Reconstructive vs Deconstructive Endovascular Approach to Intradural Vertebral Artery Aneurysms: A Multicenter Cohort Study

Abstract BACKGROUND Parent vessel sacrifice (PVS) has been a traditional way of treating complex aneurysms of the intradural vertebral artery (VA). Flow diversion (FD) has emerged as an alternative reconstructive option. OBJECTIVE To compare the long-term clinical and radiographic outcomes of intradural VA aneurysms following PVS or FD. METHODS We retrospectively reviewed and evaluated 43 consecutive patients between 2009 and 2018 with ruptured and unruptured intradural VA aneurysms treated by PVS or FD. Medical records including clinical and radiological details were reviewed. RESULTS A total of 43 intradural VA aneurysms were treated during this period. In the 14 PVS patients, the mean follow-up was 19.5 mo, and 71.4% of cases achieved modified Rankin scale (mRS) ≤2 at the last follow-up. A total of 86.5% of cases achieved complete occlusion. There was a 14.3% (2 cases) mortality rate, 14.3% (2 cases) postoperative ischemic complication rate, and 0% postoperative hemorrhaging rate. Retreatment was required in 1 case (7.1%). In the 29 FD patients, the mean follow-up was 21.8 mo, and 89.7% of cases achieved mRS ≤2 at the final follow-up. There was a 3.2% (1 case) mortality rate, 19.4% (6 cases) of postoperative ischemic complications, and 6.5% (2 cases) of postoperative hemorrhagic complications. Complete occlusion was seen in 86.5% patients. No cases required retreatment. Mortality and complication rates were not significantly different between PVS and PED (Pipeline Embolization Device) groups. CONCLUSION PVS was associated with comparable intraprocedural complications for VA aneurysms as compared to FD in the largest multicenter study to date. Both procedures have good long-term clinical and radiological outcomes.

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Endovascular management of intracranial blister aneurysms: spectrum and limitations of contemporary techniques

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2014-011443 ◽

2014 ◽

Vol 8 (1) ◽

pp. 30-37 ◽

Cited By ~ 10

Author(s):

Ramsey Ashour ◽

Stephen Dodson ◽

M Ali Aziz-Sultan

Keyword(s):

Complication Rates ◽

Endovascular Techniques ◽

Parent Vessel ◽

Endovascular Interventions ◽

Scale Scores ◽

Long Term Follow Up ◽

Surgical Bypass ◽

Endovascular Approach

BackgroundIntracranial blister aneurysms are rare lesions that are notoriously more difficult to treat than typical saccular aneurysms. High complication rates associated with surgery have sparked considerable interest in endovascular techniques, though not well-studied, to treat blister aneurysms.ObjectiveTo evaluate our experience using various endovascular approaches to treat blister aneurysms.MethodsAll consecutive blister aneurysms treated using an endovascular approach by the study authors over a 3-year period were retrospectively analyzed. A literature review was also performed.ResultsNine patients with blister aneurysms underwent 11 endovascular interventions. In various combinations, stents were used in 8/11, coils in 5/11, and Onyx in 3/11 procedures. At mean angiographic follow-up of 200 days, 8/9 aneurysms were completely occluded by endovascular means alone requiring no further treatment and 1/9 aneurysms required surgical bypass/trapping after one failed surgical and two failed endovascular treatments. At mean clinical follow-up of 416 days, modified Rankin Scale scores were improved in six patients, stable in two, and worsened in one patient. One complication occurred in 11 procedures (9%), resulting in a permanent neurologic deficit. No unintended endovascular parent vessel sacrifice, intraprocedural aneurysmal ruptures, antiplatelet-related complications, post-treatment aneurysmal re-ruptures, or deaths occurred.ConclusionThis series highlights both the spectrum and limitations of endovascular techniques currently used to treat blister aneurysms, including a novel application of stent-assisted Onyx embolization. Long-term follow-up and experience in larger studies are required to better define the role of endovascular therapy in the management of these difficult lesions.

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Long-term occlusion results with SILK flow diversion in 28 aneurysms: Do recanalizations occur during follow-up?

Interventional Neuroradiology ◽

10.1177/1591019915583119 ◽

2015 ◽

Vol 21 (3) ◽

pp. 300-310 ◽

Cited By ~ 14

Author(s):

Anastasios Mpotsaris ◽

Martin Skalej ◽

Oliver Beuing ◽

Bernd Eckert ◽

Daniel Behme ◽

...

Keyword(s):

Prospective Study ◽

Intracranial Aneurysms ◽

Flow Diverter ◽

Success Rates ◽

Imaging Data ◽

Complete Occlusion ◽

Complex Aneurysms ◽

Multicenter Prospective Study

Background and purpose The purpose of this article is to report on the long-term success rates of Silk flow-diverter (FD) treatment in a multicenter prospective study for the treatment of complex aneurysms. Methods Between May 2008 and January 2011, all consecutive patients featuring complex intracranial aneurysms eligible for FD treatment with the Silk in three neurovascular centers were included. Clinical and imaging data were assessed during hospitalization and follow-up. Results Five patients were initially asymptomatic, 20 patients showed various neurological symptoms. Twenty-eight FDs were implanted in 25 patients treating 28 aneurysms. The immediate procedure-related morbidity was 8% (two of 25), mortality 0%. One procedure-related death was observed during follow-up (in-stent thrombosis). Compared to the immediate result nearly two of three aneurysms improved during follow-up; all angiographically confirmed inflow changes took place within six months after treatment. Final anatomic outcome in 24 aneurysms of 22 patients comprised 14 (59%) with complete occlusion, seven (29%) with a neck remnant, two (8%) with residual filling <50%, none with residual filling >50% and one (4%) unchanged in comparison to its pretreatment status. Postinterventional recanalizations were seen in three of 13 (23%) aneurysms treated with FD alone; none were observed in 15 aneurysms treated with adjunctive coiling. Conclusion Anatomic presentation and location are key for successful FD treatment. The rate of successful occlusion increases during follow-up. Postinterventional monitoring for at least six months is paramount, as anatomic outcome is not reliably predictable and recanalizations may occur in initially completely occluded aneurysms.

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Transscleral vs Endoscopic Cyclophotocoagulation: Safety and Efficacy When Combined with Phacoemulsification

10.21203/rs.3.rs-1041444/v1 ◽

2021 ◽

Author(s):

Abraham Nirappel ◽

Emma Klug ◽

Cameron Neeson ◽

Mari Chachanidze ◽

Nathan Hall ◽

...

Keyword(s):

Outcome Measures ◽

Open Angle Glaucoma ◽

Common Type ◽

Complication Rates ◽

Kaplan Meier ◽

Surgical Failure ◽

Transscleral Cyclophotocoagulation ◽

The Mean

Abstract Precis: Phacoemulsification combined with MicroPulse transscleral cyclophotocoagulation appears to provide significantly greater long-term IOP reduction than phacoemulsification combined with endoscopic cyclophotocoagulation without compromising safety.Purpose: To compare the effectiveness and safety of phacoemulsification combined with endoscopic cyclophotocoagulation (phaco/ECP), phacoemulsification combined with MicroPulse transscleral cyclophotocoagulation (phaco/MP-TSCPC), and phacoemulsification alone (phaco) in the treatment of coexisting cataract and glaucoma. Methods: Retrospective cohort study of consecutive cases at Massachusetts Eye & Ear. The main outcome measures were the cumulative probabilities of failure between the phaco/ECP group, phaco/MP-TSCPC group, and the phaco alone group with failure defined as reaching NLP vision at any point postoperatively or the inability to maintain ≥20% IOP reduction from baseline with IOP between 5-18 mmHg. Additional outcome measures included changes in average IOP, number of glaucoma medications, and complication rates. Results: 64 eyes from 64 patients (25 phaco/ ECP, 20 phaco/ MPTSCPC, 19 phaco alone) were included in this study. The groups did not differ in age (mean 71.04 ± 6.7 years) or length of follow-up time. Primary open-angle glaucoma was the most common type of glaucoma in the phaco alone (42%) and phaco/ECP (48%) groups while mixed-mechanism glaucoma was the most common type in the phaco/MP-TSCPC group (40%). The mean IOP reductions at 1 year were 3.07 ± 5.3 mmHg from a baseline of 15.78 ± 4.7 in the phaco/ECP group, 6.0 ± 4.3 mmHg from a baseline of 18.37 ± 4.6 in the phaco/MP-TSCPC group and 1.0 ± 1.6 from a baseline of 14.30 ± 4.2 mmHg in the phaco alone group. Surgical failure was less likely in eyes in the phaco/MP-TSCPC and phaco/ECP groups compared to phaco alone based on the Kaplan-Meier survival criteria, with failure defined as the inability to maintain an IOP reduction of 20% or more with IOP between 5-18 mm Hg long term. There were no differences in complications among the three groups. Conclusions: Phaco/MP-TSCPC appears to provide for greater long-term IOP control than phaco alone and phaco/ECP. All three procedures had similar safety profiles.

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Myocardial SPECT Perfusion Defects in Angina Patients, Without Significant Epicardial Coronary Artery Disease. Can Pathological SPECT Affect Long-Term Prognosis?

10.21203/rs.3.rs-988779/v1 ◽

2021 ◽

Author(s):

EVANGELOS LAMPAS ◽

Kiriaki Syrmali ◽

Georgios Nikitas ◽

Emmanouil C. Papadakis ◽

Sotirios P. Patsilinakos

Keyword(s):

Mortality Rate ◽

Nyha Class ◽

Clinical Problem ◽

Cardiovascular Prognosis ◽

Reversible Ischemia ◽

The Mean ◽

Artery Disease ◽

Long Term Prognosis

Abstract Purpose: Patients with angina and a positive SPECT for reversible ischemia, with no or non-obstructive CAD on ICA represent a frequent clinical problem and predicting prognosis is challenging. Methods: A retrospective single center study focused on patients that underwent elective-ICA with angina and a positive SECT with no or non-obstructive CAD in the CathLab, during a seven-year period. Assessment of patients’ cardiovascular morbidity, mortality, and MACE during a follow-up period of at least three years after ICA, with the assist of a telephone questionnaire.Results: Data of all patients that underwent ICA for a period of 7 years (from January 1,2011 until December 31, 2017) in our hospital were analyzed. The patients that fulfilled the prespecified criteria were 569. At the telephone survey, 285(50.1%) were successfully contacted and agreed to participate. The mean age was 67.6 (SD8.8) years (35.4%female) and the mean follow-up time was 5.53years (SD1.85). Mortality rate was 1.7% (4 patients/non-cardiac causes) and 1,7% rate of revascularization. 31(10,9%) were hospitalized for cardiac reasons and 10,9% patients reported symptoms of HF (no patients with NYHA-Class above II). 21 had arrhythmic events and only two mild anginal symptoms. Noteworthy finding was, the mortality rate in the not-contacted group (12 out of 284, 4,2%), derived by public security records, did not differ significantly from the contacted-group. Conclusions: Patients with angina, a positive SPECT for reversible ischemia and no or non-obstructive CAD in ICA have very good long-term cardiovascular prognosis for at least 5 years.

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Very Late Thrombosis of a Pipeline Embolization Device Construct

Operative Neurosurgery ◽

10.1227/01.neu.0000383875.08681.23 ◽

2010 ◽

Vol 67 (3) ◽

pp. onsE313-onsE314 ◽

Cited By ~ 49

Author(s):

David Fiorella ◽

Daniel Hsu ◽

Henry H. Woo ◽

Robert W. Tarr ◽

Peter Kim Nelson

Keyword(s):

Vertebral Artery ◽

Artery Aneurysm ◽

Left Vertebral Artery ◽

Pipeline Embolization Device ◽

Complete Occlusion ◽

Brainstem Stroke ◽

Long Term Follow Up ◽

Late Thrombosis

Abstract BACKGROUND: The Pipeline embolization device (PED) is a new endoluminal construct designed to exclude aneurysms from the parent cerebrovasculature. We report the very late (>;1 year) thrombosis of a PED construct placed for the treatment of a left vertebral aneurysm. CLINICAL PRESENTATION: A patient with an occluded right vertebral artery and a large, fusiform intracranial left vertebral artery aneurysm was treated with PED and coil reconstruction. A durable, complete occlusion of the aneurysm was confirmed with control angiography at 1 year. The patient remained neurologically normal for 23 months until he experienced a transient visual disturbance followed weeks later by a minor brainstem stroke. INTERVENTION: Imaging evaluation showed thrombosis of the PED construct with complete occlusion of the left vertebral artery. After this stroke, he was initially treated with dual antiplatelet therapy and was then converted to warfarin. The patient remained neurologically stable for 5 months until he experienced progressive basilar thrombosis that ultimately resulted in a fatal stroke. CONCLUSION: The PED represents a promising new endovascular technology for the treatment of cerebral aneurysms; however, as an investigational device, long-term follow-up data are sparse at this point. The etiology of the very late thrombosis of the PED construct in this case remains unknown; however, this report underscores the need for a continued, careful systematic evaluation and close long-term follow-up of treated patients.

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Concurrent use of the Pipeline Embolization Device and coils for intracranial aneurysms: technique, safety, and efficacy

Journal of Neurosurgery ◽

10.3171/2014.12.jns141259 ◽

2015 ◽

Vol 122 (4) ◽

pp. 904-911 ◽

Cited By ~ 37

Author(s):

Erez Nossek ◽

David J. Chalif ◽

Shamik Chakraborty ◽

Kim Lombardo ◽

Karen S. Black ◽

...

Keyword(s):

Clinical Status ◽

Mass Effect ◽

Clinical Results ◽

Parent Vessel ◽

Pipeline Embolization Device ◽

Complete Occlusion ◽

Neck Size ◽

Concurrent Use ◽

The Mean

OBJECT The use of the Pipeline Embolization Device (PED) as a sole endovascular modality has been described for the treatment of brain aneurysms. The benefit of using coils concurrently with a limited number of PEDs is not well documented. The authors describe their experience with this technique as well as their midterm clinical and angiographic results. METHODS This is a retrospective review of patients treated between 2011 and 2014. The authors placed a minimal number of PEDs with the addition of coils using a “jailed” microcatheter technique. A partially dense coil mass was obtained. Immediate and midterm clinical and angiographic results are reviewed. RESULTS The authors treated 27 patients harboring 28 aneurysms using this technique. The mean aneurysm size was 11.9 mm, and the mean neck size was 5.4 mm. A mean of 1.48 PEDs were placed per patient, and a mean of 1.33 PEDs per aneurysm were placed. The Raymond score immediately after PED placement was 2 or 3 in 82.1% of the patients. There were no intraprocedural or postprocedural complications. All PEDs were successfully deployed. No clinical or technical adverse effects related to the coil mass were observed. There were no clinical or radiographic signs of ischemia in this group. At follow-up imaging, complete aneurysm occlusion was demonstrated on the first MR angiogram (3–5 months) in all patients who reached this milestone. Follow-up digital subtraction angiography (5–13 months) confirmed complete occlusion in all patients who reached this milestone. All patients maintained their baseline clinical status. CONCLUSIONS The deployment of PEDs with concurrent partially dense coiling is safe and efficacious. This technique achieved early complete occlusion and endovascular reconstruction of the parent vessel, without inducing mass effect. Favorable midterm clinical results were observed in all patients.

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Transvenous Onyx Embolization of Carotid-Cavernous Fistulas: Mid- and Long-Term Outcomes

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1710514 ◽

2020 ◽

Author(s):

André Beer-Furlan ◽

Krishna C. Joshi ◽

Bledi Brahimaj ◽

Demetrius K. Lopes

Keyword(s):

Conjunctival Injection ◽

Long Term Outcomes ◽

Duration Of Symptoms ◽

Technical Aspects ◽

Complete Occlusion ◽

Presenting Symptoms ◽

The Mean ◽

Carotid Cavernous Fistulas

Abstract Objective Endovascular treatment of carotid-cavernous fistulas (CCFs) has been consistently shown to give excellent results and is currently the mainstay of treatment of these complex vascular pathologies. Onyx is currently the most widely used agent, but there has been concern over high rates of cranial nerve (CN) deficits seen in patients with CCF treated with Onyx and paucity of data on long-term outcomes. Methods This is a retrospective analysis of patients who underwent transvenous Onyx embolization between 2011 and 2018. The data collected included demographics, comorbidities, presenting symptoms, CCF morphology, degree of obliteration, procedure-related complications, clinical outcomes, and follow-up. Results A total of seven patients (five females) were included. The median age was 66 years (range: 15–79 years). Median duration of symptoms before treatment was 4 weeks (range: 1–24 weeks). There were three direct and four indirect CCFs. Barrow classification is as follows: A-3; B-3; C-0; and D-1. Immediate complete occlusion was achieved in all cases. There was also one case of immediate postoperative change in CN function (new partial CN VI deficit) that resolved completely at 1-month follow-up. The mean length of stay was 3 days (±2). The preoperative extraocular movement CN deficits had the following outcomes: three resolved; two improved; and one persisted. Proptosis, chemosis, conjunctival injection, and tinnitus were resolved in all patients. The median follow-up was 34 months (range: 10–91 months). Conclusion Transvenous Onyx embolization is a safe and effective treatment of CCFs when technical aspects to reduce complications are performed diligently. Our technique demonstrates safety of the Onyx as a stand-alone embolization for the treatment of CCF.

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Abstract MP8: Long Term Angiographic and Clinical Outcomes From 1,000 Aneurysms Treated With the Pipeline Embolization Device

Stroke ◽

10.1161/str.52.suppl_1.mp8 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Ivan Lylyk ◽

Pedro N Lylyk ◽

Javier Lundquist ◽

Esteban Scrivano ◽

Nicolas Perez ◽

...

Keyword(s):

Mortality Rate ◽

Prospective Studies ◽

Intracranial Aneurysms ◽

Previous Treatment ◽

Complete Occlusion ◽

Long Term Stability ◽

Acute Subarachnoid Hemorrhage ◽

Complications And Mortality

Background and Purpose: Prospective studies have established the safety and efficacy of the Pipeline TM Embolization Device (PED) for the treatment of intracranial aneurysms (IA). Here, we report long-term outcomes from The Pipeline Embolization Devices for the Treatment of Intracranial Aneurysms (PEDESTRIAN) Registry. Methods: This was a retrospective review of prospectively collected data from the PEDESTRIAN registry. Between March 2006 and July 2019, consecutive patients with complex IA were treated with PED at one center in Argentina. Patients with unfavorable anatomy and/or recurrence following previous treatment were included, and those with acute subarachnoid hemorrhage (SAH) were excluded. The primary angiographic endpoint was complete occlusion and long-term stability. Clinical and angiographic follow-up was performed at 3-6 months, 12 months, and yearly thereafter. Results: A total of 835 patients (mean age 55.9±14.7 years; 80% [671/835] female) with 1,000 aneurysms were included. The majority (64.6%) of aneurysms were small (≤10mm), 25.6% were large (11-24mm), and 9.8% were giant (≥25mm). A total of 1,214 PEDs were deployed, with a single device deployed in 84.2% of aneurysms. Follow-up angiography was available for 85.1% of patients with 776 aneurysms at mean 24.6±25.0 months. Complete Raymond Roy I occlusion was demonstrated in 75.8% (588/776) of aneurysms at 12-months, 92.9% (300/323) at 2-4 years, and 96.4% (159/165) at >5 years. During the post-procedural period, mRS remained stable or improved in 96.2% of patients, with stability or improvement in 99.1% of patients in the longer term. The overall major morbidity and neurological mortality rate was 5.8% (44/835), and the all-cause mortality rate was 4.6% (38/835). Conclusions: Endovascular treatment of IA with PED is safe and effective, with rates of complete occlusion, complications, and mortality comparable to previous prospective studies. Serial angiographic follow-up showed high and increasing occlusion rates, with stable occlusion of all cases at 13 years.

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Stent-assisted embolization of 100 middle cerebral artery aneurysms

Journal of Neurosurgery ◽

10.3171/2013.1.jns121298 ◽

2013 ◽

Vol 118 (5) ◽

pp. 950-955 ◽

Cited By ~ 25

Author(s):

Andrew K. Johnson ◽

Daniel M. Heiferman ◽

Demetrius K. Lopes

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Clinical Results ◽

Complication Rates ◽

Complete Occlusion ◽

Neurological Morbidity ◽

Middle Cerebral Artery Aneurysms ◽

Vessel Reconstruction

Object The introduction of intracranial stents to aneurysm treatment allows endovascular repair of nearly all aneurysms, but the safety and durability of stent-assisted embolization of middle cerebral artery (MCA) aneurysms is unclear. Methods Ninety-one patients with 100 complex MCA aneurysms not amenable to simple coiling were treated with stent-assisted embolization as a first option. Technical and clinical results, initial follow-up imaging, and long-term annual MR angiography (MRA) were reviewed. Results Intracranial stents were successfully deployed in all 100 aneurysms. There was 1 case of significant neurological morbidity (1%) and 1 case of death (1%) related to treatment. Initial posttreatment angiography revealed complete occlusion of 48 aneurysms (48%), a residual neck in 21 (21%), and residual aneurysm filling in 31 (31%). Follow-up imaging performed in 85 (90.4%) of a possible 94 aneurysms showed complete occlusion of 77 aneurysms (90.6%), residual neck in 3 (3.5%), and residual filling in 5 (5.9%). Four aneurysms (4.7%) required retreatment. Long-term MRA follow-up revealed stability or progressive thrombosis in 47 (97.9%) of 48 aneurysms. In 11 patients Y-configuration stenting caused only 1 minor complication and provided durable occlusion in all cases. Conclusions Stent-assisted techniques increase the number of aneurysms that may be treated endovascularly and represent an acceptable alternative to craniotomy. Stents provided adequate vessel reconstruction, low complication rates, and good long-term occlusion.

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Epidemiology of heart failure and long-term follow-up outcomes in a north-African population: Results from the NAtional TUnisian REgistry of Heart Failure (NATURE-HF)

PLoS ONE ◽

10.1371/journal.pone.0251658 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251658

Author(s):

Leila Abid ◽

Salma Charfeddine ◽

Ikram Kammoun ◽

Manel Ben Halima ◽

Hedi Ben Slima ◽

...

Keyword(s):

Heart Failure ◽

Mortality Rate ◽

Clinical Epidemiology ◽

North African ◽

Long Term Follow Up ◽

North African Population ◽

The Mean ◽

Initial Hospitalization

The NATURE-HF registry was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). This is a prospective, multicenter, observational survey conducted in Tunisian Cardiology centers. A total of 2040 patients were included in the study. Of these, 1632 (80%) were outpatients with chronic HF (CHF). The mean hospital stay was 8.7 ± 8.2 days. The mortality rate during the initial hospitalization event for AHF was 7.4%. The all-cause 1-year mortality rate was 22.8% among AHF patients and 10.6% among CHF patients. Among CHF patients, the older age, diabetes, anemia, reduced EF, ischemic etiology, residual congestion and the absence of ACEI/ ARBs treatment were independent predictors of 1-year cumulative rates of rehospitalization and mortality. The female sex and the functional status were independent predictors of 1-year all-cause mortality and rehospitalization in AHF patients. This study confirmed that acute HF is still associated with a poor prognosis, while the mid-term outcomes in patients with chronic HF seems to be improved. Some differences across countries may be due to different clinical characteristics and differences in healthcare systems.

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