Page 61 - Inaugural Lecture Prof Dr Ahmad Sobri Muda

Ahmad Sobri Muda

Recently, a newly developed permanent carotid intraarterial
filter device for preventing stroke in high-risk patients, was in
final clinical trial phase. Recent findings in animal studies and in
two observational human studies studies have found the device are
safe during the procedure as well as for the long-term placement.
A randomised trial (INTERCEPT) has been scheduled for 2021 to
prove the superiority of the device combined with an anticoagulation
therapy over anticoagulation alone in patients who are at risk of
ischemic stroke.
The innovation in other neurovascular problems like brain
aneurysm and AVM continues. Following the invention of the
detachable coil and stent, flow diverter stents push the boundaries
further in the endovascular treatment of brain aneurysms. Flow
diverter stents divert the parent artery flow and change the flow
dynamics within the brain aneurysm, which disrupts the shear
wall pressure and induces thrombosis within the aneurysm. As a
result, the aneurysm will slowly thrombose and occlude. Despite
issues such as delayed devastating rupture of an aneurysm treated
with a flow diverter, improvements in techniques and stent design
demonstrated a better outcome during the early stages of use. In
recent years, with advanced tools, state-of-the-art imaging, and
sophisticated embolic materials, endovascular treatment of brain
aneurysms is very safe and provides good outcomes even in low
volume centers. Intrasaccular devices to treat brain aneurysms are
worth mentioning as recent registries show more effective occlusion
with better results in selected complex cases.
ONYX was developed as a liquid embolic material for
brain AVM embolisation as an adjunct to surgical resection. The
co-polymer possesses lava-like properties which do not stick
with the catheter, giving the option of controlled injection of

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