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1
Shokuhfar, Tahaamin, Michael C. Hurley, Anas Al-Smadi, Sameer A. Ansari, Matthew B. Potts, Babak S. Jahromi, Tord D. Alden, and Ali Shaibani. "MynxGrip vascular closure device use in pediatric neurointerventional procedures." Journal of Neurosurgery: Pediatrics 21, no. 5 (May 2018): 466–70. http://dx.doi.org/10.3171/2017.11.peds17481.
Повний текст джерелаАнотація:
OBJECTIVEThe aim of this paper was assess the efficacy and safety of using the MynxGrip arterial closure device in pediatric neuroendovascular procedures where the use of closure devices remains off-label despite their validation and widespread use in adults.METHODSA retrospective review of all pediatric patients who underwent diagnostic or interventional neuroendovascular procedures at the authors’ institution was performed. MynxGrip use was predicated by an adequate depth of subcutaneous tissue and common femoral artery (CFA) diameter. Patients remained on supine bedrest for 2 hours after diagnostic procedures and for 3 hours after therapeutic procedures. Patient demographics, procedural details, hemostasis status, and complications were recorded.RESULTSOver 36 months, 83 MynxGrip devices were deployed in 53 patients (23 male and 30 female patients; mean age 14 years) who underwent neuroendovascular procedures. The right-side CFA was the main point of access for most procedures. The mean CFA diameter was 6.24 mm and ranged from 4 mm to 8.5 mm. Diagnostic angiography comprised 46% of the procedures. A single device failure occurred without any sequelae; the device was extracted, and hemostasis was achieved by manual compression with the placement of a Safeguard compression device. No other immediate or delayed major complications were recorded.CONCLUSIONSMynxGrip can be used safely in the pediatric population for effective hemostasis and has the advantage of earlier mobilization.
2
Taha, Ammar, Ellen K. Walsh, Kathryn A. Wright, Iftikhar Ahmed, Nucharin Supakul, Eric E. Awwad, and Juan G. Tejada. "Safety and Feasibility of a Novel Vascular Closure Device in Neurointerventional Procedures." Interventional Neuroradiology 19, no. 3 (September 2013): 353–58. http://dx.doi.org/10.1177/159101991301900313.
Повний текст джерелаАнотація:
This retrospective study evaluated the safety and feasibility of a new arterial femoral access closure device in neurointerventional procedures. The study includes all consecutive adult patients who underwent femoral arteriotomy closure with the MynxGrip™ closure device after Neurointerventional procedures performed between June and December 2012. All patients had a follow-up color Doppler ultrasound (US) within 48 hours after the procedure, which was independently interpreted by two experienced radiologists to evaluate for access site complications. Device success/failure, sheath size, ambulation time, and periprocedural complications were recorded. Fifty-five closure devices were deployed in 53 patients. There were 23 (43%) males and 30 (57%) females; age ranged from 22 to 84 years (mean: 52.1 years). Thirty of the 55 procedures (55%) were therapeutic and 25 were diagnostic interventions (45%). Sheath sizes used were 5F in 35 procedures (64%) and 6F in 20 procedures (36%). The right femoral artery was accessed in 51 procedures (93%) and the left in four procedures (7%). There was only one (1.8%) minor periprocedural complication (small hematoma). Hemostasis was successful in 51 of the 55 procedures (93%) with subsequent early ambulation. No device-induced complications associated with serious clinical sequelae were reported. In our small series, the MynxGrip™ femoral access closure device provided a safe and feasible way of closing the femoral artery puncture site after neurointerventional procedures with low minor complication rates and no major complications. Further large prospective randomized trials are necessary to evaluate the efficacy of the device.
3
Caton, M. T., A. Z. Copelan, K. H. Narsinh, D. Murph, A. A. Abla, D. L. Cooke, S. W. Hetts, et al. "Form and Function in Intracranial Neurovascular Stents: A Historical Perspective and State-of-the-Art Clinical Review for the Noninterventionalist." Neurographics 11, no. 2 (March 1, 2021): 96–110. http://dx.doi.org/10.3174/ng.2000058.
Повний текст джерелаАнотація:
The use of intracranial stents in neurointerventional surgery has been practiced for decades. However, the spectrum of treatable pathology, available devices, and clinical adoption of intracranial stents has exploded in recent years. Diagnostic neuroradiologists play a critical role in the evaluation of these devices after deployment, yet may not be familiar with state-of-the-art intracranial stent devices and indications. This review provides an overview of intracranial stents for cerebrovascular disease, with 3 chief learning objectives: 1) to understand the basic principles of stent design, biomechanics, and deployment, and the resulting influence on cerebrovascular hemodynamics; 2) to be familiar with the spectrum of intracranial pathology amenable to endovascular stent placement; and 3) to recognize the radiographic appearance of successful intracranial stent deployment and intracranial stent‐related complications.Learning Objective: Recognize the key principles of design (form), current indications (function), and potential complications of intracranial stents used in neurointerventional surgery
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Al-Schameri, Abdul Rahman, Aviraj Deshmukh, Hadi Debaseh, Christoph Griessenauer, and Monika Killer-Oberpfalzer. "Accidental guide catheter fracture in mechanical thrombectomy." Interventional Neuroradiology 25, no. 3 (November 21, 2018): 297–300. http://dx.doi.org/10.1177/1591019918814011.
Повний текст джерелаАнотація:
Endovascular thrombectomy is now the standard of care for large vessel occlusion stroke. The aim is to achieve rapid and complete recanalisation while avoiding complications. Apart from the conventional complications of neurointerventional procedures, mechanical thrombectomy has its unique set of complications, inherent to the disease pathophysiology. We describe an unusual complication of catheter fracture and subsequent distal embolisation into the cerebral vasculature, which was noticed 24 hours after the procedure. Due to a lack of clinical consequences, we decided to manage it conservatively. The patient died within the following few days from respiratory complications unrelated to the stroke or the endovascular thrombectomy procedure. Consequently, we were able to retrieve the fractured segment and carry out histopathological analysis, which helped us to identify exactly its origin from the guide catheter. We believe that systematic reporting and database compilation of such device-related complications will aid in the design and development of neurointerventional devices in the future.
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Snelling, Brian M., Samir Sur, Sumedh S. Shah, Justin Caplan, Priyank Khandelwal, Dileep R. Yavagal, Robert M. Starke, and Eric C. Peterson. "Transradial Approach for Complex Anterior and Posterior Circulation Interventions: Technical Nuances and Feasibility of Using Current Devices." Operative Neurosurgery 17, no. 3 (November 28, 2018): 293–302. http://dx.doi.org/10.1093/ons/opy352.
Повний текст джерелаАнотація:
AbstractBACKGROUNDDespite several studies analyzing the safety of transradial access (TRA) for neurointervention compared to transfemoral approach (TFA), neurointerventionalists are apprehensive about implementing TRA. From our positive institutional experience, we now utilize TRA first line for a majority of our cases. Here, we present our single-institution experience.OBJECTIVETo determine safety and feasibility of TRA for neurointervention.METHODSThrough retrospective review of patients receiving TRA for anterior and posterior circulation cerebrovascular interventions at our institution between December 2015 and January 2018, we present our experience regarding this transition, while focusing on technique, complications, feasibility, indications, and limitations.RESULTSOne hundred five procedures were performed on 92 patients (anterior circulation: 77%; posterior circulation: 23%). Radial artery access was achieved in all patients. Twenty-nine cases constituted mechanical thrombectomy, 33 cases represented intracranial aneurysms treatments, and 33 cases included interventions like angioplasty, balloon test occlusion, chemotherapy delivery, and thrombolysis. TRA was used as second-line access to TFA in 5 instances due to aortic arch anomalies and atherosclerotic disease. Minor access-site complications were seen in 2.85% of patients. Ten procedures (9.0%) could not be completed with TRA, with crossover to TFA occurring in 7 cases.CONCLUSIONTRA is safe and feasible for the majority of neurointerventional procedures and provides decreased risk of major access-site complications compared to TFA. Perceived limitations of TRA can likely be eliminated via operator experience and engineering ingenuity; thus, there is a role for TRA for neurointervention, especially in patients with increased risk of access-site complications from TFA.
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Murray, Timothy Éanna, Paul Brennan, Julian T. Maingard, Ronil V. Chandra, Dilly M. Little, D. Mark Brooks, Hong K. Kok, Hamed Asadi, and Michael J. Lee. "Treatment of Visceral Artery Aneurysms Using Novel Neurointerventional Devices and Techniques." Journal of Vascular and Interventional Radiology 30, no. 9 (September 2019): 1407–17. http://dx.doi.org/10.1016/j.jvir.2018.12.733.
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Vollherbst, Dominik F., Christian Ulfert, Volker Maus, Timan Boujan, Hans Henkes, Martin Bendszus, and Markus A. Möhlenbruch. "Concomitant Acute Ischemic Stroke and Upper Extremity Arterial Occlusion: Feasibility of Mechanical Thrombectomy of the Upper Limb Using Neurointerventional Devices and Techniques." Journal of Clinical Medicine 10, no. 14 (July 20, 2021): 3189. http://dx.doi.org/10.3390/jcm10143189.
Повний текст джерелаАнотація:
Background: Concomitant acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), and acute upper extremity arterial occlusion causing upper limb ischemia (ULI) is a rarely observed coincidence. The first-line treatment for AIS is mechanical thrombectomy (MT), with or without additional intravenous thrombolysis, while there are different pharmacological, surgical and endovascular treatment options for an acute occlusion of the UL arteries. Here, we describe the practicability, efficacy and safety of neurointerventional devices and techniques for MT of upper extremity arterial occlusions. Materials and Methods: A retrospective analysis of prospectively collected patient databases from four neurovascular centers was performed. Clinical and imaging data, as well as procedural parameters, were assessed. Results: Seven out of 6138 patients (incidence: 0.11%) presenting with an AIS due to the occlusion of craniocervical arteries requiring MT and a concomitant occlusion of the brachial (4/7), axillary (2/7), or ulnar (1/7) artery causing acute ULI were identified. Craniocervical MT was technically successful in all cases. Subsequent MT of the upper limb was performed using neurointerventional thrombectomy techniques, most frequently stent retriever thrombectomy (in 4/7 cases) and direct aspiration (in 7/7 cases). MT achieved successful recanalization in 6/7 cases, and the UL completely recovered in all six cases. In one case, recanalization was not successful, and the patient still had a marginally threatened extremity after the procedure, which improved after pharmacological therapy. Conclusion: In the rare case of AIS requiring MT and concomitant acute upper extremity arterial occlusion, MT of the UL arteries using neurointerventional devices and techniques is practical, effective, and safe.
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Yuki, Ichiro, Yuichi Murayama, and Fernando Vinuela. "Development of medical devices for neurointerventional procedures: special focus on aneurysm treatment." Expert Review of Medical Devices 2, no. 5 (September 2005): 539–46. http://dx.doi.org/10.1586/17434440.2.5.539.
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Joshi, Krishna C., André Beer-Furlan, R. Webster Crowley, Michael Chen, and Stephan A. Munich. "Transradial approach for neurointerventions: a systematic review of the literature." Journal of NeuroInterventional Surgery 12, no. 9 (March 9, 2020): 886–92. http://dx.doi.org/10.1136/neurintsurg-2019-015764.
Повний текст джерелаАнотація:
BackgroundDespite the recent increase in the number of publications on diagnostic cerebral angiograms using transradial access (TRA), there have been relatively few regarding TRA for neurointerventional cases. Questions of feasibility and safety may still exist among physicians considering TRA for neurointerventional procedures.MethodsA systematic literature review was performed following PRISMA guidelines. Three online databases (MedLine via PubMed, Scopus and Embase) were searched for articles published between January 2000 and December 2019. Search terms included “Transradial access”, “Radial Access”, “Radial artery” AND “Neurointerventions". The reference lists of selected articles and pertinent available non-systematic analysis were reviewed for other potential citations. Primary outcomes measured were access site complications and crossover rates.ResultsTwenty-one studies (n=1342 patients) were included in this review. Two of the studies were prospective while the remaining 19 were retrospective. Six studies (n=616 patients) included TRA carotid stenting only. The rest of the studies included treatment for cerebral aneurysms (n=423), mechanical thrombectomy (n=127), tumor embolization (n=22), and other indications (n=154) such as angioplasty and stenting for vertebrobasilar stenosis, balloon test occlusion, embolization of dural arteriovenous fistula and arteriovenous malformation, chemotherapeutic drug delivery, intra-arterial thrombolysis, and arterial access during a venous stenting procedure. Two (0.15%) major complications and 37 (2.75%) minor complications were reported. Sixty-four (4.77%) patients crossed over to transfemoral access for completion of the procedure. Seven (0.52%) patients crossed over due to access failure and 57 (4.24%) patients crossed over to TFA due to inability to cannulate the target vessel.ConclusionThis systematic review demonstrates that TRA has a relatively low rate of access site complications and crossovers. With increasing familiarity, development of TRA-specific neuroendovascular devices, and the continued reports of its success in the literature, TRA is expected to become more widely used by neurointerventionalists.
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Kumpe, David A. "Use of Neurointerventional Devices (Hands on) (WK 22) Course codes: 122–322–922." Journal of Vascular and Interventional Radiology 14, no. 2 (February 2003): P334—P335. http://dx.doi.org/10.1016/s1051-0443(03)70272-3.
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Kumpe, David A. "Use of neurointerventional devices (HANDS-ON) (WK 42) (Course codes: 0142-0642-0842)." Journal of Vascular and Interventional Radiology 15, no. 2 (February 2004): P274. http://dx.doi.org/10.1016/s1051-0443(04)70294-8.
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Kumpe, David A. "Use of Neurointerventional Devices (Hands-On) (WK 42) (Course codes: 0342–0542–0942)." Journal of Vascular and Interventional Radiology 16, no. 2 (February 2005): P340. http://dx.doi.org/10.1016/s1051-0443(05)70310-9.
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McVeigh, Patrick Z., Raphael Sacho, Robert A. Weersink, Vitor M. Pereira, Walter Kucharczyk, Eric J. Seibel, Brian C. Wilson, and Timo Krings. "High-Resolution Angioscopic Imaging During Endovascular Neurosurgery." Neurosurgery 75, no. 2 (April 23, 2014): 171–80. http://dx.doi.org/10.1227/neu.0000000000000383.
Повний текст джерелаАнотація:
Abstract BACKGROUND: Endoluminal optical imaging, or angioscopy, has not seen widespread application during neurointerventional procedures, largely as a result of the poor imaging resolution of existing angioscopes. Scanning fiber endoscopes (SFEs) are a novel endoscopic platform that allows high-resolution video imaging in an ultraminiature form factor that is compatible with currently used distal access endoluminal catheters. OBJECTIVE: To test the feasibility and potential utility of high-resolution angioscopy with an SFE during common endovascular neurosurgical procedures. METHODS: A 3.7-French SFE was used in a porcine model system to image endothelial disruption, ischemic stroke and mechanical thrombectomy, aneurysm coiling, and flow-diverting stent placement. RESULTS: High-resolution, video-rate imaging was shown to be possible during all of the common procedures tested and provided information that was complementary to standard fluoroscopic imaging. SFE angioscopy was able to assess novel factors such as aneurysm base coverage fraction and side branch patency, which have previously not been possible to determine with conventional angiography. CONCLUSION: Endovascular imaging with an SFE provides important information on factors that cannot be assessed fluoroscopically and is a novel platform on which future neurointerventional techniques may be based because it allows for periprocedural inspection of the integrity of the vascular system and the deployed devices. In addition, it may be of diagnostic use for inspecting the vascular wall and postprocedure device evaluation.
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Shum, Pey Ling, Hong Kuan Kok, Julian Maingard, Mark Schembri, Ramon Martin Francisco Bañez, Vivienne Van Damme, Christen Barras, et al. "Environmental sustainability in neurointerventional procedures: a waste audit." Journal of NeuroInterventional Surgery 12, no. 11 (July 17, 2020): 1053–57. http://dx.doi.org/10.1136/neurintsurg-2020-016380.
Повний текст джерелаАнотація:
BackgroundOperating rooms contribute between 20% to 70% of hospital waste. This study aimed to evaluate the waste burden of neurointerventional procedures performed in a radiology department, identify areas for waste reduction, and motivate new greening initiatives.MethodsWe performed a waste audit of 17 neurointerventional procedures at a tertiary-referral center over a 3-month period. Waste was categorized into five streams: general waste, clinical waste, recyclable plastic, recyclable paper, and sharps. Our radiology department started recycling soft plastics from 13 December 2019. Hence, an additional recyclable soft plastic waste stream was added from this time point. The weight of each waste stream was measured using a digital weighing scale.ResultsWe measured the waste from seven cerebral digital subtraction angiograms (DSA), six mechanical thrombectomies (MT), two aneurysm-coiling procedures, one coiling with tumour embolization, and one dural arteriovenous fistula embolization procedure. In total, the 17 procedures generated 135.3 kg of waste: 85.5 kg (63.2%) clinical waste, 28.0 kg (20.7%) general waste, 14.7 kg (10.9%) recyclable paper, 3.5 kg (2.6%) recyclable plastic, 2.2 kg (1.6%) recyclable soft plastic, and 1.4 kg (1.0%) of sharps. An average of 8 kg of waste was generated per case. Coiling cases produced the greatest waste burden (13.1 kg), followed by embolization (10.3 kg), MT (8.8 kg), and DSA procedures (5.1 kg).ConclusionNeurointerventional procedures generate a substantial amount of waste, an average of 8 kg per case. Targeted initiatives such as engaging with suppliers to revise procedure packs and reduce packaging, digitizing paper instructions, opening devices only when necessary, implementing additional recycling programs, and appropriate waste segregation have the potential to reduce the environmental impact of our specialty.
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Gawlitza, Matthias, Sebastien Soize, Anne-Christine Januel, Cristian Mihalea, Georgios-Emmanouil Metaxas, Christophe Cognard, and Laurent Pierot. "Treatment of recurrent aneurysms using the Woven EndoBridge (WEB): anatomical and clinical results." Journal of NeuroInterventional Surgery 10, no. 7 (October 20, 2017): 629–33. http://dx.doi.org/10.1136/neurintsurg-2017-013287.
Повний текст джерелаАнотація:
BackgroundThe safety and efficacy of the Woven EndoBridge (WEB) for the treatment of naïve intracranial aneurysms has been confirmed.PurposeTo analyze the safety and efficacy of the WEB in the treatment of recurrent aneurysms.MethodsAnatomical and clinical results in consecutive patients with a recurrent aneurysm, who were treated using the WEB device in two French neurointerventional centers, were evaluated.ResultsSeventeen patients with 17 aneurysms were included. Treatment was feasible in 16 patients. In seven patients (41.2%), ancillary devices were used. Permanent morbidity due to a thromboembolic complication occurred in one patient (5.9%). There was no mortality. Follow-up angiographic studies were available for 15 patients after a mean of 12.1±6.1 months. Rates of complete occlusion, neck remnant, and aneurysm remnant were 33.3%, 40.0%, and 26.7%, respectively.ConclusionsTreatment of recurrent aneurysms using the WEB device may be reasonably safe and effective.
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He, Lucy, Travis R. Ladner, Sumit Pruthi, Matthew A. Day, Aditi A. Desai, Lori C. Jordan, and Michael T. Froehler. "Rule of 5: angiographic diameters of cervicocerebral arteries in children and compatibility with adult neurointerventional devices." Journal of NeuroInterventional Surgery 8, no. 10 (November 6, 2015): 1067–71. http://dx.doi.org/10.1136/neurintsurg-2015-012034.
Повний текст джерелаАнотація:
Background and purposeThe safety of using adult-sized neuroendovascular devices in the smaller pediatric vasculature is not known. In this study we measure vessel diameters in the cervical and cranial circulation in children to characterize when adult-approved devices might be compatible in children.MethodsFor 54 children without vasculopathy (mean age 9.5±4.9 years (range 0.02–17.8), 20F/34M) undergoing catheter angiography, the diameters of the large vessels in the cervical and cranial circulation (10 locations, 611 total measurements) were assessed by three radiologists. Mean±SD diameter was calculated for the following age groups: 0–6 months, 1, 2, 3, 4, 5–9, 10–14, and 15–18 years. To compare with adult sizes, each vessel measurement was normalized to the respective region mean diameter in the oldest age group (15–18 years). Normalized measurements were compared with age and fitted to a segmented regression.ResultsVessel diameters increased rapidly from 0 to 5 years of age (slope=0.069/year) but changed minimally beyond that (slope=0.005/year) (R2=0.2). The regression model calculated that, at 5 years of age, vessels would be 94% of the diameter of the oldest age group (compared with 59% at birth). In addition, most vessels in children under 5, while smaller, were still potentially large enough to be compatible with many adult devices.ConclusionsThe growth curve of the cervicocerebral vasculature displays rapid growth until age 5, at which point most children's vessels are nearly adult size. By age 5, most neuroendovascular devices are size-compatible, including thrombectomy devices for stroke. Under 5 years of age, some devices might still be compatible.
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Argirò, Renato, Armando Raso, Sofia Vidali, and Daniele Morosetti. "Endovascular thromboaspiration with neurointerventional devices for early hepatic artery thrombosis after split liver transplant." BMJ Case Reports 14, no. 5 (May 2021): e240583. http://dx.doi.org/10.1136/bcr-2020-240583.
Повний текст джерелаАнотація:
We report the case of a 38-year-old woman who underwent orthotopic ‘split’ liver transplant, complicated by hepatic artery thrombosis on the first postoperative day. The patient was successfully treated with an endovascular approach by mechanical thromboaspiration of the hepatic artery, using neurovascular devices, angioplasty and stenting at the site of the surgical anastomosis.
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Laengvejkal, Pavis, Doungporn Ruthirago, Parunyou Julayanont, and Yazan Alderazi. "Neurointerventional therapy for large vessel occlusion stroke: the new standard of care." Southwest Respiratory and Critical Care Chronicles 4, no. 16 (October 11, 2016): 26. http://dx.doi.org/10.12746/swrccc.v4i16.316.
Повний текст джерелаАнотація:
For the past two decades, intravenous tissue plasminogenactivator (IV tPA) has been the gold standardtreatment of acute ischemic stroke (AIS) for patientspresenting to the hospital in the first 4.5 hours aftersymptom onset. However, in patients with AIS due tointracranial large vessel occlusion (LVO), IV tPA hasvery poor recanalization rates. This group of patientshas significantly worse outcomes than those withoutLVO. Endovascular therapy has evolved significantlysince the first trial in 1998. With the publication of recenttrials using modern stent-retriever devices andselection of patients with LVO, endovascular therapyhas become the standard of care for patients with themost severe ischemic strokes. In this article we outlinethe two decade evolution of this therapy.
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Lazaro, Tyler, Visish M. Srinivasan, Phillip Cooper, Michael Phillips, Robert Garcia, Stephen R. Chen, Jeremiah Johnson, Dalis E. Collins, and Peter Kan. "A new set of eyes: development of a novel microangioscope for neurointerventional surgery." Journal of NeuroInterventional Surgery 11, no. 10 (March 16, 2019): 1036–39. http://dx.doi.org/10.1136/neurintsurg-2018-014610.
Повний текст джерелаАнотація:
BackgroundEndovascular technological advances have revolutionized the field of neurovascular surgery and have become the mainstay of treatment for many cerebrovascular pathologies. Digital subtraction angiography (DSA) is the ’gold standard' for visualization of the vasculature and deployment of endovascular devices. Nonetheless, with recent technological advances in optics, angioscopy has emerged as a potentially important adjunct to DSA. Angioscopy can offer direct visualization of the intracranial vasculature, and direct observation and inspection of device deployment. However, previous iterations of this technology have not been sufficiently miniaturized or practical for modern neurointerventional practice.ObjectiveTo describe the evolution, development, and design of a microangioscope that offers both high-quality direct visualization and the miniaturization necessary to navigate in the small intracranial vessels and provide examples of its potential applications in the diagnosis and treatment of cerebrovascular pathologies using an in vivo porcine model.MethodsIn this proof-of-concept study we introduce a novel microangioscope, designed from coherent fiber bundle technology. The microangioscope is smaller than any previously described angioscope, at 1.7 F, while maintaining high-resolution images. A porcine model is used to demonstrate the resolution of the images in vivo.ResultsVideo recordings of the microangioscope show the versatility of the camera mounted on different microcatheters and its ability to navigate external carotid artery branches. The microangioscope is also shown to be able to resolve the subtle differences between red and white thrombi in a porcine model.ConclusionA new microangioscope, based on miniaturized fiber optic technology, offers a potentially revolutionary way to visualize the intracranial vascular space.
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Henkes, Hans, Pervinder Bhogal, Marta Aguilar Pérez, Tim Lenz-Habijan, Catrin Bannewitz, Marcus Peters, Christina Sengstock, Oliver Ganslandt, Pedro Lylyk, and Hermann Monstadt. "Anti-thrombogenic coatings for devices in neurointerventional surgery: Case report and review of the literature." Interventional Neuroradiology 25, no. 6 (June 27, 2019): 619–27. http://dx.doi.org/10.1177/1591019919858000.
Повний текст джерелаАнотація:
Background: Stent-assisted coiling and extra-saccular flow diversion require dual anti-platelet therapy due to the thrombogenic properties of the implants. While both methods are widely accepted, thromboembolic complications and the detrimental effects of dual anti-platelet therapy remain a concern. Anti-thrombogenic surface coatings aim to solve both of these issues. Current developments are discussed within the framework of an actual clinical case. Case description: A 33-year-old male patient lost consciousness while doing sport and was administered 500 mg acetylsalicylic acid on site. Computed tomography revealed a massive subarachnoid haemorrhage, and digital subtraction angiography showed an aneurysm of the right middle cerebral artery. Stent-assisted coiling using a neck bridging device with a hydrophilic coating (pCONUS_HPC) was considered as an appropriate approach. Another 500 mg acetylsalicylic acid IV was given. After the single anti-platelet therapy was seen to be effective, a pCONUS_HPC was implanted, and the aneurysm sac subsequently fully occluded using coils. No thrombus formation was encountered. During the following days, 2 × 500 mg acetylsalicylic acid IV daily were required to maintain single anti-platelet therapy, monitored by frequent response testing. Follow-up digital subtraction angiography after 13 days confirmed the occlusion of the aneurysm and the patency of the middle cerebral artery. Conclusion: A variety of ways to reduce the thrombogenicity of neurovascular stents is discussed. Hydrophilic surface coatings are a valid concept to improve the haemocompatibility of neurovascular implants while avoiding the use of dual anti-platelet therapy. Phosphorylcholine and phenox hydrophilic polymer coating are currently the most promising candidates. This concept is supported by anecdotal experience. However, formalised registries and randomised trials are currently being established.
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Briganti, Francesco, Giuseppe Leone, Lorenzo Ugga, Mariano Marseglia, Antonio Macera, Andrea Manto, Luigi Delehaye, et al. "Mid-term and long-term follow-up of intracranial aneurysms treated by the p64 Flow Modulation Device: a multicenter experience." Journal of NeuroInterventional Surgery 9, no. 1 (July 20, 2016): 70–76. http://dx.doi.org/10.1136/neurintsurg-2016-012502.
Повний текст джерелаАнотація:
BackgroundExperience with the endovascular treatment of cerebral aneurysms using the p64 Flow Modulation Device is still limited. This study discusses the results and complications of this new flow diverter device.Methods40 patients (30 women, 10 men) with 50 cerebral aneurysms treated in six Italian neurointerventional centers with the p64 Flow Modulation Device between April 2013 and September 2015 were retrospectively reviewed.ResultsComplete occlusion was obtained in 44/50 aneurysms (88%) and partial occlusion in 3 (6%). In the other three aneurysms (6%), two cases of asymptomatic in-stent thrombosis and one intraprocedural occlusion of the parent vessel occurred. Technical complications were observed in eight procedures (16%). Permanent morbidity due to acute in-stent thrombosis and consequent ischemic stroke occurred in one patient (2.5%). No delayed aneurysm rupture, subarachnoid or intraparenchymal hemorrhage, or ischemic complications occurred and there were no deaths.ConclusionsEndovascular treatment with the p64 Flow Modulation Device is a safe treatment for unruptured cerebral aneurysms, resulting in a high rate of occlusion. As with other flow diverter devices, we recommend this treatment mainly for large-necked aneurysms of the internal carotid artery siphon. However, endovascular treatment with the p64 device should also be encouraged in difficult cases such as aneurysms of the posterior circulation and beyond the circle of Willis.
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Srinivasan, Visish M., Aditya Srivatsan, Alejandro M. Spiotta, Benjamin K. Hendricks, Andrew F. Ducruet, Felipe C. Albuquerque, Ajit Puri, et al. "Early postmarket results with PulseRider for treatment of wide-necked intracranial aneurysms: a multicenter experience." Journal of Neurosurgery 133, no. 6 (December 2020): 1756–65. http://dx.doi.org/10.3171/2019.5.jns19313.
Повний текст джерелаАнотація:
OBJECTIVETraditionally, stent-assisted coiling and balloon remodeling have been the primary endovascular treatments for wide-necked intracranial aneurysms with complex morphologies. PulseRider is an aneurysm neck reconstruction device that provides parent vessel protection for aneurysm coiling. The objective of this study was to report early postmarket results with the PulseRider device.METHODSThis study was a prospective registry of patients treated with PulseRider at 13 American neurointerventional centers following FDA approval of this device. Data collected included clinical presentation, aneurysm characteristics, treatment details, and perioperative events. Follow-up data included degree of aneurysm occlusion and delayed (> 30 days after the procedure) complications.RESULTSA total of 54 aneurysms were treated, with the same number of PulseRider devices, across 13 centers. Fourteen cases were in off-label locations (7 anterior communicating artery, 6 middle cerebral artery, and 1 A1 segment anterior cerebral artery aneurysms). The average dome/neck ratio was 1.2. Technical success was achieved in 52 cases (96.2%). Major complications included the following: 3 procedure-related posterior cerebral artery strokes, a device-related intraoperative aneurysm rupture, and a delayed device thrombosis. Immediately postoperative Raymond-Roy occlusion classification (RROC) class 1 was achieved in 21 cases (40.3%), class 2 in 15 (28.8%), and class 3 in 16 cases (30.7%). Additional devices were used in 3 aneurysms. For those patients with 3- or 6-month angiographic follow-up (28 patients), 18 aneurysms (64.2%) were RROC class 1 and 8 (28.5%) were RROC class 2.CONCLUSIONSPulseRider is being used in both on- and off-label cases following FDA approval. The clinical and radiographic outcomes are comparable in real-world experience to the outcomes observed in earlier studies. Further experience is needed with the device to determine its role in the neurointerventionalist’s armamentarium, especially with regard to its off-label use.
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Reyes, Dennys, Victor Becerra, Indiana Alcala, Italo Linfante, and Guilherme Dabus. "Usefulness of Cone Beam Intra-Arterial CTA for Evaluation of Flow Diverters: A Practical Approach for Daily Use." Interventional Neurology 7, no. 6 (2018): 457–63. http://dx.doi.org/10.1159/000490577.
Повний текст джерелаАнотація:
Cone beam computed tomography (CBCT), initially used for evaluation of intraprocedural complications such as hemorrhage, has evolved to provide details of implanted devices such as flow diverters. The study aim is to present our experience in using CBCT with intra-arterial injection and provide a step-by-step approach for postprocessing in a practical protocol for daily use. IRB approval was obtained, and the neurointerventional database was retrospectively reviewed from July 2012 to June 2017. Patients who underwent cone beam intra-arterial CT angiography for evaluation of implanted flow diverter devices were reviewed. Patient demographics, aneurysm location (internal carotid artery [ICA]-cavernous, ICA-paraclinoid, and ICA-distal; middle cerebral artery [MCA], anterior cerebral artery [ACA]-acom, ACA-pericallosal, vertebral artery [VA]), type (saccular, dissecting fusiform, or blister) and size, device, injection technique (contrast dilution, rate, and volume), and reconstruction protocol were recorded. Acquired images were postprocessed using a Philips Xtravision workstation. Eighty patients (63 women and 17 men) met the inclusion criteria of our study. Age range was 25–80 years old. Treated aneurysms were located in the ICA-paraclinoid in 48 cases (60%), ICA-distal in 12 cases, ICA-cavernous in 8 cases, MCA in 4 cases, VA in 4 cases, ACA-acom in 2 cases, ACA-pericallosal in 2 cases; 69 were saccular, 8 fusiform, and 3 ruptured blister aneurysms. There were 52 small, 20 large, and 8 giant aneurysms. Pipeline (Medtronic, MN, USA) was the predominant device used in 77 procedures. Two injection techniques were used: 2.5 mL/s for a total volume of 55 mL with a 2-s imaging delay or 3 mL/s for a total volume of 70 mL with a 3-s imaging delay; contrast (Ioxilan 300 mgI/mL) dilution was 10–20% in all cases. The device’s landing zones, conformability, presence of deformities, and wall apposition were successfully visualized in all cases. Metal artifact reduction program was applied in 9 coiled aneurysms, and this was satisfactory as well.
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Leishangthem, Lakshmi, and Sudhakar R. Satti. "Vessel perforation during withdrawal of Trevo ProVue stent retriever during mechanical thrombectomy for acute ischemic stroke." Journal of Neurosurgery 121, no. 4 (October 2014): 995–98. http://dx.doi.org/10.3171/2014.4.jns132187.
Повний текст джерелаАнотація:
The authors report a case of an intracranial extravasation during the withdrawal of a Trevo ProVue stent retriever device in a patient being treated for acute ischemic stroke. An 82-year-old woman developed sudden left hemiparesis and aphasia during an urgent cardiac catheterization procedure for a non–ST elevation myocardial infarction. She had a baseline National Institutes of Health Stroke Scale (NIHSS) score of at least 10 and no improvement with intravenous administration of tissue plasminogen activator (tPA). Cerebral angiography was performed with conscious sedation, confirming an occlusion of the superior division of the right middle cerebral artery (MCA). Using standard technique, a Trevo thrombectomy device was deployed across the clot. Post-thrombectomy control angiography demonstrated complete revascularization of the right MCA. The device was then gently withdrawn without difficulty. Immediately afterward the patient's blood pressure showed a sudden and significant elevation. Immediate posttreatment angiography demonstrated active extravasation from the posterior wall of the communicating segment of the right internal carotid artery. Rapid cessation of bleeding was achieved with intravenous administration of protamine and induced hypotension. Immediate neurological assessment was performed, which showed motor improvement. An immediate postintervention CT scan confirmed a moderate-sized subarachnoid hemorrhage and contrast in the prepontine cistern. The patient was discharged home on postoperative Day 3 with an NIHSS score of zero. At 6-month follow-up in the neurointerventional clinic, her NIHSS and modified Rankin Scale scores were both zero. Endovascular stent retriever devices are increasingly being used as first-line thrombectomy devices in acute embolic strokes. A unique and previously undescribed complication is vessel perforation during withdrawal of a stent retriever. Conservative treatment options and reversal of anticoagulation should be the first line of treatment for such complications. In the authors' case, performing the procedure without anesthesia was helpful in assessing the patient's neurological status.
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Saber, Hamidreza, Charles Beaman, and Satoshi Tateshima. "Complete robotic intervention for acute epistaxis in a patient with COVID-19 pneumonia: technical considerations and device selection tips." Journal of NeuroInterventional Surgery 14, no. 5 (March 10, 2022): neurintsurg—2021–018582. http://dx.doi.org/10.1136/neurintsurg-2021-018582.
Повний текст джерелаАнотація:
The use of robot-assisted technology is expanding in interventional laboratories with an increasing number of reports of effective treatment delivery in neurointerventional procedures. Here we report the feasibility of complete robot-assisted neurointervention including the guide catheter and microcatheter manipulations with subsequent embolization of the arterial source of hemorrhage in a patient hospitalized with severe COVID-19 complicated by acute epistaxis.
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Grandhi, Ramesh, Xiaoran Zhang, David Panczykowski, Phillip Choi, Christopher T. Hunnicutt, Ashutosh P. Jadhav, Andrew F. Ducruet, Tudor Jovin, and Brian Jankowitz. "Incidence of delayed angiographic femoral artery complications using the EXOSEAL vascular closure device." Interventional Neuroradiology 21, no. 3 (May 26, 2015): 401–6. http://dx.doi.org/10.1177/1591019915581776.
Повний текст джерелаАнотація:
Background and purpose Femoral artery injuries are known complications of percutaneous vascular closure devices (VCDs). We studied the incidence of delayed femoral artery angiographic irregularities after neurointerventional procedures in which the EXOSEAL extravascular closure device was used for femoral arterial puncture closure. Methods Adult patients who underwent femoral arterial puncture closures with an EXOSEAL VCD and had a follow-up femoral artery angiogram from June 2012 through August 2013 were reviewed. A blinded radiologist compared pre-deployment and follow-up femoral arteriograms for the presence of femoral artery stenosis, dissection, pseudoaneurysm, or development of an arteriovenous fistula. Hospital records were reviewed for major or minor complications of the groin site or femoral artery. Results The EXOSEAL VCD achieved hemostasis, without evidence of a groin hematoma or requiring subsequent prolonged manual compression, in 400 of 441 closures following transfemoral arterial access, representing a device success rate of 90.7%. A total of 98 patients underwent 102 repeat angiograms following closure with the EXOSEAL VCD. The average time to the repeat angiogram was 73.5 days (range 0–488, median 28). Follow-up femoral arteriography demonstrated an irregularity in seven cases, all of which were vessel stenoses of <50%. There were no dissections, pseudoaneurysms, infections, or ischemic events in the study population. Conclusions Angiographic irregularities were seen in 6.86% of cases after closure with the EXOSEAL VCD. There were no clinically significant vascular complications. Thus, femoral artery closure with EXOSEAL carries a low risk of clinically significant delayed angiographic findings.
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Khatri, Rakesh, Nassir Rostambeigi, Ameer E. Hassan, Blake Carlson, Gustavo J. Rodriguez, and Adnan I. Qureshi. "The Use of Vascular Closure Devices Outside the Catheterization Laboratory After Neurointerventional Procedures Is Safe and Effective:Evidence From a Retrospective Study." Journal of Endovascular Therapy 19, no. 2 (April 2012): 239–45. http://dx.doi.org/10.1583/11-3764.1.
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Zhang, Qiang, Hao Zhao, Qi Sun, Jingfeng Han, Hao Zhang, Tonghui Shan, Wenlong Pan, Chuanqi Gu, Ruxiang Xu, and Gengsheng Mao. "Clinical evaluation of volume of interest imaging combined with metal artifact reduction reconstruction techniques in coiling and stent assisted coiling during neurointerventional procedures." Journal of NeuroInterventional Surgery 11, no. 2 (June 22, 2018): 205–10. http://dx.doi.org/10.1136/neurintsurg-2018-013886.
Повний текст джерелаАнотація:
PurposeThree-dimensional (3D) scans with flat detector angiographic systems are widely used for neurointerventions by providing detailed vascular information. However, its associated radiation dose and streak metal artifact generated by implanted treatment devices remain issues. This work evaluates the feasibility and clinical value of volume of interest imaging combined with metal artifact reduction (VOI+MAR) to generate high quality 3D images with reduced radiation dose and metal artifacts.Material and methodsFull volume (FV) and VOI scans were acquired in 25 patients with intracranial aneurysms and treated with either endovascular coiling (n=9) or stent assisted coiling (n=16) procedures. FV and VOI scans were reconstructed with conventional syngo DynaCT and VOI +MAR prototype software, respectively.ResultsQuantitative evaluation results demonstrated that compared with standard FV syngo DynaCT images, overall image quality was improved in the VOI+MAR reconstructed images, with streak metal artifacts considerably reduced or even removed; details of soft tissue in the vicinity of the metal devices was well preserved or recovered in the majority of cases. Radiation dose to patients calculated by dose area product was found to be significantly reduced using VOI scans.ConclusionThis study confirmed the feasibility of using VOI+MAR prototype software to achieve high image quality of a small volume of clinical interest and to reduce radiation dose. This technique has potential to improve patient safety and treatment outcomes.
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Meyers, Philip M., H. Christian Schumacher, Michael J. Alexander, Colin P. Derdeyn, Anthony J. Furlan, Randall T. Higashida, Christopher J. Moran, et al. "Performance and training standards for endovascular ischemic stroke treatment." Journal of Neurosurgery 113, no. 1 (July 2010): 149–52. http://dx.doi.org/10.3171/2009.12.jns091813.
Повний текст джерелаАнотація:
Stroke is the third leading cause of death in the USA, Canada, Europe, and Japan. According to the American Heart Association and the American Stroke Association, there are now 750,000 new strokes that occur each year, resulting in 200,000 deaths, or 1 of every 16 deaths, per year in the USA alone. Endovascular therapy for patients with acute ischemic stroke is an area of intense investigation. The American Stroke Association has given a qualified endorsement of intraarterial thrombolysis in selected patients. Intraarterial thrombolysis has been studied in two randomized trials and numerous case series. Although two devices have been granted FDA approval with an indication for mechanical stroke thrombectomy, none of these thrombectomy devices has demonstrated efficacy for the improvement of patient outcomes. The purpose of the present document is to define what constitutes adequate training to perform neuroendovascular procedures in patients with acute ischemic stroke and what performance standards should be adopted to assess outcomes. These guidelines have been written and approved by multiple neuroscience societies which historically have been directly involved in the medical, surgical and endovascular care of patients with acute stroke. The participating member organizations of the Neurovascular Coalition involved in the writing and endorsement of this document are the Society of NeuroInterventional Surgery, the American Academy of Neurology, the American Association of Neurological Surgeons/Congress of Neurological Surgeons Cerebrovascular Section, and the Society of Vascular & Interventional Neurology.
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Raymond, J., P. White, D. F. Kallmes, J. Spears, T. Marotta, D. Roy, F. Guilbert, et al. "ICONE: An International Consortium of Neuro Endovascular Centres." Interventional Neuroradiology 14, no. 2 (June 2008): 203–8. http://dx.doi.org/10.1177/159101990801400213.
Повний текст джерелаАнотація:
The proliferation of new endovascular devices and therapeutic strategies calls for a prudent and rational evaluation of their clinical benefit. This evaluation must be done in an effective manner and in collaboration with industry. Such research initiative requires organisational and methodological support to survive and thrive in a competitive environment. We propose the formation of an international consortium, an academic alliance committed to the pursuit of effective neurovascular therapies. Such a consortium would be dedicated to the design and execution of basic science, device development and clinical trials. The Consortium is owned and operated by its members. Members are international leaders in neurointerventional research and clinical practice. The Consortium brings competency, knowledge, and expertise to industry as well as to its membership across a spectrum of research initiatives such as: expedited review of clinical trials, protocol development, surveys and systematic reviews; laboratory expertise and support for research design and grant applications to public agencies. Once objectives and protocols are approved, the Consortium provides a stable network of centers capable of timely realization of clinical trials or preclinical investigations in an optimal environment. The Consortium is a non-profit organization. The potential revenue generated from client-sponsored financial agreements will be re-directed to the academic and research objectives of the organization. The Consortium wishes to work in concert with industry, to support emerging trends in neurovascular therapeutic development. The Consortium is a realistic endeavour optimally structured to promote excellence through scientific appraisal of our treatments, and to accelerate technical progress while maximizing patients' safety and welfare.
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Shimamura, Norihito, Masato Naraoka, Naoya Matsuda, and Hiroki Ohkuma. "Safety of Preprocedural Antiplatelet Medication in Coil Embolization of Ruptured Cerebral Aneurysms at the Acute Stage." Interventional Neuroradiology 20, no. 4 (January 1, 2014): 413–17. http://dx.doi.org/10.15274/inr-2014-10035.
Повний текст джерелаАнотація:
Preoperative antiplatelet medication for aneurysm coil embolization during acute subarachnoid hemorrhage (SAH) is not common. However, recent advances in neurointerventional devices make antiplatelet medication necessary for SAH surgery. We tested the hypothesis that preprocedural antiplatelet therapy in the acute stage of SAH prevents complications due to ischemia or induced bleeding. We retrospectively reviewed 35 consecutive ruptured cerebral saccular aneurysms that underwent coiling at our institute. Two hundred milligrams of aspirin and 150 mg of clopidogrel were administered to the patients at least two hours before coiling. Systemic heparinization was given after sheath insertion. Procedure-related thrombus formation on digital subtraction angiography, and clinical evidence of ischemia and procedure-related stroke on CT were reviewed. The median patient age was 69 years. Five males and 30 females were included. Seventy-seven percent of patients were Hunt-Hess grades 1 to 3. Assist techniques were used in 20 cases (57%). We inserted one extracranial internal carotid artery stent, but no intracranial stent. Intraoperative thrombosis occurred in one case (2.9%), with no clinical symptoms. Postoperative cerebrospinal fluid drainage was done in three cases, but we experienced no bleeding complications. Preoperative antiplatelet therapy leads to a low rate of thromboembolic events in coiling during acute stage SAH, and this strategy had no adverse influence on bleeding complications.
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Singh, Paramdeep, Rupinderjeet Kaur, and Amarpreet Kaur. "Endovascular treatment of acute ischemic stroke." Journal of Neurosciences in Rural Practice 04, no. 03 (July 2013): 298–303. http://dx.doi.org/10.4103/0976-3147.118787.
Повний текст джерелаАнотація:
ABSTRACTEarly recanalization of the occluded artery leads to better clinical outcomes in patients with acute ischemic stroke (AIS) through protection of the time-sensitive penumbra. Intravenous administration of pharmacologic thrombolytic agents has been a standard treatment for AIS. To get better rates of recanalization, enhance the time window, and diminish the possibility of intracranial hemorrhage, endovascular thrombectomy was launched, with first authorization of the Merci clot retriever, a corkscrew-like apparatus, followed by approval of the Penumbra thromboaspiration system. Both devices lead to a high rate of recanalization. On the other hand, time to recanalization was on an average of 45 minutes, with most of the patients attaining only partial recanalization. More lately, retrievable stents have shown promise in decreasing the time to recanalization, and attaining a superior rate of complete clot resolution. The retrievable stent can be released within the clot to engage it within the struts of the stent, and afterwards it is taken back by pulling it under flow arrest. Neurointerventional techniques have a persistently ever-increasing and stimulating role in the management of AIS, as indicated by the advent of several important techniques. Stent retrievers have the capability to be ascertained as the most important approach to endovascular stroke treatment.
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Chaudhuri, Arindam, and Richard A. Moxon. "Re: “The Use of Vascular Closure Devices Outside the Catheterization Laboratory After Neurointerventional Procedures Is Safe and Effective: Evidence From a Retrospective Study” by Khatri et al." Journal of Endovascular Therapy 19, no. 5 (October 2012): 689–90. http://dx.doi.org/10.1583/jevt-12-3990l.1.
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Fargen, Kyle M., Adam S. Arthur, Alejandro M. Spiotta, Jonathan Lena, Imran Chaudry, Raymond D. Turner, and Aquilla S. Turk. "A survey of neurointerventionalists on thrombectomy practices for emergent large vessel occlusions." Journal of NeuroInterventional Surgery 9, no. 2 (April 21, 2016): 142–46. http://dx.doi.org/10.1136/neurintsurg-2015-012235.
Повний текст джерелаАнотація:
BackgroundThe effect of the five positive randomized controlled trials on thrombectomy practices and procedural volume has yet to be defined. Further, few studies have attempted to define modern thrombectomy practices in terms of selection criteria and devices used.MethodsA 21 question survey of Society of Neurointerventional Surgery (SNIS) physicians was administered using the SurveyMonkey website, addressing current practices as well as changes from before January 1, 2015 to the months after this date.ResultsA total of 78 responses were obtained (approximately 10% of SNIS membership). Prior to January 2015, two-thirds of respondents reported performing 1–5 thrombectomies per month (67%), with 31% performing more than 5 per month. Following January 2015, 62% of respondents reported performing more than 5 thrombectomies per month; 45% of respondents reported a higher number of thrombectomies after trial publication. 73% and 80% of respondents indicated that inpatient consultations and hospital to hospital transfers for thrombectomy have increased, respectively. A plurality of respondents reported using A Direct Aspiration First Pass Technique (40%) as the first strategy for revascularization. Most commonly, neurointerventionalists reported using conscious sedation (56%) for anesthesia. 74% of respondents indicated being successful with their primary technique in at least 70% of cases.ConclusionsThis survey of predominantly academic SNIS physicians indicates that inpatient consultations, hospital to hospital transfers, and thrombectomy procedural volumes have increased modestly since the publication of the five major stroke trials this year. In addition, many respondents indicated an increase in aggressiveness in pursuing thrombectomy based on selection criteria.
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Kühn, Anna Luisa, Katyucia de Macedo Rodrigues, Jasmeet Singh, Francesco Massari, and Ajit S. Puri. "Distal radial access in the anatomical snuffbox for neurointerventions: a feasibility, safety, and proof-of-concept study." Journal of NeuroInterventional Surgery 12, no. 8 (January 8, 2020): 798–801. http://dx.doi.org/10.1136/neurintsurg-2019-015604.
Повний текст джерелаАнотація:
PurposeTo report the first use of distal radial artery (dRA) access for a variety of neurointerventions and to demonstrate the safety and feasibility of this approach.MethodsA retrospective review of our prospective neurointerventional database of endovascular interventions was conducted and, between May and October 2019, all patients in whom the intervention was performed via dRA in the anatomical snuffbox were identified. Patient demographics, clinical information, procedural and radiographic data were collected.Results48 patients with a mean age of 64.4 years (range 35–84 years) were included. 27 patients were female. dRA access was achieved in all cases. Conversion to femoral access was required in five cases (10.4%) due to tortuous vessel anatomy and limited support of the catheters in the aortic arch. Interventions performed included aneurysm treatment (with flow diverters, Woven EndoBridge device placement, coiling or stent-assisted coiling), arteriovenous malformation and dural arteriovenous fistula embolization, carotid artery stentings, stroke thrombectomy, thrombolysis for central retinal artery occlusion, intracranial stenting, middle meningeal artery embolization, vasospasm treatment, and spinal angiography with embolization. Radial artery vasospasm was seen in two cases and successfully treated with antispasmolytic medication. No symptomatic radial artery occlusion or ischemic event was observed.ConclusiondRA access is safe and effective for a variety of neurointerventions. Our preliminary experience with this approach is very promising and shows high patient satisfaction.
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Burkhardt, Jan-Karl, Omar Tanweer, Miguel Litao, Pankaj Sharma, Eytan Raz, Maksim Shapiro, Peter Kim Nelson, and Howard A. Riina. "Infection risk in endovascular neurointerventions: a comparative analysis of 549 cases with and without prophylactic antibiotic use." Journal of Neurosurgery 132, no. 3 (March 2020): 797–801. http://dx.doi.org/10.3171/2018.10.jns182540.
Повний текст джерелаАнотація:
OBJECTIVEA systematic analysis on the utility of prophylactic antibiotics for neuroendovascular procedures has not been performed. At the authors’ institution there is a unique setup to address this question, with some attending physicians using prophylactic antibiotics (cefazolin or vancomycin) for all of their neurointerventions while others generally do not.METHODSThe authors performed a retrospective review of the last 549 neurointerventional procedures in 484 patients at Tisch Hospital, NYU Langone Medical Center. Clinical and radiological data were collected for analysis, including presence of prophylactic antibiotic use, local or systemic infection, infection laboratory values, and treatment. Overall, 306 aneurysms, 117 arteriovenous malformations/arteriovenous fistulas, 86 tumors, and 40 vessel stenosis/dissections were treated with coiling (n = 109), Pipeline embolization device (n = 197), embolization (n = 203), or stenting (n = 40).RESULTSAntibiotic prophylaxis was used in 265 of 549 cases (48%). There was no significant difference between patients with or without antibiotic prophylaxis in sex (p = 0.48), presence of multiple interventions (p = 0.67), diseases treated (p = 0.11), or intervention device placed (p = 0.55). The mean age of patients in the antibiotic prophylaxis group (53.4 years) was significantly lower than that of the patients without prophylaxis (57.1 years; p = 0.014). Two mild local groin infections (0.36%) and no systemic infections (0%) were identified in this cohort, with one case in each group (1/265 [0.38%] vs 1/284 [0.35%]). Both patients recovered completely with local drainage (n = 1) and oral antibiotic treatment (n = 1).CONCLUSIONSThe risk of infection associated with endovascular neurointerventions with or without prophylactic antibiotic use was very low in this cohort. The data suggest that the routine use of antibiotic prophylaxis seems unnecessary and that to prevent antibiotic resistance and reduce costs antibiotic prophylaxis should be reserved for selected patients deemed to be at increased infection risk.
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“Buddy” Connors, J. J., and Joan Wojak. "Neurointerventions–Cerebral Protection Devices and Stroke." Journal of Vascular and Interventional Radiology 13, no. 2 (February 2002): P213. http://dx.doi.org/10.1016/s1051-0443(02)70136-x.
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Elkordy, Alaa, Hidenori Endo, Kenichi Sato, Yasushi Matsumoto, Ryushi Kondo, Kuniyasu Niizuma, Toshiki Endo, Miki Fujimura, and Teiji Tominaga. "Embolization of the choroidal artery in the treatment of cerebral arteriovenous malformations." Journal of Neurosurgery 126, no. 4 (April 2017): 1114–22. http://dx.doi.org/10.3171/2016.2.jns152370.
Повний текст джерелаАнотація:
OBJECTIVE The anterior and posterior choroidal arteries are often recruited to supply arteriovenous malformations (AVMs) involving important paraventricular structures, such as the basal ganglia, internal capsule, optic radiation, lateral geniculate body, and medial temporal lobe. Endovascular embolization through these arteries is theoretically dangerous because they supply eloquent territories, are of small caliber, and lack collaterals. This study aimed to investigate the safety and efficacy of embolization through these arteries. METHODS This study retrospectively reviewed 13 patients with cerebral AVMs who underwent endovascular embolization through the choroidal arteries between 2006 and 2014. Embolization was performed as a palliative procedure before open surgery or Gamma Knife radiosurgery. Computed tomography and MRI were performed the day after embolization to assess any surgical complications. The incidence and type of complications and their association with clinical outcomes were analyzed. RESULTS Decreased blood flow was achieved in all patients after embolization. Postoperative CT detected no hemorrhagic complications. In contrast, postoperative MRI detected that 4 of the 13 patients (30.7%) developed infarctions: 3 patients after embolization through the anterior choroidal artery, and 1 patient after embolization through the lateral posterior choroidal artery. Two of the 4 patients in whom embolization was from the cisternal segment of the anterior choroidal artery (proximal to the plexal point) developed symptomatic infarction of the posterior limb of the internal capsule, 1 of whom developed morbidity (7.7%). The treatment-related mortality rate was 0%. Additional treatment was performed in 12 patients: open surgery in 9 and Gamma Knife radiosurgery in 3 patients. Complete obliteration was confirmed by angiography at the last follow-up in 10 patients. Recurrent bleeding from the AVMs did not occur in any of the cases during the follow-up period. CONCLUSIONS Ischemic complications are possible following the embolization of cerebral AVMs through the choroidal artery, even with modern neurointerventional devices and techniques. Although further study is needed, embolization through the choroidal artery may be an appropriate treatment option when the risk of surgery or radiosurgery is considered to outweigh the risk of embolization.
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Chen, Stephanie H., Roberto Suazo, Vasu Saini, Isaac Josh Abecassis, Dileep Yavagal, Robert M. Starke, and Eric C. Peterson. "Radial Artery Access for Cerebral Angiography: 2-Dimensional Operative Video." Operative Neurosurgery 20, no. 6 (April 16, 2021): E431—E432. http://dx.doi.org/10.1093/ons/opab071.
Повний текст джерелаАнотація:
Abstract A number of studies have demonstrated that the radial artery is a safer access site than the femoral artery for endovascular procedures.1-4 In the prospective randomized studies comparing transradial and transfemoral approaches for cardiac procedures, there was a 60% reduction in access site complications as well as significant decreases in all-cause mortality with the transradial approach as compared to transfemoral, which has led to the adoption of a radial first strategy.5-7 Neurointerventional studies have demonstrated similar safety benefits as well as improved patient preference.8-14 In this video, a patient presented with an unruptured anterior communicating artery aneurysm and consented to a transradial artery diagnostic cerebral angiogram. This technical video demonstrates the key preprocedural preparation, room setup, patient positioning, steps for radial artery, and distal radial artery puncture and sheath placement. Distal transradial artery access is our preferred approach for diagnostic cerebral angiography because of an improved safety profile and procedural ergonomics. In cases in which a larger radial artery is advantageous such as for neurointerventions requiring larger systems, a standard transradial approach may be performed.9 In this video, a full 6-vessel cerebral angiogram is performed, followed by our arteriotomy closure technique using our standard equipment including a 10-cm 5 French Glidesheath Slender (Terumo, Japan), 100-cm hydrophilic coated 5 French Simmons 1 catheter (Merit OEM), 0.035 hydrophilic coated guidewire, and SafeGuard closure device (Merit, Salt Lake City, Utah).
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Guerreiro, Helena, Nadine Wortmann, Thomas Andersek, Tuan N. Ngo, Andreas M. Frölich, Dieter Krause, Jens Fiehler, Anna A. Kyselyova, and Fabian Flottmann. "Novel synthetic clot analogs for in-vitro stroke modelling." PLOS ONE 17, no. 9 (September 9, 2022): e0274211. http://dx.doi.org/10.1371/journal.pone.0274211.
Повний текст джерелаАнотація:
Purpose The increased demand for training of mechanical thrombectomy in ischemic stroke and development of new recanalization devices urges the creation of new simulation models both for training and device assessment. Clots properties have shown to play a role in procedural planning and thrombectomy device effectiveness. In this study, we analyzed the characteristics and applicability of completely synthetic, animal-free clots in the setting of an in-vitro model of mechanical thrombectomy for training and device assessment. Methods Synthetic clots based on agarose (n = 12) and silicone (n = 11) were evaluated in an in-vitro neurointervention simulation of mechanical thrombectomy with clot extraction devices. Calcified clots of mixed nature were simulated with addition of 3D printed structures. 9 clots were excluded due to insufficient vessel occlusion and failure to integrate with clot extraction device. Synthetic thrombi were characterized and compared using a categorical score-system on vessel occlusion, elasticity, fragmentation, adherence and device integration. Results Both agarose-based and silicone-based clots demonstrated relevant flow arrest and a good integration with the clot extraction device. Silicone-based clots scored higher on adherence to the vessel wall and elasticity. Conclusion Selected synthetic clots can successfully be implemented in an in-vitro training environment of mechanical thrombectomy. The clots’ different properties might serve to mimic fibrin-rich and red blood cell-rich human thrombi.
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Kühn, Anna Luisa, Matthew J. Gounis, and Ajit S. Puri. "Introduction: History and Development of Flow Diverter Technology and Evolution." Neurosurgery 86, Supplement_1 (December 16, 2019): S3—S10. http://dx.doi.org/10.1093/neuros/nyz307.
Повний текст джерелаАнотація:
Abstract The introduction of flow diverter technology to the field of neurointervention has revolutionized the treatment of intracranial aneurysms. The therapy approach has shifted from intrasaccular aneurysm treatment to exclusion of the aneurysm from the blood circulation with remodeling of the parent artery. Previously, “difficult”-to-treat aneurysms including fusiform and blister aneurysms, but also aneurysms arising from a diseased vessel segment, can now be safely and permanently treated with flow diverters. A little over a decade ago, after extensive bench testing and refinement of the flow diverter concept, the device was eventually available for clinical use and today it has become a standard treatment for intracranial aneurysms. Currently, United States Food and Drug Administration (FDA)-approved flow diverters are the Pipeline Embolization Device (Medtronic) and the Surpass Streamline Flow Diverter (Stryker). The devices can either be delivered or deployed via a standard femoral artery approach or a radial artery approach. Other considerations for catheter setup and device deployment strategies depending on aneurysm location or vessel anatomy are described.
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Berczeli, Marton, Ponraj Chinnadurai, Peter T. Legeza, Gavin W. Britz, and Alan B. Lumsden. "Transcarotid access for remote robotic endovascular neurointerventions: a cadaveric proof-of-concept study." Neurosurgical Focus 52, no. 1 (January 2022): E18. http://dx.doi.org/10.3171/2021.10.focus21511.
Повний текст джерелаАнотація:
OBJECTIVE The purpose of this proof-of-concept study was to demonstrate the setup and feasibility of transcarotid access for remote robotic neurointerventions in a cadaveric model. METHODS The interventional procedures were performed in a fresh-frozen cadaveric model using an endovascular robotic system and a robotic angiography imaging system. A prototype remote, robotic-drive system with an ethernet-based network connectivity and audio-video communication system was used to drive the robotic system remotely. After surgical exposure of the common carotid artery in a cadaveric model, an 8-Fr arterial was inserted and anchored. A telescopic guiding sheath and catheter/microcatheter combination was modified to account for the “workable” length with the CorPath GRX robotic system using transcarotid access. RESULTS To simulate a carotid stenting procedure, a 0.014-inch wire was advanced robotically to the extracranial internal carotid artery. After confirming the wire position and anatomy by angiography, a self-expandable rapid exchange nitinol stent was loaded into the robotic cassette, advanced, and then deployed robotically across the carotid bifurcation. To simulate an endovascular stroke recanalization procedure, a 0.014-inch wire was advanced into the proximal middle cerebral artery with robotic assistance. A modified 2.95-Fr delivery microcatheter (Velocity, Penumbra Inc.) was loaded into the robotic cassette and positioned. After robotic retraction of the wire, it was switched manually to a mechanical thrombectomy device (Solitaire X, Medtronic). The stentriever was then advanced robotically into the end of the microcatheter. After robotic unfolding and short microcatheter retraction, the microcatheter was manually removed and the stent retriever was extracted using robotic assistance. During intravascular navigation, the device position was guided by 2D angiography and confirmed by 3D cone-beam CT angiography. CONCLUSIONS In this proof-of-concept cadaver study, the authors demonstrated the setup and technical feasibility of transcarotid access for remote robot-assisted neurointerventions such as carotid artery stenting and mechanical thrombectomy. Using transcarotid access, catheter length modifications were necessary to achieve “working length” compatibility with the current-generation CorPath GRX robotic system. While further improvements in dedicated robotic solutions for neurointerventions and next-generation thrombectomy devices are necessary, the transcarotid approach provides a direct, relatively rapid access route to the brain for delivering remote stroke treatment.
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Lin, Li-Mei, Matthew T. Bender, Geoffrey P. Colby, Narlin B. Beaty, Bowen Jiang, Jessica K. Campos, Judy Huang, Rafael J. Tamargo, and Alexander L. Coon. "Use of a next-generation multi-durometer long guide sheath for triaxial access in flow diversion: experience in 95 consecutive cases." Journal of NeuroInterventional Surgery 10, no. 2 (July 14, 2017): 137–42. http://dx.doi.org/10.1136/neurintsurg-2017-013184.
Повний текст джерелаАнотація:
BackgroundIntracranial access techniques in modern neurointerventions have shifted towards more robust access platforms. The long guide sheath is one of the building blocks of triaxial systems used in intracranial embolizations. Here we present our experience with the AXS Infinity LS long sheath in the triaxial platform for the implantation of the Pipeline embolization device (PED).MethodsWe retrospectively identified patients who underwent PED Flex treatment with the AXS Infinity LS at a single institution. Procedural data collected included parent artery tortuosity, patient demographics, vasodilator use, aneurysm characteristics, equipment utilized, and catheter-related complications.ResultsA total of 95 cases were completed using the AXS Infinity LS for the triaxial platform foundation in PED Flex treatment of cerebral aneurysms. Mean patient age was 56.2±12.2 years (range 21–86). Average aneurysm size was 6.9±6.2 mm (range 1–38). There were 89 anterior circulation cases (94%) and 6 posterior circulation cases (6%). Significant cervical ICA tortuosity was present in 11/89 (12%) and moderate to severe cavernous ICA tortuosity was present in 29/89 (33%). Mean fluoroscopy time was 40.0±19.8 min. In 14/95 cases (15%), vasospasm prophylaxis or treatment with intra-arterial verapamil infusion was performed. Catheter access-related complications included asymptomatic iatrogenic dissection in one case (1%) from the distal intracranial catheter and groin hematoma in one case (1%). No parent vessel wall abnormalities were visualized in the region of the Infinity long sheath on final control angiography in all 95 cases.ConclusionThe AXS Infinity LS is the newest long guide sheath available for modern neurointerventional procedures. We have shown its utility in augmenting the triaxial access platform in PED Flex cases by providing enhanced distal tip trackability with added support in the aortic arch and proximal great vessels.
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Nawka, Marie Teresa, Jens Fiehler, Johanna Spallek, Jan-Hendrik Buhk, and Andreas Maximilian Frölich. "Current status of training environments in neuro-interventional practice: are animal models still contemporary?" Journal of NeuroInterventional Surgery 11, no. 3 (July 26, 2018): 283–89. http://dx.doi.org/10.1136/neurintsurg-2018-014036.
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PurposeSeveral different training environments for practicing neurointerventional procedures have been realized in silico, in vitro, and in vivo. We seek to replace animal-based training with suitable alternatives. In an effort to determine present training model distribution and preferences, we interviewed interventional neuroradiologists from 25 different countries about their experience in distinct training environments.MethodsA voluntary online survey comprising 24 questions concerning the different training facilities was designed and electronically conducted with the members of the European Society for Minimally Invasive Neurological Therapy.ResultsSeventy-one physicians with an average experience of 11.8 (±8.7) years completed the survey. The majority of participants had experience with animal-based training (eg, stroke intervention: 36; 50.7%). Overall, animal-based training was rated as the most suitable environment to practice coil embolization (20 (±6)), flow diverter placement (13 (±7)), and stroke intervention (13.5 (±9)). In-vitro training before using a new device in patients was supported by most participants (35; 49.3%). Additionally, preference for certain training models was related to the years of experience.ConclusionThis survey discloses the preferred training modalities in European neurointerventional centers with the majority of physicians supporting the general concept of in-vitro training, concomitantly lacking a standardized curriculum for educating neurointerventional physicians. Most suitable training modalities appeared to be dependent on procedure and experience. As animal-based training is still common, alternate artificial environments meeting these demands must be further developed.
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Nawka, Marie Teresa, Johanna Spallek, Juliane Kuhl, Dieter Krause, Jan Hendrik Buhk, Jens Fiehler, and Andreas Frölich. "Evaluation of a modular in vitro neurovascular procedure simulation for intracranial aneurysm embolization." Journal of NeuroInterventional Surgery 12, no. 2 (July 18, 2019): 214–19. http://dx.doi.org/10.1136/neurintsurg-2019-015073.
Повний текст джерелаАнотація:
BackgroundRapid development in endovascular aneurysm therapy continuously drives demand for suitable neurointerventional training opportunities.ObjectiveTo investigate the value of an integrated modular neurovascular training environment for aneurysm embolization using additively manufactured vascular models.MethodsA large portfolio of 30 patient-specific aneurysm models derived from different treatment settings (eg, coiling, flow diversion, flow disruption) was fabricated using additive manufacturing. Models were integrated into a customizable neurointerventional simulator with interchangeable intracranial and cervical vessel segments and physiological circuit conditions (‘HANNES’; Hamburg ANatomic Neurointerventional Endovascular Simulator). Multiple training courses were performed and participant feedback was obtained using a questionnaire.ResultsTraining for aneurysm embolization could be reliably performed using HANNES. Case-specific clinical difficulties, such as difficult aneurysm access or coil dislocation, could be reproduced. During a training session, models could be easily exchanged owing to standardized connectors in order to switch to a different treatment situation or to change from ‘treated’ back to ‘untreated’ condition. Among 23 participants evaluating hands-on courses using a five-point scale from 1 (strongly agree) to 5 (strongly disagree), HANNES was mostly rated as ‘highly suitable for practicing aneurysm coil embolization’ (1.78±0.79).ConclusionHANNES offers a wide variability and flexibility for case-specific hands-on training of intracranial aneurysm treatment, providing equal training conditions for each situation. The high degree of standardization offered may be valuable for analysis of device behavior or assessment of physician skills. Moreover, it has the ability to reduce the need for animal experiments.
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Ahmed, Maham, Stephanie Zyck, and Grahame C. Gould. "Initial experience of subcutaneous nitroglycerin for distal transradial access in neurointerventions." Surgical Neurology International 12 (October 11, 2021): 513. http://dx.doi.org/10.25259/sni_711_2021.
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Background: Transradial access (TRA) for diagnostic and interventional neuroendovascular procedures has gained significant popularity in recent years due to its improved safety profile and appeal to patients compared with transfemoral access. However, risks of TRA include hand ischemia in cases of poor ulnar collateral circulation and inability to cannulate the radial artery due to its relatively small diameter. By accessing the radial artery distal to the superficial palmar arch where ulnar collateral blood flow arises, in the anatomic snuffbox, the risk of hand ischemia is theoretically eliminated. The use of subcutaneous nitroglycerin and lidocaine to improve rates of success in radial artery access has been reported in the cardiac literature, however, has yet to be described for neurointerventional procedures. We discuss our technique and report our initial experience using subcutaneous nitroglycerin and lidocaine cocktail for access to the distal transradial artery in a variety of neuroendovascular procedures. Methods: A retrospective review of our institution’s database of neurointerventional and diagnostic procedures performed using dTRA was conducted, and 64 patients were identified between February and December 2020. Patient demographics, clinical data, procedural details, and radiographic information were collected and analyzed. Results: A total of 64 patients underwent neurointerventional procedures using the subcutaneous injection for dTRA access. The procedures performed included diagnostic cerebral angiograms (n = 47), stent and balloon assisted aneurysm coiling (n = 5), flow diversion (n = 2), intra-saccular device placement (n = 1), mechanical thrombectomy (n = 1), tumor embolization (n = 1), middle meningeal artery embolization (n = 2), extracranial carotid stent placement (n = 2), and arteriovenous malformation embolization (n = 3). While no complications of hand ischemia were appreciated, the access site conversion rate was 3.1%; 2 cases required a switch to femoral artery access due to proximal vessel tortuosity and aortic anatomical variations, and not due to access site complication. Furthermore, on repeat angiograms by the same proceduralist, distal TRA (dTRA) was successful in 100% of the cases. Conclusion: dTRA using subcutaneous nitroglycerin and lidocaine is a safe and effective method for neurointerventional and diagnostic procedures.
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Setlur Nagesh, Swetadri Vasan, Kunal Vakharia, Muhammad Waqas, Stephan A. Munich, Daniel R. Bednarek, Jason M. Davies, Kenneth V. Snyder, et al. "Single-center experience of using high definition (Hi-Def) imaging during neurointervention treatment of intracranial aneurysms using flow diverters." Journal of NeuroInterventional Surgery 12, no. 9 (February 11, 2020): 897–901. http://dx.doi.org/10.1136/neurintsurg-2019-015551.
Повний текст джерелаАнотація:
BackgroundA new dual resolution imaging x-ray detector system (Canon Medical Systems Corporation, Tochigi, Japan) has a standard resolution 194 µm pixel conventional flat-panel detector (FPD) mode and a high-resolution 76 µm high-definition (Hi-Def) mode in a single unit. The Hi-Def mode enhances the visualization of the intravascular devices.ObjectiveWe report the clinical experience and physician evaluation of this new detector system with Hi-Def mode for the treatment of intracranial aneurysms using a Pipeline embolization device (PED).MethodsDuring intervention at our institute, under large field of view (FOV) regular resolution FPD mode imaging, the catheter systems and devices were first guided to the proximity of the treatment area. Final placement and deployment of the PED was performed under Hi-Def mode guidance. A post-procedure 9-question physician survey was conducted to qualitatively assess the impact of Hi-Def mode visualization on physicians’ intraoperative decision-making. One-sample t-test was performed on the responses from the survey. Dose values reported by the x-ray unit were also recorded.ResultsTwenty-five cases were included in our study. The survey results indicated that, for each of the nine questions, the physicians in all cases indicated that the Hi-Def mode improved visualization compared with the FPD mode. For the 25 cases, the mean cumulative entrance air kerma was 2.35 Gy, the mean dose area product (DAP) was 173.71 Gy.cm2, and the mean x-ray exposure time was 39.30 min.ConclusionsThe Hi-Def mode improves visualization of flow diverters and may help in achieving more accurate placement and deployment of devices.
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Lin, Li-Mei, Bowen Jiang, Matthew T. Bender, Erick M. Westbroek, Jessica K. Campos, Rafael J. Tamargo, Judy Huang, Alexander L. Coon, and Geoffrey P. Colby. "47 Consecutive Cases of Pipeline Flex Flow Diversion Utilizing a Novel Large-Bore Intracranial Intermediate Catheter: Nuances and Institutional Experience with the Syphontrak." Interventional Neurology 7, no. 3-4 (2018): 153–63. http://dx.doi.org/10.1159/000486538.
Повний текст джерелаАнотація:
Background: The increasing complexity of modern neurointerventions has necessitated a shift in intracranial access techniques towards more robust distal support platforms. Here we present our experience with the Syphontrak Support Catheter (Codman Neuro, Raynham, MA, USA) in the triaxial platform for the implantation of the second-generation Pipeline Flex embolization device (PED Flex; Medtronic Neurovascular, Irvine, CA, USA). Methods: We retrospectively identified patients who underwent PED Flex treatment utilizing the Syphontrak at a single institution. The procedural data collected included parent artery tortuosity, patient demographics, aneurysm characteristics, other equipment utilized, and catheter-related complications. Results: A total of 47 consecutive aneurysm flow diversions were successfully performed using the Syphontrak. The patients’ age ranged from 25 to 80 years (mean 57.3 ± 11.6) and 85% were women. The average aneurysm size was 4.8 ± 2.7 mm (range 2–14). All cases were in the anterior circulation, with 6 (12%) aneurysms located beyond the internal carotid artery termination. Significant cervical carotid tortuosity was present in 23% (11/47) of the cases and moderate-to-severe cavernous tortuosity (cavernous grade ≥2) in 51% (24/47) of the cases. The mean fluoroscopy time was 36.6 ± 14.8 min. In 12/47 cases (26%), vasospasm prophylaxis with intra-arterial verapamil infusion was performed. The Syphontrak was tracked to the intended distal position in all cases, with a 100% technical success of PED Flex implantation. Forty-six (98%) of the 47 patients were discharged home after an average length of stay of 1.38 days. No iatrogenic catheter-related vessel injury occurred. Transient, minor neurological morbidity occurred in 3 cases (6%) and 1 patient had a minor ischemic event (NIHSS score < 4) in the periprocedural period. Conclusion: The Syphontrak is a new large-bore, multi-durometer intermediate catheter (IC) designed for use in modern neurointerventional procedures. We have shown its utility in 47 successful cases of PED Flex flow diversion of a wide range of complexity. The IC provides robust and atraumatic distal intracranial access while also providing an enhanced image quality with its large 0.060″ inner diameter.
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Miller, Timothy R., Luciano Giacon, Matthew J. Kole, Rong Chen, Gaurav Jindal, and Dheeraj Gandhi. "Onyx embolization with the Apollo detachable tip microcatheter: A single-center experience." Interventional Neuroradiology 24, no. 3 (February 26, 2018): 339–44. http://dx.doi.org/10.1177/1591019918758494.
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Purpose The Apollo Onyx Delivery Microcatheter (Ev3, Irvine, CA) is a detachable-tip microcatheter that was developed to reduce the risk of microcatheter entrapment during ethylene-vinyl alcohol copolymer (Onyx) embolizations. We report our experience with the microcatheter in a variety of neurointerventional procedures. Methods We retrospectively reviewed all Onyx embolizations performed in the head, neck, and spine using the Apollo Onyx Delivery Microcatheter from its introduction at our institution in July 2014 to August 2016. Information regarding patient diagnoses, procedural details, as well as clinical outcomes were obtained from the electronic medical record, procedure reports, and relevant angiographic imaging. Results A total of 58 arterial pedicle Onyx embolizations were performed in 37 patients. There were no cases of microcatheter entrapment, early/inadvertent tip detachment, or vessel injury upon removal of the device. There were two instances (3.5%) of leakage of Onyx from the microcatheter detachment site during embolization, which did not result in adverse sequelae. Clinical outcomes were excellent, with nearly all embolizations achieving the intended goal. In multivariate analysis, length of Onyx reflux along the microcatheter tip and utilization of a higher viscosity agent, Onyx 34, were significantly associated with tip detachment. Conclusion The use of the Apollo Microcatheter is both safe and effective during neurointerventional embolizations using Onyx. Leakage of liquid embolic agent from the detachment site is an infrequent technical complication that may be encountered with the device.
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Imaoka, T., and K. Itoh. "Analysis of the Properties of Guiding Catheters Used in Endovascular Neurointervention." Interventional Neuroradiology 13, no. 1_suppl (March 2007): 58–63. http://dx.doi.org/10.1177/15910199070130s107.
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The backup force is one of the most important properties of the guiding catheter in modern endovascular neurointervention employing rigid or bulky devices. Several guiding catheters were examined with regard to their backup force. Each guiding catheter had unique characteristics and neither an increase in its diameter nor increase in the backup force was directly proportional. The combined use of guiding catheters (coaxial guiding catheter) led to some improvement of the backup force, and the combination of the 6Fr Envoy and 8Fr Guider Softip exhibited the best performance. This article provides some scientific background as a means to select the appropriate catheter for beginners as well as accomplished operators.