scholarly journals Endovascular treatment of unruptured aneurysms of cavernous and ophthalmic segment of internal carotid artery with flow diverter device Pipeline

2016 ◽  
Vol 50 (4) ◽  
pp. 378-384 ◽  
Author(s):  
Marko Jevsek ◽  
Charbel Mounayer ◽  
Tomaz Seruga
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Treatment Success ◽  
Giant Aneurysm ◽  
Flow Diverter ◽  
Unruptured Aneurysms ◽  
Aneurysm Neck ◽  
Flow Diverter Device

Abstract Background Intra-arterial treatment of aneurysms by redirecting blood flow is a newer method. The redirection is based on a significantly more densely braided wire stent. The stent wall keeps the blood in the lumen of the stent and slows down the turbulent flow in the aneurysms. Stagnation of blood in the aneurysm sac leads to the formation of thrombus and subsequent exclusion of the aneurysm from the circulation. The aim of the study was to evaluate flow diverter device Pipeline for broad neck and giant aneurysm treatment. Methods Fifteen patients with discovered aneurysm of the internal carotid artery were treated between November 2010 and February 2014. The majority of aneurysms of the internal carotid artery were located intradural at the ophthalmic part of the artery. The patients were treated using a flow diverter device Pipeline, which was placed over the aneurysm neck. Treatment success was assessed clinically and angiographically using O’Kelly Marotta scale. Results Control angiography immediately after the release of the stent showed stagnation of the blood flow in the aneurysm sac. In none of the patients procedural and periprocedural complications were observed. 6 months after the procedure, control CT or MR angiography showed in almost all cases exclusion of the aneurysm from the circulation and normal blood flow in the treated artery. Neurological status six months after the procedure was normal in all patients. Conclusions Treatment of aneurysms with flow diverter Pipeline device is a safe and significantly less time consuming method in comparison with standard techniques. This new method is a promising approach in treatment of broad neck aneurysms.

Flow diversion of large internal carotid artery aneurysms with the surpass device: impressions and technical nuance from the initial North American experience

2015 ◽  
Vol 8 (3) ◽  
pp. 279-286 ◽  
Author(s):  
Geoffrey P Colby ◽  
Li-Mei Lin ◽  
Justin M Caplan ◽  
Bowen Jiang ◽  
Barbara Michniewicz ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Flow Diverter ◽  
Flow Diversion ◽  
Initial Experience ◽  
Unruptured Aneurysms ◽  
Aneurysm Neck ◽  
Aneurysm Embolization ◽  
Grade Ii

BackgroundFlow diversion is an important tool for treatment of cerebral aneurysms, particularly large and giant aneurysms. The Surpass flow diverter is a new system under evaluation in the USA.ObjectiveTo report our initial experience of 20 cases with the Surpass flow diverter to demonstrate its basic properties, the required triaxial delivery platform, and the methodologies used to deploy it during treatment of large internal carotid artery (ICA) aneurysmsMethodsTwenty patients with ICA aneurysms ≥10 mm with ≥4 mm neck treated as part of the Surpass IntraCranial Aneurysm Embolization System Pivotal Trial (the SCENT trial; Stryker) were included. Details of patient demographics, aneurysm characteristics, and technical procedures were collected.ResultsTwenty patients (mean age 63.3±1.3 years; range 51–72) with 20 unruptured aneurysms (mean size 13.4±0.9 mm; range 10–21 mm) were treated. For proximal access, 60% of cases had aortic arch ≥grade II, 55% had significant cervical ICA tortuosity, and 60% had cavernous ICA ≥grade II. The Surpass device was implanted in 19/20 (95%) cases. Of 19 cases, a single device was used in 18 cases (95%) and 2 devices in only 1 case (5%). Balloon angioplasty was performed in 8/19 cases (42%). Complete aneurysm neck coverage and adequate vessel wall apposition was obtained in all 19 cases.ConclusionsSurpass is a next-generation flow diverter with unique device-specific and delivery-specific features compared with clinically available endoluminal flow diverters. Our initial experience demonstrates a favorable technical profile in treatment of large and giant ICA aneurysms.Trial registration numberNCT01716117.

scholarly journals Successful Treatment of Giant Intracranial Aneurysm Using Flow-Diverter Device: First Experience in Nepal

2020 ◽  
Vol 18 (3) ◽  
pp. 563-565
Author(s):  
Subash Phuyal ◽  
Pooja Agrawal ◽  
Ritesh Lamsal ◽  
Nirmal Prasad Neupane ◽  
Gopal Sedain
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Giant Aneurysm ◽  
Flow Diverter ◽  
Vascular Lesions ◽  
Successful Management ◽  
Flow Diverter Devices ◽  
First Time ◽  
Flow Diverter Device

Giant intracranial aneurysms are defined as aneurysms that measure over 25 mm in the greatest dimension. They are rare vascular lesions that preferentially involve regions with high-velocity blood flow, such as the cavernous and supraclinoid segments of the internal carotid artery, the middle cerebral artery, the vertebrobasilar region, and the basilar apex. The treatment of giant aneurysms is challenging and associated with high rates of morbidity and mortality. Flow-diverter devices have revolutionized their treatment in recent times. We report the successful management of two patients with giant cavernous internal carotid artery aneurysms using flow-diverter devices for the first time in Nepal. Keywords: Endovascular; flow-diverter devices; giant aneurysm

Endovascular Treatment of Aneurysms Using Flow-Diversion Embolization: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Daniel D Cavalcanti ◽  
Peter Kim Nelson ◽  
Eytan Raz ◽  
Maksim Shapiro ◽  
Erez Nossek ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Cranial Nerves ◽  
Giant Aneurysm ◽  
Flow Diverter ◽  
Flow Diversion ◽  
Neck Infection ◽  
The Right ◽  
Lower Cranial Nerves

Abstract Initially developed for large and giant wide-necked aneurysms of the internal carotid artery, flow diverter devices are now used in almost every location safely and with effectiveness.1-5 This video demonstrates a unique case of a giant aneurysm of the right petrous internal carotid artery in a 20-yr-old patient. This is an extremely rare location, and most of patients are asymptomatic.3-6 Signs of compression of the seventh and eight cranial nerves can be present and even Horner syndrome and lower cranial nerves neuropathies. Nevertheless, rupture can lead to epistaxis and otorrhagia, and ultimately to hemorrhagic shock. The patient in the current report was otherwise healthy but presented with lightheadedness and dizziness for 10 d. The patient consented to the procedure. There was no history of major trauma or head and neck infection. A transradial endovascular flow diversion embolization of a giant aneurysm of the petrous internal carotid artery is herein demonstrated in a stepwise manner. A triaxial system was used to deploy 3 overlapping devices. Concepts of J-wire technique, multiple coverage,1 and the so-called weld technique are emphasized. The role of adjunctive coiling and main reasons for failure are also discussed.7,8 Brief cases of flow diversion embolization of aneurysms of different morphologies at different locations are used to highlight the importance of assessing vessel wall apposition and follow-up imaging.

Visual complications after coil embolization of internal carotid artery aneurysms at the ophthalmic segment

2021 ◽  
pp. 159101992199688
Author(s):  
Shotaro Michishita ◽  
Toshihiro Ishibashi ◽  
Ichiro Yuki ◽  
Mitsuyoshi Urashima ◽  
Kostadin Karagiozov ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Coil Embolization ◽  
Internal Carotid ◽  
Visual Outcome ◽  
Unruptured Aneurysms ◽  
Aneurysm Neck ◽  
Significant Difference ◽  
Aneurysmal Neck ◽  
The Relationship

Background Coil embolization of aneurysms of the ophthalmic segment of the internal carotid artery (ICA-OphA ANs) has potential risks of visual complications. We analyzed this risk and focused on the relationship of the ophthalmic artery (OphA) origin with the aneurysm neck. Methods From January 2003 to April 2018, 179 unruptured ICA-OphA ANs were treated with endovascular surgery in our institution. Two ruptured and four aneurysms with missing data were excluded. Finally, 173 unruptured aneurysms were included in this study. The aneurysms were classified into three groups according to the location of the OphA origin: Separate, Shared, and Dome type. We retrospectively assessed visual complications based on the relationship between types of aneurysm and postoperative angiographic findings for the OphA. Results Visual deficits remained permanent in eleven cases (6.4%). In the Dome type, visual complications were significantly more frequent compared to the Separate type. Change in the OphA flow was significantly associated with a higher complication rate of 2.9%, but patients with changed OphA flow had a significant rate of 7.5% ( p = 0.020). We found no significant difference in the incidence of visual complications concerning the use of perioperative antithrombotic therapy. Conclusions The location of OphA origin regarding the aneurysmal neck and postoperative OphA flow were significantly correlated with the visual outcome after coil embolization for ICA-OphA ANs. Post-procedural flow in the OphA was an important factor affecting the rate of ischemic retinal complications. Retinal embolic events occurred with preserved flow in the OphA, albeit at a lower rate.

scholarly journals Three-Dimensional Intraarterial Vaso Computed Tomography Depiction of Pipeline Flex with Shield Technology Flow Diverter Stent in Ruptured Blister Aneurysm of Supraclinoid Internal Carotid Artery

2021 ◽  
Author(s):  
Rasmiranjan Padhi ◽  
Sathish Kandasamy ◽  
BalaSenthil Kumaran
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Treatment Options ◽  
Three Dimensional ◽  
Significant Risk ◽  
Flow Diverter ◽  
Aneurysm Neck ◽  
Flow Diverter Stent ◽  
Supraclinoid Internal Carotid Artery

AbstractBlister aneurysms are intracranial arterial lesions originating at nonbranching sites of the dorsal supraclinoid internal carotid artery and basilar artery.1 Among different treatment options, the use of flow-diverting devices is gaining popularity and has the potential for becoming the standard of care.2 Radiological evaluation of flow diverter braid expansion and vessel wall apposition during procedure has become useful in preventing life-threatening complications. Incomplete coverage of an aneurysm neck, kinking, or incomplete expansion and malapposition of a stent carries a significant risk for thromboembolic events.3 4

scholarly journals Supraclinoid internal carotid artery blister-like aneurysms: hypothesized pathogenesis and microsurgical clipping outcomes

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Shanwen Chen ◽  
Xin Chen ◽  
Bo Ning ◽  
Yong Cao ◽  
Shuo Wang
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Treatment Guidelines ◽  
Treatment Strategies ◽  
Neurological Dysfunction ◽  
Parent Artery ◽  
Unruptured Aneurysms ◽  
Aneurysm Neck ◽  
Microsurgical Clipping

Abstract Background Blister-like aneurysms (BLAs) on the supraclinoid segment of the internal carotid artery (ICA) are an enigma of cerebrovascular disease. Neither has a definite pathogenesis been so far identified, nor have uniform treatment guidelines been established for them. Our aim was to develop a hypothesis regarding the evolution of BLAs according to their macroscopic morphologies and to evaluate the efficacy of microsurgical clipping. Methods The clinical data and morphological features of 15 consecutive patients with 16 BLAs on the supraclinoid ICA were retrospectively reviewed. The treatment strategies were analyzed, and functional outcomes were evaluated using the modified Rankin scale (mRS). Favorable outcomes were defined as a mRS score of 0–2. Results Morphologically, aneurysm growth with expansion of the aneurysm neck before the surgical procedure occurred in two ruptured and one unruptured aneurysm. Daughter bleb formation was observed in two ruptured and five unruptured aneurysms. A varied degree of parent artery sclerosis was observed in nine patients. Thirteen patients were treated with direct surgical clipping, one patient was treated with clipping and wrapping, and the remaining patient was treated with an encircling clipping graft. Favorable and unfavorable outcomes were observed in 13 and two cases, respectively. Follow-up angiograms revealed 4 cases of stenosis with respective degree of mild, 30%, 50%, and 80% without any neurological dysfunction. Conclusions We suggest a hypothesis that BLAs on the supraclinoid ICA may share different evolving mechanisms between ruptured and unruptured lesions. A majority of them can be reliably and safely obliterated by direct clipping technique, except for the aneurysms accompanied with severely atherosclerotic parent walls.

scholarly journals Flow-diverting Stent-assisted Coil Embolization of a Ruptured Internal Carotid Artery Blister Aneurysm with the Pipeline Flex Embolization Device

2017 ◽  
Vol 08 (04) ◽  
pp. 664-667 ◽  
Author(s):  
Dale Ding ◽  
Robert M. Starke ◽  
Ayton Hope ◽  
Stefan Brew
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Flow Diverter ◽  
High Grade ◽  
Parent Vessel ◽  
Future Studies ◽  
Aneurysm Neck ◽  
Flow Diverting Stent

ABSTRACTInternal carotid artery (ICA) blister aneurysms are rare and challenging to successfully treat, using contemporary surgical or endovascular approaches, without partial or complete compromise of the parent vessel. We describe the use of a resheathable flow diverter, the Pipeline Flex Embolization Device (PFED) to perform stent-assisted coiling of a ruptured supraclinoid ICA blister aneurysm in a 56-year-old female who presented with a high-grade subarachnoid hemorrhage (SAH). The first PFED was deployed across the aneurysm neck to jail a microcatheter within the aneurysm dome, and then, two small coils were delivered into the aneurysm. After removing the coiling microcatheter, the second PFED was telescoped into the first PFED. There were no postprocedural complications, and follow-up magnetic resonance angiography 15 months after embolization showed complete aneurysm obliteration. Flow-diverting stent-assisted coiling should be considered as a reconstructive, vessel-preserving, endovascular treatment option for appropriately selected patients with ruptured ICA blister aneurysms. However, future studies are necessary to assess the periprocedural safety in the setting of acute SAH.

Ipsilateral hyperperfusion after neck clipping of a giant internal carotid artery aneurysm

2002 ◽  
Vol 97 (5) ◽  
pp. 1233-1236 ◽  
Author(s):  
Hideki Murakami ◽  
Makoto Inaba ◽  
Akiyoshi Nakamura ◽  
Takakazu Ushioda
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Giant Aneurysm ◽  
Content Type ◽  
Circulatory Disturbance ◽  
Internal Carotid Artery Aneurysm ◽  
Flow Through

✓ A 48-year-old woman exhibited hyperperfusion soon after undergoing a successful clip operation involving multiple clip placement for a giant internal carotid artery (ICA) aneurysm. Intraarterial digital subtraction angiography demonstrated a left paraclinoid giant aneurysm. Multiple clips were placed to obliterate the aneurysm during a 7minute temporary ICA occlusion. Intraoperative Doppler ultrasound flowmetry showed that the blood flow through the ICA distal to the aneurysm increased from 71.6 ml/minute before clipping to 123.3 ml/minute after. The patient exhibited right hemiparesis and motor aphasia after the operation. Postoperative imaging studies revealed an increase in perfusion and diffuse edema in the left cerebral cortex. The symptoms and diffuse brain edema gradually resolved. In this case, increase in blood flow through the ICA distal to the aneurysm may have played an important role in the circulatory disturbance.

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