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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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Li T, Shi S, Chen Q, Jiang C, Feng W, Tian Q, Long S, Wei Z, Yang J, Wang Y, Ren J, Han X, Ma J. Use of the Neuroform Atlas Stent or LVIS Jr Stent for Treatment of Unruptured Intracranial Aneurysms in Parent Arteries of <2 mm in Diameter: A Multicenter Experience. AJNR Am J Neuroradiol 2024; 45:899-905. [PMID: 38871372 PMCID: PMC11286018 DOI: 10.3174/ajnr.a8238] [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: 11/14/2023] [Accepted: 02/11/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND AND PURPOSE The Neuroform Atlas stent and the LVIS Jr stent are intracranial microstent systems for the treatment of wide-neck intracranial aneurysms. Hence, this study aimed to compare the efficacy and safety of the Neuroform Atlas stent and the LVIS Jr stent for the treatment of unruptured intracranial aneurysms in parent arteries of <2 mm in diameter. MATERIALS AND METHODS From March 2022 to April 2023, the clinical and imaging data of 135 patients with unruptured intracranial aneurysms treated with stent-assisted coiling using the Neuroform Atlas or LVIS Jr stent in parent arteries of <2 mm in diameter were retrospectively analyzed. Stent apposition was evaluated by high-resolution conebeam CT (HR-CBCT). Immediate aneurysm-embolization attenuation and occlusion at 6-month follow-up were evaluated using 2D DSA and the modified Raymond-Roy classification. Adverse events were recorded. Multivariate logistic regression analysis was undertaken to determine the independent factors affecting incomplete stent apposition. RESULTS One hundred thirty-five patients (135 aneurysms) underwent stent-assisted coiling (66 Neuroform Atlas stents and 69 LVIS Jr stents). Intraoperative HR-CBCT showed that 1 Neuroform Atlas stent and 11 LVIS Jr stents had incomplete stent apposition at the aneurysm neck (P < .05). Perioperative complications occurred in 3 cases (2.22%). These comprised 2 cases of neurologic complications (1 case of distal intracranial vascular embolism and 1 case of cerebral parenchymal hemorrhage) and 1 case of severe postprocedural gastrointestinal hemorrhage. DSA follow-up showed 3 cases of aneurysm recurrence in the LVIS Jr group. Multivariate regression analysis showed that a stent angle of ≥75° (OR, 23.963; P = .005) or a parent artery diameter mismatch ratio of ≥1.25 (OR, 8.043; P = .037) were risk factors for incomplete stent apposition, especially for the LVIS Jr stent (OR, 20.297; P = .015). CONCLUSIONS The Neuroform Atlas stent and LVIS Jr stent are efficacious in the treatment of unruptured intracranial aneurysms in parent arteries of <2 mm in diameter. Apposition of the LVIS Jr stent was worse than in the Neuroform Atlas stent at the neck of some aneurysms.
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Affiliation(s)
- Tengfei Li
- From the Department of Interventional Radiology (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Interventional Institute of Zhengzhou University (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), Zhengzhou, China
| | - Shuailong Shi
- From the Department of Interventional Radiology (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Interventional Institute of Zhengzhou University (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), Zhengzhou, China
| | - Qingliang Chen
- Department of Interventional Radiology (Q.C.), The Third People's Hospital of Henan Province, Zhengzhou, China
| | - Chao Jiang
- Department of Neurology (C.J.), The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenxian Feng
- Department of Interventional Radiology (W.F.), Zhumadian Central Hospital, Zhumadian, China
| | - Qi Tian
- From the Department of Interventional Radiology (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Interventional Institute of Zhengzhou University (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), Zhengzhou, China
| | - Shuhai Long
- From the Department of Interventional Radiology (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Interventional Institute of Zhengzhou University (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), Zhengzhou, China
| | - Zhuangzhuang Wei
- From the Department of Interventional Radiology (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Interventional Institute of Zhengzhou University (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), Zhengzhou, China
| | - Jie Yang
- From the Department of Interventional Radiology (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Interventional Institute of Zhengzhou University (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), Zhengzhou, China
| | - Ye Wang
- From the Department of Interventional Radiology (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Interventional Institute of Zhengzhou University (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), Zhengzhou, China
| | - Jianzhuang Ren
- From the Department of Interventional Radiology (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Interventional Institute of Zhengzhou University (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), Zhengzhou, China
| | - Xinwei Han
- From the Department of Interventional Radiology (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Interventional Institute of Zhengzhou University (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), Zhengzhou, China
| | - Ji Ma
- From the Department of Interventional Radiology (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Interventional Institute of Zhengzhou University (T.L., S.S., Q.T., S.L., Z.W., JY., Y.W., J.R., X.H., J.M.), Zhengzhou, China
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Long S, Shi S, Tian Q, Wei Z, Ma J, Wang Y, Yang J, Han X, Li T. Correlation of Flow Diverter Malapposition at the Aneurysm Neck with Incomplete Aneurysm Occlusion in Patients with Small Intracranial Aneurysms: A Single-Center Experience. AJNR Am J Neuroradiol 2023; 45:16-21. [PMID: 38164561 PMCID: PMC10756576 DOI: 10.3174/ajnr.a8079] [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: 08/06/2023] [Accepted: 10/29/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND PURPOSE Flow diversion treatment repairs aneurysms by altering the hemodynamics of the aneurysmal sac and providing a scaffold for endothelial cell adhesion. The purpose of this study was to investigate the correlation of flow diverter (FD) malapposition at the aneurysm neck with incomplete occlusion of small intracranial aneurysms (IAs) and investigate other factors that are possibly related to incomplete occlusion. MATERIALS AND METHODS From January 2019 to June 2022, the clinical and imaging data for 153 patients (175 aneurysms) with unruptured small IAs treated with flow diversion were retrospectively analyzed. FD apposition at the aneurysm neck was evaluated by high-resolution conebeam CT (HR-CBCT), and the complete occlusion rate for aneurysms was judged according to the latest follow-up conventional angiography findings (≥6 months). Multivariate logistic regression analysis was used to determine factors associated with incomplete aneurysm occlusion. RESULTS In total, 159 FDs were implanted in 153 patients. HR-CBCT performed after the deployment revealed FD malapposition at the aneurysm neck in 18 cases. According to the latest follow-up angiograms (average: 9.47 ± 3.35 months), the complete aneurysm occlusion rate was 66.9%. The complete occlusion rates for incomplete and complete stent apposition at the neck were 38.9% (7/18) and 70.1% (110/157), respectively. The results of regression analysis showed that an aneurysm sac with branch vessels (OR, 2.937; P = .018), incomplete stent apposition at the aneurysm neck (OR, 3.561; P = .023), and a large aneurysm diameter (OR, 1.533; P = .028) were positive predictors of incomplete aneurysm occlusion. CONCLUSIONS An aneurysm sac with branch vessels, a large aneurysm diameter, and malapposition at the aneurysm neck significantly affect aneurysm repair after FD stent-only treatment for small IAs.
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Affiliation(s)
- Shuhai Long
- From the Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuailong Shi
- From the Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qi Tian
- From the Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhuangzhuang Wei
- From the Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ji Ma
- From the Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ye Wang
- From the Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie Yang
- From the Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- From the Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tengfei Li
- From the Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Ishikawa K, Izumi T, Nishihori M, Imaizumi T, Goto S, Suzuki K, Yokoyama K, Kanamori F, Uda K, Araki Y, Saito R. Clinical Efficiency of an Artificial Intelligence-Based 3D-Angiography for Visualization of Cerebral Aneurysm: Comparison with the Conventional Method. Clin Neuroradiol 2023; 33:1143-1150. [PMID: 37400735 DOI: 10.1007/s00062-023-01325-8] [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: 04/10/2023] [Accepted: 05/31/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE Artificial intelligence (AI)-based three-dimensional angiography (3D-A) was reported to demonstrate visualization of cerebral vasculature equivalent to that of three-dimensional digital subtraction angiography (3D-DSA). However, the applicability and efficacy of the AI-based 3D‑A algorithm have not yet been investigated for 3D-DSA micro imaging. In this study, we evaluated the usefulness of the AI-based 3D‑A in 3D-DSA micro imaging. MATERIALS AND METHODS The 3D-DSA micro datasets of 20 consecutive patients with cerebral aneurysm (CA) were reconstructed with 3D-DSA and 3D‑A. Three reviewers compared 3D-DSA and 3D‑A in terms of qualitative parameters (degrees of visualization of CA and the anterior choroidal artery [AChA]) and quantitative parameters (aneurysm diameter, neck diameter, parent vessel diameter, and visible length of AChA). RESULTS Qualitative evaluation of diagnostic potential revealed that visualization of CA and the proximal to middle parts of the AChA with 3D‑A was equal to that with conventional 3D-DSA; in contrast, visualization of the distal part of the AChA was lower with 3D‑A than with 3D-DSA. Further, regarding quantitative evaluation, the aneurysm diameter, neck diameter, and parent vessel diameter were comparable between 3D‑A and 3D-DSA; in contrast, the visible length of the AChA was lower with 3D‑A than with 3D-DSA. CONCLUSIONS The AI-based 3D‑A technique is feasible and evaluable visualization of cerebral vasculature with respect to quantitative and qualitative parameters in 3D-DSA micro imaging. However, the 3D‑A technique offers lower visualization of such as the distal portion of the AChA than 3D-DSA.
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Affiliation(s)
- Kojiro Ishikawa
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan.
| | - Masahiro Nishihori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan
| | - Takahiro Imaizumi
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Shunsaku Goto
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan
| | - Keita Suzuki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan
| | - Kinya Yokoyama
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan
| | - Fumiaki Kanamori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan
| | - Kenji Uda
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya University, 65 Tsurumaicho, Syowa-ku, Nagoya, Japan
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Kawasaki T, Kikuchi T, Otani K, Mitsuno Y, Yamao Y, Sawamoto N, Takahashi R, Miyamoto S. Intraoperative cone-beam CT with metal artifact reduction for assessment of the electrode position and the intracranial structures during deep brain stimulation procedure. Acta Neurochir (Wien) 2022; 164:2309-2316. [PMID: 35851925 DOI: 10.1007/s00701-022-05313-8] [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: 12/28/2021] [Accepted: 07/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND In deep brain stimulation (DBS) for Parkinson's disease (PD), the clinical outcome largely depends on the appropriate position of the electrode implanted in the targeted structure. In intraoperative cone-beam computed tomography (CT) performed for the evaluation of the electrode position, the metal artifact induced by the implanted electrode can prevent the precise localization of the electrode. Metal artifact reduction (MAR) techniques have been recently developed that can dramatically improve the visualization of objects by reducing metal artifacts after performing cone-beam CT. Hence, in this case series, we attempted to clarify the usefulness and accuracy of intraoperative cone-beam CT with MAR (intraCBCTwM) by comparing with both intraoperative cone-beam CT without MAR (intraCBCTwoM) and conventional postoperative CT (post-CT) for the assessment of the implanted electrode position and the intracranial structures during DBS procedures. METHODS Between November 2019 and December 2020, 10 patients with PD who underwent DBS at our institution were recruited, and the images of 9 patients (bilateral: n = 8, unilateral: n = 1) were analyzed. The artifact index (AI) in intraCBCTwM or intraCBCTwoM, and conventional post-CT were retrospectively assessed using the standard deviation of the region-of-interest around the implanted electrodes and background noise. Additionally, the Euclidean distances gap of electrode tip based on post-CT in each fusion image was compared between intraCBCTwM and intraCBCTwoM. RESULTS The AI was significantly lower in intraCBCTwM than in intraCBCTwoM (P < 0.01). The mean Euclidean distance between the tip of the electrode in intraCBCTwM and in post-CT was significantly shorter compared to that in intraCBCTwoM (P < 0.05). CONCLUSIONS The results reported here suggest that intraCBCTwM is a more useful and accurate method than intraCBCTwoM to assess the implanted electrode position and intracranial structures during DBS.
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Affiliation(s)
- Toshinari Kawasaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Shogoinn Kawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan.,Department of Neurosurgery, Otsu City Hospital, Shiga, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Shogoinn Kawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan.
| | | | - Yuto Mitsuno
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Shogoinn Kawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Yukihiro Yamao
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Shogoinn Kawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Nobukatsu Sawamoto
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Shogoinn Kawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
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Yoon HG, Ko Y, Kim YS, Bak KH, Chun HJ, Na MK, Yang S, Yi HJ, Choi KS. Efficacy of 3D-Printed Titanium Mesh-Type Patient-Specific Implant for Cranioplasty. Korean J Neurotrauma 2021; 17:91-99. [PMID: 34760819 PMCID: PMC8558026 DOI: 10.13004/kjnt.2021.17.e25] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/20/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Autologous bone grafting for cranioplasty is associated with a high infection rate and bone absorption. Synthetic implant materials for cranioplasty have been developed. In this study, we evaluated the efficacy of titanium mesh-type patient-specific implants (PSIs) for patients with skull defects using the dice similarity coefficient (DSC), clinical outcomes, and artifacts caused by implants. Methods This retrospective study included 40 patients who underwent cranioplasty with a titanium mesh PSI at our institution. Based on preoperative and postoperative computed tomography scans, we calculated DSC and artifacts. Results The calculated DSC of 40 patients was 0.75, and the noise was 13.89% higher in the region of interest (ROI) near the implanted side (average, 7.64 hounsfield unit [HU]±2.62) than in the normal bone (average, 6.72 HU±2.35). However, the image signal-to-noise ratio did not significantly differ between the ROI near the implanted side (4.77±1.78) and normal bone (4.97±1.88). The patients showed no significant perioperative complications that required a secondary operation. Conclusion Titanium mesh-type PSIs for cranioplasty have excellent DSC values with lower artifacts and complication rates.
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Affiliation(s)
- Hong-Gyu Yoon
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Yong Ko
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Young-Soo Kim
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Koang-Hum Bak
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyoung-Joon Chun
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Min-Kyun Na
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
| | | | - Hyeong-Joong Yi
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
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Li T, Wang Y, Ma J, Levitt M, Mossa-Basha M, Shi C, Ran Y, Ren J, Han X, Zhu C. Application of High-Resolution Flat Detector Computed Tomography in Stent Implantation for Intracranial Atherosclerotic Stenosis. Front Neurosci 2021; 15:655594. [PMID: 34512235 PMCID: PMC8429824 DOI: 10.3389/fnins.2021.655594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate the utility of high-resolution flat-detector computed tomography (HR-FDCT) compared with conventional flat-detector computed tomography (FDCT) for stent placement in symptomatic intracranial atherosclerotic stenosis (ICAS). Methods We retrospectively reviewed the clinical data of 116 patients with symptomatic ICAS who underwent stent implantation. Images were acquired using conventional FDCT [voxel size = 0.43 mm (isotropic)] and HR-FDCT [voxel size = 0.15 mm (isotropic)]. Immediately after stent deployment, dual-volume three-dimensional (3D) fusion images were obtained from 3D digital subtraction angiography (DSA) and HR-FDCT. The image quality for stent visualization was graded from 0 to 2 (0: not able to assess; 1: limited, but able to assess; 2: clear visualization), and the stent-expansion status (“full,” “under-expanded” or “poor apposition”) was recorded. Results A total of 116 patients with symptomatic ICAS were treated successfully using 116 stents (58 NeuroformTM EZ, 42 EnterpriseTM, and 16 ApolloTM). The mean pre-stent stenosis was 80.5 ± 6.4%, which improved to 20.8 ± 6.9% after stenting. Compared with FDCT, HR-FDCT improved visualization of the fine structures of the stent to improve the image quality that significantly (mean score: 1.63 ± 0.60 vs. 0.41 ± 0.59, P < 0.001). In 19 patients, stent under-expansion (n = 11) or poor apposition (n = 8) was identified by HR-FDCT but not by conventional FDCT. After balloon dilatation, stent malapposition was shown to have improved on HR-FDCT. None of the 19 patients with stent malapposition experienced short-term complications during hospitalization or had in-stent stenosis at 6-month follow-up. Conclusion High-resolution flat-detector computed tomography (HR-FDCT) improves visualization of the fine structures of intracranial stents deployed for symptomatic ICAS compared with that visualized using conventional FDCT. High-resolution flat-detector computed tomography improves assessment of stent deployment and could reduce the risk of complications.
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Affiliation(s)
- Tengfei Li
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Yuting Wang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Ji Ma
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Michael Levitt
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - Chengcheng Shi
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Yuncai Ran
- Department of Magnetic Resonance, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianzhuang Ren
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, United States
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