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Embolization flow

A A Dmytriw, K Phan, J M Moore, V M Pereira, T Krings, A J Thomas
Uptake of flow-diverting technology is rapidly outpacing the availability of clinical evidence. Most current usage is off-label, and the endovascular community is nearer the beginning than the end of the learning curve, given the number of devices in development. A comprehensive overview of technical specifications alongside key outcome data is essential both for clinical decision-making and to direct further investigations. Most-studied has been the Pipeline Embolization Device, which has undergone a transition to the Pipeline Flex for which outcome data are sparse or heterogeneous...
March 20, 2019: AJNR. American Journal of Neuroradiology
Elias Atallah, Hassan Saad, Nikolaos Mouchtouris, Kimon Bekelis, Jackson Walker, Nohra Chalouhi, Stavropoula Tjoumakaris, Michelle Smith, Robert H Rosenwasser, Hekmat Zarzour, Nabeel Herial, James Feghali, Michael Reid Gooch, Symeon Missios, Ahmad Sweid, Pascal Jabbour
BACKGROUND: Pipeline embolization device (PED; Medtronic, Dublin, Ireland) utilization is not limited to the treatment of giant wide-necked aneurysms. It has been expanded to handle small blisters, fusiforms, and dissecting intracranial aneurysms. OBJECTIVE: To report the use of the PED in various off-label distal cerebral circulation (DCC) arteries with a follow-up to assess clinical outcomes. METHODS: Between 2011 and 2016, of 437 consecutive patients, 23 patients with aneurysms located in DCCs were treated with PED...
March 20, 2019: Neurosurgery
Edgar A Samaniego, Sudeepta Dandapat, Jorge A Roa, Mario Zanaty, Daichi Nakagawa, David M Hasan
BACKGROUND: Embolization of intracranial aneurysms with the pipeline embolization device (PED; Medtronic, Dublin, Ireland) is a widely used technique. Despite adequate dual antiplatelet therapy and intraprocedural anticoagulation, in-stent thrombosis has been described. There is limited evidence for best management of this complication. OBJECTIVE: To describe in detail the technique used to perform thrombectomy of a recently placed PED with in-stent thrombosis. The aim of the procedure is to leave the PED in place and only perform thrombectomy of the luminal clot...
March 20, 2019: Operative Neurosurgery (Hagerstown, Md.)
Lei Yi, Wenyuan Zhao, Timo Krings, Wei Wang, Jincao Chen
INTRODUCTION: Stent thrombosis (ST) is a known complication after intracranial stent implantation. The pathophysiology of ST is multifactorial and standardized treatments for ST remain uncertain. CASE REPORT: A patient harboring an unruptured aneurysm of the posterior communicating segment of the left internal carotid artery (ICA) was treated with stent-assisted coil embolization while on dual anti-aggregation therapy. Despite adherence to medication, ST occurred eight days after the intervention...
March 13, 2019: World Neurosurgery
Andreas Harloff, Paul Hagenlocher, Thomas Lodemann, Anja Hennemuth, Cornelius Weiller, Jürgen Hennig, Werner Vach
OBJECTIVES: Retrograde blood flow from complex atheroma in the descending aorta (DAo) has only recently been described as a potential mechanism of stroke. However, prevalence of this mechanism in the general population and the exact factors influencing stroke risk are unclear. METHODS: One hundred twenty-six consecutively recruited inhabitants of Freiburg, Germany, between 20 and 80 years of age prospectively underwent 3-T MRI. Aortic plaque location and thickness were determined by 3D T1 MRI (1 mm3 )...
March 15, 2019: European Radiology
Hiroki Yamada, Isako Saga, Atsuhiro Kojima, Takashi Horiguchi
BACKGROUND: Peripheral aneurysms are known to be a source of intracranial hemorrhage in patients with moyamoya disease. However, the natural history of ruptured peripheral aneurysms remains unclear. Some regress spontaneously, while others may show rebleeding. Direct treatments, such as surgical operation or intravascular treatment of the peripheral aneurysm, occasionally have a risk of severe neurological complications, due to the depth of the operative field and the fragility of the parent artery...
March 12, 2019: World Neurosurgery
Chetna Tailor, W Spencer Ashby, Donald R Gorassini, Stephen P Lownie, Kimberley Walsh, David Pelz, Robert R Hammond
OBJECTIVEEndovascular approaches have evolved from a technique practiced at very few centers to a widely available option in the management of arteriovenous malformations (AVMs) of the central nervous system. Embolization can be employed as definitive therapy or as an adjunct to surgical excision. A wide variety of embolic agents have been successfully developed and used in the clinical setting. In addition to facilitating vascular occlusion, embolic agents induce a number of reactive and destructive changes in vessel walls and the surrounding tissue...
March 15, 2019: Journal of Neurosurgery
F Cagnazzo, P Perrini, C Dargazanli, P-H Lefevre, G Gascou, R Morganti, D di Carlo, I Derraz, C Riquelme, A Bonafe, V Costalat
BACKGROUND: The safety and efficacy of flow diversion among distal anterior circulation aneurysms must be proved. PURPOSE: Our aim was to analyze the outcomes after flow diversion among MCA, anterior communicating artery, and distal anterior cerebral artery aneurysms. DATA SOURCES: A systematic search of 3 databases was performed for studies published from 2005 to 2018. STUDY SELECTION: According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting flow diversion of distal anterior circulation aneurysms...
March 14, 2019: AJNR. American Journal of Neuroradiology
Eimad Shotar, Nader-Antoine Sourour, Kevin Premat, Idriss Haffaf, Sam Ghazanfari, Alice Jacquens, Aurélien Nouet, Stéphanie Lenck, Jacques Chiras, Vincent Degos, Frédéric Clarençon
PURPOSE: Non-traumatic acute subdural hematomas (SDH) are rare and have seldom been reported in ruptured brain arteriovenous malformations (BAVM). The aim of this study was to report the frequency of acute SDH in BAVM-related hemorrhage and to determine the relationship of SDHs with BAVM angioarchitectural features. METHODS: This was a retrospective monocentric study of patients admitted for BAVM rupture between 2003 and 2017. Patients with rupture complicating or closely following partial embolization procedures were excluded...
March 13, 2019: Clinical Neuroradiology
Hippocrates Moschouris, Konstantinos Stamatiou, Katerina Malagari, Kyriaki Marmaridou, Konstantinos Kladis-Kalentzis, Michail Kiltenis, Nikolaos Papadogeorgopoulos, Aikaterini Tsavari, Kassiani Manoloudaki
PURPOSE: We aimed to assess the clinical and predictive role of contrast-enhanced ultrasonography (CEUS) as the primary method for imaging evaluation of prostatic artery embolization (PAE) for the treatment of symptomatic benign prostatic hyperplasia (BPH). METHODS: Thirty-one patients with symptomatic BPH, treated with PAE from October 2016 until February 2018, were enrolled in this prospective, single-center study. Microspheres (100-700 µm) were utilized for PAE...
March 2019: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
Yuki Nishihara, Yasuji Seyama, Masamichi Takahashi, Yujiro Matsuoka, Hiroki Kudo, Hiroyuki Kanomata, Tsuyoshi Maeshiro, Sachio Miyamoto
An 86-year-old male underwent pancreatoduodenectomy with resection and reconstruction of portal vein for pancreatic cancer. He was admitted to our hospital because of severe anemia and dyspnea ten months later. Computed tomography showed varices at the biliary-enteric anastomosis in the elevated jejunum caused by portal venous stenosis, which was suspected as the cause of anemia. Therefore, the patient underwent balloon dilatation of the portal vein followed by stent placement and coil embolization of the collaterals using a transileocolic portal vein approach...
2019: Nihon Shokakibyo Gakkai Zasshi, the Japanese Journal of Gastro-enterology
Thomas Noppeney, Reinhard Kopp, Karin Pfister, Wilma Schierling, Jeanette Noppeney, Beatrix Cucuruz
OBJECTIVE: Popliteal vein aneurysms are associated with high risk for deep venous thrombosis (DVT) and pulmonary embolism. The goal of this study was to report treatment strategies for popliteal vein aneurysms and their outcome after long-term follow-up. METHODS: All patients between June 1993 and June 2018 with diagnosed popliteal vein aneurysm were enrolled in this study and analyzed retrospectively. They received regular surveillance alone or treatment. Patients were offered aneurysm resection or lifelong anticoagulation if they had aneurysm size of twice normal vein diameter...
March 7, 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Nicholas Isom, Reza Masoomi, Adam Alli, Kamal Gupta
BACKGROUND Congenital renal vascular anomalies have been classified into 3 categories: cirsoid, angiomatous, and aneurysmal. These classifications are based on the size, location, and number of vessels involved. Aneurysmal malformations, such as the one reported here, have a single (and dilated) feeding and draining vessel. The prevalence of renal AVMs is estimated at less than 0.04%, making them rare causes of secondary hypertension. CASE REPORT A 29-year-old white woman was seen in the hypertension clinic as a referral from high-risk obstetric clinic for management of hypertension (HTN)...
March 10, 2019: American Journal of Case Reports
Adam F Prasanphanich, Christopher T Johnson, Andrey Krasnopeyev, Shraddha Cantara, Cristin Roach, Sanjeev Gumber, Raghavan Chinnadurai, Jacques Galipeau, Luke Brewster, J David Prologo
PURPOSE: To evaluate the feasibility of catheter-directed intra-arterial stem cell delivery of human mesenchymal stem cells (MSCs) to the small bowel in a porcine model. MATERIALS AND METHODS: The cranial mesenteric artery of 6 Yucatan minipigs was selectively catheterized under fluoroscopic guidance following cut-down and carotid artery access. A proximal jejunal branch artery was selectively catheterized for directed delivery of embolic microspheres (100-300 μm) or MSCs (0...
March 6, 2019: Journal of Vascular and Interventional Radiology: JVIR
Gabriele Crimi, Lorenzo Moramarco, Alessandro Mandurino-Mirizzi, Pietro Quaretti, Maurizio Ferrario
Embolic myocardial infarction account for ≈3% of all ST-segment myocardial infarction and represents a challenge often left no-reperfused because current thrombectomy technologies are inefficient to grab thrombus wedged into distal coronary arteries. We present the case of a 34-year-old man who presented with anterior STEMI and a proximal left anterior descending coronary artery ulcerated plaque with a great thrombus burden, which led to distal embolization. Failure of several attempts of manual and rheolytic thrombectomy, led us to use the "Solumbra technique", the combined use of stent retriever and Penumbra catheter was successful in restoring patency and flow...
March 9, 2019: Catheterization and Cardiovascular Interventions
Denise Brunozzi, Ali Alaraj
N-butyl cyanoacrylate glue (n-BCA, Cerenovus, Irvine, California) is commonly used to treat arteriovenous malformation (AVM). Even though Onyx (ethylene vinyl alcohol, Medtronic, Dublin, Ireland) presents more controlled injection, n-BCA is colorless, thus preferable for treatment of superficial facial malformations. N-BCA injection into AVM can result in premature distal migration or early precipitation and reflux into the feeder vessels. Here we describe a trans-arterial balloon assisted technique embolization of a complex facial AVM with n-BCA...
March 9, 2019: Operative Neurosurgery (Hagerstown, Md.)
Quentin Pellenc, Arnaud Roussel, Romain De Blic, Antoine Girault, Pierre Cerceau, Iannis Ben Abdallah, Olivier Milleron, Guillaume Jondeau, Yves Castier
OBJECTIVE: Failure of thoracic endovascular aortic repair (TEVAR) in chronic aortic dissections can be partially explained by retrograde false lumen (FL) flow through distal re-entry tears. After implantation of a thoracic stent graft, FL thrombosis occurs in less than 50% of the cases. The objectives of this study were to describe the feasibility and outcomes of FL embolization in patients with chronic aortic dissections. METHODS: Between June 2015 and January 2018, 27 patients (mean age, 61 ± 14 years) with chronic aortic dissection underwent FL embolization as an adjunct during or after TEVAR placement procedure...
March 5, 2019: Journal of Vascular Surgery
Stephanie H Chen, David McCarthy, Ricardo Hanel, Samir Sur, Pascal Jabbour, Elias Atallah, Nohra Chalouhi, Aaron Dumont, Peter Amenta, David Hasan, Daniel Raper, Kenneth Liu, John A Jane, R Webster Crowley, Pedro Aguilar-Salinas, Josh Bentley, Stephen Monteith, Bartley D Mitchell, Dileep R Yavagal, Eric C Peterson, Robert M Starke
BACKGROUND: Intracranial pseudoaneurysms (PSA) are associated with high rupture and mortality rates and have traditionally been treated by parent vessel sacrifice. There has been recent interest in utilizing flow-diverting devices for treatment of these complex lesions while preserving flow through the parent artery. OBJECTIVE: Examine the safety and efficacy of these devices in the treatment of intracranial PSA. METHODS: We performed a multi-institutional retrospective study of intracranial PSA treated with the Pipeline Embolization device (PED, Medtronic) between 2014 and 2017 at 7 institutions...
March 5, 2019: World Neurosurgery
Cyril Dargazanli, Mehdi Mahmoudi, Matteo Cappucci, François-Louis Collemiche, Julien Labreuche, Othmane Habza, Grégory Gascou, Pierre-Henri Lefèvre, Omer Eker, Isabelle Mourand, Nicolas Gaillard, Mahmoud Charif, Imad Derraz, Caroline Arquizan, Vincent Costalat
BACKGROUND AND PURPOSE: The best embolic protection strategy has not yet been established for carotid artery stenting (CAS). This article reports a new simplified approach using a balloon guide catheter inspired by stroke therapy, in patients harboring a symptomatic ICA atherosclerotic stenosis or web. In addition, the three angiographic patterns and clinical outcomes associated with this technique, called the simple flow blockage (SFB) technique are described. MATERIAL AND METHODS: This was a retrospective study with data extraction from a monocentric prospective clinical registry of consecutive patients admitted for symptomatic ICA stenosis or web...
March 7, 2019: Clinical Neuroradiology
T P Madaelil, J A Grossberg, B M Howard, C M Cawley, J Dion, R G Nogueira, D C Haussen, F C Tong
BACKGROUND AND PURPOSE: Flow diversion is an established method to treat complex intracranial aneurysms. The natural history of flow-diversion treatment failure resulting in aneurysm remnants is not well-defined. We aimed to delineate the clinical and angiographic features of this entity. MATERIALS AND METHODS: Review of a prospectively maintained Pipeline Embolization Device data base from inception to October 2017 was performed for aneurysms that demonstrated residual filling on follow-up imaging...
March 7, 2019: AJNR. American Journal of Neuroradiology
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