scholarly journals The Medina Embolic Device: Karolinska experience

2017 ◽  
Vol 24 (1) ◽  
pp. 4-13 ◽  
Author(s):  
P Bhogal ◽  
PA Brouwer ◽  
L Yeo ◽  
M Svensson ◽  
M Söderman
Keyword(s):  
Internal Carotid ◽  
Clinical Status ◽  
Superior Cerebellar Artery ◽  
Anterior Communicating Artery ◽  
Single Centre ◽  
Complete Occlusion ◽  
Neck Size ◽  
Cerebellar Artery ◽  
Single Centre Experience

Background The aim of this study was to report our single centre experience with the Medina Embolic Device (MED). Methods We performed a retrospective analysis of prospectively collected data to identify all patients treated with the MED. A total of 14 aneurysms (non-consecutive), in 13 patients, were treated including one ruptured and one partially thrombosed aneurysm. Fundus diameter was ≥5 mm in all cases. We evaluated the angiographic appearances, the clinical status, complications, and the need for adjunctive devices or repeat treatments. Results Aneurysm location was cavernous internal carotid artery (ICA; n = 1), supraclinoid ICA ( n = 1), terminal ICA ( n = 2), anterior communicating artery (AComA; n = 4), A2–3 ( n = 1), M1–2 junction ( n = 1), posterior communicating artery (PComA; n = 1), superior cerebellar artery (SCA; n = 1), and basilar tip ( n = 2). The average aneurysm fundus size was 8.6 mm (range 7–10 mm) and average neck size 3.75 mm (range 1.9–6.9 mm). Immediate angiographic results were modified Raymond–Roy occlusion classification (mRRC) I n = 2, mRRC II n = 1, mRRC IIIa n = 2, mRRC IIIb n = 2, the remaining 7 aneurysms showed complete opacification. At follow-up angiography (mean 5 months) mRRC I n = 5, mRRC II n = 5, mRRC IIIa n = 3, and persistent filling was seen in 1 aneurysm. Overall, four patients had repeat treatment and one is pending further treatment. Of the aneurysms treated with more than one MED, 75% showed complete occlusion at 6-month follow up whereas only one aneurysm treated with a single device showed complete occlusion. Overall, three patients had temporary complications and there were no deaths. Conclusions The MED is an intra-saccular flow-diverting device with satisfactory angiographic results and an acceptable safety profile. Use of a single MED cannot be recommended and further longer term studies are needed prior to widespread clinical use.

Y-configuration stenting for coiling of wide-neck bifurcation aneurysms using Low-profile Visualized Intraluminal Support Junior

2018 ◽  
Vol 11 (4) ◽  
pp. 400-404 ◽  
Author(s):  
Keun Young Park ◽  
Byung Moon Kim ◽  
Dong Joon Kim ◽  
Joonho Chung ◽  
Jae Whan Lee
Keyword(s):  
Internal Carotid ◽  
Anterior Communicating Artery ◽  
Complete Occlusion ◽  
Neck Size ◽  
Low Profile ◽  
Aneurysm Occlusion ◽  
The Mean ◽  
Procedural Success ◽  
Wide Neck

BackgroundLittle has been reported about the feasibility and durability of a Low-profile Visualized Intraluminal Support Junior (LVIS Jr) Y-stenting device for wide-neck bifurcation aneurysms.PurposeTo evaluate the feasibility and durability of LVIS Jr Y-stenting for coiling of unruptured wide-neck bifurcation aneurysms.MethodsWe identified patients in whom LVIS Jr Y-stenting was attempted for unruptured wide-neck bifurcation aneurysms from a prospectively maintained registry of a referral hospital. Procedural success rate, treatment-related morbidity, and clinical and angiographic outcomes were retrospectively assessed.ResultsLVIS Jr Y-stenting was attempted for a total of 21 aneurysms in 21 patients (mean age 60±8.9 years; M:F=6:15): nine basilar artery, six anterior communicating artery, four middle cerebral artery, one internal carotid artery, and one vertebrobasilar fenestration aneurysms. The mean dome and neck size were 7.9±2.7 mm and 5.7±1.8 mm, respectively. All attempts were successful. Treatment-related morbidity occurred in one individual with a modified Rankin Scale (mRS) score of 2. Immediate postprocedural angiograms showed complete occlusion in 15 (71.4%) and neck remnant in 6 (28.6%) patients. All 21 patients had good outcomes (mRS score 0–2) for a mean of 12 months' follow-up (range 6–27 months); mRS score 0 in 20 patients and mRS score 2 in one patient, respectively. Follow-up imaging over a mean of 11 months (range 6–18 months) was available in 18 patients (85.7%). All aneurysms showed complete occlusion at follow-up.ConclusionsLVIS Jr Y-stenting and coiling for wide-neck bifurcation aneurysms seems to be feasible with acceptable safety and to provide durable aneurysm occlusion for wide-neck bifurcation aneurysms.

LVIS Blue as a low porosity stent and coil adjuvant

2018 ◽  
Vol 10 (7) ◽  
pp. 682-686 ◽  
Author(s):  
Matthew J Koch ◽  
Christopher J Stapleton ◽  
Scott B Raymond ◽  
Susan Williams ◽  
Thabele M Leslie-Mazwi ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Posterior Inferior Cerebellar Artery ◽  
Endovascular Embolization ◽  
Superior Cerebellar Artery ◽  
Anterior Communicating Artery ◽  
Aneurysm Neck ◽  
Proximal Internal Carotid Artery ◽  
Cerebellar Artery

IntroductionThe LVIS Blue is an FDA-approved stent with 28% metallic coverage that is indicated for use in conjunction with coil embolization for the treatment of intracranial aneurysms. Given a porosity similar to approved flow diverters and higher than currently available intracranial stents, we sought to evaluate the effectiveness of this device for the treatment of intracranial aneurysms.MethodsWe performed an observational single-center study to evaluate initial occlusion and occlusion at 6-month follow-up for patients treated with the LVIS Blue in conjunction with coil embolization at our institution using the modified Raymond–Roy classification (mRRC), where mRRC 1 indicates complete embolization, mRRC 2 persistent opacification of the aneurysm neck, mRRC 3a filling of the aneurysm dome within coil interstices, and mRRC 3b filling of the aneurysm dome.ResultsSixteen aneurysms were treated with the LVIS Blue device in conjunction with coil embolization with 6-month angiographic follow-up. Aneurysms were treated throughout the intracranial circulation: five proximal internal carotid artery (ICA) (ophthalmic or communicating segments), two superior cerebellar artery, two ICA terminus, two anterior communicating artery, two distal middle cerebral artery, one posterior inferior cerebellar artery, and two basilar tip aneurysms. Post-procedurally, there was one mRRC 1 closure, five mRRC 2 closures, and 10 mRRC 3a or 3b occlusion. At follow-up, all the mRRC 1 and mRRC 3a closures, 85% of the mRRC 3b closures and 75% of the mRRC 2 closures were stable or improved to an mRRC 1 or 2 at follow-up.ConclusionsThe LVIS Blue represents a safe option as a coil adjunct for endovascular embolization within both the proximal and distal anterior and posterior circulation.

scholarly journals Endovascular treatment of wide-necked intracranial aneurysms using the novel Contour Neurovascular System: a single-center safety and feasibility study

2020 ◽  
Vol 12 (10) ◽  
pp. 987-992 ◽  
Author(s):  
Christopher Yusuf Akhunbay-Fudge ◽  
Kenan Deniz ◽  
Atul Kumar Tyagi ◽  
Tufail Patankar
Keyword(s):  
Intracranial Aneurysms ◽  
Medical Condition ◽  
Superior Cerebellar Artery ◽  
Anterior Communicating Artery ◽  
New Device ◽  
System A ◽  
Radiological Data ◽  
Cerebellar Artery ◽  
Class 1

Background and purposeWide-necked bifurcation aneurysms pose a significant challenge to the treating clinician. The Contour Neurovascular System embolization device is a novel tool for the treatment of such intracranial aneurysms. We report on our experience with this device.MethodsProspective clinical and radiological data were collected for all patients treated with the Contour device at our center. All our patients were treated on an elective basis.ResultsWe have treated 11 patients successfully with the Contour device to date. All patients were women with a mean (SD) age of 65.0 (6.4) years. In total, four basilar tip, two internal carotid artery, three middle cerebral artery, one anterior communicating artery, and one superior cerebellar artery aneurysms were treated. At 1-year follow-up, complete occlusion (Raymond Class 1) was seen in 55.56% (5/9) of cases, with 44.44% (4/9) having small neck remnants (Raymond Class 2). One patient declined 1-year catheter angiography and another had no further follow-up due to an unrelated medical condition. For six patients, 2-year radiological follow-up is available and shows stability. At 6 weeks, nine of the 11 patients had a modifed Rankin Scale score of 0, with two patients scoring 1 for headaches. Two patients had thromboembolic events, but there were no complications leading to permanent neurological disability or death. We additionally had three patients where the Contour device was attempted but was unable to be successfully used.ConclusionInitial results are promising although larger case numbers and longer follow-up are necessary to draw further conclusions on the utility and risk profile of this new device.

scholarly journals The Medina Embolic Device: early clinical experience from a single center

2016 ◽  
Vol 9 (1) ◽  
pp. 77-87 ◽  
Author(s):  
Marta Aguilar Perez ◽  
Pervinder Bhogal ◽  
Rosa Martinez Moreno ◽  
Hansjörg Bäzner ◽  
Oliver Ganslandt ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Clinical Status ◽  
Anterior Communicating Artery ◽  
Major Step ◽  
Unruptured Aneurysms ◽  
True Value ◽  
Unruptured Intracranial Aneurysms ◽  
Flow Diverters

ObjectiveTo report our initial experience with the Medina Embolic Device (MED) in unruptured intracranial aneurysms either as sole treatment or in conjunction with additional devices.Methods15 consecutive patients (6 women, 9 men) with unruptured aneurysms were treated between September 2015 and April 2016. The aneurysm fundus measured at least 5 mm. We evaluated the angiographic appearances of treated aneurysms at the end of the procedure and at follow-up, the clinical status, complications, and requirement for adjunctive devices.ResultsThe MED was successfully deployed in all but one case and adjunctive devices were required in 10 cases. Aneurysm locations were middle cerebral artery bifurcation (n=3), internal carotid artery (ICA) bifurcation (n=1), supraclinoid ICA (n=5), posterior communicating artery (n=1), anterior communicating artery (n=2), cavernous ICA (n=2), distal basilar sidewall (n=1), basilar tip (n=1). Three patients had complications although none could be attributed to the MED. Immediate angiographic results were modified Raymond-Roy classification (mRRC) I=1, mRRC II=5, mRRC IIIa=3, mRRC IIIb=5, and one patient showed contrast stasis within the fundus of the aneurysm. Follow-up angiography was available in 11 patients, with four showing complete aneurysm exclusion, six with stable remnants and one patient with an enlarging neck remnant.ConclusionsThe MED represents a major step forward in the treatment of intracranial aneurysms. It can result in rapid exclusion of an aneurysm from the circulation and has a good safety profile. We believe that the true value of the MED will be in combining its use with adjunctive devices such as endoluminal flow diverters that will result in rapid aneurysmal exclusion.

The Woven EndoBridge for unruptured intracranial aneurysms: Results in 95 aneurysms from a single center

2021 ◽  
pp. 159101992110034
Author(s):  
Tom De Beule ◽  
Thierry Boulanger ◽  
Sam Heye ◽  
Williem J van Rooij ◽  
Wim van Zwam ◽  
...  
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Superior Cerebellar Artery ◽  
Morbidity Rate ◽  
Anterior Communicating Artery ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Cerebellar Artery ◽  
Woven Endobridge ◽  
The Web

Background and purpose The Woven EndoBridge (WEB) is an intrasaccular flowdisruptor that is increasingly used for the treatment of (wide-necked) aneurysms. We present our experience with the WEB for unruptured aneurysms. Materials and methods Between April 2014 and August 2019, 93 patients with 95 unruptured aneurysms were primarily treated with the WEB. There were 69 women and 24 men, mean age 61 years (median 58, range 37–80). Results Of 95 aneurysms, 86 had been discovered incidentally, 3 were symptomatic and 6 were additional to another ruptured aneurysm. Location was anterior communicating artery 33, middle cerebral artery 29, basilar tip 19, carotid tip 8, posterior communicating artery 4, posterior inferior cerebellar artery 1, superior cerebellar artery 1. Mean aneurysm size was 6 mm (median 6, range 3–13 mm). In one aneurysm additional coils were used and in another, a stent was placed. There was one procedural rupture without clinical sequelae. There were two thrombo-embolic complications leading to permanent deficit in one patient (mRS 2). Morbidity rate was 1.0% (1 of 93, 95%CI 0.01–6.5%) and mortality was 0% (0 of 93, 95%CI 0.0–4.8%). Angiographic follow-up at six months was available in 85 patients with 87 aneurysms (91%). Of 87 aneurysms, 68 (78%) were completely occluded, 14 (16%) had a neck remnant and 5 were incompletely occluded. Four aneurysms were retreated. Retreatment rate was 4.5% (4 of 87, 95%CI 1.7–13.6%). Conclusion WEB treatment of unruptured aneurysms is safe and effective. Additional devices are needed only rarely and retreatment at follow-up is infrequent.

scholarly journals Staged Approach for Stent-Assisted Coiling of Cerebral Aneurysms after Failure of Initial Intra-Saccular Catheterization

2021 ◽  
Vol 16 (1) ◽  
pp. 46-51
Author(s):  
Abdulrahman Hamad Al-Abdulwahhab ◽  
Deok Hee Lee ◽  
Yunsun Song ◽  
Dae Chul Suh
Keyword(s):  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Superior Cerebellar Artery ◽  
Unruptured Aneurysms ◽  
Low Profile ◽  
Cerebellar Artery ◽  
Feasible Option ◽  
Staged Approach ◽  
The Mean

Purpose: Microcatheter navigation into an aneurysm sac can present difficulties through negative interactions between the deployed stent mesh and microcatheter. We hypothesized that endothelialization of the stent mesh would minimize these interactions. We aimed to assess the feasibility of staged coiling after stenting by reviewing our experiences with unavoidably staged embolization cases.Materials and Methods: Between 2011 and 2019, 7 patients (mean age 57.2 years, range 49–76 years) including 5 females, experienced 9 unruptured aneurysms treated with staged stenting and coiling due to unstable microcatheter navigation into the aneurysm after stent placement. The aneurysms were in the paraclinoid internal carotid artery (ICA) (n=3), ophthalmic origin ICA (n=1), superior cerebellar artery origin (n=2), basilar tip (n=2), and the middle cerebral artery bifurcation (n=1). The stents used were the Neuroform Atlas (n=4), Neuroform EZ (n=2), and Low-profile Visualized Intraluminal Support Blue (n=1).Results: The mean interval between stenting and coiling was 15 weeks (range, 12–21 weeks). The average navigation time between the first roadmap imaging and microcatheter insertion in the sac was 14 minutes (range, 8–20 minutes). One aneurysm was occluded without further coiling on follow-up. Staged coiling successfully treated the remaining aneurysms (n=8). No complications were identified.Conclusion: In cases of difficult intra-saccular catheterization, intentional staged coiling may be a feasible option for stent-assisted coiling of the cerebral aneurysms.

Vascular angular remodeling by kissing-Y stenting in wide necked intracranial bifurcation aneurysms

2016 ◽  
Vol 9 (12) ◽  
pp. 1233-1237 ◽  
Author(s):  
Katharina Melber ◽  
Dan Meila ◽  
Philipp Draheim ◽  
Dominik Grieb ◽  
Björn Greling ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Internal Carotid ◽  
Posterior Inferior Cerebellar Artery ◽  
Anterior Communicating Artery ◽  
Digital Subtraction ◽  
Stent Deployment ◽  
Closed Cell ◽  
Cerebellar Artery ◽  
Before And After

IntroductionSingle stent deployment leads to a change in vascular geometry in wide necked bifurcation aneurysms. In some complex cases, the use of the single stent technique might not be sufficient or may not be feasible. The kissing-Y stenting technique appears to be an alternative endovascular treatment option. The aim of this study was to evaluate the effects of the kissing-Y stenting technique on vascular angular remodeling.Methods21 patients with wide necked intracranial bifurcation aneurysms at different sites (10 anterior communicating artery, 6 middle cerebral artery, 3 basilar artery, 1 vertebral artery/posterior inferior cerebellar artery, 1 internal carotid artery/posterior communicating artery) were treated with 44 closed cell stents (follow-up 2012–2016) using the kissing-Y stenting technique. We analyzed vascular angle geometry between the mother and both affected daughter vessels by digital subtraction angiography, before and after stent deployment, using standard working projections.ResultsEndovascular treatment of wide necked intracranial aneurysms using the kissing-Y stenting technique significantly decreased the angle between the bifurcation branches from 130.4±9.5° to 91.5±9.1° (p<0.0001).ConclusionsKissing-Y stenting in wide necked bifurcation aneurysms leads to vascular angular remodeling of both affected branches. The resulting straightening of the bifurcation angle may prevent aneurysmal recurrence.

scholarly journals Neuroform Atlas stent in treatment of iatrogenic dissections of extracranial internal carotid and vertebral arteries: a single-centre experience

2019 ◽  
Vol 25 (4) ◽  
pp. 390-396 ◽  
Author(s):  
Ljubisa Borota ◽  
Ehab Mahmoud ◽  
Christoffer Nyberg
Keyword(s):  
Carotid Arteries ◽  
Internal Carotid ◽  
Favourable Outcome ◽  
Single Centre ◽  
Vertebral Arteries ◽  
Unruptured Intracranial Aneurysms ◽  
Single Centre Experience ◽  
Internal Carotid Arteries ◽  
Carotid And Vertebral Arteries

Aim of the study To present our experience in the treatment of iatrogenic dissections of extracranial internal carotid and vertebral arteries with the Neuroform Atlas stent. Materials and methods Between January 2017 and February 2018 we treated iatrogenic dissections of three internal carotid arteries and three vertebral arteries. These iatrogenic dissections occurred during the endovascular treatment of ruptured and unruptured intracranial aneurysms. The indication for stenting was haemodynamically significant, flow-limiting dissection with threatening flow arrest. In all six cases, the dissections were treated by placement of Neuroform Atlas stents in the dissected segments of internal carotid or vertebral arteries. Deployment of the stent was followed by the usual dual antiplatelet regimen. Results Single or multiple Neuroform Atlas stents were deployed without any technical difficulties, and blood flow was restored immediately after placement of the stents in all six cases. Midterm follow-up (6–8 months) showed complete reconstruction of the shape and lumen of all treated arteries, with negligible intimal hyperplasia. Conclusion Our results indicate that a favourable outcome can be achieved by treating iatrogenic dissections of extracranial internal carotid and vertebral arteries with the Neuroform Atlas stent.

scholarly journals Coiling of a recurrent broad-necked posterior communicating aneurysm incorporating a fetal cerebral artery: A technical case report

2015 ◽  
Vol 21 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Young-Joon Kim ◽  
Jung Ho Ko
Keyword(s):  
Case Report ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Posterior Cerebral Artery ◽  
Anterior Communicating Artery ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Aneurysm Occlusion ◽  
Contralateral Internal Carotid Artery

We describe a case of a right broad-necked posterior communicating artery (PcomA) aneurysm with a fetal posterior cerebral artery (PCA) incorporated in the aneurysm neck. We performed waffle cone stent-assisted coiling and achieved almost complete occlusion of the aneurysm. At 18-month follow-up angiography, the aneurysm was recanalized and further coiling was needed. The same waffle cone method of coiling might be expected to produce the same unsatisfactory results on follow-up, so we decided to use retrograde stent navigation and placement through the anterior communicating artery (AcomA) from the contralateral internal carotid artery (ICA) to the ipsilateral ICA and fetal PCA. The stent delivery microcatheter from the contralateral ICA could not be introduced in the AcomA. So 2 mg nimodipine was infused through the stent delivery microcatheter to the AcomA and the stent delivery microcatheter was passed through the AcomA easily and could be navigated to the ipsilateral A1, ICA, and to the fetal PCA. With this additional stent, the aneurysm was completely separated from the fetal PCA and ICA. Further coiling could be performed safely through the microcatheter in the ipsilateral ICA. The patient had stable aneurysm occlusion at the six-month follow up.

scholarly journals Concurrent use of the Pipeline Embolization Device and coils for intracranial aneurysms: technique, safety, and efficacy

2015 ◽  
Vol 122 (4) ◽  
pp. 904-911 ◽  
Author(s):  
Erez Nossek ◽  
David J. Chalif ◽  
Shamik Chakraborty ◽  
Kim Lombardo ◽  
Karen S. Black ◽  
...  
Keyword(s):  
Clinical Status ◽  
Mass Effect ◽  
Clinical Results ◽  
Parent Vessel ◽  
Pipeline Embolization Device ◽  
Complete Occlusion ◽  
Neck Size ◽  
Concurrent Use ◽  
The Mean

OBJECT The use of the Pipeline Embolization Device (PED) as a sole endovascular modality has been described for the treatment of brain aneurysms. The benefit of using coils concurrently with a limited number of PEDs is not well documented. The authors describe their experience with this technique as well as their midterm clinical and angiographic results. METHODS This is a retrospective review of patients treated between 2011 and 2014. The authors placed a minimal number of PEDs with the addition of coils using a “jailed” microcatheter technique. A partially dense coil mass was obtained. Immediate and midterm clinical and angiographic results are reviewed. RESULTS The authors treated 27 patients harboring 28 aneurysms using this technique. The mean aneurysm size was 11.9 mm, and the mean neck size was 5.4 mm. A mean of 1.48 PEDs were placed per patient, and a mean of 1.33 PEDs per aneurysm were placed. The Raymond score immediately after PED placement was 2 or 3 in 82.1% of the patients. There were no intraprocedural or postprocedural complications. All PEDs were successfully deployed. No clinical or technical adverse effects related to the coil mass were observed. There were no clinical or radiographic signs of ischemia in this group. At follow-up imaging, complete aneurysm occlusion was demonstrated on the first MR angiogram (3–5 months) in all patients who reached this milestone. Follow-up digital subtraction angiography (5–13 months) confirmed complete occlusion in all patients who reached this milestone. All patients maintained their baseline clinical status. CONCLUSIONS The deployment of PEDs with concurrent partially dense coiling is safe and efficacious. This technique achieved early complete occlusion and endovascular reconstruction of the parent vessel, without inducing mass effect. Favorable midterm clinical results were observed in all patients.

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