Outcome of Endovascular Repair of Popliteal Artery Aneurysms using the Supera Stent

Lauricella, Antonio; Gennai, Stefano; Covic, Tea; Leone, Nicola; Migliari, Mattia; Andreoli, F; Silingardi, Roberto

doi:10.1016/j.jvir.2020.11.003

Cited by 9 publications

(8 citation statements)

References 22 publications

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“…This, however, did not reach the level of pathological shear rates and led to a comparatively lower accumulated shear exposure than in the bent control model. The predominant importance of flow stasis suggests that (dual) antiplatelet therapy following stent placement does not necessarily inhibit aneurysm thrombosis, as confirmed in clinical pilot studies on the Supera stent [ 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Two pilot studies investigated the off-label use of the Supera stent as a flow diverting configuration in patients. The first study [ 5 ] used a dual-lined Supera stent in 28 out of 31 cases and reported aneurysm thrombosis in all of them at 4-month follow-up, whereas the second [ 6 ] used a dual-lined Supera stent in 10 out of 28 cases with an aneurysm thrombosis rate of 34.5% at 12-months, both under dual-antiplatelet therapy for the first postoperative months. Both studies deployed the Supera stent with maximal compression, which maximizes the flow modulating effect and additionally benefits stent patency [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…1 ; Video 1), creating a flow diverting configuration that can be augmented by using multiple Supera stents. In two PAA cohorts treated with 1–3 Supera stent layers, the 1-year patency was 85–100% and at median 44-month follow-up, patency was 67% [ 5 , 6 ]. Aneurysm thrombosis was seen in 88% within a week, and in 100% through 4-month follow-up [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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The Supera Interwoven Nitinol Stent as a Flow Diverting Device in Popliteal Aneurysms

Velde

Jebbink

Zambrano

et al. 2022

Cardiovasc Intervent Radiol

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Purpose The feasibility of using a compressed interwoven Supera stent as a flow diverting device for popliteal aneurysms was recently demonstrated in patients. It is unclear, however, what the optimal flow diverting strategy is, because of the fusiform shape of popliteal aneurysms and their exposure to triphasic flow. To assess this flow diverting strategy for popliteal aneurysms, flow profiles and thrombus formation likelihood were investigated in popliteal aneurysm models. Materials and Methods Six popliteal aneurysm models were created and integrated into a pulsatile flow set-up. These models covered a bent and a straight anatomy in three configurations: control, single-lined and dual-lined Supera stents. Two-dimensional flow velocities were visualized by laser particle image velocimetry. In addition, the efficacy of the stent configurations for promoting aneurysm thrombosis was assessed by simulations of residence time and platelet activation. Results On average for the two anatomies, the Supera stent led to a twofold reduction of velocities in the aneurysm for single-lined stents, and a fourfold reduction for dual-lined stents. Forward flow was optimally diverted, whereas backward flow was generally deflected into the aneurysm. The dual-lined configuration led to residence times of 15–20 s, compared to 5–15 s for the single stent configurations. Platelet activation potential was not increased by the flow diverting stents. Conclusion A compressed Supera stent was successfully able to divert flow in a popliteal aneurysm phantom. A dual-lined configuration demonstrated superior hemodynamic characteristics compared to its single-lined counterpart.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Supera Interwoven Nitinol Stent as a Flow Diverting Device in Popliteal Aneurysms

Velde

Jebbink

Zambrano

et al. 2022

Cardiovasc Intervent Radiol

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“…In selected patients, the use of stents in the popliteal artery for aneurysm repair [ 9 ] or atherosclerotic disease [ 10 ] has shown similar patency to surgical bypass. Outside selected scenarios, the primary patency of a below-the-knee bypass with the saphenous vein remains superior [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Endovascular Repair of a Traumatic Popliteal Artery Injury

Nguyen¹,

Tiziano²,

Beckermann³

et al. 2022

Cureus

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In patients who sustain a traumatic arterial injury to the lower extremities, timely intervention is key for limb salvage. Traditionally, patients with a popliteal injury have undergone an open surgical bypass but, in recent years, endovascular repair has become more frequent. We present the case of a 46-year-old male who sustained a right tibial/fibular fracture and an associated popliteal artery injury during a pedestrian versus car accident. At presentation, distal signals were not detectable on duplex ultrasonography, and computed tomography confirmed an occlusion of the P3 popliteal artery and proximal anterior tibial and tibioperoneal trunk, as well as a comminuted tibia and fibula fracture. He also had a subdural hematoma without midline shift. He was taken to the operating room emergently and, following external fixation of the tibial/fibular fracture, he underwent angiography of the right leg. There was no thrombus or extravasation but a static column of blood secondary to a flow-limiting intimal flap was present, and an endovascular repair of the popliteal artery with balloon angioplasty and Tack stents (Intact Vascular, Wayne, PA) was pursued. Heparin was not utilized due to the patient's intracranial hemorrhage. On hospital day four, he underwent internal fixation of the tibial/fibular fracture. The subarachnoid/subdural hematoma remained stable and a prophylactic dose of rivaroxaban and aspirin was started. The patient recovered well from these procedures and was discharged 16 days after the accident.

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“…The authors achieved 100% technical success, freedom from sac enlargement and prevention of distal embolization. However, complete sac thrombosis at a one-year follow-up was observed only in 34% of the cases [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Off-Label Use of a Double-Layer Micromesh Carotid Stent for Hybrid Treatment of Popliteal Artery Aneurism Complicated by Chronic Distal Embolization

Barat

Casian

2021

Case Reports in Vascular Medicine

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We report our initial experience in off-label use of the double-layer micromesh (DLM) Roadsaver® stent for the hybrid treatment of a fusiform popliteal artery aneurism complicated by distal embolization and chronic limb threatening ischemia in a COVID-19-positive young male. A 36-year-old male patient was admitted with chronic limb threatening ischemia of the left lower limb. The duplex ultrasound and computer tomography angiography (CTA) demonstrated a fusiform popliteal artery aneurism with a maximal diameter of 14 mm and distal occlusion of peroneal and both tibial arteries. Urgent hybrid intervention was performed, starting with an open thrombectomy from the distal posterior tibial artery via a retromalleolar access followed by percutaneous deployment of the DLM Roadsaver® stent (Terumo, Tokyo, Japan) for the exclusion of the popliteal artery aneurism. The flow diverting effect was observed immediately with contrast stagnation in the asymmetrical part of the aneurism sac (grade C2 of the O’Kelly-Marotta flow diversion scale). The procedure was uneventful, with the regaining of an adequate foot perfusion and palpable pulse at the posterior tibial artery. On the 2nd postoperative day, the patient was diagnosed with a symptomatic form of COVID-19 infection and transferred to a dedicated facility. At a one-month follow-up, the patient had no symptoms of limb ischemia and CTA showed complete thrombosis of the aneurism sac, absence of endoleaks, and patency of the treated arterial segment. This case demonstrates the possibility of off-label use of the DLM Roadsaver® stent for hybrid treatment of popliteal artery aneurism complicated by distal embolization and critical limb ischemia.

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Outcome of Endovascular Repair of Popliteal Artery Aneurysms using the Supera Stent

Cited by 9 publications

References 22 publications

The Supera Interwoven Nitinol Stent as a Flow Diverting Device in Popliteal Aneurysms

The Supera Interwoven Nitinol Stent as a Flow Diverting Device in Popliteal Aneurysms

Endovascular Repair of a Traumatic Popliteal Artery Injury

Off-Label Use of a Double-Layer Micromesh Carotid Stent for Hybrid Treatment of Popliteal Artery Aneurism Complicated by Chronic Distal Embolization

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