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Lin LM, Collard de Beaufort J, Wang AS, Campos JK, Zarrin DA, Meyer BM, Colby GP, Coon AL. Augmentation of flow diverter vessel wall apposition using the Comaneci device: case experience from a novel, off-label technique. J Neurointerv Surg 2024; 16:764-769. [PMID: 37586816 DOI: 10.1136/jnis-2023-020533] [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: 05/14/2023] [Accepted: 07/15/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Flow diversion (FD) embolization of intracranial cerebral aneurysms is an increasingly common modality where treatment success depends on adequate vessel wall apposition of the device. This study aimed to investigate off-label use of the Comaneci device for augmenting vessel wall apposition in post-deployed flow diversion stents (FDS). METHODS Over a 20- month period, all FD cases for the treatment of internal carotid artery (ICA) aneurysms were reviewed. Cases in which the Comaneci device was used to augment vessel wall apposition were analyzed. Data including patient demographics, case characteristics, and procedural outcomes were collected and analyzed as counts. RESULTS From a total of 74 ICA FD cases, the Comaneci device was used to improve vessel wall apposition in 22 cases (29.7%) . Of these cases, 91% were female with a mean patient age of 64.9±11.3 years, and an average aneurysm size of 4.5±2.5 mm. Comaneci device deployment and retrieval was successful in all (100%) cases, with an average fluoroscopy time of 27.3±7.8 min, an average contrast usage of 25.8±13.2 mL, and an average radiation exposure of 915.1±320.8 mGy. Only two cases (9%) required subsequent balloon angioplasty after Comaneci deployment to improve vessel wall apposition throughout the FDS. CONCLUSION Our experience with this technique demonstrates the feasibility of using the Comaneci device for augmentation of FDS vessel wall apposition with 100% success in the deployment and retrieval of the Comaneci device.
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Affiliation(s)
- Li-Mei Lin
- Neurosurgery, Carondelet Neurological Institute, Carondelet Health Network, St. Joseph's Hospital, Tucson, Arizona, USA
| | | | - Alice S Wang
- Neurosurgery, Riverside University Health System, Moreno Valley, California, USA
| | - Jessica K Campos
- Neurosurgery, University of California Irvine, Irvine, California, USA
| | - David A Zarrin
- Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Benjamen M Meyer
- Neurosurgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Geoffrey P Colby
- Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Alexander L Coon
- Neurosurgery, Carondelet Neurological Institute, Carondelet Health Network, St. Joseph's Hospital, Tucson, Arizona, USA
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2
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Rueckel J, Ozpeynirci Y, Trumm C, Brem C, Pflaeging M, Fischer TD, Liebig T. Preliminary results of intracranial aneurysm treatment with derivo2heal embolization device. Neuroradiology 2024:10.1007/s00234-024-03387-y. [PMID: 38951171 DOI: 10.1007/s00234-024-03387-y] [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: 02/01/2024] [Accepted: 05/30/2024] [Indexed: 07/03/2024]
Abstract
INTRODUCTION The Derivo 2 Heal Embolization Device (D2HED) is a novel flow diverter (FD) providing a fibrin-/heparin-based surface coating aiming at lower thrombogenicity. We evaluate periprocedural aspects and preliminary aneurysm occlusion efficacy for intracranial aneurysm treatment. METHODS Thirty-four D2HEDs deployments (34 aneurysms, 32 patients) between 04/2021 and 10/2023 were analyzed. All patients were under dual antiplatelet therapy (dAPT). Periprocedural details, adverse events, and follow-up (FU) imaging were reviewed by consultant-level neuroradiologists. Complication rates and aneurysm occlusion efficacy are compared with performance data of other FDs based on literature research. RESULTS Each intervention succeeded in the deployment of one D2HED. Significant and/or increased intraaneurysmal contrast stagnation immediately after D2HED deployment was seen in 73.5% of cases according to O'Kelly-Marotta (OKM) grading scale. Clinically relevant early adverse events occurred in three patients: Among them two cases with fusiform aneurysms in the posterior circulation (ischemic events, early in-stent-thrombosis) and one patient (ischemic event) out of the majority of 31 treated internal carotid artery aneurysms (3,2%). Regarding mid-term FU (> 165 days), one aneurysm did not show progressive occlusion presumably caused by a prominent A1 segment arising from the terminal ICA aneurysm itself. Apart from that, mid-term complete / partial occlusion rates of 80% / 20% could be demonstrated. CONCLUSION Our case series - although suffering from restricted sample size - suggests a potential effectiveness of D2HED in managing intracranial aneurysms. Further studies with larger samples are warranted to quantify long-term occlusion efficacy and the impact of antithrombogenic surface coating on the necessary (d)APT.
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Affiliation(s)
- J Rueckel
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany.
| | - Y Ozpeynirci
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - C Trumm
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - C Brem
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - M Pflaeging
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - T D Fischer
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - T Liebig
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
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Bibi R, Bankole NDA, Donnard B, Giubbolini F, Boucherit J, Barrot V, Herbreteau D, Ifergan H, Janot K, Boulouis G, Bala F. Safety and efficacy of Surpass Evolve Flow diverter for intracranial aneurysms: A study of 116 patients. Neuroradiol J 2024; 37:184-191. [PMID: 38146676 DOI: 10.1177/19714009231224408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND AND PURPOSE Flow diverter embolization is a recognized method for treating intracranial aneurysms. This study evaluates the safety and efficacy of the Surpass Evolve flow diverter in treating intracranial aneurysm. MATERIAL AND METHODS From May 2019 to June 2022, our center prospectively enrolled patients presenting with both ruptured and unruptured intracranial aneurysms. We assessed aneurysm occlusion, along with the occurrence of ischemic and hemorrhagic complications, and mortality at 6-months. The 3-month occlusion rate was determined using MR angiography, while the 6-month occlusion rate employed the O'Kelly-Marotta (OKM) grading scale on DSA. RESULTS A total of 116 patients with 120 aneurysms received treatment with the Surpass Evolve device. The average aneurysm size was 6.6 mm (range: 2-30 mm). All patients were administered two loading doses of ticagrelor (180 mg) one day before the procedure and 2 h pre-embolization. A procedural complication occurred in one case, involving wire-related perforation of an M3 branch distant from the giant aneurysm; however, this evolved favorably. There were no reported deaths linked to the treatment. Permanent neurological deficits were observed in 3 (2.5%) patients, primarily due to early in-stent thrombosis. MR angiography results at 3 months indicated complete occlusion for 87 out of 115 (75.6%) monitored aneurysms. The 6-month DSA showed neck remnant or complete occlusion (OKM grade C or D) in 86 out of the 107 (80.4%) patients who underwent follow-up. CONCLUSION The Surpass Evolve stands out as a reliable and effective flow diverter for the management of intracranial aneurysms.
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Affiliation(s)
- Richard Bibi
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Nourou Dine Adeniran Bankole
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
- Clinical Investigation Center (CIC), INSERM, University Hospital of Tours, Tours, France
| | - Baptiste Donnard
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Francesca Giubbolini
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Julien Boucherit
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
- Department of Neuroradiology, Rennes University Hospital, Rennes, France
| | - Valère Barrot
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Denis Herbreteau
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Héloïse Ifergan
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Kevin Janot
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
- Clinical Investigation Center (CIC), INSERM, University Hospital of Tours, Tours, France
| | - Fouzi Bala
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
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4
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Ma Y, Krepuska M, Madjidyar J, Schubert T, Thurner P, Kulcsar Z. Ongoing Geometric Remodeling of the Parent Artery After Flow-Diverter Stent Reconstruction in Cerebral Aneurysms: The Device Design Matters. World Neurosurg 2024; 182:e597-e601. [PMID: 38052361 DOI: 10.1016/j.wneu.2023.11.153] [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: 10/06/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE Configuration changes of the parent artery (PA) after flow-diverter (FD) stent reconstruction, caused by the bending force of the device, may have an additional role in aneurysm occlusion as a result of the secondary alteration of intra-aneurysmal hemodynamics related to the geometry alteration of the vessel. To determine the degree of PA deformation and aneurysm occlusion rates after deployment of 2 different types of FD. METHODS Patients treated with 2 different designs of cobalt-chromium braid (48 and 64 wire braid) structure FD were subject to analysis. Vascular angle changes at the level of the reconstructed segment immediately after FD deployment and at 1 year follow-up were measured and the potential relationship with aneurysmal occlusion rate was analyzed. RESULTS Forty-two patients harboring 48 aneurysms were included in the present study. The aneurysms were divided into side wall (85.4%) and bifurcation types (14.6%). Twenty-six aneurysms were treated using the Pipeline FD (48 wire braid; 54.2%) and 22 using the Evolve FD (64 wire braid; 45.8%). Of the 48 aneurysms, 42 (87.5%) met the primary end point of complete occlusion at 12 months. The median postdeployment angle change was 7.04°± 4.59° for the Pipeline and 5.05°± 2.49° for the Evolve, whereas the median 12 months follow-up angle change was 15.49°± 10.99° and 10.01°± 8.83°, respectively. PA angle changes were significantly higher in the bifurcation group compared with the side wall group both during procedure and at 12 months follow-up. Angle change had a statistically nonsignificant association with complete aneurysm occlusion. CONCLUSIONS PA deformation starts immediately after deployment and remodeling continues for 1 year after. Aneurysms located in the vessel bifurcation were more prone to PA straightening after FD deployment than were side wall aneurysms. Furthermore, Pipeline seemed to be more prone to inducing vascular deformation, compared with Evolve.
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Affiliation(s)
- Yihui Ma
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Miklos Krepuska
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jawid Madjidyar
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tilman Schubert
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Patrick Thurner
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Lauzier DC, Cler SJ, Srienc AI, Patel B, Pierce A, Gagne J, Vellimana AK, Chatterjee AR, Kansagra AP, Moran CJ, Zipfel GJ, Osbun JW. Comparative cost analysis of endovascular and open approaches for elective treatment of middle cerebral artery aneurysms. Interv Neuroradiol 2023:15910199231221298. [PMID: 38105434 DOI: 10.1177/15910199231221298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Intracranial aneurysms of the middle cerebral artery can be treated using several open surgical and endovascular approaches. Given the growing evidence of clinical equipoise between these various treatment strategies, there is a need to assess the costs associated with each. METHODS Cost of aneurysm treatment was divided into two categories for comparison. "Initial cost" comprised the total in-hospital expenses for initial aneurysm treatment and "total cost" comprised initial aneurysm treatment and all expenses relating to readmission due to treatment-related complications, prescribed catheter angiograms for monitoring of treatment stability, and any retreatments needed for a given aneurysm. The open surgical group was subdivided into a pterional approach group and a lateral supraorbital (LSO) approach group for. RESULTS Median initial cost was $37,152 (IQR $31,318-$44,947) for aneurysms treated with the pterional approach, $29,452 (IQR $27,779-$32,826) for aneurysms treated with the LSO approach, and $19,587 (IQR $14,125-$30,521) for aneurysms treated with endovascular approaches. The median total cost was $39,737 (IQR $33,891-$62,259) for aneurysms treated with the pterional approach, $31,785 (IQR $29,513-$41,099) for aneurysms treated with the LSO approach, and $24,578 (IQR $18,977-$34,547) for aneurysms treated with endovascular approaches. Analysis of variance test demonstrated variance across groups for both initial and total cost (p = 0.004, p = 0.008, respectively). In our subsequent analysis, initial cost and total cost were higher in the pterional group than the endovascular group (p = 0.003 and p = 0.006, respectively). CONCLUSIONS Endovascular treatment of elective aneurysms has a significantly lower cost than open surgical treatment with the pterional approach, but not with the LSO approach. For aneurysms not amenable to endovascular treatment, a minimally invasive LSO approach carries a lower cost burden than a pterional approach.
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Affiliation(s)
- David C Lauzier
- Department of Neurological Surgery, Washington University in St Louis School of Medicine, St Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Samuel J Cler
- Department of Neurological Surgery, Washington University in St Louis School of Medicine, St Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Anja I Srienc
- Department of Neurological Surgery, Washington University in St Louis School of Medicine, St Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Bhuvic Patel
- Department of Neurological Surgery, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Andrew Pierce
- Barnes Jewish Hospital Clinical Operations, St Louis, MO, USA
| | - Jason Gagne
- Barnes Jewish Hospital Clinical Operations, St Louis, MO, USA
| | - Ananth K Vellimana
- Department of Neurological Surgery, Washington University in St Louis School of Medicine, St Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, St Louis, MO, USA
- Department of Neurology, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Arindam R Chatterjee
- Department of Neurological Surgery, Washington University in St Louis School of Medicine, St Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, St Louis, MO, USA
- Department of Neurology, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Akash P Kansagra
- Department of Neurointerventional Surgery, California Center for Neurointerventional Surgery, St Louis, MO, USA
| | - Christopher J Moran
- Department of Neurological Surgery, Washington University in St Louis School of Medicine, St Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Gregory J Zipfel
- Department of Neurological Surgery, Washington University in St Louis School of Medicine, St Louis, MO, USA
- Department of Neurology, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Joshua W Osbun
- Department of Neurological Surgery, Washington University in St Louis School of Medicine, St Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, St Louis, MO, USA
- Department of Neurology, Washington University in St Louis School of Medicine, St Louis, MO, USA
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6
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Torche E, Cao R, Mattar A, Laubacher M, Riva R, Eker OF. Ultra-Early "Fishmouth stenosis" and thrombosis of a Surpass Evolve flow diversion device following treatment of multiples right siphon aneurysms. Neuroradiology 2023; 65:1803-1807. [PMID: 37845483 DOI: 10.1007/s00234-023-03239-1] [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: 05/24/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
We present a case of ultra-early symptomatic fish-mouth type stenosis (FMTS) of a Surpass Evolve flow diverter stent (SE-FDS) occurring within 24 h after deployment for the treatment of multiple unruptured right siphon aneurysms in a 44-year-old patient. The patient developed left hemiplegia and hemineglect, and was treated with mechanical thrombectomy (MT) and Tirofiban infusion. This is the first report of an ultra-early FMTS with a SE-FDS and its mechanism is discussed in the light of available data in the literature.
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Affiliation(s)
- Esteban Torche
- Department of Neuroradiology, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France.
- Department of Neurosurgery, Sanatorio Aleman, Concepción, Chile.
| | - Roberta Cao
- Department of Neuroradiology, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Adonis Mattar
- Department of Neuroradiology, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Morgane Laubacher
- Department of Neuroradiology, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Roberto Riva
- Department of Neuroradiology, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Omer F Eker
- Department of Neuroradiology, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
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7
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Hanel RA, Cortez GM, Coon AL, Kan P, Taussky P, Wakhloo AK, Welch BG, Dogan A, Bain M, De Vries J, Ebersole K, Meyers PM. Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide-Neck Aneurysms - SCENT: 3-year outcomes. J Neurointerv Surg 2023; 15:1084-1089. [PMID: 36375835 DOI: 10.1136/jnis-2022-019512] [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: 08/09/2022] [Accepted: 10/25/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND To report the 3-year safety and effectiveness of the Surpass Streamline flow diverter in the SCENT trial (Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide-Neck Aneurysms). METHODS The Surpass Streamline flow diverter device was evaluated in a multicenter, prospective, single-arm, non-randomized interventional trial including patients with uncoilable or previously treated but failed aneurysms of the intracranial internal carotid artery. 3-year outcomes were tabulated with descriptive statistics and compared with 1-year outcomes. RESULTS Of 180 patients in the modified intent-to-treat (mITT) cohort, 36-month clinical and angiographic follow-up was available in 134 and 117 cases, respectively. Effectiveness endpoint of complete aneurysm occlusion without clinically significant stenosis or retreatment was met in 71.8% (79/110, 95% CI 62.4% to 80.0%) of cases. Safety composite endpoint was 12.2% (22/180) over the 3-year period, with two major safety events (ipsilateral ischemic strokes) occurring between 12-36 months. Complete aneurysm occlusion was noted in 77.8% (91/117), and 99.1% (116/117) of the patients demonstrated adequate aneurysm occlusion (complete occlusion or neck residual). There were four cases (2.2%) of aneurysm rupture, all occurring within the first month of the index procedure. Target aneurysm retreatment rate was 2.8% (5/180). CONCLUSION The present findings support the long-term safety and effectiveness of the Surpass Streamline flow diverter device. TRIAL REGISTRATION NCT01716117.
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Affiliation(s)
- Ricardo A Hanel
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Gustavo M Cortez
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Alexander L Coon
- Carondelet Neurological Institute, Carondelet Saint Joseph's Hospital, Tucson, Arizona, USA
| | - Peter Kan
- Department of Neurosurgery, The University of Texas Medical Branch at Galveston School of Medicine, Galveston, Texas, USA
| | - Philipp Taussky
- Department of Neurosurgery, University of Utah Medical Center, Salt Lake City, Utah, USA
| | - Ajay K Wakhloo
- Neurointerventional Radiology, Lahey Clinic Medical Center, Burlington, Massachusetts, USA
| | - Babu G Welch
- Neurosurgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Aclan Dogan
- Interventional Neuroradiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Mark Bain
- Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joost De Vries
- Neurosurgery, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
| | - Koji Ebersole
- Neurosurgery, Radiology, University of Kansas Medical Center Department of Neurosurgery, Kansas City, Kansas, USA
| | - Philip M Meyers
- Radiology and Neurological Surgery, Columbia University, New York, New York, USA
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8
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Field NC, Custozzo A, Gajjar AA, Dalfino JC, Boulos AS, Paul AR. Comparison of pipeline embolization device, flow re-direction endoluminal device and surpass flow diverters in the treatment of intracerebral aneurysms. Interv Neuroradiol 2023:15910199231196621. [PMID: 37635329 DOI: 10.1177/15910199231196621] [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: 08/29/2023] Open
Abstract
OBJECTIVES The use of flow diversion for the treatment of intracranial aneurysms has gained broad acceptance. Three flow-diverting stents are approved by the Food and Drug Administration for use in the United States. We sought to compare the outcomes and safety profiles between the three devices at our institution. METHODS A retrospective review of aneurysms treated with pipeline embolization device (PED), flow re-direction endoluminal device (FRED), and SURPASS was performed for aneurysms treated between 2018 and 2022 at our institution. RESULTS The study cohort consisted of 142 patients. Precisely, 86 aneurysms were treated with a pipeline, 33 aneurysms were treated with FRED, and 23 aneurysms were treated with SURPASS. The 1-year complete occlusion rates were 59.4%, 60%, and 65%, respectively (0.91). Linear regression models found that only adjunctive coiling predicted aneurysm occlusion at 6 months (p = 0.02), but this effect was lost at 1 year and beyond. There was no significant difference in acute thrombotic or acute hemorrhagic complications between the three cohorts. There was a higher rate of delayed hemorrhagic complications in the SURPASS cohort (10%) compared to the PED (1.3%) and FRED (0%) cohorts (p = 0.04). There was also a higher rate of in-stent stenosis in the SURPASS cohort (20%) compared to the PED (5%) and FRED (3.1%) cohorts (p < 0.01). CONCLUSIONS Treatment with PED, FRED, and SURPASS all resulted in similar complete occlusion rates at 6 months and 1 year. SURPASS was associated with higher in-stent stenosis as well as delayed hemorrhagic complications. Additional future studies evaluating the newest generation of flow-diverting stents with long-term follow-up will be necessary to make any definitive conclusions.
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Affiliation(s)
- Nicholas C Field
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Amanda Custozzo
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Avi A Gajjar
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - John C Dalfino
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Alan S Boulos
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Alexandra R Paul
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
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9
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Gupta G, Sreenivasan S, Kane I, Salguiero L, Saifuddin A, Sundararajan S, Khandelwal P, Nourallah-Zadeh E, Sun H, Sonig A, Singla A, Nanda A, Roychowdhury S. Surpass embolization of intracranial aneurysms: Perspective from a 2-year longitudinal follow-up study across high volume comprehensive stroke centers. Interv Neuroradiol 2023:15910199231188760. [PMID: 37464776 DOI: 10.1177/15910199231188760] [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: 07/20/2023] Open
Abstract
BACKGROUND Surpass Streamline (SS; Stryker©) is an over-the-wire first-generation flow diverter (FD). There is a scarcity of data on real-world outcomes and complications of this FD. METHODS A retrospective review of consecutive cases between January 2019 and July 2021 at two high-volume comprehensive stroke centers, involving SS was conducted. RESULTS Fifty-five patients harbored 69 treated aneurysms, of which 96% were in the internal carotid petrous to terminus segments and 88% were <10 mm in size, and 12% measuring 10-24 mm. Raymond Roy Grade 1 occlusion was noted in 55 aneurysms (79.7%) at 1 year. Median follow-up duration was 26 months (mean = 26.06). Major complications were seen in eight patients (14.5%; 95% CI 6.5-26.7) and mortality attributable to SS stenting complications occurred in two (4.3%) patients. Four (7.2%) had ophthalmologic thromboembolic complications and two had (3.6%) ischemic complications. Procedural complications occurred in 10 patients (18.18%; 95% CI 9.1-30.9). Technical complications during procedure (n = 3, 5.3%) were: "confirmed" distal middle cerebral artery (MCA) guidewire perforation; "suspected" distal MCA guidewire perforation causing post-procedural subarachnoid hemorrhage and internal carotid artery dissection causing ischemic stroke. Seizures were seen in 5 (9.09%) and carotid-cavernous fistula in 1 (1.8%). Multivariate regression analysis showed technical challenges significantly predicted occurrence of major complications (p = 0.001; R2 = 0.39, F(13,43) = 2.15, p = 0.029). Univariate analysis showed technical challenges significantly predicted ophthalmological complications (R2 = 0.06, F(1,55) = 4.04, p = 0.049) and major complications (R2 = 0.21, F(1,55) = 15.11, p = 0.0002). CONCLUSION Large-scale future registry should focus on national data regarding SS safety, technical challenges, and procedural complications. We present one of the longest follow-ups for SS in literature.
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Affiliation(s)
- Gaurav Gupta
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Sanjeev Sreenivasan
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Ian Kane
- Department of Radiology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Lauren Salguiero
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Ali Saifuddin
- Department of Radiology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Srihari Sundararajan
- Department of Radiology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Priyank Khandelwal
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Emad Nourallah-Zadeh
- Department of Neurology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Hai Sun
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Ashish Sonig
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Amit Singla
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - Anil Nanda
- Department of Neurosurgery, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
| | - Sudipta Roychowdhury
- Department of Radiology, RUTGERS, Robert Wood Johnson Medical School & University Hospital, New Brunswick, NJ, USA
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10
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Vollherbst DF, Cekirge HS, Saatci I, Baltacioglu F, Onal B, Koc O, Rautio R, Sinisalo M, Tomasello A, Vega P, Martínez-Galdámez M, Lynch J, Mendes Pereira V, Bendszus M, Möhlenbruch MA. First clinical multicenter experience with the new Pipeline Vantage flow diverter. J Neurointerv Surg 2023; 15:63-69. [PMID: 35172983 DOI: 10.1136/neurintsurg-2021-018480] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/25/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Flow diversion is an innovative and increasingly used technique for the treatment of intracranial aneurysms. New flow diverters (FDs) are being introduced to improve the safety and efficacy of this treatment. The aim of this study was to assess the safety, feasibility, and efficacy of the new Pipeline Vantage (PV) FD. METHODS Patients with intracranial aneurysms treated with the PV at 10 international neurovascular centers were retrospectively analyzed. Patient and aneurysm characteristics, procedural parameters, complications, and the grade of occlusion were assessed. RESULTS 60 patients with 70 aneurysms (5.0% with acute hemorrhage, 90.0% located in the anterior circulation) were included. 82 PVs were implanted in 61 treatment sessions. The PV could be successfully implanted in all treatments. Additional coiling was performed in 18.6%, and in-stent balloon angioplasty (to enhance the vessel wall apposition) in 24.6%. Periprocedural technical complications occurred in 24.6% of the treatments, were predominantly FD deployment problems, and were all asymptomatic. The overall symptomatic complication rate was 8.2% and the neurological symptomatic complication rate was 3.3%. Only one symptomatic complication was device-related (perforator artery infarctions leading to stroke). After a mean follow-up of 7.1 months, the rate of complete aneurysm occlusion was 77.9%. One patient (1.7%) died due to aneurysmal subarachnoid hemorrhage which occurred before treatment, unrelated to the procedure. CONCLUSIONS The new PV FD is safe and feasible for the treatment of intracranial aneurysms. The short-term occlusion rates are promising but need further assessment in prospective long-term follow-up studies.
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Affiliation(s)
- Dominik F Vollherbst
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - H Saruhan Cekirge
- Interventional Neuroradiology Department, Koru Hospital, Ankara, Turkey
| | - Isil Saatci
- Interventional Neuroradiology Department, Koru Hospital, Ankara, Turkey
| | - Feyyaz Baltacioglu
- Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Baran Onal
- Radiology Department, School of Medicine, Gazi University, Ankara, Turkey
| | - Osman Koc
- Radiology Department, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Riitta Rautio
- Department of Interventional Radiology, Turku University Hospital, Turku, Finland
| | - Matias Sinisalo
- Department of Interventional Radiology, Turku University Hospital, Turku, Finland
| | - Alejandro Tomasello
- Interventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Pedro Vega
- Interventional Neuroradiology, Department of Radiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Mario Martínez-Galdámez
- Department of Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Jeremy Lynch
- Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vitor Mendes Pereira
- Department of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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11
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Teranishi K, Mishima Y, Taniguchi T, Fujii T, Nonaka S, Kitamura T, Kondo A, Oishi H. Preliminary Experience of the Surpass Streamline Flow Diverter for Large and Giant Unruptured Internal Carotid Artery Aneurysms. Neurol Med Chir (Tokyo) 2022; 62:451-457. [PMID: 36070961 PMCID: PMC9637403 DOI: 10.2176/jns-nmc.2022-0167] [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] [Indexed: 11/26/2022] Open
Abstract
As of January 2021, the Surpass Streamline (SS) is the most recently approved flow diverter in Japan. A total of 28 Japanese patients, including 9 clinical trial patients, with 28 large or giant unruptured internal carotid artery (ICA) aneurysms, underwent SS embolization at Juntendo University Hospital. Procedural failure occurred in two patients due to the difficulty to navigate the device in the tortuous parent artery. Therefore, 26 patients with 26 aneurysms were available for clinical and anatomical assessments. Patients' mean age was 62.6 years (range 46-86), and 24 patients (92.3%) were female. Mean aneurysm size and neck width were 15.4 mm and 7.7 mm, respectively, with 20 saccular and 6 fusiform aneurysms. Seven aneurysms were symptomatic due to the aneurysmal mass effect. Twenty patients underwent a 6-month follow-up angiography to evaluate the degree of occlusion. Anatomical outcomes were 12 (60%) complete occlusion (CO), 4 (20%) residual neck (RN), and 4 (20%) residual aneurysm. Favorable aneurysm occlusion consisted of CO, and RN was achieved in 16 (80.0%). There were no significant device stenoses. Aneurysmal mass effect improved in one and was unchanged in eight patients. There were three device-related complications, namely, delayed aneurysm rupture, minor ischemic stroke, and device occlusion (11.5%). One patient with minor ischemic stroke fully recovered before 30 days, and our series showed 7.7% risk of major ipsilateral stroke and neurological death at 30 days. The SS embolization for large and giant unruptured ICA aneurysms offers satisfactory anatomical and clinical outcomes with a low risk of device-related complications.
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Affiliation(s)
- Kosuke Teranishi
- Department of Neurosurgery, Juntendo University, Faculty of Medicine
| | - Yumiko Mishima
- Department of Neurosurgery, Juntendo University, Faculty of Medicine
| | - Takahiko Taniguchi
- Department of Neuroendovascular Therapy, Juntendo University, Faculty of Medicine
| | - Takashi Fujii
- Department of Neuroendovascular Therapy, Juntendo University, Faculty of Medicine
| | - Senshu Nonaka
- Department of Neurosurgery, Juntendo University, Faculty of Medicine
| | - Takayuki Kitamura
- Department of Neurosurgery, Juntendo University, Faculty of Medicine.,Department of Neuroendovascular Therapy, Juntendo University, Faculty of Medicine
| | - Akihide Kondo
- Department of Neurosurgery, Juntendo University, Faculty of Medicine
| | - Hidenori Oishi
- Department of Neurosurgery, Juntendo University, Faculty of Medicine.,Department of Neuroendovascular Therapy, Juntendo University, Faculty of Medicine
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12
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Issa R, Al-Homedi Z, Syed DH, Aziz W, Al-Omari B. Surpass Evolve Flow Diverter for the Treatment of Intracranial Aneurysm: A Systematic Review. Brain Sci 2022; 12:brainsci12060810. [PMID: 35741695 PMCID: PMC9221455 DOI: 10.3390/brainsci12060810] [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: 05/25/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE This systematic review aims to summarize the evidence investigating the effectiveness and safety of the Surpass Evolve-Flow Diverter (SE-FD) to treat brain aneurysms. METHOD We searched MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane Library from January 2019 to 29 March 2022. Terms related to the "intracranial aneurysm" and "surpass evolve flow diverter" concepts were used to search the databases; Medical Subject Headings (MeSH) and reference hand search were also utilized. RESULTS The searches primarily identified 1586 documents. A total of five studies (four case series and one cohort) were included in this review. In the included studies, 192 (74 male and 118 females) patients with 198 aneurysms were involved. In total, 153 SE-FDs were used to treat 145 aneurysms. Complete occlusion was achieved in 69/145 (48%) cases and near-complete occlusion in 24/145 (17%) cases from aneurysms treated with SE-FD. Reported postoperative complications included stent thrombosis (n = 4 patients), hemorrhage (n = 5 patients), ischemia (n = 9 patients), and neurological complications (n = 12 patients). In total, four deaths were reported with only one related to the SE-FD procedure. CONCLUSION The results of this review are based on observational data, due to the absence of clinical trials. The findings of the included studies suggest that the effectiveness of the SE-FD procedure is lower than previous FDs but the safety is similar. The included studies also suggested that SE-FD has navigability and resistance to twisting, which makes the procedure an easier method to treat aneurysms that are proximal and distal to the circle of Willis deployment. This review highlights the urgency to conduct clinical trials to confirm these suggestions.
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Affiliation(s)
- Rania Issa
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates; (R.I.); (Z.A.-H.); (D.H.S.)
| | - Zahrah Al-Homedi
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates; (R.I.); (Z.A.-H.); (D.H.S.)
| | - Dawood Hasan Syed
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates; (R.I.); (Z.A.-H.); (D.H.S.)
| | - Waseem Aziz
- Department of Neurosurgery, Sheikh Shakhbout Medical City, Abu Dhabi P.O. Box 11001, United Arab Emirates;
- Department of Neurosurgery, Alexandria University School of Medicine, Alexandria 21526, Egypt
| | - Basem Al-Omari
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates; (R.I.); (Z.A.-H.); (D.H.S.)
- Department of Epidemiology and Population Health, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates
- KU Research and Data Intelligence Support Center (RDISC) AW 8474000331, Khalifa University of Science and Technology, Abu Dhabi P.O. Box 127788, United Arab Emirates
- Correspondence: ; Tel.: +971-2-312-4452
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13
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Feigen CM, Vivanco-Suarez J, Javed K, Dardick JM, Holland R, Mendez-Ruiz A, Ortega-Gutierrez S, Haranhalli N, Altschul DJ. Pipeline Embolization Device and Pipeline Flex Versus Surpass Streamline Flow Diversion in Intracranial Aneurysms: A Retrospective Propensity Score-Matched Study. World Neurosurg 2022; 161:e384-e394. [PMID: 35151920 DOI: 10.1016/j.wneu.2022.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare safety and efficacy profiles in aneurysms treated with Pipeline Embolization Device or Pipeline Flex versus Surpass Streamline flow diverters (FDs). METHODS Patients who underwent flow diversion for aneurysm treatment at 2 centers were included. Covariates comprised patient demographics, comorbidities, and aneurysm characteristics. Metrics included number of devices, adjuvant device use, case duration, and radiation exposure. Outcomes included periprocedural complications and radiographic results at follow-up. Propensity score-matched pairs were generated using demographic and aneurysm characteristics to verify the outcomes in equally sized groups. RESULTS The majority of 141 flow diversion procedures performed on 126 patients were in the anterior circulation (96%) and unruptured (93%). Operators experienced more complications placing Surpass FDs compared with Pipelines (18.2% vs. 3.1%, P = 0.005) but used fewer Surpass devices per case (1 device in all Surpass cases and range for Pipeline cases 1-7; P < 0.001). Ballooning was more frequent for Surpass (29.5% vs. 2.1%, P < 0.001). There were no differences in mortality (2.1% vs. 0, P = 1.00), intracranial hemorrhage (3.1% vs. 0, P = 0.551), or stroke (4.2% vs. 6.8%, P = 0.680). Rates of aneurysm obliteration at follow-up were similar. Propensity-matched pairs had no differences in FD deployment complications or perioperative events, yet the significant differences remained for adjuvant balloon use and number of FDs deployed. CONCLUSIONS While the devices demonstrated similar safety and efficacy profiles, deployment of the Surpass Streamline was more technically challenging than Pipeline Embolization Device or Pipeline Flex. Prospective cohort studies are needed to corroborate these findings.
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Affiliation(s)
- Chaim M Feigen
- Montefiore Department of Neurological Surgery, Bronx, New York, USA.
| | - Juan Vivanco-Suarez
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Kainaat Javed
- Montefiore Department of Neurological Surgery, Bronx, New York, USA
| | - Joseph M Dardick
- Montefiore Department of Neurological Surgery, Bronx, New York, USA
| | - Ryan Holland
- Montefiore Department of Neurological Surgery, Bronx, New York, USA
| | - Alan Mendez-Ruiz
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Neil Haranhalli
- Montefiore Department of Neurological Surgery, Bronx, New York, USA
| | - David J Altschul
- Montefiore Department of Neurological Surgery, Bronx, New York, USA
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14
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Achey RL, Winkelman R, Sheikhi L, Davison M, Toth G, Moore N, Bain M. Use of Surpass Streamline Flow Diverter for the Endovascular Treatment of Craniocervical Aneurysms: a Single-Institution Experience. World Neurosurg 2022; 162:e281-e287. [PMID: 35276392 DOI: 10.1016/j.wneu.2022.03.008] [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: 12/21/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Flow diversion has revolutionized endovascular treatment for cerebral aneurysms. Surpass Streamline flow-diverter (SSFD) has shown promise for expanding flow diversion device options for aneurysm treatment. The SSFD differs from earlier stents by maintaining high porosity with increased pore density to ensure appropriate flow disruption. Given the delivery system's increased dimension options, and potential greater flow diverting properties, the SSFD is poised to extend the anatomic/pathologic reaches of flow diversion therapy. METHODS Data pertaining to SSFD-treated aneurysms were gathered retrospectively from 2019 to 2020. Collected information included aneurysm location, size, symptoms, complications, and occlusions rates at follow-up. Size was categorized as small (<10 mm), large (10-25 mm), and giant (>25 mm) according to SCENT trial criteria. Aneurysm occlusion on follow-up imaging was characterized by SMART grading with adequate occlusion defined as grades 3 and 4. Imaging was performed at time of treatment, six-month, and one-year follow-up. RESULTS 42 SSFD-treated aneurysms were treated throughout the cerebrovascular system; 3 cervical, 4 posterior, and 35 intracranial anterior circulation. Complete occlusion rates at six months and one year were 48% and 57% with adequate occlusion achieved in 89.6% and 85.7% respectively. Rates of complete occlusion were higher for small aneurysms (69%) compared to large aneurysms (38%). CONCLUSIONS Our data suggests comparable complete occlusion rates compared to the SCENT trial (66.1% vs 57% in our center) and adequate occlusion rates. Similar occlusion rates to prior studies despite broadened inclusion criteria/diversity of aneurysms treated demonstrates favorable generalizability of flow-diverting technology to a wide array of aneurysmal pathology.
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Affiliation(s)
- R L Achey
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland OH
| | - R Winkelman
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland OH
| | - L Sheikhi
- University of Kentucky, Kentucky Neuroscience Institute, Lexington KY
| | - M Davison
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland OH
| | - G Toth
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland OH; Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland OH
| | - N Moore
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland OH; Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland OH
| | - M Bain
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland OH; Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland OH.
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15
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Marosfoi M, Orrù E, Rabinovich M, Newman S, Patel NV, Wakhloo AK. Endovascular Treatment of Intracranial Aneurysms. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00068-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Park KY, Ozaki T, Kostynskyy A, Kortman H, Hilario A, Nicholson P, Agid R, Krings T, Pereira VM. Ticagrelor versus Clopidogrel in the Dual Antiplatelet Regimen for Intracranial Stenting or Flow-Diverter Treatment for Unruptured Cerebral Aneurysms: A Single-Center Cohort Study. AJNR Am J Neuroradiol 2021; 42:1638-1644. [PMID: 34244132 DOI: 10.3174/ajnr.a7216] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/25/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Ticagrelor is a novel P2Y12 antagonist, and little is known about its efficacy and safety in the endovascular treatment of aneurysms. This study evaluated the efficacy and safety of ticagrelor versus clopidogrel for stent-assisted coiling or flow-diversion treatment in patients with unruptured cerebral aneurysms. MATERIALS AND METHODS From November 2003 to February 2019, two hundred one patients (mean age, 57.5 years; 156 women) with 233 unruptured aneurysms underwent stent-assisted coiling or flow-diversion treatment. All patients received antiplatelet therapy of aspirin plus clopidogrel (clopidogrel group, 121 patients with 140 aneurysms) or aspirin plus ticagrelor (ticagrelor group, 80 patients with 93 aneurysms). The clinical and radiologic data in each group were retrospectively reviewed and compared. RESULTS Two hundred thirty-six procedures were performed, including stent-assisted coiling (n = 101) and flow diversion (n = 135). At 90 days, the primary outcome-a composite of any stroke and death-occurred in 9.9% of the clopidogrel group and 8.6% of the ticagrelor group (P = .822). Ischemic stroke occurred in 10 (7.0%) of the clopidogrel group and 7 (7.5%) of the ticagrelor group (P > .999). Disabling stroke occurred in 4 (2.8%) in the clopidogrel group and in 4 (4.3%) in the ticagrelor group (P = .716). Ninety-day death occurred in 3 (2.1%) in the clopidogrel group and 1 (1.1%) in the ticagrelor group (P > .999). Any bleeding at 90 days occurred in 13 (9.2%) in the clopidogrel group and 6 (6.5%) in the ticagrelor group (P = .479). CONCLUSIONS Ticagrelor appears to be as effective and safe as clopidogrel in stent-assisted coiling or flow-diversion treatment for unruptured cerebral aneurysms.
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Affiliation(s)
- K Y Park
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Neurosurgery (K.Y.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - T Ozaki
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - A Kostynskyy
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - H Kortman
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Radiology (H.K.), Elisabeth-TweeSteden Ziekenhuis St. Elisabeth Hospital, Tilburg, the Netherlands
| | - A Hilario
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - P Nicholson
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - R Agid
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - T Krings
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - V M Pereira
- From the Division of Neuroradiology (K.Y.P., T.O., A.K., H.K., A.H., P.N., R.A., T.K., V.M.P.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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17
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Early clinical experience of using the Surpass Evolve flow diverter in the treatment of intracranial aneurysms. Neuroradiology 2021; 64:343-351. [PMID: 34453182 DOI: 10.1007/s00234-021-02793-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Here, we presented our early experience with flow diversion procedures using the Surpass Evolve flow diverter (SE, Stryker) and reported the feasibility and safety profile compared to those of a control group treated with other types of flow diverters. METHODS We included 31 and 53 consecutive flow diversion procedures performed using the SE and other commercial flow diverters, respectively, to treat intracranial aneurysms at our institution. We used two commercial flow diversion systems in the comparison group: the pipeline embolization device and Surpass Streamline. RESULTS In the SE group, technical failures occurred in three (9.7%) cases, due to either incomplete wall apposition (n = 1, 3.2%) or stent migration (n = 2, 6.5%). Major complications occurred in four (12.9%) cases: delayed rupture of the target aneurysm (n = 1, 3.2%), major ischemic stroke (n = 1, 3.2%), sudden death from an unidentified cause (n = 1, 3.2%), and parent artery occlusion with stent thrombosis (n = 1, 3.2%). Balloon angioplasty was performed in eight (25.8%) cases. On post-procedure MRI, a DWI-positive lesion was detected in three (9.7%) cases. After multivariate adjustment, the SE group was independently associated with less procedural time of ≥ 90 min (adjusted OR, 0.09; 95% CI, 0.03-0.29; p < 0.001), balloon angioplasty (adjusted OR, 0.22; 95% CI, 0.07-0.75; p = 0.015), and DWI-positive lesions (adjusted OR, 0.04; 95% CI, 0.01-0.19; p < 0.001). CONCLUSION The SE is safe and easy to deploy.
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18
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Pumar JM, Mosqueira A, Olier J, Rodriguez-Fernandez C, Vega P, Gonzalez-Diaz E. Treatment of Intracranial Aneurysms Using the New Silk Vista Flow Diverter: Safety Outcomes at Short-Term Follow-Up. Front Neurol 2021; 12:713389. [PMID: 34305807 PMCID: PMC8299702 DOI: 10.3389/fneur.2021.713389] [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: 05/22/2021] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Flow diverters are widely used as the first endovascular treatment option for complex brain aneurysms due to their high percentage of occlusion and low morbi-mortality. The Silk Vista device is a new generation of flow diverters designed to facilitate full visibility, improve apposition to the vessel wall, and enhance navigability. Indeed, its greatest advantage is that it enables the easier navigation of stents between 3.5 and 4.75 mm through a 0.021 microcatheter. The objective of this study was to evaluate the safety and effectiveness of Silk Vista systems for treating cerebral aneurysms. Methods: This prospective observational study included 25 consecutive patients with 27 wide-necked unruptured aneurysms treated with SILK Vista who were retrospectively analyzed for safety and efficacy. Results: Endovascular treatment was successfully performed in all patients. The final morbidity and mortality rates were both 0.0%. Short-term (3–5 months) angiographic follow-up revealed 21 complete occlusions and 6 near-complete occlusions. No significant parent artery stenosis was observed. Conclusions: This report demonstrates the efficacy of Silk Vista in treating brain aneurysms, although longer experiences should be carried out to confirm our results.
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Affiliation(s)
- José M Pumar
- Neuroradiology Department, Catedra de Neurorradiología Intervencionista, Universidad de Santiago de Compostela, Santiago, Spain
| | - Antonio Mosqueira
- Neuroradiology Department, Catedra de Neurorradiología Intervencionista, Universidad de Santiago de Compostela, Santiago, Spain
| | - Jorge Olier
- Neuroradiology Department, Hospital Clinico Universitario de Navarra, Pamplona, Spain
| | | | - Pedro Vega
- Neuroradiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Eva Gonzalez-Diaz
- Neuroradiology Department, Hospital Universitario de Cruces, Barakaldo, Spain
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19
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Dobrocky T, Lee H, Nicholson P, Agid R, Lynch J, Swaminathan SK, Krings T, Radovanovic I, Pereira VM. When Two Is Better than One : The Buddy-wire Technique in Flow-diversion Procedures. Clin Neuroradiol 2021; 32:491-498. [PMID: 34236441 PMCID: PMC9187555 DOI: 10.1007/s00062-021-01053-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/05/2021] [Indexed: 11/24/2022]
Abstract
Background Delivery of most flow diverters (FD) requires larger, and thus stiffer microcatheters (0.021–0.027in.) which can pose challenges to intracranial navigation. The concomitant use of two microwires within one microcatheter, also known as the buddy-wire technique, may be helpful for navigation and support in challenging situations. Methods We analyzed all flow diverter procedures in our prospectively collected database. We recorded all patient-related, anatomical and procedural information. We performed univariate statistics and technical descriptions. Results In total, 208 consecutive patients treated with a FD at our institution between July 2014 and August 2020 were retrospectively analyzed. In 17 patients the buddy-wire technique was used (mean age 63 years, range 31–87 years: 16 female). Aneurysms were located at the petrous, cavernous, supraophthalmic internal carotid artery, and a proximal M2 branch in 2, 7, 7 and 1 patient(s), respectively. In all cases a 0.027in. microcatheter was used for device deployment. In 14 patients with a wide-necked aneurysm the buddy-wire provided additional support to advance the microcatheter and mitigated the ledge between the aneurysm neck and the parent artery or a side branch. In two giant cavernous aneurysms treated with telescoping FDs, the buddy-wire was used to re-enter the proximal end of the foreshortened FD. Conclusion The buddy-wire is a useful technique in FD procedures to prevent herniation of the microcatheter into the aneurysm sack, in wide-necked aneurysms to mitigate the ledge effect between the aneurysm neck and the parent artery where the microcatheter tip may get stuck, or to enable re-entry into a foreshortened FD.
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Affiliation(s)
- Tomas Dobrocky
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada. .,University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Hubert Lee
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Ronit Agid
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jeremy Lynch
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Saravana Kumar Swaminathan
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Timo Krings
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Ivan Radovanovic
- Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst Street, M5T 2S8, Toronto, Ontario, Canada
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada.,Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst Street, M5T 2S8, Toronto, Ontario, Canada
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20
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Rautio R, Alpay K, Sinisalo M, Numminen J. Treatment of intracranial aneurysms using the new Surpass Evolve flow diverter: Safety outcomes and six-month imaging follow-up. J Neuroradiol 2021; 49:80-86. [PMID: 33785389 DOI: 10.1016/j.neurad.2021.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/10/2021] [Accepted: 03/17/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Several studies have reported good long-term results in the occlusion of intracranial aneurysms with flow diverter treatment. The aim of this study was to report the safety and six-month follow-up outcomes using the new Surpass Evolve flow diverter in the treatment of intracranial aneurysms. MATERIALS AND METHODS Consecutive patients with intracranial aneurysm treated with Surpass Evolve flow diverter in two high-volume neurovascular centers between May 2019 and January 2020 were retrospectively reviewed. Procedure-related complications, aneurysm occlusion (O'Kelly-Marotta grading scale), and clinical outcomes were assessed. RESULTS Twenty-nine patients with 30 aneurysms were included in the study. Favorable aneurysm occlusion (O'Kelly Marotta grading scale C-D) at six-month follow-up was achieved in 21/27 (78%) aneurysms. No clinical procedure related thromboembolic complications were encountered. Twenty-three out of 24 patients with unruptured aneurysms treated with Surpass Evolve remained clinically intact at clinical follow-up. There was one fatal hemorrhagic procedure-related complication (3%). In five patients with ruptured aneurysms, no early or late rebleeds occurred from the aneurysms. CONCLUSIONS Surpass Evolve FD worked technically well with no intraprocedural thromboembolic complications and occlusion rates comparable to other FDs.
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Affiliation(s)
- Riitta Rautio
- Department of Interventional Radiology, Turku University Hospital, Finland; University of Turku.
| | - Kemal Alpay
- Department of Radiology, Turku University Hospital, Finland
| | - Matias Sinisalo
- Department of Interventional Radiology, Turku University Hospital, Finland
| | - Jussi Numminen
- Department of Radiology, Helsinki University Central Hospital, Finland
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21
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Maus V, Weber W, Berlis A, Maurer C, Fischer S. Initial Experience with Surpass Evolve Flow Diverter in the Treatment of Intracranial Aneurysms. Clin Neuroradiol 2020; 31:681-689. [DOI: 10.1007/s00062-020-00972-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/17/2020] [Indexed: 11/29/2022]
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22
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Dandapat S, Mendez-Ruiz A, Martínez-Galdámez M, Macho J, Derakhshani S, Foa Torres G, Pereira VM, Arat A, Wakhloo AK, Ortega-Gutierrez S. Review of current intracranial aneurysm flow diversion technology and clinical use. J Neurointerv Surg 2020; 13:54-62. [PMID: 32978269 DOI: 10.1136/neurintsurg-2020-015877] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 02/07/2023]
Abstract
Endovascular treatment of intracranial aneurysms (IAs) has evolved considerably over the past decades. The technological advances have been driven by the experience that coils fail to completely exclude all IAs from the blood circulation, the need to treat the diseased parent vessel segment leading to the aneurysm formation, and expansion of endovascular therapy to treat more complex IAs. Stents were initially developed to support the placement of coils inside wide neck aneurysms. However, early work on stent-like tubular braided structure led to a more sophisticated construct that then later was coined as a flow diverter (FD) and found its way into clinical application. Although FDs were initially used to treat wide-neck large and giant internal carotid artery aneurysms only amenable to surgical trap with or without a bypass or endovascular vessel sacrifice, its use in other types of IAs and cerebrovascular pathology promptly followed. Lately, we have witnessed an explosion in the application of FDs and subsequently their modifications leading to their ubiquitous use in endovascular therapy. In this review we aim to compile the available FD technology, evaluate the devices' peculiarities from the authors' perspective, and analyze the current literature to support initial and expanded indications, recognizing that this may be outdated soon.
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Affiliation(s)
- Sudeepta Dandapat
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Alan Mendez-Ruiz
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mario Martínez-Galdámez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Juan Macho
- Department of Diagnostic and Therapeutic Neuroradiology, Essex Center for Neurological Sciences, Queen's University Hospital, Romford, Greater London, UK.,Department of Interventional Neuroradiology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Shahram Derakhshani
- Department of Diagnostic and Therapeutic Neuroradiology, Essex Center for Neurological Sciences, Queen's University Hospital, Romford, Greater London, UK
| | | | - Vitor M Pereira
- Division of Neuroradiology, Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anil Arat
- Department of Radiology, Hacettepe University Hospitals, Ankara, Turkey
| | - Ajay K Wakhloo
- Department of Neurointerventional Radiology, Beth Israel Lahey Health, Tufts University School of Medicine, Burlington, Massachusetts, USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA .,Department of Radiology and Neurosurgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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23
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Yamaki VN, Cancelliere NM, Nicholson P, Rodrigues M, Radovanovic I, Sungur JM, Krings T, Pereira VM. Biomodex patient-specific brain aneurysm models: the value of simulation for first in-human experiences using new devices and robotics. J Neurointerv Surg 2020; 13:272-277. [PMID: 32601259 PMCID: PMC7892376 DOI: 10.1136/neurintsurg-2020-015990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/15/2020] [Accepted: 05/21/2020] [Indexed: 12/29/2022]
Abstract
Background With the recent advent of advanced technologies in the field, treatment of neurovascular diseases using endovascular techniques is rapidly evolving. Here we describe our experience with pre-surgical simulation using the Biomodex EVIAS patient-specific 3D-printed models to plan aneurysm treatment using endovascular robotics and novel flow diverter devices. Methods Pre-procedural rehearsals with 3D-printed patient-specific models of eight cases harboring brain aneurysms were performed before the first in-human experiences. To assess the reliability of the experimental model, the characteristics of the aneurysms were compared between the patient and 3D models. The rehearsals were used to define the patient treatment plan, including technique, device sizing, and operative working projections. Results The study included eight patients with their respective EVIAS 3D aneurysm models. Pre-operative simulation was performed for the first in-human robotic-assisted neurovascular interventions (n=2) and new generation flow-diverter stents (n=6). Aneurysms were located in both the anterior (n=5) and posterior (n=3) circulation and were on average 11.0±6.5 mm in size. We found reliable reproduction of the aneurysm features and similar dimensions of the parent vessel anatomy between the 3D models and patient anatomy. Information learned from pre-surgical in vitro simulation are described in detail, including an improved patient treatment plan, which contributed to successful first in-world procedures with no intraprocedural complications. Conclusions Pre-procedural rehearsal using patient-specific 3D models provides precise procedure planning, which can potentially lead to greater operator confidence, decreased radiation dose and improvements in patient safety, particularly in first in-human experiences.
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Affiliation(s)
- Vitor Nagai Yamaki
- Division of Neurosurgery, Department of Neurology, Universidade de Sao Paulo, Sao Paulo, São Paulo, Brazil
| | | | - Patrick Nicholson
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Marta Rodrigues
- Imagiology, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Porto, Portugal
| | - Ivan Radovanovic
- Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Timo Krings
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.,Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vitor M Pereira
- Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada.,Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
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24
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Matano F, Murai Y, Sato S, Koketsu K, Shirokane K, Ishisaka E, Tsukiyama A, Morita A. Risk factors for ischemic complications in vascular reconstructive surgeries. Clin Neurol Neurosurg 2020; 193:105768. [DOI: 10.1016/j.clineuro.2020.105768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022]
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