Tapered flow diverters in the treatment of intracranial aneurysms

Peker, Ahmet; Akgül, Erol; Dağlıoğlu, Ergün; Akmangit, İlkay; Kaya, Tunca; Belen, Deniz; Arat, Anıl

doi:10.5137/1019-5149.jtn.17426-16.0

Cited by 5 publications

(7 citation statements)

References 15 publications

(26 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All the patients were treated by a single neurovascular team under general anaesthesia. Patients were preloaded with clopidogrel and acetyl salicylic acid (ASA), as described previously in the literature, unless they presented acutely after subarachnoid haemorrhage (14). Under systemic heparinisation, a triaxial catheter system was used to access the larger or straighter vertebral artery.…”

Section: Vedat Acikmentioning

confidence: 99%

Endovascular treatment of superior cerebellar artery aneurysms

Açık

Dağlıoğlu²,

Akmangit³

et al. 2019

Turkish Neurosurgery

Self Cite

View full text Add to dashboard Cite

AIM: To present our experience on superior cerebellar artery (SCA) aneurysms treated with embolization by using current endovascular techniques. MATERIAL and METHODS: All SCA aneurysms treated by our endovascular team since 2013 were retrospectively evaluated. Clinical information and angiographic findings on presentation, during treatment and on follow-up were noted. RESULTS: Endovascular treatment was the primary treatment method for SCA aneurysms during the study period. Twenty three patients (15 female, 8 male) with a mean age of 50.6 years, 12 of whom with subarachnoid hemorrhage were treated. Treatments included coiling (56%), stent assisted coiling, stentriever assisted coiling, Y stent assisted coiling and flow diversion with either flow diverter placement or telescopic stenting. Two patients died secondary to consequences of subarachnoid hemorrhage. The outcome of 1 patient was Modified Rankin Scale (mRS) 3 and the outcome of remaining 20 patients was mRS 0. The rates of aneurysm occlusion according to Raymond-Roy classification were: class 1 in 11 patients, class 2 in 6 patients and class 3 in 2 patients on a mean follow-up of 15.3 months. Only one patient required retreatment. CONCLUSION: Current endovascular techniques are able to address the high rate of recanalization and retreatment of SCA aneurysms which are currently the major drawbacks associated with primary coiling when compared with surgical treatment. It remains to be shown if use of these latest techniques are associated with increased risk of thromboembolic events.

show abstract

Section: Vedat Acikmentioning

confidence: 99%

Endovascular treatment of superior cerebellar artery aneurysms

Açık

Dağlıoğlu²,

Akmangit³

et al. 2019

Turkish Neurosurgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…8 To overcome these issues, the LEO stent has been used as a scaffolding device, compensating for the low radial force of the Silk Plus flow diverter, 3 to prevent the prolapse of the device into the aneurysm 8 or to prevent delayed-configurational device changes due to device oversizing. 9 However, to date, a comparison of the safety and efficacy of this scaffolding technique over bare flow diversion has not been performed. In fact, placement of a flow diverter within a stent has been regarded as controversial or even contraindicated by many authors.…”

Section: Discussionmentioning

confidence: 99%

“…11 In addition to the procedural hassles these 2 phenomena may create, they may also lead to fish mouthing or delayed endothelization in the longer term. 9,12,13 Deployment of a device with a length of at least 3 times the length of the aneurysm neck is advised to reduce prolapse risk, 7 which may be practically impossible in cases of long-segment fusiform aneurysms or may be associated with a higher rate of parent artery occlusion after flow diversion with the Silk device. 14 In our cohort, we did not observe any of these adverse events.…”

Section: Discussionmentioning

confidence: 99%

“…However, these benefits come at the expense of a propensity to foreshorten and, at times, a delay in configurational change. 9,12 Hence, scaffolding stent placement has been used in a certain proportion of patients treated by authors who prefer to use this device. 1,3,5,25 The availability of matching sizes of the braided LEO stents for each Silk device size that can be deployed through the same delivery microcatheter also renders this technique attractive and relatively easy to perform.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Propensity Score Analysis of Flow Diverters Placed in Scaffolding Stents

Poker

Öcal

Öztürk

et al. 2021

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE: Flow-diverter deployment within a stent remains controversial, but flow-diverter deployment within a scaffolding stent has been performed occasionally. To date, an analysis of this scaffolding technique has not been reported. We aimed to evaluate whether the scaffolding technique adversely affects the outcomes of flow diversion. MATERIALS AND METHODS:Patients who had undergone intracranial aneurysm treatment using a Silk flow diverter with (scaffolding group) or without (bare flow-diverter group) a scaffolding stent were identified retrospectively and compared. Propensity score matching was used to match the aneurysms in both groups for variables with a significant difference between groups. Aneurysm occlusion rates and clinical outcomes were compared.

show abstract

“…The factors involved in residual aneurysmal filling after flow diversion include malapposition,[ 21 22 23 24 25 26 ] aneurysm size,[ 27 ] length of transition zone[ 28 ] and possibly strut thickness. [ 29 ] In a recently published animal study, apposition was more important than pore density as a predictor of aneurysm occlusion after flow diversion.…”

Section: Discussionmentioning

confidence: 99%

The exchange-free technique: A novel technique for enhancing surpass flow diverter placement

Öcal

Arat

2020

Asian J Neurosurg

View full text Add to dashboard Cite

Background: Following flow diverter placement, approximately 20% of intracranial aneurysms remain as residual aneurysms at 1 year. Device malapposition is a cause of residual aneurysms after flow diversion. We present a new and straightforward technique (exchange-free technique [EFT]) to enhance apposition of the surpass flow diverter (SFD), the only over-the-wire flow diverter currently available. Materials and Methods: We deployed laser-cut mini stents through the inner deployment catheter of the SFD. This maneuver was performed simply by withdrawing the micro-guidewire from its lumen and replacing it with a mini-stent (stents deliverable through microcatheters with inner diameter of 0.0165 inches), without a need to re-cross the deployed SFD or an exchange maneuver. All aneurysms in which this technique was utilized were retrospectively reviewed. Results: Twenty-eight patients (20 females) with 30 treated aneurysms were identified. The mean aneurysm diameter was 10.2 ± 6.6 mm. Technical success rate was 96.6% (29/30 aneurysms). There was no mortality or permanent morbidity related to the procedures. Except for the patient treated for an iatrogenic, surgery-related internal carotid artery pseudoaneurysm who died secondary to consequences of multiple surgeries, no cases of mortality or permanent morbidity were noted. Complete aneurysm occlusion rates were 78.2%, 82.1%, and 95.2% at 0–3, 3–6, and 9–12 months, respectively. None of the patients were re-treated. Conclusion: EFT is a simple and fast technique which was not associated with adverse effects in our series. The higher aneurysm obliteration rate obtained with EFT is probably the result of better wall apposition of the SFD.

show abstract

Tapered flow diverters in the treatment of intracranial aneurysms

Cited by 5 publications

References 15 publications

Endovascular treatment of superior cerebellar artery aneurysms

Endovascular treatment of superior cerebellar artery aneurysms

Propensity Score Analysis of Flow Diverters Placed in Scaffolding Stents

The exchange-free technique: A novel technique for enhancing surpass flow diverter placement

Contact Info

Product

Resources

About