Flow diversion of bifurcation aneurysms is more effective when the jailed branch is occluded: an experimental study in a novel canine model

Fahed, Robert; Gentric, Jean-Christophe; Salazkin, Igor; Gevry, Guylaine; Darsaut, T.E.

doi:10.1136/neurintsurg-2015-012240

Cited by 23 publications

(17 citation statements)

References 24 publications

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“…One explanation of the lower occlusion rate observed with flow diversion for bifurcation aneurysms might be the persistent flow through the covered braches incorporated by the aneurysm. Fahed et al ( 47 ) compared flow diversion with and without occlusion of the jailed branch in 14 wide-neck aneurysms induced in 8 canines and found that occlusion of the jailed branch resulted in better occlusion rates of aneurysmal occlusion. Patent aneurysms were associated with leaks or holes in the neo-intima covering the aneurysm neck.…”

Section: Discussionmentioning

confidence: 99%

Flow Diversion for the Treatment of MCA Bifurcation Aneurysms—A Single Centre Experience

et al. 2017

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BackgroundIntracranial aneurysms located at the bifurcation of the middle cerebral artery (MCA) can often be challenging for the neurointerventionalist. We aimed to evaluate the efficacy and safety of flow diverting stents (FDS) in the treatment of these aneurysms.Materials and methodsWe retrospectively reviewed our prospectively maintained database to collect information for all patients with unruptured saccular bifurcation MCA aneurysms treated with FDS between January 2010 and January 2016. In addition to demographic data, we recorded the location, aneurysm characteristics, previous treatments, number and type of FDS, complications, and clinical and angiographic follow-up.ResultsOur search identified 13 patients (7 males) with an average age of 61.7 years (47–74 years). All patients had a single bifurcation aneurysm of the MCA, and none of the aneurysms were acutely ruptured. The average fundus size of the saccular aneurysms was 3 mm (range 1.5–10 mm). Follow-up studies were available for 12 patients. Based on the most recent follow-up angiograms, six aneurysms (50%) were totally occluded; five aneurysms (41.7%) showed only a small remnant; and one aneurysm (8.3%) remained unchanged. One patient suffered from an ischemic stroke with resultant permanent hemiparesis (mRS 3). In another case, there was an in-stent thrombosis during the intervention, which resolved upon intra-arterial infusion of Eptifibatide (mRS 0). There were no intra-operative vessel or aneurysm ruptures and no mortalities. Angiography of the covered MCA branches showed no change in the caliber or flow of the vessel in six (50%), a reduction in caliber in five (41.7%), and a complete occlusion in one (8.3%). All caliber changes and occlusions of the vessels were asymptomatic.ConclusionIn our series, 91.7% of treated MCA bifurcation aneurysms were either completely occluded or showed only a small remnant with a good safety profile. Flow diversion of MCA bifurcation aneurysms should be considered as an alternative treatment strategy when microsurgical clipping or alternative endovascular treatment options are not feasible.

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Section: Discussionmentioning

confidence: 99%

Flow Diversion for the Treatment of MCA Bifurcation Aneurysms—A Single Centre Experience

et al. 2017

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“…The occlusion of aneurysms at branch points has also been investigated. Fahed et al 41 compared flow diversion with and without occlusion of the jailed branch in 14 wide neck aneurysms induced in 8 canines. They found that occlusion of the jailed branch resulted in better occlusion rates of aneurysmal occlusion whereas patent aneurysms were associated with less dense neointimal coverage and persistent holes in the neointima.…”

Section: Discussionmentioning

confidence: 99%

The Fate of Side Branches Covered by Flow Diverters–Results from 140 Patients

et al. 2017

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“…29 More complex aneurysm models have been constructed in canines. 5,[29][30][31] Some models were so challenging that aneurysms remained patent despite implantation of multiple flow diverters. 31,32 The complex fusiform aneurysms created in this work were larger than the standard rabbit elastase carotid model, but they remain of modest size compared with most canine vein pouch aneurysms.…”

Section: Discussionmentioning

confidence: 99%

“…2 A number of experimental aneurysm models are available to test neurovascular devices. [3][4][5] The most commonly used model is the rabbit elastase-induced saccular aneurysm model. [6][7][8][9] The model can be created by using endovascular techniques with low morbidity.…”

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confidence: 99%

Testing Stenting and Flow Diversion Using a Surgical Elastase-Induced Complex Fusiform Aneurysm Model

Fahed

Darsaut

Salazkin

et al. 2016

AJNR Am J Neuroradiol

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Flow diversion of bifurcation aneurysms is more effective when the jailed branch is occluded: an experimental study in a novel canine model

Abstract: Treatment failures following flow diversion of bifurcation aneurysms can be caused by persistent flow to the jailed branch. Branch occlusion combined with flow diversion may improve angiographic occlusion scores of a canine bifurcation aneurysm model.

Cited by 23 publications

References 24 publications

Flow Diversion for the Treatment of MCA Bifurcation Aneurysms—A Single Centre Experience

Flow Diversion for the Treatment of MCA Bifurcation Aneurysms—A Single Centre Experience

The Fate of Side Branches Covered by Flow Diverters–Results from 140 Patients

Testing Stenting and Flow Diversion Using a Surgical Elastase-Induced Complex Fusiform Aneurysm Model

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