Improved Endovascular Coiling of Wide-Neck Intracranial Aneurysms in Elderly Patients by Double-Microcatheter Technique

Flow diversion prostheses represent a new endovascular approach aimed at treating patients with large wide-neck aneurysms. Our objective is to present this new technology, to review the clinical studies on efficacy, and to emphasize its current limits. Flow diversion prostheses consist of a cylinder made of a large number of braided microfilaments providing a large metallic surface when deployed and inducing a blood flow diversion outside the aneurysm. Two different brands are currently available. Clinical data supporting their efficacy are currently limited to six non comparative cohort studies that included between 18 and 107 patients. Procedural implantation was shown to be feasible in more than 90% and safe with a thirty-day mortality between 2.8 and 5.5%. Complete occlusion rates at twelve months varied between 85.7 and 100%. Even though promising, the current status of flow diversion prostheses needs further evaluation with randomized, prospective, clinical trials with comparison to conventional strategies including endovascular coiling or surgical clipping.

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Endovascular Coiling of Intracranial Aneurysms in Elderly Patients

Neurosurgery ◽

10.1227/01.neu.0000367451.59090.d7 ◽

2010 ◽

Vol 66 (4) ◽

pp. 714-721 ◽

Cited By ~ 42

Author(s):

Nestor R. Gonzalez ◽

Joshua R. Dusick ◽

Gary Duckwiler ◽

Satoshi Tateshima ◽

Reza Jahan ◽

...

Keyword(s):

Elderly Patients ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

The Elderly ◽

Clinical Results ◽

Endovascular Coiling ◽

Unruptured Aneurysms ◽

Computed Tomographic ◽

Incomplete Occlusion

Abstract BACKGROUND More elderly patients are presenting with intracranial aneurysms. Many are poor surgical candidates and often undergo endovascular treatment. OBJECTIVE We present our experience with embolization in elderly patients. METHODS We performed a retrospective review of a prospective database of elderly patients treated with coil embolization for intracranial aneurysms. RESULTS In a period of 16 years, 205 aneurysms were treated in 196 individuals (age range, 70–96 years; mean age, 77.3 years), including 159 females (average follow-up, 16.2 months). Ninety-seven patients presented with unruptured aneurysms, and 99 patients presented after subarachnoid hemorrhage; the diagnosis was confirmed by computed tomographic scan or lumbar puncture. Complete occlusion was achieved in 53 aneurysms (26%), with a neck remnant in 127 (62%), incomplete occlusion in 13 (6%), and 12 unsuccessful attempts. Postembolization, 89.3% of patients were neurologically intact or unchanged, whereas 8.7% had new deficits. Four patients died. By modified Rankin Scale score, at last clinical evaluation, 128 patients (65%) had a good outcome. Follow-up angiograms were available for 113 aneurysms; they revealed that 62% were unchanged, 21% were further thrombosed, and 17% had recanalized. Three aneurysms ruptured after treatment during follow-up. Rupture was not associated with incomplete occlusion or neck remnant results (P = .6). Twenty-five aneurysms required reembolization. Reembolization was not associated with new deficits or death (odds ratio, 0.56; 95% confidence interval, 0.19–1.58; P = .27). CONCLUSION Coil embolization of intracranial aneurysms is safe and effective in the elderly. Preembolization clinical condition strongly correlates with clinical outcome. Incomplete embolizations are not associated with a higher rerupture risk. Additional embolization does not affect the clinical results.

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Assisted Endovascular Coiling of Wide Neck Aneurysms - Double Microcatheter and JAIL Techniques

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0034-1382238 ◽

2014 ◽

Vol 75 (S 01) ◽

Author(s):

M. Lilov ◽

T. Eftimov ◽

V. Nakov ◽

I. Todorov ◽

K. Ninov

Keyword(s):

Endovascular Coiling ◽

Wide Neck

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Faculty Opinions recommendation of International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14584.472091 ◽

2006 ◽

Author(s):

Luciana Mascia

Keyword(s):

Intracranial Aneurysms ◽

Endovascular Coiling ◽

International Subarachnoid Aneurysm Trial ◽

Aneurysm Occlusion ◽

Ruptured Intracranial Aneurysms

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DEFINING THE RISK OF RETREATMENT FOR ANEURYSM RECURRENCE OR RESIDUAL AFTER INITIAL TREATMENT BY ENDOVASCULAR COILING

Neurosurgery ◽

10.1227/01.neu.0000349922.05350.96 ◽

2009 ◽

Vol 65 (2) ◽

pp. 311-315 ◽

Cited By ~ 56

Author(s):

Andrew J. Ringer ◽

Rafael Rodriguez-Mercado ◽

Erol Veznedaroglu ◽

Elad I. Levy ◽

Ricardo A. Hanel ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Surgical Repair ◽

The United States ◽

Patient Treatment ◽

Endovascular Coiling ◽

Total Risk ◽

Clinical Recurrence ◽

Choice Of Treatment ◽

Procedural Complications

Abstract OBJECTIVE Endovascular treatment of intracranial aneurysms is less invasive than surgical repair but poses a higher risk for aneurysm recurrence, which may necessitate retreatment, thus adding to the long-term risk. Cerebrovascular neurosurgeons from 8 institutions in the United States and Puerto Rico collaborated to assess the risk of retreatment for residual or recurrent aneurysms after the initial endovascular coiling. METHODS Data were prospectively recorded for 311 patients with coiled intracranial aneurysms who underwent 352 retreatment procedures after angiographic or clinical recurrence (hemorrhage after initial coiling). Results analyzed included procedural complications and procedure-related morbidity. Morbidity was classified as major (modified Rankin scale score > 3) or minor, and temporary (<30 days) or permanent (>30 days). RESULTS Retreatment mortality was 0.85% per procedure and 0.96% per patient. Treatment-related rates were 0.32% per patient (0.28% per procedure) for permanent or temporary major disability; 1.29% for permanent minor disability (1.14% per procedure); and 1.61% for temporary minor disability (1.42% per procedure). Total risk for death or permanent major disability was 1.28% per patient and 1.13% per procedure. CONCLUSION Retreatment poses a low risk for patients with recurrences of intracranial aneurysms after initial coiling; this risk is smaller than that posed by the initial endovascular therapy. The risk of disability associated with retreatment for aneurysm recurrence after coiling must be considered prospectively in the choice of treatment but with the recognition that its effects are low in the overall management risk.

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Medina embolization device for the treatment of intracranial aneurysms: 18 months’ angiographic results

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014110 ◽

2018 ◽

Vol 11 (5) ◽

pp. 516-522 ◽

Cited By ~ 3

Author(s):

Idriss Haffaf ◽

Frédéric Clarençon ◽

Eimad Shotar ◽

Claudia Rolla-Bigliani ◽

Saskia Vande Perre ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Thromboembolic Complication ◽

Detachable Coil ◽

Mean Delay ◽

Scale Scores ◽

Long Term Follow Up ◽

Occlusion Rate ◽

Wide Neck

Background and purposeThe Medina embolization device (MED) is a new flow disruption device combining the design of a detachable coil with an intrasaccular flow disrupter. Safety and short-term angiographic effectiveness of this device have recently been reported. However, long-term angiographic results are lacking. We report herein the 18 months’ angiographic outcome in patients treated for a wide-neck intracranial aneurysm with the MED.Materials and methodsNineteen patients (17 female, mean age 50 years) with 20 wide-neck intracranial aneurysms (six ruptured; 14 unruptured) were treated by the MED between January 2015 and June 2016. Procedure-related complications were systematically recorded; discharge and 6–9 months' follow-up modified Rankin Scale scores were assessed. Angiographic mid-term and long-term follow-up were performed with a mean delay of 6.4±1.5 months (n=16 aneurysms) and 17.7±4.2 months (n=15 aneurysms), respectively. Occlusion rates were evaluated after the procedure and at the mid-term and long-term follow-up using the Roy-Raymond scale.ResultsEmbolization with the MED was feasible in all except two cases (2/20, 10%). One per-procedural perforation was recorded (1/20, 5%) and one MED deployment failed because of the aneurysm’s shape (1/20, 5%). Three cases of thromboembolic complications were observed (3/20, 15%). Only one thromboembolic complication was responsible for clinical sequelae. Grade A occlusion rate was 61% (11/18) after the procedure, 75% at 6 months' follow-up (12/16), and 80% (12/15) at long-term follow-up. Two cases (2/18, 11%) of recanalization at mid-term were documented angiographically. No recanalization occurred between the mid-term and long-term follow-up.ConclusionMED is a hybrid embolization device, combining properties of a conventional coil with those of an intrasaccular flow disrupter. Our series focusing on long-term angiographic follow-up shows a satisfactory long-term occlusion rate. Larger series with longer angiographic follow-up times are warranted to confirm these preliminary results.

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