The Role of Blood Impulse in Cerebral Aneurysm Coil Compaction: Effect of Aneurysm Neck Size

2003 ◽  
Author(s):  
Baruch B. Lieber ◽  
Chander Sadasivan ◽  
Matthew J. Gounis ◽  
Ajay K. Wakhloo
Keyword(s):  
Cerebral Aneurysms ◽  
Momentum Equation ◽  
Parent Vessel ◽  
Neck Size ◽  
Aneurysm Neck ◽  
Hemodynamic Forces ◽  
Sigmoid Curve ◽  
Detachable Coils ◽  
Aneurysm Volume

Endovascular occlusion of cerebral aneurysms with bare platinum detachable coils is now recognized as preferable to surgical clipping (ISUIA Group, 2003, ISAT Group, 2002, Bavinzski et al, 1995, Thornton et al, 2002). Dependent on coil packing density (the ratio of the coil volume deposited in an aneurysm to that of the aneurysm volume), aneurysm location, size and neck width, coil compaction with recanalization of the aneurysm remains in the long-term a major concern. The aneurysm neck size is reported to be the main predictor for aneurysm recanalization (Fernandez-Zubillaga et al, 1994). The forces exerted on the coil mass at the aneurysm neck due to blood pulsatility are larger for wide neck aneurysms as compared to small neck aneurysms (Bavinzski et al, 1995). However, impingement forces have not been evaluated. We evaluated the force impinging on the aneurysm neck in a simplified aneurysm (basilar top) geometry utilizing the impulse-momentum equation and Womersley’s flow. Maximum impingement force as a function of aneurysm neck to parent lumen diameter ratio varies as a sigmoid curve. Analysis of the hemodynamic forces affecting coil compaction in cerebral aneurysms shows that the coil mass at the aneurysm neck may be subjected to cyclic impulse impingement due to redirection of blood momentum. Orientation of the aneurysm neck and the main axis of the aneurysm in relation to the oncoming parent vessel flow may help clinicians predict the risk of coil compaction and the location of subsequent aneurysm recanalization.

Intra-Aneurysmal Occlusion of Cerebral Aneurysms Using Detachable Coils: Correlation of Aneurysm Neck Size and Treatment Results

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 114-117
Author(s):  
K. Irie ◽  
W. Taki ◽  
I. Nakahara ◽  
N. Sakai ◽  
F. Isaka ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Treatment Results ◽  
Neck Size ◽  
Aneurysm Neck ◽  
Detachable Coils ◽  
Aneurysm Occlusion ◽  
Aneurysmal Neck ◽  
Wide Neck

The aneurysmal neck size seems to be an import ant factor in the endovascular treatment outcome4,5. The purpose of the present study was to measure aneurysm neck size on angiographic films, and compare the measured value with the extent of intra-aneurysmal occlusion performed with detachable coils. The subjects were 22 patients with intracranial aneurysms treated using detachable coils. The cases were divided into two groups according to the aneurysmal neck size, 4 mm being the discriminating value for small neck. The neck of the aneurysm was successfully occluded in 19 of 22 patients. Ten aneurysms had a small neck and 9 aneurysms had a wide neck. Complete aneurysm occlusion was observed in 70% of small neck aneurysms and 25% of wide neck aneurysms. The results support that the size of the aneurysm neck correlates well with the effectiveness of endovascular treatment.

A novel endovascular clip system for the treatment of intracranial aneurysms: technology, concept, and initial experimental results

2008 ◽  
Vol 108 (6) ◽  
pp. 1230-1240 ◽  
Author(s):  
Thomas R. Marotta ◽  
Thorsteinn Gunnarsson ◽  
Ian Penn ◽  
Donald R. Ricci ◽  
Ian Mcdougall ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Delivery System ◽  
Intracranial Aneurysms ◽  
Balloon Catheter ◽  
Cerebral Aneurysms ◽  
Histopathological Analysis ◽  
Parent Vessel ◽  
Flow Models ◽  
Aneurysm Neck ◽  
Novel Device

Object The authors describe a novel device for the endovascular treatment of intracranial aneurysms, the endovascular clip system (eCLIPs). Descriptions of the device and its delivery system as well as the results of flow model tests and the treatment of experimental aneurysms are provided. Methods The eCLIPs comprises a flexible hybrid implantable device (an anchor and a covered leaf) and a balloon catheter delivery system, designed to be positioned and activated in the parent vessel in such a way that the covered portion will abut the aneurysm neck. The eCLIPs was subjected to testing in glass, elastomeric, and cadaveric flow models to determine its navigability, orientation, and activation compared with commercially available stents. In a second experiment, 8 carotid artery sidewall aneurysms in swine were treated using eCLIPs. The degree of occlusion was observed on angiography immediately following and 30 days after device activation, and a histological analysis was performed at 30 days. Results The device could navigate tortuous glass models and human cadaveric vessels. Compared with commercially available stents, the eCLIPs performed well. It could be navigated, oriented, and activated easily and reliably. With regard to the 8 porcine experimental aneurysms, immediate postactivation angiograms confirmed complete occlusion of 4 lesions and near occlusion of the other 4. Angiographic follow-up at 30 days postactivation showed occlusion of all 8 aneurysms and patency of all parent vessels. Histopathological analysis revealed aneurysm healing, with smooth-muscle cells growing across the lesion neck to allow reendothelialization. Conclusions Aneurysm occlusion with a single extrasaccular endovascular device has potential advantages. The authors believe that eCLIPs may prove to be a useful tool in the endovascular treatment of cerebral aneurysms. The system should reduce risks associated with coiling, procedure time, costs, and radiation exposure. The device satisfactorily occluded 8 experimental sidewall aneurysms. The observed healing pattern is similar to that seen after microsurgical clipping.

Treatment of Cerebral Aneurysms With Flow Divertors: Long Term Results in an In Vivo Model

2007 ◽  
Author(s):  
Chander Sadasivan ◽  
Baruch B. Lieber ◽  
Liliana Cesar ◽  
Jaehoon Seong ◽  
Ajay K. Wakhloo
Keyword(s):  
Thrombus Formation ◽  
Cerebral Aneurysms ◽  
Long Term Results ◽  
In Vivo Model ◽  
Parent Artery ◽  
Momentum Exchange ◽  
Aneurysm Neck ◽  
Flow Stasis

Subarachnoid hemorrhagic stroke is a devastating illness with a 30-day mortality rate of 45% and is mostly caused due to the rupture of an intracranial aneurysm. Although these aneurysms are currently treated surgically by clipping, or, endovascularly by coiling and stent-assisted coiling, the feasibility of successfully treating aneurysms solely by the placement of an intravascular flow-diverting mesh across the aneurysm neck was established more than a decade ago [1]. Flow divertors disrupt the momentum exchange between the parent artery and aneurysm and significantly reduce intraaneurysmal hydrodynamic vorticity. The resultant flow stasis promotes thrombus formation within the aneurysm sac, which eventually matures into fibrotic tissue, leading to the exclusion of the aneurysm from the circulation. With the increased use of stents in the intracranial circulation, cases where coiling is not feasible, or is staged as a secondary procedure, are providing clinical evidence of the successful treatment of aneurysms with stents alone [2,3]. Such reports are sporadic and, moreover, the devices used are not designed to be flow divertors. Methodological evidence of the performance of appropriately designed flow divertors in treating cerebral aneurysms is currently unavailable.

STENT REMODELING TECHNIQUE FOR COILING OF RUPTURED WIDE-NECK CEREBRAL ANEURYSMS: CASE REPORT

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. E1007-E1008 ◽  
Author(s):  
Demetrius K. Lopes ◽  
Kalani Wells
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Acute Subarachnoid Hemorrhage ◽  
The Right ◽  
Wide Neck ◽  
Cordis Corporation

Abstract OBJECTIVE To describe a novel stent remodeling technique for the coiling of ruptured wide-neck cerebral aneurysms. CLINICAL PRESENTATION A 46-year-old man presented with acute subarachnoid hemorrhage (Hunt and Hess grade IV), intracerebral hemorrhage, and hydrocephalus. Cerebral angiography revealed a wide-neck small anterior communicating artery aneurysm. Conventional coiling was not successful because of coil instability and compromise of the dominant anterior cerebral artery. TECHNIQUE A 6-French shuttle sheath (Cook Medical, Indianapolis, IN) was advanced from a right femoral approach into the right common carotid artery. To protect the parent vessel during coiling without compromising blood flow, a Prowler Select Plus catheter (Cordis Corporation, Bridgewater, NJ) was navigated across the aneurysm neck. Subsequently, an Enterprise stent (22-mm length; Cordis Corporation) was partially deployed across the aneurysm's wide neck. It was very important to watch the distal markers of the stent and lock the stent delivery wire to the Prowler Select Plus with a hemostatic valve once the stent was halfway deployed. This maneuver was essential to prevent further deployment of the stent. The SL-10 microcatheter and Synchro 14 wire (Boston Scientific, Natick, MA) were carefully navigated to the aneurysm passing through the partially deployed stent. Coils were then delivered to the aneurysm using the stent as a scaffold. After coiling, the SL-10 microcatheter was removed and the stent was recaptured into the Prowler Select Plus catheter. During the recapture, there was initial resistance. This was easily overcome after deploying the stent a little more before resheathing. During the procedure, the patient received 2000 U of heparin after the first coil was detached in the aneurysm. CONCLUSION The stent remodeling technique is a novel endovascular technique that can be used to treat ruptured wide-neck aneurysms and maintain patency of parent vessels, avoiding the use of antiplatelet therapy in acute subarachnoid hemorrhage.

scholarly journals Cerebral Aneurysm Perforations during Treatment with Detachable Coils

2006 ◽  
Vol 12 (1) ◽  
pp. 31-35 ◽  
Author(s):  
K.F. Layton ◽  
H.J. Cloft ◽  
D.F. Kallmes
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Aneurysm ◽  
Intracranial Aneurysms ◽  
Case Reports ◽  
Aneurysm Rupture ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Detachable Coils

Perforation of intracranial aneurysms during endovascular treatment with platinum micro-coils is a well-known and serious complication reported to occur in 2–4% of patients. Inflation of a remodelling balloon across the aneurysm neck or within the proximal parent vessel is an additional technique that theoretically might be useful to reduce flow within the aneurysm and achieve hemostasis. In the case reports that follow, we present our experience using this technique for managing intraprocedural aneurysm rupture.

scholarly journals Early Experiences of Neuroform Stent-Assisted Coiling in Ruptured Intracranial Aneurysms

2007 ◽  
Vol 13 (1) ◽  
pp. 31-44 ◽  
Author(s):  
Young-Joon Kim
Keyword(s):  
Intracranial Aneurysms ◽  
Three Dimensional ◽  
Parent Artery ◽  
Parent Vessel ◽  
Single Center Experience ◽  
Early Experiences ◽  
Detachable Coils ◽  
Neuroform Stent ◽  
Ruptured Intracranial Aneurysms

Endovascular treatment of ruptured intracranial aneurysms with detachable coils has proven a favorable alternative to surgical clipping. However, coiling has limitations in the treatment of complex or broad neck aneurysms because of possible coil prolapse or coil migration into the parent vessel and long-term angiographic recurrences. To achieve reconstruction of intracranial vessels with preservation of the parent artery, the use of stents has the greatest potential for assisted coil embolization. Three-dimensional coils and reconstructive techniques such as balloon-assisted remodeling may overcome these problems. But these methods had some drawbacks. The Neuroform stent is the most recently developed endovascular stent with self-expandable and micro-delivery properties that are specially designed for the treatment of unruptured intracranial broad neck aneurysms. Aim of the following working is to report a single center experience of stent-assisted coiling on ruptured intracranial aneurysms with assessment of its efficacy and safety, and follow-up findings.

Results and Problems on Direct Embolization of Cerebral Aneurysms Using Interlocking Detachable Coils

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 162-164
Author(s):  
S. Yoshimura ◽  
T. Ueda ◽  
Y. Kaku ◽  
Y. Nishimura ◽  
T. Andoh ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Clinical Results ◽  
Artery Occlusion ◽  
Neurological Deficits ◽  
Parent Artery ◽  
Neck Size ◽  
New Device ◽  
Parent Artery Occlusion ◽  
Detachable Coils ◽  
Wide Neck

The clinical results of direct embolization of cerebral aneurysms using interlocking detachable coils (IDCs) were analysed. In 27 patients who underwent direct embolization of the aneurysm, 19 patients (70%) were treated uneventfully. In the other 8 patients, symptomatic or asymptomatic complications occurred; parent artery occlusion in 3 patients, rupture of the aneurysm in 2 patients, distal embolism in 2 patients, and neurological deterioration due to enlargement of the aneurysm after embolization in 1 patient. In 5 of 8 patients in whom complications occurred, neurological deficits disappeared after additional embolizations or thrombolysis therapies. Permanent deficits were observed in 3 of all patients (11%). These deficits were caused by the parent artery occlusion due to protrusion of the detached coil in wide neck aneurysms. These results suggest that indication of direct embolization of the cerebral aneurysm should be decided according to neck size. Balloon-assisted coil placement in wide-necked aneurysms was useful but unable to prevent protrusion or migration of the coils after balloon withdrawal. Development of a new device, such as a stent for intracranial use, may make it possible.

Reduction of Intra-Aneurysmal Kinetic Energy by Intralumenal Flow Diverting Devices

2007 ◽  
Author(s):  
Jaehoon Seong ◽  
Baruch B. Lieber ◽  
Ajay K. Wakhloo
Keyword(s):  
Conclusive Evidence ◽  
Endovascular Coiling ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Custom Made ◽  
Aneurysm Occlusion ◽  
Flow Activity ◽  
Wide Neck

Endovascular coiling is an acceptable treatment of intracranial aneurysms yet long term follow-ups suggest that endovascular coiling fails to achieve complete aneurysm occlusion particularly in wide-neck and giant aneurysms. Flow diverting devices can serve as an alternative to coils in endovascular bypass of human brain aneurysms for their exclusion from the cerebral circulation. They can redirect flow away from the aneurysm distally into the parent vessel thereby reestablishing physiological flow patterns. Placing of a flow diverting device across the aneurysm neck may be sufficient to occlude the aneurysm by promoting intra-aneurysmal thrombosis, however, conclusive evidence of its efficacy are still lacking. In this study [1], we investigated in vitro the efficacy of custom designed flow diverting devices and develop indices of their performance in an elastomeric model of the elastase-induced aneurysm in rabbit. The efficacy of custom designed flow divertors is investigated in terms of reducing the flow activity inside the sac. These custom made devices possess porosities that are similar to available stents, however, their pore densities are much higher. The results will help optimize the device that will be used in the animal model.

scholarly journals Treatment of wide-necked cerebral aneurysms with the Neuroform2 Treo stent

2005 ◽  
Vol 18 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Sepehr Sani ◽  
Kirk W. Jobe ◽  
Demetrius K. Lopes
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Technical Difficulty ◽  
Neurological Complications ◽  
Clinical Effects ◽  
Parent Vessel ◽  
Cerebral Angiogram ◽  
Aneurysm Neck

Object Until recently, wide-necked aneurysms were not considered amenable to treatment with coil embolization. The recent introduction of intracranial stents has provided a method of preventing coil migration out of wide-necked aneurysms. The Neuroform2 Treo is a modification of the Neuroform stent; the new version has a higher metal/artery ratio. The authors' initial experience with the use of this stent in combination with coil embolization to treat wide-necked intracranial aneurysms is reported and technical considerations are discussed. Methods The authors' first 10 consecutive patients with wide-necked intracranial aneurysms were included in this study. Inclusion criteria restricted the group to adult patients with wide-necked intracranial aneurysms (ruptured and unruptured lesions). A wide neck was defined as a dome/neck ratio of less than 2 or a neck that was 4 mm or wider as measured on angiograms. Immediate postprocedure angiography studies were performed to determine successful coil occlusion of the aneurysm as well as patency of the parent vessel. Six-month follow-up angiograms were obtained in all patients. Ten aneurysms with poor dome/neck ratios (< 2) were studied in 10 patients. In all cases the stent was delivered to the aneurysm site and positioned without difficulty. No branch artery compromise was observed. A technical difficulty occurred in one case, with prolapse of a coil into the parent vessel, which was successfully corrected with no adverse clinical effects. There were no clinical or neurological complications associated with endovascular treatment of aneurysms in this series. One patient required further coil embolization because of findings on the 6-month follow-up cerebral angiogram. Conclusions The Neuroform2 Treo navigates similarly to the Neuroform2, with the advantage of increased aneurysm neck coverage. This feature may lower the retreatment rates for wide-necked cerebral aneurysms.

Long-term clinical and radiologic results of small cerebral aneurysms embolized with 1 or 2 detachable coils

2006 ◽  
Vol 66 (5) ◽  
pp. 507-512 ◽  
Author(s):  
Hyon-Jo Kwon ◽  
Jun-Bum Park ◽  
Yang Kwon ◽  
Jae-Sung Ahn ◽  
Byung-Duk Kwun
Keyword(s):  
Cerebral Aneurysms ◽  
Detachable Coils
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