scholarly journals “Shelf” Technique Using a Novel Braided Self-Expandable Stent for the Treatment of Wide-Necked Bifurcation Aneurysms

2021 ◽  
Author(s):  
Volker Maus ◽  
Werner Weber ◽  
Sebastian Fischer
Keyword(s):  
The Novel ◽  
Inclusion Criteria ◽  
Endovascular Techniques ◽  
Short Term ◽  
Aneurysm Neck ◽  
Ischemic Complications ◽  
Secondary Endpoints ◽  
Aneurysm Occlusion ◽  
Safe Treatment Option

Abstract Background Different endovascular techniques exist for treatment of cerebral wide-necked bifurcation aneurysms (WNBA). We present the “shelf” technique with the novel woven LVIS EVO stent, which enables forming a buttress at the level of the aneurysm neck to prevent coil prolapse and additional stenting. Methods Single-center retrospective analysis of patients treated with the “shelf” technique by using LVIS EVO stent in incidental WNBAs between January 2020 and March 2021. Inclusion criteria were saccular aneurysms with neck width ≥4 mm or a dome/neck ratio ≤2. Primary endpoint was a favorable navigation to the target vessel and successful deployment of the LVIS EVO stent with forming a buttress that enables aneurysm occlusion by subsequent coiling. Secondary endpoints were aneurysm occlusion on follow-up, procedure-related complications and clinical outcome. Results A total of 15 patients were included. The primary end point was reached in 100% of cases. A complete aneurysm occlusion at the end of the procedure was achieved in 14/15 patients (93%). No intraprocedural complications occurred. All patients except one were discharged with an modified Rankin Scale (mRS) of 0. Procedure-related morbidity was 7%. Median follow-up imaging was 115 days (7–419 days) and available for 11/15 (73%) of the patients. Of those, 10 (91%) individuals had a complete aneurysm occlusion and 1 showed a residual neck. In all patients, the covered branch was patent and no ischemic complications occurred during follow-up. Conclusion This study demonstrates the “shelf” technique with LVIS EVO stents as a feasible and safe treatment option for WNBAs with very good short-term occlusion rates.

Abstract WMP34: Low Yield of Further Angiographic Follow-up in Adequately Occluded Aneurysms After Flow Diversion

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Nohra Chalouhi ◽  
Guilherme Barros ◽  
Stavropoula Tjoumakaris ◽  
Ayan Kumar ◽  
Michael Lang ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
New Technology ◽  
Cerebral Aneurysms ◽  
Flow Diversion ◽  
Inclusion Criteria ◽  
Short Term ◽  
Complete Occlusion ◽  
Aneurysm Occlusion ◽  
Repeat Angiography

Background: Aneurysm recurrence after coil therapy remains a major shortcoming in the endovascular management of cerebral aneurysms. Flow diversion has emerged as a promising treatment for intracranial aneurysms. The safety and efficacy of this new technology is under investigation. The current study assesses the yield of further angiographic follow-up in aneurysms that have achieved adequate occlusion after treatment with the Pipeline Embolization Device (PED). Methods: Inclusion criteria were as follows: 1) treatment of one or more aneurysms with the PED, 2) available short-term (<12 months) follow-up digital subtraction angiography (DSA), 3) complete (100%) or near-complete (>95%) occlusion on short-term follow-up DSA, and 4) available further angiographic follow-up (DSA or MRA). Results: A total of 175 patients matching the inclusion criteria were identified. Aneurysm size was 9.0 mm on average. Mean angiographic follow-up was 23.4 months. On short-term follow-up DSA images, 154 (88%) had complete aneurysm occlusion and 21 (12%) had near-complete occlusion. Seven patients (4%) had further DSA follow-up alone, 39 patients (22%) had further DSA and MRA follow-up, and 129 patients (74%) had further MRA follow-up alone. On further angiographic follow-up (DSA or MRA), no patient had a decrease in the degree of aneurysm occlusion (recurrence) or required retreatment. Of the 21 patients with near-complete occlusion on initial DSA images, 5 patients (24%) progressed to complete aneurysm occlusion on further angiographic follow-up. No patient had evidence of new in-stent stenosis on further angiographic follow-up. Conclusion: In this study, the diagnostic yield of repeat angiography in adequately occluded aneurysms with the PED was very low. Based on these findings, we do not recommend further angiographic follow-up once aneurysms have achieved adequate occlusion with the PED.

scholarly journals Woven EndoBridge (WEB) Width at the Aneurysm Neck Level Affects Early Angiographic Aneurysm Occlusion

2021 ◽  
Author(s):  
Marie Teresa Nawka ◽  
Gabriel Broocks ◽  
Rosalie McDonough ◽  
Jens Fiehler ◽  
Maxim Bester
Keyword(s):  
External Validation ◽  
Short Term ◽  
Aneurysm Neck ◽  
Aneurysm Occlusion ◽  
Woven Endobridge ◽  
Web Device ◽  
Aneurysm Diameter ◽  
The Web ◽  
Web Size

Abstract Purpose Endovascular therapy with the Woven EndoBridge (WEB) device is a safe treatment approach, whereby neoendothelialization at the neck area is a crucial element for aneurysm occlusion. We hypothesized that WEB sizing at the aneurysmal neck level has an impact on early aneurysm occlusion. Methods Patients with short-term follow-up digital subtraction angiography following WEB treatment of unruptured aneurysms were included. Aneurysms were categorized according to the Bicêtre Occlusion Scale Score (BOSS) as adequately (BOSS 0, 0′, 1) or partially occluded (BOSS 2, 3, 1 + 3). The WEB device dimensions, including the average aneurysm diameter (AADi) and the average neck diameter (ANDi) as well as baseline patient characteristics were documented. Results In this study 75 patients with 76 aneurysms were included and 65 aneurysms showed adequate occlusion at short-term follow-up (86%). In univariable logistic regression analysis, smaller differences in WEB size to ANDi (D-ANDi) were significantly associated with adequate aneurysm occlusion (odds ratio, OR = 0.41, 95% confidence interval, CI 0.23–0.71, p = 0.002). Receiver operating characteristic (ROC) curve analyses displayed higher discriminative power for the D‑ANDi (AUC = 0.77, 95% CI 0.66–0.86, cut-off ≤2.9 mm) compared to the difference in WEB size to the average aneurysm diameter (D-AADi, AUC = 0.65, 95% CI 0.53–0.75, cut-off ≤1.0 mm). Conclusion Smaller differences between the WEB width and ANDi were associated with adequate early aneurysm occlusion and might thus have a higher impact on the results than the traditional device sizing considering the mean aneurysm diameter. D‑ANDi ≤2.9 mm served as an optimal cut-off to classify occlusion after WEB treatment at the short-term follow-up. Further external validation is warranted.

Intra-arterial chemotherapy for retinoblastoma: an updated systematic review and meta-analysis

2019 ◽  
Vol 11 (12) ◽  
pp. 1266-1272 ◽  
Author(s):  
Krishnan Ravindran ◽  
Lauren A Dalvin ◽  
Jose S Pulido ◽  
Waleed Brinjikji
Keyword(s):  
Metastatic Disease ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
First Line ◽  
Short Term ◽  
Systemic Complications ◽  
Substantial Heterogeneity ◽  
Insight Into

Background and purposeIntra-arterial chemotherapy for retinoblastoma has been adopted as a first-line treatment option by numerous tertiary centers. The effect of intra-arterial chemotherapy on future rates of metastatic disease as well as on globe salvage in advanced eyes remains relatively unknown.MethodsA search of PubMED, MEDLINE, EMBASE, and Web of Science electronic databases was conducted from inception until January 2019 for studies with a minimum of 10 patients reporting outcomes and complications following intra-arterial chemotherapy for retinoblastoma.ResultsA total of 20 studies met the inclusion criteria for analysis, comprising 873 patients and 1467 eyes. Only one study was comparative; there was substantial heterogeneity in reported outcomes and several overlapping patient cohorts that were published. Across all studies, 174 of 1467 eyes were enucleated (11.8%). Metastatic disease occurred in 8 of 513 patients (1.6%). Globe salvage was achieved in 318 of 906 (35.6%) cases of advanced retinoblastoma. The most common ocular complication was retinal detachment, occurring in 23% of eyes, and the most common systemic complications were transient fever and nausea/vomiting.ConclusionsThere is a paucity of higher-level evidence with adequate follow-up surrounding the long-term safety of intra-arterial chemotherapy and effect on metastasis in retinoblastoma. Studies to date have been limited by short-term follow-up. Longitudinal prospective studies could provide greater insight into the ability of intra-arterial chemotherapy to reduce the risk of retinoblastoma metastasis.

Outcome of surgical stabilisation of acetabular fractures in 16 cats

2018 ◽  
Vol 21 (6) ◽  
pp. 520-528 ◽  
Author(s):  
David L Haine ◽  
Kevin Parsons ◽  
Nicolas Barthelemy ◽  
Neil Burton ◽  
Sorrel L Langley-Hobbs
Keyword(s):  
Locking Plate ◽  
Dynamic Compression ◽  
Neurological Deficits ◽  
Acetabular Fractures ◽  
Inclusion Criteria ◽  
Perioperative Outcome ◽  
Short Term ◽  
Neurologically Normal ◽  
Orthopaedic Injuries

Objectives The aim of this study is to describe the presentation, surgical management and perioperative outcome of cats with acetabular fractures. Methods Case records and radiographs of cats with acetabular fractures were reviewed from presentation to the end of follow-up. Surgical technique, complications, radiographic reduction and the presence of neurological deficits were recorded. Results Sixteen cats with 17 acetabular fractures met the inclusion criteria. All fractures were associated with concurrent orthopaedic injuries. All cats were either moderately or severely lame on presentation. Five fractures were stabilised using screws, wire, pins and polymethylmethacrylate, nine were repaired using a straight dynamic compression plate and three were repaired using a locking plate. Two of seven cats that were neurologically normal prior to surgery developed transient neuropraxia following surgery. There were three major complications and no minor complications. At the end of follow-up 3/16 cats had full function, whereas 13/16 had acceptable function. Conclusions and relevance All cats undergoing surgical stabilisation of acetabular fractures returned to full or acceptable function by the end of the follow-up period and there was a low number of intraoperative and short-term complications. Neurological deficits were common preoperatively, but the majority of these deficits had resolved by follow-up.

scholarly journals Short- and Mid-Term Prognosis of Patients Undergoing Rotational Atherectomy in Aortoostial Coronary Lesions in Left Main or Right Coronary Arteries

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Marine Quillot ◽  
Didier Carrié ◽  
Thibault Lhermusier ◽  
Frédéric Bouisset ◽  
Romain André ◽  
...  
Keyword(s):  
Success Rate ◽  
Cardiovascular Events ◽  
Rotational Atherectomy ◽  
Complication Rates ◽  
Left Main ◽  
Short Term ◽  
Secondary Endpoints ◽  
Coronary Lesions ◽  
Procedural Success ◽  
Safe Treatment Option

Objective. To determine short-term and mid-term prognosis in patients with calcified ostial coronary lesions who underwent rotational atherectomy (RA). Background. RA was developed to facilitate stenting in complex lesions. Treatment of calcified aortoostial coronary lesions with RA appears to have poorer procedure outcomes than nonostial lesions; yet the literature on this topic is scarce. Methods. Of 498 consecutive patients who underwent RA, a total of 80 (16.1%) presented with aortoostial lesions. A comparative, monocentric study was performed between patients with aortoostial and nonaortoostial stenosis, in a retrospective registry. The primary endpoint was the procedural success rate. Secondary endpoints were the rates of major adverse cardiac and cardiovascular events (MACE) at 30 days and 24 months. Results. The procedural success rate was high and similar in patients with and without ostial lesions (96.3% vs 94.7%, p=0.78), as was the rate of angiographic complications (7.5% vs 8.4%, p=0.80). However, the 30-day mortality rate was significantly higher in the aortoostial group (11.3% vs 4.8%, p=0.04), as was the 24-month rate of MACE (43.8% vs 31.8%, p=0.04). The aortoostial location of the lesion was an independent factor associated with the occurrence of cardiovascular events at 24 months (HR = 1.52, 95% CI, 1.03-2.26, p=0.035). Conclusion. Procedural success and complication rates were similar in patients with and without aortoostial lesions. Despite a poor short- and mid-term prognosis, rotational atherectomy appears to be a feasible and safe treatment option for calcified aortoostial coronary lesions.

Flow diversion treatment for acutely ruptured aneurysms

2019 ◽  
Vol 12 (3) ◽  
pp. 283-288 ◽  
Author(s):  
Michelle F M ten Brinck ◽  
Maike Jäger ◽  
Joost de Vries ◽  
J André Grotenhuis ◽  
René Aquarius ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Flow Diverter ◽  
Poor Clinical Outcome ◽  
Good Clinical Outcome ◽  
Ruptured Aneurysms ◽  
Secondary Endpoints ◽  
Aneurysm Occlusion ◽  
Occlusion Rate ◽  
Ruptured Intracranial Aneurysms

Background and purposeFlow diverters are sometimes used in the setting of acutely ruptured aneurysms. However, thromboembolic and hemorrhagic complications are feared and evidence regarding safety is limited. Therefore, in this multicenter study we evaluated complications, clinical, and angiographic outcomes of patients treated with a flow diverter for acutely ruptured aneurysms.MethodsWe conducted a retrospective observational study of 44 consecutive patients who underwent flow diverter treatment within 15 days after rupture of an intracranial aneurysm at six centers. The primary end point was good clinical outcome, defined as modified Rankin Scale score (mRS) 0–2. Secondary endpoints were procedure-related complications and complete aneurysm occlusion at follow-up.ResultsAt follow-up (median 3.4 months) 20 patients (45%) had a good clinical outcome. In 20 patients (45%), 25 procedure-related complications occurred. These resulted in permanent neurologic deficits in 12 patients (27%). In 5 patients (11%) aneurysm re-rupture occurred. Eight patients died resulting in an all-cause mortality rate of 18%. Procedure-related complications were associated with a poor clinical outcome (mRS 3–6; OR 5.1(95% CI 1.0 to 24.9), p=0.04). Large aneurysms were prone to re-rupture with rebleed rates of 60% (3/5) vs 5% (2/39) (p=0.01) for aneurysms with a size ≥20 mm and <20 mm, respectively. Follow-up angiography in 29 patients (median 9.7 months) showed complete aneurysm occlusion in 27 (93%).ConclusionFlow diverter treatment of ruptured intracranial aneurysms was associated with high rates of procedure-related complications including aneurysm re-ruptures. Complications were associated with poor clinical outcome. In patients with available angiographic follow-up, a high occlusion rate was observed.

Reconstructive endovascular treatment of basilar artery fenestration aneurysms: A multi-centre experience and literature review

2021 ◽  
pp. 197140092110428
Author(s):  
Hanna Styczen ◽  
Sebastian Fischer ◽  
Matthias Gawlitza ◽  
Lukas Meyer ◽  
Lukas Goertz ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Basilar Artery ◽  
Flow Diversion ◽  
High Rate ◽  
Complete Occlusion ◽  
Secondary Endpoints ◽  
Aneurysm Occlusion ◽  
Complications Rate ◽  
Woven Endobridge

Background Data on outcome after endovascular treatment of basilar artery fenestration aneurysms (BAFAs) is limited. This study presents our multi-centre experience of BAFAs treated by different reconstructive techniques including coils, stent-assisted coiling (SAC), flow diversion and intra-saccular flow disruption with the Woven Endobridge (WEB). Methods Retrospective analysis of 38 BAFAs treated endovascularly between 2003 and 2020. The primary endpoint was complete aneurysm obliteration defined as Raymond–Roy occlusion classification (RROC) I on immediate and follow-up (FU) angiography. The secondary endpoints were procedure-related complications, rate of re-treatment, and clinical outcome. Results Endovascular treatment was feasible in 36/38 aneurysms (95%). The most frequent strategy was coiling (21/36, 58%), followed by SAC (7/36, 19%), WEB embolization (6/36, 17%) and flow diversion (2/36, 6%). A successful aneurysm occlusion (defined as RROC 1 and 2) on the final angiogram was achieved in 30/36 (83%) aneurysms including all patients presenting with baseline subarachnoid haemorrhage and 25/36 (69%) were occluded completely. Complete occlusion (RROC 1) was more frequently achieved in ruptured BAFAs (15/25, 60% v. 2/11, 18%; p = 0.031). Procedure-related complications occurred in 3/36 (8%) aneurysms. Re-treatment was executed in 12/36 (33%) aneurysms. After a median angiography FU of 38 months, 30/31 (97%) BAFAs were occluded successfully and 25/31 (81%) showed complete occlusion. Conclusion Reconstructive endovascular treatment of BAFAs is technically feasible with a good safety profile. Although in some cases re-treatment was necessary, a high rate of final aneurysm occlusion was achieved.

Patients undergoing hip arthroscopy with active workers’ compensation claims do not demonstrate inferior outcomes at mid-term

2018 ◽  
Vol 29 (5) ◽  
pp. 543-549
Author(s):  
Itay Perets ◽  
Dan Prat ◽  
Mary R. Close ◽  
Edwin O Chaharbakhshi ◽  
Stephanie M Rabe ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Patient Reported Outcomes ◽  
Workers Compensation ◽  
Inclusion Criteria ◽  
Short Term ◽  
Exclusion Criteria ◽  
Patient Reported ◽  
Compensation Claims ◽  
Labral Pathology

Introduction: Workers’ compensation (WC) claims have been associated with poor short-term outcomes after hip arthroscopy. We aim to report mid-term outcomes and return to work (RTW) among patients with WC claims. Methods: Data were prospectively collected and retrospectively reviewed for patients undergoing hip arthroscopy between September 2008 and July 2011. Inclusion criteria were an active WC claim at time of surgery with preoperatively-documented patient-reported outcomes (PROs). Exclusion criteria were a previous hip condition and preoperative Tönnis grade >1. Patient-reported WC cases were pair-matched to non-WC cases based on body mass index (BMI) ± 5, age ± 5 years, gender, preoperative LCEA, labral treatment, and capsular treatment. Results: 52 patients had minimum 5-year outcomes. Mean age was 40.6 (±10.6) years and a mean BMI of 27.5 (±5.3). 9 (16.7%) hips underwent secondary arthroscopies. 5 hips (9.3%) were converted to THA. There were 5 (9.3%) reports of numbness, all of which resolved spontaneously. Work status details were available for 49 patients and 47 patients (95.9%) returned to work. 42 WC hips were matched to 42 control hips. At ⩾5-year follow-up, patient-reported outcomes, visual analogue scale (VAS) and satisfaction were not different between the groups. All magnitudes in improvement were significantly higher in the WC group ( p = < 0.001) except for VAS. No significant differences were found in rates of secondary arthroscopies, conversions to THA, or complications between the groups. Conclusions: WC patients have equal favourable mid-term outcomes as non-WC patients after hip arthroscopy for the treatment of femoroacetabular impingement and labral pathology.

scholarly journals Technical feasibility and safety of transluminal antegrade dilation for hepaticojejunostomy stricture using a novel fine-gauge electrocautery dilator (with video)

2020 ◽  
Vol 08 (06) ◽  
pp. E733-E737 ◽  
Author(s):  
Takeshi Ogura ◽  
Nobu Nishioka ◽  
Masanori Yamada ◽  
Tadahiro Yamada ◽  
Saori Ueno ◽  
...  
Keyword(s):  
Bile Duct ◽  
Intrahepatic Bile Duct ◽  
The Novel ◽  
Technical Success ◽  
Long Term Follow Up ◽  
Secondary Endpoints ◽  
Patient Refusal ◽  
A Prospective Study

Abstract Background and study aims A novel fine-gauge electrocautery dilator (ED) has recently become available in Japan. The current study evaluated the safety and feasibility of transluminal antegrade dilation for hepaticojejunal stricture (HJS) using this novel ED. Patients and methods Patients who with complicated HJS were retrospectively enrolled. The primary and secondary endpoints of this study were rates of technical success defined as functional antegrade HJS dilation using the novel ED and types of adverse events, respectively. A total of 22 patients were enrolled. Among them, six were treated using an enteroscopic approach due to the absence of bile duct dilation or patient refusal to undergo EUS-HGS. Therefore, 16 patients underwent EUS-HGS. Results The procedure was successful in 15 of 16 patients (93.8 %). The contrast medium flowed from the intrahepatic bile duct to the intestine of 14 of 15 patients (93.3 %). The resolution rate of HJS was 13 of 14 (92.9 %) at 6 months. Conclusion Our technique might offer a new option with which to treat HJS, although a prospective study with long-term follow-up is needed.

scholarly journals MRA versus DSA for the follow-up imaging of intracranial aneurysms treated using endovascular techniques: a meta-analysis

2019 ◽  
Vol 11 (10) ◽  
pp. 1009-1014 ◽  
Author(s):  
Syed Uzair Ahmed ◽  
J Mocco ◽  
Xiangnan Zhang ◽  
Michael Kelly ◽  
Amish Doshi ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Clinical Factors ◽  
Endovascular Techniques ◽  
Non Invasive ◽  
Tof Mra ◽  
Contrast Enhanced ◽  
Grading Scale ◽  
Aneurysm Occlusion

BackgroundTreated aneurysms must be followed over time to ensure durable occlusion, as more than 20% of endovascularly treated aneurysms recur. While digital subtraction angiography (DSA) remains the gold standard, magnetic resonance angiography (MRA) is attractive as a non-invasive follow-up technique. Two different MRA techniques have traditionally been used: time-of-flight (TOF) and contrast-enhanced (CE) MRA. We analysed data from studies comparing MRA techniques with DSA for the follow-up of aneurysms undergoing endovascular treatment. Subgroup analysis of stent-assisted coiling (SAC) and flow diversion (FD) techniques was completed.MethodsComprehensive searches using the Embase, PubMed, and Cochrane databases were performed and updated to November 2018. Pooled sensitivity and specificity were calculated using aneurysm occlusion status as defined by the Raymond–Roy occlusion grading scale.ResultsThe literature search yielded 1579 unique titles. Forty-three studies were included. For TOF-MRA, sensitivity and specificity of all aneurysms undergoing endovascular therapy were 88% and 94%, respectively. For CE-MRA, the sensitivity and specificity were 88% and 96%, respectively. For SAC and FD techniques, sensitivity and specificity of TOF-MRA were 86% and 95%, respectively. CE-MRA had sensitivity and specificity of 90% and 92%.ConclusionMRA is a reliable modality for the follow-up of aneurysms treated using endovascular techniques. While the data are limited, MRA techniques can also be used to reliably follow patients undergoing FD and SAC. However, clinical factors must be used to optimize follow-up regimens for individual patients.

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