Low-profile visualized intraluminal support Blue stenting within a Neuroform Atlas stent for a large wide-necked aneurysm: A case report and a bench-top experiment

2021 ◽  
pp. 197140092110269
Author(s):  
Tomoko Hayashi ◽  
Hiroyuki Ikeda ◽  
Ryota Ishibashi ◽  
Toshio Fujiwara ◽  
Ryosuke Kaneko ◽  
...  
Keyword(s):  
Case Report ◽  
Coil Embolization ◽  
Cell Design ◽  
Open Cell ◽  
Aneurysm Neck ◽  
Low Profile ◽  
Closed Cell ◽  
High Metal ◽  
Silicon Tube ◽  
Aneurysm Occlusion

Low-profile visualized intraluminal support deployment in an Enterprise has been reported; however, that in an Atlas has yet to be in detail. Enterprise has a closed-cell design, while Atlas has an open-cell design. We detail here a case of a large wide-necked aneurysm treated by coil embolization with low-profile visualized intraluminal support Blue deployment within a Neuroform Atlas and a bench-top experiment using a silicon tube to test low-profile visualized intraluminal support, Atlas, Enterprise, and their combinations. A better low-profile visualized intraluminal support expansion was achieved by simultaneously pushing the wire and the system within the Atlas placed at the aneurysm neck, which resulted in an increased metal coverage of the aneurysm neck and a shorter transition zone with low metal coverage at both ends of the aneurysm neck. This technique may enable a high metal coverage by low-profile visualized intraluminal support expansion without restriction by the Atlas and contribute to aneurysm occlusion by increasing the flow-diverting effect.

LVIS Jr ‘shelf’ technique: an alternative to Y stent-assisted aneurysm coiling

2016 ◽  
Vol 8 (12) ◽  
pp. 1256-1259 ◽  
Author(s):  
Elizabeth Hai Yen Du ◽  
Jai Jai Shiva Shankar
Keyword(s):  
High Risk ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Case Series ◽  
Cell Design ◽  
Short Term ◽  
Aneurysm Neck ◽  
Closed Cell ◽  
Double Stent ◽  
Aneurysm Coiling

Wide-necked bifurcation intracranial aneurysms have traditionally not been amenable to coil embolization with the use of a single stent due to the high risk of coil prolapse. Y-configuration double stent-assisted coil embolization (‘Y-stenting’) of this aneurysm type has been shown to have generally good clinical outcomes, although the technique is complex with various challenges described in the literature. The compliant and flexible closed-cell design of braided stents such as the LVIS Jr allows for the creation of a ‘shelf’ across the aneurysm neck sufficient to prevent coil prolapse. We describe this novel ‘shelf’ technique and present a small case series of LVIS Jr stent-assisted wide-necked bifurcation intracranial aneurysm coiling in eight patients. Our small, albeit important, case series demonstrates that the ‘shelf’ technique is feasible and safe with very good short-term clinical and angiographic outcomes, and may obviate the need for Y-stenting.

scholarly journals Hemodynamic Effect of the Last Finishing Coils in Packing the Aneurysm Neck

2020 ◽  
Vol 11 ◽  
Author(s):  
Hailin Wan ◽  
Gang Lu ◽  
Lei Huang ◽  
Liang Ge ◽  
Yeqing Jiang ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Computational Study ◽  
Artery Aneurysm ◽  
Finite Element Method Simulation ◽  
Hemodynamic Effect ◽  
Aneurysm Neck ◽  
Low Profile ◽  
Hemodynamic Characteristics ◽  
Pre Treatment ◽  
Dynamics Models

Background: Using the finishing coils to densely pack the aneurysm neck is necessary. However, the exact hemodynamic effect of finishing coils in packing the aneurysm neck is unknown.Objective: To evaluate the hemodynamic characteristics of finishing coils to densely pack the aneurysm neck, using finite element method simulation.Methods: A computational study was performed based on a 44-year-old female patient with an unruptured wide-necked carotid-ophthalmic artery aneurysm treated with low-profile visualized intraluminal support stent-assisted coil embolization. Four computational fluid dynamics models including pre-treatment, post-stenting, common stent-assisted coil embolization (SACE), and common SACE with finishing coils were evaluated qualitatively and quantitatively.Results: Compared with the baseline of pretreatment model (100%), sac-averaged velocity in post-stenting, common SACE, and common SACE with finishing coil models decreased to 95.68%, 24.38%, and 13.20%, respectively; high flow volume (>0.1 m/s) around the aneurysm neck decreased to 92.19%, 9.59%, and 5.57%, respectively; and mean wall shear stress increased or decreased to 107%, 25.94%, and 23.89%, respectively.Conclusion: Finishing coils to densely pack the aneurysm neck can generate favorable hemodynamic modifications, which may decrease the recurrence.

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 Ischemic Complications after Carotid Artery Stenting Associated with Stent Cell Design: Closed-cell versus Open-cell Stents

2017 ◽  
Vol 11 (7) ◽  
pp. 327-332
Author(s):  
Masataka Nanto ◽  
Yudai Goto ◽  
Hiroyuki Yamamoto ◽  
Seisuke Tanigawa ◽  
Hayato Takeuchi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Cell Design ◽  
Open Cell ◽  
Closed Cell ◽  
Ischemic Complications ◽  
Cell Versus

scholarly journals Usefulness of contrast-enhanced and TOF MR angiography for follow-up after low-profile stent-assisted coil embolization of intracranial aneurysms

2018 ◽  
Vol 24 (6) ◽  
pp. 655-661 ◽  
Author(s):  
Selcuk Akkaya ◽  
Onur Akca ◽  
Anıl Arat ◽  
Ahmet Peker ◽  
Sinan Balci
Keyword(s):  
Coil Embolization ◽  
Imaging Modality ◽  
Stent Patency ◽  
Total Occlusion ◽  
Stent Occlusion ◽  
Tof Mra ◽  
Low Profile ◽  
Contrast Enhanced ◽  
Aneurysm Occlusion

Background Low-profile, self-expandable stents are used to treat wide-neck aneurysms located on the smaller distal intracranial arteries. This study aimed to assess the usefulness of time-of-flight (TOF) and contrast-enhanced (CE) magnetic resonance angiography (MRA) for follow-up after LEO Baby stent (LBS)-assisted coil embolization. Methods Twenty-four aneurysms treated with LBS-assisted coil embolization were evaluated. Researchers reviewed TOF MRA and CE MRA images in terms of occlusion and stent patency. Aneurysm occlusion was graded according to Raymond–Roy classification as follows: total occlusion (grade 1), residual neck (grade 2), and residual aneurysm (grade 3). Stent patency was scored as follows: occlusion (1), stenosis (2), and normal (3). Interobserver and intermodality agreement values were determined by weighted kappa (κ) statistics. Results Intermodality and interobserver values of TOF MRA and CE MRA with digital subtraction angiography (DSA) were perfect (κ = 1.00, p < 0.001) in terms of aneurysm occlusion. Rate of stent occlusion and stenosis in DSA, TOF, and MRA, respectively, were as follows: 0 and 12.5%, 16.6 and 70.8%, and 0 and 62.5%. Intermodality agreement values of TOF MRA and CE MRA with DSA were insignificant in terms of stent patency (κ = 0.065, p = 0.27; κ = 0.158, p = 0.15, respectively). Interobserver agreement was substantial in both TOF MRA (κ = 0.71, p < 0.001) and CE MRA (κ = 0.64, p = 0.001). Conclusions Both TOF and CE MRA techniques have strong concordance with DSA for the detection of aneurysm occlusion status. CE MRA can be used as a first-line noninvasive imaging modality due to its superiority to TOF MRA with respect to the visualization of in-stent signals.

scholarly journals Assisted coiling using LEO Baby or LVIS Jr stents: Report of six cases

2015 ◽  
Vol 21 (5) ◽  
pp. 566-574 ◽  
Author(s):  
Matías Negrotto ◽  
Roberto Crosa ◽  
Walter Casagrande
Keyword(s):  
Endovascular Treatment ◽  
Coil Embolization ◽  
Chronic Phase ◽  
Secondary Coil ◽  
Anterior Communicating Artery ◽  
Internal Diameter ◽  
Good Decision ◽  
Aneurysm Neck ◽  
Low Profile

Background and purpose Endovascular treatment of broad-neck, complex cerebral aneurysms is a challenging issue. Placement of a stent over the aneurysm neck and secondary coil embolization prevents coil migration and allows dense packing of the coils. Another challenge is represented by distal aneurysms situated in small vessels. In these cases, the use of little stents, which we are going call ministents, could be a good decision. These low-profile intracranial ministents can be deployed into arteries with diameters between 1.5 and 3.10 mm and delivered through microcatheters with an internal diameter of 0.0165 inches, which allows easier navigation in small-sized, delicate vessels. We present six cases of wide-neck aneurysms, with small parental arteries less than 2.5 mm using a low-profile ministent system (LEO Baby and LVIS Jr) plus coil embolization. Materials and methods We retrospectively reviewed patients in whom LEO Baby or LVIS Jr stent was used for the treatment of intracranial aneurysms. Five aneurysms were treated during 2013–2014 in our service using the LEO Baby stent and one aneurysm using LVIS Jr. Stent-assisted coil embolization was performed using the jailing technique in all cases. Clinical and angiographic findings, procedural data, and follow-up are reported. Results Six consecutive patients were included in this study. Four patients presented with subarachnoid hemorrhage in the subacute–chronic phase and two patients had unruptured aneurysms. Two of the six aneurysms were located at branches of the sylvian artery, one at the basilar artery, two at the anterior communicating artery, and one at the P1–P2 artery. The procedures were successful. Six-month control digital subtraction angiograms were obtained in all cases; they demonstrated complete occlusion of the aneurysms in all instances. All patients had good clinical outcomes on follow-up, as measured with the Glasgow Outcome Scale and Modified Rankin Scale. Conclusions The results of this small study show that the LEO Baby and LVIS Jr ministents could be safe and efficient for endovascular treatment of intracranial broad-neck aneurysms situated in small arteries.

scholarly journals Y-Stent-Assisted Coiling With Low-Profile Neuroform Atlas Stents for Endovascular Treatment of Wide-Necked Complex Intracranial Bifurcation Aneurysms

Neurosurgery ◽  
2019 ◽  
Vol 87 (4) ◽  
pp. 744-753 ◽  
Author(s):  
Kubilay Aydin ◽  
Sinan Balci ◽  
Serra Sencer ◽  
Mehmet Barburoglu ◽  
Muzaffer Reha Umutlu ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cell Structure ◽  
Related Complication ◽  
Open Cell ◽  
Low Profile ◽  
Aneurysm Occlusion ◽  
Delayed Complications ◽  
Permanent Morbidity ◽  
Stenting Procedure

Abstract BACKGROUND Y-stent-assisted coiling is one of the eligible techniques for the treatment of complex bifurcation aneurysms. In majority of previous literature, Y-stenting has been performed using stents that could be delivered through large profile microcatheters that are often difficult to manipulate during navigation through sharply angled side branches. Attempts to navigate with these large profile catheters might cause serious complications during Y-stenting procedure. OBJECTIVE To investigate the safety, feasibility, and efficacy of Y-stent-assisted coiling procedure with Neuroform Atlas stents for the treatment of complex bifurcation aneurysms; Neuroform Atlas is a recently introduced open-cell stent that can be delivered though low-profile microcatheters. METHODS We identified the patients with intracranial bifurcation aneurysms treated by Y-stent-assisted coiling procedure with Neuroform Atlas stents. We assessed the immediate postoperative and follow-up clinical and angiographic outcomes. We also investigated the periprocedural and delayed complications. RESULTS A total of 30 aneurysms in 30 patients were included in the study. Y-stenting was successfully performed without any technical complications in all cases (100%). Immediate postprocedural angiography revealed total aneurysm occlusion in 83.3% of patients. The mean angiographic follow-up time was 11.8 mo. The last follow-ups showed complete occlusion in 93.3% of patients. There was no mortality in this study. A procedure-related complication developed in 6.7% and resulted in permanent morbidity in 3.3% of patients. CONCLUSION Neuroform Atlas stent combines the advantages of low-profile deployment microcatheters with an open-cell structure to achieve a successful Y-stenting procedure. Y-stent-assisted coiling with Neuroform Atlas stents provides a safe and effective endovascular treatment for wide-necked complex bifurcation aneurysms.

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