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BMJ Case Reports Mar 2018Endovascular treatment has been the mainstay of therapy for repair of both ruptured and unruptured cerebral aneurysms. Flow diverter devices offer a new option for the...
Endovascular treatment has been the mainstay of therapy for repair of both ruptured and unruptured cerebral aneurysms. Flow diverter devices offer a new option for the treatment of complex aneurysms that were previously not amenable to coiling. Procedural adverse effects include intracranial haemorrhage and ischaemic stroke, which usually occur on the same day. Delayed complications are rare. We report a case of a patient who underwent placement of a pipeline embolisation device and developed delayed neurological deficits, which were thought to be an inflammatory reaction to the hydrophilic coating used in guidewires and microcatheters. Our patient was treated with a course of steroids, with improvement of her neurological deficits and resolution of MRI findings. As the use of flow diverter devices has increased, variable and delayed complications of such therapy are increasingly being reported in the literature.
Topics: Catheters; Embolization, Therapeutic; Female; Humans; Intracranial Aneurysm; Middle Aged; Nervous System Diseases; Steroids; Treatment Outcome
PubMed: 29574426
DOI: 10.1136/bcr-2016-216580 -
Diagnostic and Interventional Imaging Mar 2020To prospectively evaluate the efficacy and safety of embolization using hydrogel-coated coils for the treatment of pulmonary arteriovenous malformations (PAVMs).
PURPOSE
To prospectively evaluate the efficacy and safety of embolization using hydrogel-coated coils for the treatment of pulmonary arteriovenous malformations (PAVMs).
MATERIALS AND METHODS
The outcomes of 21 PAVMs in 19 patients (3 men and 16 women; mean age, 58.8±15.2 [SD] years; age range 14-78 years) treated by venous sac embolization (VSE) with additional feeding artery embolization were prospectively evaluated. For VSE, using one or more 0.018-inch hydrogel-coated coils was mandatory. Recanalization and/or reperfusion were evaluated by pulmonary arteriography 1 year after embolization.
RESULTS
The mean feeding artery and venous sac sizes were 4.0mm and 8.5mm, respectively. Embolization was successfully completed in 20/21 PAVMs, yielding a technical success rate of 95%. The feeding artery was also embolized in 17/20 successful PAVMs (85%). A technical failure occurred in one PAVM, where embolization was abandoned because of migration of one bare coil to the left ventricle. The mean numbers of hydrogel-coated coils and bare platinum detachable coils used for VSE were 3.3±2.1 (SD) (range, 1-8) and 4.4±3.9 (SD) (range, 1-17), respectively. The mean percentages of hydrogel-coated coils in number, length, and estimated volume were 42.9%, 33.3%, and 72.7% respectively. One patient with one PAVM was lost to follow-up after 3 months. Neither recanalization nor reperfusion was noted in the remaining 19 PAVMs (success rate, 19/19 [100%]). One grade 4 (coil migration) adverse event occurred, and it was treated without any sequelae.
CONCLUSION
VSE using hydrogel-coated coils with additional feeding artery embolization is a safe and effective treatment for PAVM.
Topics: Adolescent; Adult; Aged; Arteriovenous Malformations; Coated Materials, Biocompatible; Embolization, Therapeutic; Female; Humans; Hydrogels; Male; Middle Aged; Prospective Studies; Pulmonary Artery; Pulmonary Veins; Treatment Outcome; Young Adult
PubMed: 31722843
DOI: 10.1016/j.diii.2019.10.008 -
AJNR. American Journal of Neuroradiology Mar 2019The Sim&Size software simulates case-specific intraluminal Pipeline Embolization Device behavior, wall apposition, and device length in real-time on the basis of... (Comparative Study)
Comparative Study
BACKGROUND AND PURPOSE
The Sim&Size software simulates case-specific intraluminal Pipeline Embolization Device behavior, wall apposition, and device length in real-time on the basis of rotational angiography DICOM data. The purpose of this multicenter study was to evaluate whether preimplantation device simulation with the Sim&Size software results in selection of different device dimensions than manual sizing.
MATERIALS AND METHODS
In a multicenter cohort of 74 patients undergoing aneurysm treatment with the Pipeline Embolization Device, we compared apparent optimal device dimensions determined by neurointerventionalists with considerable Pipeline Embolization Device experience based on manual 2D measurements taken from rotational angiography with computed optimal dimensions determined by Sim&Size experts blinded to the neurointerventionalists' decision. Agreement between manually determined and computed optimal dimensions was evaluated with the Cohen κ. The significance of the difference was analyzed with the Wilcoxon signed rank test.
RESULTS
The agreement index between manual selection and computed optimal dimensions was low (κ for diameter = 0.219; κ for length = 0.149, < .01). Computed optimal device lengths were significantly shorter (median, 14 versus 16 mm, = 402, = -0.28, < .01). No significant difference was observed for device diameters.
CONCLUSIONS
Low agreement between manually determined and computed optimal device dimensions is not proof, per se, that virtual simulation performs better than manual selection. Nevertheless, it ultimately reflects the potential for optimization of the device-sizing process, and use of the Sim&Size software reduces, in particular, device length. Nevertheless, further evaluation is required to clarify the impact of device-dimension modifications on outcome.
Topics: Aged; Blood Vessel Prosthesis; Computer Simulation; Embolization, Therapeutic; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Software; Treatment Outcome
PubMed: 30733254
DOI: 10.3174/ajnr.A5973 -
Stroke Oct 2010The latest class of neuroendovascular devices being evaluated is intended to treat cerebral aneurysms. In addition to inducing flow stasis-mediated thrombosis of... (Review)
Review
The latest class of neuroendovascular devices being evaluated is intended to treat cerebral aneurysms. In addition to inducing flow stasis-mediated thrombosis of aneurysms and thus at times being referred to as flow diverters, these devices reconstitute pathologic arterial segments to near-physiologic normalcy. The successful implementation of such an endoluminal scaffold for vascular reconstruction in the cerebral circulation requires careful consideration of various factors drawn from engineering, physics, and biological sciences. Here we review some of these factors.
Topics: Cerebral Angiography; Cerebrovascular Circulation; Embolization, Therapeutic; Humans; Intracranial Aneurysm; Stents; Tissue Scaffolds
PubMed: 20876497
DOI: 10.1161/STROKEAHA.110.595066 -
AJNR. American Journal of Neuroradiology Nov 2019Despite several retrospective studies showing the safety and efficacy of transradial access for cerebral angiography, neurointerventionalists are apprehensive about...
BACKGROUND AND PURPOSE
Despite several retrospective studies showing the safety and efficacy of transradial access for cerebral angiography, neurointerventionalists are apprehensive about implementing TRA for neurointerventions. This reluctance is mainly due to anatomic factors, technical factors, and a long learning curve (relative to transfemoral access). We present here our experience of TRA transition for cerebral aneurysm embolization. Our aim was to demonstrate the feasibility and safety of radial access for consecutive embolizations of ruptured and unruptured cerebral aneurysms.
MATERIALS AND METHODS
We performed a retrospective review of a prospective data base on cerebral aneurysm embolizations. Between April and December 2018, radial access was considered for all consecutive patients referred to our institution for cerebral aneurysm embolization. Technical success was defined as radial access with insertion of the sheath and completion of the intervention without a crossover to conventional femoral access. The primary safety end point was the in-hospital plus 30-day incidence of radial artery occlusion. Secondary end points included intraoperative complications and neurologic complications at discharge and in the following 30 days.
RESULTS
Seventy-one patients with a cerebral aneurysm underwent 73 embolization procedures at our institution. The first-choice access route was the radial artery in 62 patients (87.3%) and the femoral artery in 9 (12.6%). Thirty-four embolizations were performed using coils, 22 used a balloon-assisted coil technique, 6 used a stent-assisted coil technique, and 2 used a flow diverter. Crossover to femoral access was observed in 2 patients (3.1%). Four patients developed coil-induced thrombi requiring intra-arterial tirofiban injections. In 1 case, an aneurysm ruptured during the operation but did not have a clinical impact. No cases of radial artery occlusion or hand ischemia were observed.
CONCLUSIONS
A transition to radial access for cerebral aneurysm embolization is feasible and does not increase the level of risk associated with the procedure.
Topics: Adult; Aged; Embolization, Therapeutic; Endovascular Procedures; Female; Humans; Intracranial Aneurysm; Intraoperative Complications; Male; Middle Aged; Radial Artery; Retrospective Studies; Stents; Treatment Outcome
PubMed: 31582386
DOI: 10.3174/ajnr.A6234 -
European Journal of Vascular and... Jun 2020
Topics: Aneurysm, False; Arteries; Catheterization, Central Venous; Central Venous Catheters; Embolization, Therapeutic; Humans; Jugular Veins; Stents; Thyroid Gland; Treatment Outcome
PubMed: 32370919
DOI: 10.1016/j.ejvs.2020.03.046 -
Interventional Neuroradiology : Journal... Oct 2023Spinal catheter angiography is commonly performed in the evaluation and treatment of spinal vascular lesions. The typical approach to spinal angiography consists of...
BACKGROUND
Spinal catheter angiography is commonly performed in the evaluation and treatment of spinal vascular lesions. The typical approach to spinal angiography consists of access through the femoral artery with the use of suitably shaped catheters for selective catheterization of the spinal segmental vasculature. The purpose of our study was to evaluate the safety and feasibility of distal transradial access through the "anatomical snuffbox" for targeted spinal angiography, for the investigation and treatment of selected spinal lesions.
METHODS
A retrospective review of patients who underwent transradial spinal angiography and embolization was performed from August 2019 to January 2022. A total of eight patients were identified, who underwent targeted spinal angiography through distal transradial access. Outcome measures were documented in a tabular manner.
RESULTS
Radial access was successful in all patients. Seven patients had vascular tumors of the spinal column and underwent tumor embolization followed by segmental artery occlusion prior to surgery. One patient had a spinal dural AV fistula that could not be embolized due to feeding vessel tortuosity and eventually went on to have a laminectomy. Mean fluoroscopy time was 31.4 min. There were no access site hemorrhagic complications. One patient experienced transient mild hand numbness during the period of hemostasis with the vascular compression device that resolved completely within 24 h.
CONCLUSIONS
Distal transradial access is a feasible and safe option for targeted spinal angiography and treatment in selected patients.
Topics: Humans; Radial Artery; Angiography; Embolization, Therapeutic; Catheters; Hemorrhage; Retrospective Studies
PubMed: 35484816
DOI: 10.1177/15910199221097489 -
BMC Neurology Jan 2021This study aimed to evaluate the efficacy and safety of Scepter dual-lumen balloon catheter for transarterial Onyx embolization of dural arteriovenous fistula (DAVF).
BACKGROUND
This study aimed to evaluate the efficacy and safety of Scepter dual-lumen balloon catheter for transarterial Onyx embolization of dural arteriovenous fistula (DAVF).
METHODS
Transarterial Onyx embolization using a Scepter dual-lumen balloon catheter (Scepter-assisted Onyx embolization) for DAVF was attempted in a total of 35 patients (mean age, 52.5 years; M:F = 24:11) between October 2012 and December 2018. The results of Scepter-assisted Onyx embolization were evaluated with respect to total procedural and Onyx injection times, the types and number of feeders requiring embolization, angiographic and clinical outcomes, and treatment-related complications.
RESULTS
Initial presentations were non-hemorrhagic neurological deficits in 10, intracranial hemorrhage in 8, seizure in 7, headache in 7, and intractable tinnitus in 3. All DAVF were aggressive type (Borden type 2, 14.3 %; type 3, 85.7 %). Scepter-assisted Onyx embolization resulted in immediately complete occlusion in 33 patients (94.3 %) and near complete occlusion in 2 patients. Middle meningeal artery (51.4 %) was the most commonly used for Scepter-assisted technique, followed by occipital artery (42.9 %), ascending pharyngeal artery (2.9 %) and superficial temporal artery (2.9 %). There was no difference in complete occlusion rate between middle meningeal artery and the other arteries (94.4 % versus 94.1 %). The median number of total feeders embolized was 1 (range, 1-3). The median total procedural time was 45 minutes (range, 21 minutes - 127 minutes) and the median Onyx injection time was 11 minutes (range, 3 minutes - 25 minutes). All patients recovered completely (n = 31) or partially (n = 4) from presenting symptoms. Treatment-related complications occurred in 2 patients, of whom one had a permanent morbidity (2.8 %, ipsilateral facial nerve palsy). No patient showed a recurrence on follow-up imaging (median, 15 months; range, 3-56 months).
CONCLUSIONS
Scepter-assisted transarterial Onyx embolization showed a very high complete occlusion rate with a low morbidity and no recurrence in aggressive type DAVF. Scepter dual-lumen balloon catheter seems to be a useful tool for transarterial Onyx embolization of DAVF.
Topics: Adult; Catheters; Central Nervous System Vascular Malformations; Dimethyl Sulfoxide; Embolization, Therapeutic; Female; Humans; Male; Middle Aged; Polyvinyls; Retrospective Studies; Treatment Outcome
PubMed: 33472604
DOI: 10.1186/s12883-021-02046-6 -
AJNR. American Journal of Neuroradiology Jan 2021Newer flow diverters are enhanced with antithrombogenic surface modifications like the Pipeline Embolization Device with Shield Technology and the Derivo Embolization... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Newer flow diverters are enhanced with antithrombogenic surface modifications like the Pipeline Embolization Device with Shield Technology and the Derivo Embolization Device and are purported to facilitate deployment and reduce ischemic events.
PURPOSE
Our aim was to review the safety and efficacy of surface-modified flow diverters in treating patients with cerebral aneurysms.
DATA SOURCES
We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and meta-analysis covering 3 major data bases and gray literature between 2014 and 2019.
STUDY SELECTION
Two reviewers independently reviewed human studies of surface-modified flow diverters for eligibility based on predetermined criteria.
DATA ANALYSIS
The random effects model and Freeman-Tukey arcsine transformation were used to pool efficacy outcomes (technical success, aneurysm occlusion at 6 and 12 months) and safety outcomes (mortality, morbidity, all ischemia, and serious ischemia). Subgroup analysis was performed to compare outcomes between 2 different flow diverters.
DATA SYNTHESIS
Eight single-arm case series involving 911 patients and 1060 aneurysms were included. The median follow-up was 8.24 months. Pooled estimate for technical success was 99.6%, while the aneurysm occlusion at 6 and 12 months were 80.5%, and 85.6%, respectively. Pooled estimates for mortality, morbidity, total ischemia, and serious ischemia rates were 0.7%, 6.0%, 6.7%, and 1.8%, respectively. Most studies were of good quality, and no significant heterogeneity was observed.
LIMITATIONS
Limitations include a retrospective, observational design in some studies; heterogeneous and underreported antiplatelet therapy; and potential performance and ecologic bias.
CONCLUSIONS
Early-to-midterm safety and efficacy for surface-modified flow diverters appear comparable with older devices, especially for small, unruptured anterior circulation aneurysms. Long-term clinical data are required to further corroborate these results.
Topics: Adult; Aged; Blood Vessel Prosthesis; Embolization, Therapeutic; Endovascular Procedures; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 33384292
DOI: 10.3174/ajnr.A6919 -
AJNR. American Journal of Neuroradiology Sep 2015Despite the increasing use of stent-assisted coiling for ruptured intracranial aneurysms, there is little consensus regarding the appropriate antiplatelet administration... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND PURPOSE
Despite the increasing use of stent-assisted coiling for ruptured intracranial aneurysms, there is little consensus regarding the appropriate antiplatelet administration for this. The objectives of this systematic review were to provide an overview of complications and their association with the method of antiplatelet administration in stent-assisted coiling for ruptured intracranial aneurysms.
MATERIALS AND METHODS
A comprehensive search of the literature in the data bases was conducted to identify studies reporting complications of stent-assisted coiling for ruptured intracranial aneurysms. The pooled event rate of preprocedural thromboembolisms, hemorrhages, and mortality was estimated from the selected studies. Subgroup analyses were performed by the method of antiplatelet administration (pre-, postprocedural, and modified). Meta-analysis was conducted to compare periprocedural complications and mortality between ruptured intracranial aneurysms and unruptured intracranial aneurysms.
RESULTS
Of the 8476 studies identified, 33 with 1090 patients were included. The event rates of thromboembolism and intra- and postprocedural hemorrhage were 11.2% (95% CI, 9.2%-13.6%), 5.4% (95% CI, 4.1%-7.2%), and 3.6% (95% CI, 2.6%-5.1%), respectively. Subgroup analyses of thromboembolism showed a statistically significant difference between groups (P < .05). In the preprocedural and modified antiplatelet groups, the risk for thromboembolism in stent-assisted coiling for ruptured intracranial aneurysm was not significantly different from that for unruptured intracranial aneurysm, though this risk of the postprocedural antiplatelet group was significantly higher in ruptured intracranial aneurysms than in unruptured intracranial aneurysms.
CONCLUSIONS
On the basis of current evidence, complications of stent-assisted coiling for ruptured intracranial aneurysm may be affected by the method of antiplatelet administration.
Topics: Aneurysm, Ruptured; Embolization, Therapeutic; Endovascular Procedures; Humans; Intracranial Aneurysm; Male; Stents; Thrombolytic Therapy
PubMed: 26138136
DOI: 10.3174/ajnr.A4365