Curative cerebrovascular reconstruction with the Pipeline embolization device: the emergence of definitive endovascular therapy for intracranial aneurysms

2018 ◽  
Vol 10 (Suppl 1) ◽  
pp. i9-i18 ◽  
Author(s):  
D Fiorella ◽  
P Lylyk ◽  
I Szikora ◽  
M E Kelly ◽  
F C Albuquerque ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Vessel Wall ◽  
Cerebral Aneurysms ◽  
Parent Artery ◽  
Endovascular Techniques ◽  
Pipeline Embolization Device ◽  
Complete Exclusion ◽  
Aneurysm Occlusion ◽  
Unruptured Cerebral Aneurysms ◽  
New Generation

Endovascular, endosaccular, coil embolization has emerged as an established therapy for both ruptured and unruptured cerebral aneurysms. However, many aneurysms are not cured using conventional endovascular techniques. Coil embolization often results in incomplete aneurysm occlusion or recanalization in the ensuing months after treatment. The Pipeline embolization device (PED; Chestnut Medical) represents a new generation endoluminal implant which is designed to treat aneurysms by reconstructing the diseased parent artery. Immediately after implantation, the PED functions to divert flow from the aneurysm, creating an environment conducive to thrombosis. With time, the PED is incorporated into the vessel wall as neointimal–endothelial overgrowth occurs along the construct. Ultimately, this process results in the durable complete exclusion of the aneurysm from the cerebrovasculature and a definitive endoluminal reconstruction of the diseased parent artery.

Pitfall in clipping of unruptured cerebral aneurysms: narrowing of the parent artery

1993 ◽  
Vol 15 (1) ◽  
pp. 56-58 ◽  
Author(s):  
Takakazu Kawamata ◽  
Nobunhiko Aoki ◽  
Tatsuo Sakai ◽  
Koji Arai
Keyword(s):  
Cerebral Aneurysms ◽  
Parent Artery ◽  
Unruptured Cerebral Aneurysms

scholarly journals Lyophilizing thrombin powder-based treatment for hemostasis during coil embolization of ruptured cerebral aneurysm: Two case reports

2019 ◽  
Vol 25 (4) ◽  
pp. 454-459
Author(s):  
Changchun Jiang ◽  
Wei Wang ◽  
Baojun Wang ◽  
Yuechun Li ◽  
Guorong Liu ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Coil Embolization ◽  
Case Reports ◽  
Balloon Catheter ◽  
Treatment Strategies ◽  
Cerebral Aneurysms ◽  
Interventional Therapy ◽  
Parent Artery ◽  
Clinical Practices ◽  
Detachable Coils

Background Rupture of cerebral aneurysm is an inevitable complication during embolization, followed by subsequent acute subarachnoid hemorrhage or intracranial hematoma, and results in the aggravation of a patient’s condition. In particular, for patients who have had a ruptured aneurysm, urgent treatment strategies are required during operation. The most common hemostatic methods seen in clinical practices are as follows: after lowering the blood pressure, we continue to embolize the aneurysms with detachable coils as soon as possible or inject with Glubran/Onyx embolization liquids, as well as use a balloon catheter to temporarily block the blood supply. If the conditions are permissible, a balloon guiding catheter may even be used to restrict the proximal blood flow. At times, due to limitations of these methods, neurosurgeons are requested to perform craniotomy to treat the hemostasis. However, the delayed transition often leads to rapid deterioration of the patient’s condition and even death due to cerebral hernia. Case description We herein presented two cases of ruptured cerebral aneurysms to provide an alternative method for hemostasis and to save the lives of patients as much as possible. In an extremely urgent situation (conventional treatment is ineffective), we successfully saved the patient’s life by injecting lyophilizing thrombin powder (LTP) solution into the aneurysmal sac and the parent artery through a microcatheter. Conclusions To our knowledge, this is the first report of successful hemostasis during coil embolization of ruptured cerebral aneurysm with LTP. Further prospective studies are needed to confirm the safety and efficacy of LTP in cerebrovascular interventional therapy.

scholarly journals Advances in endovascular aneurysm management: coiling and adjunctive devices

2020 ◽  
Vol 5 (1) ◽  
pp. 14-21
Author(s):  
Jessica K Campos ◽  
Brian V Lien ◽  
Alice S Wang ◽  
Li-Mei Lin
Keyword(s):  
Cerebral Aneurysms ◽  
Next Generation ◽  
Coil Embolisation ◽  
Interventional Techniques ◽  
Technological Advances ◽  
Aneurysm Occlusion ◽  
Unruptured Cerebral Aneurysms ◽  
Endovascular Coils

Endovascular coil embolisation continues to evolve and remains a valid modality in managing ruptured and unruptured cerebral aneurysms. Technological advances in coil properties, adjunctive devices and interventional techniques continue to improve long-term aneurysm occlusion rates. This review elaborates on the latest advances in next-generation endovascular coils and adjunctive coiling techniques for treating cerebral aneurysms.

Follow-up Study on Intra-Aneurysmal Embolization for Unruptured Cerebral Aneurysms

1999 ◽  
Vol 5 (1_suppl) ◽  
pp. 89-92 ◽  
Author(s):  
Y. Kaku ◽  
S. Yoshimura ◽  
K. Hayashi ◽  
T. Ueda ◽  
N. Sakai
Keyword(s):  
Lower Incidence ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Neurological Deficits ◽  
Safe Treatment ◽  
Unruptured Aneurysms ◽  
Follow Up Study ◽  
Platinum Coil ◽  
Unruptured Cerebral Aneurysms

We describe follow-up clinical and angiographical results in patients with unruptured cerebral aneurysms treated with IDC or GDC. In 28 patients who underwent intra-aneurysmal occlusion for unruptured aneurysms, there were no permanent neurological deficits in the periprocedural period, while three transient neurological deficits were observed. On the angiograms obtained immediately after the procedure, complete aneurysmal occlusion was achieved in three patients (10.7%), a small neck remnant was detected in two cases (7.1%), a body filling in 12 cases (42.9%) and both of them were detected in 11 patients (39.3%). On the follow up angiograms (median angiographical follow-up period 15.6 months), 46.4% of incompletely obliterated aneurysms showed aneurysmal recanalization, and a incompletely embolized aneurysm ruptured 15 months after initial embolization. Detachable platinum coil embolization is a safe treatment for unruptured aneurysms with a lower incidence of peri-procedural morbidity, wheareas follow-up results are less satisfactory in cases involving incompletely obliterated lesions. With this limitation in mind, patients need to be very carefully chosen for GDC embolization and strict follow-up angiography is mandatory when a complete embolization is not achieved.

scholarly journals Use of Distal Intracranial Catheters for Better Working View of Cerebral Aneurysms Hidden by Parent Artery or Its Branches: A Technical Note

2021 ◽  
Author(s):  
Ehab Mahmoud ◽  
Samuel Lenell ◽  
Christoffer Nyberg ◽  
Ljubisa Borota
Keyword(s):  
Endovascular Treatment ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Technical Note ◽  
Parent Artery ◽  
Endovascular Techniques ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Class 1 ◽  
Procedural Outcomes

A good working view is critical for safe and successful endovascular treatment of cerebral aneurysms. In a few cases, endovascular treatment of cerebral aneurysms may be challenging due to difficulty in obtaining a proper working view. In this report of 6 cases, we described the advantage of using a distal intracranial catheter (DIC) to achieve better visualization of cerebral aneurysms hidden by a parent artery or its branches. Between September 2017 and January 2021, we treated 390 aneurysms with endovascular techniques. In 6 cases in which it was difficult to obtain a proper working view, the DIC was placed distally close to the aneurysm in order to remove the parent artery projection from the working view and obtain better visualization of the aneurysm. Clinical and procedural outcomes and complications were evaluated. The position of the DIC was above the internal carotid artery siphon in the 6 cases. All aneurysms were successfully embolized. Raymond–Roy class 1 occlusion was achieved in all 4 unruptured aneurysms, while the result was class 2 in the 2 ruptured aneurysms. Placement of the DIC was atraumatic without dissections or significant catheter-induced vasospasm in all patients. Transient dysphasia was seen in 2 cases and transient aphasia in 1. Using this technique, we have found it possible to better visualize the aneurysm sac or neck and thereby treat cases we otherwise would have considered untreatable.

scholarly journals Post Coiling Syndrome Might Predict Recurrence after Coil Embolization of Unruptured Cerebral Aneurysms

2017 ◽  
Vol 11 (5) ◽  
pp. 235-239
Author(s):  
Yu Okuma ◽  
Kenji Sugiu ◽  
Nobuyuki Hirotsune ◽  
Tomohito Hishikawa ◽  
Kenichiro Muraoka ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Unruptured Cerebral Aneurysms

Use of the Pipeline embolization device for recurrent and residual cerebral aneurysms: a safety and efficacy analysis with short-term follow-up

2016 ◽  
Vol 9 (12) ◽  
pp. 1208-1213 ◽  
Author(s):  
Anna Luisa Kühn ◽  
Katyucia de Macedo Rodrigues ◽  
J Diego Lozano ◽  
David E Rex ◽  
Francesco Massari ◽  
...  
Keyword(s):  
Intimal Hyperplasia ◽  
Cerebral Aneurysms ◽  
Device Performance ◽  
Anterior Circulation ◽  
Pipeline Embolization Device ◽  
Safety And Efficacy ◽  
Efficacy Analysis ◽  
Unruptured Intracranial Aneurysms ◽  
Aneurysm Occlusion

ObjectiveEvaluation of the safety and efficacy of the Pipeline embolization device (PED) when used as second-line treatment for recurrent or residual, pretreated ruptured and unruptured intracranial aneurysms (IAs).MethodsRetrospective review of our database to include all patients who were treated with a PED for recurrent or residual IAs following surgical clipping or coiling. We evaluated neurological outcome and angiograms at discharge, 6- and 12-months’ follow-up and assessed intimal hyperplasia at follow-up.ResultsTwenty-four patients met our inclusion criteria. Most IAs were located in the anterior circulation (n=21). No change of preprocedure modified Rankin Scale score was seen at discharge or at any scheduled follow-up. Complete or near-complete aneurysm occlusion on 6- and 12-month angiograms was seen in 94.4% (17/18 cases) and 93.3% (14/15 cases), respectively. Complete or near-complete occlusion was seen in 100% of previously ruptured and 85.7% (6/7 cases) and 83.3% (5/6 cases) of previously unruptured cases at the 6- and 12-months’ follow-up, respectively. One case of moderate intimal hyperplasia was observed at 6 months and decreased to mild at the 12-months’ follow-up. No difference in device performance was observed among pretreated unruptured or ruptured IAs.ConclusionsTreatment of recurrent or residual IAs with a PED after previous coiling or clipping is feasible and safe. There is no difference in device performance between ruptured or unruptured IAs.

SPONTANEOUS DELAYED PROXIMAL MIGRATION OF ENTERPRISE STENT AFTER STAGED TREATMENT OF WIDE- NECKED BASILAR ANEURYSM

Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. 1012-1012 ◽  
Author(s):  
Sean D. Lavine ◽  
Philip M. Meyers ◽  
E. Sander Connolly ◽  
Robert S. Solomon
Keyword(s):  
Endovascular Treatment ◽  
Delivery System ◽  
Coil Embolization ◽  
Vascular Anatomy ◽  
Cerebral Aneurysms ◽  
Vascular Reconstruction ◽  
Adjunctive Treatment ◽  
Parent Artery ◽  
Proximal Migration ◽  
Intravascular Stent

Abstract OBJECTIVE To document a unique technical issue with a relatively newly released intravascular stent used for adjunctive treatment of wide-necked cerebral aneurysms. CLINICAL PRESENTATION A 48-year-old woman with a sister who had a large unruptured wide-necked basilar aneurysm underwent screening evaluation that revealed a nearly identical aneurysm. She also harbored small unruptured right superior cerebellar and left anterior cerebral artery aneurysms. INTERVENTION Endovascular treatment of the 11.5-mm basilar aneurysm was performed in a staged manner. Stent placement was performed first, followed by delayed coil embolization of the aneurysm 9 weeks later. Follow-up angiography at the time of the second procedure revealed significant spontaneous proximal migration of the Enterprise Vascular Reconstruction Device and Delivery System (Cordis Neurovascular, Inc., Miami Lakes, FL) with the distal extent of the device migrating from the right P2 segment into the neck of the aneurysm. Coil embolization was performed despite migration of the vascular reconstruction device. CONCLUSION The use of stents in the endovascular treatment of cerebral aneurysms has vastly improved our ability to treat complex lesions. Technical issues remain with these devices, and description of this event may alter the way we use the Enterprise Vascular Reconstruction Device and Delivery System in terms of staging procedures, and when evaluating the particular vascular anatomy of the individual patient with special attention to parent artery vessel size.

Sign in / Sign up

Export Citation Format

Share Document