Pipeline Embolization of Vertebrobasilar Aneurysms—A Multicenter Case Series

Wallace, Adam N.; Madaelil, Thomas P; Kamran, Mudassar; Miller, Timothy; Almandoz, Josser E Delgado; Grossberg, Jonathan A; Kansagra, Akash P.; Gandhi, Dheeraj; Kayan, Yasha; Cawley, C. Michael; Moran, Christopher J.; Jindal, Gaurav; CreveCoeur, Travis S.; Howard, Brian M.; Cross, DeWitte T.; Kole, Matthew J; Roy, Anil K.; Dion, Jacques E.; Osbun, Joshua W.

doi:10.1016/j.wneu.2018.12.116

Cited by 17 publications

(22 citation statements)

References 26 publications

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“…After its initial employment as a last resort strategy for wide-necked aneurysms,1 the field of application has expanded rapidly and nowadays even includes the first treatment for saccular and fusiform-shaped incidental aneurysms located within any of the proximal segments of the circle of Willis,2–8 as well as otherwise only inadequately treatable acutely ruptured aneurysms 9. The fundamental concept of flow diversion—using devices with distinctly increased surface coverage to redirect blood flow along the physiological axis of the parent vessel, away from the aneurysm sac—aims for incremental remodeling of the affected artery without touching the highly fragile aneurysm itself 3. In most cases the implanted flow diverting stent (FDS) gradually induces intra-aneurysmal thrombosis, which—synergistically with the dense mesh of the device itself—provides an ideal matrix for the relatively rapid formation of a neointima that eventually excludes the aneurysm from the circulation 2.…”

Section: Introductionmentioning

confidence: 99%

“…More specifically, the delivery systems of currently available well-established FDS such as the Pipeline Embolization Device (PED2, Medtronic, USA), p64 (Phenox, Germany), or SILK (BALT, France) require microcatheters providing large inner diameters (0.021–0.027 inch), which inherently constitute a significant stiffness and thus impede smooth atraumatic maneuverability in the distal circulus segments. As a consequence, only proximal elements of the circle of Willis such as the internal carotid arteries (ICAs), V4 segments, basilar artery, as well as the M1 and A1 segments have been treated regularly with FDS 3–8…”

Section: Introductionmentioning

confidence: 99%

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Flow diversion beyond the circle of Willis: endovascular aneurysm treatment in peripheral cerebral arteries employing a novel low-profile flow diverting stent

Schob

Hoffmann

Richter

et al. 2019

J NeuroIntervent Surg

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BackgroundFlow diversion (FD) has emerged as superior minimally invasive therapy for cerebral aneurysms. However, aneurysms of small peripheral vessel segments have not yet been adequately treatable. More specifically, currently established devices necessitate large microcatheters which impede atraumatic maneuvering. The Silk Vista Baby (SVB), a novel flow diverter, offers the as yet unique feature of deliverability via a 0.017 inch microcatheter. This study reports our first experience with the SVB in challenging intracranial vessels employing a vessel-specific tailored microcatheter strategy.Materials and methods25 patients (27 aneurysms) were prospectively included. A total of 30 SVBs were employed, predominantly targeting demanding aneurysms of the anterior communicating artery complex. The efficacy of the FD was assessed using two-dimensional vector-based perfusion and conventional digital subtraction angiography (DSA) after implantation and at the first follow-up at 3 months. The first follow-up was available in 22 patients.ResultsAll devices were implanted without technical or clinical complications. Eleven treatments were performed using the recommended Headway 17. In 14 interventions the even more maneuverable Excelsior SL10 was used, which was previously tried and tested for safety ’in vitro’ as an alternative delivery system. Aneurysmal influx was strongly reduced after implantation. All parent vessels remained patent. 17/27 aneurysms were completely occluded at first follow-up (∼2.7 months), 6/27 aneurysms showed decreased influx or delayed washout and one remained unchanged. In three cases follow-up DSAs are remaining.ConclusionsSVB provides enhanced controllability in vulnerable segments beyond the circle of Willis. Smaller variants (2.25 mm and 2.75 mm) can safely be implanted via the superiorly navigable Excelsior SL10. Hence, the SVB represents the next evolutionary step in minimally invasive treatment of cerebral aneurysms.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Flow diversion beyond the circle of Willis: endovascular aneurysm treatment in peripheral cerebral arteries employing a novel low-profile flow diverting stent

Schob

Hoffmann

Richter

et al. 2019

J NeuroIntervent Surg

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“…We assessed the full text of 111 studies and excluded 97 based on criteria. Finally, 14 studies 12,[18][19][20][21][24][25][26][27][28][29][30][31][32] were included for meta-analysis. Figure 1 shows a flow diagram of the study selection process.…”

Section: Literature Search Resultsmentioning

confidence: 99%

Efficacy and safety of flow diverters in posterior circulation aneurysms and comparison with their efficacy in anterior circulation aneurysms: A systematic review and meta-analysis

et al. 2021

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Purpose We aimed to assess the efficacy and safety of flow-diverter stents (FDs) in the management of posterior circulation cerebral aneurysms and compare FD efficacy between anterior and posterior circulation aneurysms. Methods We searched the PubMed, Scopus, Cochrane, and Web of Science databases for relevant studies through March 2020. Studies assessing FDs for posterior circulation aneurysms that included ≥20 treated aneurysms were included. Moreover, the studies compared FD efficacy between anterior and posterior circulation aneurysms were included. Data regarding angiographic aneurysmal occlusion, procedural complications, mortality, and morbidity were extracted and pooled in a random-effects meta-analysis model. Results Fourteen studies with a total of 659 patients and 676 posterior circulation aneurysms were included. The pooled rate of aneurysmal occlusion at long-term angiographic follow-up was 78% [95% confidence interval (CI), 71–85]. The pooled rates of intraparenchymal hemorrhage, ischemia, and procedure-related mortality and neurological morbidity were 2%, 8%, 7%, and 6%, respectively. Complete occlusion occurred in 82.4% of the posterior circulation aneurysm subgroup and 77.5% of the anterior circulation aneurysm subgroup. The difference was not significant (relative risk 1.01; 95% CI, 0.86–1.19; p = 0.91). Regression analysis showed that elderly patients and females had higher morbidity. Conclusion Posterior circulation aneurysms can be effectively treated with FDs with comparable occlusion rates to those in anterior circulation aneurysms. However, periprocedural complications are not negligible.

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“…With a steady improvement in neurointervention, there is a growing body of evidence favoring endovascular techniques over neurosurgery to treat most posterior circulating aneurysms, including those in the VBJ [ 4 , 5 ]. Although largely unexplored, some authors also advocate the strategy of combining neurosurgery with endovascular techniques in complex aneurysms [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of complex vertebrobasilar junction aneurysms: A report of two cases

Phuyal

Paudel

Agrawal

et al. 2020

International Journal of Surgery Case Reports

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Pipeline Embolization of Vertebrobasilar Aneurysms—A Multicenter Case Series

Cited by 17 publications

References 26 publications

Flow diversion beyond the circle of Willis: endovascular aneurysm treatment in peripheral cerebral arteries employing a novel low-profile flow diverting stent

Flow diversion beyond the circle of Willis: endovascular aneurysm treatment in peripheral cerebral arteries employing a novel low-profile flow diverting stent

Efficacy and safety of flow diverters in posterior circulation aneurysms and comparison with their efficacy in anterior circulation aneurysms: A systematic review and meta-analysis

Endovascular treatment of complex vertebrobasilar junction aneurysms: A report of two cases

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