scholarly journals Unruptured Carotid Artery Aneurysms Presenting with Symptoms of Mass Effect: Outcome after Selective Coiling, Parent Vessel Occlusion, and Flow Diversion

2013 ◽  
Vol 34 (5) ◽  
pp. 940-941 ◽  
Author(s):  
W.J. van Rooij ◽  
M. Sluzewski
Keyword(s):  
Carotid Artery ◽  
Mass Effect ◽  
Flow Diversion ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Parent Vessel Occlusion

scholarly journals Flow diversion in the treatment of aneurysms: a randomized care trial and registry

2017 ◽  
Vol 127 (3) ◽  
pp. 454-462 ◽  
Author(s):  
Jean Raymond ◽  
Jean-Christophe Gentric ◽  
Tim E. Darsaut ◽  
Daniela Iancu ◽  
Miguel Chagnon ◽  
...  
Keyword(s):  
Standard Treatment ◽  
Flow Diversion ◽  
Parent Vessel ◽  
Management Options ◽  
Vessel Occlusion ◽  
Clinical Trial Registration ◽  
Safety Outcome ◽  
Standard Management ◽  
Efficacy Outcome ◽  
Parent Vessel Occlusion

OBJECTIVEThe Flow Diversion in the Treatment of Intracranial Aneurysm Trial (FIAT) was designed to guide the clinical use of flow diversion, an innovative method to treat intracranial aneurysms, within a care trial and to study safety and efficacy.METHODSFIAT, conducted in 3 Canadian hospitals, proposed randomized allocation to flow diversion or standard management options (observation, coil embolization, parent vessel occlusion, or clip placement), and a registry of non-randomized patients treated with flow diversion. The primary safety outcome was death or dependency (modified Rankin Scale score > 2) at 3 months, to be determined for all patients who received flow diversion at any time. The primary efficacy outcome was angiographic occlusion at 3–12 months combined with an independent clinical outcome.RESULTSOf 112 participating patients recruited between May 2, 2011, and February 25, 2015, 78 were randomized (39 in each arm), and 34 received flow diversion within the registry. The study was halted due to safety concerns. Twelve (16%) of 75 patients (95% CI 8.9%–26.7%) who were allocated to or received flow diversion at any time were dead (n = 8) or dependent (n = 4) at 3 months or more, crossing a predefined safety boundary. Death or dependency occurred in 5 (13.2%) of 38 patients randomly allocated and treated by flow diversion (95% CI 5.0%–28.9%) and in 5 (12.8%) of 39 patients allocated to standard treatment (95% CI 4.8%–28.2%). Efficacy was below expectations of the trial hypothesis: 16 (42.1%) of 38 patients (95% CI 26.7%–59.1%) randomly allocated to flow diversion failed to reach the primary outcome, as compared with 14 (35.9%) of 39 patients allocated to standard treatment (95% CI 21.7%–52.9%).CONCLUSIONSFlow diversion was not as safe and effective as hypothesized. More randomized trials are needed to determine the role of flow diversion in the management of aneurysms.Clinical trial registration no.: NCT01349582 (clinicaltrials.gov)

F.04 Flow diversion in the treatment of aneurysms: A randomized care trial and registry

2016 ◽  
Vol 43 (S2) ◽  
pp. S19-S19
Author(s):  
T Darsaut ◽  
J Gentric ◽  
D Iancu ◽  
M Chow ◽  
J Rempel ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Standard Treatment ◽  
Flow Diversion ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Safety Outcome ◽  
Standard Management ◽  
Efficacy Outcome ◽  
Parent Vessel Occlusion ◽  
Safety Boundary

Background: The Flow diversion in the treatment of Intracranial Aneurysm (FIAT) trial was designed to guide the clinical use of flow diversion. Methods: FIAT proposed randomized allocation flow diversion or standard management (observation, coiling, parent vessel occlusion, or clipping), and a registry of non-randomized patients treated with flow diversion. Primary safety outcome was death or dependency (mRS > 2) at 3 months. Primary efficacy outcome was angiographic occlusion at 3-12 months combined with independent clinical outcome. Results: Of 112 participating patients recruited, 78 were randomized, and 34 received flow diversion within the registry. The study was halted for safety concerns. Twelve of 73 patients (16.4%; CI [9.7% -26.7%]) who were allocated or received flow diversion at any time were dead (n=8) or dependent (n=4) at 3 months or more, crossing a predefined safety boundary. Death or dependency occurred in 5 of 36 patients randomly allocated flow diversion and in 5 of 36 patients allocated standard treatment (13.9%; [6.1%-28.7%]). Efficacy was below hypothesized expectations: 15 of 36 patients (41.7%; [27.1%-57.8%]) randomly allocated flow diversion failed to reach the primary outcome, as compared to 11 of 36 patients allocated standard treatment (30.1%; [18.0%-46.9%]). Conclusions: Flow diversion was not as safe and effective as hypothesized. More randomized trials are needed.

scholarly journals The Many Faces of Intracranial Arterial Dissections

2010 ◽  
Vol 16 (2) ◽  
pp. 151-160 ◽  
Author(s):  
T. Krings ◽  
I-S. Choi
Keyword(s):  
Vessel Wall ◽  
Combined Treatment ◽  
Treatment Protocol ◽  
Treatment Strategies ◽  
Intramural Hematoma ◽  
Mass Effect ◽  
Vasa Vasorum ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Parent Vessel Occlusion

Intracranial arterial dissecting diseases are rare and challenging diseases with a high associated morbidity and mortality. Their common pathomechanic origin is related to blood entering the vessel wall via an endothelial and intimal tear. Depending on the fate of the thus established intramural hematoma, different symptoms may ensue including mass effect, subarachnoid hemorrhage or ischemia. If the mural hematoma ruptures all vascular layers of the intradural artery, a subarachnoid hemorrhagic will occur. If the intramural hematoma reopens distally into the parent vessel on the other hand, ischemic embolic events may happen following intramural clot formation. If the mural hematoma does neither open itself into the parent vessel nor into the subarachnoid space, the vessel wall may dilate leading to occlusion of perforator branches and local ischemia. Organization of the mural hematoma may result in a chronic dissecting process which may eventually lead to formation of a “giant partially thrombosed” aneurysm with thrombus of varying ages within the vessel wall, ingrowth of vasa vasorum and recurrent dissections with subsequent growth of the aneurysm from the periphery. Treatment strategies of these diseases should take the underlying pathomechanism into consideration and include, depending on the presentation medical treatment, parent vessel occlusion, flow reversal or diversion, surgical options or a combined treatment protocol.

scholarly journals Management of Head and Neck Pseudoaneurysms: A Review of 33 Consecutive Cases

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Eliza Anderson ◽  
Nohra Chalouhi ◽  
Aaron Dumont ◽  
Stavropoula Tjoumakaris ◽  
Mario Zanaty ◽  
...  
Keyword(s):  
Head And Neck ◽  
Treatment Options ◽  
Flow Diversion ◽  
Modified Rankin Scale ◽  
Single Patient ◽  
Single Institution ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Parent Vessel Occlusion ◽  
Procedural Complications

Background. Endosaccular coiling, vessel occlusion, stenting, stent-assisted coiling, and flow diversion are all endovascular treatment options for pseudoaneurysms (PAs) of the head and neck. We explore different clinical situations in which these were selected for PA management at a single institution.Methods. Over a period of ten years, 33 patients presented to our hospital with PAs of the head and neck. Their outcomes and procedural complications are discussed.Results. We observed a complication rate of 18.2% (6 of 33), consisting predominantly of infarcts following vessel occlusion. As measured by the modified Rankin Scale, 25 (75.8%) patients had achieved favorable outcomes on discharge. A single patient who was treated with stent-assisted coiling expired following procedural complications.Conclusions. In our series, most patients with traumatic/iatrogenic PAs were successfully treated with parent vessel sacrifice. When parent vessel occlusion is not an option, stenting with or without coiling, or flow diversion, may also be safe and effective alternatives.

scholarly journals Interpositional carotid artery bypass strategies in the surgical management of aneurysms and tumors of the skull base

2003 ◽  
Vol 14 (3) ◽  
pp. 1-6 ◽  
Author(s):  
James K. Liu ◽  
William T. Couldwell
Keyword(s):  
Carotid Artery ◽  
Skull Base ◽  
Surgical Management ◽  
Artery Bypass ◽  
Skull Base Tumors ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Vein Grafts ◽  
Complex Aneurysms ◽  
Parent Vessel Occlusion

Cerebral revascularization is an important component in the surgical management of complex skull base tumors and aneurysms. Patients who harbor complex aneurysms that cannot be clipped directly and in whom parent vessel occlusion cannot be tolerated may require cerebrovascular bypass surgery. In cases in which skull base tumors encase the carotid artery (CA) and a resection is desired, a cerebrovascular bypass may be necessary in planned CA occlusion or sacrifice. In this review the authors discuss options for performing high-flow anterograde interposition CA bypass for lesions of the skull base. The authors review three important bypass techniques involving saphenous vein grafts: the cervical-to-petrous internal carotid artery (ICA), petrous-to-supraclinoid ICA, and cervical-to-supraclinoid ICA bypass. These revascularization techniques are important tools in the surgical treatment of complex aneurysms and tumors of the skull base and cavernous sinus.

scholarly journals Flow Diversion in Aneurysms Trial: The Design of the FIAT Study

2011 ◽  
Vol 17 (2) ◽  
pp. 147-153 ◽  
Author(s):  
J. Raymond ◽  
T.E. Darsaut ◽  
F. Guilbert ◽  
A. Weill ◽  
D. Roy
Keyword(s):  
Treatment Option ◽  
Conventional Treatment ◽  
Clinical Care ◽  
Flow Diverter ◽  
Flow Diversion ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Parent Vessel Occlusion ◽  
One Year ◽  
Flow Diverters

Intracranial aneurysms, particularly large and giant, fusiform or recurrent aneurysms are increasingly treated with flow diverters (FDs), a recently introduced and approved neurovascular device. While some rare cases may not be treated any other way, in most patients a more conventional, conservative, or validated approach such as coiling, parent vessel occlusion, or surgical clipping exists. Only a randomized clinical trial can answer the question of which treatment option leads to better patient outcomes. We report the design of the FIAT study, a clinical care trial aiming to compare angiographic and clinical outcomes following treatment with a Flow-Diverter or with the best conventional treatment option. The FIAT study will include both a randomized and a registry portion. Patients will be proposed randomization to either FD stenting or best conventional treatment option (observation, coiling, stenting, or clipping) as determined by the treating physician. FIAT will recruit a total of 338 patients, to show that i) FD stenting can be performed with an ‘acceptable’ immediate complication rate of less than 15% morbidity and mortality (defined as mRS > 2); ii) FD stenting can increase from 75 to 90% the proportion of patients with a “good outcome”, defined as complete or near-complete occlusion of the aneurysm AND a good clinical outcome (mRS ≤ 2) at one year, as compared to the best conventional option. The FIAT study provides a scientific and ethical context to care for patients eligible for flow-diversion therapy.

Traumatic dissecting pathology of posterior cerebral artery: a report of two cases—aneurysm and pial arteriovenous fistula

2021 ◽  
Vol 14 (5) ◽  
pp. e237722
Author(s):  
Vignesh Selvamurugan ◽  
Surya Nandan Prasad ◽  
Vivek Singh ◽  
Zafar Neyaz
Keyword(s):  
Arteriovenous Fistula ◽  
Cerebral Artery ◽  
Road Traffic ◽  
Posterior Cerebral Artery ◽  
Case Reports ◽  
Dissecting Aneurysm ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Parent Vessel Occlusion ◽  
Pial Arteriovenous Fistula

We present two cases of 17-year-old man and 10-year-old boy presenting with subarachnoid haemorrhage and a history of road traffic accident. One patient had dissecting aneurysm of the posterior cerebral artery (PCA), and the other patient had partially thrombosed aneurysm on CT angiography. On digital subtraction angiography of the second patient, there was formation of PCA pontomesencephalic vein pial arteriovenous fistula (PAVF). Both the patients underwent endovascular treatment: stent-assisted coiling for aneurysm and coiling with parent vessel occlusion for PAVF. There were no procedural complications. Follow-up angiography showed no residual aneurysm or fistula. Trauma is one of the recognised causes of dissection, and intracranial dissections can present as stenotic lesions, aneurysms or fistulas, depending on the pathology. Traumatic dissecting PCA aneurysm has been reported in only two case reports previously, and post-traumatic PAVF in PCA has not been reported.

Abstract P519: Higher Number of Thrombectomy Passes Significantly Increases Risk of Mass Effect, Poor Functional Outcome, and Mortality

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Victor M Ringheanu ◽  
Laurie Preston ◽  
WONDWOSSEN G TEKLE ◽  
Amrou Sarraj ◽  
Ameer E Hassan
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Functional Outcome ◽  
Internal Carotid ◽  
Mass Effect ◽  
Artery Occlusion ◽  
Delayed Presentation ◽  
Vessel Occlusion ◽  
Presentation Time ◽  
Poor Outcomes

Background: Endovascular treatment (EVT) is a widely proven method to treat patients diagnosed with intracranial large vessel occlusion (LVO). Through this method of treatment, it has been hypothesized that a lower number of thrombectomy passes is an indicator of higher rates of modified Thrombolysis in Cerebral Infarction 2b-3 (mTICI) and favorable outcomes defined as modified Rankin Scale 0-2 (mRS). Methods: Through the utilization of a prospectively collected endovascular database between 2012-2020, variables such as demographics, co-morbid conditions, intracerebral hemorrhage, mass effect, mortality rate, and good/poor outcomes in regard to mTICI score and mRS assessment at discharge were examined. The outcomes between patients receiving EVT who were treated with < 3 thrombectomy passes or ≥ 3 passes were compared. Results: Out of 454 patients treated with mechanical thrombectomy of qualifying intracranial internal carotid artery or middle cerebral artery occlusion, site of occlusion (internal carotid artery, M1 and M2), a total of 372 (81.9%) were treated with < 3 thrombectomy passes (average age 70.34 ± 13.75 years, 46.0% women), and 82 (18.1%) were treated with ≥ 3 thrombectomy passes (average age 70.30 ± 13.72 years, 48.8% women). Significantly higher rates of mass effect (p=0.043), mRS score 3-6 (p=0.029), and mortality (p=0.025) were noted in patients treated with ≥ 3 thrombectomy passes. Further analysis revealed that patients presenting 6-24 hours from symptom onset had significantly lessened chance of effective recanalization (TICI 2B-3; p=0.021). Conclusion: A higher number of thrombectomy passes, characterized as ≥ 3 passes in this study, was associated with significantly worsened patient outcome in regard to functional outcome, and mortality. Further research is required to determine whether the number of thrombectomy passes is an accurate indicator of treatment outcome and whether delayed presentation time increases risk of poor outcome.

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