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Li Q, Zhu D, Lv N, Yang P, Zhou Y, Zhao R, Yang W, Lv M, Li T, Zhao W, Qi T, Jiang W, Duan C, Zhao G, Duan G, Wu Y, Zheng Q, Li Z, Zuo Q, Dai D, Fang Y, Huang Q, Hong B, Xu Y, Gu Y, Guan S, Liu J. Clinical Outcomes On Tubridge Flow Diverter in Treatmenting Intracranial Aneurysms: a Retrospective Multicenter Registry Study. Clin Neuroradiol 2024; 34:465-474. [PMID: 38361028 DOI: 10.1007/s00062-024-01393-4] [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: 12/11/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE In China, the application of nitinol Tubridge flow diverter (TFD) has become popular for treating intracranial aneurysms (IAs). In this study, we investigated the safety outcomes of the application of TFD for treating IAs in real-world scenarios. METHODS We retrospectively analyzed aneurysms treated with TFD in 235 centers throughout China between April 2018 and April 2020. The primary endpoint was the event-free survival rate at 12 months, defined as the occurrence of morbidity (spontaneous rupture, intraparenchymal hemorrhage (IPH), ischemic stroke, and permanent cranial neuropathy) or death. Univariate and multivariate analyses were performed to assess the risk factors. A good outcome was defined as a modified Rankin Score (mRS) of 0-2. RESULTS We included 1281 unruptured aneurysms treated with TFD. The overall neurological morbidity and death rates after 12 months were 5.4 and 2.8%, respectively. Ischemic strokes were the most common complication (4.2%, P < 0.001). Cranial neuropathy, IPH, and spontaneous rupture occurred in 0.3%, 0.3%, and 0.5% of aneurysms, respectively. Univariate and multivariate analyses indicated that the male gender, older age, larger aneurysm diameter, and aneurysm located on BA were the independent risk factors for neurologic events. Aneurysm located on BA was the independent risk factor for ischemic strokes. Most patients (1222) had access to the mRS, and 93.2% of them achieved good outcomes. CONCLUSION Treatment of IAs with TFD was associated with low morbidity and mortality, most of which were ischemic events. Large posterior aneurysms might be associated with a higher complication rate. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Qiang Li
- Neurovascular Center, Changhai Hospital, Naval Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Deyuan Zhu
- Department of Neurovascular Disease, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, 200080, Shanghai, China
| | - Nan Lv
- Neurovascular Center, Changhai Hospital, Naval Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Pengfei Yang
- Neurovascular Center, Changhai Hospital, Naval Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Yu Zhou
- Neurovascular Center, Changhai Hospital, Naval Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Rui Zhao
- Neurovascular Center, Changhai Hospital, Naval Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Wenjin Yang
- Neurovascular Center, Changhai Hospital, Naval Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Ming Lv
- Beijing Tiantan Hospital, Capital Medical University, 100070, Beijing, China
| | - Tianxiao Li
- Henan Provincial People's Hospital, 463599, Zhengzhou, China
| | - Wenyuan Zhao
- Zhongnan Hospital of Wuhan University, 430071, Wuhan, China
| | - Tiewei Qi
- The First Affiliated Hospital, Sun Yat-sen University, 510080, Guangzhou, China
| | - Weixi Jiang
- Xiangya Hospital Central South University, 410008, Changsha, China
| | - Chuanzhi Duan
- Zhujiang Hospital of Southern Medical University, 510280, Guangzhou, China
| | - Guangyu Zhao
- Qilu Hospital of Shandong University, 250012, Jinan, China
| | - Guoli Duan
- Neurovascular Center, Changhai Hospital, Naval Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Yina Wu
- Neurovascular Center, Changhai Hospital, Naval Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Qian Zheng
- Neurovascular Center, Changhai Hospital, Naval Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Zifu Li
- Neurovascular Center, Changhai Hospital, Naval Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Qiao Zuo
- Neurovascular Center, Changhai Hospital, Naval Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Dongwei Dai
- Neurovascular Center, Changhai Hospital, Naval Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Yibin Fang
- Department of Neurovascular Disease, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, 200080, Shanghai, China
| | - Qinghai Huang
- Neurovascular Center, Changhai Hospital, Naval Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Bo Hong
- Neurovascular Center, Changhai Hospital, Naval Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Yi Xu
- Neurovascular Center, Changhai Hospital, Naval Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Yuxiang Gu
- Huashan Hospital Affiliated to Fudan University, 200020, Shanghai, China
| | - Sheng Guan
- The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Jianmin Liu
- Neurovascular Center, Changhai Hospital, Naval Medical University, 168 Changhai Road, 200433, Shanghai, China.
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Grandhi R, Ravindra VM, Kallmes DF, Lopes D, Hanel RA, Lylyk P. Treatment of giant intracranial aneurysms using the Pipeline flow-diverting stent: Long-term results from the International Retrospective Study of the Pipeline Embolization Device (IntrePED) study. Interv Neuroradiol 2024; 30:218-226. [PMID: 36168255 PMCID: PMC11095340 DOI: 10.1177/15910199221123282] [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: 06/14/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Traditional endovascular treatments of giant intracranial aneurysms are associated with high rates of complications and retreatment. Our objective was to examine the safety and long-term efficacy of the Pipeline Embolization Device for treatment of these aneurysms. METHODS This retrospective study using the IntrePED database included all patients with giant intracranial aneurysms treated with the Pipeline device between July 2008 and February 2013. Efficacy outcomes were stratified by using the Raymond-Roy Occlusion Classification. Predefined safety outcomes included spontaneous rupture of the target aneurysm; ipsilateral intracranial hemorrhage; ischemic stroke; parent artery stenosis; and sustained cranial neuropathy. RESULTS Sixty-six embolizations were performed to treat 63 giant intracranial aneurysms (including 2 ruptured): 49 (77.8%) in the anterior and 14 (22.2%) in the posterior circulation. The median follow-up was 22.4 (0.1-60.5) months. Class I angiographic occlusion was achieved in 72.0% (36/50). The neurological morbidity/mortality rate was 23.8% (15/63), with higher rates in the posterior circulation than in the anterior circulation (22.4% vs. 28.6%). Among seven deaths, five had neurological causes. The procedure-related neurological morbidity and mortality rates were 22.7% (15/66) and 7.6% (5/66), respectively. The spontaneous rupture rate was 4.5% (3/66). Two spontaneous ruptures (1 death), 4/4 postprocedural intracranial hemorrhages, and 6/9 ischemic events occurred within 30 days. In-stent stenosis and new-onset cranial neuropathy were not observed during the angiographic follow-up period. CONCLUSIONS Although procedure-related neurological morbidity/mortality rates were not insignificant, this study confirms the feasibility and long-term efficacy of the Pipeline Embolization Device to treat giant intracranial aneurysms.
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Affiliation(s)
- Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Vijay M. Ravindra
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
- Department of Neurosurgery, University of California San Diego, La Jolla, California, USA
| | | | - Demetrius Lopes
- Department of Neurosurgery, Advocate Health, Park Ridge, Illinois, USA
| | - Ricardo A. Hanel
- Lyerly Neurosurgery, Baptist Neurological Institute, Baptist Medical Center, Jacksonville, Florida, USA
| | - Pedro Lylyk
- Department of Interventional Neuroradiology and Neurosurgery, Instituto Medico ENERI – Clínica La Sagrada Familia, Buenos Aires, CABA, Argentina
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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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Jin H, Lv J, Meng X, Liu X, He H, Li Y. Pipeline versus Tubridge in the treatment of unruptured posterior circulation aneurysms. Chin Neurosurg J 2023; 9:22. [PMID: 37542351 PMCID: PMC10401889 DOI: 10.1186/s41016-023-00337-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND To compare the safety and efficacy of pipeline embolization device (PED) and Tubridge flow diverter (TFD) for unruptured posterior circulation aneurysms. METHODS Posterior aneurysm patients treated with PED or TFD between January, 2019, and December, 2021, were retrospectively reviewed. Patients' demographics, aneurysm characteristics, treatment details, complications, and follow-up information were collected. The procedural-related complications and angiographic and clinical outcome were compared. RESULTS A total of 107 patients were involved; PED was applied for 55 patients and TFD for 52 patients. A total of 9 (8.4%) procedural-related complications occurred, including 4 (7.3%) in PED group and 5 (9.6%) in TFD group. During a mean of 10.3-month angiographic follow-up for 81 patients, complete occlusion was achieved in 35 (85.4%) patients in PED group and 30 (75.0%) in TFD group. The occlusion rate of PED group is slightly higher than that of TFD group. A mean of 25.0-month clinical follow-up for 107 patients showed that favorable clinical outcome was achieved in 53 (96.4%) patients in PED group and 50 (96.2%) patients in TFD group, respectively. No statistical difference was found in terms of procedural-related complications (p = 0.737), occlusion rate (p = 0.241), and favorable clinical outcome (0.954) between groups. CONCLUSIONS The current study found no difference in complication, occlusion, and clinical outcome between PED and TFD for unruptured PCAs.
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Affiliation(s)
- Hengwei Jin
- Department of Neurosurgery, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, No.119, South 4Th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Jian Lv
- Department of Neurosurgery, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, No.119, South 4Th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xiangyu Meng
- Neurosurgery Department, The First Hospital of Hebei Medical University, Donggang Road 89, Shijiazhuang, Hebei Province, China
| | - Xinke Liu
- Department of Neurosurgery, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, No.119, South 4Th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Hongwei He
- Department of Neurosurgery, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, No.119, South 4Th Ring West Road, Fengtai District, Beijing, 100070, China.
| | - Youxiang Li
- Department of Neurosurgery, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, No.119, South 4Th Ring West Road, Fengtai District, Beijing, 100070, China.
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Wang MY, Liu YS, An XB, Pan T, Wang F. Multiple telescoping flow diverter technique in endovascular treatment of a vertebrobasilar dissecting aneurysm: case report. Front Neurol 2023; 14:1218154. [PMID: 37521299 PMCID: PMC10374006 DOI: 10.3389/fneur.2023.1218154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
A 64-year-old man presented with headache and dizziness. A vertebrobasilar dissecting aneurysm was identified via computed tomography angiography and high resolution magnetic resonance imaging. Perioperatively, standard oral dual antiplatelet drugs were given. Two flow diverters were telespcoped for endovascular treatment of the aneurysm. Postoperatively, there were no signs of cerebral infarction and no new symptoms. At the 6-month follow-up, digital subtraction angiography showed that the aneurysm was almost completely occluded, with no other complications. This case serves as a reference for using the multiple telescoping flow diverter technique to treat vertebrobasilar dissecting aneurysm.
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Affiliation(s)
| | | | | | | | - Feng Wang
- Department of Intervention Therapy, First Affiliated Hospital of Dalian Medical University, Dalian, China
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Wang C, Zhu D, Xu X, Zhou Y, Zhao R, Li Q, Yang P, Huang Q, Xu Y, Liu J, Fang Y. Use of flow diverter device in basilar artery for aneurysm treatment: Case series and literature review. Front Neurol 2022; 13:990308. [PMID: 36062016 PMCID: PMC9428249 DOI: 10.3389/fneur.2022.990308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background Flow diverters (FDs) for the treatment of basilar artery (BA) aneurysms remain controversial. In this study, we report our initial experience of flow diversion for treatment of this pathology. Methods Consecutive patients with an aneurysm of the BA that was treated by implantation of the FD were included in our retrospective study. Procedural complications, aneurysm occlusion, and a functional outcome were evaluated. FD placement in BA for aneurysm treatment reported in the literature was also reviewed and summarized. Results Sixteen patients with 16 BA aneurysms were treated by FD implantation with (n = 8) or without (n = 8) adjunctive coiling. The Tubridge was used in 13 (81.3%) and Pipeline in 3 (18.8%) procedures. Average aneurysm size was 15.7 mm. Four aneurysms were located at the basilar apex, six at the basilar trunk, and six at the vertebrobasilar junction. Three patients experienced procedural complications (18.8%), including two ischemic strokes and one hydrocephalus, with resultant mortality in one case (6.3%). Median follow-up was 7.7 months and available for 15 aneurysms. Complete/near-complete occlusion was seen in 13 (86.7%) aneurysms. Conclusion In our initial experience, flow diversion is feasible and safe in the treatment of BA aneurysms with promising occlusion rates at mid-term follow-up. Larger cohort studies are required to validate these results.
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Affiliation(s)
- Chuanchuan Wang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Deyuan Zhu
- Department of Neurovascular Disease, School of Medicine, Shanghai Fourth People's Hospital, Tongji University, Shanghai, China
| | - Xiaolong Xu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yu Zhou
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Rui Zhao
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Qiang Li
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Pengfei Yang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Qinghai Huang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yi Xu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jianmin Liu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Jianmin Liu
| | - Yibin Fang
- Department of Neurovascular Disease, School of Medicine, Shanghai Fourth People's Hospital, Tongji University, Shanghai, China
- Yibin Fang
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Tang H, Shang C, Hua W, Lu Z, Pan J, Wang S, Xu Y, Zhao R, Zuo Q, Huang Q, Li Q, Liu J. The 8-year single-center experience of telescoping flow diverter for complex intracranial aneurysms treatment. J Clin Neurosci 2022; 100:131-137. [PMID: 35453101 DOI: 10.1016/j.jocn.2022.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/22/2022] [Accepted: 04/14/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Treatment of complex intracranial aneurysms (IAs) is still a challenging thing and this study aims to summarize the experience of telescoping flow diverters (FDs) in treating complex intracranial aneurysms. METHOD Between April 2013 to November 2020, 381 IA cases treated by flow diverters (FD) were retrieved from the database of 4988 IA cases, and finally 20 cases treated by telescoping FDs were enrolled for further analysis. RESULT Among 20 patients, 15 patients (75.0%) received Tubridge telescoping while 5 patients (25.0%) received PED telescoping. The technical success rate was 100%. The immediate occlusion results were: 7 cases of OKM grade A (35.0%), 11 cases of OKM grade B (55.0%), and 2 cases of OKM grade C (10.0%). No perioperative complications occurred. The clinical follow-up was available in 20 patients (100%) and the follow-up time was 6-96 months. One patient developed massive infarction and the other 19 patients were range between 0 and 2. The angiographic follow-up was available in 17 patients (85%) and the follow-up time was 6-27 months. The occlusion results were: 1 case of OKM grade B (5.9%), 6 cases of OKM grade C (35, 0.3%), and 10 cases of OKM grade D (58.8%). 2 patients (11.8%) developed occlusion of the patent artery. CONCLUSION Telescoping flow diverters showed low perioperative complications and high IA occlusion rate when treating complex intracranial aneurysms in follow-up time, which provides an alternative manner beyond conventional strategy for neurosurgeons.
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Affiliation(s)
- Haishuang Tang
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai 200433, People's Republic of China; Naval Medical Center of PLA, Navy Military Medical University, Shanghai 200050, People's Republic of China
| | - Chenghao Shang
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai 200433, People's Republic of China
| | - Weilong Hua
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai 200433, People's Republic of China
| | - Zhiwen Lu
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai 200433, People's Republic of China
| | - Jingxue Pan
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, People's Republic of China
| | - Shuxiao Wang
- Department of Research and Training, Strategic Support Force Medical Center, Beijing 100101, People's Republic of China
| | - Yi Xu
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai 200433, People's Republic of China
| | - Rui Zhao
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai 200433, People's Republic of China
| | - Qiao Zuo
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai 200433, People's Republic of China
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai 200433, People's Republic of China.
| | - Qiang Li
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai 200433, People's Republic of China.
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai 200433, People's Republic of China
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Low-profile LEO baby stents using dual stenting technique in treating complex intracranial aneurysms located in small artery: Initial and mid-term outcome. J Clin Neurosci 2022; 98:109-114. [PMID: 35152146 DOI: 10.1016/j.jocn.2022.02.005] [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: 08/30/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Endovascular treatment of complex intracranial aneurysms (IAs) was challenging. Our retrospective study aimed to assess the efficacy and safety of LEO Baby stents using the dual stenting technique for complex IAs. METHODS Clinical and angiographic data of 15 IAs located in small arteries treated by LEO Baby stents in our neurosurgical center were retrospectively collected and analyzed between April 2019 to January 2021. RESULTS 15 patients received dual stent-assisted coiling procedures and the stent configurations include 7 cases of T- configuration, 5 cases of parallel- configuration, 2 cases of Y- configuration, and 1case of X- configuration. 11 patients received dual stents deployment with only LEO Baby stents and 4 patients received LEO Baby stent combined with LVIS stent. Immediate postprocedural results showed Raymond I in 4 patients (26.7%), Raymond II in 5 patients (33.3%), and Raymond III in 6 patients (40.0%). One patient (6.7%) was confirmed with an ischemic complication during the procedure. All 15 patients (100%) received clinical follow-up ranging between 6 and 28 months. An mRS score of 0-2 was reached in all patients. 13 patients (86.7%) received angiographic clinical follow-up ranging between 6 and 20 months. The results revealed that Raymond I was achieved in 10 patients (76.9%) and Raymond II was achieved in 3 patients (23.1%). One patient (7.7%) in 6 months after the procedure was confirmed with asymptomatic in-stent stenosis. CONCLUSION This preliminary study suggests that dual stents deployment of LEO Baby stents was a feasible strategy for the treatment of complex IAs located in the small arteries.
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Rosengart A, Collins MK, Hendrix P, Uber R, Sartori M, Jain A, Mao J, Goren O, Schirmer CM, Griessenauer CJ. P 2Y 12 inhibitors in neuroendovascular surgery: An opportunity for precision medicine. Interv Neuroradiol 2021; 27:682-694. [PMID: 33541183 DOI: 10.1177/1591019921991394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Dual antiplatelet therapy (DAPT), primarily the combination of aspirin with a P2Y12 inhibitor, in patients undergoing intravascular stent or flow diverter placement remains the primary strategy to reduce device-related thromboembolic complications. However, selection, timing, and dosing of DAPT is critical and can be challenging given the existing significant inter- and intraindividual response variations to P2Y12 inhibitors. METHODS Assessment of indexed, peer-reviewed literature from 2000 to 2020 in interventional cardiology and neuroendovascular therapeutics with critical, peer-reviewed appraisal and extraction of evidence and strategies to utilize DAPT in cardio- and neurovascular patients with endoluminal devices. RESULTS Both geno- and phenotyping for DAPT are rapidly and conveniently available as point-of-care testing at a favorable cost-benefit ratio. Furthermore, systematic inclusion of a quantifying clinical risk score combined with an operator-linked, technical risk assessment for potential adverse events allows a more precise and individualized approach to new P2Y12 inhibitor therapy. CONCLUSIONS The latest evidence, primarily obtained from cardiovascular intervention trials, supports that combining patient pharmacogenetics with drug response monitoring, as part of an individually tailored, precision medicine approach, is both predictive and cost-effective in achieving and maintaining individual target platelet inhibition levels. Indirect evidence supports that this gain in optimizing drug responses translates to reducing main adverse events and overall treatment costs in patients undergoing DAPT after intracranial stent or flow diverting treatment.
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Affiliation(s)
- Axel Rosengart
- Department of Neurosurgery, Geisinger Health System, Danville, PA, USA
| | - Malie K Collins
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Philipp Hendrix
- Department of Neurosurgery, Saarland University Medical Center and Saarland University, Faculty of Medicine, Homburg/Saar, Germany
| | | | | | - Abhi Jain
- Department of Radiology, Einstein Medical Center, Philadelphia, PA, USA
| | - Jennifer Mao
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Oded Goren
- Department of Neurosurgery, Geisinger Health System, Danville, PA, USA
| | - Clemens M Schirmer
- Department of Neurosurgery, Geisinger Health System, Danville, PA, USA.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Christoph J Griessenauer
- Department of Neurosurgery, Geisinger Health System, Danville, PA, USA.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
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Jia L, Wang J, Zhang L, Zhang Y, You W, Yang X, Lv M. Evaluating the Tubridge™ flow diverter for large cavernous carotid artery aneurysms. Chin Neurosurg J 2020; 6:36. [PMID: 33292725 PMCID: PMC7708900 DOI: 10.1186/s41016-020-00215-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/14/2020] [Indexed: 11/21/2022] Open
Abstract
Background The Tubridge™ flow diverter (TFD) was recently developed in China; however, its safety and efficacy in treating large cavernous carotid artery aneurysms (LCCAs) are unclear. Our objective was to evaluate the safety and efficacy of the TFD in patients receiving TFDs to treat LCCAs (10–25 mm). Methods Between June 2013 and May 2014, seven patients with LCCAs were enrolled in our study, and all seven patients underwent TFD implantation combined with coils. Results Angiographic follow-up images were available for all seven patients at a median of 57.5 ± 16.7 (range, 6–69) months. Seven patients obtained favorable angiographic results defined as O’Kelly–Marotta Scale C and D. Clinical follow-up data were available for all seven patients at a median of 73.32 ± 3.6 (range, 66–78) months. No patients developed new neurological deficits. Six patients achieved a modified Rankin scale score of 0, and diplopia improved in the remaining patient. Conclusions The results were excellent for the aneurysms treated with TFDs in our patients with LCCAs. TFDs are feasible for the treatment of LCCAs, but a multicenter, controlled clinical trial is needed to evaluate the long-term safety and efficacy of the TFD to treat LCCAs.
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Affiliation(s)
- Luqiong Jia
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100070, China
| | - Jiejun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100070, China
| | - Longhui Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yunfeng Zhang
- Department of Imaging and Nuclear Medicine, Baoding No. 1 Central Hospital, Baoding, Hebei, China
| | - Wei You
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100070, China.
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, 100070, China.
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Chang Y, Huang W, Sun Q, Li S, Yan Z, Wang Q, Liu X. MicroRNA‑634 alters nerve apoptosis via the PI3K/Akt pathway in cerebral infarction. Int J Mol Med 2018; 42:2145-2154. [PMID: 30015915 DOI: 10.3892/ijmm.2018.3777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/18/2018] [Indexed: 11/06/2022] Open
Abstract
In the present study, the role and mechanism of microRNA‑634 (miRNA‑634) in the adjustment of nerve inflammation and apoptosis in cerebral infarction were investigated. In a cerebral infarction rat model, the expression of miRNA‑634 was increased, compared with that in the normal control group. The upregulated expression of miRNA‑634 in an in vitro model of cerebral infarction increased cell apoptosis and the protein expression of capsase‑3/B‑cell lymphoma 2‑associated X protein (Bax) via inactivation of the phosphoinositide 3‑kinase (PI3K)/Akt pathway. The downregulation of miRNA‑634 enhanced cell growth and inhibited cell apoptosis in the in vitro model of cerebral infarction through induction of the PI3K/Akt pathway. Subsequently, a PI3K inhibitor was used to inhibit the expression of PI3K in the in vitro model of cerebral infarction via the downregulation of miRNA‑634, which showed that cell apoptosis and the protein expression of capsase‑3/Bax were also increased. A PI3K agonist reduced the effects of the upregulation of miRNA‑634 in the in vitro model of cerebral infarction. In conclusion, the data obtained demonstrated the possible future use of miRNA‑634 as a therapeutic target in cerebral infarction through the PI3K/Akt pathway.
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Affiliation(s)
- Yajun Chang
- Department of Biochemistry and Molecular Biology, Tangshan Worker Hospital, Tangshan, Hebei 063000, P.R. China
| | - Wei Huang
- Department of Biochemistry and Molecular Biology, Tangshan Worker Hospital, Tangshan, Hebei 063000, P.R. China
| | - Qian Sun
- Department of Biochemistry and Molecular Biology, Tangshan Worker Hospital, Tangshan, Hebei 063000, P.R. China
| | - Suli Li
- Department of Biochemistry and Molecular Biology, Tangshan Worker Hospital, Tangshan, Hebei 063000, P.R. China
| | - Zhongkai Yan
- Department of Biochemistry and Molecular Biology, Tangshan Worker Hospital, Tangshan, Hebei 063000, P.R. China
| | - Qiumin Wang
- Department of Biochemistry and Molecular Biology, Tangshan Worker Hospital, Tangshan, Hebei 063000, P.R. China
| | - Xiumin Liu
- Department of Biochemistry and Molecular Biology, Tangshan Worker Hospital, Tangshan, Hebei 063000, P.R. China
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Jiang B, Paff M, Colby GP, Coon AL, Lin LM. Cerebral aneurysm treatment: modern neurovascular techniques. Stroke Vasc Neurol 2016; 1:93-100. [PMID: 28959469 PMCID: PMC5435202 DOI: 10.1136/svn-2016-000027] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 07/26/2016] [Accepted: 07/28/2016] [Indexed: 11/18/2022] Open
Abstract
Endovascular treatment of cerebral aneurysm continues to evolve with the development of new technologies. This review provides an overview of the recent major innovations in the neurointerventional space in recent years.
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Affiliation(s)
- Bowen Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Michelle Paff
- Department of Neurosurgery, University of California, Irvine School of Medicine, UC Irvine Medical Center, Orange, California, USA
| | - Geoffrey P Colby
- Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Alexander L Coon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Li-Mei Lin
- Department of Neurosurgery, University of California, Irvine School of Medicine, UC Irvine Medical Center, Orange, California, USA
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Hemodynamic Effect of Flow Diverter and Coils in Treatment of Large and Giant Intracranial Aneurysms. World Neurosurg 2016; 89:199-207. [DOI: 10.1016/j.wneu.2016.01.079] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/27/2016] [Accepted: 01/27/2016] [Indexed: 11/19/2022]
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Long-Term Outcome of Tubridge Flow Diverter(S) in Treating Large Vertebral Artery Dissecting Aneurysms-A Pilot Study. Clin Neuroradiol 2016; 27:345-350. [PMID: 26780551 DOI: 10.1007/s00062-015-0494-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE The experience of flow diverters (FDs) in treating large vertebral artery-dissecting aneurysms (VADAs) is still limited. This study was conducted to present our long-term outcome of VADAs treated with a Tubridge flow diverter (TFD), a new device developed in China. MATERIALS AND METHODS The clinical and angiographic data of six patients harboring large VADAs and treated with TFDs were prospectively collected and analyzed. RESULTS A total of nine TFDs were successfully implanted in six patients. Angiographic follow-up images were available for all patients at a median of 26.0 (18.5, 37.5) months after treatment. Five of the six VADAs were completely occluded, and the last was improved (near complete occlusion). In-stent stenosis was detected in one case and was handled appropriately by angioplasty and stenting. All covered branches and parent arteries remained patent. There were no complications or new neurological deficits observed in any of the patients. At the latest clinical follow-up (36.5 (26.0, 44.5) months), all patients achieved 0 in the modified Rankin scale score. CONCLUSIONS Our preliminary experience suggests that the Tubridge flow diverter might be an alternative treatment for large and recurrent dissecting aneurysms derived from the vertebral artery.
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Comparison of the flow diverter and stent-assisted coiling in large and giant aneurysms: safety and efficacy based on a propensity score-matched analysis. Eur Radiol 2015; 26:2369-77. [PMID: 26471273 DOI: 10.1007/s00330-015-4052-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/23/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The flow diverter (FD) is a device aimed at reconstructing the parent artery and occluding an aneurysm. We performed a propensity score-matched analysis to compare safety and efficacy between the FD and stent-assisted coiling. METHODS A database review was conducted to identify patients with large and giant unruptured aneurysms (aneurysms located in the ACA, MCA, or PCA were excluded) treated with the FD or stent-assisted coiling. A propensity score, representing the probability of using the FD, was generated for each aneurysm using the relevant patient and aneurysmal variables. Angiographic results, complications, and clinical outcomes were compared. RESULTS Forty-five aneurysms treated with the FD (FD alone: 32; FD+Coils: 13) and 45 treated with stent-assisted coiling were matched. The rate of complete occlusion was significantly (P = 0.0002) higher in the FD cohort than the conventional stent cohort at the 6-month follow-up. The FD cohort achieved greater improvement (P < 0.0001) and a lower rate of recurrence (P = 0.0001). The rate of periprocedural complications was similar, as was the proportion of patients who attained mRS ≤ 2 at discharge and at the 6-month follow-up. CONCLUSIONS Our findings provide reliable evidence demonstrating that the FD may be a preferred treatment option for large and giant unruptured aneurysms. KEY POINTS • Flow Diverter provided a higher complete occlusion rate at 6-month follow-up. • Flow Diverter achieved more progress occlusion and less recurrence. • Compared with the conventional stents, procedure-related morbidity of Flow Diverter was similar. • Flow Diverter is a preferred treatment for large and giant unruptured aneurysms.
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