Development of New Endovascular Devices for Aneurysm Treatment

Jia, Zhen; Shi, Hai; Miyachi, Shigeru; Hwang, Sun Moon; Sheen, Jae Jon; Yun, Seok-Kweon; Kim, Joong-Goo; Lee, Deok Hee; Suh, Dae Chul

doi:10.5853/jos.2017.02229

Cited by 21 publications

(17 citation statements)

References 43 publications

(80 reference statements)

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“…Though, compared to its counterparts in other intracranial locations, the A1 aneurysm often presents a more complicated entity during EVT, the development of some new devices might help to simplify the treatment [72]. Among these new devices, flow-diverting device (FDD) and the Woven EndoBridge (WEB, Sequent Medical, Aliso Viejo, California, USA) device are the most promising devices [73].…”

Section: New Technique For A1 Aneurysmsmentioning

confidence: 99%

Endovascular treatment for aneurysms at the A1 segment of the anterior cerebral artery: current difficulties and solutions

Hou

Guo

et al. 2020

Acta Neurol Belg

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Aneurysms located at the A1 segment of the anterior cerebral artery are considered rare and unique entities. Endovascular treatment (EVT) is effective in preventing aneurysmal bleeding. However, EVT for A1 aneurysms is difficult due to their distinctive configurations. A current review of EVT for A1 aneurysms is lacking. Therefore, we focused on the available literature on this specific issue. To more clearly expound this entity, we also provided some illustrative cases. The A1 segment can be equally divided into the proximal, middle, and distal segments. Proximal aneurysms are most common and difficult to treat via EVT. The A1 segment has a complex anatomy and many important branches. Due to the small size, predominant posterior direction, and sharp upturn of the microcatheter from the parent artery, microcatheter positioning and support is difficult for A1 aneurysms. EVT for A1 aneurysms mainly includes reconstructive and deconstructive strategies. The complications of EVT for A1 aneurysms include aneurysmal perforation, thromboembolic events, and coil protrusion related to stent-assisted embolization. A1 aneurysms represent rare and difficult vascular lesions. EVT is quite challenging for A1 aneurysms due to their distinctive configurations. The outcomes are acceptable.

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Section: New Technique For A1 Aneurysmsmentioning

confidence: 99%

Endovascular treatment for aneurysms at the A1 segment of the anterior cerebral artery: current difficulties and solutions

Hou

Guo

et al. 2020

Acta Neurol Belg

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“…Although the use of flow diverters and adjunctive devices has increased in recent years, detachable coils remain the mainstay approach in the endovascular treatment of intracranial aneurysms (1–5). In a study of unruptured intracranial aneurysms, ~60% of anterior circulation aneurysms were 6 mm or less, with 17% prevalence of aneurysms sizes between 1–3 mm and 43% in 4–6 mm in size range (6).…”

Section: Introductionmentioning

confidence: 99%

TARGET® Intracranial Aneurysm Coiling Prospective Multicenter Registry: Final Analysis of Peri-Procedural and Long-Term Safety and Efficacy Results

et al. 2019

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Background and Purpose: To describe the final results of the TARGET Registry, a multicenter, real-world study of patients with intracranial aneurysms treated with new generation TARGET Coils. Methods: The TARGET Registry is a prospective, single-arm study with independent medical event monitoring and core-lab adjudication. Patients with de novo intracranial aneurysms were embolized with either TARGET-360° or helical coils in 12 US centers. The primary outcome was aneurysm packing density (PD), which was assessed immediately post-procedure. The secondary outcomes were immediate and long-term aneurysm occlusion rate using the Raymond Scale, and independent functional outcome using the modified Rankin Scale (mRS). A secondary analysis investigated the influence of the use of 100% 360-complex coils on clinical and angiographic outcomes. Results: 148 patients with 157 aneurysms met the inclusion and exclusion criteria. 58 (39.2%) patients with ruptured and 90 (61.8%) with unruptured aneurysms were treated using TARGET 360°, helical Coils, or both. Median age was 58.3 (IQR 48.1–67.4), 73% female, and 71.6% were Caucasian. Median follow-up time was 5.9 (IQR 4.0–6.9) months. The majority were treated with TARGET 360-coils (63.7%), followed by mixed and helical coils only. Peri-procedural morbidity and mortality was seen in 2.7% of patients. A good outcome at discharge (mRS 0–2) was seen in 89.9% of the full cohort, and in 84.5 and 93.3% in the ruptured and unruptured patients, respectively. The median packing density was 28.8% (IQR 20.3–41.1). Long-term complete and near complete occlusion rate was seen in 90.4% of aneurysms and complete obliteration was seen in 66.2% of the aneurysms. No significant difference in clinical and angiographic outcomes were noted between the pure 360-complex coiling vs. mixed 360-complex/Helical coiling strategies. In a multivariate analysis, predictors for long-term aneurysm occlusion were aneurysm location, immediate occlusion grade, and aneurysm size. The long-term independent functional outcome was achieved in 128/135 (94.8%) patients and all-cause mortality was seen in 3/148 (2%) patients. Conclusion: In the multicenter TARGET Registry, two-thirds of aneurysms achieved long-term complete occlusion and 91.0% achieved complete or near complete occlusion with excellent independent functional outcome. Clinical Trial Registration: www.ClinicalTrials.gov , identifier: NCT01748903

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“…The technical success ranges between 92.9% and 98.7%, but the satisfactory occlusion rate of the late follow-ups ranges from 80% to 82%. 11 Recently, another available option for broad based aneurysms is the eCLIPs device. It provides a flow diversion effect along the aneurysm neck as well as bridging properties for further embolisation.…”

Section: Discussionmentioning

confidence: 99%

Using the pCANvas neck-bridging device in treating a wide-necked aneurysm of the basilar tip

et al. 2019

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Background and importance The endovascular treatment of recurrent wide-necked bifurcation aneurysms at the basilar tip remains very challenging. Many different techniques and devices have emerged in recent years as potential options but results remain less than controversial. The pCANvas is a relatively new device wielding neck-bridging properties with a haemodynamically active membrane acting as blood flow disrupter. Clinical presentation We present the clinical case of a patient in whom multiple endovascular and microsurgical attempts failed to achieve the definitive treatment of a large and wide-necked basilar tip aneurysm. The patient underwent successful endovascular implantation of the novel pCANvas device across the recurrent aneurysm neck. The device limited the blood flow to the anerysmal lumen and thus promoted faster thrombosis. Third month follow-up confirmed complete obliteration of the aneurysm. Conclusion The application of the pCANvas device offers a potential treatment option in difficult and recurrent aneurysms. The endovascular flow disruption is a relatively new feature aiming to create conditions for intraluminal thrombosis and is certainly promising for the treatment of complex bifurcation aneurysms.

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Development of New Endovascular Devices for Aneurysm Treatment

Cited by 21 publications

References 43 publications

Endovascular treatment for aneurysms at the A1 segment of the anterior cerebral artery: current difficulties and solutions

Endovascular treatment for aneurysms at the A1 segment of the anterior cerebral artery: current difficulties and solutions

TARGET® Intracranial Aneurysm Coiling Prospective Multicenter Registry: Final Analysis of Peri-Procedural and Long-Term Safety and Efficacy Results

Using the pCANvas neck-bridging device in treating a wide-necked aneurysm of the basilar tip

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