Biomedical subjects

David Fiorella

Publications and source records attributed to David Fiorella.

15 recordsLinked to original sources

PubMed2006

Durability of aneurysm embolization with matrix detachable coils.

OBJECTIVE: Matrix detachable coils (MDC; Boston Scientific/Target, Fremont, CA) are platinum coils coated with a bioabsorbable polymeric material (polyglycolic-polylactic acid). In animal models, the introduction of polyglycolic-polylactic acid-coated coils into experimental aneurysms resulted in a cellular reaction which promoted stable intra-aneurysmal scar tissue formation. The current study was undertaken to assess the durability of aneurysm occlusion after embolization with MDC. METHODS: All patients undergoing embolization were prospectively enrolled in an endovascular database at our institution. All coils used for embolization were recorded in the operative notes for the procedure. Only aneurysms embolized with 50% or greater length of MDC were included. All patients with Neuroform stents (Boston Scientific/Target, Fremont, CA) were excluded from the study. Patients were followed with conventional angiography and magnetic resonance angiography. RESULTS: During a 20-month period, 131 aneurysms were embolized with MDC. Follow up data (average, 6.9 mo; range, 1.5-22 mo) were available for 82 aneurysms (61 with conventional angiography, 21 with magnetic resonance angiography only). Of the aneurysm patients with follow-up available, 65 had small aneurysms with small necks, three were small aneurysms with wide necks, 12 were large aneurysms, and two were giant aneurysms. Overall, there were 30 (36.6%) recanalizations, 19 (23.1%) of which required retreatment. In two additional patients, retreatment was either recommended (n = 1) or attempted unsuccessfully (n = 1). Fifty-two aneurysms were unchanged or demonstrated progressive thrombosis (63.4%). The recanalization rate for small aneurysms with small necks was 26.1% (17 out of 65) with a 13.8% retreatment rate (9/65). The recanalization rate for large aneurysms was 75% (9 out of 12) with seven requiring retreatment. CONCLUSION: In the absence of Neuroform stent support, aneurysms embolized with the MDC system demonstrated a significant rate of recanalization. Many of the recanalizations were of sufficient size to warrant retreatment. The rates of recanalization observed in the present series were comparable to, or worse than, those reported for bare platinum coils.

Adult↗

PubMed2006

Neuroform in-stent stenosis: incidence, natural history, and treatment strategies.

OBJECTIVE: Delayed in-stent stenosis is an important and well-characterized complication of angioplasty and stenting for the treatment of intra- and extracranial atheromatous disease. The current series describes the incidence and natural history of in-stent stenosis after the deployment of the Neuroform stent within the cerebrovasculature for the treatment of aneurysms. METHODS: The collaborative Cleveland Clinic Foundation-Barrow Neurological Institute endovascular database was reviewed to identify cases of delayed moderate or severe in-stent stenosis observed during the follow-up of cerebral aneurysms treated with the Neuroform stent. The hospital charts, clinic records, and operative reports for these patients were reviewed. RESULTS: Of a total of 156 patients with follow-up, nine (5.8%) cases of moderate or severe delayed (>2 mo) in-stent stenosis were identified, including two parent vessel occlusions. In two cases, patients presented 3 months after stent-supported aneurysm embolization with focal neurological symptoms. Both of these patients were treated with angioplasty. One eventually required surgical bypass. Of the seven asymptomatic patients, four demonstrated some degree of spontaneous resolution at follow-up, one progressed to complete occlusion, one is awaiting further follow-up, and one patient died of unrelated causes. Of the nine patients in the series, five were treated with "bioactive" coils (Matrix, Hydrocoil, Cerecyte), three were treated with bare platinum coils, and one was treated with stenting alone. The earliest time interval to diagnosis was 2.5 months and 3 months for asymptomatic and symptomatic patients, respectively. The earliest interval documented for spontaneous resolution was 9 months. CONCLUSION: Delayed Neuroform in-stent stenosis, occurring in 5.8% of cases, is not a rare phenomenon. The stenosis can be symptomatic and may require endovascular treatment or surgical bypass. In asymptomatic patients, a strategy of "watchful waiting" may be effective because many patients demonstrate partial or complete resolution at follow-up. The spontaneous resolution of delayed in-stent stenosis has not been previously described. This may be a phenomenon unique to the application of low radial force, self-expanding stents within the nonatheromatous cerebrovasculature.

Adult↗

PubMed2006

Endovascular reconstruction with the Neuroform stent as monotherapy for the treatment of uncoilable intradural pseudoaneurysms.

OBJECTIVE: Intradural pseudoaneurysms have a malignant natural history and can be difficult to treat if parent vessel deconstruction is not feasible. These lesions often involve a long arterial segment and lack a defined saccular component that would safely accommodate the introduction of embolization coils. The current report describes the successful endovascular treatment of these lesions using a strategy of Neuroform stent reconstruction. METHODS: A retrospective review of the prospectively maintained Neuroform databases from our two institutions identified all intracranial aneurysms treated with the Neuroform stent alone, without embolization coils. The clinical charts, procedural data, and angiographic results were reviewed. RESULTS: Over a 38-month study period (10/02-2/06), 266 aneurysms were treated with the Neuroform stent. Of these, 10 were small "uncoilable" intradural pseudoaneurysms associated with subarachnoid hemorrhage. These lesions were treated using a strategy of endovascular stent reconstruction of the diseased vascular segment with one or more Neuroform stents (without concomitant coil embolization). Seven pseudoaneurysms were treated in the context of acute or subacute subarachnoid hemorrhage, and three were associated with a remote history of subarachnoid hemorrhage. Periprocedural complications occurred in two patients (clinically silent, intraprocedural thromboembolic event successfully treated with intra-arterial abciximab, symptomatic postprocedural stent thrombosis with successful thrombolysis, and excellent neurological recovery). Both complications occurred in patients with ruptured aneurysms and could be attributed to inadequate platelet inhibition at the time of the initial procedure. Follow-up conventional angiographic examinations were available for all 10 patients with pseudoaneurysms (1-18.5 mo; average, 9.0 mo). In nine cases, the aneurysms improved at follow-up, with either complete (n = 5) or near complete (n = 4) resolution. In one case, short-term follow-up (1 mo) demonstrated no significant change. No patient has rehemorrhaged after treatment. CONCLUSION: Endovascular Neuroform stent reconstruction represents an optimal strategy for the management of intradural pseudoaneurysms that require a constructive treatment strategy and are too small to accommodate the introduction of embolization coils. Nine out of 10 patients in the current series treated with this strategy demonstrated some degree of endovascular remodeling with either complete (n = 5) or partial (n = 4) angiographic resolution at follow-up. No rehemorrhages were encountered. Adequate antiplatelet therapy, even in the setting of acute subarachnoid hemorrhage, is prerequisite for the avoidance of thromboembolic complications.

Adolescent↗

PubMed2006

The role of neuroendovascular therapy for the treatment of brain arteriovenous malformations.

Neuroendovascular embolization represents a critical component of the multidisciplinary management of cerebral arteriovenous malformations. Safe and effective embolization may be performed only in the context of a well-designed, rational treatment plan that is fundamentally based on a clear understanding of the natural history of the lesion, as well as the cumulative risks of multimodality treatment. This article outlines the role of neuroendovascular embolization in arteriovenous malformation therapy with a specific emphasis on decision making in the context of formulating a treatment plan. The authors also provide a summary of the available embolic agents and their technical application, potential intraprocedural and periprocedural complications, and postprocedural management.

Blood Vessel Prosthesis↗

PubMed2005

Antiplatelet therapy in neuroendovascular therapeutics.

Our understanding of the pharmacology of antiplatelet therapy continues to evolve rapidly. Although the existing data are primarily generated in the setting of interventional and preventative cardiology studies, these data may be extrapolated to guide the rational application of these agents in neuroendovascular procedures. Platelet function testing represents an increasingly available and practical method by which to verify the adequacy of therapy and guide clinical decision making. The optimal application of these agents will undoubtedly improve the risk profile of neuroendovascular procedures, increase the success rate of acute stroke intervention, and facilitate more effective secondary stroke prevention.

Adult↗

PubMed2005

Neurovascular rescue.

Neurovascular complications of carotid artery stenting (CAS) include intracranial embolism and hemorrhage, carotid dissection, in-stent thrombosis and vasospasm. Management of these crises requires knowledge of the intracranial vascular anatomy and collateral circulation, correct identification of the complication and its clinical implications, and a response plan that is appropriate to the complication and to the skill set of the operator. In this chapter the authors discuss techniques for the avoidance and management of CAS procedural complications.

Angioplasty↗

PubMed2005

Usefulness of the Neuroform stent for the treatment of cerebral aneurysms: results at initial (3-6-mo) follow-up.

OBJECTIVE: The Neuroform microstent, a flexible, self-expanding, nitinol stent specifically designed for use in the cerebral vasculature, became available in North America for aneurysm treatment in November 2002. The present report details our experience with the Neuroform stent over the past 2 years, with an emphasis on evolving treatment strategies and treatment durability at initial (3-6 mo) follow-up. METHODS: All patients included in this report were registered in a prospectively maintained database. We assessed the clinical history, indications for stent use, aneurysm dimensions, technical details of the procedures, degree of aneurysm occlusion, angiographic and clinical findings at follow-up, and complications. RESULTS: Over a 20-month period, 64 patients with 74 aneurysms were treated with 86 Neuroform stents. Of 64 patients, 16 (25%) were treated in the context of subarachnoid hemorrhage (8 acute, 7 subacute, 1 remote). Indications for stent use included broad aneurysm neck (n = 51 stents; average neck, 5.1 mm; aneurysm size, 8.2 mm), fusiform/dissecting morphology (n = 17), salvage/bailout for coils prolapsed into the parent vessel (n = 7), and giant aneurysm (n = 11). Sixty-one aneurysms were stented and coiled with complete or near complete (>95%) occlusion in 28 patients (45.9%) and partial occlusion (<95%) in 33 patients (54%). Follow-up angiographic (n = 43) or magnetic resonance angiographic (n = 5) data (average follow-up, 4.6 mo; median, 4 mo; range, 1.5-13 mo) for 48 aneurysms (46 patients) after stent-supported coil embolization demonstrated progressive thrombosis in 25 patients (52%), recanalization in 11 patients (23%) (8 of whom were retreated), and no change in 12 patients (25%). Follow-up angiography in 5 additional patients with dissecting aneurysms treated with stents alone demonstrated interval vascular remodeling with decreased aneurysm size in all patients. Delayed, severe, in-stent stenosis was observed in 3 patients, 1 of whom was symptomatic and required angioplasty and subsequently superficial temporal artery-to-middle cerebral artery bypass surgery. Using the second-generation Neuroform2 delivery system (n = 53), very few technical problems with stent delivery and deployment have been encountered (n = 2). CONCLUSION: The Neuroform stent facilitates adequate embolization of complex cerebral aneurysms, which would not otherwise be amenable to endovascular therapy. Initial follow-up data indicate favorable progressive thrombosis and recanalization rates for aneurysms after Neuroform stent-assisted embolization. These advantages of stenting were most evident for small aneurysms with wide necks.

Cerebral Angiography↗

PubMed2005

Monorail snare technique for the recovery of stretched platinum coils: technical case report.

OBJECTIVE AND IMPORTANCE: Coil stretching represents a potentially hazardous technical complication not infrequently encountered during the embolization of cerebral aneurysms. Often, the stretched coil cannot be advanced into the aneurysm or withdrawn intact. The operator is then forced to attempt to retract the damaged coil, which may result in coil breakage, leaving behind a significant length of potentially thrombogenic stretched coil material within the parent vessel. To overcome this problem, we devised a technique to snare the distal, unstretched, intact portion of the platinum coil by use of the indwelling microcatheter and stretched portion of the coil as a monorail guide. CLINICAL PRESENTATION: We have used this technique successfully in four patients to snare coils stretched during cerebral aneurysm embolization. Three of these patients were undergoing Neuroform (Boston Scientific/Target, Fremont, CA) stent-supported coil embolization of unruptured aneurysms. In all cases, the snare was advanced easily to the targeted site for coil engagement by use of the microcatheter as a monorail guide. Once the intact distal segment of the coil was ensnared, coil removal was uneventful, with no disturbance of the remainder of the indwelling coil pack or Neuroform stent. TECHNIQUE: A 2-mm Amplatz Goose Neck microsnare (Microvena Corp., White Bear Lake, MN) was placed through a Prowler-14 microcatheter (Cordis Corp., Miami, FL). The hub of the indwelling SL-10 microcatheter (Boston Scientific, Natick, MA) was then cut away with a scalpel, leaving the coil pusher wire intact, and removed. The open 2-mm snare was then advanced over the outside of the coil pusher wire and microcatheter. The snare and Prowler-14 microcatheter were then advanced into the guiding catheter (6- or 7-French) as a unit over the indwelling SL-10 microcatheter. By use of the SL-10 microcatheter and coil as a "monorail" guide, the snare was advanced over and beyond the microcatheter and the stretched portion of the coil until the snare was in position to engage the distal unstretched coil. At this point, the snare was then closed around the intact portion of the coil, and the microcatheters, snare, and coil were removed as a unit. CONCLUSION: The monorail snare technique represents a fast, safe, and easy method by which a stretched coil can be removed.

Aged↗

PubMed2005

Balloon-in-stent technique for the constructive endovascular treatment of "ultra-wide necked" circumferential aneurysms.

INTRODUCTION: Circumferential aneurysms, which incorporate >180 degrees of the circumference of the parent vessel, present a unique therapeutic challenge, particularly in circumstances in which a deconstructive treatment strategy is not feasible. We detail a novel technique for endovascular parent vessel reconstruction with aneurysm embolization. METHODS: We performed a retrospective review of the prospectively maintained databases of our two institutions to identify cases in which a balloon-in-stent technique had been used to treat circumferential aneurysms. During the first stage of this technique, a stent (Neuroform [Boston Scientific, Natick, MA], Multilink Vision [Guidant, Indianapolis, IN], or Bx Velocity [Cordis, New Brunswick, NJ]) is placed across the neck of the aneurysm to achieve parent vessel reconstruction. During the second stage, aneurysm coil embolization is performed with a compliant temporary occlusion balloon (Sentry [Boston Scientific, Natick, MA] or Hyperglide [Microtherapeutics, Irvine, CA]) placed within the stent to unambiguously demarcate and protect the parent vessel. In some cases, during the course of the embolization, coils project over and obscure the parent vessel in both working views. Before each coil detachment, the protection balloon is deflated under blank fluoroscopic roadmap visualization. The absence of shifting of any portion of the coil mass during balloon deflation indicates that the introduced coil is external to the stent-reconstructed parent vessel (i.e., within the aneurysm) and can be detached. This process is repeated until satisfactory aneurysm embolization is achieved. After embolization, the balloon catheter may be exchanged for a stent delivery system to facilitate the placement of a second stent. RESULTS: Seven patients underwent balloon-in-stent-assisted embolization over a 15-month period. Three were performed for internal carotid aneurysms, three for basilar trunk or basilar apex aneurysms, and one for a dissecting/fusiform V4 segment vertebral artery aneurysm. In three cases, the presence of the inflated balloon facilitated the manipulation of the image intensifier into a position which produced a "down-the-barrel" view of the parent vessel. In the four additional cases, for anatomic reasons, this view could not be achieved and coil mass projected over the reconstructed parent vessel in both views. Partial aneurysm occlusion (75-90%), was achieved in five cases, and near complete (>95%) occlusion was achieved in two cases. Complications included two significant retroperitoneal hematomas and two brainstem infarcts, both of which resulted in hemisensory symptoms. CONCLUSION: The balloon-in-stent technique provides a practical and safe treatment strategy for the management of circumferential aneurysms that are not amenable to deconstructive embolization.

Adult↗

PubMed2004

Preliminary experience using the Neuroform stent for the treatment of cerebral aneurysms.

INTRODUCTION: The Neuroform microstent-a flexible, self-expandable, microcatheter-delivered, nitinol stent designed for the treatment of cerebral aneurysms-was recently approved for use in patients. We present the results of our initial experience in using the Neuroform stent to treat patients with cerebral aneurysms, with an emphasis on potential applications, technical aspects of deployment, and associated intra- and periprocedural complications. METHODS: The records of all patients treated with the Neuroform stent were entered prospectively into a database. We assessed the clinical history, indications for stent use, aneurysm dimensions, and technical details of the procedures, including any difficulties with stent placement and/or deployment, degree of aneurysm occlusion, and complications. RESULTS: During a 5-month period, 19 patients with 22 aneurysms were treated with the Neuroform stent. Twenty-five stents were deployed. Five patients had multiple stents placed. Five patients had ruptured aneurysms at the time of treatment. The indications for use were broad-necked aneurysms (n = 13; average neck length, 5.1 mm; average aneurysm size, 9 mm), fusiform or dissecting aneurysms (n = 3), salvage and/or bailout (n = 1), and giant aneurysms (n = 2). Technical problems included difficulty in deploying the stent (n = 6), inability to deploy the stent (n = 1), stent displacement (n = 2), inadvertent stent deployment (n = 1), and coil stretching (n = 1). Twenty-one of the 22 aneurysms were treated. Four aneurysms were stented without additional treatment, and 17 aneurysms were stented and coiled. Of the coiled aneurysms, complete or nearly complete (more than 95%) occlusion was achieved in 6 aneurysms, and partial occlusion was achieved in 11. Two clinically significant adverse events occurred, both of which were sequelae of periprocedural thromboembolic complications. One patient died after thrombolysis was attempted. The other patient made an excellent functional recovery after undergoing successful thrombolysis of a thrombosed basilar artery stent. CONCLUSION: The Neuroform stent is a useful device for the treatment of patients with aneurysms that may not otherwise be amenable to endovascular therapy. In the majority of cases, the stent can be deployed accurately, even within the most tortuous segments of the cerebral vasculature. Although delivery and deployment may be technically challenging, clinically significant complications are uncommon.

Adolescent↗

PubMed2004

Strategies for the management of intraprocedural thromboembolic complications with abciximab (ReoPro).

OBJECTIVE: Most complications related to endovascular neurointerventional procedures are thromboembolic. The objective of this study was to determine whether abciximab, a glycoprotein IIb/IIIa inhibitor, is a safe and effective agent for the treatment of thromboembolic complications encountered during interventional neuroradiological procedures. METHODS: A search of a prospectively maintained database identified 13 patients who were treated for intraprocedural thromboembolic complications with abciximab, either alone or in combination with tissue plasminogen activator, during a 22-month period. RESULTS: Of the 13 patients in our series (10 with aneurysms, 3 with arteriovenous malformations), 12 presented with unsecured vascular lesions, and in 9 cases the lesions were either acutely (<10 d) or subacutely (<6 mo) hemorrhagic. After the identification of a thromboembolic complication, each patient was treated with either intra-arterial (n = 5) or intravenous (n = 8) abciximab. Abciximab was administered intravenously as a 0.25-mg/kg bolus (n = 2), a 0.25-mg/kg bolus followed by a 12-hour 0.125-microg/kg/min infusion (n = 5), or a 12-hour 0.125-microg/kg/min infusion alone (n = 1). Intra-arterial abciximab (3.5-10 mg) was administered directly through a microcatheter positioned in the vicinity of the thrombus (n = 5). Five patients also were administered alteplase. Complete (n = 7) or partial (n = 6) resolution of thrombus was observed in all cases. Five patients had small infarcts in the distribution of the thromboembolic complication. In no case was new or increased hemorrhaging observed after thrombolysis. CONCLUSION: Abciximab (ReoPro), administered either intravenously or intra-arterially, is a viable option for the management of thromboembolic complications encountered during endovascular therapeutic procedures.

Abciximab↗

PubMed2004

Vertical atlantoaxial distraction injuries: radiological criteria and clinical implications.

OBJECT: The authors sought to establish radiological criteria for the diagnosis of C1-2 vertical distraction injuries. METHODS: Conventional radiography, computerized tomography (CT), and magnetic resonance (MR) imaging findings in five patients with a C1-2 vertical distraction injury were correlated with their clinical history, operative findings, and autopsy findings. The basion-dens interval (BDI) and the C-1 and C-2 lateral mass interval (LMI) were measured in 93 control patients who underwent CT angiography; these measurements were used to define the normal BDI and LMI. The MR imaging results obtained in 30 healthy individuals were used to characterize the normal signal intensity of the C1-2 joint. The MR imaging results were compared with MR images obtained in five patients with distraction injuries. In the 93 patients, the BDI averaged 4.7 mm (standard deviation [SD] 1.7 mm, range 0.6-9 mm) and the LMI averaged 1.7 mm (SD 0.48 mm, range 0.7-3.3 mm). Based on CT scanning in the five patients with distraction injuries, the BDIs (mean 11.9 mm, SD 3.2 mm; p < 0.001) and LMIs (mean 5.5 mm, SD 2 mm; p < 0.0001) were significantly greater than in the control group. Fast-spin echo inversion-recovery MR images obtained in these five patients revealed markedly increased signal distributed throughout the C1-2 lateral mass articulations bilaterally. CONCLUSIONS: In 95% of healthy individuals, the LMI ranged between 0.7 and 2.6 mm. An LMI greater than 2.6 mm indicates the possibility of a distraction injury, which can be confirmed using MR imaging. Patients with a suspected C1-2 distraction injury may be candidates for surgical fusion of C1-2.

Adolescent↗

PubMed2004

Assessment of the reproducibility of postprocessing dynamic CT perfusion data.

BACKGROUND AND PURPOSE: Commercially available software programs for the conversion of dynamic CT perfusion (CTP) source data into cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) maps require operators to subjectively define parameters that are used in subsequent postprocessing calculations. Our purpose was to define the variability of CBV, CBF, and MTT values derived from CTP maps generated from the same source data postprocessed by three different CT technologists (CTTs). METHODS: Raw data derived from dynamic CTP examinations performed in 20 subjects were postprocessed seven times by three experienced CTTs. Parenchymal regions of interest derived from each map (CBV, CBF, and MTT) were compared. The CBF maps generated by each technologist were also qualitatively assessed. Decisions made by each analyzer during postprocessing were assessed. RESULTS: The intraclass correlation coefficients were 0.73 (95% CI, 0.64-0.81), 0.87 (0.83-0.91) and 0.89 (0.85-0.93), for the CBV, CBF, and MTT parenchymal regions of interest, respectively. All individual correlation coefficients between data sets were significant to a P value <.05. Measurement error, made solely on the basis of different technologists postprocessing the same source data and expressed as the coefficients of variation, were 31%, 30%, and 14% for CBV, CBF, and MTT, respectively. The selection of the arterial input function (AIF) region of interest, venous function region of interest, and preenhancement interval were very reproducible. The technologists differed significantly with respect to the selection of the postenhancement image (PoEI) (P <.01). A retrospective review of the individual CBF maps indicated that variance in the PoEI selection accounted for much of the variation in the qualitative appearance of the CBF maps generated by different technologists. The PoEI was selected to demarcate the baseline of the AIF time-attenuation curve. It is likely that this method of PoEI selection significantly contributed to intra- and interanalyzer variability. CONCLUSION: There is a high degree of correlation between parenchymal regions of interest derived from CBV, CBF, and MTT maps generated from the same dynamic CTP source data postprocessed by different operators. The level of agreement, however, may not be sufficient to incorporate quantitative values into clinical decision making. Quantitative differences between parenchymal regions of interest were not infrequently manifest as significant differences in the qualitative appearance of the CBF maps. It is likely that, with optimization of postprocessing parameter selection, the degree of variability may be substantially reduced.

Arizona↗

PubMed2003

A reappraisal of angioplasty and stenting for the treatment of vertebral origin stenosis.

OBJECTIVE: To assess the rate of restenosis after vertebral origin angioplasty and stenting (VOAS). METHODS: We reviewed the records of 33 patients (24 men, 9 women; age range, 49-81 yr; mean, 64.5 yr) who underwent VOAS during a period of 5 years and followed each for the development of adverse sequelae through a prospectively maintained database. A neuroradiologist not involved in the stenting procedures assessed original and follow-up angiograms for evidence of restenosis. Restenosis was quantified as insignificant (0-24%), mild (25-49%), moderate (50-74%), or severe (75-100%). RESULTS: Of the 33 patients, 30 presented with transient ischemic attacks or stroke. Most (31 of 33 patients) manifested other brachiocephalic stenoses, including 27 patients with occlusion, hypoplasia, or stenosis of the contralateral vertebral artery. Angiographic follow-up (mean, 16.2 mo) was obtained in 30 patients (2 patients died before follow-up, and 1 refused). Restenosis was mild in seven patients, moderate in eight, and severe in five. The combined rate of moderate-to-severe restenosis was 43.3%. No complications resulted in permanent morbidity. One patient died as a result of a stroke in a different vascular distribution 4 months after VOAS. Another patient died as a result of basilar thrombosis in which emergent stenting had been undertaken in an effort to perform thrombolysis. CONCLUSION: Despite a technical success rate of 97% and a low incidence of complications, VOAS is associated with a high rate of moderate-to-severe restenosis.

Aged↗

PubMedDate not supplied

In-stent stenosis as a delayed complication of neuroform stent-supported coil embolization of an incidental carotid terminus aneurysm.

The Neuroform stent is the first microcatheter-delivered stent designed specifically for the treatment of cerebral aneurysms. The stent functions primarily to provide durable parent vessel protection during the embolization of broad-necked cerebral aneurysms. The present case report demonstrates in-stent stenosis occurring as a delayed complication of Neuroform stent-supported coil embolization of an unruptured cerebral aneurysm.

Aged↗