Pub Date : 2022-04-21DOI: 10.1177/15910199221095789
M. Essibayi, G. Lanzino, Z. Keser
INTRODUCTION Management of intracranial artery dissection (IAD) remains elusive in medical practice. Intracranially, vertebral artery dissection (VAD) is more commonly encountered than internal carotid artery dissection (ICAD). Deconstructive (EVT-d) and reconstructive (EVT-r) endovascular techniques have been utilized to treat VAD and ICAD. This meta-analysis investigates the safety and efficacy of EVT-r and EVT-d in the management of VAD and ICAD. METHODS The literature was searched for all studies with consecutive patient series evaluating EVT-d or EVT-r for VAD or ICAD management. Baseline characteristics and outcomes were compared between EVT-r and EVT-d groups using the random-effect model and meta-regression approaches. RESULTS Overall, 1095 cases pooled from 56 studies were included. There was no statistically significant difference in baseline characteristics between VAD and ICAD. EVT-r was applied in 647 cases (59.1%) and EVT-d in the rest There was no statistical difference in the rate of procedural complications between EVT-r and EVT-d. Although EVT-d was significantly associated with higher rates of complete aneurysm occlusion (86.4%), lower rates of good clinical outcomes (72.1%) and higher mortality (15.1%) were achieved compared to EVT-r (70.2%, 83.3%, and 9.5%; respectively). The mortality rate was higher, and good clinical outcomes were less common in ruptured aneurysms. Ischemic presentation was statistically associated with poor outcomes (mRS 3-5) but low mortality. ICAD often tended to grow following treatment and resulted in poor neurological outcomes. CONCLUSIONS IAD has favorable outcomes when treated appropriately. Novel reconstructive endovascular techniques are promising and should be integrated well in endovascular practice. Further studies are warranted.
{"title":"Endovascular treatments of intracranial vertebral and internal carotid arteries dissections: An interactive systematic review and meta-analysis.","authors":"M. Essibayi, G. Lanzino, Z. Keser","doi":"10.1177/15910199221095789","DOIUrl":"https://doi.org/10.1177/15910199221095789","url":null,"abstract":"INTRODUCTION\u0000Management of intracranial artery dissection (IAD) remains elusive in medical practice. Intracranially, vertebral artery dissection (VAD) is more commonly encountered than internal carotid artery dissection (ICAD). Deconstructive (EVT-d) and reconstructive (EVT-r) endovascular techniques have been utilized to treat VAD and ICAD. This meta-analysis investigates the safety and efficacy of EVT-r and EVT-d in the management of VAD and ICAD.\u0000\u0000\u0000METHODS\u0000The literature was searched for all studies with consecutive patient series evaluating EVT-d or EVT-r for VAD or ICAD management. Baseline characteristics and outcomes were compared between EVT-r and EVT-d groups using the random-effect model and meta-regression approaches.\u0000\u0000\u0000RESULTS\u0000Overall, 1095 cases pooled from 56 studies were included. There was no statistically significant difference in baseline characteristics between VAD and ICAD. EVT-r was applied in 647 cases (59.1%) and EVT-d in the rest There was no statistical difference in the rate of procedural complications between EVT-r and EVT-d. Although EVT-d was significantly associated with higher rates of complete aneurysm occlusion (86.4%), lower rates of good clinical outcomes (72.1%) and higher mortality (15.1%) were achieved compared to EVT-r (70.2%, 83.3%, and 9.5%; respectively). The mortality rate was higher, and good clinical outcomes were less common in ruptured aneurysms. Ischemic presentation was statistically associated with poor outcomes (mRS 3-5) but low mortality. ICAD often tended to grow following treatment and resulted in poor neurological outcomes.\u0000\u0000\u0000CONCLUSIONS\u0000IAD has favorable outcomes when treated appropriately. Novel reconstructive endovascular techniques are promising and should be integrated well in endovascular practice. Further studies are warranted.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133097446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-07DOI: 10.1177/15910199221091645
R. Hanel, G. Cortez, V. Benalia, Erin Sheffels, Daniel J. Sutphin, J. Pederson, V. Pereira
BACKGROUND The Silk Vista Baby (SVB, BALT) is a first-in-class flow-diverter device delivered using a 0.017" microcatheter, designed for the treatment of intracranial aneurysms, including those in small diameter vessels. This study reports a systematic literature review (SLR) to evaluate the safety and efficacy of using SVB to treat intracranial aneurysms in vessels less than 3.5 mm in diameter. METHODS We performed a PRISMA-compliant SLR to evaluate the outcomes of SVB in the treatment of aneurysms in small intracranial vessels. Primary outcomes were occlusion status and major stroke, and secondary outcomes included all-cause mortality, procedure-related neurologic death, and post-operative aneurysm rupture. Data were expressed as descriptive statistics only. RESULTS A total of four studies, including 163 patients with 173 intracranial aneurysms, were included. The most common aneurysm locations were the anterior cerebral artery (24.9% [43/173]), the middle cerebral artery (24.3% [42/173]), and the anterior communicating artery (23.1% [40/173]). Parent artery diameter ranged from 0.9 mm to 3.6 mm, and 29% were acutely or previously ruptured aneurysms. Overall, complete or near-complete occlusion was 72.1% on early-term follow-up. Mortality rate among the studies was 2.5%, with 3 instances adjudicated as neurologic deaths (1.8%). Major stroke was noted in 1.2% of cases, and branch occlusion or stent thrombus formation in 5.5%. CONCLUSION Our review suggests that SVB is a safe and effective treatment for intracranial aneurysms in small vessels. Further prospective and comparative studies with patient outcome data specific to aneurysm location are needed to confirm the safety and efficacy of SVB.
Silk Vista Baby (SVB, BALT)是使用0.017英寸微导管输送的一流血流分流器，专为治疗颅内动脉瘤而设计，包括小直径血管内的动脉瘤。本研究报告了一项系统的文献综述(SLR)，以评估使用SVB治疗直径小于3.5 mm的颅内动脉瘤的安全性和有效性。方法采用符合prisma标准的SLR来评估SVB治疗颅内小血管动脉瘤的效果。主要结局是闭塞状态和主要卒中，次要结局包括全因死亡率、手术相关神经系统死亡和术后动脉瘤破裂。数据仅以描述性统计表示。结果共纳入4项研究，163例颅内动脉瘤173例。动脉瘤最常见的位置为大脑前动脉(24.9%[43/173])、大脑中动脉(24.3%[42/173])和前交通动脉(23.1%[40/173])。母动脉直径为0.9 mm至3.6 mm, 29%为急性或先前破裂的动脉瘤。总体而言，在早期随访中，完全或接近完全闭塞的发生率为72.1%。这些研究的死亡率为2.5%，其中3例被判定为神经系统死亡(1.8%)。1.2%的病例发生严重中风，5.5%的病例发生分支闭塞或支架血栓形成。结论SVB是一种安全有效的治疗颅内小血管动脉瘤的方法。需要进一步的前瞻性和对比研究，包括特定于动脉瘤位置的患者结果数据，以确认SVB的安全性和有效性。
{"title":"Patient outcomes after treatment of brain aneurysm in small diameter vessels with the silk vista baby flow diverter: A systematic review.","authors":"R. Hanel, G. Cortez, V. Benalia, Erin Sheffels, Daniel J. Sutphin, J. Pederson, V. Pereira","doi":"10.1177/15910199221091645","DOIUrl":"https://doi.org/10.1177/15910199221091645","url":null,"abstract":"BACKGROUND\u0000The Silk Vista Baby (SVB, BALT) is a first-in-class flow-diverter device delivered using a 0.017\" microcatheter, designed for the treatment of intracranial aneurysms, including those in small diameter vessels. This study reports a systematic literature review (SLR) to evaluate the safety and efficacy of using SVB to treat intracranial aneurysms in vessels less than 3.5 mm in diameter.\u0000\u0000\u0000METHODS\u0000We performed a PRISMA-compliant SLR to evaluate the outcomes of SVB in the treatment of aneurysms in small intracranial vessels. Primary outcomes were occlusion status and major stroke, and secondary outcomes included all-cause mortality, procedure-related neurologic death, and post-operative aneurysm rupture. Data were expressed as descriptive statistics only.\u0000\u0000\u0000RESULTS\u0000A total of four studies, including 163 patients with 173 intracranial aneurysms, were included. The most common aneurysm locations were the anterior cerebral artery (24.9% [43/173]), the middle cerebral artery (24.3% [42/173]), and the anterior communicating artery (23.1% [40/173]). Parent artery diameter ranged from 0.9 mm to 3.6 mm, and 29% were acutely or previously ruptured aneurysms. Overall, complete or near-complete occlusion was 72.1% on early-term follow-up. Mortality rate among the studies was 2.5%, with 3 instances adjudicated as neurologic deaths (1.8%). Major stroke was noted in 1.2% of cases, and branch occlusion or stent thrombus formation in 5.5%.\u0000\u0000\u0000CONCLUSION\u0000Our review suggests that SVB is a safe and effective treatment for intracranial aneurysms in small vessels. Further prospective and comparative studies with patient outcome data specific to aneurysm location are needed to confirm the safety and efficacy of SVB.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117117487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-04DOI: 10.1177/15910199221084398
T. White, K. Shah, P. Koul, T. Link, A. Dehdashti, J. Katz, A. Patsalides, H. Woo
INTRODUCTION Current methods for angioplasty and stenting of the intracranial vasculature for neurointervention are limited. The Wingspan Stent System is Food and Drug Administration (FDA) approved with human device exemption for a limited patient group and despite numerous prospective registries and trials demonstrating reasonable safety, still carries warnings from the FDA for its use. Given these limitations, we present the technical nuances and outcomes of the off-label use of the Resolute Onyx drug-eluting stent (DES) for neurointerventional purposes. METHODS Retrospective chart review of all patients undergoing a neurointerventional procedure with the Resolute Onyx DES was done from January 2017-2021. The Resolute Onyx is a coronary balloon-mounted drug-eluting (zotarolimus) single wire laser cut stent. Technical details and procedural outcomes were collected. RESULTS In total 40 patients had attempted placement of the Resolute Onyx DES with procedural success in 95% of patients. The most common vessel stented was the basilar artery, 30% (12/40). The most common indication was intracranial atherosclerotic disease in 62.5% (25/40) patients, followed by acute stroke in 17.5% (7/40) of patients. The technical and procedural outcomes were excellent with only one technical complication (2.5%). CONCLUSIONS This series describes the initial technical safety and utility of utilizing a new generation balloon-mounted drug-eluting stent for neurointerventional purposes. This stent offers the potential for improved navigability, delivery, and outcomes compared to current neurointerventional options and warrants further study.
{"title":"The resolute Onyx drug eluting stent for neurointervention: A technical series.","authors":"T. White, K. Shah, P. Koul, T. Link, A. Dehdashti, J. Katz, A. Patsalides, H. Woo","doi":"10.1177/15910199221084398","DOIUrl":"https://doi.org/10.1177/15910199221084398","url":null,"abstract":"INTRODUCTION\u0000Current methods for angioplasty and stenting of the intracranial vasculature for neurointervention are limited. The Wingspan Stent System is Food and Drug Administration (FDA) approved with human device exemption for a limited patient group and despite numerous prospective registries and trials demonstrating reasonable safety, still carries warnings from the FDA for its use. Given these limitations, we present the technical nuances and outcomes of the off-label use of the Resolute Onyx drug-eluting stent (DES) for neurointerventional purposes.\u0000\u0000\u0000METHODS\u0000Retrospective chart review of all patients undergoing a neurointerventional procedure with the Resolute Onyx DES was done from January 2017-2021. The Resolute Onyx is a coronary balloon-mounted drug-eluting (zotarolimus) single wire laser cut stent. Technical details and procedural outcomes were collected.\u0000\u0000\u0000RESULTS\u0000In total 40 patients had attempted placement of the Resolute Onyx DES with procedural success in 95% of patients. The most common vessel stented was the basilar artery, 30% (12/40). The most common indication was intracranial atherosclerotic disease in 62.5% (25/40) patients, followed by acute stroke in 17.5% (7/40) of patients. The technical and procedural outcomes were excellent with only one technical complication (2.5%).\u0000\u0000\u0000CONCLUSIONS\u0000This series describes the initial technical safety and utility of utilizing a new generation balloon-mounted drug-eluting stent for neurointerventional purposes. This stent offers the potential for improved navigability, delivery, and outcomes compared to current neurointerventional options and warrants further study.","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125353926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-31DOI: 10.1177/15910199221091647
P. Pagano, Pedro Calvão Pires, Laurentiu Paiusan, S. Soize, P. Manceau, L. Pierot
Wide neck intracranial aneurysms are often difficult to treat with coiling alone, and sophisticated techniques such as balloon-assisted coiling, stent-assisted coiling, flow-diversion, or intrasaccular flow-disruption are sometimes required.This technical note reports the endovascular treatment of a recurrent middle cerebral bifurcation aneurysm by remodeling technique followed by flow-diverter (Silk Vista Baby) deployment through a remodeling balloon (double lumen balloon Eclipse 2L).
宽颈颅内动脉瘤通常很难单独用栓塞治疗，有时需要复杂的技术，如球囊辅助栓塞、支架辅助栓塞、血流转移或囊内血流阻断。本技术报告采用血管内重建技术治疗复发性脑中分叉动脉瘤，随后通过重建球囊(双腔球囊Eclipse 2L)部署血流分流器(Silk Vista Baby)。
{"title":"Deployment of low-profile flow-diverter through a double lumen balloon catheter (remo-diversion technique) to treat recurrent middle cerebral artery bifurcation aneurysm: A technical note.","authors":"P. Pagano, Pedro Calvão Pires, Laurentiu Paiusan, S. Soize, P. Manceau, L. Pierot","doi":"10.1177/15910199221091647","DOIUrl":"https://doi.org/10.1177/15910199221091647","url":null,"abstract":"Wide neck intracranial aneurysms are often difficult to treat with coiling alone, and sophisticated techniques such as balloon-assisted coiling, stent-assisted coiling, flow-diversion, or intrasaccular flow-disruption are sometimes required.This technical note reports the endovascular treatment of a recurrent middle cerebral bifurcation aneurysm by remodeling technique followed by flow-diverter (Silk Vista Baby) deployment through a remodeling balloon (double lumen balloon Eclipse 2L).","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"309 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116117697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01DOI: 10.1177/1591019917727401
{"title":"WFITN Committees.","authors":"","doi":"10.1177/1591019917727401","DOIUrl":"https://doi.org/10.1177/1591019917727401","url":null,"abstract":"","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131973987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01DOI: 10.1177/1591019917727399
{"title":"Welcome Message from the President of WFITN 2017.","authors":"","doi":"10.1177/1591019917727399","DOIUrl":"https://doi.org/10.1177/1591019917727399","url":null,"abstract":"","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122139141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01DOI: 10.1177/1591019917727400
Miklos Marosfo, J. A. Santos
{"title":"WFITN 2017 Faculty List.","authors":"Miklos Marosfo, J. A. Santos","doi":"10.1177/1591019917727400","DOIUrl":"https://doi.org/10.1177/1591019917727400","url":null,"abstract":"","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123656605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-12-01DOI: 10.1177/15910199010070S131
{"title":"The Japanese society for intravascular neurosurgery. Regulations for the certification board of intravascular neurosurgery.","authors":"","doi":"10.1177/15910199010070S131","DOIUrl":"https://doi.org/10.1177/15910199010070S131","url":null,"abstract":"","PeriodicalId":126264,"journal":{"name":"Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2001-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132916820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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