Treatment of Intracranial Aneurysms by Functional Reconstruction of the Parent Artery: The Budapest Experience with the Pipeline Embolization Device

Szikora, István; Berentei, Zsolt; Kulcsár, Zsolt; Marosfői, M; Vajda, Zsolt; Lee, W.; Berez, Aaron L.; Nelson, Peter Kim

doi:10.3174/ajnr.a2023

Cited by 519 publications

(442 citation statements)

References 24 publications

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“…discussion Flow-diverting stents offer new options for the treatment of intracranial aneurysms, increasing the number of aneurysms that can be treated endovascularly and allowing for improved long-term occlusion rates. 3,13,14,19 In a study by Brinjikji et al,…”

Section: Supplementary Comparison With the Department's Series Of Stementioning

confidence: 99%

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Diffusion-weighted imaging–detected ischemic lesions associated with flow-diverting stents in intracranial aneurysms: safety, potential mechanisms, clinical outcome, and concerns

Iosif

Camilleri²,

Saleme

et al. 2015

JNS

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abbreviatioNs ACA = anterior cerebral artery; AChA = anterior choroidal artery; ACoA = anterior communicating artery; ARU = aspirin reaction unit; cICA = cavernous segment of the internal carotid artery; DSA = digital subtraction angiography; DWI = diffusion-weighted imaging; ECA = external carotid artery; MCA = middle cerebral artery; mRS = modified Rankin Scale; OKM = O'Kelly and Marotta; PCoA = posterior communicating artery; PRU = P2Y12 reactivity unit; SAH = subarachnoid hemorrhage; VA = vertebral artery. submitted November 22, 2013. accepted October 7, 2014. iNclude wheN citiNg Published online January 6, 2015; DOI: 10.3171/2014.10.JNS132566. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJect It was initially considered safe for flow-diverting stents to cover the ostia of branching vessels during endovascular procedures for the treatment of intracranial aneurysms. As more recent evidence suggests, however, their use is not always free of ischemic concerns in terms of covered arterial ostia. The authors sought to determine the frequency of silent and clinically evident diffusion-weighted imaging (DWI)-detected abnormalities related to stent placement as a means of elucidating potential clinical risks. methods This is a prospective single-center study on a series of patients with intracranial aneurysms that were treated with flow-diverting stents. All patients systematically underwent an MRI protocol that included DWI before treatment, between 24 and 48 hours postprocedure, and 3 months postembolization. Effectiveness of anticoagulation treatment was assessed for all patients. Lesions seen on DWI were correlated to the parent artery and the side-branch territories and were statistically analyzed in relation to their time of occurrence and clinical presentation. The authors compared the DWI findings in these patients to findings obtained in patients treated with a stent-assisted coiling technique during the same time period. results Over the course of 18 consecutive months, 38 consecutive patients (7 males and 31 females) with 49 intracranial aneurysms were treated using flow-diverting stents. Overall, 81.6% of the DWI spots found remained clinically silent during the follow-up period. Five ischemic clinical complications (13.2%) occurred in the postprocedural period. No statistically significant correlation could be established between DWI spots or aneurysm location and clinical complications or follow-up modified Rankin Scale score at 3 months. The complication rate was 7.8% (n = 3) at the 3-month follow-up, and mortality was 0%. Compared with stent-assisted coiling, use of flow-diverting stents showed a statistically significant correlation with silent DWI findings postintervention. coNclusioNs Lesions seen on DWI resulting from the procedure are far more common than anticipated, but the technique remains safe and effective, providing an interesting alternative for "difficult" aneurysms, regardless of ...

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Section: Supplementary Comparison With the Department's Series Of Stementioning

confidence: 99%

“…3,12,14,15,19 A flow diverter is a braided stent consisting of a thick, flexible, tubular mesh. Because of its mechanical properties, when a flow diverter is deployed at the level of an aneurysm neck, it causes stagnation of blood, thus promoting thrombosis of the aneurysm sac while providing scaffolding for endothelialization.…”

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confidence: 99%

Diffusion-weighted imaging–detected ischemic lesions associated with flow-diverting stents in intracranial aneurysms: safety, potential mechanisms, clinical outcome, and concerns

Iosif

Camilleri²,

Saleme

et al. 2015

JNS

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“…In one of these patients, no flow was observed in the ophthalmic artery shortly after the treatment, and the occlusion of retinal artery was observed in the patient. In control investigations at month 6, occlusions of ophthalmic arteries were detected in two patients exposed to third or fourth placements of flow diverter stents (13). In our study, however, anterior choroidal artery was originated from the aneurysm neck in one patient.…”

Section: Discussionmentioning

confidence: 43%

“…In reports, recurrence rates are pointed out to be lower in the treatment of wide-necked aneurysms with flow di- verter stents, and recurred aneurysms are also reported as minimal due to lower likelihood of occlusions in time (13). In one of our patients with recurred aneurysm whose aneurysm was treated with coil, a flow diverter stent was placed in a way to cover the whole neck.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Flow Diverter Stents in the Treatment of Wide-Necked Intracranial Aneurysms

Özdemır

Arslan²,

Duman

et al. 2017

Iran J Radiol

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Background: To present our findings obtained from the treatment of wide-necked intracranial aneurysms with flow diverter stents. Patients and Methods: Intracranial aneurysms were determined in 19 patients (14 females, 5 males; mean age, 56.6 years) between May 2011 and June 2014, and the patients were treated using flow diverter stents. A total of 28 flow diverter stents, including 9 Silk and 19 Pipeline stents were used. Occlusion rates evaluated with computed tomography at the end of month 6 and digital subtraction angiography after one year, intraoperative success, morbidity and mortality rates were determined. Results: A total of 20 endovascular interventions, including two interventions in two different aneurysms in one patient were performed in 19 patients. Flow diverter stents were successfully implemented for wide-necked aneurysms at a success rate of 100%. Coil treatment had previously been performed in four patients. Aneurysm occlusion rates were 77.2% at month 6 and 90.9% at the end of month 12. Conclusions: The use of flow diverter stents is a reliable and effective method in the treatment of wide-necked intracranial aneurysms with high aneurysm occlusion, and low morbidity and mortality rates.

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“…Ezzel a módszerrel oldalfalaneurysmák mérettől függetlenül igen sikeresen kezelhetők, ideértve a 2-3 cm átmérőjű óriásaneurysmákat is (90% körüli teljes elzáródás, 5 éven belül 0% rekanalizá-ció) (2. ábra). Hátránya, hogy az aneurysmában kialakult thrombus szervüléséig nem biztosít garanciát az esetleges vérzés ellen, továbbá, hogy a szülőérben elhelyezett eszköz miatt, thromboemboliás szövődmények elkerülésére, tartós, kettős thrombocytaaggregáció-gát-lást (acetilszalicilsav + clopidogrel) igényel [5].…”

Section: áRamlásmódosításunclassified

Az intervenciós neuroradiológia korszerű lehetőségei

2015

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A korszerű intervenciós neuroradiológia meghatározó jelentőségűvé vált a vérzéses és ischaemiás stroke kezelésében, és jelentős szerepet tölt be a degeneratív gerincbetegségek, valamint a gerinceredetű fájdalomszindrómák kezelé-sében. Szerepe a koponyaűri aneurysmák kezelésében elsődleges. Az agyalapi nagyérelzáródások okozta ischaemiás stroke eseteiben a neurointervenciós módszerek rendkívül hatékonyak, eredményeit számos randomizált vizsgálat elemzi. Az osteoporoticus vagy tumoros eredetű patológiás csigolyatörések kezelésében a kevéssé invazív neurointervenciós eljárások szerepe kiemelkedő. Orv. Hetil., 2015, 156(17), 680-686. Kulcsszavak: intervenciós neuroradiológia, aneurysmaembolisatio, mechanikus thrombectomia, vertebroplastica Interventional neuroradiology: current optionsModern interventional neuroradiology has a leading role in the treatment of ischemic and hemorrhagic stroke, and it provides more and more important treatment options for degenerative diseases of the vertebral column and the management of correlated pain. During the last decades interventional neuroradiology has played a primary role in the treatment of intracranial berry aneurysms due to the continuous technical improvements. Ongoing studies proved superiority of mechanical stent-thrombectomy in acute proximal occlusion of cerebral arteries. Less invasive neurointerventional methods, such as vertebroplasty, are widely used in osteoporotic and neoplastic pathologic fractures of the vertebral bodies. These treatments should be performed in a specialized center by well trained physicians. Keywords: interventional neuroradiology, embolization of aneurysms, mechanical thrombectomy, vertebroplastySzikora, I., Marosfői, M., Berentei, Zs., Gubucz, I. [Interventional neuroradiology: current options]. Orv. Hetil., 2015, 156(17), 680-686. (Beérkezett: 2015 elfogadva: 2015. február 21.) ÖSSZEFOGLALÓ KÖZLEMÉNY Rövidítések CTA = CT-angiográfi a; CTP = perfúziós CT; DSA = digitális szubtrakciós angiográfi a; IAT = intraarterialis thrombolysis; IVT = intravénás thrombolysis; MT = mechanikus thrombectomia; PVP = percutan vertebroplastica; rtPA = szöveti plazminogén aktivátor; SAV = subarachnoidalis vérzés

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Treatment of Intracranial Aneurysms by Functional Reconstruction of the Parent Artery: The Budapest Experience with the Pipeline Embolization Device

Cited by 519 publications

References 24 publications

Diffusion-weighted imaging–detected ischemic lesions associated with flow-diverting stents in intracranial aneurysms: safety, potential mechanisms, clinical outcome, and concerns

Diffusion-weighted imaging–detected ischemic lesions associated with flow-diverting stents in intracranial aneurysms: safety, potential mechanisms, clinical outcome, and concerns

The Efficacy of Flow Diverter Stents in the Treatment of Wide-Necked Intracranial Aneurysms

Az intervenciós neuroradiológia korszerű lehetőségei

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