1
|
Tong X, Han M, Wu Z, Feng X, Liu A. Effects of different stent size selection on pipeline embolization device treatment of intracranial aneurysms. Ther Adv Neurol Disord 2023; 16:17562864231151475. [PMID: 36776531 PMCID: PMC9909058 DOI: 10.1177/17562864231151475] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/29/2022] [Indexed: 02/09/2023] Open
Abstract
Background Pipeline embolization device (PED) is becoming increasingly common in therapeutic practice. In idealized model studies, treatment effectiveness may vary with different stent sizes in the same vasculature. The true effect of stent size selection in the clinical setting remains unknown, however. Objective To determine the true effect of stent size selection in the clinical setting. Design It is a retrospective review. Methods A retrospective review was conducted on consecutive patients with aneurysms treated with a PED at our institution. The primary exposures were the difference between the diameter of the stent and the parent artery (DD) and the difference between the length of the stent and the aneurysm neck (DL). The outcomes were the clinical and angiographic results, perioperative complications, balloon application, and in-stent stenosis. The results were generated using univariable and multivariable logistic regression and restricted cubic spline (RCS) curves. Results A larger DD was significantly associated with incomplete occlusion [odds ratio (OR) = 2.37; 95% confidence interval (CI) = 1.43-3.98; p < 0.001], while a larger DL was significantly associated with balloon application (OR = 1.12; 95% CI = 1.02-1.23; p = 0.021) and in-stent stenosis (>25%) (OR = 1.07; 95% CI = 1.01-1.16; p = 0.042). The RCS curve indicated that the risk of incomplete occlusion increased as the DD became larger, the possibility of balloon application increased as the DL increased when the DL was >5.7 mm, and the risk of in-stent stenosis (>25%) increased as the DL increased. Conclusion In the clinical setting, stent selection was associated with treatment effectiveness and may add to the treatment burden. These occurrences should be considered for aneurysms treated with PED.
Collapse
Affiliation(s)
| | | | - Zhongxue Wu
- Neurointerventional Center, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital University, Beijing, China
| | - Xin Feng
- Neurosurgery Center, Department of Cerebrovascular Surgery, Engineering Technology Research Center of Education Ministry of China on Diagnosis and Treatment of Cerebrovascular Disease, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China,Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Guangzhou, China
| | | |
Collapse
|
2
|
Flores-Milan G, Pressman E, Peto I, Ren Z, Guerrero WR, Mokin M. Factors associated with in-stent stenosis after cerebral aneurysm embolization using a Pipeline embolization device. Interv Neuroradiol 2022; 28:731-736. [PMID: 34894820 PMCID: PMC9706256 DOI: 10.1177/15910199211066368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Flow-diverting (FD) stents, with or without coiling, are a mainstay in endovascular treatment of intracranial aneurysms (IAs). One observed complication from flow diverter stent (FDS) insertion has been in-stent stenosis. Though previously studied in the short-term period, the long-term history of this complication has yet to be described. METHODS We performed a retrospective cohort study of consecutive IAs treated with Pipeline Embolization Device (PED), with or without coiling, at our centre between September 2014 and December 2018 that had at least one digital subtraction angiogram (DSA) during follow-up. In-stent stenosis was measured from DSA images, and associated patient and procedural characteristics were analysed. RESULTS 94 patients treated with PED for IA were identified. On initial DSA during follow-up, 52 patients (55.3%) had in-stent stenosis within the PED. Of these 52 patients, 17 had a second DSA during follow-up. In this 2nd DSA, improvement and/or stable in-stent stenosis was seen 16 patients (94.1%). One patient in this group had worsening in-stent stenosis had a vertebrobasilar junction FD stent. Of the patients without in-stent stenosis on initial DSA, 15 had a second DSA during follow-up. Only one of these patients (6.7%) had new appearance of in-stent stenosis (measuring 5%). Multivariate analysis found statin use to be predictive of in-stent stenosis (p = 0.020, Odds ratio = 0.279 and 95% confidence interval = 0.095-0.821). CONCLUSIONS In-stent stenosis after FDS placement was seen in 53.2% of cases, which had between 1-50% of stenosis. 82.4% had resolution/improvement of their stenosis. Statin use was protective of in-stent stenosis.
Collapse
Affiliation(s)
- Gabriel Flores-Milan
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Elliot Pressman
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Ivo Peto
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Zeguang Ren
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Waldo R. Guerrero
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
- Neurosciences Group, Tampa General Hospital, Tampa, FL, USA
| | - Maxim Mokin
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
- Neurosciences Group, Tampa General Hospital, Tampa, FL, USA
| |
Collapse
|
3
|
Haase T, Speck U, Bienek S, Löchel M, Brunacci N, Gemeinhardt O, Schütt D, Bettink S, Kelsch B, Scheller B, Schnorr B. Drug-Coated Balloons: Drugs Beyond Paclitaxel? FRONT BIOSCI-LANDMRK 2022; 27:283. [PMID: 36336862 DOI: 10.31083/j.fbl2710283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although controversially discussed, paclitaxel is the only clinically proven drug that inhibits restenosis when released from drug-coated balloons (DCBs). Limus drugs are currently being explored as alternatives. The aim of the preclinical studies was to investigate drug candidates beyond paclitaxel considered for balloon coating. METHODS Drugs were tested with respect to dissolution in organic solvents, coating on balloons, and drug transfer to the vessel wall. Inhibition of neointimal proliferation was tested in the porcine model of coronary in-stent stenosis. Intravascular drug treatment was achieved by DCBs at the time of stent implantation. RESULTS Coating had to be adjusted for each drug. Doses on the balloons ranged from 1.0 to 8.6 μg/mm2 balloon surface. Satisfactory amounts of drug ranging from 5% to 29% of initial doses were transferred into the vessel wall. Angiographic parameters such as late lumen loss (LLL) at 4 weeks did not show reduction of in-stent neointimal proliferation by treatment with arsenic trioxide (0.87 ± 0.44 mm), betamethasone dipropionate (1.00 ± 0.54 mm), bortezomib (1.74 ± 0.46 mm), green tea extract (1.24 ± 0.51 mm), fantolon, an epothilone (0.86 ± 0.61 mm), methotrexate (1.09 ± 0.72 mm), and thalidomide (1.59 ± 0.55 mm) compared to treatment with uncoated balloons (1.07 ± 0.60 mm), while coatings with paclitaxel reliably reduced in-stent stenosis (LLL = 0.36 ± 0.25 mm). CONCLUSIONS Despite the proven antiproliferative and/or anti-inflammatory effect of the drugs, none of the coatings significantly reduced LLL compared to uncoated balloons and thus, based on the results presented here, none of the tested coatings may be considered a substitute for the paclitaxel-based coatings currently in clinical use.
Collapse
Affiliation(s)
- Tobias Haase
- Experimental Radiology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.,InnoRa GmbH, 10115 Berlin, Germany
| | - Ulrich Speck
- Experimental Radiology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | | | | | | | - Ole Gemeinhardt
- Experimental Radiology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | | | - Stephanie Bettink
- Clinical and Experimental Interventional Cardiology, University of Saarland, 66421 Homburg/Saar, Germany
| | - Bettina Kelsch
- Experimental Radiology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.,InnoRa GmbH, 10115 Berlin, Germany
| | - Bruno Scheller
- Clinical and Experimental Interventional Cardiology, University of Saarland, 66421 Homburg/Saar, Germany
| | - Beatrix Schnorr
- Experimental Radiology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| |
Collapse
|
4
|
Khorasanizadeh M, Shutran M, Schirmer CM, Salem MM, Ringer AJ, Grandhi R, Mitha AP, Levitt MR, Jankowitz BT, Taussky P, Thomas AJ, Moore JM, Ogilvy CS. North American multicenter experience with the Flow Redirection Endoluminal Device in the treatment of intracranial aneurysms. J Neurosurg 2022; 138:933-943. [PMID: 36087324 DOI: 10.3171/2022.7.jns221371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Flow diverters have revolutionized the endovascular treatment of intracranial aneurysms. Here, the authors present the first large-scale North American multicenter experience using the Flow Redirection Endoluminal Device (FRED) in the treatment of cerebral aneurysms. METHODS Consecutive cerebral aneurysms treated with FRED at 7 North American centers between June 2020 and November 2021 were included. Data collected included patient demographic characteristics, aneurysm characteristics, periprocedural and long-term complications, modified Rankin Scale (mRS) scores, and radiological follow-up. RESULTS In total, 133 aneurysms in 116 patients were treated with 123 FRED deployment procedures and included in this study. One hundred twenty-six aneurysms (94.7%) were unruptured, 117 (88.0%) saccular, and 123 (92.5%) located in anterior circulation. The mean (range) aneurysm maximal width and neck width sizes were 7.2 (1.5-42.5) mm and 4.1 (1.0-15.1) mm, respectively. Successful FRED deployment was achieved in 122 procedures (99.2%). Adjunctive coiling was used in 4 procedures (3.3%). Radiological follow-up was available for 101 aneurysms at a median duration of 7.0 months. At last follow-up, complete occlusion was observed in 55.4% of patients, residual neck in 8.9%, and filling aneurysm in 35.6%; among cases with radiological follow-up duration > 10 months, these values were 21/43 (48.8%), 3/43 (7.0%), and 19/43 (44.2%), respectively. On multivariate regression analysis, age (OR 0.93, p = 0.001) and aneurysm neck size (OR 0.83, p = 0.048) were negatively correlated with odds of complete occlusion at latest follow-up. The retreatment rate was 6/124 (4.8%). The overall complication rate was 31/116 (26.7%). Parent vessel occlusion, covered branch occlusion, and in-stent stenosis were detected in 9/99 (9.1%), 6/63 (9.5%), and 15/99 (15.2%) cases, respectively. The FRED-related, symptomatic, thromboembolic, and hemorrhagic complication rates were 22.4%, 12.9%, 6.9%, and 0.9% respectively. The morbidity rate was 10/116 patients (8.6%). There was 1 death due to massive periprocedural internal carotid artery stroke, and 3.6% of the patients had an mRS score > 2 at the last follow-up (vs 0.9% at baseline). CONCLUSIONS As the first large-scale North American multicenter FRED experience, this study confirmed the ease of successful FRED deployment but suggested lower efficacy and a higher rate of complications than reported by previous European and South American studies on FRED and other flow-diverting devices. The authors recommend judicious use of this device until future studies can better elucidate the long-term outcomes of FRED treatment.
Collapse
Affiliation(s)
- MirHojjat Khorasanizadeh
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Max Shutran
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Mohamed M Salem
- 3Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew J Ringer
- 4Mayfield Clinic, TriHealth Neuroscience Institute, Good Samaritan Hospital, Cincinnati, Ohio
| | - Ramesh Grandhi
- 5Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Alim P Mitha
- 6Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Michael R Levitt
- 7Department of Neurological Surgery, University of Washington, Seattle, Washington; and
| | - Brian T Jankowitz
- 3Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Philipp Taussky
- 5Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Ajith J Thomas
- 8Department of Neurological Surgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Justin M Moore
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christopher S Ogilvy
- 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
5
|
Mekonnen EA, Tekle WG, Desai SK, Hassan AE. Angioplasty And stenting For symptomatic intracranial atherosclerotic disease: How I Do It. Interv Neuroradiol 2022:15910199221090430. [PMID: 35331035 PMCID: PMC10399498 DOI: 10.1177/15910199221090430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intracranial atherosclerotic disease (ICAD) is a common cause of acute ischemic stroke. ICAD has a high rate of recurrent ischemic stroke despite recommended adequate medical treatment. Endovascular treatment of ICAD has been controversial due to high periprocedural complication in historic randomized clinical trials (RCTs). Recently, a multicenter prospective study of stent placement in patients with high grade intracranial stenosis that evaluated safety and efficacy of Balloon-mounted stents (BMS) in symptomatic ICAD showed low rates of periprocedural stroke (5.6%) than the SAMMPRIS (14.7%) and VISSIT (21.4%) trials. This review highlights the recent evolution of endovascular therapy for symptomatic ICAD.
Collapse
Affiliation(s)
- Ermias A Mekonnen
- Department of Neuroscience, 21755Valley Baptist Medical Center, Harlingen, TX, USA
| | - Wondwossen G Tekle
- Department of Neuroscience, 21755Valley Baptist Medical Center, Harlingen, TX, USA.,Department of Neurology, School of Medicine, 441554University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Sohum K Desai
- Department of Neuroscience, 21755Valley Baptist Medical Center, Harlingen, TX, USA.,Department of Neurology, School of Medicine, 441554University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Ameer E Hassan
- Department of Neuroscience, 21755Valley Baptist Medical Center, Harlingen, TX, USA.,Department of Neurology, School of Medicine, 441554University of Texas Rio Grande Valley, Edinburg, TX, USA
| |
Collapse
|
6
|
Lu D, Ma T, Zhu G, Zhang T, Wang N, Lei H, Sui J, Wang Z, He S, Chen L, Deng J. Willis Covered Stent for Treating Intracranial Pseudoaneurysms of the Internal Carotid Artery: A Multi-Institutional Study. Neuropsychiatr Dis Treat 2022; 18:125-135. [PMID: 35125870 PMCID: PMC8811267 DOI: 10.2147/ndt.s345163] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/16/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This work aimed to retrospectively analyze Willis covered stent (WCS)'s therapeutic efficacy in intracranial pseudoaneurysms (PSAs) of the internal carotid artery (ICA). METHODS Between June 2018 and July 2021, 56 individuals with intracranial PSAs of the ICA treated with WCS in three centers were included to analyze information regarding medical records, operative parameters, imaging findings and follow-up data. RESULTS All WCSs were successfully targeted to the ICA lesions. Total exclusion of PSA was found in 53 cases (94.6%) right upon surgery, and mild endoleak into the aneurysm remained in 3 cases (5.4%). Intraoperative thrombosis occurred in 1 case (1.8%), and tirofiban was utilized for recanalization. Follow-up by angiography showed total aneurysm occlusion in the total number of individuals, including in the 3 above cases with residual endoleak. In-stent stenosis occurred in 7 (12.5%) patients. No stent-related ischemic event was encountered. Predictive factors of late in-stent stenosis following WCS implantation in this patient group were irregular post-operative antiplatelet treatment (p = 0.015) and C4-C5 segment of the ICA (p = 0.043). CONCLUSION WCSs are effective in treating intracranial PSAs of the ICA.
Collapse
Affiliation(s)
- Dan Lu
- Department of Neurosurgery, Xi'an International Medical Center Hospital, Xi'an, People's Republic of China
| | - Tao Ma
- Department of Neurosurgery, Xi'an International Medical Center Hospital, Xi'an, People's Republic of China
| | - Gemin Zhu
- Department of Neurology, Xi'an Central Hospital, Xi'an, People's Republic of China
| | - Tao Zhang
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, People's Republic of China
| | - Naibing Wang
- Department of Neurosurgery, Xi'an International Medical Center Hospital, Xi'an, People's Republic of China
| | - Hui Lei
- Department of Neurology, Xi'an Central Hospital, Xi'an, People's Republic of China
| | - Jing Sui
- Department of Neurosurgery, Xi'an International Medical Center Hospital, Xi'an, People's Republic of China
| | - Zhiguo Wang
- Department of Neurosurgery, Xi'an International Medical Center Hospital, Xi'an, People's Republic of China
| | - Shiming He
- Department of Neurosurgery, Xi'an International Medical Center Hospital, Xi'an, People's Republic of China
| | - Lei Chen
- Department of Neurosurgery, Xi'an International Medical Center Hospital, Xi'an, People's Republic of China
| | - Jianping Deng
- Department of Neurosurgery, Tangdu Hospital, Air Force Medical University, Xi'an, People's Republic of China
| |
Collapse
|
7
|
Ryu B, White TG, Shah KA, Turpin J, Link T, Dehdashti AR, Katz JM, Black K, Woo HH. Utility of quantitative magnetic resonance angiography and non-invasive optimal vessel analysis for identification of complications and long-term hemodynamic changes in post-pipeline embolization patients. Interv Neuroradiol 2021; 28:396-403. [PMID: 34346801 PMCID: PMC9326859 DOI: 10.1177/15910199211034668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Quantitative magnetic resonance angiography and non-invasive optimal vessel analysis serve as powerful tools to collect and analyze hemodynamic data from pipeline embolization patients. At our institution, patients receive post-embolization quantitative magnetic resonance angiography within 24 h of treatment and within 6 months for follow-up to evaluate pipeline patency. Here, we aim to elucidate the long-term hemodynamic changes following pipeline embolization device placement and report two cases in which in-stent stenosis was detected. METHODS Medical records of patients who underwent pipeline embolization device placement for an internal carotid artery aneurysm between 2017 and 2019 were reviewed. Patients who received post-procedure NOVA and follow-up NOVA were included in the study (n = 32). Location and size of aneurysm, number of pipeline embolization device deployed, and complications were collected along with the non-invasive optimal vessel analysis report (flow volume rate (ml/min), mean, systolic, and diastolic flow velocities (cm/s), and vessel diameter (mm)). Internal carotid artery vessel flow rate was measured proximal to the pipeline embolization device. Derivations of hemodynamic parameters (pulsatility index, Lindegaard ratio, and wall shear stress) were calculated. RESULTS The middle cerebral artery mean and diastolic flow velocities were significantly lower on the follow-up NOVA compared to the post-procedure NOVA. Moreover, follow-up NOVA demonstrated lower middle cerebral artery wall shear stress on the side with flow diversion compared to the post-procedure NOVA. In-stent stenosis, requiring intervention, was detected in two patients on follow-up NOVA. One patient had a successful balloon angioplasty of the stented internal carotid artery that resolved her stenosis. However, the second patient developed progressive stenosis and expired despite intervention. CONCLUSION Long-term hemodynamic adaptations post-pipeline embolization device demonstrate decreased wall shear stress and decreased mean and diastolic flow velocities in the distal middle cerebral artery, which suggest decreasing velocity of blood flow with endothelialization of the device. Furthermore, follow-up NOVA is a useful tool for detecting potential flow-related complications such as in-stent stenosis.
Collapse
Affiliation(s)
- Brendan Ryu
- Department of Neurosurgery, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Timothy G White
- Department of Neurosurgery, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Kevin A Shah
- Department of Neurosurgery, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Justin Turpin
- Department of Neurosurgery, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Thomas Link
- Department of Neurosurgery, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Amir R Dehdashti
- Department of Neurosurgery, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Jeffrey M Katz
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
| | - Karen Black
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
| | - Henry H Woo
- Department of Neurosurgery, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| |
Collapse
|
8
|
Wang T, Richard SA, Jiao H, Li J, Lin S, Zhang C, Wang C, Xie X, You C. Institutional experience of in-stent stenosis after pipeline flow diverter implantation: A retrospective analysis of 6 isolated cases out of 118 patients. Medicine (Baltimore) 2021; 100:e25149. [PMID: 33725998 PMCID: PMC7982244 DOI: 10.1097/md.0000000000025149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 02/22/2021] [Indexed: 02/05/2023] Open
Abstract
Pipeline embolization devices (PLEDs) are flow diverting stents that have exhibited be safe and efficient in the treatment of complex aneurysms. Nevertheless, in-stent stenosis (ISS) has been reported as one of the cardinal complications associated with PLED. The association of wall malapposition and ISS in patient treated with PLED has not been reported.A retrospective study was conducted to identify patients with ISS after implantation of PLED as treatment for intracranial aneurysms from April 25, 2018 to April 24, 2019. Incidence of ISS and its associated causes such as sharp change of the PLED, distal wall malapposition, inconsistent compliance between parent artery as well as the PLED occlusion due to intimal hyperplasia and vessel tortuosity. Assessment of conservative treatment and retreatment outcomes of ISS were documented.In all, 6 ISS cases were identified by 2 independent neurointerventionalists out of 118 aneurysm patients treated with PLED. Thus, the incidence rate of ISS in patients treated with PLED was as low as 5% at our institution compared to other studies. The follow-up time for detection of ISS ranged from 6 to 12 months after implantation. Several combinations of reasons such as sharp change of the PLED, distal wall malapposition, inconsistent compliance between parent arteries as well as PLED occlusion due to intimal hyperplasia and vessel tortuosity accounted for the causes of ISS during our analysis. Conservative treatment with a combination of antiplatelet during follow-ups did not resolve the ISS in our study probably due to associated underlying factors above.
Collapse
Affiliation(s)
- Ting Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Street, Chengdu, PR China
| | - Seidu A. Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Street, Chengdu, PR China
- Department of Medicine, Princefield University, P. O. Box MA 128, Ho-Volta Region, Ghana West Africa
| | - He Jiao
- Department of Radiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang Street, Chengdu, PR China
| | - Junrao Li
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Street, Chengdu, PR China
| | - Sen Lin
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Street, Chengdu, PR China
| | - Changwei Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Street, Chengdu, PR China
| | - Chaohua Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Street, Chengdu, PR China
| | - Xiaodong Xie
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Street, Chengdu, PR China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Street, Chengdu, PR China
| |
Collapse
|
9
|
Hiramatsu R, Ohnishi H, Yagi R, Kuroiwa T, Wanibuchi M, Miyachi S. A Patient with a Large Aneurysm Complicated by Stenosis of the Internal Carotid Artery Distal to the Aneurysm in Whom Treatment Using a Pipeline Flex Was Performed. J Neuroendovasc Ther 2020; 14:501-507. [PMID: 37501770 PMCID: PMC10370946 DOI: 10.5797/jnet.cr.2019-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 06/15/2020] [Indexed: 07/29/2023]
Abstract
Objective We report a case of in-stent stenosis as a complication at 6 months after the deployment of Pipeline Flex. This case necessitated retreatment for parent artery occlusion. Case Presentation A 55-year-old woman with right-side visual disorder was referred to our hospital for the deployment of Pipeline Flex. Cerebral digital subtraction angiography (DSA) demonstrated a large right-side paraclinoid aneurysm in combination with severe internal carotid artery (ICA) stenosis just beyond the aneurysm. We deployed Pipeline Flex under general anesthesia. After deployment, we performed angioplasty through the Pipeline. Six months after deployment, this patient exhibited exacerbation of visual disorder. Follow-up DSA revealed in-stent stenosis at 6 months after the deployment of Pipeline Flex. Therefore, we performed parent artery occlusion. Right-side visual disorder was improved in this patient. Conclusion If Pipeline is deployed for patients with ICA stenosis just beyond an aneurysm, we need to be aware of in-stent stenosis after deployment.
Collapse
Affiliation(s)
- Ryo Hiramatsu
- Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
| | | | - Ryokichi Yagi
- Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
| | | | - Masahiko Wanibuchi
- Department of Neurosurgery and Endovascular Therapy, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shigeru Miyachi
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
| |
Collapse
|
10
|
Rteil A, Draxler M, Al Adas Z, Mohammad F, Kavousi Y, Kabbani L. Progressive stenosis of a popliteal artery stent graft by laminated thrombus. J Vasc Surg Cases Innov Tech 2020; 6:189-94. [PMID: 32322774 DOI: 10.1016/j.jvscit.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/08/2020] [Indexed: 12/03/2022]
Abstract
We present a case of failed popliteal artery aneurysm repair using a Viabahn stent graft (W. L. Gore & Associates, Flagstaff, Ariz) due to laminated thrombus formation. A 75-year-old man presented with a symptomatic popliteal artery aneurysm. He was treated with a Viabahn stent graft. On follow-up, the patient complained of lower extremity claudication, and duplex ultrasound examination showed a focal intrastent stenosis. A computed tomography scan showed a significant stenosis within the stent graft, at the level of the knee joint creases. The patient underwent superficial femoral artery to distal popliteal surgery. This case report aims to expand on the mechanism of stent graft failure in popliteal aneurysms.
Collapse
|
11
|
Hickethier T, Wenning J, Bratke G, Maintz D, Michels G, Bunck AC. Evaluation of soft-plaque stenoses in coronary artery stents using conventional and monoenergetic images: first in-vitro experience and comparison of two different dual-energy techniques. Quant Imaging Med Surg 2020; 10:612-623. [PMID: 32269922 DOI: 10.21037/qims.2020.02.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Non-invasive coronary imaging after stent placement remains challenging. Favorable results for dual-energy computed tomography (DECT) derived monoenergetic (MonoE) images have been reported for this purpose. Nowadays, there are different dual-energy techniques available, each with specific advantages and disadvantages. However, for the evaluation of coronaries after stent implantation there is no systematic comparison between different dual-energy techniques. Therefore, the aim of our study was to compare two widely used DECT systems using an in-stent restenosis (ISR) phantom setup. Methods Soft-plaque-like stenoses (~50% of lumen) were inserted into ten coronary stents embedded in contrast-filled vessel phantoms. A dual-source CT (DSCT) and a dual-layer CT (DLCT) with comparable acquisition and reconstruction parameters were used. Conventional polyenergetic (PolyE) and MonoE images with 9 different levels (40-120 keV) were calculated. ISR assessability was evaluated by subjective scoring using a 5-point scale and by the following quantitative parameters: image noise, visible lumen diameter (VLD) and ISR contrast-to-noise ratio (CNR). Results A non-significant trend towards larger VLD in DLCT images was observed. Highest noise was found in low-keV MonoE with significantly higher values for DSCT than for DLCT. Conversely, noise was significantly lower for DSCT at higher-keV MonoE. Peak ISR CNR values were found at low-keV MonoE with no significant difference between both systems. However, for PolyE and mid-energy MonoE, CNRs were significantly higher for DSCT. Subjective image quality was significantly better for PolyE and low-keV MonoE than for high-keV MonoE, also without significant difference between both systems. Conclusions Conspicuity of ISR benefits from DECT. Peak CNRs were comparable for both DECT systems and low-keV MonoE offered the highest CNR values and best subjective image quality. In contrast, high-keV MonoE cannot be recommended for stent evaluation due to poor CNR values and therefore significantly limited visualization of stenoses.
Collapse
Affiliation(s)
- Tilman Hickethier
- Department of Radiology, University Hospital Cologne, Cologne, Germany
| | - Justus Wenning
- Department of Radiology, University Hospital Cologne, Cologne, Germany
| | - Grischa Bratke
- Department of Radiology, University Hospital Cologne, Cologne, Germany
| | - David Maintz
- Department of Radiology, University Hospital Cologne, Cologne, Germany
| | - Guido Michels
- Department III of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Alexander C Bunck
- Department of Radiology, University Hospital Cologne, Cologne, Germany
| |
Collapse
|
12
|
Hayashi T, Fukuda A. [Visualization of Four Intracranial Stents and In-stent Stenosis with Stenotic Models by 3D-TOF-MRA]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2019; 75:747-754. [PMID: 31434846 DOI: 10.6009/jjrt.2019_jsrt_75.8.747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In recent years, various types of stents are deployed for the treatment of intracranial artery stenosis and aneurysms. Digital subtraction angiography has been considered to be the gold standard for the follow-up study. However, magnetic resonance angiography (MRA) is less invasive and the recent advances may contribute to the imaging of patients with intracranial stents. Then, a phantom study was carried out to evaluate the MR lumen visibility with these stents. Four stents [low-profile visualized intraluminal support (LVIS), Neuroform Atlas, Neuroform EZ, and Enterprise 2] were placed into plastic tubes with 3 mm inner diameter, and fixed in a container filled with agar. Time-of-flight MRA (TOF-MRA) was performed for these stents, and the signal intensities inside and outside the stents were measured on ImageJ software. Furthermore, 25%, 50%, and 75% stenosis models were created and passed through these stents to evaluate the diagnostic accuracy of in-stent stenosis. The signal intensity inside the LVIS stent was the highest among the four stents (P<0.001), and no significant difference was found between the signal intensities inside and outside the LVIS stent. The diagnostic accuracy with LVIS was also higher than that of Enterprise 2 (P<0.001). In conclusion, the visibility with LVIS indicates that TOF-MRA could be reliably utilized as a diagnostic tool for the detection of in-stent stenosis.
Collapse
Affiliation(s)
| | - Atsushi Fukuda
- Virginia Commonwealth University Medical Center (Current address: Preparing Section for New Faculty of Medical Science, Fukushima Medical University)
| |
Collapse
|
13
|
Ishikawa O, Tanaka M, Konno K, Hasebe T, Horikawa A, Iijima A, Saito N, Takahashi K. Swine model of in-stent stenosis in the iliac artery evaluating the serial time course. Exp Anim 2018; 67:501-508. [PMID: 30068792 PMCID: PMC6219888 DOI: 10.1538/expanim.18-0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The aim of this study was to propose a new animal model evaluating the serial time course
of in-stent stenosis by repeated carotid artery catheterization in the same animal. 16
bare-metal stents were implanted in the normal external and internal iliac artery of 8
miniature pigs. Repeated measurements were performed in the same animal every 2 weeks for
12 weeks through carotid artery catheterization. The time course and peak neointimal
proliferation were evaluated by intravascular ultrasound. Health of all animals was
assessed by clinical and hematological examinations. As a result, 7 times of carotid
artery catheterization was performed per pig, but all animals remained healthy without
both any complications and hematological inflammatory abnormalities. The time course of
neointimal proliferation of each stent was observed from the stage of hyperplasia to
partial regression. The peak neointimal proliferation varied from 6 to 12 weeks despite
implantation of identical stents using the same deployment method. In conclusion, repeated
carotid artery catheterization to the same animal is feasible without animal health
deterioration. This model should be useful to evaluate the time course of neointimal
proliferation after stent deployment in preclinical study.
Collapse
Affiliation(s)
- Osamu Ishikawa
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Minoru Tanaka
- Department of Transfusion Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kenjiro Konno
- Center for iPS Cell Research and Application, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Terumitsu Hasebe
- Department of Radiology, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji-shi, Tokyo 192-0032, Japan
| | - Ayumi Horikawa
- Department of Transfusion Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Akira Iijima
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Koki Takahashi
- Department of Transfusion Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| |
Collapse
|
14
|
Estrade L, Makoyeva A, Darsaut TE, Ghostine J, Kouznetsov E, Salazkin I, Roy D, Weill A, Raymond J. In vitro reproduction of device deformation leading to thrombotic complications and failure of flow diversion. Interv Neuroradiol 2013; 19:432-7. [PMID: 24355146 DOI: 10.1177/159101991301900405] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 07/28/2013] [Indexed: 11/17/2022] Open
Abstract
Flow diverters (FDs) are increasingly used for complex intracranial aneurysms. As these self-expanding devices are deployed across an aneurysm neck, they can undergo deformations. The potential clinical consequences of FD deformations remain unclear. We describe an immediate thrombotic complication attributed to a stereotypical stenotic deformation of an FD extremity that can occur when landing zones are of insufficient length. This case is supplemented with in vitro studies showing the relationship between i) the length of the landing zones and ii) discrepancies between the diameter of the device and recipient vessel, and the severity of FD stenosis. In vitro, a shorter landing zone was associated with a progressive stenotic deformation of the terminal ends of all FDs studied. This deformation was more pronounced when the diameter of the device was oversized compared to the size of the recipient tube. In our clinical case, the presence of this deformation led to an immediate thrombotic complication, requiring deployment of a second stent to correct the observed stenosis. In addition, treatment failure ultimately led to a fatal rupture, a failure that can be explained by residual flows through a more porous transition zone, another characteristic FD deformation which occurs when they are oversized as compared to the parent vessel, but free to expand at the level of the aneurysm. Proper selection of device diameter and length of the landing zone is important, and may decrease the incidence of deformation-related complications.
Collapse
Affiliation(s)
- Laurent Estrade
- Service de Radiologie, CHU de Reims, Hôpital Maison Blanche; Reims, France -
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Egan MJ, Trask AJ, Baker PB, Lawrence J, Ladich E, Virmani R, Hill SL, Cheatham JP, Galantowicz M, Lucchesi PA, Kovalchin JP. Histopathologic evaluation of patent ductus arteriosus stents after hybrid stage I palliation. Pediatr Cardiol 2011; 32:413-7. [PMID: 21298382 DOI: 10.1007/s00246-010-9870-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 12/07/2010] [Indexed: 10/18/2022]
Abstract
The aim of this study was to determine the histopathology of patent ductus arteriosus (PDA) in-stent stenosis after hybrid stage I palliation. The hybrid approach to palliation of hypoplastic left heart syndrome can be complicated by the development of in-stent stenosis of the PDA. This may obstruct retrograde aortic arch flow, decrease systemic circulation, and lead to interstage interventional procedures. Stented PDA samples removed from eight patients undergoing comprehensive stage II repair were examined by way of radiography and histochemistry (hematoxylin and eosin, Movat pentachrome, α-smooth muscle actin, and proliferating cell nuclear antigen). A retrospective chart review of the patients was also performed. PDA stents were in place in the PDA for a mean period of 169 ± 28 days in patients who had a mean age of 176 ± 30 days at the time of stent removal. Stent deployment caused chronic inflammation, caused fibrin deposition, and induced vascular smooth muscle-cell (VSMC) proliferation in the area immediately surrounding the stent struts. The neointimal region was composed largely of smooth muscle cells that appeared to be fully differentiated by the lack of PCNA staining. Neointimal thickening occurs in the PDA after stent placement for hybrid palliation of HLHS and is the result of inflammation, extracellular matrix deposition, and smooth muscle-cell proliferation in the peristrut region. This finding suggests that proliferating VSMCs in the peristrut region may provide the impetus for inward neointimal formation and therefore the manifestation of in-stent stenosis.
Collapse
|