scholarly journals Advances in endovascular aneurysm management: coiling and adjunctive devices

2020 ◽  
Vol 5 (1) ◽  
pp. 14-21
Author(s):  
Jessica K Campos ◽  
Brian V Lien ◽  
Alice S Wang ◽  
Li-Mei Lin
Keyword(s):  
Cerebral Aneurysms ◽  
Next Generation ◽  
Coil Embolisation ◽  
Interventional Techniques ◽  
Technological Advances ◽  
Aneurysm Occlusion ◽  
Unruptured Cerebral Aneurysms ◽  
Endovascular Coils

Endovascular coil embolisation continues to evolve and remains a valid modality in managing ruptured and unruptured cerebral aneurysms. Technological advances in coil properties, adjunctive devices and interventional techniques continue to improve long-term aneurysm occlusion rates. This review elaborates on the latest advances in next-generation endovascular coils and adjunctive coiling techniques for treating cerebral aneurysms.

Retrospective analysis of intracranial aneurysms after flow diverter treatment including color-coded imaging (syngo iFlow) as a predictor of aneurysm occlusion

2021 ◽  
pp. 159101992110240
Author(s):  
Andreas Simgen ◽  
Christine Mayer ◽  
Michael Kettner ◽  
Ruben Mühl-Benninghaus ◽  
Wolfgang Reith ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Complication Rates ◽  
Long Term Follow Up ◽  
Aneurysm Growth ◽  
Short And Long Term ◽  
Aneurysm Occlusion ◽  
Unruptured Cerebral Aneurysms

Purpose Flow Diverters (FD) have immensely extended the treatment of cerebral aneurysms in the past years. Complete aneurysm occlusion is a process that often takes a certain amount of time and is usually difficult to predict. Our aim was to investigate different syngo iFlow parameters in order to predict aneurysm occlusion. Methods Between 2014 and 2018 patients with unruptured cerebral aneurysms treated with a FD were reviewed. Aneurysm occlusion and complication rates have been assessed. In addition, various quantitative criteria were assessed using syngo iFlow before, after the intervention, and after short and long-term digital subtraction angiography (DSA). Results A total of 66 patients hosting 66 cerebral aneurysms were included in this study. 87.9% (n = 58) aneurysms in the anterior and 12.1% (n = 8) in the posterior circulation were treated. Adequate aneurysm occlusion at long-term follow-up (19.05 ± 15.1 months) was achieved in 90.9% (n = 60). Adequately occluded aneurysm revealed a significantly greater peak intensity delay (PI-D, p = 0.008) and intensity decrease ratio (ID-R, p < 0.001) compared to insufficiently occluded aneurysms. Increased intra-aneurysmal contrast agent intensity (>100%) after FD implantation resulted in an ID-R < 1, which was associated with aneurysm growth during follow-up DSA. Retreatment with another FD due to foreshortening and/or aneurysm growth was performed in 10.6% (n = 7). Overall morbidity and mortality rates were 1.5% (n = 1) and 0%. Conclusion The applied syngo iFlow parameters were found to be useful in predicting adequate aneurysm occlusion and foresee aneurysm growth, which might indicate the implantation of another FD.

scholarly journals Long-Term Results and Follow-Up Examinations after Endovascular Embolization for Unruptured Cerebral Aneurysms

2019 ◽  
Vol 40 (7) ◽  
pp. 1191-1196 ◽  
Author(s):  
T. Murakami ◽  
T. Nishida ◽  
K. Asai ◽  
Y. Kadono ◽  
H. Nakamura ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Long Term Results ◽  
Unruptured Cerebral Aneurysms

Long-term prognosis in patients with clipped unruptured cerebral aneurysms―increased cerebrovascular events in patients with surgically treated unruptured aneurysms

2013 ◽  
Vol 36 (4) ◽  
pp. 567-572 ◽  
Author(s):  
Masaaki Hokari ◽  
Satoshi Kuroda ◽  
Naoki Nakayama ◽  
Kiyohiro Houkin ◽  
Tatsuya Ishikawa ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Unruptured Aneurysms ◽  
Cerebrovascular Events ◽  
Long Term Prognosis ◽  
Unruptured Cerebral Aneurysms

scholarly journals Long-term Follow-up after Treatment for Cerebrovascular Disease. Semi-long-term Follow-up Results for the Treatment of the Unruptured Cerebral Aneurysms.

2002 ◽  
Vol 30 (2) ◽  
pp. 83-87 ◽  
Author(s):  
Katsumi MATSUMOTO ◽  
Katsuhito AKAGI ◽  
Makoto ABEKURA ◽  
Tateo SAKAGUCHI ◽  
Takahiro TOMISHIMA ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Cerebral Aneurysms ◽  
Long Term Follow Up ◽  
Unruptured Cerebral Aneurysms

scholarly journals Mid- to Long-term Prognosis of Patients with Clip-ligated Asymptomatic Unruptured Cerebral Aneurysms: De Novo and Untreated Aneurysms

2021 ◽  
Vol 49 (6) ◽  
pp. 447-452
Author(s):  
Shunsuke KAWAMOTO ◽  
Shunsuke FUKAYA ◽  
Yoshihiro ABE ◽  
Kanae OKUNUKI ◽  
Takuma SUMI ◽  
...  
Keyword(s):  
De Novo ◽  
Cerebral Aneurysms ◽  
Long Term Prognosis ◽  
Unruptured Cerebral Aneurysms

Abstract 1122‐000103: FlowDiverter:A Study Safety and Efficacy in a Consecutive Group of 53 Patient and 60 Aneurysm

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Marcelo Bolcato ◽  
ana Carolina Dalmonico ◽  
Leo Ditzel ◽  
Savio Machareti ◽  
Thiago Yoshida ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Consecutive Series ◽  
Safety And Efficacy ◽  
Grading Scale ◽  
Aneurysm Occlusion ◽  
Occlusion Rate ◽  
Flow Diverters

Introduction : Endovascular flow diverters are increasingly used for the treatment of cerebral aneurysms. We assessed the safety and efficacy of the Flow Diverters in a consecutive series of 53 patients and 60 aneurysms. Methods : Inclusion criteria were wide‐neck, blister‐like, or fusiform aneurysms independent of size, treated with the FRED, PIPELINE and SILK between December 2014 and Junho 2021. Assessment criteria were aneurysm occlusion, manifest ischemic stroke, bleeding, or death. The occlusion rate was assessed at 6 months and 1 year with DSA by using the Raymond classification and the O'Kelly‐Marotta grading scale. Results : Fifty three patients (mean age 54.3 years;81.1% female) with 60 aneurysms were treated with 9 Silk, 38 FREDs and 13 Pipeline. Aneurysm size ranged from 2.5 to 30 mm. Deployment of the Flow diverters was successful in 52 aneurysms. Three patient developed mild stroke symptoms that fully receded within days, 4 patients occlusion total carotid because resistant antiagregation and another patient’s development Swelling syndrome. There has been one death. Initial follow‐up at 6 months showed complete occlusion in 90% of the overall study group and 93,33% at 1 year. Conclusions : The flow diverter is a safe device for the treatment of cerebral aneurysms of various types. Our data reveal high occlusion rates at 6 months and 1 year. Long‐term occlusion rates are expected.

scholarly journals Mid- to Long-term Durability of Clip-ligated Asymptomatic Unruptured Cerebral Aneurysms

2021 ◽  
Vol 49 (3) ◽  
pp. 186-190
Author(s):  
Shunsuke KAWAMOTO ◽  
Shunsuke FUKAYA ◽  
Yoshihiro ABE ◽  
Kanae OKUNUKI ◽  
Takuma SUMI ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Unruptured Cerebral Aneurysms

Curative cerebrovascular reconstruction with the Pipeline embolization device: the emergence of definitive endovascular therapy for intracranial aneurysms

2018 ◽  
Vol 10 (Suppl 1) ◽  
pp. i9-i18 ◽  
Author(s):  
D Fiorella ◽  
P Lylyk ◽  
I Szikora ◽  
M E Kelly ◽  
F C Albuquerque ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Vessel Wall ◽  
Cerebral Aneurysms ◽  
Parent Artery ◽  
Endovascular Techniques ◽  
Pipeline Embolization Device ◽  
Complete Exclusion ◽  
Aneurysm Occlusion ◽  
Unruptured Cerebral Aneurysms ◽  
New Generation

Endovascular, endosaccular, coil embolization has emerged as an established therapy for both ruptured and unruptured cerebral aneurysms. However, many aneurysms are not cured using conventional endovascular techniques. Coil embolization often results in incomplete aneurysm occlusion or recanalization in the ensuing months after treatment. The Pipeline embolization device (PED; Chestnut Medical) represents a new generation endoluminal implant which is designed to treat aneurysms by reconstructing the diseased parent artery. Immediately after implantation, the PED functions to divert flow from the aneurysm, creating an environment conducive to thrombosis. With time, the PED is incorporated into the vessel wall as neointimal–endothelial overgrowth occurs along the construct. Ultimately, this process results in the durable complete exclusion of the aneurysm from the cerebrovasculature and a definitive endoluminal reconstruction of the diseased parent artery.

Long-term follow-up of unruptured intracranial aneurysms repaired in California

2014 ◽  
Vol 120 (6) ◽  
pp. 1349-1357 ◽  
Author(s):  
David D. Gonda ◽  
Alexander A. Khalessi ◽  
Brandon A. McCutcheon ◽  
Logan P. Marcus ◽  
Abraham Noorbakhsh ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Treatment Groups ◽  
Unruptured Intracranial Aneurysms ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Unruptured Cerebral Aneurysms ◽  
Aneurysm Repair

Object Using a database that enabled longitudinal follow-up, the authors assessed the long-term outcomes of unruptured cerebral aneurysms repaired by clipping or coiling. Methods An observational analysis of the California Office of Statewide Health Planning and Development (OSHPD) database, which follows patients longitudinally in time and through multiple hospitalizations, was performed for all patients initially treated for an unruptured cerebral aneurysm in the period from 1998 to 2005 and with follow-up data through 2009. Results Nine hundred forty-four cases (36.5%) were treated with endovascular coiling, 1565 cases (60.5%) were surgically clipped, and 76 cases were treated with both coiling and clipping. There was no significant difference in any demographic variable between the two treatment groups except for age (median: 55 years for the clipped group, 58 years for the coiled group, p < 0.001). Perioperative (30-day) mortality was 1.1% in patients with coiled aneurysms compared with 2.3% in those with clipped aneurysms (p = 0.048). The median follow-up was 7 years (range 4–12 years). At the last follow-up, 153 patients (16.2%) in the coiled group had died compared with 244 (15.6%) in the clipped group (p = 0.693). The adjusted hazard ratio for death at the long-term follow-up was 1.14 (95% CI 0.9–1.4, p = 0.282) for patients with endovascularly treated aneurysms. The incidence of intracranial hemorrhage was similar in the two treatment groups (5.9% clipped vs 4.8% coiled, p = 0.276). One hundred ninety-three patients (20.4%) with coiled aneurysms underwent additional hospitalizations for aneurysm repair procedures compared with only 136 patients (8.7%) with clipped aneurysms (p < 0.001). Cumulative hospital costs per patient for admissions involving aneurysm repair procedures were greater in the clipped group (median cost $98,260 vs $81,620, p < 0.001) through the follow-up. Conclusions For unruptured cerebral aneurysms, an observed perioperative survival advantage for endovascular coiling relative to that for surgical clipping was lost on long-term follow-up, according to data from an administrative database of patients who were not randomly allocated to treatment type. A cost advantage of endovascular treatment was maintained even though endovascularly treated patients were more likely to undergo subsequent hospitalizations for additional aneurysm repair procedures. Rates of aneurysm rupture following treatment were similar in the two groups.

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