scholarly journals Endovascular Treatment of a Complex Intracranial Bifurcation Aneurysm Using the “Kissing Waffle-cone Stent Placement” Technique

2019 ◽  
Vol 47 (3) ◽  
pp. 202-206
Author(s):  
Kohei NII ◽  
Yusuke MORINAGA ◽  
Misato KAWAGUCHI ◽  
Masanori TSUTSUMI
Keyword(s):  
Endovascular Treatment ◽  
Stent Placement ◽  
Bifurcation Aneurysm ◽  
Placement Technique

scholarly journals “Waffle Cone” Technique for Intra/Extra-Aneurysmal Stent Placement for the Treatment of Complex and Wide-Necked Bifurcation Aneurysm

2008 ◽  
Vol 14 (2_suppl) ◽  
pp. 49-52 ◽  
Author(s):  
Tzu-Hsien Yang ◽  
Ho-Fai Wong ◽  
Ming-Shiang Yang ◽  
Chang-Hsien Ou ◽  
Tzu-Lung Ho
Keyword(s):  
Endovascular Treatment ◽  
Stent Placement ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Three Dimensional ◽  
Parent Vessel ◽  
Surgical Clipping ◽  
Selective Embolization ◽  
Bifurcation Aneurysm

Endovascular treatment of intracranial aneurysms by coiling has become an accepted alternative to surgical clipping 1. In cases of wide-necked and sidewall aneurysms, selective embolization is difficult because of the risk of coil protrusion into the parent vessel. The use of three-dimensional coils, stents 2, and balloon remodeling have all aided the attempt to adequately manage such lesions. However, compared with sidewall aneurysms, bifurcation aneurysms are more challenging from an endovascular standpoint. Because of their specific anatomy and hemodynamics, the tendency to recur and rerupture is higher. Several authors have reported successful treatment of these complex and wide-necked bifurcation aneurysms by using Y-configured dual stent-assisted coil embolization 3,4, the double microcatheter technique 5, a more compliant balloon remodeling technique6, the TriSpan neck-bridge device7, or the waffle cone technique8. We describe two cases of wide-necked bifurcation aneurysms in which the waffle cone technique was used for coil embolization. The waffle cone technique was first described in 2006; however, the small number of published cases and the lack of follow-up prevent one from assessing this technique's durability and the probability of recanalization. We report the cases of two patients harboring unruptured wide-necked bifurcation aneurysms that were treated and followed-up for six months.

Use of Buddy Wire to Facilitate Y-Configured Stent Placement in Middle Cerebral Artery Bifurcation Aneurysms With Daughter Branches Arising From the Sac: A Technical Note

2013 ◽  
Vol 10 (1) ◽  
pp. E167-E171 ◽  
Author(s):  
Civan Islak ◽  
Osman Kizilkilic ◽  
Burak Kocak ◽  
Muzaffer Saglam ◽  
Bulent Yildiz ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Stent Placement ◽  
Clinical Presentation ◽  
Technical Note ◽  
New Technique ◽  
Bifurcation Aneurysm ◽  
Stenting Procedure ◽  
Buddy Wire

Abstract BACKGROUND AND IMPORTANCE: Endovascular treatment of geometrically complex bifurcation aneurysms using a standard Y-configured stenting technique might be extremely difficult, particularly in aneurysms with daughter branches that acutely arise from the aneurysm sac itself. In those cases, deployment of the second stent through interstices of the first stent could be troublesome because of untoward angular changes in the vascular bifurcation prompted by angular changes resulting from placement of the first stent. Here, we describe a novel application of the buddy wire technique to facilitate Y-configured stenting in middle cerebral artery (MCA) bifurcation aneurysms with unfavorable anatomic configuration. CLINICAL PRESENTATION: A 60-year-old man with a left-sided MCA bifurcation aneurysm was treated using the buddy wire technique. In addition to the standard Y-configured stenting procedure, we also inserted a 0.014-inch exchange microguidewire into the superior daughter branch, which more acutely emanated from the sac, to attain a favorable bifurcation configuration before deployment of the stents in the Y configuration. The new technique was successful, and the postprocedural course of the treatment was uneventful. CONCLUSION: Use of a buddy wire in MCA bifurcation aneurysms with unfavorable anatomic configurations may be a promising method to facilitate Y-configured stent placement. ABBREVIATION: MCA, middle cerebral artery

scholarly journals Application of parallel stent placement in the treatment of unruptured vertebrobasilar fusiform aneurysms

2017 ◽  
Vol 126 (1) ◽  
pp. 45-51 ◽  
Author(s):  
Jun Wang ◽  
Xin-Feng Liu ◽  
Bao-Min Li ◽  
Sheng Li ◽  
Xiang-Yu Cao ◽  
...  
Keyword(s):  
Stent Placement ◽  
Late Onset ◽  
Posterior Inferior Cerebellar Artery ◽  
Small Subset ◽  
Acceptable Result ◽  
Basilar Artery Thrombosis ◽  
Artery Thrombosis ◽  
Cerebellar Artery ◽  
Placement Technique

OBJECTIVE Large vertebrobasilar fusiform aneurysms (VFAs) represent a small subset of intracranial aneurysms and are often among the most difficult to treat. Current surgical and endovascular techniques fail to achieve a complete or acceptable result because of complications, including late-onset basilar artery thrombosis and perforator infarction. The parallel-stent placement technique was established in the authors' department, and this study reports the application of this technique in the treatment of unruptured VFAs. METHODS Eight patients with 8 unruptured VFAs who underwent parallel stent placement between April 2011 and August 2012 were included. The diameters of the VFAs ranged from 7.9 to 14.0 mm, and the lengths from 27.5 to 54.4 mm. Of the 8 patients with unruptured VFAs, 3 received double or triple parallel stents and 5 patients received a series-connected stent with another 1 or 2 stents deployed parallel to them. Outcomes for these patients were tabulated, based on the modified Rankin Scale (mRS) score and angiographic results. RESULTS All of the 25 stents were successfully placed without any treatment-related complications. During follow-up, 5 patients had decreased mRS scores, 2 were unchanged, and 1 was increased for subarachnoid hemorrhage. Immediate and follow-up clinical outcome was completely or partially recovered in most patients. Follow-up angiograms revealed 2 aneurysms were reduced in size and 6 were unchanged after stent placement. No in-stent stenosis, occlusion of the posterior inferior cerebellar artery, or perforators jailed by the stent occurred in any of the aneurysms. CONCLUSIONS These results provide encouraging support for the parallel-stent placement technique, which can be envisaged as an alternative strategy against unruptured VFAs. However, testing in more patients is needed.

Single-session endovascular treatment for symptomatic lower extremity deep vein thrombosis: a feasibility study

2010 ◽  
Vol 51 (3) ◽  
pp. 248-255 ◽  
Author(s):  
Byung Joon Kim ◽  
Hwan Hoon Chung ◽  
Seung Hwa Lee ◽  
Bo Kyung Je ◽  
Young Heon Lee ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Endovascular Treatment ◽  
Stent Placement ◽  
Thrombolytic Agent ◽  
Clinical Success ◽  
Single Session ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Deep Vein

Background: The risk of complications and discomfort in patients who undergo prolonged infusion of a thrombolytic agent is significant when conventional catheter-directed thrombolysis is used to treat lower extremity deep vein thrombosis (DVT). Purpose: To evaluate the feasibility and safety of single-session endovascular treatment for symptomatic lower extremity DVT. Material and Methods: Single-session endovascular treatment for lower extremity DVT was performed on 29 limbs in 26 patients diagnosed with acute DVT in our institution. Nine patients were male and 17 female, with a mean age of 64 years (range 28–82 years). At 5–10 min after the locoregional injection of the thrombolytic agent (urokinase) via a 5-Fr catheter to soften the thrombus, aspiration thrombectomy was performed with a large-bore sheath. In patients with an underlying anatomical stenosis or obstruction, combined angioplasty with or without stent placement was performed immediately after the complete removal of the thrombus. We then evaluated the technical and clinical outcomes of the procedure, along with any complications or recurrences of DVT. Results: Technical success was achieved in 24 procedures (82.8%) of single-session endovascular treatment for lower extremity DVT, and clinical success was achieved in 22 (75.9%) of these single-session procedures. Additional catheter-directed thrombolysis procedures were performed on five limbs after repeated aspiration thrombectomies failed to completely remove thrombi in those limbs. Stenotic or occlusive lesions were revealed in 24 limbs and percutaneous angioplasty procedures with or without stent placement were performed in these cases. No major complications resulted from the procedure. Conclusion: Single-session endovascular treatment is a feasible technique that provides acceptable technical and clinical success with excellent safety for treating symptomatic lower extremity DVT.

Evaluation of endovascular treatment with stent placement in abdominal aortic aneurysm

2019 ◽  
Vol 2019.57 (0) ◽  
pp. 101
Author(s):  
Nobuyasu KAGEYAMA ◽  
Fei JIANG ◽  
Masanori MURAKAMI ◽  
Xian CHEN ◽  
Junji OHGI
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Endovascular Treatment ◽  
Stent Placement ◽  
Abdominal Aortic

Staged stent-assisted angioplasty for symptomatic intracranial vertebrobasilar artery stenosis

2002 ◽  
Vol 97 (6) ◽  
pp. 1294-1301 ◽  
Author(s):  
Elad I. Levy ◽  
Ricardo A. Hanel ◽  
Bernard R. Bendok ◽  
Alan S. Boulos ◽  
Mary L. Hartney ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Stent Placement ◽  
Atherosclerotic Disease ◽  
High Grade ◽  
Content Type ◽  
Related Risk ◽  
Vertebrobasilar Artery ◽  
Neurological Morbidity ◽  
The Mean ◽  
Fine Print

Object. Medically refractory symptomatic vertebrobasilar atherosclerotic disease has a poor prognosis. Studies have shown that longer (≥ 10 mm), eccentric, high-grade (> 70%) stenoses portend increased procedure-related morbidity. The authors reviewed their experience to determine whether a staged procedure consisting of angioplasty followed by delayed (≥ 1 month later) repeated angioplasty and stent placement reduces the morbidity associated with endovascular treatment of symptomatic basilar and/or intracranial vertebral artery (VA) stenoses. Methods. The authors retrospectively reviewed the medical records in a consecutive series of eight patients who underwent planned stent-assisted angioplasty for medically refractory, symptomatic atherosclerotic disease of the intracranial posterior circulation between February 1999 and January 2002. Staged stent-assisted angioplasty was planned for these patients because the extent and degree of stenosis of the VA and/or basilar artery (BA) lesion portended an excessive procedure-related risk. The degree of stenosis, recent onset of symptoms (unstable plaque), vessel tortuosity, and lesion length and morphological features were contributing factors in determining procedure-related risk. Patient records were analyzed for location and degree of stenosis, preprocedural regimen of antiplatelet and/or anticoagulation agents, devices used, procedure-related complications, and clinical and radiographic outcomes. Among the patients in whom staged stent-assisted angioplasty was planned, vessel dissection, which necessitated immediate stent placement, occurred during passage of the balloon in one of them. In a second patient, the stent could not be maneuvered through the tortuous VA. In a third patient, the VA and BAs remained widely patent after angioplasty alone, and therefore stent placement was not required. Significant complications among the eight patients included transient aphasia and hemiparesis in one and a groin hematoma that necessitated surgical intervention in another; there was no permanent neurological morbidity. The mean stenosis before treatment was 78%, which fell to 54% after angioplasty, and the mean residual stenosis after stent placement was 30%. At the last follow-up examination, none of the treated patients had further symptoms attributable to the treated stenosis. Conclusions. The novel combination of initial angioplasty followed by delayed endoluminal stent placement may reduce the neurological morbidity associated with endovascular treatment of long, high-grade stenotic lesions. Attempting to cross high-grade stenoses with higher-profile devices such as stents may result in an embolic shower. Furthermore, neointimal proliferation and scar formation after angioplasty result in a thickened fibrous layer, which may be protective during delayed stent deployment. Larger-scale studies involving multiple centers are needed to elucidate further the lesion morphological characteristics and patient population most likely to benefit from staged procedures.

scholarly journals Vertebral Dissecting Aneurysm Treated with Wingspan Stent Deployment and Detachable Coils

2009 ◽  
Vol 15 (1) ◽  
pp. 113-116 ◽  
Author(s):  
M. Lv ◽  
X. Lv ◽  
Y. Li ◽  
X. Yang ◽  
Z. Wu
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Stent Placement ◽  
Dissecting Aneurysm ◽  
Left Vertebral Artery ◽  
Stent Deployment ◽  
Detachable Coils

We describe the first documented endovascular treatment of vertebral dissecting aneurysm using a Wingspan stent and detachable coils. A 54-year-old man presented with a nonruptured vertebral dissecting aneurysm. Because of the dissecting nature of the vertebral aneurysms, a 3×15-mm Wingspan stent was placed in the left vertebral artery. One month later, several detachable coils were introduced into the aneurysm. Six-month follow-up angiogram confirmed the obliteration. Vertebral dissecting aneurysm can be treated with Wingspan stent placement and detachable coils.

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