scholarly journals Revisiting the Risk of Intraparenchymal Hemorrhage following Aneurysm Treatment by Flow Diversion

2012 ◽  
Vol 33 (7) ◽  
pp. E107-E107 ◽  
Author(s):  
G.P. Colby ◽  
L.-M. Lin ◽  
A.L. Coon
Keyword(s):  
Flow Diversion ◽  
Intraparenchymal Hemorrhage ◽  
Aneurysm Treatment

Flow Diversion for Intracranial Aneurysm Treatment: Trials Involving Flow Diverters and Long-Term Outcomes

Neurosurgery ◽  
2019 ◽  
Vol 86 (Supplement_1) ◽  
pp. S36-S45 ◽  
Author(s):  
Bree Chancellor ◽  
Eytan Raz ◽  
Maksim Shapiro ◽  
Omar Tanweer ◽  
Erez Nossek ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Flow Diversion ◽  
Long Term Outcomes ◽  
Complex Aneurysms ◽  
Aneurysm Treatment ◽  
Endovascular Methods ◽  
Cure Rates ◽  
Flow Diverters

Abstract Flow diverters (FDs) have changed the management of brain aneurysms; not only for complex aneurysms (giant, fusiform and blister) refractory to conventional therapies, but also for unruptured lesions previously managed by traditional surgical or coil-based endovascular methods. Since 2011 when the PipelineTM Embolization Device (Medtronic) was cleared by the Food and Drug Administration for adults with large or giant wide-neck intracranial aneurysms of the internal carotid artery proximal to the posterior communicating segment, the role of flow diversion for aneurysm treatment has expanded—supported by favorably low complication and high cure rates compared with alternative treatments. Here we review the key clinical trials and the long term outcomes that have demonstrated safety and efficacy of minimized porosity endoluminal devices in the treatment of cerebral aneurysms.

scholarly journals Quantitative assessment of parent vessel and distal intracranial hemodynamics following pipeline flow diversion

2016 ◽  
Vol 23 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Sophia F Shakur ◽  
Victor A Aletich ◽  
Sepideh Amin-Hanjani ◽  
Ahmed E Hussein ◽  
Fady T Charbel ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Flow Diversion ◽  
Flow Volume ◽  
Intraparenchymal Hemorrhage ◽  
Parent Vessel ◽  
Volume Rate ◽  
Significant Difference ◽  
The Impact ◽  
Flow Velocities

Background Pipeline embolization devices (PEDs) are commonly used for endovascular treatment of cerebral aneurysms but can be associated with delayed ipsilateral intraparenchymal hemorrhage. Although intra-aneurysmal hemodynamic changes have been studied, parent vessel and intracranial hemodynamics after PED use are unknown. We examine the impact of flow diversion on parent artery and distal intracranial hemodynamics. Method Patients with internal carotid cerebral aneurysms treated with PED who had flow volume rate, flow velocities, pulsatility index, resistance index, Lindegaard ratio, and wall shear stress (WSS) obtained after treatment using quantitative magnetic resonance angiography were reviewed. Means were compared between ipsilateral and contralateral internal carotid artery (ICA) and middle cerebral artery (MCA) using paired t tests. Results A total of 18 patients were included. Mean flow volume rate was lower in the ipsilateral versus contralateral ICA ( p = 0.04) but tended to be higher in the ipsilateral versus contralateral MCA ( p = 0.08). Lindegaard ratio was higher ipsilateral to the PED in diastole ( p = 0.05). Although there was no significant difference in flow velocities, pulsatility or resistance indices, and WSS, the two cases in our cohort with hemorrhagic complications did display significant changes in MCA flows and MCA WSS. Conclusion PED placement appears to alter the elasticity of the stented ICA segment, with lower flows in the ipsilateral versus contralateral ICA. Conversely, MCA flows and MCA WSS are higher in the ipsilateral MCA among patients with hemorrhage after PED placement, suggesting the role of disrupted distal hemodynamics in delayed ipsilateral intraparenchymal hemorrhage.

scholarly journals Flow Diversion for Intracranial Aneurysm Treatment

Neurosurgery ◽  
2019 ◽  
Vol 86 (Supplement_1) ◽  
pp. S1-S2 ◽  
Author(s):  
Ajith J Thomas ◽  
Christopher S Ogilvy
Keyword(s):  
Intracranial Aneurysm ◽  
Flow Diversion ◽  
Aneurysm Treatment

Intimal Hyperplasia After Aneurysm Treatment by Flow Diversion

2019 ◽  
Vol 122 ◽  
pp. e577-e583 ◽  
Author(s):  
Sergey Sindeev ◽  
Sascha Prothmann ◽  
Sergey Frolov ◽  
Claus Zimmer ◽  
Dieter Liepsch ◽  
...  
Keyword(s):  
Intimal Hyperplasia ◽  
Flow Diversion ◽  
Aneurysm Treatment

scholarly journals A Novel Grading Scale for the Angiographic Assessment of Intracranial Aneurysms Treated Using Flow Diverting Stents

2010 ◽  
Vol 16 (2) ◽  
pp. 133-137 ◽  
Author(s):  
C.J. O'Kelly ◽  
T. Krings ◽  
D. Fiorella ◽  
T.R. Marotta
Keyword(s):  
Treatment Option ◽  
Intracranial Aneurysms ◽  
Flow Diversion ◽  
Aneurysm Treatment ◽  
Grading Scale ◽  
Standardize Reporting ◽  
Grading Scales

Flow diverting stents are emerging as a treatment option for difficult intracranial aneurysms. Current grading scales for assessment of angiographic outcomes following aneurysm treatment do not apply to aneurysms treated by flow diversion. We propose a novel grading scale based on the degree of angiographic filling and contrast stasis. This scale will facilitate communication and standardize reporting of outcomes following flow diversion treatments.

scholarly journals Utilization of a Novel, Multi-Durometer Intracranial Distal Access Catheter: Nuances and Experience in 110 Consecutive Cases of Aneurysm Flow Diversion

2017 ◽  
Vol 6 (1-2) ◽  
pp. 90-104 ◽  
Author(s):  
Geoffrey P. Colby ◽  
Li-Mei Lin ◽  
Risheng Xu ◽  
Narlin Beaty ◽  
Matthew T. Bender ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Flow Diversion ◽  
Technical Success ◽  
Anterior Circulation ◽  
Patient Demographics ◽  
Aneurysm Treatment ◽  
Vessel Injury ◽  
Wide Range ◽  
Neurological Morbidity ◽  
Coaxial Catheter

Background: Coaxial catheter support systems provide a safe and stable foundation in endovascular treatment of intracranial aneurysms. Increasingly, robust distal intracranial support is sought during complex neurointerventions. The AXS Catalyst 5 distal access catheter (Cat5) is a new intracranial catheter designed for improved trackability and stability. We report the first experience using Cat5 for aneurysm treatment by flow diversion. Methods: A single-center aneurysm database was reviewed for cases of aneurysm treatment with the Pipeline embolization device (PED) that utilized Cat5. Data were collected for patient demographics, aneurysm characteristics, procedural details, catheter positions, vessel tortuosity, and catheter related complications. Results: One hundred and ten cases of aneurysm flow diversion were successfully performed using Cat5. Patient age ranged from 21 to 86 years (mean 57 ± 12.5 years) with 84% women. Aneurysm size ranged from 2 to 28 mm (mean 5.7 ± 5.0 mm), with 97% in the anterior circulation. Twenty-four aneurysms (22%) were located beyond the ICA termination. Significant cervical carotid tortuosity was present in 26% of cases, and moderate to severe cavernous tortuosity (cavernous grade ≥2) in 45% of cases. Cat5 was tracked to the intended distal position in all cases with 100% technical success of PED implantation. No iatrogenic catheter-related vessel injury occurred, and major neurological morbidity occurred in 1 patient (1%). Summary: The Cat5 is a novel, multi-durometer cranial distal access catheter designed for use in tri-axial systems. We have demonstrated the utility of Cat5 in 110 successful cases of flow diversion with a wide range of complexity. This catheter is a new tool in the neurointerventionalist's armamentarium to achieve robust and atraumatic distal access.

Transradial approach for flow diversion treatment of cerebral aneurysms: a multicenter study

2019 ◽  
Vol 11 (8) ◽  
pp. 796-800 ◽  
Author(s):  
Stephanie H Chen ◽  
Brian M Snelling ◽  
Sumedh Subodh Shah ◽  
Samir Sur ◽  
Marie Christine Brunet ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cerebral Aneurysms ◽  
High Volume ◽  
Flow Diverter ◽  
Acute Angle ◽  
Flow Diversion ◽  
Left Internal Carotid Artery ◽  
Access Site ◽  
Transradial Approach ◽  
Aneurysm Treatment

BackgroundThe transradial approach (TRA) to endovascular procedures decreases access site morbidity and mortality in comparison with the traditional transfemoral technique (TFA). Despite its improved safety profile, there is a concern that TRA is less favorable for neurointerventional procedures that require large coaxial systems to manage the small tortuous cerebral vessels.ObjectiveTo report our experience with TRA for flow diverter placement for treatment of unruptured cerebral aneurysms.MethodsWe performed a retrospective review of prospective institutional databases at two high-volume centers to identify 49 patients who underwent flow diversion for aneurysm treatment via primary TRA between November 2016 and November 2018. Patient demographics, procedural techniques, and clinical data were recorded.ResultsOf the 49 patients, 39 underwent successful flow diversion placement by TRA. Ten patients were converted to TFA after attempted TRA. There were no procedural complications. Reasons for failure included tortuosity in eight patients and severe radial artery spasm in two.ConclusionsIn the largest reported series to date of flow diverter deployment via TRA for aneurysm treatment, we demonstrate the technical feasibility and safety of the method. The most common reason for failure of TRA was an acute angle of left common carotid artery origin or left internal carotid artery tortuosity. Overall, our data suggest that increasing adoption of TRA is merited given its apparent equivalence to the current TFA technique and its documented reduction in access site complications.

Sign in / Sign up

Export Citation Format

Share Document