scholarly journals Endovascular Treatment of Ruptured Wide-Necked Anterior Communicating Artery Aneurysms Using a Low-Profile Visualized Intraluminal Support (LVIS) Device

2021 ◽  
Vol 11 ◽  
Author(s):  
Gaici Xue ◽  
Peng Liu ◽  
Fengfeng Xu ◽  
Yibin Fang ◽  
Qiang Li ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Perioperative Complications ◽  
Class Ii ◽  
High Rate ◽  
Anterior Communicating Artery ◽  
Complete Occlusion ◽  
Low Profile ◽  
Angiographic Data ◽  
Low Rate

Objective: To evaluate the safety and efficacy of low-profile visualized intraluminal support (LVIS) stent-assisted coiling for the treatment of ruptured wide-necked anterior communicating artery (ACoA) aneurysms.Methods: The clinical and angiographic data of 31 acutely ruptured wide-necked ACoA aneurysms treated with LVIS stent-assisted coiling between January 2014 and December 2018 were retrospectively reviewed.Results: All stents were successfully deployed. The immediate angiographic results were modified Raymond-Roy class I in 27 cases, modified Raymond-Roy class II in 2 cases, and modified Raymond-Roy class IIIa in 2 cases. Intraoperative thrombosis and postoperative aneurysmal rebleeding occurred in one case each. Two patients (6.5%) who were admitted due to poor clinical grade conditions died during hospital admission as a result of initial bleeding. Angiographic follow-up (mean: 12.9 months) was performed for 26 patients, the results of which demonstrated that 25 aneurysms were completely occluded and one was class II. The last clinical follow-up (mean: 25.3 months) outcomes demonstrated that 27 patients had favorable clinical outcomes and two had poor clinical outcomes.Conclusion: LVIS stent-assisted coiling for ruptured wide-necked ACoA aneurysms was safe and effective, with a relatively low rate of perioperative complications and a high rate of complete occlusion at follow-up.

Early experience treating intracranial aneurysms using Accero: a novel, fully visible, low profile braided stent with platinum–nitinol composite wire technology

2020 ◽  
Vol 13 (1) ◽  
pp. 49-53
Author(s):  
Alberto Nania ◽  
Nicholas Dobbs ◽  
Johannes DuPlessis ◽  
Peter Keston ◽  
Jonathan Downer
Keyword(s):  
Cerebral Artery ◽  
Anterior Communicating Artery ◽  
Clinical Consequence ◽  
Composite Wire ◽  
Postoperative Hematoma ◽  
Low Profile ◽  
Angiographic Data ◽  
Aneurysm Occlusion ◽  
Braided Stent

BackgroundAccero is an innovative, fully visible, self-expanding braided stent with platinum–nitinol composite wire technology, produced by Acandis.ObjectiveTo assess the technical success and safety of this new stent by evaluating the intraprocedural behavior and complication rate, and the short-term follow-up results.MethodsForty-one consecutive patients suitable for stent-assisted coiling were selected for the use of Accero in an 11-month period. Clinical, procedural, and angiographic data, as well as 30-day morbidity, were recorded. The angiographic results, clinical follow-up at 30 days, and early imaging follow-up at 3 or 6 months were analyzed, when available.ResultsForty-one aneurysms were treated with stent-assisted coiling. All cases were elective, of which 19 were previously untreated aneurysms and 22 were recurrent aneurysms. Aneurysm location was anterior communicating artery complex (16), basilar (12 cases), middle cerebral artery bifurcation (9 cases), and internal cerebral artery (4 cases). The stent was successfully deployed and aneurysm occlusion with coils achieved in 100% of our patients. One case of on table in-stent thrombosis occurred, which resolved after administration of glycoprotein IIB/IIIA inhibitor, with no clinical consequence, and one case of postoperative hematoma at the arteriotomy site, which was managed conservatively. On early follow-up, available for 37 patients, the complete occlusion rate was 76%, with only two recurrences needing further treatment. Satisfactory aneurysm occlusion was therefore achieved in 95% of cases.ConclusionStent-assisted coiling with the Accero braided stent proved safe and effective.

scholarly journals Treatment of ruptured blood blister aneurysms using primary flow-diverter stenting with considerations for adjunctive coiling: A single-centre experience and literature review

2017 ◽  
Vol 23 (5) ◽  
pp. 465-476 ◽  
Author(s):  
Cunli Yang ◽  
Agnes Vadasz ◽  
István Szikora
Keyword(s):  
Literature Review ◽  
Clinical Outcomes ◽  
Flow Diverter ◽  
Single Centre ◽  
Primary Flow ◽  
Complete Occlusion ◽  
Treatment Techniques ◽  
Angiographic Data ◽  
Procedural Success

Objective The objective of this article is to conduct a single-centre evaluation and quick literature review of the effectiveness of primary flow-diverter (FD) treatment of ruptured blood blister aneurysms (BBAs), with additional relevance of adjunctive coiling. Methods Patients presenting with subarachnoid haemorrhage (SAH) due to ruptured BBAs and subsequently treated with FDs were retrospectively selected from June 2010 to January 2017. Treatment techniques, angiographic data on occlusion rates and procedural success as well as clinical outcomes using the modified Rankin Scale (mRS) were collated. Cross-reference of results were made with available literature. Results Thirteen patients harbouring 14 BBAs were recruited. Of the 14 aneurysms, five (35.7%) showed immediate complete occlusion after the procedure (four of these five patients had adjunctive coiling). All of the aneurysms showed complete occlusion by the six- to nine-month control diagnostic angiogram. No rebleed or retreatment was experienced. Twelve of 13 (92%) patients had an mRS score of 0–1 at the last clinical follow-up. From the pooled data of the literature review, eventual aneurysm occlusion was achieved in 48/56 patients, with five patients requiring further endovascular treatment. In the clinical follow-up period, an mRS of 0–2 was recorded for 83.3% (45/54) of patients. Conclusion Endovascular reconstruction of BBAs using FD treatment is an effective method with good final clinical outcomes. Adjunctive use of coiling achieves higher incidence of immediate complete occlusion of BBAs.

Midterm results of T-stent–assisted coiling of wide-necked and complex intracranial bifurcation aneurysms using low-profile stents

2017 ◽  
Vol 127 (6) ◽  
pp. 1288-1296 ◽  
Author(s):  
Kubilay Aydin ◽  
Serra Sencer ◽  
Mehmet Barburoglu ◽  
Mynzhylky Berdikhojayev ◽  
Yavuz Aras ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Intracranial Aneurysms ◽  
Anterior Communicating Artery ◽  
Total Occlusion ◽  
Technical Success Rate ◽  
Low Profile ◽  
Scale Scores ◽  
Occlusion Rate ◽  
Double Stent

OBJECTIVECoiling of wide-necked and complex bifurcation aneurysms frequently requires implantation of double stents in various configurations. T-stent–assisted coiling involves the nonoverlapping implantation of 2 stents to protect the daughter vessels of bifurcation and is followed by coiling of the aneurysm. The authors studied the feasibility, efficacy, and safety of the T-stent–assisted coiling procedure as well as the midterm angiographic/clinical outcomes of patients with wide-necked bifurcation intracranial aneurysms treated using this technique.METHODSThe authors retrospectively identified patients with wide-necked bifurcation intracranial aneurysms treated using double-stent–assisted coiling with a T-stent configuration.RESULTSTwenty-four patients with 24 aneurysms and a mean of age of 51.91 years were identified. The most common locations were the middle cerebral bifurcation (45.8%) and anterior communicating artery (35.7%). T stentings were performed using low-profile stents. The procedures were performed with a technical success rate of 95.8%, and an immediate total occlusion rate of 79.2% was achieved. We observed periprocedural complications in 16.7% of cases and a delayed thromboembolic event in 4.2%. The complications caused permanent morbidity in 1 patient (4.2%). No deaths occurred. The mean angiographic follow-up duration was 9.3 months. The total occlusion rate at the last follow-up was 81.2%. The recanalization rate was 4.5%. Modified Rankin Scale scores of all patients at the last follow-ups were between zero and 2.CONCLUSIONST-stent–assisted coiling using low-profile stents is a feasible, effective, and relatively safe endovascular technique used to treat wide-necked and complex intracranial aneurysms. The midterm angiographic and clinical outcomes are outstanding.

Y-configuration stenting for coiling of wide-neck bifurcation aneurysms using Low-profile Visualized Intraluminal Support Junior

2018 ◽  
Vol 11 (4) ◽  
pp. 400-404 ◽  
Author(s):  
Keun Young Park ◽  
Byung Moon Kim ◽  
Dong Joon Kim ◽  
Joonho Chung ◽  
Jae Whan Lee
Keyword(s):  
Internal Carotid ◽  
Anterior Communicating Artery ◽  
Complete Occlusion ◽  
Neck Size ◽  
Low Profile ◽  
Aneurysm Occlusion ◽  
The Mean ◽  
Procedural Success ◽  
Wide Neck

BackgroundLittle has been reported about the feasibility and durability of a Low-profile Visualized Intraluminal Support Junior (LVIS Jr) Y-stenting device for wide-neck bifurcation aneurysms.PurposeTo evaluate the feasibility and durability of LVIS Jr Y-stenting for coiling of unruptured wide-neck bifurcation aneurysms.MethodsWe identified patients in whom LVIS Jr Y-stenting was attempted for unruptured wide-neck bifurcation aneurysms from a prospectively maintained registry of a referral hospital. Procedural success rate, treatment-related morbidity, and clinical and angiographic outcomes were retrospectively assessed.ResultsLVIS Jr Y-stenting was attempted for a total of 21 aneurysms in 21 patients (mean age 60±8.9 years; M:F=6:15): nine basilar artery, six anterior communicating artery, four middle cerebral artery, one internal carotid artery, and one vertebrobasilar fenestration aneurysms. The mean dome and neck size were 7.9±2.7 mm and 5.7±1.8 mm, respectively. All attempts were successful. Treatment-related morbidity occurred in one individual with a modified Rankin Scale (mRS) score of 2. Immediate postprocedural angiograms showed complete occlusion in 15 (71.4%) and neck remnant in 6 (28.6%) patients. All 21 patients had good outcomes (mRS score 0–2) for a mean of 12 months' follow-up (range 6–27 months); mRS score 0 in 20 patients and mRS score 2 in one patient, respectively. Follow-up imaging over a mean of 11 months (range 6–18 months) was available in 18 patients (85.7%). All aneurysms showed complete occlusion at follow-up.ConclusionsLVIS Jr Y-stenting and coiling for wide-neck bifurcation aneurysms seems to be feasible with acceptable safety and to provide durable aneurysm occlusion for wide-neck bifurcation aneurysms.

scholarly journals Stent-Assisted Coiling of Cerebral Aneurysms: A Multicenter Analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Maxim Mokin ◽  
Christopher T Primiani ◽  
Keaton Piper ◽  
David Fiorella ◽  
Ansaar Rai ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cerebral Aneurysms ◽  
Final Analysis ◽  
Patient Characteristics ◽  
Aneurysm Rupture ◽  
Endovascular Coiling ◽  
Complete Occlusion ◽  
Low Profile ◽  
Grade Scale ◽  
The Difference

Abstract INTRODUCTION New devices have allowed endovascular stent-assisted coiling for the treatment of cerebral aneurysms. It remains unknown how each type of stent affects the safety, efficacy, and clinical outcomes of the stent-coiling procedure. METHODS This study compared the outcomes of endovascular coiling of cerebral aneurysms using Neuroform (NEU), Enterprise (EP), and Low-profile Vi_sualized Intraluminal Support (LVIS) stents. Cases of aneurysms treated with more than one type of stents (NEU, EP, LVIS) used for coiling of the same lesion (n = 24) or other devices (n = 32) were excluded. Patient characteristics, angiographic results using the Raymond-Roy grade scale (RRGS), clinical outcomes and procedural complications were analyzed in our study. Patients data was retrospectively collected from 6 academic centers. RESULTS A total of 659 patients with 670 cerebral aneurysms treated with stent-assisted coiling (NEU, n = 182; EP, n = 158; LVIS, n = 330) were included in final analysis. Patient characteristics included mean age 56 ? 12 yr old, female prevalence 74% and aneurysm rupture on initial presentation of 19%. The degree of occlusion at baseline angiography was significantly associated with age (P = .002), location by circulation (P = .002), aneurysm size (P = .009), and rupture status (P = .013). We found differences in complete occlusion on baseline imaging, defined as RRGS I, among the three stents: LVIS 64% (210/326); NEU 56% (95/169); EP 48% (68/143); P = .008. The difference of complete occlusion on 10.5 mo (mean) and 8 mo (median) angiographic follow-up was also significant: LVIS 84% (251/299); NEU 78% (117/150); EP 67% (83/123); P = .004. There were 7% (47/670) intraprocedural complications and 11.5% (73/632) postprocedural related complications in our cohort. CONCLUSION There were significant affects based on type of stent used for assisted coiling in the immediate and long-term angiographic outcomes in our cohort. Randomized prospective trials are warranted to compare stent types and clinical outcome.

scholarly journals Pipeline embolization device for recurrence of previously treated aneurysms

2017 ◽  
Vol 42 (6) ◽  
pp. E8 ◽  
Author(s):  
David Dornbos ◽  
Constantine L. Karras ◽  
Nicole Wenger ◽  
Blake Priddy ◽  
Patrick Youssef ◽  
...  
Keyword(s):  
Flow Diversion ◽  
High Rate ◽  
Endovascular Coiling ◽  
Vessel Occlusion ◽  
Pipeline Embolization Device ◽  
Complete Occlusion ◽  
Microsurgical Clipping ◽  
Previously Treated ◽  
Angiographic Evidence

OBJECTIVEThe utilization of the Pipeline embolization device (PED) has increased significantly since its inception and original approval for use in large, broad-necked aneurysms of the internal carotid artery. While microsurgical clipping and advances in endovascular techniques have improved overall efficacy in achieving complete occlusion, recurrences still occur, and the best modality for retreatment remains controversial. Despite its efficacy in this setting, the role of PED utilization in the setting of recurrent aneurysms has not yet been well defined. This study was designed to assess the safety and efficacy of PED in the recurrence of previously treated aneurysms.METHODSThe authors reviewed a total of 13 cases in which patients underwent secondary placement of a PED for aneurysm recurrence following prior treatment with another modality. The PEDs were used to treat aneurysm recurrence or residual following endovascular coiling in 7 cases, flow diversion in 2, and microsurgical clipping in 4. The mean time between initial treatment and retreatment with a PED was 28.1 months, 12 months, and 88.7 months, respectively. Clinical outcomes, including complications and modified Rankin Scale (mRS) scores, and angiographic evidence of complete occlusion were tabulated for each treatment group.RESULTSAll PEDs were successfully placed without periprocedural complications. The rate of complete occlusion was 80% at 6 months after PED placement and 100% at 12 months in these patients who underwent PED placement following failed endovascular coiling; there were no adverse clinical sequelae at a mean follow-up of 26.1 months. In the 2 cases in which PEDs were placed for treatment of residual aneurysms following prior flow diversion, 1 patient demonstrated asymptomatic vessel occlusion at 6 months, and the other exhibited complete aneurysm occlusion at 12 months. In patients with aneurysm recurrence following prior microsurgical clipping, the rate of complete occlusion was 100% at 6 and 12 months, with no adverse sequelae noted at a mean clinical follow-up of 27.7 months.CONCLUSIONSThe treatment of recurrent aneurysms with the PED following previous endovascular coiling, flow diversion, or microsurgical clipping is associated with a high rate of complete occlusion and minimal morbidity.

scholarly journals Endovascular Treatment of Tiny Aneurysms With Low-Profile Visualized Intraluminal Support Devices Using a “Compressed” Stent Technique

2020 ◽  
Vol 11 ◽  
Author(s):  
Yangyang Zhou ◽  
Qichen Peng ◽  
Xinzhi Wu ◽  
Yisen Zhang ◽  
Jian Liu ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcomes ◽  
Study Cohort ◽  
Modified Rankin Scale ◽  
Safety And Efficacy ◽  
Acute Thrombosis ◽  
Clinical Applicability ◽  
Low Profile ◽  
Support Devices

Objective: To investigate the safety and efficacy of low-profile visualized intraluminal support (LVIS) stent-assisted coiling of intracranial tiny aneurysms using a “compressed” stent technique.Methods: We retrospectively analyzed patients with tiny aneurysms treated in our hospital with LVIS devices using a compressed stent technique. We analyzed patients' imaging outcomes, clinical outcomes, and complications.Results: Forty-two tiny aneurysms in 42 patients were included in this study cohort; 8 patients presented with subarachnoid hemorrhage at admission. The immediate postoperative complete embolization rate was 76.2% (32/42). After an average of 8.5 months of imaging follow-up, the complete embolization rate was 90.5% (38/42), and no aneurysm recanalization occurred. After an average of 24.4 months of clinical follow-up, 95.2% (40/42) of the patients achieved favorable clinical outcomes (modified Rankin scale = 0/1). Operation-related complications occurred in two patients (4.8%); one intraoperative acute thrombosis, and one significant unilateral decreased vision during the postoperative follow-up.Conclusion: LVIS stent-assisted coiling of intracranial tiny aneurysms using a compressed stent technique is safe and effective. Combined stent compression technology is beneficial to maximize the complete embolization of aneurysms and reduce aneurysm recanalization. This study expands the clinical applicability of LVIS stents.

scholarly journals Blister-like aneurysm of the anterior communicating artery treated with only Low-profile Visualized Intraluminal Support Junior stent

2021 ◽  
Vol 12 ◽  
pp. 564
Author(s):  
Katsuyoshi Miyashita ◽  
Kosuke Nambu ◽  
Yu Shimizu ◽  
Yasuo Tohma
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Internal Carotid ◽  
Dorsal Side ◽  
Anterior Communicating Artery ◽  
Effective Treatment Option ◽  
Complete Occlusion ◽  
First Case ◽  
Low Profile

Background: Endovascular treatment is becoming a mainstream treatment for blister-like aneurysms in recent years. Blister-like aneurysms are usually located in the internal carotid artery, whereas that of the anterior communicating artery (AcomA) are very rare. We report the first case of blister-like aneurysm of AcomA that was treated solely with a neck bridging stent that resulted in complete occlusion without complication. Case Description: A 50- year- old woman was admitted to our hospital due to a subarachnoid hemorrhage. Digital subtraction angiography showed a very small aneurysm in the dorsal side of the AcomA. We considered it a blister-like aneurysm based on its size and shape. She underwent endovascular treatment under general anesthesia on day 15 after vasospasm period. Dual antiplatelet therapy was administrated 1 week prior. A Low-profile Visualized Intraluminal Support Junior stent was implanted from the left A2 to the right A1, covering the AcomA. The postoperative course was uneventful, and she was discharged with no neurological deficit. The aneurysm remained unchanged on postoperative day 14; however, complete occlusion was achieved 3 months after the treatment. Conclusion: Monotherapy with a neck bridging stent is an effective treatment option for blister-like aneurysms. Treatment with a single stent could achieve complete occlusion especially if the aneurysms occur elsewhere than the internal carotid artery. We should consider immediate additional treatment if the aneurysm grows within 1 month after initial treatment.

scholarly journals Comparison between dynamic stabilization and instrumented fusion in the treatment of spinal stenosis with degenerative lumbar scoliosis

2019 ◽  
Author(s):  
Lei Luo ◽  
Lang Fang ◽  
Qiang Zhou ◽  
Chen Zhao ◽  
Pei Li ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Perioperative Complications ◽  
Dynamic Stabilization ◽  
Degenerative Lumbar Scoliosis ◽  
Instrumented Fusion ◽  
Lumbar Scoliosis ◽  
Significant Difference ◽  
Posterior Instrumented Fusion

Abstract Background Posterior instrumented fusion is the most widely accepted surgical treatment for spinal stenosis with degenerative lumbar scoliosis (DLS). However, long fusion can affect daily activities due to lumbar stiffness. Several clinical studies have shown that Dynesys dynamic stabilization in addition to laminectomy could lead to significant improvements in clinical outcomes. This study aimed to compare the outcomes of Dynesys dynamic stabilization with posterior instrumented fusion for the management of spinal stenosis with DLS. Methods Between August 2010 and Deccember 2015, a total of 46 patients with spinal stenosis and degenerative lumbar scoliosis were enrolled in this study. 26 patients (Dynesys group) had fenestration decompression, selective intervertebral fusion and Dynesys stabilizationin. 20 patients (fusion group) underwent posterior instrumented fusion. Clinical outcomes, radiographic data, and perioperative complications were compared between the two groups. The average duration of follow-up for the Dynesys group and fusion group was 38 and 33 months respectively. Results The mean number of fixed segments were 3.3±0.8 in Dynesys group and 4.3±0.8 in fusion group. Lower average values of operative duration and blood loss were observed in the dynamic group than in the fusion group. VAS for back and leg pain improved in both groups of patients. There were significant difference in ODI and LSDI (lumbar stiffness disability index) between Dynesys group and fusion group at the last follow-up. The scoliosis Cobb's angle and lumbar lordosis significantly improved in both groups after surgery, and no significant difference were observed between the groups at the last follow-up (P＞0.05). Dynesys stabilization resulted in significantly higher preservation of motion at the implanted segments. Conclusions This study demonstrated that both Dynesys dynamic stabilization and instrumented fusion can improve clinical outcomes of patients with degenerative lumbar scoliosis. Compared to instrumented fusion, Dynesys stabilizationin have advantages on blood loss, operation time, perioperative complications. In addition, Dynesys stabilization partially preserves the ROM of the stabilized segments that may reduce the limitation on daily activities caused by lumbar stiffness. Dynesys stabilizationin can also correct scoliosis, prevent progression of the curve, and maintain lumbar lordosis in mild to moderate lumbar scoliosis without sagittal imbalance.

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