The Barrel Vascular Reconstruction Device : A Retrospective, Observational Multicentric Study

Overview

Journal Clin Neuroradiol

Specialties Neurology
Radiology

Date 2018 Jan 11

PMID 29318353

Citations 10

Authors

C Kabbasch

A Mpotsaris

V Maus

J C Altenbernd

C Loehr

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: The Barrel device is an electrolytically detachable laser cut, closed-cell microstent that is used for neck reconstruction in wide-necked bifurcation and branching aneurysms to support coiling. The key feature is a barrel section that herniates over the aneurysmal ostium. The objective was to evaluate the safety, feasibility and the immediate and mid-term occlusion results of this new device.

Material And Methods: The databases of two tertiary care centers were screened for all Barrel-based stent-assisted intracranial coil embolization of wide-necked aneurysms between June 2015 and September 2016. Case files and imaging data were retrospectively analyzed for angiographic and clinical outcome parameters, including immediate and mid-term modified Raymond-Roy aneurysm occlusion classification (RROC) rates and procedural complications.

Results: A total of 21 patients comprising 21 intracranial aneurysms (20 unruptured, 1 ruptured) were treated with the Barrel device and additional coiling of the aneurysm sac. All aneurysms were wide-necked, saccular bifurcation aneurysms defined by a dome/neck ratio ≤2. Immediate complete occlusion (RROC1) was observed in 19/21 (90%). An intra-interventional in-stent thrombus formation in two cases (10%) was medically resolved without neurological sequelae. A single case of symptomatic in-stent stenosis (5%) was cleared by balloon angioplasty. Follow-up (FU) was available in 20/21 cases (95%) after a median of 282 days (range: 17-591 days). At follow-up 19/20 aneurysms (95%) were completely occluded (RROC1).

Conclusion: The Barrel device showed a satisfactory safety profile and a promising rate of immediate and mid-term complete aneurysm occlusion for stent-assisted coil embolization of wide-necked intracranial bifurcation aneurysms, warranting further investigation of the device.

Citing Articles

Systematic Review and Meta-Analysis of Endovascular Therapy Effectiveness for Unruptured Saccular Intracranial Aneurysms.

Pineda-Castillo S, Jones E, Laurence K, Thoendel L, Cabaniss T, Zhao Y Stroke Vasc Interv Neurol. 2024; 4(2).

PMID: 38846323 PMC: 11152505. DOI: 10.1161/SVIN.123.001118.

Endovascular Treatment of Wide-Neck Bifurcation Aneurysm: Recent Trends in Coil Embolization with Adjunctive Technique.

Haryu S, Sakata H, Matsumoto Y, Niizuma K, Endo H J Neuroendovasc Ther. 2024; 18(3):75-83.

PMID: 38559450 PMC: 10973563. DOI: 10.5797/jnet.ra.2023-0072.

The Management of Intracranial Aneurysms: Current Trends and Future Directions.

Deshmukh A, Priola S, Katsanos A, Scalia G, Costa Alves A, Srivastava A Neurol Int. 2024; 16(1):74-94.

PMID: 38251053 PMC: 10801587. DOI: 10.3390/neurolint16010005.

Endovascular treatment of middle cerebral artery aneurysms: current status and future prospects.

Zhou Z, Lan W, Yu J Front Neurol. 2023; 14:1239199.

PMID: 38033773 PMC: 10684741. DOI: 10.3389/fneur.2023.1239199.

Treatment of unruptured middle cerebral artery aneurysms: Systematic review in an attempt to perform a network meta-analysis.

Arrese I, Garcia-Garcia S, Cepeda S, Sarabia R Front Surg. 2022; 9:1005602.

PMID: 36248366 PMC: 9554213. DOI: 10.3389/fsurg.2022.1005602.

References

Lowe H, Oesterle S, Khachigian L . Coronary in-stent restenosis: current status and future strategies. J Am Coll Cardiol. 2002; 39(2):183-93. DOI: 10.1016/s0735-1097(01)01742-9. View

Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J . International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet. 2002; 360(9342):1267-74. DOI: 10.1016/s0140-6736(02)11314-6. View

Benitez R, Silva M, Klem J, Veznedaroglu E, Rosenwasser R . Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils. Neurosurgery. 2004; 54(6):1359-67. DOI: 10.1227/01.neu.0000124484.87635.cd. View

Biondi A, Janardhan V, Katz J, Salvaggio K, Riina H, Gobin Y . Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and midterm follow-up. Neurosurgery. 2007; 61(3):460-8. DOI: 10.1227/01.NEU.0000290890.62201.A9. View

Alshekhlee A, Mehta S, Edgell R, Vora N, Feen E, Mohammadi A . Hospital mortality and complications of electively clipped or coiled unruptured intracranial aneurysm. Stroke. 2010; 41(7):1471-6. DOI: 10.1161/STROKEAHA.110.580647. View

Brinjikji W, Rabinstein A, Nasr D, Lanzino G, Kallmes D, Cloft H . Better outcomes with treatment by coiling relative to clipping of unruptured intracranial aneurysms in the United States, 2001-2008. AJNR Am J Neuroradiol. 2011; 32(6):1071-5. PMC: 8013132. DOI: 10.3174/ajnr.A2453. View

Cognard C, Pierot L, Anxionnat R, Ricolfi F . Results of embolization used as the first treatment choice in a consecutive nonselected population of ruptured aneurysms: clinical results of the Clarity GDC study. Neurosurgery. 2011; 69(4):837-41. DOI: 10.1227/NEU.0b013e3182257b30. View

Shapiro M, Becske T, Sahlein D, Babb J, Nelson P . Stent-supported aneurysm coiling: a literature survey of treatment and follow-up. AJNR Am J Neuroradiol. 2011; 33(1):159-63. PMC: 7966171. DOI: 10.3174/ajnr.A2719. View

Rezek I, Lingineni R, Sneade M, Molyneux A, Fox A, Kallmes D . Differences in the angiographic evaluation of coiled cerebral aneurysms between a core laboratory reader and operators: results of the Cerecyte Coil Trial. AJNR Am J Neuroradiol. 2013; 35(1):124-7. PMC: 7966467. DOI: 10.3174/ajnr.A3623. View

10.

Hong Y, Wang Y, Deng Z, Wu Q, Zhang J . Stent-assisted coiling versus coiling in treatment of intracranial aneurysm: a systematic review and meta-analysis. PLoS One. 2014; 9(1):e82311. PMC: 3893071. DOI: 10.1371/journal.pone.0082311. View

11.

Piotin M, Blanc R . Balloons and stents in the endovascular treatment of cerebral aneurysms: vascular anatomy remodeled. Front Neurol. 2014; 5:41. PMC: 3986530. DOI: 10.3389/fneur.2014.00041. View

12.

Jeon P, Kim B, Kim D, Kim D, Park K . Y-configuration double-stent-assisted coiling using two closed-cell stents for wide-neck basilar tip aneurysms. Acta Neurochir (Wien). 2014; 156(9):1677-86. DOI: 10.1007/s00701-014-2163-0. View

13.

Bartolini B, Blanc R, Pistocchi S, Redjem H, Piotin M . "Y" and "X" stent-assisted coiling of complex and wide-neck intracranial bifurcation aneurysms. AJNR Am J Neuroradiol. 2014; 35(11):2153-8. PMC: 7965174. DOI: 10.3174/ajnr.A4060. View

14.

Ko J, Han I, Cho W, Choi B, Cha S, Choi C . Crossing Y-stent technique with dual open-cell stents for coiling of wide-necked bifurcation aneurysms. Clin Neurol Neurosurg. 2015; 132:54-60. DOI: 10.1016/j.clineuro.2015.02.002. View

15.

Brassel F, Melber K, Schlunz-Hendann M, Meila D . Kissing-Y stenting for endovascular treatment of complex wide necked bifurcation aneurysms using Acandis Acclino stents: results and literature review. J Neurointerv Surg. 2015; 8(4):386-95. DOI: 10.1136/neurintsurg-2015-011691. View

16.

Henkes H, Weber W . The Past, Present and Future of Endovascular Aneurysm Treatment. Clin Neuroradiol. 2015; 25 Suppl 2:317-24. DOI: 10.1007/s00062-015-0403-1. View

17.

Spetzler R, McDougall C, Zabramski J, Albuquerque F, Hills N, Russin J . The Barrow Ruptured Aneurysm Trial: 6-year results. J Neurosurg. 2015; 123(3):609-17. DOI: 10.3171/2014.9.JNS141749. View

18.

Kim Y, Lee S, Yeom J, Yoon C, Baik S . Angiographic findings of in-stent intimal hyperplasia after stent-assisted coil embolization: are they permanent findings?. J Neurosurg. 2015; 124(2):328-33. DOI: 10.3171/2015.2.JNS142557. View

19.

Mukherjee S, Chandran A, Gopinathan A, Putharan M, Goddard T, Eldridge P . PulseRider-assisted treatment of wide-necked intracranial bifurcation aneurysms: safety and feasibility study. J Neurosurg. 2016; 127(1):61-68. DOI: 10.3171/2016.2.JNS152334. View

20.

Muhl-Benninghaus R, Simgen A, Reith W, Yilmaz U . The Barrel stent: new treatment option for stent-assisted coiling of wide-necked bifurcation aneurysms-results of a single-center study. J Neurointerv Surg. 2016; 9(12):1219-1222. DOI: 10.1136/neurintsurg-2016-012718. View