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Santos GB, Oliveira I, Gasche JL, Militzer J, Baccin CE. Stent-Induced Vascular Remodeling in Two-Step Stent-Assisted Coiling Treatment of Brain Aneurysms: A Closer Look Into the Hemodynamic Changes During the Stent Healing Period. J Biomech Eng 2021; 143:031009. [PMID: 33006371 DOI: 10.1115/1.4048645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Indexed: 11/08/2022]
Abstract
Stenting has become an important adjunctive tool for assisting coil embolization in complex-shaped intracranial aneurysms. However, as a secondary effect, stent deployment has been related to both immediate and delayed remodeling of the local vasculature. Recent studies have demonstrated that this phenomenon may assume different roles depending on the treatment stage. However, the extent of such event on the intra-aneurysmal hemodynamics is still unclear; especially when performing two-step stent-assisted coiling (SAC). Therefore, we performed computational fluid dynamics (CFD) analysis of the blood flow in four bifurcation aneurysms focusing on the stent healing period found in SAC as a two-step maneuver. Our results show that by changing the local vasculature, the intra-aneurysmal hemodynamics changes considerably. However, even though changes do occur, they were not consistent among the cases. Furthermore, by changing the local vasculature not only the shear levels change but also the shear distribution on the aneurysm surface. Additionally, a geometric analysis alone can mislead the estimation of the novel hemodynamic environment after vascular remodeling, especially in the presence of mixing streams. Therefore, although the novel local vasculature might induce an improved hemodynamic environment, it is also plausible to expect that adverse hemodynamic conditions might occur. This could pose a particularly delicate condition since the aneurysm surface remains completely exposed to the novel hemodynamic environment during the stent healing period. Finally, our study emphasizes that vascular remodeling should be considered when assessing the hemodynamics in aneurysms treated with stents, especially when evaluating the earlier stages of the treatment process.
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Affiliation(s)
- Gabriel B Santos
- Department of Mechanical Engineering, School of Engineering, São Paulo State University (UNESP), Ilha Solteira, São Paulo 15385-000, Brazil
| | - Iago Oliveira
- Department of Mechanical Engineering, School of Engineering, São Paulo State University (UNESP), Ilha Solteira, São Paulo 15385-000, Brazil
| | - José L Gasche
- Department of Mechanical Engineering, School of Engineering, São Paulo State University (UNESP), Ilha Solteira, São Paulo 15385-000, Brazil
| | - Julio Militzer
- Department of Mechanical Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Carlos E Baccin
- Interventional Neuroradiology, Hospital Israelita Albert Einstein, São Paulo, São Paulo 05652-900, Brazil
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Cagnazzo F, Cappucci M, Lefevre PH, Dargazanli C, Gascou G, Morganti R, Mazzotti V, di Carlo D, Perrini P, Mantilla D, Riquelme C, Bonafe A, Costalat V. Treatment of Intracranial Aneurysms with Self-Expandable Braided Stents: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2018; 39:2064-2069. [PMID: 30262643 DOI: 10.3174/ajnr.a5804] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/30/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND The safety and efficacy of treatment with self-expandable braided stents (LEO and LVIS) required further investigation. PURPOSE Our aim was to analyze the outcomes after treatment with braided stents. DATA SOURCES A systematic search of 3 databases was performed for studies published from 2006 to 2017. STUDY SELECTION According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting patients treated with LEO or LVIS stents. DATA ANALYSIS Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, and neurologic outcomes. DATA SYNTHESIS Thirty-five studies evaluating 1426 patients treated with braided stents were included in this meta-analysis. Successful stent delivery and complete aneurysm occlusion were 97% (1041/1095; 95% CI, 95%-98%) (I2 = 44%) and 88.3% (1097/1256; 95% CI, 85%-91%) (I2 = 72%), respectively. Overall, treatment-related complications were 7.4% (107/1317; 95% CI, 5%-9%) (I2 = 44%). Ischemic/thromboembolic events (48/1324 = 2.4%; 95% CI, 1.5%-3.4%) (I2 = 27%) and in-stent thrombosis (35/1324 = 1.5%; 95% CI, 0.6%-1.7%) (I2 = 0%) were the most common complications. Treatment-related morbidity was 1.5% (30/1324; 95% CI, 0.9%-2%) and was comparable between the LEO and LVIS groups. Complication rates between the anterior (29/322 = 8.8%; 95% CI, 3.4%-12%) (I2 = 41%) versus posterior circulation (10/84 = 10.5%; 95% CI, 4%-16%) (I2 = 0%) and distal (30/303 = 8%; 95% CI, 4.5%-12%) (I2 = 48%) versus proximal aneurysms (14/153 = 9%; 95% CI, 3%-13%) (I2 = 46%) were comparable (P > .05). LIMITATIONS Limitations were selection and publication biases. CONCLUSIONS In this analysis, treatment with the LEO and LVIS stents was relatively safe and effective. The most common complications were periprocedural thromboembolisms and in-stent thrombosis. The rate of complications was comparable among anterior and posterior circulation aneurysms, as well as for proximal and distally located lesions.
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Affiliation(s)
- F Cagnazzo
- From the Neuroradiology Department (F.G., M.C., P.-H.L., C.D., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - M Cappucci
- From the Neuroradiology Department (F.G., M.C., P.-H.L., C.D., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - P-H Lefevre
- From the Neuroradiology Department (F.G., M.C., P.-H.L., C.D., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - C Dargazanli
- From the Neuroradiology Department (F.G., M.C., P.-H.L., C.D., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - G Gascou
- From the Neuroradiology Department (F.G., M.C., P.-H.L., C.D., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - R Morganti
- Section of Statistics (R.M., V.M.), University Hospital of Pisa, Pisa, Italy
| | - V Mazzotti
- Section of Statistics (R.M., V.M.), University Hospital of Pisa, Pisa, Italy
| | - D di Carlo
- Department of Neurosurgery (D.d.C., P.P.), University of Pisa, Pisa, Italy
| | - P Perrini
- Department of Neurosurgery (D.d.C., P.P.), University of Pisa, Pisa, Italy
| | - D Mantilla
- Neuroradiology Department (D.M.), Clinic FOSCAL, Universidad Autonoma de Bucaramanga, Andrés Bello National University, Santiago, Chili
| | - C Riquelme
- From the Neuroradiology Department (F.G., M.C., P.-H.L., C.D., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - A Bonafe
- From the Neuroradiology Department (F.G., M.C., P.-H.L., C.D., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - V Costalat
- From the Neuroradiology Department (F.G., M.C., P.-H.L., C.D., G.G., C.R., A.B., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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Sedat J, Chau Y, Gaudart J, Sachet M, Beuil S, Lonjon M. Stent-assisted coiling of intracranial aneurysms using LEO stents: long-term follow-up in 153 patients. Neuroradiology 2017; 60:211-219. [PMID: 29273960 DOI: 10.1007/s00234-017-1965-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 12/15/2017] [Indexed: 01/31/2023]
Abstract
PURPOSE Coiling associated with placement of a self-expandable intracranial stent has improved the treatment of intracranial wide-necked aneurysms. Little is known, however, about the durability of this treatment. The purpose of this report is to present our experience with the LEO stent and to evaluate the complications, effectiveness, and long-term results of this technique. METHODS We analyzed the records of 155 intracranial unruptured aneurysms that were treated by stent-assisted coiling with a LEO stent between 2008 and 2012. Procedural, early post-procedural, and delayed complications were recorded. Clinical and angiographic follow-up of patients was conducted over a period of at least 36 months. RESULTS No procedural mortality was observed. One-month morbidity was observed in 14 out of 153 patients (9,15%). One hundred thirty-eight patients (with 140 aneurysms) had clinical and angiographic follow-up for more than 36 months. No aneurysm rupture was observed during follow-up. Four patients presented an intra-stent stenosis at 8 months, and 6 patients who had an early recurrence were retreated. Final results showed 85% complete occlusion, 13% neck remnants, and 2% stable incomplete occlusion. CONCLUSION Stent-assisted coiling with the LEO stent is a safe and effective treatment for unruptured intracranial aneurysms. The long-term clinical outcomes with the LEO stent are excellent with a high rate of complete occlusion that is stable over time.
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Affiliation(s)
- Jacques Sedat
- Unité de NeuroInterventionnelle, Hôpital Pasteur 2, 06000, Nice, France.
| | - Yves Chau
- Unité de NeuroInterventionnelle, Hôpital Pasteur 2, 06000, Nice, France
| | - Jean Gaudart
- Aix Marseille University, IRD, INSERM, SESSTIM, Marseille, France
| | - Marina Sachet
- Unité de NeuroInterventionnelle, Hôpital Pasteur 2, 06000, Nice, France
| | | | - Michel Lonjon
- Unité de Neurochirurgie, Hôpital Pasteur 2, Nice, France
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