Abstract 2884: Angiographic Lumen Changes From Oversized Neuroform Stent Implantation

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Marc A Lazzaro ◽  
Omar Katib ◽  
Behrad Golshani ◽  
Osama O Zaidat
Keyword(s):  
Stent Implantation ◽  
Neointimal Hyperplasia ◽  
Vessel Diameter ◽  
Radial Force ◽  
Lumen Diameter ◽  
Paired Data ◽  
Parent Vessel ◽  
Landing Zone ◽  
Neuroform Stent

Introduction: The effect of oversized intracranial stent implantation, and the potential for excessive neointimal hyperplasia from the resulting chronic outward radial force, has not been previously reported. We sought to compare the angiographic narrowing associated with implantation of oversized Neuroform stents overlapping vessels of different diameters. Methods: We reviewed an aneurysm database and identified patients treated with stent-assisted coil embolization involving stent placement overlapping a vessel size transition. Patient demographics and lesion characteristics were extracted from chart review. A submillimeter digital caliper was used for angiogram measurement of lumen diameter at four sites ( figure ). The relationship between lumen diameter and stent oversizing was compared with student’s t-test and Pearson’s correlation. Results: Twenty vessels were identified in 18 patients, providing 80 paired data points. Mean age was 52 years (SD 12), with mean follow-up time of 8 months (SD 6). The distribution of vessel transitions included BA to PCA (n = 8), A1 to A2 or M1 to M2 (n = 8), ICA to ACA or MCA (n = 3), and Vertebral artery to PICA (n = 1). Stent diameter ranged from 3 mm to 4.5 mm, and the average oversizing in the smaller diameter parent vessel landing-zone was 1.75 mm (range 0.8 to 2.9 mm) greater than the vessel diameter. The mean change in lumen size from pre-stent implantation to follow-up was not significantly different for any of the four sites; the proximal end-stent decreased by 5.5% (SD 19.7), proximal mid-stent increased by 7.3% (SD 18.8), distal mid-stent increased by 14.7% (SD 13.8), and the distal end-stent decreased by 0.9% (SD 13.1). Stent oversizing by less than a factor of 1.65 resulted in a mean lumen loss of 4.1% (SD 15.6), while oversizing by greater than a factor of 1.65 resulted in a mean lumen gain of 11.1% (SD = 17.2), (p = 0.006). Conclusions: These data suggest oversized Neuroform stent implantation within the intracranial vasculature does not lead to increased stenosis. Stent oversizing by a factor of 1.65 or more leads to significant persistent luminal gain. The non-significant trend toward lumen loss at the stent tines suggests diminished radial force or greater neointimal hyperplasia at these sites, however persistent luminal gain from the oversized stent radial force likely predominates over any neointimal hyperplasia. Figure . A NF stent overlapping the M1 and M2 segments (A, tines indicated by white arrows). Four points of measurement (B), proximal tines (1.), mid-stent in proximal landing zone (2.), mid-stent in distal landing zone (3.), and distal tines (4.).

Impact of hinge motion on stent edge restenosis after new generation drug-eluting-stent implantation in RCA

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Jimba ◽  
M Ikutomi ◽  
D Nishijyo ◽  
M Yamasaki ◽  
A Shindou ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Biomechanical Properties ◽  
Plaque Burden ◽  
Drug Eluting Stent ◽  
Landing Zone ◽  
Binary Restenosis ◽  
Drug Eluting ◽  
New Generation ◽  
Hinge Angle

Abstract Background Edge restenosis still occurs after stent implantation, even by using new generation drug-eluting stents (DES) considered to have favorable biomechanical properties. Mechanical stress imposed on the stent edge are thought to be aggravated by hinge motion at a point between the stented and unstented segments, inducing chronic local inflammation and neointimal overgrowth. Purpose The aim of this study was to investigate the association between the development of edge restenosis and hinge motion in right coronary artery (RCA) where the excessive vessel movement is commonly observed. Methods Among consecutive 650 lesions in RCA where new generation DESs were implanted between 2009 and 2019, 427 serial lesions with sets of angiographies at baseline and follow-up (6–18 month) were included. In addition to conventional quantitative angiography analysis, hinge angle at stent edges was measured (Fig. 1). All the appropriate data for intravascular imaging were analyzed for both stent edges and reference segments. Results Binary restenosis occurred in 43 lesions, and 39 of them were referred to re-intervention. Fifty five percent of them were related to stent edges (15 at proximal and 9 at distal edges). Classical risk factors including diabetes and hemodialysis were more prevalent in the restenosis group (p<0.05). Hinge angle was statistically larger in edge restenosis group than body restenosis or no restenosis group (17.3° vs 11.6° vs 10.6°, p<0.001, Fig. 2). In per-edge analysis, hinge angle, dissection and residual plaque ratio were the independent predictors for binary restenosis (Table 1) with the optimal cut-off value of hinge angle 11.5°. The coexistence of excessive hinge angle and residual plaque burden had an amplified effect on the angiographic stenotic progression at stent edge (p for interaction <0.001) and the incidents of binary restenosis (16.7% vs 1.7% p<0.01, Figs. 3,4). Conclusion Substantial stress determined by angulation at the stent edge and its interaction with residual plaque can be considered as one of the plausible mechanisms for edge restenosis. For tortuous RCA lesions, it would be important to decide the stent-landing zone for minimizing hinge motion and optimize the future stent design. Funding Acknowledgement Type of funding source: None

Endovascular Reconstruction with the Neuroform Stent as Monotherapy for the Treatment of Uncoilable Intradural Pseudoaneurysms

Neurosurgery ◽  
2006 ◽  
Vol 59 (2) ◽  
pp. 291-300 ◽  
Author(s):  
David Fiorella ◽  
Felipe C. Albuquerque ◽  
Vivek R. Deshmukh ◽  
Henry H. Woo ◽  
Peter A. Rasmussen ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Platelet Inhibition ◽  
Parent Vessel ◽  
Current Series ◽  
Vascular Segment ◽  
Initial Procedure ◽  
Acute Subarachnoid Hemorrhage ◽  
History Of ◽  
Neuroform Stent

Abstract OBJECTIVE: Intradural pseudoaneurysms have a malignant natural history and can be difficult to treat if parent vessel deconstruction is not feasible. These lesions often involve a long arterial segment and lack a defined saccular component that would safely accommodate the introduction of embolization coils. The current report describes the successful endovascular treatment of these lesions using a strategy of Neuroform stent reconstruction. METHODS: A retrospective review of the prospectively maintained Neuroform databases from our two institutions identified all intracranial aneurysms treated with the Neuroform stent alone, without embolization coils. The clinical charts, procedural data, and angiographic results were reviewed. RESULTS: Over a 38-month study period (10/02–2/06), 266 aneurysms were treated with the Neuroform stent. Of these, 10 were small “uncoilable” intradural pseudoaneurysms associated with subarachnoid hemorrhage. These lesions were treated using a strategy of endovascular stent reconstruction of the diseased vascular segment with one or more Neuroform stents (without concomitant coil embolization). Seven pseudoaneurysms were treated in the context of acute or subacute subarachnoid hemorrhage, and three were associated with a remote history of subarachnoid hemorrhage. Periprocedural complications occurred in two patients (clinically silent, intraprocedural thromboembolic event successfully treated with intra-arterial abciximab, symptomatic postprocedural stent thrombosis with successful thrombolysis, and excellent neurological recovery). Both complications occurred in patients with ruptured aneurysms and could be attributed to inadequate platelet inhibition at the time of the initial procedure. Follow-up conventional angiographic examinations were available for all 10 patients with pseudoaneurysms (1–18.5 mo; average, 9.0 mo). In nine cases, the aneurysms improved at follow-up, with either complete (n = 5) or near complete (n = 4) resolution. In one case, short-term follow-up (1 mo) demonstrated no significant change. No patient has rehemorrhaged after treatment. CONCLUSION: Endovascular Neuroform stent reconstruction represents an optimal strategy for the management of intradural pseudoaneurysms that require a constructive treatment strategy and are too small to accommodate the introduction of embolization coils. Nine out of 10 patients in the current series treated with this strategy demonstrated some degree of endovascular remodeling with either complete (n = 5) or partial (n = 4) angiographic resolution at follow-up. No rehemorrhages were encountered. Adequate antiplatelet therapy, even in the setting of acute subarachnoid hemorrhage, is prerequisite for the avoidance of thromboembolic complications.

Angiotensin-converting enzyme insertion/deletion polymorphism and risk of restenosis after directional coronary atherectomy followed by stent implantation

2004 ◽  
Vol 91 (04) ◽  
pp. 795-800 ◽  
Author(s):  
Piera Merlini ◽  
Francesco Bernardi ◽  
Alessandra Repetto ◽  
Ezio Bramucci ◽  
Maurizio Ferrario ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Neointimal Hyperplasia ◽  
Converting Enzyme ◽  
Clinical Model ◽  
Angiographic Restenosis ◽  
Stent Restenosis ◽  
Before And After ◽  
Late Loss ◽  
Loss Index

SummaryThe D allele of the insertion/deletion (I/D) polymorphism of the angiotensin I-converting enzyme (ACE) gene is associated with higher plasma and tissue ACE levels, which enhance the stimulus for neo-intimal hyperplasia. Plaque debulking before stenting reduces the plaque-related determinants of in-stent restenosis and provides an ideal clinical model for studying neointimal hyperplasia. We prospectively studied 113 consecutive patients undergoing elective DCA followed by stent implantation. The presence of I/D in ACE genome DNA was analysed by means of polymerase chain reaction. Follow-up coronary angiography was performed 6-12 months after DCA, and all of the angiograms were quantitatively analysed. The baseline clinical and angiographic characteristics of the patients with a D/D (33%), I/D (52%) and I/I (15%) genotype were well balanced. There were no significant differences in minimal lumen diameter before and after the procedure or at follow-up, and no significant differences in acute gain, late loss or the loss index. Our results indicate that ACE I/D polymorphism does not influence the risk of developing angiographic restenosis in patients undergoing DCA followed by stent implantation.

The Modified Bose Method for the Endovascular Treatment of Intracranial Atherosclerotic Arterial Stenoses Using the Enterprise Stent

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 91-101 ◽  
Author(s):  
Zsolt Vajda ◽  
Elisabeth Schmid ◽  
Thomas Güthe ◽  
Christoph Klötzsch ◽  
Alfred Lindner ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Cerebral Artery ◽  
Vessel Diameter ◽  
Radial Force ◽  
Technical Success Rate ◽  
Data Registry ◽  
Stenosis Rate ◽  
Stent Diameter ◽  
Recurrent Ischemia

Abstract BACKGROUND Balloon dilatation and deployment of a self-expanding stent is a safe treatment for intracranial atherosclerotic stenoses. The significant recurrence rate might be related to the high radial force of the Wingspan stent. OBJECTIVE To evaluate the procedural safety and stenosis recurrence rate by the use of a stent with reduced radial force (Enterprise). METHODS Two hundred nine atherosclerotic stenoses (189 patients) were treated (median age, 68 years; 132 male) in a single center. Lesion locations included internal carotid artery (n = 27), middle cerebral artery (n = 62), vertebral artery (n = 64), basilar artery (n = 55), and posterior cerebral artery (n = 1). Pre- and postmedication included acetylsalicylic acid and Clopidogrel for at least 12 months. Preprocedural and follow-up examinations included magnetic resonance imaging (MRI), neurological assessment, and digital subtraction angiography (6, 12, 26, and 52 weeks). Data registry included age, sex, normal vessel diameter, degree of stenosis, residual stenosis after stent, minimal in-stent diameter, and occurrence of ischemic symptoms during follow-up. RESULTS Median pre- and postprocedural stenosis rate was 65.4 ± 1% vs 25.1 ± 1%. Technical success rate was 100%. Major procedural complications occurred in 16 patients (8.1%). Combined neurological morbidity and mortality rate at 30 days was 2 patients (0.9%). In 174 stenoses (83%) angiographic follow-up was obtained (mean, 10.2 months). A restenosis (>50%) was observed in 43 (24.7%) cases after 4.2 months (mean) with 4 (9.3%) symptomatic lesions. Incidence of recurrent ischemia related to the stented artery was 2.2% during 10.2 months of mean follow-up. CONCLUSION Undersized balloon angioplasty and deployment of an Enterprise stent is safe and effective for intracranial stenoses. Follow-up results were equal to or better than those reported for bare-metal balloon-expandable or self-expanding stents and yielded excellent protection from recurrent ischemia.

Abstract 6031: Impact of Pre-procedural C-reactive Protein on Intravascular Ultrasound Parameters following Everolimus-eluting Stent Implantation: Results from the SPIRIT III Trial

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Daisaku Nakatani ◽  
Junya Ako ◽  
Masao Yamasaki ◽  
Takao Shimohama ◽  
Hiromasa Otake ◽  
...  
Keyword(s):  
Intravascular Ultrasound ◽  
Stent Implantation ◽  
Neointimal Hyperplasia ◽  
Volume Index ◽  
Drug Eluting Stent ◽  
List Type ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Hs Crp

Background: It has been reported that pre-procedual C-reactive protein (CRP) correlates with neointimal hyperplasia following bare-metal stent as well as a certain type of drug-eluting stent implantation. The aim of this study was to investigate potential impact of inflammation, as assessed by high sensitivity-CRP (hs-CRP) collected pre-procedure, on neointimal hyperplasia following everolimus-eluting stent (EES) implantation. Methods: Data were obtained from the SPIRIT III trial, a randomized controlled trial comparing an EES with a paclitaxel-eluting stent. Enrolled patients fulfilled the following criteria patients treated with EES stable angina; and volumetric intravascular ultrasound (IVUS) analysis available at 8 months follow-up. Volume index (volume/length) was calculated for vessel (VVI), plaque (PVI), neointima (NIV), and lumen (LVI). Percent neointimal volume (%NIV) was calculated as (NIV/SVI)× 100. Cross-sectional narrowing (CSN) was defined as neointimal area divided by stent area (%). Results: One-hundred thirty two patients met the inclusion criteria (mean age; 65±9 years, male; 75%). There was no significant correlation between hs-CRP and VVI, PVI, and LVI at either baseline or 8 months follow-up. Furthermore, hs-CRP did not correlate with %NIV (r=−0.071, P=0.416) and max CSN (r=−0.020, P=0.819) at follow-up (figure ). Conclusion: Pre-procedual inflammation assessed by hs-CRP did not affect the neointimal hyperplasia at 8 months following everolimus-eluting stent implantation.

Usefulness of the Neuroform Stent for the Treatment of Cerebral Aneurysms: Results at Initial (3–6-mo) Follow-up

Neurosurgery ◽  
2005 ◽  
Vol 56 (6) ◽  
pp. 1191-1202 ◽  
Author(s):  
David Fiorella ◽  
Felipe C. Albuquerque ◽  
Vivek R. Deshmukh ◽  
Cameron G. McDougall
Keyword(s):  
Present Report ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Cerebral Aneurysms ◽  
Parent Vessel ◽  
Technical Problems ◽  
Aneurysm Neck ◽  
Aneurysm Size ◽  
Neuroform Stent

Abstract OBJECTIVE: The Neuroform microstent, a flexible, self-expanding, nitinol stent specifically designed for use in the cerebral vasculature, became available in North America for aneurysm treatment in November 2002. The present report details our experience with the Neuroform stent over the past 2 years, with an emphasis on evolving treatment strategies and treatment durability at initial (3–6 mo) follow-up. METHODS: All patients included in this report were registered in a prospectively maintained database. We assessed the clinical history, indications for stent use, aneurysm dimensions, technical details of the procedures, degree of aneurysm occlusion, angiographic and clinical findings at follow-up, and complications. RESULTS: Over a 20-month period, 64 patients with 74 aneurysms were treated with 86 Neuroform stents. Of 64 patients, 16 (25%) were treated in the context of subarachnoid hemorrhage (8 acute, 7 subacute, 1 remote). Indications for stent use included broad aneurysm neck (n = 51 stents; average neck, 5.1 mm; aneurysm size, 8.2 mm), fusiform/dissecting morphology (n = 17), salvage/bailout for coils prolapsed into the parent vessel (n = 7), and giant aneurysm (n = 11). Sixty-one aneurysms were stented and coiled with complete or near complete (>95%) occlusion in 28 patients (45.9%) and partial occlusion (<95%) in 33 patients (54%). Follow-up angiographic (n = 43) or magnetic resonance angiographic (n = 5) data (average follow-up, 4.6 mo; median, 4 mo; range, 1.5–13 mo) for 48 aneurysms (46 patients) after stent-supported coil embolization demonstrated progressive thrombosis in 25 patients (52%), recanalization in 11 patients (23%) (8 of whom were retreated), and no change in 12 patients (25%). Follow-up angiography in 5 additional patients with dissecting aneurysms treated with stents alone demonstrated interval vascular remodeling with decreased aneurysm size in all patients. Delayed, severe, in-stent stenosis was observed in 3 patients, 1 of whom was symptomatic and required angioplasty and subsequently superficial temporal artery-to-middle cerebral artery bypass surgery. Using the second-generation Neuroform2 delivery system (n = 53), very few technical problems with stent delivery and deployment have been encountered (n = 2). CONCLUSION: The Neuroform stent facilitates adequate embolization of complex cerebral aneurysms, which would not otherwise be amenable to endovascular therapy. Initial follow-up data indicate favorable progressive thrombosis and recanalization rates for aneurysms after Neuroform stent-assisted embolization. These advantages of stenting were most evident for small aneurysms with wide necks.

The Silk Vista Baby – The UK experience

2021 ◽  
pp. 159101992110240
Author(s):  
P Bhogal ◽  
HLD Makalanda ◽  
K Wong ◽  
P Keston ◽  
J Downer ◽  
...  
Keyword(s):  
Vessel Diameter ◽  
Flow Diverter ◽  
Aneurysm Rupture ◽  
Parent Vessel ◽  
Anterior Circulation ◽  
Clinical Complications ◽  
Permanent Morbidity ◽  
Mca Aneurysm ◽  
The Uk

Background The Silk Vista Baby (SVB) flow diverter (FDS) is the only FDS deliverable via a 0.017 inch microcatheter and is specifically designed for the distal vasculature. We sought to evaluate the safety and efficacy of the SVB. Materials and Methods We performed a retrospective review to identify SVB cases at 4 tertiary neurosurgical centres within the U.K. Clinical, procedural, angiographic and follow-up data were collected. Results We identified 60 patients (35 female, 58%) of average age 54 ± 10.5 (range 30–72) with 61 aneurysms, 50 (81.9%) located in the anterior circulation. The majority of the aneurysms treated were unruptured (46, 75.4%) and saccular (46, 75.4%). Dome size was 6.2 ± 6.2 mm (range 1–36mm) and parent vessel diameter was 2.3 ± 0.4 mm (range 1.2-3.3 mm). An average number of 1.07 devices were implanted. Coils or other devices were implanted in 14 aneurysms (23.3%). At last angiographic follow-up (n = 55), 7.5 ± 4.2 months post-procedure, 32 aneurysms (57.1%) were graded as RRC I, 7 (12.5%) RRC II, and 17 RRC III (30.4%). Clinical complications, excluding death, were seen in 4 patients (6.8%) including 1 delayed aneurysm rupture and 3 symptomatic ischaemic events. Only one patient had permanent morbidity (mRS 1). 3 patients died during follow-up (5.1%); 2 deaths were related to the aneurysms (3.4%) – one ruptured dissecting MCA aneurysm, and one giant partially thrombosed posterior circulation aneurysm. 93% of patients were mRS ≤ 2 at last follow-up. Conclusion The SVB has high rates of technical success and an acceptable safety profile. Distal aneurysms may occlude slower due to relative oversizing of the devices.

scholarly journals Impact of Combination Therapy with Ezetimibe/Simvastatin Treatment on the Neointimal Response to Biodegradable Polymer Biolimus-Eluting Stent Implantation in Patients with Acute Myocardial Infarction: Serial Assessment with Optical Coherence Tomography

2018 ◽  
Vol 8 (10) ◽  
pp. 1968 ◽  
Author(s):  
Yongcheol Kim ◽  
Young Hong ◽  
Sang Kim ◽  
Min Kim ◽  
Doo Sim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Optical Coherence Tomography ◽  
Biodegradable Polymer ◽  
Stent Implantation ◽  
Neointimal Hyperplasia ◽  
Moderate Intensity ◽  
Optical Coherence ◽  
Biolimus A9

The aim of this study was to compare the neointimal response at 12-month follow-up between ezetimibe/simvastatin (Vytorin, manufactured by Merck) 10/10 mg and Vytorin 10/40 mg after biodegradable polymer Biolimus-eluting stent (BP-BES) implantation in patients with acute myocardial infarction (AMI). A total of 20 patients requiring revascularization were randomly assigned to receive either Vytorin 10/10 mg (n = 9) or Vytorin 10/40 mg (n = 11). Baseline optical coherence tomography (OCT) was performed after stent implantation, and follow-up OCT was scheduled at 12 months. We performed follow-up OCT in 18 patients (Vytorin 10/10 mg (n = 9) or Vytorin 10/40 mg (n = 9)). A total of 842 frames and 8552 struts were analyzed at initial and follow-up OCT. At follow-up, the percentage of uncovered struts was not significantly different between both groups (6.61 ± 10.29% vs. 7.57 ± 6.45%, p = 0.815). The percentage of malapposed struts was also similar between both groups (0.69 ± 1.58% vs. 1.55 ± 2.72%, respectively, p = 0.422). Mean percent neointimal hyperplasia area was not significantly different between both groups (6.53 ± 3.26% vs. 6.37 ± 8.96%, p = 0.961). This OCT study showed that both high- and moderate-intensity dosing of Vytorin was associated with relatively lower percentages of uncovered struts and malapposed struts after Biolimus A9-eluting stent implantation in patients with AMI.

scholarly journals Initial use of endothelial progenitor cells capturing stents in paediatric congenital heart disease

2013 ◽  
Vol 24 (5) ◽  
pp. 900-904 ◽  
Author(s):  
Nuno Cabanelas ◽  
José D. F. Martins ◽  
Fátima Pinto
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Stent Implantation ◽  
Congenital Heart ◽  
Ductus Arteriosus ◽  
Neointimal Hyperplasia ◽  
Complex Congenital Heart Disease ◽  
Endothelial Progenitor ◽  
Transcutaneous Oxygen

AbstractIntroductionStenosis, mediated by neointimal hyperplasia and thrombosis, is a major limiting factor in successful stent implantation. The introduction of a stent, coated in its endoluminal surface by antihuman CD34 antibodies with endothelial progenitor cell-capturing properties, opens the possibility of promoting a rapid and normal functioning coverage by endothelium and thus avoids both an excessive cell proliferation within stent and the need for long-term dual antiplatelet therapy. These stents, developed for adult coronary artery disease, have not yet been implanted in children or in those with congenital heart disease.Objective and methodsIn this paper, we describe the implantation of Genous®stents in three children with cyanotic congenital heart disease and obstructed systemic-to-pulmonary shunts. We describe the use of this stent and address its potential feasibility in paediatric congenital heart disease.ResultsTo maintain the patency of two modified Blalock–Taussig shunts and one ductus arteriosus, four Genous®stents were implanted in three infants with cyanotic heart disease. All procedures were immediately successful, with resolution of stenosis and improvement in transcutaneous oxygen saturation from 66% ± 3.6% to 92% ± 2.6%. In the follow-up, one stent had no occlusion; however, the remaining two had partial occlusion after 5 and 5.5 months, which were successfully managed with balloon dilatation preceding elective definitive surgical correction.ConclusionIn our preliminary experience, we demonstrated that Genous®stent implantation was feasible in infants with complex congenital heart disease. Additional studies with larger samples and longer follow-up are required to confirm the potential benefits of this technology in this clinical setting.

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