The ‘Sphere’: A Dedicated Bifurcation Aneurysm Flow-Diverter Device

Background and purpose Data differentiating flow diversion properties of commercially available low- and high-porosity stents are limited. This in vitro study applies angiographic analysis of intra-aneurysmal flow to compare the flow-diversion performance of five neurovascular devices in idealized sidewall and bifurcation aneurysm models. Methods Five commercial devices (Enterprise, Neuroform, LVIS, FRED, and Pipeline) were implanted in silicone sidewall and bifurcation aneurysm models under physiological average flow of blood analog fluid. High-speed angiographic images were acquired pre- and post-device implantation and contrast concentration-time curves within the aneurysm were recorded. The curves were quantified with five parameters to assess changes in contrast transport, and thus aneurysm hemodynamics, due to each device. Results Inter-device flow-diversion performance was more easily distinguished in the sidewall model than the bifurcation model. There were no obvious overall statistical trends in the bifurcation parameters but the Pipeline performed marginally better than the other devices. In the sidewall geometry, overall evidence suggests that the LVIS performed better than the Neuroform and Enterprise. The Pipeline and FRED devices were statistically superior to the three stents and Pipeline was superior to FRED in all sidewall parameters evaluated. Conclusions Based on this specific set of experiments, lower-porosity flow diverters perform significantly better in reducing intra-aneurysmal flow activity than higher-porosity stents in sidewall-type geometries. The LVIS device is potentially a better flow diverter than the Neuroform and Enterprise devices, while the Pipeline is potentially better than the FRED.

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Endovascular Treatment of a Small Aneurysm of the Superior Cerebellar Artery with a Flow-Diverter Device

The Neuroradiology Journal ◽

10.1177/197140091302600313 ◽

2013 ◽

Vol 26 (3) ◽

pp. 327-331 ◽

Cited By ~ 12

Author(s):

F. Briganti ◽

M. Marseglia ◽

G. Leone ◽

G. Briganti ◽

D. Piccolo ◽

...

Keyword(s):

Endovascular Treatment ◽

Flow Diverter ◽

Superior Cerebellar Artery ◽

Cerebellar Artery ◽

Small Aneurysm ◽

Flow Diverter Device

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Ruptured Intracanalicular Ophthalmic Artery Aneurysm Treated with Low Profile Flow Diverter Device

Clinical Neuroradiology ◽

10.1007/s00062-019-00792-2 ◽

2019 ◽

Vol 30 (1) ◽

pp. 177-180

Author(s):

S. Sirakov ◽

A. Sirakov ◽

H. Tsonev ◽

H. Hristov

Keyword(s):

Ophthalmic Artery ◽

Artery Aneurysm ◽

Flow Diverter ◽

Low Profile ◽

Profile Flow ◽

Flow Diverter Device

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E-135 initial single center experience with the fred flow diverter device

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011917.209 ◽

2015 ◽

Vol 7 (Suppl 1) ◽

pp. A103.1-A103

Author(s):

J Fifi ◽

A Otokiti ◽

D Altschul ◽

S Paramasivam ◽

A Berenstein

Keyword(s):

Flow Diverter ◽

Single Center ◽

Single Center Experience ◽

Flow Diverter Device

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Republished: Advanced digital subtraction angiography and MR fusion imaging protocol applied to accurate placement of flow diverter device

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2014-011428.rep ◽

2015 ◽

Vol 8 (2) ◽

pp. e5-e5 ◽

Cited By ~ 7

Author(s):

Giuseppe Faragò ◽

Valentina Caldiera ◽

Giovanni Tempra ◽

Elisa Ciceri

Keyword(s):

Digital Subtraction Angiography ◽

Three Dimensional ◽

Interventional Neuroradiology ◽

Fusion Imaging ◽

Flow Diverter ◽

Progressive Increase ◽

Ct Images ◽

Digital Subtraction ◽

Imaging Protocol ◽

Flow Diverter Device

In recent years there has been a progressive increase in interventional neuroradiology procedures, partially due to improvements in devices, but also to the simultaneous development of technologies and radiological images. Cone beam CT (Dyna-CT; Siemens) is a method recently used to obtain pseudo CT images from digital subtraction angiography (DSA) with a flat panel detector. Using dedicated software, it is then possible to merge Dyna-CT images with images from a different source. We report here the usefulness of advanced DSA techniques (Syngo-Dyna CT, three-dimensional DSA iPilot) for the treatment of an intracranial aneurysm with a flow diverter device. Merging MR and Dyna-CT images at the end of the procedure proved to be a simple and rapid additional method of verifying the success of the intervention.

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Fenestra Obscura: Flow Diverter Reconstruction of a Complex Vertebrobasilar Aneurysm Through an Obscured Fenestration Limb: Technical Case Report

Operative Neurosurgery ◽

10.1227/neu.0000000000000996 ◽

2015 ◽

Vol 12 (1) ◽

pp. E95-E100 ◽

Cited By ~ 5

Author(s):

Gabor Toth ◽

Ferdinand Hui ◽

Mark Bain

Keyword(s):

Basilar Artery ◽

Flow Diverter ◽

Posterior Circulation ◽

Vascular Lesions ◽

Close Proximity ◽

Vertebrobasilar Junction ◽

Artery Reconstruction ◽

Endovascular Technology ◽

Flow Diverter Device

Abstract BACKGROUND AND IMPORTANCE Basilar fenestration aneurysms are rare, challenging intracranial vascular lesions with atypical anatomy. The posterior circulation represents a difficult therapeutic dilemma because of the close proximity of crucial life-sustaining brainstem structures. The use of flow diverter technology has been very limited in posterior circulation vessels. CLINICAL PRESENTATION We present the case of a 49-year-old female patient, who was diagnosed with a symptomatic large vertebrobasilar junction aneurysm, which was initially thought to be a proximal basilar dilatation. The aneurysm was later verified to arise from the proximal end of a basilar fenestration, distended by the aneurysm fundus. The small-caliber fenestration limbs were the only connection to the distal basilar artery, but were stretched laterally and concealed by the aneurysm fundus. This complex lesion was successfully treated by flow diverter deployment through one of the fenestration limbs, followed by coiling of the aneurysm fundus, and sacrificing the contralateral vertebral artery. A 6-month follow-up angiogram showed remodeling of the basilar artery and complete occlusion of the aneurysm with good clinical outcome. Careful diagnostic workup, multidisciplinary discussions, and the innovative use of versatile endovascular technology were crucial to achieve an optimal result in this case. CONCLUSION This is the first report of a successful basilar artery reconstruction for the treatment of a large atypical vertebrobasilar junction fenestration aneurysm by deployment of a flow diverter device directly in a small, obscured fenestration limb.

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