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Chlorogiannis DD, Aloizou AM, Chlorogiannis A, Kosta N, Sänger JA, Chatziioannou A, Papanagiotou P. Exploring the latest findings on endovascular treatments for giant aneurysms: a review. Rev Neurosci 2024; 35:451-461. [PMID: 38158880 DOI: 10.1515/revneuro-2023-0082] [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: 08/02/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Abstract
Giant intracranial aneurysms represent a very challenging aspect of aneurysmal pathophysiology with very high mortality and morbidity if left untreated. Their variety in clinical presentation (subarachnoid hemorrhage, cranial nerve palsy, etc.) and pathological and imaging properties (location, anatomy, presence of collateral circulation) pose serious questions regarding the best treatment option. Admirable advances have been achieved in surgical techniques, while endovascular modalities with flow diversion techniques have become widely used. However, there is still lack of data regarding whether a single endovascular technique can be the universal treatment for such cases. In this review, we aim to summarize the current funds of knowledge concerning giant intracranial aneurysms and the role of endovascular management in their treatment.
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Affiliation(s)
| | - Athina-Maria Aloizou
- Department of Neurology, St. Josef-Hospital, Ruhr Universität Bochum, 44791Bochum, Germany
| | - Anargyros Chlorogiannis
- Department of Health Economics, Policy and Management, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Nefeli Kosta
- Department of Biology, University of Patras, 265 04 Patras, Greece
| | | | - Achilles Chatziioannou
- First Department of Radiology, School of Medicine, National & Kapodistrian University of Athens, Areteion Hospital, 115 28 Athens, Greece
| | - Panagiotis Papanagiotou
- First Department of Radiology, School of Medicine, National & Kapodistrian University of Athens, Areteion Hospital, 115 28 Athens, Greece
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, 28205 Bremen, Germany
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Çay F, Arat A. Appraisal of the Flow Diversion Effect Provided by Braided Intracranial Stents. J Clin Med 2024; 13:3409. [PMID: 38929937 PMCID: PMC11204822 DOI: 10.3390/jcm13123409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/01/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Objective: Comparison of the results of stent-assisted coiling (SAC) with braided stents (BS), flow diverters (FD), and laser-cut stents (LCS) to determine the relative flow-diverting capacity of BS (Leo baby and Accero). Methods: Saccular intracranial aneurysms treated by SAC and FD-assisted coiling were retrospectively evaluated. Aneurysm occlusion, as graded per Raymond-Roy score, was categorized as either recanalization/stable residual filling (Group A; lacking a flow diversion effect) or stable/progressive occlusion (Group B with a "flow diversion effect"). Factors predicting the flow diversion effect were evaluated. Results: Of the 194 aneurysms included, LCS, BS, and FD were used in 70 (36.1%), 86 (44.3%), and 38 (19.6%) aneurysms, respectively. Aneurysms treated by FD were larger, had wider necks, and were located on larger parent arteries (p < 0.01, 0.02, and <0.01, respectively). The mean imaging follow-up duration was 24.5 months. There were 29 (14.9%) aneurysms in Group A and 165 (85.1%) in Group B. Among a spectrum of variables, including sex, age, aneurysm size, neck width, parent artery diameter, follow-up duration, and stent type, the positive predictors for stable/progressive aneurysm occlusion were aneurysm size and placement of an FD or BS (p < 0.01 and p < 0.01, respectively, and were positive predictors over LCS: ORs 6.34 (95% CI: 1.62-24.76) and 3.11 (95% CI: 1.20-8.07), respectively) in multivariate analysis. Conclusions: The placement of BS was a predictor of flow diversion over laser-cut stents. However, the flow diversion effect was approximately half that of FDs, suggesting that BS may only be considered to have some (partial) flow diversion effects.
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Affiliation(s)
- Ferdi Çay
- Department of Radiology, Hacettepe University School of Medicine, Hacettepe Mh., A.Adnan Saygun Cd., Ankara 06230, Türkiye;
| | - Anıl Arat
- Department of Radiology, Hacettepe University School of Medicine, Hacettepe Mh., A.Adnan Saygun Cd., Ankara 06230, Türkiye;
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06520, USA
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Mantilla D, D Vera D, Ortiz AF, Piergallini L, Lara JJ, Nicoud F, Vargas O, Costalat V. Optimizing Patient Care: A Multicentric Study on the Clinical Impact of Sim&Size™ Simulation Software in Intracranial Aneurysm Treatment With Pipeline Embolization Devices. World Neurosurg 2024; 185:e1199-e1206. [PMID: 38508386 DOI: 10.1016/j.wneu.2024.03.052] [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: 10/07/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND To determine the clinical effects (stent size, and number of stents used) of the Sim&Size™ simulation software on the endovascular treatment of unruptured saccular intracranial aneurysms with Pipeline Embolization Devices (PED). METHODS This study is a retrospective analytical multicenter study of patients treated with PED (Flex and Flex with SHIELD) for intracranial aneurysm in FOSCAL clinic and CHU de Montpellier. RESULTS The study included 253 patients, of which 75 were treated in Colombia and 178 were treated in France. The majority of patients were women (83.8%), with a median age of 57.48 years, and had large vessel location (88.1%), with most aneurysms located in the ICA paraclinoid segment (56.8%). Patients in the group with Sim&Size™ simulation had shorter stents than those without simulation (15.62 mm versus 17.36 mm, P-value = 0.001). Also, a lower proportion of these patients required more than one stent (1.4% versus 7.3%, P-value = 0.022). There were 7 complications reported in the group that used the Sim&Size™ simulation software, compared to 9 complications in the group that did not use the software. CONCLUSIONS Using Sim&Size™ simulation software for endovascular treatment of patients with intracranial aneurysms using PED reduces the stent length and decreasing the number of devices needed per treatment.
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Affiliation(s)
- Daniel Mantilla
- Interventional radiology Department, Fundación oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia; Interventional radiology Department, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia; Neuroradiology, Hôpital Güi-de-Chauliac, CHU de Montpellier, Montpellier, France
| | - Daniela D Vera
- Interventional radiology Department, Fundación oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia.
| | - Andrés Felipe Ortiz
- Interventional radiology Department, Fundación oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia; Interventional radiology Department, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | | | - Juan José Lara
- Interventional radiology Department, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Franck Nicoud
- Institut Montpelliérain Alexander, Grothendieck, CNRS, Univ. Montpellier, Montpellier, France
| | - Oliverio Vargas
- Interventional radiology Department, Fundación oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia; Interventional radiology Department, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Vincent Costalat
- Neuroradiology, Hôpital Güi-de-Chauliac, CHU de Montpellier, Montpellier, France
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Korte J, Marsh LMM, Saalfeld S, Behme D, Aliseda A, Berg P. Fusiform versus Saccular Intracranial Aneurysms-Hemodynamic Evaluation of the Pre-Aneurysmal, Pathological, and Post-Interventional State. J Clin Med 2024; 13:551. [PMID: 38256685 PMCID: PMC11154261 DOI: 10.3390/jcm13020551] [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: 11/25/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Minimally-invasive therapies are well-established treatment methods for saccular intracranial aneurysms (SIAs). Knowledge concerning fusiform IAs (FIAs) is low, due to their wide and alternating lumen and their infrequent occurrence. However, FIAs carry risks like ischemia and thus require further in-depth investigation. Six patient-specific IAs, comprising three position-identical FIAs and SIAs, with the FIAs showing a non-typical FIA shape, were compared, respectively. For each model, a healthy counterpart and a treated version with a flow diverting stent were created. Eighteen time-dependent simulations were performed to analyze morphological and hemodynamic parameters focusing on the treatment effect (TE). The stent expansion is higher for FIAs than SIAs. For FIAs, the reduction in vorticity is higher (Δ35-75% case 2/3) and the reduction in the oscillatory velocity index is lower (Δ15-68% case 2/3). Velocity is reduced equally for FIAs and SIAs with a TE of 37-60% in FIAs and of 41-72% in SIAs. Time-averaged wall shear stress (TAWSS) is less reduced within FIAs than SIAs (Δ30-105%). Within this study, the positive TE of FDS deployed in FIAs is shown and a similarity in parameters found due to the non-typical FIA shape. Despite the higher stent expansion, velocity and vorticity are equally reduced compared to identically located SIAs.
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Affiliation(s)
- Jana Korte
- Department of Fluid Dynamics and Technical Flows, University of Magdeburg, 39106 Magdeburg, Germany
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany; (L.M.M.M.); (S.S.); (D.B.); (P.B.)
| | - Laurel M. M. Marsh
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany; (L.M.M.M.); (S.S.); (D.B.); (P.B.)
- Department of Mechanical Engineering, George Mason University, Fairfax, VA 22030, USA
| | - Sylvia Saalfeld
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany; (L.M.M.M.); (S.S.); (D.B.); (P.B.)
- Department of Computer Science and Automation, Ilmenau University of Technology, 98693 Ilmenau, Germany
| | - Daniel Behme
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany; (L.M.M.M.); (S.S.); (D.B.); (P.B.)
- University Hospital Magdeburg, University of Magdeburg, 39106 Magdeburg, Germany
| | - Alberto Aliseda
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA;
| | - Philipp Berg
- Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany; (L.M.M.M.); (S.S.); (D.B.); (P.B.)
- Department of Medical Engineering, University of Magdeburg, 39106 Magdeburg, Germany
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