Intrasaccular flow disruption (WEB) of a large wide-necked basilar apex aneurysm using PulseRider-assistance

Narsinh, Kazim; Caton, M Travis; Mahmood, Nausheen F.; Higashida, Randall T.; Halbach, Van V.; Hetts, Steven W.; Amans, Matthew R; Dowd, Christopher F.; Cooke, Daniel L

doi:10.1016/j.inat.2020.101072

Cited by 7 publications

(3 citation statements)

References 23 publications

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“…These devices are metal mesh spheres that work by volumetrically filling the aneurysm, thus achieving roles as both a flow diverter and coil [ 73 ]. One such device, the Woven EndoBridge (WEB) (Microvention, Aliso Viejo, CA, USA), has been demonstrated to be effective in ruptured aneurysms and may only require SAPT with aspirin [ 74 ]. WEB is currently the only intrasaccular device approved in the USA and is indicated for use in wide-necked bifurcation aneurysms [ 73 ].…”

Section: Discussionmentioning

confidence: 99%

Trends in Dual Antiplatelet Therapy Use for Neurointerventional Procedures for the Management of Intracranial Aneurysms

et al. 2023

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The use of periprocedural dual antiplatelet therapy (DAPT) has significantly evolved along with innovations in the endovascular management of intracranial aneurysms. Historically, aspirin and clopidogrel have been the most commonly employed regimen due to its safety and efficacy. However, recent studies highlight the importance of tailoring DAPT regimens to individual patient characteristics which may affect clopidogrel metabolism, such as genetic polymorphisms. In the present report, a systematic review of the literature was performed to determine optimal antiplatelet use with flow diverting stents, intracranial stents, intrasaccular devices, and stent-assisted coiling. Studies were analyzed for the number of aneurysms treated, DAPT regimen, and any thromboembolic complications. Based on inclusion criteria, 368 studies were selected, which revealed the increasing popularity of alternative DAPT regimens with the aforementioned devices. Thromboembolic or hemorrhagic complications associated with antiplatelet medications were similar across all medications. DAPT with ticagrelor, tirofiban, or prasugrel are effective and safe alternatives to clopidogrel and do not require enzymatic activation. Further clinical trials are needed to evaluate different antiplatelet regimens with various devices to establish highest-level evidence-based guidelines and recommendations.

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Section: Discussionmentioning

confidence: 99%

Trends in Dual Antiplatelet Therapy Use for Neurointerventional Procedures for the Management of Intracranial Aneurysms

et al. 2023

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“…22 There are also varying approaches for filling the aneurysm after deployment of the device, such as reports of neck-bridging devices being used in conjunction with intrasaccular flow diverters as opposed to coils. 23 Further intriguing developments in the treatment of wide-necked aneurysms include the use of hybrid devices such as the Medina embolization device, which combines the morphologies of coils and intrasaccular flow disrupters into a single instrument. 24,25 Both dual microcatheter jailing and sequential microcatheter techniques were used to perform pCONUS 2 assisted coiling in this dataset.…”

Section: Discussionmentioning

confidence: 99%

pCONUS 2 and pCONUS 2-HPC for the treatment of wide-necked intracranial aneurysms: Periprocedural, 6-month, and early 2-year follow-up outcomes

Yeomans

Sastry

2021

Interv Neuroradiol

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Background/Purpose pCONUS 2 and pCONUS 2-HPC are novel neck-bridging devices designed to support endovascular coil occlusion of wide-necked intracranial bifurcation aneurysms. This study summarises periprocedural outcomes, 6-month, and early 2-year follow-up results following its introduction in an interventional neuroradiology centre. Materials/Methods This prospective, single-arm study assessed 20 aneurysms treated over a 40 month time period from time of procedure to 2 years post-procedure. Data collected included patient demographics, aneurysm features, and intraprocedural, 6-month, and 2-year post-procedural complications and angiographic features. Results The mean age of the cohort was 59+-SD 7.7 years. 16 unruptured aneurysms were treated (pCONUS 2 13/16, pCONUS 2-HPC 3/16) and 4 ruptured aneurysms were treated with pCONUS 2-HPC. Unruptured cases received dual antiplatelet therapy pre- and post-procedure while ruptured cases received single antiplatelet therapy. 9/20 aneurysms were located at the MCA bifurcation and 7/20 at the basilar tip. The remaining 4 aneurysms were at various bifurcations in the anterior circulation. 11/20 were small (<10mm) and 9/20 were large (10–25mm). There was one periprocedural complication: a retroperitoneal bleed. There were no post-procedural intracranial complications or at 6-months follow-up. At 6 months, satisfactory occlusion was achieved in 94% of cases (15/16). There was one delayed death at 2-year follow-up from an unrelated cause. Conclusion pCONUS 2 and pCONUS 2-HPC have excellent short and medium-term safety profiles and clinical outcomes with no procedure-related mortality or morbidity and good occlusion rates at 6-month follow-up. The use of pCONUS 2-HPC with single antiplatelet therapy is feasible and did not cause any complications.

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“…However, managing apical basilar artery aneurysms and main basilar artery aneurysms presents challenges, often resulting in complications, residual aneurysms, or the need for retreatment following surgical clipping or endovascular treatment. [8,9] . Because of the mortality and morbidity related to its treatment, the benefits of treating these aneurysms must outweigh the potential complication risks, so the evaluation of the risk of rupture is crucial to determine the treatment for unruptured basilar artery aneurysms.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the Risk of Basilar Aneurysm Rupture Based on CTA Morphological Parameters

Zhang,

Chen

2023

JCNR

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Objective: To investigate morphological risk factors of basilar aneurysm rupture based on computer tomography angiography (CTA) parameters. Materials and methods: The clinical and CTA data of 43 patients with basilar aneurysm admitted to Shaanxi Provincial People’s Hospital from January 2015 to July 2023 were analyzed. The patients were divided into “ruptured group” and “unruptured group,” and the morphological parameters of aneurysms were measured. The general data and morphological parameters between the two groups were statistically analyzed. Logistic regression was used to analyzed statistically significant parameters, and the receiver operating characteristic curve was drawn to evaluate its diagnostic effectiveness. Results: Irregular aneurysms were more likely to rupture than regular aneurysms (x² = 13.971, P < 0.05). The maximum diameter (4.92 [3.37–6.94] mm), length-width ratio (1.31 [1.14–1.55]), height (4.08 [2.71–5.34] mm), aspect ratio (0.99 [0.84–1.45]), and inflow angle (133.63 ± 11.21°) of aneurysms in the ruptured group were larger than the unruptured group, and the differences were statistically significant (P < 0.05). Binary logistic regression showedthat aneurysm shape (OR = 39.347, P = 0.021), length-width ratio (OR = 313.062, P = 0.033), and inflow angle (OR = 1.156, P = 0.004) were independent risk factors for rupture. The area under the curve were 0.809, 0.842. and 0.894, respectively. Conclusion: Aneurysm shape, aspect ratio, and blood flow incidence angle are independent risk factors for basilar aneurysm rupture, which means that they can be used to predict the risk of rupture to a certain extent.

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Intrasaccular flow disruption (WEB) of a large wide-necked basilar apex aneurysm using PulseRider-assistance

Cited by 7 publications

References 23 publications

Trends in Dual Antiplatelet Therapy Use for Neurointerventional Procedures for the Management of Intracranial Aneurysms

Trends in Dual Antiplatelet Therapy Use for Neurointerventional Procedures for the Management of Intracranial Aneurysms

pCONUS 2 and pCONUS 2-HPC for the treatment of wide-necked intracranial aneurysms: Periprocedural, 6-month, and early 2-year follow-up outcomes

Analysis of the Risk of Basilar Aneurysm Rupture Based on CTA Morphological Parameters

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