Update on flow diverters for the endovascular management of cerebral aneurysms

Rajah, Gary; Narayanan, Sandra; Rangel-Castilla, Leonardo

doi:10.3171/2017.3.focus16427

Cited by 96 publications

(77 citation statements)

References 87 publications

(65 reference statements)

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“…Currently marketed flow diverting stents including PED, Surpass (Stryker, Fremont, California, USA), FRED (Microvention), SILK (Balt Extrusion, Montmorency, France), and p64 (Phenox, Bochum, Germany) have nominal wall stent coverage ranging from 30% to 40% depending on discrepancies between device size and vessel lumen 29. This is in contrast to the currently available stents Neuroform, Enterprise, and LVIS jr which have 12% and lower metallic coverage.…”

Section: Discussionmentioning

confidence: 99%

LVIS Blue as a low porosity stent and coil adjuvant

Koch

Stapleton

Raymond

et al. 2018

J NeuroIntervent Surg

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Section: Discussionmentioning

confidence: 99%

LVIS Blue as a low porosity stent and coil adjuvant

Koch

Stapleton

Raymond

et al. 2018

J NeuroIntervent Surg

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“…Next, this central diversion decreases the speed of blood flow within the aneurysm; increases stagnation; and promotes intra-aneurysmal thrombosis. This decreased wall stress and stagnant flow results in aneurysm remodeling that ultimately promotes endothelialization across the aneurysm neck and arterial reconstruction 24,42,98,102) .…”

Section: Development Of Flow-diverting Stents (Fds)mentioning

confidence: 99%

“…The FDA granted initial approval of the PED in 2011 18,21,98) . The initial FDA IFU limited its use to patients 22 years old or older with wide-necked large or giant aneurysms of the ICA from the petrous segment to superior hypophyseal artery/ ophthalmic segment 114) .…”

Section: Ifu In United States and South Koreamentioning

confidence: 99%

The Evolution of Flow-Diverting Stents for Cerebral Aneurysms; Historical Review, Modern Application, Complications, and Future Direction

Shin

Carroll

Elghareeb

et al. 2020

J Korean Neurosurg Soc

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In spite of the developing endovascular era, large (15-25 mm) and giant (>25 mm) wide-neck cerebral aneurysms remained technically challenging. Intracranial flow-diverting stents (FDS) were developed to address these challenges by targeting aneurysm hemodynamics to promote aneurysm occlusion. In 2011, the first FDS approved for use in the United States market. Shortly thereafter, the Pipeline of Uncoilable or Failed Aneurysms (PUFS) study was published demonstrating high efficacy and a similar complication profile to other intracranial stents. The initial FDA instructions for use (IFU) limited its use to patients 22 years old or older with wide-necked large or giant aneurysms of the internal carotid artery (ICA) from the petrous segment to superior hypophyseal artery/ophthalmic segment. Expanded IFU was tested in the Prospective Study on Embolization of Intracranial Aneurysms with PipelineTM Embolization Device (PREMIER) trial. With further post-approval clinical data, the United States FDA expanded the IFU to include patients with small or medium, wide-necked saccular or fusiform aneurysms from the petrous ICA to the ICA terminus. However, IFU is more restrictive in South Korea than in United States. Several systematic reviews and meta-analyses have sought to evaluate the overall efficacy of FDS for the treatment of cerebral aneurysms and consistently identify FDS as an effective technique for the treatment of aneurysms broadly with complication rates similar to other traditional techniques. A growing body of literature has demonstrated high efficacy of FDS for small aneurysms; distal artery aneurysms; non-saccular aneurysms posterior circulation aneurysms and complication rates similar to traditional techniques. In the short interval since the Pipeline Embolization Device was first introduced, FDS has been firmly entrenched as a powerful tool in the endovascular armamentarium. As new FDS are developed, established FDS are refined, and delivery systems are improved the uses for FDS will only expand further. Researchers continue to work to optimize the mechanical characteristics of the FDS themselves, aiming to optimize deploy ability and efficacy. With expanded use for small to medium aneurysms and posterior circulation aneurysms, FDS technology is firmly entrenched as a powerful tool to treat challenging aneurysms, both primarily and as an adjunct to coil embolization. With the aforementioned advances, the ease of FDS deployment will improve and complication rates will be further minimized. This will only further establish FDS deployment as a key strategy in the treatment of cerebral aneurysms.

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“…This has been achieved with a variety of flow diverting (FD) devices. Most FD devices are stent‐like devices that are placed along the parent artery and across the aneurysm orifice . Hemodynamically, the most important design parameters, are the porosity and pore size or pore density.…”

Section: Introductionmentioning

confidence: 99%

“…These devices which look like cylindrical or spherical wire meshes are implanted within the aneurysm cavity with the aim of disrupting the inflow jet and inducing aneurysm thrombosis and occlusion. They have been specifically designed for bifurcation aneurysms and, because they are deployed within the aneurysm, do not require antiplatelet therapy . No antiplatelet therapy not only implies reduced risks of complications for the patient, but also unlike endoluminal flow diverters, ruptured aneurysms can also be treated with this approach.…”

Section: Introductionmentioning

confidence: 99%

Image‐based modeling of blood flow in cerebral aneurysms treated with intrasaccular flow diverting devices

Mut

Chung

Chudyk³

et al. 2019

Numer Methods Biomed Eng

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Modeling the flow dynamics in cerebral aneurysms after the implantation of intrasaccular devices is important for understanding the relationship between flow conditions created immediately posttreatment and the subsequent outcomes. This information, ideally available a priori based on computational modeling prior to implantation, is valuable to identify which aneurysms will occlude immediately and which aneurysms will likely remain patent and would benefit from a different procedure or device.In this report, a methodology for modeling the hemodynamics in intracranial aneurysms treated with intrasaccular flow diverting devices is described. This approach combines an image-guided, virtual device deployment within patient-specific vascular models with an immersed boundary method on adaptive unstructured grids. A partial mesh refinement strategy that reduces the number of mesh elements near the aneurysm dome where the flow conditions are largely stagnant was compared with the full refinement strategy that refines the mesh everywhere around the device wires. The results indicate that using the partial mesh refinement approach is adequate for analyzing the posttreatment hemodynamics, at a reduced computational cost. The results obtained on a series of four cerebral aneurysms treated with different intrasaccular devices were in good qualitative agreement with angiographic observations. Promising results were obtained relating posttreatment flow conditions and outcomes of treatments with intrasaccular devices, which need to be confirmed on larger series. KEYWORDS cerebral aneurysms, computational hemodynamics, flow diversion, intrasaccular flow diverter

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Update on flow diverters for the endovascular management of cerebral aneurysms

Cited by 96 publications

References 87 publications

LVIS Blue as a low porosity stent and coil adjuvant

LVIS Blue as a low porosity stent and coil adjuvant

The Evolution of Flow-Diverting Stents for Cerebral Aneurysms; Historical Review, Modern Application, Complications, and Future Direction

Image‐based modeling of blood flow in cerebral aneurysms treated with intrasaccular flow diverting devices

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