The pCONus device for the endovascular treatment of wide neck bifurcation aneurysms

2015 ◽  
Vol 8 (9) ◽  
pp. 940-944 ◽  
Author(s):  
Boris Lubicz ◽  
Ricardo Morais ◽  
Faisal Alghamdi ◽  
Benjamin Mine ◽  
Laurent Collignon ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Ethics Committees ◽  
Initial Experience ◽  
New Device ◽  
Technical Issues ◽  
Wide Neck ◽  
Anatomical Outcomes ◽  
Angiographic Findings

Background and purposeThe pCONus is a new stent featuring a distal end that opens like a blossoming flower with four petals. The device is implanted in the aneurysm sac at the level of the neck. We report our initial experience in a series of patients treated with this device.MethodsThis retrospective study was approved by the authors’ ethics committees. 18 patients with 19 unruptured wide neck bifurcation intracranial aneurysms (IA) were treated by pCONus placement and coiling. Technical issues, immediate post treatment angiographic findings, and clinical and imaging follow-up were assessed.ResultsEmbolization was successful in all patients. There were 11 women and 7 men with a mean age of 60 years. Median aneurysm size was 9 mm (range 5.5–25 mm). The device was precisely placed and detached in all cases, allowing for subsequent coiling. Two patients experienced a symptomatic complication, one of which, a thromboembolism, was related to the use of the pCONus. This patient had a slight hand paresis. 16 patients had a normal neurological examination at discharge. Immediate anatomical results were 13 complete occlusions, 2 neck remnants, and 4 incomplete occlusions. Imaging follow-up was obtained in 12 patients (mean 9.5 months, range 2–24 months) and showed 9 stable occlusions and 3 recanalizations, of which 2 were retreated.ConclusionsIn this initial series of patients, endovascular treatment of wide neck bifurcation IAs with the pCONus was feasible, with acceptable clinical and anatomical outcomes. Further studies are needed to evaluate the indications, safety, and efficacy of this new device.

scholarly journals Endovascular Treatment of Small Ruptured Intracranial Aneurysms (<5 mm)

2019 ◽  
Vol 30 (4) ◽  
pp. 817-826
Author(s):  
Fei Peng ◽  
Xin Feng ◽  
Xin Tong ◽  
Baorui Zhang ◽  
Luyao Wang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Cox Proportional Hazards ◽  
Parent Artery ◽  
Parent Vessel ◽  
Fisher Grade ◽  
Wide Neck ◽  
Ruptured Intracranial Aneurysms

Abstract Purpose To investigate the long-term clinical and angiographic outcomes and their related predictors in endovascular treatment (EVT) of small (<5 mm) ruptured intracranial aneurysms (SRA). Methods The study retrospectively reviewed patients with SRAs who underwent EVT between September 2011 and December 2016 in two Chinese stroke centers. Medical charts and telephone call follow-up were used to identify the overall unfavorable clinical outcomes (OUCO, modified Rankin score ≤2) and any recanalization or retreatment. The independent predictors of OUCO and recanalization were studied using univariate and multivariate analyses. Multivariate Cox proportional hazards models were used to identify the predictors of retreatment. Results In this study 272 SRAs were included with a median follow-up period of 5.0 years (interquartile range 3.5–6.5 years) and 231 patients with over 1171 aneurysm-years were contacted. Among these, OUCO, recanalization, and retreatment occurred in 20 (7.4%), 24 (12.8%), and 11 (7.1%) patients, respectively. Aneurysms accompanied by parent vessel stenosis (AAPVS), high Hunt-Hess grade, high Fisher grade, and intraoperative thrombogenesis in the parent artery (ITPA) were the independent predictors of OUCO. A wide neck was found to be a predictor of recanalization. The 11 retreatments included 1 case of surgical clipping, 6 cases of coiling, and 4 cases of stent-assisted coiling. A wide neck and AAPVS were the related predictors. Conclusion The present study demonstrated relatively favorable clinical and angiographic outcomes in EVT of SRAs in long-term follow-up of up to 5 years. THE AAPVS, as a morphological indicator of the parent artery for both OUCO and retreatment, needs further validation.

scholarly journals One-Year Angiographic Follow-Up after WEB-SL Endovascular Treatment of Wide-Neck Bifurcation Intracranial Aneurysms

2015 ◽  
Vol 36 (12) ◽  
pp. 2320-2324 ◽  
Author(s):  
R. Sivan-Hoffmann ◽  
B. Gory ◽  
R. Riva ◽  
P.-E. Labeyrie ◽  
F. Signorelli ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
One Year ◽  
Wide Neck

scholarly journals Solitaire AB Stent-Assisted Coiling of Wide-Necked Intracranial Aneurysms

Neurosurgery ◽  
2014 ◽  
Vol 75 (3) ◽  
pp. 215-219 ◽  
Author(s):  
Benjamin Gory ◽  
Joachim Klisch ◽  
Alain Bonafé ◽  
Charbel Mounayer ◽  
Remy Beaujeux ◽  
...  
Keyword(s):  
Prospective Study ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Mean Width ◽  
Mean Diameter ◽  
The Mean ◽  
Wide Neck

Abstract BACKGROUND: Endovascular treatment of intracranial aneurysms can be technically difficult when the neck is wide. The Solitaire AB stent (Covidien, Irvine, California), the only fully retrieved stent, assists in the coiling of wide-neck intracranial aneurysms. OBJECTIVE: To evaluate the mid-term angiographic follow-up of wide-necked aneurysms treated with the Solitaire AB stent. METHODS: SOLARE (SOLitaire Aneurysm Remodeling) is a consecutive, prospective study conducted in 7 European centers. A core laboratory evaluated the postoperative and mid-term (6 month ± 15 days) angiographic results by using the Raymond classification Scale. Recanalization was defined as worsening, and progressive thrombosis was defined as improvement in the Raymond scale score. RESULTS: The mean width of the aneurysm sac was 7.5 mm, and the mean diameter of the aneurysm neck was 4.7 mm. Angiographic mid-term follow-up was obtained in 55 of 65 aneurysms (85.9%). Complete occlusion was achieved in 33 aneurysms (60%); a neck remnant was seen in 16 aneurysms (29.1%) and an aneurysm remnant in 6 aneurysms (10.9%). Of 55 aneurysms, recanalization was observed in 8 aneurysms (14.5%), and progressive thrombosis was observed in 17 aneurysms (30.9%). No bleeding or rebleeding was observed during the follow-up period. CONCLUSION: Stent-assisted coiling of wide-necked intracranial aneurysms was found to be safe and effective with the Solitaire AB stent at 6-month follow-up. Angiographic results improve with time due to progressive thrombosis of the aneurysm.

scholarly journals Low-Profile Neuroform Atlas Stent-Assisted Coiling of Intracranial Aneurysms: Single-Center Initial Experience

2019 ◽  
Vol 03 (02) ◽  
pp. 117-121 ◽  
Author(s):  
Somnath Pan ◽  
Santhosh Kumar Kannath ◽  
Jayadevan Enakshy Rajan
Keyword(s):  
Intracranial Aneurysms ◽  
Initial Experience ◽  
Single Center ◽  
Complete Occlusion ◽  
New Device ◽  
Low Profile ◽  
Ruptured Intracranial Aneurysm ◽  
Class 1 ◽  
Minimal Residual

Abstract Background Neuroform Atlas stent is a relatively new device used for stent-assisted coiling (SAC) of wide-necked intracranial aneurysms. Purpose To elaborate the initial experience in a single center to assess the efficacy and initial results of Neuroform Atlas for SAC of intracranial aneurysms. Methods Between February 2017 and September 2018, eight patients (five females, three males; mean age 56 years) underwent SAC with Neuroform Atlas. Results Five unruptured and three ruptured wide-necked aneurysms were treated with Neuroform Atlas SAC. Immediate complete occlusion modified Roy-Raymond class 1 (MRRC 1) or mild neck residue class 2 (MRRC 2) was achieved in three patients and five other patients had minimal residual interstitial filling of the aneurysm (MRRC 3b). One patient with ruptured intracranial aneurysm succumbed to the illness in the first postoperative day due to massive rebleed. Other seven patients remained clinically asymptomatic in the follow-up period. Patent stent was noted at three to seven months follow-up magnetic resonance angiography (MRA) in five patients. Complete occlusion of the aneurysm was noted in three patients, and minimal residual aneurysm was seen in two patients. Conclusion Neuroform Atlas stent is safe and effective in achieving good angiographic outcome in complex intracranial aneurysms.

p64 Flow Modulation Device in the treatment of intracranial aneurysms: initial experience and technical aspects

2015 ◽  
Vol 8 (2) ◽  
pp. 173-180 ◽  
Author(s):  
Francesco Briganti ◽  
Giuseppe Leone ◽  
Mariano Marseglia ◽  
Domenico Cicala ◽  
Ferdinando Caranci ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Aneurysm Rupture ◽  
Safe Procedure ◽  
Initial Experience ◽  
Flow Modulation ◽  
New Device ◽  
Technical Complications

BackgroundExperience with the endovascular treatment of cerebral aneurysms by flow diverter devices (FDDs) is limited to four devices (Pipeline, Covidien; FRED, Microvention; Silk, Balt Extrusion; Surpass, Stryker), as reported in different studies.ObjectiveTo describe the initial experience and the technical innovations of a new-generation FDD (p64 Flow Modulation Device, Phenox, Bochum, Germany).MethodsBetween December 2014 and February 2015, six intracranial aneurysms in five patients (four women, one man; mean age 63 years) were treated with the p64 Flow Modulation Device.ResultsImmediate post-treatment angiography showed reduced flow into all aneurysms. No long-term angiographic data are available. The device may be easily deployed and totally retrieved with a unique mechanical detachment. No periprocedural technical complications occurred. No early or delayed aneurysm rupture, no ischemic or hemorrhagic complications, and no neurological morbidity or death were seen.ConclusionsTreatment of cerebral aneurysms with the p64 Flow Modulation Device is a safe procedure with no technical complications. The mechanical detachment and the 100% retrievability are significant advantages of this new device. However, large prospective studies with long-term clinical and angiographic follow-up are necessary to assess the role of the p64 in the endovascular treatment of intracranial aneurysms.

125 Staged Endovascular Treatment of Ruptured Intracranial Aneurysms: Acute Coiling Followed By Delayed Flow Diversion

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 228-228
Author(s):  
Erick Michael Westbroek ◽  
Matthew Bender ◽  
Narlin B Beaty ◽  
Bowen Jiang ◽  
Risheng Xu AB ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Complication Rate ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Major Complication ◽  
Flow Diversion ◽  
Neurological Deficits ◽  
Major Complication Rate ◽  
Ruptured Intracranial Aneurysms

Abstract INTRODUCTION ISAT demonstrated that coiling is effective for aneurysm treatment in subarachnoid hemorrhage (SAH); however, complete occlusion of wide-necked aneurysms frequently requires adjuvants relatively contraindicated in SAH. As such, a limited “dome occlusive” strategy is often pursued in the setting of SAH. We report a single institution series of coiling of acutely ruptured aneurysms followed by delayed flow diversion for definitive, curative occlusion. METHODS A prospectively collected IRB-approved database was screened for patients with aneurysmal SAH who were initially treated by coil embolization followed by planned flow diversion at a single academic medical institution. Peri-procedural outcomes, complications, and angiographic follow-up were analyzed. RESULTS >50 patients underwent both acute coiling followed by delayed, planned flow diversion. Average aneurysm size on initial presentation was 9.5 mm. Common aneurysm locations included Pcomm (36%), Acomm (30%), MCA (10%), ACA (10%), and vertebral (5%). Dome occlusion was achieved in all cases following initial coiling. Second-stage implantation of a flow diverting stent was achieved in 49/50 cases (98%). Follow-up angiography was available for 33/50 patients (66%), with mean follow-up of 11 months. 27 patients (82%) had complete angiographic occlusion at last follow up. All patients with residual filling at follow-up still had dome occlusion. There were no mortalities (0%). Major complication rate for stage I coiling was 2% (1 patient with intra-procedural aneurysm re-rupture causing increase in a previous ICH). Major complication rate for stage 2 flow diversion was 2% (1 patient with ischemic stroke following noncompliance with dual antiplatelet regimen). Minor complications occurred in 2 additional patients (4%) with transient neurological deficits. CONCLUSION Staged endovascular treatment of ruptured intracranial aneurysms with acute dome-occlusive coil embolization followed by delayed flow diversion is a safe and effective treatment strategy.

scholarly journals Long-Term Follow-up Study of Endovascularly Treated Intracranial Aneurysms

2010 ◽  
Vol 16 (3) ◽  
pp. 231-239 ◽  
Author(s):  
L.M. Pyysalo ◽  
L.H. Keski-Nisula ◽  
T.T. Niskakangas ◽  
V.J. Kähärä ◽  
J.E. Öhman
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Bleeding Rate ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Follow Up Study ◽  
Long Term Follow Up ◽  
Rebleeding Rate

Long-term follow-up studies after endovascular treatment for intracranial aneurysm are still rare and inconclusive. The aim of this study was to assess the long-term clinical and angiographic outcome of patients with endovascularly treated aneurysms. The clinical outcome of all 185 patients with endovascularly treated aneurysms were analyzed and 77 out of 122 surviving patients were examined with MRI and MRA nine to 16 years (mean 11 years) after the initial endovascular treatment. Sixty-three patients were deceased at the time of follow-up. The cause of death was aneurysm-related in 34 (54%) patients. The annual rebleeding rate from the treated aneurysms was 1.3% in the ruptured group and 0.1% in the unruptured group. In long-term follow-up MRA 18 aneurysms (53%) were graded as complete, 11 aneurysms (32%) had neck remnants and five aneurysms (15%) were incompletely occluded in the ruptured group. The occlusion grade was lower in the unruptured group with 20 aneurysms (41%) graded as complete, 11 (22%) had neck remnants and 18 (37%) were incomplete. However, only three aneurysms were unstable during the follow-up period and needed retreatment. Endovascular treatment of unruptured aneurysms showed incomplete angiographic outcome in 37% of cases. However, the annual bleeding rate was as low as 0.1%. Endovascular treatment of ruptured aneurysms showed incomplete angiographic outcome in 15% of cases and the annual rebleeding rate was 1,3%.

Medina embolization device for the treatment of intracranial aneurysms: 18 months’ angiographic results

2018 ◽  
Vol 11 (5) ◽  
pp. 516-522 ◽  
Author(s):  
Idriss Haffaf ◽  
Frédéric Clarençon ◽  
Eimad Shotar ◽  
Claudia Rolla-Bigliani ◽  
Saskia Vande Perre ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Thromboembolic Complication ◽  
Detachable Coil ◽  
Mean Delay ◽  
Scale Scores ◽  
Long Term Follow Up ◽  
Occlusion Rate ◽  
Wide Neck

Background and purposeThe Medina embolization device (MED) is a new flow disruption device combining the design of a detachable coil with an intrasaccular flow disrupter. Safety and short-term angiographic effectiveness of this device have recently been reported. However, long-term angiographic results are lacking. We report herein the 18 months’ angiographic outcome in patients treated for a wide-neck intracranial aneurysm with the MED.Materials and methodsNineteen patients (17 female, mean age 50 years) with 20 wide-neck intracranial aneurysms (six ruptured; 14 unruptured) were treated by the MED between January 2015 and June 2016. Procedure-related complications were systematically recorded; discharge and 6–9 months' follow-up modified Rankin Scale scores were assessed. Angiographic mid-term and long-term follow-up were performed with a mean delay of 6.4±1.5 months (n=16 aneurysms) and 17.7±4.2 months (n=15 aneurysms), respectively. Occlusion rates were evaluated after the procedure and at the mid-term and long-term follow-up using the Roy-Raymond scale.ResultsEmbolization with the MED was feasible in all except two cases (2/20, 10%). One per-procedural perforation was recorded (1/20, 5%) and one MED deployment failed because of the aneurysm’s shape (1/20, 5%). Three cases of thromboembolic complications were observed (3/20, 15%). Only one thromboembolic complication was responsible for clinical sequelae. Grade A occlusion rate was 61% (11/18) after the procedure, 75% at 6 months' follow-up (12/16), and 80% (12/15) at long-term follow-up. Two cases (2/18, 11%) of recanalization at mid-term were documented angiographically. No recanalization occurred between the mid-term and long-term follow-up.ConclusionMED is a hybrid embolization device, combining properties of a conventional coil with those of an intrasaccular flow disrupter. Our series focusing on long-term angiographic follow-up shows a satisfactory long-term occlusion rate. Larger series with longer angiographic follow-up times are warranted to confirm these preliminary results.

scholarly journals Endovascular Treatment of Unruptured Intracranial Aneurysms

2011 ◽  
Vol 17 (4) ◽  
pp. 420-424 ◽  
Author(s):  
W. Yue
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Mass Effect ◽  
Mortality And Morbidity ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Mean Size ◽  
Large And Giant Aneurysms ◽  
Brain Stem Ischemia

We report the clinical and angiographic results of endovascular treatment of unruptured intracranial aneurysms. Over a three-year period, 80 unruptured aneurysms in 74 patients were electively treated with endovascular management. One aneurysm was diagnosed during investigations for a second ruptured aneurysm, 54 aneurysms were incidentally discovered, 18 aneurysms presented with symptoms of mass effect and seven aneurysms presented with symptoms of brain stem ischemia. Mean size of the 80 unruptured aneurysms was 12.5±8.0 mm (range, 2–39 mm). Thirty-six aneurysms (45%) were small (<10 mm), 38 aneurysms (47.5%) were large (10–25 mm), and six aneurysms (7.5%) were giant (25–39 mm). Forty-eight wide-necked aneurysms (60%) were coiled with the aid of a supporting device. The mortality rate was 1.25%, and the overall morbidity was 1.25%. Of these, one of the patients suffered a stroke, leading to severe disability (1.25%). In one patient, the aneurysm ruptured during treatment, resulting in death. Initial aneurysm occlusion was complete (100%) in 76.25% aneurysms, nearly complete (90%–98%) in 10% aneurysms and incomplete (60%–85%) in 13.75% aneurysms. Follow-up angiography was available in 67 patients with 73 treated aneurysms (91.25%) from one to 36 months (mean 9.3 months); partial reopening occurred in 7.5%, mainly large and giant aneurysms (5.5%). Additional coiling was performed in four aneurysms. There were no complications in additional treatments. At 14.1-month clinical follow-up (range, 2 to 36 months), mRS score was 0 in 78.75% patients, 1 in 10% patients, 2 in 8.75% and 3 in 1.25%. There was no aneurysmal rupture during the follow-up period. Endovascular treatment of unruptured intracranial aneurysms has low procedural mortality and morbidity rates.

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