scholarly journals Flow-diverting Stent-assisted Coil Embolization of a Ruptured Internal Carotid Artery Blister Aneurysm with the Pipeline Flex Embolization Device

2017 ◽  
Vol 08 (04) ◽  
pp. 664-667 ◽  
Author(s):  
Dale Ding ◽  
Robert M. Starke ◽  
Ayton Hope ◽  
Stefan Brew
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Flow Diverter ◽  
High Grade ◽  
Parent Vessel ◽  
Future Studies ◽  
Aneurysm Neck ◽  
Flow Diverting Stent

ABSTRACTInternal carotid artery (ICA) blister aneurysms are rare and challenging to successfully treat, using contemporary surgical or endovascular approaches, without partial or complete compromise of the parent vessel. We describe the use of a resheathable flow diverter, the Pipeline Flex Embolization Device (PFED) to perform stent-assisted coiling of a ruptured supraclinoid ICA blister aneurysm in a 56-year-old female who presented with a high-grade subarachnoid hemorrhage (SAH). The first PFED was deployed across the aneurysm neck to jail a microcatheter within the aneurysm dome, and then, two small coils were delivered into the aneurysm. After removing the coiling microcatheter, the second PFED was telescoped into the first PFED. There were no postprocedural complications, and follow-up magnetic resonance angiography 15 months after embolization showed complete aneurysm obliteration. Flow-diverting stent-assisted coiling should be considered as a reconstructive, vessel-preserving, endovascular treatment option for appropriately selected patients with ruptured ICA blister aneurysms. However, future studies are necessary to assess the periprocedural safety in the setting of acute SAH.

scholarly journals Internal carotid artery “donut” aneurysm treated using derivo flow diverting stent

2021 ◽  
pp. 101-101
Author(s):  
Dragoslav Nestorovic ◽  
Igor Nikolic ◽  
Svetlana Milosevic-Medenica ◽  
Aleksandar Janicijevic ◽  
Goran Tasic
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Treatment Decision ◽  
Filling Defect ◽  
Radiological Sign ◽  
Aneurysm Neck ◽  
The Right ◽  
Partial Thrombosis ◽  
Flow Diverting Stent

Introduction. Intracranial aneurysms with a radiological sign of a donut are a medical priority and have been described in a small number of cases. This radiological sign occurs in aneurysms in which there is partial thrombosis inside aneurismal sac and circular laminar flow between the aneurismal wall and the thrombus in its center. Consequently, there is a central contrast-filling defect of the aneurysm sac observed on different angiographic imaging methods. Case outline. We present a 35-year-old female patient was admitted for examination due to frequent headaches, visual disturbances on the left and loss of sight on the right eye. Digital subtraction angiography (DSA) showed an aneurysm on the right ICA measuring 25.6 ? 25 mm, while neck measured 11 mm and included part of the C6 and C7 segments. Treatment decision was made that positioning of flow diverting stent across the aneurysm neck would be most beneficial in this case. After procedure, patient was discharged in same general condition as she was before admission to the hospital. Seven months after the intervention, she reported for first digital DSA control. Normal position of the left A1was demonstrated, suggesting shrinkage of aneurysm sac. An improvement of vision on both eyes was stated. Conclusion. We present a patient with "donut" aneurysm on the internal carotid artery, successfully treated with flow diverting stent.

Successful management of bilateral internal carotid artery fusiform giant aneurysms in a patient with intimal fibroplasia using multiple flow diverters: With long-term imaging follow up

2021 ◽  
pp. 159101992110491
Author(s):  
Jieun Roh ◽  
Seung Kug Baik ◽  
Jeong A Yeom ◽  
Joo-Young Na ◽  
Sang-Won Lee
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Flow Diverter ◽  
Giant Aneurysms ◽  
The Past ◽  
Effective Treatment Modality ◽  
Flow Diverters

The authors report a rare case of sequentially developed bilateral internal carotid artery (ICA) fusiform giant aneurysms in a patient with pathologically confirmed intimal fibroplasia. Both ICA fusiform aneurysms were treated with multiple flow diverter insertion and were well-managed over the past 5.5 years of follow-up. The development of aneurysms in this rare disease entity appears to be a lifelong process based on the authors’ observations in serial angiographic follow-up studies. Reconstruction therapy using flow-diverting stents in this unique condition may be a safe and effective treatment modality.

scholarly journals Flow diverter for endovascular treatment of intracranial mirror segment internal carotid artery aneurysms

2018 ◽  
Vol 25 (1) ◽  
pp. 4-11 ◽  
Author(s):  
Anna Luisa Kühn ◽  
Peter Kan ◽  
Visish Srinivasan ◽  
David E Rex ◽  
Katyucia de Macedo Rodrigues ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Temporal Artery ◽  
Flow Diverter ◽  
Post Treatment ◽  
Pipeline Embolization Device ◽  
Device Placement ◽  
Aneurysm Occlusion

Background To evaluate the feasibility and efficacy of the pipeline embolization device in the treatment of unruptured intracranial mirror segment aneurysms. Methods Out of a total of 338 subjects, 14 were identified harboring a total of 32 internal carotid artery mirror segment aneurysms that were treated with the pipeline embolization device and were consecutively enrolled into our study. We collected data on patient demographics, modified Rankin scale (mRS) at admission, aneurysm characteristics, clinical outcome at discharge, 3–9 and at 12–18 months as well as angiography results at follow-up. Results Patients’ mean age was 52.9 years; baseline mRS was 0 in all subjects. Pipeline embolization device placement was successful in all cases. Post-treatment mRS remained 0 in 13/14 patients. One patient experienced a small intraparenchymal hemorrhage and subarachnoid hemorrhage, associated with a frontoparietal infarction resulting in right upper extremity weakness and aphasia (post-treatment mRS 3). His mRS evaluation remained stable at the 3–9-month follow-up. Three to 9-month follow-up angiography (13/14 subjects) showed complete aneurysm occlusion in 24/30 aneurysms (80%), near complete and partial occlusion in three of 30 (10%) aneurysms each. At the 9-month follow-up, one patient experienced a complete occlusion of the anterior temporal artery branch but did not present with any clinical deficits. No mRS changes were encountered over a median 6-month follow-up period. Mid-term follow-up angiography (12–18 months) available in eight of 14 subjects showed complete aneurysm occlusion in all patients. Mild intimal hyperplasia was observed in one patient. Conclusions Flow diversion technology can be used for the treatment of unruptured mirror segment aneurysms in selected patients.

scholarly journals Mid-term follow-up of staged bilateral internal carotid artery aneurysm treatment with Pipeline embolization

2019 ◽  
Vol 25 (6) ◽  
pp. 664-670
Author(s):  
Juan G Tejada ◽  
Gloria VV Lopez ◽  
Jerry ME Koovor ◽  
Kalen Riley ◽  
Mesha Martinez
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Flow Diverter ◽  
Imaging Data ◽  
Carotid Artery Aneurysm ◽  
Common Location ◽  
Internal Carotid Artery Aneurysm

Background Endovascular treatment of large complex morphology aneurysms is challenging. High recanalization rates have been reported with techniques such as stent-assisted coiling and balloon-assisted coiling. Flow diverter devices have been introduced to improve efficacy outcomes and recanalization rates. Thromboembolic complications and in-device stenosis are certainly more worrisome when treatment of bilateral internal carotid arteries has been performed. This study aimed to report our experience with mid-term imaging follow-up of staged bilateral Pipeline embolization device placement for the treatment of bilateral internal carotid artery aneurysms. Methods We reviewed the clinical, angiographic, and follow-up imaging data in all consecutive patients treated with bilateral internal carotid artery aneurysms who underwent elective Pipeline embolization. Results Six female patients were treated, harboring a total of 13 aneurysms. Of these, 60% were asymptomatic. Diplopia and headache were the most common symptoms. The most common location was the paraclinoid segment (6/13), including by cavernous segment (4/13) and ophthalmic segment (2/13). Successful delivery of the device was achieved in 12 cases. Difficult distal access precluded the deployment of the device in one case. The treatment was always staged with at least eight weeks' difference between the two procedures. All aneurysm necks were covered completely. There were no periprocedural complications. Angiographic follow-up ranged between 3 and 12 months, and computed tomography angiogram follow-up ranged between 2 and 24 months. Complete aneurysm occlusion was achieved in all cases. Conclusion In our series, Pipeline deployment for the treatment of bilateral internal carotid artery aneurysms in a staged fashion is safe and feasible. Mid-term imaging follow-up showed permanent occlusion of all the treated aneurysms.

Flow diversion of large internal carotid artery aneurysms with the surpass device: impressions and technical nuance from the initial North American experience

2015 ◽  
Vol 8 (3) ◽  
pp. 279-286 ◽  
Author(s):  
Geoffrey P Colby ◽  
Li-Mei Lin ◽  
Justin M Caplan ◽  
Bowen Jiang ◽  
Barbara Michniewicz ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Flow Diverter ◽  
Flow Diversion ◽  
Initial Experience ◽  
Unruptured Aneurysms ◽  
Aneurysm Neck ◽  
Aneurysm Embolization ◽  
Grade Ii

BackgroundFlow diversion is an important tool for treatment of cerebral aneurysms, particularly large and giant aneurysms. The Surpass flow diverter is a new system under evaluation in the USA.ObjectiveTo report our initial experience of 20 cases with the Surpass flow diverter to demonstrate its basic properties, the required triaxial delivery platform, and the methodologies used to deploy it during treatment of large internal carotid artery (ICA) aneurysmsMethodsTwenty patients with ICA aneurysms ≥10 mm with ≥4 mm neck treated as part of the Surpass IntraCranial Aneurysm Embolization System Pivotal Trial (the SCENT trial; Stryker) were included. Details of patient demographics, aneurysm characteristics, and technical procedures were collected.ResultsTwenty patients (mean age 63.3±1.3 years; range 51–72) with 20 unruptured aneurysms (mean size 13.4±0.9 mm; range 10–21 mm) were treated. For proximal access, 60% of cases had aortic arch ≥grade II, 55% had significant cervical ICA tortuosity, and 60% had cavernous ICA ≥grade II. The Surpass device was implanted in 19/20 (95%) cases. Of 19 cases, a single device was used in 18 cases (95%) and 2 devices in only 1 case (5%). Balloon angioplasty was performed in 8/19 cases (42%). Complete aneurysm neck coverage and adequate vessel wall apposition was obtained in all 19 cases.ConclusionsSurpass is a next-generation flow diverter with unique device-specific and delivery-specific features compared with clinically available endoluminal flow diverters. Our initial experience demonstrates a favorable technical profile in treatment of large and giant ICA aneurysms.Trial registration numberNCT01716117.

scholarly journals Novel use of flow diversion for the treatment of aneurysms associated with arteriovenous malformations

2017 ◽  
Vol 42 (6) ◽  
pp. E7 ◽  
Author(s):  
Craig Kilburg ◽  
Philipp Taussky ◽  
M. Yashar S. Kalani ◽  
Min S. Park
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Arteriovenous Malformations ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Flow Diversion ◽  
Complete Occlusion ◽  
Martin Grade ◽  
Flow Diverting Stent

The use of flow-diverting stents for intracranial aneurysms has become more prevalent, and flow diverters are now routinely used beyond their initial scope of approval at the proximal internal carotid artery. Although flow diversion for the treatment of cerebral aneurysms is becoming more commonplace, there have been no reports of its use to treat flow-related cerebral aneurysms associated with arteriovenous malformations (AVMs). The authors report the cases of 2 patients whose AVM-associated aneurysms were managed with flow diversion. A 40-year-old woman presented with a history of headaches that led to the identification of an unruptured Spetzler-Martin Grade V, right parietooccipital AVM associated with 3 aneurysms of the ipsilateral internal carotid artery. Initial attempts at balloon-assisted coil embolization of the aneurysms were unsuccessful. The patient underwent placement of a flow-diverting stent across the diseased vessel; a 6-month follow-up angiogram demonstrated complete occlusion of the aneurysms. In the second case, a 57-year-old man presented with new-onset seizures, and an unruptured Spetzler-Martin Grade V, right frontal AVM associated with an irregular, wide-necked anterior communicating artery aneurysm was identified. The patient underwent placement of a flow-diverting stent, and complete occlusion of the aneurysm was observed on a 7-month follow-up angiogram. These 2 cases illustrate the potential for use of flow diversion as a treatment strategy for feeding artery aneurysms associated with AVMs. Because of the need for dual antiplatelet medications after flow diversion in this patient population, however, this strategy should be used judiciously.

scholarly journals Endovascular treatment of unruptured aneurysms of cavernous and ophthalmic segment of internal carotid artery with flow diverter device Pipeline

2016 ◽  
Vol 50 (4) ◽  
pp. 378-384 ◽  
Author(s):  
Marko Jevsek ◽  
Charbel Mounayer ◽  
Tomaz Seruga
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Treatment Success ◽  
Giant Aneurysm ◽  
Flow Diverter ◽  
Unruptured Aneurysms ◽  
Aneurysm Neck ◽  
Flow Diverter Device

Abstract Background Intra-arterial treatment of aneurysms by redirecting blood flow is a newer method. The redirection is based on a significantly more densely braided wire stent. The stent wall keeps the blood in the lumen of the stent and slows down the turbulent flow in the aneurysms. Stagnation of blood in the aneurysm sac leads to the formation of thrombus and subsequent exclusion of the aneurysm from the circulation. The aim of the study was to evaluate flow diverter device Pipeline for broad neck and giant aneurysm treatment. Methods Fifteen patients with discovered aneurysm of the internal carotid artery were treated between November 2010 and February 2014. The majority of aneurysms of the internal carotid artery were located intradural at the ophthalmic part of the artery. The patients were treated using a flow diverter device Pipeline, which was placed over the aneurysm neck. Treatment success was assessed clinically and angiographically using O’Kelly Marotta scale. Results Control angiography immediately after the release of the stent showed stagnation of the blood flow in the aneurysm sac. In none of the patients procedural and periprocedural complications were observed. 6 months after the procedure, control CT or MR angiography showed in almost all cases exclusion of the aneurysm from the circulation and normal blood flow in the treated artery. Neurological status six months after the procedure was normal in all patients. Conclusions Treatment of aneurysms with flow diverter Pipeline device is a safe and significantly less time consuming method in comparison with standard techniques. This new method is a promising approach in treatment of broad neck aneurysms.

Management of Inoperable Cerebral Aneurysms by the Navigational Balloon Technique

Neurosurgery ◽  
1987 ◽  
Vol 21 (3) ◽  
pp. 296-302 ◽  
Author(s):  
Stuart M. Weil ◽  
Harry R. van Loveren ◽  
Thomas A. Tomsick ◽  
Barbara L. Quallen ◽  
John M. Tew
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Circulatory System ◽  
Cerebral Aneurysms ◽  
Aneurysm Neck ◽  
Carotid Ligation ◽  
Balloon Technique

Abstract Intravascular navigation with nondetachable balloons is a safe, effective method of treatment for inaccessible aneurysms of the internal carotid artery. The rate of ischemic complications is lower than that associated with carotid ligation, and the rate of subsequent hemorrhage is lower than that associated with either carotid ligation or direct clipping. Therefore, for many internal carotid artery aneurysms that originate at or proximal to the ophthalmic artery, the nondetachable balloon technique is an alternative treatment choice. During a 7-year period, 21 aneurysms of the internal carotid artery were treated by the nondetachable balloon technique. All 21 aneurysms were successfully excluded from the circulatory system by either proximal occlusion or trapping of the aneurysm neck. This series consisted of 8 carotid-ophthalmic artery aneurysms, 11 carotid-cavernous aneurysms (6 spontaneous, 5 traumatic), 1 petrous segment aneurysm, and 1 cervical segment aneurysm. At 3 years of follow-up, the following incidences were noted: transient ischemia, 4.7%; infarction, 9.6%; and hemorrhage, 0%. The complications were 1 case of transient hemiparesis and 2 late ischemic events. Fifty per cent of the patients underwent follow-up computed tomography, and thrombosis of the aneurysm was confirmed in all except one case, which was partially thrombosed.

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