Microstent-Assisted Coiling for Wide-Necked Intracranial Aneurysms

Objective:To describe the results, technical feasibility, efficacy and challenges encountered in our preliminary experience using a self-expandable microstent, optimized for intracranial use, as an adjunct in the endovascular treatment of wide-necked aneurysms.Methods:Only broad-necked aneurysms (dome-to-neck ratio £2, or an isolated neck size > 4.5 mm) were treated with Neuroform microstent from July 2003 to May 2004. The techniques used for stent deployment were either parallel or sequential. Angiographic results were recorded immediately for all patients and classified as Class 1 (complete occlusion), Class 2 (neck remnant) or Class 3 (sac remnant) by three interventional neuroradiologists not involved in the procedure. Follow-up angiography at six months was obtained for one case. Modified Rankin Score scale was assessed for all patients.Results:Seventeen intracranial aneurysms in a total of 18 patients were treated (mean age, 52.2 yr). Eight patients (44.4%) presented with acute subarachnoid hemorrhage. Eleven aneurysms (61.1%) were in the posterior circulation. Average dome size was 10.2 mm (range, 3.7-19.8 mm) and average neck size was 5.36 mm (range, 3.0-10.0 mm). Six out of seven aneurysms of the anterior circulation were approached with parallel technique. Eight aneurysms of the posterior circulation were approached with sequential technique. Average number of coils deployed was 9.64 (range, 4-23 coils). Eleven aneurysms (64.8%) resulted in Class 1 and/or Class 2. One technical failure was observed. Technical complications were recognized in four patients (23.5%), all of them with unruptured aneurysms in the anterior circulation. Two patients (11.7%) presented transient immediate clinical complications. One patient (5.8%) had minor permanent neurological complication. Neither major clinical complications nor death were encountered. Favorable clinical outcome (Modified Rankin Scale score 0-2) was observed in 88.2% of the patients (average follow-up time, 4.72 months).Conclusion:Absence of major permanent complications and satisfactory immediate obliteration degree in our preliminary experience indicates that microstent-assisted coiling technique is useful for the minimally invasive treatment of broad-necked complex aneurysms that are not ideal for conventional endovascular treatment and are at a high risk for conventional surgical treatment.

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Abstract 120: Surpass Flow Diverter for Endovascular Treatment of Intracranial Aneurysms - A Multicenter Preliminary Clinical and Angiographic Experience in 161 Patients with 186 Aneurysms

Stroke ◽

10.1161/str.45.suppl_1.120 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Ajay K Wakhloo ◽

Pedro Lylyk ◽

Joost de Vries ◽

Matthew J Gounis ◽

Alexandra Biondi ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Experimental Studies ◽

Flow Diverter ◽

Posterior Circulation ◽

Parent Artery ◽

Anterior Circulation ◽

Neck Size ◽

Wide Range ◽

New Generation

Objective: Validated through experimental studies a new generation of flow diverters (Surpass™ FD) was evaluated for treatment of intracranial aneurysms (IA). We present our multicenter preliminary clinical and angiographic experience. METHODS: To achieve the calculated flow disruption between the parent artery and aneurysm for thrombosis, single FDs were placed endovascularly in parent arteries. Implants measured 2.5-5.3mm in diameter with a length of 10-80mm. Patients were enrolled harboring a wide range large and giant wide-neck, fusiform and multiple small and blister-type aneurysm. Clinical and angiographic follow-up were performed at 1-3, 6, and 12 months. RESULTS: A total of 186 consecutive IA in 161 patients (mean age 57.1 years) were treated at 33 centers. Fifty-three aneurysms were smaller than 5 mm, 64 were 5-9.9mm in diameter, 47 were 10-20mm in diameter, and 22 were larger than 20mm (10.4±0.7mm, neck size 6.0±0.5mm [mean±SEM]) . The aneurysms originated in 63.4% from the internal carotid artery; 22% and 14.5% of the lesions were located in the anterior circulation distal to Circle of Willis and posterior circulation respectively. Technical success was achieved in 182 aneurysms (98%); average number of devices used per aneurysm was 1.05. Permanent morbidity and mortality during the follow-up period of mean 8.4months (range 1-24 months) including periprocedural complications for patients with aneurysms of the anterior circulation were encountered in 5 (3.7%) and 2 (1.5 %) patients respectively and 1 (3.7%) and 4 (14.8%) respectively for patients with aneurysms of the posterior circulation location. One-hundred-ten patients (70.5%) harboring 127 (70.2%) were available for clinical and angiographic follow-up and showed a complete or near complete aneurysm occlusion in 63 (81.8%) of the ICA. Aneurysms of the ICA≥10mm that were completely covered by FD and not previously stent-treated with a minimum of 6 months follow-up available in 16 patients showed a complete obliteration in 81.3% (n=13) and >90% occlusion in remaining 3 patients. CONCLUSION: Preliminary data demonstrate high safety and efficacy of a new generation of FD for a wide range of IA of the anterior and posterior circulation with a single implant.

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Treatment Of Ruptured Tiny Intracranial Aneurysms By Electrocoagulation With Guidewire Manipulation:12 Cases Report

10.21203/rs.3.rs-30106/v1 ◽

2020 ◽

Author(s):

Lixia Xia ◽

Zhongfei Hao ◽

Hongjun Wang ◽

Yan Feng ◽

Yongxuan Zhan ◽

...

Keyword(s):

Intracranial Aneurysm ◽

Intracranial Aneurysms ◽

Large Scale ◽

Posterior Circulation ◽

Suitable Method ◽

Anterior Circulation ◽

Long Term Follow Up

Abstract Background: Ruptured tiny intracranial aneurysm (RTIA) is particularly rare seen. Treatment of RTIA is more difficult and not under control.Methods: We hereby present twelve rare cases of RTIA that were diagnosed based on DSA. These patients were found due to spontaneous or traumatic SAH, 11 of whom were treated only by electrocoagulation, and one of whom was treated by stent-assisted coiling and electrocoagulation.Results: There were eight patients with aneurysms located in posterior circulation and four patients with aneurysms located in anterior circulation. 11 patients were cured only by electrocoagulation merely: ten patient’ RTIA disappeared completely and immediately and another patient’s RTIA was thrombosed two months later. The twelfth patient was carried out stent-assisted coiling and electrocoagulation. The twelve patients’ average follow-up time was 12.5 months and the outcomes were all surprisingly excellent. No revascularization of aneurysm was found. Conclusions: Electrocoagulation with guidewire manipulation is a suitable method to treat RTIA. While large-scale studies with long-term follow-up are required to validate these promising results.

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Selective endovascular treatment of 71 intracranial aneurysms with platinum coils

Journal of Neurosurgery ◽

10.3171/jns.1993.79.1.0003 ◽

1993 ◽

Vol 79 (1) ◽

pp. 3-10 ◽

Cited By ~ 164

Author(s):

Alfredo E. Casasco ◽

Armand Aymard ◽

Y. Pierre Gobin ◽

Emmanuel Houdart ◽

André Rogopoulos ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Mortality Rates ◽

Posterior Circulation ◽

Endovascular Techniques ◽

Anterior Circulation ◽

Content Type ◽

Grade Ii ◽

Platinum Coils ◽

Type Of Surgery

✓ Seventy-one intracranial aneurysms were treated by endovascular techniques, with the placement of minicoils inside the aneurysmal sac. Most aneurysms were manifest by hemorrhage (67 cases), and 43 of these were treated within the first 3 days after presentation. At the 1-year follow-up examination, the outcome was scored as good in 84.5% of cases, but the morbidity and mortality rates were 4.2% and 11.3%, respectively. Twenty-nine aneurysms in the anterior circulation and 42 in the posterior circulation were treated. In this series, 23 patients were classified as Hunt and Hess neurological Grade I, 27 as Grade II, 12 as Grade III, nine as Grade IV, and none as Grade V. Thirty-three aneurysms were less than 10 mm in diameter, 28 were 10 to 25 mm, and 10 were larger than 25 mm. The preliminary results from this study appear to justify the emergency treatment of aneurysms by this approach. Aneurysms in the posterior circulation are particularly well suited for this type of surgery.

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FRED Italian Registry: a multicenter experience with the flow re-direction endoluminal device for intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/2019.1.jns183005 ◽

2020 ◽

Vol 133 (1) ◽

pp. 174-181 ◽

Cited By ~ 5

Author(s):

Mariangela Piano ◽

Luca Valvassori ◽

Emilio Lozupone ◽

Guglielmo Pero ◽

Luca Quilici ◽

...

Keyword(s):

Adverse Event ◽

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Cerebral Aneurysms ◽

Flow Diverter ◽

Anterior Circulation ◽

Cross Sectional ◽

Safety And Efficacy ◽

Mortality And Morbidity

OBJECTIVEThe introduction of flow-diverter devices (FDDs) has revolutionized the endovascular treatment of intracranial aneurysms. Here the authors present their Italian multicenter experience using the flow re-direction endoluminal device (FRED) in the treatment of cerebral aneurysms, evaluating both short- and long-term safety and efficacy of this device.METHODSBetween February 2013 and December 2014, 169 consecutive aneurysms treated using FRED in 166 patients were entered into this study across 30 Italian centers. Data collected included patient demographics, aneurysm location and characteristics, baseline angiography, adverse event and serious adverse event information, morbidity and mortality rates, and pre- and posttreatment modified Rankin Scale scores, as well as angiographic and cross-sectional CT/MRI follow-up at 3–6 months and/or 12–24 months per institutional standard of care. All images were reviewed and adjudicated by an independent core lab.RESULTSOf the 169 lesions initially entered into the study, 4 were later determined to be extracranial or nonaneurysmal by the core lab and were excluded, leaving 165 aneurysms in 162 patients treated in 163 procedures. Ninety-one (56.2%) patients were asymptomatic with aneurysms found incidentally. Of the 165 aneurysms, 150 (90.9%) were unruptured. One hundred thirty-four (81.2%) were saccular, 27 (16.4%) were fusiform/dissecting, and the remaining 4 (2.4%) were blister-like. One hundred thirty-seven (83.0%) arose from the anterior circulation.FRED deployment was impossible in 2/163 (1.2%) cases, and in an additional 4 cases (2.5%) the device was misdeployed. Overall mortality and morbidity rates were 4.3% and 7.3%, respectively, with rates of mortality and morbidity potentially related to FRED of up to 2.4% and 6.2%, respectively. Neuroimaging follow-up at 3–6 months showed complete or nearly complete occlusion of the aneurysm in 94% of cases, increasing to 96% at 12–24 months’ follow-up. Aneurysmal sac shrinkage was observed in 78% of assessable aneurysms.CONCLUSIONSThis preliminary experience using FRED for endovascular treatment of complex unruptured and ruptured aneurysms showed a high safety and efficacy profile that is comparable to those of other FDDs currently in use.

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Endovascular treatment of bifurcation intracranial aneurysms with the WEB SL/SLS: 6-month clinical and angiographic results

Interventional Neuroradiology ◽

10.1177/1591019915590083 ◽

2015 ◽

Vol 21 (4) ◽

pp. 462-469 ◽

Cited By ~ 20

Author(s):

Patricia Bozzetto Ambrosi ◽

Benjamin Gory ◽

Rotem Sivan-Hoffmann ◽

Roberto Riva ◽

Francesco Signorelli ◽

...

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Single Layer ◽

Additional Treatment ◽

Anterior Communicating Artery ◽

Neck Size ◽

Aneurysm Occlusion ◽

Web Device ◽

The Web

Background The WEB device is a recent intrasaccular flow disruption technique developed for the treatment of wide-necked intracranial aneurysms. To date, a single report on the WEB Single-Layer (SL) treatment of intracranial aneurysms has been published with 1-months' safety results. The aim of this study is to report our experience and 6-month clinical and angiographic follow-up of endovascular treatment of wide-neck aneurysm with the WEB SL. Methods Ten patients with 10 unruptured wide-necked aneurysms were prospectively enrolled in this study. Feasibility, intraoperative and postoperative complications, and outcomes were recorded. Immediate and 6-month clinical and angiographic results were evaluated. Results Failure of WEB SL placement occurred in two cases. Eight aneurysms were successfully treated using one WEB SL without additional treatment. Three middle cerebral artery, four anterior communicating artery, and one basilar artery aneurysms were treated. Average dome width was 7.5 mm (range 5.4–10.7 mm), and average neck size was 4.9 mm (range 2.6–6.5 mm). No periprocedural complication was observed, and morbi-mortality at discharge and 6 months was 0.0%. Angiographic follow-up at 6 months demonstrated complete aneurysm occlusion in 2/8 aneurysms, neck remnant in 5/8 aneurysms, and aneurysm remnant in 1/8 aneurysm. Conclusions From this preliminary study, treatment of bifurcation intracranial aneurysms using WEB SL is feasible. WEB SL treatment seems safe at 6 months; however, the rate of neck remnants is not negligible due to compression of the WEB SL. Further technical improvements may be needed in order to ameliorate the occlusion in the WEB SL treatment.

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Endovascular treatment of symptomatic intracranial stenosis with the Wingspan stent system and Gateway PTA balloon: a multicenter series of 60 patients with acute and midterm results

Journal of Neurosurgery ◽

10.3171/2011.5.jns101583 ◽

2011 ◽

Vol 115 (4) ◽

pp. 686-693 ◽

Cited By ~ 19

Author(s):

Vincent Costalat ◽

Igor Lima Maldonado ◽

Jean-François Vendrell ◽

Carlos Riquelme ◽

Paolo Machi ◽

...

Keyword(s):

Endovascular Treatment ◽

Recurrent Stroke ◽

Neurological Complication ◽

Arterial Stenosis ◽

Technical Failure ◽

Stent Restenosis ◽

Stent System ◽

The Mean ◽

In Stent Restenosis

Object The limitations of the medical management of symptomatic intracranial arterial stenosis (SIAS) have encouraged the development of new strategies, such as endovascular treatment. In this study, the authors report and analyze a series of 63 endovascular procedures in which the Wingspan stent system was used. Methods Data from 60 patients presenting with refractory SIAS, treated in 5 French neurointerventional centers between September 2006 and August 2009, were retrieved. An angiogram was systematically obtained 6 months after the procedure and yearly thereafter. The clinical neurological status was assessed and reported using the modified Rankin scale at 1-month, 6-month, and 1-year follow-up visits. Results A total of 63 stenotic lesions was treated. The mean age of the patients was 65.3 years, and the mean diameter of the stenosis was 80.2%. Technical success was achieved in 95.2% of cases. The overall incidence of procedural complications was 20.6%, with a 4.8% rate of permanent postoperative morbidity and death. In-stent restenosis (ISR)/occlusion occurred in 11 cases (17.4%), of which 10 were asymptomatic and 9 were detected less than 1 year from the endovascular treatment. In 1 case, the patient presented with a recurrent transient ischemic attack and was treated again with angioplasty. The mean follow-up was 13.2 months. Conclusions Endovascular treatment of SIAS demonstrates a moderate risk of neurological complication. Nevertheless, considering the critical natural history of severe refractory lesions, this may be considered the first alternative in cases of failed medical therapy. Technical failure, residual stenosis, or in-stent restenosis did not lead to systematic recurrent stroke in this series, which suggests the importance of plaque stabilization and neoendothelialization.

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Clinical and angiographic long-term follow-up of completely coiled intracranial aneurysms using endovascular technique

Journal of Neurosurgery ◽

10.3171/2008.12.jns08768 ◽

2010 ◽

Vol 112 (3) ◽

pp. 575-581 ◽

Cited By ~ 45

Author(s):

Dae Seob Choi ◽

Mun Chul Kim ◽

Seon Kyu Lee ◽

Robert A. Willinsky ◽

Karel G. Terbrugge

Keyword(s):

Clinical Outcome ◽

Endovascular Treatment ◽

Glasgow Outcome Scale ◽

Intracranial Aneurysms ◽

Endovascular Embolization ◽

Morbidity Rate ◽

Neck Size ◽

Aneurysm Neck ◽

Surface Modified

Object The anatomical evolution and clinical outcome of completely coiled intracranial aneurysms after endovascular embolization have rarely been studied separately. From their prospective database, the authors reviewed follow-up angiography and clinical outcome of 87 patients whose aneurysms were designated as 100% obliterated on immediate postembolization angiography. Methods Ninety-one aneurysms (56 ruptured and 35 unruptured) in 87 patients were included in this study. Clinical outcome was evaluated using the Glasgow Outcome Scale. Follow-up angiographic findings were assessed and categorized as 1 of the following: no recanalization, recanalization with a neck remnant, or recanalization with a body remnant. For statistical analysis, the recanalization rate was correlated with: clinical presentation; the largest aneurysm diameter, aneurysm neck size, and dome-to-neck ratio; aneurysm location; and use of special techniques such as usage of a surface modified coil, balloon remodeling technique, or stent. Results At the latest clinical evaluation (mean 34.3 months), 81 (93.1%) of the 87 patients (91 aneurysms) had good clinical outcomes (Glasgow Outcome Scale Score 5). The procedure-related morbidity rate (permanent neurological deficit) was 2.3% (2 of 87), and there were no procedure-related deaths. On the latest follow-up angiography (mean 26.4 months), the recanalization rate was 26.4% (24 of 91 aneurysms): 16 (17.6%) with neck remnants and 8 (8.8%) with body remnants. The neck size of the recanalized aneurysms was statistically significantly larger than that of the nonrecanalized aneurysms (p = 0.006), and aneurysms with wide necks (≥4 mm) had a higher recanalization rate than those with a narrow neck (< 4 mm) (p = 0.002). There was no bleeding after endovascular treatment during the follow-up period. Conclusions Completely coiled aneurysms after endovascular embolization demonstrated good clinical outcome, and there was no bleeding episode after endovascular treatment; however, there was a relatively high recanalization rate.

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Spanish Registry for Embolization of Small Intracranial Aneurysms with Cerecyte Coils (SPAREC) Study

Interventional Neuroradiology ◽

10.1177/159101990801400403 ◽

2008 ◽

Vol 14 (4) ◽

pp. 375-384 ◽

Cited By ~ 4

Author(s):

E. Castro ◽

F. Villoria ◽

C. Castaño ◽

A. Romance ◽

J.C. Mendez ◽

...

Keyword(s):

Complication Rate ◽

Intracranial Aneurysms ◽

Parent Vessel ◽

Neck Size ◽

Clinical Complications ◽

Unruptured Intracranial Aneurysms ◽

Nerve Paresis ◽

Anterior Choroidal ◽

Technical Complication

This study aimed to report the results obtained in treating small ruptured and unruptured intracranial aneurysms using Cerecyte coils. A prospective, non-randomized multicenter registry operating in Spain with a reporting period between May 2005 and September 2007. We present clinical and angiographic results for 48 small aneurysms (26 ruptured, five with III cranial nerve paresis, and 17 incidental) that had undergone six months' follow-up. The volumetric percentage occlusion (VPO) achieved and percentage bioactive coils (PBC) used were assessed. No episodes of bleeding occurred during the follow-up period. The technical complication rate was 10.4% (five cases): four thromboembolic complications resolved with medication (8.3%) and one asymptomatic protrusion of a coil into the parent vessel. The clinical complication rate for the procedure was 2.1% (occlusion of the anterior choroidal artery in a ruptured anterior choroidal anaeurysm). Mean VPO was 25.2%. Balloon-assisted technique (BAT) was used in 60.4% of cases. The VPO was higher in the BAT-treated cases (P<0.05). The overall six-month recanalization rate was 16.7% (12.5% minor and 4.2% major recanalizations). Neck size and VPO were unrelated to the recanalization rate. The PBC was higher in cases with progressive Deployment of the device is safe from the standpoint of periprocedural technical and clinical complications. No episodes of hemorrhage were recorded during follow-up. The six-month recanalization and retreatment rates compared favorably with most endovascular platinum and bioactive coil series.

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Long-term Clinical and Angiographic Follow-up of Unclippable Wrapped Intracranial Aneurysms

Neurosurgery ◽

10.1227/01.neu.0000199158.02619.99 ◽

2006 ◽

Vol 58 (3) ◽

pp. 434-442 ◽

Cited By ~ 55

Author(s):

Vivek R. Deshmukh ◽

Udaya K. Kakarla ◽

Eberval Gadelha Figueiredo ◽

Joseph M. Zabramski ◽

Robert F. Spetzler

Keyword(s):

Subarachnoid Hemorrhage ◽

Intracranial Aneurysms ◽

Posterior Circulation ◽

Medical Comorbidity ◽

Anterior Circulation ◽

The Mean ◽

Lost To Follow Up ◽

Wrapping Technique

Abstract OBJECTIVE: This is the largest contemporary series examining long-term clinical and angiographic follow-up of unclippable wrapped intracranial aneurysms. METHODS: The presentation, location and shape of aneurysm, wrapping technique, outcome at discharge and last follow-up, and change in aneurysm at last angiographic follow-up were reviewed retrospectively in 74 patients with wrapped or clip-wrapped aneurysms. Patients in whom wrapping was used in conjunction with primary clipping were excluded. RESULTS: Of the 74 patients, 11 were lost to follow-up. The mean age of the remaining 63 patients (16 males, 47 females) was 56.5 years (range, 13–89 yr). Fifty-one aneurysms were located in the anterior circulation, and 17 were located in the posterior circulation. Fourteen patients presented with a ruptured aneurysm. Seventeen aneurysms were fusiform. Seven aneurysms were clip-wrapped, and 61 were wrapped with cotton. At discharge the Glasgow Outcome Scale (GOS) score was 5 in 54 patients and 4 in 5 patients. Two patients died from their presenting hemorrhage, and one from a medical comorbidity. The mean clinical follow-up was 44.1 months (range, 1–120 mo). One patient under clinical follow-up experienced subarachnoid hemorrhage. The mean angiographic follow-up of 34 patients was 41.8 months (range, 3–120 mo). During this follow-up period, no patient's aneurysm changed in size or configuration. CONCLUSION: Wrapping or clip-wrapping of unclippable intracranial aneurysms is safe and seems to confer protection against aneurysmal growth or subarachnoid hemorrhage.

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Flow diverter neuroendovascular stents – Reconstructive endovascular treatment of intracranial aneurysms – Single centre experience

Indian Journal of Neurosurgery ◽

10.4103/2277-9167.118122 ◽

2013 ◽

Vol 02 (02) ◽

pp. 182-188 ◽

Cited By ~ 1

Author(s):

Krzysztof Kadzioloka ◽

Laurent Estrade ◽

Laurent Pierot ◽

Girish Rajpal

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Antiplatelet Agents ◽

Flow Diverter ◽

Digital Subtraction ◽

Anterior Circulation ◽

Complete Occlusion ◽

Digital Subtraction Angiogram ◽

Age Range

AbstractFlow diverter stents (FDS) are new neuroendovascular tools able to achieve the complete and curative treatment of aneurysm by reconstruction of the parent arteries from which the aneurysm arises. We present our initial experience with flow diverter embolization devices and follow-up results.Patients with large, giant and wide necked aneurysms, saccular, fusiform and recurrent aneurysms were selected for the treatment. All patients were pretreated with dual antiplatelet agents at least for 7 days before procedure and continued taking both agents for 3 months after treatment. A MRI was done after 3 months of treatment and digital subtraction angiogram was performed at 4 months of treatment. After 1 year both MRI and digital subtraction angiogram was performed.11 patients (age range 37 year to 79 year, mean 51.1) with 11 intracranial aneurysms were treated with 15 flow diverter stents. 9 aneurysm were located on the anterior circulation and 2 on posterior circulation. 8 aneurysms were large (10-25 mm), 2 were small (<10 mm) and 1 was giant (>25 mm) with mean largest diameter of 13.22 mm. 9 were saccular aneurysm and 2 were fusiform, out of these 3 were remnant of the previously treated aneurysm. Treatment was achieved with 10 Silk stents in 7 patients and 5 Pipeline embolization devices in 4 patients. The mean time between treatment and follow up was 9.6 months (range 4-12 months). One mortality was noted due to rebleed after 3 weeks of treatment. Complete angiographic occlusion was achieved in 9 (90%) patients after 4 months and 1 (10%) patient had near complete occlusion at 12 months. All the patients were stable clinically during follow up period.Endovascular treatment with FDS is safe, easy, and permanent treatment for the selected group of aneurysms. The complete occlusion rate in follow-up study approaches 100% with no angiographic recurrence in this study.

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