Patency of Posterior Circulation Branches Covered by Flow Diverter Device: A Hemodynamic Study

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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Two-stage reconstructive overlapping stent LEO+ and SILK for treatment of intracranial circumferential fusiform aneurysms in the posterior circulation

Interventional Neuroradiology ◽

10.1177/1591019916656475 ◽

2016 ◽

Vol 22 (5) ◽

pp. 516-523 ◽

Cited By ~ 3

Author(s):

Guilherme Cabral de Andrade ◽

Helvercio P Alves ◽

Valter Clímaco ◽

Eduardo Pereira ◽

Alexandre Lesczynsky ◽

...

Keyword(s):

Vascular Reconstruction ◽

Flow Diverter ◽

Posterior Circulation ◽

The Self ◽

Reconstruction Technique ◽

Fusiform Aneurysm ◽

Arterial Reconstruction ◽

The Brain ◽

Flow Diverter Device

Intracranial circumferential fusiform aneurysms of the posterior circulation involving arterial branches or perforating vessels are difficult to treat. This article shows an endovascular reconstruction technique not yet described, using a telescoping self-expandable stent (LEO+) and flow-diverter device (SILK) at different surgical times. Two patients with circumferential fusiform aneurysm, one being an aneurysm of the segments P2 and P3 of the posterior cerebral artery, diagnosed after a headache, and the other a partially thrombosed aneurysm of the lower basilar artery, diagnosed following ischemia of the brain stem. Endovascular treatment was performed by means of a vascular reconstruction technique that used at different surgical times: overlapping; a telescoped self-expandable stent, LEO+; and a flow-diverter device, SILK. Angiographic control was carried out at 6 and 12 months, to evaluate arterial patency, flow maintenance in the arterial branches and perforating vessels, and thrombosis of the aneurysm. The combined use at different surgical times of the self-expandable stent and flow-diverter device was technically successful in both patients. There were no complications during the procedure, nor in the long-term follow-up with full arterial vascular reconstruction, maintenance of cerebral perfusion and complete aneurysm occlusion at the 6- and 12-month angiographic follow-up. There was no aneurysm recanalization nor intra-stent stenosis. Circumferential fusiform aneurysm of the posterior circulation involving arterial branches or perforating vessels to the brain stem may be treated with this arterial reconstruction technique at different surgical times, using the self-expandable stent called LEO+ and the flow-diverter device SILK, minimizing the risk of complications and failure of the endovascular technique, with the potential for arterial reconstruction with thrombosis of the aneurysmatic sac, as well as flow maintenance in the eloquent arteries, in this type of cerebral aneurysm.

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Abstract 120: Surpass Flow Diverter for Endovascular Treatment of Intracranial Aneurysms - A Multicenter Preliminary Clinical and Angiographic Experience in 161 Patients with 186 Aneurysms

Stroke ◽

10.1161/str.45.suppl_1.120 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Ajay K Wakhloo ◽

Pedro Lylyk ◽

Joost de Vries ◽

Matthew J Gounis ◽

Alexandra Biondi ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Experimental Studies ◽

Flow Diverter ◽

Posterior Circulation ◽

Parent Artery ◽

Anterior Circulation ◽

Neck Size ◽

Wide Range ◽

New Generation

Objective: Validated through experimental studies a new generation of flow diverters (Surpass™ FD) was evaluated for treatment of intracranial aneurysms (IA). We present our multicenter preliminary clinical and angiographic experience. METHODS: To achieve the calculated flow disruption between the parent artery and aneurysm for thrombosis, single FDs were placed endovascularly in parent arteries. Implants measured 2.5-5.3mm in diameter with a length of 10-80mm. Patients were enrolled harboring a wide range large and giant wide-neck, fusiform and multiple small and blister-type aneurysm. Clinical and angiographic follow-up were performed at 1-3, 6, and 12 months. RESULTS: A total of 186 consecutive IA in 161 patients (mean age 57.1 years) were treated at 33 centers. Fifty-three aneurysms were smaller than 5 mm, 64 were 5-9.9mm in diameter, 47 were 10-20mm in diameter, and 22 were larger than 20mm (10.4±0.7mm, neck size 6.0±0.5mm [mean±SEM]) . The aneurysms originated in 63.4% from the internal carotid artery; 22% and 14.5% of the lesions were located in the anterior circulation distal to Circle of Willis and posterior circulation respectively. Technical success was achieved in 182 aneurysms (98%); average number of devices used per aneurysm was 1.05. Permanent morbidity and mortality during the follow-up period of mean 8.4months (range 1-24 months) including periprocedural complications for patients with aneurysms of the anterior circulation were encountered in 5 (3.7%) and 2 (1.5 %) patients respectively and 1 (3.7%) and 4 (14.8%) respectively for patients with aneurysms of the posterior circulation location. One-hundred-ten patients (70.5%) harboring 127 (70.2%) were available for clinical and angiographic follow-up and showed a complete or near complete aneurysm occlusion in 63 (81.8%) of the ICA. Aneurysms of the ICA≥10mm that were completely covered by FD and not previously stent-treated with a minimum of 6 months follow-up available in 16 patients showed a complete obliteration in 81.3% (n=13) and >90% occlusion in remaining 3 patients. CONCLUSION: Preliminary data demonstrate high safety and efficacy of a new generation of FD for a wide range of IA of the anterior and posterior circulation with a single implant.

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Transcirculation Silk Vista Baby-assisted coiling in half-T configuration for the treatment of posterior communicating artery aneurysms associated with a fetal posterior circulation: An alternative flow diversion strategy

Interventional Neuroradiology ◽

10.1177/1591019920961889 ◽

2020 ◽

pp. 159101992096188

Author(s):

Mario Martínez-Galdámez ◽

Miguel Schüller-Arteaga ◽

Jorge Galván-Fernández ◽

Vladimir Kalousek ◽

Ezequiel Petra ◽

...

Keyword(s):

Flow Diverter ◽

Posterior Circulation ◽

Flow Diversion ◽

Anterior Communicating Artery ◽

Anterior Circulation ◽

Low Profile ◽

Specific Subgroup ◽

Flow Diverter Devices ◽

Profile Flow ◽

Incomplete Occlusion

Flow diverter devices have become a routine first-line option for treatment of an increasing population of intracranial aneurysms at many neurovascular centers. Despite the promising results of flow diverter stents on anterior circulation, incomplete occlusion on the presence of fetal posterior circulation has been described on several reports. Here we describe a novel technical alternative to conventional flow diversion approach for this specific subgroup of aneurysms using the low-profile flow diverter, Silk Vista Baby. The device was selectively placed into the fetal type posterior cerebral artery in half-T configuration for the treatment of a posterior communicating aneurysm using a transcirculation approach through the anterior communicating artery. This represents a useful and effective technique and should be considered when encountering the above-described situation.

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E-216 The effect of omeprazole on patients taking clopidogrel after flow diverter device placement

10.1136/neurintsurg-2020-snis.247 ◽

2020 ◽

Author(s):

J Catapano ◽

V Fredrickson ◽

A Wakim ◽

J Lundberg ◽

B Hendricks ◽

...

Keyword(s):

Flow Diverter ◽

Device Placement ◽

Flow Diverter Device

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Endovascular Treatment of a Small Aneurysm of the Superior Cerebellar Artery with a Flow-Diverter Device

The Neuroradiology Journal ◽

10.1177/197140091302600313 ◽

2013 ◽

Vol 26 (3) ◽

pp. 327-331 ◽

Cited By ~ 12

Author(s):

F. Briganti ◽

M. Marseglia ◽

G. Leone ◽

G. Briganti ◽

D. Piccolo ◽

...

Keyword(s):

Endovascular Treatment ◽

Flow Diverter ◽

Superior Cerebellar Artery ◽

Cerebellar Artery ◽

Small Aneurysm ◽

Flow Diverter Device

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Ruptured Intracanalicular Ophthalmic Artery Aneurysm Treated with Low Profile Flow Diverter Device

Clinical Neuroradiology ◽

10.1007/s00062-019-00792-2 ◽

2019 ◽

Vol 30 (1) ◽

pp. 177-180

Author(s):

S. Sirakov ◽

A. Sirakov ◽

H. Tsonev ◽

H. Hristov

Keyword(s):

Ophthalmic Artery ◽

Artery Aneurysm ◽

Flow Diverter ◽

Low Profile ◽

Profile Flow ◽

Flow Diverter Device

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Flow diverters for ruptured posterior circulation perforator aneurysms: multicenter experience and literature review

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-015558 ◽

2020 ◽

Vol 12 (7) ◽

pp. 688-694

Author(s):

Valerio Da Ros ◽

Francesco Diana ◽

Federico Sabuzi ◽

Emanuele Malatesta ◽

Antioco Sanna ◽

...

Keyword(s):

Perioperative Complications ◽

Treatment Options ◽

Flow Diverter ◽

Posterior Circulation ◽

Complication Rates ◽

Lower Complication ◽

Long Term Follow Up ◽

Ischemic Complication

BackgroundThe management of ruptured posterior circulation perforator aneurysms (rPCPAs) remains unclear. We present our experience in treating rPCPAs with flow diverter stents (FDs) and evaluate their safety and efficacy at mid- to long-term follow-up. A diagnostic and therapeutic algorithm for rPCPAs is also proposed.MethodsWe retrospectively analyzed data from all consecutive patients with rPCPAs treated with FDs at our institutions between January 2013 and July 2019. Clinical presentations, time of treatments, intra- and perioperative complications, and clinical and angiographic outcomes were recorded, with a mid- to long-term follow-up. A systematic review of the literature on rPCPAs treated with FDs was also performed.ResultsSeven patients with seven rPCPAs were treated with FDs. All patients presented with an atypical subarachnoid hemorrhage distribution and a low to medium Hunt–Hess grade. In 29% of cases rPCPAs were identified on the initial angiogram. In 57% of cases, FDs were inserted within 2 days of the diagnosis. Immediate aneurysm occlusion was observed in 14% of the cases and in 71% at the first follow-up (mean 2.4 months). At mean follow-up of 33 months (range 3–72 months) one case of delayed ischemic complication occurred. Six patients had a modified Rankin Scale (mRS) score of 0 and one patient had an mRS score of 4 at the latest follow-up.ConclusionsThe best management for rPCPAs remains unclear, but FDs seem to have lower complication rates than other treatment options. Further studies with larger series are needed to confirm the role of FDs in rPCPA.

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E-135 initial single center experience with the fred flow diverter device

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011917.209 ◽

2015 ◽

Vol 7 (Suppl 1) ◽

pp. A103.1-A103

Author(s):

J Fifi ◽

A Otokiti ◽

D Altschul ◽

S Paramasivam ◽

A Berenstein

Keyword(s):

Flow Diverter ◽

Single Center ◽

Single Center Experience ◽

Flow Diverter Device

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Republished: Advanced digital subtraction angiography and MR fusion imaging protocol applied to accurate placement of flow diverter device

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2014-011428.rep ◽

2015 ◽

Vol 8 (2) ◽

pp. e5-e5 ◽

Cited By ~ 7

Author(s):

Giuseppe Faragò ◽

Valentina Caldiera ◽

Giovanni Tempra ◽

Elisa Ciceri

Keyword(s):

Digital Subtraction Angiography ◽

Three Dimensional ◽

Interventional Neuroradiology ◽

Fusion Imaging ◽

Flow Diverter ◽

Progressive Increase ◽

Ct Images ◽

Digital Subtraction ◽

Imaging Protocol ◽

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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