Flow diverting stents in the treatment of intracranial aneurysms

2018 ◽  
Vol 20 (2) ◽  
pp. 27-34 ◽  
Author(s):  
A. O. Sosnov ◽  
V. S. Kiselev ◽  
R. R. Gafurov ◽  
A. М. Perfilev
Keyword(s):  
Death Rate ◽  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Modified Rankin Scale ◽  
Digital Subtraction ◽  
Endovascular Techniques ◽  
Total Occlusion ◽  
Study Objective ◽  
Occlusion Rate ◽  
Complications Rate

The study objectiveis to evaluate the effectiveness of surgical treatment of intracranial aneurysms with the use of flow diverting stents (FDS).Materials and methods.In 2016, in the Federal Neurosurgical Center (Novosibirsk) 64 patients (11 men, 53 women, mean age – 50.1 ± 11.4 years) with intracranial aneurysms were operated on; 69 FDS were implanted. Total number of occluded aneurysms 64.Results.The digital subtraction angiography control after 6 months demonstrated, that the total occlusion rate with was in 71 % cases, subtotal – in 29 %. An excellent and good functional outcome (modified Rankin scale 0–2) was obtained in 60 (93.7 %) patients, poor (modified Rankin scale 3–5) – in 4 (6.3 %). Complications rate were 4.7 %, death rate – 0 %.Conclusion.The implantation of FDSs is an effective method for the treating of cerebral aneurysms, including cases, when using alternative endovascular techniques has a high risk of recanalization, and the microsurgical treatment has an increased operating risk.

scholarly journals The Accuracy and Usefulness of 3D-DSA and 3D-CT Angiography for Cerebral Aneurysms

2001 ◽  
Vol 7 (1_suppl) ◽  
pp. 181-186 ◽  
Author(s):  
F. Ishida ◽  
K. Kawaguchi ◽  
M. Mizuno ◽  
T. Hoshino ◽  
K. Murao ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Three Dimensional ◽  
Cerebral Aneurysms ◽  
Computed Tomographic Angiography ◽  
Dissecting Aneurysm ◽  
Digital Subtraction ◽  
Computed Tomographic ◽  
3D Ct Angiography ◽  
The Difference ◽  
Tomographic Angiography

For evaluation of intracranial cerebral aneurysms, three-dimensional (3D) digital subtraction angiography (DSA) and 3D-computed tomographic angiography (CTA) were demonstrated in fifteen patients. The diagnostic accuracy of preoperative 3DCTA is equal to that of 3D-DSA except for the case with a dissecting aneurysm. The virtual images of 3D-CTA were well correlated with surgical findings. In endovascular treatment of intracranial aneurysms, 3D-DSA had an obvious advantage in obtaining the best working angle of the C-arm. The major branches originating from the dome were depicted on 3D-DSA in two cases that could not be judged on 3D-CTA. The aim of the present study was to verify the difference between 3D-DSA and 3D-CTA for evaluation of intracranial aneurysms.

Endovascular Retreatment of Cerebral Aneurysms Previously Treated with Endovascular Embolization

2019 ◽  
Vol 81 (03) ◽  
pp. 207-212
Author(s):  
Bu-Lang Gao ◽  
Hui Li ◽  
Cong-Hui Li ◽  
Ji-Wei Wang ◽  
Jian-Feng Liu ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Covered Stents ◽  
Partial Occlusion ◽  
Recurrence Rates ◽  
Total Occlusion ◽  
Factors Affecting ◽  
Aneurysm Size

Objective Intracranial aneurysms treated with endovascular coil embolization may recur. We investigated the factors affecting aneurysmal recurrence after embolization and effects of endovascular retreatment within 1 year. Methods In 3 years, 1,335 patients with 1,385 intracranial aneurysms were treated with coil embolization. Factors affecting aneurysm recurrence and the effects of endovascular retreatment were analyzed. Results Angiography immediately following embolization showed total occlusion in 1,030 aneurysms (74.4%), neck remnant in 207 (14.9%), and partial occlusion in 148 (10.7%), with a total peri-procedure complication rate of 4.2%. Overall, 145 patients with 151 aneurysms recurred within 1 year and the other 1,234 aneurysms remained occluded (89.1%). A significant (p < 0.05) difference existed in aneurysm size, rupture status, use of stent and immediate occlusion outcome between the two groups, with significantly (p < 0.05) lower recurrence rates in aneurysms with smaller sizes, no rupture and stent-assistance coiling. Neck remnant, partial occlusion, coiling without stent assistance, large and giant aneurysms were significant (p < 0.05) risk factors for aneurysm recurrence during the first year. The rate of recurrence was 4.7% (11/232) in aneurysms with total occlusion and 35.9% (23/64) in aneurysms with neck remnant and partial occlusion. Of the 34 recurrent aneurysms, 6 were re-embolized with detachable coils alone, 12 with stent-assisted coiling, 8 with balloon-assisted embolization, and the remaining 8 aneurysms with covered stents, resulting in total occlusion in 28 aneurysms and neck remnant in 6. Conclusion Recurrence of previously-coiled cerebral aneurysms is significantly affected by aneurysm size, use of stent and degree of immediate occlusion. Endovascular retreatment with balloon-or stent-assisted techniques or with covered stents can be safe and effective for recurrent cerebral aneurysms.

scholarly journals Early Experience Studying Cerebral Aneurysms with Rotational and Three-Dimensional Angiography and Review of CT and MR Angiography Literature

2002 ◽  
Vol 8 (4) ◽  
pp. 377-391 ◽  
Author(s):  
C.H. Castaño-Duque ◽  
J. Ruscalleda-Nadal ◽  
M. de Juan-Delago ◽  
E. Guardia-Mas ◽  
L. San Roman-Manzanera ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Three Dimensional ◽  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Lower Sensitivity ◽  
Parent Artery ◽  
Philips Medical System ◽  
Multiple Series ◽  
Total Occlusion ◽  
Aneurysmal Neck

From september 2000 to september 2001, 32 consecutive patients with ruptured intracranial aneurysms were examined with rotational and 3D reconstruction angiography using an Integris V5000 Philips Medical System: 39 aneurysms were detected. After a selective cerebral artery was catheterized with a 5F or 4F-catheter, 35 ml of contrast medium was intra-arterially administered at a rate of 4 ml/s and a 180° rotational angiography was performed in eight seconds. This information was transferred to a computer (Silicon Graphics Octane) with software (Integris 3DRA, Philips Integris Systems) and a three-dimensional reconstruction was made. The information provided by Angio-3D was useful for evaluating the parent artery, aneurysmal sac, aneurysmal neck and arterial branches. It was also very useful in selecting the therapeutic method. For open surgery, this technique provides preoperative images that are useful for planning microsurgical approaches, especially in cases of large aneurysm showing complex surrounding arteries. For endovascular embolization, various anatomic characteristics of the aneurysm such as neck and sac size, shape, lobularity, parent artery and arterial branches adjacent to the aneurysmal neck must be demonstrated. This is very important to determine the best projection for embolization and to avoid multiple series. This is also essential in the choice of the first coil to create a good basket producing total occlusion. Microaneurysms are demonstrated well with this technique whereas this is difficult to do with conventional arteriography. The Angio-RM and Angio-CT literature show a lower sensitivity and specificity in comparasion with our experience with 3D IA-ROT-DSA. For this reason, we believe that 3D IA-ROTDSA is now the gold standard for patients presenting intracranial aneurysms.

Use of the sole stenting technique for the management of aneurysms in the posterior circulation in a prospective series of 20 patients

2008 ◽  
Vol 108 (6) ◽  
pp. 1104-1118 ◽  
Author(s):  
Marco Antonio Zenteno ◽  
Jorge Arturo Santos-Franco ◽  
Jose Maria Freitas-Modenesi ◽  
Camilo Gómez ◽  
Luis Murillo-Bonilla ◽  
...  
Keyword(s):  
Clinical Utility ◽  
Posterior Circulation ◽  
Digital Subtraction ◽  
Effective Technique ◽  
Total Occlusion ◽  
Brainstem Compression ◽  
Occlusion Rate ◽  
Subarachnoid Hemorrhages ◽  
A Current

Object The use of intracranial stents in stent-assisted coil embolization is now a current neurosurgical practice worldwide. The clinical utility of these stents in the sole stenting (SS) technique, however, has not been thoroughly described, and the published reports of this experience are scarce. This study was designed to evaluate SS treatment of dissecting and nondissecting aneurysms of the posterior circulation. Methods This prospective and descriptive study was conducted in 20 consecutive patients who harbored single aneurysms of the posterior circulation and who were treated using the SS approach in the last 3 years. The clinical and radiological assessment and follow-up of the patients were evaluated using the modified Rankin scale as well as with computed tomography angiography and digital subtraction angiography at discharge and at 1, 3, 6, and 12 months. Results Eleven of the 20 patients had subarachnoid hemorrhages, 3 presented with ischemia, 1 presented with brainstem compression, and the remaining 5 patients had incidentally discovered, asymptomatic lesions. Only 1 patient had a complication (occipital infarction) attributable to the SS procedure. One patient died of rebleeding 2 weeks after the procedure. At 1 month, 40% of the patients had a subtotal or total occlusion, which increased to 55% at 3 months and 85% at 6 months, with a final subtotal or total occlusion rate of 80% at 1 year. The SS procedure in 1 case was considered a failure at 6 months because no change had been noted since the 1-month follow-up. One case showed partial occlusion and 1 case showed recanalization. Conclusions Use of SS for aneurysms in the posterior circulation complex is a safe and effective technique, demonstrating an occlusion rate of 80% at the 1-year follow up.

CURATIVE ENDOVASCULAR RECONSTRUCTION OF CEREBRAL ANEURYSMS WITH THE PIPELINE EMBOLIZATION DEVICE

Neurosurgery ◽  
2009 ◽  
Vol 64 (4) ◽  
pp. 632-643 ◽  
Author(s):  
Pedro Lylyk ◽  
Carlos Miranda ◽  
Rosana Ceratto ◽  
Angel Ferrario ◽  
Esteban Scrivano ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Digital Subtraction ◽  
Pipeline Embolization Device ◽  
Large N ◽  
Cranial Neuropathies ◽  
Digital Subtraction Angiogram ◽  
Age Range ◽  
Mean Time

Abstract OBJECTIVES The Pipeline embolization device (PED) (Chestnut Medical Technologies, Inc., Menlo Park, CA) is a new microcatheter-delivered endovascular construct designed to achieve the curative reconstruction of the parent arteries giving rise to wide-necked and fusiform intracranial aneurysms. We present our initial periprocedural experience with the PED and midterm follow-up results for a series of 53 patients. METHODS Patients harboring large and giant wide-necked, nonsaccular, and recurrent intracranial aneurysms were selected for treatment. All patients were pretreated with dual antiplatelet medications for at least 72 hours before surgery and continued taking both agents for at least 6 months after treatment. A control digital subtraction angiogram was typically performed at 3, 6, and 12 months. RESULTS Fifty-three patients (age range, 11–77 years; average age, 55.2 years; 48 female) with 63 intracranial aneurysms were treated with the PED. Small (n = 33), large (n = 22), and giant (n = 8) wide-necked aneurysms were included. A total of 72 PEDs were used. Treatment was achieved with a single PED in 44 aneurysms, with 2 overlapping PEDs in 17 aneurysms, and with 3 overlapping PEDs in 2 aneurysms. The mean time between the treatment and last follow-up digital subtraction angiogram was 5.9 months (range, 1–22 months). Complete angiographic occlusion was achieved in 56%, 93%, and 95% of aneurysms at 3 (n = 42), 6 (n = 28), and 12 (n = 18) months, respectively. The only aneurysm that remained patent at the time of the 12-month follow-up examination had been treated previously with stent-supported coiling. The presence of a preexisting endoluminal stent may have limited the efficacy of the PED reconstruction in this aneurysm. No aneurysms demonstrated a deterioration of angiographic occlusion during the follow-up period (i.e., no recanalizations). No major complications (stroke or death) were encountered during the study period. Three patients (5%), all with giant aneurysms, experienced transient exacerbations of preexisting cranial neuropathies and headache after the PED treatment. All 3 were treated with corticosteroids, and these symptoms resolved within 1 month. CONCLUSION Endovascular reconstruction with the PED represents a safe, durable, and curative treatment of selected wide-necked, large and giant cerebral aneurysms. The rate of complete occlusion at the time of the 12-month follow-up examination approached 100% in the present study. To date, no angiographic recurrences have been observed during serial angiographic follow-up.

scholarly journals The p64 flow-diverting stent in the treatment of difficult cerebral vascular aneurysms: technical features and results

2021 ◽  
Vol 23 (1) ◽  
pp. 74-82
Author(s):  
V. S. Kiselev ◽  
A. O. Sosnov ◽  
A. M. Perfiliev ◽  
R. R. Gafurov
Keyword(s):  
Postoperative Complications ◽  
High Efficiency ◽  
Low Frequency ◽  
Cerebral Aneurysms ◽  
Study Objective ◽  
Occlusion Rate ◽  
Low Incidence ◽  
Technical Features ◽  
Vascular Neurosurgery

Introduction. Since the appearance of the first flow-diverting stents (FDS) Pipeline (Covidien, USA) and Silk (Balt Extrusion, France) in 2008, numerous studies have been conducted that have shown their high efficiency in the treatment of difficult aneurysms, accompanied by a low frequency long-term recanalization with a moderate risk of developing intra- and postoperative complications, thus making them an alternative to the classic use of coils.The study objective is to evaluate the results of the p64 PPS using in the treatment of patients with cerebral aneurysms of various localization in a single neurosurgical hospital.Materials and methods. In the department of vascular neurosurgery of the Federal Neurosurgical Center, Novosibirsk for the period from June 2017 to December 2019, 90 patients (10 (11.1 %) male, 80 (88.9 %) female) with cerebral aneurysms were operated using p64 FDS.Results. All 90 patients received 93 p64 FDS. In 79 (87.8 %) patients, only a stent was implanted, in 9 (12.2 %) – in combination with coils. Follow-up after 6 months was observed in 39 (43.3 %) patients, while it should be noted that no patient showed an increase in neurological deficit. The complete occlusion rate after 6 months was 76.9 %. A favorable treatment outcome according to the modified Rankin Scale at the time of discharge was obtained in 82 (91.1 %) patients. Mortality was in 1 (1.1 %) case.Conclusion. The p64 FDS is an effective endovascular device in the treatment of patients with difficult cerebral aneurysms and has a rather low incidence of intra- and postoperative complications.

Use of flow-diverting stents as salvage treatment following failed stent-assisted embolization of intracranial aneurysms

2015 ◽  
Vol 8 (7) ◽  
pp. 692-695 ◽  
Author(s):  
Daniel M Heiferman ◽  
Joshua T Billingsley ◽  
Manish K Kasliwal ◽  
Andrew K Johnson ◽  
Kiffon M Keigher ◽  
...  
Keyword(s):  
Blood Flow ◽  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Salvage Treatment ◽  
Endovascular Techniques ◽  
Pipeline Embolization Device ◽  
Wall Apposition ◽  
Flow Diverters

Flow-diverting stents, including the Pipeline embolization device (PED) and Silk, have been beneficial in the treatment of aneurysms previously unable to be approached via endovascular techniques. Recurrent aneurysms for which stent-assisted embolization has failed are a therapeutic challenge, given the existing intraluminal construct with continued blood flow into the aneurysm. We report our experience using flow-diverting stents in the repair of 25 aneurysms for which stent-assisted embolization had failed. Nineteen (76%) of these aneurysms at the 12-month follow-up showed improved Raymond class occlusion, with 38% being completely occluded, and all aneurysms demonstrated decreased filling. One patient developed a moderate permanent neurologic deficit. Appropriate stent sizing, proximal and distal construct coverage, and preventing flow diverter deployment between the previously deployed stent struts are important considerations to ensure wall apposition and prevention of endoleak. Flow diverters are shown to be a reasonable option for treating previously stented recurrent cerebral aneurysms.

Comparison Between CTA and Digital Subtraction Angiography in the Diagnosis of Ruptured Aneurysms

Neurosurgery ◽  
2017 ◽  
Vol 80 (5) ◽  
pp. 769-777 ◽  
Author(s):  
Lucas R. Philipp ◽  
D. Jay McCracken ◽  
Courtney E. McCracken ◽  
Sameer H. Halani ◽  
Brendan P. Lovasik ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Small Sample ◽  
Digital Subtraction ◽  
Ruptured Intracranial Aneurysm ◽  
Small Sample Sizes ◽  
Low Sensitivity ◽  
Ruptured Intracranial Aneurysms

Abstract BACKGROUND: Computerized tomography angiography (CTA) is commonly used to diagnose ruptured cerebral aneurysms with sensitivities reported as high as 97% to 100%. Studies validating CTA accuracy in the setting of subarachnoid hemorrhage (SAH) are scarce and limited by small sample sizes. OBJECTIVE: To evaluate the diagnostic accuracy of CTA in detecting intracranial aneurysms in the setting of SAH. METHODS: A single-center, retrospective cohort of 643 patients was reviewed. A total of 401 patients were identified whose diagnostic workup included both CTA and confirmatory digital subtraction angiography (DSA). Aneurysms missed by CTA but diagnosed by DSA were further stratified by size and location. RESULTS: Three hundred and thirty aneurysms were detected by CTA while DSA detected a total of 431 aneurysms. False positive CTA results were seen for 24 aneurysms. DSA identified 125 aneurysms that were missed by CTA and 83.2% of those were &lt;5 mm in diameter. The sensitivity of CTA was 57.6% for aneurysms smaller than 5 mm in size, and 45% for aneurysms originating from the internal carotid artery. The overall sensitivity of CTA in the setting of SAH was 70.7%. CONCLUSION: The accuracy of CTA in the diagnosis of ruptured intracranial aneurysm may be lower than previously reported. CTA has a low sensitivity for aneurysms less than 5 mm in size, in locations adjacent to bony structures, and for those arising from small caliber parent vessels. It is our recommendation that CTA should be used with caution when used alone in the diagnosis of ruptured intracranial aneurysms.

Midterm results of T-stent–assisted coiling of wide-necked and complex intracranial bifurcation aneurysms using low-profile stents

2017 ◽  
Vol 127 (6) ◽  
pp. 1288-1296 ◽  
Author(s):  
Kubilay Aydin ◽  
Serra Sencer ◽  
Mehmet Barburoglu ◽  
Mynzhylky Berdikhojayev ◽  
Yavuz Aras ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Intracranial Aneurysms ◽  
Anterior Communicating Artery ◽  
Total Occlusion ◽  
Technical Success Rate ◽  
Low Profile ◽  
Scale Scores ◽  
Occlusion Rate ◽  
Double Stent

OBJECTIVECoiling of wide-necked and complex bifurcation aneurysms frequently requires implantation of double stents in various configurations. T-stent–assisted coiling involves the nonoverlapping implantation of 2 stents to protect the daughter vessels of bifurcation and is followed by coiling of the aneurysm. The authors studied the feasibility, efficacy, and safety of the T-stent–assisted coiling procedure as well as the midterm angiographic/clinical outcomes of patients with wide-necked bifurcation intracranial aneurysms treated using this technique.METHODSThe authors retrospectively identified patients with wide-necked bifurcation intracranial aneurysms treated using double-stent–assisted coiling with a T-stent configuration.RESULTSTwenty-four patients with 24 aneurysms and a mean of age of 51.91 years were identified. The most common locations were the middle cerebral bifurcation (45.8%) and anterior communicating artery (35.7%). T stentings were performed using low-profile stents. The procedures were performed with a technical success rate of 95.8%, and an immediate total occlusion rate of 79.2% was achieved. We observed periprocedural complications in 16.7% of cases and a delayed thromboembolic event in 4.2%. The complications caused permanent morbidity in 1 patient (4.2%). No deaths occurred. The mean angiographic follow-up duration was 9.3 months. The total occlusion rate at the last follow-up was 81.2%. The recanalization rate was 4.5%. Modified Rankin Scale scores of all patients at the last follow-ups were between zero and 2.CONCLUSIONST-stent–assisted coiling using low-profile stents is a feasible, effective, and relatively safe endovascular technique used to treat wide-necked and complex intracranial aneurysms. The midterm angiographic and clinical outcomes are outstanding.

scholarly journals Initial Experience with LVIS EVO Stents for the Treatment of Intracranial Aneurysms

2020 ◽  
Vol 9 (12) ◽  
pp. 3966
Author(s):  
Wojciech Poncyljusz ◽  
Kinga Kubiak
Keyword(s):  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Thromboembolic Complication ◽  
Anterior Communicating Artery ◽  
Unruptured Aneurysms ◽  
Low Profile ◽  
Class 1 ◽  
Occlusion Rate

Background: Over the years, a variety of intracranial stents have been developed, which has expanded the therapy options available for cerebral aneurysms. The Low profile visible intraluminal support (LVIS) EVO stents are new devices, which officially appeared on the market in 2020. The purpose of the study is to report the initial technical and clinical experience with the new stent in the treatment of intracranial aneurysms. Materials and Methods: Between February and September 2020, 30 patients with 35 intracranial aneurysms (29 unruptured and 6 ruptured) were treated using the LVIS EVO stent in our department. The aneurysms were located within internal carotid artery (ICA) (42.9%), middle cerebral artery (MCA) (31.4%), anterior communicating artery (AComA) (11.4%), basilar artery (BA) (11.4%) and anterior cerebral artery (ACA) (2.9%). Stent-assisted coil embolization was performed in all cases. Results: All stents were deployed successfully in the desired position. Immediate complete occlusion of the treated aneurysms, described as Raymond–Roy occlusion classification (RROC) class 1, was achieved in all cases. No technical complications were observed. One thromboembolic complication occurred in the group of unruptured aneurysms and one patient died due to cerebral edema from aneurysms rupture group. Conclusion: In our observation, the showed a satisfactory safety profile LVIS EVO stents seem to be very flexible, can be safely maneuvered and deployed in tortuous vessels. They showed a good initial occlusion rate when used for treating intracranial aneurysms with SAC (stent-assisted coiling).

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