Reconstructive endovascular treatment of basilar artery fenestration aneurysms: A multi-centre experience and literature review

2021 ◽  
pp. 197140092110428
Author(s):  
Hanna Styczen ◽  
Sebastian Fischer ◽  
Matthias Gawlitza ◽  
Lukas Meyer ◽  
Lukas Goertz ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Basilar Artery ◽  
Flow Diversion ◽  
High Rate ◽  
Complete Occlusion ◽  
Secondary Endpoints ◽  
Aneurysm Occlusion ◽  
Complications Rate ◽  
Woven Endobridge

Background Data on outcome after endovascular treatment of basilar artery fenestration aneurysms (BAFAs) is limited. This study presents our multi-centre experience of BAFAs treated by different reconstructive techniques including coils, stent-assisted coiling (SAC), flow diversion and intra-saccular flow disruption with the Woven Endobridge (WEB). Methods Retrospective analysis of 38 BAFAs treated endovascularly between 2003 and 2020. The primary endpoint was complete aneurysm obliteration defined as Raymond–Roy occlusion classification (RROC) I on immediate and follow-up (FU) angiography. The secondary endpoints were procedure-related complications, rate of re-treatment, and clinical outcome. Results Endovascular treatment was feasible in 36/38 aneurysms (95%). The most frequent strategy was coiling (21/36, 58%), followed by SAC (7/36, 19%), WEB embolization (6/36, 17%) and flow diversion (2/36, 6%). A successful aneurysm occlusion (defined as RROC 1 and 2) on the final angiogram was achieved in 30/36 (83%) aneurysms including all patients presenting with baseline subarachnoid haemorrhage and 25/36 (69%) were occluded completely. Complete occlusion (RROC 1) was more frequently achieved in ruptured BAFAs (15/25, 60% v. 2/11, 18%; p = 0.031). Procedure-related complications occurred in 3/36 (8%) aneurysms. Re-treatment was executed in 12/36 (33%) aneurysms. After a median angiography FU of 38 months, 30/31 (97%) BAFAs were occluded successfully and 25/31 (81%) showed complete occlusion. Conclusion Reconstructive endovascular treatment of BAFAs is technically feasible with a good safety profile. Although in some cases re-treatment was necessary, a high rate of final aneurysm occlusion was achieved.

scholarly journals Very delayed discontinuation of telescoped Pipeline embolization devices: a case report

2018 ◽  
Vol 25 (2) ◽  
pp. 182-186
Author(s):  
Manoj Bohara ◽  
Kosuke Teranishi ◽  
Kenji Yatomi ◽  
Takashi Fujii ◽  
Takayuki Kitamura ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Flow Diversion ◽  
Total Occlusion ◽  
Pipeline Embolization Device ◽  
Complete Occlusion ◽  
Radiological Features ◽  
Long Term Follow Up ◽  
Aneurysm Occlusion

Background Flow diversion with the Pipeline embolization device (PED) is a widely accepted treatment modality for aneurysm occlusion. Previous reports have shown no recanalization of aneurysms on long-term follow-up once total occlusion has been achieved. Case description We report on a 63-year-old male who had a large internal carotid artery cavernous segment aneurysm. Treatment with PED resulted in complete occlusion of the aneurysm. However, follow-up angiography at four years revealed recurrence of the aneurysm due to disconnection of the two PEDs placed in telescoping fashion. Conclusion Herein, we present the clinico-radiological features and discuss the possible mechanisms resulting in the recanalization of aneurysms treated with flow diversion.

scholarly journals Pipeline embolization device for recurrence of previously treated aneurysms

2017 ◽  
Vol 42 (6) ◽  
pp. E8 ◽  
Author(s):  
David Dornbos ◽  
Constantine L. Karras ◽  
Nicole Wenger ◽  
Blake Priddy ◽  
Patrick Youssef ◽  
...  
Keyword(s):  
Flow Diversion ◽  
High Rate ◽  
Endovascular Coiling ◽  
Vessel Occlusion ◽  
Pipeline Embolization Device ◽  
Complete Occlusion ◽  
Microsurgical Clipping ◽  
Previously Treated ◽  
Angiographic Evidence

OBJECTIVEThe utilization of the Pipeline embolization device (PED) has increased significantly since its inception and original approval for use in large, broad-necked aneurysms of the internal carotid artery. While microsurgical clipping and advances in endovascular techniques have improved overall efficacy in achieving complete occlusion, recurrences still occur, and the best modality for retreatment remains controversial. Despite its efficacy in this setting, the role of PED utilization in the setting of recurrent aneurysms has not yet been well defined. This study was designed to assess the safety and efficacy of PED in the recurrence of previously treated aneurysms.METHODSThe authors reviewed a total of 13 cases in which patients underwent secondary placement of a PED for aneurysm recurrence following prior treatment with another modality. The PEDs were used to treat aneurysm recurrence or residual following endovascular coiling in 7 cases, flow diversion in 2, and microsurgical clipping in 4. The mean time between initial treatment and retreatment with a PED was 28.1 months, 12 months, and 88.7 months, respectively. Clinical outcomes, including complications and modified Rankin Scale (mRS) scores, and angiographic evidence of complete occlusion were tabulated for each treatment group.RESULTSAll PEDs were successfully placed without periprocedural complications. The rate of complete occlusion was 80% at 6 months after PED placement and 100% at 12 months in these patients who underwent PED placement following failed endovascular coiling; there were no adverse clinical sequelae at a mean follow-up of 26.1 months. In the 2 cases in which PEDs were placed for treatment of residual aneurysms following prior flow diversion, 1 patient demonstrated asymptomatic vessel occlusion at 6 months, and the other exhibited complete aneurysm occlusion at 12 months. In patients with aneurysm recurrence following prior microsurgical clipping, the rate of complete occlusion was 100% at 6 and 12 months, with no adverse sequelae noted at a mean clinical follow-up of 27.7 months.CONCLUSIONSThe treatment of recurrent aneurysms with the PED following previous endovascular coiling, flow diversion, or microsurgical clipping is associated with a high rate of complete occlusion and minimal morbidity.

Predictors of cerebral aneurysm persistence and occlusion after flow diversion: a single-institution series of 445 cases with angiographic follow-up

2018 ◽  
Vol 130 (1) ◽  
pp. 259-267 ◽  
Author(s):  
Matthew T. Bender ◽  
Geoffrey P. Colby ◽  
Li-Mei Lin ◽  
Bowen Jiang ◽  
Erick M. Westbroek ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Flow Diversion ◽  
Single Institution ◽  
Anterior Circulation ◽  
Complete Occlusion ◽  
Aneurysm Size ◽  
Branch Vessel ◽  
Aneurysm Occlusion ◽  
Anterior Circulation Aneurysms

OBJECTIVEFlow diversion requires neointimal stent overgrowth to deliver aneurysm occlusion. The existing literature on aneurysm occlusion is limited by heterogeneous follow-up, variable antiplatelet regimens, noninvasive imaging modalities, and nonstandard occlusion assessment. Using a large, single-center cohort with low attrition and standardized antiplatelet tapering, the authors evaluated outcomes after flow diversion of anterior circulation aneurysms to identify predictors of occlusion and aneurysm persistence.METHODSData from a prospective, IRB-approved database was analyzed for all patients with anterior circulation aneurysms treated by flow diversion with the Pipeline embolization device (PED) at the authors’ institution. Follow-up consisted of catheter cerebral angiography at 6 and 12 months postembolization. Clopidogrel was discontinued at 6 months and aspirin was reduced to 81 mg daily at 12 months. Occlusion was graded as complete, trace filling, entry remnant, or aneurysm filling. Multivariate logistic regression was performed to identify predictors of aneurysm persistence.RESULTSFollow-up catheter angiography studies were available for 445 (91%) of 491 PED procedures performed for anterior circulation aneurysms between August 2011 and August 2016. Three hundred eighty-seven patients accounted for these 445 lesions with follow-up angiography. The population was 84% female; mean age was 56 years and mean aneurysm size was 6.6 mm. Aneurysms arose from the internal carotid artery (83%), anterior cerebral artery (13%), and middle cerebral artery (4%). Morphology was saccular in 90% of the lesions, and 18% of the aneurysms has been previously treated. Overall, complete occlusion was achieved in 82% of cases at a mean follow-up of 14 months. Complete occlusion was achieved in 72%, 78%, and 87% at 6, 12, and 24 months, respectively. At 12 months, adjunctive coiling predicted occlusion (OR 0.260, p = 0.036), while male sex (OR 2.923, p = 0.032), aneurysm size (OR 3.584, p = 0.011), and incorporation of a branch vessel (OR 2.206, p = 0.035) predicted persistence. Notable variables that did not predict aneurysm occlusion were prior treatments, vessel of origin, fusiform morphology, and number of devices used.CONCLUSIONSThis is the largest single-institution study showing high rates of anterior circulation aneurysm occlusion after Pipeline embolization. Predictors of persistence after flow diversion included increasing aneurysm size and incorporated branch vessel, whereas adjunctive coiling predicted occlusion.

EVALUATION OF ONYX HD-500 EMBOLIC SYSTEM IN THE TREATMENT OF 84 WIDE-NECK INTRACRANIAL ANEURYSMS

Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. E865-E875 ◽  
Author(s):  
Ronie L. Piske ◽  
Luis H. Kanashiro ◽  
Eric Paschoal ◽  
Celso Agner ◽  
Sergio S. Lima ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
High Rate ◽  
Anterior Circulation ◽  
Complete Occlusion ◽  
Aneurysm Occlusion ◽  
Incomplete Occlusion ◽  
Wide Neck ◽  
Small Aneurysms ◽  
Platinum Coils

Abstract OBJECTIVE We report our results using Onyx HD-500 (Micro Therapeutics, Inc., Irvine, CA) in the endovascular treatment of wide-neck intracranial aneurysms, which have a high rate of incomplete occlusion and recanalization with platinum coils. METHODS Sixty-nine patients with 84 aneurysms were treated. Most of the aneurysms were located in the anterior circulation (80 of 84 aneurysms), were unruptured (74 of 84 aneurysms), and were incidental. Ten presented with subarachnoid hemorrhage, and 15 were symptomatic. All aneurysms had wide necks (neck >4 mm and/or dome-to-neck ratio <1.5). Fifty aneurysms were small (<12 mm), 30 were large (12 to <25 mm) and 4 were giant. Angiographic follow-up was available for 65 of the 84 aneurysms at 6 months, for 31 of the 84 aneurysms at 18 months, and for 5 of the 84 aneurysms at 36 months. RESULTS Complete aneurysm occlusion was seen in 65.5% of aneurysms on immediate control, in 84.6% at 6 months, and in 90.3% at 18 months. The rates of complete occlusion were 74%, 95.1%, and 95.2% for small aneurysms and 53.3%, 70%, and 80% for large aneurysms at the same follow-up periods. Progression from incomplete to complete occlusion was seen in 68.2% of all aneurysms, with a higher percentage in small aneurysms (90.9%). Aneurysm recanalization was observed in 3 patients (4.6%), with retreatment in 2 patients (3.3%). Procedural mortality was 2.9%. Overall morbidity was 7.2%. CONCLUSION Onyx embolization of intracranial wide-neck aneurysms is safe and effective. Morbidity and mortality rates are similar to those of other current endovascular techniques. Larger samples and longer follow-up periods are necessary.

Abstract WMP34: Low Yield of Further Angiographic Follow-up in Adequately Occluded Aneurysms After Flow Diversion

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Nohra Chalouhi ◽  
Guilherme Barros ◽  
Stavropoula Tjoumakaris ◽  
Ayan Kumar ◽  
Michael Lang ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
New Technology ◽  
Cerebral Aneurysms ◽  
Flow Diversion ◽  
Inclusion Criteria ◽  
Short Term ◽  
Complete Occlusion ◽  
Aneurysm Occlusion ◽  
Repeat Angiography

Background: Aneurysm recurrence after coil therapy remains a major shortcoming in the endovascular management of cerebral aneurysms. Flow diversion has emerged as a promising treatment for intracranial aneurysms. The safety and efficacy of this new technology is under investigation. The current study assesses the yield of further angiographic follow-up in aneurysms that have achieved adequate occlusion after treatment with the Pipeline Embolization Device (PED). Methods: Inclusion criteria were as follows: 1) treatment of one or more aneurysms with the PED, 2) available short-term (<12 months) follow-up digital subtraction angiography (DSA), 3) complete (100%) or near-complete (>95%) occlusion on short-term follow-up DSA, and 4) available further angiographic follow-up (DSA or MRA). Results: A total of 175 patients matching the inclusion criteria were identified. Aneurysm size was 9.0 mm on average. Mean angiographic follow-up was 23.4 months. On short-term follow-up DSA images, 154 (88%) had complete aneurysm occlusion and 21 (12%) had near-complete occlusion. Seven patients (4%) had further DSA follow-up alone, 39 patients (22%) had further DSA and MRA follow-up, and 129 patients (74%) had further MRA follow-up alone. On further angiographic follow-up (DSA or MRA), no patient had a decrease in the degree of aneurysm occlusion (recurrence) or required retreatment. Of the 21 patients with near-complete occlusion on initial DSA images, 5 patients (24%) progressed to complete aneurysm occlusion on further angiographic follow-up. No patient had evidence of new in-stent stenosis on further angiographic follow-up. Conclusion: In this study, the diagnostic yield of repeat angiography in adequately occluded aneurysms with the PED was very low. Based on these findings, we do not recommend further angiographic follow-up once aneurysms have achieved adequate occlusion with the PED.

scholarly journals Super-selective coil embolization of a basilar perforator artery aneurysm previously treated by the stent-in-stent technique, using an extremely soft bare coil delivered through a one-marker microcatheter

2017 ◽  
Vol 23 (5) ◽  
pp. 492-496 ◽  
Author(s):  
Yves Chau ◽  
Marina Sachet ◽  
Jacques Sédat
Keyword(s):  
Basilar Artery ◽  
Coil Embolization ◽  
Artery Aneurysm ◽  
Modified Rankin Scale ◽  
Complete Occlusion ◽  
First Case ◽  
Previously Treated ◽  
Aneurysm Occlusion ◽  
Perforating Arteries

Background Aneurysms of the perforating arteries arising from the basilar artery trunk are rare and represent a therapeutic challenge. Methods A basilar perforator aneurysm was initially treated by the stent-in-stent technique. Enlargement of the aneurysm was seen on follow up and the sac was secondarily coiled using two extremely soft bare coils, delivered through a one-marker microcatheter. Results At 6 months, the patient had a modified Rankin Scale score of 0 and cerebral arteriography demonstrated complete occlusion of the lesion. Conclusions We describe, as far as we are aware, the first case of basilar perforator aneurysm occlusion using extremely soft bare coils, inserted through the mesh of two stents previously placed in the basilar trunk.

scholarly journals Endovascular treatment of cerebral dural arteriovenous fistulas with SQUID 12

2020 ◽  
Vol 26 (5) ◽  
pp. 651-657
Author(s):  
Emilio Lozupone ◽  
Sandra Bracco ◽  
Pietro Trombatore ◽  
Luca Milonia ◽  
Francesco D’Argento ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
High Rate ◽  
Embolic Agent ◽  
Complete Occlusion ◽  
Arteriovenous Fistulas ◽  
Clinical Complications ◽  
Lower Viscosity ◽  
Embolic Agents ◽  
Dural Arteriovenous Fistulas

Background Endovascular therapy with liquid embolic agents (LEAs) is the gold standard for the treatment of cerebral dural arteriovenous fistulas (cDAVFs). The aim of the study is to retrospectively evaluate effectiveness, safety, and midterm follow-up results of endovascular treatment of cDAVFs using SQUID 12. Methods Between June 2017 and January 2020 the authors retrospectively reviewed clinical, demographic and embolization data of 19 consecutive patients with cDAVF who underwent embolization using SQUID 12. The number of arteries catheterized for each procedure, the total amount of embolic agent, the occlusion rate, the injection time, any technical and/or clinical complications were recorded. Mid-term follow-up with DSA was reviewed. Results 20 procedures were performed in 19 patients. A transarterial approach was accomplished in 19 procedure; a combined transvenous-transarterial approach was realized in 1 treatment. The average time of injection was 33 minutes (2–82 minutes), and the average amount of SQUID 12 was 2.8 mL (0.5–6 mL). Complete angiographic cure at the end of the procedure was achieved in 17 patients. No major periprocedural adverse events were recorded. Mid-term follow-up was achieved in 15 out of 19 patients and confirmed complete occlusion of the cDAVFs in 13/15 patients (87%); in 2 of the initially cured patients a small relapse was detected. Conclusions The treatment of the cDAVFs using SQUID 12 was effective and safe. The lower viscosity seems to allow an easier penetration of the agent with a high rate of complete occlusion of the cDAVFs.

Flow-Diversion for Ophthalmic Segment Aneurysms

Neurosurgery ◽  
2015 ◽  
Vol 76 (3) ◽  
pp. 286-290 ◽  
Author(s):  
Mario Zanaty ◽  
Nohra Chalouhi ◽  
Guilherme Barros ◽  
Eric Winthrop Schwartz ◽  
Mark Philip Saigh ◽  
...  
Keyword(s):  
Complication Rate ◽  
Flow Diversion ◽  
High Rate ◽  
Complication Rates ◽  
Complete Occlusion ◽  
Obliteration Rate ◽  
Visual Symptoms ◽  
Aneurysm Occlusion ◽  
Ophthalmic Segment Aneurysms ◽  
Incomplete Occlusion

Abstract BACKGROUND: The use of flow-diversion to treat ophthalmic segment aneurysms (OSA) has not been well evaluated. OBJECTIVE: To assess the visual outcomes, the obliteration rate, and the need for retreatment of OSA treated by the pipeline embolization device (PED). METHODS: Patients who underwent treatment with PED for OSA from 2009 to 2014 were selected and retrospectively reviewed. Patient's age, sex, mode of presentation, and aneurysm size were recorded. The complication rates, the need for retreatment (due to recurrence of the aneurysm or worsening symptoms), the aneurysm occlusion rates, the evolution of visual symptoms, and the evolution of headache/retro-orbital pain were registered. RESULTS: Forty-one patients harboring 44 OSA treated by flow-diversion were identified. Females constituted 87.80% (37/41) of the cohort. The mean age was 59.16 ± 12.54 years. At final angiographic follow-up, 77.27% (34/44) had complete occlusion, 6.81% (3/44) had near-complete occlusion, and 15.90% (7/44) had incomplete occlusion. Of the 22 symptomatic OSA, complete resolution or significant improvement was noted in 72.72% (16/22), while worsening of symptoms occurred in 4.54% (1/22). Five patients out of 22 (22.72%; 5/22) had no significant changes in their symptoms. The complication rate was 2.27% (1/44). The mortality rate was 0%. CONCLUSION: The low complication rate, the high obliteration rate, and the high rate of improvement in the visual symptoms make flow-diversion an appealing option for the treatment of OSA.

scholarly journals Repeat Flow Diversion for Previously Failed Flow Diversion in A Multicenter Cohort

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Mohamed M Salem ◽  
Ahmad Sweid ◽  
Anna L Kuhn ◽  
Adam A Dmytriw ◽  
Muhammad Waqas ◽  
...  
Keyword(s):  
Initial Treatment ◽  
Clinical Status ◽  
Subsequent Treatment ◽  
Flow Diversion ◽  
Small Subset ◽  
Complete Occlusion ◽  
Maximal Diameter ◽  
Aneurysm Occlusion ◽  
Treatment Procedures

Abstract INTRODUCTION Aneurysmal persistence after pipeline embolization device (PED) treatment occurs in a small subset of treated aneurysms which might necessitate further treatment. Most cases are managed by deploying another PED in a telescoping fashion within the existing PED. There is no existing data in the literature regarding the efficacy of such strategy. METHODS A retrospective review of repeated attempts at flow diversion in 7 North-American cerebrovascular centers was performed. Patients were included if the repeat flow diversion occurred at least 6 months after initial treatment. Patients with no radiological follow up after second treatment were excluded. Clinical and radiographic data was collected from the records. The primary outcome was aneurysm occlusion at last follow-up with secondary outcomes of clinical status and complications. RESULTS A total of 58 patients (median age 57 yr, 89.7% females) harboring 58 aneurysms underwent 122 treatment procedures. Majority of aneurysms were unruptured (91.3%); 82.8% were saccular and 91.4% were located in the internal carotid artery with a mean maximal diameter of 9.5 mm. 52 patients were treated twice while 6 patients were treated 3 times. A single device was used in 87.9% of the patients in the initial treatment procedure, and in 94.8% of the patients in the subsequent treatment attempt. Mean elapsed-time between first and second treatment was 13.5 mo. Last imaging follow-up was performed at median of 33.4 mo after initial treatment, showing complete occlusion in 53.4%, and near complete occlusion (90%-99%) in 15.5% of aneurysms. Transient ischemic neurologic complications were encountered in 3.4% of patients, with no permanent complications. Last follow up mRS of 0-2 were noted in 100% of patients, with mean clinical follow up of 37 mo. 57 (98.3%) patients had a final disposition to their own home. CONCLUSION Repeat flow diversion for persistent aneurysms is associated with a reasonable chance of success and acceptable safety profile.

Endovascular treatment of previously clipped aneurysms: continued evolution of hybrid neurosurgery

2016 ◽  
Vol 9 (2) ◽  
pp. 169-172 ◽  
Author(s):  
Bradley A Gross ◽  
Felipe C Albuquerque ◽  
Karam Moon ◽  
Andrew F Ducruet ◽  
Cameron G McDougall
Keyword(s):  
Endovascular Treatment ◽  
Treatment Approach ◽  
Flow Diversion ◽  
Digital Subtraction ◽  
Narrow Neck ◽  
Neurological Morbidity ◽  
Aneurysm Occlusion ◽  
Digital Subtraction Angiographic ◽  
Therapy Treatment

Background/objectiveThe optimal management of residual or recurrent clipped aneurysms is infrequently addressed in the literature.MethodsWe reviewed our endovascular database from January 1998 to May 2016 to identify patients with clipped aneurysms undergoing subsequent endovascular treatment, evaluating treatment approach, and clinical and angiographic outcomes.Results60 patients underwent endovascular treatment of residual/recurrent clipped aneurysms; 7 rebled prior to endovascular therapy. Treatment was via coiling alone (n=25, 42%), stent assisted coiling (n=15, 25%), balloon assisted coiling (n=8, 13%), flow diversion (n=8, 13%), stenting alone (n=3, 5%), or flow diversion with coiling (n=1, 2%). The procedural permanent neurological morbidity and mortality rates were 3% and 2%, respectively. Over a clinical follow-up of 253.4 patient years (median 3.9 years), there was one rebleed in a patient who had declined further treatment. For 43 patients with at least 1 month of digital subtraction angiographic follow-up (median 3.4 years), complete aneurysm occlusion was seen in 79% of cases. Neck remnants were observed in 14%, and stable small dome remnants were observed in 7% of cases. In a subgroup of 18 patients with ‘clip induced’ narrow neck aneurysms, all domes were initially coil occluded (Raymond 1 or 2); there was no permanent procedural morbidity and no aneurysms required retreatment or recanalized over a median follow-up of 3.9 years.ConclusionsEndovascular treatment of residual or recurrent clipped aneurysms is an excellent treatment approach in well selected patients; ‘clip induced’ narrow neck aneurysms fare particularly well after treatment both angiographically and clinically.

Sign in / Sign up

Export Citation Format

Share Document