scholarly journals LVIS Jr. stent for treatment of intracranial aneurysms with parent vessel diameter of 2.5 mm or less

2018 ◽  
Vol 24 (3) ◽  
pp. 246-253 ◽  
Author(s):  
Alejandro Santillan ◽  
Srikanth Boddu ◽  
Justin Schwarz ◽  
Ning Lin ◽  
Y Pierre Gobin ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Vessel Diameter ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Low Profile ◽  
Aneurysm Occlusion ◽  
Middle Cerebral Artery Aneurysms

Background and purpose This retrospective study evaluates the safety, effectiveness, and long-term clinical and angiographic follow-up of intracranial aneurysms treated with the Low-Profile Visualized Intraluminal Support Junior (LVIS Jr.) stent and parent vessels of diameter equal to or less than 2.5 mm. Materials and methods We included all patients treated with the LVIS Jr. stent in aneurysms with small parent vessel diameter between March 2015 and July 2017. Periprocedural adverse events, immediate aneurysm occlusion rates, and clinical and angiographic follow-up are reported. Results A total of 35 patients with 35 aneurysms were included. Ten aneurysms were ruptured (28.6%) and 25 were unruptured (71.4%). The parent arteries measured 0.9 mm to 2.5 mm in diameter (mean, 2.2 mm). Intra-procedural thromboembolic complications occurred in four patients (11.4%) and there was an intraoperative aneurysm rupture in one patient (2.8%). Immediate complete aneurysm occlusion was noted in 21 out of 35 patients (60%). Clinical follow-up ranged between one and 25 months (mean, 10.5 months) and magnetic resonance angiography follow-up ranged between four and 24 months (mean, 10.4 months). Complete aneurysm occlusion was achieved in 21 out of 29 patients (72.4%) at last angiographic follow-up (mean, 9.4 months; range four to 23 months). In-stent stenosis occurred in one out of 29 patients (3.4%), who was asymptomatic. Of the four patients with in-stent thrombosis, three patients were treated with “Y configuration” (two patients with middle cerebral artery aneurysms and one patient with an anterior communicating artery aneurysm). Mortality rate was 0%. Neurological morbidity was 2.9%. Conclusions Stenting with the LVIS Jr. stent allowed us to treat complex intracranial aneurysms with parent vessel diameter of 2.5 mm or less with an acceptable safety profile.

Early postmarket results with PulseRider for treatment of wide-necked intracranial aneurysms: a multicenter experience

2020 ◽  
Vol 133 (6) ◽  
pp. 1756-1765 ◽  
Author(s):  
Visish M. Srinivasan ◽  
Aditya Srivatsan ◽  
Alejandro M. Spiotta ◽  
Benjamin K. Hendricks ◽  
Andrew F. Ducruet ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Off Label ◽  
Fda Approval ◽  
Class 1

OBJECTIVETraditionally, stent-assisted coiling and balloon remodeling have been the primary endovascular treatments for wide-necked intracranial aneurysms with complex morphologies. PulseRider is an aneurysm neck reconstruction device that provides parent vessel protection for aneurysm coiling. The objective of this study was to report early postmarket results with the PulseRider device.METHODSThis study was a prospective registry of patients treated with PulseRider at 13 American neurointerventional centers following FDA approval of this device. Data collected included clinical presentation, aneurysm characteristics, treatment details, and perioperative events. Follow-up data included degree of aneurysm occlusion and delayed (> 30 days after the procedure) complications.RESULTSA total of 54 aneurysms were treated, with the same number of PulseRider devices, across 13 centers. Fourteen cases were in off-label locations (7 anterior communicating artery, 6 middle cerebral artery, and 1 A1 segment anterior cerebral artery aneurysms). The average dome/neck ratio was 1.2. Technical success was achieved in 52 cases (96.2%). Major complications included the following: 3 procedure-related posterior cerebral artery strokes, a device-related intraoperative aneurysm rupture, and a delayed device thrombosis. Immediately postoperative Raymond-Roy occlusion classification (RROC) class 1 was achieved in 21 cases (40.3%), class 2 in 15 (28.8%), and class 3 in 16 cases (30.7%). Additional devices were used in 3 aneurysms. For those patients with 3- or 6-month angiographic follow-up (28 patients), 18 aneurysms (64.2%) were RROC class 1 and 8 (28.5%) were RROC class 2.CONCLUSIONSPulseRider is being used in both on- and off-label cases following FDA approval. The clinical and radiographic outcomes are comparable in real-world experience to the outcomes observed in earlier studies. Further experience is needed with the device to determine its role in the neurointerventionalist’s armamentarium, especially with regard to its off-label use.

scholarly journals Aneurysm Morphology and Prediction of Rupture: An International Study of Unruptured Intracranial Aneurysms Analysis

Neurosurgery ◽  
2017 ◽  
Vol 82 (4) ◽  
pp. 491-496 ◽  
Author(s):  
J Mocco ◽  
Robert D Brown ◽  
James C Torner ◽  
Ana W Capuano ◽  
Kyle M Fargen ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Morphological Characteristics ◽  
International Study ◽  
Vessel Diameter ◽  
Aneurysm Rupture ◽  
Parent Vessel ◽  
Unruptured Intracranial Aneurysm ◽  
Ruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms

Abstract BACKGROUND There are conflicting data between natural history studies suggesting a very low risk of rupture for small, unruptured intracranial aneurysms and retrospective studies that have identified a much higher frequency of small, ruptured aneurysms than expected. OBJECTIVE To use the prospective International Study of Unruptured Intracranial Aneurysms cohort to identify morphological characteristics predictive of unruptured intracranial aneurysm rupture. METHODS A case-control design was used to analyze morphological characteristics associated with aneurysm rupture in the International Study of Unruptured Intracranial Aneurysms database. Fifty-seven patients with ruptured aneurysms during follow-up were matched (by size and location) with 198 patients with unruptured intracranial aneurysms without rupture during follow-up. Twelve morphological metrics were measured from cerebral angiograms in a blinded fashion. RESULTS Perpendicular height (P = .008) and size ratio (ratio of maximum diameter to the parent vessel diameter; P = .01) were predictors of aneurysm rupture on univariate analysis. Aspect ratio, daughter sacs, multiple lobes, aneurysm angle, neck diameter, parent vessel diameter, and calculated aneurysm volume were not statistically significant predictors of rupture. On multivariate analysis, perpendicular height was the only significant predictor of rupture (Chi-square 7.1, P-value .008). CONCLUSION This study underscores the importance of other morphological factors, such as perpendicular height and size ratio, that may influence unruptured intracranial aneurysm rupture risk in addition to greatest diameter and anterior vs posterior location.

Balloon remodeling-assisted Woven EndoBridge technique: description and feasibility for complex bifurcation aneurysms

2018 ◽  
Vol 11 (4) ◽  
pp. 386-389 ◽  
Author(s):  
Cristian Mihalea ◽  
Simon Escalard ◽  
Jildaz Caroff ◽  
Léon Ikka ◽  
Aymeric Rouchaud ◽  
...  
Keyword(s):  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Neck Size ◽  
Complex Anatomy ◽  
Woven Endobridge ◽  
Web Device ◽  
Middle Cerebral Artery Aneurysms ◽  
Wide Neck

BackgroundWoven EndoBridge (WEB) deployment remains challenging in aneurysms with a complex shape or orientation.ObjectiveTo show that embolization of wide-neck bifurcation aneurysms using the WEB device balloon remodeling-assisted technique is a feasible and elegant endovascular solution compared with other techniques, such as balloon remodeling or stent-assisted coiling.Materials and methods10 cases (10 aneurysms in 9 patients) of balloon remodeling-assisted WEB treatment of unruptured complex bifurcation aneurysms were treated in our institution and retrospectively analyzed. Details of clinical presentations, technical details, perioperative and postoperative complications, and outcomes were collected. Immediate and long-term angiographic results were also evaluated.ResultsAneurysms included six middle cerebral artery aneurysms, one anterior communicating artery aneurysm, one posterior communicating artery aneurysm, one basilar artery aneurysm, and one T-shaped carotid aneurysm. Mean dome width was 6.55 mm, mean neck size 4.5 mm, mean height 4.79 mm, and mean dome-to-neck ratio was 1:1.46. Treatment was performed exclusively with the balloon remodeling-assisted WEB technique in all cases. The device was successfully deployed in every case. Periprocedural thromboembolic or hemorrhagic events did not occur. The modified Rankin Scale score at discharge was 0 for all patients. At mid-term or long-term angiographic follow-up, adequate occlusion was observed in 7 aneurysms from 8 controlled cases (87.5%), and one patient (2 aneurysms) did not have angiographic follow-up.ConclusionThe balloon remodeling-assisted WEB technique seems to be a safe and effective solution for endovascular treatment of unruptured wide-neck bifurcation aneurysms with specific complex anatomy. However, further studies are needed to evaluate the rate of complications and long-term efficacy.

PulseRider-assisted treatment of wide-necked intracranial bifurcation aneurysms: safety and feasibility study

2017 ◽  
Vol 127 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Soumya Mukherjee ◽  
Arun Chandran ◽  
Anil Gopinathan ◽  
Mani Putharan ◽  
Tony Goddard ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Clinical Status ◽  
Aneurysm Rupture ◽  
Parent Vessel ◽  
Bifurcation Aneurysm ◽  
Scale Scores ◽  
Class 1 ◽  
Aneurysm Occlusion ◽  
Vessel Dissection

OBJECTIVEThe goal of this study was to assess the safety and feasibility of PulseRider, a novel endovascular stent, in the treatment of intracranial bifurcation aneurysms with wide necks. The authors present the initial results of the first 10 cases in which the PulseRider device was used.METHODSPatients whose aneurysms were intended to be treated with the PulseRider device at 2 institutions in the United Kingdom were identified prospectively. Patient demographics, procedural details, immediate neurological and clinical status, and immediate angiographic outcomes and 6-month clinical and imaging follow-up were recorded prospectively.RESULTSAt the end of the procedure, all 10 patients showed complete aneurysm occlusion (Raymond Class 1). There were no significant intraprocedural complications except for an occurrence of thromboembolism without clinical sequelae. There was no occurrence of aneurysm rupture or vessel dissection. At 6-month follow-up, 7 and 3 patients had modified Rankin Scale scores of 0 and 1, respectively. All 10 patients had stable aneurysm occlusion (Raymond Class 1) and daughter vessel intraluminal patency on 6-month follow-up catheter angiography.CONCLUSIONSThe authors' early experience with the PulseRider device demonstrates that it is a safe and effective adjunct in the treatment of bifurcation aneurysms with wide necks arising at the middle cerebral artery bifurcation, anterior cerebral artery, basilar apex, and carotid terminus. It works by providing a scaffold at the neck of the bifurcation aneurysm, enabling neck remodeling and coil support while maintaining parent vessel intraluminal patency. Early clinical and radiological follow-up showed good functional outcome and stable occlusion rates, respectively. Further data are needed to assess medium- and long-term outcomes with PulseRider.

scholarly journals Radiological Changes in Infantile Dissecting Anterior Communicating Artery Aneurysm Treated Endovascularly

2014 ◽  
Vol 20 (6) ◽  
pp. 796-803 ◽  
Author(s):  
Kenji Yatomi ◽  
Hidenori Oishi ◽  
Munetaka Yamamoto ◽  
Yasuo Suga ◽  
Senshu Nonaka ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Blood Coagulation ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Dissecting Aneurysm ◽  
Anterior Communicating Artery ◽  
Anterior Communicating Artery Aneurysm ◽  
Radiological Changes ◽  
Dissecting Aneurysms

Intracranial aneurysms are extremely rare in infants, and to our knowledge only seven infants treated for ruptured spontaneous dissecting aneurysms have been reported. Good outcomes have been achieved with endovascular treatment of infantile aneurysm. We the endovascular treatment of a one-month-old girl for ruptured dissecting aneurysm located in the anterior communicating artery, and the unique radiological changes that were observed during the perioperative and follow-up periods. These changes suggest that blood coagulation and fibrinolytic response play a part in the repair and healing processes of dissecting aneurysms. Careful neuroradiological surveys are needed for pediatric dissecting aneurysms treated endovascularly.

Aneurysms with persistent patency after treatment with the Pipeline Embolization Device

2016 ◽  
Vol 126 (6) ◽  
pp. 1894-1898 ◽  
Author(s):  
Peter Kan ◽  
Visish M. Srinivasan ◽  
Nnenna Mbabuike ◽  
Rabih G. Tawk ◽  
Vin Shen Ban ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Pipeline Embolization Device ◽  
Cerebellar Artery ◽  
Middle Cerebral Artery Aneurysms ◽  
Flow Diverters

The Pipeline Embolization Device (PED) was approved for the treatment of intracranial aneurysms from the petrous to the superior hypophyseal segment of the internal carotid artery. However, since its approval, its use for treatment of intracranial aneurysms in other locations and non-sidewall aneurysms has grown tremendously. The authors report on a cohort of 15 patients with 16 cerebral aneurysms that incorporated an end vessel with no significant distal collaterals, which were treated with the PED. The cohort includes 7 posterior communicating artery aneurysms, 5 ophthalmic artery aneurysms, 1 superior cerebellar artery aneurysm, 1 anterior inferior cerebellar artery aneurysm, and 2 middle cerebral artery aneurysms. None of the aneurysms achieved significant occlusion at the last follow-up evaluation (mean 24 months). Based on these observations, the authors do not recommend the use of flow diverters for the treatment of this subset of cerebral aneurysms.

2D and 3D Morphologic Metrics Associated Intracranial Aneurysm Rupture

2010 ◽  
Author(s):  
Ding Ma ◽  
Sabareesh K. Natarajan ◽  
Jianping Xiang ◽  
Adnan Siddiqui ◽  
Elad I. Levy ◽  
...  
Keyword(s):  
Image Segmentation ◽  
Intracranial Aneurysms ◽  
Vessel Diameter ◽  
Aneurysm Rupture ◽  
Size Ratio ◽  
Patient Specific ◽  
3D Image ◽  
Parent Vessel ◽  
3D Image Segmentation ◽  
Aneurysm Size

Intracranial aneurysms (IAs) rupture results in severe morbidity and mortality. Therefore indentifying IA rupture risk is highly critical. Although it has been recognized that IA rupture is the result of a complex vascular degeneration process involving multiple mechanobiological factors, such information for each patient is not readily available in clinical setting. Alternatively, morphology and hemodynamic metrics can be derived from routine patient-specific imaging. In previous studies, a number of morphological metrics derived from analysis of reconstructed vascular 3D geometry have shown significance in discriminating ruptured from unruptued IAs, including in particular aneurysm size ratio, defined as IA size divided by the parent vessel diameter. However, these measures rely on 3D image segmentation and measurement, which makes them less practical in current angiographic rooms often equipped with only biplane angiogram capability and even when 3D rotational angiography is available, on-site 3D image segmentation and analyses are still not practical. Our foregoing study examined three parameters measured on 2D angiographs: aneurysm Size Ratio (SR), Aspect Ratio (AR) and Size. We found that SR had the strongest correlation with IA rupture. The current study further evaluates these geometric metrics, measured both from 3D and 2D images, with a larger cohort of saccular intracranial aneurysms.

Early experience treating intracranial aneurysms using Accero: a novel, fully visible, low profile braided stent with platinum–nitinol composite wire technology

2020 ◽  
Vol 13 (1) ◽  
pp. 49-53
Author(s):  
Alberto Nania ◽  
Nicholas Dobbs ◽  
Johannes DuPlessis ◽  
Peter Keston ◽  
Jonathan Downer
Keyword(s):  
Cerebral Artery ◽  
Anterior Communicating Artery ◽  
Clinical Consequence ◽  
Composite Wire ◽  
Postoperative Hematoma ◽  
Low Profile ◽  
Angiographic Data ◽  
Aneurysm Occlusion ◽  
Braided Stent

BackgroundAccero is an innovative, fully visible, self-expanding braided stent with platinum–nitinol composite wire technology, produced by Acandis.ObjectiveTo assess the technical success and safety of this new stent by evaluating the intraprocedural behavior and complication rate, and the short-term follow-up results.MethodsForty-one consecutive patients suitable for stent-assisted coiling were selected for the use of Accero in an 11-month period. Clinical, procedural, and angiographic data, as well as 30-day morbidity, were recorded. The angiographic results, clinical follow-up at 30 days, and early imaging follow-up at 3 or 6 months were analyzed, when available.ResultsForty-one aneurysms were treated with stent-assisted coiling. All cases were elective, of which 19 were previously untreated aneurysms and 22 were recurrent aneurysms. Aneurysm location was anterior communicating artery complex (16), basilar (12 cases), middle cerebral artery bifurcation (9 cases), and internal cerebral artery (4 cases). The stent was successfully deployed and aneurysm occlusion with coils achieved in 100% of our patients. One case of on table in-stent thrombosis occurred, which resolved after administration of glycoprotein IIB/IIIA inhibitor, with no clinical consequence, and one case of postoperative hematoma at the arteriotomy site, which was managed conservatively. On early follow-up, available for 37 patients, the complete occlusion rate was 76%, with only two recurrences needing further treatment. Satisfactory aneurysm occlusion was therefore achieved in 95% of cases.ConclusionStent-assisted coiling with the Accero braided stent proved safe and effective.

scholarly journals Endovascular treatment of bifurcation intracranial aneurysms with the WEB SL/SLS: 6-month clinical and angiographic results

2015 ◽  
Vol 21 (4) ◽  
pp. 462-469 ◽  
Author(s):  
Patricia Bozzetto Ambrosi ◽  
Benjamin Gory ◽  
Rotem Sivan-Hoffmann ◽  
Roberto Riva ◽  
Francesco Signorelli ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Single Layer ◽  
Additional Treatment ◽  
Anterior Communicating Artery ◽  
Neck Size ◽  
Aneurysm Occlusion ◽  
Web Device ◽  
The Web

Background The WEB device is a recent intrasaccular flow disruption technique developed for the treatment of wide-necked intracranial aneurysms. To date, a single report on the WEB Single-Layer (SL) treatment of intracranial aneurysms has been published with 1-months' safety results. The aim of this study is to report our experience and 6-month clinical and angiographic follow-up of endovascular treatment of wide-neck aneurysm with the WEB SL. Methods Ten patients with 10 unruptured wide-necked aneurysms were prospectively enrolled in this study. Feasibility, intraoperative and postoperative complications, and outcomes were recorded. Immediate and 6-month clinical and angiographic results were evaluated. Results Failure of WEB SL placement occurred in two cases. Eight aneurysms were successfully treated using one WEB SL without additional treatment. Three middle cerebral artery, four anterior communicating artery, and one basilar artery aneurysms were treated. Average dome width was 7.5 mm (range 5.4–10.7 mm), and average neck size was 4.9 mm (range 2.6–6.5 mm). No periprocedural complication was observed, and morbi-mortality at discharge and 6 months was 0.0%. Angiographic follow-up at 6 months demonstrated complete aneurysm occlusion in 2/8 aneurysms, neck remnant in 5/8 aneurysms, and aneurysm remnant in 1/8 aneurysm. Conclusions From this preliminary study, treatment of bifurcation intracranial aneurysms using WEB SL is feasible. WEB SL treatment seems safe at 6 months; however, the rate of neck remnants is not negligible due to compression of the WEB SL. Further technical improvements may be needed in order to ameliorate the occlusion in the WEB SL treatment.

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