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Current Medicinal Chemistry 2020
Topics: Biocompatible Materials; Biomimetics; Catheters; Embolization, Therapeutic; Equipment and Supplies; Humans; Printing, Three-Dimensional; Radiotherapy; Surface Properties; Tissue Engineering
PubMed: 32242514
DOI: 10.2174/092986732710200327171513 -
International Journal of Hyperthermia :... Nov 2017Pneumothorax is the most common complication following a pulmonary percutaneous radiofrequency ablation (RFA), and thoracic drainages are the most frequent causes of an... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Pneumothorax is the most common complication following a pulmonary percutaneous radiofrequency ablation (RFA), and thoracic drainages are the most frequent causes of an extended hospital stay. Our main objective was to show that the use of gelatin torpedoes may significantly decrease the number of chest tube placement.
MATERIALS AND METHODS
Seventy-three patients were prospectively included in this study and then randomised into two groups: 34 with embolisation and without 39 without embolisation. Each group was comparable for different pneumothorax risk factors.
RESULTS
There were 16 (47%) pneumothorax in Group A ("with embolisation"), which was significantly lower (p < .0001) than the 35 pneumothorax (90%) in Group B ("without embolisation"). The pneumothorax volume (p = .02) was significantly lower in Group A (22.7% average, standard deviation 15.6%) than in Group B (average 34.1%, standard deviation 17.1%). The number of drainages was significantly smaller in those with embolisation (3 drainages or 8%) than those without embolisation (25 drainages or 64%) (p < .001).
CONCLUSION
When using absorbable gelatin torpedoes, pulmonary RFA pathways embolisation significantly decreased the number of pneumothorax and thoracic drainages to the advantage of therapeutic abstention and exsufflation, non-invasive and functional operational techniques.
Topics: Aged; Catheter Ablation; Chest Tubes; Embolization, Therapeutic; Emphysema; Female; Gelatin; Humans; Lung; Male; Middle Aged; Pneumothorax
PubMed: 28540802
DOI: 10.1080/02656736.2017.1309578 -
Indian Heart Journal 2015Vascular plugs are ideally suited to close extra-cardiac, high flowing vascular communications. The family of vascular plugs has expanded. Vascular plugs in general have... (Review)
Review
Vascular plugs are ideally suited to close extra-cardiac, high flowing vascular communications. The family of vascular plugs has expanded. Vascular plugs in general have a lower profile and the newer variants can be delivered even through a diagnostic catheter. These features make them versatile and easy to use. The Amplatzer vascular plugs are also used for closing intracardiac defects including coronary arterio-venous fistula and paravalvular leakage in an off-label fashion. In this review, the features of currently available vascular plugs are reviewed along with tips and tricks of using them in the cardiac catheterization laboratory.
Topics: Embolization, Therapeutic; Equipment Design; Humans; Septal Occluder Device; Vascular Diseases
PubMed: 26304581
DOI: 10.1016/j.ihj.2015.07.001 -
Neurovascular devices for the treatment of intracranial aneurysms: emerging and future technologies.Expert Review of Medical Devices Mar 2020: Despite numerous advances in the endovascular treatment of intracranial aneurysms (IAs), treatment in cases of wide-neck, complex configurations or branching... (Review)
Review
: Despite numerous advances in the endovascular treatment of intracranial aneurysms (IAs), treatment in cases of wide-neck, complex configurations or branching locations remains challenging. Apart from the paradigm shift introduced by flow diverters, several other devices have seen the light or are under development in order to address these challenges.: We performed a review of the novel implantable endovascular devices which have been introduced for the treatment of IAs, from 1 January 2014 to 1 September 2019, excluding classic flow diverter and intracranial stent designs.: Alternative designs have been proposed for the treatment of IAs at branching positions, which do not jail the side branches, with or without flow diversion effect, most of which with good initial outcomes. Endosaccular devices have also been proposed, some of which with lower initial total occlusion rates. Alternative materials such as biopolymers have also been proposed and are under bench research. Despite the challenges in the exploitation of some of the new devices, most of them seem to provide solutions to some current technical shortcomings. The exploitation of the biological phenomena and the physical properties of the devices will allow us to expand the therapeutic armamentarium for more complex IA cases.
Topics: Embolization, Therapeutic; Endovascular Procedures; Equipment and Supplies; Humans; Intracranial Aneurysm; Stents; Treatment Outcome
PubMed: 32141395
DOI: 10.1080/17434440.2020.1733409 -
Journal of Neurointerventional Surgery Feb 2019Flow diversion is an innovative and increasingly used endovascular treatment for intracranial aneurysms. Its initial evaluation with the first devices available showed... (Observational Study)
Observational Study
BACKGROUND AND PURPOSE
Flow diversion is an innovative and increasingly used endovascular treatment for intracranial aneurysms. Its initial evaluation with the first devices available showed good efficacy of this treatment with variable safety results. The Flow Direction Endoluminal Device (FRED) has a specific design and was evaluated in a single-arm, multicenter, prospective, Good Clinical Practice study: SAFE (Safety and efficacy Analysis of FRED Embolic device in aneurysm treatment). This analysis reports clinical results at 1 year and anatomical results at 6 months and 1 year.
METHODS
Patients with unruptured and recanalized aneurysms located in the anterior circulation treated with FRED and FRED Jr were prospectively included. A Clinical Event Committee and a Core Laboratory independently evaluated clinical outcome and anatomical results.
RESULTS
Thirteen interventional neuroradiology centers included 103 patients/aneurysms. Aneurysm locations were supraclinoid internal carotid artery (ICA) in 71 (68.9%), cavernous ICA in 15 (14.6%), anterior cerebral or anterior communicating artery in 9 (8.7%), and middle cerebral artery in 8 (7.8%). Most aneurysms were small (<10 mm) in 71 patients (68.9%). Cumulative 1-year mortality and morbidity rates were 2/103 (1.9%) and 3/103 (2.9%), respectively, one death being related to cancer. At 1 year, anatomical results were: complete occlusion in 66/90 patients (73.3%), neck remnant in 7/90 patients (7.8%), and aneurysm remnant in 17/90 patients (18.9%).
CONCLUSIONS
SAFE study analysis at 1 year confirms the excellent safety profile of the FRED device for aneurysm treatment, with low morbidity and mortality rates (2.9% and 1.9%, respectively) and demonstrates its efficacy (adequate occlusion in 73/90 (81.1%)).
CLINICAL TRIAL REGISTRATION
Unique identifier: NCT02921698; Results.
Topics: Adult; Aged; Aged, 80 and over; Embolization, Therapeutic; Endovascular Procedures; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Prospective Studies; Self Expandable Metallic Stents; Treatment Outcome
PubMed: 30297539
DOI: 10.1136/neurintsurg-2018-014261 -
World Neurosurgery Apr 2016To review the literature on flow-diverting device (FDD) treatments for intracranial aneurysms (IAs) and to compare the safety and efficacy of FDDs with coil embolization... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To review the literature on flow-diverting device (FDD) treatments for intracranial aneurysms (IAs) and to compare the safety and efficacy of FDDs with coil embolization treatment (CET) for IAs using a meta-analysis of published studies.
METHODS
A systematic electronic search was conducted of PubMed, Springer Link, EBSCO, and the Cochrane Database on all accessible published articles through September 2015. Abstracts, full-text manuscripts, and the reference lists of retrieved articles were analyzed. Studies that explicitly compared FDD and CET approaches to the treatment of IAs were included. Odds ratios (ORs) and 95% CIs were calculated for the complete occlusion rate and the morbidity rate using a random-effects model.
RESULTS
Nine studies were included in the analysis, containing retrospectively collected data for 863 patients. FDD treatment showed a significantly higher complete occlusion rate than CET (OR = 3.13; 95% confidence interval [CI], 2.11-4.65) and the subgroup of stent-assisted coiling did (OR = 2.08; 95% CI, 1.34-3.24). FDDs did not achieve a significantly lower overall morbidity rate compared with CET (OR = 0.87; 95% CI, 0.45-1.69) or the SAC (stent-assisted coiling) subgroup (OR = 0.86; 95% CI, 0.33-2.26), and our results did not show a significant difference in mortality between the two techniques.
CONCLUSIONS
FDD treatment of IAs yielded satisfactory results in complete occlusion rate compared with CET. The FDD procedure is feasible and has no significant difference in morbidity risk. Despite the findings reported herein, further validation with well-designed, multicenter randomized controlled trials is needed.
Topics: Embolization, Therapeutic; Endovascular Procedures; Humans; Intracranial Aneurysm; Prevalence; Risk Assessment; Stents; Survival Rate; Treatment Outcome
PubMed: 26585732
DOI: 10.1016/j.wneu.2015.11.007 -
AJR. American Journal of Roentgenology Mar 2019Particulate emboli are passive agents that follow blood flow. Deployed antireflux devices obstruct blood flow. (Review)
Review
OBJECTIVE
Particulate emboli are passive agents that follow blood flow. Deployed antireflux devices obstruct blood flow.
CONCLUSION
The aim of this review is to describe the complex hemodynamic alterations to blood flow caused by the deployment of antireflux devices and the resulting changes to embolic distribution. The therapeutic goal is optimization of embolization safety and efficacy.
Topics: Angiography; Balloon Embolectomy; Embolization, Therapeutic; Equipment Design; Hemodynamics; Humans; Vascular Access Devices
PubMed: 30589385
DOI: 10.2214/AJR.18.19975 -
Journal of Biomechanics Nov 2016Radioembolization, which consist of the implantation of radioactive microspheres via intra-arterially placed microcatheter, is a safe and effective treatment for liver...
Radioembolization, which consist of the implantation of radioactive microspheres via intra-arterially placed microcatheter, is a safe and effective treatment for liver cancer. Nevertheless, radioembolization-related complications and side effects may arise, which are an active area of ongoing research. The catheter design has been claimed as an option in reducing these complications. In this paper, the influence of catheter type and location are investigated. The study was undertaken by numerically simulating the particle-hemodynamics in a patient-specific hepatic artery during liver radioembolization. The parameters modified were cancer scenario (30% liver involvement in the right lobe, 'scenario A', and in both lobes, 'scenario B'), catheter type (standard end-hole microcatheter, SMC, and antireflux catheter, ARC), and the location of the tip in the proper hepatic artery (in the straight part, 'inlet', and near the bifurcation, 'bifurcation'). Comparing ARC with SMC, the maximum and average (over segments) absolute difference in the percentage of particles that reached each segment were 19.62% and 9.06% when injecting near the inlet for scenario A; 3.54% and 1.07% injecting near the bifurcation for scenario A; and 18.31% and 11.85% injecting near the inlet for scenario B. It seems, therefore, that the location of the catheter tip in the artery is crucial in terms of particle distribution. Moreover, even though the near-tip blood flow was altered due to the presence of a catheter, the particle distribution matched the flow split if the distance between the injection point and the first bifurcation encountered enabled the alignment of particles with blood flow.
Topics: Catheters; Embolization, Therapeutic; Hemodynamics; Hepatic Artery; Humans; Liver Neoplasms; Male; Microspheres
PubMed: 27751570
DOI: 10.1016/j.jbiomech.2016.09.035 -
AJNR. American Journal of Neuroradiology Dec 2018Flow diversion is being increasingly used to treat bifurcation aneurysms. Empiric approaches have generally led to encouraging results, and a growing body of animal and...
BACKGROUND AND PURPOSE
Flow diversion is being increasingly used to treat bifurcation aneurysms. Empiric approaches have generally led to encouraging results, and a growing body of animal and ex vivo literature addresses the fate of target aneurysms and covered branches. Our prior investigations highlighted the dynamic nature of metal coverage provided by the Pipeline Embolization Device and suggested strategies for creating optimal single and multidevice constructs. We now address the geometric and hemodynamic aspects of jailing branch vessels and neighboring target aneurysms.
MATERIALS AND METHODS
Fundamental electric and fluid dynamics principles were applied to generate equations describing the relationships between changes in flow and the degree of vessel coverage in settings of variable collateral support to the jailed territory. Given the high complexity of baseline and posttreatment fluid dynamics, in vivo, we studied a simplified hypothetic system with minimum assumptions to generate the most conservative outcomes.
RESULTS
In the acute setting, Pipeline Embolization Devices modify flow in covered branches, principally dependent on the amount of coverage, the efficiency of collateral support, and intrinsic resistance of the covered parenchymal territory. Up to 30% metal coverage of any branch territory is very likely to be well-tolerated regardless of device or artery size or the availability of immediate collateral support, provided, however, that no acute thrombus forms to further reduce jailed territory perfusion.
CONCLUSIONS
Basic hemodynamic principles support the safety of branch coverage during aneurysm treatment with the Pipeline Embolization Device. Rational strategies to build bifurcation constructs are feasible.
Topics: Animals; Blood Vessel Prosthesis; Embolization, Therapeutic; Hemodynamics; Humans; Hydrodynamics; Intracranial Aneurysm; Male; Models, Theoretical; Treatment Outcome
PubMed: 30442697
DOI: 10.3174/ajnr.A5874 -
Journal of Neurointerventional Surgery Dec 2015The most widely used intracranial stents for stent-assisted coiling are Neuroform (NEU) and Enterprise stents (ENT). This study compares published outcomes between the... (Comparative Study)
Comparative Study Review
INTRODUCTION
The most widely used intracranial stents for stent-assisted coiling are Neuroform (NEU) and Enterprise stents (ENT). This study compares published outcomes between the ENT and NEU coil-assist systems and comments on the published safety and efficacy of stent-assisted coiling in general.
METHODS
A literature search was performed through PubMed for all published series of ENT or NEU stent-assisted coiling of cerebral aneurysms from 2004 to 2014. All studies including 10 or more published cases of stent-assisted coiling with ENT or NEU were included.
RESULTS
47 studies met the inclusion criteria, containing 4238 aneurysms in 4039 patients. 2111 aneurysms were treated with NEU and 2127 were treated with ENT. Mean follow-up was 14.1 months. Overall, thromboembolic events occurred in 6.4% of aneurysms, intracranial hemorrhage (ICH) in 2.6%, permanent morbidity in 3.9%, and mortality in 2.3%. Initial and final 100% angiographic occlusion was seen in 53% and 69% of patients, respectively. Deployment failures (p<0.001), ICH (p=0.001), mortality among all patients (p=0.03), and recanalization (p=0.02) were more commonly reported in NEU treated aneurysms. The ENT system was also associated with higher reported complete occlusion at follow-up (p<0.001).
CONCLUSIONS
This literature review represents the largest and most robust comparison of stent-assisted coiling devices to date, containing over 4200 aneurysms in more than 4000 patients. Comparative analyses demonstrate that both devices are reported to be safe and effective with comparable permanent morbidity.
Topics: Cerebral Angiography; Embolization, Therapeutic; Humans; Intracranial Aneurysm; Prospective Studies; Stents; Treatment Outcome
PubMed: 25352581
DOI: 10.1136/neurintsurg-2014-011457