Treatment of Experimentally Induced Aneurysms with Stents

Krings, Timo; Hans, Franz-Josef; Möller-Hartmann, W.; Brunn, Anna; Thiex, Ruth; Schmitz‐Rode, Thomas; Verken, Peter; Scherer, K.; Dreeskamp, Heiko; Stein, Klaus-Peter; Gilsbach, Joachim M.; Thron, A.

doi:10.1227/01.neu.0000159887.03290.d1

Cited by 40 publications

(34 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The incidence of in-stent stenosis is likely related to neointimal growth as has been previously suggested, 39 which can be secondary to endothelial injury. Endothelial cells play an integral role in the regulation of smooth muscle growth, and when that regulation is lost, neointimal proliferation can be seen that leads to stenosis.…”

Section: In-stent Stenosis and Perforator Patencymentioning

confidence: 74%

Stent-Assisted Reconstructive Endovascular Repair of Cranial Fusiform Atherosclerotic and Dissecting Aneurysms

Wakhloo

Mandell

Gounis

et al. 2008

Stroke

153

117

View full text Add to dashboard Cite

Background and Purpose-The purpose of this study was to investigate the periprocedural morbidity, mortality, and long-term clinical and angiographic follow-up using stent-assisted coiling and stenting alone for treatment of cranial fusiform dissecting and atherosclerotic aneurysms. Methods-The Institutional Review Board approved the study. A retrospective analysis was performed of 30 fusiform dissecting and atherosclerotic aneurysms treated in 28 patients (20 females; mean age, 52.6 years). Eleven aneurysms (37%) were located in the posterior circulation. Twenty-one (70%) originated from arterial dissection and 4 aneurysms (13%) presented with subarachnoid bleeding. Twenty-four (80%) aneurysms were treated with stents and coils, whereas 6 (20%) were treated with stents alone. Results-Immediate postprocedural angiograms in 24 aneurysms treated with stent-assisted coiling showed complete occlusion in 12 and subtotal occlusion in 11 aneurysms, whereas no occlusion was seen in one aneurysm and in all 6 aneurysms treated with stents alone. A clinical improvement or stable outcome was achieved in 25 patients (89%). The 2 cases of permanent morbidity included a patient with a finger dysesthesia associated with a perforator stroke and another patient with hemiparesis and aphasia due to a delayed in-stent thrombosis. One patient died after treatment of a giant vertebrobasilar junction aneurysm. Angiographic follow-up was available in 23 of the 27 surviving patients (85%) at a mean of 16.2 months (range, 1 to 108 months). Recanalization in 4 patients (17%) at 3, 5, 24, and 36 months required retreatment in 3. In-stent stenosis of Յ50% was found in 3 patients. Conclusion-Stent-assisted coil embolization is an attractive option for ruptured and nonruptured fusiform aneurysms with stable long-term outcome. However, recanalization observed up to 3 years after the initial obliteration emphasizes the need for long-term follow-up angiography. (Stroke. 2008;39:3288-3296.)

show abstract

Section: In-stent Stenosis and Perforator Patencymentioning

confidence: 74%

Stent-Assisted Reconstructive Endovascular Repair of Cranial Fusiform Atherosclerotic and Dissecting Aneurysms

Wakhloo

Mandell

Gounis

et al. 2008

Stroke

153

117

View full text Add to dashboard Cite

show abstract

“…Of note, we did not include aneurysms treated with standard stent designs, as different groups have extensively evaluated such stents. 1,5,6,9,[11][12][13] For instance, measurements by Sadasivan et al 9 demonstrated a reduction in TDC peak of approximately 13%.…”

Section: Discussionmentioning

confidence: 99%

“…The current design is appropriate for lateral aneurysms, and work is in progress to extend the applicability to a larger variety of aneurysm geometries, such as bifurcation aneurysms. Further studies in more representative vessel morphologies, such as the rabbit elastase model, 5,25 are in progress, and initial results have been already presented. 26 It appears probable that the AVS may become a valued tool in the aneurysm treatment armamentarium.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11] Development may yield such potential benefits as reduced surgery time, lower dome perforation risk, shorter recovery time, reduced aneurysm recanalization, increased numbers of treatable aneurysms, and reduced costs. Various groups have reported both in vitro and in vivo aneurysm treatment results with commercially available stents, 1,5,6,12,13 whereas our group has been developing specially designed stents. 2,3,7,8,14 Hemodynamic conditions in an IA dome vary significantly depending on aneurysm geometry, 15 and hence may require different treatments.…”

mentioning

confidence: 99%

“…In principle, a simple solution might use low-porosity or fullycovered stents. 5 However, perforator occlusion can cause permanent brain injury or even death, and therefore must be addressed in stent design.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Asymmetric Vascular Stent

Ionita

Paciorek

Hoffmann

et al. 2008

Stroke

View full text Add to dashboard Cite

Background and Purpose-Intracranial aneurysm (IA) treatment through hemodynamic modification with novel stent designs is a burgeoning area of research. We present a feasibility study for a new low-porosity patch-containing stent designed to treat intracranial aneurysms. The device is deployed so the patch covers the aneurysm neck ensuring strong flow diversion away from the aneurysm while keeping a low probability of occlusion of perforating vessels. Methods-We created 17 side-wall aneurysms in 6 dogs, 2 per carotid artery if animal size permitted. Twelve proximal aneurysms were treated with AVSs: 5 distal aneurysms were untreated, serving as controls against self-thrombosis; 7 treated aneurysms were fully-covered; and 5 were partially-covered. After 4 weeks, a final angiogram was performed and aneurysms were explanted. Angiograms acquired pre-and posttreatment and at 4-week follow-up were analyzed quantitatively using normalized time-density curves (NTDC). Cone-beam micro-CT and histological specimen analysis were then performed. Results-Posttreatment, NTDC average peaks dropped to 45% of initial values for the partially-covered aneurysms and 78% for the fully-covered aneurysms. Cone-beam micro-CT imaging performed at 4 weeks posttreatment showed partial thrombosis in 4 of 5 partially-covered aneurysms and complete thrombosis in all fully-covered aneurysms. Histology revealed neointimal coverage of all asymmetrical patch regions and thrombus formation in both fully-and partially-covered aneurysms. Four-week follow-up was not done for 1 animal (2 controls, 2 treated) that expired because of groin hemorrhage and for another animal (1 aneurysm) with an occluded carotid. Conclusions-We

show abstract

Strategy for analysis of flow diverting devices based on multi‐modality image‐based modeling

Cebral

Mut

Raschi

et al. 2014

Numer Methods Biomed Eng

View full text Add to dashboard Cite

Quantification and characterization of the hemodynamic environment created after flow diversion treatment of cerebral aneurysms is important to understand the effects of flow diverters and their interactions with the biology of the aneurysm wall and the thrombosis process that takes place subsequently. This paper describes the construction of multi-modality image-based subject-specific CFD models of experimentally created aneurysms in rabbits and subsequently treated with flow diverters. Briefly, anatomical models were constructed from 3D rotational angiography images, flow conditions were derived from Doppler ultrasound measurements, stent models were created and virtually deployed, and the results were compared to in vivo digital subtraction angiography and Doppler ultrasound images. The models were capable of reproducing in vivo observations, including velocity waveforms measured in the parent artery, peak velocity values measured in the aneurysm, and flow structures observed with digital subtraction angiography before and after deployment of flow diverters. The results indicate that regions of aneurysm occlusion after flow diversion coincide with slow and smooth flow patterns, while regions still permeable at the time of animal sacrifice were observed in parts of the aneurysm exposed to larger flow activity, i.e. higher velocities, more swirling and more complex flow structures.

show abstract

Treatment of Experimentally Induced Aneurysms with Stents

Cited by 40 publications

References 42 publications

Stent-Assisted Reconstructive Endovascular Repair of Cranial Fusiform Atherosclerotic and Dissecting Aneurysms

Stent-Assisted Reconstructive Endovascular Repair of Cranial Fusiform Atherosclerotic and Dissecting Aneurysms

Asymmetric Vascular Stent

Strategy for analysis of flow diverting devices based on multi‐modality image‐based modeling

Contact Info

Product

Resources

About