Will Coiling Survive through the Next Decade?

Henkes, Hans; Klisch, Joachim; Lylyk, Pedro

doi:10.3390/jcm11113230

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…In this study we present the second largest case series on NICE lesions to date and the largest series specifically regarding flow diversion, which is of particular interest as FDs are increasingly used to treat various aneurysms and their use will likely further increase in the future. 21 For example, Cruz et al reported in their case series on two of seven patients treated with FDs, 22 three of six patients were treated with FDs in the series by Bayas et al, 4 and six of 32 patients were treated with FDs in the largest case series to date by Shotar et al 2 Biopsy-confirmed cases have shown that NICE lesions result from granulomatous foreign body reactions to microemboli formed by hydrophilic polymer coatings. The biopsies unveiled a spectrum of pathological findings including granulomas, angiitis, a periadventitial response characterized by giant cells reacting to foreign bodies, and microabscesses encapsulating foreign material, along with neutrophilic granulocytes and multinucleated macrophages.…”

Section: Discussionmentioning

confidence: 99%

Non-ischemic cerebral enhancing (NICE) lesions after flow diversion for intracranial aneurysms: a multicenter study

Richter,

Möhlenbruch,

Vollherbst

et al. 2024

J NeuroIntervent Surg

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BackgroundNon-ischemic cerebral enhancing (NICE) lesions have been reported as a rare complication of various neuroendovascular procedures, but information on their incidence after flow diversion is scant. It is unclear if specific devices or novel coating technologies may impact their occurrence.MethodsWe conducted a multicenter study on the incidence of NICE lesions after flow diverter (FD) implantation for cerebral aneurysm treatment.ResultsEight centers identified 15 patients and provided detailed data. The clinical presentation ranged from asymptomatic to hemiplegia and cognitive impairment. The mean time to diagnosis after treatment was 65.1±101.5 days. Five centers disclosed information on all of their 1201 FD procedures during the inclusion period (2015–2022), during which 12 patients were diagnosed with NICE lesions in these institutions—that is, an incidence of 1%. FD coatings did not increase the incidence (6/591 patients (1%) treated with surface-modified FD vs 6/610 patients (1%) treated with bare FD; P=1.00). Significantly increased rates of 3.7% (6 cases in 161 procedures; P<0.01) and 3.3% (5 cases in 153 procedures; P<0.01) were found with stents of two specific product lines. The use of one product line was associated with a significantly lower incidence (0 cases in 499 procedures (0%); P<0.01).ConclusionsNovel stent coatings are not associated with an increased incidence of NICE lesions. The incidence rate of 1% suggests that these lesions may occur more often after flow diversion than after other endovascular treatments. We found a concerning accumulation of NICE lesion cases when FDs from two product families were used.

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Section: Discussionmentioning

confidence: 99%

Non-ischemic cerebral enhancing (NICE) lesions after flow diversion for intracranial aneurysms: a multicenter study

Richter,

Möhlenbruch,

Vollherbst

et al. 2024

J NeuroIntervent Surg

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“…Our institution is a tertiary referral center with an average of 1224 neurovascular interventions per year in the period of 2015–2021, including an average of 162 coiling procedures, 212 procedures with implantation of one or more flow-diversion units [ 21 ], an average of 376 thrombectomies and 212 primary carotid interventions per year. The catheter laboratory team consists of 6 interventionalists including 3 senior interventionalists.…”

Section: Methodsmentioning

confidence: 99%

Is Crash Loading Acceptable in Carotid Artery Stenting?

et al. 2022

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Purpose In elective carotid artery stenting (CAS), antiplatelet therapy (APT) is crucial. Several international societies have provided guidelines for loading time and dosage in endovascular treatment; however, no recommendations have been made for urgent, nonthrombectomy-associated CAS without adequate loading time. Here, we investigated the short-term outcomes for APT-naïve patients receiving “crash loading” (CL) on the day of intervention, compared with those for patients wi APT onset 3–5 days (semi-CL) or more than 5 days before CAS (EL). Methods Outcomes of patients 30 days after CAS were evaluated in terms of the rates of in-stent thrombus, re-stenosis, stroke, hemorrhagic and thrombotic events, other periprocedural occurrences, in-hospital death and CAS-associated death. Patients’ biological, pathological and hemostatic factors were recorded and compared. Results A total of 1158 patients who received CAS at the authors’ neuroradiology institution were analyzed: 275 EL, 846 semi-CL, and 37 CL. The patients receiving CL had the lowest rate of stroke, but the highest rates of CAS-associated and in-hospital deaths, although the deaths were not necessarily associated with APT. In-stent thrombosis was the highest in the semi-CL group. The rates and types of periprocedural occurrences favored the CL group. Conclusion With the medical regimen used in this study, urgent CAS with CL APT did not produce more ischemic, thrombotic and hemorrhagic complications than longer loading times. However, careful patient selection might be crucial and adequate loading times should remain the standard of care.

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Stent retriever expansion as a corrective maneuver to optimize inadequately deployed flow diverter stents

Khanafer,

Almohammad,

von Gottberg

et al. 2024

Interv Neuroradiol

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Background and Purpose As flow diversion (FD) is becoming increasingly important in the endovascular treatment of intracranial aneurysms, the rate of technical complications is also increasing. Inadequate FD implantation may lead to both ischemic complications and decreased treatment efficacy. The aim of this study was to evaluate the efficacy of off-label stent retriever (SR) use in managing technical complications associated with FD implantation. Materials and Methods A retrospective analysis of data from patients who underwent FD treatment at two neuroradiology centers was performed. The objective was to identify cases in which the FD was inadequately deployed and SR expansion was performed as a corrective maneuver. The analysis included anatomic characteristics, technical information, angiographic and clinical outcomes, and complications. Results A total of 35 corrective maneuvers with SR were performed in 25 FD treatments. The corrective maneuvers in all treatments were successful, and no additional devices or therapies were required. No procedural complications or technical difficulties were documented. Conclusion With the growing role of FDs in neurointerventional treatment, familiarity with corrective maneuvers after technical complications or inadequate implantation is important. The findings in our selected cohort demonstrated that SR expansion is an effective and safe corrective maneuver for incompletely opened FDs.

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Will Coiling Survive through the Next Decade?

Abstract: During the past three decades, neuroendovascular therapy has evolved from a focus on new disease concepts to revised treatment strategies and, ultimately, to versatile new technologies [...]

Cited by 3 publications

References 22 publications

Non-ischemic cerebral enhancing (NICE) lesions after flow diversion for intracranial aneurysms: a multicenter study

Non-ischemic cerebral enhancing (NICE) lesions after flow diversion for intracranial aneurysms: a multicenter study

Is Crash Loading Acceptable in Carotid Artery Stenting?

Stent retriever expansion as a corrective maneuver to optimize inadequately deployed flow diverter stents

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