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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 -
Science Robotics Aug 2021Catheters used for endovascular navigation in interventional procedures lack dexterity at the distal tip. Neurointerventionists, in particular, encounter challenges in...
Catheters used for endovascular navigation in interventional procedures lack dexterity at the distal tip. Neurointerventionists, in particular, encounter challenges in up to 25% of aneurysm cases largely due to the inability to steer and navigate the tip of the microcatheters through tortuous vasculature to access aneurysms. We overcome this problem with submillimeter diameter, hydraulically actuated hyperelastic polymer devices at the distal tip of microcatheters to enable active steerability. Controlled by hand, the devices offer complete 3D orientation of the tip. Using saline as a working fluid, we demonstrate guidewire-free navigation, access, and coil deployment in vivo, offering safety, ease of use, and design flexibility absent in other approaches to endovascular intervention. We demonstrate the ability of our device to navigate through vessels and to deliver embolization coils to the cerebral vessels in a live porcine model. This indicates the potential for microhydraulic soft robotics to solve difficult access and treatment problems in endovascular intervention.
Topics: Animals; Biomedical Engineering; Calibration; Catheterization; Catheters; Cerebral Arteries; Computer Simulation; Elasticity; Embolization, Therapeutic; Endovascular Procedures; Equipment Design; Female; Humans; Imaging, Three-Dimensional; Intracranial Aneurysm; Polymers; Robotics; Swine; United States
PubMed: 34408094
DOI: 10.1126/scirobotics.abf0601 -
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 -
Journal of Interventional Cardiology Oct 1995The first transcatheter closure of an atrial septal defect (ASD) was performed by King and Mills in 1976. The Lock Clamshell occluder and the buttoned device are the... (Review)
Review
The first transcatheter closure of an atrial septal defect (ASD) was performed by King and Mills in 1976. The Lock Clamshell occluder and the buttoned device are the latest devices to undergo clinical trials. Successful transcatheter closure has been possible with minimal morbidity and mortality. Small residual shunts may remain, however, in up to 20% of patients 1 year after the procedure. The clinical significance and natural history of these small residual atrial communications remains to be determined. This article reviews the history and development of the current ASD closure techniques, with emphasis on the experience with the Lock Clamshell occluder and the buttoned device.
Topics: Cardiac Catheterization; Child; Embolization, Therapeutic; Heart Septal Defects, Atrial; Humans; Infant; Ultrasonography
PubMed: 10159518
DOI: 10.1111/j.1540-8183.1995.tb00581.x -
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 -
BMJ Case Reports Nov 2012Tunnelled central venous catheters are commonly used for a variety of indications, including home parenteral nutrition, but are rarely associated with fracture and...
Tunnelled central venous catheters are commonly used for a variety of indications, including home parenteral nutrition, but are rarely associated with fracture and embolisation; the risk of embolisation is reported to be greater with catheters placed via the subclavian vein rather than the internal jugular route. We report the case of a 64-year-old woman with type 3 (chronic and irreversible) intestinal failure who presented with pain and swelling on infusion of parenteral nutrition through her internal jugular catheter. A chest x-ray showed fracture and embolisation of her catheter into the right ventricle. The embolised portion was retrieved and removed via the femoral route, without complication and the catheter replaced. We discuss causes of line embolisation, and highlight the possibility of embolisation occurring with an internal jugular catheter.
Topics: Cardiac Catheterization; Catheterization, Central Venous; Catheters, Indwelling; Echocardiography; Embolism; Equipment Failure; Female; Foreign-Body Migration; Heart Atria; Heart Ventricles; Humans; Jugular Veins; Middle Aged; Parenteral Nutrition, Home Total; Short Bowel Syndrome
PubMed: 23175013
DOI: 10.1136/bcr-2012-007249 -
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 -
Diagnostic and Interventional Radiology... 2017Occlusion time (OT) is an important factor in the treatment of pulmonary arteriovenous malformations (PAVMs) since it can lead to serious complications. The purpose of...
PURPOSE
Occlusion time (OT) is an important factor in the treatment of pulmonary arteriovenous malformations (PAVMs) since it can lead to serious complications. The purpose of our study is to calculate the OT of Amplatzer vascular plug (AVP, St Jude Medical), and correlate it to the type of the device used (AVP or AVP 2) and the percent of device oversizing. Technical success rates and complications were also recorded.
METHODS
We retrospectively studied a total of 19 patients with 47 PAVMs who received percutaneous transcatheter embolization therapy using either AVP or AVP 2. We recorded the location, type, feeding artery diameter, AVP device used, and OT of each PAVM. We correlated the percent of device oversizing and the type of AVP with the OT. We also studied the rate of persistence of PAVM for both devices.
RESULTS
Forty-six (98%) of the PAVMs were simple. Device diameters ranged from 4.0-16.0 mm with device oversizing ranging between 14% and 120%. There was a statistically significant difference in the OT of AVP and AVP 2 (3 min 54 s vs. 5 min 30 s, P = 0.030). There was a weak positive correlation between OT and device oversizing for AVP (r=0.246, P = 0.324) and AVP 2 (r=0.261, P = 0.240). No major complications were identified. Immediate technical success rate was 100%.
CONCLUSION
The use of AVP 2, and increase in device oversizing were not associated with reduction in the OT of PAVMs. There was no reported difference in safety between the two devices, and no major complications were noted.
Topics: Adult; Arteriovenous Malformations; Embolization, Therapeutic; Female; Humans; Male; Middle Aged; Pulmonary Artery; Pulmonary Veins; Retrospective Studies; Septal Occluder Device; Treatment Outcome; Young Adult
PubMed: 27856403
DOI: 10.5152/dir.2016.16120 -
AJNR. American Journal of Neuroradiology Sep 2016The Woven EndoBridge (WEB) device was recently introduced for intrasaccular treatment of wide-neck aneurysms without the need for adjunctive support. We present our... (Observational Study)
Observational Study
BACKGROUND AND PURPOSE
The Woven EndoBridge (WEB) device was recently introduced for intrasaccular treatment of wide-neck aneurysms without the need for adjunctive support. We present our first experience in using the WEB for small ruptured aneurysms.
MATERIALS AND METHODS
During 11 months, 32 of 71 (45%) endovascularly treated acutely ruptured aneurysms were treated with the WEB. The patients were 12 men and 20 women, with a mean age of 61 years (range, 34-84 years). The mean aneurysm size was 4.9 mm, and 14 were ≤4 mm. Of 32 aneurysms, 24 (75%) had a wide neck.
RESULTS
All 32 aneurysms were adequately occluded after WEB placement. There were no procedural ruptures and no complications related to the WEB device. No adjunctive stents or balloons were needed. In 3 patients, thromboembolic complications occurred. One patient developed an infarction, and 2 patients were asymptomatic. The procedural complication rate was 3%. Seven patients admitted in poor clinical grade conditions died during hospital admission due to the sequelae of SAH. In 18 patients with angiographic follow-up at 3 months, 16 aneurysms remained adequately occluded. Two aneurysms showed slight compression of the WEB without reopening. Clinical follow-up in the 25 patients who survived the hospital admission period revealed mRS 1-2 in 24 and mRS 4 in 1. There were no rebleeds from the ruptured aneurysms during follow-up.
CONCLUSIONS
WEB treatment of small ruptured aneurysms was safe and effective without the need for anticoagulation, adjunctive stents, or balloons. Our preliminary experience indicates that the WEB may be a valuable alternative to coils in the treatment of acutely ruptured aneurysms.
Topics: Adult; Aged; Aged, 80 and over; Aneurysm, Ruptured; Embolization, Therapeutic; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Postoperative Complications; Stents
PubMed: 27102307
DOI: 10.3174/ajnr.A4811 -
AJNR. American Journal of Neuroradiology May 2016The use of the Pipeline Embolization Device in the management of recurrent previously stented cerebral aneurysms is controversial. The aim of this study was to evaluate...
BACKGROUND AND PURPOSE
The use of the Pipeline Embolization Device in the management of recurrent previously stented cerebral aneurysms is controversial. The aim of this study was to evaluate the efficacy and safety of the Pipeline Embolization Device in the treatment of recurrent, previously stented aneurysms.
MATERIALS AND METHODS
Twenty-one patients with previously stented recurrent aneurysms who later underwent Pipeline Embolization Device placement (group 1) were retrospectively identified and compared with 63 patients who had treatment with the Pipeline Embolization Device with no prior stent placement (group 2). Occlusion at the latest follow-up angiogram, recurrence and retreatment rates, clinical outcome, complications, and morbidity and mortality observed after treatment with the Pipeline Embolization Device were analyzed.
RESULTS
Patient characteristics were similar between the 2 groups. The mean time from stent placement to recurrence was 25 months. Pipeline Embolization Device treatment resulted in complete aneurysm occlusion in 55.6% of patients in group 1 versus 80.4% of patients in group 2 (P = .036). The retreatment rate in group 1 was 11.1% versus 7.1% in group 2 (P = .62). The rate of good clinical outcome at the latest follow-up in group 1 was 81% versus 93.2% in group 2 (P = .1). Complications were observed in 14.3% of patients in group 1 and 9.5% of patients in group 2 (P = .684).
CONCLUSIONS
The use of the Pipeline Embolization Device in the management of previously stented aneurysms is less effective than the use of this device in nonstented aneurysms. Prior stent placement can worsen the safety and efficacy profile of this device.
Topics: Adult; Aged; Cerebral Angiography; Embolization, Therapeutic; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Recurrence; Retreatment; Retrospective Studies; Stents; Treatment Outcome
PubMed: 26611991
DOI: 10.3174/ajnr.A4613