Aneurysm stent

Lanzino, G., Kanaan, Y., Perrini, P., Dayoub, H. Fraser, K. (2005) Emerging concepts in the treatment of intracranial aneurysms stents, coated coils, and liquid embolic agents. Neurosurgery, 57, 449-459. 

Abdominal aortic aneurysms bifurcated supported stent graft (Excluder, Gore). 

I I Wolf YG, Arko FR, Hill BB, et al. Gender differences in endovascular abdominal aortic aneurysm repair with the AneuRx stent graft. J Vase Surg 2002 35(5) 882-886. 

Zarins CK, Bloch DA, Crabtree T, et al. Stent graft migration after endovascular aneurysm repair importance of proximal fixation. J Vase Surg 2003 38(6) 1264-1272 discussion 72. 

Berg R Kaufmann D, van Marrewijk CJ, et al. Spinal cord ischaemia after stent-graft treatment for infra-renal abdominal aortic aneurysms, Analysis of the Eurostar database, Eur J Vase Endovasc Surg 2001 22(4) 342-347. 

Verhoeven EL, PrinsTR, Tielliu IFRetal. Xreatment of short-necked infrarenal aortic aneurysms with fenestrated stent-grafts shortterm results. Eur J Vase Endovasc Surg 2004 27(5) 477-483. 

A 31-year-old woman suddenly developed central chest pain, with a normal electrocardiogram. Changes in troponin and creatine kinase MB were consistent with acute myocardial infarction. Drug screening was positive for amphetamines and barbiturates. Coronary angiography showed an aneurysm with 99% occlusion of the proximal left circumflex coronary artery and extravasation of contrast material. A stent was inserted percutaneously and antegrade flow was achieved without residual stenosis. 

A 64-year-old obese man with a history of radiocontrast-induced nephropathy had an MRI scan, which confirmed the presence of an aortic aneurysm from just below the renal arteries to the aortic bifurcation (31). Percutaneous stenting of the aortic aneurysm... 

In contrast to angiography, IVUS provides quantitative information from within the vessel on diameter, circumference, luminal diameter, plaque volume, and percent stenosis. Qualitative information regarding the amount of plaque elevation, plaque composition (e.g., calcific, fibrous, or fatty plaque), and the presence of plaque versus thrombus, thrombus versus tumor, and aneurysm and hematoma can be provided with IVUS. IVUS is also used as a therapeutic adjunct with PTCA, atherectomy, stent or graft placement, and fibrinolysis, although routine use may not be justified. These combination procedures may be monitored in real time as the procedure (e.g., atherectomy) is being performed. 

Peluso JP, van Rooij WJ, Sluzewski M, Beute GN. A new self-expandable nitinol stent for the treatment of wide-neck aneurysms initial clinical experience. AJNR Am J Neuroradiol. 2008 29 1405-1408... 

Lubicz B, Leclerc X, Levivier M et al. Retractable self-expandable stent for endovascular treatment of widenecked intracranial aneurysms prehminary experience. Neurosurgery. 2006 58 451-457 discussion 451-457... 

Yavuz K, Geyik S, Pamuk AG et al. Immediate and midterm follow-up results of using an electrodetachable, fuUy retrievable SOLO stent system in the endovascular coU occlusion of widenecked cerebral aneurysms. J Neurosutg. 2(X)7 107 49-55... 

Dake M.D., Miller D.C., Semba C.P. et al. 1994. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N. Engl. J. Med. 331 1729-34. 

Figure 7.3 is a schematic showing how stent-assisted embolization can be performed during aneurysm embolization (Lanzino et al, 2005). 

Embolic materials for both intracranial AVMs and aneurysms have come a long way since the first endovascular embolization procedure was carried out. Much advancement to this branch of neurosurgery came about because of an emphasis on development of equipment that was better suited to endovascular techniques. Some of these inventions include flow-directed microcatheters, endovascular balloons, and re-designed stents. Owing to a greater capacity to perform endovascular techniques with suitable equipment, the development of better embolic materials has followed. Now, there are a variety of techniques and materials that endovascular neurosurgeons have at their disposal, all of which provide a variety of benefits, yet have considerable drawbacks. Efforts are always being made to improve current materials and techniques, as well as to... 

Small, W., Buckley, P. R., Wilson, T., Benett, W. J., Hartman, J., Saloner, D. Maitland, D. (2007) Shape memory polymer stent with expandable foam a new concept for endovascular embolization of fusiform aneurysms. IEEE Transactions on Biomedical Engineering, 54, 1157—1160. 

Internal Iliac Artery Embolization in the Stent-Graft Treatment of Aortoiliac Aneurysms... 

Stent-assisted and balloon-assisted coil remodeling technique (in wide neck aneurysms) [126-129]... 

Phatouros CC, Sasaki TY, Higashida RT,et al. (2000) Stent-supported coil embolization the treatment of fusiform and wide-neck aneurysms and pseudoaneurysms. Neurosurgery 47 107-113... 

Type I endoleak is caused by failure to achieve a circumferential seal at either the proximal (type lA) or distal end (type IB) of the stentgraft. Type IC endoleak is due to non-occluded iliac artery in patients with aorto-mono-iliac stent and femoral-femoral bypass. With type I endoleak, the aneurysm is perfused directly from the aorta or the iliac arteries (inflows). The leak usually communicates through a channel (sometimes multiple channels) with the aneurysmal sac. There are several outflow vessels, mainly lumbar arteries and inferior mesenteric artery (IMA) that communicate with the channel and or the sac (Figs. 14.1,14.2). The pressure within a type I leak is systemic. The tension on the aortic wall remains high. 

Cuypers P, Buth J, Harris PL,et al (1999) Realistic expectations for patients with stent-graft treatment of abdominal aortic aneurysms. Results of a European multicentre registry. Eur J Vase Endovasc Surg 17 507-516... 

Fan CM, Rafferty EA, Geller EC et al (2001) Endovascular stent-graft in abdominal aortic aneurysms The relationship between patent vessels that arise from the aneurysmal sac and early endoleak. Radiology 218 176-182... 

Cejna M, Loewe C, Schoder M, et al (2002) MR angiography vs CT angiography in the follow-up of Nitinol stent grafts in the endoluminally treated aortic aneurysms. Eur Radiology 12 2443-2450... 

As mentioned above, status of the internal iliac arteries is an important anatomic consideration in the treatment of aortoiliac aneurysms. Indications for embolization of IIA in association with EVAR include aneurysm of the IIA or ectatic or aneurysmal common iliac artery (CIA) involving the origin of IIA. Additionally, extension of stent-graft into the external iliac artery (El A) may become necessary if the CIA is judged to be too short for adequate or safe anchoring of the device or if there is a distal type-I endoleak. This will lead to loss of antegrade flow in the IIA. 

Fig. 15.2a-c. Embolization of IIA before aortic stent graft implantation (courtesy of Dr Luc Stockx). a Right common iliac angiogram demonstrating the internal and external iliac arteries. b,c Coil embolization of the proximal llA. Note the extension of the aneurysm to the level of iliac bifurcation... 

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