scholarly journals A protocol for the reduction of applied torque on parent vessel duringelastase-induced aneurysm formation using rabbit animal models

2021 ◽  
Author(s):  
Sergio A. Pineda-Castillo ◽  
Keely A. Laurence ◽  
Hannah Homburg ◽  
Kar-Ming Fung ◽  
Bradley N. Bohnstedt ◽  
...  
Keyword(s):  
Animal Models ◽  
Intracranial Aneurysms ◽  
Endovascular Embolization ◽  
Parent Vessel ◽  
Applied Torque ◽  
Present Technique ◽  
Improved Stability ◽  
Animal Surgery ◽  
Ligation Method ◽  
Elastic Lamina

Endovascular therapies for intracranial aneurysms requires animal models for testing the safety andeffectiveness prior to translation to the clinic. Rabbits combined with the elastase and right commoncarotid artery (RCCA) ligation methods is currently a widely used animal model for endovascular de-vice testing. However, the injection of elastase utilizing angiocatheters may potentially exerts adversetorque to the parent vessel and the optimal aneurysm creation period has not been well investigated.In this study, we present a modification to the elastase/RCCA-ligation method by replacing the angio-catheter with a butterfly catheter. Formation of saccular aneurysms was introduced in New Zealandwhite rabbits (n=6), and were maintained for 2, 4 and 6 weeks. The formed aneurysms exhibitedan elongated geometry and were stable during the study period. We found that the modification inthe animal surgery procedure provides improved manipulation of the surgical area, prolonged injec-tion of elastase, and effective degradation of the vascular elastic lamina. Compared to the traditionalelastase/RCCA-ligation method, the present technique can more effectively reduce unwanted injury tothe parent vessel and, therefore, improved stability of the vasculature for testing the efficacy of newlydeveloped endovascular embolization devices.

Neurosurgical management of cerebral aneurysms following unsuccessful or incomplete endovascular embolization

1995 ◽  
Vol 83 (5) ◽  
pp. 843-853 ◽  
Author(s):  
John H. Gurian ◽  
Neil A. Martin ◽  
Wesley A. King ◽  
Gary R. Duckwiler ◽  
Guido Guglielmi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Content Type ◽  
Neurological Improvement ◽  
Parent Vessel Occlusion ◽  
Group B

✓ Modern endovascular techniques permit treatment of intracranial aneurysms in many circumstances when surgery is associated with significant morbidity. Occasionally, embolization of aneurysms is unsuccessful or incomplete or followed by complications, in which case surgical management is required. Since 1986, 196 patients have undergone embolization of intracranial aneurysms at the authors' institution and 21 (11%) required subsequent surgical treatment. Attempted embolization failed in five patients (Group A). Ten patients (Group B) had only partial occlusion of the aneurysm or demonstrated recanalization on follow-up studies. Eight of these Group B patients underwent embolization with Guglielmi detachable coils (GDCs), representing 5.7% of the 141 GDC-treated patients in this experience. Surgical treatment in these two groups consisted of clipping (eight cases), surgical parent vessel occlusion (one case), and parent vessel occlusion with extracranial—intracranial bypass (six cases). Fourteen (93%) of the 15 patients in these two groups had an excellent or good outcome with complete aneurysm occlusion. Six patients underwent surgery to treat complications related to the endovascular procedure (Group C). Of these, four patients had neurological improvement compared to their preoperative state, and two died. This series of cases demonstrates that surgical treatment of aneurysms is usually possible with good results following incomplete embolization and emphasizes the need for close and continued neurosurgical involvement in the endovascular management of intracranial aneurysms.

Techniques for Virtual Stenting of Intracranial Aneurysms

2007 ◽  
Author(s):  
Sunil Appanaboyina ◽  
Fernando Mut ◽  
Rainald Löhner ◽  
Christopher M. Putman ◽  
Juan R. Cebral
Keyword(s):  
Intracranial Aneurysms ◽  
Numerical Models ◽  
Thrombus Formation ◽  
Endovascular Embolization ◽  
Computational Grids ◽  
Patient Specific ◽  
Parent Vessel ◽  
Invasive Approach ◽  
Aneurysm Neck

Intracranial aneurysms are pathological dilations of the arteries in the brain, whose rupture is often fatal. Surgery and endovascular embolization are the two most common methods of treatment. Surgery involves opening a portion of the skull and placing metallic clips at the aneurysm neck thereby preventing blood flow into the aneurysm. In the case of embolization, a catheter is used to pack platinum coils in the aneurysm reducing the inflow and promoting thrombus formation. Due to its less invasive approach endovascular embolization is preferred over surgery. Nevertheless this approach also has some serious aftereffects. Coil compaction followed by the re-growth or the formation of the secondary aneurysm is the most common problem. The endovascular embolization approach also has a serious shortcoming that the coils alone cannot be used to block every type of aneurysm. Wide neck or fusiform aneurysms are coiled with the help of stents. Recent studies show that stent, which is a hollow cylindrical mesh, can be successfully used to limit the flow of blood into the aneurysm. However these studies have been conducted using idealized in-vitro and numerical models. Studies conducted using patient-specific models generated from medical images will provide a more realistic approach to computationally investigate the effects of stents on intra-aneurysmal flow patterns. However generation of computational grids inside the parent vessel and around these stents is a challenging task. In this paper an algorithm to map the stent to a patient-specific vascular model and an adaptive unstructured embedded gridding technique to model flow around stents are presented. Finally these techniques are demonstrated on patient-specific cases to prove their feasibility.

scholarly journals Definition and extraction of 2D shape indices of intracranial aneurysm necks for rupture risk assessment

2021 ◽  
Author(s):  
Sarah Mittenentzwei ◽  
Oliver Beuing ◽  
Belal Neyazi ◽  
I. Erol Sandalcioglu ◽  
Naomi Larsen ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Intracranial Aneurysms ◽  
Treatment Decision ◽  
3D Models ◽  
Subsequent Treatment ◽  
Rupture Risk ◽  
Parent Vessel ◽  
Brain Vessels ◽  
Ruptured Aneurysms ◽  
Shape Indices

Abstract Purpose Intracranial aneurysms are local dilations of brain vessels. Their rupture, as well as their treatment, is associated with high risk of morbidity and mortality. In this work, we propose shape indices for aneurysm ostia for the rupture risk assessment of intracranial aneurysms. Methods We analyzed 84 middle cerebral artery bifurcation aneurysms (27 ruptured and 57 unruptured) and their ostia, with respect to their size and shape. We extracted 3D models of the aneurysms and vascular trees. A semi-automatic approach was used to separate the aneurysm from its parent vessel and to reconstruct the ostium. We used known indices to quantitatively describe the aneurysms. For the ostium, we present new shape indices: the 2D Undulation Index (UI$$_\mathrm{2D}$$ 2 D ), the 2D Ellipticity Index (EI$$_\mathrm{2D}$$ 2 D ) and the 2D Noncircularity Index (NCI$$_\mathrm{2D}$$ 2 D ). Results were analyzed using the Student t test, the Mann–Whitney U test and a correlation analysis between indices of the aneurysms and their ostia. Results Of the indices, none was significantly associated with rupture status. Most aneurysms have an NCI$$_\mathrm{2D}$$ 2 D below 0.2. Of the aneurysms that have an NCI$$_\mathrm{2D}$$ 2 D above 0.5, only one is ruptured, which indicates that ruptured aneurysms often have a circular-shaped ostium. Furthermore, the ostia of ruptured aneurysms tend to have a smaller area, which is also correlated with the aneurysm’s size. While also other variables were significantly correlated, strong linear correlations can only be seen between the area of the ostium with the aneurysm’s volume and surface. Conclusion The proposed shape indices open up new possibilities to quantitatively describe and compare ostia, which can be beneficial for rupture risk assessment and subsequent treatment decision. Additionally, this work shows that the ostium area and the size of the aneurysm are correlated. Further longitudinal studies are necessary to analyze whether stable and unstable aneurysms can be distinguished by their ostia.

Revascularization and Aneurysm Surgery: Current Status

Neurosurgery ◽  
1985 ◽  
Vol 16 (1) ◽  
pp. 111-116 ◽  
Author(s):  
Robert F. Spetzler ◽  
Philip L. Carter
Keyword(s):  
Intracranial Aneurysms ◽  
Current Status ◽  
Aneurysm Surgery ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Flow Measurements ◽  
Stump Pressure ◽  
Blood Flow Measurements ◽  
Vessel Ligation

Abstract Unclippable intracranial aneurysms are most effectively treated by hunterian ligation; however, the attendant risk of cerebral ischemia is significant. Many techniques have been used in an attempt to predict the safety of proximal vessel occlusion. Unfortunately, there is none that is risk-free and highly successful. A combination of stump pressure and cerebral blood flow measurements has been shown to be the most accurate in the acute assessment. In addition, recent studies have demonstrated that the long term risk of carotid ligation is significant. Extracranial-intracranial bypass grafting (EC-IC) has been shown to improve the safety of parent vessel ligation and is a low risk procedure. Whenever hunterian ligation is planned for the treatment of an intracranial aneurysm, EC-IC should be strongly considered. (Neurosurgery 16:111–116, 1985)

A novel endovascular clip system for the treatment of intracranial aneurysms: technology, concept, and initial experimental results

2008 ◽  
Vol 108 (6) ◽  
pp. 1230-1240 ◽  
Author(s):  
Thomas R. Marotta ◽  
Thorsteinn Gunnarsson ◽  
Ian Penn ◽  
Donald R. Ricci ◽  
Ian Mcdougall ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Delivery System ◽  
Intracranial Aneurysms ◽  
Balloon Catheter ◽  
Cerebral Aneurysms ◽  
Histopathological Analysis ◽  
Parent Vessel ◽  
Flow Models ◽  
Aneurysm Neck ◽  
Novel Device

Object The authors describe a novel device for the endovascular treatment of intracranial aneurysms, the endovascular clip system (eCLIPs). Descriptions of the device and its delivery system as well as the results of flow model tests and the treatment of experimental aneurysms are provided. Methods The eCLIPs comprises a flexible hybrid implantable device (an anchor and a covered leaf) and a balloon catheter delivery system, designed to be positioned and activated in the parent vessel in such a way that the covered portion will abut the aneurysm neck. The eCLIPs was subjected to testing in glass, elastomeric, and cadaveric flow models to determine its navigability, orientation, and activation compared with commercially available stents. In a second experiment, 8 carotid artery sidewall aneurysms in swine were treated using eCLIPs. The degree of occlusion was observed on angiography immediately following and 30 days after device activation, and a histological analysis was performed at 30 days. Results The device could navigate tortuous glass models and human cadaveric vessels. Compared with commercially available stents, the eCLIPs performed well. It could be navigated, oriented, and activated easily and reliably. With regard to the 8 porcine experimental aneurysms, immediate postactivation angiograms confirmed complete occlusion of 4 lesions and near occlusion of the other 4. Angiographic follow-up at 30 days postactivation showed occlusion of all 8 aneurysms and patency of all parent vessels. Histopathological analysis revealed aneurysm healing, with smooth-muscle cells growing across the lesion neck to allow reendothelialization. Conclusions Aneurysm occlusion with a single extrasaccular endovascular device has potential advantages. The authors believe that eCLIPs may prove to be a useful tool in the endovascular treatment of cerebral aneurysms. The system should reduce risks associated with coiling, procedure time, costs, and radiation exposure. The device satisfactorily occluded 8 experimental sidewall aneurysms. The observed healing pattern is similar to that seen after microsurgical clipping.

LVIS Blue as a low porosity stent and coil adjuvant

2018 ◽  
Vol 10 (7) ◽  
pp. 682-686 ◽  
Author(s):  
Matthew J Koch ◽  
Christopher J Stapleton ◽  
Scott B Raymond ◽  
Susan Williams ◽  
Thabele M Leslie-Mazwi ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Posterior Inferior Cerebellar Artery ◽  
Endovascular Embolization ◽  
Superior Cerebellar Artery ◽  
Anterior Communicating Artery ◽  
Aneurysm Neck ◽  
Proximal Internal Carotid Artery ◽  
Cerebellar Artery

IntroductionThe LVIS Blue is an FDA-approved stent with 28% metallic coverage that is indicated for use in conjunction with coil embolization for the treatment of intracranial aneurysms. Given a porosity similar to approved flow diverters and higher than currently available intracranial stents, we sought to evaluate the effectiveness of this device for the treatment of intracranial aneurysms.MethodsWe performed an observational single-center study to evaluate initial occlusion and occlusion at 6-month follow-up for patients treated with the LVIS Blue in conjunction with coil embolization at our institution using the modified Raymond–Roy classification (mRRC), where mRRC 1 indicates complete embolization, mRRC 2 persistent opacification of the aneurysm neck, mRRC 3a filling of the aneurysm dome within coil interstices, and mRRC 3b filling of the aneurysm dome.ResultsSixteen aneurysms were treated with the LVIS Blue device in conjunction with coil embolization with 6-month angiographic follow-up. Aneurysms were treated throughout the intracranial circulation: five proximal internal carotid artery (ICA) (ophthalmic or communicating segments), two superior cerebellar artery, two ICA terminus, two anterior communicating artery, two distal middle cerebral artery, one posterior inferior cerebellar artery, and two basilar tip aneurysms. Post-procedurally, there was one mRRC 1 closure, five mRRC 2 closures, and 10 mRRC 3a or 3b occlusion. At follow-up, all the mRRC 1 and mRRC 3a closures, 85% of the mRRC 3b closures and 75% of the mRRC 2 closures were stable or improved to an mRRC 1 or 2 at follow-up.ConclusionsThe LVIS Blue represents a safe option as a coil adjunct for endovascular embolization within both the proximal and distal anterior and posterior circulation.

Abstract 3956: Outcomes of Patients Undergoing Endovascular Treatment for Mycotic Intracranial Aneurysms

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Ameer E Hassan ◽  
Saqib A Chaudhry ◽  
M Fareed K Suri ◽  
Adnan I Qureshi
Keyword(s):  
Surgical Treatment ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Multivariate Logistic Regression Analysis ◽  
Primary Treatment ◽  
Endovascular Embolization ◽  
Parent Artery ◽  
Hospital Outcomes ◽  
Aneurysm Wall ◽  
Mycotic Aneurysms

Background: Mycotic intracranial aneurysms are rare with primary treatment focusing on underlying infection to reduce the high mortality rates. Treating these aneurysms remains challenging and obliteration procedures without sacrificing the parent artery often fail due to the fusiform and fragile aneurysm wall. Objective: To determine the outcomes associated with endovascular embolization in patients with mycotic intracranial aneurysms using a large nationally representative sample. Methods: We determined the frequency of endovascular and surgical procedures performed in patients with mycotic intracranial aneurysms and associated in-hospital outcomes using data from the Nationwide Inpatient Survey (NIS) data files from 2002 to 2009. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate logistic regression analysis. Results: Of the 1,915 patients admitted with the diagnosis of infected “mycotic” aneurysms, 83 (4.3%) underwent endovascular embolization, and 59 (3.1%) underwent surgical treatment. In mycotic aneurysms treated with endovascular treatment compared to surgical treatment, discharge outcomes were better with higher rates of minimal disability self-care (40% vs. 23.7% p=0.2436), and lower rates of moderate-severe disability (36% vs. 40% p=0.7874), and in-hospital deaths death (22.9 vs. 35.2 p= 0.3608). After adjusting for age, gender, and hospital teaching status, discharge mortality after endovascular treatment was not inferior to surgical treatment (odds ratio [OR] 1.58, 95% confidence interval [CI] 0.14 - 17.9) or those treated medically (OR 0.56, 95% CI 0.132 - 2.36). Conclusion: Endovascular embolization for mycotic intracranial aneurysms provides comparable outcomes to surgical treatment and should be considered whenever feasible when aneurysm obliteration is indicated.

scholarly journals Use of the Coupler Microanastomotic Device for the Treatment of a Distal Posterior Inferior Cerebellar Artery Aneurysm Via Excision and End-to-End Anastomosis—A Case Report

2020 ◽  
Vol 1 (2) ◽  
Author(s):  
Oded Goren ◽  
Raghuram Sampath ◽  
Akshal S Patel ◽  
Christoph J Griessenauer ◽  
Clemens M Schirmer ◽  
...  
Keyword(s):  
Case Report ◽  
Intracranial Aneurysms ◽  
Clinical Presentation ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Parent Vessel ◽  
First Case ◽  
Cerebellar Artery ◽  
End To End ◽  
Coupler Device

ABSTRACT BACKGROUND AND IMPORTANCE The Coupler microanastomotic device (Medical Companies Alliance, Birmingham, Alabama) aims at facilitating safe and efficient end-to-end reconstruction of the native vessel ends following resection of intracranial aneurysms. CLINICAL PRESENTATION We report the first case of the Coupler device used to treat a ruptured posterior inferior cerebellar artery (PICA) aneurysm. Following aneurysmal trapping and excision, the native parent vessel ends were connected in an end-to-end fashion. CONCLUSION The microanastomotic Coupler device is an acceptable option for end-to-end anastomosis and was successfully applied in the management of a ruptured fusiform PICA aneurysm.

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