-
Interventional Neuroradiology : Journal... Jun 2017Background The selection of a pre-shaped microcatheter or a shaping method must be carefully considered for successful aneurysm coiling. The objective of this report is...
Background The selection of a pre-shaped microcatheter or a shaping method must be carefully considered for successful aneurysm coiling. The objective of this report is to verify the use of intravascular placement to establish an appropriate microcatheter shape. Methods Fifteen patients (15 aneurysms) were included in this study because of the predicted difficulty of microcatheter insertion and stabilisation. The SL-10 straight microcatheter was inserted into the parent artery until the tip of the catheter passed through the neck of the aneurysm. After 5 minutes, the microcatheter was pulled out and the shape acquired from intravascular placement was confirmed and compared with the three-dimensional rotational angiography. In addition, the microcatheter tip was steam-shaped for coiling and coil embolisation was performed. A silicone flow model was also used to confirm our findings. The first experiment compared the bend angle in four different microcatheters placed in the model for 5 minutes. In the second experiment, the SL-10 straight microcatheter was placed in the model, and the bend angle was measured at 2.5, 5, 7.5 and 10 minutes to observe the changes in bend angle over time. Results The SL-10 straight microcatheter, in place for 5 minutes, acquired a shape similar to the patient's own vessel. Among the 15 patients included, 13 were treated using an intravascular shaped microcatheter. In the flow model experiments, the SL-10 most easily acquired the vessel shape, and the shape change stabilised after 5 minutes. Conclusion Shaping the SL-10 straight microcatheter using intravascular placement is an effective shaping method for aneurysm coil embolisation.
Topics: Catheters; Cerebral Angiography; Embolization, Therapeutic; Equipment Design; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Radiography, Interventional
PubMed: 28166669
DOI: 10.1177/1591019917689926 -
Journal of Vascular and Interventional... Jun 2010To develop and characterize radiopaque embolization microspheres capable of in vivo detection with intraprocedural fluoroscopy and computed tomography (CT) imaging and...
PURPOSE
To develop and characterize radiopaque embolization microspheres capable of in vivo detection with intraprocedural fluoroscopy and computed tomography (CT) imaging and to evaluate their spatial distribution inside target tissues during and after transcatheter embolization.
MATERIALS AND METHODS
Polyvinyl alcohol hydrogel microspheres were loaded with Lipiodol and examined for iodine content, stability of loading, and conspicuity with fluoroscopy and CT in vitro. Transcatheter embolization of swine liver and kidney was performed with the radiopaque microspheres and spatial distribution was evaluated with intraprocedural fluoroscopy and CT. Ex vivo evaluation was performed with light microscopy and micro-CT.
RESULTS
In vitro analyses demonstrated that radiopaque microspheres could be loaded with sufficient iodine content to be detected with routine fluoroscopy and CT imaging and that such loading was relatively stable. Radiopaque microspheres were visible in vivo with fluoroscopy and CT during transcatheter embolization. CT imaging during embolization procedures demonstrated a dose-dependent relationship in the number and size of visualized embolized arteries. Imaging features of radiopaque microsphere distribution inside target tissues correlated well with ex vivo light microscopic and micro-CT evaluation of microsphere distribution.
CONCLUSIONS
Radiopaque embolization microspheres are visualized during transcatheter embolization with routine intraprocedural fluoroscopy and CT. These radiopaque microspheres provided the three-dimensional spatial distribution of embolic material inside target organs during the procedure, and therefore can provide real-time intraprocedural feedback for the interventional radiologist. These microspheres may be useful for demonstrating the influence of material and technical variability in transcatheter embolization in addition to providing intraprocedural identification of tissue at risk of undertreatment.
Topics: Animals; Catheterization; Contrast Media; Embolization, Therapeutic; Iodized Oil; Microspheres; Radiographic Image Enhancement; Radiography, Interventional; Reproducibility of Results; Sensitivity and Specificity; Swine
PubMed: 20494290
DOI: 10.1016/j.jvir.2010.02.031 -
Hong Kong Medical Journal = Xianggang... Oct 2011OBJECTIVE. To review our hospital's experience with the pipeline embolisation device to reconstruct wide-necked intracranial aneurysms. DESIGN. Descriptive case series....
OBJECTIVE. To review our hospital's experience with the pipeline embolisation device to reconstruct wide-necked intracranial aneurysms. DESIGN. Descriptive case series. SETTING. A regional neurosurgical centre in Hong Kong. PATIENTS. Patients presented with wide-necked intracranial internal carotid artery aneurysms who underwent pipeline embolisation device reconstruction between October 2008 and June 2009. RESULTS. There were 13 wide-necked internal carotid artery aneurysms (in nine patients) treated by pipeline embolisation device reconstruction. Eleven aneurysms were de-novo; two were recurrent. The complete occlusion rate was 66% (8/13) at the first angiographic follow-up and 69% (9/13) at the second follow-up. One patient developed in-stent stenosis and in another there was distal migration of the stent. There was no added neurological deficit in any patient. CONCLUSION. In our series, the clinical results from using the pipeline embolisation device for the treatment of non-ruptured internal carotid artery aneurysms appeared encouraging. However, larger studies with longer follow-up duration are warranted to assess the complications and durability of the device for reconstructing internal carotid artery aneurysms.
Topics: Adult; Aged; Aneurysm; Angiography, Digital Subtraction; Carotid Artery Diseases; Carotid Artery, Internal; Embolization, Therapeutic; Female; Hong Kong; Humans; Male; Middle Aged; Prosthesis Failure; Retrospective Studies; Stents
PubMed: 21979478
DOI: No ID Found -
Interventional Neuroradiology : Journal... Apr 2017Background Flow diverter (FD) malapposition is associated with stroke-related complications. We document the use of self-expanding nitinol stents to remove/reduce the...
Background Flow diverter (FD) malapposition is associated with stroke-related complications. We document the use of self-expanding nitinol stents to remove/reduce the ledge of a FD deployed for aneurysm treatment. Methods We identified five patients who were treated with the Pipeline embolization device (PED) in conjunction with a Neuroform EZ stent for inadequate wall apposition of the ends of the FD at our institution between May 2014 and July 2015. Among other parameters, angiographic results, cone-beam computed tomography assessment of wall apposition and patient clinical outcome were evaluated. Results Incomplete device end apposition was seen in three cases, and precarious positioning of the distal end of the PED over the aneurysm neck was seen in two cases. In all five cases, successful treatment with good wall apposition and proper pinning of the PED distal edge was achieved using an additional Neuroform EZ stent. Appropriate aneurysm neck coverage and flow stagnation was seen in all cases. The combination of high radial outward force and open-cell design permits the Neuroform EZ stent to jail the malappositioned edges of the FD while maintaining good vessel-wall apposition itself and prevent migration of the PED. Short-term follow-up angiography showed device patency and complete aneurysm obliteration in all cases. Conclusions Preliminary results of this small case series suggest that the Neuroform EZ stent allows for effective treatment of FD malapposition in selected patients amenable for this endovascular approach. Long-term and larger cohort studies are needed to validate these results.
Topics: Adult; Aged; Alloys; Angiography, Digital Subtraction; Blood Vessel Prosthesis; Cerebral Angiography; Cone-Beam Computed Tomography; Embolization, Therapeutic; Female; Humans; Imaging, Three-Dimensional; Intracranial Aneurysm; Male; Middle Aged; Prosthesis Design; Retrospective Studies; Stents; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 27956518
DOI: 10.1177/1591019916681981 -
Lab on a Chip Oct 2020Embolotherapy using particle embolics is normally performed with exogenous contrast to assist in visualization. However, the exact location of the embolics cannot be...
Embolotherapy using particle embolics is normally performed with exogenous contrast to assist in visualization. However, the exact location of the embolics cannot be identified after contrast washout. We developed a novel, pseudo-check valve-integrated microfluidic device, that partitions barium- impregnated alginate from crosslinking solution, thereby preventing nozzle failure. This enables rapid and continuous generation of inherently X-ray-visible embolic microspheres (XEMs) with uniform size. The XEMs are visible under clinical X-ray and cone beam CT both in vitro and in vivo. In particular, we demonstrated the embolization properties of these XEMs in large animals, performing direct intra- and post-procedural assessment of embolic delivery. The persistent radiopacity of these XEMs enables real-time evaluation of embolization precision and offers great promise for non-invasive follow-up examination without exogenous contrast. We also demonstrated that bariatric arterial embolization with XEMs significantly suppresses weight gain in swine, as an example of a non-oncological application of embolotherapy.
Topics: Alginates; Animals; Embolization, Therapeutic; Microfluidics; Microspheres; Swine; X-Rays
PubMed: 32869821
DOI: 10.1039/d0lc00098a -
EuroIntervention : Journal of EuroPCR... Aug 2014Distal embolisation during carotid artery stenting (CAS) is the main cause of cerebral complications; thus, the amount of embolisation occurring during CAS can be...
AIMS
Distal embolisation during carotid artery stenting (CAS) is the main cause of cerebral complications; thus, the amount of embolisation occurring during CAS can be considered as a surrogate endpoint of cerebral complications. Our aim was to find patient characteristics which are associated with a higher risk of embolisation during CAS.
METHODS AND RESULTS
From January to December 2010 all consecutive patients undergoing CAS with embolic protection at three medium- to high-volume Italian centres were prospectively enrolled in this multicentre study. After CAS, the embolic debris was classified by visual inspection into two groups: "scarce" (no debris or hardly visible debris), and "relevant" (visible embolic debris) embolisation. Two hundred and thirty-six consecutive patients (79% males, 32.7% symptomatic) were enrolled. Open cell stents were used in 52.7% of the patients, distal filters were employed in 85.5% and proximal protection in 14.5%. Procedural success was achieved in 100% of procedures. Relevant embolisation was observed in 16.1% of patients, including those who suffered all the periprocedural complications (4.2%). At multivariate statistical analysis, high circulating LDL cholesterol and C-reactive protein levels were the only factors associated with relevant embolisation.
CONCLUSIONS
In this study, high circulating LDL cholesterol and C-reactive protein levels were associated with relevant embolisation after CAS, opening up the hypothesis that therapy with statins before elective CAS may reduce plaque embolisation and improve outcome. (EudraCT number: 016737-95).
Topics: Aged; C-Reactive Protein; Carotid Stenosis; Cholesterol, LDL; Embolic Protection Devices; Embolism; Female; Humans; Male; Middle Aged; Risk Factors; Stents
PubMed: 25138189
DOI: 10.4244/EIJV10I4A88 -
Interventional Neuroradiology : Journal... Apr 2018Small and broad-necked aneurysms are generally very difficult to treat using endovascular therapy. The arrival of the low-profile stent (e.g., Low-profile Visualized... (Review)
Review
Utility of bulging technique for endovascular treatment of small and wide-necked aneurysms with a Low-profile Visualized Intraluminal Support (LVIS Jr.) device: A case report and review of the literature.
Small and broad-necked aneurysms are generally very difficult to treat using endovascular therapy. The arrival of the low-profile stent (e.g., Low-profile Visualized Intraluminal Support; LVIS) has enabled reconstructive treatment for these aneurysms. In addition, the bulging technique using LVIS is an effective and attractive technique for performing stent-assisted coiling to preserve parent arteries and achieve neck coverage. We report here a patient with a small and wide-necked ruptured basilar artery (BA) top aneurysm, in whom successful treatment was achieved by stent-assisted coiling with LVIS Jr. using the bulging technique. A 74-year-old woman with moderate hypertension consulted for treatment of subarachnoid hemorrhage with a ruptured BA top aneurysm measuring 2.7 mm in height with a 4.3 mm neck. We initially tried emergency balloon-assisted coiling, but coiling proved difficult. We therefore performed stent-assisted coiling with LVIS Jr. using the bulging technique. The postoperative course was uneventful, with no aggravation of neurological symptoms, and the patient was discharged 14 days postoperatively. This treatment strategy with LVIS Jr. using the bulging technique may be very useful for patients with a ruptured aneurysm with a small and broad neck that would otherwise require treatment with intravascular devices or open surgery.
Topics: Aged; Aneurysm, Ruptured; Basilar Artery; Cone-Beam Computed Tomography; Embolization, Therapeutic; Endovascular Procedures; Equipment Design; Female; Humans; Intracranial Aneurysm; Self Expandable Metallic Stents; Subarachnoid Hemorrhage
PubMed: 29160136
DOI: 10.1177/1591019917743065 -
Journal of Cancer Research and... 2020The objective of this study was to evaluate the degradation characteristics and embolic effect of gelatin microspheres (GMSs) produced domestically in China through an...
OBJECTIVE
The objective of this study was to evaluate the degradation characteristics and embolic effect of gelatin microspheres (GMSs) produced domestically in China through an experimental study comparing the embolization of rabbit renal arteries using GMSs and tris-acryl microspheres.
MATERIALS AND METHODS
Sixteen healthy adult New Zealand white rabbits were randomly divided into two groups. Group A was embolized with GMSs produced in China with a diameter of 150-200 μm (n = 8), and Group B was embolized with tris-acryl microspheres with a diameter of 100-200 μm (n = 8). The renal arteries were embolized through femoral artery puncture and catheterization. Renal artery angiography rechecks and hematoxylin and eosin staining of tissue sections were performed at 1 day, 4 days, 7 days, and 14 days after embolization, respectively, to observe vascular recanalization, degradation of microspheres, and embolic effect.
RESULTS
Group A: Digital subtraction angiography showed complete recanalization at 14 days. The changes in embolic necrotic areas at different time points after embolization were similar in the two groups. At 4 days after embolization, changes in glomerular structure were observed in the kidney on the embolic side. At 7 days after embolization, atrophy, degeneration, and necrosis of the glomeruli, as well as degeneration and inflammatory cell infiltration of the renal tubules, were observed in the kidney on the embolic side. At 14 days after embolization, extensive atrophy and hyalinization of the glomeruli were observed, and local renal tissue showed patchy fibrosis with calcification of internal tissue. Hyperplasia of fibrillar connective tissue was observed in the renal interstitium.
CONCLUSION
The GMSs produced domestically in China can be completely degraded after embolizing blood vessels for 14 days. The GMSs are similar to tris-acryl microspheres in arterial embolization effect and are safe and effective.
Topics: Angiography, Digital Subtraction; Animals; Catheterization, Peripheral; Embolization, Therapeutic; Femoral Artery; Gelatin; Microspheres; Models, Animal; Rabbits; Renal Artery
PubMed: 33565508
DOI: 10.4103/jcrt.JCRT_1065_19 -
Journal of Vascular Surgery Jun 2021Carotid artery aneurysms and pseudoaneurysms (extracranial carotid artery aneurysm [ECCAs]) are relatively rare. The gold standard treatment has historically been open...
OBJECTIVE
Carotid artery aneurysms and pseudoaneurysms (extracranial carotid artery aneurysm [ECCAs]) are relatively rare. The gold standard treatment has historically been open repair; however, there is increasing evidence of successful treatment of ECCAs with endovascular techniques. Our study examines the evolving experience with endovascular management of ECCAs at a tertiary care center.
METHODS
We performed a retrospective analysis of patients with ECCAs who underwent endovascular interventions at a single institution from 2010 to 2020. With increasing experience, the techniques evolved from covered stents to stent-assisted coil embolization and finally to braided stents and overlapping closed cell stents.
RESULTS
There were 18 ECCAs in 17 patients treated with endovascular modalities. The average age was 65.9 years. There were 11 males (64.7%). Seven aneurysms (38.9%) were symptomatic: three patients had painless pulsatile masses, three patients had painful pulsatile masses, and one had transient ischemia attacks. Two (11.1%) were treated with covered stents, 2 (11.1%) were treated with stent-assisted embolization, 2 (11.1%) were treated with flow-diverting braided stents, 10 (55.6%) were treated with overlapping bare metal stents, and 2 (11.1%) were treated with embolization or ligation alone. Technical success was achieved in all patients. The mean duration of follow up was 338 days (range, 8-3039 days). No perioperative or postoperative complications were encountered, including no neurologic deficits and no embolic events. All patients were discharged on postoperative day 1 or 2. All 16 stents (100%) retained vessel patency on follow-up imaging and exclusion of ECCAs was confirmed on postprocedure surveillance imaging.
CONCLUSIONS
Endovascular modalities for the management of ECCAs have evolved with experience. Our study suggests that endovascular management is technically feasible as well as clinically effective and suggests an algorithm for navigating the various treatment modalities.
Topics: Adult; Aged; Aged, 80 and over; Aneurysm; Aneurysm, False; Carotid Artery Diseases; Databases, Factual; Embolization, Therapeutic; Endovascular Procedures; Female; Humans; Male; Middle Aged; Retrospective Studies; Stents; Time Factors; Treatment Outcome
PubMed: 33098945
DOI: 10.1016/j.jvs.2020.06.133 -
AJNR. American Journal of Neuroradiology Sep 2020Impairment of macrophage polarization from a proinflammatory macrophage type 1 (M1) population to an anti-inflammatory macrophage type 2 (M2) population is a hallmark of...
BACKGROUND AND PURPOSE
Impairment of macrophage polarization from a proinflammatory macrophage type 1 (M1) population to an anti-inflammatory macrophage type 2 (M2) population is a hallmark of poor wound healing. In this study, we aimed to evaluate the distribution of M1 and M2 macrophages and to analyze their association with healing in aneurysms embolized by endovascular coiling.
MATERIALS AND METHODS
Elastase-induced aneurysms were created in female rabbits and subsequently embolized with platinum coils. Aneurysm occlusions were evaluated with angiographic imaging at 1 ( = 6), 3 ( = 5), or 6 ( = 6) months. Aneurysm tissues were harvested for histologic analysis, quantification of M1 and M2 macrophages by immunofluorescence, and collagen deposition determined by Masson trichrome staining. Histologic grading of aneurysm healing was also performed. Untreated aneurysms were used as controls ( = 6).
RESULTS
The M1 macrophage population was highest at 1 month posttreatment, progressively decreasing at 3 and 6 months. The M2 macrophage population progressively increased at 3 and 6 months posttreatment. The highest collagen deposition was at 6 months posttreatment. We found a moderate-to-weak direct correlation between the percentage of M2 macrophages and collagen deposition, as well as total histologic scores overall, and a strongly positive direct correlation between the percentage of M2 macrophages and total histologic scores at 6 months posttreatment.
CONCLUSIONS
Our data support the direct correlation between M2 macrophage polarization and healing in aneurysm tissues. Our results show a positive relationship between M2 macrophage populations and total histologic scores at later stages of healing after endovascular coiling. We conclude that interventions aimed at stimulating M2 macrophage expression locally may improve aneurysm healing after coil embolization.
Topics: Animals; Blood Vessel Prosthesis; Embolization, Therapeutic; Female; Intracranial Aneurysm; Macrophages; Platinum; Rabbits; Wound Healing
PubMed: 32816763
DOI: 10.3174/ajnr.A6719