Single-stage endovascular treatment of multiple intracranial aneurysms with combined endovascular techniques: is it safe to treat all at once?

2016 ◽  
Vol 9 (11) ◽  
pp. 1069-1074 ◽  
Author(s):  
Cagatay Andic ◽  
Fatih Aydemir ◽  
Ozgur Kardes ◽  
Murat Gedikoglu ◽  
Sule Akin
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Single Stage ◽  
Endovascular Techniques ◽  
Multiple Intracranial Aneurysms ◽  
Treat All

scholarly journals Multiple Intracranial Aneurysms

2002 ◽  
Vol 8 (2) ◽  
pp. 95-106 ◽  
Author(s):  
F. Mont'Alverne ◽  
A. Tournade ◽  
C. Riquelme ◽  
M. Musacchio
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Arterial Wall ◽  
Multiple Intracranial Aneurysms ◽  
Ruptured Aneurysms ◽  
Mixed Treatment ◽  
Lost To Follow Up ◽  
High Degree ◽  
Mean Time

We evaluate endovascular treatment (EVT) as an option to deal with multiple intracranial aneurysms(MA). From 1994 to 2001, 24 patients underwent EVT for 59 MA. Patients were followed-up clinically and angiographically in a period ranging from 6 to 93 months (mean time of 22.2) and from 4 to 69 months (mean time of 19.3), respectively. Ten patients (41.6%) were treated either by EVT (n=7, 29, 16%) or by mixed treatment (EVT and surgery; n=3, 12.5%). Reasons for treating just ruptured aneurysms: six (25%) had aneurysms smaller than 5 mm; three (12.5%) deaths; two (8.33%) were in the subacute period; two (8.33%) lost to follow-up; one (4.17%) authorised no procedure. No rebleeding was detected at the clinical follow-up, but there were five deaths. At immediate arteriographic control: 28 (85%) aneurysms were fully occluded, four (12%) with neck flow and one (03%) with sac flow. For 20 aneurysms followed-up: stability of occlusion was reached in seven cases (35%) and repermeabilization in 13 (65%). Management of recanalization was close arteriography in seven (54%), re-embolization in five (38%) and surgery in one (08%). When treating MA, EVT is advisable either alone or in mixed therapy. As a high degree of repermeabilization was disclosed, strict arteriographic control is required. The mechanisms underlying aneurysmal formation may be also involved in the recanalization phenomenon, a possible new manifestation of the fragility of the arterial wall.

scholarly journals Indications and practical application of strategies in the endovascular management of intracranial aneurysms

2013 ◽  
Vol 20 (3) ◽  
pp. 221-239
Author(s):  
Marco Antonio Zenteno ◽  
Jorge Arturo Santos-Franco ◽  
Ángel Lee ◽  
Fernando Vinuela ◽  
Jose-Maria Modenesi Freitas ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Endovascular Management ◽  
Practical Application ◽  
Endovascular Techniques ◽  
Endovascular Technique ◽  
Rational Choices ◽  
Pros And Cons

Abstract The occlusion of intracranial aneurysms is more successful and stable by properly planning the approach and application of endovascular techniques. The next step is a relentless analysis of the different indications of endovascular treatment, tailoring a strategy suitable for the specific case, and making more rational choices for the management of aneurysms. Indications and strategies according to the analysis of the aneurysmal complex are given, as well as pros and cons of the endovascular technique according to different anatomical locations

scholarly journals Microsurgery for Multiple Intracranial Aneurysms

2021 ◽  
Vol 32 (1) ◽  
pp. 81-88
Author(s):  
Laís Miotta Simoncello ◽  
Hsuan Hua Chen ◽  
Lucas do Amaral Genta Mansano ◽  
Manauela Iglesias Borges ◽  
Sophia Fuentes Rosa ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Single Stage ◽  
Anterior Communicating Artery ◽  
Multiple Intracranial Aneurysms ◽  
Complex Aneurysms ◽  
Microsurgical Clipping ◽  
Microsurgical Approach ◽  
The Right ◽  
Age Range

Background: A total of 23 patients with 52 aneurysms were surgically treated in single surgery at a Neurosurgical Service of the Health Service of the State of São Paulo from 2009 to 2011. Method: Retrospective analysis of patients undergoing clipping of two or more cerebral aneurysms in a single stage, from January 2007 to July 2012. Results: Twenty-nine patients underwent two or more clipping cerebral aneurysms in a single surgery – 28 with a single craniotomy and one through two craniotomies. Of these, 20, 7, 1 and 1 were submitted to the clipping of 2, 3, 4 and 5 cerebral aneurysms, respectively. Five were male and 24 were female, and the age range was 40 to 66-years-old. Eight left craniotomies were performed to approach 17 lateralized brain aneurysms to the left and five to the right, as well as three anterior communicating complex aneurysms. Twelve craniotomies were performed on the right to approach 23 intracranial aneurysms lateralized to the right and six on the left, as well as 15 anterior communicating artery complex aneurysms and 1 on the basilar artery. Of the 29 patients, 28 evolved with 1-3 pts and only one with 4-5 pts on the Rankin scale, six months after surgery. Conclusion: We advocate microsurgical approach for most of the cases of multiple intracranial aneurysms aiming the microsurgical clipping of all intracranial aneurysms if feasible through a single stage and a single craniotomy.

Emerging Concepts in the Treatment of Intracranial Aneurysms: Stents, Coated Coils, and Liquid Embolic Agents

Neurosurgery ◽  
2005 ◽  
Vol 57 (3) ◽  
pp. 449-459 ◽  
Author(s):  
Giuseppe Lanzino ◽  
Yassine Kanaan ◽  
Paolo Perrini ◽  
Hayan Dayoub ◽  
Kenneth Fraser
Keyword(s):  
Endovascular Treatment ◽  
Effective Treatment ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Clinical Experiences ◽  
Endovascular Techniques ◽  
Future Directions ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Embolic Materials

ABSTRACT ENDOVASCULAR TECHNIQUES FOR the treatment of intracranial aneurysms are rapidly evolving. Modifications of more traditional coils have been introduced. Such modifications include newer coils coated with various polymers to increase both coil thrombogenicity and degree of aneurysm packing. In addition, newer coil designs aimed at improving the conformability of the coil to the aneurysm have been used with promising preliminary results. The availability of a newer generation of stents specifically designed for intracranial navigation allows for more effective treatment of aneurysms with wide necks, which usually have been considered unsuitable for optimal endovascular treatment. Endovascular alternatives to coil embolization, such as liquid embolic materials, also have been explored for the treatment of intracranial aneurysms, with varying results. We summarize the rationale for use of these newer devices and early clinical experiences. Areas of current research and future directions of endovascular aneurysm treatment also are discussed.

scholarly journals Multiple Intracranial Aneurysms: Endovascular Treatment and Complications

2014 ◽  
Vol 20 (4) ◽  
pp. 442-447 ◽  
Author(s):  
Xun Shen ◽  
Tao Xu ◽  
Xuan Ding ◽  
Wenlei Wang ◽  
Zhi Liu ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Brain Ischemia ◽  
Intracranial Aneurysms ◽  
Mass Effect ◽  
Endovascular Embolization ◽  
Endovascular Techniques ◽  
Surgical Clipping ◽  
Multiple Intracranial Aneurysms

This study evaluated the results of endovascular embolization of multiple intracranial aneurysms. A retrospective hospital chart and radiograph review were made of all patients with multiple intracranial aneurysms seen between March 2010 and January 2011. Ten patients presented with subarachnoid hemorrhage, four with mass effect, two with brain ischemia and twenty were incidental. These 36 patients harbored 84 aneurysms, 63 of which were treated with endovascular techniques, two by surgical clipping, and 19 were left untreated. Of the coil-treated lesions, a complete endovascular occlusion was achieved in 54 aneurysms (85.7%), and eight (12.7%) presented neck remnants with one (1.6%) stented only. Twenty-six patients (72.2%) underwent coil embolization of more than one aneurysm in the first session. Follow-up angiographic studies in 31 patients demonstrated an unchanged or improved result in 93.0% of the aneurysms (53 lesions) and coil compaction in 7.0% (four lesions). The overall clinical outcome was excellent in 33 patients (91.7%), good in one (2.8%) and fair in two (5.5%). Endovascular techniques may be a particularly suitable method for treating multiple intracranial aneurysms.

scholarly journals A Patient with Eight Intracranial Aneurysms: Endovascular Treatment in Two Sessions

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Erol Akgul ◽  
Hasan Bilen Onan ◽  
Huseyin Tugsan Balli ◽  
Nuri Eralp Cetinalp
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Treatment Modalities ◽  
Review Of The Literature ◽  
Endovascular Techniques ◽  
Endovascular Technique ◽  
Anterior Circulation ◽  
First Choice ◽  
Flow Diverters

The frequency of multiple intracranial aneurysms seen in patients with or without subarachnoid hemorrhage is high. The advancement of the endovascular technique and devices has ensured that endovascular treatment of intracranial aneurysms is the first choice in most cases, especially in unruptured ones. Different combinations of treatment modalities and techniques can be used in the management of multiple aneurysms. But in selected patients without subarachnoid hemorrhage, treatment of all aneurysms in one or more sessions with endovascular techniques is less traumatic than that with surgery. In the literature, the maximum number of aneurysms in one patient treated endovascularly and/or surgically is seven. In this case report, we present, with a review of the literature, a patient with eight intracranial aneurysms, all of which were treated in two sessions with various endovascular techniques. A 40-year-old female patient was admitted due to headache. Angiography showed eight aneurysms in the posterior circulation and, bilaterally, in the anterior circulation. All aneurysms were treated endovascularly in two sessions. In the treatment of the aneurysms, different endovascular techniques were used including flow diverters stents, stent-assisted coiling, Y-stent-assisted coiling, and coiling alone.

Evaluation of ischemic lesion prevalence after endovascular treatment of intracranial aneurysms, as documented by 3-T diffusion-weighted imaging: a 2-year, single-center cohort study

2018 ◽  
Vol 128 (4) ◽  
pp. 982-991 ◽  
Author(s):  
Christina Iosif ◽  
Jean-Christophe Lecomte ◽  
Eduardo Pedrolo-Silveira ◽  
George Mendes ◽  
Marie-Paule Boncoeur Martel ◽  
...  
Keyword(s):  
Cohort Study ◽  
Endovascular Treatment ◽  
Diffusion Weighted Imaging ◽  
Intracranial Aneurysms ◽  
Published Data ◽  
Single Center ◽  
Endovascular Techniques ◽  
Ischemic Lesion ◽  
Diffusion Weighted

OBJECTIVEEven though published data exist concerning the prevalence of ischemic lesions detected by diffusion-weighted imaging (DWI) following endovascular treatment of intracranial aneurysms, a single-center cross-evaluation of the different endovascular techniques has been lacking. The authors sought to prospectively evaluate the prevalence and clinical significance of ischemic lesions occurring after endovascular treatment of intracranial aneurysms and to compare the safety and effectiveness of a broad spectrum of currently accepted endovascular techniques in a single-center setting.METHODSThis was a prospective cohort study involving consecutive patients treated for intracranial aneurysms exclusively by endovascular means, excluding treatments in the acute rupture phase, in a center featuring an endovascular-only treatment policy for intracranial aneurysms. All patients underwent MRI, including a 3-directional DWI sequence, before treatment, 24 hours postprocedure, and 6 months following endovascular embolization. Selective angiography was performed at 6 months’ follow-up.RESULTSFrom January 2012 through December 2013, 164 aneurysms were treated in 128 consecutive patients. Endovascular techniques included coiling (14.6%), balloon-assisted coiling (20.1%), stent-assisted coiling (3.7%), low-profile stent-assisted coiling, flow diversion (38.4%), and very complex treatments (6.1%) involving 2 stents in Y or T configurations. On postprocedure MRI, the rates of occurrence of new DWI-positive lesions were 64.3% for coiling, 54.5% for remodeling, 61.1% for stent-assisted coiling, 53.7% for flow-diverting stents, and 75% for very complex treatments (p = 0.4962). The 6-month procedure-related morbidity and mortality rates were 6.25% and 0%, respectively. At 6 months’ follow-up, 93% of the patients had modified Rankin Scale (mRS) scores of 0–2. Very complex treatments offered a higher complete occlusion rate (100%) than all other techniques (66.7%–88.9%). Age and length of procedure were independent factors for DWI lesion occurrence. The diameter of DWI lesions on 24-hour postprocedure MRI was positively correlated with mRS score at discharge. Among the DWI-positive lesions measuring less than 2 mm in diameter on the 24-hour MRI, 44.12% had regressed at 6 months.CONCLUSIONSProcedure-related DWI lesions are far more often encountered in silent forms than they are clinically evident. They do not seem to be significantly correlated with procedure-related complications, nor do they seem to impair clinical outcome, regardless of the endovascular technique. Small lesions (< 2 mm in diameter) may regress within 6 months. The use of the most adapted technique, in terms of aneurysm configuration, results in significant total occlusion rates, with acceptable safety.

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