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Research ArticleInterventional

Testing Flow Diverters in Giant Fusiform Aneurysms: A New Experimental Model Can Show Leaks Responsible for Failures

T.E. Darsaut, F. Bing, I. Salazkin, G. Gevry and J. Raymond
American Journal of Neuroradiology December 2011, 32 (11) 2175-2179; DOI: https://doi.org/10.3174/ajnr.A2657
T.E. Darsaut
aFrom Centre hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Department of Radiology (T.E.D., F.B., J.R.)
bCHUM Research Centre, Interventional Neuroradiology Research Laboratory (T.E.D., I.S., G.G., J.R.), Montreal, Quebec, Canada
cUniversity of Alberta, Mackenzie Health Science Centre, Division of Neurosurgery (T.E.D.), Edmonton, Alberta, Canada.
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F. Bing
aFrom Centre hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Department of Radiology (T.E.D., F.B., J.R.)
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I. Salazkin
bCHUM Research Centre, Interventional Neuroradiology Research Laboratory (T.E.D., I.S., G.G., J.R.), Montreal, Quebec, Canada
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G. Gevry
bCHUM Research Centre, Interventional Neuroradiology Research Laboratory (T.E.D., I.S., G.G., J.R.), Montreal, Quebec, Canada
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J. Raymond
aFrom Centre hospitalier de l'Université de Montréal (CHUM), Notre-Dame Hospital, Department of Radiology (T.E.D., F.B., J.R.)
bCHUM Research Centre, Interventional Neuroradiology Research Laboratory (T.E.D., I.S., G.G., J.R.), Montreal, Quebec, Canada
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    Fig 1.

    Surgical construction of the model. Schematic depicting surgical construction of lingual fusiform model with or without branches, with venous patch graft remodeling to form large or giant aneurysms.

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    Fig 2.

    Angiographic results of treatments. Angiographic demonstration of giant fusiform aneurysm with (A) or without (B) arterial branches, 6 weeks after construction, immediately before treatment. Both have been treated with multiple FD constructs to span the aneurysmal dilation (arrows in C and D). Stent placement in the aneurysm with arterial branches led to treatment failure (E), whereas, in the aneurysm with surgically occluded branches led to almost complete aneurysm thrombosis after FD (F).

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    Fig 3.

    Residual aneurysm, neointima formation, and leaks. Note patent, open aneurysms (A; corresponding to Fig 2E), when the aneurysm serves as a reservoir for feeding branches. When branches are absent (B) the aneurysm is almost completely occluded, with pouches containing thrombus in various stages or organization (*). A small crescentic remnant, fed by a small leak (curved arrows) is present (**; aneurysm corresponding to Fig 2F). The FDs are covered with neointima both inside and outside (C), and leaks penetrate both neointimal layers covering the stents (D and E). There is good neointimal coverage of the stent struts apposed to the parent artery (E). Note patent arterial branch ostium but partially covered with neointimal tissue and organizing clot (F).

Tables

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  • Angiographic and pathologic outcomes after flow diversion in experimental fusiform aneurysms

    AneurysmPatent BranchesAneurysm Size (Length × Width × Height) (mm)No. of FD StentsLength of Deployed Stents (mm in 3.5 mm vessel)Angiographic Outcome% Occlusion at Pathology
    Immediate2 wk12 wk
    1Yes25 × 12.5 × 12.5252 + 52 (104)3330
    2Yes17.5 × 10 × 10152 (52)3330
    3Yes25 × 12.5 × 12.5346 + 30 + 26 (102)3330
    4Yes25 × 12 × 12446 + 40 + 26 + 26 (138)3330
    5No18 × 10 × 12246 + 17 (83)32180
    6No19 × 10 × 12337 + 37 + 26 (100)32180
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American Journal of Neuroradiology: 32 (11)
American Journal of Neuroradiology
Vol. 32, Issue 11
1 Dec 2011
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Testing Flow Diverters in Giant Fusiform Aneurysms: A New Experimental Model Can Show Leaks Responsible for Failures
T.E. Darsaut, F. Bing, I. Salazkin, G. Gevry, J. Raymond
American Journal of Neuroradiology Dec 2011, 32 (11) 2175-2179; DOI: 10.3174/ajnr.A2657

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Testing Flow Diverters in Giant Fusiform Aneurysms: A New Experimental Model Can Show Leaks Responsible for Failures
T.E. Darsaut, F. Bing, I. Salazkin, G. Gevry, J. Raymond
American Journal of Neuroradiology Dec 2011, 32 (11) 2175-2179; DOI: 10.3174/ajnr.A2657
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