Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

A Novel Flow Diverter (Tubridge) for the Treatment of Recurrent Aneurysms: A Single-Center Experience

  • Zhang, Yongxin (Department of Neurosurgery, Changhai Hospital, Second Military Medical University) ;
  • Huang, Qing-Hai (Department of Neurosurgery, Changhai Hospital, Second Military Medical University) ;
  • Fang, Yibin (Department of Neurosurgery, Changhai Hospital, Second Military Medical University) ;
  • Yang, Pengfei (Department of Neurosurgery, Changhai Hospital, Second Military Medical University) ;
  • Xu, Yi (Department of Neurosurgery, Changhai Hospital, Second Military Medical University) ;
  • Hong, Bo (Department of Neurosurgery, Changhai Hospital, Second Military Medical University) ;
  • Liu, Jianmin (Department of Neurosurgery, Changhai Hospital, Second Military Medical University)
  • Received : 2016.07.08
  • Accepted : 2016.10.20
  • Published : 2017.10.01
⟨ Previous Next ⟩

Abstract

Objective: The Tubridge flow diverter (FD) is a novel device aimed at reconstructing the parent artery and occluding complex aneurysms. Retreatment of recurrent aneurysms using the FD is challenging. We report our initial experience in the repair of aneurysm recurrence with the FD. Materials and Methods: A database was reviewed prospectively, and 8 patients with 8 recurrent aneurysms (mean size, 16.7 mm) were identified. Four aneurysms had previously ruptured. The previous aneurysm treatment consisted of coiling in 1 aneurysm and single-stent-assisted coiling in 7 aneurysms. The procedural complications and clinical and angiographic outcomes were analyzed. Results: Six aneurysms were treated by using a single Tubridge FD alone, while the remaining 2 were treated with FD + coiling. The immediate results of the 8 aneurysms were that they all showed incomplete occlusion. Neither major ischemic nor hemorrhagic complications occurred; however, 1 patient experienced a vasospasm. Follow-up angiographies were available for 7 aneurysms; the mean follow-up was 16.9 months (7-36 months). Five aneurysms were completely occluded, whereas 2 had a residual neck. Severe asymptomatic stenosis of 1 parent artery of a vertebral artery dissecting aneurysm was found. All visible branches covered by the FD were patent. All patients were clinically assessed as having attained a favorable outcome (modified Rankin Scale score ${\leq}2$) at discharge and follow-up. Conclusion: In selected patients, the Tubridge FD can provide a safe and efficient option for the retreatment of recurrent aneurysms. Nevertheless, attention should be paid to several technical points.

Keywords

Acknowledgement

Supported by : Natural Science Foundation of China

References

  1. McDonald JS, McDonald RJ, Fan J, Kallmes DF, Lanzino G, Cloft HJ. Comparative effectiveness of unruptured cerebral aneurysm therapies: propensity score analysis of clipping versus coiling. Stroke 2013;44:988-994 https://doi.org/10.1161/STROKEAHA.111.000196
  2. Lin N, Cahill KS, Frerichs KU, Friedlander RM, Claus EB. Treatment of ruptured and unruptured cerebral aneurysms in the USA: a paradigm shift. J Neurointerv Surg 2012;4:182-189 https://doi.org/10.1136/jnis.2011.004978
  3. Campi A, Ramzi N, Molyneux AJ, Summers PE, Kerr RS, Sneade M, et al. Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke 2007;38:1538-1544 https://doi.org/10.1161/STROKEAHA.106.466987
  4. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002;360:1267-1274 https://doi.org/10.1016/S0140-6736(02)11314-6
  5. Ferns SP, Sprengers ME, van Rooij WJ, Rinkel GJ, van Rijn JC, Bipat S, et al. Coiling of intracranial aneurysms: a systematic review on initial occlusion and reopening and retreatment rates. Stroke 2009;40:e523-e529 https://doi.org/10.1161/STROKEAHA.108.527705
  6. Dorfer C, Gruber A, Standhardt H, Bavinzski G, Knosp E. Management of residual and recurrent aneurysms after initial endovascular treatment. Neurosurgery 2012;70:537-553; discussion 553-554 https://doi.org/10.1227/NEU.0b013e3182350da5
  7. Kim BM, Kim DJ, Kim DI. A new flow-diverter (the FloWise): in-vivo evaluation in an elastase-induced rabbit aneurysm model. Korean J Radiol 2016;17:151-158 https://doi.org/10.3348/kjr.2016.17.1.151
  8. Huang QH, Yang PF, Zhang X, Shi Y, Shao XM, Liu JM. [Effects of flow diverter with low porosity on cerebral aneurysms: a numerical stimulative study]. Zhonghua Yi Xue Za Zhi 2010;90:1024-1027
  9. Simgen A, Ley D, Roth C, Yilmaz U, Korner H, Muhl-Benninghaus R, et al. Evaluation of a newly designed flow diverter for the treatment of intracranial aneurysms in an elastase-induced aneurysm model, in New Zealand white rabbits. Neuroradiology 2014;56:129-137 https://doi.org/10.1007/s00234-013-1296-9
  10. Zhou Y, Yang PF, Fang YB, Xu Y, Hong B, Zhao WY, et al. A novel flow-diverting device (Tubridge) for the treatment of 28 large or giant intracranial aneurysms: a single-center experience. AJNR Am J Neuroradiol 2014;35:2326-2333 https://doi.org/10.3174/ajnr.A3925
  11. Hong B, Wang K, Huang Q, Xu Y, Fang X, Li Z, et al. Effects of metal coverage rate of flow diversion device on neointimal growth at side branch ostium and stented artery: an animal experiment in rabbit abdominal aorta. Neuroradiology 2012;54:849-855 https://doi.org/10.1007/s00234-011-0984-6
  12. Suh SH, Cloft HJ, Lanzino G, Woodward K, Kallmes DF. Interobserver agreement after pipeline embolization device implantation. AJNR Am J Neuroradiol 2013;34:1215-1218 https://doi.org/10.3174/ajnr.A3371
  13. Roy D, Milot G, Raymond J. Endovascular treatment of unruptured aneurysms. Stroke 2001;32:1998-2004 https://doi.org/10.1161/hs0901.095600
  14. Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005;366:809-817 https://doi.org/10.1016/S0140-6736(05)67214-5
  15. Darsaut TE, Raymond J. Barrow Ruptured Aneurysm Trial: 3-year results. J Neurosurg 2013;119:1642-1644 https://doi.org/10.3171/2013.5.JNS13917
  16. Taki W, Sakai N, Suzuki H; Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) group. Importance of independent evaluation of initial anatomic results after endovascular coiling for ruptured cerebral aneurysms. J Clin Neurosci 2013;20:527-531 https://doi.org/10.1016/j.jocn.2012.01.058
  17. Taki W; PRESAT group, Sakai N, Suzuki H. Factors predicting retreatment and residual aneurysms at 1 year after endovascular coiling for ruptured cerebral aneurysms: Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) in Japan. Neuroradiology 2012;54:597-606 https://doi.org/10.1007/s00234-011-0945-0
  18. Nguyen TN, Hoh BL, Amin-Hanjani S, Pryor JC, Ogilvy CS. Comparison of ruptured vs unruptured aneurysms in recanalization after coil embolization. Surg Neurol 2007;68:19-23 https://doi.org/10.1016/j.surneu.2006.10.021
  19. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003;34:1398-1403 https://doi.org/10.1161/01.STR.0000073841.88563.E9
  20. Chalouhi N, Tjoumakaris S, Gonzalez LF, Dumont AS, Starke RM, Hasan D, et al. Coiling of large and giant aneurysms: complications and long-term results of 334 cases. AJNR Am J Neuroradiol 2014;35:546-552 https://doi.org/10.3174/ajnr.A3696
  21. Johnston SC, Dowd CF, Higashida RT, Lawton MT, Duckwiler GR, Gress DR; CARAT Investigators. Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the Cerebral Aneurysm Rerupture After Treatment (CARAT) study. Stroke 2008;39:120-125 https://doi.org/10.1161/STROKEAHA.107.495747
  22. Ringer AJ, Rodriguez-Mercado R, Veznedaroglu E, Levy EI, Hanel RA, Mericle RA, et al. Defining the risk of retreatment for aneurysm recurrence or residual after initial treatment by endovascular coiling: a multicenter study. Neurosurgery 2009;65:311-315; discussion 315 https://doi.org/10.1227/01.NEU.0000349922.05350.96
  23. Renowden SA, Koumellis P, Benes V, Mukonoweshuro W, Molyneux AJ, McConachie NS. Retreatment of previously embolized cerebral aneurysms: the risk of further coil embolization does not negate the advantage of the initial embolization. AJNR Am J Neuroradiol 2008;29:1401-1404 https://doi.org/10.3174/ajnr.A1098
  24. Henkes H, Fischer S, Liebig T, Weber W, Reinartz J, Miloslavski E, et al. Repeated endovascular coil occlusion in 350 of 2759 intracranial aneurysms: safety and effectiveness aspects. Neurosurgery 2008;62(6 Suppl 3):1532-1537 https://doi.org/10.1227/01.neu.0000333815.79777.3b
  25. Tahtinen OI, Manninen HI, Vanninen RL, Rautio R, Haapanen A, Seppanen J, et al. Stent-assisted embolization of recurrent or residual intracranial aneurysms. Neuroradiology 2013;55:1221-1231. https://doi.org/10.1007/s00234-013-1234-x
  26. Zhang X, Lv N, Wang C, Cao W, Liu J, Huang Q. Late recurrence of a completely occluded large intracranial aneurysm treated with a Tubridge flow diverter. J Neurointerv Surg 2017;9:e6 https://doi.org/10.1136/neurintsurg-2016-012268.rep
  27. Fischer S, Vajda Z, Aguilar Perez M, Schmid E, Hopf N, Bazner H, et al. Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections. Neuroradiology 2012;54:369-382 https://doi.org/10.1007/s00234-011-0948-x
  28. Chalouhi N, Chitale R, Starke RM, Jabbour P, Tjoumakaris S, Dumont AS, et al. Treatment of recurrent intracranial aneurysms with the pipeline embolization device. J Neurointerv Surg 2014;6:19-23 https://doi.org/10.1136/neurintsurg-2012-010612
  29. Heiferman DM, Billingsley JT, Kasliwal MK, Johnson AK, Keigher KM, Frudit ME, et al. Use of flow-diverting stents as salvage treatment following failed stent-assisted embolization of intracranial aneurysms. J Neurointerv Surg 2016;8:692-695 https://doi.org/10.1136/neurintsurg-2015-011672
  30. Daou B, Starke RM, Chalouhi N, Tjoumakaris S, Hasan D, Khoury J, et al. Pipeline embolization device in the treatment of recurrent previously stented ccerebral aneurysms. AJNR Am J Neuroradiol 2016;37:849-855 https://doi.org/10.3174/ajnr.A4613
  31. Sedat J, Chau Y, Moubarak K, Vargas J, Lonjon M. Endovascular treatment of recurrent coiled aneurysms: assessment of complications and rebleeding during a decade in a single center. Interv Neuroradiol 2012;18:14-19
  32. Wagner A, Cortsen M, Hauerberg J, Romner B, Wagner MP. Treatment of intracranial aneurysms. Reconstruction of the parent artery with flow-diverting (Silk) stent. Neuroradiology 2012;54:709-718 https://doi.org/10.1007/s00234-011-0949-9
  33. Velioglu M, Kizilkilic O, Selcuk H, Kocak B, Tureci E, Islak C, et al. Early and midterm results of complex cerebral aneurysms treated with silk stent. Neuroradiology 2012;54:1355-1365 https://doi.org/10.1007/s00234-012-1051-7
  34. Yu SC, Kwok CK, Cheng PW, Chan KY, Lau SS, Lui WM, et al. Intracranial aneurysms: midterm outcome of pipeline embolization device--a prospective study in 143 patients with 178 aneurysms. Radiology 2012;265:893-901 https://doi.org/10.1148/radiol.12120422

Cited by

  1. Age of Data in Contemporary Research Articles Published in Representative General Radiology Journals vol.19, pp.6, 2018, https://doi.org/10.3348/kjr.2018.19.6.1172
  2. A Newly-Developed Flow Diverter (FloWise) for Internal Carotid Artery Aneurysm: Results of a Pilot Clinical Study vol.20, pp.3, 2019, https://doi.org/10.3348/kjr.2018.0421
  3. Endovascular treatment of traumatic carotid pseudoaneurysm with Tubridge flow diverter: A case report vol.25, pp.6, 2019, https://doi.org/10.1177/1591019919855862
  4. Flow diverter stents in the treatment of recanalized intracranial aneurysms vol.27, pp.4, 2017, https://doi.org/10.1177/1591019921990507