Volume changes of extremely large and giant intracranial aneurysms after treatment with flow diverter stents

Carneiro, Ângelo; Rane, Neil; Küker, Wilhelm; Cellerini, M.; Corkill, Rufus; Byrne, James

doi:10.1007/s00234-013-1304-0

Cited by 39 publications

(32 citation statements)

References 25 publications

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“…Importantly, to provide a scaffold for neo-endothelialization, apposition of the device to the vessel wall is paramount. Conversely, device malapposition may result in so-called endoleak and incomplete aneurysm occlusion,9 10 while late thrombosis as a consequence of poor apposition increases risks for stroke-related complications from thromboembolic events 11 12…”

Section: Introductionmentioning

confidence: 99%

Grading of Regional Apposition after Flow-Diverter Treatment (GRAFT): a comparative evaluation of VasoCT and intravascular OCT

Marel

Gounis

Weaver

et al. 2015

J NeuroIntervent Surg

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BACKGROUND: Poor vessel wall apposition of flow diverter (FD) stents poses risks for stroke-related complications when treating intracranial aneurysms, necessitating long-term surveillance imaging. To facilitate quantitative evaluation of deployed devices, a novel algorithm is presented that generates intuitive two-dimensional representations of wall apposition from either high-resolution contrast-enhanced cone-beam CT (VasoCT) or intravascular optical coherence tomography (OCT) images. METHODS: VasoCT and OCT images were obtained after FD implant (n=8 aneurysms) in an experimental sidewall aneurysm model in canines. Surface models of the vessel wall and FD device were extracted, and the distance between them was presented on a two-dimensional flattened map. Maps and cross-sections at potential locations of malapposition detected on VasoCT-based maps were compared. The performance of OCT-based apposition detection was evaluated on manually labeled cross-sections using logistic regression against a thresholded ( \u3e /=0.25 mm) apposition measure. RESULTS: VasoCT and OCT acquisitions yielded similar Grading of Regional Apposition after Flow-Diverter Treatment (GRAFT) apposition maps. GRAFT maps from VasoCT highlighted 16 potential locations of malapposition, of which two were found to represent malapposed device struts. Logistic regression showed that OCT could detect malapposition with a sensitivity of 98% and a specificity of 81%. CONCLUSIONS: GRAFT delivered quantitative and visually convenient representations of potential FD malapposition and occasional acute thrombus formation. A powerful combination for future neuroendovascular applications is foreseen with the superior resolution delivered by intravascular OCT

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Section: Introductionmentioning

confidence: 99%

Grading of Regional Apposition after Flow-Diverter Treatment (GRAFT): a comparative evaluation of VasoCT and intravascular OCT

Marel

Gounis

Weaver

et al. 2015

J NeuroIntervent Surg

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“…2,12 Temporary clipping of arterial segments in these circumstances was not studied in the present work.…”

Section: Discussionmentioning

confidence: 97%

Temporary surgical clipping of flow-diverted arteries in an experimental aneurysm model

Darsaut

Salazkin

Gentric

et al. 2016

JNS

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obJeCtive Surgical management of recurrent aneurysms following failed flow diversion may pose difficulties in securing vascular control with temporary clips. The authors tested the efficacy and impact of different types of aneurysm clips on flow-diverted arteries. Methods Six wide-necked experimental aneurysms were created in canines and treated with Pipeline flow diverters. In 4 aneurysms, occlusion of the artery at the level of the proximal and distal landing zones (n = 2 per aneurysm) was attempted, using temporary, fenestrated, single, and double permanent aneurysm clips. Two aneurysms served as unclipped controls. Serial angiography was performed to investigate the efficacy of clip occlusion, flow diverter deformation, and thrombus formation. After the animals were killed, the flow-diverted aneurysm constructs were opened and photographed to determine neointimal or device damage as a result of clip placement. results Angiography-confirmed clip occlusion was only possible for 4 of 8 of the tested flow-diverted arterial segments. Clip application attempts led to filling defects consistent with thrombus formation in 2 of 4 flow-diverted constructs, and to minor damage of the flow diverter with neointimal fracture in 1 of 4 cases. CoNClusioNs Aneurysm clips placed on canine parent arteries bearing a Pipeline flow diverter were unable to reliably stop blood flow. Application of aneurysm clips can cause mild damage to the device and neointima, which might translate into thromboembolic risks. If possible, vascular control should be sought beyond the terminal ends of the implanted device.

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“…23) Carneiro et al 23) reported that after eight FD deployments, two aneurysms had increased in size, three were unchanged, and three decreased in volume after a mean follow-up period of 20 months. There are currently no reports about aneurysmal volume expansion immediately after PED placement.…”

Section: Discussionmentioning

confidence: 99%

A Pipeline Embolization Device for the Treatment of Large and Giant Intracranial Aneurysms: Initial Experience at a Single Center

Nakae

Suzuki

Hirata

et al. 2017

JNET

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Objective: The Pipeline Embolization Device (PED) (Covidien, Irvine, CA, USA) is an endovascular microcatheter delivery system for the curative reconstruction of parent arteries harboring large/giant, wide-necked, and fusiform intracranial aneurysms. Here, we describe our initial experience with the PED to evaluate its safety, complications, and effectiveness. Results: A total of 11 complications were experienced by nine patients with a mean follow-up period of 6.5 months. Five major complications defined as ipsilateral stroke in four patients were encountered: two procedure-related ischemic strokes, one delayed ischemic stroke, and two intracerebral hemorrhages. In one patient, the symptom was persistent 3 months post-procedure. Of the other five patients with complications, four went on to recover completely 3 months post-procedure. Overall, the total complication rate for treatment with PED was 39.1% (9/23). Morbidity rate at 3 months post-procedure was 8.7% (2/23), and mortality rate 3 months post-procedure was 0%. Angiographic follow-up examination was carried out in 10 patients at 6 months and revealed no filling (0%) of aneurysm in four patients, entry remnant (<5%) in five, and subtotal filling (5%-95%) in another patient. Conclusion:The PED placement is effective therapy for the treatment of large/giant and wide-necked intracranial aneurysms. Despite the relatively low rate of permanent complications associated with the PED, it is important to note that the total complication rate was not negligible.

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Volume changes of extremely large and giant intracranial aneurysms after treatment with flow diverter stents

Abstract: Complete occlusion of the aneurysms leads, in most cases, to its shrinkage. In cases of late aneurysm growth or regrowth, consideration should be given to possible endoleak as the cause.

Cited by 39 publications

References 25 publications

Grading of Regional Apposition after Flow-Diverter Treatment (GRAFT): a comparative evaluation of VasoCT and intravascular OCT

Grading of Regional Apposition after Flow-Diverter Treatment (GRAFT): a comparative evaluation of VasoCT and intravascular OCT

Temporary surgical clipping of flow-diverted arteries in an experimental aneurysm model

A Pipeline Embolization Device for the Treatment of Large and Giant Intracranial Aneurysms: Initial Experience at a Single Center

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