Usefulness of Coil-assisted Technique in Treating Wide-neck Intracranial Aneurysms: Neck-bridge Procedure Using the Coil Mass as a Support
|
|
- Virginia Jefferson
- 6 years ago
- Views:
Transcription
1 Journal of Neuroendovascular Therapy 2017; 11: Online December 14, 2016 DOI: /jnet.tn Usefulness of Coil-assisted Technique in Treating Wide-neck Intracranial Aneurysms: Neck-bridge Procedure Using the Coil Mass as a Support Hajime Nakamura, Takeo Nishida, Katsunori Asai, Yoshinori Kadono, and Tomoaki Murakami Objective: The coil-assisted technique (CAT) for delivering the wire or catheter to the vessel distal to large wide-neck intracranial aneurysms is described. Case Presentations: We present three cases treated with this technique. The first coil placed in the aneurysm without detaching is used as a support of the wire or catheter in its passing through the aneurysmal neck. This technique was used in order to deliver a guidewire and a balloon catheter in two cases, and to deploy neck-bridge stent in one case. Conclusion: CAT can be performed simply by changing the order of procedure without any use of additional devices. We think this technique might be useful in treating wide-neck intracranial aneurysms in order to get the distal vessel safely. Keywords intracranial aneurysms, wide-neck aneurysm, coil embolization, coil-assisted technique Introduction Even in case of wide-neck aneurysms, satisfactory embolization has become possible using balloon neck remodeling technique or stent-assisted technique. However, it is occasionally difficult to deliver the guidewire or catheter to the vessel distal to a wide-neck aneurysm located at the vessel bifurcation (e.g., basilar artery bifurcation aneurysm, middle cerebral artery bifurcation aneurysm) or on the outer side of a curved vessel (e.g., large internal carotid artery aneurysm). In such patients, the coil-assisted technique (CAT), by which the first coil is placed in the aneurysm without detaching and the catheter or guidewire is delivered to the distal vessel using the coil mass as a support, may be useful. The technique is outlined by presenting three cases that we treated. Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan Received: July 6, 2016; Accepted: October 26, 2016 Corresponding author: Hajime Nakamura. Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka , Japan hajime@nsurg.med.osaka-u.ac.jp This work is licensed under a Creative Commons Attribution-NonCommercial- NoDerivatives International License The Japanese Society for Neuroendovascular Therapy Case Presentations Case 1: Unruptured left middle cerebral artery aneurysm A 76-year-old male diagnosed with a left middle cerebral artery aneurysm visited our hospital, and coil embolization of the aneurysm was performed according to patient s request. The aneurysm, 7 mm in maximum diameter and 5 mm in neck length, was located at the left M1-M2 bifurcation (Fig. 1A). Since the aneurysm had low dome/neck ratio, we decided to use balloon-assisted technique in the treatment. The orifice was on the origin of the M2 superior trunk, so we first attempted to deliver CHIKAI-14 (Asahi Intecc, Aichi, Japan) to the vessel and place Scepter C 4 10 mm (Terumo, Tokyo, Japan) beside the aneurysmal neck. However, it was unattainable because the tip of CHIKAI-14 escaped into the aneurysm and could not be passed to distal vessel (Fig. 1B). We, therefore, placed Scepter C at the origin of the inferior trunk, to which CHIKAI-14 was easily delivered, as a precaution against aneurysm perforation, and then inserted the first coil into the aneurysm without adhering to secure the parent artery (Fig. 1C). Although a part of the coil escaped toward the parent artery as expected, CHIKAI-14 and Scepter C could be delivered to the superior trunk using the coil mass as a support (Fig. 1D). After this procedure, the coil was redeployed in the aneurysm by balloon-assisted 220
2 Usefulness of Coil-assisted Technique Fig. 1 Case 1: Left MCA aneurysm. (A) Pre-operative angiogram shows a wide-neck MCA aneurysm. (B) It is difficult to deliver guidewire through aneurysmal neck to M2 superior trunk. (C) First coil is inserted into the aneurysm. (D) Guidewire is successfully delivered to M2 superior trunk by support of the coil mass. (E) Ten coils are inserted totally. (F) Angiogram shows complete obliteration of the aneurysm. MCA: middle cerebral artery technique, and desirable framing was accomplished. Additional coils were inserted serially, and complete obliteration could be achieved without stent placement (Figs. 1D and 1E). Case 2: Unruptured anterior communicating artery aneurysm A 77-year-old male diagnosed with an anterior communicating artery aneurysm visited our hospital, and coil embolization of the aneurysm was performed according to patient s request. The aneurysm, 11 mm in maximum diameter and 7 mm in neck length, was located at the anterior communicating artery (Fig. 2A). Since the aneurysm had low dome/neck ratio, we decided to use balloonassisted technique or stent placement in the treatment. The orifice was on the origin of A2 segment of right anterior cerebral artery, so we attempted to deliver CHIKAI-14 to the vessel and place Scepter XC 4 11 mm (Terumo) beside the aneurysmal neck. However, the tip of CHIKAI- 14 escaped into aneurysm and this procedure seemed to be difficult without any support (Fig. 2B). We, therefore, placed Scepter XC on the origin of the right A1 as a precaution against aneurysm perforation, and inserted the first coil into the aneurysm without adhering to secure the parent artery. Since the depth of the aneurysm was relatively larger than its neck width, the first coil could be deployed in the aneurysm without escaping toward the parent artery (Fig. 2C). Then, we attempted to deliver CHIKAI-14 to the right A2 using the coil mass as a support; however, CHIKAI-14 fell into the coil mass and could not be passed to the distal part of right A2. Since the first coil was not escaping to parent artery, we decided to detach the first coil in this state and insert subsequent coils continuously. After inserting additional coils, delivery of CHIKAI- 14 to the right A2 became possible (Fig. 2D), and Scepter XC was placed on the proximal part of right A2 (Fig. 2E). At the final step, neck-bridge stent seemed to be essential to keep the patency of parent artery, so we deployed LVIS Jr mm (Terumo) from right A2 to right A1 and complete obliteration of the aneurysm was achieved (Fig. 2F). Case 3: Ruptured right internal carotid-posterior communicating artery aneurysm An 80-year-old female diagnosed with a ruptured large internal carotid-posterior communicating artery aneurysm (World Federation of Neurosurgical Societies [WFNS] grade 1) was transported to our hospital. The aneurysm, 13 mm in maximum diameter and 10 mm in neck length, was located at the posterior wall of right internal carotid artery, and posterior communicating artery originated near the neck (Figs. 3A and 3B). The anterior choroidal artery 221
3 Nakamura H, et al. Fig. 2 Case 2: Acom aneurysm. (A) Pre-operative angiogram shows a wide-neck Acom aneurysm. (B) It is difficult to deliver guidewire through aneurysmal neck to right A2. (C) First coil is inserted into the aneurysm. (D) Guidewire is successfully delivered to right A2 by support of the coil mass. (E) Scepter XC is inserted to distal A2 (arrow heads). (F) Angiogram after stent deployment shows complete obliteration of the aneurysm. Acom: Anterior communicating artery Fig. 3 Case 3: Right ICA aneurysm. (A) and (B) Pre-operative angiogram shows a large wide-neck ICA aneurysm (A) anterior-posterior projection, (B) right-left projection. (C) Guidewire is delivered to right middle cerebral artery, and microcatheters are positioned in aneurysm. (D) First coil is inserted into the aneurysm. (E) Coil loops in the parent artery are pushed into the aneurysm by stent (arrow head). (F) Angiogram after the procedure shows complete obliteration of the aneurysm. ICA: internal carotid artery 222
4 Usefulness of Coil-assisted Technique was likely to be adhered to the aneurysmal wall and marked calcification of internal carotid artery was detected by CT angiography, so we selected endovascular treatment rather than neck clipping. Since the length of aneurysmal neck was wide and transient neck remodeling by balloon-assisted technique seemed to be insufficient to get effective embolization, we decided to use stent-assisted technique. The guidewire and catheter could be easily delivered to the distal part of the aneurysm, and two catheters were placed in the aneurysm for embolization (Fig. 3C). Because of the width of the aneurysmal neck, we expected that the stent might escape into the aneurysm if it was deployed in the absence of coil mass. We, therefore, placed the first coil in the aneurysm without adhering to secure the parent artery, then deployed Enterprise VRD 37 mm (Johnson & Johnson, Miami, FL, USA) from middle cerebral artery to internal carotid artery (Figs. 3D and 3E). By deploying the stent, a part of the first coil displaced toward the parent artery was pushed back into the aneurysm by stent itself, and the coil mass worked well as a support to avoid displacement of the stent into the aneurysm (Fig. 3E). Thereafter, additional coils were inserted serially through the two catheters placed in the aneurysm. Eventually, sufficient embolization was achieved, and the patency of internal carotid artery and the posterior communicating artery could be preserved (Fig. 3F). Discussion Satisfactory embolization of wide-neck intracranial aneurysms has become possible using balloon-assisted technique or stent-assisted techniques. 1 3) However, it is prerequisite to deliver the catheter to the vessel distal to the aneurysm for use of these techniques. In delivering the guidewire to the vessel distal to the wide-neck intracranial aneurysms, we can easily expect that the wire tip escape into the aneurysm especially in case of M1-2 junction or basilar bifurcation aneurysms (Fig. 4A). Similarly, in case of a sidewall-type aneurysm developing toward the outside of the vascular curvature, the wire tip is also expected to escape toward the aneurysm. In treating such aneurysms, it may be needed to push the guidewire (or catheter) into the aneurysm and turn the direction along aneurysmal wall in order to deliver it to the distal vessel. With this procedure, undesirable stress may be applied to some part of the aneurysmal wall, and aneurysm perforation may occur in some cases. To solve this problem, we speculated that the coil mass build in aneurysm might prevent the wire escaping into aneurysm and help it to go into the distal vessel. We call this technique CAT for convenience in this paper. When we use this technique, the first coil should be a relatively rigid, thick, and long one with almost same size of the major axis of the aneurysm in order to get sufficient support. Additionally, the first coil should be deployed nearly its entire length to make a dense bundle of coils, possibly only in aneurysm. Regarding the guidewire, the tip should be firmly bended to J shape, not only to prevent it to move into the coil mass, but also to make it easily pass to the distal vessel (Fig. 4B). Since the coil used for CAT supposed to work as a temporary support to prevent the intrusion of the guidewire or catheter into the aneurysm, the procedure can be forwarded even if the coils have escaped toward the parent vessel (Figs. 4B and 4C). We, however, have to pay attention in patients with high risk of thrombus formation (e.g., no use of antiplatelet drugs). Once the distal vessel has been secured, the coil that has deviated into the parent artery has to be drawn back into the catheter until it seated only in the aneurysm (Fig. 4D), and the following procedure will be continued with balloon-assisted or stent-assisted technique (Fig. 4E). Even in case that the guidewire passed to the distal vessel through the coil mass, the entanglement between guidewire and coil mass is resolved by rewinding the coil until the interference disappear. When sufficient support cannot be obtained by a single coil as in Case 2, it may be reasonable to detach the first coil and insert additional coils to make the coil mass tough enough to use CAT. If the first coil escaped into the parent artery and the guidewire did not go to the distal vessel, we may have to give up CAT and attempt to get the distal vessel using a flow-guide catheter or a microcatheter with its tip bent sharply. When all these techniques did not work well, embolization itself may be abandoned to prevent procedure-related complications. Another thing we have to think of is the selection of balloon catheter. In the treatment with CAT, reshaping of the guidewire is often necessary and a double lumen-type balloon catheter is useful for this purpose. If we use a single lumen-type balloon catheter, blood flows back into the balloon lumen when we withdraw the wire from the catheter, and the balloon catheter must be re-filled with a contrast medium before re-insertion of the wire. On the other hand, with a double lumen-type balloon catheter, the wire can be withdrawn and reshaped frequently without withdrawing 223
5 Nakamura H, et al. Fig. 4 Guidewire delivery with CAT. (A) Guidewire delivery without coil mass is difficult. (B) Guidewire delivery with CAT is started. (C) Guidewire is delivered into the distal artery through the aneurysmal neck successfully. (D) Coil is pulled into microcatheter until the loops in the parent artery are removed. (E) Balloonassisted technique can be used as usual. (F) Embolization is completed. CAT: coil-assisted technique Fig. 5 Stent deployment with CAT. (A) and (B) Stent dislodgement into the aneurysm may occur in the case of a large wide-neck aneurysm. (C) and (D) Stent deployment with CAT is performed. Stent is stable and coil loops in the parent artery are pushed into the aneurysm. CAT: coil-assisted technique the catheter outside. We, therefore, think that a double lumen-type balloon catheter is more convenient than the singe lumen type from this point of view. In Case 1 of this report, we anticipated that the wire tip might be reshaped to get M2 superior trunk frequently, so double lumen-type balloon catheter was selected from the beginning. CAT is also useful when we place a neck-bridge stent in patient of large sidewall-type wide-neck aneurysm, not only for safe securing of the parent artery but also for prevention of stent displacement into the aneurysm (Fig. 5A). According to a report by Gao et al., stent dislodgement during subsequent procedures occurred in two cases (0.8%) of the 239 treatments for wide-neck intracranial aneurysms. 4) If stent dislodgement occurred in a large wideneck aneurysm located on the outer side of the vascular curvature, the stent may fall into the aneurysm (Fig. 5B). In Case 3 of this report, CAT was not necessary for securing the distal vessel, but we deployed a stent after placing the first coil without detaching in consideration of the possibility of stent dislodgement (Figs. 5C and 5D). Using this maneuver, stent was safely deployed and the coil mass was pushed back into the aneurysm by the stent. Conclusion The CAT was reported as a useful method to deliver a guidewire to the vessel distal to the aneurysmal neck. This method, which can be performed simply by changing the order of procedure without any use of additional devices, 224
6 Usefulness of Coil-assisted Technique might be worth attempting in case of large wide-neck aneurysm. Disclosure Statement The first author and coauthors have no conflicts of interest. References 1) Shapiro M, Babb J, Becske T, et al: Safety and efficacy of adjunctive balloon remodeling during endovascular treatment of intracranial aneurysms: a literature review. AJNR Am J Neuroradiol 2008; 29: ) Cekirge HS, Yavuz K, Geyik S, et al: HyperForm balloon remodeling in the endovascular treatment of anterior cerebral, middle cerebral, and anterior communicating artery aneurysms: clinical and angiographic follow-up results in 800 consecutive patients. J Neurosurg 2011; 114: ) Geyik S, Yavuz K, Yurttutan N, et al: Stent-assisted coiling in endovascular treatment of 500 consecutive cerebral aneurysms with long-term follow-up. AJNR Am J Neuroradiol 2013; 34: ) Gao X, Liang G, Li Z, et al: Complications and adverse events associated with Neuroform stent-assisted coiling of wide-neck intracranial aneurysms. Neurol Res 2011; 33:
A Novel Technique of Microcatheter Shaping with Cerebral Aneurysmal Coil Embolization: In Vivo Printing Method
Journal of Neuroendovascular Therapy 2017; 11: 48 52 Online November 28, 2016 DOI: 10.5797/jnet.tn.2016-0051 A Novel Technique of Microcatheter Shaping with Cerebral Aneurysmal Coil Embolization: In Vivo
More informationThree Cases with Wide-necked Cerebral Aneurysms in Whom the T-stent Technique Was Useful
DOI: 10.5797/jnet.tn.2017-0127 Three Cases with Wide-necked Cerebral Aneurysms in Whom the T-stent Technique Was Useful Yusuke Morinaga, Hayatsura Hanada, Ayumu Eto, Takafumi Mitsutake, Fumihiro Hiraoka,
More informationORIGINAL PAPER. Hemispheric divided coiling technique for coil embolization of middle- and large-sized intracranial aneurysms
Nagoya J. Med. Sci. 79. 505 ~ 513, 2017 doi:10.18999/nagjms.79.4.505 ORIGINAL PAPER Hemispheric divided coiling technique for coil embolization of middle- and large-sized intracranial aneurysms Tomotaka
More informationSingle-stage Coil Embolization for Kissing Aneurysms of the Internal Carotid Artery Using Enterprise Stent: Three Cases Reports
Journal of Neuroendovascular Therapy 2018; 12: 6 13 Online September 21, 2017 DOI: 10.5797/jnet.oa.2017-0017 Single-stage Coil Embolization for Kissing Aneurysms of the Internal Carotid Artery Using Enterprise
More informationRepair of Intracranial Vessel Perforation with Onyx-18 Using an Exovascular Retreating Catheter Technique
Repair of Intracranial Vessel Perforation with Onyx-18 Using an Exovascular Retreating Catheter Technique Michael Horowitz M.D. Pittsburgh, Pennsylvania Background Iatrogenic intraprocedural rupture rates
More informationCoil Embolization of Cerebral Tiny Aneurysms
Journal of Neuroendovascular Therapy 2016; 10: 243 248 Online November 9, 2016 DOI: 10.5797/jnet.oa.2016-0035 Coil Embolization of Cerebral Tiny Aneurysms Terumasa Kuroiwa, 1 Fuminori Shimizu, 2 Taro Yamashita,
More informationShallow aneurysms with wide necks pose a technical challenge
ORIGINAL RESEARCH INTERVENTIONAL Coil Protection Using Small Helical Coils for Wide-Neck Intracranial Aneurysms: A Novel Approach Y.D. Cho, J.Y. Lee, J.H. Seo, S.J. Lee, H.-S. Kang, J.E. Kim, O.-K. Kwon,
More informationORIGINAL PAPER. 8-F balloon guide catheter for embolization of anterior circulation aneurysms: an institutional experience in 152 patients
Nagoya J. Med. Sci. 79. 435 ~ 441, 2017 doi:10.18999/nagjms.79.4.435 ORIGINAL PAPER 8-F balloon guide catheter for embolization of anterior circulation aneurysms: an institutional experience in 152 patients
More informationShallow aneurysms with wide necks pose a technical challenge
Published June 14, 2012 as 10.3174/ajnr.A3157 ORIGINAL RESEARCH Y.D. Cho J.Y. Lee J.H. Seo S.J. Lee H.-S. Kang J.E. Kim O.-K. Kwon Y.J. Son M.H. Han Coil Protection Using Small Helical Coils for Wide-Neck
More informationKissing Aneurysms at Fenestrated Proximal Basilar Artery: Double-barrel Stent-assisted Coiling Using Dual Closed-cell Stents
Journal of Cerebrovascular and Endovascular Neurosurgery pissn 2234-8565, eissn 2287-3139, http://dx.doi.org/10.7461/jcen.2017.19.2.120 Case Report Kissing Aneurysms at Fenestrated Proximal Basilar Artery:
More informationInitial Experience with the New Double-lumen Scepter Balloon Catheter for Treatment of Wide-necked Aneurysms
Original Article Neurointervention http://dx.doi.org/10.3348/kjr.2013.14.5.832 pissn 1229-6929 eissn 2005-8330 Korean J Radiol 2013;14(5):832-840 Initial Experience with the New Double-lumen Scepter Balloon
More informationA Case of Retrieval of a Migrated Coil with a Stent Retriever
Journal of Neuroendovascular Therapy 2018; 12: 186 192 Online November 10, 2017 DOI: 10.5797/jnet.cr.2017-0073 A Case of Retrieval of a Migrated Coil with a Stent Retriever Norio Fujii, Takayuki Iwakami,
More informationRescue Balloon Reposition of the Protruding Coil Loops during Endovascular Treatment of An Anterior Communicating Artery Aneurysm: A Case Report
Case Report Rescue Balloon Reposition of the Protruding Coil Loops during Endovascular Treatment of An Anterior Communicating Artery Aneurysm: A Case Report Hong Gee Roh, MD 1, Hyun-Seung Kang, MD 2, Pyoung
More informationCOIL EMBOLIZATION OF WIDE NECK CEREBRAL ANEURYSMS USING BALLOON REMODELING TECHNIQUE-INITIAL EXPERIENCE IN PAKISTAN
O R I G I N A L A R T I C L E COIL EMBOLIZATION OF WIDE NECK CEREBRAL ANEURYSMS USING BALLOON REMODELING TECHNIQUE-INITIAL EXPERIENCE IN PAKISTAN Dr.Qasim Bashir 1, Dr.Hina Nabi Ahmed 2 1 Department of
More informationPipeline Embolization Device
Pipeline Embolization Device The power to redefine aneurysm treatment. REDEFINE The Pipeline device redefines treatment for large or giant wide-necked aneurysms by reconstructing the parent artery and
More informationCASE REPORT. Alpha horizontal stent delivery for coil embolization of a broad-necked large basilar apex aneurysm: a case report
Nagoya J. Med. Sci. 77. 659 ~ 665, 2015 CASE REPORT Alpha horizontal stent delivery for coil embolization of a broad-necked large basilar apex aneurysm: a case report Tomotaka Ohshima, Masamune Nagakura,
More informationBalloon-assisted guide catheter positioning to overcome extreme cervical carotid tortuosity: technique and case experience
Department of Neurosurgery, Stony Brook University Medical Center, Cerebrovascular Center, Stony Brook, New York, USA Correspondence to Dr D Fiorella, Department of Neurological Surgery, Stony Brook University
More informationPosterior Cerebral Artery Aneurysms with Common Carotid Artery Occlusion: A Report of Two Cases
Journal of Neuroendovascular Therapy 2017; 11: 371 375 Online March 3, 2017 DOI: 10.5797/jnet.cr.2016-0114 Posterior Cerebral Artery Aneurysms with Common Carotid Artery Occlusion: A Report of Two Cases
More informationY-Stent-Assisted Coil Embolization of Anterior Circulation Aneurysms
Interventional Neuroradiology 18: 158-163, 2012 www.centauro.it Y-Stent-Assisted Coil Embolization of Anterior Circulation Aneurysms Using Two Solitaire AB Devices: a Single Center Experience M. Martínez-Galdámez
More informationFirst experience in intracranial aneurysm occlusion by balloon assisted coiling technique
100 Chiriac et al Intracranial aneurysm occlusion by balloon assisted coiling technique First experience in intracranial aneurysm occlusion by balloon assisted coiling technique A. Chiriac, B. Iliescu
More informationEndovascular treatment is increasingly used for ruptured
ORIGINAL RESEARCH P. Jeon B.M. Kim D.I. Kim S.I. Park K.H. Kim D.J. Kim S.H. Suh S.K. Huh Y.B. Kim Reconstructive Endovascular Treatment of Fusiform or Ultrawide-Neck Circumferential Aneurysms with Multiple
More informationMechanical Thrombectomy of Large Vessel Occlusions Using Stent Retriever Devices
Mechanical Thrombectomy of Large Vessel Occlusions Using Stent Retriever Devices Joey English MD, PhD Medical Director, Neurointerventional Services California Pacific Medical Center Hospitals, San Francisco,
More informationDEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service
M AY. 6. 2011 10:37 A M F D A - C D R H - O D E - P M O N O. 4147 P. 1 DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service Food and Drug Administration 10903 New Hampshire Avenue Document Control
More informationIrretrievable unraveled coil remaining in the vascular lumen between the cerebral aneurysm and puncture site
Technical Note JNET 3:42-46, 2009 Irretrievable unraveled coil remaining in the vascular lumen between the cerebral aneurysm and puncture site Kouhei NII 1) Masanari ONIZUK 1) Yoshirou KNEKO 2) Hiroshi
More informationIntroducing a New Treatment Method for Brain Aneurysms
Pipeline Embolization Device Introducing a New Treatment Method for Brain Aneurysms UNDERSTANDING ANEURYSMS What is a brain aneurysm? An aneurysm is an outpouching in an artery caused by weakness in the
More informationOriginal Article The temporary caging technique for catheter navigation in patients with intracranial wide-necked aneurysms
Int J Clin Exp Med 2015;8(7):11214-11219 www.ijcem.com /ISSN:1940-5901/IJCEM0010334 Original Article The temporary caging technique for catheter navigation in patients with intracranial wide-necked aneurysms
More informationCoiling of ruptured and unruptured intracranial aneurysms
ORIGINAL RESEARCH W.J. van Rooij G.J. Keeren J.P.P. Peluso M. Sluzewski Clinical and Angiographic Results of Coiling of 196 Very Small (< 3 mm) Intracranial Aneurysms BACKGROUND AND PURPOSE: Coiling of
More informationThe self-expandable Neuroform2 stent (Boston Scientific,
ORIGINAL RESEARCH V. Katsaridis C. Papagiannaki C. Violaris Embolization of Acutely Ruptured and Unruptured Wide-Necked Cerebral Aneurysms Using the Neuroform2 Stent without Pretreatment with Antiplatelets:
More informationHorizontal Stent Assisted Coiling of Wide Neck Basilar Tip Aneurysm: Comparison of Two Cases
Journal of Cerebrovascular and Endovascular Neurosurgery pissn 2234-8565, eissn 2287-3139, http://dx.doi.org/10.7461/jcen.2017.19.3.201 Case Report Horizontal Stent Assisted Coiling of Wide Neck Basilar
More informationBifurcated system Proximal suprarenal stent Modular (aortic main body and two iliac legs) Full thickness woven polyester graft material Fully
Physician Training Bifurcated system Proximal suprarenal stent Modular (aortic main body and two iliac legs) Full thickness woven polyester graft material Fully supported by self-expanding z-stents H&L-B
More informationReport of Flow Diverter Clinical Trials in Japan
Journal of Neuroendovascular Therapy 2017; 11: 124 132 Online May 21, 2016 DOI: 10.5797/jnet.ra-diverter.2016-0006 Report of Flow Diverter Clinical Trials in Japan Hidenori Oishi 1,2 and Nobuyuki Sakai
More informationHigh-Flow, Small-Hole Arteriovenous Fistulas: Treatment with Electrodetachable Coils
High-Flow, Small-Hole Arteriovenous Fistulas: Treatment with Electrodetachable Coils Guido Guglielmi, Fernando Viñuela, Gary Duckwiler, Jacques Dion, and Alfredo Stocker Summary: We present one case of
More informationEx Vivo Release of Pipeline Embolization Device Polytetrafluoroethylene Sleeves: A Technical Note
DOI: 10.5797/jnet.tn.2017-0105 Ex Vivo Release of Pipeline Embolization Device Polytetrafluoroethylene Sleeves: A Technical Note Yu Takahashi, Kenji Sugiu, Jun Haruma, Satoshi Murai, Naoya Kidani, Shingo
More informationRole, safety, and efficacy of WEB flow disruption: a review
The ejournal of the European Society of Minimally Invasive Neurological Therapy Role, safety, and efficacy of WEB flow disruption: a review EJMINT Invited Review, 2014: 1419000139 (8 th May 2014) Laurent
More informationSingle Pass MCA Revascularization with Trevo
Single Pass MCA Revascularization with Trevo By Concentric Medical ProVueTM Retriever Case Reported By Sascha Prothmann, MD Klinikum rechts der Isar, Munich, Germany Images contained herein courtesy of
More informationTreatment of Unruptured Vertebral Artery Dissecting Aneurysms
33 Treatment of Unruptured Vertebral Artery Dissecting Aneurysms Isao NAITO, M.D., Shin TAKATAMA, M.D., Naoko MIYAMOTO, M.D., Hidetoshi SHIMAGUCHI, M.D., and Tomoyuki IWAI, M.D. Department of Neurosurgery,
More informationTIPS & TRICKS for optimal SILK placement
I. Antiplatelet Premedication: The correctly chosen premedication is essential. PLAVIX (minimum 600mg) should ideally be administered during eight days prior to procedure (75mg per day). However, a loading
More informationEndosaccular aneurysm occlusion with Guglielmi detachable coils for obstructive hydrocephalus caused by a large basilar tip aneurysm Case report
Neurosurg Focus 7 (4):Article 5, 1999 Endosaccular aneurysm occlusion with Guglielmi detachable coils for obstructive hydrocephalus caused by a large basilar tip aneurysm Case report Akira Watanabe, M.D.,
More informationNeuroform EZ Stent System
Neuroform EZ Stent System Directions for Use 2 Neuroform EZ Stent System 1 cm 1.9 cm 135 cm 185 cm ONLY Caution: Federal Law (USA) restricts this device to sale by or on the order of a physician. warning
More informationAncillary Components with Z-Trak Introduction System
Ancillary Components with Z-Trak Introduction System Zenith Flex AAA Endovascular Graft Ancillary Components Converter Converters can be used to convert a bifurcated graft into an aortouniiliac graft if
More informationInterlocking Detachable Coil Occlusion in the Endovascular Treatment of Intracranial Aneurysms: Preliminary Results
Interlocking Detachable Coil Occlusion in the Endovascular Treatment of Intracranial Aneurysms: Preliminary Results H. Saruhan Cekirge, Isil Saatci, Murat M. Firat, Ferhun Balkanci, and Aytekin Besim PURPOSE:
More informationPractical Feasibility and Packing Density of Endovascular Coiling Using Target Nano TM Coils in Small Cerebral
Journal of Cerebrovascular and Endovascular Neurosurgery pissn 34-8565, eissn 87-339, http://dx.doi.org/.746/jcen.5.7.4.95 Original Article Practical Feasibility and Packing Density of Endovascular Coiling
More informationEndovascular treatment for pseudoocclusion of the internal carotid artery
Endovascular treatment for pseudoocclusion of the internal carotid artery Daqiao Guo, Xiao Tang, Weiguo Fu Institute of Vascular Surgery, Fudan University, Department of Vascular Surgery, Zhongshan Hospital
More informationUse of a Flow Re-direction Endoluminal Device (FRED) for Wide-neck Large/Giant Cerebral Aneurysms
DOI: 10.5797/jnet.ra-diverter.2016-0022 Use of a Flow Re-direction Endoluminal Device (FRED) for Wide-neck Large/Giant Cerebral Aneurysms Yuji Matsumaru, Tatsuo Amano, and Masayuki Sato Objective: There
More informationNIH Public Access Author Manuscript J Am Coll Radiol. Author manuscript; available in PMC 2013 June 24.
NIH Public Access Author Manuscript Published in final edited form as: J Am Coll Radiol. 2010 January ; 7(1): 73 76. doi:10.1016/j.jacr.2009.06.015. Cerebral Aneurysms Janet C. Miller, DPhil, Joshua A.
More informationTwo Cases of Carotid Artery Stenting Combined Balloon- and Self-expanding Stent for the Spontaneous Internal Carotid Artery Dissections
Journal of Neuroendovascular Therapy 2017; 11: 437 442 Online June 13, 2017 DOI: 10.5797/jnet.tn.2016-0059 Two Cases of Carotid Artery Stenting Combined Balloon- and Self-expanding Stent for the Spontaneous
More informationZenith Renu AAA Converter Graft. Device Description Planning and Sizing Deployment Sequence Patient Follow-Up
Zenith Renu AAA Converter Graft Device Description Planning and Sizing Deployment Sequence Patient Follow-Up Device description: Device indications The Zenith Renu AAA Converter Graft with Z-Trak Introduction
More informationCan Flow diverters be used in acute SAH
Can Flow diverters be used in acute SAH Dr. Hazem Habboub DMRD, FRCR, FACR King Hussein Medical Center Amman- Jordan Dr.I Qtqish Dr. M Khawladeh Dr. S. Haddad Dr. S Jfoot - Flow diverters represent a paradigm
More informationRuby Coil. Large Volume Detachable Coils
Ruby Coil Ruby Case Examples 38 mm Hepatic Artery Aneurysm Pulmonary AVM 2 Coils Dr. James Benenati Miami Cardiac and Vascular Institute, FL Y90 Embolization Type 2 Endoleak Dr. J Moskovitz Florida Hospital,
More informationCAROTID ARTERY ANGIOPLASTY
CAROTID ARTERY ANGIOPLASTY Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Medical Coverage Guideline
More informationNovel non-occlusive temporary endoluminal neck protection device to assist in the treatment of aneurysms in a canine model
1 Stroke and Cerebrovascular Center, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA 2 Stroke and Cerebrovascular Center, Department of Radiology, Medical
More informationDiffusion-Weighted Imaging Abnormalities after Percutaneous Transluminal Angioplasty and Stenting for Intracranial Atherosclerotic Disease
AJNR Am J Neuroradiol 26:385 389, February 2005 Diffusion-Weighted Imaging Abnormalities after Percutaneous Transluminal Angioplasty and Stenting for Intracranial Atherosclerotic Disease Tomoyuki Tsumoto
More informationRetrieval of Unintended Migrated Detached Coil - Case Report -
Journal of Cerebrovascular and Endovascular Neurosurgery pissn 2234-8565, eissn 2287-3139, http://dx.doi.org/10.7461/jcen.2014.16.3.268 Case Report Retrieval of Unintended Migrated Detached Coil - Case
More informationRuptured intracranial vertebral confluence
Endovascular Transluminal Stent-Assisted Coil Embolization of a Vertebral Confluence Aneurysm: Technique Report Michael B. Horowitz, M.D., Elad I. Levy, M.D., Christopher J. Koebbe, M.D., and Charles C.
More informationTreatment of Superior Sagittal Sinus Dural Arteriovenous Fistula by Transarterial Multiple Balloon-assisted Onyx Embolization: A Case Report
DOI: 10.5797/jnet.tn.2016-0136 Treatment of Superior Sagittal Sinus Dural Arteriovenous Fistula by Transarterial Multiple Balloon-assisted Onyx Embolization: A Case Report Shunsuke Yamashita, 1 Atsushi
More informationY-Stent Assisted Coil Embolisation of Wide-Necked Aneurysms Using a New Fully Retrievable and Detachable Intracranial Stent: Report of Two Cases
Case Report Y-Stent Assisted Coil Embolisation of Wide-Necked Aneurysms Using a New Fully Retrievable and Detachable Intracranial Stent: Report of Two Cases Ahmad Sobri Muda 1, Ahmad Razali Md Ralib 2,
More informationUPSTATE Comprehensive Stroke Center
Comprehensive Stroke Center Disclosures NO CONFLICTS OF INTEREST TO DISCLOSE Objectives Review the natural history and treatment options for intracranial aneurysms Discuss current endovascular therapy
More informationWLNC 2018 ISTANBUL CASES
WLNC 2018 ISTANBUL CASES WLNC 2018 KOBE / ISTANBUL CASES PT 1 NK 62 Y F Presented with dizziness 2 years ago MR-DSA: Falcotentorial Dural AVF WLNC 2018 KOBE / ISTANBUL CASES MRI 2017 WLNC 2018 KOBE / ISTANBUL
More informationKansai Rosai Hospital Cardiovascular Center
Successful internal iliac aneurysm exclusion by using coil embolization and upside down Gore Excluder contralateral leg with extracorporeal predeployment Kansai Rosai Hospital Center Shota Okuno, Osamu
More informationThe current optimized approach for patients with a ruptured
ORIGINAL RESEARCH I. Oran C. Cinar Continuous Intra-Arterial Infusion of Nimodipine During Embolization of Cerebral Aneurysms Associated With Vasospasm BACKGROUND AND PURPOSE: Despite rigorous efforts,
More information(12) Patent Application Publication (10) Pub. No.: US 2012/ A1
(19) United States US 2012O316632A1 (12) Patent Application Publication (10) Pub. No.: US 2012/0316632 A1 Gao (43) Pub. Date: Dec. 13, 2012 (54) RETRIEVABLE COVERED STENT FOR (52) U.S. Cl.... 623A1.2 BFURCATION
More informationRuptured aberrant internal carotid artery pseudoaneurysm presenting with spontaneous massive ear bleeding following a single sneeze: a case report
Case eport JNET 7:312-316, 2013 uptured aberrant internal carotid artery pseudoaneurysm presenting with spontaneous massive ear bleeding following a single sneeze: a case report Seiichiro HIONO 1) Eiichi
More informationInitial experience with implantation of novel dual layer flow-diverter device FRED
Case report Videosurgery Initial experience with implantation of novel dual layer flow-diverter device FRED Wojciech Poncyljusz 1, Leszek Sagan 2, Krzysztof Safranow 3, Monika Rać 3 1 Department of Interventional
More informationLVIS Intraluminal Stent Device: Separates itself from other stents used in treatments for aneurysm with recent PMA FDA approval
LVIS Intraluminal Stent Device: Separates itself from other stents used in treatments for aneurysm with recent PMA FDA approval 1 What is an aneurysm? A brain aneurysm is a bulging, weak area in the wall
More informationFirst described by Sundt and Murphey, 1 the term blister
ORIGINAL RESEARCH J.R. Gaughen, Jr D. Hasan A.S. Dumont M.E. Jensen J. Mckenzie A.J. Evans The Efficacy of Endovascular Stenting in the Treatment of Supraclinoid Internal Carotid Artery Blister Aneurysms
More informationSurgical Support System for Cerebral Aneurysm Coil Embolization
Technical Paper Surgical Support System for Cerebral Aneurysm Coil Embolization Yoshitaka NAGANO Yukihiro NISHIO Noriaki MATSUBARA Shigeru MIYACHI Hideo FUJIMOTO Endovascular coil embolization is becoming
More informationBeneficial Remodeling of Small Saccular Intracranial Aneurysms after Staged Stent Only Treatment: A Case Series
Beneficial Remodeling of Small Saccular Intracranial Aneurysms after Staged Stent Only Treatment: A Case Series Eric M. Nyberg, MD,* and Theodore C. Larson, MD Background: We evaluated the effect of stent
More informationPenumbra INTRACRANIAL ACCESS REDEFINED
Penumbra INTRACRANIAL ACCESS REDEFINED BENCHMARK Case Examples Stability & Compatibility Atraumatic Navigation Flow Diverter Delivery Pipeline BENCHMARK Stability Without Surpass Full distal shaft radiopacity
More informationLong term follow-up of patients with coiled intracranial aneurysms Sprengers, M.E.S.
UvA-DARE (Digital Academic Repository) Long term follow-up of patients with coiled intracranial aneurysms Sprengers, M.E.S. Link to publication Citation for published version (APA): Sprengers, M. E. S.
More informationFLEXIBLE, BALOON EXPANDABLE
EARLY RESULTS OF A CLINICAL TRIAL OF FLEXIBLE, BALOON EXPANDABLE COVERED STENT GRAFT IN ILIAC OCCLUSIVE DISEASE Chris LeCroy Coastal Vascular and Interventional Pensacola, Florida Clinical Trial WL GORE
More informationNew Stroke Interventions. Scott L. Zuckerman M.D. Vanderbilt Neurosurgery
New Stroke Interventions Scott L. Zuckerman M.D. Vanderbilt Neurosurgery Agenda Clot Retrieval Devices Merci Penumbra Stent Retrievers Solitaire Trevo New Technology Funnel ReCover MERCI Retriever (2004)
More informationFor Personal Use. Copyright HMP 2013
Case Report J INVASIVE CARDIOL 2013;25(2):E39-E41 A Case With Successful Retrograde Stent Delivery via AC Branch for Tortuous Right Coronary Artery Yoshiki Uehara, MD, PhD, Mitsuyuki Shimizu, MD, PhD,
More informationQuick Reference Guide
Quick Reference Guide Indications for Use The AFX Endovascular AAA System is indicated for endovascular treatment in patients with AAA. The devices are indicated for patients with suitable aneurysm morphology
More informationSURPASS FLOW DIVERTER
SURPASS FLOW DIVERTER SCENT TRIAL UPDATE Ajay K. Wakhloo, M.D., Ph.D., FAHA Department of Radiology, Neurology and Neurosurgery Division Neuroimaging and Intervention University of Massachusetts SVIN -
More informationLimitations of thrombolysis, including low recanalization
ORIGINAL RESEARCH Solitaire Flow-Restoration Device for Treatment of Acute Ischemic Stroke: Safety and Recanalization Efficacy Study in a Swine Vessel Occlusion Model R. Jahan BACKGROUND AND PURPOSE: The
More informationEffectiveness of IVUS in Complex Cases
Effectiveness of IVUS in Complex Cases Satoru Sumituji,M.D. Rinku General Medical Center IVUS is can provide images of the vessel wall and the tissue around the vessel which cannot be viewed by angiography.
More informationCook Medical. Zenith Flex AAA Endovascular Graft with Z-Trak Introduction System Physician Training
Cook Medical Zenith Flex AAA Endovascular Graft with Z-Trak Introduction System Physician Training Bifurcated system Proximal suprarenal stent Modular (aortic main body and two iliac legs) Full-thickness,
More informationThe treatment of wide-neck and giant intracranial aneurysms
Published December 8, 2011 as 10.3174/ajnr.A2790 ORIGINAL RESEARCH H.A. Deutschmann M. Wehrschuetz M. Augustin K. Niederkorn G.E. Klein Long-Term Follow-Up after Treatment of Intracranial Aneurysms with
More informationCase Report. Case Report
AJNR Am J Neuroradiol 25:333 337, February 2004 Case Report Stent-Coil Treatment of a Distal Internal Carotid Artery Dissecting Pseudoaneurysm on a Redundant Loop by Use of a Flexible, Dedicated Nitinol
More informationSHA aneurysms are rare. They arise from the internal carotid
Published March 8, 2012 as 10.3174/ajnr.A3004 ORIGINAL RESEARCH N. Chalouhi S. Tjoumakaris A.S. Dumont L.F. Gonzalez C. Randazzo D. Gordon R. Chitale R. Rosenwasser P. Jabbour Superior Hypophyseal Artery
More informationDetectability of unruptured intracranial aneurysms on thinslice non-contrast-enhanced CT
Detectability of unruptured intracranial aneurysms on thinslice non-contrast-enhanced CT Poster No.: C-9 Congress: ECR 5 Type: Scientific Exhibit Authors: M. Nakadate, Y. Iwasa, M. Kishino, U. Tateishi;
More informationEpidemiology And Treatment Of Cerebral Aneurysms At An Australian Tertiary Level Hospital
ISPUB.COM The Internet Journal of Neurosurgery Volume 9 Number 2 Epidemiology And Treatment Of Cerebral Aneurysms At An Australian Tertiary Level Hospital A Granger, R Laherty Citation A Granger, R Laherty.
More informationQuality Metrics. Stroke Related Procedure Outcomes
Quality Metrics Stroke Related Procedure Outcomes Below is a description of some of the stroke-related procedures performed at St. Dominic Hospital in Jackson, with quality information on the complication
More informationMoyamoya Syndrome with contra lateral DACA aneurysm: First Case report with review of literature
Romanian Neurosurgery Volume XXXI Number 3 2017 July-September Article Moyamoya Syndrome with contra lateral DACA aneurysm: First Case report with review of literature Ashish Kumar Dwivedi, Pradeep Kumar,
More informationIncidental aneurysms are now more frequently diagnosed
ORIGINAL RESEARCH S.-H. Im M.H. Han O.-K. Kwon B.J. Kwon S.H. Kim J.E. Kim C.W. Oh Endovascular Coil Embolization of 435 Small Asymptomatic Unruptured Intracranial Aneurysms: Procedural Morbidity and Patient
More informationAlessandro Della Puppa
Intraoperative measurement of arterial blood flow in complex cerebral aneurysms surgery Studio flussimetrico intra-operatorio nel clipping degli aneurismi complessi Alessandro Della Puppa NEUROSURGERY
More informationStent-assisted coil embolization of a wide-necked renal artery aneurysm
Stent-assisted coil embolization of a wide-necked renal artery aneurysm Bjoern Kitzing 1*, John Vedelago 1, Nick Bajic 1, Grace Lai 1, Richard Waugh 1 1. Department of Radiology, Royal Prince Alfred Hospital,
More informationTechniques in cerebral aneurysm surgery
SYⅤ-1 Surgery for large and giant cerebral aneurysm Hidetoshi Murata, Ryohei Miyazaki, Mitsuru Sato, Nobuyuki Shimizu, Takahiro Tanaka, Taishi Nakamura, Shigeta Miyake, Jun Suenaga, Tetsuya Yamamoto Department
More informationSolitaire FR Revascularization Device
Solitaire FR Revascularization Device FEATURING PARAMETRIC DESIGN Restore. Retrieve. Revive. 5 Revolutionizing Mechanical Thrombectomy with Parametric Design Solitaire FR Device The Solitaire FR revascularization
More informationTo balloon, or not to balloon
To balloon, or not to balloon that is the question Demetrius K. Lopes, MD Professor of Neurosurgery and Radiology Director, Rush Center for Neuroendovascular Surgery Section Chief, Cerebrovascular Neurosurgery
More informationStudying Aneurysm Devices in the Intracranial Neurovasculature
Studying Aneurysm Devices in the Intracranial Neurovasculature The benefits and risks of treating unruptured aneurysms depend on the anatomical location. One approach to studying devices to treat unruptured
More informationAn Overview of Post-EVAR Endoleaks: Imaging Findings and Management. Ravi Shergill BSc Sean A. Kennedy MD Mark O. Baerlocher MD FRCPC
An Overview of Post-EVAR Endoleaks: Imaging Findings and Management Ravi Shergill BSc Sean A. Kennedy MD Mark O. Baerlocher MD FRCPC Disclosure Slide Mark O. Baerlocher: Current: Consultant for Boston
More informationCerebrovascular Neurosurgery: The Highly Specialized Care for All Aspects of Cerebrovascular Disease
Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/medical-breakthroughs-from-pennmedicine/cerebrovascularneurosurgery-highly-specializedcare/7083/
More informationComparison between Solitaire AB and Enterprise stent assisted coiling for intracranial aneurysms
EXPERIMENTAL AND THERAPEUTIC MEDICINE 10: 145-153, 2015 Comparison between Solitaire AB and Enterprise stent assisted coiling for intracranial aneurysms HUA WEI YE 1*, YA QI LIU 1,2*, QIU JING WANG 2,
More informationEndovascular treatment (EVT) of intracranial aneurysms is an
ORIGINAL RESEARCH INTERVENTIONAL Endovascular Treatment of Middle Cerebral Artery Aneurysms for 120 Nonselected Patients: A Prospective Cohort Study B. Gory, A. Rouchaud, S. Saleme, F. Dalmay, R. Riva,
More informationEnterprise Stent-assisted Cerebral Aneurysm Coiling: Can Antiplatelet Therapy be Terminated after Neointima Formation with the Enterprise Stent?
Journal of Neuroendovascular Therapy 2016; 10: 201 205 Online September 9, 2016 DOI: 10.5797/jnet.oa.2016-0052 Enterprise Stent-assisted Cerebral Aneurysm Coiling: Can Antiplatelet Therapy be Terminated
More informationDepartment of Internal Medicine, Saitama Citizens Medical Center, Saitama , Japan
Case Reports in Cardiology Volume 2016, Article ID 8790347, 5 pages http://dx.doi.org/10.1155/2016/8790347 Case Report GuideLiner Catheter Use for Percutaneous Intervention Involving Anomalous Origin of
More informationThe Endovascular Treatment of Traumatic Cavernous Sinus Arteriovenous Fistulas: A Single-center Experience
Journal of Neuroendovascular Therapy 2017; 11: 450 456 Online June 7, 2017 DOI: 10.5797/jnet.oa.2016-0139 The Endovascular Treatment of Traumatic Cavernous Sinus Arteriovenous Fistulas: A Single-center
More informationNellix Endovascular System: Clinical Outcomes and Device Overview
Nellix Endovascular System: Clinical Outcomes and Device Overview Jeffrey P. Carpenter, MD Professor and Chief, Department of Surgery CAUTION: Investigational device. This product is under clinical investigation
More informationStent-assisted Coil Placement in a Wide-necked Persistent Trigeminal Artery Aneurysm with Jailing of the Trigeminal Artery: A Case Report
Stent-assisted Coil Placement in a Wide-necked Persistent Trigeminal Artery Aneurysm with Jailing of the Trigeminal Artery: A Case Report Mohammed I. Mohammed, Johnny S. Sandhu, and Ajay K. Wakhloo AJNR
More information