title: Flow diversion of bifurcation aneurysms is more effective when the jailed branch is occluded: an experimental study in a novel canine model.
abstract: BACKGROUND
  Flow diverters (FDs) are increasingly used for bifurcation aneurysms. Failure of aneurysm occlusion may be caused by residual flow maintaining patency of the jailed branch along with the aneurysm. Our aim was to test whether endovascular occlusion of the jailed branch could improve efficacy of flow diversion of bifurcation aneurysms.
  
  
  METHODS
  Sixteen wide-necked lingual-carotid artery bifurcation aneurysms were created in eight canines. Patent aneurysms were randomly allocated 4 weeks later to flow diversion combined with jailed branch occlusion using coils and/or Onyx (n=6) or flow diversion alone (n=8). Angiographic results of aneurysm occlusion at 3 months were scored using an ordinal scale. Pathology specimens were photographed and neointimal coverage estimated using a semiquantitative scoring system.
  
  
  RESULTS
  Fourteen aneurysms were patent at 1 month. FD deployment was successful in all cases but, at 3-month follow-up, three devices had prolapsed into the aneurysm. None of the bifurcation aneurysms treated with FD alone were occluded at 3 months. Endovascular branch occlusion combined with flow diversion significantly improved aneurysm occlusion rates compared with flow diversion alone (median angiographic scores 2 vs 0: p=0.0137). Flow-limiting parent vessel stenosis was not observed in any arteries. Devices were covered with thick neointima in most cases, but patent aneurysms were associated with leaks or holes in the neointima covering the aneurysm neck.
  
  
  CONCLUSIONS
  Treatment failures following flow diversion of bifurcation aneurysms can be caused by persistent flow to the jailed branch. Branch occlusion combined with flow diversion may improve angiographic occlusion scores of a canine bifurcation aneurysm model.
authors.affiliation: Laboratory of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Fahed
authors.affiliation: Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Montreal, Quebec, Canada.
authors.forename: J C
authors.initials: JC
authors.lastname: Gentric
authors.affiliation: Laboratory of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada.
authors.forename: I
authors.identifier: http://orcid.org/0000-0001-6261-5826
authors.initials: I
authors.lastname: Salazkin
authors.affiliation: Laboratory of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Gevry
authors.affiliation: Laboratory of Interventional Neuroradiology, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada.|Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Montreal, Quebec, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Raymond
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada.
authors.forename: T E
authors.initials: TE
authors.lastname: Darsaut
mesh_terms: D000792:Angiography; D000818:Animals; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000601:surgery*; D003251:Constriction, Pathologic; D004195:Disease Models, Animal; D004285:Dogs; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D015607:Stents; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: Aneurysm; Flow Diverter