Eficacia y seguridad del stent Pipeline Vantage Shield versus el stent Pipeline Flex Shield en pacientes con aneurismas intracraneales no rotos, estudio multicéntrico

Introducción y objetivos: Los aneurismas intracraneales no rotos son abultamientos patológicos de las paredes arteriales que pueden romperse y causar una hemorragia subaracnoidea. Recientemente se han utilizado endoprótesis con superficies modificadas como tratamiento de los aneurismas intracraneale...

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Autores:: Catalá, Andrés José

Tipo de recurso:

Fecha de publicación:: 2024

Institución:: Universidad Autónoma de Bucaramanga - UNAB

Repositorio:: Repositorio UNAB

Idioma:: spa

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network_acronym_str	UNAB2
network_name_str	Repositorio UNAB
repository_id_str
dc.title.spa.fl_str_mv	Eficacia y seguridad del stent Pipeline Vantage Shield versus el stent Pipeline Flex Shield en pacientes con aneurismas intracraneales no rotos, estudio multicéntrico
dc.title.translated.spa.fl_str_mv	Efficacy and safety in the use of Pipeline Vantage Shield stent versus Pipeline Flex Shield stent in the treatment of patients with unruptured intracranial aneurysms: a multicenter study
title	Eficacia y seguridad del stent Pipeline Vantage Shield versus el stent Pipeline Flex Shield en pacientes con aneurismas intracraneales no rotos, estudio multicéntrico
spellingShingle	Eficacia y seguridad del stent Pipeline Vantage Shield versus el stent Pipeline Flex Shield en pacientes con aneurismas intracraneales no rotos, estudio multicéntrico Medical sciences Health sciences Unruptured intracranial aneurysm Intracranial aneurysm Cerebrovascular disease Public health Epidemiology Radiodiagnosis Medical X-ray Diagnostic imaging Ciencias médicas Enfermedad cerebrovascular Salud pública Epidemiología Radiodiagnóstico Radiografía médica Diagnóstico por imagen Ciencias de la salud Aneurisma intracraneal Aneurisma intracraneal no roto PED
title_short	Eficacia y seguridad del stent Pipeline Vantage Shield versus el stent Pipeline Flex Shield en pacientes con aneurismas intracraneales no rotos, estudio multicéntrico
title_full	Eficacia y seguridad del stent Pipeline Vantage Shield versus el stent Pipeline Flex Shield en pacientes con aneurismas intracraneales no rotos, estudio multicéntrico
title_fullStr	Eficacia y seguridad del stent Pipeline Vantage Shield versus el stent Pipeline Flex Shield en pacientes con aneurismas intracraneales no rotos, estudio multicéntrico
title_full_unstemmed	Eficacia y seguridad del stent Pipeline Vantage Shield versus el stent Pipeline Flex Shield en pacientes con aneurismas intracraneales no rotos, estudio multicéntrico
title_sort	Eficacia y seguridad del stent Pipeline Vantage Shield versus el stent Pipeline Flex Shield en pacientes con aneurismas intracraneales no rotos, estudio multicéntrico
dc.creator.fl_str_mv	Catalá, Andrés José
dc.contributor.advisor.none.fl_str_mv	Serrano Gómez, Sergio Eduardo
dc.contributor.advisor.spa.fl_str_mv	Mantilla García, Daniel Eduardo
dc.contributor.author.none.fl_str_mv	Catalá, Andrés José
dc.contributor.cvlac.spa.fl_str_mv	Mantilla García, Daniel Eduardo [0001437130] Serrano Gómez, Sergio Eduardo [0001521095]
dc.contributor.googlescholar.spa.fl_str_mv	Catalá, Andrés José [4p-5O-YAAAAJ] Mantilla García, Daniel Eduardo [es&oi=ao]
dc.contributor.orcid.spa.fl_str_mv	Catalá, Andrés José [0000-0003-3339-6630] Mantilla García, Daniel Eduardo [0000-0003-1532-2101] Serrano Gómez, Sergio Eduardo [0000-0002-3119-0439]
dc.contributor.scopus.spa.fl_str_mv	Catalá, Andrés José [7811136500]
dc.contributor.apolounab.spa.fl_str_mv	Mantilla García, Daniel Eduardo [daniel-eduardo-mantilla-garcía] Serrano Gómez, Sergio Eduardo [sergio-eduardo-serrano-gomez-2]
dc.subject.keywords.spa.fl_str_mv	Medical sciences Health sciences Unruptured intracranial aneurysm Intracranial aneurysm Cerebrovascular disease Public health Epidemiology Radiodiagnosis Medical X-ray Diagnostic imaging
topic	Medical sciences Health sciences Unruptured intracranial aneurysm Intracranial aneurysm Cerebrovascular disease Public health Epidemiology Radiodiagnosis Medical X-ray Diagnostic imaging Ciencias médicas Enfermedad cerebrovascular Salud pública Epidemiología Radiodiagnóstico Radiografía médica Diagnóstico por imagen Ciencias de la salud Aneurisma intracraneal Aneurisma intracraneal no roto PED
dc.subject.lemb.spa.fl_str_mv	Ciencias médicas Enfermedad cerebrovascular Salud pública Epidemiología Radiodiagnóstico Radiografía médica Diagnóstico por imagen
dc.subject.proposal.spa.fl_str_mv	Ciencias de la salud Aneurisma intracraneal Aneurisma intracraneal no roto PED
description	Introducción y objetivos: Los aneurismas intracraneales no rotos son abultamientos patológicos de las paredes arteriales que pueden romperse y causar una hemorragia subaracnoidea. Recientemente se han utilizado endoprótesis con superficies modificadas como tratamiento de los aneurismas intracraneales. Así pues, la comparación de la eficacia y la seguridad de la endoprótesis Pipeline Flex Shield y la endoprótesis Pipeline Vantage Shield contribuye a la literatura científica. Con el objetivo de determinar la eficacia de estas endoprótesis, creemos que la endoprótesis pipeline vantage shield es tan eficaz y segura como la endoprótesis pipeline flex shield en el tratamiento de pacientes con aneurismas no rotos. Materiales y métodos: Analizamos datos a través de una cohorte multicéntrica anonimizada de múltiples servicios de radiología intervencionista en Colombia desde enero de 2017 hasta junio de 2023. Resultados: 574 aneurismas intracraneales no rotos en 546 pacientes. A los 12 meses, los resultados angiográficos globales adecuados de la escala de clasificación O'Kelly-Marotta (OKM C-D) fueron del 83,13%. Para la endoprótesis Pipeline Embolization Device con tecnología Vantage (PEDV) fue del 97,47% y para la endoprótesis Pipeline Flex Embolization Device con tecnología Shield (PED-Shield) del 80,39% (p< 0,001). Mortalidad (0,93%, p=0,342) y morbilidad global 0,53% (PEDV 0,35% y PED-Shield 0,17%). Eventos de complicaciones globales 3,1%, eventos tromboembólicos 2,11% en el stent PED-Shield y 6,7% en el stent PEDV (p=0,008). (p=0,342) Las complicaciones hemorrágicas globales fueron del 1,74%, en el stent PED-Shield (0,92%) y dos en el stent PEDV (1,45%). Conclusiones: El stent PEDV mejoró la eficacia en comparación con el stent PED-Shield a los 12 meses, mientras que el stent PED-Shield mostró un perfil de seguridad ligeramente mejor.
publishDate	2024
dc.date.accessioned.none.fl_str_mv	2024-11-21T19:27:04Z
dc.date.available.none.fl_str_mv	2024-11-21T19:27:04Z
dc.date.issued.none.fl_str_mv	2024-10-01
dc.type.eng.fl_str_mv	Thesis
dc.type.driver.spa.fl_str_mv	info:eu-repo/semantics/masterThesis
dc.type.local.spa.fl_str_mv	Tesis
dc.type.hasversion.spa.fl_str_mv	info:eu-repo/semantics/acceptedVersion
dc.type.redcol.spa.fl_str_mv	http://purl.org/redcol/resource_type/TM
status_str	acceptedVersion
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dc.identifier.instname.spa.fl_str_mv	instname:Universidad Autónoma de Bucaramanga - UNAB
dc.identifier.reponame.spa.fl_str_mv	reponame:Repositorio Institucional UNAB
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identifier_str_mv	instname:Universidad Autónoma de Bucaramanga - UNAB reponame:Repositorio Institucional UNAB repourl:https://repository.unab.edu.co
dc.language.iso.spa.fl_str_mv	spa
language	spa
dc.relation.references.spa.fl_str_mv	1. Sweeney K, Silver N, Javadpour M. Subarachnoid haemorrhage (spontaneous aneurysmal). BMJ clinical evidence [Internet]. 2016;2016:1213. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794735/ 2. Shin D-S, Carroll CP, Elghareeb M, Hoh BL, Kim B-T. The Evolution of Flow- Diverting Stents for Cerebral Aneurysms; Historical Review, Modern Application, Complications, and Future Direction. Journal of Korean Neurosurgical Society. 2020 Mar 1;63(2):137–52. 3. Starke RM, Thompson J, Pagani A, Choubey A, Wainwright JM, Wolf MF, et al. Preclinical safety and efficacy evaluation of the Pipeline Vantage Embolization Device with Shield Technology. Journal of NeuroInterventional Surgery [Internet]. 2020 Oct 1 [cited 2023 Mar 4];12(10):981–6. Available from: https://jnis.bmj.com/content/12/10/981 4. Texakalidis P, Bekelis K, Atallah E, Tjoumakaris S, Rosenwasser RH, Jabbour P. Flow diversion with the pipeline embolization device for patients with intracranial aneurysms and antiplatelet therapy: a systematic literature review. Clin Neurol Neurosurg. 2017;161:78-87. 5. Laurrent Pierot, MD, PhD; Ajay K. Wakhloo, MD, PhD. Endovascular Treatment of Intracranial Aneurysms. 2013. STROKE. AHA Journals. Doi: 10.1161/STROKEAHA.113.000733 6. Brown RD, Broderick JP. Unruptured intracranial aneurysms: epidemiology, natural history, management options, and familial screening. The Lancet Neurology [Internet]. 2014 Apr;13(4):393–404. Available from: https://www.thelancet.com/journals/laneur/article/PIIS1474- 4422%2814%2970015-8/fulltext 7. 7. Feigin V.L., Lawes C.M., Bennett D.A., Barker-Collo S.L., Parag V.: Worldwide stroke incidence and early case fatality reported in 56 population-based studies: A systematic review. The Lancet Neurology 2009; 8: pp. 355-369. 8. Jordan L.C., Johnston S.C., Wu Y.W., Sidney S., Fullerton H.J.: The importance of cerebral aneurysms in childhood hemorrhagic stroke: A population-based study. Stroke 2009; 40: pp. 400-405. 9. Hyodo, A. Eric M. Deshaies, Christopher S. Eddleman, and Alan S, Boulos, (Eds): handbook of neuroendovascular surgery. Acta Neurochir 154, 1537– 1538 (2012). 10. Szikora I., Turányi E., Marosfoi M.: Evolution of flow-diverter endothelialization and thrombus organization in giant fusiform aneurysms after flow diversion: A histopathologic study. American Journal of Neuroradiology 2015; 36: pp. 1716- 1720. 11. Tawk RG, Hasan TF, D'Souza CE, Peel JB, Freeman WD. Diagnosis and Treatment of Unruptured Intracranial Aneurysms and Aneurysmal Subarachnoid Hemorrhage. Mayo Clinic Proceedings [Internet]. 2021 July1;96(7):1970–2000. Available from: https://www.sciencedirect.com/science/article/pii/S0025619621000410 12. Lylyk P., Miranda C., Ceratto R., Ferrario A., Scrivano E., Luna H.R., et al.: Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: The Buenos Aires experience. Neurosurgery 2009; 64: pp. 632-642. 13. Atasoy D, Kandasamy N, Hart J, Lynch J, Yang S-H ., Walsh D, et al. Outcome Study of the Pipeline Embolization Device with Shield Technology in Unruptured Aneurysms (PEDSU). American Journal of Neuroradiology [Internet]. 2019 Nov 14; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911729/ 14. Starke RM, Thompson J, Pagani A, Choubey A, Wainwright JM, Wolf MF, et al. Preclinical safety and efficacy evaluation of the Pipeline Vantage Embolization Device with Shield Technology. Journal of NeuroInterventional Surgery [Internet]. 2020 Oct 1;12(10):981–6. Available from: https://jnis.bmj.com/content/12/10/981 15. Xu Z, Rui Y-N, Hagan JP, Kim DH. Intracranial Aneurysms: Pathology, Genetics, and Molecular Mechanisms. NeuroMolecular Medicine. 2019 May 4;21(4):325–43. 16. Wiebers DO, Whisnant JP, Huston JR 3rd, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003;362: 103–10. 17. Brinjikji W, Zhu Y-Q ., Lanzino G, Cloft HJ, Murad MH, Wang Z, et al. Risk Factors for Growth of Intracranial Aneurysms: A Systematic Review and Meta- Analysis. American Journal of Neuroradiology. 2015 Nov 26;37(4):615–20. 18. Long B, Koyfman A, Runyon MS. Subarachnoid Hemorrhage: Updates in Diagnosis and Management. Emergency medicine clinics of North America [Internet]. 2017;35(4):803–24. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28987430 19. Cianfoni A, Pravatà E, De Blasi R, Tschuor CS, Bonaldi G. Clinical presentation of cerebral aneurysms. European Journal of Radiology. 2013 Oct;82(10):1618– 22. 20. Jeong HW, Seo JH, Kim ST, Jung CK, Suh S. Clinical Practice Guideline for the Management of Intracranial Aneurysms. Neurointervention [Internet]. 2014;9(2):63. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4239410/ 21. Etminan N, Dörfler A, Steinmetz H. Unruptured intracranial aneurysms— pathogenesis and individualized management. Deutsches Aerzteblatt Online. 2020 Apr 3 22. Briganti F, Leone G, Marseglia M, Mariniello G, Caranci F, Brunetti A, et al. Endovascular treatment of cerebral aneurysms using flow-diverter devices: A systematic review. The Neuroradiology Journal. 2015 Aug;28(4):365–75. 23. Chancellor B, Raz E, Shapiro M, Tanweer O, Nossek E, Riina HA, et al. Flow Diversion for Intracranial Aneurysm Treatment: Trials Involving Flow Diverters and Long-Term Outcomes. Neurosurgery. 2019 Dec 16;86(Supplement_1):S36–45. 24. Atasoy D, Kandasamy N, Hart J, Lynch J, Yang S-H ., Walsh D, et al. Outcome Study of the Pipeline Embolization Device with Shield Technology in Unruptured Aneurysms (PEDSU). American Journal of Neuroradiology [Internet]. 2019 Nov 14; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911729/ 25. Starke RM, Thompson J, Pagani A, Choubey A, Wainwright JM, Wolf MF, et al. Preclinical safety and efficacy evaluation of the Pipeline Vantage Embolization Device with Shield Technology. Journal of NeuroInterventional Surgery [Internet]. 2020 Oct 1 [cited 2023 Mar 4];12(10):981–6. Available from: https://jnis.bmj.com/content/12/10/981 26. Starke RM, Thompson J, Pagani A, Choubey A, Wainwright JM, Wolf MF, et al. Preclinical safety and efficacy evaluation of the Pipeline Vantage Embolization Device with Shield Technology. Journal of NeuroInterventional Surgery [Internet]. 2020 Oct 1;12(10):981–6. Available from: https://jnis.bmj.com/content/12/10/981 27. Mansoor N, Sciacca S, Siddiqui J, Benger M, Balasundaram P, Kandasamy N, et al. P07 Multicenter outcome study of the pipeline vantage flow diverter. Journal of NeuroInterventional Surgery [Internet]. 2022 Sep 1 [cited 2023 Mar 20];14(Suppl 2):A12–2. Available from: https://jnis.bmj.com/content/14/Suppl_2/A12.2
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dc.coverage.spatial.spa.fl_str_mv	Floridablanca (Santander, Colombia)
dc.coverage.temporal.spa.fl_str_mv	Enero del 2017 y Mayo del 2023
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dc.publisher.grantor.spa.fl_str_mv	Universidad Autónoma de Bucaramanga UNAB
dc.publisher.faculty.spa.fl_str_mv	Facultad Ciencias de la Salud
dc.publisher.program.spa.fl_str_mv	Especialización en Radiología Intervencionista
dc.publisher.programid.none.fl_str_mv	ERI-2152
institution	Universidad Autónoma de Bucaramanga - UNAB
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spelling	Serrano Gómez, Sergio Eduardo275cde51-75b0-4ea4-a1aa-90e0999f9ce7Mantilla García, Daniel Eduardo02f2cc58-14df-4196-a68a-08dc2290cdc0500Catalá, Andrés José2851aa43-54e0-4a1e-95ea-40b234ae9b0cMantilla García, Daniel Eduardo [0001437130]Serrano Gómez, Sergio Eduardo [0001521095]Catalá, Andrés José [4p-5O-YAAAAJ]Mantilla García, Daniel Eduardo [es&oi=ao]Catalá, Andrés José [0000-0003-3339-6630]Mantilla García, Daniel Eduardo [0000-0003-1532-2101]Serrano Gómez, Sergio Eduardo [0000-0002-3119-0439]Catalá, Andrés José [7811136500]Mantilla García, Daniel Eduardo [daniel-eduardo-mantilla-garcía]Serrano Gómez, Sergio Eduardo [sergio-eduardo-serrano-gomez-2]Floridablanca (Santander, Colombia)Enero del 2017 y Mayo del 2023UNAB Campus Bucaramanga2024-11-21T19:27:04Z2024-11-21T19:27:04Z2024-10-01http://hdl.handle.net/20.500.12749/27513instname:Universidad Autónoma de Bucaramanga - UNABreponame:Repositorio Institucional UNABrepourl:https://repository.unab.edu.coIntroducción y objetivos: Los aneurismas intracraneales no rotos son abultamientos patológicos de las paredes arteriales que pueden romperse y causar una hemorragia subaracnoidea. Recientemente se han utilizado endoprótesis con superficies modificadas como tratamiento de los aneurismas intracraneales. Así pues, la comparación de la eficacia y la seguridad de la endoprótesis Pipeline Flex Shield y la endoprótesis Pipeline Vantage Shield contribuye a la literatura científica. Con el objetivo de determinar la eficacia de estas endoprótesis, creemos que la endoprótesis pipeline vantage shield es tan eficaz y segura como la endoprótesis pipeline flex shield en el tratamiento de pacientes con aneurismas no rotos. Materiales y métodos: Analizamos datos a través de una cohorte multicéntrica anonimizada de múltiples servicios de radiología intervencionista en Colombia desde enero de 2017 hasta junio de 2023. Resultados: 574 aneurismas intracraneales no rotos en 546 pacientes. A los 12 meses, los resultados angiográficos globales adecuados de la escala de clasificación O'Kelly-Marotta (OKM C-D) fueron del 83,13%. Para la endoprótesis Pipeline Embolization Device con tecnología Vantage (PEDV) fue del 97,47% y para la endoprótesis Pipeline Flex Embolization Device con tecnología Shield (PED-Shield) del 80,39% (p< 0,001). Mortalidad (0,93%, p=0,342) y morbilidad global 0,53% (PEDV 0,35% y PED-Shield 0,17%). Eventos de complicaciones globales 3,1%, eventos tromboembólicos 2,11% en el stent PED-Shield y 6,7% en el stent PEDV (p=0,008). (p=0,342) Las complicaciones hemorrágicas globales fueron del 1,74%, en el stent PED-Shield (0,92%) y dos en el stent PEDV (1,45%). Conclusiones: El stent PEDV mejoró la eficacia en comparación con el stent PED-Shield a los 12 meses, mientras que el stent PED-Shield mostró un perfil de seguridad ligeramente mejor.Introducción ........................................................................................................................................6 Justificación ........................................................................................................................................7 Planteamiento del problema ...............................................................................................................8 Marco teórico .................................................................................................................................... 11 Definición ...................................................................................................................................... 11 Epidemiología ............................................................................................................................... 11 Factores de riesgo ......................................................................................................................... 12 Manifestaciones clínicas ................................................................................................................ 12 Diagnóstico ................................................................................................................................... 13 Tratamiento ................................................................................................................................... 13 Estado del arte.................................................................................................................................. 15 Pregunta de investigación ................................................................................................................. 18 Objetivos ........................................................................................................................................... 18 Objetivo general ............................................................................................................................ 18 Objetivos específicos .................................................................................................................... 18 Hipótesis ........................................................................................................................................... 19 Metodología ...................................................................................................................................... 19 Tipo de estudio .............................................................................................................................. 19 Población ...................................................................................................................................... 19 Tamaño de muestra .......................................................................................................................... 20 Criterios de inclusión ..................................................................................................................... 21 Criterios de exclusión .................................................................................................................... 21 Variables ....................................................................................................................................... 21 Recolección de la información .......................................................................................................... 24 Control de sesgos ......................................................................................................................... 25 Plan de análisis ................................................................................................................................. 25 Análisis univariado ........................................................................................................................ 25 Análisis bivariado .......................................................................................................................... 25 Consideraciones éticas ..................................................................................................................... 26 Cronograma de actividades .............................................................................................................. 28 Resultados ........................................................................................................................................ 28 Resultados de eficacia .................................................................................................................. 31 Complicaciones ............................................................................................................................. 33 Eventos tromboembólicos ............................................................................................................. 33 Eventos hemorrágicos neurológicos y no neurológicos ................................................................. 34 Mortalidad ..................................................................................................................................... 35 Morbilidad ..................................................................................................................................... 36 Antiagregantes y anticoagulación .................................................................................................. 37 Independencia funcional ............................................................................................................... 38 Discusión .......................................................................................................................................... 39 Características de los pacientes y aneurismas .............................................................................. 39 Resultados de eficacia .................................................................................................................. 39 Seguridad y complicaciones .......................................................................................................... 40 Inadecuada aposición de la pared del stent ............................................................................... 41 Hiperplasia intimal ..................................................................................................................... 41 Limitaciones ............................................................................................................................... 41 Conclusión ........................................................................................................................................ 42 Referencias ...................................................................................................................................... 42EspecializaciónBackground and Purpose: Unruptured intracranial aneurysms are pathological bulging of the arterial walls that could rupture and cause subarachnoid hemorrhage. Recently, stents with modified surfaces have been used as treatment for intracranial aneurysms. Thus, comparing efficacy and security of the pipeline flex shield stent and the pipeline vantage shield stent contributes to the scientific literature. Aiming to determine the efficacy of these stents, we believe the pipeline vantage shield stent is as effective and safe as the pipeline flex shield stent in management of patients with unruptured aneurysms. Materials and Methods: We analyzed data through an anonymized, multicentered-cohort from multiple interventional radiology services in Colombia from January 2017 until June 2023. Results: 574 unruptured intracranial aneurysms in 546 patients. At 12 months, overall adequate O’Kelly-Marotta grading scale (OKM C-D) angiographic results was 83.13%. For the Pipeline Embolization Device with Vantage Technology (PEDV) stent was 97.47% and for the Pipeline Flex Embolization Device with Shield Technology (PED-Shield) stent 80.39 % (p< 0.001). Mortality (0.93%, p=0.342) and overall morbidity 0.53% (PEDV 0.35% and 0.17% PED-Shield). Overall complications events 3.1%, thromboembolic events 2.11% in the PED-Shield stent and 6.7% in the PEDV stent (p=0.008). (p=0.342) Overall bleeding complications were 1.74%, in the PED-Shield stent (0.92%) and two in PEDV stent (1.45%). Conclusion: The PEDV stent improved efficacy in comparison with PED-Shield stent at 12-months while the PED-Shield stent showed a slightly better safety profile.Modalidad Presencialapplication/pdfspahttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Abierto (Texto Completo)Atribución-NoComercial-SinDerivadas 2.5 Colombiahttp://purl.org/coar/access_right/c_abf2Eficacia y seguridad del stent Pipeline Vantage Shield versus el stent Pipeline Flex Shield en pacientes con aneurismas intracraneales no rotos, estudio multicéntricoEfficacy and safety in the use of Pipeline Vantage Shield stent versus Pipeline Flex Shield stent in the treatment of patients with unruptured intracranial aneurysms: a multicenter studyThesisinfo:eu-repo/semantics/masterThesisTesisinfo:eu-repo/semantics/acceptedVersionhttp://purl.org/redcol/resource_type/TMEspecialista en Radiología IntervencionistaUniversidad Autónoma de Bucaramanga UNABFacultad Ciencias de la SaludEspecialización en Radiología IntervencionistaERI-2152Medical sciencesHealth sciencesUnruptured intracranial aneurysmIntracranial aneurysmCerebrovascular diseasePublic healthEpidemiologyRadiodiagnosisMedical X-rayDiagnostic imagingCiencias médicasEnfermedad cerebrovascularSalud públicaEpidemiologíaRadiodiagnósticoRadiografía médicaDiagnóstico por imagenCiencias de la saludAneurisma intracranealAneurisma intracraneal no rotoPED1. Sweeney K, Silver N, Javadpour M. Subarachnoid haemorrhage (spontaneous aneurysmal). BMJ clinical evidence [Internet]. 2016;2016:1213. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794735/2. Shin D-S, Carroll CP, Elghareeb M, Hoh BL, Kim B-T. The Evolution of Flow- Diverting Stents for Cerebral Aneurysms; Historical Review, Modern Application, Complications, and Future Direction. Journal of Korean Neurosurgical Society. 2020 Mar 1;63(2):137–52.3. Starke RM, Thompson J, Pagani A, Choubey A, Wainwright JM, Wolf MF, et al. Preclinical safety and efficacy evaluation of the Pipeline Vantage Embolization Device with Shield Technology. Journal of NeuroInterventional Surgery [Internet]. 2020 Oct 1 [cited 2023 Mar 4];12(10):981–6. Available from: https://jnis.bmj.com/content/12/10/9814. Texakalidis P, Bekelis K, Atallah E, Tjoumakaris S, Rosenwasser RH, Jabbour P. Flow diversion with the pipeline embolization device for patients with intracranial aneurysms and antiplatelet therapy: a systematic literature review. Clin Neurol Neurosurg. 2017;161:78-87.5. Laurrent Pierot, MD, PhD; Ajay K. Wakhloo, MD, PhD. Endovascular Treatment of Intracranial Aneurysms. 2013. STROKE. AHA Journals. Doi: 10.1161/STROKEAHA.113.0007336. Brown RD, Broderick JP. Unruptured intracranial aneurysms: epidemiology, natural history, management options, and familial screening. The Lancet Neurology [Internet]. 2014 Apr;13(4):393–404. Available from: https://www.thelancet.com/journals/laneur/article/PIIS1474- 4422%2814%2970015-8/fulltext 7.7. Feigin V.L., Lawes C.M., Bennett D.A., Barker-Collo S.L., Parag V.: Worldwide stroke incidence and early case fatality reported in 56 population-based studies: A systematic review. The Lancet Neurology 2009; 8: pp. 355-369.8. Jordan L.C., Johnston S.C., Wu Y.W., Sidney S., Fullerton H.J.: The importance of cerebral aneurysms in childhood hemorrhagic stroke: A population-based study. Stroke 2009; 40: pp. 400-405.9. Hyodo, A. Eric M. Deshaies, Christopher S. Eddleman, and Alan S, Boulos, (Eds): handbook of neuroendovascular surgery. Acta Neurochir 154, 1537– 1538 (2012).10. Szikora I., Turányi E., Marosfoi M.: Evolution of flow-diverter endothelialization and thrombus organization in giant fusiform aneurysms after flow diversion: A histopathologic study. American Journal of Neuroradiology 2015; 36: pp. 1716- 1720.11. Tawk RG, Hasan TF, D'Souza CE, Peel JB, Freeman WD. Diagnosis and Treatment of Unruptured Intracranial Aneurysms and Aneurysmal Subarachnoid Hemorrhage. Mayo Clinic Proceedings [Internet]. 2021 July1;96(7):1970–2000. Available from: https://www.sciencedirect.com/science/article/pii/S002561962100041012. Lylyk P., Miranda C., Ceratto R., Ferrario A., Scrivano E., Luna H.R., et al.: Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: The Buenos Aires experience. Neurosurgery 2009; 64: pp. 632-642.13. Atasoy D, Kandasamy N, Hart J, Lynch J, Yang S-H ., Walsh D, et al. Outcome Study of the Pipeline Embolization Device with Shield Technology in Unruptured Aneurysms (PEDSU). American Journal of Neuroradiology [Internet]. 2019 Nov 14; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911729/14. Starke RM, Thompson J, Pagani A, Choubey A, Wainwright JM, Wolf MF, et al. Preclinical safety and efficacy evaluation of the Pipeline Vantage Embolization Device with Shield Technology. Journal of NeuroInterventional Surgery [Internet]. 2020 Oct 1;12(10):981–6. Available from: https://jnis.bmj.com/content/12/10/98115. Xu Z, Rui Y-N, Hagan JP, Kim DH. Intracranial Aneurysms: Pathology, Genetics, and Molecular Mechanisms. NeuroMolecular Medicine. 2019 May 4;21(4):325–43.16. Wiebers DO, Whisnant JP, Huston JR 3rd, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003;362: 103–10.17. Brinjikji W, Zhu Y-Q ., Lanzino G, Cloft HJ, Murad MH, Wang Z, et al. Risk Factors for Growth of Intracranial Aneurysms: A Systematic Review and Meta- Analysis. American Journal of Neuroradiology. 2015 Nov 26;37(4):615–20.18. Long B, Koyfman A, Runyon MS. Subarachnoid Hemorrhage: Updates in Diagnosis and Management. Emergency medicine clinics of North America [Internet]. 2017;35(4):803–24. Available from: https://www.ncbi.nlm.nih.gov/pubmed/2898743019. Cianfoni A, Pravatà E, De Blasi R, Tschuor CS, Bonaldi G. Clinical presentation of cerebral aneurysms. European Journal of Radiology. 2013 Oct;82(10):1618– 22.20. Jeong HW, Seo JH, Kim ST, Jung CK, Suh S. Clinical Practice Guideline for the Management of Intracranial Aneurysms. Neurointervention [Internet]. 2014;9(2):63. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4239410/21. Etminan N, Dörfler A, Steinmetz H. Unruptured intracranial aneurysms— pathogenesis and individualized management. Deutsches Aerzteblatt Online. 2020 Apr 322. Briganti F, Leone G, Marseglia M, Mariniello G, Caranci F, Brunetti A, et al. Endovascular treatment of cerebral aneurysms using flow-diverter devices: A systematic review. The Neuroradiology Journal. 2015 Aug;28(4):365–75.23. Chancellor B, Raz E, Shapiro M, Tanweer O, Nossek E, Riina HA, et al. Flow Diversion for Intracranial Aneurysm Treatment: Trials Involving Flow Diverters and Long-Term Outcomes. Neurosurgery. 2019 Dec 16;86(Supplement_1):S36–45.24. Atasoy D, Kandasamy N, Hart J, Lynch J, Yang S-H ., Walsh D, et al. Outcome Study of the Pipeline Embolization Device with Shield Technology in Unruptured Aneurysms (PEDSU). American Journal of Neuroradiology [Internet]. 2019 Nov 14; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911729/25. Starke RM, Thompson J, Pagani A, Choubey A, Wainwright JM, Wolf MF, et al. Preclinical safety and efficacy evaluation of the Pipeline Vantage Embolization Device with Shield Technology. Journal of NeuroInterventional Surgery [Internet]. 2020 Oct 1 [cited 2023 Mar 4];12(10):981–6. Available from: https://jnis.bmj.com/content/12/10/98126. Starke RM, Thompson J, Pagani A, Choubey A, Wainwright JM, Wolf MF, et al. Preclinical safety and efficacy evaluation of the Pipeline Vantage Embolization Device with Shield Technology. Journal of NeuroInterventional Surgery [Internet]. 2020 Oct 1;12(10):981–6. Available from: https://jnis.bmj.com/content/12/10/98127. Mansoor N, Sciacca S, Siddiqui J, Benger M, Balasundaram P, Kandasamy N, et al. P07 Multicenter outcome study of the pipeline vantage flow diverter. Journal of NeuroInterventional Surgery [Internet]. 2022 Sep 1 [cited 2023 Mar 20];14(Suppl 2):A12–2. Available from: https://jnis.bmj.com/content/14/Suppl_2/A12.2ORIGINALTrabajo final.pdfTrabajo final.pdfTesisapplication/pdf492191https://repository.unab.edu.co/bitstream/20.500.12749/27513/1/Trabajo%20final.pdf4d9a71cc71fa6d013d9716ca7be528b7MD51open accessLicencia.pdfLicencia.pdfLicenciaapplication/pdf280483https://repository.unab.edu.co/bitstream/20.500.12749/27513/3/Licencia.pdfd40b17b5428309d551363db9729e98ddMD53metadata only accessLICENSElicense.txtlicense.txttext/plain; charset=utf-8829https://repository.unab.edu.co/bitstream/20.500.12749/27513/2/license.txt3755c0cfdb77e29f2b9125d7a45dd316MD52open accessTHUMBNAILTrabajo final.pdf.jpgTrabajo final.pdf.jpgIM Thumbnailimage/jpeg8210https://repository.unab.edu.co/bitstream/20.500.12749/27513/4/Trabajo%20final.pdf.jpg70061662298ef040ede4204c703f046fMD54open accessLicencia.pdf.jpgLicencia.pdf.jpgIM Thumbnailimage/jpeg12994https://repository.unab.edu.co/bitstream/20.500.12749/27513/5/Licencia.pdf.jpgd0aae17985361383673b86e5c96ac76dMD55metadata only access20.500.12749/27513oai:repository.unab.edu.co:20.500.12749/275132024-11-21 22:00:10.771open accessRepositorio Institucional \| Universidad Autónoma de Bucaramanga - UNABrepositorio@unab.edu.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

Eficacia y seguridad del stent Pipeline Vantage Shield versus el stent Pipeline Flex Shield en pacientes con aneurismas intracraneales no rotos, estudio multicéntrico

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