scholarly journals Flow-Diversion Treatment for Unruptured Nonsaccular Intracranial Aneurysms of the Posterior and Distal Anterior Circulation: A Meta-Analysis

2020 ◽  
Vol 41 (1) ◽  
pp. 134-139 ◽  
Author(s):  
F. Cagnazzo ◽  
P.-H. Lefevre ◽  
I. Derraz ◽  
C. Dargazanli ◽  
G. Gascou ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Meta Analysis ◽  
Flow Diversion ◽  
Anterior Circulation

Panacea or problem: flow diverters in the treatment of symptomatic large or giant fusiform vertebrobasilar aneurysms

2012 ◽  
Vol 116 (6) ◽  
pp. 1258-1266 ◽  
Author(s):  
Adnan H. Siddiqui ◽  
Adib A. Abla ◽  
Peter Kan ◽  
Travis M. Dumont ◽  
Shady Jahshan ◽  
...  
Keyword(s):  
Natural History ◽  
Intracranial Aneurysms ◽  
Neurological Status ◽  
Posterior Circulation ◽  
The Other ◽  
Flow Diversion ◽  
Morbidity And Mortality ◽  
Anterior Circulation ◽  
Subsequent Withdrawal ◽  
Vertebrobasilar Aneurysms

Object The use of flow-diverting stents has gained momentum as a curative approach in the treatment of complex proximal anterior circulation intracranial aneurysms. There have been some reported attempts of treating formidable lesions in the posterior circulation. Posterior circulation giant fusiform aneurysms have a particularly aggressive natural history. To date, no one approach has been shown to be comprehensively effective or low risk. The authors report the initial results, including the significant morbidity and mortality encountered, with flow diversion in the treatment of large or giant fusiform vertebrobasilar aneurysms at Millard Fillmore Gates Circle Hospital. Methods The authors retrospectively reviewed their prospectively collected endovascular database to identify patients with intracranial aneurysms who underwent treatment with flow-diverting devices and determined that 7 patients had presented with symptomatic large or giant fusiform vertebrobasilar aneurysms. The outcomes of these patients, based on the modified Rankin Scale (mRS), were tabulated, as were the complications experienced. Results Among the 7 patients, Pipeline devices were placed in 6 patients and Silk devices in 1 patient. At the last follow-up evaluation, 4 patients had died (mRS score of 6), all of whom were treated with the Pipeline device. The other 3 patients had mRS scores of 5 (severe disability), 1, and 0. The deaths included posttreatment aneurysm ruptures in 2 patients and lack of improvement in neurological status related to presenting brainstem infarcts and subsequent withdrawal of care in the other 2 patients. Conclusions Whether flow diversion will be an effective strategy for treatment of large or giant fusiform vertebrobasilar aneurysms remains to be seen. The authors' initial experience suggests substantial morbidity and mortality associated with the treatment and with the natural history. As outcomes data slowly become available for patients receiving these devices for fusiform posterior circulation aneurysms, practitioners should use these devices judiciously.

scholarly journals Early Versus Delayed Flow Diversion for Ruptured Intracranial Aneurysms: A Meta-Analysis

2019 ◽  
Vol 126 ◽  
pp. 41-52 ◽  
Author(s):  
Rimal Hanif Dossani ◽  
Devi P. Patra ◽  
Jennifer Kosty ◽  
Fareed Jumah ◽  
Okkes Kuybu ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Meta Analysis ◽  
Flow Diversion ◽  
Ruptured Intracranial Aneurysms

scholarly journals Flow Diversion for Intracranial Aneurysms Beyond the Circle of Willis

2021 ◽  
Vol 12 ◽  
Author(s):  
Jinlu Yu ◽  
Xianli Lv
Keyword(s):  
Intracranial Aneurysms ◽  
Circle Of Willis ◽  
Flow Diversion ◽  
Arterial Phase ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Aneurysm Neck ◽  
Therapeutic Outcomes ◽  
Aneurysm Occlusion

Background: Few reports have shown the therapeutic outcomes of flow diversion (FD) for intracranial aneurysms beyond the circle of Willis, and the efficacy of this technique remains unclear.Materials and methods: A retrospective study was performed on 22 consecutive patients, diagnosed with intracranial aneurysms beyond the circle of Willis, and treated with pipeline embolization device (PED) (Medtronic, Irvine, California, USA) between January 2015 and December 2019.Result: The 22 patients were between 16 and 66 years old (mean 44.5 ± 12.7 years), and six patients were male (27.3%, 6/22). Twenty-two patients had 23 aneurysms. The 23 aneurysms were 3–25 mm in diameter (12.2 ± 7.1 mm on average). The diameter of the parent artery was 1.3–3.0 mm (2.0 ± 0.6 mm on average). The 23 aneurysms were located as follows: 17 (73.9%, 17/23) were in the anterior circulation, and 6 (26.1%, 6/23) were in the posterior circulation. PED deployment was technically successful in all cases. Two overlapping PEDs were used to cover the aneurysm neck in 3 cases. One PED was used to overlap the two tandem P1 and P2 aneurysms. Other cases were treated with single PED. Coil assistance was used to treat 7 aneurysms, including 4 recurrent aneurysms and 3 new cases requiring coiling assistance during PED deployment. There were no cases of complications during PED deployment. All patients were available at the follow-up (mean, 10.9 ± 11.4 months). All patients presented with a modified Rankin Score (mRS) of 0. During angiographic follow-up, complete embolization was observed in 22 aneurysms in 21 patients, and one patient had subtotal embolization with the prolongation of stasis in the arterial phase.Conclusion: PED deployment for intracranial aneurysms beyond the circle of Willis is feasible and effective, with high rates of aneurysm occlusion.

scholarly journals Utilization of a Novel, Multi-Durometer Intracranial Distal Access Catheter: Nuances and Experience in 110 Consecutive Cases of Aneurysm Flow Diversion

2017 ◽  
Vol 6 (1-2) ◽  
pp. 90-104 ◽  
Author(s):  
Geoffrey P. Colby ◽  
Li-Mei Lin ◽  
Risheng Xu ◽  
Narlin Beaty ◽  
Matthew T. Bender ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Flow Diversion ◽  
Technical Success ◽  
Anterior Circulation ◽  
Patient Demographics ◽  
Aneurysm Treatment ◽  
Vessel Injury ◽  
Wide Range ◽  
Neurological Morbidity ◽  
Coaxial Catheter

Background: Coaxial catheter support systems provide a safe and stable foundation in endovascular treatment of intracranial aneurysms. Increasingly, robust distal intracranial support is sought during complex neurointerventions. The AXS Catalyst 5 distal access catheter (Cat5) is a new intracranial catheter designed for improved trackability and stability. We report the first experience using Cat5 for aneurysm treatment by flow diversion. Methods: A single-center aneurysm database was reviewed for cases of aneurysm treatment with the Pipeline embolization device (PED) that utilized Cat5. Data were collected for patient demographics, aneurysm characteristics, procedural details, catheter positions, vessel tortuosity, and catheter related complications. Results: One hundred and ten cases of aneurysm flow diversion were successfully performed using Cat5. Patient age ranged from 21 to 86 years (mean 57 ± 12.5 years) with 84% women. Aneurysm size ranged from 2 to 28 mm (mean 5.7 ± 5.0 mm), with 97% in the anterior circulation. Twenty-four aneurysms (22%) were located beyond the ICA termination. Significant cervical carotid tortuosity was present in 26% of cases, and moderate to severe cavernous tortuosity (cavernous grade ≥2) in 45% of cases. Cat5 was tracked to the intended distal position in all cases with 100% technical success of PED implantation. No iatrogenic catheter-related vessel injury occurred, and major neurological morbidity occurred in 1 patient (1%). Summary: The Cat5 is a novel, multi-durometer cranial distal access catheter designed for use in tri-axial systems. We have demonstrated the utility of Cat5 in 110 successful cases of flow diversion with a wide range of complexity. This catheter is a new tool in the neurointerventionalist's armamentarium to achieve robust and atraumatic distal access.

Clipping Versus Coiling in Anterior Circulation Ruptured Intracranial Aneurysms: A Meta-Analysis

2017 ◽  
Vol 104 ◽  
pp. 482-488 ◽  
Author(s):  
George Fotakopoulos ◽  
Eleni Tsianaka ◽  
Kostas Fountas ◽  
Demosthenes Makris ◽  
Michael Spyrou ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Meta Analysis ◽  
Anterior Circulation ◽  
Ruptured Intracranial Aneurysms

scholarly journals Flow Diversion in Ruptured Intracranial Aneurysms: A Meta-Analysis

2016 ◽  
Vol 38 (3) ◽  
pp. 590-595 ◽  
Author(s):  
T.P. Madaelil ◽  
C.J. Moran ◽  
D.T. Cross ◽  
A.P. Kansagra
Keyword(s):  
Intracranial Aneurysms ◽  
Meta Analysis ◽  
Flow Diversion ◽  
Ruptured Intracranial Aneurysms

Abstract WMP26: Aneurysm Location and Its Relationship With Thrombotic and Hemorrhagic Complications During Flow Diversion Procedures: A Meta-Analysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ebunoluwa Ajadi ◽  
Michael Nisiewicz ◽  
Shaowli Kabir ◽  
Justin Fraser
Keyword(s):  
Absolute Risk ◽  
Meta Analysis ◽  
Posterior Circulation ◽  
Flow Diversion ◽  
Inclusion Criteria ◽  
Anterior Circulation ◽  
Hemorrhagic Events ◽  
Hemorrhagic Complications ◽  
Thrombotic Complications ◽  
The Relationship

Background and Purpose: Flow diversion with the Pipeline Embolization Device (PED; Medtronic, Minneapolis, MN) has become increasingly utilized in the treatment of otherwise difficult to manage wide-necked aneurysms. Variations in the propensity for hemorrhagic and thrombotic complications during these procedures has been attributed to differences in location as defined be an anterior circulation versus a posterior circulation location. This meta-analysis was conducted to assess and fully characterize the relationship between these aneurysm locations and thrombotic and hemorrhagic events. Materials and Methods: The currently available literature (2013 - 2018) was surveyed with PubMed and Google Scholar searches. Included studies were those for which aneurysm locations were accurately reported and for which intra and perioperative adverse events were noted. The data was subject to statistical analysis to assess the relationship between an anterior or posterior circulation location and thrombotic or hemorrhagic events. The collected data was subsequently statistically analyzed to assess for publication bias. Results: The searches yielded 49 studies, of which 34 met the inclusion criteria for this meta-analysis. The current meta-analysis assessed 4060 anterior circulation pipeline procedures for hemorrhagic complications, and 3100 for thrombotic complications. This study also assessed 608 posterior circulation pipeline procedures for hemorrhagic events, and 582 for thrombotic events. An anterior circulation location was associated with a 3% absolute risk of hemorrhagic events (CI: 0.02 - 0.04), and a 4% absolute risk of thrombotic events (CI: 0.04 - 0.05). A posterior circulation location was associated with a 6% absolute risk of hemorrhagic complications (CI: 0.04 - 0.08) and showed a greater 13% absolute risk of thrombotic events (CI: 0.10 - 0.16). Conclusions: A posterior circulation aneurysm location is associated with a higher propensity for both thrombotic and hemorrhagic events compared to an anterior circulation location. Thrombotic complications are almost twice as likely compared to hemorrhagic complications in the posterior location.

Long-Term Efficacy of Clipping Versus Coiling of Intracranial Aneurysms: A Systematic Review and Meta-Analysis

2018 ◽  
Author(s):  
Alexander F. Hulsbergen ◽  
Lida Mirzaei ◽  
Arthur T. Van der Boog ◽  
Timothy R. Smith ◽  
Ivo S. Muskens ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intracranial Aneurysms ◽  
Meta Analysis ◽  
Term Efficacy

Safety and efficacy of ticagrelor as single antiplatelet therapy in prevention of thromboembolic complications associated with the Pipeline Embolization Device (PED): multicenter experience

2020 ◽  
Vol 12 (11) ◽  
pp. 1113-1116 ◽  
Author(s):  
Mahmoud H Mohammaden ◽  
Stephen W English ◽  
Christopher J Stapleton ◽  
Eman Khedr ◽  
Ahmed Shoyb ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Thromboembolic Complications ◽  
Anterior Circulation ◽  
Safety And Efficacy ◽  
Complex Aneurysm ◽  
Post Procedure ◽  
Systemic Side Effects ◽  
Ischemic Events

BackgroundFlow diversion (FD) is a common treatment modality for complex intracranial aneurysms. A major concern regarding the use of FD is thromboembolic events (TEE). There is debate surrounding the optimal antiplatelet regimen to prevent TEE. We aim to evaluate the safety and efficacy of ticagrelor as a single antiplatelet therapy (SAPT) for the prevention of TEE following FD for complex aneurysm treatment.MethodsA retrospective review of a prospectively maintained neuroendovascular database at three endovascular centers was performed. Patients were included if they had an intracranial aneurysm that was treated with FD between January 2018 and September 2019 and were treated with ticagrelor as SAPT. Primary outcomes included early (within 72 hours post-procedure) and late (within 6 months) ischemic events.ResultsA total of 24 patients (mean age 47.7 years) with 36 aneurysms were eligible for analysis, including 15 (62.5%) females. 14 (58.3%) patients presented with subarachnoid hemorrhage. 35 aneurysms arose from the anterior circulation and 1 from the posterior circulation. 23 aneurysms had a saccular morphology, whereas 7 were fusiform and 6 were blister. For the treatment of all 36 aneurysms, 30 procedures were performed with 32 FD devices. Procedural in-stent thrombosis occurred in 2 cases and was treated with intra-arterial tirofiban without complications. Aneurysm re-bleeding was reported in 1 (4.2%) patient. There were no reported early or late TEE. Three patients discontinued ticagrelor due to systemic side effects.ConclusionTicagrelor is a safe and effective SAPT for the prevention of TEE after FD. Large multicenter prospective studies are warranted to validate our findings.

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