Transcirculation Silk Vista Baby-assisted coiling in half-T configuration for the treatment of posterior communicating artery aneurysms associated with a fetal posterior circulation: An alternative flow diversion strategy

2020 ◽  
pp. 159101992096188
Author(s):  
Mario Martínez-Galdámez ◽  
Miguel Schüller-Arteaga ◽  
Jorge Galván-Fernández ◽  
Vladimir Kalousek ◽  
Ezequiel Petra ◽  
...  
Keyword(s):  
Flow Diverter ◽  
Posterior Circulation ◽  
Flow Diversion ◽  
Anterior Communicating Artery ◽  
Anterior Circulation ◽  
Low Profile ◽  
Specific Subgroup ◽  
Flow Diverter Devices ◽  
Profile Flow ◽  
Incomplete Occlusion

Flow diverter devices have become a routine first-line option for treatment of an increasing population of intracranial aneurysms at many neurovascular centers.  Despite the promising results of flow diverter stents on anterior circulation, incomplete occlusion on the presence of fetal posterior circulation has been described on several reports.  Here we describe a novel technical alternative to conventional flow diversion approach for this specific subgroup of aneurysms using the low-profile flow diverter, Silk Vista Baby. The device was selectively placed into the fetal type posterior cerebral artery in half-T configuration for the treatment of a posterior communicating aneurysm using a transcirculation approach through the anterior communicating artery. This represents a useful and effective technique and should be considered when encountering the above-described situation.

Periprocedural safety and technical outcomes of the new Silk Vista Baby flow diverter for the treatment of intracranial aneurysms: results from a multicenter experience

2019 ◽  
Vol 11 (7) ◽  
pp. 723-727 ◽  
Author(s):  
Mario Martínez-Galdámez ◽  
Alessandra Biondi ◽  
Vladimir Kalousek ◽  
Vitor M Pereira ◽  
Giuseppe Ianucci ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Maximum Diameter ◽  
Anterior Communicating Artery ◽  
Low Profile ◽  
Incomplete Filling ◽  
Angiographic Data ◽  
Clinical Consequences ◽  
Profile Flow ◽  
Average Size

PurposeThe aim of our study was to assess the technical success and the safety of this new low-profile flow diverter Silk Vista Baby (SVB) by evaluating the intraprocedural and periprocedural complication rate.Material/methodsClinical, procedural, and angiographic data were analyzed.Results: 41 consecutive patients (28 women; age average 50.5 years) with 43 aneurysms were treated with SVB. Aneurysm sizes were classified by their maximum diameter, with an average size of 9.5 mm (range 2–30 mm). Thirty-four cases were unruptured. five aneurysms previously ruptured, had recurrence after the initial coiling. There were two ruptured cases. Aneurysms' locations were: M1 segment (five cases), M2 segment (three cases), M3 segment (one case), middle cerebral artery (MCA) bifurcation (six cases), carotid-T (two cases), anterior communicating artery/A1/A2 (11 cases), pericallosal artery (four cases), supraclinoid ICA (two cases), PCom (one case), V4 segment (three cases), PCA (three cases), SCA (one case), and PICA (one case). We had five intraprocedural complications which resolved without clinical consequences and three events postprocedural events. Initial occlusion rates were: eight aneurysms (18.6%) were completely occluded, five aneurysms (11.6%) showed near-complete occlusion, four cases (9.3%) showed incomplete filling, and 26 cases (60.4%) showed persisting filling. The mRS score at discharge from the hospital did not change from the admission mRS score.ConclusionOur study demonstrated that the use of the new low-profile flow diverter, SVB device, for the treatment of intracranial aneurysms is feasible and technically safe.

scholarly journals Coil embolization with overlapping horizontal low-profile stents to treat a giant thrombosed fetal posterior cerebral artery aneurysm using contralateral approach through anterior communicating artery: Case report

2021 ◽  
Vol 12 ◽  
pp. 347
Author(s):  
Yasuhisa Kanematsu ◽  
Kenji Shimada ◽  
Yoshiteru Tada ◽  
Masaaki Korai ◽  
Takeshi Miyamoto ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Coil Embolization ◽  
Posterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Flow Diverter ◽  
Flow Diversion ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
First Case ◽  
Low Profile

Background: The treatment of internal carotid artery (ICA) – posterior communicating artery aneurysms (ICPC aneurysms) is challenging when a fetal posterior cerebral artery (PCA) arises from the saccular neck. This complex angioarchitecture renders endovascular approaches difficult. Giant thrombosed IC-PC aneurysms are also hard to treat by endovascular coiling because its flow-diversion effect is insufficient. Case Description: We report the first case of a ruptured giant thrombosed IC-PC aneurysm associated with a fetal PCA that was successfully treated by coil embolization with retrograde overlap horizontal stenting using low-profile stents introduced through the contralateral ICA. The aneurysm was completely occluded and follow-up MRI scans demonstrated the reduction of the aneurysmal size. Conclusion: Our technique is advantageous because low-profile stents can be used to treat lesions not accessible with flow-diverter stents due their presence in complex angioarchitectures, and overlap stenting may have flow-diversion effects that can result in the complete occlusion of giant thrombosed aneurysms.

Abstract 120: Surpass Flow Diverter for Endovascular Treatment of Intracranial Aneurysms - A Multicenter Preliminary Clinical and Angiographic Experience in 161 Patients with 186 Aneurysms

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Ajay K Wakhloo ◽  
Pedro Lylyk ◽  
Joost de Vries ◽  
Matthew J Gounis ◽  
Alexandra Biondi ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Experimental Studies ◽  
Flow Diverter ◽  
Posterior Circulation ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Neck Size ◽  
Wide Range ◽  
New Generation

Objective: Validated through experimental studies a new generation of flow diverters (Surpass™ FD) was evaluated for treatment of intracranial aneurysms (IA). We present our multicenter preliminary clinical and angiographic experience. METHODS: To achieve the calculated flow disruption between the parent artery and aneurysm for thrombosis, single FDs were placed endovascularly in parent arteries. Implants measured 2.5-5.3mm in diameter with a length of 10-80mm. Patients were enrolled harboring a wide range large and giant wide-neck, fusiform and multiple small and blister-type aneurysm. Clinical and angiographic follow-up were performed at 1-3, 6, and 12 months. RESULTS: A total of 186 consecutive IA in 161 patients (mean age 57.1 years) were treated at 33 centers. Fifty-three aneurysms were smaller than 5 mm, 64 were 5-9.9mm in diameter, 47 were 10-20mm in diameter, and 22 were larger than 20mm (10.4±0.7mm, neck size 6.0±0.5mm [mean±SEM]) . The aneurysms originated in 63.4% from the internal carotid artery; 22% and 14.5% of the lesions were located in the anterior circulation distal to Circle of Willis and posterior circulation respectively. Technical success was achieved in 182 aneurysms (98%); average number of devices used per aneurysm was 1.05. Permanent morbidity and mortality during the follow-up period of mean 8.4months (range 1-24 months) including periprocedural complications for patients with aneurysms of the anterior circulation were encountered in 5 (3.7%) and 2 (1.5 %) patients respectively and 1 (3.7%) and 4 (14.8%) respectively for patients with aneurysms of the posterior circulation location. One-hundred-ten patients (70.5%) harboring 127 (70.2%) were available for clinical and angiographic follow-up and showed a complete or near complete aneurysm occlusion in 63 (81.8%) of the ICA. Aneurysms of the ICA≥10mm that were completely covered by FD and not previously stent-treated with a minimum of 6 months follow-up available in 16 patients showed a complete obliteration in 81.3% (n=13) and >90% occlusion in remaining 3 patients. CONCLUSION: Preliminary data demonstrate high safety and efficacy of a new generation of FD for a wide range of IA of the anterior and posterior circulation with a single implant.

Overview of Different Flow Diverters and Flow Dynamics

Neurosurgery ◽  
2019 ◽  
Vol 86 (Supplement_1) ◽  
pp. S21-S34 ◽  
Author(s):  
Georgios A Maragkos ◽  
Adam A Dmytriw ◽  
Mohamed M Salem ◽  
Vincent M Tutino ◽  
Hui Meng ◽  
...  
Keyword(s):  
Rapid Evolution ◽  
Evidence Base ◽  
Flow Diverter ◽  
Outcome Data ◽  
Flow Diversion ◽  
Comprehensive Overview ◽  
Flow Diverter Devices ◽  
Technical Specifications ◽  
Flow Diverters

Abstract Over the past decade, flow diverter technology for endocranial aneurysms has seen rapid evolution, with the development of new devices quickly outpacing the clinical evidence base. However, flow diversion has not yet been directly compared to surgical aneurysm clipping or other endovascular procedures. The oldest and most well-studied device is the Pipeline Embolization Device (PED; Medtronic), recently transitioned to the Pipeline Flex (Medtronic), which still has sparse data regarding outcomes. To date, other flow diverting devices have not been shown to outperform the PED, although information comes primarily from retrospective studies with short follow-up, which are not always comparable. Because of this lack of high-quality outcome data, no reliable recommendations can be made for choosing among flow diversion devices yet. Moreover, the decision to proceed with flow diversion should be individualized to each patient. In this work, we wish to provide a comprehensive overview of the technical specifications of all flow diverter devices currently available, accompanied by a succinct description of the evidence base surrounding each device.

Panacea or problem: flow diverters in the treatment of symptomatic large or giant fusiform vertebrobasilar aneurysms

2012 ◽  
Vol 116 (6) ◽  
pp. 1258-1266 ◽  
Author(s):  
Adnan H. Siddiqui ◽  
Adib A. Abla ◽  
Peter Kan ◽  
Travis M. Dumont ◽  
Shady Jahshan ◽  
...  
Keyword(s):  
Natural History ◽  
Intracranial Aneurysms ◽  
Neurological Status ◽  
Posterior Circulation ◽  
The Other ◽  
Flow Diversion ◽  
Morbidity And Mortality ◽  
Anterior Circulation ◽  
Subsequent Withdrawal ◽  
Vertebrobasilar Aneurysms

Object The use of flow-diverting stents has gained momentum as a curative approach in the treatment of complex proximal anterior circulation intracranial aneurysms. There have been some reported attempts of treating formidable lesions in the posterior circulation. Posterior circulation giant fusiform aneurysms have a particularly aggressive natural history. To date, no one approach has been shown to be comprehensively effective or low risk. The authors report the initial results, including the significant morbidity and mortality encountered, with flow diversion in the treatment of large or giant fusiform vertebrobasilar aneurysms at Millard Fillmore Gates Circle Hospital. Methods The authors retrospectively reviewed their prospectively collected endovascular database to identify patients with intracranial aneurysms who underwent treatment with flow-diverting devices and determined that 7 patients had presented with symptomatic large or giant fusiform vertebrobasilar aneurysms. The outcomes of these patients, based on the modified Rankin Scale (mRS), were tabulated, as were the complications experienced. Results Among the 7 patients, Pipeline devices were placed in 6 patients and Silk devices in 1 patient. At the last follow-up evaluation, 4 patients had died (mRS score of 6), all of whom were treated with the Pipeline device. The other 3 patients had mRS scores of 5 (severe disability), 1, and 0. The deaths included posttreatment aneurysm ruptures in 2 patients and lack of improvement in neurological status related to presenting brainstem infarcts and subsequent withdrawal of care in the other 2 patients. Conclusions Whether flow diversion will be an effective strategy for treatment of large or giant fusiform vertebrobasilar aneurysms remains to be seen. The authors' initial experience suggests substantial morbidity and mortality associated with the treatment and with the natural history. As outcomes data slowly become available for patients receiving these devices for fusiform posterior circulation aneurysms, practitioners should use these devices judiciously.

Flow diversion treatment of aneurysms of the complex region of the anterior communicating artery: which stent placement strategy should ‘I’ use? A single center experience

2019 ◽  
Vol 11 (11) ◽  
pp. 1118-1122 ◽  
Author(s):  
Igor Pagiola ◽  
Cristian Mihalea ◽  
Jildaz Caroff ◽  
Léon Ikka ◽  
Vanessa Chalumeau ◽  
...  
Keyword(s):  
Anatomical Variation ◽  
Flow Diverter ◽  
Outcome Data ◽  
Flow Diversion ◽  
Anterior Communicating Artery ◽  
Stent Deployment ◽  
Unruptured Aneurysms ◽  
Single Center Experience ◽  
Region Flow ◽  
Woven Endobridge

BackgroundAneurysms of the anterior communicating artery (ACoA) are difficult to treat with coiling or clipping because of the anatomical variation in this region. Flow diversion represents a feasible treatment, but no consensus exists as to which stent deployment technique is more suitable.MethodsAll patients with ACoA aneurysms treated with flow diverters between April 2014 and November 2018 were retrospectively analyzed. Aneurysm characteristics, follow-up results, and clinical outcome data were recorded, and a new classification comparing the diameters of both A1 segments is proposed: H1=same diameters; H2=<50% difference in diameters; H3= ≥50% difference; and Y=no A1 segment.ResultsWe analyzed 30 procedures in 30 patients with ACoA aneurysms, including 16 ruptured aneurysms treated with coiling embolization and 4 previously unruptured aneurysms (two Medina and two Woven EndoBridge devices). Adequate aneurysm occlusion occurred in 86.9%; one patient (3.3%) experienced symptomatic ischemic stroke. The global thromboembolic complications for each group were 17.6% (H1), 25% (H2), and 60% (H3).ConclusionFlow diversion treatment in this region is safe, feasible, and effective. The most suitable anatomical configuration for flow diverter treatment seems to be the H1 configuration where the ‘I technique’ is suitable (from an A1 segment to the ipsilateral A2). There is a tendency that the H3 configuration is not a good indication for flow diverter treatment. However, further studies are needed to evaluate the feasibility of this anatomical classification and the reproducibility of our findings.

Expanding the Indications for Flow Diversion: Treatment of Posterior Circulation Aneurysms

Neurosurgery ◽  
2019 ◽  
Vol 86 (Supplement_1) ◽  
pp. S76-S84
Author(s):  
Nimer Adeeb ◽  
Christopher S Ogilvy ◽  
Christoph J Griessenauer ◽  
Ajith J Thomas
Keyword(s):  
Antiplatelet Agents ◽  
Posterior Circulation ◽  
Flow Diversion ◽  
High Morbidity ◽  
Complication Rates ◽  
Anterior Circulation ◽  
Risk Of Rupture ◽  
Lower Complication ◽  
Ischemic Complications ◽  
Posterior Circulation Aneurysms

Abstract Posterior circulation aneurysms are often associated with a higher risk of rupture and compressive symptoms compared to their anterior circulation counterpart. Due to high morbidity and mortality associated with microsurgical treatment of those aneurysms, endovascular therapy gained ascendance as the preferred method of treatment. Flow diversion has emerged as a promising treatment option for posterior circulation aneurysms with a higher occlusion rate compared to other endovascular techniques and a lower complication rate compared to microsurgery. While treatment of saccular and dissecting aneurysms is often associated with comparatively good outcomes, fusiform and dolichoectatic aneurysms should be carefully selected prior to treatment to avoid devastating thromboembolic complications. Occlusion of covered posterior circulation branches showed no correlation with ischemic complications, and appropriate antiplatelet regimen and switching Clopidogrel nonresponders to different antiplatelet agents were associated with lower complication rates following flow diversion of posterior circulation aneurysms.

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