posterior circulation intracranial aneurysms. Previous studies demonstrated high rates of successful aneurysm occlusion and a favorable safety profile. Location specific results are needed to guide treatment decision making. However, it is unclear whether there are specific differences in safety and efficacy outcomes between carotid and more distal anterior circulation aneurysms. Methods The ATLAS IDE trial was a prospective, single arm, independently adjudicated, multicenter study that evaluated the safety and efficacy of the Neuroform Atlas Stent System. We compare differences in efficacy and safety outcomes of proximal internal carotid artery (ICA) versus distal and bifurcation anterior circulation aneurysms. Primary effectiveness endpoint: complete aneurysm occlusion without clinically significant stenosis or retreatment. Primary safety endpoint: rate of major ipsilateral stroke (increase in NIHSS score !4) or neurological death.Results Of the 202 anterior circulation participants enrolled, 182 patients composed the modified intention to treat cohort and were included in the analysis. Proximal subgroup included 70 (38.5%) aneurysms located at the internal carotid artery (ICA) and 112 (61.5%) at the distal anterior circulation (including ICA terminus/bifurcation). Patients from proximal aneurysm subgroup were more likely to be younger (57.4 vs. 62.1, p=.03), female (85.7% vs. 65.2%, p=.006), and to have larger parent vessel diameters (p<.0001). At one-year follow-up, there were no significant differences in the primary efficacy endpoint (85.5% vs. 83.9%, p=0.78), complete aneurysm occlusion rates (88.7% vs. 87.9%, p=0.78), recanalization rates (6.5% vs. 5.4%, p=0.76), and incidence of retreatment (2.9% vs. 4.5%, p=.55) between proximal ICA aneurysms and distal aneurysms, respectively. While it appeared that the distal group had a higher complication rate, the result was not statistically significant (6.3% vs. 1.4%, p=0.14). Conclusion Based on these findings of the ATLAS IDE trial, the Neuroform Atlas Stent System is a safe and efficacious treatment modality for unruptured anterior circulation intracranial aneurysms in both proximal and distal, bifurcation aneurysms. Additional, studies are needed to assess complication rates in larger populations. This may have important implications for the selection of treatment modalities for intracranial aneurysms.
ConclusionsThe results show that increasing packing density has a predictable effect on biologically relevant metrics calculated via computational fluid dynamics with particle tracking. These changes are thought to reflect alterations in the biomechanical microenvironment that promote stable thrombus formation, which is critical for the success of endovascular therapies. Our results suggest that the maximal hemodynamic effects of packing density may be achieved near a 33.3% threshold.
period, with 738 CAS procedures in 632 patients included after exclusion criteria. Overall restenosis rate was 17%, with a 14% restenosis rate at 2 years-time. Multivariable analysis demonstrated former/current smoking status (OR=2.1 [95%CI 1.2-3.9]), moderate contralateral stenosis (OR 3.0 [95%CI 1.4-6.7]), severe contralateral stenosis (OR3.0 [1.4-6.3]), and residual stenosis (OR 454 [95% 85-2413]) were associated with restenosis. AUC for the multivariable model was 0.78. Cutpoint degree for residual stenosis was ~30%, where there was a 9% and 35% rate of restenosis in those less than, and greater than, 30% residual stenosis, respectively (figure 1). Conclusion We present the largest single-center data in the US to date on carotid artery stenosis treated with CAS, and factors associated with restenosis. Residual in-stent carotid stenosis and smoking history were independent predictors. Maximizing treatment of initial stenosis within stent for carefully selected patients and aggressive smoking cessation education are important steps in preventing future carotid restenosis.
Introduction In 2003, Higashida et al. proposed the Thrombolysis in Cerebral Infarction (TICI) scale to standardize grading of angiographic outcomes after ischemic stroke intervention. Grades 0-3 represent a spectrum from no perfusion to complete perfusion and are routinely documented after mechanical thrombectomy (MT). Although a TICI score of 3 is the best angiographic outcome, not all TICI 3 patients have Abstracts
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