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Balci S, Çay F, Uysal A, Arat A. Initial Experience with the New DERIVO ® Mini Embolisation Device for the Treatment of Intracranial Aneurysms. Brain Sci 2024; 14:911. [PMID: 39335406 PMCID: PMC11430613 DOI: 10.3390/brainsci14090911] [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: 06/23/2024] [Revised: 08/30/2024] [Accepted: 09/05/2024] [Indexed: 09/30/2024] Open
Abstract
The aim of this study is to present the outcomes of cerebral aneurysm treatment with the DERIVO® mini Embolisation Device (DMD), which is compatible with microcatheters with 0.021-inch inner diameters. Consecutive patients treated with DMD were identified retrospectively. Patient and aneurysm characteristics, procedural findings, clinical outcomes and follow-up imaging results were evaluated. A total of 44 target aneurysms in 30 patients were treated with DMD. The mean age of the patients was 49.9 (range, 4-77 years). Four patients with five aneurysms presented with acute subarachnoid hemorrhage. The mean aneurysm size was 6.8 mm (range, 1.5-22 mm). In 29 (65.9%) aneurysms, adjunctive devices were used for endovascular treatment. The overall mortality rate was 3.3% and procedure-related mortality was 0%. Overall neurologic morbidity was 6.6% and none of the patients had a permanent sequela secondary to the procedure. The mean clinical follow-up period was 20.9 months (range, 3 days-46 months) and the mean DSA follow-up period was 10.9 months. A total of 37 (84.1%) aneurysms demonstrated total occlusion (Raymond-Roy [RR 1]); 3 (6.8%) aneurysms had a neck remnant or infundibular filling at the origin of the jailed side branch (RR 2), 4 (9.1%) aneurysms had residual aneurysm filling (RR 3). For those aneurysms treated with bare DMD, the total occlusion rate was 73.3% at a mean follow-up of 16.1 months. In this initial clinical single-center experience, DMD had a good safety profile and efficacy comparable with the currently used flow diverters.
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Affiliation(s)
- Sinan Balci
- Department of Radiology, Hacettepe University, 06230 Ankara, Turkey; (S.B.); (F.Ç.); (A.U.)
| | - Ferdi Çay
- Department of Radiology, Hacettepe University, 06230 Ankara, Turkey; (S.B.); (F.Ç.); (A.U.)
| | - Aycan Uysal
- Department of Radiology, Hacettepe University, 06230 Ankara, Turkey; (S.B.); (F.Ç.); (A.U.)
| | - Anil Arat
- Department of Radiology, Hacettepe University, 06230 Ankara, Turkey; (S.B.); (F.Ç.); (A.U.)
- Department of Neurosurgery, Yale University, New Haven, CT 06510, USA
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Liu C, Cai Y, Zang C, Guo K, Hu X. Innovations in intracranial aneurysm treatment: a pilot study on the Choydar flow diverter. Front Neurol 2024; 15:1413681. [PMID: 39026585 PMCID: PMC11254627 DOI: 10.3389/fneur.2024.1413681] [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: 04/07/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024] Open
Abstract
Background The flow diverter (FD) has emerged as a promising treatment option for intracranial aneurysms. Recently, a novel flow-diverting stent, the Choydar FD device, has been developed within our nation. Objective To introduce the newly developed Choydar FD device and present our preliminary clinical experience with its application in the treatment of intracranial aneurysms. Methods A total of 23 patients with 23 unruptured intracranial aneurysms, comprising 20 (87.0%) aneurysms located at the internal carotid artery and 3 (13.0%) at the vertebral artery, were treated with the Choydar FD device between December 2021 and April 2022. Patient baseline data, clinical and angiographic outcomes were collected and analyzed. Results The Choydar FD device was successfully deployed in all patients (100%), with 18 aneurysms (78.3%) additionally treated with coils. One patient experienced an ischemic event with sensory disturbance during the perioperative period. At the 1-year follow-up, all patients demonstrated good clinical outcomes. Of the 23 aneurysms with available angiographic follow-up, 22 (95.7%) achieved complete occlusion, and one patient exhibited in-stent stenosis without neurological deficits. Conclusion The initial clinical results of the Choydar FD device are encouraging, and it appears to be a useful option for treating intracranial aneurysms with acceptable efficacy and safety. Future studies with larger sample sizes and longer follow-up durations are warranted to validate these findings.
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Affiliation(s)
- Changya Liu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yike Cai
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chunguang Zang
- Department of Neurosurgery, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Kaikai Guo
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuebin Hu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Da Ros V, Sabuzi F, D'Argento F, Pedicelli A, Gavrilovic V, Sponza M, Di Giuliano F, Biraschi F, Iacobucci M, Grillea G, Bartolo A, Patassini M, Remida P, Quilici L, Faragò G, Varrassi M, Cavasin N, Arpesani R, Giordano AV, Umana G, Garaci F, Floris R. Midterm follow-up after embolization of intracranial aneurysms proximal to the circle of Willis with the Silk Vista flow diverter: the I-MAMA registry. Neuroradiology 2024; 66:1013-1020. [PMID: 38563963 PMCID: PMC11133109 DOI: 10.1007/s00234-024-03336-9] [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: 09/10/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE The aim of this registry was to assess technical success, procedural safety and mid- to long-term follow-up results of the Silk Vista "Mama" (SVM) flow diverter (BALT, Montmorency, France) for the treatment of proximal intracranial aneurysms. METHODS Between August 2020 and March 2022, data from nine Italian neurovascular centres were collected. Data included patients' clinical presentation, aneurysms' size, location and status, technical details, overall complications and mid- to long-term angiographic follow-up. RESULTS Forty-eight aneurysms in 48 patients were treated using the SVM. Most aneurysms were small (≤ 10 mm: no. 29, 60%) and unruptured (no. 31, 65%); 13 aneurysms were recurrent after coiling or clipping. 37/48 aneurysms involved the internal carotid artery (77%). Optimal opening and complete wall apposition of the device were achieved in 46 out of 48 cases (96%). Four intra- or periprocedural complications occurred (two thrombotic complications successfully resolved, one cerebellar ischemia, one perirenal hematoma), without new neurological deficit. No significant intra-stent stenosis or stent displacement was observed during follow-up. No FD-related morbidity nor mortality was reported. At midterm (6-12 months) to long-term (> 12 months) follow-up, complete aneurysm occlusion (OKM D) was achieved in 76% of cases. Eighty-eight percent of patients had complete aneurysm occlusion or entry remnant (OKM D + C). CONCLUSIONS Our experience suggests that the new generation of low-profile SVM flow diverter for the treatment of proximal intracranial aneurysms is safe and effective, with low rates of intraprocedural complications and acceptable mid- to long-term occlusion rate.
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Affiliation(s)
- Valerio Da Ros
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Federico Sabuzi
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesco D'Argento
- UOSD Neuroradiologia Interventistica, Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Alessandro Pedicelli
- UOSD Neuroradiologia Interventistica, Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Vladimir Gavrilovic
- Division of Vascular and Interventional Radiology, Udine University Hospital, 33100, Udine, Italy
| | - Massimo Sponza
- Division of Vascular and Interventional Radiology, Udine University Hospital, 33100, Udine, Italy
| | - Francesca Di Giuliano
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Biraschi
- Department of Human Neurosciences, Interventional Neuroradiology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Marta Iacobucci
- Department of Human Neurosciences, Interventional Neuroradiology, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Giovanni Grillea
- UOC Di Neuroradiologia Diagnostica E Terapeutica, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, IS, Italy
| | - Andrea Bartolo
- UOC Di Neuroradiologia Diagnostica E Terapeutica, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, IS, Italy
| | - Mirko Patassini
- Struttura Complessa Di Neuroradiologia, Ospedale San Gerardo, ASST, Monza, Italy
| | - Paolo Remida
- Struttura Complessa Di Neuroradiologia, Ospedale San Gerardo, ASST, Monza, Italy
| | - Luca Quilici
- Department of Neuroradiology, AAST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Faragò
- Department of Neuroradiology, AAST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Varrassi
- Radiology Department, S. Salvatore Hospital, L'Aquila, Italy
| | - Nicola Cavasin
- Neuroradiologia, Ospedale Dell'Angelo Mestre, Venice, Italy
| | - Roberto Arpesani
- Interventional Radiology Unit, Spedali Riuniti Di Livorno, Livorno, Italy
| | | | - Giuseppe Umana
- Department of Neurosurgery, Cannizzaro Hospital, Catania, Italy
| | - Francesco Garaci
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Floris
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Jun YJ, Hwang DK, Lee HS, Kim BM, Park KD. Flow Diverter Performance Comparison of Different Wire Materials for Effective Intracranial Aneurysm Treatment. Bioengineering (Basel) 2024; 11:76. [PMID: 38247953 PMCID: PMC10813681 DOI: 10.3390/bioengineering11010076] [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: 11/28/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
A flow diverter (FD) is an effective method for treating wide-necked intracranial aneurysms by inducing hemodynamic changes in aneurysms. However, the procedural technique remains challenging, and it is often not performed properly in many cases of deployment or placements. In this study, three types of FDs that changed the material of the wire were prepared within the same structure. Differences in physical properties, such as before and after delivery loading stent size, radial force, and radiopacity, were evaluated. The performances in terms of deployment and trackability force were also evaluated in a simulated model using these FDs. Furthermore, changes of deployment patterns when these FDs were applied to a 3D-printed aneurysm model were determined. The NiTi FD using only nitinol (NiTi) wire showed 100% size recovery and 42% to 45% metal coverage after loading. The low trackability force (10.9 to 22.9 gf) allows smooth movement within the delivery system. However, NiTi FD cannot be used in actual surgeries due to difficulties in X-ray identification. NiTi-Pt/W FD, a combination of NiTi wire and platinum/tungsten (Pt/W) wire, had the highest radiopacity and compression force (6.03 ± 0.29 gf) among the three FDs. However, it suffered from high trackability force (22.4 to 39.9 gf) and the end part braiding mesh tended to loosen easily, so the procedure became more challenging. The NiTi(Pt) FD using a platinum core nitinol (NiTi(Pt)) wire had similar trackability force (11.3 to 22.1 gf) to NiTi FD and uniform deployment, enhancing procedural convenience. However, concerns about low expansion force (1.79 ± 0.30 gf) and the potential for migration remained. This comparative analysis contributes to a comprehensive understanding of how different wire materials influence the performance of FDs. While this study is still in its early stages and requires further research, its development has the potential to guide clinicians and researchers in optimizing the selection and development of FDs for the effective treatment of intracranial aneurysms.
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Affiliation(s)
- Yeo Jin Jun
- Taewoong Medical, 14, Gojeong-ro, Wolgot-myeon, Gimpo-si 10022, Republic of Korea; (Y.J.J.); (D.K.H.); (H.S.L.)
- Department of Molecular Science and Technology, Ajou University, 206, World Cup-ro, Yeongtong-gu, Suwon-si 16499, Republic of Korea
| | - Doo Kyung Hwang
- Taewoong Medical, 14, Gojeong-ro, Wolgot-myeon, Gimpo-si 10022, Republic of Korea; (Y.J.J.); (D.K.H.); (H.S.L.)
| | - Hee Sun Lee
- Taewoong Medical, 14, Gojeong-ro, Wolgot-myeon, Gimpo-si 10022, Republic of Korea; (Y.J.J.); (D.K.H.); (H.S.L.)
| | - Byung Moon Kim
- Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea;
| | - Ki Dong Park
- Department of Molecular Science and Technology, Ajou University, 206, World Cup-ro, Yeongtong-gu, Suwon-si 16499, Republic of Korea
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Ferreira T, Awuah WA, Tan JK, Adebusoye FT, Ali SH, Bharadwaj HR, Aderinto N, Fernandes C, Zahid MJ, Abdul-Rahman T. The current landscape of intracranial aneurysms in Africa: management outcomes, challenges, and strategies-a narrative review. Neurosurg Rev 2023; 46:194. [PMID: 37548805 DOI: 10.1007/s10143-023-02102-4] [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: 06/19/2023] [Revised: 07/19/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
Intracranial aneurysms (IAs) pose complex and potentially life-threatening challenges in Africa, where limited resources, restricted access to specialised healthcare facilities, and disparities in healthcare provision amplify the difficulties of management. Timely diagnosis and treatment are pivotal in preventing complications, including subarachnoid haemorrhage. Treatment options encompass observation, surgical clipping, endovascular coiling, and flow diversion. Positive outcomes observed in IA management in Africa include high survival rates, favourable functional outcomes, successful treatment techniques, and the absence of complications in some cases. However, negative outcomes such as postoperative complications, reduced quality of life, perioperative mortality, and the risk of recurrence persist. Challenges in IA management encompass limited access to diagnostic tools, a scarcity of specialised healthcare professionals, and an unequal distribution of services. Addressing these challenges requires interventions focused on improving access to diagnostic tools, expanding the number of trained professionals, and establishing specialised IA treatment centres. Collaboration, research, and capacity-building efforts hold significant importance in improving patient outcomes and reducing disparities in IA management across Africa.
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Affiliation(s)
- Tomas Ferreira
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Wireko Andrew Awuah
- Faculty of Medicine, Sumy State University, Sanatorna St, 31, Sumy, Sumy Oblast, 40000, Ukraine
| | | | - Favour Tope Adebusoye
- Faculty of Medicine, Sumy State University, Sanatorna St, 31, Sumy, Sumy Oblast, 40000, Ukraine.
| | - Syed Hasham Ali
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Nicholas Aderinto
- Internal Medicine Department, LAUTECH Teaching Hospital, Oyo, Nigeria
| | | | | | - Toufik Abdul-Rahman
- Faculty of Medicine, Sumy State University, Sanatorna St, 31, Sumy, Sumy Oblast, 40000, Ukraine
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