Rescue Treatment of Thromboembolic Complications During Endovascular Treatment of Cerebral Aneurysms

BackgroundThromboembolic complications (TECs) are frequent during the endovascular treatment of unruptured aneurysms. To prevent TECs, dual antiplatelet therapy using aspirin and clopidogrel is recommended for the perioperative period. In patients with a poor response, clopidogrel is a risk factor for TECs. To prevent TECs, our study assessed the stratified use of prasugrel.MethodsPatients who underwent endovascular therapy for unruptured cerebral aneurysms from April 2017 to August 2019 were enrolled in this clinical study and given premedication with aspirin and clopidogrel for 2 weeks prior to the procedure. P2Y12 reaction units (PRU) were measured using the VerifyNow assay on the day before the procedure (tailored group). In subgroups with PRU <240, the clopidogrel dose was maintained (CPG subgroup). In subgroups with PRU ≥240, clopidogrel was changed to prasugrel (PSG subgroup). We compared the occurrence of TECs with retrospective consecutive cases from January 2015 to March 2017 without PRU assessments (non-tailored group). The frequency of TECs within 30 days was assessed as the primary endpoint.ResultsThe tailored and non-tailored groups comprised 167 and 50 patients, respectively. TECs occurred in 11 (6.6%) and 8 (16%) patients in the tailored and non-tailored groups (P=0.048), respectively. The HR for TECs was significantly reduced in the tailored group (HR 0.3, 95% CI 0.11 to 0.81); P=0.017) compared with the non-tailored group.ConclusionThe results suggest that tailored dual antiplatelet therapy medication with PRU significantly reduces the frequency of TECs without increasing hemorrhagic complications.

Download Full-text

Mechanical thrombectomy “as a rescue treatment” of thromboembolic complications during endovascular treatment of intracranial aneurysms

Journal of Neuroradiology ◽

10.1016/j.neurad.2013.08.002 ◽

2013 ◽

Vol 40 (5) ◽

pp. 360-363 ◽

Cited By ~ 3

Author(s):

Krzysztof Kadziolka ◽

Sebastien Soize ◽

Laurent Pierot

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Mechanical Thrombectomy ◽

Thromboembolic Complications ◽

Rescue Treatment

Download Full-text

A novel endovascular clip system for the treatment of intracranial aneurysms: technology, concept, and initial experimental results

Journal of Neurosurgery ◽

10.3171/jns/2008/108/6/1230 ◽

2008 ◽

Vol 108 (6) ◽

pp. 1230-1240 ◽

Cited By ~ 14

Author(s):

Thomas R. Marotta ◽

Thorsteinn Gunnarsson ◽

Ian Penn ◽

Donald R. Ricci ◽

Ian Mcdougall ◽

...

Keyword(s):

Endovascular Treatment ◽

Delivery System ◽

Intracranial Aneurysms ◽

Balloon Catheter ◽

Cerebral Aneurysms ◽

Histopathological Analysis ◽

Parent Vessel ◽

Flow Models ◽

Aneurysm Neck ◽

Novel Device

Object The authors describe a novel device for the endovascular treatment of intracranial aneurysms, the endovascular clip system (eCLIPs). Descriptions of the device and its delivery system as well as the results of flow model tests and the treatment of experimental aneurysms are provided. Methods The eCLIPs comprises a flexible hybrid implantable device (an anchor and a covered leaf) and a balloon catheter delivery system, designed to be positioned and activated in the parent vessel in such a way that the covered portion will abut the aneurysm neck. The eCLIPs was subjected to testing in glass, elastomeric, and cadaveric flow models to determine its navigability, orientation, and activation compared with commercially available stents. In a second experiment, 8 carotid artery sidewall aneurysms in swine were treated using eCLIPs. The degree of occlusion was observed on angiography immediately following and 30 days after device activation, and a histological analysis was performed at 30 days. Results The device could navigate tortuous glass models and human cadaveric vessels. Compared with commercially available stents, the eCLIPs performed well. It could be navigated, oriented, and activated easily and reliably. With regard to the 8 porcine experimental aneurysms, immediate postactivation angiograms confirmed complete occlusion of 4 lesions and near occlusion of the other 4. Angiographic follow-up at 30 days postactivation showed occlusion of all 8 aneurysms and patency of all parent vessels. Histopathological analysis revealed aneurysm healing, with smooth-muscle cells growing across the lesion neck to allow reendothelialization. Conclusions Aneurysm occlusion with a single extrasaccular endovascular device has potential advantages. The authors believe that eCLIPs may prove to be a useful tool in the endovascular treatment of cerebral aneurysms. The system should reduce risks associated with coiling, procedure time, costs, and radiation exposure. The device satisfactorily occluded 8 experimental sidewall aneurysms. The observed healing pattern is similar to that seen after microsurgical clipping.

Download Full-text

MTI (Dendron) Variable Detachable Coils

Interventional Neuroradiology ◽

10.1177/159101990300900106 ◽

2003 ◽

Vol 9 (1) ◽

pp. 47-52

Author(s):

J. Thammaroj ◽

V. Jayakrishnan ◽

S. Lamin ◽

S. Jenkins ◽

E. Teasdale ◽

...

Keyword(s):

Endovascular Treatment ◽

Feasibility Study ◽

Clinical Experience ◽

Cerebral Aneurysms ◽

Detachable Coils ◽

Formed Part ◽

Small Aneurysms ◽

Initial Clinical Experience

We present our initial clinical experience of Dendron Variable Detachable System (VDS) coils, now Sapphire VDS from MTI, in the endovascular treatment of cerebral aneurysms. VDS coils, uniquely, can be detached at variable points along their length, allowing placement of as much or as little as desired of the coil within the aneurysm. Our ten patients formed part of a multicentre feasibility study. VDS coils were successfully deployed in all but one aneurysm. The electrolytic detachment mechanism with practice is both simple to use and reliable. The coils are however slightly stiffer than standard coils limiting their use in small aneurysms. This remains a technology in evolution.

Download Full-text