O-030 Preliminary French Registry Clinical Experience with the Barrel Bifurcation Vascular Reconstruction Device

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Abstract

Background/purpose

Endovascular Stent-assisted coiling is a well establish technique for treatment of wide-necked intracranial aneurysms. However, it remains a challenge to successfully treat complex wide-necked bifurcate aneurysms by using a single-stent and double (X and Y) stenting introduce other procedural variables. The purpose of the French Barrel™ Prospective Registry, an intention to treat study, is to investigate a single stent technique utilizing a novel fully retrievable barrel-shaped vascular reconstruction device for wide-necked bifurcate aneurysm stent assisted coiling treatment.

Methods

8 patients were enrolled within the French Barrel Registry thus far. This is a review of initial cases performed at the three French centers where Barrel VRD Device (Reverse Medical Corp, Irvine, CA) was used. Elective treatment was performed between December 2013 and March 2014. In this case series, various models of Barrel VRD device were utilised as neck-bridging devices in wide-necked bifurcate aneurysms in conjunction with embolization coils. These cases included; ACoA, MCA, Carotid Terminus, and Basilar Tip aneurysms.

Results

7 patients were treated with a single Barrel VRD device, at three French sites. Patients were placed on a double anti-platelet protocol (Clopidogrel and ASA) prior to treatment. 1 patient was enrolled, but not treated due to being a low anti-platelet responder. Patients presented with wide-necked bifurcate aneurysms measuring 4.71+/-1.62 mm necks and 1.33 +/- 0.39 mm dome/neck ratios. Aneurismal parent and branching vessel diameters were 2.69 +/- 0.44 mm and 2.45 +/- 0.25 mm, respectively. Technical success was 100% (7/7), and all embolizations were deemed clinically acceptable with initial Raymond Grade-1 in 5/7 (71%), Grade-2 in 1/7 (14%), and Grade-3 in 1/7 (14%) post-procedure. In all cases, the Barrel devices were easily positioned, via a 021 microcatheter, and offered both trans-cell or “jailed” coil microcatheter placement, good neck bridging and coil mass support, and fairly rapid detachment. As the device is resheathable, it could be placed into either branching bifurcation vessel, depending on which vessel position offered better neck coverage. No procedural Barrel device migration or coil loop protrusion was noted. Additionally, the device could be manipulated in situ to further optimise neck coverage. Discharge mRS was 0 for all patients. AE’s included 2 groin hematomas, and 1 aneurysm coil perforation, related to the procedure, not the Barrel device.

Conclusions

The initial French Barrel Registry results demonstrate that the Barrel VRD device is new tool for the endovascular treatment of wide neck bifurcate type aneurysms.

Disclosures

M. Piotin: 2; C; Covidien, Stryker, Balt, MicroVention, Reverse Medical, Neuravi, Penumbra. R. Bpanc: 2; C; Covidien, Stryker, Balt, MicroVention, Reverse Medical, Neuravi, Penumbra. J. Berge: None. F. Turjman: None.

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