Commentary: Delayed Intracranial Parenchymal Changes After Aneurysmal Coil Embolization Procedures for Unruptured Intracranial Aneurysms

Purpose Among all stents available for neuroendovascular therapy, the low-profile visible intraluminal support stent bears the highest metal coverage ratio. We deployed a low-profile visible intraluminal support stent with a delivery wire or/and microcatheter system push action to shorten the low-profile visible intraluminal support stent and thus achieve a flow diversion effect. We report our single-institution experience with the use of low-profile visible intraluminal support stents for intentionally shortened deployment (shortening group) and non-shortened deployment (non-shortening group) for unruptured intracranial aneurysms. Methods We retrospectively reviewed the medical records of 130 patients with 131 intracranial aneurysms who were treated with low-profile visible intraluminal support stent-assisted coil embolization from February 2016–January 2019. All perioperative complications were noted. Every 6 months, we re-examined the patients with cerebral angiography or magnetic resonance angiography. The outcomes of aneurysm occlusion were evaluated by the modified Raymond–Roy occlusion classification. We used the finite element method and computational fluid dynamics to investigate the hemodynamics after shortened low-profile visible intraluminal support stent deployment. Results Immediately after treatment, the modified Raymond-Roy occlusion classification was significantly better in the shortening group than in the non-shortening group ( p<0.05). The latest angiographic outcomes showed the same tendency. Hemodynamic analysis by computational fluid dynamics suggested an adequate flow diversion effect with the use of our intentional shortening method. Conclusions Stent-assisted coil embolization using this technique showed good results of a high complete occlusion rate and low complication rate. These findings suggest that shortened low-profile visible intraluminal support stent deployment yields a flow diversion effect and may lead to early intra-aneurysmal thrombus formation.

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Delayed Bleeding of Unruptured Intracranial Aneurysms After Coil Embolization: A Retrospective Case Series

World Neurosurgery ◽

10.1016/j.wneu.2021.02.061 ◽

2021 ◽

Vol 149 ◽

pp. e135-e145

Author(s):

Kazuhiro Ando ◽

Hitoshi Hasegawa ◽

Tomoaki Suzuki ◽

Shoji Saito ◽

Kohei Shibuya ◽

...

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Case Series ◽

Retrospective Case ◽

Delayed Bleeding ◽

Retrospective Case Series ◽

Unruptured Intracranial Aneurysms

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Long-term outcomes of coil embolization of unruptured intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/2017.6.jns17174 ◽

2018 ◽

Vol 129 (6) ◽

pp. 1492-1498 ◽

Cited By ~ 6

Author(s):

Masaomi Koyanagi ◽

Akira Ishii ◽

Hirotoshi Imamura ◽

Tetsu Satow ◽

Kazumichi Yoshida ◽

...

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Additional Treatment ◽

Long Term Outcomes ◽

Unruptured Intracranial Aneurysms ◽

Risk Of Rupture ◽

Long Term Follow Up ◽

Multiple Stroke

OBJECTIVELong-term follow-up results of the treatment of unruptured intracranial aneurysms (UIAs) by means of coil embolization remain unclear. The aim of this study was to analyze the frequency of rupture, retreatment, stroke, and death in patients with coiled UIAs who were followed for up to 20 years at multiple stroke centers.METHODSThe authors retrospectively analyzed data from cases in which patients underwent coil embolization between 1995 and 2004 at 4 stroke centers. In collecting the late (≥ 1 year) follow-up data, postal questionnaires were used to assess whether patients had experienced rupture or retreatment of a coiled aneurysm or any stroke or had died.RESULTSOverall, 184 patients with 188 UIAs were included. The median follow-up period was 12 years (interquartile range 11–13 years, maximum 20 years). A total of 152 UIAs (81%) were followed for more than 10 years. The incidence of rupture was 2 in 2122 aneurysm-years (annual rupture rate 0.09%). Nine of the 188 patients with coiled UIAs (4.8%) underwent additional treatment. In 5 of these 9 cases, the first retreatment was performed more than 5 years after the initial treatment. Large aneurysms were significantly more likely to require retreatment. Nine strokes occurred over the 2122 aneurysm-years. Seventeen patients died in this cohort.CONCLUSIONSThis study demonstrates a low risk of rupture of coiled UIAs with long-term follow-up periods of up to 20 years. This suggests that coiling of UIAs could prevent rupture for a long period of time. However, large aneurysms might need to be followed for a longer time.

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Delayed Intracranial Parenchymal Changes After Aneurysmal Coil Embolization Procedures for Unruptured Intracranial Aneurysms

Operative Neurosurgery ◽

10.1093/ons/opz299 ◽

2019 ◽

Vol 19 (1) ◽

pp. 76-83 ◽

Cited By ~ 3

Author(s):

Ichiro Nakagawa ◽

Hun Soo Park ◽

Masashi Kotsugi ◽

Yudai Morisaki ◽

Takeshi Wada ◽

...

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Perioperative Complications ◽

White Matter Lesions ◽

Steroid Treatment ◽

Cerebral White Matter ◽

Nickel Allergy ◽

Skin Patch ◽

Unruptured Intracranial Aneurysms ◽

Inflammatory Changes

Abstract BACKGROUND With the recent advances in endovascular treatment devices, it has become standard in wide-neck or large intracranial aneurysms to perform coil embolization with adjunctive techniques. However, device-related perioperative complications have been reported because of the use of more complex systems. OBJECTIVE To investigate patients who developed multiple parenchymal lesions after undergoing coil embolization for treating an unruptured intracranial aneurysm. METHODS This study investigated 305 consecutive patients who underwent coil embolization of unruptured intracranial aneurysms between 2015 and 2017. Delayed inflammatory changes referred to the delayed observation of multiple cerebral white matter lesions on follow-up magnetic resonance imaging at an area corresponding to the perfused area of the treatment target vessel. The timing and pattern of onset, device used, the combined use of adjunctive techniques, and the clinical course after steroid treatment were retrospectively investigated. RESULTS The 7 patients (2.3%) who showed delayed inflammatory changes were all women with a mean age of 59 yr. A mean duration from treatment to onset was 28 d. Symptoms were convulsions in 3 patients, hemiplegia in 2 patients, and homonymous hemianopia in 1 patient. All 7 patients were treated with adjunctive technique including stents, double catheter method, and balloon assist. Response to steroid treatment was satisfactory both clinically and on imaging in all 7 patients. Skin patch test was positive for nickel allergy in 2 patients. CONCLUSION Clinicians must be fully aware of symptomatic delayed inflammatory changes may occur after endovascular aneurysmal treatment with the use of various devices.

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Endovascular Coil Embolization of 435 Small Asymptomatic Unruptured Intracranial Aneurysms: Procedural Morbidity and Patient Outcome

American Journal of Neuroradiology ◽

10.3174/ajnr.a1290 ◽

2008 ◽

Vol 30 (1) ◽

pp. 79-84 ◽

Cited By ~ 57

Author(s):

S.-H. Im ◽

M.H. Han ◽

O.-K. Kwon ◽

B.J. Kwon ◽

S.H. Kim ◽

...

Keyword(s):

Patient Outcome ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Unruptured Intracranial Aneurysms ◽

Endovascular Coil Embolization

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Coil Embolization for Unruptured Intracranial Aneurysms at the Dawn of Stent Era: Results of the Japanese Registry of Neuroendovascular Therapy (JR-NET) 3

Neurologia medico-chirurgica ◽

10.2176/nmc.st.2019-0210 ◽

2020 ◽

Vol 60 (2) ◽

pp. 55-65

Author(s):

Tetsu SATOW ◽

Go IKEDA ◽

Jun C. TAKAHASHI ◽

Koji IIHARA ◽

Nobuyuki SAKAI ◽

...

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Unruptured Intracranial Aneurysms

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Endovascular Enterprise stent-assisted coil embolization for wide-necked unruptured intracranial aneurysms

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2012.11.010 ◽

2013 ◽

Vol 20 (9) ◽

pp. 1276-1279 ◽

Cited By ~ 9

Author(s):

Sung-Kyun Hwang ◽

Gyojun Hwang ◽

Jae Seung Bang ◽

Chang Wan Oh ◽

O-Ki Kwon

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Unruptured Intracranial Aneurysms

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Headache Outcomes After Coil Embolization in Patients with Unruptured Intracranial Aneurysms: Do They Get Better or Worse? A Prospective Analysis

World Neurosurgery ◽

10.1016/j.wneu.2018.02.138 ◽

2018 ◽

Vol 114 ◽

pp. e191-e198 ◽

Cited By ~ 1

Author(s):

Jung Hyun Park ◽

Hoon Kim ◽

Seong Rim Kim ◽

Ik Seong Park ◽

Min Seok Byeon ◽

...

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Prospective Analysis ◽

Unruptured Intracranial Aneurysms

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Endovascular coil embolization of unruptured intracranial aneurysms: a Korean multicenter study

Acta Neurochirurgica ◽

10.1007/s00701-014-2033-9 ◽

2014 ◽

Vol 156 (5) ◽

pp. 847-854 ◽

Cited By ~ 18

Author(s):

Soon Chan Kwon ◽

◽

O-Ki Kwon

Keyword(s):

Multicenter Study ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Unruptured Intracranial Aneurysms ◽

Endovascular Coil Embolization

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Cognitive Outcome and Clinically Silent Thromboembolic Events After Coiling of Asymptomatic Unruptured Intracranial Aneurysms

Neurosurgery ◽

10.1227/neu.0b013e3182846f74 ◽

2012 ◽

Vol 72 (4) ◽

pp. 638-645 ◽

Cited By ~ 16

Author(s):

Dong-Hun Kang ◽

Yang-Ha Hwang ◽

Yong-Sun Kim ◽

Geum Ye Bae ◽

Seung Jae Lee

Keyword(s):

Cognitive Deficits ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Cognitive Outcome ◽

Cognitively Impaired ◽

Thromboembolic Events ◽

Cognitive Changes ◽

Focal Neurological Deficit ◽

Unruptured Intracranial Aneurysms ◽

Significant Difference

Abstract BACKGROUND: Thromboembolic events are the most common complication after coiling of unruptured intracranial aneurysms (UIAs). However, it remains unclear whether these clinically silent ischemic lesions (CSILs) have any clinical significance. OBJECTIVE: To evaluate cognitive outcome after coil embolization of asymptomatic UIAs and its relationship with CSILs after the procedure. METHODS: We prospectively enrolled 40 UIA patients who showed no new focal neurological deficit after coil embolization. CSILs were assessed with diffusion-weighted imaging (DWI) within 1 day after the procedure. A battery of neuropsychological tests was performed 3 times: preoperatively and postoperatively at 1 and 4 weeks after coil embolization. RESULTS: The incidence of cognitive impairment after coiling in patients with UIAs was 44% (17 of 39) at 1 week and 19% (7 of 37) at 4 weeks after coil embolization. DWI within 1 day after coil embolization revealed that 60% of patients (24 of 40) showed CSILs. However, no significant difference was found in any mean cognitive scores or in the number of cognitively impaired variables between patients with and without CSILs at weeks 1 and 4. Additional correlation analysis revealed no correlations between the number of CSILs on DWI and the cognitive sum z score at both 1 and 4 weeks. CONCLUSION: Exhaustive neuropsychological evaluation of UIA patients who underwent coil embolization demonstrated recovery or improvements from baseline cognitive function after 4 weeks, although some patients still showed cognitive deficits at 4 weeks after the procedure. However, we found no statistically significant relationship between the presence and number of CSILs on DWI and cognitive changes after the procedure.

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