scholarly journals Physiological remodeling of bifurcation aneurysms: preclinical results of the eCLIPs device

2018 ◽  
Vol 128 (2) ◽  
pp. 475-481 ◽  
Author(s):  
Thomas R. Marotta ◽  
Howard A. Riina ◽  
Ian McDougall ◽  
Donald R. Ricci ◽  
Monika Killer-Oberpfalzer
Keyword(s):  
Current Therapy ◽  
High Recurrence Rate ◽  
Preclinical Model ◽  
Thromboembolic Complications ◽  
Aneurysm Neck ◽  
Novel Device ◽  
Aneurysm Occlusion ◽  
Functional Features ◽  
Water Hammer Effect ◽  
Complex Lesions

OBJECTIVEIntracranial bifurcation aneurysms are complex lesions for which current therapy, including simple coiling, balloon- or stent-assisted coiling, coil retention, or intrasaccular devices, is inadequate. Thromboembolic complications due to a large burden of intraluminal metal, impedance of access to side branches, and a high recurrence rate, due largely to the unmitigated high-pressure flow into the aneurysm (water hammer effect), are among the limitations imposed by current therapy. The authors describe herein a novel device, eCLIPs, and its use in a preclinical laboratory study that suggests the device's design and functional features may overcome many of these limitations.METHODSA preclinical model of wide-necked bifurcation aneurysms in rabbits was used to assess functional features and efficacy of aneurysm occlusion by the eCLIPs device.RESULTSThe eCLIPs device, in bridging the aneurysm neck, allows coil retention, disrupts flow away from the aneurysm, leaves the main vessel and side branches unencumbered by intraluminal metal, and serves as a platform for endothelial growth across the neck, excluding the aneurysm from the circulation.CONCLUSIONSThe eCLIPs device permits physiological remodeling of the bifurcation.

Low-profile visualized intraluminal support Blue stenting within a Neuroform Atlas stent for a large wide-necked aneurysm: A case report and a bench-top experiment

2021 ◽  
pp. 197140092110269
Author(s):  
Tomoko Hayashi ◽  
Hiroyuki Ikeda ◽  
Ryota Ishibashi ◽  
Toshio Fujiwara ◽  
Ryosuke Kaneko ◽  
...  
Keyword(s):  
Case Report ◽  
Coil Embolization ◽  
Cell Design ◽  
Open Cell ◽  
Aneurysm Neck ◽  
Low Profile ◽  
Closed Cell ◽  
High Metal ◽  
Silicon Tube ◽  
Aneurysm Occlusion

Low-profile visualized intraluminal support deployment in an Enterprise has been reported; however, that in an Atlas has yet to be in detail. Enterprise has a closed-cell design, while Atlas has an open-cell design. We detail here a case of a large wide-necked aneurysm treated by coil embolization with low-profile visualized intraluminal support Blue deployment within a Neuroform Atlas and a bench-top experiment using a silicon tube to test low-profile visualized intraluminal support, Atlas, Enterprise, and their combinations. A better low-profile visualized intraluminal support expansion was achieved by simultaneously pushing the wire and the system within the Atlas placed at the aneurysm neck, which resulted in an increased metal coverage of the aneurysm neck and a shorter transition zone with low metal coverage at both ends of the aneurysm neck. This technique may enable a high metal coverage by low-profile visualized intraluminal support expansion without restriction by the Atlas and contribute to aneurysm occlusion by increasing the flow-diverting effect.

A novel endovascular clip system for the treatment of intracranial aneurysms: technology, concept, and initial experimental results

2008 ◽  
Vol 108 (6) ◽  
pp. 1230-1240 ◽  
Author(s):  
Thomas R. Marotta ◽  
Thorsteinn Gunnarsson ◽  
Ian Penn ◽  
Donald R. Ricci ◽  
Ian Mcdougall ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Delivery System ◽  
Intracranial Aneurysms ◽  
Balloon Catheter ◽  
Cerebral Aneurysms ◽  
Histopathological Analysis ◽  
Parent Vessel ◽  
Flow Models ◽  
Aneurysm Neck ◽  
Novel Device

Object The authors describe a novel device for the endovascular treatment of intracranial aneurysms, the endovascular clip system (eCLIPs). Descriptions of the device and its delivery system as well as the results of flow model tests and the treatment of experimental aneurysms are provided. Methods The eCLIPs comprises a flexible hybrid implantable device (an anchor and a covered leaf) and a balloon catheter delivery system, designed to be positioned and activated in the parent vessel in such a way that the covered portion will abut the aneurysm neck. The eCLIPs was subjected to testing in glass, elastomeric, and cadaveric flow models to determine its navigability, orientation, and activation compared with commercially available stents. In a second experiment, 8 carotid artery sidewall aneurysms in swine were treated using eCLIPs. The degree of occlusion was observed on angiography immediately following and 30 days after device activation, and a histological analysis was performed at 30 days. Results The device could navigate tortuous glass models and human cadaveric vessels. Compared with commercially available stents, the eCLIPs performed well. It could be navigated, oriented, and activated easily and reliably. With regard to the 8 porcine experimental aneurysms, immediate postactivation angiograms confirmed complete occlusion of 4 lesions and near occlusion of the other 4. Angiographic follow-up at 30 days postactivation showed occlusion of all 8 aneurysms and patency of all parent vessels. Histopathological analysis revealed aneurysm healing, with smooth-muscle cells growing across the lesion neck to allow reendothelialization. Conclusions Aneurysm occlusion with a single extrasaccular endovascular device has potential advantages. The authors believe that eCLIPs may prove to be a useful tool in the endovascular treatment of cerebral aneurysms. The system should reduce risks associated with coiling, procedure time, costs, and radiation exposure. The device satisfactorily occluded 8 experimental sidewall aneurysms. The observed healing pattern is similar to that seen after microsurgical clipping.

Enlargement of basilar artery aneurysms following balloon occlusion — “water-hammer effect”

1991 ◽  
Vol 75 (6) ◽  
pp. 963-968 ◽  
Author(s):  
Eddie S. K. Kwan ◽  
Carl B. Heilman ◽  
William A. Shucart ◽  
Richard P. Klucznik
Keyword(s):  
Basilar Artery ◽  
Water Hammer ◽  
Balloon Occlusion ◽  
Successful Therapy ◽  
Content Type ◽  
Aneurysm Neck ◽  
Water Hammer Effect ◽  
Fine Print

✓ Two patients with distal basilar aneurysms were treated with intra-aneurysmal balloon occlusion. After apparently successful therapy, follow-up angiograms demonstrated aneurysm enlargement with balloon migration distally in the sac. Geometric mismatch between the base of the balloons and the aneurysm neck together with transmitted pulsation through the 2-hydroxyl-ethylmethacrylate (HEMA)-filled balloon directly contributed to aneurysm enlargement. In this report, the authors discuss the problems of progressive aneurysm enlargement due to a “water-hammer effect” and the possibility of hemorrhage following subtotal occlusion.

Flow Modification of Cerebral Aneurysm by Flow Diverter (Pipeline) With Different Packing Densities

2012 ◽  
Author(s):  
Jianping Xiang ◽  
Ding Ma ◽  
Adnan Siddiqui ◽  
Hui Meng
Keyword(s):  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
High Recurrence Rate ◽  
Parent Vessel ◽  
Novel Device ◽  
Flow Modification ◽  
Fine Mesh ◽  
High Flexibility ◽  
Vessel Reconstruction ◽  
Packing Densities

Flow diverter, a braided fine mesh stent, is emerging as a novel device to treat wide-necked, fusiform, and giant cerebral aneurysms since these types of aneurysms are either untreatable otherwise or have high recurrence rate treated by endovascular coils. Flow diverter devices represent a major paradigm shift in the endovascular treatment of aneurysms from filling the aneurysm cavity to diverting blood flow away from aneurysm sac with parent vessel reconstruction. Due to its high flexibility, a flow diverter can be manipulated during deployment process to achieve better results; for example, an experienced neuro-interventionalist can manipulate the stent’s local metal coverage through coordinated movement of catheter pull-back, pusher advancement, and distal coil release to pack higher density for the aneurysm orifice region to divert more flow away from aneurysm, making aneurismal thrombosis quicker and easier. Pipeline embolization device is the first flow diverter approved by FDA. In this study, we investigate the flow modification of a wide-necked aneurysm by Pipeline with different packing densities.

Reduction of Intra-Aneurysmal Kinetic Energy by Intralumenal Flow Diverting Devices

2007 ◽  
Author(s):  
Jaehoon Seong ◽  
Baruch B. Lieber ◽  
Ajay K. Wakhloo
Keyword(s):  
Conclusive Evidence ◽  
Endovascular Coiling ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Custom Made ◽  
Aneurysm Occlusion ◽  
Flow Activity ◽  
Wide Neck

Endovascular coiling is an acceptable treatment of intracranial aneurysms yet long term follow-ups suggest that endovascular coiling fails to achieve complete aneurysm occlusion particularly in wide-neck and giant aneurysms. Flow diverting devices can serve as an alternative to coils in endovascular bypass of human brain aneurysms for their exclusion from the cerebral circulation. They can redirect flow away from the aneurysm distally into the parent vessel thereby reestablishing physiological flow patterns. Placing of a flow diverting device across the aneurysm neck may be sufficient to occlude the aneurysm by promoting intra-aneurysmal thrombosis, however, conclusive evidence of its efficacy are still lacking. In this study [1], we investigated in vitro the efficacy of custom designed flow diverting devices and develop indices of their performance in an elastomeric model of the elastase-induced aneurysm in rabbit. The efficacy of custom designed flow divertors is investigated in terms of reducing the flow activity inside the sac. These custom made devices possess porosities that are similar to available stents, however, their pore densities are much higher. The results will help optimize the device that will be used in the animal model.

scholarly journals Intraarterial Thrombolysis for Thromboemboli Associated with Endovascular Aneurysm Coiling

2002 ◽  
Vol 8 (2) ◽  
pp. 151-158 ◽  
Author(s):  
C.J. Koebbe ◽  
M.B. Horowitz ◽  
E.I. Levy ◽  
K. Dutton ◽  
C.C. Jungries ◽  
...  
Keyword(s):  
Clinical Success ◽  
Neurologic Deficit ◽  
Thromboembolic Complications ◽  
Intraarterial Thrombolysis ◽  
Aneurysm Embolization ◽  
Procedural Complications ◽  
Aneurysm Occlusion ◽  
Risk Of Hemorrhage ◽  
Aneurysm Coiling ◽  
Clot Disruption

With the rapidly developing applications of GDC endovascular aneurysm embolization, the recognition and treatment of potential intra-procedural complications is crucial to reducing the morbidity and mortality of this procedure. Thromboembolic complications occur with an incidence of 2–11% with endovascular aneurysm coiling. We describe five cases in which the intraarterial use of thrombolytics was applied to disrupt a fresh clot and recanalize the occluded vessels with variable angiographic and clinical success. Five cases are presented in which thromboembolic complications occurred during or shortly after GDC endovascular aneurysm occlusion. The complication was recognized while depositing coils in two cases, on post-embolization angiogram in one, and a few hours following embolization in two cases in which a new neurologic deficit developed in the ICU. In those cases recognized while the microcatheter was near the aneurysm site, immediate thrombolysis was performed at the site of occlusion. The patients who developed a new neurologic deficit were returned to the endovascular suite and the site of occlusion was noted to be distal to the coiled aneurysm. Clot disruption was performed with the microcatheter before delivering intraarterial thrombolytics. Thromboembolic complications of GDC aneurysm embolization are fortunately rare and can be managed with delivery of thrombolytic therapy at the site of occlusion. Intraarterial thrombolysis of fresh clot caused by GDC aneurysm occlusion can successfully open the occluded vessels but not without serious risk of hemorrhage.

scholarly journals 1 Dissecting β-catenin associated inflammation in patients with desmoid fibromatosis to identify prognostic biomarkers

2021 ◽  
Vol 9 (Suppl 3) ◽  
pp. A1-A1
Author(s):  
Laura Bergamaschi ◽  
Federica Perrone ◽  
Francesca Rini ◽  
Licia Rivoltini ◽  
Chiara Castelli ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Immune Cells ◽  
Peripheral Blood ◽  
Prognostic Biomarkers ◽  
Molecular Profile ◽  
High Recurrence Rate ◽  
Desmoid Fibromatosis ◽  
Inflammatory Status ◽  
Functional Features ◽  
Promising Source

BackgroundDesmoid fibromatosis (DF) is a locally aggressive rare tumor with high recurrence rate after surgery and unpredictable clinical course. Standard of care for DF patients is active surveillance; however, 30% of patients will progress and need active treatments. Biomarkers discriminating aggressive forms of DF are not available and prediction of progressing patients remains challenging. DF harbors mutations in β-catenin and a transcriptional ‘inflammatory phenotype’. Cancer-associated inflammation is fostered by systemic factors and detectable in circulating immune cells. Blood leukocytes thus represent a promising source of prognostic biomarkers for DF patients. In this study we investigate phenotypic and functional features of peripheral blood immune cells and molecular profile of DF biopsies to identify DF patients at risk of progression and guide tailored therapeutic approaches.MethodsThis is a prospective observational study enrolling patients with primary sporadic desmoid fibromatosis under active surveillance (n=80). Tumor and blood samples collected at diagnosis and during active surveillance will be studied by 1. transcriptomic analysis of DF biopsies; 2. multiparametric flowcytometry and functional profiling of blood cells; 3. RNA profiling of whole blood; 4. evaluation of plasma levels of cyto/chemokine and ctDNA of β-catenin variants. Levels of blood analytes will be correlated with patients‘ clinical outcome and integrated with immunological parameters.ResultsPeripheral blood immune profile of 42 cases and 17 healthy donors (HD) shows that DF patients display at baseline an altered myeloid profile compared to HD, which is maintained in a subset of patients during the first year of active surveillance. An increase in immunosuppressive activated granulocytes and granulocytic myeloid-derived suppressor cells, defined by differential co-expression of CD15, CD11b, CD16 and LOX1, is observed, concomitantly, with a boost of monocyte subsets, defined by co-expression of CD33, CD11b, CD14, CD16, HLA-DR and PDL1. Immunosuppressive low density granulocytes are increased in progressing patients compared to HD and regressors. Of note, a significant up-regulation of immunosuppressive PMN-MDSC (defined as CD15+LOX-1+) is observed in DF harboring T41A mutation, but not in S45 mutated DF.Transcriptomic data of DF biopsies and of plasma analytes are ongoing.ConclusionsSystemic alterations of immunosuppressive and inflammatory myeloid cell subsets in peripheral blood of DF patients indicate that the inflammatory status detected at tumor site is reflected at systemic level. The altered myeloid profile supports the involvement of the immune system in DF onset and may represent a marker of disease aggressiveness.AcknowledgementsSupported by Italian Ministry of Health (RF-2016-02362609).Trial RegistrationNot applicable.ReferencesNot applicable.Ethics ApprovalThe study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of Fondazione IRCCS Istituto Nazionale dei Tumori di Milano (protocol code INT85/10).ConsentWritten informed consent was obtained from the patient for publication of this abstract. A copy of the written consent is available for review by the Editor of this journal.

scholarly journals Flow Diversion for Intracranial Aneurysms Beyond the Circle of Willis

2021 ◽  
Vol 12 ◽  
Author(s):  
Jinlu Yu ◽  
Xianli Lv
Keyword(s):  
Intracranial Aneurysms ◽  
Circle Of Willis ◽  
Flow Diversion ◽  
Arterial Phase ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Aneurysm Neck ◽  
Therapeutic Outcomes ◽  
Aneurysm Occlusion

Background: Few reports have shown the therapeutic outcomes of flow diversion (FD) for intracranial aneurysms beyond the circle of Willis, and the efficacy of this technique remains unclear.Materials and methods: A retrospective study was performed on 22 consecutive patients, diagnosed with intracranial aneurysms beyond the circle of Willis, and treated with pipeline embolization device (PED) (Medtronic, Irvine, California, USA) between January 2015 and December 2019.Result: The 22 patients were between 16 and 66 years old (mean 44.5 ± 12.7 years), and six patients were male (27.3%, 6/22). Twenty-two patients had 23 aneurysms. The 23 aneurysms were 3–25 mm in diameter (12.2 ± 7.1 mm on average). The diameter of the parent artery was 1.3–3.0 mm (2.0 ± 0.6 mm on average). The 23 aneurysms were located as follows: 17 (73.9%, 17/23) were in the anterior circulation, and 6 (26.1%, 6/23) were in the posterior circulation. PED deployment was technically successful in all cases. Two overlapping PEDs were used to cover the aneurysm neck in 3 cases. One PED was used to overlap the two tandem P1 and P2 aneurysms. Other cases were treated with single PED. Coil assistance was used to treat 7 aneurysms, including 4 recurrent aneurysms and 3 new cases requiring coiling assistance during PED deployment. There were no cases of complications during PED deployment. All patients were available at the follow-up (mean, 10.9 ± 11.4 months). All patients presented with a modified Rankin Score (mRS) of 0. During angiographic follow-up, complete embolization was observed in 22 aneurysms in 21 patients, and one patient had subtotal embolization with the prolongation of stasis in the arterial phase.Conclusion: PED deployment for intracranial aneurysms beyond the circle of Willis is feasible and effective, with high rates of aneurysm occlusion.

scholarly journals Endoscope- versus microscope-integrated near-infrared indocyanine green videoangiography in aneurysm surgery

2019 ◽  
Vol 131 (5) ◽  
pp. 1413-1422 ◽  
Author(s):  
Gerrit Fischer ◽  
Jana Rediker ◽  
Joachim Oertel
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Digital Subtraction Angiography ◽  
Digital Subtraction ◽  
Aneurysm Surgery ◽  
Indocyanine Green Videoangiography ◽  
Aneurysm Neck ◽  
Aneurysm Occlusion ◽  
Perforating Arteries

OBJECTIVEThe quality of surgical treatment of intracranial aneurysms is determined by complete aneurysm occlusion while preserving blood flow in the parent, branching, and perforating arteries. For a few years, there has been a nearly noninvasive and cost-effective technique for intraoperative flow evaluation: microscope-integrated indocyanine green videoangiography (mICG-VA). This method allows for real-time information about blood flow in the aneurysm and the involved vessels, but its limitations are seen in the evaluation of structures located in the depth of the surgical field, especially through small craniotomies. To compensate for these drawbacks, an endoscope-integrated ICG-VA (eICG-VA) was developed. The objective of the present study was to assess the use of eICG-VA in comparison with mICG-VA for intraoperative blood flow evaluation.METHODSIn the period between January 2011 and January 2015, 216 patients with a total of 248 intracranial saccular aneurysms were surgically treated in the Department of Neurosurgery of Saarland University Medical Center in Homburg/Saar, Germany. During 95 surgeries in 88 patients with a total of 108 aneurysms, intraoperative evaluation was performed with both eICG-VA and mICG-VA. After clipping, evaluation of complete aneurysm occlusion and flow in the parent, branching, and perforating arteries was performed using both methods. Intraoperative applicability of each technique was compared with the other and with postoperative digital subtraction angiography as a standard evaluation technique.RESULTSEvaluation of completeness of aneurysm occlusion and of flow in the parent, branching, and perforating arteries was more successful with eICG-VA than with mICG-VA, especially for aneurysm neck assessment (88.9% vs 69.4%). For 63.9% of the aneurysms (n = 69), both methods were equivalent, but in 30.6% of the cases (n = 33), the eICG-VA provided better results for evaluating the post-clipping situation. In 4.6% of these aneurysms (n = 5), the information given by the additional endoscope considerably changed the surgical procedure. Thus, one residual aneurysm (0.9%), two neck remnants (1.9%), and two branch occlusions (1.9%) could be prevented. Nevertheless, two incomplete aneurysm occlusions (1.9%) and six neck remnants (5.6%) were revealed by postoperative digital subtraction angiography.CONCLUSIONSEndoscope-integrated ICG-VA seems to be an improvement that might increase the quality of aneurysm surgery by providing additional information. It offers higher illumination, magnification, and an extended viewing angle. Its main advantage is its ability to assess deep-seated aneurysms, especially through small craniotomies, but further studies are required.

Orbitozygomatic Approach Clipping of an Anterior Communicating Artery Aneurysm: 2-Dimensional Operative Video

2020 ◽  
Vol 18 (5) ◽  
pp. E160-E160
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Artery Aneurysm ◽  
Optic Chiasm ◽  
Anterior Communicating Artery ◽  
Aneurysm Neck ◽  
Institutional Review ◽  
Orbitozygomatic Approach ◽  
Interhemispheric Fissure ◽  
Aneurysm Occlusion ◽  
Neck Control

Abstract Anterior communicating artery (ACoA) aneurysms can orient rostrally into the interhemispheric fissure or caudally into the optic chiasm. The majority of these aneurysms project into the interhemispheric fissure. This patient had an ACoA aneurysm with a multilobulated appearance, and the primary lobe projected into the interhemispheric fissure. The cisterns were opened sharply via an orbitozygomatic approach to permit proximal, distal, and neck control. A permanent clip was applied across the aneurysm neck and on a small contralateral aneurysm. Postoperative imaging confirmed complete aneurysm occlusion. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

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