A New Stent for Direct Treatment of Intracranial Aneurysms

2009 ◽  
Author(s):  
Xiang Zhou ◽  
Zhong You
Keyword(s):  
Intracranial Aneurysms ◽  
Open Surgery ◽  
Layer Structure ◽  
Operation Time ◽  
Endovascular Coiling ◽  
Artery Wall ◽  
Surgical Clipping ◽  
Surgical Clip ◽  
Subarachnoid Hemorrhages ◽  
The Brain

The intracranial aneurysm is a weak region in the wall of an artery in the brain, where dilation of the artery wall may occur. Because the wall of the aneurysm is very thin, lacking the normal layer structure found in healthy arteries, it is easy to rupture and leads to subarachnoid hemorrhages [1, 2]. Current methods for treating the intracranial aneurysms are surgical clipping and endovascular coiling [3]. In the surgical clipping method, a surgical clip is placed across the neck of the aneurysm through open surgery. The risk of this method is high, especially for elderly or medically complicated patients. In endovascular coiling, one or more coils are delivered into the aneurysm from a remote incision on the artery to trigger a thrombus inside the aneurysm sac. This method is less invasive and therefore safer compared to surgical clipping. However, it is less suitable for treating wide-necked aneurysms because the coils can not stay permanently inside the aneurysm sac. To solve this problem, stents have been used in association with coils [4]. In this procedure, a stent is first placed across the neck of the aneurysm, serving as a scaffold inside the artery lumen. Then, the coils are delivered into the aneurysm through the interstices of the stent. Although stent-assisted coiling is superior to using coils alone for the treatment of the wide-necked aneurysms, it is more complicated and requires longer operation time. Besides, neither of the coiling embolization methods can be used for treating the aneurysms which lack a defined saccular component.

scholarly journals Endovascular embolization versus surgical clipping in a single surgeon series of basilar artery aneurysms: a complementary approach in the endovascular era

2021 ◽  
Vol 163 (5) ◽  
pp. 1527-1540
Author(s):  
Ethan A. Winkler ◽  
Anthony Lee ◽  
John K. Yue ◽  
Kunal P. Raygor ◽  
W. Caleb Rutledge ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Open Surgery ◽  
Endovascular Embolization ◽  
Neurologic Outcome ◽  
Endovascular Coiling ◽  
Surgical Clip ◽  
Complementary Approach ◽  
Complete Obliteration ◽  
Good Neurologic Outcome ◽  
Appropriate Therapy

Abstract Background Currently, most basilar artery aneurysms (BAAs) are treated endovascularly. Surgery remains an appropriate therapy for a subset of all intracranial aneurysms. Whether open microsurgery would be required or utilized, and to what extent, for BAAs treated by a surgeon who performs both endovascular and open procedures has not been reported. Methods Retrospective analysis of prospectively maintained, single-surgeon series of BAAs treated with endovascular or open surgery from the first 5 years of practice. Results Forty-two procedures were performed in 34 patients to treat BAAs—including aneurysms arising from basilar artery apex, trunk, and perforators. Unruptured BAAs accounted for 35/42 cases (83.3%), and the mean aneurysm diameter was 8.4 ± 5.4 mm. Endovascular coiling—including stent-assisted coiling—accounted for 26/42 (61.9%) treatments and led to complete obliteration in 76.9% of cases. Four patients in the endovascular cohort required re-treatment. Surgical clip reconstruction accounted for 16/42 (38.1%) treatments and led to complete obliteration in 88.5% of cases. Good neurologic outcome (mRS ≤ 2) was achieved in 88.5% and 75.0% of patients in endovascular and open surgical cohorts, respectively (p = 0.40). Univariate logistic regression analysis demonstrated that advanced age (OR 1.11[95% CI 1.01–1.23]) or peri-procedural adverse event (OR 85.0 [95% CI 6.5–118.9]), but not treatment modality (OR 0.39[95% CI 0.08–2.04]), was the predictor of poor neurologic outcome. Conclusions Complementary implementation of both endovascular and open surgery facilitates individualized treatment planning of BAAs. By leveraging strengths of both techniques, equivalent clinical outcomes and technical proficiency may be achieved with both modalities.

Anesthetic Management of Intracranial Aneurysms

2018 ◽  
Author(s):  
Matthew J Hammer ◽  
Laura B Hemmer
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Motor Evoked Potentials ◽  
Anesthetic Management ◽  
Endovascular Coiling ◽  
Key Words Adenosine ◽  
The Past ◽  
Surgical Clip ◽  
Complex Patients ◽  
Grading Scales

Despite efforts in the past decades to improve outcomes, intracranial aneurysm surgery still carries a considerable mortality risk, and its complications can cause a marked disability. To optimize and safely anesthetize a patient for these high-risk surgeries, the anesthesiologist must have a detailed understanding of the natural history, systemic physiologic perturbations, and intraoperative and postoperative complications of intracranial aneurysms. Various grading scales are used to predict adverse events, such as vasospasm or mortality, and are outlined in this chapter. Endovascular coiling and open surgical clip ligation (clipping) are the two most commonly employed interventions for treatment of aneurysms. The anesthetic goals for these complex patients are summarized.   This review contains 2 tables and 59 references.  Key Words: adenosine, burst suppression, emergence hypertension, endovascular coiling, indocyanine green, intracranial aneurysm clipping, intraoperative hypothermia, motor evoked potentials

scholarly journals Endovascular Coiling of Aneurysm Remnants after Clipping in Patients with Follow-up

2005 ◽  
Vol 11 (1) ◽  
pp. 41-48 ◽  
Author(s):  
S. Mangiafico ◽  
M. Cellerini ◽  
G. Villa ◽  
F. Ammannati ◽  
L. Paoli ◽  
...  
Keyword(s):  
Treatment Strategy ◽  
Intracranial Aneurysms ◽  
Endovascular Embolization ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Anterior Circulation ◽  
Therapeutic Alternative ◽  
Relative Safety

The vast majority of intracranial aneurysms can be obliterated completely with surgical clipping. However, postoperative remnants occur in about 4 to 8% of patients who undergo postoperative angiography. Endovascular embolization has been successfully performed in patients with postoperative aneurysm remnant and it may represent a therapeutic alternative to surgical reintervention. Twelve aneurysm remnants after surgical clipping were treated with endovascular embolization using GDC. All aneurysms were located in the anterior circulation. Our experience confirms the feasibility and relative safety of this treatment strategy that may be considered a valid alternative to reintervention.

scholarly journals Balloon-Assisted Cannulation for Difficult Anterior Cerebral Artery Access

2017 ◽  
Vol 7 (1-2) ◽  
pp. 48-52
Author(s):  
Varun Naragum ◽  
Mohamad AbdalKader ◽  
Thanh N. Nguyen ◽  
Alexander Norbash
Keyword(s):  
Cerebral Artery ◽  
Paradigm Shift ◽  
Intracranial Aneurysms ◽  
Anterior Cerebral Artery ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
Surgical Clipping ◽  
Ruptured Aneurysms ◽  
Common Location ◽  
Proximal Middle Cerebral Artery

The anterior communicating artery is a common location for intracranial aneurysms. Compared to surgical clipping, endovascular coiling has been shown to improve outcomes for patients with ruptured aneurysms and we have seen a paradigm shift favoring this technique for treating aneurysms. Access to the anterior cerebral artery can be challenging, especially in patients with tortuous anatomy or subarachnoid hemorrhage or in patients presenting with vasospasm. We present a technique for cannulating the anterior cerebral artery using a balloon inflated in the proximal middle cerebral artery as a rebound surface.

Surgical Clipping vs Endovascular Coiling for Newly Diagnosed and Recurrent Cerebral Aneurysms: an Update on the Current Literature. Single-Center Case Series

2018 ◽  
Vol 2 (1) ◽  
pp. 16-21
Author(s):  
F. Salle ◽  
A. Jaume ◽  
G. Castelluccio ◽  
E. Spagnuolo
Keyword(s):  
Intracranial Aneurysms ◽  
Young Patients ◽  
Case Series ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Newly Diagnosed ◽  
Review Of The Literature ◽  
Surgical Experience ◽  
Surgical Clipping ◽  
The Ideal

Abstract The ideal treatment for intracranial aneurysms has been highly controversial in the last few decades. It is particularly difficult to decide between clipping vs. coiling when it comes to an aneurysm that has already been treated. The authors performed a review of the literature published in the last ten years amongst the main neurosurgical publications and make recommendations based on this evidence and the surgical experience of the eldest author of this paper (ES). A series of cases of recurrent, incompletely coiled aneurysms treated with surgery is presented. Conclusions: aneurysms with a convenient configuration and location for either clipping or coiling might be better managed by surgical clipping in young patients considering that this treatment achieves higher rates of occlusion with a lower incidence of rebleeding. In elderly patients, each case must be discussed.

scholarly journals C.03 Surgical clipping or endovascular coiling for unruptured intracranial aneurysms: a pragmatic randomized trial

2017 ◽  
Vol 44 (S2) ◽  
pp. S12-S13
Author(s):  
TE Darsaut ◽  
Keyword(s):  
Randomized Trial ◽  
Intracranial Aneurysms ◽  
Primary Outcome ◽  
Morbidity And Mortality ◽  
Neurological Deficits ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Microsurgical Clipping ◽  
Unruptured Intracranial Aneurysms ◽  
One Year

Background: Unruptured intracranial aneurysms (UIAs) are treated using endovascular treatment or microsurgical clipping. The safety and efficacy of treatments have not been compared in a randomized trial. Methods: We randomly allocated clipping or coiling to patients with 3-25mm UIAs judged treatable both ways. The primary outcome was treatment failure, defined as: initial failure of aneurysm treatment, intracranial hemorrhage or residual aneurysm on one year imaging. Secondary outcomes included neurological deficits following treatment, hospitalization >5 days, overall morbidity and mortality and angiographic results at one year. Results: 136 patients were enrolled from 2010 through 2016 and 134 patients were treated. The one-year primary outcome, available for 104 patients, was reached in 5/48 (10.4% (4.5%-22.2%)) patients allocated surgical clipping, and 10/56 (17.9% (10.0%-29.8%)) patients allocated endovascular coiling (OR: 0.54 (0.13, 1.90), P=0.40). Morbidity and mortality (mRS>2) at one year occurred in 2/48 (4.2% (1.2%-14.0%)) and 2/56 (3.6% (1.0%-12.1%)) patients allocated clipping and coiling respectively. New neurological deficits (15/65 vs 6/69; OR: 3.12 (1.05, 10.57), P=0.031), and hospitalizations beyond 5 days (30/65 vs 6/69; OR: 8.85 (3.22,28.59), P=0.0001) were more frequent after clipping. Conclusions: Surgical clipping led to greater initial treatment-related morbidity than endovascular coiling. At one year, the superior efficacy of clipping remains unproven and in need of randomized evidence.

scholarly journals Applications of multislice CT angiography in the surgical clipping and endovascular coiling of intracranial aneurysms

2010 ◽  
Vol 24 (6) ◽  
pp. 467-473 ◽  
Author(s):  
Wenhua Chen ◽  
Yilin Yang ◽  
Wei Xing ◽  
Ya Peng ◽  
Jianguo Qiu ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Intracranial Aneurysms ◽  
Multislice Ct ◽  
Endovascular Coiling ◽  
Surgical Clipping
Sign in / Sign up

Export Citation Format

Share Document