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Use of pCONUS HPC for the treatment of unruptured wide- necked bifurcation aneurysms: early clinical experience using single antiplatelet therapy

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Stroke & Vascular Neurology 2021年第1期6卷 57-64页

作者： Marta Aguilar Perez Victoria Hellstern Carmen Serna Candel Christina Wendl Hansjorg Bazner Oliver Gansladt Hans Henkes neuroradiologische klinik NeurozentrumKlinikum StuttgartStuttgartGermany Institut fur Rontgendiagnostik Zentrum fur NeuroradiologieFakultat für Medizin der Universitat RegensburgRegensburgGermany Neurologische klinik NeurozentrumKlinikum StuttgartStuttgartGermany Neurochirurgische NeurozentrumKlinikum StuttgartStuttgartGermany Medizinische Fakultat Universitat Duisburg-EssenEssenGermany

Background In recent years,a growing number of stents and stent-like devices have become available to facilitate the treatment of challenging ***,the need for dual antiplatelet therapy can limit their use,especially in ruptured *** hydrophilic polymer coating(pHPC,phenox)is a novel glycan-based multilayer polymer that reduces platelet *** study aims to report our initial experience using the pCONUS HPC device for the treatment of unruptured wide-necked bifurcation aneurysms(WNBA)using acetylsalicylic acid(ASA)as single antiplatelet therapy(SAPT).Methods We retrospectively identified all patients who were treated with the pCONUS HPC for unruptured WNBA in a multi-staged procedure using ASA as *** were made of periprocedural complications,clinical outcome and angiographic and clinical *** We identified 15 patients with 15 *** average age was 69 years old(range,41-76).Seven aneurysms were located in the middle cerebral artery,five in the anterior communicating artery,two at the basilar tip and one in the posterior communicating *** post-treatment angiography showed five aneurysms with modified Raymond-Roy classification(mRRC)grade Ⅰ and four aneurysms with mRRC grade Ⅱ.There were no haemorrhagic *** patients developed thrombus formation during the second treatment session,all of them completely resolving after administration of glycoprotein Ⅱb/Ⅲa *** follow-up data were available for 10 patients and showed adequate occlusion(mRRC Ⅰ or Ⅱ)in eight aneurysms(80%).In-stent stenosis was observed in one patient whereas two patients showed de novo stenosis in one of the efferent *** This early experience on the use of the pCONUS HPC device suggests that it can be useful for treating unruptured WNBA under ASA as *** investigation with a randomised treatment registry and larger cohort is needed.

关键词： treatment bifurcation HPC

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Treatment practice of vasospasm during endovascular thrombectomy: an international survey

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Stroke & Vascular Neurology 2024年第5期9卷 490-496页

作者： Jessica Jesser Thanh Nguyen Adam A Dmytriw Hiroshi Yamagami Zhongrong Miao Louisa Johanna Sommer Andrea Stockero Johannes Alex Rolf Pfaff Johanna Ospel Mayank Goyal Aman B Patel Vitor Mendes Pereira Uta Hanning Lukas Meyer Wim H van Zwam Martin Bendszus Martin Wiesmann Markus Möhlenbruch Charlotte Sabine Weyland Neuroradiology University Hospital HeidelbergHeidelbergGermany Neurology Boston University School of MedicineBostonMassachusettsUSA St.Michael's Hospital Departments of Medical Imaging and NeurosurgeryNeurovascular CenterUniversity of TorontoTorontoOntarioCanada Neuroendovascular Program Harvard Medical SchoolMassachusetts General HospitalBostonMassachusettsUSA Stroke Neurology National Hospital Organization Osaka National HospitalOsakaJapan Department of Interventional Neuroradiology Beijing Tiantan HospitalBeijingChina Neuroradiology University Hospital AachenAachenGermany University Insitute for Neuroradiology at PMU Uniklinikum Salzburg—Christian-Doppler-KlinikSalzburgAustria Departments of Diagnostic Imaging and Clinical Neurosciences University of CalgaryCalgaryAlbertaCanada Neuroendovascular Program Massachusetts General HospitalBostonMassachusettsUSA Department of Neurosurgery Unity Health TorontoTorontoOntarioCanada Universitatsklinikum Hamburg Eppendorf klinik und Poliklinik fur neuroradiologische Diagnostik und Intervention HamburgGermany Diagnostic and Interventional Neuroradiology Universitatsklinikum Hamburg Eppendorf Klinik und Poliklinik fur Neuroradiologische Diagnostik und InterventionHamburgGermany Radiology Maastricht University Medical CenterMaastrichtThe Netherlands

Background and aim The clinical importance and management of vasospasm as a complication during endovascular stroke treatment(EVT)has not been well *** sought to investigate current expert opinions in neurointervention and therapeutic strategies of iatrogenic vasospasm during *** We conducted an anonymous international online survey(4 April 2023 to 15 May 2023)addressing treatment standards of neurointerventionalists(NIs)practising *** illustrative cases of patients with vasospasm during EVT were *** study groups were compared according to the NI’s opinion regarding the potential influence of vasospasm on patient outcome after EVT using descriptive *** In total,534 NI from 56 countries responded,of whom 51.5%had performed>200 *** was considered a complication potentially influencing the patient’s outcome by 52.6%(group 1)whereas 47.4%did not(group 2).Physicians in group 1 more often added vasodilators to their catheter flushes during EVT routinely(43.7%vs 33.9%,p=0.033)and more often treated severe large-vessel vasospasm with vasodilators(75.3%vs 55.9%;p<0.001),as well as extracranial vasospasm(61.4%vs 36.5%,p<0.001)and intracranial medium-vessel vasospasm(27.1%vs 11.2%,p<0.001),compared with group *** case of a large-vessel vasospasm and residual and amenable medium-vessel occlusion during EVT,the study groups showed different treatment *** 2 continued the EVT immediately more often,without initiating therapy to treat the vasospasm first(9.6%vs 21.1%,p<0.001).Conclusion There is disagreement among NIs about the clinical relevance of vasospasm during EVT and its *** was a higher likelihood of use of preventive and active vasodilator treatment in the group that perceived vasospasm as a relevant complication as well as differing interventional strategies for continuing an EVT in the presence of a large-vessel vasospasm.

关键词： survey continued routine

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