Endovascular Treatment of Basilar Tip Aneurysms Using Guglielmi Detachable Coils: Anatomic and Clinical Outcomes in 73 Patients from a Single Institution

Neurosurgery ◽  
2000 ◽  
Vol 47 (6) ◽  
pp. 1332-1342 ◽  
Author(s):  
Satoshi Tateshima ◽  
Yuichi Murayama ◽  
Y. Pierre Gobin ◽  
Gary R. Duckwiler ◽  
Guido Guglielmi ◽  
...  
Keyword(s):  
Los Angeles ◽  
Clinical Outcomes ◽  
Medical Center ◽  
Clinical Status ◽  
Giant Aneurysm ◽  
Detachable Coil ◽  
Complete Occlusion ◽  
Unruptured Aneurysms ◽  
Guglielmi Detachable Coil

ABSTRACT OBJECTIVE Seventy-three consecutive patients with 75 basilar tip aneurysms were treated with Guglielmi detachable coil (GDC) technology. Their anatomic and clinical outcomes are discussed. METHODS Seventy-five basilar tip aneurysms were treated with the GDC system at the University of California, Los Angeles Medical Center from 1990 to 1999. The average age of the population was 48.3 years (range, 28–82 yr). Forty-two patients (57.5%) presented with acute subarachnoid hemorrhage, 8 patients (10.9%) had unruptured aneurysms with mass effect, and 23 patients (31.5%) had incidental aneurysms. Thirty-one aneurysms (41.3%) were small with a small neck, 18 (24%) were small with a wide neck, 16 (21.3%) were large, and 10 (13.3%) were giant aneurysms. RESULTS Immediate anatomic outcomes demonstrated complete or near-complete occlusion in 64 aneurysms (85.3%) and incomplete occlusion in 7 aneurysms (9.3%). Four aneurysms (5.3%) could not be embolized because of anatomic difficulties. Of the 69 patients treated with GDCs, 63 patients (91.3%) remained neurologically intact or unchanged from their initial clinical status. Procedure-related morbidity and mortality were 4.1% and 1.4%, respectively. Long-term follow-up angiograms were obtained in 41 patients with 42 aneurysms. Thirty aneurysms (71.4%) demonstrated complete or near-complete occlusion. One incompletely embolized giant aneurysm ruptured during the follow-up period. CONCLUSION In contrast to surgical clipping of basilar tip aneurysms, the main technical challenge of the Guglielmi detachable coiling procedure depends on the shape of the aneurysm, not its location. The results of this study indicate that endovascular GDC technology is an appropriate therapeutic alternative in ruptured or unruptured basilar tip aneurysms regardless of patient age, clinical presentation, clinical status, or timing of treatment.

Natural history of the neck remnant of a cerebral aneurysm treated with the Guglielmi detachable coil system

2000 ◽  
Vol 93 (4) ◽  
pp. 561-568 ◽  
Author(s):  
Motoharu Hayakawa ◽  
Yuichi Murayama ◽  
Gary R. Duckwiler ◽  
Y. Pierre Gobin ◽  
Guido Guglielmi ◽  
...  
Keyword(s):  
Los Angeles ◽  
Medical Center ◽  
Detachable Coil ◽  
Content Type ◽  
Giant Aneurysms ◽  
Guglielmi Detachable Coil ◽  
Small Aneurysms ◽  
Fine Print

Object. The long-term durability of Guglielmi detachable coil (GDC) embolization of cerebral aneurysms is still unknown. The purpose of this study was to evaluate the anatomical evolution of neck remnants in aneurysms treated with GDCs.Methods. Of 455 aneurysms treated with GDCs from 1990 to 1998 at the University of California at Los Angeles Medical Center, 178 aneurysms (39%) had residual necks postembolization. Long-term follow-up angiograms were obtained in 73 of these aneurysms in 71 patients. The mean duration of angiographic follow up was 17.3 months. Twenty-four of the aneurysms were small with small necks, 24 were small with wide necks, 15 were large, and 10 were giant aneurysms.In small aneurysms with small necks, postembolization angiography revealed 12 aneurysms (50%) with progressive thrombosis, eight (33%) unchanged, and four (17%) with recanalization. In small aneurysms with wide necks, six (25%) had progressive thrombosis, eight (33%) remained unchanged, and 10 (42%) had recanalization. In large aneurysms, two (13%) were unchanged and 13 (87%) had recanalization. Of the giant aneurysms only one (10%) remained unchanged and nine (90%) had recanalization. Overall, 18 aneurysms (25%) exhibited progressive thrombosis, 19 (26%) remained unchanged, and 36 (49%) displayed recanalization on follow-up angiography. During the last 2 years of the study, the recanalization rate decreased and a higher rate of progressive thrombosis was noted in aneurysms with small necks. These positive changes are related to important new technical developments.Conclusions. Treatment with GDCs appears to be effective and the results permanent in most small aneurysms with small necks. However, there are important technical limitations in the current GDC technology that prevent recanalization in wide-necked or large or giant aneurysms.

scholarly journals 5-Year Angiographic and Clinical Follow-up of Coil-Embolised Intradural Saccular Aneurysms

2002 ◽  
Vol 8 (4) ◽  
pp. 349-366 ◽  
Author(s):  
LL Batista ◽  
J. Mahadevan ◽  
M. Sachet ◽  
H. Alvarez ◽  
G. Rodesch ◽  
...  
Keyword(s):  
First Year ◽  
Coil Embolisation ◽  
Short Term ◽  
Detachable Coil ◽  
Complete Occlusion ◽  
Guglielmi Detachable Coil ◽  
Short And Long Term ◽  
Arterial Aneurysms

The purpose of the paper is the follow-up of embolised intradural saccular Arterial Aneurysms (AA), excluding giant, dissecting, inflammatory, fusiform or AA associated to BVAM. Since its introduction in 1991, the Guglielmi Detachable Coil has offered protection against aneurysmal rebleeding in the critical few days and months after SAH regardless of the grade. A number of questions remain: is complete angiographic obliteration necessary at first embolisation? What duration of clinical / angiographic follow-up (FU) is required to ensure the risk of haemorrhage has been eliminated? What is the long-term protection against rebleeding? One hundred and two patients with 160 intradural saccular AA embolised before april 1997 were selected for this study. They had at least 5-yrs clinical FU, of which 22 patients had a mid-term (3 years) and 45 patients had a 5-year or more angiographic FU (mean 67,7 months per patient). Twenty-eight embolised AAs with 100% occlusion at 1 year, remained unchanged on the 5-year angiograms. A further 14 patients with complete occlusion at 1 year showed persisting complete occlusion on angiogram at 3-years FU, which in our series means that complete occlusion after the first year post-embolisation implies that the aneurysm will remain completely occluded. All secondary spontaneous thromboses (27.6% of cases), occurred during the first year pos-embolisation. In six patients with subtotal or partial occlusion no change was seen for three consecutive years of FU; none showed later change at 5-year angiography. Below 80% occlusion our series does not provide enough information but we consider the situation instable. No mortality related to the procedure was observed in the unruptured AA group. No bleeding or re-bleeding has occurred since the beginning of our experience (1993) in saccular AA treated by GDC-Coil. Coil-embolisation of properly selected patients is effective in protecting against bleeding or re-bleeding at short and long-term with stable morphological results provided a strict follow-up control is established at short term.

scholarly journals Angiographical Follow-up Results of Cerebral Aneurysms Treated by Guglielmi Detachable Coil System

2001 ◽  
Vol 7 (1_suppl) ◽  
pp. 137-142 ◽  
Author(s):  
T. Hyogo ◽  
T. Kataoka ◽  
K. Hayase ◽  
H. Nakamura
Keyword(s):  
Cerebral Aneurysms ◽  
Side Wall ◽  
Long Term Results ◽  
Partial Occlusion ◽  
Detachable Coil ◽  
Complete Occlusion ◽  
Guglielmi Detachable Coil ◽  
Wide Neck

To examine the long term results of endovascular treatment of cerebral aneurysms with the Guglielmi detachable coil (GDC) system, follow-up (F/U) angiography was performed at 6, 12 and 24 months after the procedure. We analyzed 45 cases, 49 procedures of GDC treated cerebral aneurysms from 1997.6. to 2000.5. Follow-up angiography was achieved at 6M 43/45 (96%), 12M 29/33 (87%) and 24M 22/25 (88%). Angiographical changes were found 23/43 (53%) of the cases at 6M F/U. There were angiographical improvements in 12 cases (CP: complete occlusion, NR: neck remnant, PA: partial occlusion, PA-CP; 8, NR-CP; 1, PA-NR; 3) and angiographical worsening in 11 cases (CP-NR; 5, CP-PA; 3, PA-PA; 3) at 6M F/U. Two cases had been demonstrating progressive angiographical worsening at 6M and 12MF/U (CP-NR-PA). No angiographical change was found at 24MF/U. There was no case of hemorrhage or re-hemorrhage after GDC treatment. In cases of side-wall aneurysm, tight packing of the inflow side of the aneurysm and small neck aneurysm were thought to be causes of the angiographical improvements. In patients with wide neck aneurysms with partial occlusion result were angiographic worsening at the F/U. Other factors of angiographical worsening were improper working angle at the procedure and improper follow-up angle at the angiography and the intraluminal clot in the case of ruptured aneurysm.

Guglielmi Detachable Coil embolization of cerebral aneurysms: 11 years' experience

2003 ◽  
Vol 98 (5) ◽  
pp. 959-966 ◽  
Author(s):  
Yuichi Murayama ◽  
Yih Lin Nien ◽  
Gary Duckwiler ◽  
Y. Pierre Gobin ◽  
Reza Jahan ◽  
...  
Keyword(s):  
Los Angeles ◽  
Medical Center ◽  
Cerebral Aneurysms ◽  
Detachable Coil ◽  
Content Type ◽  
The Past ◽  
Guglielmi Detachable Coil ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. The authors report on their 11 years' experience with embolization of cerebral aneurysms using Guglielmi Detachable Coil (GDC) technology and on the attendant anatomical and clinical outcomes. Methods. Since December 1990, 818 patients harboring 916 aneurysms were treated with GDC embolization at University of California at Los Angeles Medical Center. For comparative purposes, the patients were divided into two groups: Group A included their initial 5 years' experience with 230 patients harboring 251 aneurysms and Group B included the later 6 years' experience with 588 patients harboring 665 aneurysms. Angiographically demonstrated complete occlusion was achieved in 55% of aneurysms and a neck remnant was displayed in 35.4% of lesions. Incomplete embolization was performed in 3.5% of aneurysms, and in 5% occlusion was attempted unsuccessfully. A comparison between the two groups revealed a higher complete embolization rate in patients in Group B compared with that in Group A patients (56.8 and 50.2%, respectively). The overall morbidity/mortality rate was 9.4%. Angiographic follow ups were obtained in 53.4% of cases of aneurysms, and recanalization was exhibited in 26.1% of aneurysms in Group A and 17.2% of those in Group B. The overall recanalization rate was 20.9%. Note that recanalization was related to the size of the dome and neck of the aneurysm. Overall incidence of delayed aneurysm rupture was 1.6%, a rate that improved in the past 5 years to 0.5%. Ten of 12 delayed ruptures occurred in large or giant aneurysms. Conclusions. The clinical and postembolization outcomes in patients treated with the GDC system have improved in the past 5 years. Aneurysm recanalization, however, is still a major limitation of current GDC therapy. Follow-up angiography is mandatory after GDC embolization of cerebral aneurysms. Further technical and device improvements are mandatory to overcome current GDC limitations.

Microsurgical Treatment of Basilar Apex Aneurysms: Perioperative and Long-term Clinical Outcome

Neurosurgery ◽  
2004 ◽  
Vol 54 (2) ◽  
pp. 286-299 ◽  
Author(s):  
Alan P. Lozier ◽  
Grace H. Kim ◽  
Robert R. Sciacca ◽  
E. Sander Connolly ◽  
Robert A. Solomon
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Giant Aneurysm ◽  
Outcome Data ◽  
Surgical Morbidity ◽  
Detachable Coil ◽  
Entire Cohort ◽  
Guglielmi Detachable Coil

Abstract OBJECTIVE We sought to analyze the perioperative and long-term clinical outcome data for patients with microsurgically treated basilar apex aneurysms. METHODS We identified 98 consecutively treated basilar apex aneurysms in patients prospectively enrolled in a cerebral aneurysm database. RESULTS Fifty patients presented with subarachnoid hemorrhage, and 19 aneurysms were giant. Eighty-four of 98 aneurysms were directly clipped. Surgical morbidity was 19.4% for the entire cohort and 8.8% for the unruptured, nongiant subgroup. The most common complication resulting in long-term morbidity was perforator injury. Sixty-seven percent of patients with clipped aneurysms were independent at discharge; this fraction increased to 79.0% at the 3-month follow-up examination. Good long-term outcomes (modified Rankin Scale score ≤2) were achieved in 56 (70%) of 80 cases. The mean Barthel Index of surviving patients was 95.8 ± 15.0 (median = 100, n = 66). Patients with unruptured, nongiant lesions fared considerably better than patients in other cohorts. Ninety-three percent of this subgroup was independent at discharge; this fraction increased to 100% at the 3-month follow-up examination (n = 27). In univariate analyses, poor clinical grade, giant aneurysm size, major operative complications, and operations performed early in the series were associated with worse outcomes. In the multivariate analysis, unruptured giant aneurysm status was found to confer a tremendous risk for poor outcome (risk ratio, 80.0; 95% confidence interval, 8.0–800.7; P < 0.01). Surviving patients were observed for a mean clinical follow-up period of 7.4 ± 3.7 years. The annual rate of postoperative subarachnoid hemorrhage was 0.18% for all clipped aneurysms and 0% for completely clipped lesions. CONCLUSION In comparison to data from the existing literature regarding Guglielmi detachable coil embolization of basilar apex aneurysms, the data presented suggest that surgical clipping should be an important component of a multimodality approach to the treatment of patients with basilar apex aneurysms.

scholarly journals P-Cresyl Sulfate Is a Valuable Predictor of Clinical Outcomes in Pre-ESRD Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Cheng-Jui Lin ◽  
Chi-Feng Pan ◽  
Chih-Kuang Chuang ◽  
Fang-Ju Sun ◽  
Duen-Jen Wang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cardiovascular Event ◽  
Cox Regression ◽  
Medical Center ◽  
Serum Biochemistry ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Valuable Marker ◽  
Valuable Predictor

Background/Aims. Previous studies have reported p-cresyl sulfate (PCS) was related to endothelial dysfunction and adverse clinical effect. We investigate the adverse effects of PCS on clinical outcomes in a chronic kidney disease (CKD) cohort study.Methods. 72 predialysis patients were enrolled from a single medical center. Serum biochemistry data and PCS were measured. The clinical outcomes including cardiovascular event, all-cause mortality, and dialysis event were recorded during a 3-year follow-up.Results. After adjusting other independent variables, multivariate Cox regression analysis showed age (HR: 1.12,P=0.01), cardiovascular disease history (HR: 6.28,P=0.02), and PCS (HR: 1.12,P=0.02) were independently associated with cardiovascular event; age (HR: 0.91,P<0.01), serum albumin (HR: 0.03,P<0.01), and PCS level (HR: 1.17,P<0.01) reached significant correlation with dialysis event. Kaplan-Meier analysis revealed that patients with higher serum p-cresyl sulfate (>6 mg/L) were significantly associated with cardiovascular and dialysis event (log rankP=0.03, log rankP<0.01, resp.).Conclusion. Our study shows serum PCS could be a valuable marker in predicting cardiovascular event and renal function progression in CKD patients without dialysis.

scholarly journals Intraaneurysmal Embolization for Wide-Necked Aneurysms Remodeling Technique, Combined Neck-Clipping and Coiling Therapy, Scaffolding Technique

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 95-101 ◽  
Author(s):  
T. Nakahara ◽  
T. Hidaka ◽  
M. Kutsuna ◽  
M. Yamanaka ◽  
K. Sakoda
Keyword(s):  
Endovascular Treatment ◽  
Neurological Deficits ◽  
Circulation System ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Detachable Coil ◽  
Obliteration Rate ◽  
Guglielmi Detachable Coil ◽  
Scaffolding Technique

We reported the results of the endovascular treatment using Guglielmi detachable coil (GDC) for wide-necked aneurysms. Fourteen aneurysms were treated with remodeling technique. One aneurysm was performed endovascular treatment followed by partial neck clipping. The other was treated with scaffolding technique. All aneurysms could not be performed by conventional GDC treatment initially because of coil protrusion into the parent artery due to wide neck of these aneurysms. These aneurysms sited at anterior circulation system in 10 cases, and at posterior circulation system in 6 cases. Immediately after the procedure, the obliteration rate could be obtained complete occlusion in 3 cases, > 95% occlusion in 7 cases, > 90% occlusion in 3 cases and < 90% occlusion in 3 cases. In 14 patients follow-up angiography or magnetic resonance image (MRI) was carried out. The angiographic follow-up period is range from 2 to 19 months (mean: 10 months). The results of angiographical follow-up indicated increasing obliteration rate with all aneurysms except for 2 cases. In these 2 cases, the reembolization was needed for recanalization of the aneurysm. The clinical follow-up period is range form one to 26 months (mean: 15 months). There is no evidence of aneurysmal rupture and all cases have been survival without any permanent neurological deficits. The GDC treatment with additional technique (remodeling technique, combined neck-clipping and coiling therapy, scaffolding technique) provides safety and effectiveness, even if there are wide-necked aneurysms.

scholarly journals Mid-term outcomes of bony increased offset-reverse total shoulder arthroplasty in the Asian population

2021 ◽  
Vol 24 (3) ◽  
pp. 125-134
Author(s):  
Kirtan Tankshali ◽  
Dong-Whan Suh ◽  
Jong-Hun Ji ◽  
Chang-Yeon Kim
Keyword(s):  
Los Angeles ◽  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
Intraoperative Complications ◽  
Total Shoulder Arthroplasty ◽  
Asian Population ◽  
Reverse Total Shoulder Arthroplasty ◽  
Scapular Notching ◽  
Reverse Total Shoulder

Background: To evaluate clinical and radiological outcomes of bony increased offset-reverse total shoulder arthroplasty (BIO-RSA) in the Asian population at mid-term follow-up.Methods: From June 2012 to August 2017 at a single center, 43 patients underwent BIO-RSA, and 38 patients with a minimum of 2 years of follow-up were enrolled. We evaluated the preoperative and postoperative clinical outcomes, radiological outcomes (notching and loosening), and complications of BIO-RSA at the last follow-up. In addition, we divided these patients into notching and not-notching groups and compared the demographics, preoperative, and postoperative characteristics of patients between the two groups.Results: Visual analog scale, American Shoulder and Elbow Surgeons, University of California-Los Angeles, and Simple Shoulder Test scores improved significantly from preoperative (average: 5, 39.43, 16.22, 3.94) to postoperative (average: 1.71, 78.91, 28.34, 7.8; p<0.05) outcomes. All range of motion except internal rotation improved significantly at the final follow-up (p<0.05), and the bone graft was well-incorporated with the native glenoid in all patients (100%). However, scapular notching was observed in 20/38 patients (53%). In the comparison between notching and not-notching groups (18 vs. 20 patients), there were no significant differences in demographics, radiological parameters, and clinical outcomes except acromion-greater tuberosity (AT) distance (p=0.003). Intraoperative complications were three metaphyseal fractures and one inferior screw malposition. Postoperative complications included one heterotopic ossification, one scapula neck stress fracture, one humeral stem loosening, and one late infection.Conclusions: BIO-RSA resulted in improved clinical outcomes at mid-term follow-up in the Asian population. Although better cosmesis and advantages of glenoid lateralization were observed, we observed higher rates of scapular notching compared to previously reported rates in BIO-RSA studies. In addition, adequate glenoid lateralization with appropriate humeral lengthening (AT distance) might reduce scapular notching.

scholarly journals Efficacy of threading lasso fixation in repairing partial articular supraspinatus tendon avulsion lesions: a retrospective study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sun-Yu Chen ◽  
Zhan-Hao Xiao ◽  
Jian-Kun Wang
Keyword(s):  
Los Angeles ◽  
Clinical Outcomes ◽  
Case Series ◽  
Visual Analog Scale Score ◽  
Supraspinatus Tendon ◽  
Fixation Technique ◽  
Retrospective Case ◽  
The Mean ◽  
Tendon Avulsion

Abstract Background The partial articular supraspinatus tendon avulsion (PASTA) lesion repair remains a topic of debate. We have performed in situ repair of PASTA lesions using a potentially viable threading lasso fixation technique. This retrospective case series aimed to evaluate the clinical outcomes of PASTA lesion repair using threading lasso fixation. To the best of our knowledge, this is the first study to review this technique and its outcomes in terms of pain and upper extremity function. Methods Twenty-five patients with PASTA lesions who were treated with threading lasso fixation were reviewed. All patients were followed up for at least 1 year. Preoperative and follow-up data were retrospectively collected and reviewed. Clinical outcomes were assessed to evaluate the efficacy of the surgery. Results There were no postoperative complications. The average follow-up period was 25.7 (22–27) months. At the last follow-up, all patients underwent follow-up magnetic resonance imaging; only two cases showed a partially healed tendon and no case converted to full-thickness tear. Furthermore, shoulder pain decreased and mobility was recovered, with statistically significant differences in all scoring measures. Specifically, the mean visual analog scale score decreased from 5.4 ± 1.2 before surgery to 1.1 ± 0.8 at the last follow-up (t = 14.908, P < 0.01), and the mean American Shoulder and Elbow Surgeons Shoulder Assessment Form score improved significantly from 51.6 ± 6.4 to 89.3 ± 5.2 (t = 22.859, P < 0.01). Additionally, the mean University of California Los Angeles score improved from 17.8 ± 3.5 preoperatively to 32.3 ± 1.4 (t = 19.233, P < 0.01). Conclusions Arthroscopic repair using threading lasso fixation is a novel transtendinous technique for patients with partial articular supraspinatus tendon avulsion. Tendon integrity is preserved with this method, which may result in improved function. Overall, threading lasso fixation technique is an effective treatment.

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