China
Africa
Explore chapters and articles related to this topic
Endovascular Implants
Published in Wilmer W Nichols, Michael F O'Rourke, Elazer R Edelman, Charalambos Vlachopoulos, McDonald's Blood Flow in Arteries, 2022
Elazer Edelman, Lambros Athanasiou, Farhad Rikhtegar Nezami
The technical success of these new procedures is high, particularly when performed in select centers of excellence. However, even with skilled operators, there is an increased risk, due to both the complexity of the disease and endovascular techniques, leading to endoleaks, renal impairment, stroke, paraplegia and death. Therefore, meshed flow diverter devices have been introduced that focus not on blocking the blood from flowing to the aneurysm sac but in altering the blood flow dynamics.
Adult Autopsy
Published in Cristoforo Pomara, Vittorio Fineschi, Forensic and Clinical Forensic Autopsy, 2020
Cristoforo Pomara, Monica Salerno, Vittorio Fineschi
A 40-year-old woman was admitted to the ED because of a long-term cephalea. Angio-CT of the brain was performed, and a fusiform aneurysm of the supraclinoid portion of the left carotid artery was diagnosed. She underwent an endovascular treatment with a flow diverter device by femoral access. During the procedure, a sudden flow reduction was observed with contrast spreading out of the vessels. After a few hours, an intraoperative CT scan was performed and showed a diffuse subarachnoid hemorrhage. The woman fell into a coma and died the day after. The prosecutor requested an autopsy because of a malpractice claim.
A realistic way to investigate the design, and mechanical properties of flow diverter stents
Published in Expert Review of Medical Devices, 2021
Prasanth Velvaluri, Mariya S. Pravdivtseva, Johannes Hensler, Fritz Wodarg, Olav Jansen, Eckhard Quandt, Jan-Bernd Hövener
An intracranial aneurysm is an abnormal dilatation of the brain arteries with a 30-day mortality rate of 45% in the case of hemorrhagic stroke [1]. Therefore, it is vital to identify and treat aneurysms that may rupture. Today, different approaches are available to treat aneurysms [2]. A relatively new and successful method uses stand-alone braided flow diverter (FD) devices to reconstruct the vessel [3–5]. FDs were found to be particularly useful for treating aneurysms with a complex anatomy [6]. Despite numerous and often successful FDs applications, complications during and after FDs placement still occur, resulting in, e.g. a (delayed) aneurysm rupture [7,8], torsional collapse during deployment [9]. An occlusion of the aneurysm after the deployment of FD may occur via two main biological mechanisms: the formation of intra-aneurysmal thrombosis, caused by flow disruption, or the growth of endothelial cells on the struts of the device itself [10]. Here, the flow modifications as well as mechanical forces exerted on the vessels play an important role. Understanding these mechanisms is crucial to improve the treatment outcome of FDs. Various device properties (design and mechanical) may influence the biological mechanisms, thereby changing the clinical outcomes.
Braided stents and their impact in intracranial aneurysm treatment for distal locations: from flow diverters to low profile stents
Published in Expert Review of Medical Devices, 2019
Christina Iosif, Alessandra Biondi
Flow diverter stents represent a major breakthrough and a paradigm shift in the treatment of intracranial aneurysms, especially of those with complex configurations. Their emergence has shifted the interest from the aneurysm’s sac, which is in a way the symptom of complex hemodynamic and biological interactions- to the parent artery and thus the regional remodeling and healing. Low-profile, braided stents represent in a way less dense devices of a similar concept of sliding cells with very thin struts that provide to some extent flow diversion properties, without the disadvantages of high metal coverage in front of perforators and with the added benefit of delivery through thin microcatheters and dual-lumen balloons.