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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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Goertz L, Zopfs D, Kottlors J, Borggrefe J, Pennig L, Schlamann M, Kabbasch C. Long-term Safety and Efficacy of the Derivo Embolization Device in a Single-center Series. Clin Neuroradiol 2024:10.1007/s00062-024-01423-1. [PMID: 38814452 DOI: 10.1007/s00062-024-01423-1] [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: 01/03/2024] [Accepted: 05/05/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE This study analyzes the long-term clinical and angiographic outcomes of the Derivo Embolization Device (DED), an advanced flow diverter device with an electropolished surface, for the treatment of intracranial aneurysms. METHODS A consecutive series of 101 patients (mean age: 58 years, 72% female) treated with the DED for 122 aneurysms at a single center between 2017 and 2023 was retrospectively analyzed for major (change in National Institutes of Health Stroke Scale [NIHSS] score ≥ 4 points) and minor (change in NIHSS score < 4 points) neurological events, procedural morbidity (increase of at least one point on the modified Rankin Scale), and angiographic results. RESULTS There were 14 (11%) recurrent aneurysms, 15 (12%) ruptured aneurysms, 26 (21%) posterior circulation aneurysms and 16 (13%) fusiform or dissecting aneurysms. Device deployment failed in 1 case (1%). Procedure-related symptomatic procedural complications consisted of 2 (2%) major events (1 major stroke and 1 vessel perforation with intracranial hemorrhage and infarction) and 6 minor events (6 minor strokes). Procedural morbidity was 5%. There were no late ischemic or hemorrhagic events during follow-up. Complete and favorable aneurysm occlusion was achieved in 54% (40/74) and 62% (46/74) at a mean of 5 months, 71% (27/38) and 87% (33/38) at a mean of 12 months, and 76% (25/33) and 97% (32/33) at a mean of 35 months, respectively. CONCLUSION The results demonstrate progressive aneurysm occlusion beyond 12 months after DED implantation with an almost 100% favorable occlusion rate. Procedural morbidity was low and there were no late complications.
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Affiliation(s)
- Lukas Goertz
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - David Zopfs
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Jonathan Kottlors
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Jan Borggrefe
- Department of Radiology, University Hospital Minden, Minden, Germany
| | - Lenhard Pennig
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Marc Schlamann
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Christoph Kabbasch
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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Goertz L, Zopfs D, Kottlors J, Pennig L, Schob S, Schlamann M, Kabbasch C. Treatment of intracranial aneurysms with large-diameter (≥5.5 mm) Derivo Embolization Devices, with particular focus on 7 and 8 mm diameter devices. Interv Neuroradiol 2024:15910199241248479. [PMID: 38706147 DOI: 10.1177/15910199241248479] [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: 05/07/2024] Open
Abstract
OBJECTIVE There are few studies on flow diverters with diameters >5 mm. We present our preliminary experience with the 5.5-8 mm Derivo Embolization Device (DED) implants for the treatment of cerebral aneurysms. METHODS A consecutive series of 26 patients (median age: 60 years) treated for 32 aneurysms in 26 procedures was retrospectively analyzed for procedural characteristics, complications, and mid-term angiographic results. RESULTS The median aneurysm size was 10.5 mm, 2 of 30 (6%) aneurysms were ruptured and 9 (28%) had a fusiform or dissecting morphology. DED implantation was performed in the internal carotid artery in 18 of 26 (69%) procedures and in the vertebrobasilar artery in 8 (31%). Device deployment failed in 1 (4%) procedure. The 7 and 8 mm implants were successfully deployed in 5 cases. Additional balloon angioplasty or stent implantation was performed in 3 (12%) cases to improve wall apposition. Complications included 1 (4%) major stroke and 2 (8%) minor strokes. Angiographic follow up at a mean of 6 months showed complete occlusion in 8 of30 (27%) aneurysms and favorable occlusion in 14 (47%). CONCLUSIONS The use of large diameter DEDs was safe and feasible. The mid-term occlusion rates are acceptable considering the complex subset of aneurysms studied. Further studies are warranted to define the indications for large-diameter DEDs and to evaluate their long-term efficacy.
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Affiliation(s)
- Lukas Goertz
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Cologne, Germany
| | - David Zopfs
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Cologne, Germany
| | - Jonathan Kottlors
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Cologne, Germany
| | - Lenhard Pennig
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Cologne, Germany
| | - Stefan Schob
- Department of Radiology and Neuroradiology, University Hospital Halle, Halle, Germany
| | - Marc Schlamann
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Cologne, Germany
| | - Christoph Kabbasch
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Cologne, Germany
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Marsool Marsool MD, Bharadwaj HR, Ali SH, Aderinto N, Shah MH, Shing N, Dalal P, Huang H, Wellington J, Chaudri T, Awuah WA, Pacheco-Barrios N, Macha-Quillama L, Fernandez-Guzman D, Hussien Mohamed Ahmed KA. Exploring the Landscape of Intracranial Aneurysms in South America: A Comprehensive Narrative Review Intracranial Aneurysms in South America. World Neurosurg 2024; 185:3-25. [PMID: 38286319 DOI: 10.1016/j.wneu.2024.01.108] [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: 12/15/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024]
Abstract
Exploring the landscape of intracranial aneurysms in South America unravels a complex interplay of epidemiological factors, clinical manifestations, and therapeutic challenges. The study methodically conducts a comprehensive literature review spanning the years 2003 to 2023, focusing on English-language articles obtained from diverse databases to elucidate the multifaceted nature of intracranial aneurysms in the region. Results and discussions categorize outcomes into positive domains, emphasizing successful treatments, favorable recoveries, and high survival rates, while also shedding light on negative aspects such as residual aneurysms and complications. The research illuminates significant gaps in pathological typing of intracranial aneurysms and exposes challenges in healthcare accessibility, notably the disparities in neurosurgical resources. Management challenges, including constrained infrastructure access, a neurosurgeon shortage, and gender disparities, are underscored. Transitioning to future prospects, the study advocates for strategic interventions, proposing expanded neurosurgical training, multidisciplinary approaches, improved funding, enhanced access to care, and fostering international collaborations. The study concludes by emphasizing the pivotal role of collaborative efforts, intensified training programs, and global partnerships in propelling intracranial aneurysm management forward in South America, ultimately contributing to enhanced patient outcomes across the region.
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Affiliation(s)
| | | | - Syed Hasham Ali
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Nicholas Aderinto
- Internal Medicine Department, LAUTECH Teaching Hospital, Oyo, Nigeria
| | | | - Nathanael Shing
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
| | - Priyal Dalal
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
| | - Helen Huang
- University of Medicine and Health Science, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jack Wellington
- Department of Neurosurgery, Bradford Teaching Hospital NHS Foundation Trust, Bradford, United Kingdom
| | | | | | | | - Luis Macha-Quillama
- Alberto Hurtado Medical School, Cayetano Heredia Peruvian University, Lima, Peru
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Meyer L, Stracke CP, Bester M, Kallmes KM, Zeleňák K, Rouchaud A, Martínez-Galdámez M, Jabbour P, Nguyen TN, Siddiqui AH, Fiehler J, Gellissen S. Predictors of aneurysm occlusion after treatment with flow diverters: a systematic literature review. J Neurointerv Surg 2024; 16:482-490. [PMID: 37316195 DOI: 10.1136/jnis-2022-019993] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/24/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Flow diverters (FDs) have become an integral part of treatment for brain aneurysms. AIM To summarize available evidence of factors associated with aneurysm occlusion (AO) after treatment with a FD. METHODS References were identified using the Nested Knowledge AutoLit semi-automated review platform between January 1, 2008 and August 26, 2022. The review focuses on preprocedural and postprocedural factors associated with AO identified in logistic regression analysis. Studies were included if they met the inclusion criteria of study details (ie, study design, sample size, location, (pre)treatment aneurysm details). Evidence levels were classified by variability and significancy across studies (eg, low variability ≥5 studies and significance in ≥60% throughout reports). RESULTS Overall, 2.03% (95% CI 1.22 to 2.82; 24/1184) of screened studies met the inclusion criteria for predictors of AO based on logistic regression analysis. Predictors of AO with low variability in multivariable logistic regression analysis included aneurysm characteristics (aneurysm diameter), particularly complexity (absence of branch involvement) and younger patient age. Predictors of moderate evidence for AO included aneurysm characteristics (neck width), patient characteristics (absence of hypertension), procedural (adjunctive coiling) and post-deployment variables (longer follow-up; direct postprocedural satisfactory occlusion). Variables with a high variability in predicting AO following FD treatment were gender, FD as re-treatment strategy, and aneurysm morphology (eg, fusiform or blister). CONCLUSION Evidence of predictors for AO after FD treatment is sparse. Current literature suggests that absence of branch involvement, younger age, and aneurysm diameter have the highest impact on AO following FD treatment. Large studies investigating high-quality data with well-defined inclusion criteria are needed for greater insight into FD effectiveness.
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Affiliation(s)
- Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Paul Stracke
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Interventional Neuroradiology, University Hospital Muenster, Muenster, Germany
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Kamil Zeleňák
- Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia
| | - Aymeric Rouchaud
- Department of Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Mario Martínez-Galdámez
- Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Thanh N Nguyen
- Departments of Radiology and Neurology, Boston Medical Center, Boston, Massachusetts, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Gellissen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Goertz L, Styczen H, Siebert E, Li Y, Schlamann M, Forsting M, Bohner G, Deuschl C, Kabbasch C. FRED X flow diverter for the treatment of intracranial aneurysms: Two-center experience and mini-review of the literature. Interv Neuroradiol 2024:15910199241246018. [PMID: 38651292 DOI: 10.1177/15910199241246018] [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: 04/25/2024] Open
Abstract
OBJECTIVE The flow re-direction endoluminal device (FRED) is a safe and effective treatment option for intracranial aneurysms. The novel FRED X features an antithrombotic surface coating ("X Technology") on an otherwise unmodified stent design. This two-center study evaluates the clinical safety and efficacy of FRED X and compares it to the literature. METHODS Consecutive patients treated between 2020 and 2023 were retrospectively reviewed for aneurysm characteristics, procedural details and complications, and angiographic outcomes. A mini-review of the literature for FRED X clinical trials was performed and results were pooled using a random effects model. RESULTS Thirty-four patients (mean age 56 years) were treated for 34 aneurysms. The mean aneurysm size was 7.7 ± 5.0 mm, 7 (21%) were ruptured, 6 (18%) were recurrent after previous treatment, 11 (32.3%) were located in the posterior circulation, and 4 (12.5%) had non-saccular morphology. All procedures were technically successful and no balloon angioplasty was required. There was 1 (2.9%) symptomatic complication (a transient ischemic attack) and no procedural morbidity or mortality. Technical asymptomatic events included 1 procedural stent occlusion that was reopened with thrombectomy and 3 cases of vasospasm. Complete and adequate occlusion rates were 68% (19/28) and 89% (25/28) at a mean follow-up time of 6 months, respectively. The results of this study are comparable to previous FRED X studies. CONCLUSIONS The results demonstrate a high feasibility and procedural safety of the FRED X with adequate mid-term occlusion rates. Long-term and comparative studies are needed to evaluate the full potential of the FRED X.
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Affiliation(s)
- Lukas Goertz
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Cologne, Germany
| | - Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Eberhard Siebert
- Department of Neuroradiology, University Hospital Berlin (Charité), Berlin, Germany
| | - Yan Li
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Marc Schlamann
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Cologne, Germany
| | - Michael Forsting
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Georg Bohner
- Department of Neuroradiology, University Hospital Berlin (Charité), Berlin, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Christoph Kabbasch
- Faculty of Medicine and University Hospital, Department of Radiology and Neuroradiology, University of Cologne, Cologne, Germany
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Goertz L, Hohenstatt S, Vollherbst DF, Weyland CS, Nikoubashman O, Styczen H, Gronemann C, Weiss D, Kaschner M, Pflaeging M, Siebert E, Zopfs D, Kottlors J, Pennig L, Schlamann M, Bohner G, Liebig T, Turowski B, Dorn F, Deuschl C, Wiesmann M, Möhlenbruch MA, Kabbasch C. Safety and efficacy of coated flow diverters in the treatment of ruptured intracranial aneurysms: a retrospective multicenter study. J Neurointerv Surg 2024:jnis-2024-021516. [PMID: 38569886 DOI: 10.1136/jnis-2024-021516] [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: 01/22/2024] [Accepted: 03/07/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND This multicenter study evaluated the safety and efficacy of coated flow diverters (cFDs) for the treatment of ruptured intracranial aneurysms. METHODS Consecutive patients treated with different cFDs for ruptured aneurysms under tirofiban at eight neurovascular centers between 2016 and 2023 were retrospectively analyzed. The majority of patients were loaded with dual antiplatelet therapy after the treatment. Aneurysm occlusion was determined using the O'Kelly-Marotta (OKM) grading scale. Primary outcome measures were major procedural complications and aneurysmal rebleeding during hospitalization. RESULTS The study included 60 aneurysms (posterior circulation: 28 (47%)) with a mean size of 5.8±4.7 mm. Aneurysm morphology was saccular in 28 (47%), blister-like in 12 (20%), dissecting in 13 (22%), and fusiform in 7 (12%). Technical success was 100% with a mean of 1.1 cFDs implanted per aneurysm. Adjunctive coiling was performed in 11 (18%) aneurysms. Immediate contrast retention was observed in 45 (75%) aneurysms. There was 1 (2%) major procedural complication (a major stroke, eventually leading to death) and no aneurysmal rebleeding. A good outcome (modified Rankin Scale 0-2) was achieved in 40 (67%) patients. At a mean follow-up of 6 months, 27/34 (79%) aneurysms were completely occluded (OKM D), 3/34 (9%) had an entry remnant (OKM C), and 4/34 (12%) had residual filling (OKM A or B). There was 1 (3%) severe in-stent stenosis during follow-up that was treated with balloon angioplasty. CONCLUSIONS Treatment of ruptured aneurysms with cFDs was reasonably safe and efficient and thus represents a valid treatment option, especially for complex cases.
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Affiliation(s)
- Lukas Goertz
- Department of Radiology and Neuroradiology, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Sophia Hohenstatt
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dominik F Vollherbst
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Omid Nikoubashman
- Department of Neuroradiology, University Hospital Aachen, Aachen, Germany
| | - Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | | | - Daniel Weiss
- Department of Neuroradiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marius Kaschner
- Department of Neuroradiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Muriel Pflaeging
- Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
| | - Eberhard Siebert
- Department of Neuroradiology, University Hospital Berlin (Charité), Berlin, Germany
| | - David Zopfs
- Department of Radiology and Neuroradiology, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Jonathan Kottlors
- Department of Radiology and Neuroradiology, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Lenhard Pennig
- Department of Radiology and Neuroradiology, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Marc Schlamann
- Department of Radiology and Neuroradiology, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Georg Bohner
- Department of Neuroradiology, University Hospital Berlin (Charité), Berlin, Germany
| | - Thomas Liebig
- Department of Neuroradiology, University Hospital Munich (LMU), Munich, Germany
| | - Bernd Turowski
- Department of Neuroradiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Martin Wiesmann
- Department of Neuroradiology, University Hospital Aachen, Aachen, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Kabbasch
- Department of Radiology and Neuroradiology, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
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Goertz L, Zopfs D, Schönfeld M, Zaeske C, Pennig L, Brinker G, Schlamann M, Kabbasch C. First clinical experience with the Derivo 2heal embolization device for the treatment of intracranial aneurysms. Interv Neuroradiol 2023:15910199231193577. [PMID: 37574801 DOI: 10.1177/15910199231193577] [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: 08/15/2023] Open
Abstract
OBJECTIVE The development of new flow-diverting devices with antithrombotic coatings may result in an improved safety profile, particularly a reduction in ischaemic stroke rates. The aim of this study was to evaluate our initial experience with the recently introduced coated Derivo® 2heal® Embolization Device (Acandis, Pforzheim, Germany). METHODS This is a retrospective, single-centre analysis of patients with intracranial aneurysms undergoing Derivo® 2heal® Embolization Device treatment. Patient and aneurysm characteristics, procedural parameters, complications, and degree of initial and short-term aneurysm occlusion were evaluated on an intention-to-treat basis. RESULTS A total of 16 unruptured aneurysms in 9 patients were treated with the Derivo® 2heal® Embolization Device in 10 treatment sessions. In one case the Derivo® 2heal® Embolization Device could not be deployed due to severe friction in the microcatheter. In all successful cases, one Derivo® 2heal® Embolization Device was sufficient to treat the target aneurysm and no additional coiling was performed. In-stent balloon angioplasty was performed in one procedure (10%) to improve vessel wall apposition. Twelve arterial side branches were covered in 9 procedures and all were patent at the end of the procedure. There were no clinical complications and no thromboembolic events during treatment. At the end of the procedure, contrast retention was observed in 13/16 (81%) aneurysms and at short-term follow-up, 6/9 (67%) were completely occluded. CONCLUSIONS The preliminary results of the new Derivo® 2heal® Embolization Device appear promising and warrant further evaluation by multicentre studies with long-term follow-up.
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Affiliation(s)
- Lukas Goertz
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Strasse 62, Cologne, Germany
| | - David Zopfs
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Strasse 62, Cologne, Germany
| | - Michael Schönfeld
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Strasse 62, Cologne, Germany
| | - Charlotte Zaeske
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Strasse 62, Cologne, Germany
| | - Lenhard Pennig
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Strasse 62, Cologne, Germany
| | - Gerrit Brinker
- Faculty of Medicine and University Hospital, Center for Neurosurgery, University of Cologne, Kerpener Strasse 62, Cologne, Germany
| | - Marc Schlamann
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Strasse 62, Cologne, Germany
| | - Christoph Kabbasch
- Department of Radiology and Neuroradiology, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Strasse 62, Cologne, Germany
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Ma Y, Madjidyar J, Schubert T, Thurner P, Barnaure I, Kulcsar Z. Single antiplatelet regimen in flow diverter treatment of cerebral aneurysms: The drug matters. A systematic review and meta-analysis. Interv Neuroradiol 2023:15910199231177745. [PMID: 37221854 DOI: 10.1177/15910199231177745] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Hemorrhagic and thromboembolic complications (TECs) are the main concerns in the endovascular treatment of intracranial aneurysms using flow diverter devices (FDs). The clinical demand for single antiplatelet therapy (SAPT) is increasing especially with the development of devices with lower thrombogenicity profile. However, the safety of SAPT is not well established. OBJECTIVE To analyze the safety and efficacy of SAPT in terms of ischemic and hemorrhagic complications in patients undergoing FDs treatment for cerebral aneurysms. METHODS A systematic literature search and meta-analysis were conducted in PubMed, Ovid MEDLINE, Ovid Embase, and Web of Science from January 2010 until October 2022. Twelve articles which reported SAPT and data on hemorrhagic, TECs, and mortality following FDs treatment were included. RESULTS Overall, the 12 studies involved 237 patients with 295 aneurysms. Five investigated the safety and efficacy of SAPT in 202 unruptured aneurysms. Six studies focused on 57 ruptured aneurysms. One study included both ruptured and unruptured aneurysms. Among the 237 patients, prasugrel was most often used as SAPT in 168 cases (70.9%), followed by aspirin in 42 (17.7%) patients, and by ticagrelor in 27 (11.4%). Overall, the hemorrhagic complication rate was 0.1% (95% CI 0% to 1.8%). The TEC rate was 7.6% (95% CI 1.7% to 16.1%). In the subgroup analysis, the TEC rates of prasugrel monotherapy of 2.4% (95% CI 0% to 9.3%) and ticagrelor monotherapy of 4.2% (95% CI 0.1% to 21.1%) were lower than of aspirin monotherapy 20.2% (95% CI 5.9% to 38.6%). The overall mortality rate was 1.3% (95% CI 0% to 6.1%). CONCLUSION According to the available data, SAPT regimen in patients undergoing FDs treatment for cerebral aneurysms has an acceptable safety profile, especially with the use of ADP-receptor antagonists.
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Affiliation(s)
- Yihui Ma
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - 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
| | - Isabelle Barnaure
- 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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10
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Gonzalez SM, Iordanou J, Adams W, Tsiang J, Frazzetta J, Kim M, Rezaii E, Pecoraro N, Zsigray B, Simon JE, Zakaria J, Jusue-Torres I, Li D, Heiferman DM, Serrone JC. Effect of Stent Porosity, Platelet Function Test Usage, and Dual Antiplatelet Therapy Duration on Clinical and Radiographic Outcomes After Stenting for Cerebral Aneurysms: A Meta-Analysis. World Neurosurg 2023; 171:159-166.e13. [PMID: 36529432 DOI: 10.1016/j.wneu.2022.12.055] [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: 11/13/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The use of stents with various porosities for treating cerebral aneurysms requires dual antiplatelet therapy (DAPT) without clear guidelines on the utility of platelet function tests (PFTs) and the duration of DAPT. We sought to determine the effects of stent porosity, PFT usage, and DAPT duration on the radiographic and clinical outcomes after stenting of cerebral aneurysms. METHODS PubMed was searched on March 29, 2021 for studies of cerebral aneurysm stenting that had specified the stent type and DAPT duration. A random effects meta-analysis was used to measure the prevalence of nonprocedural thrombotic and hemorrhagic events, clinical outcomes, aneurysm occlusion, and in-stent stenosis stratified by stent porosity, PFT usage, and DAPT duration. RESULTS The review yielded 105 studies (89 retrospective and 16 prospective) with 117 stenting cohorts (50 high porosity, 17 intermediate porosity, and 50 low porosity). In the high-, intermediate-, and low-porosity stenting cohorts, PFT usage was 26.0%, 47.1%, and 62.0% and the mean DAPT duration was 3.51 ± 2.33, 3.97 ± 1.92, and 5.18 ± 2.27 months, respectively. The intermediate-porosity stents showed a reduced incidence of hemorrhagic events (π = 0.32%) compared with low-porosity stents (π = 1.36%; P = 0.01) and improved aneurysm occlusion (π = 6.18%) compared with high-porosity stents (π = 14.42%; P = 0.001) and low-porosity stents (π = 11.71%; P = 0.04). The prevalence of in-stent stenosis was lower for the intermediate-porosity (π = 0.57%) and high-porosity (π = 1.51%) stents than for the low-porosity stents (π = 3.30%; P < 0.05). PFT use had resulted in fewer poor clinical outcomes (π = 3.54%) compared with those without PFT use (π = 5.94%; P = 0.04). The DAPT duration had no effect on the outcomes. CONCLUSIONS In the present meta-analysis, which had selected for studies of cerebral aneurysm stenting that had reported the DAPT duration, intermediate-porosity stents and PFT use had resulted significantly improved outcomes. No effect of DAPT duration could be detected.
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Affiliation(s)
| | - Jordan Iordanou
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - William Adams
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Illinois, USA
| | - John Tsiang
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Joseph Frazzetta
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Miri Kim
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Elhaum Rezaii
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Nathan Pecoraro
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Brandon Zsigray
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Joshua E Simon
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jehad Zakaria
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | | | - Daphne Li
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Daniel M Heiferman
- Department of Neurological Surgery, Edward-Elmhurst Health, Naperville, Illinois, USA
| | - Joseph C Serrone
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA; Department of Neurological Surgery, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA.
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11
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Thormann M, Sillis N, Thoma T, Altenbernd J, Berger B, Cioltan A, Loehr C, Bohner G, Siebert E, Nordmeyer H, Mpotsaris A, Behme D. The DERIVO®2 Embolization Device in the treatment of ruptured and unruptured intracranial aneurysms: A multicenter analysis. Interv Neuroradiol 2022:15910199221142643. [PMID: 36567499 DOI: 10.1177/15910199221142643] [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: 12/27/2022] Open
Abstract
BACKGROUND Flow diverters are an increasingly used treatment option for intracranial aneurysms. A recent addition to the European market is the DERIVO®2 Embolization Device (DED2), promising improved radiopacity. We aimed to assess the safety and efficacy of the DED2 regarding angiographic and clinical outcomes in ruptured and unruptured cerebral aneurysms. METHODS We performed a multicenter trial at six interventional centers. Data were prospectively collected and all patients treated with the DED2 were included. The primary endpoint was angiographic aneurysm occlusion at 6 months as assessed by the O'Kelly Marotta (OKM) grading scale with a favorable outcome definition of OKM C + D. Clinical outcome was evaluated according to the modified Rankin scale (mRS). RESULTS Between August 2020 and July 2021, 37 patients were treated with the DED2 and were included in our analysis. Five patients presented with ruptured aneurysms. Median age was 60 years, 27 patients were female, and 10 male. Median mRS was 0 (range 0-4). Mean aneurysm size was 8.9 ± 7.1 mm with a mean neck size of 6.5 ± 6.1. The DED2 fully opened at deployment in all cases. Clinical follow-up was available for 30 patients (81%). Twenty-five (83%) had an mRS of 0 or 1. Three patients with ruptured aneurysms died during the follow-up period. No treatment-related major morbidity was observed. Follow-up imaging was available in 27 (90%) patients, with 23 patients (85%) showing satisfactory aneurysm occlusion OKM grade C-D. CONCLUSION In this small cohort, the DED2 provided safe and effective treatment of ruptured and unruptured intracranial aneurysms.
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Affiliation(s)
- Maximilian Thormann
- University Clinic for Neuroradiology, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Nele Sillis
- University Clinic for Neuroradiology, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Taina Thoma
- University Clinic for Neuroradiology, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Jens Altenbernd
- Department of Radiology and Neuroradiology, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Björn Berger
- Department of Neuroradiology, Evangelisches Klinikum Bethel, Universitätsklinikum OWL, Bielefeld, Germany
| | - Andrea Cioltan
- Department of Radiology and Neuroradiology, 39546Klinikum Vest GmbH Behandlungszentrum Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
| | - Christian Loehr
- Department of Radiology and Neuroradiology, Klinikum Vest Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
| | - Georg Bohner
- Institute of Neuroradiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eberhard Siebert
- Institute of Neuroradiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hannes Nordmeyer
- Department of Interventional Neuroradiology Radprax, 39655St Lukas Klinik, Solingen, Germany
- School of Medicine, Department of Health, 12263Witten/Herdecke University, Witten, Germany
| | - Anastasios Mpotsaris
- Department for Diagnostic and Interventional Radiology and Neuroradiology, Munich Clinic Harlaching, Munich, Germany
| | - Daniel Behme
- University Clinic for Neuroradiology, 39067University Hospital Magdeburg, Magdeburg, Germany
- Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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12
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Chagas Lourenço G, Dantas F, Silva E Carvalho T, Firmino RUR, Quesado Filgueiras Filho M, Tosello RT, José Leão C, Leo Piske R, Zenóbio Darwich R. Endovascular treatment of intracranial aneurysms using the Derivo Embolization Device: a multicenter experience. J Neurointerv Surg 2022:neurintsurg-2022-018648. [PMID: 35705359 DOI: 10.1136/neurintsurg-2022-018648] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/27/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Flow diversion is the first-line treatment for several types of intracranial aneurysms. We report on a large series of patients treated with the Derivo Embolization Device who underwent a 1-year angiographic control follow-up. METHODS We performed a multicenter retrospective analysis of prospectively collected data, designed to evaluate the clinical and angiographic results of treatment of intracranial aneurysms with the Derivo Flow Diverter. The primary endpoint was complete occlusion of the aneurysm within 12 months, which was evaluated using DSA. The secondary endpoint was the absence of any serious adverse events. Univariate and multivariate logistic regression analyses were performed to analyze the data. RESULTS The study was conducted from December 2016 to September 2019 and enrolled 127 patients with 177 intracranial aneurysms, treated at three different centers. Efficacy at 6 months was 70.1% (122/174) for total occlusion and 87.3% (152/174) for favorable occlusion and, at 12 months, it was 83.3% (145/174) for total occlusion and 97.7% (170/174) for favorable occlusion. Regarding safety concerns, 97.6% (124/127) of patients did not experience severe adverse effects during the follow-up period of 12 months, and there was no procedure-related mortality. CONCLUSIONS The Derivo Embolization Device, achieving a total occlusion rate of 83.3% and a favorable occlusion rate of 97.7% in a 1-year angiographic control study of 174 aneurysms with minor morbidity and no intervention-related mortality, is a safe and effective treatment for intracranial aneurysms.
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Affiliation(s)
- Galileu Chagas Lourenço
- Department of Interventional Neuroradiology, Biocor Instituto, Nova Lima, Minas Gerais, Brazil
| | - François Dantas
- Department of Interventional Neuroradiology, Biocor Instituto, Nova Lima, Minas Gerais, Brazil
| | - Tiago Silva E Carvalho
- Department of Interventional Neuroradiology, Biocor Instituto, Nova Lima, Minas Gerais, Brazil
| | | | | | - Renato Tavares Tosello
- Centro de Neuro-Angiografia, Hospital Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
| | - Cláudio José Leão
- Department of Interventional Neuroradiology, Hospital Geral de Goiânia Dr Alberto Rassi, Goiania, Brazil
| | - Ronie Leo Piske
- Department of Interventional Neuroradiology, Beneficência Portuguesa de São Paulo, Sao Paulo, Brazil
| | - Rogério Zenóbio Darwich
- Department of Interventional Neuroradiology, Biocor Instituto, Nova Lima, Minas Gerais, Brazil
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13
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Monteiro A, Burke SM, Baig AA, Khan S, Cappuzzo JM, Waqas M, Dietrich JE, Levy EI, Siddiqui AH. A systematic review and meta-analysis of the Derivo Embolization Device: a novel surface-modified flow diverter for intracranial aneurysm treatment. J Neurointerv Surg 2022; 14:1125-1129. [PMID: 35232753 DOI: 10.1136/neurintsurg-2021-018390] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/27/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Surface-modified flow diverters (FDs) designed to reduce thrombogenicity represent the next frontier for intracranial aneurysm treatment. The Derivo Embolization Device (DED) is a novel FD with titanium oxide and titanium oxynitride finishing of the struts. We performed a systematic review of pertinent literature, aiming to evaluate the device's effectiveness and safety. METHODS A literature search of PubMed, Embase, and MEDLINE was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Five studies comprising 481 aneurysms were included. These studies were conducted in Turkey, Brazil, Germany, Poland, and Italy; two were prospective and three were retrospective. Twenty-six aneurysms (5.4%) were ruptured. The antiplatelet regimens were heterogeneous, but dual antiplatelet therapy was administered preprocedurally in all studies and maintained for 3-12 months before a switch to single antiplatelet therapy. The rate of periprocedural ischemic and hemorrhagic complications was 4.9% (95% CI 2.9% to 7%). Adjunctive coiling was used in 25.6% (95% CI 11.4% to 39.8%) of aneurysms. The complete angiographic occlusion rate was 81.4% (95% CI 71.3% to 91.5%), mortality rate was 2.1% (95% CI 0.4% to 3.9%), with follow-up ranging from 9 to 18 months. Delayed aneurysm rupture was reported in one patient. CONCLUSIONS The DED has been increasingly used in other countries. We identified low rates of periprocedural complications and mortality and a high rate of complete occlusion.
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Affiliation(s)
- Andre Monteiro
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | | | - Ammad A Baig
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Slah Khan
- Medical Student, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Muhammad Waqas
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | | | - Elad I Levy
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA.,Neurosurgery and Radiology and Canon Stroke and Vascular Research Center and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA .,Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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14
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Hudson JS, Lang MJ, Gross BA. Novel Innovation in Flow Diversion. Neurosurg Clin N Am 2022; 33:215-218. [DOI: 10.1016/j.nec.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Internal carotid artery “donut” aneurysm treated using DERIVO flow-diverting stent. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh210718101n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Intracranial aneurysms with a radiological sign of a donut are a medical priority and have been described in a small number of cases. This radiological sign occurs in aneurysms in which there is partial thrombosis inside aneurismal sac and circular laminar flow between the aneurismal wall and the thrombus in its center. Consequently, there is a central contrast-filling defect of the aneurysm sac observed on different angiographic imaging methods. Case outline. We present a 35-year-old female patient admitted for examination due to frequent headaches, visual disturbances on the left and loss of sight on the right eye. Digital subtraction angiography (DSA) showed an aneurysm on the right internal carotid artery measuring 25.6 ? 25 mm, while neck measured 11 mm and included part of the C6 and C7 segments. Treatment decision was made that placing a flow-diverting stent across the aneurysm neck would be most beneficial in this case. After the procedure, the patient was discharged in the same general condition as she was before admission to the hospital. Seven months after the intervention, she reported for her first DSA control examination. Normal position of the left A1 segment was demonstrated, suggesting shrinkage of the aneurysm sac. An improvement of vision on both eyes was stated. Conclusion. We present a patient with a ?donut? aneurysm on the internal carotid artery, successfully treated with a flow-diverting stent.
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16
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GÜZELDAĞ H, ONAN B, PİŞKİN FC, SÖZÜTOK S. Geniş boyunlu paraoftalmik anevrizmaların akım çevirici stent implantasyonu ile endovasküler tedavisi. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.977944] [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] Open
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17
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Fujimura S, Brehm A, Takao H, Uchiyama Y, Karagiozov K, Fukudome K, Yamamoto M, Murayama Y, Psychogios MN. Hemodynamic Characteristics and Clinical Outcome for Intracranial Aneurysms treated with the Derivo Embolization Device, a Novel Second-Generation Flow Diverter. World Neurosurg 2021; 159:e252-e259. [PMID: 34929366 DOI: 10.1016/j.wneu.2021.12.033] [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: 08/13/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE We investigated the relationship between hemodynamic characteristics and clinical outcomes for aneurysms treated by the Derivo Embolization Device (DED), a novel second-generation Flow-Diverter Stent, using computational fluid dynamics (CFD). MATERIALS AND METHODS Data were retrospectively obtained from two centers between 2017 and 2019. During the period, 23 patients were treated for 23 aneurysms with DED. In 17 patients we were able to conduct CFD analysis as six were excluded due to pre-coiling, unsuitable arterial geometry, and complex geometric form. Aneurysm occlusion was rated with the O`Kelly-Marotta (OKM) grading scale on DSA 6 months after stent placement in all patients. Hemodynamic and morphological parameters were statistically compared between two groups: with full occlusion and with a remnant. RESULTS Full occlusion was observed in 17 out of 23 (73.9%) patients. In the group suitable for CFD analysis, we observed 13 fully occluded aneurysms and 4 with any remnant (specifically 1 OKM C, 1 B and 2 A). The energy loss per volume (ELV), which indicates the energy loss through the aneurysm, was significantly larger in pre and post stenting (p<.05) in the complete occlusion cases. In addition, the inflow concentration index (ICI) and inflow area ratio (IAR) of the remnant cases were significantly larger and lower, respectively (p<.05). CONCLUSION Our CFD results indicate that the energy loss involved with the blood flow passing through an aneurysm and concentrated inflow into aneurysm were the most important factors to determine whether an aneurysm will become a complete occlusion or remnant case.
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Affiliation(s)
- Soichiro Fujimura
- Department of Mechanical Engineering, Tokyo University of Science, 6-3-1 Niijuku, Katsushika-ku, Tokyo 125-8585, Japan; Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Alex Brehm
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Hiroyuki Takao
- Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan; Department of Neurosurgery, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan; Graduate School of Mechanical Engineering, Tokyo University of Science, 6-3-1 Niijuku, Katsushika-ku, Tokyo 125-8585, Japan
| | - Yuya Uchiyama
- Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan; Graduate School of Mechanical Engineering, Tokyo University of Science, 6-3-1 Niijuku, Katsushika-ku, Tokyo 125-8585, Japan
| | - Kostadin Karagiozov
- Department of Neurosurgery, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Koji Fukudome
- Department of Mechanical Engineering, Tokyo University of Science, 6-3-1 Niijuku, Katsushika-ku, Tokyo 125-8585, Japan
| | - Makoto Yamamoto
- Department of Mechanical Engineering, Tokyo University of Science, 6-3-1 Niijuku, Katsushika-ku, Tokyo 125-8585, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
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18
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Bonafe A, Perez MA, Henkes H, Lylyk P, Bleise C, Gascou G, Sirakov S, Sirakov A, Stockx L, Turjman F, Petrov A, Roth C, Narata AP, Barreau X, Loehr C, Berlis A, Pierot L, Miś M, Goddard T, Clifton A, Klisch J, Wałęsa C, Dall'Olio M, Spelle L, Clarencon F, Yakovlev S, Keston P, Nuzzi NP, Dima S, Wendl C, Willems T, Schramm P. Diversion-p64: results from an international, prospective, multicenter, single-arm post-market study to assess the safety and effectiveness of the p64 flow modulation device. J Neurointerv Surg 2021; 14:898-903. [PMID: 34782399 PMCID: PMC9380510 DOI: 10.1136/neurintsurg-2021-017809] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/21/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The use of flow diversion to treat intracranial aneurysms has increased in recent years. OBJECTIVE To assess the safety and angiographic efficacy of the p64 flow modulation device. METHODS Diversion-p64 is an international, prospective, multicenter, single-arm, study conducted at 26 centers. The p64 flow modulation device was used to treat anterior circulation aneurysms between December 2015 and January 2019. The primary safety endpoint was the incidence of major stroke or neurologic death at 3-6 months, with the primary efficacy endpoint being complete aneurysm occlusion (Raymond-Roy Occlusion Classification 1) on follow-up angiography. RESULTS A total of 420 patients met the eligibility criteria and underwent treatment with the p64 flow modulation device (mean age 55±12.0 years, 86.2% female). Mean aneurysm dome width was 6.99±5.28 mm and neck width 4.47±2.28 mm. Mean number of devices implanted per patient was 1.06±0.47, with adjunctive coiling performed in 14.0% of the cases. At the second angiographic follow-up (mean 375±73 days), available for 343 patients (81.7%), complete aneurysm occlusion was seen in 287 (83.7%) patients. Safety data were available for 413 patients (98.3%) at the first follow-up (mean 145±43 days) with a composite morbidity/mortality rate of 2.42% (n=10). CONCLUSIONS Diversion-p64 is the largest prospective study using the p64 flow modulation device. The results of this study demonstrate that the device has a high efficacy and carries a low rate of mortality and permanent morbidity.
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Affiliation(s)
- Alain Bonafe
- Department of Neuroradiology, Hopital Gui de Chauliac, Montpellier, France
| | - Marta Aguilar Perez
- Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, Germany
| | - Hans Henkes
- Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Baden-Württemberg, Germany
| | - Pedro Lylyk
- Departamento de Neurociencias, ENERI, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Carlos Bleise
- Departamento de Neurociencias, ENERI, Clínica La Sagrada Familia, Buenos Aires, Argentina
| | - Gregory Gascou
- Department of Neuroradiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Stanimir Sirakov
- Department of Radiology, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Alexander Sirakov
- Department of Radiology, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Luc Stockx
- Neuroradiology, Ziekenhuis Oost-Limburg - Campus Sint Jan, Genk, Belgium
| | - Francis Turjman
- Department of Interventional Neuroradiology, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - Andrey Petrov
- Department of Vascular Neurosurgery, Russian Polenov Neurosurgical Institute, Federal Almazov North West Medical Research Centre, St Petersburg, Russian Federation
| | - Christian Roth
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte gGmbH, Bremen, Germany
| | - Ana-Paula Narata
- Department of Interventional Neuroradiology, Regional University Hospital, Tours, France
| | - Xavier Barreau
- Department of Neuroradiology, Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin, Bordeaux, France
| | - Christian Loehr
- Department of Radiology and Neuroradiology, Klinikum Vest GmbH Behandlungszentrum Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Nordrhein-Westfalen, Germany
| | - Ansgar Berlis
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Augsburg, Augsburg, Bayern, Germany
| | - Laurent Pierot
- Department of Neuroradiology, Hôpital Maison Blanche, Reims, France
| | - Marcin Miś
- Department of General Radiology, Interventional Radiology, and Neuroradiology, Wroclaw Medical University, Wroclaw, Dolnoslaskie, Poland
| | - Tony Goddard
- Department of Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andy Clifton
- Department of Neuroradiology, St George's Hospital, London, UK
| | - Joachim Klisch
- Department of Neuroradiology, HELIOS Klinikum Erfurt, Erfurt, Thüringen, Germany
| | - Cezary Wałęsa
- Neuroradiology, Regionalny Szpital Specjalistyczny im dr Wl Bieganskiego, Grudziadz, Poland
| | - Massimo Dall'Olio
- Neuroradiology, Ospedale Bellaria Carlo Alberto Pizzardi, Bologna, Italy
| | - Laurent Spelle
- Department of Interventional Neuroradiology, BICETRE HOSPITAL - APHP, Le Kremlin-Bicetre, France.,Faculty of Medicine, Paris-Saclay University, Le Kremlin-Bicetre, France
| | - Frédéric Clarencon
- Department of Neuroradiology, Hôpital Universitaire Pitié Salpêtrière Service de Neuroradiologie Interventionnelle, Paris, Île-de-France, France
| | - Sergey Yakovlev
- Neuroradiology, Burdenko Neurosurgical Clinic, Moskva, Russian Federation
| | - Peter Keston
- Department of Clinical Neuroscience, NHS Lothian, Edinburgh, UK
| | - Nunzio Paolo Nuzzi
- Neuroradiologia Interventistica, IRCCS Istituto Clinico Humanitas, Rozzano, Lombardia, Italy
| | - Stefanita Dima
- Clinica de Neurochirurgie si Terapie Endovasculara Neurolife, Life Memorial Hospital, Bucharest, Romania
| | - Christina Wendl
- Institut für Röntgendiagnostik, Universitatsklinikum Regensburg, Regensburg, Bayern, Germany
| | | | - Peter Schramm
- Department of Neuroradiology, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lubeck, Schleswig-Holstein, Germany
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19
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Butt W, Kim CN, Ramaswamy R, Smith A, Maliakal P. Implantation of Large Diameter (5.5-6 mm) Derivo Embolization Devices for the Treatment of Cerebral Aneurysms. Clin Neuroradiol 2021; 32:481-489. [PMID: 34498094 DOI: 10.1007/s00062-021-01086-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The efficacy of flow diverters is dependent upon robust wall apposition in the parent artery. Usage in large caliber cerebral vessels has therefore been limited as few implants with diameters > 5 mm exist. We present our initial experience in treating cerebral aneurysms using the 5.5 mm and 6 mm diameter implants of the Derivo embolization device (DED). METHODS Our prospectively maintained institutional database was reviewed to identify patients in whom a > 5 mm DED was implanted between November 2016 and February 2021. The primary efficacy outcome was complete or near-complete aneurysm occlusion at 6 months (O'Kelly-Marotta, OKM, C-D, adapted for magnetic resonance angiography). Safety outcomes included 30-day major morbidity defined as modified Rankin Score (mRS) 3-5, mortality, serious adverse events and procedural complications. RESULTS A total of 21 large diameter DEDs were deployed in 18 patients (age 59.5 ± 14.1 years), harboring 19 unruptured aneurysms. Of the aneurysms 14 (73.7%) were saccular in morphology (sac diameter 10.9 ± 5.5 mm, neck diameter 6.8 ± 3.1 mm), 3 (15.8%) aneurysms were dissecting, 1 (5.3%) iatrogenic pseudoaneurysm and 1 (5.3%) fusiform. Aneurysm locations were: ICA (internal carotid artery) (n = 17); (7 cavernous, 4 paraophthalmic, 2 paraclinoid, 1 petrous, 2 communicating, 1 cervical); vertebrobasilar (n = 2). Adjunct stenting to optimize proximal wall apposition was undertaken in 5 (27.8%) patients. At 6 months 75% of patients followed-up met the primary efficacy endpoint (OKM C-D). There were no serious adverse events, 30-day major morbidity (mRS 3-5) or mortality. CONCLUSION Implantation of large diameter (5.5 mm and 6 mm) DEDs into capacious cerebral vessels to treat a range of complex aneurysms is safe and technically feasible but may require adjunct stenting to optimize proximal wall apposition. Short-term efficacy of this device subset is comparable to previous DED and other flow diverter studies. Long-term follow-up and comparative studies are required for further assessment.
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Affiliation(s)
- Waleed Butt
- Interventional Neuroradiology, Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust, Hull, UK. .,Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Cha-Ney Kim
- Interventional Neuroradiology, Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Rajesh Ramaswamy
- Interventional Neuroradiology, Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Aubrey Smith
- Interventional Neuroradiology, Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Paul Maliakal
- Interventional Neuroradiology, Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust, Hull, UK
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20
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Mahajan NP, Mushtaq M, Bhatti A, Purkayastha S, Dange N, Cherian M, Gupta V, Huded V. REtrospective Multicenter INdian Study of Derivo Embolization Device (REMIND): Periprocedural Safety. Neurointervention 2021; 16:232-239. [PMID: 34425637 PMCID: PMC8561030 DOI: 10.5469/neuroint.2021.00227] [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: 05/11/2021] [Accepted: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose The treatment of aneurysms with characteristics such as complex morphology, fusiform, blister-like, wide neck, or large size has been revolutionized with the introduction of flow diverters. Though flow diverters have several advantages over coiling, they also have certain important disadvantages such as the lack of immediate protection against rupture, the risk of ischemic stroke, the need for antiplatelet therapy, and long latency for complete effect. The Derivo Embolization Device (DED) is a second-generation self-expanding device that is claimed to be less thrombogenic than conventional devices. We retrospectively evaluated the periprocedural safety and risks associated with the DED across 5 centers in India. Materials and Methods This is a multicentric, retrospective, observational study of DED, conducted at 5 high volume endovascular therapy centers in India from May 2018 to June 2020. Periprocedural demographic, clinical, and angiographic data were collected from a retrospective review of patient charts. Results A total of 96 patients, including 56 (58.3%) females, aged between 16–80 years (60±12.7 years) harboring 106 aneurysms were studied. Seven (7.3%) were noted to harbor multiple aneurysms: 6 had 3 aneurysms each, while 1 patient had 5 aneurysms. The following aneurysm characteristics were noted: average size, 9.8±8.2 mm; average neck size, 6.9±8.5 mm; wide-necked (>4 mm), 63 (59.4%); giant (>25 mm), 8 (7.5%); and anterior circulation location, 98 (92.5%). Eighteen (17%) of these were ruptured. Additional balloon angioplasty was performed in 5 (5.2%) patients. Intraprocedural problems were encountered in 3 (3.1%), of which only 1 had clinical implications, the device fish-mouthing with stent thrombosis resulting in a malignant middle cerebral artery territory infarction. The modified Rankin scale at 3 months was worse in 1 patient. Conclusion DED is a newer generation flow diverter stent with a low periprocedural complication rate.
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Affiliation(s)
- Niranjan Prakash Mahajan
- Division of Interventional Neurology, Department of Neurology, Mazumdar Shaw Medical Centre, Narayana Health City, Bangalore, India
| | - Mudasir Mushtaq
- Division of Interventional Neurology, Department of Neurology, Mazumdar Shaw Medical Centre, Narayana Health City, Bangalore, India
| | - Amit Bhatti
- Division of Interventional Neurology, Department of Neurology, Mazumdar Shaw Medical Centre, Narayana Health City, Bangalore, India
| | - Sukalyan Purkayastha
- Department of Interventional Neuroradiology, Institute of Neurosciences, Kolkata, India
| | - Nitin Dange
- Department of Neurosurgery, King Edward Memorial Hospital and Seth G.S. Medical College, Mumbai, India
| | - Mathew Cherian
- Department of Diagnostic and Interventional Radiology, Kovai Medical Centre and Hospital, Coimbatore, India
| | - Vipul Gupta
- Department of Neurointerventional Surgery, Artemis Hospital, Gurugram, India
| | - Vikram Huded
- Division of Interventional Neurology, Department of Neurology, Mazumdar Shaw Medical Centre, Narayana Health City, Bangalore, India
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21
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Manzato LB, Santos RB, Filho PMM, Miotto G, Bastos AM, Vanzin JR. Brazilian FRED Registry: A Prospective Multicenter Study for Brain Aneurysm Treatment-The BRED Study. AJNR Am J Neuroradiol 2021; 42:1822-1826. [PMID: 34413065 DOI: 10.3174/ajnr.a7258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/01/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The development of flow diverters has changed the endovascular approach to intracranial aneurysms. On the basis of good results, the indications for flow diverters have expanded to include aneurysms of different shapes, locations, and sizes. The objective of the study was to report on the performance of the Flow Re-Direction Endoluminal Device (FRED) in intracranial aneurysm treatment at early and medium-term follow-up. MATERIALS AND METHODS This single-arm, multicentric, prospective, observational study assessed aneurysm treatment with the FRED. The primary outcome was complete aneurysm occlusion at 6 and 12 months, and the secondary outcome was to evaluate the safety of the FRED with respect to stroke and death rates. RESULTS Between June 2016 and August 2018, a total of 100 consecutive patients with 131 aneurysms were treated in 107 procedures. Total occlusion rates were 91% and 95% at 6 and 12 months. There was 1 death, and the total final morbidity rate was 1.8%. The complication rate was 4.6%. CONCLUSIONS As reported previously, the FRED has proved to be a safe and effective tool, with high occlusion rates. The design of the stent makes it more difficult to perform balloon angioplasty compared with similar devices. A branch arising from the aneurysm sac was found to be a predictor of nonocclusion at 12 months, though larger series are needed to estimate the magnitude of the association.
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Affiliation(s)
- L B Manzato
- From the Department of Interventional Neuroradiology (L.B.M., P.M.M.F., G.M., J.R.V.), Neurology and Neurosurgery Service, Clinicas Hospital of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil .,Department of Interventional Neuroradiology (R.B.S., A.M.B.), Beneficente Portuguesa Hospital, Belém, Brazil
| | - R B Santos
- From the Department of Interventional Neuroradiology (L.B.M., P.M.M.F., G.M., J.R.V.), Neurology and Neurosurgery Service, Clinicas Hospital of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil.,Department of Interventional Neuroradiology (R.B.S., A.M.B.), Beneficente Portuguesa Hospital, Belém, Brazil
| | - P M M Filho
- From the Department of Interventional Neuroradiology (L.B.M., P.M.M.F., G.M., J.R.V.), Neurology and Neurosurgery Service, Clinicas Hospital of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil.,Department of Interventional Neuroradiology (R.B.S., A.M.B.), Beneficente Portuguesa Hospital, Belém, Brazil
| | - G Miotto
- From the Department of Interventional Neuroradiology (L.B.M., P.M.M.F., G.M., J.R.V.), Neurology and Neurosurgery Service, Clinicas Hospital of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil.,Department of Interventional Neuroradiology (R.B.S., A.M.B.), Beneficente Portuguesa Hospital, Belém, Brazil
| | - A M Bastos
- From the Department of Interventional Neuroradiology (L.B.M., P.M.M.F., G.M., J.R.V.), Neurology and Neurosurgery Service, Clinicas Hospital of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil.,Department of Interventional Neuroradiology (R.B.S., A.M.B.), Beneficente Portuguesa Hospital, Belém, Brazil
| | - J R Vanzin
- From the Department of Interventional Neuroradiology (L.B.M., P.M.M.F., G.M., J.R.V.), Neurology and Neurosurgery Service, Clinicas Hospital of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil.,Department of Interventional Neuroradiology (R.B.S., A.M.B.), Beneficente Portuguesa Hospital, Belém, Brazil
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22
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Piano M, Lozupone E, Sgoifo A, Nuzzi NP, Asteggiano F, Pero G, Quilici L, Iannucci G, Cerini P, Comelli C, Peschillo S, Princiotta C, Pedicelli A, Limbucci N, Ganci G, Trasimeni G, Ciceri E, Faragò G, Giorgianni A, DE Nicola M, Remida P, Lafe E, Mardighian D, Ruggiero M, Lazzarotti GA, Cavasin N, Castellan L, Chiumarulo L, Burdi N, Paolucci A, Briganti F, Natrella M, Florio FP, Pavia M, Gallesio I, Lucente G, Gozzoli L, Caputo N, Vagnarelli S, Boccardi E, Valvassori L. Long-term follow-up of the Derivo® Embolization Device (DED®) for intracranial aneurysms: the Italian Multicentric Registry. J Neurosurg Sci 2021; 65:361-368. [PMID: 33879762 DOI: 10.23736/s0390-5616.21.05300-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The flow-diverter devices (FDDs) safety and effectiveness have been demonstrated by large series and meta-analyses. Due to the high occlusion rates and the acceptable morbidity rates of FDDs, the indications for their use are continuously expanding. We presented our Italian multicentric experience using the second generation of DERIVO® Embolization Device (DED®; Acandis, Pforzheim, Germany) to cure cerebral aneurysms, evaluating both middle and long-term safety and efficacy of this device. METHODS Between July 2016 and September 2017 we collected 109 consecutive aneurysms in 108 patients treated using DED® during 109 endovascular procedures in 34 Italian centers (100/109 aneurysms were unruptured, 9/109 were ruptured). The collected data included patient demographics, aneurysm location and characteristics, baseline angiography, adverse event and serious adverse event information, morbidity and mortality rates, and pre- and post-treatment modified Rankin Scale scores. Midterm and long-term clinical, angiographic and cross-sectional CT/MR follow-up were recorded and collected until December 2018. RESULTS In 2/109 cases, DED® placement was classified as technical failures. The overall mortality and morbidity rates were respectively 6.5% and 5.5%. Overall DERIVO® related mortality and morbidity rates were respectively 0% and 4.6% (5 out of 108 patients). Midterm neuroimaging follow-up showed the complete or nearly complete occlusion of the aneurysm in 90% cases, which became 93% at long-term follow-up. Aneurysmal sac shrinking was observed in 65% of assessable aneurysms. CONCLUSIONS Our multicentric experience using DED® for endovascular treatment of unruptured and ruptured aneurysms showed a high safety and efficacy profile, substantially equivalent or better compared to the other FDDs.
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Affiliation(s)
| | | | | | | | | | - Guglielmo Pero
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luca Quilici
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Paolo Cerini
- Maggiore della Carità University Hospital, Novara, Italy
| | | | | | | | | | | | | | | | - Elisa Ciceri
- Azienda Ospedaliera Universitaria Integrata di Verona (AOUI-Vr), Verona, Italy
| | - Giuseppe Faragò
- IRCCS Neurologic Institute C. Besta Foundation, Milan, Italy
| | | | | | - Paolo Remida
- ASST San Gerardo Hospital, Monza, Monza-Brianza, Italy
| | - Elvis Lafe
- IRCCS Polyclinic San Matteo Foundation, Pavia, Italy
| | | | | | | | | | | | | | | | | | | | | | - Francesco P Florio
- Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Foggia, Italy
| | | | - Ivan Gallesio
- AON SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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23
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Adamou A, Alexandrou M, Roth C, Chatziioannou A, Papanagiotou P. Endovascular Treatment of Intracranial Aneurysms. Life (Basel) 2021; 11:life11040335. [PMID: 33920264 PMCID: PMC8070180 DOI: 10.3390/life11040335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 11/20/2022] Open
Abstract
Traditionally, surgical clipping was the only available treatment modality for intracranial aneurysms. However, in the last few decades, the endovascular therapy of intracranial aneurysms (IAs) has seen a tremendous evolution and development. From coiling to flow diversion and flow disruptor devices, endovascular treatment modalities have increased in number and received broader indications throughout the years. In this review article, the treatment modalities for the endovascular management of IAs are presented, emphasizing newer devices and technologies.
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Affiliation(s)
- Antonis Adamou
- Department of Radiology-Medical Imaging, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, 41110 Larissa, Greece;
| | - Maria Alexandrou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, 28205 Bremen, Germany; (M.A.); (C.R.)
| | - Christian Roth
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, 28205 Bremen, Germany; (M.A.); (C.R.)
| | - Achilles Chatziioannou
- First Department of Radiology, School of Medicine, National & Kapodistrian University of Athens, Areteion Hospital, 11528 Athens, Greece;
| | - Panagiotis Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, 28205 Bremen, Germany; (M.A.); (C.R.)
- First Department of Radiology, School of Medicine, National & Kapodistrian University of Athens, Areteion Hospital, 11528 Athens, Greece;
- Correspondence:
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24
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Li YL, Roalfe A, Chu EYL, Lee R, Tsang ACO. Outcome of Flow Diverters with Surface Modifications in Treatment of Cerebral Aneurysms: Systematic Review and Meta-analysis. AJNR Am J Neuroradiol 2020; 42:327-333. [PMID: 33384292 DOI: 10.3174/ajnr.a6919] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/08/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Newer flow diverters are enhanced with antithrombogenic surface modifications like the Pipeline Embolization Device with Shield Technology and the Derivo Embolization Device and are purported to facilitate deployment and reduce ischemic events. PURPOSE Our aim was to review the safety and efficacy of surface-modified flow diverters in treating patients with cerebral aneurysms. DATA SOURCES We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and meta-analysis covering 3 major data bases and gray literature between 2014 and 2019. STUDY SELECTION Two reviewers independently reviewed human studies of surface-modified flow diverters for eligibility based on predetermined criteria. DATA ANALYSIS The random effects model and Freeman-Tukey arcsine transformation were used to pool efficacy outcomes (technical success, aneurysm occlusion at 6 and 12 months) and safety outcomes (mortality, morbidity, all ischemia, and serious ischemia). Subgroup analysis was performed to compare outcomes between 2 different flow diverters. DATA SYNTHESIS Eight single-arm case series involving 911 patients and 1060 aneurysms were included. The median follow-up was 8.24 months. Pooled estimate for technical success was 99.6%, while the aneurysm occlusion at 6 and 12 months were 80.5%, and 85.6%, respectively. Pooled estimates for mortality, morbidity, total ischemia, and serious ischemia rates were 0.7%, 6.0%, 6.7%, and 1.8%, respectively. Most studies were of good quality, and no significant heterogeneity was observed. LIMITATIONS Limitations include a retrospective, observational design in some studies; heterogeneous and underreported antiplatelet therapy; and potential performance and ecologic bias. CONCLUSIONS Early-to-midterm safety and efficacy for surface-modified flow diverters appear comparable with older devices, especially for small, unruptured anterior circulation aneurysms. Long-term clinical data are required to further corroborate these results.
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Affiliation(s)
- Y-L Li
- From the Division of Neuroradiology, Department of Radiology (Y.-L.L., E.Y.-L.C., R.L.), Queen Mary Hospital, Hong Kong, China
| | - A Roalfe
- Nuffield Department of Primary Care Health Sciences (A.R.), University of Oxford, Oxford, UK
| | - E Y-L Chu
- From the Division of Neuroradiology, Department of Radiology (Y.-L.L., E.Y.-L.C., R.L.), Queen Mary Hospital, Hong Kong, China
| | - R Lee
- From the Division of Neuroradiology, Department of Radiology (Y.-L.L., E.Y.-L.C., R.L.), Queen Mary Hospital, Hong Kong, China
| | - A C O Tsang
- Division of Neurosurgery, Department of Surgery (A.C.O.T.), University of Hong Kong, Hong Kong, China
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25
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Hou K, Li G, Lv X, Xu B, Xu K, Yu J. Delayed rupture of intracranial aneurysms after placement of intra-luminal flow diverter. Neuroradiol J 2020; 33:451-464. [PMID: 32851918 PMCID: PMC7788679 DOI: 10.1177/1971400920953299] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Though flow diverter is a safe and efficient modality, some patients can experience delayed aneurysmal rupture. The mechanism of delayed rupture is still obscure to us. METHODS We performed a systematic search in the PubMed database for patients with delayed rupture of intracranial aneurysms after flow diverter placement. RESULTS A total of 36 articles reporting on 60 patients were included in the final analysis. Of the 49 patients with description of presenting symptoms, six (12.2%) patients were incidentally diagnosed, 39 (87.8%) patients were admitted for aneurysmal rupture or mass effect. Multiple flow diverters were used in 38.3% (18/47) of the patients. Coil assistance was applied in 13.0% (7/54) of the patients. Delayed aneurysmal rupture led to intracranial hemorrhage or carotid-cavernous sinus fistula (CCF) in 76.8% (43/56) and 23.2% (13/56) of the patients, respectively. Of the 55 patients with description of outcome, 14 (25.5%) patients achieved good recovery, one (1.8%) patient was severely disabled, 40 (72.7%) patients died. All of the patients in the CCF group survived and experienced good recovery. CONCLUSION Increased intra-aneurysmal pressure, destabilization of the aneurysm wall by intra-aneurysmal thrombus, persistent residual intra-aneurysmal flow, characteristics of the specific aneurysm, and mechanical injury by the flow diverter might conjointly contribute to the final delayed rupture. There has been no established preventive measure to decrease the incidence of delayed rupture yet. The treatment and outcome depend on the presentation of delayed rupture. Patients presenting with aneurysm-related intracranial hemorrhage have a dismal outcome. Those presenting with CCFs usually have a satisfactory recovery.
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Affiliation(s)
- Kun Hou
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Guichen Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xianli Lv
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Baofeng Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
- Jinlu Yu, Department of Neurosurgery, The First Hospital of Jilin University, 1 Xinmin Avenue, Changchun 130021, China.
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Comparative Analysis of the Pipeline and the Derivo Flow Diverters for the Treatment of Unruptured Intracranial Aneurysms-A Multicentric Study. World Neurosurg 2020; 145:e326-e331. [PMID: 33080402 DOI: 10.1016/j.wneu.2020.10.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/10/2020] [Accepted: 10/12/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Flow diversion represents a safe and efficient technique for the endovascular treatment of complex intracranial aneurysms. This study compares 2 competing flow diverters, the Pipeline embolization device (PED) and the Derivo Embolization Device (DED) regarding technical aspects, clinical outcome, and angiographic results. METHODS A total of 111 patients with unruptured aneurysms were treated with the PED (n = 62) or the DED (n = 49) between 2011 and 2019. Procedural specifics, complication rates, functional outcome, and aneurysm occlusion were evaluated retrospectively. RESULTS Flow-diverter implantation was technically successful in all patients. There were no significant differences regarding baseline characteristics, adjunctive coiling, and fluoroscopy time. Multiple devices were more often used in the PED group (35.6%) than in the DED group (4.1%, P < 0.001). Procedural adverse events occurred in 4 cases of each group (PED: 5.5%, DED: 8.2%, P = 0.713), including 3 thromboembolic events and 1 hemorrhagic event per group. Morbidity rates were similar between the 2 groups (PED: 2.7%, DED: 4.1%, P = 1.0). There was no procedural mortality. At 6-month follow-up, complete or near-complete occlusion (O'Kelly-Marotta scale C+D) was achieved in 79.0% (49/62) after PED implantation and 80.0% (32/40) after DED implantation (P = 0.354). CONCLUSIONS In regard to complication rates, functional outcome, and aneurysm occlusion, no significant differences were found between the PED and DED collective.
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27
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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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28
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Taschner CA, Stracke CP, Dorn F, Kadziolka KB, Kreiser K, Solymosi L, Pham M, Buhk JH, Turowski B, Reith W, Elsheikh S, Meckel S, Janssen H, Hammer A, Beuing O, Jansen O, Urbach H, Knauth M, Jenkner C, Chapot R. Derivo embolization device in the treatment of unruptured intracranial aneurysms: a prospective multicenter study. J Neurointerv Surg 2020; 13:541-546. [PMID: 32900908 PMCID: PMC8142444 DOI: 10.1136/neurintsurg-2020-016303] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 11/24/2022]
Abstract
Background Flow diverters (FD) are used regularly for the endovascular treatment of unruptured intracranial aneurysms. We aimed to assess the safety and effectiveness of the Derivo embolization device (DED) with respect to long-term clinical and angiographic outcomes. Methods A prospective multicenter trial was conducted at 12 centers. Patients presenting with modified Rankin Score (mRS) of 0–1, treated for unruptured intracranial aneurysms with DED were eligible. Primary endpoint was the mRS assessed at 18 months with major morbidity defined as mRS 3–5. Satisfactory angiographic occlusion was defined as 3+4 on the Kamran scale. Results Between July 2014 and February 2018, 119 patients were enrolled. Twenty-three patients were excluded. Ninety-six patients, 71 (74%) female, mean age 54±12.0 years, were included in the analysis. Mean aneurysm size was 14.2±16.9 mm. The mean number of devices implanted per patient was 1.2 (range 1–3). Clinical follow-up at 18 months was available in 90 (94%) patients, resulting in a mean follow-up period of 14.8±5.2 months. At last available follow-up of 96 enrolled patients, 91 (95%) remained mRS 0–1. The major morbidity rate (mRS 3–5) was 3.1% (3/96), major stroke rate was 4.2% (4/96), and mortality was 0%. Follow-up angiographies were available in 89 (93%) patients at a median of 12.4±5.84 months with a core laboratory adjudicated satisfactory aneurysm occlusion in 89% (79/89). Conclusion Our results suggest that DED is a safe and effective treatment for unruptured aneurysms with high rates of satisfactory occlusion and comparably low rates of permanent neurological morbidity and mortality. Trial registration DRKS00006103
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Affiliation(s)
- Christian A Taschner
- Department of Neuroradiology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christian Paul Stracke
- Department of Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus Essen, Essen, Germany
| | - Franziska Dorn
- Department of Neuroradiology, LMU University Hospital of Munich, Munich, Germany
| | - Krzysztof Bartosz Kadziolka
- Endovascular Neurosurgery, Neurosurgery Department, The Children's Memorial Health Institute, Western Hospital, Grodzisk Mazowiecki, Poland
| | - Kornelia Kreiser
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - László Solymosi
- Department of Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Mirko Pham
- Department of Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Jan Hendrik Buhk
- Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
| | - Bernd Turowski
- Department of Neuroradiology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Reith
- Department of Diagnostic and Interventional Neuroradiology, Saarland University, Homburg-Saar, Germany
| | - Samer Elsheikh
- Department of Neuroradiology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
| | - Stephan Meckel
- Department of Neuroradiology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
| | - Hendrik Janssen
- Department of Neuroradiology, Paracelsus Medical University, Nuremberg, Germany.,Department of Neuroradiology, Klinikum Ingolstadt, Ingolstadt, Germany
| | - Alexander Hammer
- Department of Neuroradiology, Paracelsus Medical University, Nuremberg, Germany
| | - Oliver Beuing
- Department of Neuroradiology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, Campus Kiel, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Horst Urbach
- Department of Neuroradiology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany
| | - Michael Knauth
- Institute for Diagnostic and Interventional Neuroradiology, University Medicine Göttingen, Göttingen, Germany
| | - Carolin Jenkner
- Faculty of Medicine, Universityof Freiburg, Freiburg, Germany
| | - René Chapot
- Department of Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus Essen, Essen, Germany
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29
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Campos JK, Cheaney Ii B, Lien BV, Zarrin DA, Vo CD, Colby GP, Lin LM, Coon AL. Advances in endovascular aneurysm management: flow modulation techniques with braided mesh devices. Stroke Vasc Neurol 2020; 5:1-13. [PMID: 32411402 PMCID: PMC7213520 DOI: 10.1136/svn-2020-000347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/28/2020] [Indexed: 02/07/2023] Open
Abstract
Flow diverters and flow disruption technology, alongside nuanced endovascular techniques, have ushered in a new era of treating cerebral aneurysms. Here, we provide an overview of the latest flow modulation devices and highlight their clinical applications and outcomes.
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Affiliation(s)
- Jessica K Campos
- Department of Neurosurgery, University of California Irvine School of Medicine, Orange, California, USA
| | - Barry Cheaney Ii
- Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - Brian V Lien
- Department of Neurosurgery, University of California Irvine School of Medicine, Orange, California, USA
| | - David A Zarrin
- Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chau D Vo
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Geoffrey P Colby
- UCLA Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Li-Mei Lin
- Carondelet Neurological Institute, St. Joseph's Hospital, Carondelet Health Network, Tucson, Arizona, United States
| | - Alexander L Coon
- Carondelet Neurological Institute, St. Joseph's Hospital, Carondelet Health Network, Tucson, Arizona, United States
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