Safety and efficacy of the Derivo Embolization Device for the treatment of ruptured intracranial aneurysms

Goertz, Lukas; Dorn, Franziska; Kraus, Bastian; Borggrefe, Jan; Schlamann, Marc; Forbrig, Robert; Turowski, Bernd; Kabbasch, Christoph

doi:10.1136/neurintsurg-2018-014166

Cited by 36 publications

(21 citation statements)

References 29 publications

(21 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The antiplatelet regimen after intracranial stent implantation consisted of intravenous infusion of tirofiban started preinterventionally and continued for 24 hours, followed by 4 months of oral ingestion of clopidogrel and a lifelong oral administration of acetylsalicylic acid. [12][13][14][15] After aneurysm treatment, the patients were routinely surveilled at an intensive care unit for at least 14 days after ictus. The blood flow velocity in the large cerebral arteries was determined daily by transcranial Doppler ultrasound.…”

Section: Asah Management Protocolmentioning

confidence: 99%

Delayed hospital admission of patients with aneurysmal subarachnoid hemorrhage: clinical presentation, treatment strategies, and outcome

Goertz

Pflaeging

Hamisch

et al. 2021

Journal of Neurosurgery

Self Cite

View full text Add to dashboard Cite

OBJECTIVETimely aneurysm occlusion and neurointensive care treatment are key principles in the management of aneurysmal subarachnoid hemorrhage (aSAH) to prevent secondary brain injury. Patients with early (EHA) and delayed hospital admission (DHA) were compared in terms of clinical presentation, treatment strategies, aSAH-related complications, and outcome.METHODSIn this retrospective study, consecutive aSAH patients were treated at a single neurovascular center between 2009 and 2019. Propensity score matching was performed to account for divergent baseline characteristics.RESULTSAmong 509 included patients, 55 were admitted more than 48 hours after ictus (DHA group). DHA patients were significantly younger (52 ± 11 vs 56 ± 14 years, p = 0.03) and had lower World Federation of Neurosurgical Societies scores (p < 0.01) than EHA patients. In 54.5% of the cases, DHA patients presented with neurological deterioration or aggravated symptoms. Propensity score matching revealed a higher vasospastic infarction rate in the DHA group (41.5%) than in the EHA group (22.6%) (p = 0.04). A similar portion of patients in both groups achieved favorable outcome at midterm follow-up (77.3% vs 73.6%, p = 0.87). DHA patients (62.3%) received conventional coiling more often than EHA patients (41.5%) (p = 0.03).CONCLUSIONSDHA patients are at an increased risk of cerebral infarction. Nevertheless, state-of-the-art neurointensive care treatment can result in a good clinical outcome.

show abstract

Section: Asah Management Protocolmentioning

confidence: 99%

Delayed hospital admission of patients with aneurysmal subarachnoid hemorrhage: clinical presentation, treatment strategies, and outcome

Goertz

Pflaeging

Hamisch

et al. 2021

Journal of Neurosurgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…Additionally, the two flared ends of the Derivo device have 3 fluoroscopic markers each and seem to accumulate more thrombus relative to the mid-section of the device. Recent clinical data with the Derivo embolization device shows high incidence of thromboembolic events including in-stent thrombosis [25,26]. Similarly, P64 – a braided Nitinol flow diverter – was found to have higher platelet activation, thrombin generation, and thrombus deposition on the devices intraluminal surfaces post experiment.…”

Section: Discussionmentioning

confidence: 95%

Thrombogenicity assessment of Pipeline, Pipeline Shield, Derivo and P64 flow diverters in an in vitro pulsatile flow human blood loop model

et al. 2019

View full text Add to dashboard Cite

Flow diversion is a disruptive technology for the treatment of intracranial aneurysms. However, these intraluminal devices pose a risk for thromboembolic complications despite dual antiplatelet therapy. We report the thrombogenic potential of the following flow diversion devices measured experimentally in a novel human blood in-vitro pulsatile flow loop model: Pipeline™ Flex Embolization Device (Pipeline), Pipeline™ Flex Embolization Device with Shield Technology™ (Pipeline Shield), Derivo Embolization Device (Derivo), and P64 Flow Modulation Device (P64). Thrombin generation (Mean ± SD; μg/mL) was measured as: Derivo (28 ± 11), P64 (21 ± 4.5), Pipeline (21 ± 6.2), Pipeline Shield (0.6 ± 0.1) and Negative Control (1.5 ± 1.1). Platelet activation (IU/μL) was measured as: Derivo (4.9 ± 0.7), P64 (5.2 ± 0.7), Pipeline (5.5 ± 0.4), Pipeline Shield (0.3 ± 0.1), and Negative Control (0.9 ± 0.7). We found that Pipeline Shield had significantly lower platelet activation and thrombin generation than the other devices tested (p < .05) and this was comparable to the Negative Control (no device, p > .05). High resolution scanning electron microscopy performed on the intraluminal and cross-sectional surfaces of each device showed the lowest accumulation of platelets and fibrin on Pipeline Shield relative to Derivo, P64, and Pipeline. Derivo and P64 also had higher thrombus accumulation at the flared ends. Pipeline device with Phosphorylcholine surface treatment (Pipeline Shield) could mitigate device material related thromboembolic complications.

show abstract

“…So far, 12 case series of ruptured dissecting aneurysms or ruptured blood blister-like aneurysms treated in acute phase with flow diverter have been reported. [13][14][15][16][17][18][19][20][21][22][23][24] In these reports, 115 ruptured site (68 internal carotid artery, six middle cerebral artery, one anterior cerebral artery, 26 vertebral artery, six basilar artery, two posterior cerebral artery, three anterior inferior cerebellar artery, three posterior inferior cerebellar artery) were treated; 101 were treated with only flow diverter, 14 with flow diverter and coil. In these 115 cases, no rebleeding from ruptured site and 10 symptomatic thrombotic events were observed after procedure.…”

Section: Discussionmentioning

confidence: 99%

Ruptured Basilar Artery Dissection Diagnosed Using Magnetic Resonance Vessel Wall Imaging and Treated with Coil Embolization with Overlapping LVIS Stents: A Case Report

Sonobe

Yoshida

Niizuma

et al. 2020

NMC Case Report Journal

View full text Add to dashboard Cite

The diagnosis and treatment of patients with ruptured basilar artery dissection (rBAD) are often difficult. We present a case of rBAD diagnosed with magnetic resonance vessel wall imaging (MR-VWI) and treated with coil embolization with overlapping low-profile visualized intraluminal support (LVIS) stents. The case is of a 49-year-old woman with subarachnoid hemorrhage. digital subtraction angiography (DSA) showed irregularity in an anterior wall of the middle portion of the basilar artery, indicating the presence of a false lumen. MR-VWI showed local enhancement in an arterial wall, which was consistent with the wall irregularity observed in DSA. Overlapping stents (two LVIS stents) was performed in the basilar artery and coils were placed in the false lumen. The false lumen was completely thrombosed, and anterograde blood flow of the basilar artery was preserved. Dual antiplatelet therapy was administered, and the patient underwent an uneventful postoperative course. DSA performed 6 months later showed a white-collar sign. MR-VWI has attracted attention as a useful modality for detecting a ruptured lesion in patients with subarachnoid hemorrhage. This is the first report, to the best of our knowledge, describing the practical use of MR-VWI for rBAD. MR-VWI is suggested to improve diagnostic accuracy for rBAD. There are no established treatments for rBAD; reconstructive endovascular treatments comprising stent placement and coil embolization of a false lumen are promising. The LVIS stent has a braided design and high metal coverage ratio and is considered to be reasonable for use in rBAD. Coil embolization of a false lumen with overlapping LVIS stents may be effective for rBAD.

show abstract

Safety and efficacy of the Derivo Embolization Device for the treatment of ruptured intracranial aneurysms

Abstract: In this pilot study, endovascular treatment of ruptured intracranial aneurysms with the DED was feasible and not associated with any incidence of rebleeding. Larger series with longer follow-up are warranted to reach a definite conclusion about this device.

Cited by 36 publications

References 29 publications

Delayed hospital admission of patients with aneurysmal subarachnoid hemorrhage: clinical presentation, treatment strategies, and outcome

Delayed hospital admission of patients with aneurysmal subarachnoid hemorrhage: clinical presentation, treatment strategies, and outcome

Thrombogenicity assessment of Pipeline, Pipeline Shield, Derivo and P64 flow diverters in an in vitro pulsatile flow human blood loop model

Ruptured Basilar Artery Dissection Diagnosed Using Magnetic Resonance Vessel Wall Imaging and Treated with Coil Embolization with Overlapping LVIS Stents: A Case Report

Contact Info

Product

Resources

About