Researcher:
Aydın, Kubilay

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Kubilay

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Aydın

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Aydın, Kubilay

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2017 - 201942020 - 20239

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    Feasibility and results of the stentectomy procedure performed as rescue treatment for acute thrombosis of self-expandable intracranial stents: a case series
    (Lippincott Williams & Wilkins, 2022) Onal, Yılmaz; Velioğlu, Murat; Barburoğlu Mehmet; Aydın, Kubilay; Cengiz, Duygu; Doctor; Other; N/A; N/A; Koç University Hospital; N/A; N/A
    Background: Self-expandable stents have been increasingly used for endovascular treatment of intracranial aneurysms. Because the usage of intracranial stents has increased overall, total numbers of complications associated with these devices have increased. Thrombosis, distortion, or incomplete opening of stents are potential complications that may result in occlusion of the parent artery. In such cases, removal of the stent (stentectomy) may be the only solution to avoid serious clinical consequences. Objective: To investigate the feasibility and efficacy of a novel stentectomy technique for removal of thrombosed self-expandable stents. Methods: A retrospective review was performed of patients who underwent the stentectomy procedure. Initial and follow-up imaging and clinical outcomes were assessed. Immediate postprocedural and follow-up clinical statuses were assessed using the modified Rankin scale. Results: Seven patients were included in this study (mean age: 54.1 years). The stentectomy was successful in 6 of 7 patients (85.7%). Seven stents in 6 patients were successfully removed to treat the acute in-stent thrombosis that was resistant to alternative bail-out treatments. The removed stents were self-expandable braided in 2 patients, flow diverters in 2 patients, and laser cut open-cell stents in 2 patients. Stentectomy failed to retrieve a thrombosed braided stent in 1 patient. The modified Rankin scale score of all patients who underwent a success stentectomy was <= 1. Conclusion: The stentectomy procedure using the defined technique is feasible to retrieve thrombosed stents and effective to restore the blood flow. It can be considered a last resort option to treat acute in-stent thrombosis resistant to alternative bail-out treatments.
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    Basilar artery occlusion management: an international survey of middle versus high-income countries
    (Sage, 2022) Drumm, Brian; Herning, Ana; Klein, Piers; Raymond, Jean; Abdalkader, Mohamad; Huo, Xiaochuan; Chen, Yimin; Siegler, James E.; Peacock, Meabh; Schonewille, Wouter J.; Liu, Xinfeng; Hu, Wei; Ji, Xunming; Li, Chuanhui; Alemseged, Fana; Liu, Liping; Nagel, Simon; Strbian, Daniel; Rebello, Leticia C.; Yaghi, Shadi; Qureshi, Muhammad M.; Fischer, Urs; Tsivgoulis, Georgios; Kaesmacher, Johannes; Yamagami, Hiroshi; Puetz, Volker; Sylaja, Pn; Marto, Joao Pedro; Sacco, Simona; Kristoffersen, Espen Saxhaug; Demeestere, Jelle; Conforto, Adriana B.; Meyer, Lukas; Kaiser, Daniel P. O.; Reiff, Tilman; Romoli, Michele; Diana, Francesco; Lobotesis, Kyriakos; Roi, Dylan; Masoud, Hesham E.; Ma, Alice; Mohammaden, Mahmoud H.; Doheim, Mohamed F.; Zhu, Yuyou; Sang, Hongfei; Sun, Dapeng; Ton, Mai Duy; Raynald; Li, Fengli; Lapergue, Bertrand; Hanning, Uta; Yang, Qingwu; Lee, Jin Soo; Thomalla, Gotz; Yang, Pengfei; Liu, Jianmin; Campbell, Bruce C., V; Chen, Hui-Sheng; Zaidat, Osama O.; Qiu, Zhongming; Nogueira, Raul G.; Miao, Zhongrong; Nguyen, Thanh N.; Banerjee, Soma; N/A; Aydın, Kubilay; Doctor; N/A; Koç University Hospital; N/A
    Background and Purpose: Two early basilar artery occlusion (BAO) randomized controlled trials (RCTs) did not establish the superiority of endovascular thrombectomy (EVT) over medical management. Yet many providers continued to recommend EVT. The goal of the present article is to compare physicians' diagnostic and management strategies of BAO among middle-income and high-income countries (MICs and HICs, respectively). Methods: We conducted an international survey from January to March 2022 regarding management strategies in acute BAO, to examine clinical and imaging parameters influencing clinician management of patients with BAO. We compared responses between physicians from HIC and MIC. Results: Among the 1245 respondents from 73 countries, 799 (64.2%) were from HIC, with the remaining 393 (31.6%) from MIC. Most respondents perceived that EVT was superior to medical management for acute BAO, but more so in respondents from HIC (98.0% vs. 94.2%, p < 0.01). MIC respondents were more likely to believe further RCTs were warranted (91.6% vs. 74.0%, p < 0.01) and were more likely to find it acceptable to enroll any patient who met a trial's criteria in the standard medical treatment arm (58.8% vs. 38.5%, p < 0.01). Conclusions: In an area where clinical equipoise was called into question despite the lack of RCT evidence, we found that respondents from MIC were more likely to express willingness to enroll patients with BAO in an RCT than their HIC counterparts.
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    Crossing Y-Solitaire thrombectomy as a rescue treatment for refractory acute occlusions of the middle cerebral artery
    (Bmj Publishing Group, 2019) Ozgur Oztop; Yesilot, Nilufer; Vanli, Ebru Nur Yavuz; Akpek, Sergin; Aydın, Kubilay; Barburoğlu, Mehmet; Doctor; Doctor; N/A; N/A; Koç University Hospital; N/A; 176761
    Background Mechanical thrombectomy using a stent retriever has become the standard of care for acute large-vessel occlusions in the anterior circulation. Clots that are refractory to single stent retriever thrombectomy remain a challenge for neurointerventionalists. Objective To assess the efficacy and safety of double stent retriever (crossing Y-Solitaire) thrombectomy as a rescue treatment for acute middle cerebral artery (MCA) occlusions that are refractory to single stent retriever thrombectomy. Methods We retrospectively reviewed the databases of our hospitals to identify patients who presented with an acute MCA occlusion and were treated with crossing Y-Solitaire thrombectomy. The angiographic (Thrombolysis in Cerebral Infarction (TICI) scale) and clinical outcomes (National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores) and complications were assessed. Results Ten patients were included in the study. The median initial NIHSS score and Alberta Stroke Program Early CT Score (ASPECTS) were 19.0 and 9.6, respectively. Crossing Y-Solitaire thrombectomy was performed as a rescue technique after unsuccessful single Solitaire thrombectomy passes in all cases. Successful recanalization (TICI 2b/3) was achieved in 8 (80%) patients. We observed asymptomatic reperfusion hemorrhages in 2 (20%) patients. No procedural related complications were seen other than reversible vasospasms in 5 (50%) patients. Sixty percent of the patients had a mRS score of between 2 and 0 at 90 days after the procedure. There was no mortality. Conclusion Crossing Y-Solitaire thrombectomy seems to be an effective and safe alternative rescue technique to treat refractory MCA bifurcation occlusions that are refractory to standard thrombectomy procedures.
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    The angiographic and clinical follow-up outcomes of the wide-necked and complex intracranial aneurysms treated with LVIS EVO-assisted coiling
    (NLM (Medline), 2023) Puthuran, Mani; Onal, Yilmaz; Barburoglu, Mehmet; Chandran, Arun; Berdikhojayev, Mynzhylky; Gravino, Gilbert; Velioglu, Murat; Sencer, Serra; Aygün, Murat Serhat; Aydın, Kubilay; Şentürk, Yunus Emre; Teaching Faculty; Doctor; Doctor; School of Medicine; N/A; N/A; Koç University Hospital; 291692; N/A; N/A
    Background: The Low Profile Visible Intraluminal Support EVO (LVIS EVO) is a self-expandable braided stent, which was recently introduced for the treatment of intracranial aneurysms. Full visibility of the stent and a relatively high metal coverage ratio are the unique features of the LVIS EVO. Objective: To assess the safety, efficacy, and midterm durability of LVIS EVO stent-assisted coiling for the treatment of wide-necked intracranial aneurysms. Methods: The endovascular databases were reviewed to identify patients treated with LVIS EVO-assisted coiling. The technical success and immediate clinical/angiographic outcomes were assessed. Periprocedural and delayed complications were evaluated. The follow-up angiographic/clinical outcomes were investigated. The preprocedural/follow-up neurological statuses were assessed with the modified Rankin Scale. Results: One hundred three aneurysms in 103 patients (63 females) with a mean age of 54.9 ± 11.3 years were included. The mean maximum sac diameter was 6.2 ± 2.9 mm. The procedural technical success rate was 100%. Immediate postprocedural angiography showed complete occlusion in 77.7%. The mean duration of the angiographic follow-up was 8.8 ± 3.6 months. Follow-up angiography showed complete aneurysm occlusion in 89% of the 82 patients with angiographic follow-up. Recanalization was observed in 7.3% of 82 patients. Two patients (2.4%) required retreatment. In addition, 8.7% of the patients had at least 1 complication, and 2.9% of the patients developed a permanent morbidity. All patients had mRS scores ≤2. Conclusion: The results of this study demonstrate that SAC with LVIS EVO is a relatively safe, efficient, and durable treatment for wide-necked and complex intracranial aneurysms. Copyright © Congress of Neurological Surgeons 2022. All rights reserved.
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    Y-stent-assisted coiling with low-profile neuroform atlas stents for endovascular treatment of wide-necked complex intracranial bifurcation aneurysms
    (Oxford University Press (OUP), 2020) Balcı, Sinan; Sencer, Serra; Barburoğlu, Mehmet; Umutlu, Muzaffer Reha; Arat, Anıl; N/A; Aydın, Kubilay; Doctor; N/A; Koç University Hospital; N/A
    BACKGROUND: Y-stent-assisted coiling is one of the eligible techniques for the treatment of complex bifurcation aneurysms. In majority of previous literature, Y-stenting has been performed using stents that could be delivered through large profile microcatheters that are often difficult to manipulate during navigation through sharply angled side branches. Attempts to navigate with these large profile catheters might cause serious complications during Y-stenting procedure. OBJECTIVE: To investigate the safety, feasibility, and efficacy of Y-stent-assisted coiling procedure with Neuroform Atlas stents for the treatment of complex bifurcation aneurysms; Neuroform Atlas is a recently introduced open-cell stent that can be delivered though low-profile microcatheters. METHODS: We identified the patients with intracranial bifurcation aneurysms treated by Y-stent-assisted coiling procedure with Neuroform Atlas stents. We assessed the immediate postoperative and follow-up clinical and angiographic outcomes. We also investigated the periprocedural and delayed complications. RESULTS: A total of 30 aneurysms in 30 patients were included in the study. Y-stenting was successfully performed without any technical complications in all cases (100%). Immediate postprocedural angiography revealed total aneurysm occlusion in 833% of patients. The mean angiographic follow-up time was 11.8 mo. The last follow-ups showed complete occlusion in 93.3% of patients. There was no mortality in this study. A procedure-related complication developed in 6.7% and resulted in permanent morbidity in 3.3% of patients. CONCLUSION: Neuroform Atlas stent combines the advantages of low-profile deployment microcatheters with an open-cell structure to achieve a successful Y-stenting procedure. Y-stent-assisted coiling with Neuroform Atlas stents provides a safe and effective endovascular treatment for wide-necked complex bifurcation aneurysms.
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    Safety, efficacy, and durability of stent plus balloon-assisted coiling for the treatment of wide-necked intracranial bifurcation aneurysms
    (Oxford Univ Press Inc, 2021) Stracke, Paul; Berdikhojayev, Mynzhylky; Barburoglu, Mehmet; Mosimann, Pascal J.; Suleimankulov, Nurzhan; Sarshayev, Marat; Sencer, Serra; Chapot, Rene; N/A; Aydın, Kubilay; Doctor; N/A; Koç University Hospital; N/A
    Backround: Wide-necked bifurcation aneurysms remain a challenge for endovascular surgeons. Dual-stent-assisted coiling techniques have been defined to treat bifurcation aneurysms with a complex neck morphology. However, there are still concerns about the safety of dual-stenting procedures. Stent plus balloon-assisted coiling is a recently described endovascular technique that enables the coiling of wide-necked complex bifurcation aneurysms by implanting only a single stent. OBJECTIVE: To investigate the feasibility, efficacy, safety, and durability of this technique for the treatment of wide-necked bifurcation aneurysms. METHODS: A retrospective review was performed of patients with wide-necked intracranial bifurcation aneurysms treated with stent plus balloon-assisted coiling. The initial and follow-up clinical and angiographic outcomeswere assessed. Preprocedural and follow-up clinical statuses were assessed using modified Rankin scale. RESULTS: A total of 61 patients (mean age: 54.6 +/- 10.4 yr) were included in the study. The immediate postprocedural digital subtraction angiography revealed complete aneurysm occlusion in 86.9% of the cases. A periprocedural complication developed in 11.5% of the cases. We observed a delayed ischemic complication in 4.9%. There was no mortality in this study. The permanent morbidity rate was 3.3%. The follow-up angiography was performed in 55 of 61 patients (90.1%) (the mean follow-up period was 25.5 +/- 27.3 mo). The rate of complete aneurysm occlusion at the final angiographic follow-up was 89.1%. The retreatment rate was 1.8%. CONCLUSION: The results of this study showed that stent plus balloon-assisted coiling is a feasible, effective, and relatively safe endovascular technique for the treatment of widenecked bifurcation aneurysms located in the posterior and anterior circulation.
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    Initial and long-term outcomes of complex bifurcation aneurysms treated by Y-stent-assisted coiling with low-profile braided stents
    (Amer Soc Neuroradiology, 2018) Men, S.; Barburoglu, M.; Sencer, S.; Akpek, S.; N/A; Aydın, Kubilay; Doctor; N/A; Koç University Hospital; N/A
    BACKGROUND and PURPOSE: Coiling complex intracranial bifurcation aneurysms often necessitates the implantation of double stents in various configurations, such as Y-stent placement. Low-profile braided stents have been introduced recently to facilitate the endovascular treatment of wide-neck aneurysms. We aimed to investigate the feasibility, safety, efficacy, and durability of Y-stent-assisted coiling with double low-profile braided stents for the treatment of complex bifurcation aneurysms. MATERIALS and METHODS: A retrospective review was performed to identify patients who were treated using Y-stent-assisted coiling with low-profile braided stents. Technical success was assessed, as were initial and follow-up clinical and angiographic outcomes. Periprocedural and delayed complications were reviewed. Preprocedural and follow-up clinical statuses were assessed using the modified Rankin Scale. RESULTS: Forty patients with 40 intracranial aneurysms were included in the study. Y-stent placement was successfully performed in all cases. Immediate postprocedural digital subtraction angiography images revealed total aneurysm occlusion in 72.5% of cases. The mean angiographic follow-up time was 24.8 months. The last follow-up angiograms showed complete occlusion in 85% of patients. During follow-up, only 1 patient showed an increase in the filling status of the aneurysm and that patient did not require retreatment. There was no mortality in this study. The overall procedure-related complication rate, including asymptomatic complications, was 17.5%. A permanent morbidity developed in 1 patient (2.5%). CONCLUSIONS: The long-term angiographic and clinical outcomes of this retrospective study demonstrate that Y-stent-assisted coiling using low-profile braided stents is an effective, relatively safe, and durable endovascular treatment for wide-neck and complex bifurcation aneurysms.
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    Long-term outcomes of wide-necked intracranial bifurcation aneurysms treated with T-stent-assisted coiling
    (American Association Neurological Surgeons, 2021) Stracke, Christian Paul; Barburoğlu, Mehmet; Yamaç, Elif; Berdikhojayev, Mynzhylky; Sencer, Serra; Chapot, Rene; Aydın, Kubilay; Doctor; N/A; Koç University Hospital; N/A
    Objective The endovascular treatment of complex bifurcation aneurysms possessing a neck that incorporates multiple side branches remains a surgical challenge. Double-stent-assisted coiling techniques, such as those with stents in an X and Y configuration, enable the endovascular treatment of wide-necked complex intracranial bifurcation aneurysms. However, the intraluminal struts at the intersection point in X- and Y-stents are not amenable to endothelialization, which may lead to thromboembolic complications. Stenting in the T configuration is a relatively new double-stent coiling technique. T-stenting differs from X- or Y-stenting in that there are no overlapping or intersecting stent segments. Promising short-term results of T-stent-assisted coiling were recently reported. However, the long-term results have not yet been demonstrated. This retrospective study investigated the long-term angiographic and clinical results in patients with wide-necked complex intracranial bifurcation aneurysms treated with T-stent-assisted coiling. METHODS A retrospective review was performed to identify patients with wide-necked complex intracranial bifurcation aneurysms treated with T-stent-assisted coiling at 4 institutions. The technical success and the initial and follow-up clinical and angiographic outcomes were assessed. Aneurysm filling status was assessed according to the Raymond classification. Periprocedural and delayed complications were reviewed. The neurological status of the patients was evaluated using the modified Rankin Scale (mRS). RESULTS One hundred two aneurysms in 102 patients (54 females), whose mean age was 57.9 +/- 13.0 years, were included in the study. T-stenting was performed successfully in all patients. Immediate postprocedural angiography revealed complete occlusion in 83.3% of patients. Periprocedural complications developed in 13.7%, resulting in permanent morbidity in 1.9% and death in 1%. Eighty patients (78.4%) had at least one follow-up DSA examination performed at 6 months or later following the endovascular procedure. The mean duration of angiographic follow-up was 30.0 +/- 16.3 months. The last follow-up examinations showed complete occlusion in 90.0% of patients. During the follow-up period, only 1 patient (1.3%) required retreatment. Delayed thromboembolic complications were observed in 4 patients (3.9%) without permanent morbidity. The mRS scores of all patients at the last clinical follow-up were between 0 and 2. CONCLUSIONS The short-term angiographic findings showed that T-stent-assisted coiling is a feasible and effective endovascular method to treat wide-necked complex bifurcation aneurysms. The long-term angiographic follow-up results suggest that T-stent-assisted coiling provides a durable treatment for wide-necked complex bifurcation aneurysms with favorable clinical outcomes, demonstrating the long-term safety of T-stent-assisted coiling.
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    Flow diverter stents in the treatment of recanalized intracranial aneurysms
    (Sage, 2021) Akgul, Erol; Onan, Hasan Bilen; Islek, Irem; Tonge, Mehmet; Durmus, Yavuz; Barburoglu, Mehmet; Azizova, Aynur; Erol, Cengiz; Hakyemez, Bahattin; Sencer, Serra; Arat, Anil; N/A; Aydın, Kubilay; Doctor; N/A; Koç University Hospital; N/A
    Background We assessed the safety and efficacy of flow diverter stents (FDSs) in the treatment of recanalized or residual intracranial aneurysms treated endovascularly. Materials & Methods Patients whose recanalized or residual aneurysms were treated with FDSs in five tertiary hospitals were reviewed retrospectively. The patients' demographic data, aneurysm characteristics, types of previous treatment, and clinical complications, or serious adverse events associated with FDSs, as well as the results of neurological and angiographic follow-up assessments, were recorded. Results Eighty-six patients (37 males) with 87 aneurysms were included in this study. Eighty (91.9%) aneurysms were in the anterior and seven (8.1%) in the posterior circulation. The initial treatment methods were the primary coiling or balloon remodeling technique in 69 (79.3%) and stent-assisted coiling in 18 (20.7%) aneurysms. The endovascular procedure was successful in all patients. Complications occurred in four patients, for a total complication rate of 4.6%. A technical complication developed in one patient (1.2%). An in-stent thrombosis treated with tirofiban was seen in two cases. Late in-stent stenosis exceeding 50% was treated with balloon angioplasty in one patient. The mean length of follow-up was 21.0 months. The first angiographic follow-up (3-6 months) revealed the complete occlusion of 74 aneurysms (85.1%). While 76 aneurysms (87.4%) were occluded at the last angiographic follow-up (mean: 26.0 months), 11 aneurysms (12.6%) were still filling. Morbimortality was zero. Conclusion The drawback of endovascular treatment is aneurysmal remnants or recurrences, which is safely and durably amenable to flow diversion.
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    In reply: safety, efficacy, and durability of stent plus balloon-assisted coiling for the treatment of wide-necked intracranial bifurcation aneurysms
    (Oxford Univ Press Inc, 2021) Stracke, Paul; Berdikhojayev, Mynzhylky; Barburoglu, Mehmet; Mosimann, Pascal; Suleimankulov, Nurzhan; Sarshayev, Marat; Sencer, Serra; Chapot, Rene; N/A; Aydın, Kubilay; Doctor; N/A; Koç University Hospital; N/A