nitinol and Subarachnoid-Hemorrhage

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 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 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