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Felipe C Albuquerque - One of the best experts on this subject based on the ideXlab platform.
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use of the apollo detachable tip Microcatheter for endovascular embolization of arteriovenous malformations and arteriovenous fistulas
Journal of Neurosurgery, 2019Co-Authors: Bruno C Flores, Gregory M. Weiner, Brian T. Jankowitz, Alfred P See, Andrew F Ducruet, Felipe C AlbuquerqueAbstract:OBJECTIVELiquid embolic agents have revolutionized endovascular management of arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs). Nonetheless, since 2005, the US FDA has received more than 100 reports of Microcatheter breakage or entrapment related to Onyx embolization, including 9 deaths. In 2014, the Apollo detachable-tip Microcatheter became the first of its kind available in the US. Since then, few reports on its safety have been published.METHODSThe authors conducted a retrospective review of endovascular cases by searching the patient databases at 2 tertiary cerebrovascular centers (Barrow Neurological Institute and University of Pittsburgh Medical Center). Patients who underwent endovascular embolization of an AVM or AVF using the Apollo Microcatheter were identified. Patient demographics and lesion characteristics were collected. The authors analyzed Apollo-specific endovascular variables, such as number of Microcatheterizations, sessions, and pedicles embolized; Microcatheter ti...
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monorail snare technique for the recovery of stretched platinum coils technical case report
Neurosurgery, 2005Co-Authors: David Fiorella, Felipe C Albuquerque, Vivek R Deshmukh, Cameron G McdougallAbstract:OBJECTIVE AND IMPORTANCE: Coil stretching represents a potentially hazardous technical complication not infrequently encountered during the embolization of cerebral aneurysms. Often, the stretched coil cannot be advanced into the aneurysm or withdrawn intact. The operator is then forced to attempt to retract the damaged coil, which may result in coil breakage, leaving behind a significant length of potentially thrombogenic stretched coil material within the parent vessel. To overcome this problem, we devised a technique to snare the distal, unstretched, intact portion of the platinum coil by use of the indwelling Microcatheter and stretched portion of the coil as a monorail guide. CLINICAL PRESENTATION: We have used this technique successfully in four patients to snare coils stretched during cerebral aneurysm embolization. Three of these patients were undergoing Neuroform (Boston Scientific/Target, Fremont, CA) stent-supported coil embolization of unruptured aneurysms. In all cases, the snare was advanced easily to the targeted site for coil engagement by use of the Microcatheter as a monorail guide. Once the intact distal segment of the coil was ensnared, coil removal was uneventful, with no disturbance of the remainder of the indwelling coil pack or Neuroform stent. TECHNIQUE A 2-mm Amplatz Goose Neck microsnare (Microvena Corp., White Bear Lake, MN) was placed through a Prowler-14 Microcatheter (Cordis Corp., Miami, FL). The hub of the indwelling SL-10 Microcatheter (Boston Scientific, Natick, MA) was then cut away with a scalpel, leaving the coil pusher wire intact, and removed. The open 2-mm snare was then advanced over the outside of the coil pusher wire and Microcatheter. The snare and Prowler-14 Microcatheter were then advanced into the guiding catheter (6- or 7-French) as a unit over the indwelling SL-10 Microcatheter. By use of the SL-10 Microcatheter and coil as a monorail guide, the snare was advanced over and beyond the Microcatheter and the stretched portion of the coil until the snare was in position to engage the distal unstretched coil. At this point, the snare was then closed around the intact portion of the coil, and the Microcatheters, snare, and coil were removed as a unit. CONCLUSION: The monorail snare technique represents a fast, safe, and easy method by which a stretched coil can be removed.
Bailing Chen - One of the best experts on this subject based on the ideXlab platform.
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Microcatheter first pass effect predicts acute intracranial artery atherosclerotic disease related occlusion
Neurosurgery, 2019Co-Authors: Wenhuo Chen, Meifang Zhang, Alai Zhan, Yuehong Chen, Yanchuan Shi, Bailing ChenAbstract:BACKGROUND The differentiation between intracranial atherosclerotic stenosis (ICAS) and intracranial embolism as the immediate cause of acute ischemic stroke requiring endovascular therapy is important but challenging. In cases of ICAS, we often observe a phenomenon we call the Microcatheter "first-pass effect," which is temporary blood flow through the occluded intracranial artery when the angiographic Microcatheter is initially advanced through the site of total occlusion and immediately retrieved proximally. OBJECTIVE To evaluate whether this Microcatheter first-pass effect can be used to differentiate ICAS from intracranial embolism. METHODS A total of 61 patients with acute ischemic stroke resulting from large intracranial artery occlusion and in whom recanalization was achieved by endovascular treatment were included in the study. The Microcatheter first-pass effect was tested in these patients. The sensitivity, specificity, positive predictive values (PPV), and accuracy of the Microcatheter first-pass effect for prediction of ICAS were assessed. RESULTS The Microcatheter first-pass effect was more frequently observed in patients with ICAS than in those with intracranial embolism (90.9% vs 12.8%, P < .001). For identifying ICAS, sensitivity, specificity, PPV, and accuracy of the Microcatheter first-pass effect were 90.9%, 87.2%, 80.0%, 88.5%, respectively. CONCLUSION The sensitivity and PPV of the Microcatheter first-pass effect are high for prediction of ICAS in patients with acute symptoms.
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Microcatheter “First-Pass Effect” Predicts Acute Intracranial Artery Atherosclerotic Disease-Related Occlusion
Neurosurgery, 2018Co-Authors: Wenhuo Chen, Meifang Zhang, Alai Zhan, Yuehong Chen, Yanchuan Shi, Bailing ChenAbstract:BACKGROUND The differentiation between intracranial atherosclerotic stenosis (ICAS) and intracranial embolism as the immediate cause of acute ischemic stroke requiring endovascular therapy is important but challenging. In cases of ICAS, we often observe a phenomenon we call the Microcatheter "first-pass effect," which is temporary blood flow through the occluded intracranial artery when the angiographic Microcatheter is initially advanced through the site of total occlusion and immediately retrieved proximally. OBJECTIVE To evaluate whether this Microcatheter first-pass effect can be used to differentiate ICAS from intracranial embolism. METHODS A total of 61 patients with acute ischemic stroke resulting from large intracranial artery occlusion and in whom recanalization was achieved by endovascular treatment were included in the study. The Microcatheter first-pass effect was tested in these patients. The sensitivity, specificity, positive predictive values (PPV), and accuracy of the Microcatheter first-pass effect for prediction of ICAS were assessed. RESULTS The Microcatheter first-pass effect was more frequently observed in patients with ICAS than in those with intracranial embolism (90.9% vs 12.8%, P
David Fiorella - One of the best experts on this subject based on the ideXlab platform.
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monorail snare technique for the retrieval of an adherent Microcatheter from an onyx cast technical case report
Neurosurgery, 2008Co-Authors: M Kelly, Raymond D Turner, Vivek Gonugunta, Peter A Rasmussen, Henry H Woo, David FiorellaAbstract:OBJECTIVE: Microcatheters retained after Onyx (eV3 Neurovascular, Inc., Irvine, CA) embolization represent a potential source of thromboembolic complications. Catheter retention depends on the degree of Onyx reflux and vessel tortuosity. To overcome this problem, we have adapted a previously described monorail snare technique for stretched coils to remove an adherent Microcatheter from the occipital artery during Onyx embolization of a dural arteriovenous fistula. CLINICAL PRESENTATION: We used this technique successfully in a 62-year-old man with a posterior fossa dural arteriovenous fistula. An Echelon-10 Microcatheter (eV3 Neurovascular, Inc.) system became adherent in the right occipital artery because of reflux and vessel tortuosity. Significant stretching of the Microcatheter was observed during attempted removal. INTERVENTION: A 2-mm Amplatz Goose Neck microsnare (Microvena Corp., White Bear Lake, MN) was placed through a Rapid Transit Microcatheter (Cordis Corp., Miami, FL). The hub of the indwelling Echelon Microcatheter was cut off and the snare advanced over the outside of the Microcatheter. The snare and Rapid Transit Microcatheter were then advanced into the guiding catheter (6-French) as a unit over the indwelling Echelon Microcatheter. Using the adherent Echelon as a "monorail" guide, the snare and Rapid Transit Microcatheter were advanced distally into the occipital artery and the snare was retracted to engage the Microcatheter. The Microcatheters and snare were then easily removed because of the second vector of force placed by the snare system on the adherent Microcatheter very close to the point of adherence. CONCLUSION: The monorail snare technique represents a simple and safe way to remove an adherent Microcatheter from an Onyx cast during the embolization of dural arteriovenous fistulas. Prospective knowledge of this technique will facilitate more aggressive embolization without the reservation that a retained Microcatheter could require surgical removal or anticoagulation.
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MONORAIL SNARE TECHNIQUE FOR ADHERENT Microcatheter : TECHNICAL CASE REPORT. Commentaries
Neurosurgery, 2008Co-Authors: M Kelly, Raymond D Turner, Vivek Gonugunta, Peter A Rasmussen, Henry H Woo, David Fiorella, Robert H. Rosenwasser, Charles J. Prestigiacomo, Rocco A. Armonda, Rodney N. SamuelsonAbstract:OBJECTIVE: Microcatheters retained after Onyx (eV3 Neurovascular, Inc., Irvine, CA) embolization represent a potential source of thromboembolic complications. Catheter retention depends on the degree of Onyx reflux and vessel tortuosity. To overcome this problem, we have adapted a previously described monorail snare technique for stretched coils to remove an adherent Microcatheter from the occipital artery during Onyx embolization of a dural arteriovenous fistula. CLINICAL PRESENTATION: We used this technique successfully in a 62-year-old man with a posterior fossa dural arteriovenous fistula. An Echelon-10 Microcatheter (eV3 Neurovascular, Inc.) system became adherent in the right occipital artery because of reflux and vessel tortuosity. Significant stretching of the Microcatheter was observed during attempted removal. INTERVENTION: A 2-mm Amplatz Goose Neck microsnare (Microvena Corp., White Bear Lake, MN) was placed through a Rapid Transit Microcatheter (Cordis Corp., Miami, FL). The hub of the indwelling Echelon Microcatheter was cutoff and the snare advanced over the outside of the Microcatheter. The snare and Rapid Transit Microcatheter were then advanced into the guiding catheter (6-French) as a unit over the indwelling Echelon Microcatheter. Using the adherent Echelon as a "monorail" guide, the snare and RapidTransit Microcatheter were advanced distal ly into the occipital artery and the snare was retracted to engage the Microcatheter. The Microcatheters and snare were then easily removed because of the second vector of force placed by the snare system on the adherent Microcatheter very close to the point of adherence. CONCLUSION: The monorail snare technique represents a simple and safe way to remove an adherent Microcatheter from an Onyx cast during the embolization of dural arteriovenous fistulas. Prospective knowledge of this technique will facilitate more aggressive embolization without the reservation that a retained Microcatheter could require surgical removal or anticoagulation.
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monorail snare technique for the recovery of stretched platinum coils technical case report
Neurosurgery, 2005Co-Authors: David Fiorella, Felipe C Albuquerque, Vivek R Deshmukh, Cameron G McdougallAbstract:OBJECTIVE AND IMPORTANCE: Coil stretching represents a potentially hazardous technical complication not infrequently encountered during the embolization of cerebral aneurysms. Often, the stretched coil cannot be advanced into the aneurysm or withdrawn intact. The operator is then forced to attempt to retract the damaged coil, which may result in coil breakage, leaving behind a significant length of potentially thrombogenic stretched coil material within the parent vessel. To overcome this problem, we devised a technique to snare the distal, unstretched, intact portion of the platinum coil by use of the indwelling Microcatheter and stretched portion of the coil as a monorail guide. CLINICAL PRESENTATION: We have used this technique successfully in four patients to snare coils stretched during cerebral aneurysm embolization. Three of these patients were undergoing Neuroform (Boston Scientific/Target, Fremont, CA) stent-supported coil embolization of unruptured aneurysms. In all cases, the snare was advanced easily to the targeted site for coil engagement by use of the Microcatheter as a monorail guide. Once the intact distal segment of the coil was ensnared, coil removal was uneventful, with no disturbance of the remainder of the indwelling coil pack or Neuroform stent. TECHNIQUE A 2-mm Amplatz Goose Neck microsnare (Microvena Corp., White Bear Lake, MN) was placed through a Prowler-14 Microcatheter (Cordis Corp., Miami, FL). The hub of the indwelling SL-10 Microcatheter (Boston Scientific, Natick, MA) was then cut away with a scalpel, leaving the coil pusher wire intact, and removed. The open 2-mm snare was then advanced over the outside of the coil pusher wire and Microcatheter. The snare and Prowler-14 Microcatheter were then advanced into the guiding catheter (6- or 7-French) as a unit over the indwelling SL-10 Microcatheter. By use of the SL-10 Microcatheter and coil as a monorail guide, the snare was advanced over and beyond the Microcatheter and the stretched portion of the coil until the snare was in position to engage the distal unstretched coil. At this point, the snare was then closed around the intact portion of the coil, and the Microcatheters, snare, and coil were removed as a unit. CONCLUSION: The monorail snare technique represents a fast, safe, and easy method by which a stretched coil can be removed.
Wenhuo Chen - One of the best experts on this subject based on the ideXlab platform.
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Microcatheter first pass effect predicts acute intracranial artery atherosclerotic disease related occlusion
Neurosurgery, 2019Co-Authors: Wenhuo Chen, Meifang Zhang, Alai Zhan, Yuehong Chen, Yanchuan Shi, Bailing ChenAbstract:BACKGROUND The differentiation between intracranial atherosclerotic stenosis (ICAS) and intracranial embolism as the immediate cause of acute ischemic stroke requiring endovascular therapy is important but challenging. In cases of ICAS, we often observe a phenomenon we call the Microcatheter "first-pass effect," which is temporary blood flow through the occluded intracranial artery when the angiographic Microcatheter is initially advanced through the site of total occlusion and immediately retrieved proximally. OBJECTIVE To evaluate whether this Microcatheter first-pass effect can be used to differentiate ICAS from intracranial embolism. METHODS A total of 61 patients with acute ischemic stroke resulting from large intracranial artery occlusion and in whom recanalization was achieved by endovascular treatment were included in the study. The Microcatheter first-pass effect was tested in these patients. The sensitivity, specificity, positive predictive values (PPV), and accuracy of the Microcatheter first-pass effect for prediction of ICAS were assessed. RESULTS The Microcatheter first-pass effect was more frequently observed in patients with ICAS than in those with intracranial embolism (90.9% vs 12.8%, P < .001). For identifying ICAS, sensitivity, specificity, PPV, and accuracy of the Microcatheter first-pass effect were 90.9%, 87.2%, 80.0%, 88.5%, respectively. CONCLUSION The sensitivity and PPV of the Microcatheter first-pass effect are high for prediction of ICAS in patients with acute symptoms.
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Microcatheter “First-Pass Effect” Predicts Acute Intracranial Artery Atherosclerotic Disease-Related Occlusion
Neurosurgery, 2018Co-Authors: Wenhuo Chen, Meifang Zhang, Alai Zhan, Yuehong Chen, Yanchuan Shi, Bailing ChenAbstract:BACKGROUND The differentiation between intracranial atherosclerotic stenosis (ICAS) and intracranial embolism as the immediate cause of acute ischemic stroke requiring endovascular therapy is important but challenging. In cases of ICAS, we often observe a phenomenon we call the Microcatheter "first-pass effect," which is temporary blood flow through the occluded intracranial artery when the angiographic Microcatheter is initially advanced through the site of total occlusion and immediately retrieved proximally. OBJECTIVE To evaluate whether this Microcatheter first-pass effect can be used to differentiate ICAS from intracranial embolism. METHODS A total of 61 patients with acute ischemic stroke resulting from large intracranial artery occlusion and in whom recanalization was achieved by endovascular treatment were included in the study. The Microcatheter first-pass effect was tested in these patients. The sensitivity, specificity, positive predictive values (PPV), and accuracy of the Microcatheter first-pass effect for prediction of ICAS were assessed. RESULTS The Microcatheter first-pass effect was more frequently observed in patients with ICAS than in those with intracranial embolism (90.9% vs 12.8%, P
Avery J. Evans - One of the best experts on this subject based on the ideXlab platform.
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single center experience with a dual Microcatheter technique for the endovascular treatment of wide necked aneurysms
Journal of Neurosurgery, 2014Co-Authors: Christopher R Durst, Mary E. Jensen, Robert M Starke, John R Gaughen, Scott R Geraghty, Derek K Kreitel, Ricky Medel, Nicholas Demartini, Kenneth C Liu, Avery J. EvansAbstract:Object The endovascular treatment of wide-necked aneurysms can be technically challenging due to distal coil migration or impingement of the parent vessel. In this paper, the authors illustrate an alternative method for the treatment of wide-necked intracranial aneurysms using a dual Microcatheter technique. Methods The authors' first 100 consecutive patients who underwent coil embolization of a wide-necked aneurysm using a dual Microcatheter technique are reported. With this technique, 2 Microcatheters are used to introduce coils into the aneurysm. The coils are deployed either sequentially or concurrently to form a stable construct and prevent coil herniation or migration. Angiographic and clinical outcomes are reported. Results The technical success rate of the dual Microcatheter technique is 91% with a morbidity and mortality of 1% and 2%, respectively. Clinical outcomes are excellent with 93% of patients demonstrating a modified Rankin Scale score of 0–2 at long-term follow-up regardless of their sco...
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Thrombogenicity of hydrophilic and nonhydrophilic Microcatheters and guiding catheters
American Journal of Neuroradiology, 1997Co-Authors: David F. Kallmes, J. K. Mcgraw, Avery J. Evans, John M. Mathis, R W Hergenrother, Mary E. Jensen, Harry J. Cloft, Maria Beatriz S. Lopes, Jacques E. DionAbstract:PURPOSE To assess in a swine model the in vivo thrombogenicity of various Microcatheters and guiding catheters as a function of catheter material, catheter coating, and duration of implantation. METHODS Microcatheters (Tracker 18 and Fastracker 18, Target Therapeutics, Fremont, Calif; Magic 1.8, Balt, Montmorency, France; and Transit, Cordis Endovascular Systems, Miami Lakes, Fla) were placed through 6F guiding catheters (Fasguide, Target Therapeutics, and Envoy, Cordis Endovascular Systems) into the common carotid arteries of swine for 30 minutes (short term), 90 minutes (medium term), and 35 days (long term). Guiding catheters were implanted for 5 hours. At the end of the implantation periods the catheters were retracted and fixed for scanning electron microscopy. RESULTS The surface of the Fastracker Microcatheter was devoid of debris after both short- and medium-term implantation. The Tracker Microcatheter had minimal accumulation of cellular elements whereas the Transit Microcatheter showed moderate accumulation of nondeformed red blood cells. Neither the Tracker nor the Transit Microcatheter showed evidence of increasing debris accumulation after medium-term implantation as compared with short-term implantation. The Magic Microcatheter was coated with gross thrombus after both short- and medium-term implantation. The Fasguide guiding catheter was nearly devoid of debris, while the Envoy guiding catheter had moderate thrombus formation. Long-term implantation of the Fastracker Microcatheter was well tolerated whereas that of the Transit catheter resulted in vessel occlusion. CONCLUSIONS Hydrophilic Microcatheters and guiding catheters are less thrombogenic than their nonhydrophilic counterparts, but not all hydrophilic coatings are equally hypothrombogenic. Degree of thrombogenicity depends on catheter material rather than surface morphology. Medium-term implantation did not yield increasing thrombus formation relative to short-term implantation.