Short – term outcomes of flow diverter stent (Pipeline) for treatment intracranial aneurysms

Background: With the approval of detachable coils in 1995, endovascular treatment of intracranial aneurysms has become an alternative to surgical clip ligation. Despite the introduction of “modified” coils and advanced techniques such as stent-assisted and balloon-assisted coiling, coil embolization has major limitations because of inability to completely and permanently occlude all aneurysms. As stents were being developed for intracranial use, it was hypothesized that stents could be utilized to divert flow “away” from the aneurysm “back” into the parent vessel, and the concept of “endovascular flow diversion” was proposed. This study aims to report our experience with cerebral aneurysms, which may improve in the treatment with the flow-diverter stent and follow up (1). Methods: This study was conducted in consecutive series of 23 patients. 23 procedures were performed for treating these patients in Ha Noi heart hospital from January 2019 to January 2020. 23 flow diverter stents (Pipeline) were used. Aneurysms morphology, stent patency and cerebral parenchyma before and after intervention were analyzed on images of digital subtraction angiography (DSA), computed tomography (CT) and magnetic resonance (MR). The follow-up data after 3–6 months and 12 months were recorded. Results: In 23 patients (8 men, 15 women), aneurysms of internal carotid artery were mostly common (95.7%), especially in cavernous segments. 13 cases (74%) had saccular aneurysms, and 2 cases (9%) had multiple aneurysms, and only 3 cases (13%) had fusiform aneurysms. Endovascular treatment was successfully performed at rate of 100%.. Mortality and morbidity rates were 0% and 0%, respectively. MRI and MSCT follow-up at 3 months showed complete or incomplete occlusions of aneurysms was 26.1% or 34.8%, respectively. Conclusions: Deployment of flow diverter stent is safe and effective with high rate of successful and low procedural complications

EPICARDIAL CLIP CLOSURE OF THE LEFT ATRIAL APPENDAGE: REPLY

Epicardial surgical clip is showed to be a safe and effective tool in order to achieve a complete left atrial appendage (LAA) exclusion thus reducing the risk of stroke in patients with atrial fibrillation. Historically, other methods as surgical ligation, internal oversewing or external stapling showed to be largely uneffective with an incidence of LAA residual flow ranging from 25% to 35% thus, increasing per se 5- to 10-fold the risk of stroke. Epicardial LAA exclusion by means of external clip could be potentially released under transesophageal echocardiographic guidance thus increasing the procedural success rate of complete closure with no residual stump left.

Novel Breast Specimen Orientation Approach through 3D Visualizations for Relocating Inadequate Margins based on the Surgical Clips: Feasibility Study.

Purpose: The current breast specimen orientation method after breast-conserving surgery is potentially inaccurate due to deformability and mobility of the extracted breast tissue. This complicates targeted relocation during re-excision or radiation. Therefore, we propose a new 3D-visualization method to communicate the breast specimen orientation to instantly provide an intuitive overview of the resection margins in relation to the surgical clips on the wound bed.Methods: In 15 female patients undergoing breast-conserving surgery, the surgeon labeled the surgical clips on the specimen and the wound bed. During pathologic assessment, after inking, a 3D scan was made of the specimen. Tumor tissue was annotated on the histological image and transposed to the respective location inside the 3D model. The transposed resection margins with respect to the labeled surgical clips were calculated and visualized. Intuitivity of the visualization was tested (face validity) as well as the quality of displayed resection margins and labeled clips.Results: Average face validity score for 3D-visualization was between ‘++’ and ‘+’ for surgeons and between ‘+’ and ‘+/-’ for pathologists. Average difference between computed resection margins and reported histologic margins was 1 mm. In 8 cases not all clips could be labeled in situ. In 5 cases not all labeled clips could be retrieved by pathology. Conclusion: The visualizations appeared valuable in interdisciplinary communications. The displayed resection margins approximated the reported margins. Consistent accurate surgical clip labelling proved challenging.

Woven EndoBridge Embolized Aneurysm Clippings: 2-Dimensional Operative Video

The Woven EndoBridge (WEB) device (MicroVention, Aliso Viejo, California) is an intrasaccular flow disruptor used for the treatment of both unruptured and ruptured intracranial aneurysms. WEB has been shown to have 54% complete and 85% adequate aneurysm occlusion rates at 1-yr follow-up.1 Residual and recurrent ruptured aneurysms have been shown to have a higher risk of re-rupture than completely occluded aneurysms.2 With increased utilization of WEB in the United States, optimizing treatment strategies of residual aneurysms previously treated with the WEB device is essential, including surgical clipping.3,4 Here, we present an operative video demonstrating the surgical clip occlusion of previously ruptured middle cerebral artery and anterior communicating artery aneurysms that had been treated with the WEB device and had sizable recurrence on follow-up angiography. Informed consent was obtained from both patients. Lessons learned include the following: (1) the WEB device is highly compressible, unlike coils; (2) proximal WEB marker may interfere with clip closure; (3) no evidence of WEB extrusion into the subarachnoid space; (4) no more scarring than expected in ruptured cases; and (5) clipping is a feasible option for treating WEB recurrent or residual aneurysms.