nitinol and Aneurysm--Ruptured

Conventional coiling is standard for treatment of ruptured intracranial aneurysms. We compared clinical and angiographic outcomes between intrasaccular flow disruption with the Woven EndoBridge (WEB) and conventional coiling in patients with aneurysmal subarachnoid hemorrhage (aSAH) using a propensity score-matched analysis.. This is a retrospective study of consecutive patients with aSAH treated with the WEB or conventional coiling between 2010 and 2019. Baseline characteristics, procedural complications, angiographic results, and functional outcome were compared between both groups.. Fifty-two patients treated with the WEB and 236 patients treated by coiling were included. The WEB group was characterized by a higher patient age (P = 0.024), a wider aneurysm neck (P < 0.001), and more frequent location at the posterior circulation (P = 0.004). Procedural complications were comparable between WEB (19.2%) and coiling (22.7%, P = 0.447). In-hospital mortality rates were higher in the coiling group (WEB: 5.8%, coiling: 17.8%; P = 0.0034). Favorable outcome (modified Rankin scale ≤2) was obtained in 51.3% after WEB embolization and in 55.0% after coiling (P = 0.653). Retreatment was performed in 26.4% of patients after WEB and in 25.8% after coiling (P = 0.935). Propensity score analysis confirmed these results and revealed higher adequate occlusion rates at midterm follow-up for WEB-treated aneurysms (WEB: 93.9%, coiling: 76.2%, P = 0.058).. Compared with conventional coiling, aSAH patients treated with the WEB have a similar clinical and potentially improved angiographic outcome at midterm follow-up. The WEB might be considered as an alternative to conventional coiling for the treatment of RIAs, in particular for those with wide-necked and thus challenging anatomy.

Topics: Adult; Aged; Alloys; Aneurysm, Ruptured; Cerebral Angiography; Endovascular Procedures; Female; Hospital Mortality; Humans; Intracranial Aneurysm; Male; Middle Aged; Postoperative Complications; Propensity Score; Retrospective Studies; Subarachnoid Hemorrhage; Surgical Mesh; Treatment Outcome

Stent-assisted coiling is an accepted endovascular treatment (EVT) for wide-necked intracranial aneurysms. The Neuroform stent (Target Therapeutics, Fremont, Calif) is a flexible nitinol self-expandable stent that was designed to potentially overcome the limitations of balloon expandable coronary stents in the intracranial circulation. The aim of this study was to reenforce the use of this stent for EVT of wide-necked cerebral aneurysms.. Between March 2005 and March 2008, 24 patients harboring wide-necked cerebral aneurysms were treated with stent reconstruction of the aneurysm neck. Inclusion criteria restricted the group to adult patients with wide-necked intracranial aneurysms (ruptured and unruptured lesions). Immediate postprocedure angiography studies were performed to determine successful coil occlusion of the aneurysm as well as patency of the parent vessel. We assessed the clinical history, aneurysm dimensions, and technical detail of the procedures, including any difficulties with stent placement and deployment, degree of aneurysm occlusion, and complications. Clinical outcome was assessed with the Glasgow Outcome Scale (GOS).. The stent was easily navigated and precisely positioned in 24 of 26 cases. However, technical difficulties occurred in 9 patients, including difficulties in crossing the stents interstice in 6 cases, inadvertent stent delivery (n = 1), and incapacity of stent delivery (n = 1) and incapacity of crossing the neck (n = 1). These latter 2 cases were classified as failures of the stent-assisted technique. A single procedural complication occurred, involving transient nonocclusive intrastent thrombus formation, which was treated uneventfully with abciximab. Seventeen patients experienced excellent clinical outcomes (GOS 5), with good outcomes (GOS 4) in 5 patients and a poor outcome (GOS 3) in 2 patients. There were no treatment-related deaths or neurologic complications (mean clinical follow-up, 12 months). Angiographic results consisted of 17 complete occlusions, 4 neck remnants, and 3 incomplete occlusions.. The Neuroform stent is very useful for EVT of wide-necked intracranial aneurysms because it is easy to navigate and to deploy accurately. In most cases, the stent can be deployed precisely, even in very tortuous carotid siphons. Although in some cases delivery and deployment was challenging, clinically significant complications were not observed.

Topics: Adult; Aged; Alloys; Aneurysm, Ruptured; Carotid Artery Diseases; Cerebral Angiography; Embolization, Therapeutic; Equipment Design; Female; Glasgow Outcome Scale; Humans; Intracranial Aneurysm; Male; Middle Aged; Stents; Tomography, X-Ray Computed; Treatment Outcome

Further to the rapid enlargement of an aneurysm to 5.6 cm in diameter after 3 years of surveillance, a 79-year-old patient was fitted with a Vanguard modular stent graft and monitored on a regular basis for 6 years. Two years later, the aneurysmal sac ruptured. The patient died 1 month after an open surgery. The device was devoid of any encapsulation and the ipsilateral limb was detached from the body. The Nitinol skeleton was mostly maintained, however, some polypropylene sutures were broken. The resulting motion of the sharp-angled Nitinol wires caused abrasion and resulted in a few localized holes that were sufficient to permit blood to percolate through the textile wall. Some polyester yarns in the warp direction were ruptured. The Nitinol wire used in this device was shown to be corrosion resistant but the selection of the polypropylene suture was inappropriate. Because this technology is maturing rapidly, these weaknesses can be avoided in the future generations of endovascular devices. It is recommended that these Nitinol wires be sutured to the fabric and that polyester yarns stronger than 68 decitex in tubes 8 mm in diameter are selected.

Topics: Aged; Alloys; Aneurysm, Ruptured; Aortic Aneurysm, Abdominal; Biocompatible Materials; Blood Vessel Prosthesis; Equipment Failure Analysis; Fatal Outcome; Humans; Male; Materials Testing; Microscopy, Electron, Scanning; Polypropylenes; Reoperation; Stents; Sutures; Tomography, X-Ray Computed

Stent systems for intracranial use are continuously improved. We report our initial experience using a new self-expanding easy-to-place nitinol stent (Enterprise) in the treatment of wide-neck intracranial aneurysms.. Between January and October 2007, 16 aneurysms in 15 patients were treated with stent assistance. Aneurysm size was a mean of 13.2 mm (median, 12 mm; range, 7-30 mm). Eight aneurysms had reopened after prior coiling, and 8 aneurysms were primarily treated, 1 after acute subarachnoid hemorrhage. Response to antiplatelet premedication was tested with a P2Y12 assay before stent placement. On a 3D angiographic workstation, stent placement was simulated to assess vessel caliber and appropriate stent length.. In all aneurysms, the stent could be placed at the exact location as predicted from the computer simulation. Stent placement proved to be technically easy without the need for recapture in all patients. Although placement of the microcatheter through the stent struts and subsequent coil placement was challenging in some patients, coiling after stent placement resulted in complete or near-complete occlusion in all aneurysms. There were no technical or clinical complications. At 6 months, angiographic follow-up in 14 aneurysms revealed 4 aneurysms recanalized to 80% occlusion, 3 of which were additionally coiled.. In this small series, delivery and deployment of the Enterprise stent was technically easy. There were no technical or clinical complications. The device was valuable in the treatment of wide-neck aneurysms. The need for antiplatelet medication in patients treated with this and other stents remains a significant disadvantage.

Topics: Adult; Aged; Alloys; Aneurysm, Ruptured; Aspirin; Cerebral Angiography; Clopidogrel; Combined Modality Therapy; Computer Simulation; Embolization, Therapeutic; Equipment Design; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Intracranial Aneurysm; Male; Middle Aged; Platelet Aggregation Inhibitors; Premedication; Retreatment; Stents; Subarachnoid Hemorrhage; Ticlopidine

The Guglielmi Detachable Coil introduced by the Boston Scientific Corporation has been widely used for endovascular coiling of aneurysm. Recently, Sapphire platinum detachable coils (eV3, Irvine, CA) have been introduced for aneurysm coiling. Herein, we report our clinical experience with the Sapphire coil to evaluate the incidence of coil related complications and the rate of aneurysm occlusion.. Consecutive patients who underwent embolization with Sapphire detachable coils were prospectively enrolled from January 2004 to September 2004 and the data were retrospectively analyzed. Patient demographics, including age, gender, presenting symptoms, Hunt and Hess grade, Fisher grade and locations of the vascular anomalies were collected. Additionally, complications associated with the coils and rates of aneurysm occlusion were observed and the data compiled.. 29 patients underwent Sapphire coil embolization for intracranial aneurysms. Mean age was 50 +/- 18 (mean +/- SD) years with 81% being females. Aneurysm neck reconstruction was required in 7 cases, 6 with Neuroform stent (5 unruptured aneurysms) and 1 with balloon assistance (ruptured aneurysm). In 7 cases, Sapphire coils were used along with other coils. There were no events of thromboembolism or ruptures of aneurysms during coil embolization. However, multi-diameter coils demonstrated stretching in 4 stent-assisted cases without any adverse consequences. Complete occlusion of the aneurysm was achieved in 79.31% of the patients, neck remnant in 6.89, and partial coiling was achieved in 13.79%.. The Sapphire coil could safely be used in the treatment of both ruptured and unruptured aneurysms. However, multi-diameter non-stretch resistant coils may be associated with coil stretching when used in conjunction with a stent. Further study is still required for definitive results.

Topics: Adult; Aged; Alloys; Aneurysm, Ruptured; Cerebral Angiography; Databases, Factual; Embolization, Therapeutic; Female; Humans; Intracranial Aneurysm; Iridium; Male; Middle Aged; Platinum; Retrospective Studies

The authors report their experience with the use of the Neuroform Microdelivery System for intravascular reconstruction. They assess the technical feasibility of the system, the efficacy of the combined application of stent and detachable coils, and the follow-up findings.. Fifty patients found to harbor a complex wide-necked intracranial aneurysm were selected for the study. Different strategies were chosen and the performance and technical success of the device were evaluated. Stent placement was recorded as optimal or suboptimal with respect to the stent position. Clinical and angiographic follow-up examinations were obtained. Forty-six patients with 48 intracranial aneurysms were treated, leading to a technical success rate of 92%. Forty-two lesions were located in the anterior circulation. In every case the dome/neck ratio was less than 2 and the mean aneurysm size in these patients was 8.8 mm. The most frequent clinical presentation was subarachnoid hemorrhage in 48% of cases. Stent placement was optimal in 81.2% of cases and suboptimal in 18.8%. In 31% of cases, the investigators encountered difficulties in placing the Neuroform stent. Clinical follow up was recorded in all patients and angiographic follow up was obtained in 63%. There were no cases of repeated hemorrhage. In a single case in which only the stent was implanted progressive thrombosis was identified during the follow-up period. The procedure-related morbidity and mortality rates were 8.6 and 2.1%, respectively.. On the basis of the results, the authors conclude that the Neuroform self-expanding stent is a flexible and useful device that can be readily and safely maneuvered through tortuous intracranial vessels, enabling the endovascular treatment of complex wide-necked aneurysms. Early in the authors' experience, stent delivery presented difficulties; however, a second generation of devices has resolved this limitation. Although the early results are promising, the long-term benefit of this technique has to be proved by angiographic and clinical follow-up examinations.

Topics: Adult; Aged; Alloys; Aneurysm, Ruptured; Angiography, Digital Subtraction; Angioplasty, Balloon; Cerebral Angiography; Combined Modality Therapy; Embolization, Therapeutic; Equipment Design; Equipment Failure; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Outcome Assessment, Health Care; Retreatment; Stents; Subarachnoid Hemorrhage; Survival Rate; Technology Assessment, Biomedical

A rupture of the popliteal artery is a rare but dangerous complication of aneurysmal disease. It accounts for 4% of all popliteal artery aneurysms encountered and threatens the loss of the extremity and, infrequently, is also life-threatening.(1) when this clinical entity is confronted, a prompt operative intervention is indispensable for increasing the chances of limb salvage. We report the first, to our knowledge, successful endovascular treatment of a ruptured popliteal artery aneurysm with a new polytetrafluoroethylene stent-graft in a patient who was unfit for a conventional surgical approach because of his severe pulmonary disease.

Topics: Alloys; Aneurysm, Ruptured; Angiography; Blood Vessel Prosthesis Implantation; Equipment Design; Follow-Up Studies; Humans; Male; Middle Aged; Polytetrafluoroethylene; Popliteal Artery; Prosthesis Design; Pulmonary Emphysema; Stents; Treatment Outcome; Ultrasonography, Doppler, Duplex; Vascular Patency