Surpass flow diverter in the treatment of intracranial aneurysms: a prospective multicenter study

BACKGROUND AND PURPOSE

Incomplete occlusion and recanalization of large and wide-neck brain aneurysms treated by endovascular therapy remains a challenge. We present preliminary clinical and angiographic results of an experimentally optimized Surpass flow diverter for treatment of intracranial aneurysms in a prospective, multicenter, nonrandomized, single-arm study.

MATERIALS AND METHODS

At 24 centers, 165 patients with 190 intracranial aneurysms of the anterior and posterior circulations were enrolled. The primary efficacy end point was the percentage of intracranial aneurysms with 100% occlusion on 6-month DSA. The primary safety end point was neurologic death and any stroke through a minimum follow-up of 6 months.

RESULTS

Successful flow-diverter delivery was achieved in 161 patients with 186 aneurysms (98%); the mean number of devices used per aneurysm was 1.05. Clinical follow-up (median, 6 months) of 150 patients (93.2%), showed that the primary safety end point occurred in 18 subjects. Permanent neurologic morbidity and mortality were 6% and 2.7%, respectively. Morbidity occurred in 4% and 7.4% of patients treated for aneurysms of the anterior and posterior circulation, respectively. Neurologic death during follow-up was observed in 1.6% and 7.4% of patients with treated intracranial aneurysms of the anterior and posterior circulation, respectively. Ischemic stroke at ≤30 days, SAH at ≤7 days, and intraparenchymal hemorrhage at ≤7 days were encountered in 3.7%, 2.5%, and 2.5% of subjects, respectively. No disabling ischemic strokes at >30 days or SAH at >7 days occurred. New or worsening cranial nerve deficit was observed in 2.7%. Follow-up angiography available in 158 (86.8%) intracranial aneurysms showed 100% occlusion in 75%.

CONCLUSIONS

Clinical outcomes of the Surpass flow diverter in the treatment of intracranial aneurysms show a safety profile that is comparable with that of stent-assisted coil embolization. Angiographic results showed a high rate of intracranial aneurysm occlusion.

Detached Coil Migration that Assisted Stent Migration, during Stent Assisted Coiling of a Recurrent Aneurysm. A Case Report

This is a pictorial case report of previously unreported intra-procedural complication of an intra-procedural migrated stent-coil complex. It shows fluoroscopic detail of the migration of a stent with the help of a migrated coil with subsequent retrieval of coil and deployment of a second stent proximally. It also briefly covers postulated mechanisms for this in the discussion. In our clinical practice we experienced an unusual case during stent assisted coiling of a right Posterior Communicating Artery Aneurysm (PCOM) where a coil migrated through a deployed stent into the parent artery and become ensnared into a distal stent strut. This caused stent migration distally. Studies have shown that stent assisted coiling of cerebral aneurysms is an effective treatment that lowers the risk of recurrence. There are several complications associated with both coiling and stent deployment. Multiple cases of individual coil migration and stent misplacement have been described in the literature, such as coil protrusion through a stent with open cell designs and a single case of delayed coil migration through a deployed stent. Various aetiologies are described for these, which we cover, and we postulate on the factors relevant to our case and suggest the biggest contributing factor was an open side stent design. We believe this is a rare documented acute case of a migrated coil that has assisted stent migration. We suggest caution particularly when small coils need to be deployed alongside open cell and side design stents.

Embolization of a Wide Neck Giant Basilar Tip Aneurysm Using Two Coils

Pictorial demonstration of aneurysm lumen thrombosis and diversion of flow hemodynamics with the use of a minimum number of coils in the treatment of hemorrhagic basilar tip aneurysm. We present a 62-year-old lady who underwent endovascular treatment for acute subarachnoid hemorrhage due to a giant basilar tip aneurysm and a left carotico-ophthalmic aneurysm. Following deployment of two of the longest available coils, the procedure was terminated due to a sudden change of jet flow within the aneurysm and unsustainable coil and microcatheter positions in spite of further attempts. Post-procedural follow-up angiogram on day 22, revealed an approximately 90% occlusion of the giant basilar tip aneurysm. Significant reduction in flow dynamic by minimum number of coils can achieve remarkable and near complete thrombosis and occlusion of a giant basilar tip aneurysm.

Fibromuscular dysplasia of the middle cerebral artery in an adolescent male. A case report

To illustrate the imaging features of fibromuscular dysplasia (FMD) in this rare presumptive case of FMD in a sixteen year old male with intracranial features only and highlight it as an important cause of stroke in the young. FMD is a non-atheroscelerotic, non-inflammatory vasculopathic arterial disease affecting large and medium size vessels of unknown aetiology. It is a rare cause of paediatric stroke and strokes in young adults. This is a pictorial presentation of an unusual presumptive case of fibromuscular dysplasia (FMD) affecting the middle cerebral artery in a sixteen year old male with classic Digital Subtraction Angiography (DSA) findings. The focal neurological findings and pattern seen on sequential brain scans clearly associates the presence of this vascular lesion to cerebral infarction. Classic imaging findings of the epidemiology, pathology and radiological appearance of FMD are discussed. Emphasis is placed on the patient's imaging presentations including DSA. FMD is a vascular dysplasia that typical affects the renal vasculature and commonly the extracranial internal carotid artery. When a young adult or child presents with stroke FMD should be considered and is more likely to have intracranial features.

Phase-2 study of neoadjuvant chemoradiation in locally advanced rectal adenocarcinoma: The Radio-Xelox study

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Background: Neoadjuvant Radiation treatment has been shown in many studies to decrease the incidence of loco-regional relapse in pts with locally-advanced Rectal Adenocarcinoma. Capecitabine and Oxaliplatin are both effective antineoplastic drugs in Colorectal Adenocarcinoma. They also have radiosensitizing effects. Hence,it is rational to combine these agents in association with radiotherapy,to achieve local controle and prevent systemic spread of the cancer. Methods: Thirty-eight pts with Rectal Adenocarcinoma (T3-T4 and/or N+) received radiation treatment (2.0 Gy, 5days a wk over 5 wks,total dose 50 Gy) plus oral Capecitabine at 600 mg/m2 twice a day and iv Oxaliplatin at 35 mg/m2 once weekly × 5wks. Surgery was performed 6wks post completion of XRT. Our end points were safety/feasibility and response/efficacy as demonstrable by the rate of pathologic complete remission (path-CR). Results: Seven pts (20%) acheived path-CR. Diarrhea was the most important severe adverse effect (in 25% of pts). fourteen pts (40%) showed good regression (very few cancer cells in fibronecrotic tissue Dworak grade 3). The remaining 17 pts showed less favorable regression or no significant change. Conclusions: Preoperative Radiation treatment plus chemotherapy with XELOX regimen is feasible, safe and effective with an impressive rate of path-CR in locoregionally advanced Rectal Adenocarcinoma.

No significant financial relationships to disclose.