Single-center experience with the new generation Derivo Embolization Device in ruptured dissecting and blister aneurysms

Kaschner, Marius; Petridis, Athanasios K.; Turowski, Bernd

doi:10.1177/0284185119852731

Cited by 14 publications

(7 citation statements)

References 30 publications

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“…The BBA subgroup in the review demonstrated a 35% immediate occlusion rate and an 18% overall complication rate (7). Several studies have reported 0-33.3% immediate occlusion rates and 0-27% periprocedural complication rates (25,(33)(34)(35)(36). In this study, the immediate occlusion rate and periprocedural complication rate were 16.6%, and these results are consistent with those in the literature.…”

Section: Discussionsupporting

confidence: 89%

“…To our knowledge, there is no article focusing on the early treatment of ruptured BBAs treated with FDs. There had been some mixed (early and delayed treatment fashion) data and only one aforementioned delayed treatment safety and efficacy report ( 3 , 8 , 25 , 30 , 33 , 35 , 38 ). Our results contribute to the safety profile of FDs in the early treatment period of ruptured BBAs of ICA with a similar outcome and complication rates compared to delayed treatment and overall data regardless of time to treatment.…”

Section: Discussionmentioning

confidence: 99%

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Early Treatment of Ruptured Blood Blister-Like Aneurysms of the Internal Carotid Artery With Flow Diverters Using Single Antiplatelet Therapy: A Single-Center Experience With Long-Term Follow-Up

Tanburoğlu

Andıç

2021

Front. Neurol.

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Background and Purpose: Blood Blister-like aneurysms (BBAs) of the internal carotid artery (ICA) are rare entities of cerebral aneurysms. FD use in acutely ruptured aneurysms, timing of treatment and antiplatelet regimen are main debate topics in clinical practice when the treatment decision is flow diversion. The aim of this study is to report the safety and efficacy of a single-center FD treatment for ruptured BBAs in the early phase of SAH using the SAPT regimen.Material and Method: This study involved a retrospective analysis of a prospectively collected database. Records of patients admitted to our clinic and treated by endovascular route on ruptured BBA between January 2013 and December 2020 were reviewed. Ruptured supraclinoid ICA BBAs treated with FD devices with SAPT within 48 h from ictus of SAH are included. BBA of atypical anatomic locations, other endovascular techniques performed, and delayed admissions (>48 h) were excluded from the study. Demographic, clinical and angiographic features of patients and aneurysms, FD types and numbers, periprocedural complications, immediate and follow-up angiographic and clinical outcomes were recorded.Results: A total of six patients with ruptured BBAs treated via FDs within 48 h and used SAPT were included in the study. The mean age was 41.6 years (range from 34 to 45 years), and four of six patients were female. All patients were treated within 48 h after ictus, and the mean treatment day was 1.33 days. One patient received ticagrelor, and five patients received prasugrel as SAPT for one year after treatment. No procedure-related death and rebleeding were recorded. One (16.7 %) treatment responsive procedure-related complication occurred (transient ischemia). Overall good outcome rate was 83.3%. One patient died due to pneumonia. The immediate control angiograms showed complete occlusions of BBAs in one patient (16.6%). The complete occlusion rate was 100 % for five survivors at the control angiogram. The median follow-up was 49.5 months.Conclusion: This single-center experience suggests that early treatment (<2 days) within SAH of ruptured BBAs with FDs using SAPT is safe and effective in terms of clinical and radiological long-term outcomes.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Early Treatment of Ruptured Blood Blister-Like Aneurysms of the Internal Carotid Artery With Flow Diverters Using Single Antiplatelet Therapy: A Single-Center Experience With Long-Term Follow-Up

Tanburoğlu

Andıç

2021

Front. Neurol.

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“…So far, 12 case series of ruptured dissecting aneurysms or ruptured blood blister-like aneurysms treated in acute phase with flow diverter have been reported. [13][14][15][16][17][18][19][20][21][22][23][24] In these reports, 115 ruptured site (68 internal carotid artery, six middle cerebral artery, one anterior cerebral artery, 26 vertebral artery, six basilar artery, two posterior cerebral artery, three anterior inferior cerebellar artery, three posterior inferior cerebellar artery) were treated; 101 were treated with only flow diverter, 14 with flow diverter and coil. In these 115 cases, no rebleeding from ruptured site and 10 symptomatic thrombotic events were observed after procedure.…”

Section: Discussionmentioning

confidence: 99%

Ruptured Basilar Artery Dissection Diagnosed Using Magnetic Resonance Vessel Wall Imaging and Treated with Coil Embolization with Overlapping LVIS Stents: A Case Report

Sonobe

Yoshida

Niizuma

et al. 2020

NMC Case Report Journal

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The diagnosis and treatment of patients with ruptured basilar artery dissection (rBAD) are often difficult. We present a case of rBAD diagnosed with magnetic resonance vessel wall imaging (MR-VWI) and treated with coil embolization with overlapping low-profile visualized intraluminal support (LVIS) stents. The case is of a 49-year-old woman with subarachnoid hemorrhage. digital subtraction angiography (DSA) showed irregularity in an anterior wall of the middle portion of the basilar artery, indicating the presence of a false lumen. MR-VWI showed local enhancement in an arterial wall, which was consistent with the wall irregularity observed in DSA. Overlapping stents (two LVIS stents) was performed in the basilar artery and coils were placed in the false lumen. The false lumen was completely thrombosed, and anterograde blood flow of the basilar artery was preserved. Dual antiplatelet therapy was administered, and the patient underwent an uneventful postoperative course. DSA performed 6 months later showed a white-collar sign. MR-VWI has attracted attention as a useful modality for detecting a ruptured lesion in patients with subarachnoid hemorrhage. This is the first report, to the best of our knowledge, describing the practical use of MR-VWI for rBAD. MR-VWI is suggested to improve diagnostic accuracy for rBAD. There are no established treatments for rBAD; reconstructive endovascular treatments comprising stent placement and coil embolization of a false lumen are promising. The LVIS stent has a braided design and high metal coverage ratio and is considered to be reasonable for use in rBAD. Coil embolization of a false lumen with overlapping LVIS stents may be effective for rBAD.

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“…It has no distal or proximal device markers. The safety and efficacy of the Derivo ® device have been shown in several studies [10,[34][35][36]. Post-interventional data for Derivo ® 2 show the desired flow redirection and activity reduction inside the aneurysm, which is beneficial for thrombosis formation with marked decreases in neck flow rate and mean inflow velocity [37].…”

Section: Introductionmentioning

confidence: 92%

Computational Flow Diverter Implantation—A Comparative Study on Pre-Interventional Simulation and Post-Interventional Device Positioning for a Novel Blood Flow Modulator

Thormann,

Stahl,

Marsh

et al. 2024

Fluids

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Due to their effect on aneurysm hemodynamics, flow diverters (FD) have become a routine endovascular therapy for intracranial aneurysms. Since over- and undersizing affect the device’s hemodynamic abilities, selecting the correct device diameter and accurately simulating FD placement can improve patient-specific outcomes. The purpose of this study was to validate the accuracy of virtual flow diverter deployments in the novel Derivo® 2 device. We retrospectively analyzed blood flows in ten FD placements for which 3D DSA datasets were available pre- and post-intervention. All patients were treated with a second-generation FD Derivo® 2 (Acandis GmbH, Pforzheim, Germany) and post-interventional datasets were compared to virtual FD deployment at the implanted position for implanted stent length, stent diameters, and curvature analysis using ANKYRAS (Galgo Medical, Barcelona, Spain). Image-based blood flow simulations of pre- and post-interventional configurations were conducted. The mean length of implanted FD was 32.61 (±11.18 mm). Overall, ANKYRAS prediction was good with an average deviation of 8.4% (±5.8%) with a mean absolute difference in stent length of 3.13 mm. There was a difference of 0.24 mm in stent diameter amplitude toward ANKYRAS simulation. In vessels exhibiting a high degree of curvature, however, relevant differences between simulated and real-patient data were observed. The intrasaccular blood flow activity represented by the wall shear stress was qualitatively reduced in all cases. Inflow velocity decreased and the pulsatility over the cardiac cycle was weakened. Virtual stenting is an accurate tool for FD positioning, which may help facilitate flow FDs’ individualization and assess their hemodynamic impact. Challenges posed by complex vessel anatomy and high curvatures must be addressed.

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Single-center experience with the new generation Derivo Embolization Device in ruptured dissecting and blister aneurysms

Cited by 14 publications

References 30 publications

Early Treatment of Ruptured Blood Blister-Like Aneurysms of the Internal Carotid Artery With Flow Diverters Using Single Antiplatelet Therapy: A Single-Center Experience With Long-Term Follow-Up

Early Treatment of Ruptured Blood Blister-Like Aneurysms of the Internal Carotid Artery With Flow Diverters Using Single Antiplatelet Therapy: A Single-Center Experience With Long-Term Follow-Up

Ruptured Basilar Artery Dissection Diagnosed Using Magnetic Resonance Vessel Wall Imaging and Treated with Coil Embolization with Overlapping LVIS Stents: A Case Report

Computational Flow Diverter Implantation—A Comparative Study on Pre-Interventional Simulation and Post-Interventional Device Positioning for a Novel Blood Flow Modulator

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