High Occlusion Rates Research Articles

Impact of preaneurysmal M1 length in unruptured middle cerebral artery aneurysm: mid-term outcome and single-center experience

ObjectiveThis study was design to investigate the surgical and functional outcome based on the preaneurysmal M1 length for unruptured MCA aneurysm. MethodsAmong 250 consecutive patients with unruptured aneurysms operated in our institution between 2015 and 2017, 72 were MCA aneurysms. Risk factors for IR (i.e., intraoperative rupture) were investigated including age, sex, preaneurysmal M1 length, maximal MCA aneurysm diameter, neck size, aneurysm shape, sphenoid ridge proximation sign. Outcome was measured at discharge, 1 yr and last follow-up. Outcome was compared according to the preaneurysmal M1 length. ResultsAmong 68 patients included, five patients (7.3%) suffered IR. Mean maximal diameter of MCA aneurysm (7.9 mm ± 3.4 vs. 4.5 ± 1.8; p = 0.01) was significantly associated with IR risk. Mean M1 length seemed to be shorter in the IR group although not statistically significant (16.2 mm ± 5.1 vs. 11.5 mm ± 4.8; p = 0.053). Mid-term outcome was favorable for all patients at last follow-up but was worsen in case of short preaneurysmal M1 segment (10.7 mm ± 4.8 vs. 16.4 mm ± 5.3, p = 0.02). Complete aneurysm occlusion was achieved for sixty-nine patients (95.5%) with 6.9% of early postoperative complications. ConclusionsThe microsurgical treatment of unruptured MCA aneurysm was associated with favorable mid-term outcome in all patients and high rates of complete occlusion. Aneurysm size was significantly associated with the intraoperative rupture risk for unruptured MCA aneurysm and patients with a short preaneurysmal M1 segment seemed to have a greater risk of intraoperative rupture although not statistically significant. Short preaneurysmal M1 patients had worsen mid-term outcome.

Angiographic and clinical outcomes from 396 aneurysms treated with the pipeline flex embolization device with shield technology.

The PEDESTRIAN registry demonstrated high rates of complete long-term occlusion and good clinical outcomes among patients with intracranial aneurysms treated with the pipeline embolization device. The pipeline flex embolization device with shield technology was introduced to minimize thromboembolic complications. In this study, we investigated the safety and effectiveness of pipeline embolization device with shield technology among all patients treated for intracranial aneurysms at our center. This was a single-arm retrospective study of prospectively collected data of patients treated with pipeline embolization device with shield technology at our high-volume center between January 2018-January 2021. The primary efficacy endpoint was complete occlusion as measured by a class 1 Raymond-Roy score at 1-year and 2-year follow-up. The primary safety endpoint was major morbidity and neurological mortality up to 1 year following intervention. A total of 328 patients (mean age 56.1 ± 14.7 years; 81.1% female), 80 of whom were previously included in PEDESTRIAN, with 396 aneurysms, were analyzed. A total of 378 devices were deployed, with 93.9% (372/396) of aneurysms requiring only one device. Follow-up angiography was available for 90.2% (296/328) of the procedures after a mean time of 14.0 ± 8.2 months. Complete occlusion was demonstrated for 78.5% (132/168) of aneurysms at 12 months and 90.7% (98/108) at 24 months. The overall rates of major morbidity and neurological mortality after 2 years were 1.5% (5/328) and 0.6% (2/328), respectively. Our results demonstrate high rates of complete long-term occlusion among patients treated with pipeline embolization device with shield technology. We also observed low rates of mortality and morbidity consistent with fewer thromboembolic complications with pipeline embolization devices with shield technology.

700 Flow-redirection Intraluminal Device (FRED) System for the Management of Intracranial Aneurysms: A Systematic Review and Metanalysis

INTRODUCTION: Multiple FDs are available for clinical use. Over the years, the FDs technology has improved considerably. However, overall complications and safety issues using FRED have not been evaluated in detail. Studies comprehensively investigating the clinical and technical events in FRED usage to treat IAs are not available. The purpose of this study is to investigate the outcome, overall complication rates, occlusion rate, retreatment, thromboembolic, and hemorrhagic complications for different patient cohorts treated with FRED flow diverter. METHODS: The following descriptors were used for the search: Flow-Redirection Intraluminal Device (FRED) system for the treatment of Intracranial aneurysms, Intracranial aneurysms, and Complication with no constraints applied was searched. Two authors independently revived and identified the studies, and two independent review authors extracted the data. A random-effect model was used to pool data, and the results were reported (odds ratios and 95% CI); heterogeneity was reported as I2. RESULTS: Nine studies were included in the final analysis, which involved retrospectively and prospectively collected data on 1167 patients. The use of FRED was associated with a rate of occlusion of 85% (95% confidence interval [CI] 79.5%–90.9%). Low retreatment rate of 2.5% (95% CI 1.0%–4.6%), low thromboembolic complication rate of 4.9% (95% CI 3.0%–7.31%), low hemorrhagic complication rate of 1.35% (95% CI 0.7%–2.0%). The mortality rate was 4% (95% CI 0.8%–2.1%). An overall good outcome was 95.1% (95% CI 92.1%–97.4%), and poor outcome was 4.8% (95% CI 2.5%–7.8%). CONCLUSIONS: The available evidence suggests that FRED offers favorable results for the management of intracranial aneurysms, results in high occlusion rate and low complication rates

247 Novel Automated Active Irrigation With Drainage Leads to Significantly Faster Hematoma Clearance and Lower Catheter-related Infections Compared to Passive Drainage Alone for cSDHA Propensity Score-matched Comparative Study with Volumetric Analysis

INTRODUCTION: Passive drainage post-surgical evacuation of symptomatic chronic subdural hematoma (cSDH) is currently standard of care. High rates of infection, drain occlusion, and recurrence are associated complications. METHODS: A prospectively maintained database was retrospectively searched for consecutive patients presenting with cSDH. One-to-one PSM of covariates (including baseline comorbidities and presentation hematoma volume) in active and passive irrigation groups was performed to adjust for treatment selection bias. Rates of hematoma clearance, catheter-related occlusion, and infection; number of revisions; and length of hospital stay were recorded. RESULTS: This study included 55 patients: active continuous irrigation-drainage-21 (21 post-PSM); passive drainage-34 (21 post-PSM). For PSM groups, a significantly higher rate of hematoma clearance was obtained in the active irrigation-drainage group (0.5±0.4 vs. 0.4±0.5 ml/day in the passive drainage group; odds ratio [OR] = 1.291 (confidence interval [CI]:1.062-1.570, P = 0.002) and a significantly lower rate of catheter-related infections (OR = 0.051; CI: 0.004-0.697, P = 0.039). A non-significantly lower hematoma expansion rate at discharge was noted in the active irrigation-drainage group (4.8% vs. 23.8%; OR = 0.127; P = 0.186). No statistical difference in all-cause in-hospital mortality or discharge GCS score was observed between groups. CONCLUSIONS: Active and automated continuous irrigation plus drainage following cSDH surgical evacuation results in faster hematoma clearance and led to favorable clinical outcomes and low complication and revision rates compared to passive irrigation.

Treatment of intracranial aneurysms with pipeline embolization device: a single-center experience.

Endovascular therapy is the primary treatment modality for intracranial aneurysms (IA). The objective of this study was to assess the effectiveness and safety of a pipeline embolization device (PED) for the treatment of IA. This retrospective study was conducted at a single center. Data were collected for all patients who underwent PED treatment at the Fourth Affiliated Hospital of Xinjiang Medical University between December 2018 and January 2022. Clinical characteristics, aneurysm-related characteristics, treatment details, and clinical and imaging outcomes were collected and analyzed. A total of 60 consecutive patients with 60 IAs were treated with a PED. The mean age of the participants was 61.8 years, with 53% being female. The average size of the aneurysms was 14.7 mm, with 54 located in the anterior circulation and six in the posterior circulation. The median last follow-up time was 13.0 months (range, 11-24 months). All patients underwent final digital subtraction angiography (DSA) for angiographic follow-up, and 50 aneurysms (83.3%) were completely occluded. The overall complication rate was 3.3%, and there were no reported mortalities. Among the 12 cases of ruptured aneurysms, all of which underwent adjunctive coil embolization, the complete occlusion rate was 91.7% with a complication rate of 16.6% [ischemic complication and modified Rankin scale (mRS) deteriorated]. In the 6 cases of posterior circulation aneurysms (2 in the basilar artery), 5 cases achieved complete occlusion and 1 case achieved near-complete occlusion, with no reported complications or mortality. The use of PEDs appears to be an effective treatment option for IA, demonstrating high occlusion rates and low complication rates. While the application of PEDs for the treatment of ruptured aneurysms did not increase the risk of secondary aneurysm rupture, caution is still warranted due to a higher complication rate. In the treatment of aneurysms of the vertebrobasilar artery using PEDs, this study achieved favorable efficacy outcomes without complications nor patient mortality. However, further studies are needed to validate these findings.

Evaluation of the EMBOPIPE flow diverter device: in vivo and in vitro experiments

BackgroundAlthough flow diverter device (FDD) has brought revolutionized advances in endovascular treatment of intracranial aneurysms, it also presents considerable drawbacks as well, as the innovation for novel device has never stopped. This preclinical research aims to evaluate the safety and efficacy of a newly developed FDD, the EMBOPIPE, through in vivo and in vitro experiments.MethodsAneurysms were induced in 20 New Zealand white rabbits which were randomized to three follow-up groups according to the time elapsed after EMBOPIPE implantation (28, 90, and 180 days). Additional EMBOPIPEs were implanted in the abdominal aorta to cover the renal artery in nine rabbits. Angiography was performed immediately after device placement in all groups. Aneurysm occlusion, patency of renal arteries, and pathological outcomes were assessed. For the in vitro experiments, we measured the thrombogenic potential of EMBOPIPEs (n = 5) compared with bare stents (n = 5) using the Chandler loop model. Evaluation indicators were the platelet counts, macroscopic observations and scanning electron microscopy.ResultsEMBOPIPEs were successfully deployed in 19 of 20 rabbit aneurysms (95.0%). The rates of complete or near-complete aneurysm occlusion were 73.3%, 83.3%, and 100% in the 28-, 90-, and 180-day groups, respectively. All renal arteries covered by EMBOPIPEs remained patent, and the mean difference in renal artery diameter before and after the device placement in the three groups was 0.07 mm, 0.10 mm, and 0.10 mm, respectively (p = 0.77). Renal pathology was normal in all cases. The pathological findings of the aneurysms were as follows: thickened and adequate neointimal coverage at the aneurysm neck, minimal inflammatory response, near-complete smooth muscle cell layer, and endothelialization along the device. In vitro experiments showed that the platelet counts were significantly higher in EMBOPIPE blood samples than in bare stent samples and that platelet adhesion to the device was lower in the EMBOPIPE stent struts compared with bare stent struts through macroscopic observations and scanning electron microscopy.ConclusionsThe EMBOPIPE can achieve high rates of aneurysm occlusion while maintaining excellent branch artery patency. It exhibited wonderful pathological results. This novel device with phosphorylcholine surface modification could reduce platelet thrombus attached to the stent struts.

Minimally invasive left atrial appendage occlusion plus reduced dose direct oral anticoagulant to prevent stroke in patients with atrial fibrillation-the LAAO-PlusRE.

The onset of atrial fibrillation (AF) has a direct association with left atrial appendage (LAA) function, as demonstrated by recent studies demonstrating the link between left atrial (LA) wall fibrosis, impaired contractility, and the development of AF. Non-valvular AF (NVAF) affects almost 30 million people worldwide, with this number expected to increase in the next 20 years. It is the main cause of ischemic stroke, with significant subsequent economic and social impact. Currently, the mainstay of stroke prevention in patients with NVAF is oral anticoagulation (OAC), which reduces the incidence of ischemic events at the stake of increased hemorrhagic events. Despite the introduction and widespread use of direct oral anticoagulants (DOACs), which almost completely replaced vitamin K antagonists (VKAs), the adherence to OAC is still low, hindering the efficacy of stroke prevention. Percutaneous LAA occlusion (LAAO) is now indicated (class IIB) in patients with NVAF at increased ischemic risk who cannot undergo OAC. Recently published data demonstrated that a reduced dose of DOAC after percutaneous LAAO is superior to long-term dual antiplatelet therapy (DAPT) for stroke prevention in the mid-term. One of the possible pitfalls of percutaneous LAAO is postprocedural peri-device leaks (PDLs) that have been associated with increased thromboembolic events. According to LAAOS III results, surgical LAAO during cardiac surgery brings a 33% reduction in risk of stroke at five years, independently from the OAC regimen with a high rate of complete appendage occlusion. The combination of surgical LAAO and reduced dose DOAC might ensure adequate embolic prevention, lowering the hemorrhagic risk. The present manuscript aims to describe the rationale and design of the Minimally Invasive Left Atrial Appendage Occlusion Plus REduced Dose DOAC To Prevent Stroke In Patients With Atrial Fibrillation Randomized Clinical Trial (LAAO-PlusRE).

Abstract WP181: Treatment of Unruptured Small and Medium Wide-Necked Aneurysms of the Internal Carotid Artery Using the 64-Wire Surpass Evolve: Results of the SEASE International Registry

Introduction: The management of wide-necked internal carotid artery (ICA) aneurysms is technically challenging with established endovascular and microsurgical techniques that are limited by the associated morbidity and/or recurrence. The PREMIER study first demonstrated high rates of complete occlusion without parent vessel stenosis or permanent neurological complications after the treatment of wide-necked small and medium-sized intracranial ICA aneurysms with the 48-wire pipeline. We aimed to assess the effectiveness and safety of the new generation 64-wire Surpass Evolve (SE) flow diverter for the treatment of the same intracranial ICA aneurysm population. Methods: This is a sub-analysis from the Safety and Effectiveness Assessment of the Surpass Evolve (SEASE) registry, an observational cohort study including 15 academic institutions in North America and Europe spanning between 2020-2023. Analysis included patients with unruptured wide-necked saccular aneurysms (not previously treated), measuring <12 mm along the ICA segments. Primary effectiveness was complete occlusion (Raymond Roy Class 1) without retreatment at 1-year follow-up (core lab adjudicated), and primary safety was major stroke (ischemic/hemorrhagic) in the territory supplied by the target artery or death. Results: 129 cases were included (median age 58 years, IQR: 50-67 years, 85% females). Median aneurysm and neck size were 5.8 mm (IQR: 4.0-7.5) and 4.1 (IQR, 3.0-5.5). Most aneurysms were in the ICA C6 segment (66.7%, 86/129), followed by the C7 segment (21.0%, 21/129). Successful implantation was encountered in 99% (128/129) of the cases. At a median 10.1 months (IQR: 6.3-12.6), the rate of complete occlusion was 75.2% (91/121), ≥50% in-stent stenosis 7% (9/129), and retreatment 0.8% (1/129). Major stroke and overall mortality were reported in 1.6% (2/129) of the cases. Conclusion: Our study evaluating outcomes from the SEASE international multicenter registry found that patients with wide-necked unruptured saccular small to medium-sized aneurysms can be effectively treated with the 64-wire chrome-cobalt SE. Furthermore, the SE showed a considerable safety profile for this patient population.

Preoperative embolisation of renal cell carcinoma metastases to the spine - evaluation of procedural and clinical outcome.

Renal cell carcinoma (RCC) is the fourth most common metastatic tumour of the spine. RCC metastases are highly vascular and might cause life-threatening intraoperative bleeding. That is why preoperative embolisation is performed to reduce intraoperative blood loss. The aim of this study was to evaluate the procedural and clinical outcomes of preoperative embolisation of RCC metastases to the vertebral column. In this single-centre retrospective study, data of 59 consecutive patients undergoing endovascular treatment prior to surgical resection were collected and evaluated. In all cases superselective catheterisation and occlusion of feeding vessels was attempted and performed if deemed safe and possible. Completeness of embolisation, procedural details, and the complication rate were evaluated. Surgical procedures were carried out within 48 hours after embolisation. The surgical approach was dependent on the anatomical site and osseous destruction. Intraoperative blood loss was estimated. Fifty-nine patients with a mean age of 63 years were included. Complete embolisation was successful in 76% (45/59) and partial in 15% (9/59). Microspheres were the most commonly used embolic material. In 5 cases (8%) safe occlusion was not possible due to the radiculomedullary artery originating from the same pedicle as the tumour. Minor complications (vomiting, increased pain) occurred in 8 patients. Paraplegia (one transient and one permanent) was noted in 2 cases. Estimated intraoperative blood loss was 830 ± 410 ml. The results of our study show that preoperative embolisation is a feasible and effective method with a relatively high rate of occlusion and low complication rate.

Protocol for a Single-Center Randomized Controlled Trial of Percutaneous Coronary Intervention Via Distal Transradial Access Versus Transradial Access

Background: Although transradial access (TRA) has become the main vascular access for coronary intervention, its high radial artery occlusion rate limits its application in some patients. Studies have shown that compared with TRA, distal transradial access (dTRA) with the snuffbox area or the Hegu acupoint area as the puncture point significantly decreases the incidence of radial artery occlusion. However, no randomized controlled study has confirmed the safety and efficacy of coronary artery intervention via dTRA in China. Methods and analyses: This single-center, prospective, randomized controlled, superiority open-label study will enroll 428 consecutive patients with coronary heart disease undergoing percutaneous coronary intervention as the study population. After preoperative evaluation, the participants will be randomly divided into a study group (dTRA) and control group (TRA) in a 1:1 ratio. The primary endpoint (radial artery occlusion at 24 hours after operation) and secondary endpoint events will be evaluated and recorded. Study registration: This study has been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR2300073902).

2078. Comparison of Complication Types in Patients Receiving Vesicant Intravenous Antimicrobials or Vasopressors via Midlines and PICCs: A Retrospective Review

Abstract Background Peripherally inserted central catheters (PICC) are frequently used for long-term intravenous access in hospitalized patients; however, their use is associated with an increased risk of catheter-related bloodstream infection (CRBSI). Midline catheters (MC) have emerged as a potentially safer alternative and are associated with reduced rates of CRBSI but increased risk of thrombosis. Until recently, the use of several vasopressors and antibiotics via MC has been limited due to unknown adverse events. We aimed to compare the hazard ratios for CRBSI, thrombosis, catheter occlusion, and overall adverse events (AE) in adult intensive care unit (ICU) patients receiving vesicant antibiotics or vasopressors through PICC or MC. Methods We reviewed patients in 13 ICUs at one quaternary care center from April 2021 to September 2022 who received selected vesicant antibiotics (vancomycin, meropenem, and fluoroquinolones) or vasopressors through either PICC or MC. Patients who received both PICC and MC or other central access during the admission were excluded. Hazard ratios (HR) were compared using Kaplan-Meier survival curves and the log-long rank test. Cox regression was applied to adjust for potential confounding factors, including age, gender, ICU type (medical vs. surgical), duration of therapy, and length of stay. Results 445 patients (359 MCs, 86 PICCs) were included with 4,897 device days (3,910 MCs, 987 PICCs). Patient characteristics were similar across the two arms (Table 1). Figure 1 shows Kaplan-Meier survival estimate curves comparing PICC and MC. After adjusting for confounders (Table 2), the HR for CRBSI (0.86 [95% CI, 0.08 – 9.41)] and thrombosis (0.41 [95% CI, 0.09- 1.91]) were similar between the two devices. Compared to MC, PICCs were associated with higher occlusion rates (HR, 11.93 [95% CI, 2.97 – 47.89]). There were no significant differences in overall AE between the two groups (HR 1.72 [95% CI, 0.81 – 3.64]).Table 1:Characteristics of patients who received PICC or MC.MC: Midline Catheter; PICC: Peripherally Inserted Central Catheter; MICU: Medical Intensive Care Unit; SICU: Surgical Intensive Care Unit; DOT: Days of TherapyFigure 1:Kaplan-Meier Survival Estimate Curves Comparing PICC and MC. PICC: Peripherally Inserted Central Catheter; MC: Midline Catheter; The log-rank test was used for statistical significance.Table 2:Cox proportional-hazards multivariable model. DVT: Deep Vein Thrombosis; SVT: Superficial Vein Thrombosis; PICC: Peripherally Inserted Central Catheter; MC: Midline Catheter; SICU: Surgical Intensive Care Unit; MICU: Medical Intensive Care Unit; DOT: Days of Therapy; CI: 95% Confidence Interval Conclusion This study suggests similar infection and thrombosis hazards in ICU patients receiving vesicant antibiotics and vasopressors via PICC or MC. Notably, the study was not sufficiently powered to detect differences in outcomes. Larger studies are needed to assess the safety of administering these medications in MCs. Disclosures Sabra L. Shay, BSN, MPH, Premier Inc.: Employee

Comparative Analysis of Mortality and Amputation Rates in Patients Undergoing Atherectomy for Infra-Popliteal Peripheral Arterial Disease: Insight From the VQI.

Infra-popliteal peripheral arterial disease (IPPAD) poses challenges due to high restenosis and occlusion rates. The BASIL-2 trial demonstrated the superiority of endovascular treatment compared with surgical bypass in patients with IPPAD. However, the association between different endovascular modalities and clinical outcomes has not been conclusive. Combining plain old balloon angioplasty (POBA) with atherectomy is associated with improved clinical outcomes compared with POBA alone. Patients who underwent POBA vs POBA+atherectomy for IPPAD from the Vascular Quality Initiative database were identified. To mitigate potential selection bias, we employed propensity score matching (PSM) to balance the distribution of confounding variables for mortality identified on multivariable logistic regression. Subsequently, we compared patient characteristics and long-term outcomes between the 2 treatment groups. Among patients who underwent endovascular intervention for IPPAD, 19 979 individuals (80.8%) were treated with POBA alone, while 4747 (19.2%) were treated with both POBA+atherectomy after PSM. Propensity score matching ensured minimal differences in baseline characteristics, such as indication for lower extremity revascularization (LER) and history of LER. After PSM, patients receiving POBA+atherectomy experienced higher rates of technical success and lower perioperative complications, such as renal complications and hematoma, compared with POBA alone. During long-term follow-up, patients who underwent atherectomy had lower rates of major amputation and major adverse limb events (MALE) but slightly lower freedom from reintervention. Nonetheless, there were no differences in mortality. Combining POBA with atherectomy appears to be a safe approach in patients with IPPAD, with lower rates of long-term amputation and MALE at the cost of a higher risk of reintervention. The use of adjunctive atherectomy is associated with improved long-term outcomes in patients with infra-popliteal disease.

Abstract 037: Aneurysm Occlusion Rates with WEB Treatment: Single‐Institution Study and Review

Introduction To provide our single‐institution experience and outcome data with the WEB device in 51 patients treated for ruptured and unruptured intracranial aneurysms. Methods Occlusion rates in a cohort of 51 patients treated with WEB were collected at time of procedure and at last follow‐up between the years 2019 and 2021. Angiographic outcomes were assessed on the WEB occlusion scale (WOS) and occlusion status scale (OSC). Compaction was assessed on imaging. Functional outcomes were assessed using the modified Rankin Scale. Thromboembolic complications and retreatments were recorded. Statistical analysis was performed to identify predictors of inadequate occlusion. Results A total of 51 patients underwent endovascular embolization using the WEB device with a mean follow‐up of 14.9 months. Ruptured aneurysmal subarachnoid hemorrhage accounted for 15.7% (8/51) of all patients. Most of the patients (92.1%) were functionally independent at presentation. The most common aneurysm location in the present study was MCA bifurcation (52.9%). The median maximal aneurysm diameter was 6.9mm, while the median neck size was 4.4mm. Last follow‐up consisted of 49 patients and imaging was obtained in 45 patients. Adequate occlusion was documented at 97.8% (WOS) and 93.3% (OSC). Retreatment was required in 1 aneurysm. Minor compaction was noted in 11.1% with no cases of major compaction. The majority of patients had the same presenting and post‐procedure mRS. Thromboembolic complications were encountered in 7.8% (4/51) of procedures; 3 of which were symptomatic and none were permanent. There were no hemorrhagic complications. An analysis of the data shows that larger aneurysm dimensions, necessity for adjunctive stent, and minor compaction were significantly associated with inadequate occlusion. Aneurysm height and dome width remained independent predictors of inadequate occlusion Conclusion This study confirms the safety and efficacy profile of the WEB device for the embolization of intracranial aneurysms at our institution. A high rate of adequate occlusion at a midterm follow‐up demonstrates high efficacy of the WEB device in our experience. Predictors of inadequate occlusion, which we explored, proved consistent with the literature on known variables associated with residual aneurysms.

Safety and effectiveness of the LVIS and LVIS Jr devices for the treatment of intracranial aneurysms: Final results of the LEPI multicenter cohort study

BackgroundThe Low profile visualized intraluminal support (LVIS)/LVIS Jr is a self-expanding braiding stent for the treatment of intracranial aneurysm. This study is to determine the safety and effectiveness of the LVIS/LVIS Jr for the treatment of intracranial aneurysms in a real-world setting. MethodsThis prospective, observational, multicenter study enrolled patients with unruptured, ruptured and recanalized intracranial aneurysms treated with the LVIS stents, between February 2018 to December 2019. Primary endpoint was the cumulative morbidity and mortality rate (CMMR) assessed at 12 months follow-up (FU). ResultsA total of 130 patients were included (62.3 % women, mean age 55.9 ± 11.4) on an intention-to-treat basis. Four patients (3.1 %) had 2 target aneurysms; 134 total aneurysms were treated. The aneurysms were mainly located on the middle cerebral artery (41/134; 30.6 %) and the anterior communicating artery (31/134; 23.1 %). The CMMR at 1 year linked to the procedure and/or device was 4.6 % (6/130). The overall mortality was 1.5 % (2/130), none of these deaths adjudged as being linked to the procedure and/or device. All aneurysms (134/134, 100 %) were successfully treated with LVIS stent and/or other devices. At a mean FU of 16.8 months post-procedure, complete/nearly complete occlusion was achieved in 112 aneurysms (92.6 %), and only 3 patients (2.5 %) required aneurysm retreatment. ConclusionThis study provides evidence that the LVIS/LVIS Jr devices are safe and effective in the treatment of complex intracranial aneurysms, with very high rates of adequate occlusion at FU. These angiographic results are stable over time with an acceptable complication rate.Trial Registration: ClinicalTrial.gov under NCT 03553771.

Failure of Reconstructive Technique to Repair a Giant Intracranial Fusiform Aneurysm of the Basilar Artery: Case Report and Literature Review in the Pediatric Population

AbstractTreatment of giant basilar aneurysm presents a major treatment challenge, especially in the pediatric population. Morbidity and mortality approach 80 and 30%, respectively. Both reconstructive and deconstructive techniques are associated with high rates of complete occlusion and good neurological outcomes. We report a 14-year-old male with a giant basilar trunk aneurysm treated with an endovascular approach. Clinical symptoms began following an ischemic stroke 2 weeks prior to admission. Endovascular treatment was performed through a reconstructive technique by single flow diverter device (FDD) in the basilar artery; however, this technique failed. At 1-year follow-up, without additional endovascular treatment, the mid-basilar artery and aneurysm were occluded, with vertebrobasilar flow maintained through collaterals from the right posterior communicating artery. We present a challenging management of giant basilar aneurysm in a pediatric patient experiencing a failure of FDD deployment; however, we highlight the importance of collateral flow development in progressive occlusions.

Long-term Follow-up After Aneurysm Treatment with the Flow Redirection Endoluminal Device (FRED) Flow Diverter

IntroductionThis study focuses on long-term outcomes after aneurysm treatment with either the Flow Re-Direction Endoluminal Device (FRED) or the FRED Jr. to investigate the durability of treatment effect and long-term complications.MethodsThis study is based on a retrospective analysis of a prospectively maintained patient data base. Patients treated with either FRED or FRED Jr. between 2013 and 2017 at our institution, and thus a possibility for ≥ 5 years of follow-up, were included. Aneurysm occlusion rates, recurrence rates, modified Rankin scale score shifts to baseline, and delayed complications were assessed.ResultsIn this study 68 patients with 84 aneurysms had long-term follow-up with a mean duration of 57.3 months and 44 patients harboring 52 aneurysms had a follow-up ≥ 5 years with a mean follow-up period of 69.2 months. Complete occlusion was reached in 77.4% at 2 years and increased to 84.9% when the latest available imaging result was considered. Younger age and the absence of branch involvement were predictors for aneurysm occlusion in linear regression analysis. After the 2‑year threshold, there were 3 reported symptomatic non-serious adverse events. Of these, one patient had a minor stroke, one a transitory ischemic attack and one had persistent mass effect symptoms due to a giant aneurysm, none of these resulted in subsequent neurological disability.ConclusionThis long-term follow-up study demonstrates that the FRED and FRED Jr. are safe and effective for the treatment of cerebral aneurysms in the long term, with high rates of complete occlusion and low rates of delayed adverse events.

Aneurysmal recurrence and retreatment modalities after Woven EndoBridge (WEB) device implantation: A systematic review and meta-analysis.

The Woven EndoBridge (WEB) device is used to treat wide-neck bifurcation aneurysms (WNBAs). We conducted a systematic review and meta-analysis to determine the retreatment rate strategies following aneurysmal recurrence of WEB device treated WNBAs. This study is reported following the PRISMA 2020 guidelines. We conducted a systematic review of the literature using PubMed, Scopus, Embase, and Web of Science. Data were pooled using a random-effects model. We calculated pooled prevalence and corresponding 95% confidence intervals (CI). We included 11 studies. The overall retreatment rate was 171/1875 aneurysms (10.3%; 95% CI = 8.3-12.9). Stent-assisted coiling was used to treat 59 aneurysms (36.7%; 95% CI = 26.4-48.5), and flow diverters were used to treat 44 aneurysms (18.7%; 95% CI = 9.9-32.5). Following retreatment, the complete occlusion rate was 57/91 aneurysms (62.8%; 95% CI = 48.2-75.3) and the adequate occlusion rate was 24/91 aneurysms (26.4%; 18.4%-36.4%). The most common aneurysmal recurrence site was the anterior communicating artery (44/136 aneurysms, 32.4%; 95% CI = 25.0-40.7). Roughly 10% of WNBAs initially treated with the WEB device will undergo retreatment. Retreatment is an effective strategy for WEB-treated aneurysms, with high rates of adequate and complete occlusion. Future studies should work to identify risk factors for aneurysmal recurrence.

Management of Intracranial Aneurysms that Do Not Occlude on Initial Follow-up After Treatment With the Pipeline Embolization Device.

The pipeline embolization device (PED) has become widely accepted as a safe and efficacious treatment for intracranial aneurysms with high rates of complete occlusion at initial follow-up. For aneurysms that are not completely occluded at initial follow-up, further treatment decision-making is varied. Furthermore, the risk of aneurysmal rupture in these incompletely occluded aneurysms after PED is not known. The objective of this study was to determine treatment decision-making that results in increased occlusion status at final follow-up and to evaluate risk of rupture in those aneurysms that do not go onto occlusion. This study is a retrospective review of prospective data for intracranial aneurysms treated with PED at two institutions from 2013 to 2019. Aneurysms with near-complete or incomplete occlusion at initial follow-up were included in the statistical analysis. There were 606 total aneurysms treated at two academic institutions with PED with incomplete occlusion at initial follow-up in 134 aneurysms (22.1%). Of the 134 aneurysms that were nonoccluded at initial follow-up, 76 aneurysms (56.7%) went on to complete or near complete occlusion with final complete or near complete occlusion in 90.4% of all aneurysms treated. The time to final imaging follow-up was 28.2 months (13.8-44.3) Retreatment with a second flow diverter was used in 28 aneurysms (20.9%). No aneurysms that were incompletely occluded at initial follow-up had delayed rupture. Furthermore, older patient age was statistically significant for incomplete occlusion at initial follow-up ( P = .05). Intracranial aneurysms treated with the PED that do not occlude at initial follow-up may go on to complete occlusion with continuous observation, alteration in antiplatelet regimens, or repeat treatment. Delayed aneurysmal rupture was not seen in patients with incomplete occlusion.

Transcatheter closure of perimembranous ventricular septal defects by coils le

Background: Ventricular septal defect (VSD) is the most frequently occurring congenital cardiac disease, accounts nearly 20-30% of all cases.
 Surgery still the corrective therapy with high success and low complication but having some problems: cardiopulmonary bypass, anesthesia, ICU, sternalitis, chest scar...
 Recently many progress in cardiac intervention applied to treat congenital heart disease especially percutaneous VSD closure. currently patients with VSD have other choice to cure safely, effectively and less complication.[1]
 Objectives: To evaluate the long-term (more than 3 years follow-up) results from transcatheter closure of perimembranous VSD by Coil Le.
 Methods: This is the descriptive clinical trial and follow-up.
 Result: 27 patients selected by echocardiography, 25 patients were closed successfully (92.6% success rate) with Coil Le. Complete occlusion (no shunt) is 96.0% and no late AVB at least 3 years follow-up.
 Conclusions: Transcatheter closure of perimembranous VSD by Coil Le is effective with high occlusion rate, no significant complications and is suitable for selected PMVSD.

Use of the Neuroform Atlas stent for wide-necked cerebral aneurysms

To investigate the effect and safety of the Neuroform Atlas (NFA) stent in stent-assisted coiling of wide-necked intracranial aneurysms, patients with wide-necked intracranial aneurysms were retrospectively enrolled and treated with the NFA stent-assisted coiling. The modified Rankin scale (mRS) grades and Raymond grades were used to assess the clinical outcomes and aneurysm occlusion degrees, respectively, after embolization and at follow-up. Totally, 122 patients were enrolled with 129 wide-necked aneurysms, and forty-nine (40.2%) patients experienced subarachnoid hemorrhage. A total of 134 NFA stents were deployed in all patients. Immediately after endovascular embolization, the Raymond grade was I in 112 (86.8%), II in 8 (6.2%), and III in 9 (7.0%). Complications occurred in 7 (5.7%) patients, including stent displacement in 2 (1.6%) patients, thrombosis and cerebral infarction in 4 (3.3%), and death in 1 (0.8%). Clinical follow-up was performed in 113 (92.6%) patients 6–30 (mean 21) months after embolization, with the mRS grade 0 in 99 (87.6%) patients, 1 in 7 (6.2%), 2 in 5 (4.4%), and 3 in 2 (1.8%). Good prognosis (mRS ≤ 2) was achieved in 111 (98.2%) patients while poor prognosis (mRS > 2) in two (1.8%). Digital subtraction angiography was conducted in 98 (80.3%) patients with 104 (80.6%) aneurysms 6–30 (mean 21) months after embolization. The Raymond grade was grade I in 94 (90.4%) aneurysms, II in 4 (3.8%), and III in 6 (5.8%). Compared with the Raymond grades immediately after embolization, 93 (89.4%) aneurysms disappeared, 9 (8.7%) remained unchanged in the occlusion status, and 2 (1.9%) were recurrent. In conclusion, the NFA stent may have a high aneurysm occlusion rate and a low complication rate in assisting coiling of wide-necked intracranial aneurysms even though further studies are necessary to prove this.