Flow diverters are used for many purposes:
1. Giant aneurysms
2. Dissecting aneurysms
3. Blister aneuryms
4. Fusiform aneuryms
5. Wide neck aneurysms

While many cases have contrast stasis immediately after flow diverter placement, actual aneurysm 'closure' and arterial wall remodeling  and endothelialisation takes place after a variable time-frame.
We came across a case of subarachnoid hemorrhage, wherein DSA showed a irregular mild fusiform dilatation of the supraclinoid ICA with multiple blister like outpouchings.

Single PED Flex was placed, with no immediate change in appearance.
Patient developed vasospasm features, and was taken up for intra-arterial spasmolysis, during which the DSA showed smoothing of the arterial contour and non-visualisation of the blisters.

It can be said with guarantee that endothelialisation has not taken place, and the smoothening is due to the flow diversion effect. Probably the vasospasm also has added to the appearance.

DIAGNOSTIC DSA





FLOW DIVERTER



NEXT MORNING CHECK ANGIOGRAM

24 years male patient with post traumatic hemorrhage-was comatose for 24 days, then recovered.
DSA was done as there was a left parasellar mass, and showed a dissecting aneurysm.
Pipeline Flex was inserted on elective basis.
No contrast stasis was seen in control angiogram, however CT done after few hours showed complete thrombosis
Patient is doing well and is on follow up.
Check DSA is planed after 6 months.







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J NeuroIntervent Surg 2010;2:A8-A9 doi:10.1136/jnis.2010.003244.19
SNIS 7th Annual Meeting  Oral abstract

Novel non-occlusive temporary endoluminal neck protection device to assist in the treatment of wide necked aneurysms in a canine model

1. R Turner IV1,
2. B Croy1,
3. D Casigny2,
4. I Chaudry3,
5. A Turk3

¹Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
²Neuroradiology, University of Wisconsin, Madison, Wisconsin, USA
³Neuroradiology, Medical University of South Carolina, Charleston, South Carolina, USA

Abstract

Introduction Current endovascular treatment of wide necked aneurysms often requires the use of an adjuvant device. Balloon assist technique requires temporary occlusion of the parent vessel. Intravascular stents require the use of antiplatelet medication. A novel device which achieves temporary neck protection without parent vessel occlusion or antiplatelet medication is examined in a canine model.
Method 20 sidewall, wide necked aneurysms were created in 10 canines, one in each carotid artery, using a vein graft technique and allowed to mature. In each canine, one aneurysm was catheterized with a microcatheter while the temporary aneurysm neck bridge system (TANBS) was unsheathed across the neck of the aneurysm and the aneurysm was coiled. The second aneurysm in each canine was coiled without an adjunctive device. The TANBS was assessed for coil herniation, coil entrapment within the device, trackability, deliverability, TANBS deployability, TANBS recapturabilty and radio-opacity. The five animals were sacrificed acutely and five were sacrificed at 28 days and the carotid artery was explanted and sent for necropsy to assess for injury to the endothelium.
Results There were 17 aneurysms present for coiling out of the 20 aneurysms originally created. Three aneurysms thrombosed were occluded on angiography at the time of coiling. Ten of the aneurysms, one in each of the canines, were coiled to occlusion while the TANBS device was deployed across the neck of the aneurysm. The seven remaining aneurysms located on the contralateral carotid artery were coiled to occlusion without assistance.
The TANBS was successfully moved through the delivery, navigated into position across the aneurysm neck, deployed, resheathed and removed without adverse events in all cases. The coils were successfully placed into the aneurysms without evidence of coil herniation around the device or through its interstices. During device resheathing there was no evidence of interaction with the deployed coils as evidenced by movement of a coil loop or change in configuration of the coil mass. There was no change in the aneurysm occlusion result following the removal of the device. The radio-opacity of the device was adequate using GE/OEC 9800 C-Arm. Angiography did not reveal evidence of vasospasm or vessel dissection following removal of the device.
Two coiled aneurysm in each group had mild fibroblasts on histology. The largest aneurysm was associated with the greatest degree of fibrosis. Three specimens in two canines were associated with severe inflammation, with both aneurysms in one canine, and the control aneurysm in a second animal. A third animal had a moderate–severe inflammatory response in the TANBS group. All other aneurysms were associated with minimal or mild inflammatory response. Overall, fibrosis was greatest in the chronic (28 day) group, while inflammation was most prominent in the acute group. There were no cases of parent vessel endothelial injury, perforation or intramural dissection.
Conclusion The TANBS device was technically successful in all cases and provided parent artery protection as it was intended with no adverse events related to its use. Necropsy demonstrated that there was no evidence of endothelial injury related to the device.

• Preliminary experience with a novel neck bridge device for bifurcation aneurysm treatment

1. S Tateshima1, A Turk III2
2. ¹Division of Interventional Neuroradiology, UCLA Medical Center, Los Angeles, California, USA
3. ²Medical University of South Carolina, Charleston, South Carolina, USA

Abstract