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Emergency Radiology May 2008Amplatzer Vascular Plug (AVP) is a device recently proposed for extra-cardiac procedures such as arterial and venous embolisation. In this paper, we assess the... (Review)
Review
Amplatzer Vascular Plug (AVP) is a device recently proposed for extra-cardiac procedures such as arterial and venous embolisation. In this paper, we assess the usefulness of AVP in emergency embolisation presenting our preliminary experience and reviewing the Literature. During the last year, we selected 31 patients for embolisation using AVP. The following nine procedures were performed in emergency (8 males, mean 72.4 years, range 57-85): four ruptured abdominal aortic aneurysm, one traumatic hepatic pseudoaneurysm with arterio-portal fistula, one carotid pseudoaneurysm due to neoplastic erosion, one renal tumor with active bleeding, one ruptured isolated iliac aneurysm and one ruptured hypogastric aneurysm. We used a total of 13 AVPs. The follow-up was carried out by computed tomography angiography (CTA) and/or contrast-enhanced ultrasound (CEUS), 3 months after the procedure and then every 3 months. We obtained immediate technical success in all nine cases. No rupture or dissection of the treated arteries occurred. We observed only an asymptomatic spasm. During a mean follow-up of 5.3 months (range 3-12 months), CTA and/or CEUS showed complete occlusion of the treated arteries. The AVP is useful in some emergency settings. In the authors' experience, the device allows precise, controlled release and can be deployed to the target more rapidly than other traditional methods. The device cannot be used in all patients due to limited ability to negotiate tortuous vessels and limited size availability. In our institution, the AVP is less expensive than alternatives. In our experience and as reported in the early literature, the device is easy to use, versatile, and achieved a high technical success rate. Further studies may confirm the effectiveness and demonstrate additional indications.
Topics: Aged; Aged, 80 and over; Blood Vessel Prosthesis; Embolization, Therapeutic; Emergencies; Female; Humans; Male; Middle Aged; Radiography, Interventional; Treatment Outcome; Vascular Surgical Procedures
PubMed: 18193463
DOI: 10.1007/s10140-007-0696-8 -
Interventional Neuroradiology : Journal... Aug 2020The Woven EndoBridge Device (WEB) is efficient and safe in the treatment of wide-neck bifurcation intracranial aneurysms. A crucial step in operative planning is... (Review)
Review
The Woven EndoBridge Device (WEB) is efficient and safe in the treatment of wide-neck bifurcation intracranial aneurysms. A crucial step in operative planning is establishing the appropriate dimension of the device, and there are limitations to the therapeutic solutions provided by WEBs. We describe a case of a right middle cerebral artery bifurcation wide-neck aneurysm treated with WEB. After the initial deployment of a WEB proven oversized, we substituted it with a smaller one that presented immediate post-detachment intra-aneurysmal tilt probably resulting from undersizing. The 24-h angiographic control identified a partial displacement of the device in the superior middle cerebral artery branch. We describe rescue techniques with review of the literature and our treatment strategy, including effort to reposition the device followed by stent deployment. The treatment was electively completed by the coil-through technique. The post-detachment WEB tilt should be considered an unstable position and treated either by removal of the device or with adjunctive implants. Each WEB size adapts to a range of aneurysmal height and width. This range is not always the same for each specific WEB dimension, based on the table provided by the manufacturer. This eventually predisposes to a different behavior of different WEB sizes regarding the modification of the device's height in relation to the modification of the diameter after deployment.
Topics: Blood Vessel Prosthesis; Cerebral Angiography; Embolization, Therapeutic; Endovascular Procedures; Female; Humans; Intracranial Aneurysm; Middle Aged; Prosthesis Design; Stents
PubMed: 32436457
DOI: 10.1177/1591019920926334 -
Neurological Research Apr 2015Endovascular coil embolization has become an effective treatment modality for most intracranial aneurysms. However, complex aneurysms including large and giant... (Review)
Review
OBJECTIVE
Endovascular coil embolization has become an effective treatment modality for most intracranial aneurysms. However, complex aneurysms including large and giant aneurysms, fusiform shaped aneurysms, wide necked aneurysm, or small aneurysm that are unsuitable for coil embolization are still deterrent to be treated. Flow diversion is a novel concept that is applied in the treatment of these complex intracranial aneurysms.
METHOD
We review the results and important features of 25 aneurysms in 24 patients who underwent endovascular treatment by using the pipeline flow-diverter embolization device.
RESULT
At 6 month follow-up, all aneurysms (100%) showed total occlusion in our series. Only one patient who had giant vertebrobasilar aneurysm experienced major complication related to endovascular treatment.
DISCUSSION
We suggest that parent artery reconstruction via flow diversion with the PED is a valid and safe treatment modality.
Topics: Adult; Aged; Aged, 80 and over; Embolization, Therapeutic; Endovascular Procedures; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Stents; Treatment Outcome; Young Adult
PubMed: 25310354
DOI: 10.1179/1743132814Y.0000000450 -
Cardiovascular and Interventional... 2001The square stent is a new, simply constructed, self-expanding device that has recently been described. Compared with other stents, the square stent has a minimal amount... (Review)
Review
The square stent is a new, simply constructed, self-expanding device that has recently been described. Compared with other stents, the square stent has a minimal amount of metal and thus requires a smaller-diameter catheter for introduction. Despite the small amount of metal present, the square stent has adequate expansile force. We have been evaluating the square stent for various interventional applications. In addition to the basic square stent, combinations of square stents and coverings for square stents were developed and evaluated to expand its uses and indications. One of the coverings tested is a new biomaterial: small intestinal submucosa (SIS). This paper will discuss the various applications of the square stent, which include a retrievable inferior vena cava filter, vascular occluder, graft adapter, and venous and aortic valves. In addition, we will review the important properties of SIS as a covering for the square stent.
Topics: Animals; Aortic Valve; Biocompatible Materials; Blood Vessels; Embolization, Therapeutic; Equipment Design; Heart Valve Prosthesis; Humans; Intestinal Mucosa; Pulmonary Embolism; Stents; Vena Cava Filters
PubMed: 11779008
DOI: 10.1007/s00270-001-0041-7 -
Neurosurgery Jan 2020Over the past decade, flow diverter technology for endocranial aneurysms has seen rapid evolution, with the development of new devices quickly outpacing the clinical... (Review)
Review
Over the past decade, flow diverter technology for endocranial aneurysms has seen rapid evolution, with the development of new devices quickly outpacing the clinical evidence base. However, flow diversion has not yet been directly compared to surgical aneurysm clipping or other endovascular procedures. The oldest and most well-studied device is the Pipeline Embolization Device (PED; Medtronic), recently transitioned to the Pipeline Flex (Medtronic), which still has sparse data regarding outcomes. To date, other flow diverting devices have not been shown to outperform the PED, although information comes primarily from retrospective studies with short follow-up, which are not always comparable. Because of this lack of high-quality outcome data, no reliable recommendations can be made for choosing among flow diversion devices yet. Moreover, the decision to proceed with flow diversion should be individualized to each patient. In this work, we wish to provide a comprehensive overview of the technical specifications of all flow diverter devices currently available, accompanied by a succinct description of the evidence base surrounding each device.
Topics: Blood Vessel Prosthesis; Embolization, Therapeutic; Endovascular Procedures; Humans; Intracranial Aneurysm; Retrospective Studies; Treatment Outcome
PubMed: 31838536
DOI: 10.1093/neuros/nyz323 -
Heart, Lung & Circulation 2007Re-do coronary artery bypass graft (CABG) surgery carries significant risk to the patient and existing patent internal thoracic artery grafts. Stenting stenotic... (Review)
Review
Re-do coronary artery bypass graft (CABG) surgery carries significant risk to the patient and existing patent internal thoracic artery grafts. Stenting stenotic saphenous vein grafts (SVGs) with drug-eluting stents (DES) using embolic protection devices (EPDs) is therefore probably the optimum treatment. However, this is fraught with challenges such as distal embolisation and restenosis which may result in peri-procedural myocardial infarction and target vessel failure, respectively. This review focuses on the nature of SVG disease, percutaneous intervention utilising embolic protection and future directions aimed at combating the disappointingly high procedural complication rate and long-term recurrence in this group.
Topics: Angioplasty, Balloon; Coronary Restenosis; Drug-Eluting Stents; Embolization, Therapeutic; Humans; Saphenous Vein
PubMed: 17606404
DOI: 10.1016/j.hlc.2007.03.016 -
Current Problems in Diagnostic Radiology 2014Percutaneous vascular embolization is one of the major applications of interventional radiology. A wide variety of embolization agents are currently available for... (Review)
Review
Percutaneous vascular embolization is one of the major applications of interventional radiology. A wide variety of embolization agents are currently available for clinical use. The interventional radiologist needs to be up to date with the newer and different types of embolic agents available along with their biopharmaceutical characteristics, strengths, and weaknesses that have been reviewed. For the purpose of this review, we have classified embolization agents into mechanical occlusion devices, particulate agents, and liquid agents, with some degree of overlap between some of the agents.
Topics: Angioplasty, Balloon, Coronary; Embolization, Therapeutic; Female; Gelatin; Hemoptysis; Humans; Male; Microspheres; Polyvinyls; Radiography; Radiology, Interventional; Sclerosing Solutions; Tissue Adhesives
PubMed: 24290201
DOI: 10.1067/j.cpradiol.2013.10.003 -
The Journal of Cardiovascular Surgery Dec 2016Percutaneous, catheter-directed embolotherapy is an established interventional technique for the management of many vascular disorders. For more than three decades,... (Review)
Review
Percutaneous, catheter-directed embolotherapy is an established interventional technique for the management of many vascular disorders. For more than three decades, typical embolization devices included macro and microcoils, polyvinyl alcohol microparticles, glue and certain liquids such as absolute alcohol. In the past decade, however, several new embolic devices and refinements of existing embolic devices have arrived on the market and a number of clinical studies have demonstrated their added value. In this review article, these new embolic devices and their typical indications will be discussed, as well as the results of studies involving the embolic devices.
Topics: Adult; Animals; Chemoembolization, Therapeutic; Embolization, Therapeutic; Equipment Design; Female; Humans; Male; Middle Aged; Sclerosing Solutions; Sclerotherapy; Tissue Adhesives; Treatment Outcome; Vascular Access Devices; Young Adult
PubMed: 27647339
DOI: No ID Found -
Journal of Interventional Cardiology Apr 2001This article reviews the experience in the last decade with Sideris buttoned devices for occlusion of patent ductus arteriosus (PDA). The devices used were the regular... (Review)
Review
This article reviews the experience in the last decade with Sideris buttoned devices for occlusion of patent ductus arteriosus (PDA). The devices used were the regular buttoned device, the infant buttoned device, the device with the folding plug, and the wireless device. The buttoned devices were implanted transvenously and introduced through 7Fr-8Fr long sheaths for PDAs up to 12 mm; wireless devices required 9Fr-11Fr sheaths for PDAs up to 22 mm. All different shapes of ductus were occluded. The records of 356 patients in the international and Food and Drug Administration (FDA) supervised United States (US) clinical trials were reviewed. Despite excellent long-term full occlusion rates and the absence of significant complications with the regular buttoned device, modifications were necessary to improve the full occlusion rates in 24 hours. The 24-hour rates improved from 60% with the regular device to 85% with the folding plug device. Most residual shunts disappeared on long-term follow-up without significant complications. Wireless devices were developed for very large PDAs and have excellent occlusion rates. The buttoned device with the incorporated folding plug and the wireless devices are currently under clinical trial. The safety record of the new devices needs to be established with larger clinical trials.
Topics: Adolescent; Adult; Child; Child, Preschool; Ductus Arteriosus, Patent; Embolization, Therapeutic; Equipment Design; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Prostheses and Implants
PubMed: 12053312
DOI: 10.1111/j.1540-8183.2001.tb00742.x -
Medicine Jun 2021Both coil embolization (CE) and flow-diverting device (FDD) placement are widely used for treatment of intracranial aneurysms (IAs). The aim of this meta-analysis is to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Both coil embolization (CE) and flow-diverting device (FDD) placement are widely used for treatment of intracranial aneurysms (IAs). The aim of this meta-analysis is to compare the relative clinical safety and efficacy of FDD and CE for the treatment of unruptured IAs.
METHODS
The PubMed, Embase, and Cochrane Library databases were searched for relevant studies from the date of inception through April 2020. The primary endpoint for this meta-analysis was the 6-month rate of complete occlusion, while secondary endpoints included rates of retreatment, complications, and parental arterial patency.
RESULTS
This meta-analysis includes 8 studies, which included 839 total patients that underwent FDD and 2734 that underwent CE. FDD group exhibited a significantly higher pooled 6-month complete occlusion rate (P = .02). The subgroup analysis demonstrated that FDD treatment was associated with significantly higher pooled 6-month complete occlusion rates in patients with large or giant IAs (P < .00001), whereas no differences in 6-month complete occlusion rates were observed between the FDD and CE groups of patients with non-large/giant IAs (P = .83). The pooled retreatment (P = .16) and complication (P = .15) rates were comparable between 2 groups. The CE group exhibited significantly higher pooled parent artery patency rate (P = .01). The funnel plots did not reveal any evidence of publication bias.
CONCLUSIONS
FDDs can be used to effectively and safely treat large and giant IAs, achieving higher rates of complete occlusion than CE treatment. For non-large/giant IAs, we observed comparable efficacy between FDD and CE treatments.
Topics: Embolization, Therapeutic; Humans; Intracranial Aneurysm; Retreatment; Stents; Treatment Outcome; Vascular Patency
PubMed: 34128887
DOI: 10.1097/MD.0000000000026351