scholarly journals Robotic-assisted intracranial aneurysm treatment: 1 year follow-up imaging and clinical outcomes

2021 ◽  
pp. neurintsurg-2021-017865
Author(s):  
Nicole Mariantonia Cancelliere ◽  
Jeremy Lynch ◽  
Patrick Nicholson ◽  
Tomas Dobrocky ◽  
Saravana Kumar Swaminathan ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Clinical Outcomes ◽  
Intracranial Aneurysms ◽  
Robotic System ◽  
Robotic Assisted ◽  
Technical Success Rate ◽  
Aneurysm Treatment ◽  
Technical Accuracy ◽  
Aneurysm Embolization

BackgroundThe use of robotics in medicine may enable increased technical accuracy, reduced procedural time and radiation exposure, and remote completion of procedures. We have previously described the first-in-human, robotic-assisted cerebral aneurysm treatment using the CorPath GRX Robotic System. In this report we discuss our early experiences and outcomes using this robotic device for endovascular treatment of intracranial aneurysms using stent-assisted coil embolization and flow diversion.MethodsThe patient and disease characteristics, procedural details, and follow-up imaging and clinical outcomes of consecutive patients undergoing robotically-assisted intracranial aneurysm embolization between November 2019 and February 2020 are presented.ResultsSix patients underwent robotically-assisted embolization of intracranial aneurysms. Four of the patients were treated with a neck-bridging stent (with or without coiling) and two patients were treated with a flow-diverting stent. Two patients were treated in the subacute period of subarachnoid hemorrhage and four patients were treated electively. All of the procedures could be completed robotically and there was no need for unplanned manual intervention. The technical success rate of the procedures was 100%. There was no morbidity or mortality associated with the procedures. One year follow-up imaging showed that four aneurysms were completely obliterated (Raymond-Roy Occlusion Classification (RROC) class I) and the remaining two were occluded with a residual neck (RROC class II).ConclusionsThe Corpath GRX Robotic System demonstrated a precise control over the microcatheter, wire and stent during aneurysm treatment. Robotic neuro-procedures seem to be safe and effective and demonstrate stable occlusion results in the midterm follow-up.

Midterm results of T-stent–assisted coiling of wide-necked and complex intracranial bifurcation aneurysms using low-profile stents

2017 ◽  
Vol 127 (6) ◽  
pp. 1288-1296 ◽  
Author(s):  
Kubilay Aydin ◽  
Serra Sencer ◽  
Mehmet Barburoglu ◽  
Mynzhylky Berdikhojayev ◽  
Yavuz Aras ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Intracranial Aneurysms ◽  
Anterior Communicating Artery ◽  
Total Occlusion ◽  
Technical Success Rate ◽  
Low Profile ◽  
Scale Scores ◽  
Occlusion Rate ◽  
Double Stent

OBJECTIVECoiling of wide-necked and complex bifurcation aneurysms frequently requires implantation of double stents in various configurations. T-stent–assisted coiling involves the nonoverlapping implantation of 2 stents to protect the daughter vessels of bifurcation and is followed by coiling of the aneurysm. The authors studied the feasibility, efficacy, and safety of the T-stent–assisted coiling procedure as well as the midterm angiographic/clinical outcomes of patients with wide-necked bifurcation intracranial aneurysms treated using this technique.METHODSThe authors retrospectively identified patients with wide-necked bifurcation intracranial aneurysms treated using double-stent–assisted coiling with a T-stent configuration.RESULTSTwenty-four patients with 24 aneurysms and a mean of age of 51.91 years were identified. The most common locations were the middle cerebral bifurcation (45.8%) and anterior communicating artery (35.7%). T stentings were performed using low-profile stents. The procedures were performed with a technical success rate of 95.8%, and an immediate total occlusion rate of 79.2% was achieved. We observed periprocedural complications in 16.7% of cases and a delayed thromboembolic event in 4.2%. The complications caused permanent morbidity in 1 patient (4.2%). No deaths occurred. The mean angiographic follow-up duration was 9.3 months. The total occlusion rate at the last follow-up was 81.2%. The recanalization rate was 4.5%. Modified Rankin Scale scores of all patients at the last follow-ups were between zero and 2.CONCLUSIONST-stent–assisted coiling using low-profile stents is a feasible, effective, and relatively safe endovascular technique used to treat wide-necked and complex intracranial aneurysms. The midterm angiographic and clinical outcomes are outstanding.

Abstract 1122‐000113: Periprocedural Safety of Intracranial Aneurysm Embolization with Extra Soft Coils: Interim Analysis of SURF Study

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Clemens Schirmer ◽  
Kimberly Kicielinski ◽  
Albert Yoo ◽  
Ian Kaminsky ◽  
Amer Alshekhlee ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Intracerebral Hemorrhage ◽  
Real World ◽  
Interim Analysis ◽  
Intracranial Aneurysms ◽  
Previous History ◽  
Serious Adverse Events ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Aneurysm Embolization

Introduction : Coiling with extra soft coils is a widely accepted safe and durable treatment option for intracranial aneurysms but lacks prospective real‐world outcomes. Extra soft coils are specifically designed as fill and finish coils. The primary objective of the SURF study, a postmarket registry, is to assess the real‐world experience of extra soft coils as fill and finish coils to support adequate aneurysm occlusion at 1‐year follow‐up. This study is an interim analysis of periprocedural safety results and ramp‐up of a trial during the COVID‐19 pandemic. Methods : The SURF trial is a postmarket, prospective, multicenter, single‐arm, observational trial aiming to enroll about 800 patients. Patients undergoing embolization of intracranial aneurysm with an extra soft coil as the finishing coil were enrolled at 34 centers globally from November 2019 through July 20, 2021, and will be followed up for approximately 1 year. During the first wave of COVID‐19 in the US, enrollment was behind expectations but has caught up with projections as of July 2020. The primary safety endpoints for this interim analysis were serious adverse events (SAEs) within 24 hours after the procedure and device‐related SAEs up to 7 days after the procedure or to discharge. Results : This interim analysis is for 346 enrolled patients, characterized by a mean age of 60.1 years and being predominantly (73.1%) female. Medical history included 62.4% of patients with hypertension and 18.2% of patients with a previous history of stroke. The most common aneurysm locations were the internal carotid artery (35.2%) and the anterior cerebral artery (31.1%). Unassisted coiling was the modality of choice in 49.6% of procedures, followed by stent‐assisted coiling in 30.0% and balloon‐assisted coiling in 16.9%. The rate of SAEs within 24 hours after the procedure was 7.8% (27/346; 95% CI, 5.0%‐10.6%). Device‐related SAEs occurred in 1.4% (5/346; 95% CI, 0.2%‐2.7%) of patients up to 7 days after the procedure or to discharge. The rate of major ipsilateral stroke up to discharge was 0.6% (2/346; 95% CI, 0.0%‐1.4%), and the rate of symptomatic intracerebral hemorrhage was 1.4% (5/346; 95% CI, 0.2%‐2.7%), including 2 intraprocedural ruptures and 3 patients who had ruptured aneurysm at baseline and had intraventricular and intracerebral hemorrhage. Patient follow‐up is ongoing. Conclusions : We report interim outcomes from the SURF study. This postmarket registry evaluates the safety of extra soft coils as fill and finish coils in the treatment of intracranial aneurysms. Trial ramp‐up, despite temporary delay during the initial COVID‐19 wave, has been progressing along with expectations.

scholarly journals Treatment Of Ruptured Tiny Intracranial Aneurysms By Electrocoagulation With Guidewire Manipulation:12 Cases Report

2020 ◽  
Author(s):  
Lixia Xia ◽  
Zhongfei Hao ◽  
Hongjun Wang ◽  
Yan Feng ◽  
Yongxuan Zhan ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Large Scale ◽  
Posterior Circulation ◽  
Suitable Method ◽  
Anterior Circulation ◽  
Long Term Follow Up

Abstract Background: Ruptured tiny intracranial aneurysm (RTIA) is particularly rare seen. Treatment of RTIA is more difficult and not under control.Methods: We hereby present twelve rare cases of RTIA that were diagnosed based on DSA. These patients were found due to spontaneous or traumatic SAH, 11 of whom were treated only by electrocoagulation, and one of whom was treated by stent-assisted coiling and electrocoagulation.Results: There were eight patients with aneurysms located in posterior circulation and four patients with aneurysms located in anterior circulation. 11 patients were cured only by electrocoagulation merely: ten patient’ RTIA disappeared completely and immediately and another patient’s RTIA was thrombosed two months later. The twelfth patient was carried out stent-assisted coiling and electrocoagulation. The twelve patients’ average follow-up time was 12.5 months and the outcomes were all surprisingly excellent. No revascularization of aneurysm was found. Conclusions: Electrocoagulation with guidewire manipulation is a suitable method to treat RTIA. While large-scale studies with long-term follow-up are required to validate these promising results.

scholarly journals P.051 Validation of the unruptured intracranial aneurysm treatment score against “real-world” MDT decisions

2017 ◽  
Vol 44 (S2) ◽  
pp. S26-S26
Author(s):  
H Godbout ◽  
J Jarrett ◽  
GE Pickett
Keyword(s):  
Intracranial Aneurysm ◽  
Clinical Outcomes ◽  
Real World ◽  
Aneurysm Rupture ◽  
Case Control Studies ◽  
Clinical Tool ◽  
Unruptured Intracranial Aneurysm ◽  
Aneurysm Treatment ◽  
Elective Treatment ◽  
Aneurysm Repair

Background: Intracranial aneurysms are relatively common and often incidentally detected. Elective treatment may eliminate the risk of future hemorrhage, but carries risks of permanent deficit or death. Case-control studies have suggested factors predisposing to aneurysm rupture as well as risks of elective aneurysm repair. A clinical tool was recently developed to weigh benefits of repair against treatment risks. We evaluate its performance against real-world clinical decisions made by a cerebrovascular multidisciplinary team (MDT). Methods: Chart review of all patients with unruptured intracranial berry aneurysms (UIA) discussed at cerebrovascular MDT rounds 2008-2015. Management decisions and clinical outcomes were recorded. The Unruptured Intracranial Aneurysm Treatment Score (UIATS) was calculated for each patient (each aneurysm in the case of multiple UIA). Results: We identified 240 patients with a total of 279 aneurysms. UIATS recommended aneurysm repair in 79 cases, conservative management in 88 cases, and was equivocal in 112 cases. Where the UIATS gave a clear decision, that decision was concordant with the MDT decision in 119/167 cases (71%). Discordant decisions often related to the presence of comorbidities. Clinical outcomes did not differ in cases where the recommendations were clearly concordant vs. discordant. Conclusions: The UIATS may provide guidance to non-expert clinicians. It did not outperform the MDT.

Single-center experience with a dual microcatheter technique for the endovascular treatment of wide-necked aneurysms

2014 ◽  
Vol 121 (5) ◽  
pp. 1093-1101 ◽  
Author(s):  
Christopher R. Durst ◽  
Robert M. Starke ◽  
John R. Gaughen ◽  
Scott Geraghty ◽  
K. Derek Kreitel ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Technical Success ◽  
Parent Vessel ◽  
Technical Success Rate ◽  
Single Center Experience ◽  
Long Term Follow Up ◽  
Coil Migration

Object The endovascular treatment of wide-necked aneurysms can be technically challenging due to distal coil migration or impingement of the parent vessel. In this paper, the authors illustrate an alternative method for the treatment of wide-necked intracranial aneurysms using a dual microcatheter technique. Methods The authors' first 100 consecutive patients who underwent coil embolization of a wide-necked aneurysm using a dual microcatheter technique are reported. With this technique, 2 microcatheters are used to introduce coils into the aneurysm. The coils are deployed either sequentially or concurrently to form a stable construct and prevent coil herniation or migration. Angiographic and clinical outcomes are reported. Results The technical success rate of the dual microcatheter technique is 91% with a morbidity and mortality of 1% and 2%, respectively. Clinical outcomes are excellent with 93% of patients demonstrating a modified Rankin Scale score of 0–2 at long-term follow-up regardless of their score at presentation. Retreatment rates are 18%. Conclusions The dual microcatheter technique may be a safe and efficacious first line of treatment for widenecked aneurysms.

The Silk Flow-Diverting Stent in the Endovascular Treatment of Complex Intracranial Aneurysms: Technical Aspects and Midterm Results in 24 Consecutive Patients

Neurosurgery ◽  
2011 ◽  
Vol 70 (3) ◽  
pp. 617-624 ◽  
Author(s):  
Olli I. Tähtinen ◽  
Hannu I. Manninen ◽  
Ritva L. Vanninen ◽  
Janne Seppänen ◽  
Tero Niskakangas ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Parent Artery ◽  
Thromboembolic Events ◽  
Midterm Results ◽  
Related Complication ◽  
Permanent Disability ◽  
Technical Aspects ◽  
Technical Success Rate ◽  
Flow Diverting Stent

Abstract Background: The flow-diverting stent is a new option in endovascular therapy specifically designed for the endovascular reconstruction of a segmentally diseased artery. The safety of flow-diverting stents is still equivocal. Objective: To evaluate the technical aspects, thromboembolic events, adjunctive therapies, and midterm results in patients with complex intracranial aneurysms treated with a flow-diverting stent (Silk; Balt Extrusion, Montmorency, France). Methods: We retrospectively examined angiographic images and clinical reports of 24 consecutive patients (29 stents) treated (n = 23) or attempted to treat (n = 1) with a flow-diverting device in 2 Finnish centers between March 2009 and October 2010. Results: The primary technical success rate was 67% (16/24). Adjunctive therapies were required in 6 (25%) patients, including 4 cases where intra-arterial abciximab was administered for the treatment of intraprocedural thromboembolic events. Technique-related complication rate and the 30-day mortality rate were each 4% (1/24). Follow-up imaging revealed 1 case of delayed in-stent thrombosis resulting in permanent disability of the patient, 1 asymptomatic occlusion, and 1 asymptomatic stenosis of the stented artery. Complete occlusion of the aneurysm with fully patent parent artery was observed in 16 of the 23 aneurysms (70%) where follow-up images were available. Conclusion: Many previously untreatable cerebral aneurysms may be successfully treated with the Silk flow-diverting stent, but the associated risk of thromboembolic events is justifiable only if conventional endovascular or surgical treatment options are not applicable. Perioperative thromboembolic events should be prepared for and treated without unnecessary delays because they frequently respond to adjunctive medical therapy.

scholarly journals Complications in the Treatment of Intracranial Aneurysms with Silk Stents: An Analysis of 30 Consecutive Patients

2012 ◽  
Vol 18 (4) ◽  
pp. 413-425 ◽  
Author(s):  
L. Cirillo ◽  
M. Leonardi ◽  
M. Dall'Olio ◽  
C. Princiotta ◽  
A. Stafa ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Mass Effect ◽  
Late Complications ◽  
Giant Aneurysms ◽  
Risk Of Bleeding ◽  
Carotid Siphon ◽  
Aneurysm Treatment ◽  
Vertebrobasilar Circulation

Flow-diverting stents (Silk and PED) have radically changed the approach to intracranial aneurysm treatment from the use of endosaccular materials to use of an extraaneurysmal endoluminal device. However, much debate surrounds the most appropriate indications for the use of FD stents and the problems raised by several possible complications. We analysed our technical difficulties and the early (less than ten days after treatment) and late complications encountered in 30 aneurysms treated comprising 13 giant lesions, 12 large, five with maximum diameters <10 mm and one blister-like aneurysm. In our experience the primary indications for the use of FD stents can be the symptomatic intracavernous giant aneurysms. Although the extracavernous carotid siphon aneurysms have major risk of bleeding, FD stents are indicated clearly explaining the risks to the patient in case of severe mass effect. There is a very complex assessment for aneurysms of the vertebrobasilar circulation.

scholarly journals Rescue therapy with stent retrievers for thromboembolism during endovascular treatment of intracranial aneurysms

2018 ◽  
Vol 76 (5) ◽  
pp. 332-338 ◽  
Author(s):  
Zeferino Demartini Junior ◽  
Luana A. Maranha Gatto ◽  
Gelson Luis Koppe ◽  
Tatiana F. von Hertwig de Oliveira ◽  
Alexandre Novicki Francisco
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Mechanical Thrombectomy ◽  
Rescue Therapy ◽  
Arterial Occlusion ◽  
Complete Recovery ◽  
Aneurysm Embolization ◽  
Stent Retrievers ◽  
Arterial Recanalization

ABSTRACT Thromboembolism is the most frequent complication in endovascular treatment of intracranial aneurysms, causing disability and death. As stent retrievers have achieved high rates of arterial recanalization in the management of ischemic stroke, these devices were tested as rescue therapy of thromboembolism during aneurysm embolization. We retrospectively analyzed 10 consecutive patients with transprocedural arterial occlusion, treated with mechanical thrombectomy at a single center. Good angiographic recanalization was achieved in eight cases, mTICI 3, 2b and 2a in five, three and two patients, respectively, without additional complications or any deaths. Five patients showed complete recovery (mRS 0) and all patients showed improvement of disability (average mRS 1.1) over a mean follow-up period of 31 months. Eight patients had good clinical recovery, while two remained with deficits (mRS 3 and 4). The study found that the stent retriever is a valuable, rapid and effective tool for restoring blood flow, improving the safety of endovascular treatment.

Feasibility, Safety, and Periprocedural Complications of Pipeline Embolization for Intracranial Aneurysm Treatment Under Conscious Sedation: University at Buffalo Neurosurgery Experience

2015 ◽  
Vol 11 (3) ◽  
pp. 426-430 ◽  
Author(s):  
Leonardo Rangel-Castilla ◽  
Marshall C Cress ◽  
Stephan A Munich ◽  
Ashish Sonig ◽  
Chandan Krishna ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
General Anesthesia ◽  
Radiation Exposure ◽  
Intracranial Aneurysms ◽  
Conscious Sedation ◽  
Contrast Material ◽  
Neurological Complications ◽  
Safe Procedure ◽  
Aneurysm Treatment ◽  
The Mean

Abstract BACKGROUND Endovascular Pipeline Embolization Device (PED) placement for intracranial aneurysms is performed under general anesthesia at most centers because of perceived improved image quality and patient safety. OBJECTIVE To report the feasibility, safety, and outcomes associated with the use of the PED for intracranial aneurysms performed in awake patients after the administration of conscious sedation (CS) and a local anesthetic. METHODS Between March 2012 and September 2014, 130 patients with 139 intracranial aneurysms (8 ruptured) were treated with the PED under CS at our institution. Procedure details and time (including duration, radiation exposure, and fluoroscopy) and procedure-related complications were retrospectively reviewed. RESULTS A total of 155 PED deployment procedures were performed under CS. Treatment was successfully completed in all cases. Anesthesia was converted from CS to general anesthesia during 5 procedures. Mean interval from patient entry at the endovascular suite to procedure initiation was 18 minutes (range, 5 minutes-1 hour 10 minutes). Mean procedure length was 1 hour 25 minutes (range, 30 minutes-3 hours 51 minutes). Mean ± SD values for fluoroscopy time and radiation exposure were 36.17 ± 18.4 minutes and 1367 ± 897 mGy, respectively. The mean amount of contrast material administered was 211.37 ± 83.5 mL. Permanent neurological complications were seen in 4 patients (3%). CONCLUSION In our experience, CS for PED placement for intracranial aneurysm treatment is feasible and safe. Procedure and fluoroscopy times and amount of radiation exposure are similar to or less than described in reports of PED placement under general anesthesia. CS allows direct neurological evaluation and earlier detection of and response to intraprocedural complications.

Sign in / Sign up

Export Citation Format

Share Document