Intra-aneurysmal thrombus modification after flow-diversion

Zanaty, Mario; Jabbour, Pascal; Sader, Roula Bou; Chalouhi, Nohra; Tjoumakaris, Stavropoula; Rosenwasser, Robert H.; Gonzalez, L. Fernando

doi:10.1016/j.jocn.2014.05.033

Cited by 11 publications

(5 citation statements)

References 19 publications

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“…The pressure reduction related to intra-aneurysmal blood stasis is not synonymous with aneurysm healing taking into account the complexity of biological thrombosis, and the evolution of aneurysms treated by flow diverters is sometimes unpredictable. 29–32 This complex process is poorly understood and influenced by the patient and aneurysm characteristics and the pharmacological environment during the pre and postoperative phase. This simple parameter will stay a bench test indicator that could not guarantee the success of a given device for a given aneurysm.…”

Section: Discussionmentioning

confidence: 99%

The pressure reduction coefficient: A new parameter to assess aneurysmal blood stasis induced by flow diverters/disruptors

et al. 2016

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Background and purpose Pore density (PD), surface metal coverage (SMC) and the number of wires are all different parameters which can influence the efficacy of a flow disruptor/diverter. Nevertheless, the relative importance of a parameter to induce intra-aneurysmal blood stasis is still poorly evaluated. Therefore, comparison between devices based on a unique value is not reliable. The aim of this study was to propose a new bench top parameter (the pressure reduction coefficient (PRC; ξ)) in order to assess the global haemodynamic effect of each flow diverter/disruptor to slow flow. Methods Eight devices were tested in vitro during three different flow conditions. For the eight devices, the PRC was computed at different volumetric flow rates to characterise flow reduction. Comparison was made with SMC, PD and the number of wires. Results The PRC obtained for flow disruptors was on average 1.5 times more efficient in reducing flow compared to flow diverters. PD (mm2) ranged from 24 to 38 for flow diverters and did not independently correlate with the PRC. The SMC of flow diverters ranged from 25% to 70%, and ranged from 20% to 100% for flow disruptors, without independent correlation to the PRC. The number of wires ranged from 48 to 96 for the flow diverters and did not correlate independently to the PRC. Conclusion There were no direct correlations between individual device characteristics and the PRC, suggesting a multifaceted and interrelating association of the overall design of each implant. Hence, the PRC could be used as a simple, reliable parameter to assess the overall capacity of flow disruptors/diverters to induce intra-aneurysmal blood stasis.

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Section: Discussionmentioning

confidence: 99%

The pressure reduction coefficient: A new parameter to assess aneurysmal blood stasis induced by flow diverters/disruptors

et al. 2016

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“…Their low porosity aims to moderate and impede the intra-aneurysmal velocities (Pereira et al, 2014a;Larrabide et al, 2015). This flow reduction is known to favor progressive IA thrombosis leading to aneurysm occlusion (Zanaty et al, 2014). Despite of the high treatment efficacy of FDSs (Murthy et al, 2014), it is quite challenging in daily practice to fulfill some of the procedural requirements i.e.…”

Section: Introductionmentioning

confidence: 99%

Geometrical deployment for braided stent

Bouillot

Brina

Ouared

et al. 2016

Medical Image Analysis

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The prediction of flow diverter stent (FDS) implantation for the treatment of intracranial aneurysms (IAs) is being increasingly required for hemodynamic simulations and procedural planning. In this paper, a deployment model was developed based on geometrical properties of braided stents. The proposed mathematical description is first applied on idealized toroidal vessels demonstrating the stent shortening in curved vessels. It is subsequently generalized to patient specific vasculature predicting the position of the filaments along with the length and local porosity of the stent. In parallel, in-vitro and in-vivo FDS deployments were measured by contrast-enhanced cone beam CT (CBCT) in idealized and patient-specific geometries. These measurements showed a very good qualitative and quantitative agreement with the virtual deployments and provided experimental validations of the underlying geometrical assumptions. In particular, they highlighted the importance of the stent radius assessment in the accuracy of the deployment prediction. Thanks to its low computational cost, the proposed model is potentially implementable in clinical practice providing critical information for patient safety and treatment outcome assessment.

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“…In the same report, all of the patients with completely occluded aneurysms experienced improvement in or even complete resolution of their nerve compression symptoms (Szikora et al 2013). In a report by Zanaty et al (2015), a total of 6/8 patients (75%) with large, intracranial partially thrombosed aneurysms showed complete angiographic occlusion with reduced thrombus and were no longer symptomatic. The other two patients experienced an increased thrombus despite complete angiographic occlusion.…”

Section: Discussionmentioning

confidence: 89%

Anterior Cerebral Artery (A1 Segment) Aneurysm: Giant Partially Thrombosed A1 Aneurysm with Mass Effect, Treated with a Pipeline Embolization Device, Complete Resolution of the Mass Effect, and Modification of the Shape of the Implant During Long-Term Follow-Up

Viso¹,

Lylyk²,

Pérez³

et al. 2019

The Aneurysm Casebook

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A giant A1 aneurysm exerting mass effect which was displacing both A1 arteries was found in a 64-year-old male patient who had presented with headaches and diplopia. The patient was treated with a Pipeline Embolization Device with good clinical and angiographic outcomes, with the singularity that the device changed shape as the mass effect from the aneurysm diminished. Actually, management of unruptured giant intracranial aneurysms is a matter of controversy among the neurovascular community. Several endovascular strategies have been used, such as stent-assisted coiling, flow diversion, and flow diversion and coils, with varying occlusion and complication rates reported. In this chapter, we present a case which shows the feasibility of using just one flow diverter stent as a sole treatment method for giant aneurysms. The various therapeutic options for treating of giant aneurysms are the main topic of this chapter.

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Intra-aneurysmal thrombus modification after flow-diversion

Cited by 11 publications

References 19 publications

The pressure reduction coefficient: A new parameter to assess aneurysmal blood stasis induced by flow diverters/disruptors

The pressure reduction coefficient: A new parameter to assess aneurysmal blood stasis induced by flow diverters/disruptors

Geometrical deployment for braided stent

Anterior Cerebral Artery (A1 Segment) Aneurysm: Giant Partially Thrombosed A1 Aneurysm with Mass Effect, Treated with a Pipeline Embolization Device, Complete Resolution of the Mass Effect, and Modification of the Shape of the Implant During Long-Term Follow-Up

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