Local Experience with a New Retrievable Device for Stroke Thrombectomy in a Tertiary Academic Center

Abstract

Background: Endovascular therapy (EVT) is considered to be the first line treatment for aneurysm however this treatment option has its limitations in cases of wide necked aneurysm (WNA). These include high risk of coil protrusion in the parent vessel and early recanalization in case of bifurcation aneurysms. These limitations prompted the development of more complex endovascular techniques. In the present short review, we give introduction of these techniques and devices and provide case examples performed in Rashid hospital Dubai. Methods: Balloon Remodeling: This technique is probably the more frequently used in the treatment of WNBAs. Balloon is temporarily inflated in front of the aneurysm neck followed by coil packing and deflation before permanent coil deployment to evaluate possible migration. In more than 30 cases of ruptured and unruptured WNA's dealt at Rashid hospital, the remodeling technique was shown to be safe and potentially improved anatomical results. Stent Assisted Coiling: A stent can be deployed across the aneurysm neck in the parent vessel and coiling performed with catheter progressed through the stent struts. Y Stenting: When the aneurysm is centered at bifurcation, a Y stenting technique can be used. Although the chances of morbidity are higher in this technique, we did not encounter any complications in our patient series at Rashid Hospital except occasional spasm in parent vessel. Woven Endobridge Device: WEB is an intrasaccular flow disrupter having a braided nitinol mesh. The mesh structure of the WEB provides a stentlike apposition to the aneurysm wall. Flow Diverters: Flow diverters are low-porosity stents designed to reduce hemodynamic exchange between the aneurysm and the parent artery, which promotes thrombosis and neointimal overgrowth over the aneurysm neck. Flow-diverter treatment is associated with high efficacy, but with safety that is inferior to standard coiling. pCONus: The pCONus is a stent-like endovascular implant featuring a distal end that opens like a blossoming flower with its four petals resting on the inside of the aneurysm along the neck. The petals support the deployment of coils inside the aneurysm. Other Devices: Pulse Rider device self expandable implants and Luna device are few other techniques employed in the coiling of wide neck aneurysms. Results: Provided in the form of pictures case examples. Conclusions: The management of a patient with a wide necked cerebral aneurysm is complex, however the continuous development of new neuro endovascular techniques and materials nowadays offer a significantly wider range of therapeutic possibilities in cases of aneurysms with unfavorable size and configurations which have traditionally been treated surgically.