Neurointervention.  2018 Sep;13(2):133-137. 10.5469/neuroint.2018.00934.

Internal Carotid Artery Reconstruction with a “Mega Flow Diverter”: First Experience with the 6×50 mm DERIVO Embolization Device

• Martínez-Galdámez M
• Rodríguez C
• Hermosín
• Crespo-Vallejo E
• Monedero G
• Chaviano J
• Zheng B

• KMID: 2424064
• DOI: http://doi.org/10.5469/neuroint.2018.00934

Abstract

Endoluminal reconstruction with a flow diverter device has emerged as a viable and often preferable alternative to traditional techniques for the treatment of intracranial aneurysms. Precise measurement and device selection are mandatory steps when considering flow diverters usage in order to avoid potential complications. In this sense, incomplete wall-apposition has been described as a predictive factor for immediate in-stent and delayed thrombosis after stent use. One significant usage limitation of flow diverter devices is the parent artery diameter, since the maximum opening of the sizes available are recommended for vessel diameters between 5.2-5.75 mm. Here we present the first clinical use of the largest flow diverter available, the 6×50 mm DERIVO embolization device (Acandis GmbH & Co. KG, Pforzheim, Germany), into the arterial circulation for a cervical internal carotid artery endovascular reconstruction. This is a new device for large or fusiform aneurysms requiring flow diversion, especially located in the vertebrobasilar system or extracranial segments.

Keyword

Derivo embolization device; Aaneurysm; Carotid artery, Internal

MeSH Terms

Aneurysm
Arteries
Carotid Artery, Internal*
Humans
Intracranial Aneurysm
Parents
Stents
Thrombosis

Figure

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  Fig. 1. (A) Magnetic resonance angiography. Volumetric reconstruction showing 2 aneurysms/pseudoaneurysms at the cervical internal carotid artery with arterial tortuosity, probably secondary to a cervical dissection (arrow). (B) 3D common carotid angiography. One single device was selected based on maximal diameter of the parent artery.

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  Fig. 2. Digital subtraction angiography. (A, B) Roadmap. A triaxial system was used. The delivery technique did not differ from other flow diverters. Note that DERIVO devices of 40 and 50 mm, as the selected 6×50 mm, have no distal tip making deployment easier and more flexible, especially in curves. No resheating was needed for reposition.

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  Fig. 3. Digital subtraction angiography. (A) XperCT. The device is fully visible because all nitinol wires feature an opaque platinum core. (B, C) Images showing a correct wall-apposition of the device and contrast stagnation of both aneurysms with a single device. The contour of the device is clearly visible under fluoroscopy.

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