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Jeremic PA, do Nascimento VC, Rice H, de Villiers L. Single Centre Initial Experience with the Scepter Mini Balloon Microcatheter. Interv Neuroradiol 2024; 30:389-395. [PMID: 36168238 PMCID: PMC11310727 DOI: 10.1177/15910199221128442] [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: 05/26/2022] [Accepted: 09/06/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The use of balloon microcatheters in interventional neuroradiology is well documented. However, their use is sometimes limited by the small diameter and excessive tortuosity of the vasculature. The Scepter Mini dual-lumen balloon microcatheter (SMBM) (Microvention, Aliso Viejo, CA) has been designed to address these challenges by decreasing the distal catheter profile, allowing distal access to the target vessel. METHODS This is a single-centre retrospective analysis of the initial cases performed using the Scepter Mini balloon microcatheter. The targeted conditions were vascular malformations. Patient clinical data, angiographic features of the vascular abnormalities and operation reports were reviewed and the procedural parameters, radiation doses, occlusion rates and complications were assessed. RESULTS A total of 15 SMBM were used in 11 cases. In all cases the procedure performed was balloon inflation and antegrade delivery of precipitating hydrophobic injectable liquid (PHIL) (Microvention, Aliso Viejo, CA) for embolisation of a targeted feeding vessel and cranial and spinal vascular malformations. Successful feeding vessel distal access and antegrade liquid embolisation was achieved in 100% of the cases. One of the 11 cases was an emergency procedure. One procedural target vessel rupture, likely due to overinflation, and three minor post-procedure complications were observed. CONCLUSION The SMBM represents a significant advance in the treatment of cerebrospinal vascular malformations, allowing balloon catheter access into tortuous and small calibre vessels.
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Affiliation(s)
| | | | - Hal Rice
- Department of Interventional Neuroradiology, Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Laetitia de Villiers
- Department of Interventional Neuroradiology, Gold Coast Hospital and Health Service, Gold Coast, Australia
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2
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Matsoukas S, Bageac D, Yaeger K, Berenstein A, T Fifi J, Shigematsu T. Initial experience with the Scepter Mini catheter for the embolization of vascular malformations in the pediatric population. Neuroradiol J 2021; 35:520-526. [PMID: 34609932 PMCID: PMC9437497 DOI: 10.1177/19714009211049084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Achieving distal access and flow control are of significant importance for the treatment of intracerebral arteriovenous shunting lesions. The Scepter Mini catheter is a low-profile, dual-lumen balloon catheter, designed to provide navigability in small-caliber, tortuous intracranial vessels. OBJECTIVE To describe the initial experience of the Scepter Mini catheter in the treatment of pediatric arteriovenous malformations and fistulas. METHODS A single-institution, retrospective chart review identified all consecutive uses of the Scepter Mini catheter for endovascular embolization of vascular malformations in the pediatric population. RESULTS Three different arterial pedicles were embolized with the Scepter Mini catheter in two different patients. One patient was diagnosed with a vein of Galen malformation that had undergone multiple treatments and the other with a torcular dural arteriovenous fistula. All cases encompassed quite challenging tortuosity of small-caliber feeders which prevented the use of another microcatheter. The Scepter Mini catheter navigated into feeding arteries of diameters 0.65, 1.9, and 1.25 mm, and its balloon was inflated to achieve excellent blood flow control. Total obliteration (100%) of the shunting lesion was achieved in both cases. No reflux, pedicle rupture or other untoward effects were observed. Both patients had an uneventful recovery. CONCLUSION The Scepter Mini catheter afforded fast and safe distal access, flow control, and treatment of arteriovenous malformations in this initial pediatric cohort. The catheter's low profile and easy navigability should support its use in tortuous and small arterial feeders, especially in the pediatric population.
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Affiliation(s)
- Stavros Matsoukas
- Department of Neurosurgery, 5864The Mount Sinai Hospital, The Mount Sinai Hospital, USA
| | - Devin Bageac
- Department of Neurosurgery, 5864The Mount Sinai Hospital, The Mount Sinai Hospital, USA
| | - Kurt Yaeger
- Department of Neurosurgery, 5864The Mount Sinai Hospital, The Mount Sinai Hospital, USA
| | - Alejandro Berenstein
- Department of Neurosurgery, 5864The Mount Sinai Hospital, The Mount Sinai Hospital, USA
| | - Johanna T Fifi
- Department of Neurosurgery, 5864The Mount Sinai Hospital, The Mount Sinai Hospital, USA
| | - Tomoyoshi Shigematsu
- Department of Neurosurgery, 5864The Mount Sinai Hospital, The Mount Sinai Hospital, USA
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3
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Mehta T, Hassan A, Masood K, Tekle W, Grande A, Tummala R, Jagadeesan BD. The next step in balloon assisted endovascular neurosurgical procedures: A case series of initial experience with the Scepter Mini balloon microcatheter. Interv Neuroradiol 2021; 27:298-306. [PMID: 33164616 PMCID: PMC8050521 DOI: 10.1177/1591019920972884] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/25/2020] [Accepted: 10/13/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The use of compliant dual lumen balloon microcatheters (CDLB) for the endovascular treatment of vascular malformations, wide neck aneurysms, and intracranial angioplasty (for vasospasm) is well documented. Navigation of 4 mm or larger CDLB within tortuous and small distal intracranial vessels can be challenging. Recently, the lower profile Scepter Mini balloon microcatheter (SMB) has been approved for use, with potential for improved intracranial navigation. OBJECTIVE Discuss operative experience of Scepter Mini (Microvention, Aliso Viejo, CA). METHODS We describe our initial experience with the SMB in a series of nine patients. RESULTS The balloon microcatheter was used for delivery of liquid embolic in six patients (Case 1, 2, 6-9), adjunct support for delivery or positioning of the Woven Endobridge (WEB) device in two (Case 3,4), and gentle post-deployment repositioning of a WEB device in the last one (Case 5). We were able to successfully navigate the SMB over a 0.008 "micro wire to the target lesion in all the patients. We experienced initial difficulty with injecting liquid embolic in Case 2. We postulate that the SMB was in a tortuous segment of a dural vessel in this patient, and that it kinked on inflation with occlusion of the liquid embolic delivery lumen; this was overcome with slightly proximal repositioning and reinflation of the SMB. CONCLUSION Our initial experience shows that the SMB has potential to be useful in endovascular neurosurgical procedures requiring balloon assistance within smaller diameter blood vessels.
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Affiliation(s)
- Tapan Mehta
- Department of Neurology, Neurosurgery and Radiology, University of Minnesota, Minneapolis, MN, USA
- Ayer Neuroscience Institute, Hartford Healthcare, Hartford, CT, USA
| | - Ameer Hassan
- Department of Neuroscience, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, TX, USA
| | - Kamran Masood
- Department of Neurology, Neurosurgery and Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Wondwossen Tekle
- Department of Neuroscience, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, TX, USA
| | - Andrew Grande
- Department of Neurology, Neurosurgery and Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Ramachandra Tummala
- Department of Neurology, Neurosurgery and Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Bharathi D Jagadeesan
- Department of Neurology, Neurosurgery and Radiology, University of Minnesota, Minneapolis, MN, USA
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4
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Jang CK, Kim BM, Park KY, Lee JW, Kim DJ, Chung J, Kim JH. Scepter dual-lumen balloon catheter for Onyx embolization for dural arteriovenous fistula. BMC Neurol 2021; 21:31. [PMID: 33472604 PMCID: PMC7816325 DOI: 10.1186/s12883-021-02046-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/04/2021] [Indexed: 01/17/2023] Open
Abstract
Background This study aimed to evaluate the efficacy and safety of Scepter dual-lumen balloon catheter for transarterial Onyx embolization of dural arteriovenous fistula (DAVF). Methods Transarterial Onyx embolization using a Scepter dual-lumen balloon catheter (Scepter-assisted Onyx embolization) for DAVF was attempted in a total of 35 patients (mean age, 52.5 years; M:F = 24:11) between October 2012 and December 2018. The results of Scepter-assisted Onyx embolization were evaluated with respect to total procedural and Onyx injection times, the types and number of feeders requiring embolization, angiographic and clinical outcomes, and treatment-related complications. Results Initial presentations were non-hemorrhagic neurological deficits in 10, intracranial hemorrhage in 8, seizure in 7, headache in 7, and intractable tinnitus in 3. All DAVF were aggressive type (Borden type 2, 14.3 %; type 3, 85.7 %). Scepter-assisted Onyx embolization resulted in immediately complete occlusion in 33 patients (94.3 %) and near complete occlusion in 2 patients. Middle meningeal artery (51.4 %) was the most commonly used for Scepter-assisted technique, followed by occipital artery (42.9 %), ascending pharyngeal artery (2.9 %) and superficial temporal artery (2.9 %). There was no difference in complete occlusion rate between middle meningeal artery and the other arteries (94.4 % versus 94.1 %). The median number of total feeders embolized was 1 (range, 1–3). The median total procedural time was 45 minutes (range, 21 minutes – 127 minutes) and the median Onyx injection time was 11 minutes (range, 3 minutes – 25 minutes). All patients recovered completely (n = 31) or partially (n = 4) from presenting symptoms. Treatment-related complications occurred in 2 patients, of whom one had a permanent morbidity (2.8 %, ipsilateral facial nerve palsy). No patient showed a recurrence on follow-up imaging (median, 15 months; range, 3–56 months). Conclusions Scepter-assisted transarterial Onyx embolization showed a very high complete occlusion rate with a low morbidity and no recurrence in aggressive type DAVF. Scepter dual-lumen balloon catheter seems to be a useful tool for transarterial Onyx embolization of DAVF.
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Affiliation(s)
- Chang Ki Jang
- Departments of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Moon Kim
- Division of Interventional Neuroradiology, Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, 120-752, Seodaemun-gu, Seoul, South Korea.
| | - Keun Young Park
- Departments of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Whan Lee
- Departments of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Joon Kim
- Division of Interventional Neuroradiology, Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, 120-752, Seodaemun-gu, Seoul, South Korea
| | - Joonho Chung
- Departments of Neurosurgery, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jun-Hwee Kim
- Division of Interventional Neuroradiology, Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, 120-752, Seodaemun-gu, Seoul, South Korea
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5
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Scheitler KM, Nesvick CL, Wijdicks EF. Pretruncal Subarachnoid Hemorrhage in a Patient with Cerebrospinal Fluid Leak. Neurocrit Care 2020; 34:350-353. [PMID: 32588332 DOI: 10.1007/s12028-020-01030-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Kristen M Scheitler
- Department of Neurological Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Cody L Nesvick
- Department of Neurological Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Eelco F Wijdicks
- Department of Neurocritical Care and Hospital Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
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6
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Koizumi S, Shojima M, Ishikawa O, Hasegawa H, Miyawaki S, Nakatomi H, Saito N. S-shaped distal access catheter supported microcatheter navigation into the lenticulostriate artery feeders of brain arteriovenous malformations. Interv Neuroradiol 2020; 26:725-732. [PMID: 32558595 DOI: 10.1177/1591019920935275] [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
BACKGROUND Although the embolization of lenticulostriate artery feeders is often warranted in the treatment of brain arteriovenous malformations, it is technically challenging due to steep and repeated angulations. Here, we describe our novel technique of navigating a flow-guided microcatheter into lenticulostriate artery feeders using the strong support provided by an S-shaped distal access catheter. METHODS We reviewed our retrospective cohort of brain arteriovenous malformations, in which lenticulostriate artery feeders were attempted to embolize. RESULT During the study period, endovascular embolization was performed in 25 arteriovenous malformations cases. Of these, eight lenticulostriate artery feeders were present in six cases (24%). In two cases, lenticulostriate artery feeder catheterization was avoided from the beginning due to the small diameters of the feeders. After all, microcatheter navigation for lenticulostriate artery feeders were attempted in four cases with six lenticulostriate artery feeders. In all the six feeders, the S-shaped distal access catheter was successful in supporting the microcatheter to advance distally to the lenticulostriate artery feeders, even if other approaches were unsuccessful. Of the six catheterized lenticulostriate artery feeders, four were embolized. Symptomatic infarction in the lenticulostriate artery territory and mild vasospasm occurred in two cases each, but they did not result in permanent neurological deficits. CONCLUSION Although some potential complications need to be considered, the S-shaped distal access catheter technique appears to be an effective alternative approach to gaining access to difficult feeders of arteriovenous malformations.
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Affiliation(s)
- Satoshi Koizumi
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masaaki Shojima
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.,Department of Neurosurgery and Center for Cerebrovascular Intervention, Saitama Medical University Saitama Medical Center, Kawagoe, Saitama, Japan
| | - Osamu Ishikawa
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.,Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Satoru Miyawaki
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hirofumi Nakatomi
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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7
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Injection of N‑butyl Cyanoacrylate Through a Dual-Lumen Balloon for Embolization of High-flow Intranidal Fistulas in Brain Arteriovenous Malformations: Technical Note. Clin Neuroradiol 2019; 30:313-319. [PMID: 30972426 DOI: 10.1007/s00062-019-00780-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE N-butyl cyanoacrylate (NBCA) glue is a valuable liquid embolic agent for the endovascular treatment of brain arteriovenous malformations (BAVM). The use of NBCA carries a risk of embolic agent reflux and distal migration with ensuing possibility of venous drainage compromise. The aim of this technical note is to describe a single center case series of high-flow intranidal fistulas embolized though a dual lumen balloon under local flow-arrest conditions. METHODS This article presents a retrospective description of a case series including five NBCA injections through a dual lumen balloon performed by a single operator in three patients with BAVM. Demographic, clinical, imaging and procedure-related data are reported. RESULTS The three patients presented with ruptured BAVMs. Of the patients, one underwent proximal flow-related ruptured aneurysm coiling before planned BAVM embolization. In the three patients, staged BAVM embolization as a first line treatment was decided. Preliminary embolization of high-flow BAVM fistulas by NBCA using a dual lumen balloon under local flow-arrest conditions was performed and five separate injections were carried out without any complications. No balloon entrapment or rupture was observed. CONCLUSION High-flow BAVM fistulas can be treated with NBCA embolization using a dual lumen balloon under local flow-arrest conditions.
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8
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Embolization of brain arteriovenous malformations with the diluted Onyx technique: initial experience. Neuroradiology 2019; 61:471-478. [PMID: 30712140 DOI: 10.1007/s00234-019-02176-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Insufficient nidus occlusion is a matter of great concern to routine Onyx embolization of brain arteriovenous malformations (AVMs). This paper described an efficient method which using the diluted Onyx embolization technique to treat brain AVM. METHODS The diluted Onyx technique was performed in a series of 15 patients with brain AVMs (10 males, 5 females; age range, 11-44 years). It consists of initial embolization with routine Onyx-18, followed by the diluted Onyx (1.5 mL of Onyx-18 diluted with 0.5 mL of DMSO) through the same microcatheter. The technical skills and angiographic and clinical outcomes were analyzed. RESULTS A total of 15 embolization sessions were performed with diluted Onyx via 16 arterial feeders in these 15 patients. Each patient underwent one attempt of diluted Onyx through a single feeder except one patient. In this patient, the AVM was simultaneously embolized with diluted Onyx through double microcatheters which were placed in two feeders. When the length of reflux reached to 2 cm (or close to the determined length) and the embolic material could not move distally any more despite some rounds of "injection-reflux-waiting," regular Onyx 18 was changed to diluted Onyx. Antegrade flow of embolic material into the nidus was observed in 12 cases but failed in 3. An average of 90% (range 55-100%) estimated size reduction was achieved, and 6 AVMs were completely obliterated. No functionally relevant complications occurred. CONCLUSION The diluted Onyx technique could be a useful adjunct to routine Onyx embolization which may offer more embolic material penetrating into the nidus of AVM, but additional work is needed to validate this technique.
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9
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Heit J, Connolly I, Choudhri O. Percutaneous use of a dual lumen Scepter XC balloon for embolization of a complex facial arteriovenous malformation: a technical report. Clin Neuroradiol 2016; 26:485-491. [PMID: 27142059 DOI: 10.1007/s00062-016-0515-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Jeremy Heit
- Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, 94305, Stanford, CA, USA
| | - Ian Connolly
- Department of Neurosurgery, Stanford University Medical Center, 300 Pasteur Drive, 94305, Stanford, CA, USA
| | - Omar Choudhri
- Department of Neurological Surgery, University of California, 505 Parnassus Ave, 94143 0112, San Francisco, CA, USA.
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10
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Kim JW, Kim BM, Park KY, Kim DJ, Kim DI. Onyx Embolization for Isolated Type Dural Arteriovenous Fistula Using a Dual-Lumen Balloon Catheter. Neurosurgery 2016; 78:627-36. [DOI: 10.1227/neu.0000000000001069] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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11
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Stapleton CJ, Kumar JI, Walcott BP, Torok CM, Agarwalla PK, Koch MJ, Patel AB. The effect of basilar artery bifurcation angle on rates of initial occlusion, recanalization, and retreatment of basilar artery apex aneurysms following coil embolization. Interv Neuroradiol 2016; 22:389-95. [PMID: 26922975 DOI: 10.1177/1591019916633243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/25/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Arterial bifurcations are common locations for aneurysm development given the altered hemodynamic forces and shear stress variations present at these locations. Recent reports indicate that a wide basilar artery bifurcation angle is an independent predictor of aneurysm development, growth, and subsequent rupture. METHODS To determine the effect of basilar artery bifurcation angle on rates of initial occlusion, recanalization, and retreatment of basilar artery apex aneurysms following coil embolization, the records of 46 patients with basilar artery apex aneurysms treated with endovascular coil embolization from 2007 to 2013 were analyzed. RESULTS A wide basilar artery bifurcation angle was associated with a Raymond-Roy Occlusion Classification (RROC) III occlusion in univariate analysis, but was not a statistically significant factor in multivariate modeling. An increasing basilar artery bifurcation angle was not associated with aneurysm recanalization or retreatment following coil embolization. Increasing packing density (p < .01) was the only statistically significant predictor of a RROC I or II closure. The initial RROC designation was the most powerful predictor of both eventual aneurysm recanalization (p = .01) and retreatment (p = .02). While increasing aneurysm size (p < .01), increasing aneurysm volume (p < .01), and increasing neck size (p < .01) were associated with wide basilar artery bifurcation angles, neck size (p = .03) was the only statistically significant predictor of basilar artery bifurcation angle on multivariate analyses. CONCLUSION Basilar artery bifurcation angle fails to predict rates of initial occlusion, recanalization, and retreatment on multivariate modeling in our series. Basilar artery apex aneurysm neck size independently correlates with basilar artery bifurcation angle.
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Affiliation(s)
- Christopher J Stapleton
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA Neuroendovascular Program, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Jay I Kumar
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Brian P Walcott
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Collin M Torok
- Neuroendovascular Program, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Pankaj K Agarwalla
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Matthew J Koch
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA Neuroendovascular Program, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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Endovascular treatment for superior cerebellar artery aneurysms: morphological features, technique, and outcome. Neuroradiology 2014; 56:647-54. [DOI: 10.1007/s00234-014-1375-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 04/23/2014] [Indexed: 11/26/2022]
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13
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Wang J, Tan HQ, Zhu YQ, Li MH, Li ZZ, Yan L, Cheng YS. Complex hemodynamic insult in combination with wall degeneration at the apex of an arterial bifurcation contributes to generation of nascent aneurysms in a canine model. AJNR Am J Neuroradiol 2014; 35:1805-12. [PMID: 24788130 DOI: 10.3174/ajnr.a3926] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The detailed mechanisms of cerebral aneurysm generation remain unclear. Our aim was to investigate whether specific hemodynamic insult in combination with arterial wall degeneration leads to the development of aneurysms in a canine model. MATERIALS AND METHODS New branch points in the common carotid artery were created in 18 dogs. Nine animals subsequently received elastase insult at the arterial bifurcation apex (elastase-treated bifurcation group); the control bifurcation group (n=9) received saline, and 3 dogs received an elastase insult to both straight common carotid arteries (elastase-treated straight group). Angiographic and hemodynamic analysis was performed immediately and 12 and 24 weeks' postsurgery; histologic response was evaluated at 12 and 24 weeks. RESULTS Angiography revealed nascent aneurysms (mean, 3.2±0.4 mm) at the arterial bifurcation apices in 5/9 models of the elastase-treated bifurcation group (versus 0 in the control bifurcation group and elastase-treated straight group) without any observed aneurysm rupture. Histologic analysis revealed internal elastic lamina discontinuity, elastic fiber disruption, a thinner muscular layer, reduced smooth-muscle cell proliferation, increased inflammatory cell (macrophage) infiltration, and expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 in the media of the elastase-treated bifurcation group compared with that in either the control bifurcation group or the elastase-treated straight group (P<.001). Hemodynamic analysis after surgery indicated that the apex experienced extremely low wall shear stress and flow velocity and the highest relative and total pressure in the elastase-treated bifurcation group, while the values returned to normal after arterial wall remodelling. CONCLUSIONS In our study, combined hemodynamic insult and arterial wall degeneration at arterial bifurcations are required for the generation of aneurysms in a canine model.
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Affiliation(s)
- J Wang
- From the Department of Diagnostic and Interventional Radiology (J.W., H.-Q.T., Y.-Q.Z., M.-H.L., L.Y., Y.-S.C.), Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - H-Q Tan
- From the Department of Diagnostic and Interventional Radiology (J.W., H.-Q.T., Y.-Q.Z., M.-H.L., L.Y., Y.-S.C.), Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Y-Q Zhu
- From the Department of Diagnostic and Interventional Radiology (J.W., H.-Q.T., Y.-Q.Z., M.-H.L., L.Y., Y.-S.C.), Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - M-H Li
- From the Department of Diagnostic and Interventional Radiology (J.W., H.-Q.T., Y.-Q.Z., M.-H.L., L.Y., Y.-S.C.), Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Z-Z Li
- School of Mechanical Engineering (Z.-Z.L.), Shanghai Jiao Tong University, Shanghai, China
| | - L Yan
- From the Department of Diagnostic and Interventional Radiology (J.W., H.-Q.T., Y.-Q.Z., M.-H.L., L.Y., Y.-S.C.), Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Y-S Cheng
- From the Department of Diagnostic and Interventional Radiology (J.W., H.-Q.T., Y.-Q.Z., M.-H.L., L.Y., Y.-S.C.), Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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14
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Monteith SJ, Tsimpas A, Dumont AS, Tjoumakaris S, Gonzalez LF, Rosenwasser RH, Jabbour P. Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device. J Neurosurg 2014; 120:945-54. [PMID: 24460489 DOI: 10.3171/2013.12.jns13945] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Despite advances in surgical and endovascular techniques, fusiform aneurysms remain a therapeutic challenge. Introduction of flow-diverting stents has revolutionized the treatment of aneurysms with wide necks and of complex morphology. The authors report their experience with the endovascular treatment of fusiform aneurysms using the Pipeline Embolization Device. METHODS A retrospective review of 146 patients with cerebral aneurysms treated with the Pipeline Embolization Device between June 2011 and January 2013 was performed. Twenty-four patients were identified as having fusiform aneurysms. Twenty-four aneurysms in these 24 patients were treated. The mean patient age was 59 years. There were 9 men and 15 women. Angiographic and clinical data (including the modified Rankin Scale [mRS] score) were recorded at the time of treatment and at follow-up. The aneurysms were located in the internal carotid artery in 8 patients (33.3%), middle cerebral artery in 8 patients (33.3%), anterior cerebral artery in 1 patient (4%), and vertebrobasilar circulation in 7 patients (29%). The aneurysms were smaller than 10 mm in 3 patients, 10-25 mm in 16 patients, and larger than 25 mm in 5 patients. The mean largest dimension diameter was 18 mm. RESULTS Stent deployment was successful in all cases. The minor procedural morbidity was 4% (1 case). Morbidity and mortality related to aneurysm treatment were 4.2% and 4.2%, respectively. The mean mRS scores preoperatively and at clinical follow-up (median 6.0 months, mean 6.9 months) were 0.71 and 1.2, respectively (91.7% presented with an mRS score of 2 or better, and 79.2% had an mRS score of 2 or better at the 6.0-month follow-up). At clinical follow-up, 82.6% of patients were stable or had improved, 13.0% worsened, and 4.2% had died. Twenty-two (91.7%) of 24 patients had follow-up angiography available (mean follow-up time 6.3 months); 59% had excellent angiographic results (> 95% or complete occlusion), 31.8% had complete aneurysm occlusion, 27.3% had greater than 95% aneurysm occlusion, 18.2% had a moderate decrease in size (50%-95%), 4.5% had a minimal decrease in size (< 50%), 13.6% had not changed, and 4.5% had an increase in size. CONCLUSIONS This series demonstrates that endovascular treatment of fusiform cerebral aneurysms with flow diversion was a safe and effective treatment. Procedural complications were low. Long-term morbidity and mortality rates were acceptable given the complex nature of these lesions.
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Affiliation(s)
- Stephen J Monteith
- Department of Neurological Surgery, Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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