scholarly journals Anti-thrombogenic coatings for devices in neurointerventional surgery: Case report and review of the literature

2019 ◽  
Vol 25 (6) ◽  
pp. 619-627 ◽  
Author(s):  
Hans Henkes ◽  
Pervinder Bhogal ◽  
Marta Aguilar Pérez ◽  
Tim Lenz-Habijan ◽  
Catrin Bannewitz ◽  
...  
Keyword(s):  
Acetylsalicylic Acid ◽  
Middle Cerebral Artery ◽  
Digital Subtraction Angiography ◽  
Cerebral Artery ◽  
Thrombus Formation ◽  
Surface Coatings ◽  
Digital Subtraction ◽  
Anti Platelet Therapy ◽  
Frequent Response ◽  
The Right

Background: Stent-assisted coiling and extra-saccular flow diversion require dual anti-platelet therapy due to the thrombogenic properties of the implants. While both methods are widely accepted, thromboembolic complications and the detrimental effects of dual anti-platelet therapy remain a concern. Anti-thrombogenic surface coatings aim to solve both of these issues. Current developments are discussed within the framework of an actual clinical case. Case description: A 33-year-old male patient lost consciousness while doing sport and was administered 500 mg acetylsalicylic acid on site. Computed tomography revealed a massive subarachnoid haemorrhage, and digital subtraction angiography showed an aneurysm of the right middle cerebral artery. Stent-assisted coiling using a neck bridging device with a hydrophilic coating (pCONUS_HPC) was considered as an appropriate approach. Another 500 mg acetylsalicylic acid IV was given. After the single anti-platelet therapy was seen to be effective, a pCONUS_HPC was implanted, and the aneurysm sac subsequently fully occluded using coils. No thrombus formation was encountered. During the following days, 2 × 500 mg acetylsalicylic acid IV daily were required to maintain single anti-platelet therapy, monitored by frequent response testing. Follow-up digital subtraction angiography after 13 days confirmed the occlusion of the aneurysm and the patency of the middle cerebral artery. Conclusion: A variety of ways to reduce the thrombogenicity of neurovascular stents is discussed. Hydrophilic surface coatings are a valid concept to improve the haemocompatibility of neurovascular implants while avoiding the use of dual anti-platelet therapy. Phosphorylcholine and phenox hydrophilic polymer coating are currently the most promising candidates. This concept is supported by anecdotal experience. However, formalised registries and randomised trials are currently being established.

scholarly journals Stent-assisted coil embolization on down-the-barrel view with spring-shaped microcatheter in patient with M1 ultrawide necked circumferential aneurysm

2018 ◽  
pp. bcr-2017-013597
Author(s):  
Hyo Sung Kwak ◽  
Jung Soo Park ◽  
Eun Jeong Koh
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Middle Cerebral Artery ◽  
Digital Subtraction Angiography ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Digital Subtraction ◽  
Safe Technique ◽  
Delayed Complications

Herein, we describe a technique for stent-assisted coil embolization with a spring-shaped microcatheter in a patient with an M1 ultrawide-necked circumferential aneurysm in the middle cerebral artery (MCA). A 49-year-old man was referred for treatment of an incidentally detected M1 large-circumference aneurysm on magnetic resonance angiography. Subsequent digital subtraction angiography revealed an 18.2×16.5 mm ultrawide-necked circumferential aneurysm on the distal M1 portion of the left MCA, and we planned stent-assisted coil embolization using a spring-shaped microcatheter. After we deployed the stent, we performed coil embolization under the down-the-barrel view by pulling out the microcatheter little by little. Using this technique, we could fill the coil mass evenly into the aneurysmal sac around the stent. And there were no immediate or delayed complications after the procedure. Stent-assisted coiling using a spring-shaped microcatheter is a useful and safe technique for treating ultrawide-necked circumferential aneurysm or fusiform aneurysms.

Abstract WP137: Validation of a New Diagnostic Scoring System of Transcranial Doppler for Middle Cerebral Artery Stenosis

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Qing Hao ◽  
Steven R Levine ◽  
Clotilde Balucani ◽  
Edward Feldmann
Keyword(s):  
Middle Cerebral Artery ◽  
Digital Subtraction Angiography ◽  
Cerebral Artery ◽  
Transcranial Doppler ◽  
Scoring System ◽  
Hard Copy ◽  
Digital Subtraction ◽  
Ratio Score ◽  
Predictive Values ◽  
New Scoring

Introduction: Large vessel intracranial stenosis (LVIS) is the most common stroke subtype worldwide and is associated with high risk of stroke recurrence. Current transcranial Doppler (TCD) diagnostic criteria for LVIS mainly rely on velocity measurement with unsatisfactory accuracy. Hypothesis: A new scoring system that integrated several features of the cerebral blood flow velocity from TCD is able to offer more reliable identification of significant (≥ 50%) LVIS. Methods: Using the TCD-Digital Subtraction Angiography (DSA) database from a previous NIH-funded trial - Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA), the hard copy TCDs from SONIA trial were reviewed blinded to the results of DSA. A summed score was calculated for each middle cerebral artery (MCA) based on the four parameters: mean velocity (MV) (score 0: MV<80 cm/s, 1: MV=80-99 cm/s, 2: MV=100-119 cm/s, 3: MV≥120 cm/s); stenotic/pre-stenoic ratio (score 0: ratio<2, 1: ratio≥2); stenotic/contralateral MCA ratio (score 0: ratio<1.50, 1: ratio=1.50-1.99, 2: ratio ≥ 2.00); spectrum pattern (score 0: normal spectrum, 1: any pattern of turbulence). DSA results (presence of ≥ 50% stenosis) from SONIA were used as the gold standard. To define the optimal score that predict significant stenosis on DSA, predictive values (positive predictive value [PPV] and negative predictive values [NPV], and overall accuracy) with 95% CI were calculated. Results: 110 MCAs with both TCD and DSA were available in 72 patients (50.7 % of total patients with TCD). The mean score was 1.8 (SEM 0.21), the optimal cutoff score with balanced PPV and NPV for identifying ≥50% stenosis was >4 with the PPV 76% (53-92), NPV = 84% (75-91) and overall accuracy 83% (76-90).The PPV of the new scoring system (76%) was higher than velocity-only criteria in SONIA (i.e. previously validated cutpoints from SONIA of MV=80 cm/s [32%] or 100 cm/s [37%]), while NPV remained similar between the two methods (84% for new scoring vs 86% or 85%). Conclusions: The new TCD scoring system suggested higher diagnostic accuracy compared to the velocity-only method in diagnosis of ≥50% MCA stenosis using digital subtraction angiography as the confirmative method. Further validation is required.

scholarly journals Republished: Stent-assisted coil embolization on down-the-barrel view with spring-shaped microcatheter in patient with M1 ultrawide necked circumferential aneurysm

2018 ◽  
Vol 10 (6) ◽  
pp. e13-e13
Author(s):  
Hyo Sung Kwak ◽  
Jung Soo Park ◽  
Eun Jeong Koh
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Middle Cerebral Artery ◽  
Digital Subtraction Angiography ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Digital Subtraction ◽  
Safe Technique ◽  
Delayed Complications

Herein, we describe a technique for stent-assisted coil embolization with a spring-shaped microcatheter in a patient with an M1 ultrawide-necked circumferential aneurysm in the middle cerebral artery (MCA). A 49-year-old man was referred for treatment of an incidentally detected M1 large-circumference aneurysm on magnetic resonance angiography. Subsequent digital subtraction angiography revealed an 18.2×16.5 mm ultrawide-necked circumferential aneurysm on the distal M1 portion of the left MCA, and we planned stent-assisted coil embolization using a spring-shaped microcatheter. After we deployed the stent, we performed coil embolization under the down-the-barrel view by pulling out the microcatheter little by little. Using this technique, we could fill the coil mass evenly into the aneurysmal sac around the stent. And there were no immediate or delayed complications after the procedure. Stent-assisted coiling using a spring-shaped microcatheter is a useful and safe technique for treating ultrawide-necked circumferential aneurysm or fusiform aneurysms.

M2/M2 Side-to-Side Rescue Anastomosis for Accidental M2 Trunk Occlusion during Middle Cerebral Artery Aneurysm Clipping: Technical Note

Neurosurgery ◽  
2001 ◽  
Vol 49 (3) ◽  
pp. 743-748 ◽  
Author(s):  
Hans-Jakob Steiger ◽  
Seiro Ito ◽  
Robert Schmid-Elsässer ◽  
Eberhard Uhl
Keyword(s):  
Intracerebral Hemorrhage ◽  
Middle Cerebral Artery ◽  
Digital Subtraction Angiography ◽  
Cerebral Artery ◽  
Artery Aneurysm ◽  
Maximum Diameter ◽  
Digital Subtraction ◽  
Emergency Procedure ◽  
Aneurysm Clipping ◽  
Mca Aneurysm

Abstract OBJECTIVE A technically feasible and rapid technique for revascularizing the main branches of the middle cerebral artery (MCA) is described. This technique is applied mainly when clipping of an MCA aneurysm is complicated and occlusion of the origin of an MCA main branch results. METHODS M2/M2 side-to-side anastomosis was applied in two patients in whom unplanned M2 occlusion occurred during the course of complicated MCA aneurysm clipping. The first patient underwent an emergency procedure after temporoparietal intracerebral hemorrhage. Unilateral mydriasis precluded preoperative angiographic workup, and a complex large MCA aneurysm was found as the source of hemorrhage. Shaping of the aneurysm neck by bipolar coagulation and clipping resulted in accidental occlusion of the superior trunk, and patency could not be regained despite multiple clip corrections. The second patient had an unruptured multilobulated aneurysm 8 mm in maximum diameter. Continuity of the inferior trunk was lost during clipping because of a tear at the origin. In both instances, side-to-side anastomosis was placed approximately 15 mm from the bifurcation, where the MCA main trunks ran side by side for a length of approximately 5 mm. RESULTS After intracerebral hemorrhage, the first patient recovered to a level of moderate disability within 2 months. Substantial hemiparesis and expressive dysphasia remained as sequelae of the intracerebral hemorrhage. Digital subtraction angiography 2 months after the emergency procedure confirmed patency of the side-to-side anastomosis. The second patient was neurologically intact after recovery from anesthesia. Before discharge from the hospital on postoperative Day 8, digital subtraction angiography confirmed patency of the anastomosis. CONCLUSION The MCA main branches usually run in close proximity for a short segment at the bottleneck entrance to the insular cistern. M2/M2 side-to-side anastomosis at this site is a rapid and feasible mode of revascularization of an M2 trunk accidentally occluded during complicated MCA aneurysm clipping.

scholarly journals Preoperative simulation of a middle cerebral artery aneurysm clipping using a rotational three-dimensional digital subtraction angiography

2021 ◽  
Vol 12 ◽  
pp. 70
Author(s):  
Yuiko Kimura ◽  
Toshihiro Mashiko ◽  
Eiju Watanabe ◽  
Kensuke Kawai
Keyword(s):  
Middle Cerebral Artery ◽  
Digital Subtraction Angiography ◽  
Cerebral Artery ◽  
Three Dimensional ◽  
Artery Aneurysm ◽  
Digital Subtraction ◽  
Preoperative Simulation ◽  
The Difference ◽  
Operative Findings ◽  
Cerebral Artery Aneurysm

Background: In recent years, young neurosurgeons have had few opportunities to gain experience with clipping surgeries. The first author was sometimes surprised that she could not predict the anatomical relationships between the aneurysm and vessels during actual surgery. This study investigated the differences between the expected and actual operative findings during clipping surgery for aneurysms of the middle cerebral artery. Methods: Medical records for 15 patients who underwent rotational three-dimensional (3D) digital subtraction angiography (3D-DSA) before the clipping surgery were analyzed after the surgery. The anatomical relationships between the aneurysm and parent arteries were defined by the intraoperative findings just before clipping. The viewing direction to obtain this definitive perspective (virtual viewing direction) was measured. The angle between this viewing direction and the coordinate axis was denoted as the “virtual angle for clipping (VAC).” Results: The VAC between the X-axis and viewing direction on the XY-plane (VAC-XY) ranged from –43° to +73° (mean, +27°), and the angle between the XY-plane and viewing direction (VAC-Z) ranged from +25° to –34° (mean, 5.5°). The difference between the VAC-XY and mean angle was significantly larger in cases with hidden branches behind the aneurysm. In these cases, the virtual viewing direction visualized the neck of the aneurysm. There is no correlation between M1 length and VAC-XY or VAC-Z discrepancy. Conclusion: 3D-DSA or 3D computed tomography angiography images visualizing the neck of the aneurysm should be obtained in combination with images obtained from the standard oblique angle.

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