Use of self-expanding stents for better intracranial flow diverter wall apposition
AuthorsKuhn, Anna L.
Wakhloo, Ajay K.
Gounis, Matthew J.
de Macedo Rodrigues, Katyucia
Lozano, Juan Diego
Marosfoi, Miklos G.
Rex, David E.
Puri, Ajit S.
UMass Chan AffiliationsNew England Center for Stroke Research
Division of Neuroimaging and Intervention, Department of Radiology
Document TypeJournal Article
MetadataShow full item record
AbstractBackground Flow diverter (FD) malapposition is associated with stroke-related complications. We document the use of self-expanding nitinol stents to remove/reduce the ledge of a FD deployed for aneurysm treatment. Methods We identified five patients who were treated with the Pipeline embolization device (PED) in conjunction with a Neuroform EZ stent for inadequate wall apposition of the ends of the FD at our institution between May 2014 and July 2015. Among other parameters, angiographic results, cone-beam computed tomography assessment of wall apposition and patient clinical outcome were evaluated. Results Incomplete device end apposition was seen in three cases, and precarious positioning of the distal end of the PED over the aneurysm neck was seen in two cases. In all five cases, successful treatment with good wall apposition and proper pinning of the PED distal edge was achieved using an additional Neuroform EZ stent. Appropriate aneurysm neck coverage and flow stagnation was seen in all cases. The combination of high radial outward force and open-cell design permits the Neuroform EZ stent to jail the malappositioned edges of the FD while maintaining good vessel-wall apposition itself and prevent migration of the PED. Short-term follow-up angiography showed device patency and complete aneurysm obliteration in all cases. Conclusions Preliminary results of this small case series suggest that the Neuroform EZ stent allows for effective treatment of FD malapposition in selected patients amenable for this endovascular approach. Long-term and larger cohort studies are needed to validate these results.
SourceInterv Neuroradiol. 2017 Apr;23(2):129-136. doi: 10.1177/1591019916681981. Epub 2016 Dec 12. Link to article on publisher's site
Permanent Link to this Itemhttp://hdl.handle.net/20.500.14038/48220
Related ResourcesLink to Article in PubMed