Follow-up Angiography of Intracranial Aneurysms Treated with Endovascular Placement of Guglielmi Detachable Coils

Neurosurgery ◽  
2002 ◽  
Vol 50 (2) ◽  
pp. 239-250 ◽  
Author(s):  
John Thornton ◽  
Gerard M. Debrun ◽  
Victor A. Aletich ◽  
Qasim Bashir ◽  
Fady T. Charbel ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Endovascular Coiling ◽  
Guglielmi Detachable Coils ◽  
Detachable Coils ◽  
Aneurysm Occlusion ◽  
Male Patients ◽  
The Mean ◽  
Angiographic Findings

ABSTRACT OBJECTIVE The success of endovascular treatment of intracranial aneurysms with Guglielmi detachable coils (GDCs) is dependent on the long-term exclusion of the aneurysm from the circulation. We reviewed our experience with the long-term angiographic follow-up monitoring of aneurysms that had been treated with GDCs. METHODS All patients whose aneurysms had been treated with GDCs between January 1995 and August 1999 and who subsequently underwent follow-up angiography at 6 months or more were included in this study. We reviewed all of the angiographic findings, to determine the percentage of aneurysm occlusion on the initial angiograms and on the last available follow-up angiograms. The categories of aneurysm occlusion used were 100%, ≥95%, and less than 95% occlusion. RESULTS One hundred thirty patients with 141 aneurysms underwent 143 endovascular coiling procedures and subsequently underwent angiographic follow-up monitoring of 6 months or more. There were 102 female and 28 male patients. The mean angiographic follow-up period was 16.7 months (range, 6–62 mo). The initial rates of occlusion were 100% for 56 aneurysms (39%), ≥95% for 65 aneurysms (46%), and less than 95% for 22 aneurysms (15%). Recurrence of one aneurysm (1.8%) was observed. Of the 87 aneurysms that were incompletely occluded initially, there was progressive thrombosis in 40 (46%), stable neck remnants in 23 (26%), and enlargement of the residual neck in 24 (28%). The final occlusion rates, determined on the last available angiograms, were 100% for 88 aneurysms (61%), ≥95% for 31 aneurysms (22%), and less than 95% for 24 aneurysms (17%). No patient experienced repeat or new subarachnoid hemorrhage more than 6 months after the initial treatment. CONCLUSION Late angiographic follow-up monitoring of aneurysms that have been treated with GDCs demonstrates the durability of the treatment. Aneurysms with large residual neck remnants were subjected to further treatment, whereas aneurysms with small residual neck remnants remain under observation.

scholarly journals Long-term Follow-up of Intracranial Aneurysms Occluded with Guglielmi Detachable Coils: Prediction of the Angiographical Changes on Incompletely Embolized Aneurysms.

2003 ◽  
Vol 31 (2) ◽  
pp. 121-128
Author(s):  
Tadashi NONAKA ◽  
Kazuhisa YOSHIFUJI ◽  
Futoshi MATSUNO ◽  
Kouichi HARAGUCHI ◽  
Michio INOUE ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Guglielmi Detachable Coils ◽  
Long Term Follow Up ◽  
Detachable Coils

Rupture of Intracranial Aneurysms during Endovascular Coiling: Management and Outcomes

Neurosurgery ◽  
2001 ◽  
Vol 49 (4) ◽  
pp. 807-813 ◽  
Author(s):  
Elad Levy ◽  
Christopher J. Koebbe ◽  
Michael B. Horowitz ◽  
Charles A. Jungreis ◽  
G. Lee Pride ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Demographic Data ◽  
Clinical Status ◽  
Endovascular Coiling ◽  
Aneurysmal Rupture ◽  
Detachable Coils ◽  
The Mean

Abstract OBJECTIVE In this study, the incidence, etiologies, and management with respect to clinical outcome of patients with iatrogenic aneurysmal rupture during attempted coil embolization of intracranial aneurysms are reviewed. METHODS A retrospective analysis was conducted of 274 patients with intracranial aneurysms treated with Guglielmi detachable coils over a 6-year period from 1994 to 2000. Patient medical records were examined for demographic data, aneurysm location, the number of coils deployed preceding and after aneurysmal rupture, the etiology of the rupture, and the clinical status on admission and at the time of discharge. RESULTS Of 274 patients with intracranial aneurysms treated with coil embolization, six (2%) had an intraprocedural rupture. Of these six, two were women and four were men. The mean age was 67 years (range, 52–85 yr). Mean follow-up time was 8 months (range, 0–25 mo). Aneurysmal rupture resulted from detachment of the last coil in three patients, detachment of the third coil (of four) in one patient, and insertion of the first coil in another patient. In one patient, the aneurysmal rupture was a result of catheter advancement before detachment of the last coil. The Glasgow Outcome Scale score at last follow-up examination was 1 in two patients, 2 in two patients, and 5 in two patients. CONCLUSION The rate of rupture of aneurysms during coil embolization is approximately 2 to 4%. The clinical outcome may be related to the timing of the rupture and the number of coils placed before rupture. If extravasation of contrast agent is seen, which suggests intraprocedural rupture, further coil deposition should be attempted if safely possible.

Long-term Clinical and Angiographic Results of Neuroform Stent-Assisted Coil Embolization in Wide-Necked Intracranial Aneurysms

Neurosurgery ◽  
2011 ◽  
Vol 70 (5) ◽  
pp. 1232-1237 ◽  
Author(s):  
Alejandro Santillan ◽  
Edward Greenberg ◽  
Athos Patsalides ◽  
Kimberly Salvaggio ◽  
Howard A. Riina ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Univariate Analysis ◽  
High Rate ◽  
Long Term Results ◽  
Aneurysm Occlusion ◽  
The Mean ◽  
Neuroform Stent

Abstract BACKGROUND: Neuroform stent-assisted coil embolization facilitates the endovascular treatment of wide-necked intracranial aneurysms. However, the safety and efficacy of its long-term use have not been fully elucidated. OBJECTIVE: To retrospectively examine the long-term results of Neuroform stent usage in conjunction with coil embolization in wide-necked intracranial aneurysms. METHODS: Between November 2002 and December 2010, 79 patients harboring wide-necked intracranial aneurysms were treated with use of the Neuroform stent. The stenting procedure failed in 2 patients. Therefore, 77 patients harboring 79 intracranial aneurysms were included for analysis. Patient and aneurysm characteristics, progression of aneurysm occlusion, and occurrence of complications were analyzed. Follow-up imaging included digital subtraction angiography (DSA) or magnetic resonance angiography (MRA). Kaplan-Meier analysis, as well as univariate analysis were performed to determine the progression of aneurysm occlusion and to examine the predictive factors for complete aneurysm occlusion, respectively. RESULTS: Overall, complete aneurysm occlusion was observed in 42.4% of the cases immediately after treatment and progressed to 96.5% at 7-year follow-up. The mean angiographic follow-up time was 25.8 months (range, 0–84 months). Eleven aneurysms (14%) were re-treated. Sixty-eight patients (88.3%) had favorable clinical outcome with a modified Rankin Scale (mRS) ⩽ 1, 3 patients (3.9%) had an mRS of 2, and 5 patients (6.5%) did not have a clinical follow-up. The mean clinical follow-up time was 45.4 months (range, 3–92 months). One patient (1.3%) died of a procedure-related hemorrhage. CONCLUSION: Neuroform stent-assisted coil embolization of wide-necked intracranial aneurysms prevents hemorrhage and provides a high rate of aneurysm occlusion at long-term follow-up.

scholarly journals Angiographic Follow-up of Embolization Using Guglielmi Detachable Coils for Cerebral Aneurysms

2003 ◽  
Vol 9 (1_suppl) ◽  
pp. 47-50 ◽  
Author(s):  
Y. Nakai ◽  
M. Sonobe ◽  
K. Sugita ◽  
Y. Matsumaru
Keyword(s):  
Morphological Changes ◽  
Cerebral Aneurysms ◽  
Guglielmi Detachable Coils ◽  
Complete Occlusion ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Detachable Coils ◽  
Aneurysm Occlusion

The purpose of this study is to evaluate the mid or long-term angiographical stability of Guglielmi Detachable Coils (GDC) after embolization for cerebral aneurysms. Between march 1997 and november 2001, 164 aneurysms, including 116 ruptured and 48 unruptured aneurysms, were treated using GDC at Mito National Hospital. Cerebral angiograms over one month after embolization were obtained in 111 aneurysms, including 71 ruptured and 40 unruptured aneurysms. At the time of initial GDC embolization of the 71 ruptured aneurysms, complete occlusion was achieved in 31 aneurysms, neck remnant in 18 aneurysms, and body filling in 22 aneurysms. Morphological changes were observed in 26 aneurysms (37%) in follow-up. Progressive thrombosis was obtained in 12 out of 71 aneurysms, no changes were shown in 45, and recanalizations occurred in 14. In the initial embolization of the 40 unruptured aneurysms, complete occlusion was achieved in 15 aneurysms, neck remnant in five and body filling in 20 aneurysms respectively. Morphological changes were observed in 12 aneurysms (30%), in which 12 aneurysms showed progressive thrombosis and 28 aneurysms were unchanged. There were significant differences of the long-term angiographical stability between ruptured and unruptured aneurysms. Rigorous follow-up angiography is mandatory when complete aneurysm occlusion is not achieved in ruptured aneurysms.

scholarly journals Evaluation of the Stability of Intracranial Aneurysms Occluded with Guglielmi Detachable Coils

2001 ◽  
Vol 7 (1_suppl) ◽  
pp. 143-148 ◽  
Author(s):  
S. Tamatani ◽  
Y. Ito ◽  
T. Koike ◽  
H. Abe ◽  
T. Kumagai ◽  
...  
Keyword(s):  
Guglielmi Detachable Coils ◽  
Aneurysm Neck ◽  
Term Stability ◽  
Long Term Stability ◽  
Detachable Coils ◽  
The Mean ◽  
The Stability ◽  
Small Aneurysms

The purpose of this study is to evaluate the long-term stability of embolized aneurysms using the volume embolization rate (VER). One hundred and six aneurysms in 96 patients who were treated with Guglielmi detachable coils were selected for this study. Follow-up angiography was performed at six or more months after initial treatment. Every aneurysm was packed as densely as possible, however, the percentage of stability varied according to the size of the aneurysm or the size of the aneurysm neck. The percentage of stable aneurysm was 82% (56/68) in small aneurysms with small necks, 68% (13/19) in small aneurysms with wide necks and 42% (8/19) in large aneurysms. The mean VER of embolized aneurysms in each size was 30%, 22% and 17%, respectively. There was a correlation between the percentage of stable aneurysms and the mean VER. On the other hand, there seemed to be a difference of VER for the stability of embolized aneurysms between ruptured aneurysms and unruptured ones. In small aneurysms with small necks, the stability of embolized aneurysms in ruptured ones was obtained only when the VER was greater than 30%, whereas it was found in unruptured ones even though the VER was less than 20%. In conclusion, the long-term stability of embolized aneurysms was obtained in small-sized aneurysms, especially small neck aneurysms, and unruptured ones. The VER is a good, objective index to predict the long-term stability of embolized aneurysms.

scholarly journals Usefulness of 3D T1-SPACE in Combination With 3D-TOF MRA for Follow-Up Evaluation of Intracranial Aneurysms Treated With Pipeline Embolization Devices

2020 ◽  
Vol 11 ◽  
Author(s):  
Qiuji Shao ◽  
Qiaowei Wu ◽  
Qiang Li ◽  
Tianxiao Li ◽  
Li Li ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Coincidence Rate ◽  
Space Sequence ◽  
Stent Patency ◽  
Tof Mra ◽  
Long Term Follow Up ◽  
Aneurysm Occlusion ◽  
Imaging Artifacts

Object: Follow-up evaluation of intracranial aneurysms treated by flow-diverting stents using MRI is challenging due to the presence of imaging artifacts. This study evaluated 3D T1-SPACE in combination with 3D-TOF sequence for follow-up evaluation of intracranial aneurysms treated with Pipeline embolization devices.Methods: Forty patients with 53 intracranial aneurysms who were treated with Pipeline Embolization Devices from October 2018 to July 2019 were enrolled in this study. All patients were evaluated for aneurysm occlusion and stent patency 4 to 7 months post-treatment using 3D T1-SPACE sequence, 3D-TOF MRA, and DSA examinations.Results: With regards to aneurysm occlusion, the intermodality (DSA and 3D-TOF MRA) agreement was good (κ = 0.755). The specificity of 3D-TOF MRA was 94.4% (34/36), the sensitivity was 76.5% (13/17), the total coincidence rate was 88.7% (47/53). With regards to the patency of the stented arteries after PED treatment, 3D T1-SPACE sequence was more accurate compared to 3D-TOF MRA (Z = −6.283, P < 0.001), with a no-artifact rate of 95.7% (44/46).Conclusions: 3D T1-SPACE sequence provides better image quality and higher accuracy for evaluating stented parent arteries compared to TOF-MRA. 3D-TOF MRA may be valuable in the evaluation of aneurysm occlusion. The combination of these two modalities may be used for long-term follow-up of intracranial aneurysms treated with Pipeline Embolization Devices.

Endovascular treatment of basilar tip aneurysms using electrolytically detachable coils

1996 ◽  
Vol 84 (3) ◽  
pp. 393-399 ◽  
Author(s):  
Cameron G. McDougall ◽  
Van V. Halbach ◽  
Christopher F. Dowd ◽  
Randall T. Higashida ◽  
Donald W. Larsen ◽  
...  
Keyword(s):  
Initial Treatment ◽  
Content Type ◽  
Initial Treatment Period ◽  
Long Term Follow Up ◽  
Detachable Coils ◽  
Aneurysm Occlusion ◽  
Permanent Morbidity ◽  
Fine Print

✓ Preliminary experience using electrolytically detachable coils to treat basilar tip aneurysms in 33 patients is described. The most frequent presentation was subarachnoid hemorrhage (SAH) in 23 patients. All patients were referred after neurosurgical assessment and exclusion as candidates for surgical clipping of their aneurysms. At the time of initial treatment complete aneurysm occlusion was achieved in seven (21.2%) of 33 patients. In 17 of the patients (51.5%), greater than 90% but less than 100% aneurysm occlusion was achieved. Angiographic follow up (mean 11.7 months) was available in 19 patients. At follow-up angiography four (21%) of 19 aneurysms were 100% occluded and 12 (63.2%) of 19 were more than 90% but less than 100% occluded. The mean clinical follow-up time in treated patients surviving beyond the initial treatment period is 15 months. One patient suffered major permanent morbidity from thrombosis of the basilar tip region a few hours after coil placement. One patient treated following SAH experienced further hemorrhage 6 months later. No other patient suffered direct or indirect permanent morbidity as a consequence of this method of treatment. The authors believe that this technique is a reasonable alternative for patients who are not candidates for conventional surgical treatment or in whom such treatment has failed. This study's follow-up period is brief and greater experience with long-term follow-up study is mandatory.

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