scholarly journals Stent-Assisted Coiling of Cerebral Aneurysms: A Multicenter Analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Maxim Mokin ◽  
Christopher T Primiani ◽  
Keaton Piper ◽  
David Fiorella ◽  
Ansaar Rai ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cerebral Aneurysms ◽  
Final Analysis ◽  
Patient Characteristics ◽  
Aneurysm Rupture ◽  
Endovascular Coiling ◽  
Complete Occlusion ◽  
Low Profile ◽  
Grade Scale ◽  
The Difference

Abstract INTRODUCTION New devices have allowed endovascular stent-assisted coiling for the treatment of cerebral aneurysms. It remains unknown how each type of stent affects the safety, efficacy, and clinical outcomes of the stent-coiling procedure. METHODS This study compared the outcomes of endovascular coiling of cerebral aneurysms using Neuroform (NEU), Enterprise (EP), and Low-profile Vi_sualized Intraluminal Support (LVIS) stents. Cases of aneurysms treated with more than one type of stents (NEU, EP, LVIS) used for coiling of the same lesion (n = 24) or other devices (n = 32) were excluded. Patient characteristics, angiographic results using the Raymond-Roy grade scale (RRGS), clinical outcomes and procedural complications were analyzed in our study. Patients data was retrospectively collected from 6 academic centers. RESULTS A total of 659 patients with 670 cerebral aneurysms treated with stent-assisted coiling (NEU, n = 182; EP, n = 158; LVIS, n = 330) were included in final analysis. Patient characteristics included mean age 56 ? 12 yr old, female prevalence 74% and aneurysm rupture on initial presentation of 19%. The degree of occlusion at baseline angiography was significantly associated with age (P = .002), location by circulation (P = .002), aneurysm size (P = .009), and rupture status (P = .013). We found differences in complete occlusion on baseline imaging, defined as RRGS I, among the three stents: LVIS 64% (210/326); NEU 56% (95/169); EP 48% (68/143); P = .008. The difference of complete occlusion on 10.5 mo (mean) and 8 mo (median) angiographic follow-up was also significant: LVIS 84% (251/299); NEU 78% (117/150); EP 67% (83/123); P = .004. There were 7% (47/670) intraprocedural complications and 11.5% (73/632) postprocedural related complications in our cohort. CONCLUSION There were significant affects based on type of stent used for assisted coiling in the immediate and long-term angiographic outcomes in our cohort. Randomized prospective trials are warranted to compare stent types and clinical outcome.

Stent-assisted coiling of cerebral aneurysms: multi-center analysis of radiographic and clinical outcomes in 659 patients

2019 ◽  
Vol 12 (3) ◽  
pp. 289-297 ◽  
Author(s):  
Maxim Mokin ◽  
Christopher T Primiani ◽  
Zeguang Ren ◽  
Keaton Piper ◽  
David J Fiorella ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Patient Characteristics ◽  
Aneurysm Rupture ◽  
Endovascular Coiling ◽  
Complete Occlusion ◽  
Stent Type ◽  
Low Profile ◽  
Grade Scale ◽  
Procedural Complications ◽  
The Difference

IntroductionThe endovascular stent-assisted coiling approach for the treatment of cerebral aneurysms is evolving rapidly with the availability of new stent devices. It remains unknown how each type of stent affects the safety and efficacy of the stent-coiling procedure.MethodsThis study compared the outcomes of endovascular coiling of cerebral aneurysms using Neuroform (NEU), Enterprise (EP), and Low-profile Visualized Intraluminal Support (LVIS) stents. Patient characteristics, treatment details and angiographic results using the Raymond–Roy grade scale (RRGS), and procedural complications were analyzed in our study.ResultsOur study included 659 patients with 670 cerebral aneurysms treated with stent-assisted coiling (NEU, n=182; EP, n=158; LVIS, n=330) that were retrospectively collected from six academic centers. Patient characteristics included mean age 56.3±12.1 years old, female prevalence 73.9%, and aneurysm rupture on initial presentation of 18.8%. We found differences in complete occlusion on baseline imaging, defined as RRGS I, among the three stents: LVIS 64.4%, 210/326; NEU 56.2%, 95/169; EP 47.6%, 68/143; P=0.008. The difference of complete occlusion on 10.5 months (mean) and 8 months (median) angiographic follow-up remained significant: LVIS 84%, 251/299; NEU 78%, 117/150; EP 67%, 83/123; P=0.004. There were 7% (47/670) intra-procedural complications and 11.5% (73/632) post-procedural-related complications in our cohort. Furthermore, procedure-related complications were higher in the braided-stents vs laser-cut, P=0.002.ConclusionsThere was a great variability in techniques and choice of stent type for stent-assisted coiling among the participating centers. The type of stent was associated with immediate and long-term angiographic outcomes. Randomized prospective trials comparing the different types of stents are warranted.

Stent-assisted coiling of cerebral aneurysms: a single-center clinical and angiographic analysis

2017 ◽  
Vol 10 (7) ◽  
pp. 687-692 ◽  
Author(s):  
Jun Wang ◽  
Jan Vargas ◽  
Alejandro Spiotta ◽  
Imran Chaudry ◽  
Raymond D Turner ◽  
...  
Keyword(s):  
Multivariate Logistic Regression Analysis ◽  
Cerebral Aneurysms ◽  
Multivariate Logistic Regression ◽  
Complete Occlusion ◽  
Post Procedure ◽  
Low Profile ◽  
Nitinol Stents ◽  
Grade Scale ◽  
Procedural Complications

ObjectiveThis study retrospectively compared the clinical and angiographic outcomes of treating cerebral aneurysms with Neuroform (NEU), Enterprise (EP), and Low-profile Visualized Intraluminal Support (LVIS/LVIS Jr) stents.Materials and methodsWe conducted a retrospective analysis of a procedural database. All aneurysm procedures using any of the three types of self-expanding nitinol stents (NEU, EP and LVIS/LVIS Jr) were included. Intra-procedure complications, post-procedure complications, and angiographic results (Raymond–Roy grade scale, RRGS) were analyzed retrospectively. A multivariate logistic regression analysis was conducted to identify predictors of intra-procedure and post-procedure complications.ResultsTwo hundred and forty-three aneurysms in 229 patients treated with stent-assisted coiling were included (NEU group: 109 aneurysms; EP group: 61 aneurysms; LVIS/LVIS Jr: 73 aneurysms). The LVIS/LVIS Jr group was associated with the lowest rate of initial complete occlusion (RRGS I: 47.9%; 35/73). Follow-up showed the proportion of RRGS I increased for all stent groups but was greatest in the LVIS/LVIS Jr group. Overall, 17 intra-procedural complications were seen in 229 patients (7.4%) and 15 post-procedural complications were found in 198 patients at follow-up (7.6%), with no differences between stent groups. Thrombotic events were the most common complications and occurred in 13 patients (13/229, 5.7%).ConclusionsAll three types of stents used to treat cerebral aneurysms with unfavorable neck were safe and effective, providing suitable support for the coil mass. LVIS/LVIS Jr promotes better progressive aneurysm complete occlusion than the other two stents but seems to cause more common intra-procedural stent-related thrombotic events and fewer post-procedural complications.

scholarly journals Level of headaches after surgical aneurysm clipping decreases significantly faster compared to endovascular coiled patients

2017 ◽  
Vol 7 (2) ◽  
Author(s):  
Athanasios K. Petridis ◽  
Jan F. Cornelius ◽  
Marcel A. Kamp ◽  
Sina Falahati ◽  
Igor Fischer ◽  
...  
Keyword(s):  
Aneurysm Rupture ◽  
Endovascular Coiling ◽  
Analog Scale ◽  
Surgical Clipping ◽  
Time Points ◽  
Ruptured Aneurysms ◽  
Aneurysm Clipping ◽  
Incidental Aneurysms ◽  
The Difference ◽  
Late Recovery

In incidental aneurysms, endovascular treatment can lead to post-procedural headaches. We studied the difference of surgical <em>clipping</em> <em>vs</em>. endovascular <em>coiling</em> in concern to post-procedural headaches in patients with ruptured aneurysms. Sixtyseven patients with aneurysmal subarachnoidal haemorrhage were treated in our department from September 1<sup>st</sup> 2015 - September 1<sup>st</sup> 2016. 43 Patients were included in the study and the rest was excluded because of late recovery or highgrade subarachnoid bleedings. Twenty-two were surgical treated and twenty-one were interventionally treated. We compared the post-procedural headaches at the time points of 24 h, 21 days, and 3 months after treatment using the visual analog scale (VAS) for pain. After surgical clipping the headache score decreased for 8.8 points in the VAS, whereas the endovascular treated population showed a decrease of headaches of 3.3 points. This difference was highly statistical significant and remained significant even after 3 weeks where the pain score for the surgically treated patients was 0.68 and for the endovascular treated 1.8. After 3 months the pain was less than 1 for both groups with surgically treated patients scoring 0.1 and endovascular treated patients 0.9 (not significant). Clipping is relieving the headaches of patients with aneurysm rupture faster and more effective than endovascular coiling. This effect stays significant for at least 3 weeks and plays a crucial role in stress relieve during the acute and subacute ICU care of such patients.

EVALUATING IMAGING FEATURE ON CTA AND DSA OF RUPTURED CEREBRAL ANEURYSMS

2017 ◽  
pp. 14-20
Author(s):  
Thanh Vu Huynh ◽  
Van Ngoc Cuong Le
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Aneurysm Rupture ◽  
Imaging Feature ◽  
Key Words Aneurysm ◽  
Diagnostic Efficacy ◽  
Imaging Characteristics ◽  
The Difference ◽  
Ruptured Intracranial Aneurysms

Objective: To compare the imaging feature of ruptured intracranial aneurysms on CTA and DSA. Material and Methods: From April 2016 to June 2017, 33 cases with SAH was performed CTA and DSA to all cases. The results of the CTA were compared with the DSAresults to determine the diagnostic efficacy of CTA in evaluating characterizations of ruptured cerebral aneurysms. Results: The difference is not statistically significant between CTA and DSA in evaluating of aneurysm size, location, rupture status, and other imaging characteristics. Conclusion: CTA is invaluable in evaluatingruptured cerebral aneurysms that guide clinicians to make planning the treatment. Key words: aneurysm, rupture, subarachnoid, hemorrhage

scholarly journals Endovascular embolization of branch-incorporated cerebral aneurysms

2017 ◽  
Vol 30 (6) ◽  
pp. 600-606 ◽  
Author(s):  
Yasuhiro Kawabata ◽  
Takuya Nakazawa ◽  
Shunichi Fukuda ◽  
Satoru Kawarazaki ◽  
Tomokazu Aoki ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Posterior Communicating Artery ◽  
Endovascular Coiling ◽  
Modified Rankin Scale ◽  
Dominant Type ◽  
Complete Occlusion ◽  
Grade 5 ◽  
Incomplete Occlusion

Objectives The aim of this study was to examine the feasibility, technique, and clinical and angiographic outcomes of endovascular coiling to treat a cerebral aneurysm with a branch incorporated into the aneurysmal wall. Methods From 2012 to 2016, 25 patients with 26 cerebral aneurysms having a branch incorporated into the aneurysm (9 unruptured, 17 ruptured) were treated to prevent rupture or re-bleeding from the sac while preserving the incorporated branch by using single-catheter ( n = 18), balloon-remodeling ( n = 4), stent-assisted coiling ( n = 3), or double-catheter ( n = 1) techniques. Results Endovascular coiling was conducted in 26 procedures without angiographic occlusion of the incorporated branch. Post-embolization angiography revealed near-complete occlusion ( n = 8; 30.7%), neck remnant ( n = 13; 50%), and incomplete occlusion ( n = 5; 19.3%) aneurysms. Thromboembolisms were observed in four (15.4%) patients during or after the procedure. A procedure-related neurological deficit was observed in one (3.8%) patient. When patients with a preictal modified Rankin Scale (mRS) score of 3 presenting with grade 5 subarachnoid hemorrhage were excluded, all patients had favorable outcomes (mRS 0–2). Six (23.1%) recurrent aneurysms were observed during follow-up, five of which were treated endovascularly at 5–22 months without complication. The location of an aneurysm at the ICA-posterior communicating artery associated with the dominant-type posterior communicating artery was significantly associated with recurrence ( p = 0.041). Conclusions Cerebral aneurysms with an incorporated branch were safely treated using conventional endovascular coiling. However, treatment durability was unsatisfactory, especially for dominant-type ICA-posterior communicating artery aneurysms.

scholarly journals Cerebral Vasospasm in Patients over 80 Years Treated by Coil Embolization for Ruptured Cerebral Aneurysms

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Tomohito Hishikawa ◽  
Yuji Takasugi ◽  
Tomohisa Shimizu ◽  
Jun Haruma ◽  
Masafumi Hiramatsu ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Coil Embolization ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Patient Characteristics ◽  
Age Group ◽  
Older Patient ◽  
Symptomatic Vasospasm ◽  
Group A ◽  
Group B

Object. The effect on clinical outcomes of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage (SAH) in patients over 80 years who underwent coil embolization was evaluated.Methods. Forty-four cases were reviewed and divided into two groups according to patient age: Group A, 79 years or younger, and Group B, 80 or older. Patient characteristics, prevalence of symptomatic vasospasm, modified Rankin Scale (mRS) scores at discharge and frequency of symptomatic vasospasm in patients with mRS scores of 3–6 were analyzed.Results. Thirty-two (73%) of the 44 cases were categorized as Group A and 12 (27%) as Group B. Group B had a significantly higher prevalence of symptomatic vasospasm compared to Group A(P=0.0040). mRS scores at discharge were significantly higher in Group B than in Group A(P=0.0494). Among cases with mRS scores of 3–6, there was a significantly higher frequency of symptomatic vasospasm in Group B than in Group A(P=0.0223).Conclusions. In our cohort of aneurysmal SAH patients treated by coil embolization, patients over 80 years of age were more likely to suffer symptomatic vasospasm, which significantly correlated with worse clinical outcomes, than those 79 years and under.

Mid-term Results of Endovascular Coiling of Wide-Necked Aneurysms Using Double Stents in a Y Configuration

Neurosurgery ◽  
2011 ◽  
Vol 69 (2) ◽  
pp. 421-429 ◽  
Author(s):  
Alejandro M. Spiotta ◽  
Rishi Gupta ◽  
David Fiorella ◽  
Vivekananda Gonugunta ◽  
Bjorn Lobo ◽  
...  
Keyword(s):  
Initial Treatment ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Thromboembolic Complications ◽  
Endovascular Management ◽  
Spontaneous Thrombosis ◽  
Complete Occlusion ◽  
Neck Recurrence ◽  
Mid Term Results

Abstract BACKGROUND: Double stenting in a Y configuration may be used to treat a subset of wide-necked aneurysms not amenable to reconstruction with a single stent. OBJECTIVE: We studied the feasibility, safety, and mid-term angiographic outcome of patients treated using this technique. METHODS: A retrospective review was undertaken of all coil embolizations of wide-necked aneurysms using double stents in a Y configuration. RESULTS: Nineteen patients were identified from 2002 to 2010 (14 women, 5 men) with a mean age of 57.4 years. Stents were deployed in a Y configuration achieving complete occlusion (5/19), residual neck (5/19), and residual aneurysm filling (9/19). Angiographic follow-up was available for a mean of 16 months, and clinical follow up was available for a mean of 21.4 months. The incidence of complications at the initial treatment was 6 of 19 (31.6%), and delayed thromboembolic complications occurred in 2 of 19 (10.5%). An angiographic neck recurrence requiring retreatment developed in only 1 of the patients in whom complete occlusion was obtained with the initial treatment. Spontaneous thrombosis and complete occlusion on follow-up imaging were found in 6 patients in whom initial neck or aneurysm filling was observed. Ultimately, 12 of the aneurysms (63.2%) were completely occluded on follow-up angiography. CONCLUSION: Y-stent reconstruction enables the endovascular management of otherwise complex, wide-necked cerebral aneurysms and can be performed safely in experienced hands with satisfactory mid-term results, even in cases requiring retreatment.

scholarly journals Endovascular Treatment of Ruptured Wide-Necked Anterior Communicating Artery Aneurysms Using a Low-Profile Visualized Intraluminal Support (LVIS) Device

2021 ◽  
Vol 11 ◽  
Author(s):  
Gaici Xue ◽  
Peng Liu ◽  
Fengfeng Xu ◽  
Yibin Fang ◽  
Qiang Li ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Perioperative Complications ◽  
Class Ii ◽  
High Rate ◽  
Anterior Communicating Artery ◽  
Complete Occlusion ◽  
Low Profile ◽  
Angiographic Data ◽  
Low Rate

Objective: To evaluate the safety and efficacy of low-profile visualized intraluminal support (LVIS) stent-assisted coiling for the treatment of ruptured wide-necked anterior communicating artery (ACoA) aneurysms.Methods: The clinical and angiographic data of 31 acutely ruptured wide-necked ACoA aneurysms treated with LVIS stent-assisted coiling between January 2014 and December 2018 were retrospectively reviewed.Results: All stents were successfully deployed. The immediate angiographic results were modified Raymond-Roy class I in 27 cases, modified Raymond-Roy class II in 2 cases, and modified Raymond-Roy class IIIa in 2 cases. Intraoperative thrombosis and postoperative aneurysmal rebleeding occurred in one case each. Two patients (6.5%) who were admitted due to poor clinical grade conditions died during hospital admission as a result of initial bleeding. Angiographic follow-up (mean: 12.9 months) was performed for 26 patients, the results of which demonstrated that 25 aneurysms were completely occluded and one was class II. The last clinical follow-up (mean: 25.3 months) outcomes demonstrated that 27 patients had favorable clinical outcomes and two had poor clinical outcomes.Conclusion: LVIS stent-assisted coiling for ruptured wide-necked ACoA aneurysms was safe and effective, with a relatively low rate of perioperative complications and a high rate of complete occlusion at follow-up.

Stent-assisted coiling of cerebral aneurysms using the Y-stenting technique: a systematic review and meta-analysis

2019 ◽  
Vol 11 (7) ◽  
pp. 683-689 ◽  
Author(s):  
Manuel F Granja ◽  
Gustavo M Cortez ◽  
Pedro Aguilar-Salinas ◽  
Guilherme Jose Agnoletto ◽  
Gregory Imbarrato ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Random Effect ◽  
Cerebral Aneurysms ◽  
Stroke Rate ◽  
Complete Occlusion ◽  
Ruptured Aneurysms ◽  
Statistical Heterogeneity ◽  
Related Mortality

BackgroundBifurcation aneurysms can be treated with stent-assisted coiling using two stents in a Y-configuration. We aim to investigate the angiographic and clinical outcomes of Y-stent constructs for the treatment of intracranial aneurysms.MethodsA systematic review of PubMed, Ovid MEDLINE, and Ovid EMBASE databases was conducted based on PRISMA guidelines. The study selection was performed using the ‘Ryyan’ application. Our analysis included 18 studies with 327 patients. Inclusion criteria were: articles published from January 2000 to November 2017, English language, including cerebral aneurysms treated via Y-stenting, and ≥5 cases with radiographic/clinical outcomes. Technical notes, editorials, reviews, and animal studies were excluded. A random-effect meta-analysis was performed on angiographic and clinical outcomes, including aneurysm occlusion, modified Rankin Scale, neurological outcome, and procedure-related mortality. 95% CIs and event rates were estimated. Statistical heterogeneity was assessed using I2 statistics.ResultsThe procedure-related good outcome rate was 92% and complete occlusion rate was 91%. The permanent neurological deficit rate was 4% and procedure-related mortality was 2%. The procedure-related stroke rate was 12%. A total of 28/146 (19%) patients had ruptured aneurysms. At long-term follow-up, overall stroke rate was 9% in patients with unruptured aneurysm. The mortality rate was higher in cases with ruptured aneurysms than in those with unruptured aneurysms (18% vs 0.8%; p<0.001).ConclusionsY-stenting for bifurcation aneurysms yields a high rate of complete occlusion and low rates of mortality and stroke. Careful patient selection is needed.

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