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Flow diversion of bifurcation aneurysms is more effective when the jailed branch is occluded: an experimental study in a novel canine model
- Source :
- Journal of NeuroInterventional Surgery. 9:311-315
- Publication Year :
- 2016
- Publisher :
- BMJ, 2016.
-
Abstract
- BackgroundFlow 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.Materials and methodsSixteen 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.ResultsFourteen 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.ConclusionsTreatment 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.
- Subjects :
- Neointima
medicine.medical_specialty
Constriction, Pathologic
030218 nuclear medicine & medical imaging
03 medical and health sciences
Dogs
0302 clinical medicine
Aneurysm
Occlusion
medicine
Animals
Treatment Failure
cardiovascular diseases
Bifurcation
medicine.diagnostic_test
Flow diversion
business.industry
Angiography
Intracranial Aneurysm
General Medicine
medicine.disease
Surgery
Disease Models, Animal
Stenosis
Carotid Arteries
Treatment Outcome
medicine.anatomical_structure
cardiovascular system
Stents
Neurology (clinical)
Radiology
business
030217 neurology & neurosurgery
Artery
Subjects
Details
- ISSN :
- 17598486 and 17598478
- Volume :
- 9
- Database :
- OpenAIRE
- Journal :
- Journal of NeuroInterventional Surgery
- Accession number :
- edsair.doi.dedup.....a5bb172c85f52555bd9bf36b0cceaf14