title: Use of self-expanding stents for better intracranial flow diverter wall apposition.
abstract: Background Flow diverter (FD) malapposition is associated with stroke-related complications. We document the use of self-expanding nitinol stents to remove/reduce the ledge of a FD deployed for aneurysm treatment. Methods We identified five patients who were treated with the Pipeline embolization device (PED) in conjunction with a Neuroform EZ stent for inadequate wall apposition of the ends of the FD at our institution between May 2014 and July 2015. Among other parameters, angiographic results, cone-beam computed tomography assessment of wall apposition and patient clinical outcome were evaluated. Results Incomplete device end apposition was seen in three cases, and precarious positioning of the distal end of the PED over the aneurysm neck was seen in two cases. In all five cases, successful treatment with good wall apposition and proper pinning of the PED distal edge was achieved using an additional Neuroform EZ stent. Appropriate aneurysm neck coverage and flow stagnation was seen in all cases. The combination of high radial outward force and open-cell design permits the Neuroform EZ stent to jail the malappositioned edges of the FD while maintaining good vessel-wall apposition itself and prevent migration of the PED. Short-term follow-up angiography showed device patency and complete aneurysm obliteration in all cases. Conclusions Preliminary results of this small case series suggest that the Neuroform EZ stent allows for effective treatment of FD malapposition in selected patients amenable for this endovascular approach. Long-term and larger cohort studies are needed to validate these results.
authors.affiliation: 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA.
authors.forename: Anna Luisa
authors.initials: AL
authors.lastname: Kühn
authors.affiliation: 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Wakhloo
authors.affiliation: 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gounis
authors.affiliation: 2 Department of Neurosurgery, Baylor College of Medicine, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Kan
authors.affiliation: 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA.
authors.forename: Katyucia
authors.initials: K
authors.lastname: de Macedo Rodrigues
authors.affiliation: 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA.
authors.forename: J Diego
authors.initials: JD
authors.lastname: Lozano
authors.affiliation: 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA.
authors.forename: Miklos G
authors.initials: MG
authors.lastname: Marosfoi
authors.affiliation: 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Perras
authors.affiliation: 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Brooks
authors.affiliation: 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Howk
authors.affiliation: 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Rex
authors.affiliation: 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA.
authors.forename: Francesco
authors.initials: F
authors.lastname: Massari
authors.affiliation: 1 Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, USA.
authors.forename: Ajit S
authors.initials: AS
authors.lastname: Puri
mesh_terms: D000328:Adult; D000368:Aged; D000497:Alloys; D015901:Angiography, Digital Subtraction; D001807:Blood Vessel Prosthesis; D002533:Cerebral Angiography; D054893:Cone-Beam Computed Tomography; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000497:Alloys; C013616:nitinol
keywords: Aneurysm; flow diverter; malapposition; open-cell stent; radial force