collapse
Affiliation(s)
- Nimer Adeeb
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christoph J Griessenauer
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Apar S Patel
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Paul M Foreman
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Carlos E Baccin
- Department of Neurosurgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Raghav Gupta
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Abdulrahman Alturki
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mark R Harrigan
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
11
|
Kocur D, Ślusarczyk W, Przybyłko N, Bażowski P, Właszczuk A, Kwiek S. Stent-Assisted Endovascular Treatment of Anterior Communicating Artery Aneurysms - Literature Review. Pol J Radiol 2016; 81:374-9. [PMID: 27559426 PMCID: PMC4981124 DOI: 10.12659/pjr.896818] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/07/2016] [Indexed: 11/23/2022] Open
Abstract
The anterior cerebral artery is a common location of intracranial aneurysms. The standard coil embolization technique is limited by its inability to occlude wide-neck aneurysms. Stent deployment across the aneurysm neck supports the coil mass inside the aneurysmal sac, and furthermore, has an effect on local hemodynamic and biologic changes. In this article, various management strategies and techniques as well as angiographic outcomes and complications related to stent-assisted endovascular treatment of anterior communicating artery aneurysms are presented. This treatment method is safe and associated with low morbidity and mortality rates.
Collapse
Affiliation(s)
- Damian Kocur
- Department of Neurosurgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Wojciech Ślusarczyk
- Department of Neurosurgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
- Department of Physiology, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Nikodem Przybyłko
- Department of Neurosurgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Piotr Bażowski
- Department of Neurosurgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Adam Właszczuk
- Department of Physiology, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Stanisław Kwiek
- Department of Neurosurgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| |
Collapse
|
12
|
Sanal B, Nas OF, Hacikurt K, Hakyemez B, Erdogan C. Retrievable Stent-Assisted Coiling Technique Using a Solitaire Stent: Treatment of Pancreaticoduodenal Artery Aneurysm Associated With Celiac Artery Occlusion. Vasc Endovascular Surg 2016; 50:84-7. [PMID: 26983665 DOI: 10.1177/1538574416631644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
True aneurysm of pancreaticoduodenal arcade (PDA) is usually accompanied by stenosis or occlusion of celiac trunk (CeT). The up-to-date and first choice treatment modality of PDA aneurysm is the endovascular approach in nearly all cases except few selected ones necessitating surgery. The main approach in endovascular treatment is embolization of the aneurysm by preserving the parent artery. A case with concomitant CeT occlusion and PDA aneurysm was treated with coil embolization by preserving inferior pancreaticoduodenal artery with retrievable Solitaire(®) stent. In our knowledge, this is the first case with PDA aneurysm treated with this technique.
Collapse
Affiliation(s)
- Bekir Sanal
- Faculty of Medicine, Department of Radiology, Dumlupinar University, Kutahya, Turkey
| | - Omer Fatih Nas
- Faculty of Medicine, Department of Radiology, Uludag University, Bursa, Turkey
| | - Kadir Hacikurt
- Faculty of Medicine, Department of Radiology, Uludag University, Bursa, Turkey
| | - Bahattin Hakyemez
- Faculty of Medicine, Department of Radiology, Uludag University, Bursa, Turkey
| | - Cuneyt Erdogan
- Faculty of Medicine, Department of Radiology, Uludag University, Bursa, Turkey
| |
Collapse
|
13
|
Pérez MA, Henkes H, Bouillot P, Brina O, Slater LA, Pereira VM. Intra-aneurysmal hemodynamics: evaluation of pCONus and pCANvas bifurcation aneurysm devices using DSA optical flow imaging. J Neurointerv Surg 2015; 8:1197-1201. [PMID: 26701125 PMCID: PMC5099319 DOI: 10.1136/neurintsurg-2015-011927] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/02/2015] [Indexed: 11/29/2022]
Abstract
Background Implantation of self-expanding stents from the parent artery into the sac of a bifurcation aneurysm is regularly used to facilitate endovascular coil occlusion with the so-called waffle cone technique (WCT). Self-expanding aneurysm bridging stents like Solitaire AB, can be used; however, bifurcation devices like pCONus and pCANvas are especially designed for WCT. These devices provide additional support for coil implantation owing to intraluminal nylon fibers (pCONus) or membranes (pCANvas) covering the intracranial aneurysm neck. Objective Assessment of the intra-aneurysmal hemodynamic impact of these three devices: a regular intracranial stent (Solitaire AB) and two bifurcation devices (pCONus and pCANvas). Material and methods An in vitro experiment was set up using a silicone model of a basilar tip aneurysm filled with blood mimicking fluid under a pulsatile circulation. Solitaire AB, pCONus, and pCANvas were successively implanted in the model for hemodynamic evaluation. High frame rate DSA series were acquired under various conditions. Intra-aneurysmal flow changes, including mean aneurysm flow amplitude ratio (R), were subsequently assessed by the optical flow method, measuring the detector velocity field before and after device implantations. Results pCONus and Solitaire minimally reduced the intra-aneurysmal flow (R=0.96, p=0.17 and R=0.91, p=0.01, respectively), whereas pCANvas strongly diminished the intra-aneurysmal flow (R=0.41, p=5×10−12). Conclusions Waffle cone deployment of stents and technique-specific devices had no undesirable effect on the intra-aneurysmal flow. In particular, no increased flow was redirected into the aneurysm sac. The intraluminal membrane of the pCANvas strongly reduced the intra-aneurysmal flow, potentially preventing recanalization problems.
Collapse
Affiliation(s)
- Marta Aguilar Pérez
- Klinik für Neuroradiologie, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
| | - Hans Henkes
- Klinik für Neuroradiologie, Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany
| | - Pierre Bouillot
- Interventional Neuroradiology Unit, University Hospital of Geneva, Geneva, Switzerland Laboratory for Hydraulic Machines (LMH), Ecole Polytechnique Fédérale de Lausanne (EPFL), Avenue de Cour 33bis, CH-1007 Lausanne, Switzerland
| | - Olivier Brina
- Interventional Neuroradiology Unit, University Hospital of Geneva, Geneva, Switzerland
| | - Lee-Anne Slater
- Joint Division of Medical Imaging, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Vitor Mendes Pereira
- Joint Division of Medical Imaging, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
14
|
Fischer S, Weber A, Titschert A, Brenke C, Kowoll A, Weber W. Single-center experience in the endovascular treatment of wide-necked intracranial aneurysms with a bridging intra-/extra-aneurysm implant (pCONus). J Neurointerv Surg 2015; 8:1186-1191. [PMID: 26658279 PMCID: PMC5099317 DOI: 10.1136/neurintsurg-2015-012004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/30/2015] [Indexed: 12/04/2022]
Abstract
Purpose To retrospectively evaluate the safety and efficacy of the endovascular treatment of wide-necked intracranial aneurysms assisted by a novel intra-/extra-aneurysm stent-like implant (pCONus). Methods Initial and follow-up angiographic and clinical results are presented of 25 patients with 25 unruptured and ruptured wide-necked intracranial aneurysms treated by reconstruction of the aneurysm neck using the pCONus implant followed by coil occlusion of the fundus. Results Successful intra-/extra-aneurysm deployment of the pCONus with coil occlusion of the fundus was achieved in all but one case. Procedure-related ischemic complications were observed in three cases with permanent deterioration in one. Acceptable aneurysm occlusion was achieved in all cases. Follow-up angiography revealed sufficient occlusion in 81.0% of the aneurysms. Intimal hyperplasia in the stented segment of the parent artery or device migration has not been observed to date. Conclusions The pCONus device offers a promising treatment option for complex wide-necked bifurcation intracranial aneurysms. Acute or delayed dislocations of coils into the parent artery are successfully avoided.
Collapse
Affiliation(s)
- S Fischer
- Knappschaftskrankenhaus Bochum-Langendreer Universitätsklinik, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin, Bochum, Germany
| | - A Weber
- Knappschaftskrankenhaus Bochum-Langendreer Universitätsklinik, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin, Bochum, Germany
| | - A Titschert
- Knappschaftskrankenhaus Bochum-Langendreer Universitätsklinik, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin, Bochum, Germany
| | - C Brenke
- Knappschaftskrankenhaus Bochum-Langendreer Universitätsklinik, Klinik für Neurochirurgie, Bochum, Germany
| | - A Kowoll
- Knappschaftskrankenhaus Bochum-Langendreer Universitätsklinik, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin, Bochum, Germany
| | - W Weber
- Knappschaftskrankenhaus Bochum-Langendreer Universitätsklinik, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin, Bochum, Germany
| |
Collapse
|
15
|
Nas OF, Kacar E, Kaya A, Erdogan C, Hakyemez B. Modified Y-configured stents with the waffle-cone technique by use of Solitaire® stent for patients with wide-necked bifurcation aneurysms. Jpn J Radiol 2015; 33:503-8. [PMID: 26142255 DOI: 10.1007/s11604-015-0454-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/25/2015] [Indexed: 11/28/2022]
Abstract
Endovascular treatment of wide-necked bifurcation aneurysms can be challenging, despite improvements in endovascular techniques. Y stent-assisted coiling is one such technique, but this may not be technically feasible, especially in cases of acute angulation between the proximal and distal parent arteries, and may require use of "modified Y-configured stents with the waffle-cone technique". We report three cases of wide-necked bifurcation aneurysms that were successfully treated by use of the Solitaire® stent.
Collapse
Affiliation(s)
- Omer Fatih Nas
- Department of Radiology, Uludag University Faculty of Medicine, Bursa, Turkey,
| | | | | | | | | |
Collapse
|
16
|
Lee SM, Kim YJ, Ko JH. The effectiveness of the waffle-cone technique in treating complex intracranial aneurysms. Interv Neuroradiol 2015; 21:470-8. [PMID: 26092438 DOI: 10.1177/1591019915590529] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report 13 consecutive cases of complex intracranial aneurysms treated by the waffle-cone technique and the midterm angiographic results and discuss the effectiveness and safety of this technique. We performed a retrospective review to evaluating the angiographic results and clinical effectiveness of 15 cases in which waffle-cone stenting for treating broad-necked complex intracranial aneurysms at our institution up to July 2008. Among these 15 patients, we enrolled 13 patients who had undergone at least one follow-up angiography. We collected patient data including age, sex, ruptured state, aneurysm size, neck size, complications, initial Hunt and Hess (HH) grade, modified Rankin Score (mRS) at the last angiographic follow-up, and initial and follow- up angiographic results.The mean size of the aneurysm was 10.6 mm (range, 4.0 to 20.4 mm) and the mean size of the aneurysm neck was 5.7 mm (range, 2.7 to 9.2 mm). The mean angiographic follow-up time was 13.6 months (range, six to 30 months). There were no procedure-related complications. However, there were two delayed complications. One complication was delayed focal embolic infarct and the other complication was delayed rebleeding. Angiographic improvement was achieved in two cases (15.4%), stable occlusion was achieved in seven cases (53.8%), and recanalization or compaction that needed retreatment occurred in four cases (30.8%). We think that the waffle-cone technique is an effective alternative in selected aneurysms unable to be "Y" stented or surgically clipped.
Collapse
Affiliation(s)
- Shih-Min Lee
- Department of Neurosurgery, Dankook University, College of Medicine, Korea
| | - Young-Joon Kim
- Department of Neurosurgery, Dankook University, College of Medicine, Korea
| | - Jung Ho Ko
- Department of Neurosurgery, Dankook University, College of Medicine, Korea
| |
Collapse
|
17
|
Duan G, Feng Z, Zhang L, Zhang P, Chen L, Hong B, Xu Y, Zhao W, Liu J, Huang Q. Solitaire stents for the treatment of complex symptomatic intracranial stenosis after antithrombotic failure: safety and efficacy evaluation. J Neurointerv Surg 2015; 8:680-4. [PMID: 26041096 DOI: 10.1136/neurintsurg-2015-011734] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/11/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To evaluate the feasibility, safety, and efficacy of Solitaire stent placement after balloon angioplasty for the treatment of complex symptomatic intracranial atherosclerotic stenosis (ICAS). METHODS We retrospectively reviewed the clinical data from 44 patients who underwent Solitaire stent placement for complex symptomatic ICAS at our department between November 2010 and March 2014, with focus on the clinical factors, lesion characteristics, treatment results, and periprocedural complications. We also summarized the early outcomes and imaging findings during the follow-up period. RESULTS Overall, the technical success rate was 100% (44/44). Post-stenting residual stenosis ranged from 0% to 40% (mean 15.00±12.94%). The overall 30-day rate of procedure-related complications was 9.09% (4/44). The incidence of recurrent ischemic events related to the territory artery was 4.55% during a mean clinical follow-up period of 25.5 months. Five patients (11.36%) developed in-stent restenosis during a mean angiographic follow-up period of 9.3 months. CONCLUSIONS This is the first case series study of ICAS treated by Solitaire stent placement. Deployment of a Solitaire stent with balloon angioplasty in the treatment of complex severe intracranial stenosis appears safe and effective, with a high technical success rate, relatively low periprocedural complication rate, and favorable outcome during follow-up.
Collapse
Affiliation(s)
- Guoli Duan
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhengzhe Feng
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Lei Zhang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Ping Zhang
- Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Lei Chen
- Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Bo Hong
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yi Xu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wenyuan Zhao
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| |
Collapse
|
18
|
Nas OF, Kacar E, Kaya A, Erdogan C, Hakyemez B. Rare use of twin Solitaire® stents in the double waffle-cone technique for endovascular treatment of a wide-necked bifurcation aneurysm. Interv Neuroradiol 2015; 21:167-70. [PMID: 25964439 DOI: 10.1177/1591019915581998] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Endovascular treatment of wide-necked bifurcation aneurysms may be challenging. The waffle-cone technique can be used in these aneurysms in case of acute angulation between parent artery and distal artery of the aneurysm. Solitaire® stent (Ev3, Irvine, CA, USA) has the significant advantage of mitigating the potential complication risks. This study reports the second case in the literature in which endovascular treatment of a wide-necked bifurcation aneurysm with the double waffle-cone technique by using twin Solitaire® stents proved to be successful.
Collapse
Affiliation(s)
- Omer Fatih Nas
- Department of Radiology, Uludag University Medical Faculty, Bursa, Turkey
| | - Emre Kacar
- Department of Radiology, Afyon Kocatepe University Medical Faculty, Afyonkarahisar, Turkey
| | - Ahmet Kaya
- Department of Radiology, Uludag University Medical Faculty, Bursa, Turkey
| | - Cuneyt Erdogan
- Department of Radiology, Uludag University Medical Faculty, Bursa, Turkey
| | - Bahattin Hakyemez
- Department of Radiology, Uludag University Medical Faculty, Bursa, Turkey
| |
Collapse
|