Effect of the Shelving Technique on the Outcome of Embolization in Intracranial Bifurcation Aneurysms

Çay, Ferdi; Arat, Anıl

doi:10.3174/ajnr.a7583

Cited by 3 publications

(4 citation statements)

References 31 publications

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“…In fact, in our study, the porosity of the shelfed ReSolv stent was equivalent to that of the Pipeline stent and higher than that of the unshelfed ReSolv stent, yet flow diversion was significantly improved. This implies that the shelf technique for bifurcation aneurysms is different from the compaction technique for sidewall aneurysms, and does not result in a higher metallic ratio at the neck as has been suggested 4. This also seems to indicate that neck coverage is more important than porosity for flow-diverting stents as a determinant of the flow diversion effect, and is in agreement with the suggestion that closing the free stent segment leads to optimal performance 24…”

Section: Discussionsupporting

confidence: 84%

“…The LVIS and Leo stents are intermediate porosity braided devices that can be deployed using a technique that creates a ‘shelf’ at the level of the neck in order to improve neck coverage 2 3. The maneuver required for the shelf technique of these intermediate porosity stents at the aneurysm neck has not been shown to improve the flow diversion effect, thus requiring dense coil packing in addition to stent placement 4…”

Section: Introductionmentioning

confidence: 99%

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In vitro flow diversion effect of the ReSolv stent with the shelf technique in a bifurcation aneurysm model

Belanger,

Morrish,

McClarty

et al. 2023

J NeuroIntervent Surg

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BackgroundFlow-diverting stents are not currently indicated for the treatment of bifurcation aneurysms, and some case series have demonstrated low occlusion rates, possibly due to a lack in neck coverage. The ReSolv stent is a unique hybrid metal/polymer stent that can be deployed with the shelf technique in order to improve neck coverage.MethodsA Pipeline, unshelfed ReSolv, and shelfed ReSolv stent were deployed in the left-sided branch of an idealized bifurcation aneurysm model. After determining stent porosity, high-speed digital subtraction angiography runs were acquired under pulsatile flow conditions. Time–density curves were created using two region of interest (ROI) paradigms (total aneurysm and left/right), and four parameters were extracted to characterize flow diversion performance.ResultsThe shelfed ReSolv stent demonstrated better aneurysm outflow alterations compared to the Pipeline and unshelfed ReSolv stent when using the total aneurysm as the ROI. On the left side of the aneurysm, there was no significant difference between the shelfed ReSolv stent and the Pipeline. On the right side of the aneurysm, however, the shelfed ReSolv stent had a significantly better contrast washout profile than the unshelfed ReSolv stent and the Pipeline stent.ConclusionsThe ReSolv stent with the shelf technique demonstrates the potential to improve flow diversion outcomes for bifurcation aneurysms. Further in vivo testing will help to determine whether the additional neck coverage leads to better neointimal scaffolding and long-term aneurysm occlusion.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

In vitro flow diversion effect of the ReSolv stent with the shelf technique in a bifurcation aneurysm model

Belanger,

Morrish,

McClarty

et al. 2023

J NeuroIntervent Surg

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“…In the most recent report on SAC treatment for WNBAs, the rates of complete occlusion during follow-up and procedure-related permanent morbidity were 80.8%–90.9% and 1.5%–8.6%, respectively. 17 – 19) Although these studies have shown favorable results, treatment of WNBAs in which both branches are involved in the neck can be very difficult using a single stent. In such cases, developmental techniques such as the waffle cone technique or Y-stent-assisted coiling may be applied.…”

Section: Stent-assisted Coilingmentioning

confidence: 99%

“…16) InthemostrecentreportonSACtreatmentforWNBAs, theratesofcompleteocclusionduringfollow-upandprocedure-related permanent morbidity were 80.8%-90.9% and1.5%-8.6%,respectively. [17][18][19] Althoughthesestudies have shown favorable results, treatment of WNBAs in which both branches are involved in the neck can be very difficultusingasinglestent.Insuchcases,developmental techniques such as the waffle cone technique orY-stentassistedcoilingmaybeapplied.Neck-bridgingstentsfor coil embolization not only provide a mechanical scaffolding effect but also lead to the development of flow-diverterstents,focusingontheflow-divertinghemodynamiceffect.…”

Section: Stent-assisted Coilingmentioning

confidence: 99%

Endovascular Treatment of Wide-Neck Bifurcation Aneurysm: Recent Trends in Coil Embolization with Adjunctive Technique

Haryu,

Sakata,

Matsumoto

et al. 2024

JNET

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Wide-neck bifurcation aneurysms (WNBAs) are sometimes challenging to treat. During endovascular treatment, it is important to prevent coil deviation and preserve normal vessels. Adjunctive balloon- and stent-assisted techniques have been developed. A meta-analysis of endovascular treatments of WNBAs revealed that only 40% of patients had complete occlusion. Recently, novel devices have been developed to expand the range of treatment options. Flow-diverter stents and intra-aneurysmal flow disruption devices do not require coils; however, coil embolization remains the standard procedure used by many neurointerventionists. This review describes the recent trends in adjunctive techniques for supporting coil embolization for WNBAs. We referred to literature on balloon-assisted techniques, stent-assisted techniques, Y-stenting, PulseRider, Barrel stents, Comaneci temporary stents, pCONUS, and eCLIPs. These reports showed that adequate embolization rates were generally greater than 80%, and the complete occlusion rate was as high as 94.6%. All devices had a relatively high occlusion rate; however, it may be inaccurate to simply compare each device because of the heterogeneity of the studies. It is important to select the best treatment for each individual case by considering not only literature-based efficacy and safety but also patient background, aneurysm characteristics, and operator experience.

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Enterprise 2 Stent-Assisted Embolization of Paraclinoid Aneurysms: A Single Center Preliminary Study

Wu¹,

Lai²,

Zhao³

et al. 2022

CIA

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Objective Enterprise stent has been widely used for assisted embolization in wide-necked aneurysms while delayed ischemia or thromboembolic complications for its incomplete stent apposition. The purpose of this study was to summarize and analyze the clinical experience of using Enterprise 2 (EP2) stent-assisted embolization in the treatment of paraclinoid aneurysms. Methods From January 2019 to December 2020, the clinical and imaging data of 98 patients with paraclinoid aneurysms treated with EP2 stent-assisted embolization were enrolled retrospectively. Preliminary experience and follow-up outcomes of EP2 stent-assisted embolization of paraclinoid aneurysms were assessed by using the Raymond grade and modified Rankin Scale. Results Of the 98 aneurysms, all stents were released satisfactorily. The immediate postprocedural angiography revealed a complete occlusion of the aneurysms with 77.55% of the (76/98) patients, and the last follow-up angiograms showed complete occlusion with 83.67% of the (82/98) patients. The average aneurysm size was (4.11 ± 1.25) mm, the aneurysm diameter was (4.41 ± 1.37) mm, the vessel radius was (3.87 ± 0.32) mm, the diameter at the distal of stent was (3.23 ± 0.21) mm, and the proximal was (4.18 ± 0.23) mm. Among the 98 aneurysms, 13 cases had incomplete stent apposition, 3 cases had intraoperative knotting, and the stents were improved post adjusted; 2 cases had vasospasm and 1 case had stenosis during operation, the symptoms were improved after symptomatic treatment. The result demonstrated that stent length and inner bending radius of parent artery were the pivotal factors affecting incomplete stent apposition (P < 0.01). Conclusion The EP2 stent for the treatment of paraclinoid aneurysms is safe and effective, however, the length of the stent and the inner bending radius of parent artery are important factors affecting incomplete stent apposition.

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Effect of the Shelving Technique on the Outcome of Embolization in Intracranial Bifurcation Aneurysms

Cited by 3 publications

References 31 publications

In vitro flow diversion effect of the ReSolv stent with the shelf technique in a bifurcation aneurysm model

In vitro flow diversion effect of the ReSolv stent with the shelf technique in a bifurcation aneurysm model

Endovascular Treatment of Wide-Neck Bifurcation Aneurysm: Recent Trends in Coil Embolization with Adjunctive Technique

Enterprise 2 Stent-Assisted Embolization of Paraclinoid Aneurysms: A Single Center Preliminary Study

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