1
|
Rodriguez Caamaño I, Remollo S, Terceño M, Blanco A, Bashir S, Castaño C. Y Stent-Assisted Coiling Technique for Bifurcation Aneurysms Using Double Neuroform® Stent: a Large Restrospective Series. Clin Neuroradiol 2024:10.1007/s00062-024-01437-9. [PMID: 39023542 DOI: 10.1007/s00062-024-01437-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/21/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Stent assisted coiling technique have shown to be an effective and safe endovascular strategy for wide neck bifurcation aneurysms in achieving greater packing, allowing the closure of the aneurysm and preserving the parent arteries, compared to simple coiling. MATERIAL AND METHODS We conducted a retrospective analysis of 79 patients with cerebral aneurysms treated using 'Y'-configuration double Neuroform® stent-assisted coiling at our center from July 2009 to July 2022. RESULTS Of the 79 patients, 76% (60/79) were incidental unruptured cerebral aneurysm and 24% were patients treated for aneurysm recanalization of a previous ruptured aneurysm (19/79). The most frequent locations were anterior communicating artery (AComA) 44.3% (35/79) and middle cerebral artery (MCA) 32.9% (26/79). We found a complete and almost complete aneurysm occlusion (Raymond-Roy occlusion classification (RROC) 1 and 2): in 100% (79/79) in the angiography after procedure, in 97.6% (42/43) at the first follow-up at 6-8 months and 100% (57/57) at the first 1-2 years of follow-up. No mortality related to treatment was detected. We registered 2.5% (2/79) major ipsilateral strokes, one due to acute in stent thrombosis (patient had a mRS: 0 in follow up at 90 days) and a spinal anterior artery occlusion (patient had a mRS: 3 in follow up at 90 days). CONCLUSION The 'Y' stent-assisted coiling technique with double Neuroform® is a safe and effective technique for the treatment of wide-neck bifurcation aneurysms, with high rates of complete occlusion, preserving the permeability of the afferent and efferent arteries and low rate of complications.
Collapse
Affiliation(s)
- Isabel Rodriguez Caamaño
- Neurointerventional radiology Hospital Germans Trias I Pujol, Carretera de Canyet, s/n, 08916, Badalona, Spain
| | - Sebastián Remollo
- Neurointerventional radiology Hospital Germans Trias I Pujol, Carretera de Canyet, s/n, 08916, Badalona, Spain
| | - Mikel Terceño
- Neurointerventional radiology Hospital Josep Trueta, Girona, Spain
| | - Alberto Blanco
- Neurosurgery Hospital Germans Trias I Pujol, Badalona, Spain
| | - Saima Bashir
- Neurointerventional radiology Hospital Josep Trueta, Girona, Spain
| | - Carlos Castaño
- Neurointerventional radiology Hospital Germans Trias I Pujol, Carretera de Canyet, s/n, 08916, Badalona, Spain.
| |
Collapse
|
2
|
Korte J, Gaidzik F, Larsen N, Schütz E, Damm T, Wodarg F, Hövener JB, Jansen O, Janiga G, Berg P, Pravdivtseva MS. In vitro and in silico assessment of flow modulation after deploying the Contour Neurovascular System in intracranial aneurysm models. J Neurointerv Surg 2024; 16:815-823. [PMID: 37852752 PMCID: PMC11287554 DOI: 10.1136/jnis-2023-020403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/15/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The novel Contour Neurovascular System (Contour) has been reported to be efficient and safe for the treatment of intracranial, wide-necked bifurcation aneurysms. Flow in the aneurysm and posterior cerebral arteries (PCAs) after Contour deployment has not been analyzed in detail yet. However, this information is crucial for predicting aneurysm treatment outcomes. METHODS Time-resolved three-dimensional velocity maps in 14 combinations of patient-based basilar tip aneurysm models with and without Contour devices (sizes between 5 and 14 mm) were analyzed using four-dimensionsal (4D) flow MRI and numerical/image-based flow simulations. A complex virtual processing pipeline was developed to mimic the experimental shape and position of the Contour together with the simulations. RESULTS On average, the Contour significantly reduced intra-aneurysmal flow velocity by 67% (mean w/ = 0.03m/s; mean w/o = 0.12m/s; p-value=0.002), and the time-averaged wall shear stress by more than 87% (mean w/ = 0.17Pa; mean w/o = 1.35Pa; p-value=0.002), as observed by numerical simulations. Furthermore, a significant reduction in flow (P<0.01) was confirmed by the neck inflow rate, kinetic energy, and inflow concentration index after Contour deployment. Notably, device size has a stronger effect on reducing flow than device positioning. However, positioning affected flow in the PCAs, while being robust in effectively reducing flow. CONCLUSIONS This study showed the high efficacy of the Contour device in reducing flow within aneurysms regardless of the exact position. However, we observed an effect on the flow in PCAs, which needs to be investigated further.
Collapse
Affiliation(s)
- Jana Korte
- Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
- Research campus STIMULATE, University of Magdeburg, Magdeburg, Germany
| | - Franziska Gaidzik
- Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
- Research campus STIMULATE, University of Magdeburg, Magdeburg, Germany
| | - Naomi Larsen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Erik Schütz
- Research campus STIMULATE, University of Magdeburg, Magdeburg, Germany
| | - Timo Damm
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
| | - Fritz Wodarg
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Jan-Bernd Hövener
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Gábor Janiga
- Laboratory of Fluid Dynamics and Technical Flows, University of Magdeburg, Magdeburg, Germany
- Research campus STIMULATE, University of Magdeburg, Magdeburg, Germany
| | - Philipp Berg
- Research campus STIMULATE, University of Magdeburg, Magdeburg, Germany
- Department of Healthcare Telematics and Medical Engineering, University of Magdeburg, Magdeburg, Germany
| | - Mariya S Pravdivtseva
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
| |
Collapse
|
3
|
Siddiqui A, Fargen KM, Vranic JE, Patel AB, Ogilvy CS, Thomas AJ, Mascitelli JR, Fifi JT, Mocco J, De Leacy RA. A core-lab adjudicated analysis of single-stent assisted coiling of wide-neck bifurcation aneurysms. J Neurointerv Surg 2024:jnis-2023-020995. [PMID: 38631905 DOI: 10.1136/jnis-2023-020995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND AND PURPOSE Core-lab adjudicated data regarding the efficacy of the single-stent assisted aneurysm coiling technique 'L-stenting' are lacking. We present a multicenter, core-lab adjudicated study evaluating the safety and effectiveness of single-stent assisted coiling in the treatment of wide-neck bifurcation aneurysms (WNBAs). METHODS Consecutive patients who underwent L-stenting for WNBAs at three academic institutions between 2015 and 2019 were included in this retrospective study. Clinical safety and efficacy outcomes were gathered from the patient chart, and angiographic imaging was evaluated by core lab analysis. Safety and efficacy outcomes were summarized and predictors of safety and efficacy were calculated. RESULTS Of 128 patients treated, 124 had angiographic outcome data at last follow-up. Of those, 110 had adequate (core-lab adjudicated modified Raymond Roy (mRR) score of 1 or 2) occlusion (88.7%). During follow-up, 19 patients (14.8%) required retreatment. There were 17 complications experienced in 12 patients: intraoperative (n=8, 6.25%), perioperative (n=5, 3.9%), or delayed (n=6; n=4 attributed to device/procedure, 3.1%). Significant predictors of complete occlusion were smaller aneurysm size and use of the jailing technique (P=0.0276). Significant predictors of retreatment were larger size, neck size, and larger dome to neck ratio (P=0.0008). CONCLUSION This study provides multicenter, core-lab adjudicated angiographic data regarding the efficacy of single-stent assisted coiling for WNBAs. This study acts as a validated comparator for future studies investigating novel devices or techniques for treating this challenging subgroup of aneurysms.
Collapse
Affiliation(s)
| | - Kyle M Fargen
- Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Justin E Vranic
- Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aman B Patel
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Justin R Mascitelli
- Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Johanna T Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J Mocco
- The Mount Sinai Health System, New York, New York, USA
| | | |
Collapse
|
4
|
Spitz L, Korte J, Gaidzik F, Larsen N, Preim B, Saalfeld S. Assessment of intracranial aneurysm neck deformation after contour deployment. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03189-w. [PMID: 38819700 DOI: 10.1007/s11548-024-03189-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE The contour neurovascular system (CNS) is a novel device to treat intracranial wide-necked bifurcation aneurysms, with few studies assessing its long-term effects. Particularly its impact on aneurysm morphology has not been explored yet. We present a preliminary study to explore this impact for the first time, focusing on the neck curve and ostium of the aneurysm. METHODS We investigated seven aneurysms treated with the CNS to assess ostium deformation after CNS deployment by comparing models extracted from in vivo medical pre-treatment and follow-up scans via morphological analysis. Time between pre- and follow-up scans was ten months on average. Size and shape indices like area, neck diameter, ellipticity index, undulation index, and more were assessed. RESULTS Ostium size was reduced after treatment. On average, ostium area was reduced at a rate of - 0.58 (± 4.88) mm2 per year, from 15.52 (± 3.51) mm2 to 13.30 (± 2.27) mm2, and ostium width from 5.01 (± 0.54) mm to 4.49 (± 0.45) mm, with an average reduction of - 0.59 (± 0.87) mm. This shrinking positively correlated with time passing. Shape deformation was low, though notably mean ellipticity index was reduced by 0.06 (± 0.15) on average, indicating ostia were less elongated after treatment. CONCLUSION We interpret the shrinking of the ostium as part of the healing process. Shape changes were found to be small enough to conclude no shape deformation of the ostium from CNS deployment, but the analysis of more cases with more parameters and information is necessary.
Collapse
Affiliation(s)
- Lena Spitz
- Department of Simulation and Graphics, Otto-von-Guericke University, Universtitaetsplatz 2, 39106, Magdeburg, Sachsen-Anhalt, Germany.
- Research campus STIMULATE, Magdeburg, Germany.
| | - Jana Korte
- Research campus STIMULATE, Magdeburg, Germany
- Laboratory of Fluid Dynamics and Technical Flows, Otto-von-Guericke University, Magdeburg, Germany
| | - Franziska Gaidzik
- Research campus STIMULATE, Magdeburg, Germany
- Laboratory of Fluid Dynamics and Technical Flows, Otto-von-Guericke University, Magdeburg, Germany
| | - Naomi Larsen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Bernhard Preim
- Department of Simulation and Graphics, Otto-von-Guericke University, Universtitaetsplatz 2, 39106, Magdeburg, Sachsen-Anhalt, Germany
- Research campus STIMULATE, Magdeburg, Germany
| | - Sylvia Saalfeld
- Research campus STIMULATE, Magdeburg, Germany
- Computational Medicine Group, Technical University Ilmenau, Ilmenau, Germany
| |
Collapse
|
5
|
Griessenauer CJ, Ghozy S, Biondi A, Hecker C, Wodarg F, Liebig T, Patankar T, Lamin S, Martínez-Galdámez M, Cognard C, Fiehler J, Dorn F, Dmytriw AA, Killer-Oberpfalzer M. Contour Neurovascular System for endovascular embolization of cerebral aneurysms: a multicenter cohort study of 10 European neurovascular centers. J Neurointerv Surg 2024:jnis-2023-021378. [PMID: 38760167 DOI: 10.1136/jnis-2023-021378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/28/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Intrasaccular devices have become increasingly popular in the treatment of cerebral aneurysms, particularly at the bifurcation. Here we evaluate the Contour Neurovascular System, an intrasaccular device for the endovascular treatment of cerebral aneurysms, in a multicenter cohort study, the largest to the best of our knowledge. METHODS Consecutive patients with intracranial aneurysms treated with the Contour Neurovascular System between February 2017 and October 2022 at 10 European neurovascular centers were prospectively collected and retrospectively reviewed. Patient and aneurysm characteristics, procedural details, and angiographic and clinical outcomes were evaluated. RESULTS During the study period, 279 aneurysms (median age of patients 60 years, IQR 52-68) were treated with Contour. In 83.2% of patients the device was placed electively, whereas the remaining patients were treated in the setting of acute subarachnoid hemorrhage. The most common locations were the middle cerebral artery (26.5%) followed by the anterior communicating region (26.2%). Median aneurysm dome and neck size were 5.2 mm (IQR 4.2-7) and 3.9 mm (IQR 3-5). Contour size 7 (39%) and 9 (25%) were most used. Thromboembolic and hemorrhagic complications occurred in 6.8% and 0.4% of aneurysms, respectively. Raymond-Roy 1 and 2 occlusions at last follow-up were achieved in 63.2% and 28.3%, respectively, resulting in adequate occlusion of 91.5% of aneurysms. CONCLUSION This is the largest multicenter study reporting the outcome on the Contour Neurovascular System. At 1 year, the self-evaluated data on safety and efficacy are comparable to data of existing intrasaccular devices. Contour is a promising technology in the treatment of cerebral aneurysms.
Collapse
Affiliation(s)
- Christoph J Griessenauer
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Alessandra Biondi
- Department of Interventional Neuroradiology, Besançon University Hospital, Besançon, France
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive - UR 481 LINC, Université Franche-Comté, Besançon, France
| | - Constantin Hecker
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
- Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Fritz Wodarg
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Thomas Liebig
- Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
| | - Tufail Patankar
- Department of Neuroradiology, Leeds General Infirmary, Leeds, UK
| | - Saleh Lamin
- Diagnostic and Interventional Neuroradiology, University Hospital Birmingham, Queen Elizabeth, Birmingham, UK
| | - Mario Martínez-Galdámez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Radiology and Interventional Neuroradiology, Hospital La Luz, Quironsalud, Madrid, Spain
| | | | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University of Bonn, Bonn, Germany
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Neuroradiology & Neurointervention, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Monika Killer-Oberpfalzer
- Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria
- Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
6
|
Griessenauer CJ, Killer-Oberpfalzer M, Beredjiklian CM, Lunzer M. Microsurgical Clipping after Failed Contour Device Embolization of an Anterior Communicating Artery Aneurysm: Technical Note. J Neurol Surg A Cent Eur Neurosurg 2024; 85:319-321. [PMID: 37257842 DOI: 10.1055/a-2103-7639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Endovascular therapy has revolutionized the treatment of cerebral aneurysms in recent years and decades. So-called intrasaccular devices (i.e., Woven EndoBridge [WEB], MicroVention, Aliso Viejo, California, United States; or Contour, Cerus Neurovascular, Fremont, California, United States) are a promising endovascular technology, especially for wide-based aneurysms. However, long-term outcome data are currently particularly scarce for Contour and strategies for failed Contour cases are lacking. Here, we report the feasibility of microsurgical clipping after failed Contour device embolization. METHODS Feasibility of microsurgical clipping after failed aneurysm embolization with a Contour intrasaccular device was assessed in a patient. RESULTS We present the case of a 36-year-old male patient diagnosed with Hunt and Hess grade 1 subarachnoid hemorrhage from an anterior communicating artery aneurysm. The ruptured aneurysm was initially treated with the Contour device. After 3 months, angiographic imaging showed a clear aneurysm residual deemed not endovascularly accessible. The patient was then successfully clipped using microsurgical techniques. The patient was discharged with no neurologic abnormalities. CONCLUSION After thorough bibliographical research, this presents the first published case report of microsurgical clipping after failed embolization with Contour. The main insights gained after clipping were that the Contour does not significantly disturb or hinder clipping. In contrast to coils in aneurysms to be clipped, the Contour can be easily compressed by the clip blades and does not have to be removed. In addition, the Contour had not migrated into the subarachnoid space and there was no abnormal scarring. Clipping appears to be a reasonable treatment strategy for failure of embolization with Contour if endovascular means are not suitable.
Collapse
Affiliation(s)
- Christoph J Griessenauer
- Department of Neurosurgery, Christina Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
- Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | | | - Carlos M Beredjiklian
- Department of Neurosurgery, Christina Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Manuel Lunzer
- Department of Neurosurgery, Christina Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
7
|
Lyu M, Torii R, Liang C, Peach TW, Bhogal P, Makalanda L, Li Q, Ventikos Y, Chen D. Treatment for middle cerebral artery bifurcation aneurysms: in silico comparison of the novel Contour device and conventional flow-diverters. Biomech Model Mechanobiol 2024:10.1007/s10237-024-01829-3. [PMID: 38587717 DOI: 10.1007/s10237-024-01829-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/09/2024] [Indexed: 04/09/2024]
Abstract
Endovascular treatment has become the standard therapy for cerebral aneurysms, while the effective treatment for middle cerebral artery (MCA) bifurcation aneurysms remains a challenge. Current flow-diverting techniques with endovascular coils cover the aneurysm orifice as well as adjacent vessel branches, which may lead to branch occlusion. Novel endovascular flow disruptors, such as the Contour device (Cerus Endovascular), are of great potential to eliminate the risk of branch occlusion. However, there is a lack of valid comparison between novel flow disruptors and conventional (intraluminal) flow-diverters. In this study, two in silico MCA bifurcation aneurysm models were treated by specific Contour devices and flow-diverters using fast-deployment algorithms. Computational fluid dynamic simulations were used to examine the performance and efficiency of deployed devices. Hemodynamic parameters, including aneurysm inflow and wall shear stress, were compared among each Contour device, conventional flow-diverter, and untreated condition. Our results show that the placement of devices can effectively reduce the risk of aneurysm rupture, while the deployment of a Contour device causes more flow reduction than using flow-diverters (e.g. Silk Vista Baby). Besides, the Contour device presents the flow diversion capability of targeting the aneurysm neck without occluding the daughter vessel. In summary, the in silico aneurysm models presented in this study can serve as a powerful pre-planning tool for testing new treatment techniques, optimising device deployment, and predicting the performance in patient-specific aneurysm cases. Contour device is proved to be an effective treatment of MCA bifurcation aneurysms with less daughter vessel occlusion.
Collapse
Affiliation(s)
- Mengzhe Lyu
- Department of Mechanical Engineering, University College London, London, UK
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, UK
| | - Ce Liang
- Department of Mechanical Engineering, University College London, London, UK
| | - Thomas W Peach
- Department of Mechanical Engineering, University College London, London, UK
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, London, UK
| | - Levansri Makalanda
- Department of Interventional Neuroradiology, The Royal London Hospital, London, UK
| | - Qiaoqiao Li
- School of International Education, University of International Business and Economics, Beijing, 100029, China
| | - Yiannis Ventikos
- Department of Mechanical and Aerospace Engineering, Monash University, Clayton, Australia.
| | - Duanduan Chen
- School of Medical Technology, Beijing Institute of Technology, Beijing, 100081, China.
| |
Collapse
|
8
|
Pineda-Castillo SA, Jones ER, Laurence KA, Thoendel LR, Cabaniss TL, Zhao YD, Bohnstedt BN, Lee CH. Systematic Review and Meta-Analysis of Endovascular Therapy Effectiveness for Unruptured Saccular Intracranial Aneurysms. STROKE (HOBOKEN, N.J.) 2024; 4:e001118. [PMID: 38846323 PMCID: PMC11152505 DOI: 10.1161/svin.123.001118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/13/2023] [Indexed: 06/09/2024]
Abstract
Background Currently, endovascular treatment of intracranial aneurysms (ICAs) is limited by low complete occlusion rates. The advent of novel endovascular technology has expanded the applicability of endovascular therapy; however, the superiority of novel embolic devices over the traditional Guglielmi detachable coils (GDCs) is still debated. We performed a systematic review of literature that reported Raymond-Roy occlusion classification (RROC) rates of modern endovascular devices to determine their immediate and follow-up occlusion effectiveness for the treatment of unruptured saccular ICAs. Methods A search was conducted using electronic databases (PUBMED, Cochrane, ClinicalTrials.gov, Web of Science). We retrieved studies published between 2000-2022 reporting immediate and follow-up RROC rates of subjects treated with different endovascular ICA therapies. We extracted demographic information of the treated patients and their reported angiographic RROC rates. Results A total of 80 studies from 15 countries were included for data extraction. RROC rates determined from angiogram were obtained for 21,331 patients (72.5% females, pooled mean age: 58.2 (95% CI: 56.8-59.6), harboring 22,791 aneurysms. The most frequent aneurysm locations were the internal carotid artery (46.4%, 95% CI: 41.9%-50.9%), the anterior communicating artery (26.4%, 95% CI: 22.5%-30.8%), the middle cerebral artery (24.5%, 95% CI:19.2%-30.8%) and the basilar tip (14.4%, 95% CI:11.3%-18.3%). The complete occlusion probability (RROC-I) was analyzed for GDCs, the Woven EndoBridge (WEB), and flow diverters. The RROC-I rate was the highest in balloon-assisted coiling (73.9%, 95% CI: 65.0%-81.2%) and the lowest in the WEB (27.8%, 95% CI:13.2%-49.2%). The follow-up RROC-I probability was homogenous in all analyzed devices. Conclusions We observed that the coil-based endovascular therapy provides acceptable rates of complete occlusion, and these rates are improved in balloon-assisted coils. Out of the analyzed devices, the WEB exhibited the shortest time to achieve >90% probability of follow-up complete occlusion (~18 months). Overall, the GDCs remain the gold standard for endovascular treatment of unruptured saccular aneurysms.
Collapse
Affiliation(s)
- Sergio A. Pineda-Castillo
- Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, OK, USA
| | - Evan R. Jones
- Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, OK, USA
| | - Keely A. Laurence
- Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, OK, USA
| | - Lauren R. Thoendel
- Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, OK, USA
| | - Tanner L. Cabaniss
- Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, OK, USA
| | - Yan D. Zhao
- Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Bradley N. Bohnstedt
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chung-Hao Lee
- Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, OK, USA
- Department of Bioengineering, University of California Riverside, Riverside, CA, USA
| |
Collapse
|
9
|
Caroff J, Cortese J, D'Argento F, Popica DA, Mihalea C, Spelle L. The Bicêtre occlusion scale is well suited to assess the efficacy of the Contour embolization device. J Neuroradiol 2024; 51:220-223. [PMID: 37652262 DOI: 10.1016/j.neurad.2023.08.006] [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: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND The Contour Embolization Device (CED) is typically assessed using coiling angiographic outcomes. However, these scales do not address device-specific problematics. We evaluated the usability of the Bicêtre occlusion scale (BOS) with the CED. RESULTS BOS scores can be analyzed as BOSS 0 = no residual flow, BOSS 1 = residual flow inside the CED but with complete neck-sealing, BOSS 2 = neck-remnant, BOSS 3 = aneurysm-remnant, BOSS 1 + 3 = contrast filling inside the device and aneurysmal sac without complete neck-sealing. CONCLUSION BOS usage should be encouraged as it provides a more comprehensive assessment of the mechanism of CED occlusion, especially considering the potential prognostic value of the neck sealing assessment.
Collapse
Affiliation(s)
- Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, 78 Rue du General Leclerc, Le Kremlin-Bicêtre, France; INSERM U1176, Bicêtre Hospital, 78 Rue du General Leclerc, Le Kremlin-Bicêtre, France.
| | - Jonathan Cortese
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, 78 Rue du General Leclerc, Le Kremlin-Bicêtre, France; Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France
| | - Francesco D'Argento
- UOSD Neuroradiologia Interventistica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Dan Adrian Popica
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, 78 Rue du General Leclerc, Le Kremlin-Bicêtre, France
| | - Cristian Mihalea
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, 78 Rue du General Leclerc, Le Kremlin-Bicêtre, France
| | - Laurent Spelle
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Paris Saclay University, 78 Rue du General Leclerc, Le Kremlin-Bicêtre, France; Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France
| |
Collapse
|
10
|
Heiferman DM, Goyal N, Inoa V, Nickele CM, Arthur AS. A new era in the treatment of wide necked bifurcation aneurysms: Intrasaccular flow disruption. Interv Neuroradiol 2024; 30:31-36. [PMID: 35469513 PMCID: PMC10956467 DOI: 10.1177/15910199221094390] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/26/2022] [Indexed: 11/15/2022] Open
Abstract
Wide-necked bifurcation aneurysms (WNBAs) are challenging lesions to treat via both open surgical and endovascular techniques. Presently, there are 3 intrasaccular devices available to address many of the limitations of prior techniques, all of which are at different phases of approval for human use around the world. These devices include the Woven EndoBridge (WEB®) made by MicroVention, the Artisse™ Embolization Device made by Medtronic, and the Contour Neurovascular System™ made by Cerus Endovascular. Although heterogenous in design, these devices rely on the principle of using fine mesh overlying the aneurysm neck to slow blood inflow, promoting stagnation and thrombosis that ultimately leads to healing across the neck and exclusion from the circulation. While our understanding improves as long-term occlusion rates from these devices continue to be studied, the safety profiles and short-term success rates demonstrated in recent studies provide optimism for these innovative intrasaccular devices for the treatment of WNBAs. In this paper, we review these 3 intra-saccular flow disruption devices for use in WNBAs and summarize recent literature and studies of their effectiveness and safety.
Collapse
Affiliation(s)
- Daniel M. Heiferman
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, Tennessee, USA
| | - Nitin Goyal
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, Tennessee, USA
| | - Violiza Inoa
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, Tennessee, USA
| | - Christopher M. Nickele
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, Tennessee, USA
| | - Adam S. Arthur
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Department of Neurological Surgery, University of Tennessee College of Medicine, Memphis, Tennessee, USA
| |
Collapse
|
11
|
Jagtiani P, Sioutas GS, Vivanco-Suarez J, Burkhardt JK, Srinivasan VM. An updated meta-analysis on the safety and effectiveness of the Contour Neurovascular system. Interv Neuroradiol 2024:15910199231226280. [PMID: 38225202 DOI: 10.1177/15910199231226280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Affiliation(s)
- Pemla Jagtiani
- School of Medicine, SUNY Downstate Health Sciences University, New York, NY, USA
| | - Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Juan Vivanco-Suarez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
12
|
Bellanger G, Darcourt J, Januel AC, Cognard C. The reversed umbrella: displacement of a Contour device into an MCA aneurysm 18 months after treatment. J Neurointerv Surg 2024; 16:213-215. [PMID: 36941045 DOI: 10.1136/jnis-2022-019814] [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: 10/29/2022] [Accepted: 02/05/2023] [Indexed: 03/22/2023]
Abstract
SummaryThe Contour is a promising new device designed to treat large-neck intra-cranial aneurysms. We describe a first case of Contour device displacement 18 months after initial treatment.A patient with a 10 mm unruptured right middle cerebral artery bifurcation aneurysm was treated with a 9 mm Contour. The device was correctly positioned at the neck during treatment and at the 6 month angiography follow-up. At 18 months follow-up we noticed a full displacement of the device into the aneurysm dome. The Contour had a reversed shape and the aneurysm was still fully opacified. No neurological event occurred during the whole follow-up. Contour may be a promising tool but needs to be assessed over a long-term period.
Collapse
Affiliation(s)
| | - Jean Darcourt
- Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
| | | | - Christophe Cognard
- Diagnostic and Therapeutic Neuroradiology, Hôpital Purpan, Toulouse, France
| |
Collapse
|
13
|
Zhou Z, Lan W, Yu J. Endovascular treatment of middle cerebral artery aneurysms: current status and future prospects. Front Neurol 2023; 14:1239199. [PMID: 38033773 PMCID: PMC10684741 DOI: 10.3389/fneur.2023.1239199] [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: 06/13/2023] [Accepted: 10/20/2023] [Indexed: 12/02/2023] Open
Abstract
Middle cerebral artery (MCA) aneurysms are complex and widely distributed throughout the course of the MCA. Various types of aneurysms can occur in the MCA. Ruptured as well as unruptured MCA aneurysms may require treatment to avoid bleeding or rebleeding. Currently, clipping is regarded as the first-line choice for the treatment of MCA aneurysms. However, endovascular treatment (EVT) is emerging as an alternative treatment in selected cases. EVT techniques vary. Therefore, it is necessary to review EVT for MCA aneurysms. In this review, the following issues were discussed: MCA anatomy and anomalies, classifications of MCA aneurysms, the natural history of MCA aneurysms, EVT status and principle, deployments of traditional coiling techniques and flow diverters (FDs), and deployments and prospects of intrasaccular flow disruptors and stent-like devices. According to the review and our experience, traditional coiling EVT is still the preferred therapy for most MCA aneurysms. FD deployment can be used in selective MCA aneurysms. Parent artery occlusion (PAO) can be used to treat distal MCA aneurysms. In addition, new devices can be used to treat MCA aneurysms, such as intrasaccular flow disruptors and stent-like devices. In general, EVT is gaining popularity as an alternative treatment option; however, there is still a lack of evidence regarding EVT, and longer-term data are not currently available for most EVT devices.
Collapse
Affiliation(s)
- Zibo Zhou
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Wenjing Lan
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| |
Collapse
|
14
|
Nejadhamzeeigilani H, Buende T, Saleem N, Goddard T, Patankar T. Single centre experience of stent-assisted coiling of wide-necked basilar tip aneurysms. Br J Radiol 2023; 96:20220504. [PMID: 37660365 PMCID: PMC10607421 DOI: 10.1259/bjr.20220504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/03/2023] [Accepted: 07/14/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE To report clinical and radiological follow-up outcomes of stent-assisted coiling of wide-necked basilar tip aneurysms and to evaluate the safety and efficacy of this treatment choice. METHODS A retrospective review was carried out of 19 patients with wide-necked basilar tip aneurysms in our institution between 2010 and 2020. The rates of perioperative complication, morbidity, mortality, imaging follow-up and re-treatment were analysed. RESULTS Our technical complication rate was 11% but did not result in treatment failure. The combined procedure related morbidity and mortality rate of the 19 patients who underwent stent assisted coiling was also 11%. 16 of 19 patients had undergone angiographic follow-up with a mean period of 32 months. 81% of patients with angiographic follow-up had a satisfactory occlusion (RROI or II) with 11% requiring re-treatment. Those requiring re-treatment were both treated with laser-cut stents; this is in contrast with no re-treatments required in the patients treated with braided stents. CONCLUSION Our report provides acceptable outcomes in wide-necked basilar termination aneurysms which are very challenging to treat. Aneurysms treated with braided stents had better efficacy outcomes than those with laser-cut stents. ADVANCES IN KNOWLEDGE Given the emergent and increasing utility of alternative endovascular techniques such as intrasaccular devices and flow diverters, real-world data are lacking on more conventional approaches such stent-assisted coiling, especially so in the posterior circulation. The associated relatively higher aneurysmal haemorrhagic risk in this location warrants further additional safety and efficacy data for this treatment approach, which this paper provides.
Collapse
Affiliation(s)
- Hamed Nejadhamzeeigilani
- Department of Interventional Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Thierry Buende
- Department of Interventional Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Nayyar Saleem
- Department of Interventional Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Tony Goddard
- Department of Interventional Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Tufail Patankar
- Department of Interventional Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| |
Collapse
|
15
|
Carraro do Nascimento V, de Villiers L, Dhillon PS, Domitrovic L, Leblanc JP, Booth M, Rice H. The Aristotle 18 and 24 microwires in neuroIntervention: Early experience at a single centre. Interv Neuroradiol 2023:15910199231204923. [PMID: 37796767 DOI: 10.1177/15910199231204923] [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: 10/07/2023] Open
Abstract
BACKGROUND Current neurointerventional procedures are expanding the use of large bore microcatheters, of up to 0.033" inner diameters, to accommodate intrasaccular flow disruptors or neck-bridging devices, including flow diverters. The use of large bore microwires may mitigate the ledge gap between wire and catheter, facilitate navigation and offer support in distal tortuous anatomy. We aim to report our early experience using the novel Aristotle (Scientia Vascular, West Valley City, UT) 18 and 24 microwires in neurovascular interventions. METHODS We analysed neurointerventional procedures in which the Aristotle 18 and 24 microwires were used at a single centre. Prospectively collected data, from March 2022 to February 2023, including patient's clinical outcome (successful target vessel, aneurysm catheterisation, peri-procedural complications (thromboembolic, haemorrhagic, vessel dissection or perforation) were analysed. RESULTS Overall, the use of Aristotle 18 and 24 microwires was recorded in 84 neurointerventional procedures during the study period, including endovascular aneurysm treatment (n = 30), endovascular thrombectomy (n = 46), dural venous sinus manometry/stent placement (n = 7), and extracranial carotid artery stent placement (n = 1). The Aristotle 18 microwire was used in conjunction with 0.021" microcatheters and the Aristotle 24 microwire with the 0.027 or 0.033" microcatheters. In all cases (100%), the target vessel or aneurysm was reached with the microwire, allowing seamless advancement of the selected microcatheters. No procedure related complications were recorded. CONCLUSIONS The use of the Aristotle 18 and 24 microwires in neurointerventional procedures is feasible and safe. The microwires provide reduced ledge gap, improved torquability, support and safety over standard 0.014" microwires.
Collapse
Affiliation(s)
| | - Laetitia de Villiers
- Interventional Neuroradiology, Gold Coast University Hospital, Southport, QLD, Australia
| | - Permesh Singh Dhillon
- Interventional Neuroradiology, Gold Coast University Hospital, Southport, QLD, Australia
| | - Luis Domitrovic
- Interventional Neuroradiology, Gold Coast University Hospital, Southport, QLD, Australia
| | | | - Madison Booth
- Medical School, University of Queensland, St Lucia, QLD, Australia
| | - Hal Rice
- Interventional Neuroradiology, Gold Coast University Hospital, Southport, QLD, Australia
| |
Collapse
|
16
|
Sirakov A, Bhogal P, Sirakova K, Penkov M, Minkin K, Ninov K, Hristov H, Hadzhiyanev A, Karakostov V, Sirakov S. Endovascular treatment of wide-necked intracranial aneurysms using the Nautilus Intrasaccular System: initial case series of 41 patients at a single center. J Neurointerv Surg 2023; 15:989-994. [PMID: 36261278 PMCID: PMC10511998 DOI: 10.1136/jnis-2022-019295] [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: 06/24/2022] [Accepted: 10/04/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Endovascular treatment of intracranial wide-necked and bifurcation aneurysms (WNBA) is technically challenging. The Nautilus Intrasaccular System is designed to provide a mechanical barrier at the aneurysm neck to support coil embolization. We report the results of a single-center series of patients treated for intracranial aneurysms with the Nautilus. METHODS Clinical and radiological data were retrospectively collected for all patients treated with the Nautilus for an unruptured or ruptured intracranial aneurysm at our center between March 2021 and March 2022. Clinical outcomes (modified Rankin Scale (mRS) scores), Raymond-Roy angiographic occlusion, recanalization, and complications were measured immediately post-procedure and at 3-6-month follow-up. RESULTS A total of 41 patients of mean age 56.7 years (range 37-83 years) were treated with the Nautilus, with 41 saccular aneurysms (18 (43.9%) unruptured and 23 (56.1%) ruptured). The majority of aneurysms (39/41 (95.1%)) were located in the anterior circulation. We experienced no technical complications. One patient had an asymptomatic post-procedural minor stroke related to the procedure. Immediate Class I occlusion was achieved in 30 (73.1%) patients. The rate of all-cause mortality was 7.3% (3/41). One patient was lost to follow-up. At follow-up, 94.5% (35/37) of patients achieved Class I occlusion and 94.5% (35/37) had an mRS score of 0. There were no procedural-related deaths or permanent morbidities at discharge or follow-up. CONCLUSION This study demonstrates good safety and effectiveness using the Nautilus Intrasaccular System to treat both ruptured and unruptured intracranial aneurysms. Larger studies are needed to confirm these findings.
Collapse
Affiliation(s)
- Alexander Sirakov
- Radiology Department, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | | | - Kristina Sirakova
- Radiology Department, University Hospital Alexandrovska, Sofia, Bulgaria
| | - Marin Penkov
- Radiology Department, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Krasimir Minkin
- Neurosurgery Department, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Kristian Ninov
- Neurosurgery Department, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Hristo Hristov
- Neurosurgery Department, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Asen Hadzhiyanev
- Neurosurgery Department, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Vasil Karakostov
- Neurosurgery Department, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Stanimir Sirakov
- Radiology Department, University Hospital St Ivan Rilski, Sofia, Bulgaria
| |
Collapse
|
17
|
Biondi A, Primikiris P, Vitale G, Charbonnier G. Endosaccular flow disruption with the Contour Neurovascular System: angiographic and clinical results in a single-center study of 60 unruptured intracranial aneurysms. J Neurointerv Surg 2023; 15:838-843. [PMID: 35995545 DOI: 10.1136/jnis-2022-019271] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/06/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The Contour Neurovascular System is a novel device designed to treat intracranial aneurysms by intrasaccular flow disruption. We report our experience and mid-term follow-up in a series of patients treated with the Contour. METHODS The patients were divided into an intention to treat and a per protocol population, the latter defined by the successful implantation of the Contour device. The intention to treat population included 53 patients (30 women, mean age 56 years) with 60 unruptured intracranial aneurysms (53 in the anterior circulation and seven in the posterior circulation). There was clinical and angiographic follow-up immediate postoperatively and at 24 hours, 3 months and 1 year using the Raymond-Roy classification and the O'Kelly-Marotta grading scale. RESULTS The Contour was successfully implanted in 54/60 (90%) aneurysms. With regard to the angiographic follow-up, there was adequate occlusion (defined as complete occlusion or presence of a neck remnant) in 31.5% of 54 aneurysms immediately postoperatively, 62.3% (in 53/54 aneurysms) at 24 hours, 81.4% (in 43/54 aneurysms) at 3 months, and 89.3% (in 28/54 aneurysms) at 1 year. Technical complications in 60 aneurysms of the intention to treat population included two (3.3%) inadvertent detachments of the device. Thromboembolic events were observed in four of the 60 aneurysms (6.7%), with no clinical symptoms in three patients and transient morbidity in one (1.7%). No aneurysm bleeding was observed and no patient was retreated during the 1-year follow-up period. There was no permanent morbidity or mortality. CONCLUSIONS The Contour device is effective and safe in the treatment of intracranial aneurysms. However, more experience and long-term follow-up are needed.
Collapse
Affiliation(s)
- Alessandra Biondi
- Department of Interventional Neuroradiology, University Hospital Centre Besancon, Besancon, France
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive - UR 481, Université de Franche-Comté, Besancon, France
| | - Panagiotis Primikiris
- Department of Interventional Neuroradiology, University Hospital Centre Besancon, Besancon, France
| | - Giovanni Vitale
- Department of Interventional Neuroradiology, University Hospital Centre Besancon, Besancon, France
| | - Guillaume Charbonnier
- Department of Interventional Neuroradiology, University Hospital Centre Besancon, Besancon, France
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive - UR 481, Université de Franche-Comté, Besancon, France
| |
Collapse
|
18
|
Gallo-Pineda F, Fernández-Gómez M, Hidalgo-Barranco C. Rescue stenting after artery occlusion as a complication of an intrasaccular device-assisted coiling embolization: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE23171. [PMID: 38015019 PMCID: PMC10550550 DOI: 10.3171/case23171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/10/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Endovascular embolization of wide-necked aneurysms can be challenging. The development of intrasaccular devices like the Contour has enabled us to approach these aneurysms effectively by reducing recanalization rates and eliminating the need for dual antiplatelet therapy, which is particularly beneficial in the case of ruptured aneurysms. Although complications from using these devices are rare, it is crucial to address them properly. In this case, the authors highlight how to manage artery thrombosis caused by device protrusion during aneurysm embolization. OBSERVATIONS This report describes a complication in a male patient with a ruptured anterior communicating artery wide-necked aneurysm. Following Contour-assisted coiling of the aneurysm, a realignment of the detachable apex of the device occluded the A2 segment of the right anterior cerebral artery. After the failure of intra-arterial and intravenous tirofiban infusion as well as mechanical thrombectomy, a self-expanding open-cell stent was deployed in the involved vessel, achieving successful reperfusion. LESSONS The Contour device has a detachable zone that can cause occlusion of the parent vessel after deployment. The use of a stent as a rescue maneuver may be useful if reperfusion of the vessel cannot be achieved through other methods such as aspiration or full-dose antiplatelet therapy.
Collapse
Affiliation(s)
| | - Miriam Fernández-Gómez
- Division of Interventional Neuroradiology, Torrecárdenas University Hospital, Almería, Spain
| | - Carlos Hidalgo-Barranco
- Division of Interventional Neuroradiology, Torrecárdenas University Hospital, Almería, Spain
| |
Collapse
|
19
|
Islim FI, Saleem N, Patankar T. A review and journey in intrasaccular treatment of intracranial aneurysms. Interv Neuroradiol 2023:15910199231182460. [PMID: 37321652 DOI: 10.1177/15910199231182460] [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: 06/17/2023] Open
Abstract
The invested effort and collaboration of clinicians and medical device companies to improve occlusion rates and clinical outcomes for patients with intracranial aneurysms treated via less invasive endovascular means led to the development of the concept of intrasaccular devices. Intrasaccular devices were introduced to offer simple treatment options, offering easier navigation through difficult anatomy, simpler and quicker deployment into large and wide-neck aneurysms. Additionally, they offer easier sizing, whilst offering a wide range of options suitable for aneurysms of different sizes. The concept of most intrasaccular devices is to occupy the aneurysm neck, however offering better stability than simple coiling, therefore increasing the chance of long-term aneurysm occlusion. This is achieved without a sizable metal content within the parent vessel, contrary to flow diverters, theoretically reducing the risk of thromboembolic events. This review aims to discuss the history and latest developments of intrasaccular intracranial devices, which offer an exciting and potentially successful option for treatment of complex intracranial aneurysms.
Collapse
Affiliation(s)
| | - Nayyar Saleem
- Department of Neuroradiology, Leeds General Infirmary, Leeds, UK
| | - Tufail Patankar
- Department of Neuroradiology, Leeds General Infirmary, Leeds, UK
| |
Collapse
|
20
|
Celik E, Goertz L, Ozpeynirci Y, Schlamann M, Dorn F, Lehnen N, Siebert E, Liebig T, Kabbasch C. Comparative assessment of woven endobridge embolization and standard coil occlusion for the treatment of ruptured basilar tip aneurysms. Neuroradiology 2023; 65:765-773. [PMID: 36460785 DOI: 10.1007/s00234-022-03096-4] [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: 07/25/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Endovascular coil occlusion represents the standard treatment for basilar tip aneurysms. Recently, this role has been rivalled by intrasaccular flow disruptors across numerous centres. We retrospectively compared WEB embolization and coiling for the treatment of ruptured basilar tip aneurysms. METHODS Patients treated with WEB or coiling at four neurovascular centres were reviewed. Procedure-related complications, clinical outcome, and angiographic results were retrospectively compared. RESULTS The study included 23 patients treated with the WEB (aneurysm size: 6.6 ± 1.9 mm) and 56 by coiling (aneurysm size: 6.7 ± 2.5 mm). Stent-assistance was more often necessary with coiling than with WEB embolization (32% vs. 4%, p = 0.009). A modified Rankin scale score ≤ 2 at discharge had 21 (37.5%) patients in the coiling group and 12 (52.2%) in the WEB group (p = 0.235). Immediate complete and adequate occlusion rates were 52% for the WEB and 87% for coiling. At short-term follow-up, these rates were 87% for the WEB and 72% for coiling, respectively. There was no delayed aneurysm re-bleeding during follow-up. CONCLUSION Both coiling and WEB seem to prevent rebleeding in ruptured BTA aneurysms. WEB embolization required less frequently stent-support than coiling, potentially advantageous for SAH patients to avoid anti-platelet therapy in the light of concomitant procedures like ventricular drainage.
Collapse
Affiliation(s)
- Erkan Celik
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany.
| | - Lukas Goertz
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - Yigit Ozpeynirci
- Department of Neuroradiology, Ludwig's Maximilian University Munich, Munich, Germany
| | - Marc Schlamann
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Nils Lehnen
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Eberhard Siebert
- Department of Neuroradiology, University Hospital of Berlin (Charité), Berlin, Germany
| | - Thomas Liebig
- Department of Neuroradiology, Ludwig's Maximilian University Munich, Munich, Germany
| | - Christoph Kabbasch
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
| |
Collapse
|
21
|
Morales-Caba L, Lylyk I, Vázquez-Añón V, Bleise C, Scrivano E, Perez N, Lylyk PN, Lundquist J, Bhogal P, Lylyk P. The pCONUS2 and pCONUS2 HPC Neck Bridging Devices : Results from an International Multicenter Retrospective Study. Clin Neuroradiol 2023; 33:129-136. [PMID: 35819477 PMCID: PMC10014770 DOI: 10.1007/s00062-022-01191-w] [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: 10/31/2021] [Accepted: 06/16/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Bifurcation aneurysms represent an ongoing endovascular challenge with a variety of techniques and devices designed to address them. We present our multicenter series of the pCONUS2 and pCONUS2 HPC devices when treating bifurcation aneurysms. METHODS We performed a retrospective review of our prospectively maintained databases at 3 tertiary neurointerventional centers to identify all patients who underwent coil embolization with the pCONUS2 or pCONUS2 HPC device between February 2015 and August 2021. We recorded baseline demographics, aneurysm data, complications, immediate and delayed angiographic results. RESULTS We identified 55 patients with 56 aneurysms, median age 63 years (range 42-78 years), 67.3% female (n = 37). The commonest aneurysm location was the MCA bifurcation (n = 40, 71.4%). Average dome height was 8.9 ± 4.2 mm (range 3.2-21.5 mm), average neck width 6.4 ± 2.5 mm (range 2.6-14 mm), and average aspect ratio 1.3 ± 0.6 (range 0.5-3.3). The pCONUS2 was used in 64.3% and the pCONUS2 HPC in 35.7%. The procedural technical success rate was 98.2%. Intraoperative complications occurred in 5 cases (8.9%), 4 of which were related to the coils with partial thrombus formation on the pCONUS2 HPC seen in 1 case that was resolved with heparin. In relation to the procedure and treatment of the aneurysm the overall permanent morbidity was 1.8% (n = 1/55) and mortality 0%. Delayed angiographic follow-up (48 aneurysms) at median 12 months postprocedure (range 3-36 months) demonstrated adequate occlusion of 83.4% of aneurysms. CONCLUSION The pCONUS2 and pCONUS2 HPC devices carry a high technical success rate, low complication and retreatment rate, and good rates of adequate occlusion. Larger prospective confirmatory studies are required.
Collapse
Affiliation(s)
- L Morales-Caba
- Department of Neuroradiology, Hospital Universitari i Politècnic La Fe, València, Spain
- Department of Radiology, Hospital Universitari La Ribera, Alzira, Spain
| | - I Lylyk
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - V Vázquez-Añón
- Department of Neuroradiology, Hospital Universitari i Politècnic La Fe, València, Spain
- Department of Radiology, Hospital Universitari La Ribera, Alzira, Spain
| | - C Bleise
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - E Scrivano
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - N Perez
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - P N Lylyk
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - J Lundquist
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - P Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, Whitechapel Road, E1 1BB, London, UK.
| | - P Lylyk
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| |
Collapse
|
22
|
Wodarg F, Ozpeynirci Y, Hensler J, Jansen O, Liebig T. Contour-Assisted coiling with jailed microcatheter May result in better occlusion (CoCoJaMBO) in wide-necked intracranial aneurysms: Proof of principle and immediate angiographic results. Interv Neuroradiol 2023; 29:79-87. [PMID: 35014885 PMCID: PMC9893242 DOI: 10.1177/15910199211069782] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Wide-necked bifurcation aneurysms, partially thrombosed, and recurrences of large and giant aneurysms are challenging to treat. We report our preliminary experience with a Contour-assisted coiling technique and discuss the periprocedural safety, feasibility, and effectiveness of the approach. METHODS We retrospectively reviewed consecutive patients who received endovascular treatment for intracranial aneurysms with an intra-aneurysmal flow disruptor (Contour) at two neurovascular centres between October 2018 and December 2020 and identified patients treated with a combination of Contour and platinum coils. Clinical and procedural data were recorded. RESULTS For this analysis, 8 patients (5 female) aged 60.1 ± 9.2 years on average were identified. Three of 8 aneurysms were associated with previous acute subarachnoid hemorrhage (SAH). The mean average dome height was 12.8 ± 7.6 mm, mean maximum dome width 10.3 ± 5.4 mm, and neck width 5.5 ± 2.5 mm. The mean dome-to-neck ratio was 1.9 ± 1.0. Immediate complete occlusion of the aneurysm was seen in 5 of 8 cases. In one SAH patient, a parent vessel was temporarily occluded but could be reopened rapidly. One device detached prematurely without any sequelae. No other procedural adverse events were recorded. CONCLUSION From this initial experience, Contour with adjunctive coiling is a safe and technically feasible method for endovascular treatment of large, wide-necked, partially thrombosed, recurrent, or ruptured bifurcation aneurysms. Further studies with larger numbers of patients and longer follow-up are needed to confirm our results.
Collapse
Affiliation(s)
- Fritz Wodarg
- Department of Radiology and Neuroradiology, University Hospital
Schleswig-Holstein, Campus Kiel, Christian-Albrechts University, Germany
| | - Yigit Ozpeynirci
- Institute of Neuroradiology, LMU-University Hospital,
Ludwig-Maximilians-University, Munich, Germany
| | - Johannes Hensler
- Department of Radiology and Neuroradiology, University Hospital
Schleswig-Holstein, Campus Kiel, Christian-Albrechts University, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital
Schleswig-Holstein, Campus Kiel, Christian-Albrechts University, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, LMU-University Hospital,
Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
23
|
Russo R, Molinaro S, Bergui M. Cerus Endovascular Contour Neurovascular System Protrusion into Parent Artery Successfully Managed with Post-detachment Bail-out PTA. Clin Neuroradiol 2023; 33:561-564. [PMID: 36692523 DOI: 10.1007/s00062-022-01257-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/26/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Riccardo Russo
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Department of Neuroscience, Neuroradiological Unit, University of Turin, Corso Bramante 88, 10126, Turin, Italy.
| | - Stefano Molinaro
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Department of Neuroscience, Neuroradiological Unit, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Mauro Bergui
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Department of Neuroscience, Neuroradiological Unit, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| |
Collapse
|
24
|
Pravdivtseva MS, Pravdivtsev AN, Peters S, Hensler J, Larsen N, Hövener JB, Jansen O, Wodarg F. The effect of the size of the new contour neurovascular device for altering intraaneurysmal flow. Interv Neuroradiol 2023:15910199221145985. [PMID: 36594503 DOI: 10.1177/15910199221145985] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Recently, a novel intrasaccular device (contour neurovascular system, contour) was introduced to treat intracranial aneurysms. Contour is placed at thе aneurysm neck and reduces the intraaneurysmal blood inflow. Contour comes in a range of sizes to target different aneurysms. The efficiency of altering flow with contour and the effect of device size have not yet been investigated. Therefore, we studied the effect of the device size with patient-based aneurysm models using 2D digital subtraction angiography (DSA). METHODS Three patient-based aneurysm models with necks ranging from 2.7 to 9.7 mm were produced, providing standardized testing conditions. Contours with diameters of 5, 11, and 14 mm were implanted into the models, four of each size. 2D DSA images were acquired before and after implanting contour (15 frames/s, manual contrast injection). After injecting angiographic contrast agent, the DSA signal was recorded over time to calculate the contrast washout time (WOT), which is a measure of flow diversion efficiency. RESULTS All contour devices caused contrast agent stasis and increased WOT in aneurysm sac (p-value = 0.0005). The median relative WOT was largest for 5-mm contour (6.6 ± 3.2) and similar for 11-mm contour (3.4 ± 2.6) and 14-mm contour (3.2 ± 3.8). The implantation procedure might affect WOT values even for contours of the same size; the overall relative WOT ranged between 1.5 and 10.89. CONCLUSION The 5-mm contour showed the longest WOT value in our study, while no apparent difference between 11-mm contour and 14-mm contour was found.
Collapse
Affiliation(s)
- Mariya S Pravdivtseva
- Department of Radiology and Neuroradiology, Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), 54186University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
| | - Andrey N Pravdivtsev
- Department of Radiology and Neuroradiology, Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), 54186University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
| | - Sönke Peters
- Department of Radiology and Neuroradiology, 9179University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Johannes Hensler
- Department of Radiology and Neuroradiology, 9179University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Naomi Larsen
- Department of Radiology and Neuroradiology, 9179University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Jan-Bernd Hövener
- Department of Radiology and Neuroradiology, Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), 54186University Medical Center Schleswig-Holstein (UKSH), Kiel University, Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, 9179University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Fritz Wodarg
- Department of Radiology and Neuroradiology, 9179University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| |
Collapse
|
25
|
Hecker C, Broussalis E, Griessenauer CJ, Killer-Oberpfalzer M. A mini-review of intrasaccular flow diverters. J Neurointerv Surg 2023; 15:70-74. [PMID: 35580985 DOI: 10.1136/neurintsurg-2021-018426] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/08/2022] [Indexed: 12/16/2022]
Abstract
Treatment of wide-necked complex intracranial aneurysms continues to challenge neurointerventionalists. Intrasaccular flow diverters have expanded the armamentarium considerably and are now used extensively. While five types of devices have already obtained the CE mark for use within Europe, only the Woven EndoBridge (WEB) device is approved by the US Food and Drug Administration. Other intrasaccular devices are the Luna/Artisse Aneurysm Embolization System (Medtronic), the Medina Embolic Device (Medtronic), the Contour Neurovascular System (Cerus), and the Neqstent Coil Assisted Flow Diverter (Cerus). This mini review will provide a compact overview of these devices and a summary of the current literature.
Collapse
Affiliation(s)
- Constantin Hecker
- Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria .,Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Erasmia Broussalis
- Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria.,Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christoph J Griessenauer
- Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria.,Department of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Monika Killer-Oberpfalzer
- Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria.,Institute of Neurointervention, Paracelsus Medical University Salzburg, Salzburg, Austria
| |
Collapse
|
26
|
Kurzakova IO, Yakovlev SB. [pConus device for endovascular treatment of basilar bifurcation aneurysms]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:83-92. [PMID: 37650280 DOI: 10.17116/neiro20238704183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Aneurysm occlusion with microcoils is an effective and safe procedure. However, bifurcation aneurysms usually have a wide neck, and their occlusion is still a difficult objective. OBJECTIVE To evaluate the efficacy and safety of bifurcation stents in the treatment of basilar bifurcation aneurysms. MATERIAL AND METHODS A retrospective analysis included 34 patients with basilar bifurcation aneurysms between 2016 and 2022. The pConus bifurcation stent was used as a stent-assistance for endovascular occlusion of aneurysms with microcoils. We analyzed technical features of stent implantation and clinical results of endovascular treatment. Mean aneurysm dimension was 8.4 mm, neck size - 4.6 mm. Preoperative MSR score 0-2 was observed in 94.7% of patients, 3-5 scores - in 5.3% of patients. RESULTS There were no significant changes in functional status early after surgery (MSR grading system). Total aneurysm occlusion was achieved in 67.6% of patients, subtotal - 17.6% of cases, partial - 14.8%. There were no technical or early postoperative clinical complications. Six months after surgery, total occlusion was observed in 77.8% of patients, subtotal occlusion - 14.8%, partial occlusion - 4%. MSR score 0-2 was observed between 3 and 12 months after surgery. One patient died from other cause rather aneurysm. Redo intervention due to aneurysm recanalization was performed in 1 patient. CONCLUSION The pConus bifurcation stent is effective and safe in endovascular treatment of basilar bifurcation aneurysms of the most complex configuration. There was a minimal risk of aneurysm recanalization in long-term postoperative period.
Collapse
|
27
|
Ghozy S, Lashin BI, Elfil M, Bilgin C, Kobeissi H, Shehata M, Kadirvel R, Kallmes DF. The safety and effectiveness of the Contour Neurovascular System for the treatment of wide-necked aneurysms: A systematic review and meta-analysis of early experience. Interv Neuroradiol 2022:15910199221139546. [PMID: 36384322 DOI: 10.1177/15910199221139546] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The Contour is a new generation intrasaccular flow disruption tool that aims to cover the aneurysm neck and is sized according to the neck diameter. While several case series have been published, no literature review has been performed on this promising device. OBJECTIVE To assess the safety and effectiveness profile of the Contour Neurovascular System for wide-necked aneurysms. METHODS We followed the recommendations of the PRISMA checklist Four databases were searched with a supplemental manual search. All data were analyzed using R software version 4.2.1. RESULTS We finally included six studies with 131 treated aneurysms. The overall procedural time was 97.27 (95% CI = 70.07-124.47) minutes, ranging from 78.9 to 136.0 min. The pooled adequate occlusion rate was 84.21% (95% CI = 75.45-90.25), and the overall functional independence rate was 94.74% (87.97-97.79). The overall adverse event rate was 4.70 (95% CI = 3.24-6.76), varying among different events from 0.78 to 8.53%. Thromboembolic events were the most commonly encountered in 8.53% of the patients (95% CI = 4.78-14.74), followed by headache and minor stroke with incidence rates of 5.88 (95% CI = 2.83-11.83) and 4.35 (95% CI = 1.41-12.63), respectively. The overall procedural time in studies using the Contour system only was 86.17 (95% CI = 68.70-10.64) minutes, while it was 136 (95% CI = 90.96-181.04) in the Contour-assisted coiling procedures. However, both techniques were comparable regarding adequate occlusion rates and functional independence. CONCLUSION With the anticipation of future studies, the Contour Neurovascular System is a safe and effective treatment option for wide-necked intracranial aneurysms.
Collapse
Affiliation(s)
- Sherief Ghozy
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
- Nuffield Department of Primary Care Health Sciences and Department for Continuing Education (EBHC program), Oxford University, Oxford, UK
| | | | - Mohamed Elfil
- Department of Neurological Sciences, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Cem Bilgin
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | - Hassan Kobeissi
- College of Medicine, Central Michigan University, Mount Pleasant, MI, USA
| | - Mostafa Shehata
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | - Ramanathan Kadirvel
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, 6915Mayo Clinic, Rochester, MN, USA
| | - David F Kallmes
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
28
|
Webb M, Riina H, Mascitelli J. Wide-Neck and Bifurcation Aneurysms. Neurosurg Clin N Am 2022; 33:359-369. [DOI: 10.1016/j.nec.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
29
|
Sirakov A, Bhogal P, Sirakova K, Minkin K, Ninov K, Karakostov V, Sirakov S. Intrasaccular neck-bridging: A technical note on Nautilus-assisted coiling of wide-necked cerebral aneurysms. Feasibility study, immediate and early angiographic results. Interv Neuroradiol 2022; 28:746-755. [PMID: 35818746 DOI: 10.1177/15910199221113738] [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: 11/16/2022] Open
Abstract
PURPOSE Various adjunctive devices have been reported to be helpful during the endovascular coiling of complex, wide-necked cerebral aneurysms. This study aimed to describe the utilization of a recently introduced intrasaccular neck-bridging implant specifically designed to facilitate coil embolization. METHODS We retrospectively reviewed eight consecutive patients who underwent treatment for intracranial aneurysms with the Nautilus intrasaccular bridging system between February 2022 to May 2022. We evaluated the angiographic appearances of treated aneurysms at the end of the procedure and early follow-up, the clinical status and complications. RESULTS Eight patients with eight cerebral aneurysms (3 men and 5 women, mean age 52.8 years (range 39-66) were analyzed. Five of the treated aneurysms were managed in an acute case scenario. There were no technical difficulties while executing the technique. No other procedural adverse events were documented. Immediate complete occlusion of the aneurysm was seen in 6 patients, neck remnant in 1 and stable aneurysm reperfusion in one case. Early radiological follow-up was available in five patients, and the observed occlusion rates were - RR class I in all radiologically screened aneurysms. CONCLUSION Nautilus-assisted coil embolization represents a rapid and safe solution for complex cerebral aneurysms. In our opinion this device symbolizes a significant step forward in treating intracranial aneurysms. We believe that the technique's actual value consists of the fact that the device is fully compatible with the modern low-profile microcatheter technology and does not involve the need for antiplatelet medications.
Collapse
Affiliation(s)
- A Sirakov
- Interventional Radiology Department, UH St Ivan Rilski, Sofia, Bulgaria
| | - P Bhogal
- Interventional Neuroradiology Department, 112001The Royal Hospital, London, UK
| | - K Sirakova
- Neurosurgery Department, 266309UH St Ivan Rilski, Sofia, Bulgaria
| | - K Minkin
- Neurosurgery Department, 266309UH St Ivan Rilski, Sofia, Bulgaria
| | - K Ninov
- Radiology Department, 58788UH Aleksandrovska, Sofia, Bulgaria
| | - V Karakostov
- Neurosurgery Department, 266309UH St Ivan Rilski, Sofia, Bulgaria
| | - S Sirakov
- Interventional Radiology Department, UH St Ivan Rilski, Sofia, Bulgaria
| |
Collapse
|
30
|
Cavasin N, Gava UA, Magrini S, Cagliari E. Treatment of a ruptured fetal-type posterior communicating aneurysm with a combined approach using the new contour neurovascular system. BMJ Case Rep 2022; 15:e248065. [PMID: 35440434 PMCID: PMC9020296 DOI: 10.1136/bcr-2021-248065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/04/2022] Open
Abstract
Fetal-type posterior communicating artery (FPCom) aneurysms are associated with higher rates of recurrence after endovascular treatment than aneurysms at other locations. We report the case of a patient with a subarachnoid haemorrhage and ruptured right-sided FPCom aneurysm. The patient underwent acute endovascular treatment with application of a novel combined approach-partial coiling to protect the dome and occlusion of the neck with a new flow-disrupter, endosaccular device, Contour (Cerus Endovascular)-as a stable, single-step treatment to prevent rebleeding in the acute stage and long-term potential recurrences.
Collapse
|
31
|
Yaeger K, Mocco J. Future Directions of Endovascular Neurosurgery. Neurosurg Clin N Am 2022; 33:233-239. [DOI: 10.1016/j.nec.2021.11.007] [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]
|
32
|
Liebig T, Killer-Oberpfalzer M, Gal G, Schramm P, Berlis A, Dorn F, Jansen O, Fiehler J, Wodarg F. The Safety and Effectiveness of the Contour Neurovascular System (Contour) for the Treatment of Bifurcation Aneurysms: The CERUS Study. Neurosurgery 2022; 90:270-277. [PMID: 35113830 DOI: 10.1227/neu.0000000000001783] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Contour is a novel intra-aneurysmal flow disrupting device to treat intracranial aneurysms. OBJECTIVE To evaluate the safety and effectiveness of the Contour device for treatment of nonruptured intracranial bifurcation aneurysms through a prospective, multicenter, single-arm study. METHODS Thirty-four patients were enrolled. Primary end points were successful occlusion at 6 mo for efficacy and any major stroke or nonaccidental death up to 30 d or major disabling stroke within 6 mo for safety. Secondary end points were occlusion at 12 mo, retreatment rate, procedure time, and procedure-related/device-related adverse events. Procedural and follow-up imaging was reviewed by an independent core laboratory. Adverse events were reviewed and adjudicated by a clinical events committee. RESULTS In total, 32 of 34 aneurysms were successfully implanted and, 2 of 34 in the intention-to-treat (ITT) group did not receive the Contour and were excluded from follow-up after 30 d. In addition, 2 of 32 were lost to angiographic follow-up and regarded as treatment failure. The primary safety end point was met in 2 patients in the ITT group. In the perprotocol (PP) group, complete occlusion was seen in 14 of 32 (44%) at 6 mo and 22 of 32 (69%) at 12 mo. Adequate occlusion (Raymond-Roy [RR] 1 and 2) was reached in 84% at a last available follow-up. One patient from the ITT group and 1 from the PP group received additional treatment during follow-up. CONCLUSION The Contour seems to be both safe and effective in the treatment of intracranial bifurcation aneurysms.
Collapse
Affiliation(s)
- Thomas Liebig
- Institute of Neuroradiology, LMU-University Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Monika Killer-Oberpfalzer
- Department of Neurology/Institute of Neurointervention, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Gyula Gal
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Peter Schramm
- Department of Neuroradiology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ansgar Berlis
- Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Franziska Dorn
- Institute of Neuroradiology, LMU-University Hospital, Ludwig-Maximilians University, Munich, Germany
- Department of Neuroradiology, University of Bonn, Bonn, Germany
| | - Olav Jansen
- Institute of Neuroradiology, LMU-University Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fritz Wodarg
- Institute of Neuroradiology, LMU-University Hospital, Ludwig-Maximilians University, Munich, Germany
| |
Collapse
|
33
|
De Leacy R, Bageac DV, Siddiqui N, Bellon RJ, Park MS, Schirmer CM, Woodward KB, Zaidat OO, Spiotta AM. Safety and Long-Term Efficacy Outcomes for Endovascular Treatment of Wide-Neck Bifurcation Aneurysms of the Middle Cerebral Artery: Insights From the SMART Registry. Front Neurol 2022; 13:830296. [PMID: 35197925 PMCID: PMC8860028 DOI: 10.3389/fneur.2022.830296] [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: 12/06/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Wide-necked middle cerebral artery bifurcation aneurysms pose specific challenges to endovascular management. Surgical clipping remains the standard treatment approach for these aneurysms in many centers. While recent data suggests the endovascular treatment may be comparable, a prospective datapoint has been lacking. Materials and Methods The Penumbra SMART registry, a prospective, multi-center, single-arm outcomes registry of Penumbra coil-treated aneurysms, was queried for endovascularly treated MCA bifurcation aneurysms with wide necks (dome:neck ratio <2 or neck >4 mm). Safety and efficacy outcomes were summarized for ruptured and unruptured aneurysms, including rupture, complication rate, and 1-year occlusion outcomes. Results Seventy-two aneurysms across 31 sites were enrolled. Of these, a total of 15 presented as ruptured aneurysms. Serious adverse events were reported in 21 (29.2%) of patients, with 8 (11.1%) attributed to the device/procedure. Immediately postoperatively, 75.0% of cases achieved “adequate” Raymond Roy Class I (40.3%) or II (34.7%) occlusion outcomes. Of the 72 patients treated, 60 (83.3%) underwent follow-up angiography at 1 year, and among these, 95.0% had 1-year occlusion outcomes of Raymond Roy Class I (71.7%) or II (23.3%). A total of 6 aneurysms (10.0%) were required or were planned for retreatment at the last follow-up. Conclusion This study represents the most significant prospective sample of endovascularly treated wide-neck MCA bifurcation aneurysms conducted to date. It supports the safety and efficacy of endovascular treatment of these aneurysms.
Collapse
Affiliation(s)
- Reade De Leacy
- Department of Neurosurgery, Mount Sinai Hospital, New York, NY, United States
| | - Devin V Bageac
- Department of Neurosurgery, Mount Sinai Hospital, New York, NY, United States
| | - Neha Siddiqui
- Department of Neurosurgery, Mount Sinai Hospital, New York, NY, United States
| | | | - Min S Park
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States
| | - Clemens M Schirmer
- Department of Neurosurgery and Neuroscience Institute, Geisinger Health System, Wilkes-Barre, PA, United States.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | | | | | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, United States
| |
Collapse
|
34
|
Results of the pToWin Study: Using the pCONUS Device for the Treatment of Wide-Neck Intracranial Aneurysms. J Clin Med 2022; 11:jcm11030884. [PMID: 35160333 PMCID: PMC8836830 DOI: 10.3390/jcm11030884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/03/2022] Open
Abstract
Coil embolization has become a well-established option for the treatment of intracranial aneurysms. Yet, wide-neck bifurcation aneurysms (WNBAs) remain a challenge. The pCONUS is the first generation of a stent-like implant for the bridging of WNBAs to enable coiling. The pToWin study was a prospective, single-arm, multicenter study conducted to analyze the safety and efficacy of the pCONUS in the treatment of WNBAs. The primary effectiveness endpoint was the rate of adequate occlusion of the aneurysm at 3–6 and 7–12 months. The primary safety endpoint was the occurrence of major ipsilateral stroke or neurological death during the follow-up. A total of 115 patients were included. Aneurysm locations were the middle cerebral artery in 52 (45.2%), the anterior communicating artery in 35 (30.4%), the basilar artery in 23 (20%), the internal carotid artery terminus in three (2.6%), and the pericallosal artery in two (1.7%) patients. Treatment was successfully performed in all but one patient. The morbi-mortality rate was 1.9% and 2.3% at 3–6 and 7–12 months, respectively. Of the aneurysms, 75.0% and 65.6% showed adequate occlusion at 3–6 and 7–12 months, respectively. pCONUS offers a safe and reasonably effective treatment of WNBAs, demonstrated by acceptable adequate aneurysm occlusion and low rates of adverse neurologic events.
Collapse
|
35
|
Schob S, Brill R, Siebert E, Sponza M, Schüngel MS, Wohlgemuth WA, Götz N, Mucha D, Gopinathan A, Scheer M, Prell J, Bohner G, Gavrilovic V, Skalej M. Indirect Flow Diversion for Off-Centered Bifurcation Aneurysms and Distant Small-Vessel Aneurysms, a Retrospective Proof of Concept Study From Five Neurovascular Centers. Front Neurol 2022; 12:801470. [PMID: 35069430 PMCID: PMC8770821 DOI: 10.3389/fneur.2021.801470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Treatment of cerebral aneurysms using hemodynamic implants such as endosaccular flow disruptors and endoluminal flow diverters has gained significant momentum during recent years. The intended target zone of those devices is the immediate interface between aneurysm and parent vessel. The therapeutic success is based on the reduction of aneurysmal perfusion and the subsequent formation of a neointima along the surface of the implant. However, a subset of aneurysms-off-centered bifurcation aneurysms involving the origin of efferent branches and aneurysms arising from peripheral segments of small cerebral vessels-oftentimes cannot be treated via coiling or implanting a hemodynamic implant at the neck level for technical reasons. In those cases, indirect flow diversion-a flow diverter deployed in the main artery proximal to the parent vessel of the aneurysm-can be a viable treatment strategy, but clinical evidence is lacking in this regard. Materials and Methods: Five neurovascular centers contributed to this retrospective analysis of patients who were treated with indirect flow diversion. Clinical data, aneurysm characteristics, anti-platelet medication, and follow-up results, including procedural and post-procedural complications, were recorded. Results: Seventeen patients (mean age: 60.5 years, range: 35-77 years) with 17 target aneurysms (vertebrobasilar: n = 9) were treated with indirect flow diversion. The average distance between the flow-diverting stent and the aneurysm was 1.65 mm (range: 0.4-2.4 mm). In 15/17 patients (88.2%), perfusion of the aneurysm was reduced immediately after implantation. Follow-ups were available for 12 cases. Delayed opacification (OKM A3: 11.8%), reduction in size (OKM B1-3: 29.4%) and occlusion (D1: 47.1%) were observable at the latest investigation. Clinically relevant procedural complications and adverse events in the early phase and in the late subacute phase were not observed in any case. Conclusion: Our preliminary data suggest that indirect flow diversion is a safe, feasible, and effective approach to off-centered bifurcation aneurysms and distant small-vessel aneurysms. However, validation with larger studies, including long-term outcomes and optimized imaging, is warranted.
Collapse
Affiliation(s)
- Stefan Schob
- Abteilung für Neuroradiologie, Klinik & Poliklinik für Radiologie, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | - Richard Brill
- Abteilung für Neuroradiologie, Klinik & Poliklinik für Radiologie, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | - Eberhard Siebert
- Institut für Neuroradiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Massimo Sponza
- Angiography and Interventional Radiology Unit, Department of Radiology, Azienda Sanitari Universitaria Friuli Centrale, Udine, Italy
| | - Marie-Sophie Schüngel
- Abteilung für Neuroradiologie, Klinik & Poliklinik für Radiologie, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | - Walter Alexander Wohlgemuth
- Abteilung für Neuroradiologie, Klinik & Poliklinik für Radiologie, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | - Nico Götz
- Abteilung für Neuroradiologie, Klinik & Poliklinik für Radiologie, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | - Dirk Mucha
- Institut für Radiologie und Neuroradiologie, Heinrich-Braun-Klinikum, Zwickau, Germany
| | - Anil Gopinathan
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Maximilian Scheer
- Klinik & Poliklinik für Neurochirurgie, Universitätsklinikum Halle, Halle (Saale), Germany
| | - Julian Prell
- Klinik & Poliklinik für Neurochirurgie, Universitätsklinikum Halle, Halle (Saale), Germany
| | - Georg Bohner
- Institut für Neuroradiologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Vladimir Gavrilovic
- Angiography and Interventional Radiology Unit, Department of Radiology, Azienda Sanitari Universitaria Friuli Centrale, Udine, Italy
| | - Martin Skalej
- Abteilung für Neuroradiologie, Klinik & Poliklinik für Radiologie, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| |
Collapse
|
36
|
Dange N, Roy J. Initial Experience with the Contour Device in the Treatment of Ruptured Intracranial Wide-necked Bifurcation Aneurysms: A Single-operator, Multicenter Study. Neurol India 2022; 70:2059-2064. [DOI: 10.4103/0028-3886.359281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
37
|
Fatania K, Patankar DT. Comprehensive review of the recent advances in devices for endovascular treatment of complex brain aneurysms. Br J Radiol 2022; 95:20210538. [PMID: 34609898 PMCID: PMC8722252 DOI: 10.1259/bjr.20210538] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The International Subarachnoid Aneurysm Trial (ISAT) showed superiority for endovascular treatment of ruptured aneurysms and technology has since moved on rapidly. Many approaches and technology now exist for the endovascular management of ruptured and unruptured intracranial aneurysms, which reflects their varied nature - there is no one-size-fits-all technique. We aim to provide an overview of the various classes of device and the major developments over the past decade. Coiling is the oldest of the technology and continues to demonstrate high levels of occlusion and acceptable risks, making it the default treatment choice, particularly in the acutely ruptured aneurysm setting. Advances on coiling include the use of adjuncts such as balloons, stents and fully retrievable temporary neck-bridging devices, which have facilitated the treatment of more complex aneurysms. Flow divertors have also revolutionised complex aneurysm treatment with small added risk in acute aneurysm treatment and seek to remodel the aneurysm-vessel interface without accessing the aneurysm sac. The latest development and most promising avenue appears to be intrasaccular flow disrupting devices like WEB, Contour and Neqstent that provide excellent opportunities to treat wide neck complex aneurysm with minimal mortality and morbidity and good occlusion rates and may in future replace a significant number of stent-assisted coiling too.
Collapse
Affiliation(s)
- Kavi Fatania
- Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | |
Collapse
|
38
|
Lyu M, Ventikos Y, Peach TW, Makalanda L, Bhogal P. Virtual Flow-T Stenting for Two Patient-Specific Bifurcation Aneurysms. Front Neurol 2021; 12:726980. [PMID: 34803876 PMCID: PMC8595090 DOI: 10.3389/fneur.2021.726980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
The effective treatment of wide necked cerebral aneurysms located at vessel bifurcations (WNBAs) remains a significant challenge. Such aneurysm geometries have typically been approached with Y or T stenting configurations of stents and/or flow diverters, often with the addition of endovascular coils. In this study, two WNBAs were virtually treated by a novel T-stenting technique (Flow-T) with a number of braided stents and flow-diverter devices. Multiple possible device deployment configurations with varying device compression levels were tested, using fast-deployment algorithms, before a steady state computational hemodynamic simulation was conducted to examine the efficacy and performance of each scenario. The virtual fast deployment algorithm based on a linear and torsional spring analogy is used to accurately deploy nine stents in two WNBAs geometries. The devices expand from the distal to proximal side of the devices with respect to aneurysm sac. In the WNBAs modelled, all configurations of Flow-T device placement were shown to reduce factors linked with increased aneurysm rupture risk including aneurysm inflow jets and high aneurysm velocity, along with areas of flow impingement and elevated wall shear stress (WSS). The relative position of the flow-diverting device in the secondary daughter vessel in the Flow-T approach was found to have a negligible effect on overall effectiveness of the procedure in the two geometries considered. The level of interventionalist-applied compression in the braised stent that forms the other arm of the Flow-T approach was shown to impact the aneurysm inflow reduction and aneurysm flow pattern more substantially. In the Flow-T approach the relative position of the secondary daughter vessel flow-diverter device (the SVB) was found to have a negligible effect on inflow reduction, aneurysm flow pattern, or WSS distribution in both aneurysm geometries. This suggests that the device placement in this vessel may be of secondary importance. By contrast, substantially more variation in inflow reduction and aneurysm flow pattern was seen due to variations in braided stent (LVIS EVO or Baby Leo) compression at the aneurysm neck. As such we conclude that the success of a Flow-T procedure is primarily dictated by the level of compression that the interventionalist applies to the braided stent. Similar computationally predicted outcomes for both aneurysm geometries studied suggest that adjunct coiling approach taken in the clinical intervention of the second geometry may have been unnecessary for successful aneurysm isolation. Finally, the computational modelling framework proposed offers an effective planning platform for complex endovascular techniques, such as Flow-T, where the scope of device choice and combination is large and selecting the best strategy and device combination from several candidates is vital.
Collapse
Affiliation(s)
- Mengzhe Lyu
- Department of Mechanical Engineering, University College London (UCL), London, United Kingdom
| | - Yiannis Ventikos
- Department of Mechanical Engineering, University College London (UCL), London, United Kingdom.,School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Thomas W Peach
- Department of Mechanical Engineering, University College London (UCL), London, United Kingdom
| | - Levansri Makalanda
- Department of Interventional Neuroradiology, The Royal London Hospital, London, United Kingdom
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, London, United Kingdom
| |
Collapse
|
39
|
Catapano JS, Karahalios K, Rumalla K, Srinivasan VM, Rutledge C, Baranoski JF, Cole TS, Jadhav AP, Ducruet AF, Albuquerque FC. Endovascular treatment of ruptured anterior communicating aneurysms: a 17-year institutional experience with coil embolization. J Neurointerv Surg 2021; 14:1018-1021. [PMID: 34615688 DOI: 10.1136/neurintsurg-2021-017695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/25/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Ruptured anterior communicating artery (ACoA) aneurysms can be challenging to treat via an endovascular procedure. This study analyzed retreatment rates and neurological outcomes associated with ruptured ACoA aneurysms treated via endovascular coiling. METHODS All patients with a ruptured ACoA aneurysm treated with endovascular coiling from 2003 to 2019 were retrospectively analyzed at a single center. Two comparisons were performed: no retreatment versus retreatment and coil embolization versus balloon-assisted coil embolization. Outcomes included retreatment and neurological outcome assessed via modified Rankin Scale (mRS). RESULTS During the study period, 186 patients with ruptured ACoA aneurysms underwent coil embolization. Treatment included standard coil embolization (68.3%, n=127), balloon-assisted coiling (28.5%, n=53), and stent-assisted embolization (2.7%, n=5). Angiographic outcomes were as follows: class I, 65.1% (n=121); class II, 28.5% (n=53); and class III, 6.5% (n=12). There were no aneurysm reruptures after the index procedure. The mean (SD) mRS score was 2.7 (2.0) at last follow-up (mortality, 19 (10%)). Retreatment occurred in 9.7% (n=18). Patients with retreatment were younger with lower-grade subarachnoid hemorrhage and more favorable functional status at discharge. Patients with aneurysms >7 mm (n=36) were significantly more likely to have recurrence (22.2% vs 6.7%, P=0.005). CONCLUSIONS Endovascular treatment of ruptured ACoA aneurysms is safe and is associated with low mortality and retreatment rates. Younger patients with favorable functional status and larger aneurysm size are more likely to be retreated. Ruptured aneurysms <4 mm, although prevalent in the study (29%), never required retreatment.
Collapse
Affiliation(s)
| | | | - Kavelin Rumalla
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | | | - Caleb Rutledge
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | | | - Tyler S Cole
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | | | - Andrew F Ducruet
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | | |
Collapse
|
40
|
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
|
41
|
Thormann M, Mpotsaris A, Behme D. Treatment of a middle cerebral artery bifurcation aneurysm with the novel Contour Neurovascular System compatible with 0.021″ catheters. Neuroradiol J 2021; 35:396-398. [PMID: 34423661 PMCID: PMC9244739 DOI: 10.1177/19714009211041523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background For wide-necked intracranial aneurysms, endo-saccular flow disruption can be a viable
alternative to coiling or flow diverters. The Contour Neurovascular System is an
intrasaccular flow diverter device targeting the neck of the aneurysm. Until now, the
system had to be delivered through a 0.027″ microcatheter. We report the first
implantation and follow-up of the novel Contour 021 system compatible with 0.021″
microcatheters. Case presentation: A 54-year-old male patient presented with an unruptured
right middle cerebral artery aneurysm at the right temporopolar branch. Existing
medication included apixaban. An arteriogram showed a broad-based aneurysm. Due to its
asymmetric geometry, neither the Woven EndoBridge nor stent-assisted coil embolisation
were regarded as promising treatment strategies. To uphold the option of different
treatment options, prasugrel 10 mg was initiated before treatment. Implantation was
performed under general anaesthesia via femoral artery puncture. A 0.021″ Headway™
catheter was used for accessing the aneurysm. The Contour device was oversized to the
equatorial plane. Deployment was successful with only one attempt without the need for
re-sheathing. Follow-up catheter angiography was performed after three months, showing
complete occlusion of the aneurysm. No procedure-related complications occurred. Conclusion The 0.021 design of the Contour enlarges the subgroup of patients that can be treated
with endo-saccular devices and will enable treatment of smaller and more distal
aneurysms.
Collapse
Affiliation(s)
- Maximilian Thormann
- Maximilian Thormann, Universitätsklinikum
Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany.
| | | | | |
Collapse
|
42
|
Maus V, Weber W, Fischer S. "Shelf" Technique Using a Novel Braided Self-Expandable Stent for the Treatment of Wide-Necked Bifurcation Aneurysms. Clin Neuroradiol 2021; 31:1187-1193. [PMID: 34283247 PMCID: PMC8648644 DOI: 10.1007/s00062-021-01032-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/28/2021] [Indexed: 11/21/2022]
Abstract
Background Different endovascular techniques exist for treatment of cerebral wide-necked bifurcation aneurysms (WNBA). We present the “shelf” technique with the novel woven LVIS EVO stent, which enables forming a buttress at the level of the aneurysm neck to prevent coil prolapse and additional stenting. Methods Single-center retrospective analysis of patients treated with the “shelf” technique by using LVIS EVO stent in incidental WNBAs between January 2020 and March 2021. Inclusion criteria were saccular aneurysms with neck width ≥4 mm or a dome/neck ratio ≤2. Primary endpoint was a favorable navigation to the target vessel and successful deployment of the LVIS EVO stent with forming a buttress that enables aneurysm occlusion by subsequent coiling. Secondary endpoints were aneurysm occlusion on follow-up, procedure-related complications and clinical outcome. Results A total of 15 patients were included. The primary end point was reached in 100% of cases. A complete aneurysm occlusion at the end of the procedure was achieved in 14/15 patients (93%). No intraprocedural complications occurred. All patients except one were discharged with an modified Rankin Scale (mRS) of 0. Procedure-related morbidity was 7%. Median follow-up imaging was 115 days (7–419 days) and available for 11/15 (73%) of the patients. Of those, 10 (91%) individuals had a complete aneurysm occlusion and 1 showed a residual neck. In all patients, the covered branch was patent and no ischemic complications occurred during follow-up. Conclusion This study demonstrates the “shelf” technique with LVIS EVO stents as a feasible and safe treatment option for WNBAs with very good short-term occlusion rates.
Collapse
Affiliation(s)
- Volker Maus
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, In der Schornau 23-25, 44892, Bochum, Germany.
| | - Werner Weber
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, In der Schornau 23-25, 44892, Bochum, Germany
| | - Sebastian Fischer
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Universitätsklinik der Ruhr-Universität Bochum, In der Schornau 23-25, 44892, Bochum, Germany
| |
Collapse
|
43
|
Sirakov A, Matanov S, Bhogal P, Sirakov S. Nautilus-assisted coil embolization for a complex AcomA wide-necked aneurysm in the setting of acute subarachnoid hemorrhage. J Neurointerv Surg 2021; 14:310. [PMID: 34140287 DOI: 10.1136/neurintsurg-2021-017670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 05/11/2021] [Indexed: 01/18/2023]
Abstract
Numerous devices and sophisticated strategies have been developed to further increase the number of aneurysms amenable to endovascular treatment.1-4 Despite the superfluity of available neurovascular armamentarium, wide-necked bifurcation aneurysms can still pose a significant technical challenge to the treating clinician.5-7 Neck bridging is a conceptually new approach, which provides increased occlusion rates with lower recurrence and complications rates.8-10 The Nautilus (EndoStream Medical) is an intrasaccular bridging device intended to assist in coil embolization of wide-necked cerebral aneurysms. This CE-marked device, available in various sizes, consists of flexible-layers, and is a nitinol-based, detachable implant. The device is delivered through a standard microcatheter with a minimal 0.0165" inner diameter and is fully radiopaque and completely resheathable.Owing to its unique 'tornado' like shape the device entirely reconstructs the aneurysmal neck, which facilitates the following coil embolization. In this video 1, we demonstrate the use of Nautilus - assisted coil embolization for a complex anterior communicating artery (AcomA) wide-necked aneurysm in the setting of acute subarachnoid hemorrhage.neurintsurg;neurintsurg-2021-017670v1/V1F1V1Video 1.
Collapse
Affiliation(s)
- Alexander Sirakov
- Radiology Department, University Hospital St Ivan Rilski, Sofia, Sofiâ, Bulgaria
| | - Svetozar Matanov
- Radiology Department, University Hospital St Ivan Rilski, Sofia, Sofiâ, Bulgaria
| | - Pervinder Bhogal
- Interventional neuroradiology, Royal London Hospital, London, UK
| | - Stanimir Sirakov
- Radiology Department, University Hospital St Ivan Rilski, Sofia, Sofiâ, Bulgaria
| |
Collapse
|
44
|
Fries F, Tomori T, Schulz-Schaeffer WJ, Jones J, Yilmaz U, Kettner M, Simgen A, Reith W, Mühl-Benninghaus R. Treatment of experimental aneurysms with a GPX embolic agent prototype: preliminary angiographic and histological results. J Neurointerv Surg 2021; 14:286-290. [PMID: 33947771 PMCID: PMC8862012 DOI: 10.1136/neurintsurg-2021-017308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/08/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022]
Abstract
Background Recently, liquid embolic agents have emerged for the endovascular treatment of cerebral aneurysms. Here we describe the in vivo performance of a novel liquid embolization agent (GPX Embolic Device). Methods Elastase-induced aneurysms were embolized with a GPX prototype under balloon assistance. Digital subtraction angiography was performed pre-deployment and immediately after, and at 5, 10, and 30 min post-deployment in 10 rabbits and at 1 month in 8 rabbits. The early post-deployment intra-aneurysmal flow was graded as unchanged, moderately diminished, or completely absent. At 1 month the status of aneurysm occlusion was evaluated. Adhesion to catheter material and migration of GPX was assessed. Results The mean aneurysm neck diameter, width, and height were 3.6±1.0 mm, 3.0±0.8 mm, and 7.4±1.4 mm, respectively. The mean dome-to-neck ratio was 0.9±0.2. Complete stagnation of intra-aneurysmal flow was observed in 9 of 10 aneurysms (90%) within 30 min of device deployment. One aneurysm showed moderately diminished intra-aneurysmal flow at 30 min. At 1 month, 8 aneurysms were completely occluded. There was no evidence of GPX adhesion to the catheter material. Histologically, a leukocyte and foreign body reaction to GPX was detectable 28 days after embolization. Conclusions This is the first preclinical study reporting the performance of a protype version of the GPX Embolic Device in a wide-neck aneurysm model. GPX showed promising results by achieving and maintaining high rates of complete angiographic occlusion, but may induce an inflammatory reaction.
Collapse
Affiliation(s)
- Frederik Fries
- Department of Neuroradiology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - Toshiki Tomori
- Department of Neuroradiology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - Walter J Schulz-Schaeffer
- Department of Neuropathology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - Joshua Jones
- Engeneering and Development, FLUIDX Medical Technology, Salt Lake City, Utah, USA
| | - Umut Yilmaz
- Department of Neuroradiology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - Michael Kettner
- Department of Neuroradiology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - Andreas Simgen
- Department of Neuroradiology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - Wolfgang Reith
- Department of Neuroradiology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| | - Ruben Mühl-Benninghaus
- Department of Neuroradiology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Saarland, Germany
| |
Collapse
|
45
|
Yeomans J, Sastry A. pCONUS 2 and pCONUS 2-HPC for the treatment of wide-necked intracranial aneurysms: Periprocedural, 6-month, and early 2-year follow-up outcomes. Interv Neuroradiol 2021; 27:805-814. [PMID: 33887974 DOI: 10.1177/15910199211011887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/PURPOSE pCONUS 2 and pCONUS 2-HPC are novel neck-bridging devices designed to support endovascular coil occlusion of wide-necked intracranial bifurcation aneurysms. This study summarises periprocedural outcomes, 6-month, and early 2-year follow-up results following its introduction in an interventional neuroradiology centre. MATERIALS/METHODS This prospective, single-arm study assessed 20 aneurysms treated over a 40 month time period from time of procedure to 2 years post-procedure. Data collected included patient demographics, aneurysm features, and intraprocedural, 6-month, and 2-year post-procedural complications and angiographic features. RESULTS The mean age of the cohort was 59+-SD 7.7 years. 16 unruptured aneurysms were treated (pCONUS 2 13/16, pCONUS 2-HPC 3/16) and 4 ruptured aneurysms were treated with pCONUS 2-HPC. Unruptured cases received dual antiplatelet therapy pre- and post-procedure while ruptured cases received single antiplatelet therapy. 9/20 aneurysms were located at the MCA bifurcation and 7/20 at the basilar tip. The remaining 4 aneurysms were at various bifurcations in the anterior circulation. 11/20 were small (<10mm) and 9/20 were large (10-25mm). There was one periprocedural complication: a retroperitoneal bleed. There were no post-procedural intracranial complications or at 6-months follow-up. At 6 months, satisfactory occlusion was achieved in 94% of cases (15/16). There was one delayed death at 2-year follow-up from an unrelated cause. CONCLUSION pCONUS 2 and pCONUS 2-HPC have excellent short and medium-term safety profiles and clinical outcomes with no procedure-related mortality or morbidity and good occlusion rates at 6-month follow-up. The use of pCONUS 2-HPC with single antiplatelet therapy is feasible and did not cause any complications.
Collapse
Affiliation(s)
- J Yeomans
- University Hospital of Wales, Cardiff, UK
| | - A Sastry
- University Hospital of Wales, Cardiff, UK
| |
Collapse
|
46
|
Ozpeynirci Y, Hutschenreuter B, Forbrig R, Brückmann H, Liebig T, Dorn F. Endovascular treatment of basilar tip aneurysms in the era of endosaccular flow disruption: a comparative study. Neuroradiology 2020; 63:619-626. [PMID: 32968826 PMCID: PMC7966124 DOI: 10.1007/s00234-020-02555-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/09/2020] [Indexed: 11/26/2022]
Abstract
Purpose This study aims to compare endosaccular flow disruptor (EFD) for treatment of basilar tip aneurysm (BTA) with coiling in terms of safety and efficacy. Methods We retrospectively reviewed patients treated with an EFD for BTAs at our institution between 2013 and 2019 to standard coiling from the same period (control group). Patient demographics, aneurysm characteristics, procedural data, complications and clinical and angiographic outcome were compared between groups. Results Twenty-three (56%) patients were treated with an EFD and eighteen (44%) patients were treated with coiling. Average aneurysm size was 8 mm in the EFD group and 6.9 mm in the coiling group, respectively (P = 0.2). Average fluoroscopy time, treatment DAP and air kerma were 33 min, 76 Gycm2 and 1.7 Gy in the EFD group and 81 min, 152 Gycm2 and 3.8 Gy in the coiling group, respectively (P < 0.001). In the EFD group, clinically relevant thromboembolic complications occurred in one patient (4%) vs. in 5 patients (28%) in the coiling group (P = 0.07). In each group, 4 patients had an unfavourable outcome at discharge (P = 0.7). Adequate occlusion rates were 96% in the EFD group and 100% and coiling group. Six (26%) patients were prescribed long-term antiplatelet therapy in the EFD group vs. eleven (61%) patients in the coiling group (P = 0.02). Conclusion Both treatment concepts provided similar technical success and safety. However, procedure time, radiation exposure and a need for long-term antiaggregation were lower with EFD.
Collapse
Affiliation(s)
- Yigit Ozpeynirci
- Department of Neuroradiology, Ludwig Maximilian University, Munich, Germany.
| | | | - Robert Forbrig
- Department of Neuroradiology, Ludwig Maximilian University, Munich, Germany
| | - Hartmut Brückmann
- Department of Neuroradiology, Ludwig Maximilian University, Munich, Germany
| | - Thomas Liebig
- Department of Neuroradiology, Ludwig Maximilian University, Munich, Germany
| | - Franziska Dorn
- Department of Neuroradiology, Ludwig Maximilian University, Munich, Germany
| |
Collapse
|
47
|
Ospel JM, Kashani N, Mayank A, Liebig T, Kaesmacher J, Holtmannspötter M, Shankar J, Almekhlafi MA, Mitha AP, Wong JH, Goyal M. Current and future usefulness and potential of virtual simulation in improving outcomes and reducing complications in endovascular treatment of unruptured intracranial aneurysms. J Neurointerv Surg 2020; 13:251-254. [PMID: 32669397 DOI: 10.1136/neurintsurg-2020-016343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Simulation training has been used in the aviation industry and surgical specialties for many years, but integration into neurointerventional practice is lagging behind. OBJECTIVE To investigate how neurointerventionalists perceive the usefulness and limitations of simulation tools for the treatment of unruptured intracranial aneurysms (UIAs), and to identify simulation applications that were perceived to be most valuable for endovascular UIA treatment. METHODS A web-based international multidisciplinary survey was conducted among neurointerventionalists. Participants were asked for their perceptions on the usefulness of current simulation tools and the potential impact of future simulation tools in endovascular UIA treatment. They identified simulation applications that could add most value to endovascular UIA treatment and help to specifically reduce endovascular UIA treatment complications. RESULTS 233 neurointerventionalists from 38 countries completed the survey, most of whom (157/233 (67.4%)) had access to a simulator as a trainee, but only 15.3% used it frequently. Most participants (117/233 (50.2%)) considered currently available simulation tools relatively useful for endovascular UIA treatment, with greater value for trainees than for staff. Simulation of new devices (147/233 (63.1%)) and virtual practice runs in individual patient anatomy (119/233 (51.1%)) were considered most valuable for reducing endovascular UIA treatment complications. CONCLUSION Although neurointerventionalists perceived currently available simulation tools relatively useful, they did not use them regularly during their training. A priori testing of new devices and practice runs in individual patient anatomy in a virtual environment were thought to have the greatest potential for reducing endovascular UIA treatment complications.
Collapse
Affiliation(s)
- Johanna Maria Ospel
- Department of Radiology, Universitatsspital Basel, Basel, Switzerland.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Nima Kashani
- Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Arnuv Mayank
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Thomas Liebig
- Department of Neuroradiology, LMU Munich, Munich, Germany
| | | | | | - Jai Shankar
- Department of Radiology, University of Manitoba, Winnipeg, Nova Scotia, Canada
| | - Mohammed A Almekhlafi
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Alim P Mitha
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Department of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - John H Wong
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Department of Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - Mayank Goyal
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada .,Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| |
Collapse
|