Paradigm Shift of Endovascular Therapy after Clinical Introduction of a Flow Diverter for Large Intracranial Aneurysms

Oishi, Hidenori; Teranishi, Kosuke; Yatomi, Kenji; Yamamoto, Munetaka; Arai, Hajime

doi:10.7887/jcns.26.104

Cited by 2 publications

(5 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The risk of serious complications such as delayed cerebral aneurysm rupture is high in FD embolization for large aneurysms, symptomatic aneurysms, aneurysms with a dome-to-neck ratio >1.6, and aneurysms that exhibit a jet flow pattern of inflowing contrast medium. 5,12) In such cases, coil embolization is sometimes utilized in combination with FD. 5,13) In the present case, the dome-to-neck ratio was high at 2.58, and the aneurysm had protruded into the dura mater.…”

Section: Discussionmentioning

confidence: 99%

“…5,12) In such cases, coil embolization is sometimes utilized in combination with FD. 5,13) In the present case, the dome-to-neck ratio was high at 2.58, and the aneurysm had protruded into the dura mater. Thus, we determined that the risk for subarachnoid hemorrhage because of delayed cerebral aneurysm rupture was high, and used concurrent coil embolization.…”

Section: Discussionmentioning

confidence: 99%

“…From the 4-Fr sheath, a microcatheter for coil insertion (Echelon10, ev3; Covidien, Irvine, CA, the device is technically difficult, necessitating use by surgeons with a high degree of experience in intra cerebrovascular treatments, as well as appropriate training prior to use. 5) Further technical skills may be necessary when sufficient force cannot be transmitted to the catheter because of severe vascular tortuosity. For this reason, when using FD embolization at our institution, we perform the procedure with direct puncture of the CCA under direct visualization by making a small incision to the neck when 1) the vascular right caudate nucleus on diffusion-weighted imaging (Fig.…”

Section: Endovascular Treatmentmentioning

confidence: 99%

“…The FD is technically difficult to use, 5) and even greater skills may be required when sufficient force cannot be transmitted to the catheter because of severe vascular tortuosity. For FD embolization procedures performed at our institution, when a transfemoral approach is deemed difficult, we perform direct puncture of the common carotid artery (CCA) under direct visualization by making a small incision.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Use of Direct Carotid Artery Puncture Access for Flow Diverter Embolization Combined with Coil Embolization: A Case Report

Funakoshi

Ando

Chihara

et al. 2019

JNET

View full text Add to dashboard Cite

The flow diverter (FD) was developed as a new approach for treating aneurysms. However, FD embolization requires high technical skills and is challenging when the access to the aneurysm is difficult and when sufficient force cannot be transmitted to the catheter because of severe vascular tortuosity. For FD embolization, when a transfemoral approach is too difficult, we perform direct puncture of the common carotid artery (CCA) under direct visualization by making a small incision. Herein, we report our experience using this approach.Case Presentation: We present a case of an 80-year-old woman with an unruptured aneurysm on the right internal carotid artery (ICA) treated by FD embolization in conjunction with coil embolization. We considered that access to the aneurysm would be challenging, with limited catheter maneuverability because of severe tortuosity of the bilateral femoral arteries and the region from the right CCA to the ICA. Thus, we decided to access the aneurysm by direct puncture of the right CCA. The aneurysm was easily accessed using this approach, and a stable procedure was completed by placing a sheath with a detachable hemostasis valve and then switching the hemostasis valve to a Y-connector on the sheath. As good catheter control was obtained despite the vascular tortuosity, the Pipeline Flex could be deployed and placed at the appropriate position. Conclusion:Direct puncture of the CCA under direct visualization for FD embolization is useful when access to the aneurysm is challenging and when catheter maneuverability decreases because of severe tortuosity.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Endovascular Treatmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Use of Direct Carotid Artery Puncture Access for Flow Diverter Embolization Combined with Coil Embolization: A Case Report

Funakoshi

Ando

Chihara

et al. 2019

JNET

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4][5][6] In Japan, it is also widely accepted that utilisation of the Pipeline Flex embolisation device (Medtronic, Irvine, CA, USA) to treat wide-necked aneurysms, with a diameter of 10 mm or greater, located at the region proximal to the bifurcation of the internal carotid artery to the posterior communicating artery is safe and effective. 7 The FD has a high metal covering ratio of 30-35%. It was developed to prevent growth or rupture of aneurysms without coil embolisation, while it alters the blood flow so as not to allow flow into the aneurysm, thus preserving the parent artery.…”

Section: Introductionmentioning

confidence: 99%

Patency of anterior choroidal artery after flow diverter deployment with assessment of magnetic resonance imaging follow-up

et al. 2018

Self Cite

View full text Add to dashboard Cite

We aimed to analyse the patency rate of the anterior choroidal artery, and presented imaging and neurological findings, after deployment of a flow diverter in the anterior choroidal artery in the treatment of patients with intracranial aneurysms. Methods: Among the 139 patients who underwent a flow diverter deployment from December 2012 to September 2017 in our hospital, there were 21 patients (15.1%) for whom their anterior choroidal artery was covered for the procedure with a flow diverter. The patients' age, sex, size of aneurysm and the presence or absence of an anterior choroidal artery occlusion, neurological findings and postoperative infarction in the anterior choroidal artery region were analysed retrospectively. Results: The mean age of the six male and 15 female patients was 61.5 years (range 32-77 years). The mean maximal diameter of the aneurysms was 16.4 mm (range 10.0-29.4 mm). The anterior choroidal artery was patent in all 21 patients; however, a haemodynamic alteration in the anterior choroidal artery was detected in one patient. Postoperatively, hemiparesis was observed in two patients (9.5%) and a visual field defect in one patient (4.8%), both of which were the symptoms of infarction of the cortical branch of the middle cerebral artery or retinal artery ischaemia. However, no patients had symptoms due to ischaemia of the anterior choroidal artery confirmed with magnetic resonance imaging. Conclusions: In all patients who underwent flow diverter deployment, the anterior choroidal artery was patent and no ischaemia was detected in the imaging or evidenced by neurological findings. Therefore, flow diverter deployment in the anterior choroidal artery was considered to be a safe procedure.

show abstract

Paradigm Shift of Endovascular Therapy after Clinical Introduction of a Flow Diverter for Large Intracranial Aneurysms

Cited by 2 publications

References 39 publications

Use of Direct Carotid Artery Puncture Access for Flow Diverter Embolization Combined with Coil Embolization: A Case Report

Use of Direct Carotid Artery Puncture Access for Flow Diverter Embolization Combined with Coil Embolization: A Case Report

Patency of anterior choroidal artery after flow diverter deployment with assessment of magnetic resonance imaging follow-up

Contact Info

Product

Resources

About