BACKGROUND AND PURPOSE:Incomplete occlusion and recanalization of large and wide-neck brain aneurysms treated by endovascular therapy remains a challenge. We present preliminary clinical and angiographic results of an experimentally optimized Surpass flow diverter for treatment of intracranial aneurysms in a prospective, multicenter, nonrandomized, single-arm study.
Background The Silk Vista Baby (SVB) flow diverter (FDS) is the only FDS deliverable via a 0.017 inch microcatheter and is specifically designed for the distal vasculature. We sought to evaluate the safety and efficacy of the SVB. Materials and Methods We performed a retrospective review to identify SVB cases at 4 tertiary neurosurgical centres within the U.K. Clinical, procedural, angiographic and follow-up data were collected. Results We identified 60 patients (35 female, 58%) of average age 54 ± 10.5 (range 30–72) with 61 aneurysms, 50 (81.9%) located in the anterior circulation. The majority of the aneurysms treated were unruptured (46, 75.4%) and saccular (46, 75.4%). Dome size was 6.2 ± 6.2 mm (range 1–36mm) and parent vessel diameter was 2.3 ± 0.4 mm (range 1.2-3.3 mm). An average number of 1.07 devices were implanted. Coils or other devices were implanted in 14 aneurysms (23.3%). At last angiographic follow-up (n = 55), 7.5 ± 4.2 months post-procedure, 32 aneurysms (57.1%) were graded as RRC I, 7 (12.5%) RRC II, and 17 RRC III (30.4%). Clinical complications, excluding death, were seen in 4 patients (6.8%) including 1 delayed aneurysm rupture and 3 symptomatic ischaemic events. Only one patient had permanent morbidity (mRS 1). 3 patients died during follow-up (5.1%); 2 deaths were related to the aneurysms (3.4%) – one ruptured dissecting MCA aneurysm, and one giant partially thrombosed posterior circulation aneurysm. 93% of patients were mRS ≤ 2 at last follow-up. Conclusion The SVB has high rates of technical success and an acceptable safety profile. Distal aneurysms may occlude slower due to relative oversizing of the devices.
Background: Mechanical thrombectomy has revolutionised the treatment of acute ischaemic stroke due to large vessel occlusion. It is well recognised that patients are more likely to benefit when reperfusion happens quickly, however, there is uncertainty as to how best to deliver this service. Objectives: To compare outcomes of patients in Northern Ireland who underwent thrombectomy via direct admission to the single endovascular centre (mothership [MS]) with those transferred from primary stroke centres (drip-and-ship [DS]). Methods: Analysis was conducted on the records of all patients who underwent thrombectomy from January 2014 to December 2017 inclusive. The primary outcome measure was 3 months functional independence (modified Rankin Score [mRS] 0–2). Secondary outcome measures were full recovery (mRS 0) at 3 months, symptomatic intracranial haemorrhage (sICH) rates and mortality rates. Results: Two hundred fourteen patients underwent thrombectomy (MS 124, DS 90). Patients in the MS group were older (median 73 vs. 70 years, p = 0.026), but there was no significant difference in baseline National Institutes of Health Stroke Scale (median 15 MS vs. 16.5 DS, p = 0.162) or thrombolysis rates (41.9% MS vs. 54.4% DS, p = 0.070) between the groups. Time from stroke onset to arrival at thrombectomy centre was shorter in the MS group (median 71 vs. 218 min, p < 0.001) but door to groin puncture time was shorter in the DS group (median 30 vs. 60 min, p < 0.001). There was no significant difference in 3 months functional independence (51.6% MS vs. 62.2% DS, p = 0.123), or in the secondary outcome measures of full recovery (21.8% MS vs. 12.2% DS, p = 0.071), sICH (MS 0.8%, DS 4.4%, p = 0.082) and mortality (MS 24.2%, DS 20.0%, p = 0.468). Conclusions: Our analysis showed similar outcomes after thrombectomy in the MS and DS groups. For patients potentially eligible for thrombectomy, rapid access to the endovascular centre is essential to optimise both the number of patients treated and the outcomes achieved.
Study findings indicate fewer cognitive deficits following endovascular coiling. Cognitive deficits in the clipped group may be due in part to the invasive nature of neurosurgical clipping. Further prospective research with regard to long-term cognitive and emotional outcomes is warranted. IMPLICATIONS OF REHABILITATION: • Treatment of ruptured intracranial aneurysms by either endovascualar coiling or neurosurgical clipping can result in significant long-term physical disability as well as cognitive impairment. • Observed cognitive impairment(s) tend to be less in patients following endovascular coiling. • Following ruptured aneurysm, patients with cognitive impairment report reduced health related quality of life and increased anxiety. • Those with identified cognitive impairment(s) may benefit from cognitive remediation.
Objectives Validated through in vitro and in vivo experimental studies a new generation of flow diverters (Surpass™ FD) was evaluated for treatment of intracranial aneurysms (IA). We present our multicentre preliminary clinical and angiographic experience. Methods To achieve the calculated flow disruption between the parent artery and aneurysm, needed for a saccular thrombosis, single FDs, tailored to local haemodynamics, were placed endovascularly in parent arteries and bridging the aneurysm. Implants measured 2.5-5.3mm in diameter with a length of10–80mm. Enrolled were patients harbouring a wide range of non-acutely ruptured large and giant wide-neck, fusiform and multiple small aneurysms, blister-type aneurysms and aneurysms associated with segmental artery disease. All patients were pretreated with dual antiplatelet for at least 72 hours before surgery and continued on both agents for at least 3 months after treatment. Clinical and angiographic follow-up were typically performed at 1–3, 6, and 12 months. Results A total of 186 consecutive IA in 161 patients (mean age 57.1 years, range 28–82 years; 71% female) were treated at 23 centres. Fifty-three aneurysms were smaller than 5 mm, 64 were 5–9.9mm in diameter, 47 were10–20mm in diameter, and 22 were larger than 20mm (aneurysm diameter 10.4 ± 0.7mm, neck size 6.0 ± 0.5mm [mean ± SEM]). The aneurysms originated in 63.4% of the cases from the internal carotid artery; in 22% and 14.5% of the cases they were located in the anterior circulation distal to Circle of Willis and posterior circulation respectively. Technical success was achieved in 182 aneurysms (98%); incorrect FD placement with partial aneurysm coverage was observed in 5 aneurysms (2.7%). FDs were placed over 4 previously placed stents for coil embolisation; average number of devices used per aneurysm was 1.05. Permanent morbidity and mortality during the follow-up period of 8.7 months (range 1–24 months) including periprocedural complications were encountered in 5/134 (3.7%) and 2/134 (1.5%) of patients, respectively, within aneurysms of the anterior circulation; and 1/27 (3.7%) and 4/27 (14.8%) of patients, respectively, with posterior circulation aneurysm (one patient died from cancer, two patients died of pneumonia). Ninety-seven patients (60%) with 112 aneurysms were available for clinical and angiographic follow-up. Progressive thrombosis with complete occlusion was seen in 71% of aneurysms of the anterior circulation and 64% of aneurysms located distal to Circle of Willis and in 72% of aneurysms of the posterior circulation and included cases with improper device placement or FD covering previous stents. Occlusion in the range of range 95–100% was seen in 79%, 68% and 89% of aneurysms of the anterior circulation, aneurysms located distal to Circle of Willis and posterior circulation respectively. Conclusion Preliminary data demonstrate high safety and effectiveness profile of a new generation of FD for a wide range of IA of the anterior and posterior circulation without the need for coil...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.