Triple antiplatelet therapy with addition of cilostazol to aspirin and clopidogrel for Y-stent-assisted coil embolization of cerebral aneurysms

Kono, Kenichi; Shintani, Aki; Yoshimura, Ryo; Okada, Hideo; Tanaka, Yūko; Fujimoto, Takeshi; Tomura, Nagatsuki; Terada, Tomoaki

doi:10.1007/s00701-013-1771-4

Cited by 24 publications

(13 citation statements)

References 30 publications

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“…There are a number of reports on the differences between open-cell stents and closed-cell stents regarding wall apposition, hemodynamic effects, various configurations, such as Ystents, and recanalization rates [1,5,9,[13][14][15][16]. With regard to wall apposition, the Enterprise stent tends to cause malposition and kink in acutely curved vessels [2].…”

Section: Discussionmentioning

confidence: 99%

In vitro experiments of vessel wall apposition between the Enterprise and Enterprise 2 stents for treatment of cerebral aneurysms

Kono

Terada

2015

Acta Neurochir

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The Enterprise 2 stent has better wall apposition in curved vessels than the Enterprise stent. The gap between a vessel wall and the Enterprise 2 stent is approximately half that of the Enterprise stent. However, gaps and kinks are still present in curved vessels with a small radius. Caution should be taken for kinks and malposition in acutely curved vessels, such as the siphon of the internal carotid artery.

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Section: Discussionmentioning

confidence: 99%

In vitro experiments of vessel wall apposition between the Enterprise and Enterprise 2 stents for treatment of cerebral aneurysms

Kono

Terada

2015

Acta Neurochir

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“…Nevertheless, we performed stent-assisted endovascular techniques only if a good response to clopidogrel and ASA with values below the reference standards was ensured in the multiplate function test before all endovascular procedures. Kono et al 23 reported that even triple antiplatelet therapy may not prevent thromboembolic events and highlighted the importance of a platelet function evaluation before employment of intracranial stents. We report only one case of procedural embolism managed with the administration of tirofiban.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of complex intracranial aneurysms using Acandis Acclino stents

Brassel

Grieb

Meila

et al. 2016

J NeuroIntervent Surg

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“…The rest of the 33 cases were excluded because of the following reasons: insufficient imaging quality for CFD (n = 2), retreatment cases (n = 5) [17], [18], post-operative in-stent stenosis (n = 1), post-operative in-stent occlusion (n = 1) [19], bifurcation aneurysms including aneurysms with small branches arising from the neck of aneurysms, such as those at the junction of the vertebral artery and the posterior inferior cerebellar artery, or ophthalmic artery aneurysms (n = 17) [20], and cavernous carotid artery aneurysms (n = 7) [21]. Cavernous carotid artery aneurysms were excluded because the internal carotid artery around the cavernous portion is partly covered with skull bones, which disturb changes in vascular geometry by stent placement.…”

Section: Methodsmentioning

confidence: 99%

Hemodynamic Effects of Stent Struts versus Straightening of Vessels in Stent-Assisted Coil Embolization for Sidewall Cerebral Aneurysms

2014

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BackgroundRecent clinical studies have shown that recanalization rates are lower in stent-assisted coil embolization than in coiling alone in the treatment of cerebral aneurysms.ObjectiveThis study aimed to assess and compare the hemodynamic effect of stent struts and straightening of vessels by stent placement on reducing flow velocity in sidewall aneurysms, with the goal of reducing recanalization rates.MethodsWe evaluated 16 sidewall aneurysms treated with Enterprise stents. We performed computational fluid dynamics simulations using patient-specific geometries before and after treatment, with or without stent struts.ResultsStent placement straightened vessels by a mean (±standard deviation) of 12.9°±13.1° 6 months after treatment. Placement of stent struts in the initial vessel geometries reduced flow velocity in aneurysms by 23.1%±6.3%. Straightening of vessels without stent struts reduced flow velocity by 9.6%±12.6%. Stent struts had significantly stronger effects on reducing flow velocity than straightening (P = 0.004, Wilcoxon test). Deviation of the effects was larger by straightening than by stent struts (P = 0.01, F-test). The combination of stent struts and straightening reduced flow velocity by 32.6%±12.2%. There was a trend that larger inflow angles produced a larger reduction in flow velocity by straightening of vessels (P = 0.16).ConclusionIn sidewall aneurysms, stent struts have stronger effects (approximately 2 times) on reduction in flow velocity than straightening of vessels. Hemodynamic effects by straightening vary in each case and can be predicted by inflow angles of pre-operative vessel geometry. These results may be useful to design a treatment strategy for reducing recanalization rates.

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Triple antiplatelet therapy with addition of cilostazol to aspirin and clopidogrel for Y-stent-assisted coil embolization of cerebral aneurysms

Cited by 24 publications

References 30 publications

In vitro experiments of vessel wall apposition between the Enterprise and Enterprise 2 stents for treatment of cerebral aneurysms

In vitro experiments of vessel wall apposition between the Enterprise and Enterprise 2 stents for treatment of cerebral aneurysms

Endovascular treatment of complex intracranial aneurysms using Acandis Acclino stents

Hemodynamic Effects of Stent Struts versus Straightening of Vessels in Stent-Assisted Coil Embolization for Sidewall Cerebral Aneurysms

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