Endovascular treatment of complex intracranial aneurysms using Acandis Acclino stents

2016 ◽  
Vol 9 (9) ◽  
pp. 854-859 ◽  
Author(s):  
Friedhelm Brassel ◽  
Dominik Grieb ◽  
Dan Meila ◽  
Martin Schlunz-Hendann ◽  
Björn Greling ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Demographic Data ◽  
Artery Aneurysm ◽  
Parent Artery ◽  
Complication Rates ◽  
Safe Procedure ◽  
Internal Carotid Artery Aneurysm ◽  
Dissecting Aneurysms

ObjectiveTo determine the safety and effectiveness of a new low-profile, laser-cut, closed-cell stent system in the treatment of complex intracranial aneurysms.MethodsA total number of 43 patients with complex intracranial aneurysms were treated using 60 Acandis Acclino stent systems (follow-up 2012–2016; mean 11 months). 36 patients presented with wide-necked intracranial aneurysms, dissecting aneurysms were seen in 7 patients. 39 patients received stent-assisted coiling. We analyzed demographic data and follow-up results.ResultsSixty stents were successfully deployed. In one paraophthalmic internal carotid artery aneurysm the stent could not be placed. Thirty-three wide necked aneurysms were treated by single or multiple stent-assisted coiling. Complete occlusion was achieved in 31 of those cases (94% Raymond−Roy occlusion classification, RROC 1). Two patients showed stable residual aneurysmal filling (RROC 3). In three wide-necked aneurysms, sole stenting was the preferred treatment. For dual stent-assisted procedures the kissing-Y stenting technique was successfully performed in 11 aneurysms. In all dissecting aneurysms constructive therapy with stenting and preservation of the affected parent artery was achieved. Additional subsequent coil embolization was intentionally planned and successfully performed in 6 of the 7 dissecting aneurysms. The overall directly procedure-related complication rate was 7%, including one death.ConclusionsEndovascular treatment of complex intracranial aneurysms using Acclino stents is a feasible and safe procedure with low complication rates. Even severe cases can be treated among others using the kissing-Y stenting technique, with good mid-term results.

scholarly journals Radiological Changes in Infantile Dissecting Anterior Communicating Artery Aneurysm Treated Endovascularly

2014 ◽  
Vol 20 (6) ◽  
pp. 796-803 ◽  
Author(s):  
Kenji Yatomi ◽  
Hidenori Oishi ◽  
Munetaka Yamamoto ◽  
Yasuo Suga ◽  
Senshu Nonaka ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Blood Coagulation ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Dissecting Aneurysm ◽  
Anterior Communicating Artery ◽  
Anterior Communicating Artery Aneurysm ◽  
Radiological Changes ◽  
Dissecting Aneurysms

Intracranial aneurysms are extremely rare in infants, and to our knowledge only seven infants treated for ruptured spontaneous dissecting aneurysms have been reported. Good outcomes have been achieved with endovascular treatment of infantile aneurysm. We the endovascular treatment of a one-month-old girl for ruptured dissecting aneurysm located in the anterior communicating artery, and the unique radiological changes that were observed during the perioperative and follow-up periods. These changes suggest that blood coagulation and fibrinolytic response play a part in the repair and healing processes of dissecting aneurysms. Careful neuroradiological surveys are needed for pediatric dissecting aneurysms treated endovascularly.

WingSpan Stent System in the endovascular treatment of intracranial aneurysms: clinical experience with midterm follow-up results

2008 ◽  
Vol 109 (3) ◽  
pp. 445-453 ◽  
Author(s):  
Kivilcim Yavuz ◽  
Serdar Geyik ◽  
Isil Saatci ◽  
H. Saruhan Cekirge
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Treatment Strategies ◽  
Radial Force ◽  
Parent Artery ◽  
Aneurysm Neck ◽  
Stent System ◽  
Thrombosis Rate ◽  
Dissecting Aneurysms

Object The WingSpan stent is a new self-expandable neurovascular stent designed for endovascular treatment of intracranial atheromatous lesions. The authors report their experience with the use of this stent for the endovascular treatment of intracranial aneurysms. Methods Thirty-seven patients with 40 wide-necked intracranial aneurysms were treated using the WingSpan stent. Twenty-two aneurysms (55%) were small and 18 (45%) were large or giant. In all but 4 aneurysms, embolization was completed by packing the aneurysm sac with platinum coils. In 4 dissecting aneurysms that were fusiform or too small and wide necked to be catheterized, the stent was used alone. In these cases, the stent bridged the aneurysm neck to allow for flow redirection and the potential stent-induced endothelization effect. Results Follow-up angiograms obtained in 3 of 4 aneurysms, treated with only stent placement, demonstrated aneurysmal thrombosis and parent artery remodeling in 2 patients and moderate decrease in size in 1. Follow-up angiography obtained at 6 months to 1 year in 31 aneurysms after stent-supported coil embolization demonstrated complete occlusion in 23 aneurysms (74.2%) with a progressive thrombosis rate of 66.7% (10 of 15 aneurysms), and a recanalization rate of 16.1%. Conclusions In treating wide-necked intracranial aneurysms, the WingSpan Stent System is very flexible, secure, and effective. Its delivery system is very easy and exact in that it exerts higher outward radial force, thus providing an excellent conformability and a strong scaffold to hold the coils in place. It may offer an effective treatment when used alone in some fusiform or very wide-necked, small dissecting aneurysms in which other surgical or endovascular treatment strategies are not deemed feasible.

Endovascular treatment of vertebral artery dissecting aneurysms : a 20-year institutional experience

2021 ◽  
pp. neurintsurg-2020-017089
Author(s):  
Joshua S Catapano ◽  
Andrew F Ducruet ◽  
Megan S Cadigan ◽  
Dara S Farhadi ◽  
Neil Majmundar ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Parent Artery ◽  
Complication Rates ◽  
Neurological Outcomes ◽  
Poor Neurological Outcome ◽  
Institutional Experience ◽  
Procedural Complications ◽  
Dissecting Aneurysms

BackgroundThe ideal treatment for unruptured vertebral artery dissecting aneurysms (VADAs) and ruptured dominant VADAs remains controversial. We report our experience in the management and endovascular treatment of patients with VADAs.MethodsPatients treated endovascularly for intradural VADAs at a single institution from January 1, 1999, to December 31, 2019, were retrospectively reviewed. Primary neurological outcomes were assessed using modified Rankin Scale (mRS) scores, with mRS >2 considered a poor neurological outcome. Additionally, any worsening (increase) in the mRS score from the preoperative neurological examination was considered a poor outcome.ResultsNinety-one patients of mean (SD) age 53 (11.6) years (48 (53%) men) underwent endovascular treatment for VADAs. Fifty-four patients (59%) presented with ruptured VADAs and 44 VADAs (48%) involved the dominant vertebral artery. Forty-seven patients (51%) were treated with vessel sacrifice of the parent artery, 29 (32%) with flow diversion devices (FDDs), and 15 (17%) with stent-assisted coil embolization (stent/coil). Rates of procedural complications and retreatment were significantly higher with stent/coil treatment (complications 4/15; retreatment 6/15) than with vessel sacrifice (complications 1/47; retreatment 2/47) or FDD (complications 2/29; retreatment 4/29) (p=0.008 and p=0.002, respectively). Of 37 patients with unruptured VADAs treated, only two (5%) had mRS scores >2 on follow-up.ConclusionEndovascular FDD treatment of VADAs appears to be associated with lower retreatment and complication rates than stenting/coiling, although further study is required for confirmation. Endovascular treatment of unruptured VADAs was safe and was associated with favorable angiographic and neurological outcomes.

scholarly journals Late Thromboembolic Events after Treatment of Intracranial Aneurysms with Guglielmi Detachable Coils

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 356-357
Author(s):  
Colin P Derdeyn ◽  
Christopher J Moran ◽  
DeWitte T Cross ◽  
Michael R Chicoine ◽  
Ralph G Dacey
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Additional Patient ◽  
Superior Cerebellar Artery ◽  
Parent Artery ◽  
Imaging Data ◽  
Guglielmi Detachable Coils ◽  
Kaplan Meier ◽  
Detachable Coils

P98 Purpose: Thrombo-embolic complications associated with the endovascular treatment of intracranial aneurysms with Guglielmi Detachable Coils (GDC) generally occur at the time of the procedure or soon after. The purpose of this report is to determine the frequency of late thrombo-embolic events after GDC. Methods: The records of 189 patients who underwent GDC repair of one or more intracranial aneurysms at our institution were reviewed. The occurence of an ischemic event referrable to a coiled aneurysm was determined by clinical, angiographic, and imaging data. Events occuring within 2 days of the endovascular procedure were considered peri-procedural. Kaplan-Meier analysis of ischemic events over time was performed. Results: Two patients suffered documented thrombo-embolic events. One patient presented 5 weeks after coiling with a transient ischemic attack. Angiography demonstrated thrombus on the surface of the coils at the neck of a large ophthalmic artery aneurysm. The second patient presented with a posterior circulation stroke 4 weeks after coiling of a large superior cerebellar artery aneurysm. Angiography showed no significant proximal disease, with thrombus beginning at the neck of the treated aneurysm and extending out both P1 segments. No intra-procedural problems during the initial coiling had occured with either patient. There was no evidence for protrusion of coils into the parent artery in either patient. Both patients had been receiving daily aspirin (325 mg). One additional patient reporting symptoms suggesting possible ischemics event was evaluated and diagnosed as having atypical migraines. The frequency of a clinical thromboembolic event during the first year after coiling (excluding procedural complications) was 1.1%. Conclusions: Thrombo-embolic events may occur as late as 5 weeks after endovascular treatment of aneurysms with GDC.

scholarly journals Endovascular Treatment of Small Ruptured Intracranial Aneurysms (<5 mm)

2019 ◽  
Vol 30 (4) ◽  
pp. 817-826
Author(s):  
Fei Peng ◽  
Xin Feng ◽  
Xin Tong ◽  
Baorui Zhang ◽  
Luyao Wang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Cox Proportional Hazards ◽  
Parent Artery ◽  
Parent Vessel ◽  
Fisher Grade ◽  
Wide Neck ◽  
Ruptured Intracranial Aneurysms

Abstract Purpose To investigate the long-term clinical and angiographic outcomes and their related predictors in endovascular treatment (EVT) of small (<5 mm) ruptured intracranial aneurysms (SRA). Methods The study retrospectively reviewed patients with SRAs who underwent EVT between September 2011 and December 2016 in two Chinese stroke centers. Medical charts and telephone call follow-up were used to identify the overall unfavorable clinical outcomes (OUCO, modified Rankin score ≤2) and any recanalization or retreatment. The independent predictors of OUCO and recanalization were studied using univariate and multivariate analyses. Multivariate Cox proportional hazards models were used to identify the predictors of retreatment. Results In this study 272 SRAs were included with a median follow-up period of 5.0 years (interquartile range 3.5–6.5 years) and 231 patients with over 1171 aneurysm-years were contacted. Among these, OUCO, recanalization, and retreatment occurred in 20 (7.4%), 24 (12.8%), and 11 (7.1%) patients, respectively. Aneurysms accompanied by parent vessel stenosis (AAPVS), high Hunt-Hess grade, high Fisher grade, and intraoperative thrombogenesis in the parent artery (ITPA) were the independent predictors of OUCO. A wide neck was found to be a predictor of recanalization. The 11 retreatments included 1 case of surgical clipping, 6 cases of coiling, and 4 cases of stent-assisted coiling. A wide neck and AAPVS were the related predictors. Conclusion The present study demonstrated relatively favorable clinical and angiographic outcomes in EVT of SRAs in long-term follow-up of up to 5 years. THE AAPVS, as a morphological indicator of the parent artery for both OUCO and retreatment, needs further validation.

scholarly journals Endovascular Treatment of Ruptured Dissecting Posterior Inferior Cerebellar Artery Aneurysms

2012 ◽  
Vol 18 (4) ◽  
pp. 442-448 ◽  
Author(s):  
I. Ioannidis ◽  
N. Nasis ◽  
A. Andreou
Keyword(s):  
Endovascular Treatment ◽  
Medical Center ◽  
Posterior Inferior Cerebellar Artery ◽  
Vascular Anatomy ◽  
Parent Artery ◽  
Parent Vessel ◽  
Cerebellar Artery ◽  
Clinical Records ◽  
Dissecting Aneurysms

Dissecting aneurysms of the posterior inferior cerebellar artery (PICA) distal to its origin from vertebral artery (VA) are very rare. Although rare, they associated with a high risk of rebleeding and they present a therapeutic challenge. This study reviewed the clinical presentations, angiographic characteristics of dissecting aneurysms of the PICA and to assess the clinical and angiographic outcomes of patients who underwent endovascular treatment. Ten patients with ten dissecting aneurysms who underwent endovascular treatment were identified in the clinical records of a single medical center from January 2000 to December 2010. The mean follow-up duration was 2.8 years. All patients presented with subarachnoid hemorrhage (SAH). They all underwent endovascular treatment, which included occlusion of the dissected segment and the parent artery after detailed angiographic evaluation of the vascular anatomy, and test occlusion of the PICA. In all patients the endovascular treatment was successfully completed without procedure related complications. Long-term follow-up studies in seven out of ten patients showed complete occlusion of the aneurysm with no new neurologic deficits. The clinical outcome was good in eight cases, whereas two patients with poor clinical condition at admission died during their initial hospital stay. Endovascular occlusion of the parent vessel and the dissected segment is relatively safe treatment option for dissecting aneurysms of the PICA distal to its origin.

Problems in Endovascular Procedures in Acute Ruptured Intracranial Aneurysms

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 121-124 ◽  
Author(s):  
T. Shibuya ◽  
H. Kushi ◽  
K. Kinoshita ◽  
T. Saito ◽  
N. Hayashi
Keyword(s):  
Intracranial Aneurysms ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Artery Aneurysm ◽  
Endovascular Procedure ◽  
Parent Artery ◽  
Internal Carotid Artery Aneurysm ◽  
Ruptured Intracranial Aneurysm ◽  
Severe Atherosclerosis ◽  
Ruptured Intracranial Aneurysms

Fifteen patients with acute ruptured intracranial aneurysms were treated with interlocking detachable coil (IDC) embolization. All graded poorly, i.e., Hunt & Kosnik grades IV and V. Aneurysm occurred in the anterior circulation in 14 patients and at the basilar tip in one, of these, 13 were small and 2 large. The endovascular procedure was conducted in a transfemoral approach under local anesthesia. Aneurysmal obliteration was examined transitionally after embolization. Final outcome was evaluated using the Glasgow outcome scale (GOS). Total aneurysmal occlusion was observed immediately after IDC embolization in 11 patients. Two cases of coil migration to the parent artery occurred during endovascular procedure in patients with severe atherosclerosis. Aneurysmal rupture occurred during the endovascular procedure in a small internal carotid artery aneurysm when coil detachment failed. Follow-up angiography showed coil compaction in 2 patients, one patient experienced deterioration when the aneurysm ruptured. Eleven patients (73.3%) retained total aneurysmal occlusion and had no rebleeding. The overall GOS indicated good recovery in 5 patients, severe disability in 2, persistent vegetative state in 2, and death in 6. IDC embolization in severe acute ruptured intracranial aneurysm successfully prevented rebleeding, but our series was limited by the very small aneurysm size and the presence of severe atherosclerosis.

Extended intracranial applications for ethylene vinyl alcohol copolymer (Onyx): mycotic and dissecting aneurysms

2009 ◽  
Vol 111 (1) ◽  
pp. 114-118 ◽  
Author(s):  
Donald V. La Barge ◽  
Perry P. Ng ◽  
Edwin A. Stevens ◽  
Nathan K. Friedline ◽  
John R. Kestle ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Technical Success ◽  
Ethylene Vinyl Alcohol ◽  
University Of Utah ◽  
Parent Artery Occlusion ◽  
The University ◽  
Dissecting Aneurysms

The authors describe the off-label use of Onyx for embolization of fusiform mycotic and dissecting intracranial aneurysms based on their experience with 3 patients treated at the University of Utah Hospital from 2006 through 2007. Technical success in occluding the parent artery/aneurysm was achieved in all patients. There were no complications. The authors conclude that Onyx can be used to achieve occlusion of fusiform mycotic and dissecting intracranial aneurysms in conjunction with parent artery occlusion.

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