Endovascular treatment of complex middle cerebral artery aneurysms using TuBridge flow diverters

Li, Feng; Yang, Yibing; Luo, Lijuan; Liao, Bingye; Ou, Siqi; Xiao, Weiping; Guo, Ning; Qi, Tao

doi:10.1177/1591019920946216

Cited by 16 publications

(8 citation statements)

References 30 publications

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“…As the final angiographic results of our study showed that the rate of complete occlusion (RROC 1) was 80.0% in the SAC group, which was similar to the main results of the last 10 years (from 70 to 88.9%) ( 15 – 21 ). In the LSM group, 90.3% of aneurysms in complete occlusion (OKM grade D) was the highest rate compared to the results from other LSM studies [70.0% ( 9 ), 73.7% ( 5 )], even higher than TuBridge flow diverters (50% in OKM grades D and C) ( 22 ) or a meta-analysis of flow-diverting stents (78.7% in complete/near complete occlusion) ( 23 ) in MCA. For complicated aneurysms, the two-stage operation is accepted due to the high risk of rupture during coiling ( 24 ).…”

Section: Discussionmentioning

confidence: 57%

Flow diversion effect of the leo braided stent for aneurysms in the posterior and distal anterior circulations: A multicenter cohort study

Duan

Xu²,

Qin³

et al. 2022

Front. Neurol.

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Background and purposeThe treatment of aneurysms located in the posterior and distal anterior circulations remains a challenge. Leo stents with a flow diversion (FD) effect may be a potential option, which needs to be clearly studied.MethodsFrom January 2016 to October 2021, 133 patients with 145 aneurysms in the posterior and distal anterior circulations, treated with Leo stents, were retrospectively analyzed in three neurosurgical centers. Data on demographic information, aneurysm characteristics, procedural outcomes, postoperative course, and aneurysm occlusion were retrospectively analyzed.ResultsAfter immediate surgery, 90 aneurysms (60.1%) were in complete occlusion [Raymond-Ray Occlusion Class (RROC) 1 and O'Kelly Marotta (OKM) grade D], 29 aneurysms (20%) in good occlusion (RROC 2 and OKM grade C), 17.9% in incomplete occlusion (RROC 3a or OKM grade B), and no aneurysms in invalid occlusion (RROC 3b and OKM grade A). A total of 112 patients with 117 aneurysms received angiographic follow-up (mean 11.4 months), and the degree of occlusion showed a significant improvement (Z = 3.900, p < 0.001). The complete occlusion rate increased to 84.6% (99/117), while good and incomplete occlusion decreased to 6.8% (8/117) and 8.6% (10/117), respectively. A total of 14 cases (10.5%) presented narrowing of the parent artery, and nine cases (6.8%) had injured side branches. Cerebral hemorrhage occurred in four patients (3.0%), and symptomatic ischemic infarction occurred in six patients (4.5%). The final permanent morbidity (mCS ≥3) and mortality were 2.8% (3/133) and 0.8% (1/133), respectively. For 82 aneurysms treated by stent-assisted with coiling (SAC), large-sized, ruptured aneurysms (χ2 = 7.767, p = 0.005) occurred. For 63 aneurysms treated by LEO stent monotherapy (LSM), multiple aneurysms, fusiform aneurysms (χ2 = 18.958, p < 0.01), and/or small-sized aneurysms (Z = −2.692, p = 0.007) occurred.ConclusionsLeo stents are safe and effective for aneurysms located in the posterior and distal anterior circulations. The overall degree of occlusion improved during a follow-up because of the FD effect of Leo stents. Aneurysms in these areas should be treated with personalized measures.

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Section: Discussionmentioning

confidence: 57%

Flow diversion effect of the leo braided stent for aneurysms in the posterior and distal anterior circulations: A multicenter cohort study

Duan

Xu²,

Qin³

et al. 2022

Front. Neurol.

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“…Only 4 subjects with posterior circulation aneurysms were included in this study and were not discussed in detail. Subsequently, the application of Tubridge has been reported in other different subtypes, such as recurrent aneurysms, middle cerebral artery aneurysms, and cavernous carotid artery aneurysms ( 17 , 25 , 26 ). The safety and the efficacy of using Tubridge in BA aneurysms have not been evaluated.…”

Section: Discussionmentioning

confidence: 99%

Use of flow diverter device in basilar artery for aneurysm treatment: Case series and literature review

Wang

Zhu²,

Xu³

et al. 2022

Front. Neurol.

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BackgroundFlow diverters (FDs) for the treatment of basilar artery (BA) aneurysms remain controversial. In this study, we report our initial experience of flow diversion for treatment of this pathology.MethodsConsecutive patients with an aneurysm of the BA that was treated by implantation of the FD were included in our retrospective study. Procedural complications, aneurysm occlusion, and a functional outcome were evaluated. FD placement in BA for aneurysm treatment reported in the literature was also reviewed and summarized.ResultsSixteen patients with 16 BA aneurysms were treated by FD implantation with (n = 8) or without (n = 8) adjunctive coiling. The Tubridge was used in 13 (81.3%) and Pipeline in 3 (18.8%) procedures. Average aneurysm size was 15.7 mm. Four aneurysms were located at the basilar apex, six at the basilar trunk, and six at the vertebrobasilar junction. Three patients experienced procedural complications (18.8%), including two ischemic strokes and one hydrocephalus, with resultant mortality in one case (6.3%). Median follow-up was 7.7 months and available for 15 aneurysms. Complete/near-complete occlusion was seen in 13 (86.7%) aneurysms.ConclusionIn our initial experience, flow diversion is feasible and safe in the treatment of BA aneurysms with promising occlusion rates at mid-term follow-up. Larger cohort studies are required to validate these results.

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“…Their conclusion was that telescoping flow diverters showed low perioperative complications and high aneurysm occlusion rate when treating complex intracranial aneurysms. Liang et al [ 13 ] reported the treatment of 8 complex middle cerebral artery aneurysms using the Tubridge device, with no intra-procedural complications, no morbidity or mortality at a mean follow-up of 11.3 ± 3.6 months, suggesting safety and efficacy of endovascular treatment of the middle cerebral artery aneurysms using the Tubridge flow diverter. Because the Tubridge device is still at the initial stage of clinical application, most studies are only composed of a small series of patients as demonstrated in the above studies.…”

Section: Discussionmentioning

confidence: 99%

“…The device has platinum-iridium radiopaque microfilaments which can improve visualization of the device during endovascular treatment. [11][12][13][14][15] The PARAT clinical trial investigating the clinical effect of the Tubridge device in managing large or giant unruptured cerebral aneurysms in multiple centers reported a 75.34% rate of complete aneurysm occlusion at 6 months of follow-up, which was significantly greater than that for stent-assisted coiling (24.53%). [11] The Tubridge device has different design concept, releasing manner, and sizes, and it may have different endovascular performance in treating intracranial aneurysms compaed with other flow diverting devices.…”

Section: Introductionmentioning

confidence: 99%

Effect and safety of Tubridge flow diverter in the treatment of unruptured intracranial aneurysms

Shao

et al. 2022

Medicine

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The effect and safety of the Tubridge flow diverting device are unknown in the treatment of intracranial aneurysms after optimization of the device, improvement in the deployment of the device, and accumulation of experience of using the device. This retrospective one-center study was performed to investigate the clinical effect and safety of the Tubridge flow diverting device in the treatment of unruptured intracranial aneurysms. Twenty-three patients with 33 unruptured intracranial aneurysms which were treated with the Tubridge device were retrospectively enrolled. The clinical data, endovascular procedure, complications, and follow-up were analyzed. Twenty-seven Tubridge devices were deployed to treat the 33 aneurysms, and the deployment was failed in 1 case, resulting in the success stenting rate of 96.3%. In 5 (15.2%) aneurysms, coils were loosely packed. Peri-procedural complications occurred in 2 patients (8.7%), including 1 procedure-related complication in which the distal end of a Tubridge device herniated into the aneurysm cavity. In another case, weakness of left upper limb occurred on the second day post procedure, with instent thrombosis being suspected, which was recovered after medication. No other complications occurred. Twenty-three (100%) patients had clinical follow-up 6 months later, with the mRS of 0 in 21 patients, 1 in 1, and 2 in 1. Five (21.7%) patients with 11 aneurysms underwent digital subtraction angiography at 6-month follow-up, with 8 aneurysms being completely occluded (Raymond grade I) and 3 aneurysms still visible (Raymond grade III). The Tubridge flow diverter may be safe and effective in the treatment of unruptured intracranial aneurysms with low perioperative complications and good follow-up outcomes even though multi-center and prospective clinical studies with a large size sample are still needed to validate these results.

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Endovascular treatment of complex middle cerebral artery aneurysms using TuBridge flow diverters

Cited by 16 publications

References 30 publications

Flow diversion effect of the leo braided stent for aneurysms in the posterior and distal anterior circulations: A multicenter cohort study

Flow diversion effect of the leo braided stent for aneurysms in the posterior and distal anterior circulations: A multicenter cohort study

Use of flow diverter device in basilar artery for aneurysm treatment: Case series and literature review

Effect and safety of Tubridge flow diverter in the treatment of unruptured intracranial aneurysms

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