13 research outputs found
Single-Center Experience With the Bare p48MW Low-Profile Flow Diverter and Its Hydrophilically Covered Version for Treatment of Bifurcation Aneurysms in Distal Segments of the Anterior and Posterior Circulation
Background and Purpose: Flow diversion has profoundly changed the way aneurysms
are treated. However, it conventionally requires dual antiplatelet medication and has yet
been considered off-label use in the posterior circulation or within peripheral vessels of the
anterior circulation. Here, we report our experience with the p48MW/p48MW hydrophilic
coating (HPC) in the anterior and posterior circulation. This novel low-profile flow diverter
is specifically designed for treatment of small peripheral vessels, and the p48MW HPC
has an anti-thrombotic polymer coating, which allows application of a single antiplatelet
function medication in conditions that expectably require further surgery.
Materials and Methods: Thirty-two patients were prospectively included. Twenty-six
treatments were performed with one flow diverter, four required two overlapping flow
diverters, one case demanded three overlapping flow diverters, and in one case,
extensive dissecting aneurysm telescoping with eight flow diverters was necessary.
Twenty-two complex bifurcation aneurysms were treated. Three months’ follow-up was
available for 14 patients.
Results: Deployment was uneventful in all cases. In four cases, undersizing was
unavoidable and resulted in significant shortening of the flow diverter, which demanded
implantation of further flow diverters to sufficiently treat the target aneurysm. Three
flow diverters required balloon angioplasty for optimal wall approximation. All parent
vessels remained patent. Available 3-month follow-up studies showed decreased influx
or delayed washout in all aneurysms; none was occluded completely. There were no
device-related clinical complications.
Conclusions: Implantation of the p48MW/p48MW HPC is safe and effective for
treatment of distally located cerebral aneurysms. Considering the reported rates of
ischemic complications associated with flow diversion of complex bifurcation aneurysms,
the p48MW/p48MW HPC potentially provides increased safety for complex bifurcation
aneurysms in the anterior and posterior circulation
Endovascular Treatment of Intracranial Aneurysms in Small Peripheral Vessel Segments—Efficacy and Intermediate Follow-Up Results of Flow Diversion With the Silk Vista Baby Low-Profile Flow Diverter
Background and Purpose: Low-profile flow diverter stents (FDS) quite recently
amended peripheral segments as targets for hemodynamic aneurysm treatment;
however, reports on outcomes, especially later than 3 months, are scarce. This study
therefore reports our experience with the novel silk vista baby (SVB) FDS and respective
outcomes after 8 and 11 months with special respect to specific adverse events.
Materials and Methods: Forty-four patients (mean age, 53 years) harboring 47
aneurysms treated with the SVB between June 2018 and December 2019 were included
in our study. Clinical, procedural, and angiographic data were collected. Follow-ups were
performed on average after 3, 8, and 11 months, respectively. Treatment effect was
assessed using the O’Kelly Marotta (OKM) grading system.
Results: Overall, angiographic follow-ups were available for 41 patients/45 aneurysms.
Occlusion or significant reduction in aneurysmal perfusion (OKM: D1, B1–B3 and
A2–A3) was observed in 98% of all aneurysms after 8 months. Only 2% of the treated
aneurysms remained morphologically unaltered and without an apparent change in
perfusion (OKM A1). Adverse events in the early post-interventional course occurred
in seven patients; out of them, mRS-relevant morbidity at 90 days related to FDS
treatment was observable in two patients. One death occurred in the context of
severe SAH related to an acutely ruptured dissecting aneurysm of the vertebral artery.
Conclusion: The SVB achieves sufficient occlusion rates of intracranial aneurysms
originating from peripheral segments, which are comparable to prior established
conventional FDS with acceptably low complication rates. However, alteration of a
hemodynamic equilibrium in distal localizations requires special attention to prevent
ischemic events
First Experience of Three Neurovascular Centers With the p64MW-HPC, a Low-Profile Flow Diverter Designed for Proximal Cerebral Vessels With Antithrombotic Coating
Background: In the last decade, flow diversion (FD) has been established as
hemodynamic treatment for cerebral aneurysms arising from proximal and distal cerebral
arteries. However, two significant limitations remain—the need for 0.027” microcatheters
required for delivery of most flow diverting stents (FDS), and long-term dual anti-platelet
therapy (DAPT) in order to prevent FDS-associated thromboembolism, at the cost
of increasing the risk for hemorrhage. This study reports the experience of three
neurovascular centers with the p64MW-HPC, a FDS with anti-thrombotic coating that
is implantable via a 0.021” microcatheter.
Materials and methods: Three neurovascular centers contributed to this retrospective
analysis of patients that had been treated with the p64MW-HPC between March 2020
and March 2021. Clinical data, aneurysm characteristics, and follow-up results, including
procedural and post-procedural complications, were recorded. The hemodynamic effect
was assessed using the O’Kelly–Marotta Scale (OKM).
Results: Thirty-two patients (22 female, mean age 57.1 years) with 33 aneurysms
(27 anterior circulation and six posterior circulation) were successfully treated with
the p64MW-HPC. In 30/32 patients (93.75%), aneurysmal perfusion was significantly
reduced immediately post implantation. Follow-up imaging was available for 23
aneurysms. Delayed aneurysm perfusion (OKM A3: 8.7%), reduction in aneurysm size
(OKM B1-3: 26.1%), or sufficient separation from the parent vessel (OKM C1-3 and
D1: 65.2%) was demonstrated at the last available follow-up after a mean of 5.9
months. In two cases, device thrombosis after early discontinuation of DAPT occurred.
One delayed rupture caused a caroticocavernous fistula. The complications were
treated sufficiently and all patients recovered without permanent significant morbidity.
Conclusion: Treatment with the p64MW-HPC is safe and feasible and achieves
good early aneurysm occlusion rates in the proximal intracranial circulation, which are
comparable to those of well-established FDS. Sudden interruption of DAPT in the
early post-interventional phase can cause in-stent thrombosis despite the HPC surface
modification. Deliverability via the 0.021” microcatheter facilitates treatment in challenging
vascular anatomies
Flow Diversion for Reconstruction of Intradural Vertebral Artery Dissecting Aneurysms Causing Subarachnoid Hemorrhage—A Retrospective Study From Four Neurovascular Centers
Objective: Dissecting aneurysms (DAs) of the vertebrobasilar territory manifesting
with subarachnoid hemorrhage (SAH) are associated with significant morbi-mortality,
especially in the case of re-hemorrhage. Sufficient reconstruction of the affected vessel
is paramount, in particular, if a dominant vertebral artery (VA) is impacted. Reconstructive
options include stent-assisted coiling and flow diversion (FD). The latter is technically less
challenging and does not require catheterization of the fragile aneurysm. Our study aims
to report a multicentric experience with FD for reconstruction of DA in acute SAH.
Materials and Methods: This retrospective study investigated 31 patients (age: 30–78
years, mean 55.5 years) who had suffered from SAH due to a DA of the dominant VA.
The patients were treated between 2010 and 2020 in one of the following German
neurovascular centers: University Hospital Leipzig, Katharinenhospital Stuttgart, BG
Hospital Bergmannstrost Halle/Saale, and Heinrich-Braun-Klinikum Zwickau. Clinical
history, imaging, implanted devices, and outcomes were reviewed for the study.
Results: Reconstruction with flow-diverting stents was performed in all cases. The
p64 was implanted in 14 patients; one of them required an additional balloon expandable stent to reconstruct severe stenosis in the target segment. One case
demanded additional liquid embolization after procedural rupture, and in one case,
p64 was combined with a PED. Further 13 patients were treated exclusively with
the PED. The p48MW-HPC was used in two patients, one in combination with two
additional Silk Vista Baby (SVB). Moreover, one patient was treated with a single SVB,
one with a SILK+. Six patients died [Glasgow Outcome Scale (GOS) 1]. Causes of
death were periprocedural re-hemorrhage, thrombotic occlusion of the main pulmonary
artery, and delayed parenchymal hemorrhage. The remaining three patients died in the
acute–subacute phase related to the severity of the initial hemorrhage and associated
comorbidities. One patient became apallic (GOS 2), whereas two patients had severe
disability (GOS 3) and four had moderate disability (GOS 4). Eighteen patients showed a
complete recovery (GOS 5).
Conclusion: Reconstruction of VA-DA in acute SAH with flow-diverting stents is a
promising approach. However, the severity of the condition is reflected by high overall
morbi-mortality, even despite technically successful endovascular treatment
Distal Flow Diversion with Anti-Thrombotically Coated and Bare Metal Low-Profile Flow Diverters—A Comparison
Background and purpose: The establishment of low-profile flow diverting stents (FDS), for example, the Silk Vista Baby (SVB) and the p48MW, facilitated endovascular treatment of peripheral cerebral aneurysms. This study therefore aims to compare the performance and outcomes of the SVB with those of the p48MW HPC, with a special focus on hemodynamic aspects of peripheral segments and bifurcations. Materials and methods: The study cohort comprises 108 patients, who were either treated with the SVB or the p48MW HPC between June 2018 and April 2021. Results: Sixty patients received a SVB and forty-eight patients a p48MW HPC. The SVB was used predominantly in the AcomA-complex, and the p48MW HPC in the MCA bifurcation. Immediately after implantation, significant hemodynamic downgrading (OKM A2-A3, B1-B3, C3) was achieved in 60% in the SVB group vs. 75.1% in the p48MW HPC group. At the second follow-up, after an average of 8.8 and 10.9 months, respectively, OKM D1 was observed in 64.4% of the SVB group vs. 27.3% in the p48MW HPC group. Only 1.7% vs. 6.8% of the aneurysms remained morphologically unaltered (OKM A1). Adverse events with persisting neurologic sequalae at last follow-up were largely comparable in both groups (5.0% vs. 4.2%). Conclusion: Immediately after implantation, the p48MW HPC had a more profound hemodynamic impact than the SVB; however, early complete occlusions were achieved in a greater proportion of lesions after implantation of the uncoated SVB
Single-Center Experience With the Bare p48MW Low-Profile Flow Diverter and Its Hydrophilically Covered Version for Treatment of Bifurcation Aneurysms in Distal Segments of the Anterior and Posterior Circulation
Background and Purpose: Flow diversion has profoundly changed the way aneurysms
are treated. However, it conventionally requires dual antiplatelet medication and has yet
been considered off-label use in the posterior circulation or within peripheral vessels of the
anterior circulation. Here, we report our experience with the p48MW/p48MW hydrophilic
coating (HPC) in the anterior and posterior circulation. This novel low-profile flow diverter
is specifically designed for treatment of small peripheral vessels, and the p48MW HPC
has an anti-thrombotic polymer coating, which allows application of a single antiplatelet
function medication in conditions that expectably require further surgery.
Materials and Methods: Thirty-two patients were prospectively included. Twenty-six
treatments were performed with one flow diverter, four required two overlapping flow
diverters, one case demanded three overlapping flow diverters, and in one case,
extensive dissecting aneurysm telescoping with eight flow diverters was necessary.
Twenty-two complex bifurcation aneurysms were treated. Three months’ follow-up was
available for 14 patients.
Results: Deployment was uneventful in all cases. In four cases, undersizing was
unavoidable and resulted in significant shortening of the flow diverter, which demanded
implantation of further flow diverters to sufficiently treat the target aneurysm. Three
flow diverters required balloon angioplasty for optimal wall approximation. All parent
vessels remained patent. Available 3-month follow-up studies showed decreased influx
or delayed washout in all aneurysms; none was occluded completely. There were no
device-related clinical complications.
Conclusions: Implantation of the p48MW/p48MW HPC is safe and effective for
treatment of distally located cerebral aneurysms. Considering the reported rates of
ischemic complications associated with flow diversion of complex bifurcation aneurysms,
the p48MW/p48MW HPC potentially provides increased safety for complex bifurcation
aneurysms in the anterior and posterior circulation
Single-Center Experience With the Bare p48MW Low-Profile Flow Diverter and Its Hydrophilically Covered Version for Treatment of Bifurcation Aneurysms in Distal Segments of the Anterior and Posterior Circulation
Background and Purpose: Flow diversion has profoundly changed the way aneurysms
are treated. However, it conventionally requires dual antiplatelet medication and has yet
been considered off-label use in the posterior circulation or within peripheral vessels of the
anterior circulation. Here, we report our experience with the p48MW/p48MW hydrophilic
coating (HPC) in the anterior and posterior circulation. This novel low-profile flow diverter
is specifically designed for treatment of small peripheral vessels, and the p48MW HPC
has an anti-thrombotic polymer coating, which allows application of a single antiplatelet
function medication in conditions that expectably require further surgery.
Materials and Methods: Thirty-two patients were prospectively included. Twenty-six
treatments were performed with one flow diverter, four required two overlapping flow
diverters, one case demanded three overlapping flow diverters, and in one case,
extensive dissecting aneurysm telescoping with eight flow diverters was necessary.
Twenty-two complex bifurcation aneurysms were treated. Three months’ follow-up was
available for 14 patients.
Results: Deployment was uneventful in all cases. In four cases, undersizing was
unavoidable and resulted in significant shortening of the flow diverter, which demanded
implantation of further flow diverters to sufficiently treat the target aneurysm. Three
flow diverters required balloon angioplasty for optimal wall approximation. All parent
vessels remained patent. Available 3-month follow-up studies showed decreased influx
or delayed washout in all aneurysms; none was occluded completely. There were no
device-related clinical complications.
Conclusions: Implantation of the p48MW/p48MW HPC is safe and effective for
treatment of distally located cerebral aneurysms. Considering the reported rates of
ischemic complications associated with flow diversion of complex bifurcation aneurysms,
the p48MW/p48MW HPC potentially provides increased safety for complex bifurcation
aneurysms in the anterior and posterior circulation
Endovascular Treatment of Intracranial Aneurysms in Small Peripheral Vessel Segments—Efficacy and Intermediate Follow-Up Results of Flow Diversion With the Silk Vista Baby Low-Profile Flow Diverter
Background and Purpose: Low-profile flow diverter stents (FDS) quite recently
amended peripheral segments as targets for hemodynamic aneurysm treatment;
however, reports on outcomes, especially later than 3 months, are scarce. This study
therefore reports our experience with the novel silk vista baby (SVB) FDS and respective
outcomes after 8 and 11 months with special respect to specific adverse events.
Materials and Methods: Forty-four patients (mean age, 53 years) harboring 47
aneurysms treated with the SVB between June 2018 and December 2019 were included
in our study. Clinical, procedural, and angiographic data were collected. Follow-ups were
performed on average after 3, 8, and 11 months, respectively. Treatment effect was
assessed using the O’Kelly Marotta (OKM) grading system.
Results: Overall, angiographic follow-ups were available for 41 patients/45 aneurysms.
Occlusion or significant reduction in aneurysmal perfusion (OKM: D1, B1–B3 and
A2–A3) was observed in 98% of all aneurysms after 8 months. Only 2% of the treated
aneurysms remained morphologically unaltered and without an apparent change in
perfusion (OKM A1). Adverse events in the early post-interventional course occurred
in seven patients; out of them, mRS-relevant morbidity at 90 days related to FDS
treatment was observable in two patients. One death occurred in the context of
severe SAH related to an acutely ruptured dissecting aneurysm of the vertebral artery.
Conclusion: The SVB achieves sufficient occlusion rates of intracranial aneurysms
originating from peripheral segments, which are comparable to prior established
conventional FDS with acceptably low complication rates. However, alteration of a
hemodynamic equilibrium in distal localizations requires special attention to prevent
ischemic events
First Experience of Three Neurovascular Centers With the p64MW-HPC, a Low-Profile Flow Diverter Designed for Proximal Cerebral Vessels With Antithrombotic Coating
Background: In the last decade, flow diversion (FD) has been established as
hemodynamic treatment for cerebral aneurysms arising from proximal and distal cerebral
arteries. However, two significant limitations remain—the need for 0.027” microcatheters
required for delivery of most flow diverting stents (FDS), and long-term dual anti-platelet
therapy (DAPT) in order to prevent FDS-associated thromboembolism, at the cost
of increasing the risk for hemorrhage. This study reports the experience of three
neurovascular centers with the p64MW-HPC, a FDS with anti-thrombotic coating that
is implantable via a 0.021” microcatheter.
Materials and methods: Three neurovascular centers contributed to this retrospective
analysis of patients that had been treated with the p64MW-HPC between March 2020
and March 2021. Clinical data, aneurysm characteristics, and follow-up results, including
procedural and post-procedural complications, were recorded. The hemodynamic effect
was assessed using the O’Kelly–Marotta Scale (OKM).
Results: Thirty-two patients (22 female, mean age 57.1 years) with 33 aneurysms
(27 anterior circulation and six posterior circulation) were successfully treated with
the p64MW-HPC. In 30/32 patients (93.75%), aneurysmal perfusion was significantly
reduced immediately post implantation. Follow-up imaging was available for 23
aneurysms. Delayed aneurysm perfusion (OKM A3: 8.7%), reduction in aneurysm size
(OKM B1-3: 26.1%), or sufficient separation from the parent vessel (OKM C1-3 and
D1: 65.2%) was demonstrated at the last available follow-up after a mean of 5.9
months. In two cases, device thrombosis after early discontinuation of DAPT occurred.
One delayed rupture caused a caroticocavernous fistula. The complications were
treated sufficiently and all patients recovered without permanent significant morbidity.
Conclusion: Treatment with the p64MW-HPC is safe and feasible and achieves
good early aneurysm occlusion rates in the proximal intracranial circulation, which are
comparable to those of well-established FDS. Sudden interruption of DAPT in the
early post-interventional phase can cause in-stent thrombosis despite the HPC surface
modification. Deliverability via the 0.021” microcatheter facilitates treatment in challenging
vascular anatomies
First Experience of Three Neurovascular Centers With the p64MW-HPC, a Low-Profile Flow Diverter Designed for Proximal Cerebral Vessels With Antithrombotic Coating
Background: In the last decade, flow diversion (FD) has been established as
hemodynamic treatment for cerebral aneurysms arising from proximal and distal cerebral
arteries. However, two significant limitations remain—the need for 0.027” microcatheters
required for delivery of most flow diverting stents (FDS), and long-term dual anti-platelet
therapy (DAPT) in order to prevent FDS-associated thromboembolism, at the cost
of increasing the risk for hemorrhage. This study reports the experience of three
neurovascular centers with the p64MW-HPC, a FDS with anti-thrombotic coating that
is implantable via a 0.021” microcatheter.
Materials and methods: Three neurovascular centers contributed to this retrospective
analysis of patients that had been treated with the p64MW-HPC between March 2020
and March 2021. Clinical data, aneurysm characteristics, and follow-up results, including
procedural and post-procedural complications, were recorded. The hemodynamic effect
was assessed using the O’Kelly–Marotta Scale (OKM).
Results: Thirty-two patients (22 female, mean age 57.1 years) with 33 aneurysms
(27 anterior circulation and six posterior circulation) were successfully treated with
the p64MW-HPC. In 30/32 patients (93.75%), aneurysmal perfusion was significantly
reduced immediately post implantation. Follow-up imaging was available for 23
aneurysms. Delayed aneurysm perfusion (OKM A3: 8.7%), reduction in aneurysm size
(OKM B1-3: 26.1%), or sufficient separation from the parent vessel (OKM C1-3 and
D1: 65.2%) was demonstrated at the last available follow-up after a mean of 5.9
months. In two cases, device thrombosis after early discontinuation of DAPT occurred.
One delayed rupture caused a caroticocavernous fistula. The complications were
treated sufficiently and all patients recovered without permanent significant morbidity.
Conclusion: Treatment with the p64MW-HPC is safe and feasible and achieves
good early aneurysm occlusion rates in the proximal intracranial circulation, which are
comparable to those of well-established FDS. Sudden interruption of DAPT in the
early post-interventional phase can cause in-stent thrombosis despite the HPC surface
modification. Deliverability via the 0.021” microcatheter facilitates treatment in challenging
vascular anatomies