(b)(6) 2020 lit1 (hcp): cherian, jacob, mahsa dabagh, visish m srinivasan, stephen chen, jeremiah johnson, ajay wakhloo, vipul gupta, j macho, amanda randles, and peter kan.2020.Balloon-mounted stents for treatment of refractory flow diverting device wall malapposition.¿ operative neurosurgery (hagerstown, md.)¿19 (1): 3742.Doi:10.1093/ons/opz297.Medtronic received a literature article aiming to describe the use of balloon-mounted stents within flow diverters for correction of flow-limiting stenosis and device malapposition.After attempts to perform balloon angioplasty proved unsuccessful, bms deployment successfully opened the stenotic parent artery and improved fdd wall apposition in all 4 cases.In the second case a (b)(6)-yr-old boy with chronic headaches was found to have a growing giant cerebral aneurysm of the right ica in its petrous segment.Two pipeline flex device were deployed across the aneurysm spanning the petrous and cavernous ica segments.Subsequent angiography demonstrated critical stenosis within the pipeline at the site of pre-existing stenosis.Post-processing with 2 intracranial balloons was unsuccessful.With a guide catheter passed distal to the area of flow-limiting stenosis within the stent, a bms microcatheter was delivered into the guide catheter at the site of parent vessel stenosis follow-up computed tomography angiography at 1 month showed persistent aneurysm filling, but no residual stenosis.Six-month follow-up angiography demonstrated complete occlusion of the right ica with no aneurysm filling.The occlusion was located at the site of the overlapping stents and occurred despite continuation of dual antiplatelet therapy and a previously documented antiplatelet response on platelet function testing.The patient, nonetheless, demonstrated excellent collaterals through anterior and posterior communicating arteries and remained in unchanged neurologic condition.
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