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Cardiology in the Young Oct 2023Device embolisation is a serious adverse event during transcatheter duct closure. This study analyses risk factors for embolisation.
BACKGROUND
Device embolisation is a serious adverse event during transcatheter duct closure. This study analyses risk factors for embolisation.
METHODS
Demographic parameters, echocardiographic anatomy, haemodynamics, and procedural characteristics of consecutive duct closures in a tertiary centre over 8 years were analysed. Procedures complicated by embolisation were compared to uncomplicated procedures.
RESULTS
Fifteen embolisations occurred during 376 procedures. All except one embolisation were in infants. The pulmonary artery: aortic pressure ratio was 0.78 ± 0.22. Embolisation was seen significantly more commonly in Type C tubular ducts. Vascular plugs were more significantly associated with embolisations. Logistic regression analysis showed device embolisation was significantly higher in age group of < 6 months compared to 6-12 months (p = 0.02), higher in those with tubular ducts versus conical ducts (p = 0.003), use of vascular plugs compared to conventional duct occluders (p = 0.05), and in duct closure with undersized devices (p = 0.001). There was no in-hospital mortality. Three patients needed surgical retrieval while others were successfully managed in catheterisation laboratory.
CONCLUSIONS
Device embolisation complicates 4% of transcatheter duct closures, with need for surgery in one-fifth of them. Larger ducts with high pulmonary artery pressures in younger and smaller infants are more often associated with device embolisation. Tubular ducts are more prone for embolisation compared to usual conical ducts. Softer vascular plugs are often associated with embolisations. Intentional device undersizing to avoid vascular obstruction in small patients is a frequent risk factor for embolisation. Precise echocardiographic measurements, correct occluder choice, proper technique and additional care in patients with high pulmonary artery pressures are mandatory to minimise embolisations.
Topics: Infant; Humans; Ductus Arteriosus, Patent; Treatment Outcome; Cardiac Catheterization; Embolization, Therapeutic; Risk Factors; Septal Occluder Device
PubMed: 36515000
DOI: 10.1017/S1047951122003973 -
Advanced Materials (Deerfield Beach,... Aug 2019Minimally invasive transcatheter embolization is a common nonsurgical procedure in interventional radiology used for the deliberate occlusion of blood vessels for the... (Review)
Review
Minimally invasive transcatheter embolization is a common nonsurgical procedure in interventional radiology used for the deliberate occlusion of blood vessels for the treatment of diseased or injured vasculature. A wide variety of embolic agents including metallic coils, calibrated microspheres, and liquids are available for clinical practice. Additionally, advances in biomaterials, such as shape-memory foams, biodegradable polymers, and in situ gelling solutions have led to the development of novel preclinical embolic agents. The aim here is to provide a comprehensive overview of current and emerging technologies in endovascular embolization with respect to devices, materials, mechanisms, and design guidelines. Limitations and challenges in embolic materials are also discussed to promote advancement in the field.
Topics: Animals; Biocompatible Materials; Embolization, Therapeutic; Endovascular Procedures; Humans; Metals; Microspheres; Polymers
PubMed: 31168915
DOI: 10.1002/adma.201901071 -
The Neuroradiology Journal Aug 2015Flow-diverter devices (FDDs) are new-generation stents placed in the parent artery at the level of the aneurysm neck to disrupt the intra-aneurysmal flow thus favoring... (Review)
Review
BACKGROUND
Flow-diverter devices (FDDs) are new-generation stents placed in the parent artery at the level of the aneurysm neck to disrupt the intra-aneurysmal flow thus favoring intra-aneurysmal thrombosis.
OBJECTIVE
The objective of this review article is to define the indication and results of the treatment of intracranial aneurysms by FDD, reviewing 18 studies of endovascular treatment by FDDs for a total of 1704 aneurysms in 1483 patients.
METHODS
The medical literature on FDDs for intracranial aneurysms was reviewed from 2009 to December 2014. The keywords used were: "intracranial aneurysms," "brain aneurysms," "flow diverter," "pipeline embolization device," "silk flow diverter," "surpass flow diverter" and "FRED flow diverter."
RESULTS
The use of these stents is advisable mainly for unruptured aneurysms, particularly those located at the internal carotid artery or vertebral and basilar arteries, for fusiform and dissecting aneurysms and for saccular aneurysms with large necks and low dome-to-neck ratio. The rate of aneurysm occlusion progressively increases during follow-up (81.5% overall rate in this review). The non-negligible rate of ischemic (mean 4.1%) and hemorrhagic (mean 2.9%) complications, the neurological morbidity (mean 3.5%) and the reported mortality (mean 3.4%) are the main limits of this technique.
CONCLUSION
Treatment with FDDs is a feasible and effective technique for unruptured aneurysms with complex anatomy (fusiform, dissecting, large neck, bifurcation with side branches) where coiling and clipping are difficult or impossible. Patient selection is very important to avoid complications and reduce the risk of morbidity and mortality. Further studies with longer follow-up are necessary to define the rate of complete occlusion.
Topics: Cerebral Angiography; Embolization, Therapeutic; Endovascular Procedures; Equipment Design; Humans; Intracranial Aneurysm; Stents
PubMed: 26314872
DOI: 10.1177/1971400915602803 -
Current Cardiology Reports Jul 2021Device embolization is a rare but potentially life-threatening complication of transcatheter structural heart interventions and may require prompt intervention. The... (Review)
Review
PURPOSE OF REVIEW
Device embolization is a rare but potentially life-threatening complication of transcatheter structural heart interventions and may require prompt intervention. The present work aims to provide an overview of strategies for device retrievals in order to better guide the evaluation and management of device embolization.
RECENT FINDINGS
Although the evolution of transcatheter device therapies has had a tremendous impact on the management in structural heart disease, availability of various retrieval devices, knowledge in how to use them, and multidisciplinary collaboration are key for successful device retrieval. Understanding the reasons for embolization, strategies to avoid embolization, and the techniques for retrieval of devices used in structural heart disease should be appreciated by the treating physician.
Topics: Cardiac Catheterization; Device Removal; Embolization, Therapeutic; Humans; Septal Occluder Device
PubMed: 34269875
DOI: 10.1007/s11886-021-01554-8 -
Heart, Lung & Circulation Oct 2014In this study, we aim to summarise our experience with techniques used for the transcatheter retrieval of embolised devices.
AIMS
In this study, we aim to summarise our experience with techniques used for the transcatheter retrieval of embolised devices.
METHODS
We retrospectively reviewed the transcatheter retrieval of embolised devices in seven patients who underwent an attempted transcatheter closure of perimembranous ventricular septal defects (PMVSDs) between October 2002 and October 2013. The incidence, the main causes for the device's embolisation, and the techniques for transcatheter retrieval of the embolised device are discussed.
RESULTS
The incidence of device embolisation in our centre was 0.82% (seven embolisations in 852 device placements). The main causes for device embolisation included undersized devices and inadequate subaortic rims. Among the seven embolisations, six of the devices were retrieved percutaneously without mortality, while one was retrieved during surgery. Of these patients, five had a HeartR(TM) Membranous VSD occluder of their PMVSDs, and the remaining two had surgical PMVSD closures.
CONCLUSIONS
Our approach to the transcatheter retrieval of the embolised devices is associated with good results.
Topics: Adult; Cardiac Catheterization; Child, Preschool; Device Removal; Embolism; Heart Septal Defects, Ventricular; Humans; Middle Aged; Prosthesis Failure; Retrospective Studies; Septal Occluder Device; Young Adult
PubMed: 24816142
DOI: 10.1016/j.hlc.2014.03.029 -
Biomedical Microdevices Feb 2012A microfluidic based device has been developed for the characterisation of embolisation behaviour with polyvinyl alcohol (PVA) hydrogel beads within a microchannel...
A microfluidic based device has been developed for the characterisation of embolisation behaviour with polyvinyl alcohol (PVA) hydrogel beads within a microchannel network with bifurcations which mimic the blood vessel network. Both distal and proximal embolisations were achieved within the PMMA-made microdevice exhibiting comparable embolisation characteristics with those observed in vivo. Results showed that small beads allowed more distal embolisations with a reduced control of the spatial location of occlusion sites. In contrast, large beads generated effective proximal embolisations with an improved reproducibility of embolisation performance. Embolic bead hydrodynamics, partitioning at bifurcations, penetration through microchannels and embolisation locations across the channel network were characterised by quantifying the effects of embolic bead size, bead concentration, channel geometry and fluidic conditions. This development provided further insights into the physical principles governing embolisation performances within the constructed microdevices allowing the improvement of the predictability and controllability of the clinical process outcomes. Furthermore, it can potentially provide a useful platform for preclinical research as an alternative to animal models, with an ultimate goal to reduce the amount of animal testing.
Topics: Biomimetics; Embolization, Therapeutic; Humans; Microfluidic Analytical Techniques; Polyvinyl Alcohol
PubMed: 21987002
DOI: 10.1007/s10544-011-9593-8 -
No Shinkei Geka. Neurological Surgery Mar 2023The increase in the number of carotid artery stenting cases can be attributed to a decrease in complications owing to the evolution of devices. In this procedure, the... (Review)
Review
The increase in the number of carotid artery stenting cases can be attributed to a decrease in complications owing to the evolution of devices. In this procedure, the choice of the protection device and stent for each case is the main concern. Embolic protection devices(EPD)that prevent distal embolization can be divided into proximal and distal types. Previously, balloon-type devices were used as distal EPDs; however, since they are no longer available, filter-type devices are now mainstream. Carotid stents are also divided into open- and closed-cell types. Therefore, this review describes the characteristics of each device in the actual cases at our hospital.
Topics: Humans; Carotid Stenosis; Stents; Endovascular Procedures; Embolic Protection Devices; Embolization, Therapeutic; Treatment Outcome
PubMed: 37055052
DOI: 10.11477/mf.1436204746 -
Cardiology in the Young Feb 2024We report on a 6-month-old infant (6 Kg/ 64 cm) with perimembranous ventricular septal defect (absent sub-aortic rim, 10 mm left ventricular entry, and 4 and 6 mm right...
We report on a 6-month-old infant (6 Kg/ 64 cm) with perimembranous ventricular septal defect (absent sub-aortic rim, 10 mm left ventricular entry, and 4 and 6 mm right ventricular exists) and successful retrograde closure using an 8x6 mm KONAR-MF™ VSD occluder (Lifetech, China). Immediate and 48 hours post-procedure ultrasounds showed an accurately positioned device and two jets of mild-to-moderate residual shunts. At the 2-week follow-up, the device did not change position and the shunt was stable and intra-prosthetic. The scheduled 3-month follow-up was skipped for familial reasons. The patient came back without alarming symptoms for the regular 6-month follow-up, and the device was found embolised to the left pulmonary artery. The device was retrieved surgically, and the defect was patch-closed with excellent outcomes. There was a pseudoaneurysm involving the tricuspid valve chordae and the device was endothelialized partially on one edge suggesting that embolization occurred somewhere between 3 months and 6 months post-operative. Defects with compromised anatomies should be closed surgically to avoid suboptimal results, especially in small infants.
Topics: Infant; Humans; Cardiac Catheterization; Echocardiography; Embolization, Therapeutic; Tricuspid Valve; Heart Septal Defects, Ventricular; Septal Occluder Device; Treatment Outcome
PubMed: 38167420
DOI: 10.1017/S104795112300433X -
Cardiovascular and Interventional... Aug 2012The Amplatzer Vascular Plug (AVP) is an established embolic device that can be an excellent alternative to coils or detachable balloons to embolize medium to large... (Review)
Review
The Amplatzer Vascular Plug (AVP) is an established embolic device that can be an excellent alternative to coils or detachable balloons to embolize medium to large vessels with high flow. The device is easy to use and can be precisely deployed in the target vessel with high resistance to migration and a low recanalization rate. The technical success of this device is high, indications for use are expanding, and no absolute contraindications have been reported. Since its introduction, the AVP has grown from a single device to a group of 4 models (AVP, AVP II, AVP III, and AVP 4). Each model has a unique design and features that fit different vascular anatomies, hemodynamic situations, and clinical scenarios. Therefore, the new models cannot simply be treated as replacements for older ones. Unpredictable occlusion time remains a major shortcoming for the new models of the AVP. Large vessel size, high flow status, and coagulopathy can prolong the occlusion time, which can offset the cost benefit, reduced procedure time, and reduced radiation dose typically seen with use of the AVP alone. Coils or multiple AVPs can be used to expedite the occlusion process, and large Gelfoam particles also can be used as an adjunct to achieve rapid and reliable occlusion with minimal cost.
Topics: Angiography; Embolization, Therapeutic; Foreign-Body Migration; Humans; Prosthesis Design; Septal Occluder Device; Time Factors; Vascular Diseases; Vascular Patency; Vascular Surgical Procedures
PubMed: 22526108
DOI: 10.1007/s00270-012-0387-z -
Journal of Neurosurgery Oct 2015
Topics: Embolization, Therapeutic; Endovascular Procedures; Female; Hemodynamics; Humans; Intracranial Aneurysm; Male; Models, Cardiovascular; Stents
PubMed: 26090837
DOI: 10.3171/2014.12.JNS142537