Detailed imaging (CT, MRI, angiography) is used in pre-procedural evaluation to evaluate the size, location, and vascular anatomy of aneurysms. To lower the risk of thromboembolism, dual antiplatelet therapy (aspirin and clopidogrel) is initiated several days before the surgery.
The femoral artery is typically used to gain vascular access when under general anesthesia. In the parent artery that supplies the aneurysm, a guiding catheter is inserted proximally.
In order to deliver the flow-diverting stent device, a microcatheter is advanced distal to the aneurysm neck over a microguidewire.
The targeted landing zones and parent vascular diameter determined by 3D angiography are used to determine the size of the flow diverter stent (FDS).
Unsheathing the stent from the microcatheter allows the flow diverter to be carefully and slowly deployed over the aneurysm neck, guaranteeing full wall apposition without overly obscuring vital branch or perforator arteries.
Unsheathing the stent from the microcatheter allows the flow diverter to be carefully and slowly deployed over the aneurysm neck, guaranteeing full wall apposition without overly obscuring vital branch or perforator arteries.
Coils may occasionally be inserted inside the aneurysm sac to hasten thrombosis and offer instant protection, particularly in situations of big or ruptured aneurysms.
Angiography is used to verify the location of the device, the apposition of the vascular wall, and the change in flow across the aneurysm. Proper placement is confirmed by many angiographic views.
Access site hemostasis is ensured, and all catheters and wires are gently removed.
To avoid stent thrombosis, dual antiplatelet therapy must be continued. Patients' neurological condition and any problems, such as bleeding or artery obstruction, are tracked.
Aneurysm thrombosis, vascular remodeling, and flow diverter patency are evaluated by routine imaging follow-up (angiography, MRI) every six months to a year.
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Large, enormous, or wide-necked cerebral aneurysms, particularly those that are challenging to clip or coil.
Fusiform, dissecting, blister-like, and bleeding blister-like aneurysms that are difficult to cure technically or entail a significant risk.
Recurrent aneurysms following prior surgical or coiling procedures.
Sidewall aneurysms that can be placed with a flow diverter are usually found in the internal carotid artery or other large vessels.
Because of the size of the vessel and the involvement of branches, choose distal or bifurcation aneurysms with greater caution.
Following stent implantation, patients must be able to tolerate dual antiplatelet medication.
Situations in which both aneurysm occlusion and parent vessel repair are desired.
Effective for complicated aneurysms that are challenging to treat with conventional clipping or coiling, such as massive, huge, wide-neck, fusiform, blister, and previously treated recurrent aneurysms.
By rerouting blood flow away from the aneurysm sac while maintaining the parent vessel and other branches, it encourages progressive aneurysm thrombosis.
Provides an endovascular scaffold that promotes neointimal growth throughout time, facilitating vessel wall regeneration.
Achieves high rates of total aneurysm occlusion; recent investigations have indicated occlusion rates of 70–80%.
Procedure duration and complications have decreased due to improved safety profiles brought about by technological developments and operator expertise.
Enables the treatment of aneurysms in distal vessels as well as anterior and posterior circulations.
Lowers the chance of aneurysm rupture following therapy because thrombosis occurs gradually as opposed to suddenly.
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