Endovascular coil embolization of residual or recurrent aneurysms after surgical clipping

2000 ◽  
Vol 41 (2) ◽  
pp. 111-115 ◽  
Author(s):  
H.S. Cekirge ◽  
C. Islak ◽  
M.M. Firat ◽  
N. Kocer ◽  
I. Saatci
Keyword(s):  
Treatment Option ◽  
Coil Embolization ◽  
Guglielmi Detachable Coils ◽  
Surgical Clipping ◽  
Present Treatment ◽  
Complete Obliteration ◽  
Detachable Coils ◽  
Endovascular Coil Embolization ◽  
Endovascular Approach ◽  
Good Treatment Option

Purpose: Treatment of residual or recurrent aneurysms after surgical clipping is a challenge and most surgeons prefer to avoid a second surgical attempt. We present treatment of 4 residual or recurrent aneurysms after surgical clipping with electrolytically detachable coils. Material and Methods: In 3 of 4 patients, recurrent aneurysms were diagnosed with angiography 2 months, 5 years and 14 years after surgery, although the domes of the aneurysms were opened following clipping during the surgery. In the 4th patient, an early postoperative angiogram revealed filling of a residual aneurysm secondary to the incomplete neck clipping. Guglielmi detachable coils were used to occlude the residual or recurrent aneurysm. Results: The endovascular approach was successful in all patients and the control angiograms showed complete obliteration of the aneurysms with no recanalization. Conclusion: The endovascular approach is a good treatment option for patients in whom complete obliteration of the aneurysm cannot be achieved by surgical clipping. Opening of the aneurysm sac after clipping does not necessarily preclude aneurysm regrowth from a neck remnant proximal to the clip.

scholarly journals Coil placement after clipping: endovascular treatment of incompletely clipped cerebral aneurysms

1996 ◽  
Vol 1 (3) ◽  
pp. E2
Author(s):  
Michael Forsting ◽  
Friedrich K. Albert ◽  
Olav Jansen ◽  
Rüdiger von Kummer ◽  
Alfred Aschoff ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Aneurysms ◽  
Surgical Clipping ◽  
Detachable Coil ◽  
Complete Occlusion ◽  
Guglielmi Detachable Coil ◽  
Complete Obliteration ◽  
Endovascular Approach ◽  
Good Treatment Option ◽  
Platinum Coils

In up to 4% of patients whose aneurysms are microsurgically clipped, there is an expected or unexpected aneurysm residuum. The authors describe two patients in whom surgical clipping did not result in complete obliteration of the aneurysm sac and in whom a second operation was not believed to be the solution to the problem. In both patients complete occlusion of the aneurysm residuum was achieved via an endovascular approach. Using the Guglielmi detachable coil system, it was possible to place two platinum coils selectively into the aneurysms. The endovascular approach may be a good treatment option for all patients in whom surgical clipping does not result in complete obliteration of the aneurysm sac and reoperation is contraindicated or unacceptable to the patient.

Coil placement after clipping: endovascular treatment of incompletely clipped cerebral aneurysms

1996 ◽  
Vol 85 (5) ◽  
pp. 966-969 ◽  
Author(s):  
Michael Forsting ◽  
Friedrich K. Albert ◽  
Olav Jansen ◽  
Rüdiger von Kummer ◽  
Alfred Aschoff ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Surgical Clipping ◽  
Detachable Coil ◽  
Content Type ◽  
Complete Occlusion ◽  
Guglielmi Detachable Coil ◽  
Complete Obliteration ◽  
Endovascular Approach ◽  
Good Treatment Option ◽  
Platinum Coils

✓ In up to 4% of patients whose aneurysms are microsurgically clipped, there is an expected or unexpected aneurysm residuum. The authors describe two patients in whom surgical clipping did not result in complete obliteration of the aneurysm sac and in whom a second operation was not believed to be the solution to the problem. In both patients complete occlusion of the aneurysm residuum was achieved via an endovascular approach. Using the Guglielmi detachable coil system, it was possible to place two platinum coils selectively into the aneurysms. The endovascular approach may be a good treatment option for all patients in whom surgical clipping does not result in complete obliteration of the aneurysm sac and reoperation is contraindicated or unacceptable to the patient.

scholarly journals Early experience with a novel net temporary bridging device (Cascade) to assist endovascular coil embolization of intracranial aneurysms

2020 ◽  
pp. 1-9
Author(s):  
Alejandro Tomasello ◽  
David Hernandez ◽  
Laura Ludovica Gramegna ◽  
Sonia Aixut ◽  
Roger Barranco Pons ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Type I ◽  
Type Ii ◽  
Unruptured Aneurysms ◽  
Complete Obliteration ◽  
Acute Subarachnoid Hemorrhage ◽  
Endovascular Coil Embolization ◽  
The Mean

OBJECTIVEThe goal of this study was to evaluate the effectiveness and safety of a new noncompletely occlusive net-assisted remodeling technique in which the Cascade net device is used for temporary bridging of intracranial aneurysms.METHODSBetween July 2018 and May 2019, patients underwent coil embolization with the Cascade net device within 4 centers in Europe. Analysis of angiographic (modified Raymond-Roy classification [MRRC]) and clinical outcomes data was conducted immediately following treatment and at the 6-month follow-up.RESULTSFifteen patients were included in the study (mean age 58 ± 13 years, 11/15 [73.3%] female). Ten patients had unruptured aneurysms, and 5 presented with ruptured aneurysms with acute subarachnoid hemorrhage. The mean aneurysm dome length was 6.27 ± 2.33 mm and the mean neck width was 3.64 ± 1.19 mm. Immediately postprocedure, MRRC type I (complete obliteration) was achieved in 11 patients (73.3%), whereas a type II (residual neck) was achieved in 4 patients (26.7%). Follow-up examination was performed in 7/15 patients and showed stabilization of aneurysm closure with no thromboembolic complications and only 1 patient with an increased MRRC score (from I to II) due to coil compression.CONCLUSIONSInitial experience shows that the use of a new noncompletely occlusive net-assisted remodeling technique with the Cascade net device may be safe and effective for endovascular coil embolization of intracranial aneurysms.

ENDOVASCULAR TREATMENT OF MIDDLE CEREBRAL ARTERY ANEURYSMS WITH DETACHABLE COILS

Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. 876-889 ◽  
Author(s):  
Shuichi Suzuki ◽  
Satoshi Tateshima ◽  
Reza Jahan ◽  
Gary R. Duckwiler ◽  
Yuichi Murayama ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Bypass Surgery ◽  
Combined Treatment ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Surgical Clipping ◽  
Endovascular Coil Embolization

Abstract OBJECTIVE Because of their anatomic configuration, middle cerebral artery (MCA) aneurysms are most often treated with surgical clipping. However, endovascular coil embolization of these aneurysms is an increasingly used alternative. We retrospectively reviewed the anatomic and clinical outcomes of patients with MCA aneurysms who underwent endovascular treatment at our institution. METHODS One hundred fifteen MCA aneurysms in 115 patients (mean age, 55.1 years) were treated by an endovascular technique from April 1990 to March 2007. Forty-eight patients (42%) presented with acute subarachnoid hemorrhage, and 67 patients (58%) had unruptured aneurysms. Fifty-three aneurysms (46%) were small with a small neck, 28 (24%) were small with a wide neck, 22 (19%) were large, and 12 (11%) were giant. RESULTS Angiographic results immediately after embolization showed complete occlusion in 53 aneurysms (46%), a neck remnant in 51 (44%), and incomplete occlusion in 3 (3%). Because of anatomic difficulties, we could not embolize 8 aneurysms (7%). Thirteen patients underwent combined treatment that included endovascular and extracranial-intracranial bypass surgery. Morbidity and mortality rates were 6.9% (8 patients) and 3% (3 patients), respectively. Procedure-related complications were encountered in 10 patients (9%). Seventy patients had long-term follow-up angiograms. Seven aneurysms (10%) were recanalized; all were large or giant. One partially embolized large aneurysm ruptured 13 months after embolization. CONCLUSION In this series, endovascular coil embolization of MCA aneurysms has morbidity and mortality rates comparable to those of conventional surgical clipping. Combined treatment of endovascular and bypass surgery can successfully treat large or giant complex fusiform MCA aneurysms.

Ruptured “blisterlike” aneurysm with a pseudoaneurysm formation requiring delayed intervention with endovascular coil embolization

2004 ◽  
Vol 101 (1) ◽  
pp. 159-162 ◽  
Author(s):  
Shuichi Tanoue ◽  
Hiro Kiyosue ◽  
Shunro Matsumoto ◽  
Masanori Yamashita ◽  
Hirofumi Nagatomi ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Treatment Options ◽  
Cerebral Aneurysms ◽  
Saccular Aneurysm ◽  
Content Type ◽  
Pseudoaneurysm Formation ◽  
Complete Obliteration ◽  
Detachable Coils ◽  
The Right ◽  
Fine Print

✓ A ruptured blisterlike aneurysm of the supraclinoid ICA rarely occurs. Nevertheless, it is recognized as a dangerous lesion because of the high risk of intraoperative bleeding associated with this lesion's wide fragile neck. There has been only one report of a blisterlike aneurysm treated by endosaccular packing after surgical wrapping. The authors describe the case of a ruptured blisterlike aneurysm with a pseudoaneurysm cavity, which was treated by coil embolization. This 63-year-old woman suffered a subarachnoid hemorrhage (SAH). Three cerebral aneurysms were identified on cerebral angiograms. A large saccular aneurysm at the ophthalmic portion of the right ICA was embolized with Guglielmi Detachable Coils (GDCs). Two small hemipherically shaped aneurysms on the C-2 and C-3 portions of the left ICA were observed conservatively. Thirteen days later, recurrent SAH was identified on computerized tomography scans. Angiography demonstrated the formation of a pseudoaneurysm from the aneurysm on the C-2 portion of the left ICA. Endosaccular embolization with GDCs was performed 40 days after admission. Disappearance of the pseudoaneurysm cavity and residual dome filling was seen immediately after the procedure. Follow-up angiography performed 9 months after embolization demonstrated complete obliteration of the aneurysm. This case illustrates that when treatment options for a blisterlike aneurysm with a pseudoaneurysm are unsuitable during the acute phase, coil embolization can be applied following progression of the lesion into a saccular aneurysm during the chronic stage.

Endovascular Approach vs Microsurgical Approach for Posterior Circulation Aneurysms

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 171-176 ◽  
Author(s):  
K. Nakabayashi ◽  
M. Negoro ◽  
Y. Itou ◽  
K. Ichihara
Keyword(s):  
Clinical Outcome ◽  
Early Stage ◽  
Posterior Circulation ◽  
Surgical Clipping ◽  
Detachable Coil ◽  
Guglielmi Detachable Coil ◽  
Detachable Coils ◽  
Posterior Circulation Aneurysms ◽  
Microsurgical Approach ◽  
Endovascular Approach

We compare the results of detachable coil embolization with those of surgical clipping in patients with posterior circulation aneurysms. Surgical procedure was performed in 31 patients (basilar tip: 13 cases, SCA: 8 cases, basilar trunk: 1 case, VA: 9 cases). Thirty one aneurysms were treated by embolization with Guglielmi detachable coil (GDC) and interlocking detachable coil (IDC) (basilar tip: 14 cases, SCA: 1 case, basilar trunk: 6 cases, VA: 10 cases). In surgical cases, clinical outcome at discharge showed good recovery (GR) in 14 cases, moderate deficits (MD) in 11 cases, severe deficits (SD) in 2 cases, and dead (D) in 4 cases. In embolization cases, clinical outcome at discharge showed GR in 19 cases, MD in 4 cases, SD in 1 case, and D in 1 case. Embolization with detachable coils is less invasive than surgical clipping in the management of patients with posterior circulation aneurysms. Embolization with detachable coils in ruptured posterior circulation aneurysm cases at an early stage of SAH may improve clinical outcome.

Transvenous Coil Embolization of an Intraorbital Arteriovenous Fistula

Neurosurgery ◽  
2012 ◽  
Vol 72 (1) ◽  
pp. E130-E134 ◽  
Author(s):  
Richard W. Williamson ◽  
Andrew F. Ducruet ◽  
R. Webster Crowley ◽  
Cameron G. McDougall ◽  
Felipe C. Albuquerque
Keyword(s):  
Coil Embolization ◽  
Ophthalmic Artery ◽  
Vascular Malformations ◽  
Transarterial Embolization ◽  
Rare Type ◽  
Arteriovenous Fistulas ◽  
Ocular Symptoms ◽  
Detachable Coils ◽  
Endovascular Coil Embolization ◽  
Carotid Cavernous Fistulas

Abstract BACKGROUND AND IMPORTANCE: Purely intraorbital arteriovenous fistulas (AVFs), which are rare vascular malformations that clinically mimic carotid-cavernous fistulas (CCFs), involve a fistula from the ophthalmic artery to 1 of the draining ophthalmic veins. We describe a case of an intraorbital AVF treated with transvenous endovascular coil embolization via the inferior petrosal sinus (IPS) route and review the literature on this rare entity. CLINICAL PRESENTATION: An 81-year-old woman sought treatment after 7 days of progressive left-sided visual acuity loss, chemosis, and lateral rectus palsy. Magnetic resonance imaging demonstrated dilated vascularity in the left orbit raising suspicions for a CCF. Cerebral angiography showed a purely intraorbital AVF with a fistula between the left ophthalmic artery and superior ophthalmic vein (SOV). Transvenous selective catheterization of the fistula was performed by successfully navigating the ipsilateral IPS to the cavernous sinus and SOV. The fistula was then embolized using detachable coils. The patient was discharged the next day. Three weeks after embolization, her ocular symptoms and findings had resolved. CONCLUSION: Intraorbital AVFs are a rare type of AVF that can be treated by direct surgical ligation, transarterial embolization, or transvenous embolization. We successfully navigated the IPS, which is frequently stenotic or occluded secondary to chronically increased fistulous drainage, and utilized this route to embolize the fistula with detachable coils.

scholarly journals The Barrow Ruptured Aneurysm Trial

2012 ◽  
Vol 116 (1) ◽  
pp. 135-144 ◽  
Author(s):  
Cameron G. McDougall ◽  
Robert F. Spetzler ◽  
Joseph M. Zabramski ◽  
Shahram Partovi ◽  
Nancy K. Hills ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Treatment Modality ◽  
Primary Outcome ◽  
Surgical Clipping ◽  
Aneurysm Clipping ◽  
Endovascular Coil Embolization ◽  
Poor Outcomes ◽  
One Year ◽  
Intent To Treat ◽  
Clip Occlusion

Object The purpose of this ongoing study is to compare the safety and efficacy of microsurgical clipping and endovascular coil embolization for the treatment of acutely ruptured cerebral aneurysms and to determine if one treatment is superior to the other by examining clinical and angiographic outcomes. The authors examined the null hypothesis that no difference exists between the 2 treatment modalities in the setting of subarachnoid hemorrhage (SAH). The current report is limited to the clinical results at 1 year after treatment. Methods The authors screened 725 patients with SAH, resulting in 500 eligible patients who were enrolled prospectively in the study after giving their informed consent. Patients were assigned in an alternating fashion to surgical aneurysm clipping or endovascular coil therapy. Intake evaluations and outcome measurements were collected by nurse practitioners independent of the treating surgeons. Ultimately, 238 patients were assigned to aneurysm clipping and 233 to coil embolization. The 2 treatment groups were well matched. There were no anatomical exclusions. Crossing over was allowed, but primary outcome analysis was based on the initial treatment modality assignment. Posttreatment care was standardized for both groups. Patient outcomes at 1 year were independently assessed using the modified Rankin Scale (mRS). A poor outcome was defined as an mRS score > 2 at 1 year. The primary outcome was based on the assigned group; that is, by intent to treat. Results One year after treatment, 403 patients were available for evaluation. Of these, 358 patients had actually undergone treatment. The remainder either died before treatment or had no identifiable source of SAH. A poor outcome (mRS score > 2) was observed in 33.7% of the patients assigned to aneurysm clipping and in 23.2% of the patients assigned to coil embolization (OR 1.68, 95% CI 1.08–2.61; p = 0.02). Of treated patients assigned to the coil group, 124 (62.3%) of the 199 who were eligible for any treatment actually received endovascular coil embolization. Patients who crossed over from coil to clip treatment fared worse than patients assigned to coil embolization, but no worse than patients assigned to clip occlusion. No patient treated by coil embolization suffered a recurrent hemorrhage. Conclusions One year after treatment, a policy of intent to treat favoring coil embolization resulted in fewer poor outcomes than clip occlusion. Although most aneurysms assigned to the coil treatment group were treated by coil embolization, a substantial number crossed over to surgical clipping. Although a policy of intent to treat favoring coil embolization resulted in fewer poor outcomes at 1 year, it remains important that high-quality surgical clipping be available as an alternative treatment modality.

Surgical Transvenous Embolization of a Carotid-Cavernous Dural Fistula with Cortical Drainage via a Petrosal Vein: Two Technical Case Reports

Neurosurgery ◽  
2002 ◽  
Vol 50 (6) ◽  
pp. 1380-1384 ◽  
Author(s):  
Tsuyoshi Hara ◽  
Jun-ichiro Hamada ◽  
Yutaka Kai ◽  
Yukitaka Ushio
Keyword(s):  
Case Reports ◽  
Transvenous Embolization ◽  
Guglielmi Detachable Coils ◽  
Dural Fistula ◽  
Petrosal Vein ◽  
Ocular Symptoms ◽  
Detachable Coils ◽  
Endovascular Approach ◽  
Transvenous Approach ◽  
Fistula Site

Abstract OBJECTIVE AND IMPORTANCE We present two interesting cases involving carotid-cavernous dural fistulae draining only or predominantly into the petrosal vein after previous incomplete, complicated, endovascular treatments. Transvenous embolization with Guglielmi detachable coils, via the petrosal vein, during surgical exposure completely obliterated the fistulae. CLINICAL PRESENTATION A 64-year-old man manifesting left ocular symptoms after incomplete embolization of a left carotid-cavernous dural fistula and a 56-year-old woman manifesting left hemiparesis after complicated embolization of a right carotid-cavernous dural fistula were referred to our hospital. A percutaneous transvenous approach was attempted in both cases, but the catheter could not reach the fistula site. A combined open surgical and endovascular approach was then used. INTERVENTION The hemispheric branch of the petrosal vein was exposed via a retromastoid craniectomy. The catheter was then directly introduced into the hemispheric branch, followed by navigation into the fistula site. The fistula was completely embolized with Guglielmi detachable coils. CONCLUSION The technique of surgical transvenous embolization via a petrosal vein is a valuable alternative for the treatment of carotid-cavernous dural fistulae that drain only or predominantly into the petrosal vein, when the percutaneous transvenous route is not accessible.

scholarly journals Long-Term Medical Resource Consumption between Surgical Clipping and Endovascular Coiling for Aneurysmal Subarachnoid Hemorrhage: A Propensity Score–Matched, Nationwide, Population-Based Cohort Study

2021 ◽  
Vol 18 (11) ◽  
pp. 5989
Author(s):  
Yang-Lan Lo ◽  
Zen Lang Bih ◽  
Ying-Hui Yu ◽  
Ming-Chang Li ◽  
Ho-Min Chen ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Medical Cost ◽  
Coil Embolization ◽  
Resource Consumption ◽  
Endovascular Coiling ◽  
Medical Resource ◽  
Surgical Clipping ◽  
Icu Stay ◽  
Endovascular Coil Embolization

Purpose: To estimate long-term medical resource consumption in patients with subarachnoid aneurysmal hemorrhage (SAH) receiving surgical clipping or endovascular coiling. Patients and methods: From Taiwan’s National Health Insurance Research Database, we enrolled patients with aneurysmal SAH who received clipping or coiling. After propensity score matching and adjustment for confounders, a generalized linear mixed model was used to determine significant differences in the accumulative hospital stay (days), intensive care unit (ICU) stay, and total medical cost for aneurysmal SAH, as well as possible subsequent surgical complications and recurrence. Results: The matching process yielded a final cohort of 8102 patients (4051 and 4051 in endovascular coil embolization and surgical clipping, respectively) who were eligible for further analysis. The mean accumulative hospital stay significantly differed between coiling (31.2 days) and clipping (46.8 days; p < 0.0001). After the generalized linear model adjustment of gamma distribution with a log link, compared with the surgical clipping procedure, the adjusted odds ratios (aOR; 95% confidence interval [CI]) of the medical cost of accumulative hospital stay for the endovascular coil embolization procedure was 0.63 (0.60, 0.66; p < 0·0001). The mean accumulative ICU stay significantly differed between the coiling and clipping groups (9.4 vs. 14.9 days; p < 0.0001). The aORs (95% CI) of the medical cost of accumulative ICU stay in the endovascular coil embolization group was 0.61 (0.58, 0.64; p < 0.0001). The aOR (95% CI) of the total medical cost of index hospitalization in the endovascular coil embolization group was 0·85 (0.82, 0.87; p < 0.0001). Conclusions: Medical resource consumption in the coiling group was lower than that in the clipping group.

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