scholarly journals P.114 Flow diversion of bifurcation aneurysms is more effective when the jailed branch is occluded: an experimental study in a novel canine model

2016 ◽  
Vol 43 (S2) ◽  
pp. S47-S47
Author(s):  
T Darsaut ◽  
R Fahed ◽  
G Gevry ◽  
J Gentric ◽  
I Salazkin ◽  
...  
Keyword(s):  
Canine Model ◽  
Flow Diversion ◽  
Ordinal Scale ◽  
Residual Flow ◽  
Parent Vessel ◽  
Vessel Stenosis ◽  
Aneurysm Occlusion ◽  
Neointimal Coverage ◽  
Flow Diverters

Background: Flow diverters (FDs) are increasingly used for bifurcation aneurysms. Failure of aneurysm occlusion may be caused by residual flow maintaining patency of the jailed branch along with the aneurysm. Methods: Sixteen wide-necked lingual-carotid artery bifurcation aneurysms were created in 8 canines. Patent aneurysms were randomly allocated 4 weeks later to flow diversion combined with jailed branch occlusion using coils and/or Onyx (n=6) or flow diversion alone (n=8). Angiographic results of aneurysm occlusion at three months were scored using an ordinal scale. Pathology specimens were photographed and neointimal coverage estimated. Results: Fourteen aneurysms were patent at one month. FD deployment was successful in all cases, but at 3 month follow-up, 3 devices had prolapsed into the aneurysm. None of the bifurcation aneurysms treated with FD alone were occluded at 3 months. Endovascular branch occlusion combined with flow diversion significantly improved aneurysm occlusion rates (median angiographic score of 2) compared to flow diversion alone (median score of 0: P=0.0137). Flow-limiting parent vessel stenosis was not observed in any arteries. Devices were covered with thick neointima in most cases. Conclusions: Treatment failures following flow diversion of bifurcation aneurysms can be caused by persistent flow to the jailed branch. Branch occlusion combined with flow diversion may improve angiographic occlusion of canine aneurysms.

Flow diversion of bifurcation aneurysms is more effective when the jailed branch is occluded: an experimental study in a novel canine model

2016 ◽  
Vol 9 (3) ◽  
pp. 311-315 ◽  
Author(s):  
R Fahed ◽  
J C Gentric ◽  
I Salazkin ◽  
G Gevry ◽  
J Raymond ◽  
...  
Keyword(s):  
Canine Model ◽  
Flow Diversion ◽  
Ordinal Scale ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Bifurcation Aneurysm ◽  
Vessel Stenosis ◽  
Aneurysm Occlusion ◽  
Neointimal Coverage

BackgroundFlow diverters (FDs) are increasingly used for bifurcation aneurysms. Failure of aneurysm occlusion may be caused by residual flow maintaining patency of the jailed branch along with the aneurysm. Our aim was to test whether endovascular occlusion of the jailed branch could improve efficacy of flow diversion of bifurcation aneurysms.Materials and methodsSixteen wide-necked lingual–carotid artery bifurcation aneurysms were created in eight canines. Patent aneurysms were randomly allocated 4 weeks later to flow diversion combined with jailed branch occlusion using coils and/or Onyx (n=6) or flow diversion alone (n=8). Angiographic results of aneurysm occlusion at 3 months were scored using an ordinal scale. Pathology specimens were photographed and neointimal coverage estimated using a semiquantitative scoring system.ResultsFourteen aneurysms were patent at 1 month. FD deployment was successful in all cases but, at 3-month follow-up, three devices had prolapsed into the aneurysm. None of the bifurcation aneurysms treated with FD alone were occluded at 3 months. Endovascular branch occlusion combined with flow diversion significantly improved aneurysm occlusion rates compared with flow diversion alone (median angiographic scores 2 vs 0: p=0.0137). Flow-limiting parent vessel stenosis was not observed in any arteries. Devices were covered with thick neointima in most cases, but patent aneurysms were associated with leaks or holes in the neointima covering the aneurysm neck.ConclusionsTreatment failures following flow diversion of bifurcation aneurysms can be caused by persistent flow to the jailed branch. Branch occlusion combined with flow diversion may improve angiographic occlusion scores of a canine bifurcation aneurysm model.

scholarly journals Endovascular Treatment of Intracranial Aneurysms in the Flow Diverter Era: Frequency of Use and Results in a Consecutive Series of 550 Treatments in a Single Centre

2014 ◽  
Vol 20 (4) ◽  
pp. 428-435 ◽  
Author(s):  
Willem Jan van Rooij ◽  
Ratna S Bechan ◽  
Jo P. Peluso ◽  
Menno Sluzewski
Keyword(s):  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Flow Diversion ◽  
Consecutive Series ◽  
Complication Rates ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Permanent Neurological Deficit ◽  
Flow Diverters

Flow diverter devices became available in our department in 2009. We considered treatment with flow diverters only in patients with aneurysms not suitable for surgery or conventional endovascular techniques. This paper presents our preliminary experience with flow diverters in a consecutive series of 550 endovascular aneurysm treatments. Between January 2009 and July 2013, 550 endovascular treatments for intracranial aneurysms were performed. Of these, 490 were first-time aneurysm treatments in 464 patients and 61 were additional treatments of previously coiled aneurysms in 51 patients. Endovascular treatments consisted of selective coiling in 445 (80.8%), stent-assisted coiling in 68 (12.4%), balloon-assisted coiling in 13 (2.4%), parent vessel occlusion in 12 (2.2%) and flow diverter treatment in 12 (2.2%). Eleven patients with 12 aneurysms were treated with flow diverters. Two patients had ruptured dissecting aneurysms. One patient with a basilar trunk aneurysm died of acute in stent thrombosis and another patient died of brain stem ischaemia at 32 months follow-up. One patient had ischaemia with permanent neurological deficit. Two aneurysms are still open at up to 30 months follow-up. Flow diversion was used in 2% of all endovascular treatments. Both our own poor results and the high complication rates reported in the literature have converted our initial enthusiasm to apprehension and hesitancy. The safety and efficacy profile of flow diversion should discourage the use of these devices in aneurysms that can be treated with other techniques.

scholarly journals Vertebral artery aneurysms and the risk of cord infarction following spinal artery coverage during flow diversion

2020 ◽  
pp. 1-10
Author(s):  
Adam A. Dmytriw ◽  
Anish Kapadia ◽  
Alejandro Enriquez-Marulanda ◽  
Carmen Parra-Fariñas ◽  
Anna Luisa Kühn ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Flow Diverter ◽  
Thromboembolic Complication ◽  
Flow Diversion ◽  
Cerebellar Artery ◽  
Aneurysm Occlusion ◽  
Aneurysm Diameter ◽  
Flow Diverters

OBJECTIVECoverage of the anterior spinal artery (ASA) ostia is a source of considerable consternation regarding flow diversion (FD) in vertebral artery (VA) aneurysms due to cord supply. The authors sought to assess the association between coverage of the ASA, posterior spinal artery (PSA), or lateral spinal artery (LSA) ostia when placing flow diverters in distal VAs and clinical outcomes, with emphasis on cord infarction.METHODSA multicenter retrospective study of 7 institutions in which VA aneurysms were treated with FD between 2011 and 2019 was performed. The authors evaluated the risk of ASA and PSA/LSA occlusion, associated thromboembolic complication, complications overall, aneurysm occlusion status, and functional outcome.RESULTSSixty patients with 63 VA and posterior inferior cerebellar artery aneurysms treated with FD were identified. The median aneurysm diameter was 7 mm and fusiform type was the commonest morphology (42.9%). During a procedure, 1 (61.7%) or 2 (33.3%) flow diverters were placed. Complete occlusion was achieved in 71.9%. Symptomatic thromboembolic complications occurred in 7.4% of cases and intracranial hemorrhage in 10.0% of cases. The ASA and PSA/LSA were identified in 51 (80.9%) and 35 (55.6%) complications and covered by the flow diverter in 29 (56.9%) and 13 (37.1%) of the procedures, respectively. Patency after flow diverter coverage on last follow-up was 89.2% for ASA and 100% for PSA/LSA, not significantly different between covered and noncovered groups (p = 0.5 and p > 0.99, respectively). No complications arose from coverage.CONCLUSIONSFD aneurysm treatment in the posterior circulation with coverage of ASA or PSA/LSA was not associated with higher rates of occlusion of these branches or any instances of cord infarction.

Compaction of flow diverters improves occlusion of experimental wide-necked aneurysms

2015 ◽  
Vol 8 (10) ◽  
pp. 1072-1077 ◽  
Author(s):  
Jean-Christophe Gentric ◽  
Igor Salazkin ◽  
Guylaine Gevry ◽  
Jean Raymond ◽  
Tim Darsaut
Keyword(s):  
Treated Group ◽  
Grading System ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Group 4 ◽  
Aneurysm Occlusion ◽  
Group 3 ◽  
Neointimal Coverage ◽  
Carotid Aneurysms ◽  
Flow Diverters

IntroductionFlow diverters (FDs) are increasingly used in the treatment of wide-necked aneurysms.ObjectiveTo examine the hypothesis that intentional FD compaction might improve aneurysm occlusion rates.MethodsBilateral wide-necked carotid aneurysms were created in 12 dogs. Endovascular treatment was performed 1 month later, using Pipeline embolization devices deployed with compaction across the aneurysm neck (n=12). Group 1a consisted of aneurysms treated with a single compacted FD (n=8), while group 1b aneurysms required two compacted FDs (n=4). Control aneurysms were treated with a single non-compacted FD (group 3; n=6), or not treated (group 4; n=4). Angiographic results were compared at 3 months. Pathology specimens were photographed and the neointimal coverage of devices scored using an ordinal grading system.ResultsTwenty-two of 24 aneurysms were patent at 1 month. Deployment with compaction was successful in eight cases (group 1a aneurysms). The compaction maneuver led to immediate FD prolapse into the aneurysm in four cases, rescued by deploying a second, telescoping FD (forming group 1b aneurysms). One compacted device later migrated distally, leaving the aneurysm untreated. Angiographic results differed significantly between groups (p=0.0002). At 3 months, aneurysms successfully treated with a single compacted FD were more often occluded at 3 months (7/7) than aneurysms flow-diverted without compaction (2/6; p=0.021). All aneurysms treated with two compacted FDs were occluded, while all untreated aneurysms remained patent. There were no parent vessel stenoses.ConclusionsCompaction of FDs can improve angiographic occlusion of experimental wide-necked aneurysms.

scholarly journals Very delayed discontinuation of telescoped Pipeline embolization devices: a case report

2018 ◽  
Vol 25 (2) ◽  
pp. 182-186
Author(s):  
Manoj Bohara ◽  
Kosuke Teranishi ◽  
Kenji Yatomi ◽  
Takashi Fujii ◽  
Takayuki Kitamura ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Flow Diversion ◽  
Total Occlusion ◽  
Pipeline Embolization Device ◽  
Complete Occlusion ◽  
Radiological Features ◽  
Long Term Follow Up ◽  
Aneurysm Occlusion

Background Flow diversion with the Pipeline embolization device (PED) is a widely accepted treatment modality for aneurysm occlusion. Previous reports have shown no recanalization of aneurysms on long-term follow-up once total occlusion has been achieved. Case description We report on a 63-year-old male who had a large internal carotid artery cavernous segment aneurysm. Treatment with PED resulted in complete occlusion of the aneurysm. However, follow-up angiography at four years revealed recurrence of the aneurysm due to disconnection of the two PEDs placed in telescoping fashion. Conclusion Herein, we present the clinico-radiological features and discuss the possible mechanisms resulting in the recanalization of aneurysms treated with flow diversion.

scholarly journals Endovascular treatment of intracranial ‘blister’ and dissecting aneurysms

2019 ◽  
Vol 32 (5) ◽  
pp. 353-365 ◽  
Author(s):  
Marius G Kaschner ◽  
Bastian Kraus ◽  
Athanasios Petridis ◽  
Bernd Turowski
Keyword(s):  
Endovascular Treatment ◽  
Favourable Outcome ◽  
Modified Rankin Scale ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Parent Vessel Occlusion ◽  
Aneurysm Occlusion ◽  
Vessel Reconstruction ◽  
Dissecting Aneurysms

IntroductionBlister and dissecting aneurysms may have a different pathological background but they are commonly defined by instability of the vessel wall and bear a high risk of fatal rupture and rerupture. Lack of aneurysm sack makes treatment challenging.PurposeThe purpose of this study was to assess the safety and feasibility of endovascular treatment of intracranial blister and dissecting aneurysms.MethodsWe retrospectively analysed all patients with ruptured and unruptured blister and dissecting aneurysms treated endovascularly between 2004–2018. Procedural details, complications, morbidity/mortality, clinical favourable outcome (modified Rankin Scale ≤2) and aneurysm occlusion rates were assessed.ResultsThirty-four patients with endovascular treatment of 35 aneurysms (26 dissecting aneurysms and 9 blister aneurysms) were included. Five aneurysms were treated by parent vessel occlusion, and 30 aneurysms were treated by vessel reconstruction using stent monotherapy ( n = 9), stent-assisted coiling ( n = 7), flow diverting stents ( n = 13) and coiling + Onyx embolization ( n = 1). No aneurysm rebleeding and no procedure-related major complications or deaths occurred. There were five deaths in consequence of initial subarachnoid haemorrhage. Complete occlusion (79.2%) was detected in 19/24 aneurysms available for angiographic follow-up, and aneurysm recurrence in 2/24 (8.3%). The modified Rankin Scale ≤2 rate at mean follow-up of 15.1 months was 64.7%.ConclusionTreatment of blister and dissecting aneurysms developed from coil embolization to flow diversion with multiple stents to the usage of flow diverting stents. Results using modern flow diverting stents encourage us to effectively treat this aneurysm entity endovascularly by vessel reconstruction. Therefore, we recommend preference of vessel reconstructive techniques to parent vessel occlusion.

scholarly journals Application of flow diverters in the treatment of aneurysms in the internal carotid artery bifurcation region

2020 ◽  
Vol 33 (4) ◽  
pp. 297-305
Author(s):  
Mostafa Mahmoud ◽  
Ahmed Farag ◽  
Mostafa Farid ◽  
Ahmed Elserwi ◽  
Amr Abdelsamad ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Case Reports ◽  
Therapeutic Option ◽  
Case Series ◽  
Flow Diversion ◽  
Occlusion Rate ◽  
Flow Diverters

Introduction The treatment of aneurysms in the internal carotid bifurcation region (ICABR), including aneurysms of the true internal carotid artery (ICA) terminus, those inclined on the proximal A1 or M1 segments or at the most distal pre-bifurcation (ICA) segment, is often challenging in microsurgical clipping and endovascular surgery. Few reports had discussed flow diversion as a therapeutic option for this group. Methods This was a retrospective study analysing flow diversion in treating ICABR aneurysms. Seven patients harbouring eight aneurysms in the ICABR were treated with flow diversion. Five aneurysms were inclined on the proximal A1 segment, and three were located at the most distal pre-bifurcation segment. Patients’ demographics, presentation, procedure technical description, angiographic and clinical follow-up were recorded. PubMed and Ovid MEDLINE were also reviewed for articles published in English, including case series or case reports, for ICABR aneurysms treated with flow diverters. Results All patients except one underwent angiographic follow-up. The Karman–Byrne occlusion scale was used to determine the occlusion rate. All six patients with documented angiographic follow-up had a class IV occlusion score. No permanent or transient neurological or non-neurological complications were encountered in this study. Conclusion Treating ICABR aneurysms using flow diversion is feasible, with a promising angiographic occlusion rate. Further studies are needed to analyse long-term clinical and angiographic results.

Overview of Different Flow Diverters and Flow Dynamics

Neurosurgery ◽  
2019 ◽  
Vol 86 (Supplement_1) ◽  
pp. S21-S34 ◽  
Author(s):  
Georgios A Maragkos ◽  
Adam A Dmytriw ◽  
Mohamed M Salem ◽  
Vincent M Tutino ◽  
Hui Meng ◽  
...  
Keyword(s):  
Rapid Evolution ◽  
Evidence Base ◽  
Flow Diverter ◽  
Outcome Data ◽  
Flow Diversion ◽  
Comprehensive Overview ◽  
Flow Diverter Devices ◽  
Technical Specifications ◽  
Flow Diverters

Abstract Over the past decade, flow diverter technology for endocranial aneurysms has seen rapid evolution, with the development of new devices quickly outpacing the clinical evidence base. However, flow diversion has not yet been directly compared to surgical aneurysm clipping or other endovascular procedures. The oldest and most well-studied device is the Pipeline Embolization Device (PED; Medtronic), recently transitioned to the Pipeline Flex (Medtronic), which still has sparse data regarding outcomes. To date, other flow diverting devices have not been shown to outperform the PED, although information comes primarily from retrospective studies with short follow-up, which are not always comparable. Because of this lack of high-quality outcome data, no reliable recommendations can be made for choosing among flow diversion devices yet. Moreover, the decision to proceed with flow diversion should be individualized to each patient. In this work, we wish to provide a comprehensive overview of the technical specifications of all flow diverter devices currently available, accompanied by a succinct description of the evidence base surrounding each device.

scholarly journals Pipeline-assisted coil embolization of a large middle cerebral artery pseudoaneurysm in a 9-month-old infant: experience from the youngest flow diversion case

2018 ◽  
Vol 22 (5) ◽  
pp. 532-540 ◽  
Author(s):  
Geoffrey P. Colby ◽  
Bowen Jiang ◽  
Matthew T. Bender ◽  
Narlin B. Beaty ◽  
Erick M. Westbroek ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Pediatric Population ◽  
Flow Diversion ◽  
Left Middle Cerebral Artery ◽  
Artery Pseudoaneurysm ◽  
First Case ◽  
Aneurysm Occlusion

Intracranial aneurysms in the pediatric population are rare entities. The authors recently treated a 9-month-old infant with a 19-mm recurrent, previously ruptured, and coil-embolized left middle cerebral artery (MCA) pseudoaneurysm, which was treated definitively with single-stage Pipeline-assisted coil embolization. The patient was 5 months old when she underwent resection of a left temporal Grade 1 desmoplastic infantile ganglioglioma at an outside institution, which was complicated by left MCA injury with a resultant 9-mm left M1 pseudoaneurysm. Within a month, the patient had two aneurysmal rupture events and underwent emergency craniectomy for decompression and evacuation of subdural hematoma. The pseudoaneurysm initially underwent coil embolization; however, follow-up MR angiography (MRA) revealed aneurysm recanalization with saccular enlargement to 19 mm. The patient underwent successful flow diversion–assisted coil embolization at 9 months of age. At 7 months after the procedure, follow-up MRA showed complete aneurysm occlusion without evidence of in-stent thrombosis or stenosis. Experience with flow diverters in the pediatric population is still in its early phases, with the youngest reported patient being 22 months old. In this paper the authors report the first case of such a technique in an infant, whom they believe to be the youngest patient to undergo cerebral flow diversion treatment.

Sign in / Sign up

Export Citation Format

Share Document