Y-Stent-Assisted Coiling With Low-Profile Neuroform Atlas Stents for Endovascular Treatment of Wide-Necked Complex Intracranial Bifurcation Aneurysms

Abstract BACKGROUND Y-stent-assisted coiling is one of the eligible techniques for the treatment of complex bifurcation aneurysms. In majority of previous literature, Y-stenting has been performed using stents that could be delivered through large profile microcatheters that are often difficult to manipulate during navigation through sharply angled side branches. Attempts to navigate with these large profile catheters might cause serious complications during Y-stenting procedure. OBJECTIVE To investigate the safety, feasibility, and efficacy of Y-stent-assisted coiling procedure with Neuroform Atlas stents for the treatment of complex bifurcation aneurysms; Neuroform Atlas is a recently introduced open-cell stent that can be delivered though low-profile microcatheters. METHODS We identified the patients with intracranial bifurcation aneurysms treated by Y-stent-assisted coiling procedure with Neuroform Atlas stents. We assessed the immediate postoperative and follow-up clinical and angiographic outcomes. We also investigated the periprocedural and delayed complications. RESULTS A total of 30 aneurysms in 30 patients were included in the study. Y-stenting was successfully performed without any technical complications in all cases (100%). Immediate postprocedural angiography revealed total aneurysm occlusion in 83.3% of patients. The mean angiographic follow-up time was 11.8 mo. The last follow-ups showed complete occlusion in 93.3% of patients. There was no mortality in this study. A procedure-related complication developed in 6.7% and resulted in permanent morbidity in 3.3% of patients. CONCLUSION Neuroform Atlas stent combines the advantages of low-profile deployment microcatheters with an open-cell structure to achieve a successful Y-stenting procedure. Y-stent-assisted coiling with Neuroform Atlas stents provides a safe and effective endovascular treatment for wide-necked complex bifurcation aneurysms.

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Endovascular Treatment of Vertebral and Basilar Artery Aneurysms with Low-Profile Visualized Intraluminal Support Device

10.21203/rs.3.rs-52499/v1 ◽

2020 ◽

Author(s):

Quanlong Hong ◽

Wenqiang Li ◽

Jing Ma ◽

Peng Jiang ◽

Yisen Zhang

Keyword(s):

Endovascular Treatment ◽

Basilar Artery ◽

Current Knowledge ◽

Endovascular Embolization ◽

Low Profile ◽

Closed Cell ◽

Procedural Complications ◽

Permanent Morbidity ◽

A Minor

Abstract Background: The Low-profile Visualized Intraluminal Support (LVIS) device is a self-expanding, nitinol, single-braid, closed-cell device that was recently developed for endovascular embolization of intracranial aneurysms. However, current knowledge regarding the use of LVIS devices to treat vertebral and basilar artery aneurysms is limited. We aimed to evaluate the feasibility, efficacy, and safety of the LVIS device for treating vertebral and basilar artery aneurysms.Methods: Between January 2015 and December 2017, patients with vertebral and basilar artery aneurysms treated using LVIS stents were enrolled in this study. We analyzed patients’ demographic, clinical and aneurysmal characteristics, procedural details, complications, and angiographic and clinical follow-up results.Results: We identified 63 patients with 64 vertebral and basilar artery aneurysms who underwent treatment with (n=59) or without (n=5) LVIS stenting, including 10 patients with ruptured aneurysms. Forty-one aneurysms were located at the vertebral artery, and 23 at the basilar artery. Intraprocedural-related complications developed in three (4.8%) patients, while none of these patients developed morbidities or died during follow-up. Three patients developed post-procedural complications (4.8%). Two patients experienced ischemic events immediately post-procedure. A minor permanent morbidity developed in one of the two patients (1.6%). The mortality rate was 1.6%, for that the patient died of brainstem hemorrhage after 1 month of follow-up. At a mean follow-up of 12.5 months, 39/43 (90.7%) patients had stable or improved aneurysms, and four (9.3%) had recanalized.Conclusions: Endovascular treatment of vertebral and basilar artery aneurysms with the LVIS device is feasible, safe, and effective in the short-term. Long-term and larger cohort studies are necessary to validate our results.

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Low-profile visualized intraluminal support Blue stenting within a Neuroform Atlas stent for a large wide-necked aneurysm: A case report and a bench-top experiment

The Neuroradiology Journal ◽

10.1177/19714009211026900 ◽

2021 ◽

pp. 197140092110269

Author(s):

Tomoko Hayashi ◽

Hiroyuki Ikeda ◽

Ryota Ishibashi ◽

Toshio Fujiwara ◽

Ryosuke Kaneko ◽

...

Keyword(s):

Case Report ◽

Coil Embolization ◽

Cell Design ◽

Open Cell ◽

Aneurysm Neck ◽

Low Profile ◽

Closed Cell ◽

High Metal ◽

Silicon Tube ◽

Aneurysm Occlusion

Low-profile visualized intraluminal support deployment in an Enterprise has been reported; however, that in an Atlas has yet to be in detail. Enterprise has a closed-cell design, while Atlas has an open-cell design. We detail here a case of a large wide-necked aneurysm treated by coil embolization with low-profile visualized intraluminal support Blue deployment within a Neuroform Atlas and a bench-top experiment using a silicon tube to test low-profile visualized intraluminal support, Atlas, Enterprise, and their combinations. A better low-profile visualized intraluminal support expansion was achieved by simultaneously pushing the wire and the system within the Atlas placed at the aneurysm neck, which resulted in an increased metal coverage of the aneurysm neck and a shorter transition zone with low metal coverage at both ends of the aneurysm neck. This technique may enable a high metal coverage by low-profile visualized intraluminal support expansion without restriction by the Atlas and contribute to aneurysm occlusion by increasing the flow-diverting effect.

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Endovascular treatment of PICA aneurysms with a Low-profile Visualized Intraluminal Support (LVIS Jr) device

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-012070 ◽

2015 ◽

Vol 8 (10) ◽

pp. 1030-1033 ◽

Cited By ~ 15

Author(s):

Edgar A Samaniego ◽

German Abdo ◽

Ricardo A Hanel ◽

Andrey Lima ◽

Santiago Ortega-Gutierrez ◽

...

Keyword(s):

Endovascular Treatment ◽

Acute Phase ◽

Posterior Inferior Cerebellar Artery ◽

Short Term ◽

Small Series ◽

Low Profile ◽

Procedural Complications ◽

Reconstructive Technique ◽

Pica Aneurysms

ObjectiveTo describe the treatment of posterior inferior cerebellar artery (PICA) aneurysms with the Low-profile Visualized Intraluminal Support Device (LVIS Jr) stent.Materials and methodsThe databases of three institutions were retrospectively reviewed. Patients who underwent endovascular treatment of PICA aneurysms using a reconstructive technique where the LVIS Jr stent was totally or partially deployed into the PICA were included in the analysis. Clinical presentation, aneurysm and PICA sizes, procedural complications, and clinical and angiographic follow-up information was recorded and analyzed.ResultsSeven patients who underwent endovascular treatment of PICA aneurysms with an LVIS Jr stent were identified. Four aneurysms were treated in the acute phase of subarachnoid hemorrhage (SAH). There were no symptomatic complications. One patient had spasm distal to the stent as a result of mechanical straightening of the vessel. One patient was treated in the acute phase of SAH and required a gycoprotein IIb/IIIa inhibitor after the stent was implanted. This patient needed to be re-treated to complete embolization. All patients had good clinical outcomes (Glasgow Outcome Scale 5). No in-stent stenosis or occlusion was seen on short-term angiographic follow-up and the aneurysms were occluded.ConclusionsThis small series suggests that the use of a reconstructive technique with the LVIS Jr stent for the treatment of PICA aneurysms is feasible, safe and effective in the short term.

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Single-center experience with the new generation Derivo Embolization Device in ruptured dissecting and blister aneurysms

Acta Radiologica ◽

10.1177/0284185119852731 ◽

2019 ◽

Vol 61 (1) ◽

pp. 37-46 ◽

Cited By ~ 1

Author(s):

Marius Georg Kaschner ◽

Athanasios Petridis ◽

Bernd Turowski

Keyword(s):

Digital Subtraction Angiography ◽

Flow Diverter ◽

High Morbidity ◽

Digital Subtraction ◽

Related Complication ◽

Single Center Experience ◽

Flow Diverter Stent ◽

Aneurysm Occlusion ◽

New Generation

Background Treatment of ruptured dissecting and blister aneurysms is technically challenging with potentially high morbidity and mortality. The Derivo Embolisation Device (Derivo) is a flow diverter stent designed for the treatment of intracranial aneurysms. Purpose To assess the safety and feasibility of the Derivo in the treatment of ruptured dissecting and blister aneurysms. Material and Methods We retrospectively analyzed all patients with ruptured dissecting and blister aneurysms treated with the Derivo between February 2016 and July 2018. Procedural details, complications, morbidity within 30 days, and angiographic aneurysm occlusion rates, initially and after six months, were assessed. Results In 10 patients 11 ruptured dissecting and blister aneurysms were treated with 12 Derivos as monotherapy. No aneurysm rebleeding was observed at follow-up. One treatment-related complication occurred including a coil perforation of an additionally treated aneurysm. One patient died due to brain edema. Initial digital subtraction angiography revealed complete (O’Kelly–Marotta [OKM] classification D) and favorable (OKM D+C) occlusion rate in three aneurysms. Six-month follow-up for digital subtraction angiography and clinical evaluation was available in 6/9 patients with complete (OKM D) occlusion in all aneurysms (6/6). Favorable (modified Rankin Scale [mRS] ≤ 2) and moderate (mRS 3) clinical outcome after a mean follow-up of 10 months was observed in six and two patients, respectively. Conclusion Endovascular treatment with the Derivo in ruptured dissecting and blister aneurysms revealed a sufficient initial division of aneurysms from the circulation without rebleeding. The Derivo is associated with high procedural and clinical short-term safety.

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Endovascular treatment of intracranial ‘blister’ and dissecting aneurysms

The Neuroradiology Journal ◽

10.1177/1971400919861406 ◽

2019 ◽

Vol 32 (5) ◽

pp. 353-365 ◽

Cited By ~ 1

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.

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Early experience treating intracranial aneurysms using Accero: a novel, fully visible, low profile braided stent with platinum–nitinol composite wire technology

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-015918 ◽

2020 ◽

Vol 13 (1) ◽

pp. 49-53

Author(s):

Alberto Nania ◽

Nicholas Dobbs ◽

Johannes DuPlessis ◽

Peter Keston ◽

Jonathan Downer

Keyword(s):

Cerebral Artery ◽

Anterior Communicating Artery ◽

Clinical Consequence ◽

Composite Wire ◽

Postoperative Hematoma ◽

Low Profile ◽

Angiographic Data ◽

Aneurysm Occlusion ◽

Braided Stent

BackgroundAccero is an innovative, fully visible, self-expanding braided stent with platinum–nitinol composite wire technology, produced by Acandis.ObjectiveTo assess the technical success and safety of this new stent by evaluating the intraprocedural behavior and complication rate, and the short-term follow-up results.MethodsForty-one consecutive patients suitable for stent-assisted coiling were selected for the use of Accero in an 11-month period. Clinical, procedural, and angiographic data, as well as 30-day morbidity, were recorded. The angiographic results, clinical follow-up at 30 days, and early imaging follow-up at 3 or 6 months were analyzed, when available.ResultsForty-one aneurysms were treated with stent-assisted coiling. All cases were elective, of which 19 were previously untreated aneurysms and 22 were recurrent aneurysms. Aneurysm location was anterior communicating artery complex (16), basilar (12 cases), middle cerebral artery bifurcation (9 cases), and internal cerebral artery (4 cases). The stent was successfully deployed and aneurysm occlusion with coils achieved in 100% of our patients. One case of on table in-stent thrombosis occurred, which resolved after administration of glycoprotein IIB/IIIA inhibitor, with no clinical consequence, and one case of postoperative hematoma at the arteriotomy site, which was managed conservatively. On early follow-up, available for 37 patients, the complete occlusion rate was 76%, with only two recurrences needing further treatment. Satisfactory aneurysm occlusion was therefore achieved in 95% of cases.ConclusionStent-assisted coiling with the Accero braided stent proved safe and effective.

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Predictive factors of incomplete aneurysm occlusion after endovascular treatment with the Pipeline embolization device

Journal of Neurosurgery ◽

10.3171/2019.1.jns183226 ◽

2020 ◽

Vol 132 (5) ◽

pp. 1598-1605 ◽

Cited By ~ 5

Author(s):

Georgios A. Maragkos ◽

Luis C. Ascanio ◽

Mohamed M. Salem ◽

Sricharan Gopakumar ◽

Santiago Gomez-Paz ◽

...

Keyword(s):

Endovascular Treatment ◽

Predictive Factors ◽

Cohort Analysis ◽

Multivariable Analysis ◽

Pipeline Embolization Device ◽

Unruptured Aneurysms ◽

Maximal Diameter ◽

Aneurysm Occlusion ◽

Incomplete Occlusion

OBJECTIVEThe Pipeline embolization device (PED) is a routine choice for the endovascular treatment of select intracranial aneurysms. Its success is based on the high rates of aneurysm occlusion, followed by near-zero recanalization probability once occlusion has occurred. Therefore, identification of patient factors predictive of incomplete occlusion on the last angiographic follow-up is critical to its success.METHODSA multicenter retrospective cohort analysis was conducted on consecutive patients treated with a PED for unruptured aneurysms in 3 academic institutions in the US. Patients with angiographic follow-up were selected to identify the factors associated with incomplete occlusion.RESULTSAmong all 3 participating institutions a total of 523 PED placement procedures were identified. There were 284 procedures for 316 aneurysms, which had radiographic follow-up and were included in this analysis (median age 58 years; female-to-male ratio 4.2:1). Complete occlusion (100% occlusion) was noted in 76.6% of aneurysms, whereas incomplete occlusion (≤ 99% occlusion) at last follow-up was identified in 23.4%. After accounting for factor collinearity and confounding, multivariable analysis identified older age (> 70 years; OR 4.46, 95% CI 2.30–8.65, p < 0.001); higher maximal diameter (≥ 15 mm; OR 3.29, 95% CI 1.43–7.55, p = 0.005); and fusiform morphology (OR 2.89, 95% CI 1.06–7.85, p = 0.038) to be independently associated with higher rates of incomplete occlusion at last follow-up. Thromboembolic complications were noted in 1.4% and hemorrhagic complications were found in 0.7% of procedures.CONCLUSIONSIncomplete aneurysm occlusion following placement of a PED was independently associated with age > 70 years, aneurysm diameter ≥ 15 mm, and fusiform morphology. Such predictive factors can be used to guide individualized treatment selection and counseling in patients undergoing cerebrovascular neurosurgery.

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

The Neuroradiology Journal ◽

10.1177/19714009211042877 ◽

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.

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Endovascular treatment of bifurcation intracranial aneurysms with the WEB SL/SLS: 6-month clinical and angiographic results

Interventional Neuroradiology ◽

10.1177/1591019915590083 ◽

2015 ◽

Vol 21 (4) ◽

pp. 462-469 ◽

Cited By ~ 20

Author(s):

Patricia Bozzetto Ambrosi ◽

Benjamin Gory ◽

Rotem Sivan-Hoffmann ◽

Roberto Riva ◽

Francesco Signorelli ◽

...

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Single Layer ◽

Additional Treatment ◽

Anterior Communicating Artery ◽

Neck Size ◽

Aneurysm Occlusion ◽

Web Device ◽

The Web

Background The WEB device is a recent intrasaccular flow disruption technique developed for the treatment of wide-necked intracranial aneurysms. To date, a single report on the WEB Single-Layer (SL) treatment of intracranial aneurysms has been published with 1-months' safety results. The aim of this study is to report our experience and 6-month clinical and angiographic follow-up of endovascular treatment of wide-neck aneurysm with the WEB SL. Methods Ten patients with 10 unruptured wide-necked aneurysms were prospectively enrolled in this study. Feasibility, intraoperative and postoperative complications, and outcomes were recorded. Immediate and 6-month clinical and angiographic results were evaluated. Results Failure of WEB SL placement occurred in two cases. Eight aneurysms were successfully treated using one WEB SL without additional treatment. Three middle cerebral artery, four anterior communicating artery, and one basilar artery aneurysms were treated. Average dome width was 7.5 mm (range 5.4–10.7 mm), and average neck size was 4.9 mm (range 2.6–6.5 mm). No periprocedural complication was observed, and morbi-mortality at discharge and 6 months was 0.0%. Angiographic follow-up at 6 months demonstrated complete aneurysm occlusion in 2/8 aneurysms, neck remnant in 5/8 aneurysms, and aneurysm remnant in 1/8 aneurysm. Conclusions From this preliminary study, treatment of bifurcation intracranial aneurysms using WEB SL is feasible. WEB SL treatment seems safe at 6 months; however, the rate of neck remnants is not negligible due to compression of the WEB SL. Further technical improvements may be needed in order to ameliorate the occlusion in the WEB SL treatment.

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