A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease☆

Introduction
The purpose of this study was to evaluate the safety and efficacy of the recently available flow diverter “pipeline embolization device” (PED) for the treatment of intracranial aneurysms and dissections.

/pdf/pipeline-embolization-device-ped-for-neurovascular-1p253f8r0y.pdf

Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections

OBJECTIVE The objective of this study was to review the literature on the use of flow-diverting devices (FDDs) to treat intracranial aneurysms (IAs) and to investigate the safety and complications related to FDD treatment for IAs by performing a meta-analysis of published studies METHODS A systematic electronic database search was conducted using the Springer, EBSCO, PubMed, Medline, and Cochrane databases on all accessible articles published up to January 2016, with no restriction on the publication year Abstracts, full-text manuscripts, and the reference lists of retrieved articles were analyzed Random-effects meta-analysis was used to pool the complication rates across studies RESULTS Sixty studies were included, which involved retrospectively collected data on 3125 patients The use of FDDs was associated with an overall complication rate of 170% (95% confidence interval [CI] 136%-205%) and a low mortality rate of 28% (95% CI 12%-44%) The neurological morbidity rate was 45% (95% CI 32%-58%) No significant difference in the complication or mortality rate was observed between 2 commonly used devices (the Pipeline embolization device and the Silk flow-diverter device) A significantly higher overall complication rate was found in the case of ruptured IAs than in unruptured IA (odds ratio 23, 95% CI 12-43) CONCLUSIONS The use of FDDs in the treatment of IAs yielded satisfactory results with regard to complications and the mortality rate The risk of complications should be considered when deciding on treatment with FDDs Further studies on the mechanism underlying the occurrence of adverse events are required

/pdf/complications-associated-with-the-use-of-flow-diverting-4ur9n65ckp.pdf

Complications associated with the use of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis.

The Pipeline embolization device (PED) is the most widely used flow diverter in endovascular neurosurgery In 2011, the device received FDA approval for the treatment of large and giant aneurysms in the internal carotid artery extending from the petrous to the superior hypophyseal segments However, as popularity of the device grew and neurosurgeons gained more experience, its use has extended to several other indications Some of these off-label uses include previously treated aneurysms, acutely ruptured aneurysms, small aneurysms, distal circulation aneurysms, posterior circulation aneurysms, fusiform aneurysms, dissecting aneurysms, pseudoaneurysms, and even carotid-cavernous fistulas The authors present a literature review of the safety and efficacy of the PED in these off-label uses

/pdf/off-label-uses-of-the-pipeline-embolization-device-a-review-280dhwra2j.pdf

Off-label uses of the Pipeline embolization device: a review of the literature

OBJECTIVE. Spinal leakage of CSF causes almost all cases of spontaneous intracranial hypotension. Leak detection and localization are important for both diagnosis and treatment. The myelographic appearance of the leaks may vary, however, depending on the cause of the leak, rate of leakage, and imaging modality used. CONCLUSION. The purpose of this article is to review the imaging of spinal CSF leaks and to assist in the selection of appropriate imaging modalities in this condition.

https://www.ajronline.org/doi/pdf/10.2214/AJR.15.14884

Myelographic Techniques for the Detection of Spinal CSF Leaks in Spontaneous Intracranial Hypotension

BACKGROUND AND PURPOSE: Recent studies on stent placement of significant stenoses at the origin of the vertebral artery reported excellent immediate results. Long-term outcomes, however, were disappointing due to high restenosis rates and stent breakage. In the present study, we evaluated the application of a short drug-eluting balloon-expandable coronary stent for the endovascular treatment of these frequent lesions. MATERIALS AND METHODS: In a period of 23 months, 48 patients (12 women, 36 men) with a mean age of 68 years (range, 46–82 years) harboring 52 significant ostial vertebral artery stenoses underwent treatment with short (8 mm) balloon-expandable paclitaxel-eluting coronary stents. Stents were deployed as closely as possible so that the proximal end was just at the origin of the vertebral artery, with high inflation pressure applied. Patients were under continuous medication with acetylsalicylic acid and clopidogrel before and after the treatment. Follow-up clinical assessment and angiography were performed in all patients. RESULTS: Periprocedural complications were not encountered. Stenosis severity was reduced from 62 ± 2% (mean ± standard error of the mean) preprocedurally to 15 ± 2% postprocedurally. Follow-up angiography at 7.7 ± 0.6 months revealed a mean stenosis degree of 24 ± 3%. None of the patients developed posterior circulation symptoms related to the treated segment during the follow-up period. Recurrent stenosis (>50%) at follow-up was found in 6 (12%) lesions. CONCLUSIONS: Stent placement of significant ostial vertebral artery stenosis by using short drug-eluting stents is safe and yields good midterm patency rates and excellent protection from posterior circulation ischemia.

http://www.ajnr.org/content/ajnr/30/9/1653.full.pdf

Treatment of Stenoses of Vertebral Artery Origin Using Short Drug-Eluting Coronary Stents: Improved Follow-Up Results

Introduction
This study aimed to evaluate the diagnostic imaging findings and treatment results of patients with idiopathic intracranial hypotension (IIH) due to cerebrospinal fluid (CSF) leaks.

Detection and treatment of spinal CSF leaks in idiopathic intracranial hypotension

We evaluated the coronary balloon-expandable cobalt chromium stent Coroflex Blue for the treatment of intracranial atherosclerotic arterial stenoses (IAAS). Between March 2007 and October 2007, a total of 25 patients (20 male, age median 67 years) with 30 IAAS underwent endovascular treatment using Coroflex Blue stents (B. Braun, Germany). Location and degree of target stenoses before and after treatment and at follow-up and adverse clinical sequelae of treatment were registered. Angiographic follow-up was scheduled for 6, 12, 26, and 52 weeks after the treatment. The 30 treated lesions were located as follows: nine in intracranial–extradural internal carotid artery (ICA), three in intradural ICA, five in middle cerebral artery, eight in intradural vertebral artery, and five in basilar artery. The technical success rate was 100%. The degree of stenoses prior to and after treatment was 61 ± 2% and 26 ± 3% (mean ± SE), respectively. A residual stenosis of <50% was achieved in 29 (97%) procedures. Treatment was uneventful in 28 out of 30 procedures (93%); one patient suffered a transient and one patient a permanent neurological deficit. Angiographic follow-up was available in all of the patients (100%) after 15.2 months (median) and showed significant (i.e., more than 50%) degree of recurrent stenosis in 11 (37%) of the lesions. Retreatment was performed in 11 (37%) lesions. The Coroflex Blue stent is easily inserted and safely deployed into intracranial arteries. The incidence of recurrent stenoses remains a concern. Stringent angiographic and clinical follow-up and retreatment are therefore mandatory.

Treatment of intracranial atherosclerotic arterial stenoses with a balloon-expandable cobalt chromium stent (Coroflex Blue): procedural safety, efficacy, and midterm patency.

ORIGINAL RESEARCH Treatment of Stenoses of Vertebral Artery Origin Using Short Drug-Eluting Coronary Stents: Improved Follow-Up Results

Zusammenfassung Die spontane intrakranielle Hypotension ist Folge eines spinalen Liquorverlustes und geht meist mit einem orthostatischen Kopfschmerz einher. Für die Diagnostik gibt es keine einheitlichen Parameter, anhand bildmorphologischer Zeichen kann die SIH in der kranialen MRT vermutet werden und ist dann mittels einer Bildgebung der Wirbelsäule direkt nachzuweisen.

Spontane intrakranielle Hypotension

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