A Novel Flow Diverter for Direct Treatment of Cerebral Aneurysms

Volume 1A: Abdominal Aortic Aneurysms; Active and Reactive Soft Matter; Atherosclerosis; BioFluid Mechanics; Education; Biotransport Phenomena; Bone, Joint and Spine Mechanics; Brain Injury; Cardiac Mechanics; Cardiovascular Devices, Fluids and Imaging; Cartilage and Disc Mechanics; Cell and Tissue Engineering; Cerebral Aneurysms; Computational Biofluid Dynamics; Device Design, Human Dynamics, and Rehabilitation; Drug Delivery and Disease Treatment; Engineered Cellular Environments ◽

10.1115/sbc2013-14013 ◽

2013 ◽

Author(s):

Jiayao Ma ◽

Zhong You ◽

James Byrne

Keyword(s):

Cerebral Aneurysm ◽

Adult Population ◽

Cerebral Aneurysms ◽

Flow Diverter ◽

Severe Disability ◽

Direct Treatment ◽

Brain Vasculature ◽

The Brain

Cerebral aneurysm (CA) is a localised dilatation in the wall of the brain vasculature which can cause it to swell out like a balloon. If not treated, it will continue to grow and eventually tear or rupture, resulting in severe disability from stroke and, in around 25% of cases, death [1]. CAs affect up to 5% of the adult population with 1% of detected aneurysms rupture every year [2].

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Prevention of complication in cerebral aneurysm microsurgery, associated with their non-radical clipping

Endovascular Neuroradiology ◽

10.26683/2304-9359-2020-3(33)-66-77 ◽

2020 ◽

Vol 33 (3) ◽

pp. 66-77

Author(s):

A.V. Byndiu ◽

M.Yu. Orlov ◽

M.V. Yelieinyk ◽

S.O. Lytvak

Keyword(s):

Cerebral Aneurysm ◽

Glasgow Outcome Scale ◽

Cerebral Arteries ◽

Cerebral Aneurysms ◽

Saccular Aneurysm ◽

Results Of Treatment ◽

Intraoperative Rupture ◽

Temporary Clipping ◽

The Brain

Objective ‒ to analyze the effectiveness of intraoperative contact Doppler, repositioning the clip on the aneurysm and pilot clipping of the cervical aneurysm as the main methods of prevention of inadequate clipping of the cervical aneurysm in patients with intraoperative rupture of aneurysms. Materials and methods. Due to the use of intraoperative contact ultrasound Doppler control it was possible to avoid inadequate clipping of cerebral aneurysms in 16 cases, of which in 12 (75.00 %) cases ‒ incomplete clipping of cerebral aneurysms, in 3 (18.75 %) cases ‒ compression of the aneurysm’s artery-carrier, in 1 (6.25 %) case ‒ slipping of the clip with cerebral aneurysm. Perioperative examination of patients, in addition to intraoperative contact ultrasound Doppler control of radical clipping cerebral aneurysms, included clinical and neurological examination, computed tomography of the brain, cerebral angiography, ultrasound duplex scanning of the main vessels of the head and neck. In the analysis of observations of inadequate clipping of cerebral aneurysms (according to contact intraoperative Doppler), the following parameters were considered: size, location of cerebral aneurysm, timing of surgery after subarachnoid hemorrhage, anatomical forms of intracranial hemorrhage. Results. The purpose of the operations was to devascularize saccular aneurysm to prevent its re-rupture, to reduce the mass effect caused by intracerebral hematoma; reduction of intracranial pressure, rehabilitation of basal cisterns of the brain., But in the postoperative period there was a tendency to worsen the results of treatment, the appearance of focal neurological symptoms on the background of cerebral vasospasm with subsequent development of ischemic complications in patients with III‒V degree according to the Hunt‒Hess Scale on admission, in patients with prolonged temporary clipping of the cerebral aneurysm-artery and prolonged mechanical manipulation of the cerebral arteries and cerebral aneurysm. It should be noted that all patients in our sample, with complicated clipping of cerebral saccular aneurysms, had an intraoperative rupture of the MA, which complicated the process of clipping the saccular aneurysm and prolonged the time of surgery and was one of the inducers of postoperative aggravating consequences. There was a tendency to worsen the results of treatment in patients with III–IV degree according to the Hunt‒Hess Scale. Thus, patients with 1 point according to the Glasgow Outcome Scale, there were 2 patients who had II and III degrees according to Hunt–Hess Scale at hospitalization; among discharged patients with 3 point according to Glasgow Outcome Scale was dominated by patients from the second century according to Hunt‒Hess Scale at hospitalization, among patients with 5 point according to Glasgow Outcome Scale dominated patients who had I degree according to the Hunt‒Hess Scale at hospitalization. Conclusions. Inadequate clipping of the cervix cerebral aneurysm is the main type of non-hemorrhagic complications in the surgery of cerebral aneurysms. The Inadequate clipping of the cervix of the cerebral aneurysm includes the presence of residual blood flow in the cerebral aneurysm after its clipping, stenosis/compression of the main and perforating cerebral arteries with a clip, slipping of the clip from the aneurysm. Among the factors influencing the radical and adequate clipping of the cervix cerebral aneurysm are the size, location of the aneurysm, atherosclerotic lesions of the walls of the arteries and neck of the aneurysm and transferred subarachnoid hemorrhage. Reliable methods of prevention of inadequate clipping of saccular aneurysm are the use of intraoperative Doppler blood flow control, pilot clipping of complex aneurysms, optimization and individualization of surgical access. Aggravating factors that lead to unsatisfactory results of treatment of patients and negative clinical dynamics after the operation of clipping cerebral saccular aneurysm are: severe condition of the patient before surgery (III‒V gr. according to the Hunt‒Hess Scale), severe cerebral edema, intraoperative rupture of saccular aneurysm, long-term mechanical manipulations on cerebral arteries (long-term temporary clipping of saccular aneurysm, isolation of saccular aneurysm and «neighboring» cerebral arteries from arachnoid adhesions, frequent repositioning of the clip).

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Silent Cerebral Infarcts and Cerebral Aneurysms Are Prevalent in Adults with Sickle Cell Disease

Blood ◽

10.1182/blood.v124.21.2712.2712 ◽

2014 ◽

Vol 124 (21) ◽

pp. 2712-2712

Author(s):

Adetola A. Kassim ◽

Sumit Pruthi ◽

Matthew Day ◽

Michael R. DeBaun ◽

Lori C. Jordan

Keyword(s):

Sickle Cell Disease ◽

Cerebral Aneurysm ◽

Sickle Cell ◽

Cerebral Aneurysms ◽

Cell Disease ◽

Cerebral Infarcts ◽

Transfusion Therapy ◽

History Of ◽

The Brain ◽

Saccular Aneurysms

Abstract Introduction: Neurologic complications are a major cause of morbidity in sickle cell disease (SCD). The cumulative cerebral risk for neurological complications in sickle cell anemia has been estimated around 50% by age 14 (Bernaudin et. al, 2011;Blood 4:1130-40). Silent cerebral infarcts (SCI), is the most commonly recognized cause of neurological injury, associated with cognitive difficulties (King et al, Am J Hematol 2014;89:162-7) found in 20-40% of children with SCD, more common in genotype SS or Sβ0 thalassemia. The prevalence of SCI has not been well studied in adults. The prevalence of intracranial saccular aneurysms by radiographic and autopsy series is estimated to be 3.2% in a population without comorbidity, a mean age of 50 years, and a 1:1 gender ratio. (Valk et al, Lancet Neurol 2011; 10: 626–36) while other investigators found a 1.8% prevalence and no increased incidence with age (Vernooij et al NEJM 2007;357:1821-8). The goal of this study was to assess the prevalence of neurologic morbidity, including SCI, overt stroke, and cerebral aneurysm, in a large cohort of adults with SCD. We hypothesized the SCI would be more prevalent in adults compared to children with SCD. Methods: Due to the high prevalence of cerebral infarcts in children with SCD, we elected to obtain as part of routine clinical practice, a MRI and magnetic resonance angiography (MRA) of the brain in adults with SCD in our Hematology clinic. As standard care if SCIs are seen, neurocognitive testing is recommended, and based on this testing and MRI results, appropriate patients are referred for vocational rehabilitation service. All MRIs and MRAs were reviewed by 2 board certified neuroradiologists and consensus findings were recorded including presence of cerebral infarcts, intracerebral hemorrhage, aneurysms and cerebralvasculopathy. All adults with SCD were followed by a single hematologist and were asked about neurological symptoms. Medical records were reviewed to see if stroke like symptoms had been reported. If no symptoms were reported and no abnormalities were documented on neurological examination, then infarcts were judged to be silent. Results: The study population included 94 adults with SCD (80% HbSS or Hb Sβ0 thalassemia; 11% HbSC, and 9% other), 51% males, median age 26 years, interquartile range (22-36 years) who had MRI of the brain and 88 had MRA of the brain. Of these, 91 MRIs were of sufficient quality to assess for the presence or absence of infarcts. Infarcts were present in 58% (53 individuals) with multiple infarcts in 40% (37 patients); infarcts were overt/symptomatic in 13% (12) and silent in 45% (41). Hemorrhages were present in 8 patients (9%) and of these, 7 of 8 also had infarcts present on MRI. MRI and MRA of the brain were felt of adequate quality to assess for vascular disease or aneurysm in 79 patients. Of these 7.5% (6 of 79 patients) had moyamoya vasculopathy and 7.5% (6 of 79 patients) had saccular aneurysms with no overlap between groups. All of the adults with moyamoya vasculopathy had overt strokes. The aneurysms were incidental findings and all were <5mm in size. Patients were referred to Neurosurgery for evaluation of aneurysmal lesions. Amongst the 12 adults with a history of overt stroke, 67% were on therapy (50% on hydroxyurea therapy; 17% on chronic blood transfusion therapy), 42% (5 of 12) received aspirin for stroke and 1 patient was already on warfarin for history of systemic thrombosis at the time of stroke. Conclusions: Silent cerebral infarctions are common in adults with SCD. Silent cerebral infarcts were present in 45% and over strokes had occurred in 13% of adults with SCD. Our aneurysm prevalence of 7.5% in a younger cohort (median age 26 years) suggests that adults with SCD may have a higher prevalence of cerebral aneurysms than the general population. Further study is warranted to assess whether SCD should be considered a comorbidity that confers a higher risk of cerebral aneurysm in adults. The optimal strategies for primary and secondary stroke prevention and to mitigate against the progressive cerebral vasculopathy in adults with SCD are still being debated. Disclosures No relevant conflicts of interest to declare.

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Flow Diverter Device for Treatment of Cerebral Aneurysm with Short-Term Follow Up: Two Case Reports

Kosin Medical Journal ◽

10.7180/kmj.2021.36.2.193 ◽

2021 ◽

Vol 36 (2) ◽

pp. 193-199

Author(s):

Jung Hyun Park

Keyword(s):

Cerebral Aneurysm ◽

Case Reports ◽

Cerebral Aneurysms ◽

Treatment Method ◽

Flow Diverter ◽

Dissecting Aneurysm ◽

Short Term ◽

Unruptured Cerebral Aneurysm ◽

Flow Diverter Device

The flow diverter device (FDD) is an important treatment method for cerebral aneurysms, especially for intracranial dissecting aneurysms. This paper is the result of FDD treatment for two cases of vertebral dissecting aneurysm (VADA) patients and short-term follow-up at 3 months. All two cases were targeted for unruptured cerebral aneurysm, and 4-vessel angiography was performed as a follow-up examination for 3 months after receiving the procedure. As result, it was possible to shorten the period of use of antiplatelet drugs. In the case of VADA, there are limitations in general coiling procedures or conventional surgical treatment methods. In that sense, the FDD treatment method can be a very effective alternative treatment of VADA

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Risk Assessment of Cerebral Aneurysm Rupture and Regrowth

ASME 2008 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2008-193065 ◽

2008 ◽

Author(s):

Emily M. Childress ◽

Christina Yarborough ◽

Sinjae Hyun ◽

Arthur J. Ulm ◽

Joe Sam Robinson

Keyword(s):

Risk Assessment ◽

Blood Vessels ◽

Cerebral Aneurysm ◽

Cerebral Aneurysms ◽

Aneurysm Rupture ◽

Ruptured Aneurysms ◽

Central Nerve System ◽

Nerve System ◽

The Brain

Cerebral aneurysms are dilatations in blood vessels of the brain. It is estimated that approximately 10 in every 100,000 persons per year has cerebral aneurysms and it occurs most often in people between ages 30 and 60 years [1]. Of these, roughly 27,000 patients per year are reported to have ruptured aneurysms. Since ruptures can lead to such conditions as central nerve system (CNS) hemorrhages in subarachnoid and intraparenchymal spaces, the chance of survival, once this occurs, is 50%.

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A Novel Flow Diverter for Direct Treatment of Cerebral Aneurysms

Volume 3: 16th International Conference on Advanced Vehicle Technologies; 11th International Conference on Design Education; 7th Frontiers in Biomedical Devices ◽

10.1115/detc2014-35699 ◽

2014 ◽

Author(s):

Jiayao Ma ◽

Thomas Peach ◽

Zhong You ◽

Rafik R. Rizkallah ◽

James Byrne

Keyword(s):

In Silico ◽

Cerebral Aneurysms ◽

Flow Diverter ◽

Flow Reduction ◽

Direct Treatment ◽

In Vivo Testing ◽

Biological Reaction ◽

Aneurysm Model ◽

Flow Diverting Stent

A summary of the manufacturing, in-silico and in-vivo testing of a laser cut cerebral flow-diverting stent (FDS) prototype is presented. The predicted flow-reduction achieved by both variants of the FDS design compares favorably with current commercially available designs. FDS design II is implanted into a swine aneurysm model to validate both the flow-diverting capability and a lack of adverse biological reaction.

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Flared non-flow diverting ends of the FRED flow diverter for cerebral aneurysms facilitate device anchoring at the arterial bifurcation

The Neuroradiology Journal ◽

10.1177/19714009211013508 ◽

2021 ◽

pp. 197140092110135

Author(s):

Jan-Karl Burkhardt ◽

Laura Stone McGuire ◽

Christoph J Griessenauer

Keyword(s):

Cerebral Aneurysm ◽

Anterior Cerebral Artery ◽

Cerebral Aneurysms ◽

Flow Diverter ◽

Technical Note ◽

Posterior Communicating Artery ◽

Illustrative Case ◽

Landing Zone ◽

Arterial Bifurcation ◽

Close Proximity

Introduction The Flow Redirection Intraluminal Device (FRED) flow diverter has a unique bilayer design, with the outer scaffolding stent extending beyond the inner flow diverting component by about 3 mm at each end. Here, we describe a technique to utilize these unrestrained flared ends for precise flow diverter placement in cases where the aneurysm and an adjacent branch are in close proximity and branch jailing is not desired, such as in posterior communicating artery aneurysms. Technical note: The distal end of the FRED device is pushed out of the microcatheter at the carotid terminus. Once the distal flared ends are fully open and well situated in the terminus, ideally with at least one of the limbs in the A1 segment of the anterior cerebral artery, the device is unsheathed under gentle forward pressure. This technique stabilizes the device at the distal landing zone and prevents unintended foreshortening at the distal end. This is particularly important for aneurysms located adjacent to the carotid terminus in order to assure adequate neck coverage, as well as avoiding jailing one of the branching parent arteries. An illustrative case is provided. Conclusions The non-flow diverting unrestrained flared ends of the FRED stabilize the distal end of the device when deployed directly into the branches at the arterial bifurcation. The technique is useful to provide adequate neck coverage of cerebral aneurysm located directly adjacent to the bifurcation as is frequently the case with posterior communicating artery aneurysms.

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Faculty Opinions recommendation of A molecular atlas of cell types and zonation in the brain vasculature.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732663948.793550129 ◽

2018 ◽

Author(s):

Richard Daneman

Keyword(s):

Cell Types ◽

Brain Vasculature ◽

The Brain

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P120 The burden of the management of cerebral aneurysms in Africa: a scoping review

BJS Open ◽

10.1093/bjsopen/zrab032.119 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Francklin Tetinou ◽

Ulrick Sidney Kanmounye ◽

Igor Nitcheu ◽

Aliyu Baba Ndajiwo ◽

Nourou Dine A Bankole ◽

...

Keyword(s):

Cerebral Aneurysm ◽

Full Text ◽

Cerebral Aneurysms ◽

Clinical Findings ◽

African Countries ◽

Female Predominance ◽

Full Text Retrieval ◽

Intracerebral Aneurysm ◽

Study Participants ◽

Mean Time

Abstract Introduction In Africa, the epidemiology, management, and prognosis of cerebral aneurysms remain poorly understood. Cerebral aneurysms are still highly underdiagnosed and inadequately treated in Africa due to a lack of vascular neurosurgeons and infrastructure. In this review we mapped the burden and management of intracerebral aneurysm in Africa. Methods A full systematic search on articles published in Africa on brain aneurysms was performed in PubMed, African Journals Online, Google Scholar, WHO Global Health Library and LILACS with no language restrictions. The search results were merged, uploaded into Rayyan software, (FDT, USK, IN, NDAB) independently based on the pre-defined inclusion and exclusion criteria. The full text of the remaining articles were then retrieved and screened by three reviewers independently (FDT, USK, NDAB). Conflicts were resolved by mutual agreement. From all included documents, we extracted information regarding study design, socio-demographic characteristics, clinical findings, type of treatment and outcome results. Results We included 28 articles in our full text retrieval. These studies totaled 1181 patients managed for cerebral aneurysm in Africa. Half (50.0%; n = 14) of all studies had been published in the past 5 years and nearly half (46.4%; n = 13) of these studies were conducted in two countries: eight in Morocco and five in South Africa, we didn’t found any publication on cerebral aneurysm for nearly 80% of African countries. Also, there was a female predominance among cerebral aneurysm study participants (62.5%), and the mean time from diagnosis to surgery was 12.1 days. Cerebral aneurysms were most often located in the internal carotid artery (29.6%) and anterior cerebral artery (23.2%). Microneurosurgery (67%) was the most widely used option in these studies ahead of coiling (7.9%). Patient outcomes were judged favorable in 64.2% of cases, and the mortality rate following surgical (open vascular and endovascular) intervention was 19.4%. Conclusion The management of intracerebral aneurysms remains suboptimal in Africa. There are few peer-reviewed reports of aneurysm practice.

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