Cerebral Aneurysm – Future Directions PDF
Preview Cerebral Aneurysm – Future Directions
Cerebral Aneurysm – Future Directions Maksim Shapiro, MD Bernard and Irene Schwartz Interventional Neuroradiology Center NYU School of Medicine, New York City Credits and Acknowledgements • Peter Kim Nelson, MD • Tibor Becske, MD • Eytan Raz, MD • NIR Staff of NYU Langone Medical Center • NIR Staff of Bellevue HHC • Patients and Families of PUFS / PUFS CA Trial Disclosures • Maksim Shapiro, MD: Consultant and Pipeline Device Proctor for Medtronic, manufacturer of the Pipeline™ device Unmet Need Drives Innovation Philosophy -- endosaccular vs. endoluminal approach • Saccular – target aneurysm sac – balloons, coils, Onyx 500, Web, Luna, Medina, etc. • Luminal – target parent vessel – underlying vessel dysplasia – parent vessel occlusion, clipping, “endoluminal devices” a.k.a. flow diverters – Pipeline, Silk, Phenox, Surpass, Fred Surgical Timeline • Historical Timeline • 1933 – wrapping – Norman Dott • 1938 – clipping – Walter Dandy • 1970s – surgical microscope • 2002 -- ISAT • 2010s –open surgical decline 1. Dott NM. Intracranial aneurysms cerebral arterio-radiography and surgical treatment. Edinb Med J1933;40: 219-34 2. Dandy WE. Intracranial aneurysm of the internal carotid artery cured by operation. Ann Surg 1938;107: 654-9 3. Krayenbuhl HA, Yasargil MG, Flamm ES, et al. Microsurgical treatment of intracranial saccular aneurysms. J Neurosurg 1972;37: 678-86 Endovascular Timeline • 1971 Serbienko balloons • 1990 Guglielmi DC • 2002 ISAT • 2007 PITA trial – Pipeline • 2011 PUFS FDA Pipeline approval Molyneux AJ1, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005 Sep 3-9;366(9488):809-17. Nelson PK1, Lylyk P, Szikora I, Wetzel SG, Wanke I, Fiorella D. The pipeline embolization device for the intracranial treatment of aneurysms trial. AJNR Am J Neuroradiol. 2011 Jan;32(1):34-40. doi: 10.3174/ajnr.A2421. Epub 2010 Dec 9. Becske T1, Kallmes DF, Saatci I, McDougall CG, Szikora I, Lanzino G, Moran CJ, Woo HH, Lopes DK, Berez AL, Cher DJ, Siddiqui AH, Levy EI, Albuquerque FC, Fiorella DJ, Berentei Z, Marosfoi M, Cekirge SH, Nelson PK. Pipeline for uncoilable or failed aneurysms: results from a multicenter clinical trial. Radiology. 2013 Jun;267(3):858-68. doi: 10.1148/radiol.13120099. Epub 2013 Feb 15. Coil Timeline • 1990 GDC • 1994 Balloon Remodeling • 2002 Neuroform Device FDA HDE • 2005+ coated coils (PGLA) • 2014 LVIS, LVIS Jr • 1990-present: continued refinement in bare Platinum coil technology (maturity) Coil Strategies Balloon-assisted Coiling L. Pierota, C. Cognardb, L. Spellec and J. Moretc AJNR 2012 33: 12-15
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