Korean J Radiol.  2017 Oct;18(5):852-859. 10.3348/kjr.2017.18.5.852.

A Novel Flow Diverter (Tubridge) for the Treatment of Recurrent Aneurysms: A Single-Center Experience

• Zhang Y
• Huang QH
• Fang Y
• Yang P
• Xu Y
• Hong B
• Liu J

• KMID: 2427222
• DOI: http://doi.org/10.3348/kjr.2017.18.5.852

Abstract

OBJECTIVE
The Tubridge flow diverter (FD) is a novel device aimed at reconstructing the parent artery and occluding complex aneurysms. Retreatment of recurrent aneurysms using the FD is challenging. We report our initial experience in the repair of aneurysm recurrence with the FD.
MATERIALS AND METHODS
A database was reviewed prospectively, and 8 patients with 8 recurrent aneurysms (mean size, 16.7 mm) were identified. Four aneurysms had previously ruptured. The previous aneurysm treatment consisted of coiling in 1 aneurysm and single-stent-assisted coiling in 7 aneurysms. The procedural complications and clinical and angiographic outcomes were analyzed.
RESULTS
Six aneurysms were treated by using a single Tubridge FD alone, while the remaining 2 were treated with FD + coiling. The immediate results of the 8 aneurysms were that they all showed incomplete occlusion. Neither major ischemic nor hemorrhagic complications occurred; however, 1 patient experienced a vasospasm. Follow-up angiographies were available for 7 aneurysms; the mean follow-up was 16.9 months (7-36 months). Five aneurysms were completely occluded, whereas 2 had a residual neck. Severe asymptomatic stenosis of 1 parent artery of a vertebral artery dissecting aneurysm was found. All visible branches covered by the FD were patent. All patients were clinically assessed as having attained a favorable outcome (modified Rankin Scale score ≤ 2) at discharge and follow-up.
CONCLUSION
In selected patients, the Tubridge FD can provide a safe and efficient option for the retreatment of recurrent aneurysms. Nevertheless, attention should be paid to several technical points.

Keyword

Intracranial aneurysms; Flow diverter; Recurrent aneurysms

MeSH Terms

Adult
Angiography
Cerebral Arteries/diagnostic imaging
Embolization, Therapeutic/adverse effects/instrumentation/*methods
Female
Hemorrhage/etiology
Humans
Intracranial Aneurysm/*therapy
Ischemia/etiology
Male
Middle Aged
Recurrence
Treatment Outcome
Vasospasm, Intracranial/etiology

Figure

• 

  Fig. 1 Tubridge flow diverter is new type of flow diversion device developed by MicroPort Medical Company.It was designed with pore size of 0.040–0.050 mm2 at nominal diameter, aiming to provide high metal coverage (approximately 30.0 to 35.0 percent).

• 

  Fig. 2 An illustrated recurrent aneurysms treated by flow diverter.A. Left internal carotid artery three-dimensional reconstruction showing large ophthalmic segment aneurysm of approximately 20.4 mm. B. aneurysm was treated with Neuroform stent-assisted coiling, and immediate result showed residual sac. C. At 33-month follow-up, aneurysm was significantly recurrent (arrowhead). D, E. Cross-sectional images by DynaCT showing markers and morphology of prior stent (white arrows). F. Unsubtracted working projection showing FD implantation procedure. Three white arrows point to distal end, proximal end, and marker in middle of FD, respectively. G. Postoperative angiography revealing decreased filling of sac. And ophthalmic artery covered by FD was patent (black arrow). H. 11-month follow-up angiography revealing that aneurysm is completely occluded with ophthalmic artery being patent (arrowhead). FD = flow diverter

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