Jean-Christophe Gentric1, Igor Salazkin2, Guylaine Gevry2, Jean Raymond3, Tim Darsaut4. 1. Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Montreal, Quebec, Canada Groupe d'étude de la Thrombose en Bretagne Occidentale (GETBO, EA 3878), Brest, France. 2. Laboratory of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada. 3. Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Montreal, Quebec, Canada Laboratory of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada. 4. Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada.
Abstract
INTRODUCTION: Flow diverters (FDs) are increasingly used in the treatment of wide-necked aneurysms. OBJECTIVE: To examine the hypothesis that intentional FD compaction might improve aneurysm occlusion rates. METHODS: Bilateral wide-necked carotid aneurysms were created in 12 dogs. Endovascular treatment was performed 1 month later, using Pipeline embolization devices deployed with compaction across the aneurysm neck (n=12). Group 1a consisted of aneurysms treated with a single compacted FD (n=8), while group 1b aneurysms required two compacted FDs (n=4). Control aneurysms were treated with a single non-compacted FD (group 3; n=6), or not treated (group 4; n=4). Angiographic results were compared at 3 months. Pathology specimens were photographed and the neointimal coverage of devices scored using an ordinal grading system. RESULTS: Twenty-two of 24 aneurysms were patent at 1 month. Deployment with compaction was successful in eight cases (group 1a aneurysms). The compaction maneuver led to immediate FD prolapse into the aneurysm in four cases, rescued by deploying a second, telescoping FD (forming group 1b aneurysms). One compacted device later migrated distally, leaving the aneurysm untreated. Angiographic results differed significantly between groups (p=0.0002). At 3 months, aneurysms successfully treated with a single compacted FD were more often occluded at 3 months (7/7) than aneurysms flow-diverted without compaction (2/6; p=0.021). All aneurysms treated with two compacted FDs were occluded, while all untreated aneurysms remained patent. There were no parent vessel stenoses. CONCLUSIONS: Compaction of FDs can improve angiographic occlusion of experimental wide-necked aneurysms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
INTRODUCTION: Flow diverters (FDs) are increasingly used in the treatment of wide-necked aneurysms. OBJECTIVE: To examine the hypothesis that intentional FD compaction might improve aneurysm occlusion rates. METHODS: Bilateral wide-necked carotid aneurysms were created in 12 dogs. Endovascular treatment was performed 1 month later, using Pipeline embolization devices deployed with compaction across the aneurysm neck (n=12). Group 1a consisted of aneurysms treated with a single compacted FD (n=8), while group 1b aneurysms required two compacted FDs (n=4). Control aneurysms were treated with a single non-compacted FD (group 3; n=6), or not treated (group 4; n=4). Angiographic results were compared at 3 months. Pathology specimens were photographed and the neointimal coverage of devices scored using an ordinal grading system. RESULTS: Twenty-two of 24 aneurysms were patent at 1 month. Deployment with compaction was successful in eight cases (group 1a aneurysms). The compaction maneuver led to immediate FD prolapse into the aneurysm in four cases, rescued by deploying a second, telescoping FD (forming group 1b aneurysms). One compacted device later migrated distally, leaving the aneurysm untreated. Angiographic results differed significantly between groups (p=0.0002). At 3 months, aneurysms successfully treated with a single compacted FD were more often occluded at 3 months (7/7) than aneurysms flow-diverted without compaction (2/6; p=0.021). All aneurysms treated with two compacted FDs were occluded, while all untreated aneurysms remained patent. There were no parent vessel stenoses. CONCLUSIONS: Compaction of FDs can improve angiographic occlusion of experimental wide-necked aneurysms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Robert Fahed; Tim E Darsaut; Jean-Christophe Gentric; Behzad Farzin; Igor Salazkin; Guylaine Gevry; Jean Raymond Journal: Neuroradiology Date: 2017-02-27 Impact factor: 2.804
Authors: R J Damiano; V M Tutino; N Paliwal; D Ma; J M Davies; A H Siddiqui; H Meng Journal: AJNR Am J Neuroradiol Date: 2017-01-05 Impact factor: 3.825