Flow Diverters in the Treatment of Pediatric Cerebrovascular Diseases

Barburoğlu, Mehmet; Arat, Anıl

doi:10.3174/ajnr.a4959

Cited by 40 publications

(22 citation statements)

References 58 publications

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“…To date, there is no standard of treatment for pediatric aneurysms and flow diversion has been demonstrated to be a safe and effective alternative. 2,14 However, these patients require close monitoring because they are placed on dualantiplatelet therapy and are exposed to potential delayed events that can occur after using a flow diverter well described in the adult population. 23 In our case, the decision to treat the aneurysm was made based on progression of the lesion and the use of a flow diverter was considered the most appropriate choice, given the lack of good microsurgical and endovascular options.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional printing and neuroendovascular simulation for the treatment of a pediatric intracranial aneurysm: case report

Sullivan¹,

Aguilar‐Salinas²,

Santos³

et al. 2018

Journal of Neurosurgery: Pediatrics

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The use of simulators has been described in a variety of fields as a training tool to gain technical skills through repeating and rehearsing procedures in a safe environment. In cerebrovascular surgery, simulation of skull base approaches has been used for decades. The use of simulation in neurointervention to acquire and enhance skills before treating a patient is a newer concept, but its utilization has been limited due to the lack of good models and deficient haptics. The advent of 3D printing technology and the development of new training models has changed this landscape. The prevalence of aneurysms in the pediatric population is much lower than in adults, and concepts and tools sometimes have to be adapted from one population to another. Neuroendovascular rehearsal is a valid strategy for the treatment of complex aneurysms, especially for the pediatric population. The authors present the case of an 8-year-old boy with a fusiform intracranial aneurysm and documented progressive growth, who was successfully treated after the authors rehearsed the placement of a flow diverter using a patient-specific 3D-printed replicator system model.

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Section: Discussionmentioning

confidence: 99%

Three-dimensional printing and neuroendovascular simulation for the treatment of a pediatric intracranial aneurysm: case report

Sullivan¹,

Aguilar‐Salinas²,

Santos³

et al. 2018

Journal of Neurosurgery: Pediatrics

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“…19 Recently, utilization of these tests in children has been reported. 3,5 Since the stent construct became occluded asymptomatically soon after the cessation of APT, the critical role of APT in the maintenance of stent patency is clearly evident. Occlusion occurred chronically, at a time point between 12 and 14 months after the treatment, and it is plausible that partial endothelialization of the stent construct had occurred by that time, enabling a more gradual occlusion.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, our case highlights the challenges of cerebrovascular stent utilization in children. Although the sizes of the currently available neurovascular stents, flow diverters, and endovascular access systems meet the need for pediatric interventions, 3 the lack of age-or weight-based pediatric APT protocols in neurointervention, as well as problems related to compliance with enteral medications in children, limit the applicability of these devices in the pediatric population. Use of bioabsorbable stent-like devices has been reported in young patients undergoing cerebrovascular interventions, but the use of these devices in children has not been reported yet, and long-term results with these devices are unknown.…”

Section: Discussionmentioning

confidence: 99%

Hybrid vascular intervention for a giant cervical carotid artery aneurysm in a clopidogrel-hyporesponsive child

Öcal¹,

Yılmaz²,

Peynircioğlu³

et al. 2018

Journal of Neurosurgery: Pediatrics

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Aneurysms of the extracranial internal carotid artery (ICA) in pediatric patients are rare and mostly treated surgically. The authors present the case of a child with a giant extracranial ICA aneurysm presenting with gradual airway compression. A plan was made to explore the aneurysm surgically and straighten the associated carotid artery kinks during the operation to enable further endovascular treatment if primary reconstruction of the carotid artery proved not to be possible. Finally, the aneurysm was successfully treated with staged hybrid intervention, which consisted of surgical correction of parent artery kinks followed by endovascular implantation of stent grafts. The child tolerated the procedure well without adverse events. A craniocervical CT angiogram at 5 months showed patency of the stent construct and relief of airway compression. However, a follow-up CT angiogram at 14 months showed total occlusion of the ipsilateral carotid artery without clinical sequelae and complete cessation of airway compression. The management of this was unique since the patient is the first reported case of clopidogrel hyporesponsiveness in a child undergoing neurovascular intervention with prasugrel monotherapy. Point-of-care testing–based adjustment of prasugrel necessitated education of the patient’s family regarding the loss of effect of the prasugrel tablets upon crushing and contact with air.

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“…Biochemical hyperresponsiveness to clopidogrel (P2Y12 reaction unit < 60) was also reported in the study of Barburoglu and Arat, resulting in the hyperresponsive patients ceasing aspirin and continuing only with clopidogrel for 6 months. 17 Regarding risk factors for biochemical resistance, in the study of Yee et al, children with aspirin resistance did not differ from aspirin-responsive children in terms of age, race, platelet count, or aspirin dose, indication, or therapy duration. 10 In the study of Emani et al, biochemical aspirin resistance was the highest in neonates weighing less than 5 kg who were given 20.25 mg/day of aspirin.…”

Section: Monitoring Testsmentioning

confidence: 92%

Antiplatelet Therapy Monitoring in Neonates and Children

Huang

Soeharto

Damara

et al. 2018

Semin Thromb Hemost

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Antiplatelet agents are used for the prevention and treatment of thromboembolic disease in an increasingly complex population of pediatric patients. Despite their importance for clinical outcome, there is no consensus on the most effective monitoring strategies. This review describes the current state of knowledge focusing on antiplatelet therapy monitoring in children. The authors searched five databases (PubMed-NCBI, MEDLINE-OVID, SCOPUS-Elsevier, ScienceDirect, and Cochrane) from January 2000 to October 2017 using keywords selected a priori. Identified articles were sorted according to the antiplatelet agents administered, methods of antiplatelet monitoring, and outcome measures. Twenty studies were included, with 14 cohort studies, 3 randomized controlled trials, and 3 cross-sectional studies. Eleven different antiplatelet monitoring tools were used, with the most common being Light Transmission Aggregometry, Urinary Thromboxane, Thromboelastography with Platelet Mapping, and VerifyNow. In the majority of studies, antiplatelet therapy monitoring was used to describe adequacy or responsiveness to treatment based on laboratory cut-off values, which were not uniform and sourced from adult studies or extrapolated from test manuals. Several studies evaluated monitoring related to clinical outcome or adjusted therapy to reach predefined therapeutic targets. There was no single laboratory method found to be distinctly better for monitoring antiplatelet treatment. Associations between laboratory assays and clinical outcomes or assays and gold standard measurements were highly inconsistent. The current literature lacks consensus on clinical benefits and measurable effects of monitoring antiplatelet therapy in pediatric patients. This review highlights important areas for research required to determine the value of antiplatelet therapy monitoring in children.

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Flow Diverters in the Treatment of Pediatric Cerebrovascular Diseases

Abstract: BACKGROUND AND PURPOSE:There is very limited data concerning utilization of flow diverters in children. Our aim is to report results for the treatment of complex intracranial aneurysms and carotid cavernous fistulas by using flow diverters in children.

Cited by 40 publications

References 58 publications

Three-dimensional printing and neuroendovascular simulation for the treatment of a pediatric intracranial aneurysm: case report

Three-dimensional printing and neuroendovascular simulation for the treatment of a pediatric intracranial aneurysm: case report

Hybrid vascular intervention for a giant cervical carotid artery aneurysm in a clopidogrel-hyporesponsive child

Antiplatelet Therapy Monitoring in Neonates and Children

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