Advances in endovascular aneurysm management: coiling and adjunctive devices

Campos, Jessica K.; Lien, Brian V.; Wang, Alice S; Lin, Li-Mei

doi:10.1136/svn-2019-000303

Cited by 35 publications

(21 citation statements)

References 41 publications

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“…The development of aneurysm clips and effective microsurgical techniques (163,164), pioneered in 1911 by Harvey Cushing's invention of the silver clip (165), significantly improved aneurysmal rebleeding rates. More recently, endovascular coiling has emerged as a less invasive alternative to surgical clipping: the aneurysm is accessed with a microcatheter and platinum coils are deployed into the aneurysm, stimulating the formation of a clot that permanently occludes the aneurysm (166,167). Although re-bleeding remains a significant risk for SAH patients (11), cerebrovascular constriction and ischemia has now become the primary cause of death and disability in SAH patients who survive the initial rupture (1,11,12).…”

Section: Clinical Interventions For Ischemia In Sahmentioning

confidence: 99%

Cerebral Autoregulation in Subarachnoid Hemorrhage

2021

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Subarachnoid hemorrhage (SAH) is a devastating stroke subtype with a high rate of mortality and morbidity. The poor clinical outcome can be attributed to the biphasic course of the disease: even if the patient survives the initial bleeding emergency, delayed cerebral ischemia (DCI) frequently follows within 2 weeks time and levies additional serious brain injury. Current therapeutic interventions do not specifically target the microvascular dysfunction underlying the ischemic event and as a consequence, provide only modest improvement in clinical outcome. SAH perturbs an extensive number of microvascular processes, including the “automated” control of cerebral perfusion, termed “cerebral autoregulation.” Recent evidence suggests that disrupted cerebral autoregulation is an important aspect of SAH-induced brain injury. This review presents the key clinical aspects of cerebral autoregulation and its disruption in SAH: it provides a mechanistic overview of cerebral autoregulation, describes current clinical methods for measuring autoregulation in SAH patients and reviews current and emerging therapeutic options for SAH patients. Recent advancements should fuel optimism that microvascular dysfunction and cerebral autoregulation can be rectified in SAH patients.

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Section: Clinical Interventions For Ischemia In Sahmentioning

confidence: 99%

Cerebral Autoregulation in Subarachnoid Hemorrhage

2021

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“…Flow diverter devices may be a feasible option in these cases. 7,8,12,17,18,22,23 In the current study, adjunctive balloon angioplasty was employed in 5 (5.2%) patients, while coiling of the aneurysmal sac was carried out in 12 (12.5%). Angioplasty was employed in 1 patient with an anterior cerebral artery dissecting aneurysm in whom the device had landed on the terminal internal carotid artery causing flow-limitation in the middle cerebral artery, which was described above.…”

Section: Discussionmentioning

confidence: 94%

“…4,5 Flow diverter devices thus expanded the interventionists' armamentarium and were found to be a safe and effective treatment; unlike coiling, the occlusion rates were better the longer the follow-up. 6,7 Though they are especially useful for unruptured aneurysms, they may also be of use for some ruptured subtypes, like blister-like aneurysms, in which they may be the mainstay therapy. 8 The treatment of aneurysms with characteristics such as complex morphology, fusiform, blister-like, wide neck, or large size has been revolutionized with the introduction of flow diverter stents.…”

Section: Introductionmentioning

confidence: 99%

“…Improved radio-opacity, the ability to resheath partially deployed devices and reduced thrombogenicity are a few of the advanced features with the newer devices, aiding easier and more accurate device deployment with reduced periprocedural complication rates. 7,12,15 The Derivo Embolization Device (DED) (Acandis, Pforzheim, Germany) belongs to the newer generation of devices and is claimed to be superior to the older devices.…”

Section: Introductionmentioning

confidence: 99%

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REtrospective Multicenter INdian Study of Derivo Embolization Device (REMIND): Periprocedural Safety

et al. 2021

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Purpose: The treatment of aneurysms with characteristics such as complex morphology, fusiform, blister-like, wide neck, or large size has been revolutionized with the introduction of flow diverters. Though flow diverters have several advantages over coiling, they also have certain important disadvantages such as the lack of immediate protection against rupture, the risk of ischemic stroke, the need for antiplatelet therapy, and long latency for complete effect. The Derivo Embolization Device (DED) is a second-generation self-expanding device that is claimed to be less thrombogenic than conventional devices. We retrospectively evaluated the periprocedural safety and risks associated with the Derivo Embolization Device across 5 centers in India.Materials and Methods: This is a multicentric, retrospective, observational study of DED, conducted at 5 high volume endovascular therapy centers in India from May 2018 to June 2020. Periprocedural demographic, clinical, and angiographic data were collected from a retrospective review of patient charts.Results: A total of 96 patients, including 56 (58.3%) females, aged between 16–80 years (60±12.7 years) harboring 106 aneurysms were studied. Seven (7.3%) were noted to harbor multiple aneurysms: 6 had 3 aneurysms each, while 1 patient had 5 aneurysms. The following aneurysm characteristics were noted: average size, 9.8±8.2 mm; average neck size, 6.9±8.5 mm; wide-necked (>4mm), 63 (59.4%); giant (>25mm), 8 (7.5%); and anterior circulation location, 98 (92.5%). Eighteen (17%) of these were ruptured. Additional balloon angioplasty was performed in 5 (5.2%) patients. Intraprocedural problems were encountered in 3 (3.1%), of which only 1 had clinical implications, the device fish-mouthing with stent thrombosis resulting in a malignant middle cerebral artery territory infarction. The modified Rankin scale at 3 months was worse in 1 patient.Conclusion: DED is a newer generation flow diverter stent with a low periprocedural complication rate.

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“…Several clinical studies and multicenter trials with long-term follow-up reported an aneurysm occlusion rate of 90–96% ( 28 – 30 ). In the present study, the 6-month follow-up DSA after coil treatment showed an aneurysm occlusion rate of up to 94.66% (i.e., RROC class I and class II) for patients assigned to the Avenir group and 96.95% for those in the Axium group.…”

Section: Discussionmentioning

confidence: 99%

Avenir® vs. AxiumTM Coils for the Treatment of Intracranial Aneurysms: Results of a Multicenter Randomized Controlled Trial With Short-Term Follow-Up

Cimpoca

et al. 2022

Front. Neurol.

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PurposeEndovascular coil occlusion is a successful and rapidly evolving strategy used to treat patients who present with intracranial aneurysms. This study aimed to compare the safety and efficacy of the Avenir® and AxiumTM passive mechanically detachable coil systems.MethodsA prospective, multicenter, randomized controlled study was carried out at ten medical centers from March 2018 to December 2019. A series of consecutive patients diagnosed with intracranial aneurysms were randomly assigned to undergo endovascular treatment with either the Avenir® or the AxiumTM mechanically detachable coil systems. The short-term outcomes from the two groups were compared with a focus on treatment efficacy and safety.ResultsA total of 162 and 161 patients were enrolled in the Avenir and Axium groups, respectively. The rate of successful coil detachment was 100% for the Avenir group and 99.38% for the Axium group. At the six-month follow-up visit, the overall aneurysm occlusion rate was 94.66% for the Avenir group and 96.95% for the Axium group (p > 0.05). We observed no statistically significant differences in clinical condition (as per the modified Rankin Scale) or the degree of aneurysm occlusion (as determined by digital subtraction angiography [DSA] and Raymond-Roy Occlusion Classification). Surgical complications were reported in 27 subjects in the Avenir group and 22 in the Axium group (p > 0.05). DSA performed at 6 months revealed complete aneurysm occlusion in 84 and 86% of patients in the Avenir and Axium groups, respectively.ConclusionWe observed no significant short-term differences with respect to efficacy or safety when using either Avenir® or AxiumTM coils for the treatment of intracranial aneurysms.

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Advances in endovascular aneurysm management: coiling and adjunctive devices

Cited by 35 publications

References 41 publications

Cerebral Autoregulation in Subarachnoid Hemorrhage

Cerebral Autoregulation in Subarachnoid Hemorrhage

REtrospective Multicenter INdian Study of Derivo Embolization Device (REMIND): Periprocedural Safety

Avenir® vs. AxiumTM Coils for the Treatment of Intracranial Aneurysms: Results of a Multicenter Randomized Controlled Trial With Short-Term Follow-Up

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