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Temporary surgical clipping of flow-diverted arteries in an experimental aneurysm model

Tim E. Darsaut, Igor Salazkin, Jean-Christophe Gentric, Elsa Magro, Guylaine Gevry, Michel W. Bojanowski, and Jean Raymond

A s flow diversion increases in popularity, neurosurgeons may be faced with persistent or recurring aneurysms following endovascular treatment. 1 , 5 , 8 In narrow surgical corridors, or when the flow diverter spans a long arterial segment, it may be difficult to gain access to a normal artery proximal or distal to the device to place an aneurysm clip, and temporarily clipping the segment of artery containing the flow diverter may become necessary. 4 , 9 Clipping of a flow-diverted arterial segment, to our knowledge, has not been reported in the

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Benchtop proof of concept and comparison of iron- and magnesium-based bioresorbable flow diverters

Alexander A. Oliver, Cem Bilgin, Andrew J. Vercnocke, Kent D. Carlson, Ramanathan Kadirvel, Roger J. Guillory II, Adam J. Griebel, Jeremy E. Schaffer, Dan Dragomir-Daescu, and David F. Kallmes

. References 1 Brinjikji W , Murad MH , Lanzino G , Cloft HJ , Kallmes DF . Endovascular treatment of intracranial aneurysms with flow diverters: a meta-analysis . Stroke . 2013 ; 44 ( 2 ): 442 – 447 . 23321438 2 Dandapat S , Mendez-Ruiz A , Martínez-Galdámez M , Review of current intracranial aneurysm flow diversion technology and clinical use . J Neurointerv Surg . 2021 ; 13 ( 1 ): 54 – 62 . 32978269 3 Kallmes DF , Hanel R , Lopes D , International retrospective study of the Pipeline Embolization Device: a multicenter aneurysm

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Bilateral blindness following flow diverter placement in a giant thrombosed cavernous carotid aneurysm: illustrative case

Basant K. Misra, Alay V. Khandhar, and Reema Pradhan

their common manifestations, causing cranial nerve deficits. 3 Endovascular therapy (EVT) with a flow diverter (FD) is currently considered the preferred mode of treatment for symptomatic CCA aneurysm. The presented case demonstrates an example of GIA of the CCA that was treated with FDs, resulting in a yet unreported and unintended result. Illustrative Case A 66-year-old man presented to an outside facility with a history of retro-orbital pain; rapid deterioration of vision in the right eye; and associated severe headache, vomiting, and diminished sensations

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Does the clopidogrel CYP2C19 genotype assay predict postprocedure stenosis in cerebral aneurysms treated with a flow diverter?

Austin J. Allen, Aaron Gelinne, Nathan S. Quig, Samuel Reed, Darshan Shastri, James P. Ho, and Edward Yap

chronic stent thrombosis (stenosis) in patients undergoing flow diversion treatment of cerebral aneurysms. Methods Subject Identification This was a retrospective study of a consecutive series of patients who received a flow diverter for treatment of cerebral aneurysms at a single academic medical center between January 1, 2012, and May 31, 2020. Patients were identified based on a query of our institution’s electronic medical record system. Keywords used to identify patients were "pipeline" and "PED." These keywords were chosen to identify patients treated

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Compressive optic neuropathy caused by a flow-diverter-occluded-but-still-growing supraclinoid internal carotid aneurysm: illustrative case

Yuang-Seng Tsuei, Yun-Yen Fu, Wen-Hsien Chen, Wen-Yu Cheng, Chih-Hsiang Liao, and Chiung-Chyi Shen

optic neuropathy. 3 , 4 In the literature, however, little is mentioned about a flow-diverter-occluded large ICA aneurysm still being able to grow and cause compressive optic neuropathy. Here, we present a rare case and discuss treatment concerns. Illustrative Case A 57-year-old woman with a medical history of hypertension and uterine cancer status after total abdominal hysterectomy was found to have a right ICA aneurysm (approximately 17 mm) on magnetic resonance angiography (MRA) of the brain in a health checkup ( Fig. 1 ). She was referred to our

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Flow diverters versus stent-assisted coiling in unruptured intracranial vertebral artery dissecting aneurysms

Jiangli Han, Xin Tong, Mingyang Han, Fei Peng, Hao Niu, Fei Liu, and Aihua Liu

-assisted coiling (SAC) or flow diverters (FDs) is often selected for unruptured IVADAs, as well as for ruptured IVADAs located at the dominant VA and involving the posterior inferior cerebellar artery (PICA) or with a positive result on balloon occlusion testing performed to weigh vessel sacrifice. 7 , 15 , 16 In the last two decades, SAC has been established as an effective and safe approach for IVADAs. 5 , 7 , 17 More recently, use of FDs has been extended to unruptured IVADAs, with seemingly favorable outcomes demonstrated in some studies with small sample sizes. 6 , 8

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High-fidelity virtual stenting: modeling of flow diverter deployment for hemodynamic characterization of complex intracranial aneurysms

Jianping Xiang, Robert J. Damiano, Ning Lin, Kenneth V. Snyder, Adnan H. Siddiqui, Elad I. Levy, and Hui Meng

T he prevalence of intracranial aneurysms is estimated to be 1%–5% in the general population. 19 , 20 Aneurysm rupture leads to subarachnoid hemorrhage, and can result in devastating morbidity and mortality as well as high health care costs. 20 Flow diversion via flow diverters (FDs) such as the Pipeline Embolization Device (PED, Covidien) is a novel therapeutic method for the treatment of complex intracranial aneurysms, which can be challenging for both conventional microsurgical and endovascular techniques. The PED is a self-expandable, braided, mesh

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Midterm and long-term follow-up of cerebral aneurysms treated with flow diverter devices: a single-center experience

Special topic

Mariangela Piano, Luca Valvassori, Luca Quilici, Guglielmo Pero, and Edoardo Boccardi

, 18 , 24 Flow diversion is a new concept for the endovascular treatment of challenging intracranial aneurysms. With the use of a flow diverter device, one can exclude the sac from circulation, without catheterizing it, reducing the risk of aneurysm rupture, lowering the recanalization rate, and avoiding the mass effect associated with coiling. 1 The aim of this work is to report our single-center experience with the 2 neurovascular flow diverter stents approved for clinical use: the Pipeline embolization device (Covidien, CE marked and FDA approved) and the Silk

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Flow diverter therapy for immunosuppressant-resistant vertebral artery fusiform aneurysm due to eosinophilic granulomatosis with polyangiitis: illustrative case

Tetsuya Hayashi, Hiroyuki Sakata, Masayuki Ezura, Atsushi Saito, Yoshinari Osada, and Teiji Tominaga

EGPA is unusual, the treatment strategy for this rare condition has not been established. Herein, we report a case of EGPA-related cerebral aneurysm treated successfully with flow diverter therapy, and present some of the characteristics and treatment of EGPA-related cerebral aneurysms with a literature review. Illustrative Case A 67-year-old female who had undergone radiographic follow-up of a small left convexity meningioma for 3 years complained of a gradual increase in eosinophil count. She was clinically diagnosed with idiopathic eosinophilia at the

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Flow diverters failing to occlude experimental bifurcation or curved sidewall aneurysms: an in vivo study in canines

Laboratory investigation

Tim E. Darsaut, Fabrice Bing, Igor Salazkin, Guylaine Gevry, and Jean Raymond

the animals on an 81-mg daily course of ASA, a 150-mg loading dose of clopidogrel, and a daily 37.5-mg dose of clopidogrel thereafter. Endovascular treatment was performed 4–6 weeks after surgical aneurysm construction, through a coaxial microcatheter system introduced via a percutaneous transfemoral approach. Aneurysms were treated with 36- and 48-wire prototype FDs. Flow diverters are manufactured with a stent-in-stent construction, in which an inner flow-diverting stent mesh is coupled to an outer conventional higher-porosity stent. The nominal lengths of all