scholarly journals Early clinical experience with the p48MW HPC and p64MW HPC flow diverters in the anterior circulation aneurysm using single anti-platelet treatment

2021 ◽  
pp. 159101992110295
Author(s):  
Pervinder Bhogal ◽  
Andrey Petrov ◽  
Ganbaatar Rentsenkhu ◽  
Baatarjan Nota ◽  
Erdenebat Ganzorig ◽  
...  
Keyword(s):  
Clinical Results ◽  
Dome Height ◽  
Anterior Circulation ◽  
Post Procedure ◽  
Neurological Morbidity ◽  
Procedural Complications ◽  
Previously Treated ◽  
Flow Diverters ◽  
Overall Mortality

Background The p64MW HPC and p48MW HPC flow diverters have reduced thrombogenicity due to hydrophilic coating. The purpose of this study was to evaluate its safety and efficacy in Mongolian patients under single antiplatelet therapy (SAPT) with prasugrel. Materials and methods We performed a retrospective review of patients enrolled into our prospectively maintained database to identify all patients treated with either the p48MW HPC or p64MW HPC under SAPT. We recorded baseline demographics, aneurysm size and location, procedural complications, angiographic and clinical results. Results 24 patients, (female = 21, 87.5%), age 48.2 ± 11.6 years (range 25–63) underwent treatment of 30 aneurysms with either p64MW HPC or p48MW HPC. All aneurysms were saccular with dome width 8.2 ± 6.5 (range 1.6–26.0 mm) and dome height 7.6 ± 6.7 (range 1.6–30.0 mm). None of the aneurysms were previously treated. The average PRU was 54.6 ± 31.2 (range 1–127) on pre-operative VerifyNow testing. Angiographic follow-up was available for 13 patients (17 aneurysms), 183 ± 36 days post-procedure, at which point 64.7% of aneurysms (n = 11/17) were completely occluded and 11.8% (n = 2/17) had only neck remnants resulting in 76.5% of aneurysms being adequately occluded A single intra-operative complication (4.2%) occurred however all patients were mRS ≤1 at last follow-up. There were two post-operative complications neither of which resulted in permanent neurological morbidity. There were no instances of post-operative aneurysmal rupture or delayed parenchymal haemorrhage. The overall mortality was 0%. Conclusion The efficacy and safety of p64MW HPC coated devices under SAPT is similar to uncoated flow diverters that require DAPT.

pCONUS 2 and pCONUS 2-HPC for the treatment of wide-necked intracranial aneurysms: Periprocedural, 6-month, and early 2-year follow-up outcomes

2021 ◽  
pp. 159101992110118
Author(s):  
J Yeomans ◽  
A Sastry
Keyword(s):  
Antiplatelet Therapy ◽  
Interventional Neuroradiology ◽  
Anterior Circulation ◽  
Unruptured Aneurysms ◽  
Patient Demographics ◽  
Post Procedure ◽  
Included Patient ◽  
Intracranial Complications ◽  
Procedural Complications

Background/Purpose pCONUS 2 and pCONUS 2-HPC are novel neck-bridging devices designed to support endovascular coil occlusion of wide-necked intracranial bifurcation aneurysms. This study summarises periprocedural outcomes, 6-month, and early 2-year follow-up results following its introduction in an interventional neuroradiology centre. Materials/Methods This prospective, single-arm study assessed 20 aneurysms treated over a 40 month time period from time of procedure to 2 years post-procedure. Data collected included patient demographics, aneurysm features, and intraprocedural, 6-month, and 2-year post-procedural complications and angiographic features. Results The mean age of the cohort was 59+-SD 7.7 years. 16 unruptured aneurysms were treated (pCONUS 2 13/16, pCONUS 2-HPC 3/16) and 4 ruptured aneurysms were treated with pCONUS 2-HPC. Unruptured cases received dual antiplatelet therapy pre- and post-procedure while ruptured cases received single antiplatelet therapy. 9/20 aneurysms were located at the MCA bifurcation and 7/20 at the basilar tip. The remaining 4 aneurysms were at various bifurcations in the anterior circulation. 11/20 were small (<10mm) and 9/20 were large (10–25mm). There was one periprocedural complication: a retroperitoneal bleed. There were no post-procedural intracranial complications or at 6-months follow-up. At 6 months, satisfactory occlusion was achieved in 94% of cases (15/16). There was one delayed death at 2-year follow-up from an unrelated cause. Conclusion pCONUS 2 and pCONUS 2-HPC have excellent short and medium-term safety profiles and clinical outcomes with no procedure-related mortality or morbidity and good occlusion rates at 6-month follow-up. The use of pCONUS 2-HPC with single antiplatelet therapy is feasible and did not cause any complications.

149 Emergency Clot Retrieval and Stenting for Posterior Circulation Stroke

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Daga ◽  
M T Ahmad ◽  
M Taneja
Keyword(s):  
Treatment Option ◽  
Current Literature ◽  
Basilar Artery ◽  
Cerebral Angiography ◽  
Posterior Circulation ◽  
Anterior Circulation ◽  
Acute Setting ◽  
Post Procedure ◽  
Basilar Artery Stenosis

Abstract The current literature regarding the morphology and presentations of strokes due to basilar artery stenosis/occlusion is limited. This pathology is a rare cause of stroke and its management is not clearly decided in guidelines or published literature. Moreover, posterior circulation strokes are reported to be more devastating than anterior circulation. We present a case of a 68-year-old male who presented in an acute setting with reduced consciousness, myoclonic jerks, weakness and nausea due to a stroke from an occluded mid-segment basilar artery. MRI showed evidence of left cerebellar and right occipital infarcts. Emergent cerebral angiography was performed, and he was immediately treated by thrombectomy and stenting (Stryker Wingspan stent). The patient made a full recovery within one week and remained well at follow-up 3 months post-procedure. Emergency recanalization of basilar artery strokes, by clot retrieval and stenting, should be considered as a treatment option.

scholarly journals Endovascular Treatment of Intracranial Aneurysms Using the Novel Low Profile Visualized Intraluminal Support EVO Stent: Multicenter Early Feasibility Experience

2021 ◽  
Author(s):  
Michelle Foo ◽  
Julian Maingard ◽  
Jonathan Hall ◽  
Yifan Ren ◽  
Goran Mitreski ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Flow Diversion ◽  
Definitive Treatment ◽  
Dome Height ◽  
The Novel ◽  
Short Term ◽  
Low Profile ◽  
Procedural Complications ◽  
Related Mortality

Purpose: Low-profile, self-expandable stents have broadened therapeutic options available for definitive treatment of intracranial aneurysms. The novel Low-Profile Visualized Intraluminal Support (LVIS) EVO stent extends upon the success of its predecessor, the LVIS Jr stent, aiming to enable higher visibility and greater opening ability within a self-expandable and fully retrievable microstent system. In this study, we aim to report the early safety and feasibility experience with the LVIS EVO stent.Materials and Methods: A multicenter, retrospective, observational study was conducted on patients who had intracranial aneurysms treated with the LVIS EVO stent across 3 Australian neurovascular centers between February 2020 and September 2020. Short-term technical and clinical outcomes were evaluated.Results: A total of 22 LVIS EVO stents were successfully implanted to treat 15 aneurysms (3 ruptured, 12 unruptured) in 15 patients. Aneurysms ranged from 2 mm to 35 mm in dome height. The LVIS EVO stent was used for stent-assisted coiling in 11 patients and flow diversion in 4 patients. There were no device-related procedural complications. There were 2 cases of peri-procedural symptomatic thromboembolic complications and no procedure-related mortality. At early radiological follow up, 10 patients had complete occlusion, 4 patients had small neck remnants, and 1 patient who was managed with flow diversion had a residual aneurysm.Conclusion: Early experience with the LVIS EVO stent demonstrated safety and feasibility for stent-assisted coiling as well as flow diversion for intracranial aneurysms. In this heterogeneous cohort, including ruptured, complex, and large aneurysms, all cases were technically successful.

Pipeline for the treatment of distal cerebral circulation aneurysms: A multicenter study focusing on periprocedural Complications

2021 ◽  
pp. 159101992110637
Author(s):  
Chao Ma ◽  
Haoyu Zhu ◽  
Shikai Liang ◽  
Fei Liang ◽  
Jintao Han ◽  
...  
Keyword(s):  
Cerebral Circulation ◽  
Mortality And Morbidity ◽  
Technical Success Rate ◽  
Medical Centers ◽  
Complete Obliteration ◽  
Previously Treated ◽  
The Mean ◽  
Ischemic Events ◽  
Overall Mortality

Background and Aim Distal cerebral circulation aneurysms (DCCAs) remain treatment challenges for neurointervention. The off-label use of the pipeline embolization device (PED) for these aneurysms remains controversial. This study aimed to evaluate the safety and efficacy of PED for DCCAs in a multicenter cohort of patients. Methods Between March 2016 and June 2021, we retrospectively analyzed the neurointerventional data on the clinical and radiological records of all patients undergoing PED treatment of DCCAs at three medical centers. Results A total of 53 consecutive patients with 53 DCCAs were treated with PED. The mean aneurysm size was 12.3 ± 5.7 mm. In total, 75.4% (40/53) were fusiform and 24.5% (13/53) were saccular. Of these, 17.0% (9/53) were recurrent aneurysms that were previously treated with endovascular or microsurgical approaches. The technical success rate was 100%, among which 81.1% (43/53) procedures were completed with a single PED, and the rest (10/53, 18.8%) required telescoping with two devices. Angiographic follow-up data were available for 51 patients, with a median follow-up time of 12 months. At the latest follow-up, 46/51 (90.2%) aneurysms showed complete obliteration, and 4/51 (7.8%) showed reduced filling. Periprocedural complications such as hemorrhage were observed in two patients with MCA aneurysms (3.8%, 2/53), and ischemic events occurred in six patients (11.3%, 6/53). The overall mortality and morbidity rates were 7% (4/53). Conclusions PED is a viable option for treating DCCAs, especially for recurrent aneurysms. Coverage of bifurcation branches and perforator may increase the risk of complications.

Predictors of unfavorable outcome in stent-assisted coiling for symptomatic unruptured intracranial spontaneous vertebral artery dissecting aneurysms (uis-VADAs): results from a multicenter study

2021 ◽  
pp. neurintsurg-2021-017619
Author(s):  
Kaijun Zhao ◽  
Rui Zhao ◽  
Xinjian Yang ◽  
Sheng Guan ◽  
Guobiao Liang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Vertebral Artery ◽  
Multicenter Study ◽  
Multivariate Logistic Regression Analysis ◽  
Unfavorable Outcome ◽  
Low Profile ◽  
Procedural Complications ◽  
Dissecting Aneurysms ◽  
Overall Mortality

ObjectiveTo evaluate predictors of unfavorable outcome in stent-assisted coiling for symptomatic unruptured intracranial spontaneous vertebral artery dissecting aneurysms (uis-VADAs) based on 608 reconstructed lesions in 30 medical centres.MethodsA total of 608 patients (male:female=479:129; mean age, 53.26±10.26 years) with 608 symptomatic uis-VADAs underwent reconstructive treatments using stent(s) with coils between January 2009 and December 2015. Treatments and predictors of unfavorable outcomes were retrospectively analyzed.ResultsMainly, three methods were used to treat patients with uis-VADAs, including routine single-stent in 208 patients (such as Enterprise and others), new low-profile LVIS single stent in 107 patients, and multiple stents in 293 patients. During the median 66 months of clinical follow-up, 14 patients died, and 16 of the remaining 594 survivors had unfavorable outcomes (modified Rankin Scale score 3–5). The overall mortality rate was 2.3% (14/608), and the unfavorable outcome (mRS score 3–6) rate was 4.9% (30/608). Multivariate logistic regression analysis indicated that preprocedural ischemic infarctions (OR=3.78; 95% CI 1.52 to 9.40; p<0.01), diabetes mellitus (OR=3.74; 95% CI 1.31 to 10.68; p=0.01), and procedural complications (OR=14.18; 95% CI 5.47 to 36.80; p<0.01) were predictors of unfavorable outcome in the reconstructed VADAs.ConclusionsThis multicenter study indicated that preprocedural ischemic infarctions, diabetes mellitus, and procedural complications were related to unfavorable clinical outcomes in the reconstructed uis-VADAs.

Abstract WMP32: Cost-Effectiveness of Flow Diverters versus Coiling in the Treatment of Carotid Sidewall Aneurysms

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Michel Piotin ◽  
Gabriele Ciccio ◽  
Hocine Redjem ◽  
Stanislas Smajda ◽  
Jean P Desilles ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Endovascular Treatment ◽  
Treatment Options ◽  
Complication Rates ◽  
Patient Demographics ◽  
Carotid Siphon ◽  
Procedural Complications ◽  
Procedural Costs ◽  
Flow Diverters

Purpose: Flow Diverters (FD) have dramatically impacted the manner of endovascular treatment (EVT) of carotid siphon sidewall aneurysms. However, the indications remain unclear when compared to conventional coiling and stent-assisted coiling. We conducted herein a retrospective monocentric study in order to evaluate the safety and cost-effectiveness of EVT, comparing treatment with FD versus coiling. Materials and Methods: Based on a prospectively gathered database we selected unruptured sidewall carotid siphon aneurysms treated in our department since the introduction of FD (2008 to 2016) for which the maximum sac diameter was 15 mm. Patient demographics, aneurysm characteristics (sac and neck sizes, dome-to-neck ratio), treatment options (FD, simple coiling or with balloon-remodeling technique [BRT], stent-assisted-coiling [SAC]), procedural and peri-procedural complications, angiographic results at follow-up were collected. Total procedural costs were also recorded. Both groups of patients and aneurysms were compared. Results: 226 aneurysms in 211 patients (1.1 aneurysm per patient) during 216 procedures (including 158 BRT and 42 SAC procedures) were coiled. 161 aneurysms in 114 patients (1.4 aneurysm per patient) during 126 procedures were treated with FD (no coils). Aneurysms in the FD group had larger neck and lower dome-to-neck ratio. No mortality occurred in both groups. Complication rates were similar in both groups. Angiographic follow-up was longer in the coiling group. There was no difference in term of total aneurysm circulatory exclusion at follow-up between the 2 groups. FD treatment was twice more expansive than coiling (aggregated costs of simple coiling, BRT and SAC). Conclusions: In the light of the clinical, angiographic results and costs, there is no rational to consider FD treatment for small and medium sizes carotid siphon aneurysms as the first EVT option. Coiling remains a valid therapeutic alternative in the FD era.

scholarly journals Volume versus standard coils in the treatment of intracranial aneurysms

2015 ◽  
Vol 8 (10) ◽  
pp. 1034-1040 ◽  
Author(s):  
Johannes Kaesmacher ◽  
Christina Müller-Leisse ◽  
Thomas Huber ◽  
Tobias Boeckh-Behrens ◽  
Bernhard Haller ◽  
...  
Keyword(s):  
Packing Density ◽  
Intracranial Aneurysms ◽  
Case Review ◽  
Retrospective Case ◽  
Safety And Efficacy ◽  
Volume Versus ◽  
Subgroup Analyses ◽  
Previously Treated ◽  
Flow Diverters

BackgroundVolume coils were developed to improve occlusion rates of intracranial aneurysms. Previous studies have shown increased packing density and comparable occlusion rates, but subgroup analyses of aneurysm size have not been carried out.ObjectiveTo evaluate the safety and efficacy of the Penumbra Coil 400 (PC400) system in treating intracranial aneurysms compared with standard diameter coils.MethodsA monocentric retrospective case review of 260 aneurysms in 233 patients was carried out. In 37 aneurysms the PC400 system was used, while 223 aneurysms were treated with conventional coils. Previously treated aneurysms and aneurysms treated with flow diverters were excluded. Aneurysm and procedure characteristics, packing density, postprocedural and follow-up occlusion grades as well as coil compaction were evaluated.ResultsAneurysms treated with PC400 coils had higher volume (218.9 vs 47.1 mm3, p<0.001), wider necks (3.0 vs 2.5 mm, p=0.005), and greater dome/neck ratio (2.0 vs 1.6, p=0.001) in comparison with aneurysms treated with conventional coils. Compared with controls, in the PC400 group we achieved higher packing densities (43.2% vs 34.4%, p<0.001; in aneurysms ≥7 mm 42.2% vs 27.8%, p<0.001). On follow-up angiography we observed less coil compaction (23.8% vs 64.3%, p=0.003) and less aneurysm recurrence (14.3% vs 40.5%, p=0.046) in aneurysms ≥7 mm when using the PC400 system.ConclusionsUse of the PC400 system as opposed to conventional coils suggests that the PC400 system is safe and effective in treating intracranial aneurysms. Despite having been applied in a potentially more difficult-to-treat group, the use of PC400 was associated with less coil compaction and aneurysm recurrence in aneurysms ≥7 mm.

scholarly journals Surgery for Unruptured Intracranial Aneurysms in the ISAT and ISUIA Era

2012 ◽  
Vol 39 (2) ◽  
pp. 174-179 ◽  
Author(s):  
Laurent Thines ◽  
Philippe Bourgeois ◽  
Jean-Paul Lejeune
Keyword(s):  
Intracranial Aneurysms ◽  
Consecutive Series ◽  
Thin Wall ◽  
Anterior Circulation ◽  
Microsurgical Clipping ◽  
Unruptured Intracranial Aneurysms ◽  
Neurological Morbidity ◽  
Wide Neck ◽  
Temporary Clipping

Background:The ISAT and ISUIA studies, along with the improvement of endovascular treatment (EVT) have strongly influenced the management of intracranial aneurysms (IAs). We present our experience in the microsurgical treatment of unruptured IAs (UIAs) in this context.Methods:We retrospectively reviewed a consecutive series of non-giant UIAs selected for surgery during a five-year period. Patients and aneurysms characteristics, surgical results and outcome assessed by the Glascow Outcome Scale (GOS) at three month follow-up were studied.Results:Eighty-five patients underwent 93 surgical procedures to obliterate 113 UIAs. Those were incidental in 89% of the cases and mainly located on the middle cerebral artery (65%). Patients were assigned to surgery according to their medical history (young, previous subarachnoid haemorrhage), aneurysm characteristics (wide neck, branch at the neck, “small” size, associated “surgical” aneurysm) or failure of EVT (5%). Operatively, 48% of UIAs had thin wall or blebs and 71% were occluded with one titanium clip. Thrombectomy or temporary clipping were necessary in 4% and 11% of the cases, three aneurysms peroperatively ruptured, four were deemed unclippable, three paraclinoid UIAs had an intracavernous residue and 16% were wrapped because of a small neck remnant (class 2). The mortality rate was 0% and 4% of the patients experienced a definitive major neurological deterioration. Final GOS was unchanged in 96% of the patients.Conclusions:Despite reduction in operative cases and in appropriately selected patients ineligible to EVT, microsurgical clipping of non-giant anterior circulation UIAs can still achieve good outcome with very low mortality and neurological morbidity.

scholarly journals Delayed Stroke after Aneurysm Treatment with Flow Diverters in Small Cerebral Vessels: A Potentially Critical Complication Caused by Subacute Vasospasm

2019 ◽  
Vol 8 (10) ◽  
pp. 1649 ◽  
Author(s):  
Schob ◽  
Richter ◽  
Lindner ◽  
Planitzer ◽  
Hamerla ◽  
...  
Keyword(s):  
Neurocritical Care ◽  
Critical Level ◽  
Neointimal Hyperplasia ◽  
Brain Perfusion ◽  
Endovascular Technique ◽  
Post Procedure ◽  
Patients At Risk ◽  
Flow Diverters ◽  
Cerebrovascular Hemodynamics

Flow diversion (FD) is a novel endovascular technique based on the profound alteration of cerebrovascular hemodynamics, which emerged as a promising minimally invasive therapy for intracranial aneurysms. However, delayed post-procedural stroke remains an unexplained concern. A consistent follow-up-regimen has not yet been defined, but is required urgently to clarify the underlying cause of delayed ischemia. In the last two years, 223 patients were treated with six different FD devices in our center. We identified subacute, FD-induced segmental vasospasm (SV) in 36 patients as a yet unknown, delayed-type reaction potentially compromising brain perfusion to a critical level. Furthermore, 86% of all patients revealed significant SV approximately four weeks after treatment. In addition, 56% had SV with 25% stenosis, and 80% had additional neointimal hyperplasia. Only 13% exhibited SV-related high-grade stenosis. One of those suffered stroke due to prolonged SV, requiring neurocritical care and repeated intra-arterial (i.a.) biochemical angioplasty for seven days to prevent territorial infarction. Five patients suffered newly manifested, transient hemicrania accompanying a compensatorily increased ipsilateral leptomeningeal perfusion. One treated vessel obliterated permanently. Hence, FD-induced SV is a frequent vascular reaction after FD treatment, potentially causing symptomatic ischemia or even stroke, approximately one month post procedure. A specifically early follow-up-strategy must be applied to identify patients at risk for ischemia, requiring intensified monitoring and potentially anti-vasospastic treatment.

scholarly journals Pipeline Flex embolisation device with Shield Technology for the treatment of patients with intracranial aneurysms: periprocedural and 6 month outcomes

2020 ◽  
Vol 33 (6) ◽  
pp. 471-478
Author(s):  
James Yeomans ◽  
Lilian Sandu ◽  
Anand Sastry
Keyword(s):  
Antiplatelet Therapy ◽  
Case Series ◽  
Interventional Neuroradiology ◽  
Flow Diverter ◽  
Patient Demographics ◽  
Post Procedure ◽  
Time Period ◽  
Included Patient ◽  
Procedural Complications

Background and purpose The Pipeline Flex embolisation device with Shield Technology (Pipeline Shield) is a novel flow diverter which reduces intra-vessel thrombogenicity. This study summarises periprocedural outcomes and 6-month follow-up results following its introduction in a tertiary interventional neuroradiology centre. Materials and methods This prospective, single-arm study assessed 32 aneurysms treated over a 21-month time period from the time of procedure to 6 months post-procedure. Data collected included patient demographics, aneurysm features and intraprocedural and 6-month post-procedural complications. Results The mean age of the cohort was 58.8 ± Standard Deviation 8.5 years. Twenty-eight aneurysms were treated electively and four acutely. The elective cases received dual antiplatelet therapy post-procedure. The acute cases received single antiplatelet therapy post-procedure. Of the target aneurysms, 16/32 (50%) were small (<10 mm), 13/32 (41%) were large (10–25 mm) and 3/32 (9%) were giant (≥25 mm). There was no mortality in the series. There were two periprocedural complications (2/32, 6.2%): a stroke and a dissection. There were no post-procedural complications. At 6 months post-procedure, satisfactory occlusion (defined as Raymond–Roy 1 or 2) was achieved in 90.6% and 93.8% by way of magnetic resonance angiography and digital subtraction angiography assessment, respectively. There was no implant migration, no significant intraluminal hyperplasia or in-stent stenosis and no cases of aneurysm recurrence. Conclusion The Pipeline Shield has an excellent 6- month safety profile with an acceptable rate of intraprocedural complications, no post-procedure complications and no mortality in this case series of 32 acute and elective cases.

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