scholarly journals Healing of Aneurysm after Treatment Using Flow Diverter Stent : Histopathological Study in Experimental Canine Carotid Side Wall Aneurysm

2020 ◽  
Vol 63 (1) ◽  
pp. 34-44 ◽  
Author(s):  
Jong Young Lee ◽  
Young Dae Cho ◽  
Hyun-Seung Kang ◽  
Moon Hee Han
Keyword(s):  
Side Wall ◽  
Flow Diverter ◽  
Histopathological Study ◽  
Flow Diverter Stent ◽  
Experimental Canine

scholarly journals Very late ischemic complications in flow-diverter stents: a retrospective analysis of a single-center series

2016 ◽  
Vol 125 (4) ◽  
pp. 929-935 ◽  
Author(s):  
Alexis Guédon ◽  
Frédéric Clarençon ◽  
Federico Di Maria ◽  
Charlotte Rosso ◽  
Alessandra Biondi ◽  
...  
Keyword(s):  
Side Wall ◽  
Flow Diverter ◽  
Superior Cerebellar Artery ◽  
Left Internal Carotid Artery ◽  
Average Delay ◽  
Focal Neurological Deficit ◽  
Diffusion Weighted Images ◽  
Flow Diverter Stent ◽  
Ischemic Complications ◽  
Focal Stenosis

OBJECTIVE The authors evaluate the rate and discuss the pathomechanisms of very late (≥ 4-month) ischemic complications after flow-diverter stent (FDS) placement for intracranial aneurysms. METHODS The authors retrospectively reviewed the clinical data of the patients treated at Pitié-Salpêtrière Hospital between January 2010 and September 2014, who underwent FDS placement for intracranial aneurysm. The patients received dual-antiplatelet therapy (clopidogrel and aspirin) 5 days before and 3–6 months after the procedure and then aspirin alone for 6–9 months. An ischemic complication was defined as a sudden focal neurological deficit documented on diffusion-weighted images. RESULTS Eighty-six consecutive patients were included. Three (3.5%) patients treated with the Pipeline embolization device experienced a delayed acute ischemic stroke (2 cases of perforator/side-wall branch infarction and 1 case of thromboembolic stroke) with an average delay of 384 days (4 months, 20 months, and 13 months, respectively). The aneurysm locations were the left superior cerebellar artery, the right anterior choroid artery, and the left internal carotid artery (paraclinoid segment), respectively. The complications occurred after the patients had completed the antiaggregation protocol, except for Patient 1, who was receiving aspirin alone because of a spontaneous hematoma. At the acute phase, no in-stent thromboses were found on digital subtraction angiography. In Patient 2, the treated anterior choroid artery was occluded 20 months after the procedure. In Patient 3, a focal stenosis (approximately 40%) of the distal aspect of the FDS, probably caused by intimal hyperplasia, was seen. CONCLUSIONS Very late ischemic complications after FDS treatment were observed in 3.5% of the cases in the authors' series, some of which occurred as late as more than 1 year after placement.

A Computational Modelling for Hemodynamic Conditions Following Flow-Diverting Treatment in Cerebral Aneurysms

2018 ◽  
Author(s):  
Gen Fu ◽  
Alexandrina Untaroiu
Keyword(s):  
Average Velocity ◽  
Physiological State ◽  
Cerebral Aneurysms ◽  
Side Wall ◽  
Flow Diverter ◽  
Geometrical Parameters ◽  
Parent Artery ◽  
Flow Diverter Stent ◽  
Structure Of Flow ◽  
Flow Diverters

Cerebral aneurysms are abnormal dilations of blood vessels within the skull that, in some cases, may rupture and bleed. The rupture of an aneurysm can cause significant bleeding into or around the brain (a stroke). Flow diverters are specially designed low porosity stents that are deployed into the parent artery to cover the neck of the aneurysm. The dense mesh-like structure of flow diverters aims at redirecting flow from the aneurysm to the parent artery and vice versa, resulting in flow stasis in the aneurysm and promoting thrombus formation conditions. The thrombosed aneurysm is then resorbed by the body’s wound healing mechanisms-the end result of which is a remodeled vessel returned to its normal physiological state. Most previous studies have been focused on correlating the hemodynamic conditions with the outcome of the flow diverters. On the other hand, the effects of the location of the stents have not been addressed. In this study, a numerical simulation of an idealized side wall aneurysm model is used to predict the hemodynamic conditions for different flow diverter stent locations. The CFD model of the aneurysm is developed based on data from the literature and the geometrical parameters are set according to the test data. Pulsatile boundary conditions are chosen according to the normal physiological conditions. The entire stent geometry is used to model the effect of the stent on the flow characteristics. The hemodynamic conditions in the aneurysm corresponding to different stent locations are compared. The results show that the average velocity and vorticity are significantly different depending on different stent locations. Marked reduction in average velocity, average vorticity, and mean wall shear stress within the aneurysm sac have been observed even in malposition cases. The results of this study can be further used to guide the deployment of the flow diverter stent in clinical application.

Management of giant internal carotid aneurysm by extracranial-intracranial bypass and flow diverter stent

2021 ◽  
pp. 1-5
Author(s):  
Assylbek Kaliyev ◽  
Yerbol Makhambetov ◽  
Yerkin Medetov ◽  
Marat Kulmirzayev ◽  
Serik Dusembayev ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Flow Diverter ◽  
Flow Diverter Stent

Ocular Trauma with Ophthalmic Artery Injury as a Rare Cause of Subarachnoid Hemorrhage: a Case Report and Review of the Literature

2021 ◽  
Author(s):  
Michael Veldeman ◽  
Hani Ridwan ◽  
Dimah Hasan ◽  
Annette Rieg ◽  
Hans Clusmann ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Ophthalmic Artery ◽  
Ocular Trauma ◽  
Delayed Cerebral Ischemia ◽  
Penetrating Trauma ◽  
Flow Diverter ◽  
Pseudoaneurysm Formation ◽  
Flow Diverter Stent ◽  
Close Observation

Abstract Background and Importance Traumatic avulsion of the ophthalmic artery is a rare cause of subarachnoid hemorrhage (SAH). In this case, a relative minor fall with isolated ocular trauma caused bulbar dislocation and rupture of the ophthalmic artery in its intracranial segment resulting in subarachnoid bleeding. Clinical Presentation In a female patient in her 70s, a direct penetrating trauma to the orbit by a door handle resulted in basal SAH with blood dispersion into both Sylvian fissures. Cerebral angiography revealed a blunt-ending stump at the origin of the ophthalmic artery. To provide protection against further bleeding, a flow diverter stent was placed in the internal carotid artery to cover the origin of the ophthalmic artery. After a longer intensive care stay complicated by pneumonia and respiratory insufficiency, the patient made a full recovery. Of all four reported cases (including ours), delayed cerebral ischemia was seen in one patient and hydrocephalus in two patients. These potential complications necessitate close observation and fitting treatment similar to aneurysmal SAH. Conclusion Due to similar physiologic aspects, this type of bleed mimics many aspects of aneurysmal SAH. In this case, we observed no hydrocephalus or the development of delayed cerebral ischemia. This represents, however, the first reported case treated by placement of a flow diverter stent to prevent rebleeding and pseudoaneurysm formation.

High-Resolution MRI Visualization of Aneurysmal Thrombosis after Flow Diverter Stent Placement

2014 ◽  
Vol 25 (2) ◽  
pp. 310-311 ◽  
Author(s):  
Benjamin Gory ◽  
Monica Sigovan ◽  
Carolina Vallecilla ◽  
Guy Courbebaisse ◽  
Francis Turjman
Keyword(s):  
High Resolution ◽  
Stent Placement ◽  
Flow Diverter ◽  
Flow Diverter Stent ◽  
High Resolution Mri

scholarly journals Silk flow-diverter stent for the treatment of complex intracranial aneurysms: A one-year follow-up multicenter study

2018 ◽  
Vol 24 (4) ◽  
pp. 357-362 ◽  
Author(s):  
G Foa Torres ◽  
F Roca ◽  
A Noguera ◽  
J Godes ◽  
S Petrocelli ◽  
...  
Keyword(s):  
Mortality Rates ◽  
Flow Diverter ◽  
Clinical Findings ◽  
Safe Alternative ◽  
Complex Aneurysms ◽  
Flow Diverter Stent ◽  
Class 1 ◽  
One Year ◽  
Therapeutic Alternatives

Background Flow-diverter stents have been successfully used in the treatment of complex aneurysms with limited therapeutic alternatives. We report our experience using the Silk flow diverter (SFD; Balt Extrusion, Montmorency, France) for the treatment of complex aneurysms in four Argentine centers. Methods We conducted a retrospective review of 246 consecutive patients who were treated with the SFD at four Argentine centers between January 2009 and January 2017. The patient and aneurysm characteristics, as well as the details of the procedure, were analyzed. The angiographic and clinical findings were recorded during and immediately after the procedure and at 12-month follow-up. Results Angiography follow-up at 12 months was possible in 235 patients (95.5%) with 282 aneurysms. A total of 265 aneurysms (93.9%) presented with complete occlusion of the aneurysmal sac (class 1) and 17 aneurysms (6.1%) presented with partial occlusion (class 2). The 12-month clinical follow-up showed 11 patients with major events (seven, scale 2; five, scale 3; and two, scale 4). The morbidity and mortality rates were 4.2% (11/289) and 2.1% (5/289), respectively. Conclusions The treatment of aneurysms with the SFD was associated with a low rate of complications and a high percentage of aneurysmal occlusion. These findings suggest that SFD is an effective and safe alternative in the endovascular treatment of complex aneurysms.

Single-center experience with the new generation Derivo Embolization Device in ruptured dissecting and blister aneurysms

2019 ◽  
Vol 61 (1) ◽  
pp. 37-46 ◽  
Author(s):  
Marius Georg Kaschner ◽  
Athanasios Petridis ◽  
Bernd Turowski
Keyword(s):  
Digital Subtraction Angiography ◽  
Flow Diverter ◽  
High Morbidity ◽  
Digital Subtraction ◽  
Related Complication ◽  
Single Center Experience ◽  
Flow Diverter Stent ◽  
Aneurysm Occlusion ◽  
New Generation

Background Treatment of ruptured dissecting and blister aneurysms is technically challenging with potentially high morbidity and mortality. The Derivo Embolisation Device (Derivo) is a flow diverter stent designed for the treatment of intracranial aneurysms. Purpose To assess the safety and feasibility of the Derivo in the treatment of ruptured dissecting and blister aneurysms. Material and Methods We retrospectively analyzed all patients with ruptured dissecting and blister aneurysms treated with the Derivo between February 2016 and July 2018. Procedural details, complications, morbidity within 30 days, and angiographic aneurysm occlusion rates, initially and after six months, were assessed. Results In 10 patients 11 ruptured dissecting and blister aneurysms were treated with 12 Derivos as monotherapy. No aneurysm rebleeding was observed at follow-up. One treatment-related complication occurred including a coil perforation of an additionally treated aneurysm. One patient died due to brain edema. Initial digital subtraction angiography revealed complete (O’Kelly–Marotta [OKM] classification D) and favorable (OKM D+C) occlusion rate in three aneurysms. Six-month follow-up for digital subtraction angiography and clinical evaluation was available in 6/9 patients with complete (OKM D) occlusion in all aneurysms (6/6). Favorable (modified Rankin Scale [mRS] ≤ 2) and moderate (mRS 3) clinical outcome after a mean follow-up of 10 months was observed in six and two patients, respectively. Conclusion Endovascular treatment with the Derivo in ruptured dissecting and blister aneurysms revealed a sufficient initial division of aneurysms from the circulation without rebleeding. The Derivo is associated with high procedural and clinical short-term safety.

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