scholarly journals Hemodynamic Analysis for Endovascular Treatment in Small Unruptured Intracranial Aneurysms: A Matched Comparison Study of Flow Diverter Versus LVIS

2021 ◽  
Author(s):  
Jian Liu ◽  
Wenqiang Li ◽  
Yisen Zhang ◽  
Kun Wang ◽  
Xinjian Yang ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Clinical Analysis ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Unruptured Intracranial Aneurysms ◽  
Key Factor ◽  
Occlusion Rate ◽  
Two Parameters

Abstract BackgroundWe compared the treatment of small unruptured intracranial aneurysms (UIAs) with flow diverter and LVIS assisted coiling to determine the effects of hemodynamic changes caused by different stent and coil packing in endovascular treatment.MethodsFifty-one UIAs in 51 patients treated with pipeline embolization device (PED) were included in this study, and defined as the PED group. We matched controls 1:1 and enrolled 51 UIAs who treated with LVIS stent, which defined as the LVIS group. Computational fluid dynamics were performed to assess hemodynamic alterations between PED and LVIS. Clinical analysis was also performed between these two groups after the match.ResultsThere was no difference in procedural complications between two groups (P=0.558). At the first angiographic follow-up, the complete occlusion rate was significantly higher in the LVIS group compared with that in the PED group (98.0% vs 82.4%, P = 0.027). However, during the further angiographic follow-up, the complete occlusion rate in PED group achieved 100%, which was higher than that in LVIS group (98.0%). Compared with the LVIS group after treatment, cases in PED group showed a higher value of velocity in the aneurysm (0.03 ± 0.09 vs 0.01 ± 0.01, P=0.037) and WSS on the aneurysm (2.32 ± 5.40 vs 0.33 ± 0.47, P=0.011). Consequently, the reduction ratios of these two parameters were also showed statistical differences. These parameters in LVIS group showed much higher reduction ratios. However, the reduction ratio of the velocity on the neck plane was comparable between two groups. ConclusionsBoth LVIS and PED were safe and effective for the treatment of small UIAs. However, LVIS-assisted coiling produced greater hemodynamic alterations in the aneurysm sac compared with PED. The hemodynamics in the aneurysm neck may be a key factor for aneurysm outcome.

scholarly journals Hemodynamic analysis for endovascular treatment in small unruptured intracranial aneurysms: a matched comparison study of flow diverter versus LVIS

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Jian Liu ◽  
Wenqiang Li ◽  
Yisen Zhang ◽  
Kun Wang ◽  
Xinjian Yang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Clinical Analysis ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Unruptured Intracranial Aneurysms ◽  
Occlusion Rate ◽  
Two Parameters

Abstract Background We compared the treatment of small unruptured intracranial aneurysms (UIAs) with flow diverter and LVIS-assisted coiling to determine the effects of hemodynamic changes caused by different stent and coil packing in endovascular treatment. Methods Fifty-one UIAs in 51 patients treated with pipeline embolization device (PED) were included in this study and defined as the PED group. We matched controls 1:1 and enrolled 51 UIAs who were treated with LVIS stent, which were defined as the LVIS group. Computational fluid dynamics were performed to assess hemodynamic alterations between PED and LVIS. Clinical analysis was also performed between these two groups after the match. Results There was no difference in procedural complications between the two groups (P = 0.558). At the first angiographic follow-up, the complete occlusion rate was significantly higher in the LVIS group compared with that in the PED group (98.0% vs. 82.4%, P = 0.027). However, during the further angiographic follow-up, the complete occlusion rate in the PED group achieved 100%, which was higher than that in the LVIS group (98.0%). Compared with the LVIS group after treatment, cases in the PED group showed a higher value of velocity in the aneurysm (0.03 ± 0.09 vs. 0.01 ± 0.01, P = 0.037) and WSS on the aneurysm (2.32 ± 5.40 vs. 0.33 ± 0.47, P = 0.011). Consequently, the reduction ratios of these two parameters also showed statistical differences. These parameters in the LVIS group showed much higher reduction ratios. However, the reduction ratio of the velocity on the neck plane was comparable between two groups. Conclusions Both LVIS and PED were safe and effective for the treatment of small UIAs. However, LVIS-assisted coiling produced greater hemodynamic alterations in the aneurysm sac compared with PED. The hemodynamics in the aneurysm neck may be a key factor for aneurysm outcome.

scholarly journals Evaluation of the Accero Stent for Stent-Assisted Coiling of Unruptured Wide-Necked Intracranial Aneurysm Treatment with Short-Term Follow-Up

2020 ◽  
Vol 9 (9) ◽  
pp. 2808
Author(s):  
Wojciech Poncyljusz ◽  
Kinga Kubiak ◽  
Leszek Sagan ◽  
Bartosz Limanówka ◽  
Katarzyna Kołaczyk
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Clinical Results ◽  
Class I ◽  
Unruptured Aneurysms ◽  
Patient Demographics ◽  
Stent Deformation ◽  
Unruptured Intracranial Aneurysms ◽  
Occlusion Rate

Background: Stent-assisted coiling is an effective method of treating intracranial aneurysms. The aim of the study was to assess the safety and efficacy of the new Accero stent for the treatment of intracranial aneurysms. Materials and Methods: It was a retrospective, single-center study. Eighteen unruptured intracranial aneurysms were treated using the stent-assisted coiling method with the Accero stent. Patient demographics, aneurysm characteristics, procedural parameters, grade of occlusion, complications, and clinical results were analyzed. Follow-up magnetic resonance (MR) was performed 6 months after intervention. Results: Seventeen patients with 18 incidental unruptured aneurysms were electively treated with coiling and the Accero stent. The aneurysms were located on internal carotid artery (ICA), middle cerebral artery (MCA) and basilar artery (BA). All stents were deployed successfully. Immediate complete occlusion rate Raymond-Roy occlusion classification (RROC) class I was achieved in 13 cases and class II in 4 cases. Complications occurred in 2/17 treatments and included guidewire stent perforation with subarachnoid hemorrhage (SAH) and stent deformation. Vascular spasm in the subarachnoid hemorrhage (SAH) patient subsided before discharge. Ninety days after intervention, the modified Rankin Scale (mRS) value was 0. RROC class I was observed in 88.23% of cases in follow-up. Conclusion: The Accero stent provides excellent support for coil mass. It constitutes an efficacious device with good initial occlusion rate for treating wide-necked unruptured intracranial aneurysms.

Flow redirection endoluminal device (FRED) for treatment of intracranial aneurysms: A systematic review

2021 ◽  
pp. 159101992110279
Author(s):  
Muhammad Waqas ◽  
Rimal H Dossani ◽  
Modhi Alkhaldi ◽  
Jocelyn Neveu ◽  
Justin M Cappuzzo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Complication Rates ◽  
Mesh Terms ◽  
Aneurysm Occlusion ◽  
Occlusion Rate ◽  
Layered Flow ◽  
Comparative Safety

Introduction The Flow Redirection Endoluminal Device (FRED; MicroVention) is a dual-layered flow diverter used for the treatment of intracranial aneurysms. The objective of this systematic review was to compile device-related safety and effectiveness data. Methods The literature from January 1, 2013 to April 30, 2021 was searched for studies describing use of the FRED for intracranial aneurysm treatment irrespective of aneurysm location and morphology. The review included anterior and posterior circulation ruptured and unruptured saccular, fusiform or dissection, and blister aneurysms. MeSH terms related to “flow re-direction endoluminal device” and “FRED for aneurysms” were used. Data related to indication, complications, and rates of aneurysm occlusion were retrieved and analyzed. Results Twenty-two studies with 1729 intracranial aneurysms were included in this review. Overall reported morbidity was 3.9% (range 0–20%). Overall procedure-related mortality was 1.4% (range 0–6%). Complication rates fell into 5 categories: technical (3.6%), ischemic (3.8%), thrombotic or stenotic (6%), hemorrhagic (1.5%), and non-neurological (0.8%). The aneurysm occlusion rate between 0 and 3 months (reported in 11 studies) was 47.8%. The occlusion rate between 4 and 6 months (reported in 14 studies) was 73.8%. Occlusion rates continued to increase to 75.1% at 7–12 months (reported in 10 studies) and 86.6% for follow-up beyond 1 year (reported in 10 studies). Conclusion This review indicated that the FRED is a safe and effective for the treatment of intracranial aneurysms. Future studies should directly compare the FRED with other flow diverters for a better understanding of comparative safety and effectiveness among the different devices.

Intracranial aneurysms managed by parent artery reconstruction using Tubridge: Study protocol for a prospective, multicenter, post-market clinical trial

2020 ◽  
pp. 159101992097623
Author(s):  
Qiaowei Wu ◽  
Li Li ◽  
Qiuji Shao ◽  
Tianming Xu ◽  
Kaitao Chang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Intracranial Aneurysms ◽  
Parent Artery ◽  
Reconstruction Technique ◽  
Long Term Outcomes ◽  
Complete Occlusion ◽  
Post Market ◽  
Occlusion Rate

Background As a new endovascular reconstruction technique, flow diverter (FD) shows excellent efficacy and safety for treatment of intracranial aneurysms. In a previous multicenter, randomized, controlled, pre-market study, Tubridge FD showed remarkably higher complete occlusion rate compared with traditional stent-assisted coiling. However, a nonsignificant higher complication rate in the Tubridge group was noted. Considering the learning curve, the safety, and long-term outcomes of Tubridge FD should be verified in new prospective, real world, multicenter, post-market trials. Methods This study is a prospective, multicenter, single-arm, post-market clinical trial that evaluates the safety and efficacy of Tubridge in the treatment of patients with intracranial aneurysms by reconstructing parent artery. We expect 200 participants who meet the inclusion and exclusion criteria to be included. Clinical information and angiographic results (Raymond–Roy grading scale, RRGS) will be recorded objectively. The primary endpoint will be the complete occlusion rate of the target aneurysm (RRGS 1) at 12-month follow-up. Secondary endpoints will include the adequate occlusion rate (RRGS 1 & 2) and the rate of major in-stent stenosis (>50%) at 12-month follow-up, technique success rate, changes of modified Rankin Scale before and after the procedure, the rate of aneurysm related disability, neurological mortality, and all-cause mortality within follow-up period. Discussion This post-market, prospective trial may offer more information on the safety and long-term outcomes of Tubridge FD. When the study is complete, the results may provide us a new strategy for the treatment of intracranial aneurysms. Trial registration: WHO-Chinese Clinical Trial Registry: ChiCTR2000032282.

scholarly journals Long-term occlusion results with SILK flow diversion in 28 aneurysms: Do recanalizations occur during follow-up?

2015 ◽  
Vol 21 (3) ◽  
pp. 300-310 ◽  
Author(s):  
Anastasios Mpotsaris ◽  
Martin Skalej ◽  
Oliver Beuing ◽  
Bernd Eckert ◽  
Daniel Behme ◽  
...  
Keyword(s):  
Prospective Study ◽  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Success Rates ◽  
Imaging Data ◽  
Complete Occlusion ◽  
Complex Aneurysms ◽  
Multicenter Prospective Study

Background and purpose The purpose of this article is to report on the long-term success rates of Silk flow-diverter (FD) treatment in a multicenter prospective study for the treatment of complex aneurysms. Methods Between May 2008 and January 2011, all consecutive patients featuring complex intracranial aneurysms eligible for FD treatment with the Silk in three neurovascular centers were included. Clinical and imaging data were assessed during hospitalization and follow-up. Results Five patients were initially asymptomatic, 20 patients showed various neurological symptoms. Twenty-eight FDs were implanted in 25 patients treating 28 aneurysms. The immediate procedure-related morbidity was 8% (two of 25), mortality 0%. One procedure-related death was observed during follow-up (in-stent thrombosis). Compared to the immediate result nearly two of three aneurysms improved during follow-up; all angiographically confirmed inflow changes took place within six months after treatment. Final anatomic outcome in 24 aneurysms of 22 patients comprised 14 (59%) with complete occlusion, seven (29%) with a neck remnant, two (8%) with residual filling <50%, none with residual filling >50% and one (4%) unchanged in comparison to its pretreatment status. Postinterventional recanalizations were seen in three of 13 (23%) aneurysms treated with FD alone; none were observed in 15 aneurysms treated with adjunctive coiling. Conclusion Anatomic presentation and location are key for successful FD treatment. The rate of successful occlusion increases during follow-up. Postinterventional monitoring for at least six months is paramount, as anatomic outcome is not reliably predictable and recanalizations may occur in initially completely occluded aneurysms.

Treatment of distal unruptured intracranial aneurysms using a surface-modified flow diverter under prasugrel monotherapy: a pilot safety trial

2021 ◽  
pp. neurintsurg-2020-017262
Author(s):  
Luis Henrique de Castro-Afonso ◽  
Guilherme Seizem Nakiri ◽  
Thiago Giansante Abud ◽  
Lucas Moretti Monsignore ◽  
Rafael Kiyuze Freitas ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Anterior Circulation ◽  
Antiplatelet Medication ◽  
Unruptured Intracranial Aneurysms ◽  
Trial Treatment ◽  
Ischemic Complications ◽  
Carotid Aneurysms ◽  
Surface Modified

BackgroundFlow diverters (FDs) are effective in the treatment of carotid aneurysms. Compared with carotid aneurysms, the treatment of distal intracranial aneurysms with FDs has been associated with a relatively high incidence of complications. Low thrombogenic modified-surface FDs may reduce ischemic complications and allow for the use of a single antiplatelet medication. The aim of this study was to assess the safety and efficacy of the p48 MW HPC Flow Modulation Device (Phenox GmbH, Bochum, Germany) to treat distal intracranial aneurysms used in combination with prasugrel monotherapy.MethodsThis was a single-center, prospective, pivotal, open, single-arm study. Patients were included in this study from December 2019 to September 2020. The primary endpoints were the incidence of any neurologic deficit after treatment until 1 month of follow-up, defined as National Institutes of Health Stroke Scale (NIHSS) ≥1, and the incidence of acute ischemic lesions in magnetic resonance imagin (MRI) images 48 hours after treatment. The secondary endpoint was the rate of complete occlusion of the aneurysms at the 1-month follow-up.ResultsTwenty-one patients harboring 27 distal aneurysms of the anterior circulation were included. Mean age was 57.8 (SD 9.7) years, and 16 patients were female (80%). No patient had neurologic symptoms at the 1-month follow-up. Four patients (20%) had asymptomatic acute brain ischemic lesions on MRI. Complete aneurysm occlusion occurred in 9/27 (33.3%) aneurysms at the 1-month follow-up.ConclusionIn this pilot safety trial, treatment of distal intracranial aneurysms with p48 MW HPC under monotherapy with prasugrel appeared to be safe.

GEL THE NEC: a prospective registry evaluating the safety, ease of use, and efficacy of the HydroSoft coil as a finishing device

2017 ◽  
Vol 10 (1) ◽  
pp. 83-87 ◽  
Author(s):  
Waleed Brinjikji ◽  
Arun P Amar ◽  
Josser E Delgado Almandoz ◽  
Orlando Diaz ◽  
Pascal Jabbour ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Perioperative Complications ◽  
Major Complication ◽  
Clinical Results ◽  
Ease Of Use ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Registration Number ◽  
Occlusion Rate

Background and purposeThe HydroSoft coil was developed as a finishing coil, ideally to be placed along the aneurysm neck to enhance intracranial aneurysm healing. The GEL THE NEC (Gaining Efficacy Long Term: Hydrosoft, an Emerging, New, Embolic Coil) multicenter registry was developed to assess the safety and efficacy of HydroSoft coils in treating intracranial aneurysms. We report angiographic and clinical results of this prospective registry.Materials and methodsGEL THE NEC was performed at 27 centers in five countries. Patients aged 21–90 years with a ruptured or unruptured aneurysm 3–15 mm in size were eligible for enrollment. The following variables were obtained: demographics/comorbidities, aneurysm geometry, adjunctive devices used, proportion of patients in whom HydroSoft coils were successfully placed, and long-term angiographic outcomes (graded by an independent core laboratory using the Modified Raymond Scale), and procedure-related adverse events. Predictors of good angiographic outcome were studied using χ2 and t-tests.ResultsA total of 599 patients with 599 aneurysms were included in this study. HydroSoft coils were successfully deployed in 577 (96.4%) patients. Procedure-related major morbidity and mortality were 0.5% (3/599) and 1.3% (8/599), respectively. The most common perioperative complications were iatrogenic vasospasm (30/599, 5.0%), thromboemboli (27/599, 4.5%), and aneurysm perforation (16/599, 2.7%). At last angiographic follow-up (mean 9.0±6.3 months), the complete occlusion rate was 63.2% (280/442) and near complete occlusion rate was 25.2% (107/442). The core laboratory read recanalization rate was 10.8% (46/425) and the retreatment rate was 3.4% (20/599).ConclusionsEndovascular treatment of intracranial aneurysms with HydroSoft coils resulted in complete/near complete occlusion rates of 88% and a major complication rate of 1.8%.Trial registration numberNCT01000675.

scholarly journals Ultra-small diameter coils for treatment of intracranial aneurysms

2015 ◽  
Vol 21 (1) ◽  
pp. 50-54 ◽  
Author(s):  
Gaurav Jindal ◽  
Timothy Miller ◽  
Narlin Beaty ◽  
Ajit Puri ◽  
Dheeraj Gandhi
Keyword(s):  
Intracranial Aneurysms ◽  
Small Diameter ◽  
Clinical Analysis ◽  
Maximum Diameter ◽  
Brain Aneurysm ◽  
Academic Hospitals ◽  
Aneurysm Occlusion ◽  
Occlusion Rate ◽  
Aneurysm Diameter

This study reports our initial clinical experience treating very small intracranial aneurysms using only Target® Nano™ coils. Retrospective angiographic and clinical analysis was performed on a non-randomized single arm registry of all intracranial aneurysms treated with only Target® Nano™ coils (1 mm and 1.5 mm diameter only) during a 12 month period at two academic hospitals. Fourteen patients with 14 intracranial aneurysms were treated. The maximum diameter of saccular aneurysms treated ranged from 1.5 to 3.5 mm; minimum aneurysm diameter was 1.1 to 2 mm. The immediate complete aneurysm occlusion rate was 86% (12/14), and a small residual within the aneurysm was seen in 14% (2/14) of cases. Packing density from coils ranged between 24% and 83% (mean 51%). The immediate complication rate was 0% (0/14). The angiographic/MR angiography follow-up period was 22 to 70 weeks (mean 37 weeks) with an overall complete occlusion rate of 9/11 (81%), recurrence in 18% (2/11), and lack of follow-up in three cases, two due to death during hospitalization and one procedure not yet due for imaging follow-up. Both patients who died presented with brain aneurysm ruptures prior to treatment. Both recurrences were retreated with repeat coiling procedures. Our initial results using only Target® Nano™ coils for the endovascular treatment of very small intracranial aneurysms have demonstrated initial good safety and efficacy profiles.

scholarly journals Flow diverter neuroendovascular stents – Reconstructive endovascular treatment of intracranial aneurysms – Single centre experience

2013 ◽  
Vol 02 (02) ◽  
pp. 182-188 ◽  
Author(s):  
Krzysztof Kadzioloka ◽  
Laurent Estrade ◽  
Laurent Pierot ◽  
Girish Rajpal
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Antiplatelet Agents ◽  
Flow Diverter ◽  
Digital Subtraction ◽  
Anterior Circulation ◽  
Complete Occlusion ◽  
Digital Subtraction Angiogram ◽  
Age Range

AbstractFlow diverter stents (FDS) are new neuroendovascular tools able to achieve the complete and curative treatment of aneurysm by reconstruction of the parent arteries from which the aneurysm arises. We present our initial experience with flow diverter embolization devices and follow-up results.Patients with large, giant and wide necked aneurysms, saccular, fusiform and recurrent aneurysms were selected for the treatment. All patients were pretreated with dual antiplatelet agents at least for 7 days before procedure and continued taking both agents for 3 months after treatment. A MRI was done after 3 months of treatment and digital subtraction angiogram was performed at 4 months of treatment. After 1 year both MRI and digital subtraction angiogram was performed.11 patients (age range 37 year to 79 year, mean 51.1) with 11 intracranial aneurysms were treated with 15 flow diverter stents. 9 aneurysm were located on the anterior circulation and 2 on posterior circulation. 8 aneurysms were large (10-25 mm), 2 were small (<10 mm) and 1 was giant (>25 mm) with mean largest diameter of 13.22 mm. 9 were saccular aneurysm and 2 were fusiform, out of these 3 were remnant of the previously treated aneurysm. Treatment was achieved with 10 Silk stents in 7 patients and 5 Pipeline embolization devices in 4 patients. The mean time between treatment and follow up was 9.6 months (range 4-12 months). One mortality was noted due to rebleed after 3 weeks of treatment. Complete angiographic occlusion was achieved in 9 (90%) patients after 4 months and 1 (10%) patient had near complete occlusion at 12 months. All the patients were stable clinically during follow up period.Endovascular treatment with FDS is safe, easy, and permanent treatment for the selected group of aneurysms. The complete occlusion rate in follow-up study approaches 100% with no angiographic recurrence in this study.

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