Influence of Stent Configuration on Cerebral Aneurysm Fluid Dynamics

2010 ◽  
Author(s):  
Haithem Babiker ◽  
L. Fernando Gonzalez ◽  
Felipe Albuquerque ◽  
Daniel Collins ◽  
Arius Elvikis ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Treatment Option ◽  
Treatment Options ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Invasive Technique ◽  
Surgical Clipping ◽  
The Past ◽  
Alternative Treatment Option ◽  
Wide Neck

Treatment options for cerebral aneurysms have drastically evolved in the last decade. In the past, surgical clipping through craniotomy was the predominant treatment option for cerebral aneurysms. Presently, endovascular coiling, a minimally invasive technique, has superseded clipping in many centers [1]. However, the coiling of wide-neck aneurysms is still a challenge [2]. Complete aneurysmal occlusion is often impossible [3]. Recently, stand-alone stents have been explored as an alternative treatment option for wide-neck aneurysms [4].

Generation of Realistic Physical Models of Cerebral Aneurysms for In Vitro Flow Visualisation

2009 ◽  
Author(s):  
Paul Fahy ◽  
Tim McGloughlin ◽  
Patrick Delassus ◽  
Liam Morris
Keyword(s):  
Treatment Options ◽  
Cerebral Aneurysms ◽  
Physical Models ◽  
Endovascular Coiling ◽  
Flow Visualisation ◽  
Cerebral Vasculature ◽  
Surgical Clipping ◽  
The Media ◽  
Media Layer

An aneurysm is a localised persistent dilation of the blood vessel wall. Aneurysm formation is hypothesised to be a consequence of haemodynamically generated forces working on the arterial wall leading to degeneration of the media layer (1). This focal degeneration typically occurs at curved arterial segments and at bifurcation points around the circle of Willis. Intracranial aneurysms are traditionally classified by aetiology and morphology. The majority are idiopathic and saccular. It is estimated that 1.5–6% of the general population have or will develop an intracranial aneurysm, predominantly occurring in women, most of them being asymptomatic (1). If left undetected these aneurysms may rupture with a 30 day mortality rate of 45% (1). There are two treatment options surgical clipping or endovascular coiling. Both of these techniques exclude the aneurysm from the normal circulation. Endovascular coiling is preferred due to its minimally invasive nature. Numerous studies have been done so far based on idealized glass models and using FVM, FEA methods, but very little testing has been carried out on devices using realistic silicone models. This is mainly because of the complexity of the cerebral vasculature. Silicone replicas of both realistic and idealised models were manufactured based on CT scans and anatomical dimensions obtained from literature, respectively (2).

scholarly journals The use of flow diverters to treat aneurysms of the posterior inferior cerebellar artery: Report of three cases

2018 ◽  
Vol 24 (5) ◽  
pp. 489-498 ◽  
Author(s):  
Pervinder Bhogal ◽  
Jorge Chudyk ◽  
Carlos Bleise ◽  
Ivan Lylyk ◽  
Hans Henkes ◽  
...  
Keyword(s):  
Treatment Option ◽  
Intraoperative Complications ◽  
Posterior Inferior Cerebellar Artery ◽  
Endovascular Coiling ◽  
Medical Illness ◽  
Unruptured Aneurysms ◽  
Alternative Treatment Option ◽  
Cerebellar Artery ◽  
Flow Diverters

Objective The objective of this study was to report our experience on the use of flow diverting stents placed within the posterior inferior cerebellar artery (PICA) as a treatment option for aneurysms of the PICA. Methods Three patients with aneurysms of the PICA, both ruptured and unruptured, underwent treatment of their aneurysms with placement of a single flow diverter in the PICA across the neck of the aneurysm. Adjunctive techniques such as coiling were not used. We present the angiographic and clinical follow-up data. Results The procedure was a technical success in all cases and there were no intraoperative complications. Follow-up data were available for two patients and this showed complete occlusion of the aneurysm with the PICA remaining patent. There was no evidence, either clinical or radiological, of medullary or pontine infarction. One patient died during the follow-up period from an unrelated medical illness (community acquired pneumonia). Conclusion Flow diverters can be successfully placed within the PICA to treat both ruptured and unruptured aneurysms, and they represent an alternative treatment option to endovascular coiling or microscopic neurosurgery.

scholarly journals Neurosurgical applications of MRI guided laser interstitial thermal therapy (LITT)

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Usama Salem ◽  
Vinodh A. Kumar ◽  
John E. Madewell ◽  
Donald F. Schomer ◽  
Dhiego Chaves de Almeida Bastos ◽  
...  
Keyword(s):  
Treatment Options ◽  
Thermal Therapy ◽  
Invasive Technique ◽  
Laser Device ◽  
Invasive Treatment ◽  
Laser Interstitial Thermal Therapy ◽  
Alternative Treatment Option ◽  
Selective Ablation ◽  
Potential Applications ◽  
Mri Guided

Abstract MRI-guided laser interstitial thermal therapy (LITT) is the selective ablation of a lesion or a tissue using heat emitted from a laser device. LITT is considered a less invasive technique compared to open surgery that provides a nonsurgical solution for patients who cannot tolerate surgery. Although laser ablation has been used to treat brain lesions for decades, recent advances in MRI have improved lesion targeting and enabled real-time accurate monitoring of the thermal ablation process. These advances have led to a plethora of research involving the technique, safety, and potential applications of LITT. LITT is a minimally invasive treatment modality that shows promising results and is associated with decreased morbidity. It has various applications, such as treatment of glioma, brain metastases, radiation necrosis, and epilepsy. It can provide a safer alternative treatment option for patients in whom the lesion is not accessible by surgery, who are not surgical candidates, or in whom other standard treatment options have failed. Our aim is to review the current literature on LITT and provide a descriptive review of the technique, imaging findings, and clinical applications for neurosurgery.

Treatment of cerebral aneurysms in children: analysis of the Kids' Inpatient Database

2014 ◽  
Vol 14 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Aws Alawi ◽  
Randall C. Edgell ◽  
Samer K. Elbabaa ◽  
R. Charles Callison ◽  
Yasir Al Khalili ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Coil Embolization ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Complication Rates ◽  
Surgical Clipping ◽  
Treatment Groups ◽  
Risk Of Death ◽  
Inpatient Database

Object Endovascular coiling and surgical clipping are viable treatment options of cerebral aneurysms. Outcome data of these treatments in children are limited. The objective of this study was to determine hospital mortality and complication rates associated with surgical clipping and coil embolization of cerebral aneurysms in children, and to evaluate the trend of hospitals' use of these treatments. Methods The authors identified a cohort of children admitted with the diagnoses of cerebral aneurysms and aneurysmal subarachnoid hemorrhage from the Kids' Inpatient Database for the years 1998 through 2009. Hospital-associated complications and in-hospital mortality were compared between the treatment groups and stratified by aneurysmal rupture status. A multivariate regression analysis was used to identify independent variables associated with in-hospital mortality. The Cochrane-Armitage test was used to assess the trend of hospital use of these operations. Results A total of 1120 children were included in this analysis; 200 (18%) underwent aneurysmal clipping and 920 (82%) underwent endovascular coiling. Overall in-hospital mortality was higher in the surgical clipping group compared with the coil embolization group (6.09% vs 1.65%, respectively; adjusted odds ratio [OR] 2.52, 95% CI 0.97–6.53, p = 0.05). The risk of postoperative stroke or hemorrhage was similar between the two treatment groups (p = 0.86). Pulmonary complications and systemic infection were higher in the surgical clipping population (p < 0.05). The rate of US hospitals' use of endovascular coiling has significantly increased over the years included in this study (p < 0.0001). Teaching hospitals were associated with a lower risk of death (OR 0.13, 95% CI 0.03–0.46; p = 0.001). Conclusions Although both treatments are valid, endovascular coiling was associated with fewer deaths and shorter hospital stays than clip placement. The trend of hospitals' use of coiling operations has increased in recent years.

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 Clipping of previously coiled cerebral aneurysms: efficacy, safety, and predictors in a cohort of 111 patients

2016 ◽  
Vol 125 (6) ◽  
pp. 1337-1343 ◽  
Author(s):  
Badih Daou ◽  
Nohra Chalouhi ◽  
Robert M. Starke ◽  
Guilherme Barros ◽  
Lina Ya'qoub ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Good Clinical Outcome ◽  
Surgical Clipping ◽  
Anterior Circulation ◽  
Intraoperative Angiography ◽  
Aneurysm Size ◽  
Aneurysm Occlusion ◽  
The Mean

OBJECTIVE With the increasing number of aneurysms treated with endovascular coiling, more recurrences are being encountered. The aim of this study was to evaluate the efficacy and safety of microsurgical clipping in the treatment of recurrent, previously coiled cerebral aneurysms and to identify risk factors that can affect the outcomes of this procedure. METHODS One hundred eleven patients with recurrent aneurysms whose lesions were managed by surgical clipping between January 2002 and October 2014 were identified. The rates of aneurysm occlusion, retreatment, complications, and good clinical outcome were retrospectively determined. Univariate and multivariate logistic regressions were performed to identify factors associated with these outcomes. RESULTS The mean patient age was 50.5 years, the mean aneurysm size was 7 mm, and 97.3% of aneurysms were located in the anterior circulation. The mean follow-up was 22 months. Complete aneurysm occlusion, as assessed by intraoperative angiography, was achieved in 97.3% of aneurysms (108 of 111 patients). Among patients, 1.8% (2 of 111 patients) had a recurrence after clipping. Retreatment was required in 4.5% of patients (5 of 111) after clipping. Major complications were observed in 8% of patients and mortality in 2.7%. Ninety percent of patients had a good clinical outcome. Aneurysm size (OR 1.4, 95% CI 1.08–1.7; p = 0.009) and location in the posterior circulation were significantly associated with higher complications. All 3 patients who had coil extraction experienced a postoperative stroke. Aneurysm size (OR 1.2, 95% CI 1.02–1.45; p = 0.025) and higher number of interventions prior to clipping (OR 5.3, 95% CI 1.3–21.4; p = 0.019) were significant predictors of poor outcome. An aneurysm size > 7 mm was a significant predictor of incomplete obliteration and retreatment (p = 0.018). CONCLUSIONS Surgical clipping is safe and effective in treating recurrent, previously coiled cerebral aneurysms. Aneurysm size, location, and number of previous coiling procedures are important factors to consider in the management of these aneurysms.

Treatment of Cerebral Aneurysms—Surgical Clipping or Endovascular Coiling: The Guiding Principles

2014 ◽  
Vol 33 (05) ◽  
pp. 476-487 ◽  
Author(s):  
Ravishankar Shivashankar ◽  
Timothy Miller ◽  
Gaurav Jindal ◽  
J. Simard ◽  
E. Aldrich ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Guiding Principles

scholarly journals Medicare expenditures for elderly patients undergoing surgical clipping or endovascular intervention for subarachnoid hemorrhage

2017 ◽  
Vol 126 (3) ◽  
pp. 805-810 ◽  
Author(s):  
Kimon Bekelis ◽  
Daniel J. Gottlieb ◽  
Yin Su ◽  
Giuseppe Lanzino ◽  
Michael T. Lawton ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Elderly Patients ◽  
Instrumental Variable ◽  
Cerebral Aneurysms ◽  
Treatment Method ◽  
Cost Of Care ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Unmeasured Confounding ◽  
The Impact

OBJECTIVE The impact of treatment method—surgical clipping or endovascular coiling—on the cost of care for patients with aneurysmal subarachnoid hemorrhage (SAH) is debated. Here, the authors investigated the association between treatment method and long-term Medicare expenditures in elderly patients with aneurysmal SAH. METHODS The authors performed a cohort study of 100% of the Medicare fee-for-service claims data for elderly patients who had undergone treatment for ruptured cerebral aneurysms in the period from 2007 to 2012. To control for measured confounding, the authors used propensity score–adjusted multivariable regression analysis with mixed effects to account for clustering at the hospital referral region (HRR) level. An instrumental variable (regional rates of coiling) analysis was used to control for unmeasured confounding by creating pseudo-randomization on the treatment method. RESULTS During the study period, 3210 patients underwent treatment for ruptured cerebral aneurysms and met the inclusion criteria. Of these patients, 1206 (37.6%) had surgical clipping and 2004 (62.4%) had endovascular coiling. The median total Medicare expenditures in the 1st year after admission for SAH were $113,000 (IQR $77,500–$182,000) for surgical clipping and $103,000 (IQR $72,900–$159,000) for endovascular coiling. When the authors adjusted for unmeasured confounders by using an instrumental variable analysis, clipping was associated with increased 1-year Medicare expenditures by $19,577 (95% CI $4492–$34,663). CONCLUSIONS In a cohort of Medicare patients with aneurysmal SAH, after controlling for unmeasured confounding, surgical clipping was associated with increased 1-year expenditures in comparison with endovascular coiling.

Treatment of ruptured and unruptured cerebral aneurysms in the USA: a paradigm shift

2018 ◽  
Vol 10 (Suppl 1) ◽  
pp. i69-i76 ◽  
Author(s):  
Ning Lin ◽  
Kevin S Cahill ◽  
Kai U Frerichs ◽  
Robert M Friedlander ◽  
Elizabeth B Claus
Keyword(s):  
Hospital Mortality ◽  
Cerebral Aneurysms ◽  
Unruptured Aneurysm ◽  
Ruptured Aneurysm ◽  
Teaching Hospitals ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Unruptured Aneurysms ◽  
The Usa ◽  
Over Time

BackgroundIntegration of data from clinical trials and advancements in technology predict a change in selection for treatment of patients with cerebral aneurysm.ObjectiveTo describe patterns of use and in-hospital mortality associated with surgical and endovascular treatments of cerebral aneurysms over the past decade.Materials and methodsThe data are 34 899 hospital discharges with a diagnosis of ruptured or unruptured cerebral aneurysm from 1998 to 2007 identified from the Nationwide Inpatient Sample (NIS). The rates of endovascular coiling and surgical clipping and in-hospital mortality among patients with an aneurysm are examined over a decade by hospital and patient demographic characteristics.ResultsFrom 1998 to 2007, 20 134 discharges with a ruptured aneurysm and 14 765 discharges with an unruptured aneurysm were identified. Over this decade, the number of patients discharged with a ruptured aneurysm was stable while the number discharged with an unruptured aneurysm increased significantly. The use of endovascular coiling increased at least twofold for both groups of patient (p<0.001) with the majority of unruptured aneurysms treated with coiling by 2007. Although whites were more likely than non-whites to undergo coiling versus clipping for a ruptured aneurysm (OR=1.30; 95% CI 1.13 to 1.48) and men with unruptured aneurysms were more likely than women to undergo coiling (OR=1.26; 95% CI 1.13 to 1.40), by 2007 differences in treatment selection by gender and racial subgroups were decreased or statistically non-significant. Over time the use of coiling spread from primarily large, teaching hospitals to smaller, non-teaching hospitals.ConclusionsThe majority of unruptured aneurysms in the USA are now treated with endovascular coiling. Although surgical clipping is used for treatment of most ruptured aneurysms, its use is decreasing over time. Dissemination of endovascular procedures appears widespread across patient and hospital subgroups.

Preliminary In Vitro Estimates of Intra-Aneurysmal Void Sizes After Endovascular Coiling

2011 ◽  
Author(s):  
B. B. Lieber ◽  
C. Sadasivan ◽  
D. J. Fiorella ◽  
H. H. Woo ◽  
J. Brownstein ◽  
...  
Keyword(s):  
Cardiac Cycle ◽  
Density Ratio ◽  
Cerebral Aneurysms ◽  
Quantitative Measure ◽  
Treatment Method ◽  
Endovascular Coiling ◽  
Aneurysm Neck ◽  
Wide Neck ◽  
Packing Densities

Endovascular coiling has become a well-established treatment method for cerebral aneurysms. The primary drawback of the technique is aneurysm recanalization requiring periodic angiographic follow-ups and possible aneurysm re-treatment. A recent review [1] estimates that 20% of treated aneurysms re-canalize and that half of those aneurysms (10%) are re-treated. Aneurysm recanalization is, in turn, largely caused by compaction of the coil mass due to hemodynamic impingement forces every cardiac cycle. Currently, the only quantitative measure used to characterize effectiveness of the treatment is the aneurysm packing density (ratio of total volume of coils inserted into the aneurysm and the volume of the aneurysm). Lower packing densities have been correlated with higher coil compaction rates [2], so aneurysms are generally coiled to maximal packing. A wider aneurysm neck is also correlated with higher coil-compaction rates. Coiling in such wide-neck aneurysms is performed either with the support of a balloon that is removed post-coiling or with the support of an intracranial stent that is implanted. Such assist devices also improve aneurysm packing densities [3].

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