Transradial approach for flow diversion treatment of cerebral aneurysms: a multicenter study

2019 ◽  
Vol 11 (8) ◽  
pp. 796-800 ◽  
Author(s):  
Stephanie H Chen ◽  
Brian M Snelling ◽  
Sumedh Subodh Shah ◽  
Samir Sur ◽  
Marie Christine Brunet ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cerebral Aneurysms ◽  
High Volume ◽  
Flow Diverter ◽  
Acute Angle ◽  
Flow Diversion ◽  
Left Internal Carotid Artery ◽  
Access Site ◽  
Transradial Approach ◽  
Aneurysm Treatment

BackgroundThe transradial approach (TRA) to endovascular procedures decreases access site morbidity and mortality in comparison with the traditional transfemoral technique (TFA). Despite its improved safety profile, there is a concern that TRA is less favorable for neurointerventional procedures that require large coaxial systems to manage the small tortuous cerebral vessels.ObjectiveTo report our experience with TRA for flow diverter placement for treatment of unruptured cerebral aneurysms.MethodsWe performed a retrospective review of prospective institutional databases at two high-volume centers to identify 49 patients who underwent flow diversion for aneurysm treatment via primary TRA between November 2016 and November 2018. Patient demographics, procedural techniques, and clinical data were recorded.ResultsOf the 49 patients, 39 underwent successful flow diversion placement by TRA. Ten patients were converted to TFA after attempted TRA. There were no procedural complications. Reasons for failure included tortuosity in eight patients and severe radial artery spasm in two.ConclusionsIn the largest reported series to date of flow diverter deployment via TRA for aneurysm treatment, we demonstrate the technical feasibility and safety of the method. The most common reason for failure of TRA was an acute angle of left common carotid artery origin or left internal carotid artery tortuosity. Overall, our data suggest that increasing adoption of TRA is merited given its apparent equivalence to the current TFA technique and its documented reduction in access site complications.

Abstract 1122‐000158: Flow Diversion of Cerebral Aneurysms via Direct Carotid Artery Cutdown: A Case Series

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Yahia M Lodi ◽  
Varun V Reddy ◽  
Adam Cloud ◽  
Zara T Lodi ◽  
Ravi Pande
Keyword(s):  
Carotid Artery ◽  
Case Series ◽  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Flow Diversion ◽  
Vascular Surgeon ◽  
Clinical Events ◽  
History Of ◽  
Severity Of The Disease ◽  
Arch Aneurysm

Introduction : Flow diversion (FD) of the cerebral aneurysms (CA) are performed either by trans femoral or transradial approach. Safety and feasibility of an alternative option such as direct Carotid artery Cutdown (DCAC) and FD for the treatment of the CA in a situation when tradition approaches are not feasible is not well described. Methods : Retrospective review. Results : First patient; 67 years old man with history of hypertension, hyperlipidemia, smoking, and stenting of the aortic arch aneurysm was diagnosed with symptomatic bilateral ICA DSA buy a CT angiography. Right ICA DSA was in multi‐level extending from cervical carotid artery to the skull base measured 19 × 15 × 20 mm and the left was 16 × 9 × 22 mm. Considering the severity of the disease and the presence of symptoms, planned for a DCAC by vascular surgeon followed by FD by neurovascular surgeon (NES) in a staged fashion. A 6F sheath was placed from right common carotid artery (CCA) to right ICA by a vascular surgeon. A CAT5 catheter was navigated to the ICA beyond DSA. FD was achieved using Surpass streamline measuring 4 × 50 mm x2 and a 5 × 40 mm. The DCAC site was sutured by vascular surgeon and patient was extubated. Using similar techniques, Left‐sided DPA was repaired using 5 × 50 mm surpass streamline flow diverter in 3 months. Second patient; 75 years old women’s let ICA opththalmic (ICA‐O) aneurysm grown from 8 mm to 12 mm with headaches. TF and TR approaches failed, underwent DCAC and FD with pipeline flex (PF) 5 × 30 mm using phenom plus and phenom XT27 microcatheter. Third patient; 65 years old women with LICA‐0 9 mm symptomatic aneurysm with occlusions femoral and radial arteries due to smoking underwent FD with PF of 4 × 30 mm. There were no clinical events, first patient’s right ICA radiographic dissection was repaired by VS prior to extubation. Patients were discharged home in 48 hours with NIHSS 0 and achieved baseline mRS. Patients were continued full antiplatelets for six months followed by an 81 mg baby aspirin and 75 mg of clopidogrel. Follow‐up MR angiogram demonstrate complete obligations of the aneurysms without stenosis. Conclusions : Our case series demonstrate that DCAC for the FD of the intracranial aneurysm is feasible and safe when performed carefully and in coordination with a multidisciplinary team. Further studies are required.

Flow Diversion for Intracranial Aneurysm Treatment: Trials Involving Flow Diverters and Long-Term Outcomes

Neurosurgery ◽  
2019 ◽  
Vol 86 (Supplement_1) ◽  
pp. S36-S45 ◽  
Author(s):  
Bree Chancellor ◽  
Eytan Raz ◽  
Maksim Shapiro ◽  
Omar Tanweer ◽  
Erez Nossek ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Flow Diversion ◽  
Long Term Outcomes ◽  
Complex Aneurysms ◽  
Aneurysm Treatment ◽  
Endovascular Methods ◽  
Cure Rates ◽  
Flow Diverters

Abstract Flow diverters (FDs) have changed the management of brain aneurysms; not only for complex aneurysms (giant, fusiform and blister) refractory to conventional therapies, but also for unruptured lesions previously managed by traditional surgical or coil-based endovascular methods. Since 2011 when the PipelineTM Embolization Device (Medtronic) was cleared by the Food and Drug Administration for adults with large or giant wide-neck intracranial aneurysms of the internal carotid artery proximal to the posterior communicating segment, the role of flow diversion for aneurysm treatment has expanded—supported by favorably low complication and high cure rates compared with alternative treatments. Here we review the key clinical trials and the long term outcomes that have demonstrated safety and efficacy of minimized porosity endoluminal devices in the treatment of cerebral aneurysms.

scholarly journals 2D parametric contrast time-density analysis for the prediction of complete aneurysm occlusion at six months’ post-flow diversion stent

2020 ◽  
Vol 26 (4) ◽  
pp. 468-475 ◽  
Author(s):  
Ahmed E Hussein ◽  
Meghana Shownkeen ◽  
Andre Thomas ◽  
Christopher Stapleton ◽  
Denise Brunozzi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Density Ratio ◽  
Area Under The Curve ◽  
Cerebral Aneurysms ◽  
Flow Diversion ◽  
Aneurysm Occlusion ◽  
Occlusion Rate ◽  
Time Density

Objective Indications for the treatment of cerebral aneurysms with flow diversion stents are expanding. The current aneurysm occlusion rate at six months ranges between 60 and 80%. Predictability of complete vs. partial aneurysm occlusion is poorly defined. Here, we evaluate the angiographic contrast time-density as a predictor of aneurysm occlusion rate at six months’ post-flow diversion stents. Methods Patients with unruptured cerebral aneurysms proximal to the internal carotid artery terminus treated with single flow diversion stents were included. 2D parametric parenchymal blood flow software (Siemens-Healthineers, Forchheim, Germany) was used to calculate contrast time-density within the aneurysm and in the proximal adjacent internal carotid artery. The area under the curve ratio between the two regions of interests was assessed at baseline and after flow diversion stents deployment. The area under the curve ratio between completely vs. partially occluded aneurysms at six months’ follow-up was compared. Results Thirty patients with 31 aneurysms were included. Mean aneurysm diameter was 8 mm (range 2–28 mm). Complete occlusion was obtained in 19 aneurysms. Younger patients ( P = 0.006) and smaller aneurysms ( P = 0.046) presented higher chance of complete obliteration. Incomplete occlusion of the aneurysm was more likely if the area under the curve contrast time-density ratio showed absolute ( P = 0.001) and relative percentage ( P = 0.001) decrease after flow diversion stents deployment. Area under ROC curve was 0.85. Conclusion Negative change in the area under the curve ratio indicates less contrast stagnation in the aneurysm and lower chance of occlusion. These data provide a real-time analysis after aneurysm treatment. If validated in larger datasets, this can prompt input to the surgeon to place a second flow diversion stents.

scholarly journals Flow-diverter stenting in post-traumatic pseudoaneurysm of cavernous internal carotid artery with epistaxis

2015 ◽  
Vol 21 (3) ◽  
pp. 325-328 ◽  
Author(s):  
Andrea Giorgianni ◽  
Carlo Pellegrino ◽  
Renzo Minotto ◽  
Anna Mercuri ◽  
Fabio Baruzzi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Flow Diverter ◽  
Left Internal Carotid Artery ◽  
Sphenoidal Sinus ◽  
Occlusion Test ◽  
Flow Diverter Stent ◽  
Traumatic Pseudoaneurysm ◽  
Post Traumatic

This paper is a case report of a young patient after a major head trauma causing multiple skull base fractures. The trauma occasioned pseudoaneurysm (PSA) from intracavernous C4 segment of left internal carotid artery (ICA) protruding in the sphenoidal sinus. After two months, two episodes of massive epistaxis occurred. Consequently, the post-traumatic PSA was treated, after carotid occlusion test, with flow-diverter stent positioning. A computed tomography angiography study performed in the following days showed complete resolution of the post-traumatic PSA lesion and ICA patency.

Dual Microwire Rail Technique to Advance a Microcatheter Past the Ostium of a Dissecting Carotid Artery Aneurysm for Flow Diverter Deployment: 2-Dimensional Operative Video

2019 ◽  
Author(s):  
Kunal Vakharia ◽  
Stephan A Munich ◽  
Muhammad Waqas ◽  
Matthew J McPheeters ◽  
Elad I Levy
Keyword(s):  
Carotid Artery ◽  
Video Recording ◽  
Artery Aneurysm ◽  
Flow Diverter ◽  
Flow Diversion ◽  
Carotid Artery Aneurysm ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Wall Apposition ◽  
Flow Diverters

Abstract Flow diversion using a Pipeline embolization device (PED; Medtronic, Dublin, Ireland) is an effective therapy for treating cavernous aneurysms. Currently, flow diverters require a 0.027-inch microcatheter for deployment. To navigate across these aneurysms, a 0.014-inch microwire is used, which often does not offer a sturdy enough rail to advance a 0.027-inch microcatheter past dissecting artery aneurysm ostia. We present a patient with a right cavernous dissecting carotid artery aneurysm. A step off between the 0.027-inch VIA microcatheter (MicroVention Terumo, Tustin, California) and 0.014-inch Synchro 2 microwire (Stryker Neurovascular, Fremont, California) resulted in difficulty with navigation of the microcatheter across the dissected portion of the aneurysm. A dual microwire rail technique involving two 0.014-inch Synchro 2 microwires was used to advance the VIA microcatheter past the dissecting artery aneurysm ostia for PED deployment. The introduction of the second microwire eliminated the step off between the microwire and microcatheter, providing a stronger rail and easier navigation of the microcatheter, without aggressive pushing. Postembolization runs showed optimal wall apposition and contrast stasis within the aneurysm, with successful flow diversion of the aneurysm. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary.

Flow diversion of large internal carotid artery aneurysms with the surpass device: impressions and technical nuance from the initial North American experience

2015 ◽  
Vol 8 (3) ◽  
pp. 279-286 ◽  
Author(s):  
Geoffrey P Colby ◽  
Li-Mei Lin ◽  
Justin M Caplan ◽  
Bowen Jiang ◽  
Barbara Michniewicz ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Flow Diverter ◽  
Flow Diversion ◽  
Initial Experience ◽  
Unruptured Aneurysms ◽  
Aneurysm Neck ◽  
Aneurysm Embolization ◽  
Grade Ii

BackgroundFlow diversion is an important tool for treatment of cerebral aneurysms, particularly large and giant aneurysms. The Surpass flow diverter is a new system under evaluation in the USA.ObjectiveTo report our initial experience of 20 cases with the Surpass flow diverter to demonstrate its basic properties, the required triaxial delivery platform, and the methodologies used to deploy it during treatment of large internal carotid artery (ICA) aneurysmsMethodsTwenty patients with ICA aneurysms ≥10 mm with ≥4 mm neck treated as part of the Surpass IntraCranial Aneurysm Embolization System Pivotal Trial (the SCENT trial; Stryker) were included. Details of patient demographics, aneurysm characteristics, and technical procedures were collected.ResultsTwenty patients (mean age 63.3±1.3 years; range 51–72) with 20 unruptured aneurysms (mean size 13.4±0.9 mm; range 10–21 mm) were treated. For proximal access, 60% of cases had aortic arch ≥grade II, 55% had significant cervical ICA tortuosity, and 60% had cavernous ICA ≥grade II. The Surpass device was implanted in 19/20 (95%) cases. Of 19 cases, a single device was used in 18 cases (95%) and 2 devices in only 1 case (5%). Balloon angioplasty was performed in 8/19 cases (42%). Complete aneurysm neck coverage and adequate vessel wall apposition was obtained in all 19 cases.ConclusionsSurpass is a next-generation flow diverter with unique device-specific and delivery-specific features compared with clinically available endoluminal flow diverters. Our initial experience demonstrates a favorable technical profile in treatment of large and giant ICA aneurysms.Trial registration numberNCT01716117.

scholarly journals Novel use of flow diversion for the treatment of aneurysms associated with arteriovenous malformations

2017 ◽  
Vol 42 (6) ◽  
pp. E7 ◽  
Author(s):  
Craig Kilburg ◽  
Philipp Taussky ◽  
M. Yashar S. Kalani ◽  
Min S. Park
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Arteriovenous Malformations ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Flow Diversion ◽  
Complete Occlusion ◽  
Martin Grade ◽  
Flow Diverting Stent

The use of flow-diverting stents for intracranial aneurysms has become more prevalent, and flow diverters are now routinely used beyond their initial scope of approval at the proximal internal carotid artery. Although flow diversion for the treatment of cerebral aneurysms is becoming more commonplace, there have been no reports of its use to treat flow-related cerebral aneurysms associated with arteriovenous malformations (AVMs). The authors report the cases of 2 patients whose AVM-associated aneurysms were managed with flow diversion. A 40-year-old woman presented with a history of headaches that led to the identification of an unruptured Spetzler-Martin Grade V, right parietooccipital AVM associated with 3 aneurysms of the ipsilateral internal carotid artery. Initial attempts at balloon-assisted coil embolization of the aneurysms were unsuccessful. The patient underwent placement of a flow-diverting stent across the diseased vessel; a 6-month follow-up angiogram demonstrated complete occlusion of the aneurysms. In the second case, a 57-year-old man presented with new-onset seizures, and an unruptured Spetzler-Martin Grade V, right frontal AVM associated with an irregular, wide-necked anterior communicating artery aneurysm was identified. The patient underwent placement of a flow-diverting stent, and complete occlusion of the aneurysm was observed on a 7-month follow-up angiogram. These 2 cases illustrate the potential for use of flow diversion as a treatment strategy for feeding artery aneurysms associated with AVMs. Because of the need for dual antiplatelet medications after flow diversion in this patient population, however, this strategy should be used judiciously.

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