Triggering of Carotid Sinus Reflex during Deployment of the Flow-diverter Device

In recent years there has been a progressive increase in interventional neuroradiology procedures, partially due to improvements in devices, but also to the simultaneous development of technologies and radiological images. Cone beam CT (Dyna-CT; Siemens) is a method recently used to obtain pseudo CT images from digital subtraction angiography (DSA) with a flat panel detector. Using dedicated software, it is then possible to merge Dyna-CT images with images from a different source. We report here the usefulness of advanced DSA techniques (Syngo-Dyna CT, three-dimensional DSA iPilot) for the treatment of an intracranial aneurysm with a flow diverter device. Merging MR and Dyna-CT images at the end of the procedure proved to be a simple and rapid additional method of verifying the success of the intervention.

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Fenestra Obscura: Flow Diverter Reconstruction of a Complex Vertebrobasilar Aneurysm Through an Obscured Fenestration Limb: Technical Case Report

Operative Neurosurgery ◽

10.1227/neu.0000000000000996 ◽

2015 ◽

Vol 12 (1) ◽

pp. E95-E100 ◽

Cited By ~ 5

Author(s):

Gabor Toth ◽

Ferdinand Hui ◽

Mark Bain

Keyword(s):

Basilar Artery ◽

Flow Diverter ◽

Posterior Circulation ◽

Vascular Lesions ◽

Close Proximity ◽

Vertebrobasilar Junction ◽

Artery Reconstruction ◽

Endovascular Technology ◽

Flow Diverter Device

Abstract BACKGROUND AND IMPORTANCE Basilar fenestration aneurysms are rare, challenging intracranial vascular lesions with atypical anatomy. The posterior circulation represents a difficult therapeutic dilemma because of the close proximity of crucial life-sustaining brainstem structures. The use of flow diverter technology has been very limited in posterior circulation vessels. CLINICAL PRESENTATION We present the case of a 49-year-old female patient, who was diagnosed with a symptomatic large vertebrobasilar junction aneurysm, which was initially thought to be a proximal basilar dilatation. The aneurysm was later verified to arise from the proximal end of a basilar fenestration, distended by the aneurysm fundus. The small-caliber fenestration limbs were the only connection to the distal basilar artery, but were stretched laterally and concealed by the aneurysm fundus. This complex lesion was successfully treated by flow diverter deployment through one of the fenestration limbs, followed by coiling of the aneurysm fundus, and sacrificing the contralateral vertebral artery. A 6-month follow-up angiogram showed remodeling of the basilar artery and complete occlusion of the aneurysm with good clinical outcome. Careful diagnostic workup, multidisciplinary discussions, and the innovative use of versatile endovascular technology were crucial to achieve an optimal result in this case. CONCLUSION This is the first report of a successful basilar artery reconstruction for the treatment of a large atypical vertebrobasilar junction fenestration aneurysm by deployment of a flow diverter device directly in a small, obscured fenestration limb.

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The ‘Sphere’: A Dedicated Bifurcation Aneurysm Flow-Diverter Device

Cardiovascular Engineering and Technology ◽

10.1007/s13239-014-0188-4 ◽

2014 ◽

Vol 5 (4) ◽

pp. 334-347 ◽

Cited By ~ 10

Author(s):

Thomas Peach ◽

J. Frederick Cornhill ◽

Anh Nguyen ◽

Howard Riina ◽

Yiannis Ventikos

Keyword(s):

Flow Diverter ◽

Bifurcation Aneurysm ◽

Flow Diverter Device

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

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v18i3.2678 ◽

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

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

Radiology and Oncology ◽

10.1515/raon-2016-0049 ◽

2016 ◽

Vol 50 (4) ◽

pp. 378-384 ◽

Cited By ~ 4

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.

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