Vertebral Artery Aneurysm: Ruptured Dissecting Aneurysm, Implantation of Telescoping p48MW HPC Flow Diverter Stents Under Antiaggregation with ASA Only

Colgan, Frances; Pérez, Marta Aguilar; Hellstern, Victoria; Reinhard, Matthias; Krämer, Stefan; Bäzner, Hansjörg; Ganslandt, Oliver; Henkes, Hans

doi:10.1007/978-3-319-77827-3_80

Cited by 2 publications

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References 27 publications

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“… 16 Anecdotal experience has shown that the p48MW HPC can be implanted under ASA or prasugrel single antiplatelet therapy (SAPT). 17 , 18 The same can be expected for the 64-wire variant. The data presented here confirm that the p64MW HPC flow diverter can be safely implanted in patients taking ASA and clopidogrel as DAPT and with a wide variety of measurable response levels.…”

Section: Discussionsupporting

confidence: 60%

Initial experience with the novel p64MW HPC flow diverter from a cohort study in unruptured anterior circulation aneurysms under dual antiplatelet medication

Петров

Rentsenkhuu²,

Nota³

et al. 2020

Interv Neuroradiol

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Objective p64MW HPC is a new low-profile flow diverter with reduced thrombogenicity due to hydrophilic coating. The purpose of this study was to evaluate its safety and efficacy in Mongolian patients under dual antiplatelet therapy. Methods Consecutive patients with unruptured anterior circulation aneurysms were prospectively enrolled. All patients received aspirin and clopidogrel before and six months after the procedure, followed by lifelong aspirin medication. High platelet reactivity (VerifyNow) did not trigger further action. The safety and efficacy endpoints were clinical outcome and aneurysm occlusion. Results In 29 patients (26 female, median age 57 years), 46 aneurysms (neck width 3.3 mm, fundus diameter 3.7 mm, median) were treated. Dual platelet function inhibition was confirmed in eight patients (28%). The response to Clopidogrel was between 100 and 239 P2Y12 reaction units (VerifyNow) in 13 patients (45%). Non-response to at least one drug was found in 8 of 29 patients (28%). One collapsed p64MW HPC required balloon angioplasty. No other periprocedural thrombus formation occurred. Postprocedural MRI revealed lesions with diffusion restriction in 3 of 29 patients. Digital subtraction angiography after three months for 42 of 46 (91%) aneurysms showed an adequate aneurysm occlusion in 25 (60%). Distal p64MW HPC migration of 3 implants was retreated with another p64MW HPC. Follow-up digital subtraction angiography of 26 of 46 (57%) aneurysms after six months showed adequate aneurysm occlusion in 22 (85%). Significant in-stent stenosis or thrombosis, morbidity or mortality was not encountered. Conclusion p64MW HPC implantation in patients under dual antiplatelet therapy with or without dual platelet function inhibition has a low procedural complication rate. The early aneurysm occlusion rate is high.

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Section: Discussionsupporting

confidence: 60%

Initial experience with the novel p64MW HPC flow diverter from a cohort study in unruptured anterior circulation aneurysms under dual antiplatelet medication

Петров

Rentsenkhuu²,

Nota³

et al. 2020

Interv Neuroradiol

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Comprehensive review of the recent advances in devices for endovascular treatment of complex brain aneurysms

Fatania

Patankar

2021

The British Journal of Radiology

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The International Subarachnoid Aneurysm Trial (ISAT) showed superiority for endovascular treatment of ruptured aneurysms and technology has since moved on rapidly. Many approaches and technology now exist for the endovascular management of ruptured and unruptured intracranial aneurysms, which reflects their varied nature – there is no one-size-fits-all technique. We aim to provide an overview of the various classes of device and the major developments over the past decade. Coiling is the oldest of the technology and continues to demonstrate high levels of occlusion and acceptable risks, making it the default treatment choice, particularly in the acutely ruptured aneurysm setting. Advances on coiling include the use of adjuncts such as balloons, stents and fully retrievable temporary neck-bridging devices, which have facilitated the treatment of more complex aneurysms. Flow divertors have also revolutionised complex aneurysm treatment with small added risk in acute aneurysm treatment and seek to remodel the aneurysm–vessel interface without accessing the aneurysm sac. The latest development and most promising avenue appears to be intrasaccular flow disrupting devices like WEB, Contour and Neqstent that provide excellent opportunities to treat wide neck complex aneurysm with minimal mortality and morbidity and good occlusion rates and may in future replace a significant number of stent-assisted coiling too.

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Vertebral Artery Aneurysm: Ruptured Dissecting Aneurysm, Implantation of Telescoping p48MW HPC Flow Diverter Stents Under Antiaggregation with ASA Only

Cited by 2 publications

References 27 publications

Initial experience with the novel p64MW HPC flow diverter from a cohort study in unruptured anterior circulation aneurysms under dual antiplatelet medication

Initial experience with the novel p64MW HPC flow diverter from a cohort study in unruptured anterior circulation aneurysms under dual antiplatelet medication

Comprehensive review of the recent advances in devices for endovascular treatment of complex brain aneurysms

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