Can a self-expanding aneurysm stent be clipped? Emergency proximal control options for the vascular neurosurgeon.

MedStar author(s):
Citation: Neurosurgery. 68(4):1056-62, 2011 Apr.PMID: 21242822Institution: MedStar Washington Hospital CenterDepartment: RadiologyForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal ArticleSubject headings: *Aneurysm/su [Surgery] | *Endovascular Procedures/is [Instrumentation] | *Neurosurgical Procedures/is [Instrumentation] | *Physicians | *Stents | *Surgical Instruments | Emergency Medical Services/ma [Manpower] | Emergency Medical Services/mt [Methods] | Endovascular Procedures/mt [Methods] | Neurosurgical Procedures/mt [Methods] | Vascular Surgical Procedures/is [Instrumentation] | Vascular Surgical Procedures/ma [Manpower] | Vascular Surgical Procedures/mt [Methods]Year: 2011Local holdings: Available online from MWHC library: 1992 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0148-396X
Name of journal: NeurosurgeryAbstract: BACKGROUND: If a self-expanding stent has been placed during endovascular treatment of an aneurysm and subsequently an open aneurysm surgery becomes necessary in the same or an adjacent area, is it possible and safe to obtain proximal control by placing a temporary clip on the artery at a point where it contains the stent?CONCLUSION: The Neuroform(3) and Enterprise stents responded favorably to temporary clip application, returning to their original diameter after clip removal and showing no sign of permanent structural modification. The Pipeline flow-diverting stent, however, was irreversibly deformed by clip application. These data indicate that temporary clip application to certain stents is possible. Further in vivo study is required.METHODS: This is an in vitro flow model study using an accepted synthetic blood vessel substitute. The Neuroform(3) (Boston Scientific), Enterprise (Cordis/Codman), and Pipeline (ev3) stents were deployed within the flow model; temporary clips were applied; and angiographic measurements subsequently made.OBJECTIVE: To evaluate the effect of temporary clip application to 3 separate stent systems in an in vitro flow model with the stated hypothesis that clip application to these stents will result in permanent stent deformation.RESULTS: Two 4 x 30-mm Neuroform(3) stents, two 4.5 x 28-mm Enterprise stents, and two 3.75 x 20-mm Pipeline stents were successfully deployed and clipped repeatedly (4 iterations). Two- and 3-dimensional angiograms were obtained. After repeated clip occlusion, the Neuroform(3) and Enterprise stents returned to their original configuration and diameter. Clip application to both also resulted in immediate flow arrest. In contrast, initial clip application to the Pipeline stents did not result in flow arrest, but the second single clip application did. The Pipeline stents were also irreversibly deformed after the experimental protocol, with an average luminal diameter reduction of 26.85% (P < .05).All authors: Armonda RA, Bank WO, Bell RS, Kerber CW, Vo AHFiscal year: FY2011Digital Object Identifier: Date added to catalog: 2013-09-17
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 21242822 Available 21242822

Available online from MWHC library: 1992 - present, Available in print through MWHC library: 1999 - 2006

BACKGROUND: If a self-expanding stent has been placed during endovascular treatment of an aneurysm and subsequently an open aneurysm surgery becomes necessary in the same or an adjacent area, is it possible and safe to obtain proximal control by placing a temporary clip on the artery at a point where it contains the stent?

CONCLUSION: The Neuroform(3) and Enterprise stents responded favorably to temporary clip application, returning to their original diameter after clip removal and showing no sign of permanent structural modification. The Pipeline flow-diverting stent, however, was irreversibly deformed by clip application. These data indicate that temporary clip application to certain stents is possible. Further in vivo study is required.

METHODS: This is an in vitro flow model study using an accepted synthetic blood vessel substitute. The Neuroform(3) (Boston Scientific), Enterprise (Cordis/Codman), and Pipeline (ev3) stents were deployed within the flow model; temporary clips were applied; and angiographic measurements subsequently made.

OBJECTIVE: To evaluate the effect of temporary clip application to 3 separate stent systems in an in vitro flow model with the stated hypothesis that clip application to these stents will result in permanent stent deformation.

RESULTS: Two 4 x 30-mm Neuroform(3) stents, two 4.5 x 28-mm Enterprise stents, and two 3.75 x 20-mm Pipeline stents were successfully deployed and clipped repeatedly (4 iterations). Two- and 3-dimensional angiograms were obtained. After repeated clip occlusion, the Neuroform(3) and Enterprise stents returned to their original configuration and diameter. Clip application to both also resulted in immediate flow arrest. In contrast, initial clip application to the Pipeline stents did not result in flow arrest, but the second single clip application did. The Pipeline stents were also irreversibly deformed after the experimental protocol, with an average luminal diameter reduction of 26.85% (P < .05).

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