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- Hirsch, Joshua A., et al.
(författare)
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Midterm clinical experience with a complex-shaped detachable platinum coil system for the treatment of cerebral aneurysms: Trufill DCS Orbit detachable coil system registry interim results
- 2007
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Ingår i: Journal of Vascular and Interventional Radiology. - : Elsevier BV. - 1051-0443. ; 18:12, s. 1487-1494
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To report an interim analysis of the registry data and evaluate the performance of Trufill DCS Orbit coils in terms of the stability of initial aneurysmal occlusion. MATERIALS AND METHODS: From May 1, 2004, to February 1, 2006, 291 patients with ruptured or unruptured aneurysms were enrolled in a multiple-center global registry from 37 centers in the United States, Europe, and Latin America to be treated via endovascular embolization with Trufill DCS Orbit detachable platinum coils. Acute and long-term anatomic and clinical data were collected and evaluated. RESULTS: Initially, complete obliteration was reported in 187 of 300 treated aneurysms (62.3%) for which data were available; one treated aneurysm had no initial occlusion data. At follow-up (<= 1 year), 99 aneurysms were assessed. For 56 aneurysms with initial complete obliteration, 49 (87.5%) remained stable. The overall grade of occlusion of 99 aneurysms remained stable or improved in 81 cases (81.8%). Recanalization was seen in 16.2% of aneurysms (15 cases of coil compaction and one case of aneurysm growth); two aneurysms (2.0%) had coil migration. Five aneurysms (5.1%) underwent repeat treatment. CONCLUSIONS: The use of Trufill DCS Orbit coils for the endovascular occlusion of aneurysms allowed a favorable rate of initial complete obliteration, high packing density, and aneurysmal stability at follow-up as long as 1 year. Longer-term follow-up is needed to determine the long-term stability of aneurysmal occlusion.
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| 2. |
- Ospel, Johanna M., et al.
(författare)
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What is a Challenging Clot? : A DELPHI Consensus Statement from the CLOTS 7.0 Summit
- 2023
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Ingår i: Clinical Neuroradiology. - 1869-1439 .- 1869-1447. ; 33:4, s. 1007-1016
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Tidskriftsartikel (refereegranskat)abstract
- Background: Predicting a challenging clot when performing mechanical thrombectomy in acute stroke can be difficult. One reason for this difficulty is a lack of agreement on how to precisely define these clots. We explored the opinions of stroke thrombectomy and clot research experts regarding challenging clots, defined as difficult to recanalize clots by endovascular approaches, and clot/patient features that may be indicative of such clots. Methods: A modified DELPHI technique was used before and during the CLOTS 7.0 Summit, which included experts in thrombectomy and clot research from different specialties. The first round included open-ended questions and the second and final rounds each consisted of 30 closed-ended questions, 29 on various clinical and clot features, and 1 on number of passes before switching techniques. Consensus was defined as agreement ≥ 50%. Features with consensus and rated ≥ 3 out of 4 on the certainty scale were included in the definition of a challenging clot. Results: Three DELPHI rounds were performed. Panelists achieved consensus on 16/30 questions, of which 8 were rated 3 or 4 on the certainty scale, namely white-colored clots (mean certainty score 3.1), calcified clots under histology (3.7) and imaging (3.7), stiff clots (3.0), sticky/adherent clots (3.1), hard clots (3.1), difficult to pass clots (3.1) and clots that are resistant to pulling (3.0). Most panelists considered switching endovascular treatment (EVT) techniques after 2–3 unsuccessful attempts. Conclusion: This DELPHI consensus identified 8 distinct features of a challenging clot. The varying degree of certainty amongst the panelists emphasizes the need for more pragmatic studies to enable accurate a priori identification of such occlusions prior to EVT.
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