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Shi S, Long S, Hui F, Tian Q, Wei Z, Ma J, Yang J, Wang Y, Han X, Li T. Safety and Efficacy of LVIS Jr Stent-assisted Coiling of Intracranial Aneurysms in Small-diameter Parent Arteries : A Single-center Experience. Clin Neuroradiol 2024; 34:587-595. [PMID: 38451269 DOI: 10.1007/s00062-024-01397-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/02/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE To investigate the safety and efficacy of LVIS Jr stent-assisted coiling (SAC) of intracranial aneurysms (IAs) in small-diameter parent arteries and determine the factors influencing incomplete aneurysm occlusion. MATERIAL AND METHODS Clinical and imaging data of 130 patients with IAs in small-diameter parent arteries that were treated with LVIS Jr SAC were retrospectively analyzed. Stent apposition was evaluated by high-resolution flat detector CT, and aneurysm embolization density was evaluated using 2D-DSA. Perioperative complications were recorded. Multivariate logistic regression analyses were performed to determine possible factors for incomplete aneurysm occlusion. RESULTS In this study, 130 patients (60 and 70 patients with ruptured and unruptured aneurysms, respectively) were successfully treated with LVIS Jr SAC. Immediate digital subtraction angiography (DSA) showed that the aneurysm occlusion was Raymond-Roy class I, II, IIIa, and IIIb in 93 (71.5%), 24 (18.5%), 8 (6.2%), and 5 (3.8%) cases, respectively. There were three cases of acute in-stent thrombosis and two cases of severe vasospasm observed during the perioperative period. The 6‑month follow-up angiograms indicated that complete aneurysm occlusion in 122 patients was 79.5% (97/122). Multivariate logistic regression analyses showed that an aneurysm size > 10.0 mm, parent artery mean diameter < 2.0 mm, and incomplete stent apposition at the aneurysm neck were possible risk factors for incomplete aneurysm occlusion. CONCLUSION The LVIS Jr SAC is effective for managing IAs in small-diameter parent arteries. An aneurysm size > 10.0 mm, parent artery mean diameter < 2.0 mm, and incomplete stent apposition at the aneurysm neck are possible risk factors for incomplete aneurysm occlusion.
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Affiliation(s)
- Shuailong Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jianshe Road No. 1, Er qi district, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Shuhai Long
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jianshe Road No. 1, Er qi district, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | | | - Qi Tian
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jianshe Road No. 1, Er qi district, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Zhuangzhuang Wei
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jianshe Road No. 1, Er qi district, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Ji Ma
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jianshe Road No. 1, Er qi district, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Jie Yang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jianshe Road No. 1, Er qi district, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Ye Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jianshe Road No. 1, Er qi district, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jianshe Road No. 1, Er qi district, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Tengfei Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jianshe Road No. 1, Er qi district, Zhengzhou, Henan, China.
- Interventional Institute of Zhengzhou University, Zhengzhou, China.
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Dazeo N, Orlando JI, García C, Muñoz R, Obrado L, Fernandez H, Blasco J, Román LS, Macho JM, Ding A, Utz R, Larrabide I. Computer Aided Intracranial Aneurysm Treatment Based on 2D/3D Mapping, Virtual Deployment and Online Distal Marker Detection. Cardiovasc Eng Technol 2024:10.1007/s13239-024-00745-y. [PMID: 39160330 DOI: 10.1007/s13239-024-00745-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/19/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE To introduce a computational tool for peri-interventional intracranial aneurysm treatment guidance that maps preoperative planning information from simulation onto real-time X-Ray imaging. METHODS Preoperatively, multiple flow diverter (FD) devices are simulated based on the 3D mesh of the vessel to treat, to choose the optimal size and location. In the peri-operative stage, this 3D information is aligned and mapped to the continuous 2D-X-Ray scan feed from the operating room. The current flow diverter position in the 3D model is estimated by automatically detecting the distal FD marker locations and mapping them to the treated vessel. This allows to visually assess the possible outcome of releasing the device at the current position, and compare it with the one chosen pre-operatively. RESULTS The full pipeline was validated using retrospectively collected biplane images from four different patients (5 3D-DSA datasets in total). The distal FD marker detector obtained an average F1-score of 0.67 ( ± 0.224 ) in 412 2D-X-Ray scans. After aligning 3D-DSA + 2D-X-Ray datasets, the average difference between simulated and deployed positions was 0.832 mm ( ± 0.521 mm). Finally, we qualitatively show that the proposed approach is able to display the current location of the FD compared to their pre-operatively planned position. CONCLUSIONS The proposed method allows to support the FD deployment procedure by merging and presenting preoperative simulation information to the interventionists, aiding them to make more accurate and less risky decisions.
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Affiliation(s)
- Nicolas Dazeo
- Yatiris Research Group, PLADEMA Institute, CONICET-UNICEN, Campus Universitario, Tandil, Argentina.
| | - José Ignacio Orlando
- Yatiris Research Group, PLADEMA Institute, CONICET-UNICEN, Campus Universitario, Tandil, Argentina
| | - Camila García
- Yatiris Research Group, PLADEMA Institute, CONICET-UNICEN, Campus Universitario, Tandil, Argentina
| | - Romina Muñoz
- Yatiris Research Group, PLADEMA Institute, CONICET-UNICEN, Campus Universitario, Tandil, Argentina
| | | | | | - Jordi Blasco
- Department of Neuroradiology, Hospital Clinic, Barcelona, Spain
| | - Luis San Román
- Department of Neuroradiology, Hospital Clinic, Barcelona, Spain
| | - Juan M Macho
- Department of Neuroradiology, Hospital Clinic, Barcelona, Spain
| | | | | | - Ignacio Larrabide
- Yatiris Research Group, PLADEMA Institute, CONICET-UNICEN, Campus Universitario, Tandil, Argentina
- Mentice S. L., Barcelona, Spain
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Sharashidze V, Raz E, Nossek E, Kvint S, Riina H, Rutledge C, Baranoski J, Khawaja A, Chung C, Nelson PK, Shapiro M. Comprehensive Analysis of Post-Pipeline Endothelialization and Remodeling. AJNR Am J Neuroradiol 2024; 45:893-898. [PMID: 38663989 DOI: 10.3174/ajnr.a8228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/06/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND AND PURPOSE Successful post-flow-diverter endoluminal reconstruction is widely believed to require endothelial overgrowth of the aneurysmal inflow zone. However, endothelialization/neointimal overgrowth is a complex process, over which we currently have very limited influence. Less emphasized is vascular remodeling of the target arterial segment, the dynamic response of the vessel to flow-diverter implantation. This process is distinct from flow modifications in covered branches. It appears that basic angiographic methods allow simple and useful observations. The purpose of this article was to quantitatively evaluate observable postimplantation changes in target vessels following deployment of Pipeline endoluminal constructs. MATERIALS AND METHODS One hundred consecutive adults with unruptured, previously untreated, nondissecting aneurysms treated with the Pipeline Embolization Device with Shield Technology and the availability of follow-up conventional angiography were studied with 2D DSA imaging. Target vessel size; Pipeline Embolization Device diameter; endothelial thickness; and various demographic, antiplatelet, and device-related parameters were recorded and analyzed. RESULTS The thickness of neointimal overgrowth (mean, 0.3 [SD, 0.1] mm; range, 0.1-0.7 mm) is inversely correlated with age and is independent of vessel size, smoking status, sex, and degree of platelet inhibition. The decrease in lumen diameter caused by neointimal overgrowth, however, appears counteracted by outward remodeling (dilation) of the target arterial segment. This leads to an increase in the diameter with a corresponding decrease in length (foreshortening) of the implanted Pipeline Embolization Device. This physiologic remodeling process affects optimally implanted devices and is not a consequence of stretching, device migration, vasospasm, and so forth. A direct, linear, statistically significant relationship exists between the degree of observed outward remodeling and the diameter of the implanted Pipeline Embolization Device relative to the target vessel. Overall, remodeled arterial diameters were reduced by 15% (SD, 10%) relative to baseline and followed a normal distribution. Clinically relevant stenosis was not observed. CONCLUSIONS Vessel healing involves both outward remodeling and neointimal overgrowth. Judicial oversizing could be useful in specific settings to counter the reduction in lumen diameter due to postimplant neointimal overgrowth; however, this overszing needs to be balanced against the decrease in metal coverage accompanying the use of oversized devices. Similar analysis for other devices is essential.
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Affiliation(s)
- Vera Sharashidze
- From the Department of Radiology (V.S., E.R.., S.K., H.R., A.K., C.C., P.K.N., M.S.), NYU Grossman School of Medicine and Bellevue H+Hospitals, New York, New York
- Department of Neurosurgery (V.S., E.R, E.N., H.R., C.R., J.B., P.K.N., M.S.), NYU Grossman School of Medicine and Bellevue H+Hospitals, New York, New York
| | - Eytan Raz
- From the Department of Radiology (V.S., E.R.., S.K., H.R., A.K., C.C., P.K.N., M.S.), NYU Grossman School of Medicine and Bellevue H+Hospitals, New York, New York
- Department of Neurosurgery (V.S., E.R, E.N., H.R., C.R., J.B., P.K.N., M.S.), NYU Grossman School of Medicine and Bellevue H+Hospitals, New York, New York
| | - Erez Nossek
- Department of Neurosurgery (V.S., E.R, E.N., H.R., C.R., J.B., P.K.N., M.S.), NYU Grossman School of Medicine and Bellevue H+Hospitals, New York, New York
| | - Svetlana Kvint
- From the Department of Radiology (V.S., E.R.., S.K., H.R., A.K., C.C., P.K.N., M.S.), NYU Grossman School of Medicine and Bellevue H+Hospitals, New York, New York
| | - Howard Riina
- From the Department of Radiology (V.S., E.R.., S.K., H.R., A.K., C.C., P.K.N., M.S.), NYU Grossman School of Medicine and Bellevue H+Hospitals, New York, New York
- Department of Neurosurgery (V.S., E.R, E.N., H.R., C.R., J.B., P.K.N., M.S.), NYU Grossman School of Medicine and Bellevue H+Hospitals, New York, New York
- Department of Neurology (H.R., M.S.), NYU Grossman School of Medicine and Bellevue H+Hospitals, New York, New York
| | - Caleb Rutledge
- Department of Neurosurgery (V.S., E.R, E.N., H.R., C.R., J.B., P.K.N., M.S.), NYU Grossman School of Medicine and Bellevue H+Hospitals, New York, New York
| | - Jacob Baranoski
- Department of Neurosurgery (V.S., E.R, E.N., H.R., C.R., J.B., P.K.N., M.S.), NYU Grossman School of Medicine and Bellevue H+Hospitals, New York, New York
| | - Ayaz Khawaja
- From the Department of Radiology (V.S., E.R.., S.K., H.R., A.K., C.C., P.K.N., M.S.), NYU Grossman School of Medicine and Bellevue H+Hospitals, New York, New York
| | - Charlotte Chung
- From the Department of Radiology (V.S., E.R.., S.K., H.R., A.K., C.C., P.K.N., M.S.), NYU Grossman School of Medicine and Bellevue H+Hospitals, New York, New York
| | - Peter Kim Nelson
- From the Department of Radiology (V.S., E.R.., S.K., H.R., A.K., C.C., P.K.N., M.S.), NYU Grossman School of Medicine and Bellevue H+Hospitals, New York, New York
- Department of Neurosurgery (V.S., E.R, E.N., H.R., C.R., J.B., P.K.N., M.S.), NYU Grossman School of Medicine and Bellevue H+Hospitals, New York, New York
| | - Maksim Shapiro
- From the Department of Radiology (V.S., E.R.., S.K., H.R., A.K., C.C., P.K.N., M.S.), NYU Grossman School of Medicine and Bellevue H+Hospitals, New York, New York
- Department of Neurosurgery (V.S., E.R, E.N., H.R., C.R., J.B., P.K.N., M.S.), NYU Grossman School of Medicine and Bellevue H+Hospitals, New York, New York
- Department of Neurology (H.R., M.S.), NYU Grossman School of Medicine and Bellevue H+Hospitals, New York, New York
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Huang C, Feng X, Tong X, Wen Z, Zhu Y, Xu A, Huang M, Ma G, Hu Y, Shi H, Guo Z, Liu A, Duan C. Stent-to-vessel diameter ratio is associated with in-stent stenosis after flow-diversion treatment of intracranial aneurysms. J Stroke Cerebrovasc Dis 2024; 33:107833. [PMID: 38925449 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107833] [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: 03/04/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND AND PURPOSE Flow-diversion treatment for intracranial aneurysms has been associated with the development of in-stent stenosis (ISS) for unclear reasons. We assess whether the size of the stent relative to that of the vessel (the stent-to-vessel diameter ratio, or SVR) may be predictive of the development of ISS after treatment with flow diverters. METHODS We retrospectively reviewed patients with unruptured intracranial aneurysms who underwent flow-diversion treatment using either the Pipeline or Tubridge embolization device from September 2018 to September 2022. The relationship between SVR and ISS was analyzed. Multiple logistic regression models were used to determine the significant predictors. RESULTS A total of 458 patients with 481 aneurysms were included. In a mean angiographic follow-up of 10.73 ± 3.97 months, ISS was detected in 68 cases (14.1 %). After adjusting for candidate variables, a higher distal SVR (DSVR) was associated with an increased risk of ISS (adjusted odds ratio [aOR] = 3.420, 95 % confidence interval [CI] = 1.182 - 9.889, p = 0.023). We conducted a subgroup analysis of the two different flow diverters to assess the effects of their individual characteristics. Our results showed a significant association between the DSVR and the incidence of ISS in both the Pipeline (aOR = 4.033, 95 % CI = 1.156-14.072, p = 0.029) and Tubridge groups (aOR = 11.981, 95 % CI=1.005-142.774, p = 0.049). CONCLUSION A higher DSVR was associated with an increased risk of ISS. This may help neurointerventionalists select an appropriate stent size when conducting flow-diversion treatment for intracranial aneurysms.
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Affiliation(s)
- Chi Huang
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, CN
| | - Xin Feng
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, CN
| | - Xin Tong
- Beijing Neurosurgical Institute, Neurointervention Center Beijing, Beijing, CN
| | - Zhuohua Wen
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, CN
| | - Yajun Zhu
- The First Affiliated Hospital of Chongqing Medical University, Department of Neurosurgery, Chongqing, CN
| | - Anqi Xu
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, CN
| | - Mengshi Huang
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, CN
| | - Gengwu Ma
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, CN
| | - Yuqi Hu
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, CN
| | - Hongyu Shi
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, CN
| | - Zongduo Guo
- The First Affiliated Hospital of Chongqing Medical University, Department of Neurosurgery, Chongqing, CN
| | - Aihua Liu
- Beijing Neurosurgical Institute, Neurointervention Center Beijing, Beijing, CN.
| | - Chuanzhi Duan
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou, CN
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Dong L, Wang C, Wei D, Peng Q, Wu X, Chen X, Li M, Li T, Liu H, Zhao Y, Duan R, Jin W, Zhang Y, Wang Y, Lv M. Spontaneous delayed migration or shortening after pipeline embolization device treatment of intracranial aneurysm: incidence, management, and risk factors. J Neurointerv Surg 2024:jnis-2024-021535. [PMID: 38580442 DOI: 10.1136/jnis-2024-021535] [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: 01/24/2024] [Accepted: 03/23/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Studies reporting spontaneous delayed migration or shortening (SDMS) after treatment with the Pipeline Embolization Device (PED) are limited. This study aimed to evaluate the incidence of SDMS after PED treatment, propose management strategies, and identify the risk factors contributing to its occurrence. METHODS We retrospectively reviewed consecutive patients with an intracranial aneurysm (IA) treated with PEDs at three institutions. SDMS was classified as type I or II based on whether the PED covered the aneurysm neck. RESULTS The total cohort comprised 790 patients. SDMS was identified in 24 (3.04%) patients. Eighteen of the 24 patients had type I SDMS and did not require retreatment, while the remaining six patients had type II SDMS and all received retreatment. Multivariate logistic regression showed that the difference between the proximal and distal parent artery diameters (DPAD) (adjusted OR 2.977; 95% CI 1.054 to 8.405; P=0.039) and device tortuosity index (DTI) (adjusted OR 8.059; 95% CI 2.867 to 23.428; P<0.001) were independent predictors of SDMS after PED treatment, while the difference in length (DL) (adjusted OR 0.841; 95% CI 0.738 to 0.958; P=0.009) and PED plus coiling (adjusted OR 0.288; 95% CI 0.106 to 0.785; P=0.015) were protective factors. CONCLUSION The incidence of SDMS after PED treatment of IA was 3.04%. For patients with type I SDMS with incomplete aneurysm occlusion we recommend continuous imaging follow-up while, for patients with type II SDMS, we recommend aggressive retreatment. The DPAD and DTI were independent risk predictors of SDMS after PED treatment, while the DL and PED plus coiling were protective factors.
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Affiliation(s)
- Linggen Dong
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dachao Wei
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qichen Peng
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinzhi Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiheng Chen
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Mingtao Li
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Tong Li
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - He Liu
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yang Zhao
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Ran Duan
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Weitao Jin
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Yukun Zhang
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Yang Wang
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Oliver AA, Senol YC, Bilgin C, Schaffer JE, Kadirvel R, Kallmes DF, Wainwright JM. Intraluminal Flow Diverter Design Primer for Neurointerventionalists. AJNR Am J Neuroradiol 2024; 45:365-370. [PMID: 38164542 PMCID: PMC11288553 DOI: 10.3174/ajnr.a8076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/29/2023] [Indexed: 01/03/2024]
Abstract
The clinical use of flow diverters for the treatment of intracranial aneurysms has rapidly grown. Consequently, the market and technology for these devices has also grown. Clinical performance characteristics of the flow diverter are well-known to the clinician. However, the engineering design principles behind how these devices achieve ideal clinical performance are less understood. This primer will summarize flow diverter design parameters for neurointerventionalists with the aim of promoting collaboration between clinicians and engineers.
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Affiliation(s)
- Alexander A Oliver
- From the Department of Biomedical Engineering and Physiology (A.A.O., D.F.K.), Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota
- Department of Radiology (A.A.O., C.B., R.K., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - Yigit Can Senol
- Department of Neurologic Surgery (Y.C.S., R.K.), Mayo Clinic, Rochester, Minnesota
| | - Cem Bilgin
- Department of Radiology (A.A.O., C.B., R.K., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | | | - Ramanathan Kadirvel
- Department of Radiology (A.A.O., C.B., R.K., D.F.K.), Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery (Y.C.S., R.K.), Mayo Clinic, Rochester, Minnesota
| | - David F Kallmes
- From the Department of Biomedical Engineering and Physiology (A.A.O., D.F.K.), Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota
- Department of Radiology (A.A.O., C.B., R.K., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - John M Wainwright
- MIVI Neuroscience (J.M.W.), Eden Prairie, Minnesota
- The Henry Samueli School of Engineering (J.M.W.), University of California, Irvine, California
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Liang X, Tong X, Xue X, Liu A, Hu Z. Comparison of pipeline embolization device and tubridge flow diverter for posterior circulation aneurysms: A multicentre propensity score matched study. Heliyon 2024; 10:e27410. [PMID: 38510002 PMCID: PMC10950592 DOI: 10.1016/j.heliyon.2024.e27410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/22/2024] Open
Abstract
Rationale and objectives The off-label use of flow diverters (FDs) has broadened to include treating aneurysms in posterior circulation (PC). A novel flow diverter, the Tubridge flow diverter (TFD), has been created in China specifically for treating PC aneurysms. However, studies comparing between pipeline embolization device (PED) and TFD are rare. Thus, our study aimed to explore the effectiveness of PED and TFD in the treatment of PC aneurysms using a propensity score matched cohort design. Methods Retrospective data collection was conducted on patients who underwent treatment with either PED or TFD over the period from 2015 through 2020. Propensity score matching (PSM) was employed to calibrate for patient age; history of ischemic stroke; aneurysm size; morphology; location and neck; number of FDs; parent vessel diameter; and the employment of assisted coiling and balloon techniques. Data on previously ruptured aneurysms was not included in the analysis. A comparison was conducted between the two devices to assess perioperative complications, aneurysm occlusion rates, and functional outcomes. Results A total of 252 PC aneurysms were treated in 248 patients. Clinical and imaging follow-ups were lost in 26 and 47 patients, respectively. Major perioperative complications occurred in 7.5% of the cases, with favorable clinical outcomes in 91.0% and complete occlusion in 79.1%. Eighty-two (32.5%) aneurysms were treated with TFD, while 170 (67.5%) aneurysms were treated with PED. PSM was used to account for these significant variations, producing 82 matched pairs of unruptured aneurysms treated with PED or TFD. In terms of functional and angiographic outcomes, no significant differences were found between PED and TFD (functional outcome, p = 0.594 and angiographic outcome, p = 0.415). However, more perioperative major complications were found in patients treated with TFD (p = 0.005) compared with those receiving PED. Conclusion The comparative study of PED and TFD in the treatment of PC aneurysms resulted in positive clinical results and sustained occlusion rates, with acceptable perioperative complications. However, higher quality studies are needed to enhance our understanding of the use of FDs for treating of PC aneurysms.
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Affiliation(s)
- Xin Liang
- Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Department of Neurosurgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China
| | - Xin Tong
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xiaopeng Xue
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Zhiqiang Hu
- Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
- Department of Neurosurgery, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, 100038, China
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