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Endovascular treatment of unruptured aneurysms of cavernous and ophthalmic segment of internal carotid artery with flow diverter device Pipeline

View Article: PubMed Central - PubMed

ABSTRACT

Background: Intra-arterial treatment of aneurysms by redirecting blood flow is a newer method. The redirection is based on a significantly more densely braided wire stent. The stent wall keeps the blood in the lumen of the stent and slows down the turbulent flow in the aneurysms. Stagnation of blood in the aneurysm sac leads to the formation of thrombus and subsequent exclusion of the aneurysm from the circulation. The aim of the study was to evaluate flow diverter device Pipeline for broad neck and giant aneurysm treatment.

Methods: Fifteen patients with discovered aneurysm of the internal carotid artery were treated between November 2010 and February 2014. The majority of aneurysms of the internal carotid artery were located intradural at the ophthalmic part of the artery. The patients were treated using a flow diverter device Pipeline, which was placed over the aneurysm neck. Treatment success was assessed clinically and angiographically using O’Kelly Marotta scale.

Results: Control angiography immediately after the release of the stent showed stagnation of the blood flow in the aneurysm sac. In none of the patients procedural and periprocedural complications were observed. 6 months after the procedure, control CT or MR angiography showed in almost all cases exclusion of the aneurysm from the circulation and normal blood flow in the treated artery. Neurological status six months after the procedure was normal in all patients.

Conclusions: Treatment of aneurysms with flow diverter Pipeline device is a safe and significantly less time consuming method in comparison with standard techniques. This new method is a promising approach in treatment of broad neck aneurysms.

No MeSH data available.


Related in: MedlinePlus

Control DSA direct after the positioning of the flow diverter stent shows some residual filling of the aneurism (arrow). The stent fits the vessel wall perfectly.
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j_raon-2016-0049_fig_003: Control DSA direct after the positioning of the flow diverter stent shows some residual filling of the aneurism (arrow). The stent fits the vessel wall perfectly.

Mentions: 5000 units of heparin bolus i.a. are administered followed by the passage of the neck of the aneurysm with Marxsmann microcatheter (ev3, Covidien, USA) with the help of the micro guide wire. The guide wire is than removed and the Pipeline stent with the radiopaque pusher wire (ev3, Covidien, USA) is introduced. Pusher wire, serving now as a guide wire, is introduced in the initial segment of the middle cerebral artery (M1), in order to achieve an adequate stability of the catheter. A control angiography through the guiding catheter is performed to control the position of the stent in relation to the neck of the aneurysm. Release of the stent is performed by extraction of the guiding catheter and the simultaneous introduction of the pusher wire. The stent must open completely and it must fit the vessel wall tightly (Figure 2). Then the pusher wire can be extracted and the final angiography is performed, to check the position of the stent, if the stent is completely opened and fits the vessel wall tightly. Particular attention should be paid to the possible occurrence of dissection at the start and the end of the stent. Care should be taken that the stent fits the vessel wall perfectly, otherwise clotting of blood between the stent and the vessel wall can occur, which may lead to thrombus formation, and the closure of the stent lumen (Figure 3).Figure 2


Endovascular treatment of unruptured aneurysms of cavernous and ophthalmic segment of internal carotid artery with flow diverter device Pipeline
Control DSA direct after the positioning of the flow diverter stent shows some residual filling of the aneurism (arrow). The stent fits the vessel wall perfectly.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC5120584&req=5

j_raon-2016-0049_fig_003: Control DSA direct after the positioning of the flow diverter stent shows some residual filling of the aneurism (arrow). The stent fits the vessel wall perfectly.
Mentions: 5000 units of heparin bolus i.a. are administered followed by the passage of the neck of the aneurysm with Marxsmann microcatheter (ev3, Covidien, USA) with the help of the micro guide wire. The guide wire is than removed and the Pipeline stent with the radiopaque pusher wire (ev3, Covidien, USA) is introduced. Pusher wire, serving now as a guide wire, is introduced in the initial segment of the middle cerebral artery (M1), in order to achieve an adequate stability of the catheter. A control angiography through the guiding catheter is performed to control the position of the stent in relation to the neck of the aneurysm. Release of the stent is performed by extraction of the guiding catheter and the simultaneous introduction of the pusher wire. The stent must open completely and it must fit the vessel wall tightly (Figure 2). Then the pusher wire can be extracted and the final angiography is performed, to check the position of the stent, if the stent is completely opened and fits the vessel wall tightly. Particular attention should be paid to the possible occurrence of dissection at the start and the end of the stent. Care should be taken that the stent fits the vessel wall perfectly, otherwise clotting of blood between the stent and the vessel wall can occur, which may lead to thrombus formation, and the closure of the stent lumen (Figure 3).Figure 2

View Article: PubMed Central - PubMed

ABSTRACT

Background: Intra-arterial treatment of aneurysms by redirecting blood flow is a newer method. The redirection is based on a significantly more densely braided wire stent. The stent wall keeps the blood in the lumen of the stent and slows down the turbulent flow in the aneurysms. Stagnation of blood in the aneurysm sac leads to the formation of thrombus and subsequent exclusion of the aneurysm from the circulation. The aim of the study was to evaluate flow diverter device Pipeline for broad neck and giant aneurysm treatment.

Methods: Fifteen patients with discovered aneurysm of the internal carotid artery were treated between November 2010 and February 2014. The majority of aneurysms of the internal carotid artery were located intradural at the ophthalmic part of the artery. The patients were treated using a flow diverter device Pipeline, which was placed over the aneurysm neck. Treatment success was assessed clinically and angiographically using O’Kelly Marotta scale.

Results: Control angiography immediately after the release of the stent showed stagnation of the blood flow in the aneurysm sac. In none of the patients procedural and periprocedural complications were observed. 6 months after the procedure, control CT or MR angiography showed in almost all cases exclusion of the aneurysm from the circulation and normal blood flow in the treated artery. Neurological status six months after the procedure was normal in all patients.

Conclusions: Treatment of aneurysms with flow diverter Pipeline device is a safe and significantly less time consuming method in comparison with standard techniques. This new method is a promising approach in treatment of broad neck aneurysms.

No MeSH data available.


Related in: MedlinePlus