scholarly journals 2D Fast Spoiled Gradient Echo (2D-FSPGR) Gd-DTPA Enhanced Dynamic MR Angiography in Cerebral Aneurysms after Treatment with Platinum Detachable Coils

2001 ◽  
Vol 7 (1_suppl) ◽  
pp. 65-72 ◽  
Author(s):  
T. Hayashi ◽  
J. Asai ◽  
H. Sugimoto ◽  
M. Honda ◽  
K. Satoh ◽  
...  
Keyword(s):  
Mr Angiography ◽  
Cerebral Aneurysms ◽  
Arterial Phase ◽  
Parent Artery ◽  
Residual Flow ◽  
Tof Mra ◽  
First Pass ◽  
Platinum Coil ◽  
Detachable Coils ◽  
Artery Flow

The purpose of this study is to evaluate the perfusional state of cerebral aneurysms treated by platinum detachable coils using three different techniques of MR angiography (MRA), and to compare the results of each MRA technique. Thirty examinations were investigated in twelve patients. They were three men and nine women, and their average age was 67y.o. They were all treated by platinum detachable coils for cerebral aneurysms. We obtained three different types of MRA on the same day; 2D-FSPGR Gd-DTPA enhanced dynamic MRA, 3D-TOF MRA with and without Gd-DTPA enhancement. On 2D FSPGR enhanced dynamic MRA, we used the first pass arterial phase for judgement that did not overlap the venous phase. In each study, we evaluated parent artery flow, branch artery flow, residual flow in coils, and residual neck. Digital subtraction angiography (DSA) was used as gold standard. On 3D-TOF MRA examinations without enhancement, parent artery flow was correctly identified with an accuracy of 96.7% with DSA confirmation. Branch artery flow was identified with an accuracy of 91.3%. Flow in the coils was correctly identified with an accuracy of 86.7%. Residual neck was correctly evaluated with an accuracy of 83.3%. On 3D-TOF MRA with enhancement, parent artery flow was correctly identified with an accuracy of 96.7%. Branch artery flow was identified with an accuracy of 91.3%. Flow in the coils was correctly identified with an accuracy of 93.3%. Residual neck was correctly identified with an accuracy of 86.7%. On 2D FSPGR enhanced dynamic MRA, parent artery flow was correctly identified with an accuracy of 100%. Branch artery flow was identified with an accuracy of 94.2%. Flow in the coils was correctly identified with an accuracy of 96.7%. Residual neck was correctly evaluated with an accuracy of 100%. Parent artery flow, branch artery flow, residual flow in coils, and residual necks were seen more accurately with 2D-FSPGR Gd-DTPA enhanced dynamic MRA than 3D-TOF MRA with and without enhancement. With T1 shortening effect of Gd-DT-PA and first pass arterial phase of 2D-FSPGR enhanced dynamic MRA techniques, we could evaluate more accurately the perfusional status of platinum-coil-treated cerebral aneurysms and arteries adjacent to the aneurysms than with non enhanced or enhanced 3D TOF MRA.

scholarly journals Lyophilizing thrombin powder-based treatment for hemostasis during coil embolization of ruptured cerebral aneurysm: Two case reports

2019 ◽  
Vol 25 (4) ◽  
pp. 454-459
Author(s):  
Changchun Jiang ◽  
Wei Wang ◽  
Baojun Wang ◽  
Yuechun Li ◽  
Guorong Liu ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Coil Embolization ◽  
Case Reports ◽  
Balloon Catheter ◽  
Treatment Strategies ◽  
Cerebral Aneurysms ◽  
Interventional Therapy ◽  
Parent Artery ◽  
Clinical Practices ◽  
Detachable Coils

Background Rupture of cerebral aneurysm is an inevitable complication during embolization, followed by subsequent acute subarachnoid hemorrhage or intracranial hematoma, and results in the aggravation of a patient’s condition. In particular, for patients who have had a ruptured aneurysm, urgent treatment strategies are required during operation. The most common hemostatic methods seen in clinical practices are as follows: after lowering the blood pressure, we continue to embolize the aneurysms with detachable coils as soon as possible or inject with Glubran/Onyx embolization liquids, as well as use a balloon catheter to temporarily block the blood supply. If the conditions are permissible, a balloon guiding catheter may even be used to restrict the proximal blood flow. At times, due to limitations of these methods, neurosurgeons are requested to perform craniotomy to treat the hemostasis. However, the delayed transition often leads to rapid deterioration of the patient’s condition and even death due to cerebral hernia. Case description We herein presented two cases of ruptured cerebral aneurysms to provide an alternative method for hemostasis and to save the lives of patients as much as possible. In an extremely urgent situation (conventional treatment is ineffective), we successfully saved the patient’s life by injecting lyophilizing thrombin powder (LTP) solution into the aneurysmal sac and the parent artery through a microcatheter. Conclusions To our knowledge, this is the first report of successful hemostasis during coil embolization of ruptured cerebral aneurysm with LTP. Further prospective studies are needed to confirm the safety and efficacy of LTP in cerebrovascular interventional therapy.

scholarly journals Efficacy of 3-D Reconstructed Time of Flight MRA Follow-up of the Embolized Cerebral Aneurysms

2006 ◽  
Vol 12 (1_suppl) ◽  
pp. 45-48 ◽  
Author(s):  
T. Saguchi ◽  
Y. Murayama ◽  
T. Ishibashi ◽  
M. Ebara ◽  
K. Irie ◽  
...  
Keyword(s):  
Time Of Flight ◽  
Cerebral Aneurysms ◽  
Guglielmi Detachable Coils ◽  
Morphological Examination ◽  
Tof Mra ◽  
Detachable Coils ◽  
Similar Images ◽  
A Current

A follow-up of the embolized cerebral aneurysm with Guglielmi Detachable Coils (GDC) were performed mainly using craniograms and digital subtraction angiograms (DSA) so far. Recently, several authors have reported about efficacy of the time of flight (TOF) magnetic resonance angiogram (MRA) as a follow-up for the embolized cerebral aneurysms. In our institution, 3-D reconstructed TOF MRAs have been performed as a follow-up of the embolized cerebral aneurysms. We examined efficacy of 3-D reconstructed TOF MRA. 3-D TOF MRA was performed for a follow-up of the embolized cerebral aneurysms at our outpatient clinic in 35 patients. Morphological examination of the 3-D images between 3-D TOF MRA and 3-D DSA was performed. Almost similar images of 3-D MRA were obtained after 3-D reconstruction as compared with those of 3-D DSA. In three cases, recanalization was suspected in the 3-D TOF MRA. And recanalization was confirmed in the 3-D DSA actually. A quality of 3-D TOF MRA for a diagnosis of recanalization was good and practical. However, in two cases, arteries were partially disappeared in the 3-D TOF MRA. These were the artifact due to coil mass and this is a current limitation of 3-D TOF MRA. The images of 3-D TOF MRA that were reconstructed in the 3-D workstation were very similar to those of 3-D DSA. 3-D reconstructed TOF MRA was very useful for a less-invasive diagnosis of a recanalization of the embolized cerebral aneurysms.

Magnetic Resonance Angiography for Evaluation of Intracranial Aneurysms Treated with Guglielmi Detachable Coils

1998 ◽  
Vol 11 (1) ◽  
pp. 19-25 ◽  
Author(s):  
E. Cotroneo ◽  
M. Dazzi ◽  
R. Gigli ◽  
G. Guidetti ◽  
G.P. Cantore ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Mr Angiography ◽  
Cerebral Aneurysms ◽  
Digital Subtraction ◽  
Contrast Injection ◽  
Guglielmi Detachable Coils ◽  
Non Invasive ◽  
Mri Angiography ◽  
Detachable Coils

Thirteen cases of cerebral aneurysms submitted to endovascular treatment using Guglielmi detachable coils (GDC) are described. Control MRI-angiography 3D TOF was performed three and six months later. In order to spare patients the discomfort and risks related to repeated trauma and iodate contrast injection, we examined the possibility of an alternative non-invasive diagnostic method. For this purpose, the digital subtraction angiograms performed three and six months after embolisation were compared with the MR-angiograms obtained in the same period, all using the same tomograph at middle field intensity (0.5T). We discuss the outcome of this comparison and the limits of the MR-angiography method in the follow-up of aneurysms submitted to endovascular treatment.

Follow-up imaging of clipped intracranial aneurysms with 3-T MRI: comparison between 3D time-of-flight MR angiography and pointwise encoding time reduction with radial acquisition subtraction-based MR angiography

2021 ◽  
pp. 1-6
Author(s):  
Jae Ho Kim ◽  
Sung Jun Ahn ◽  
Mina Park ◽  
Yong Bae Kim ◽  
Bio Joo ◽  
...  
Keyword(s):  
Image Quality ◽  
Mr Angiography ◽  
Time Of Flight ◽  
Parent Artery ◽  
Point Scale ◽  
Radial Acquisition ◽  
Tof Mra ◽  
Time Reduction ◽  
Acceptable Image Quality

OBJECTIVE Metallic susceptibility artifact due to implanted clips is a major limitation of using 3D time-of-flight magnetic resonance angiography (TOF-MRA) for follow-up imaging of clipped aneurysms (CAs). The purpose of this study was to compare pointwise encoding time reduction with radial acquisition (PETRA) subtraction-based MRA with TOF-MRA in terms of imaging quality and visibility of clip-adjacent arteries for use in follow-up imaging of CAs. METHODS Sixty-two patients with 73 CAs were included retrospectively in this comparative study. All patients underwent PETRA-MRA after TOF-MRA performed simultaneously with 3-T MRI between September 2019 and March 2020. Two neuroradiologists independently compared images obtained with both MRA modalities to evaluate overall image quality using a 4-point scale and visibility of the parent artery and branching vessels near the clips using a 3-point scale. Subgroup analysis was performed according to the number of clips (less-clipped [1–2 clips] vs more-clipped [≥ 3 clips] aneurysms). The ability to detect aneurysm recurrence was also assessed. RESULTS Compared with TOF-MRA, PETRA-MRA showed acceptable image quality (score of 3.97 ± 0.18 for TOF-MRA vs 3.73 ± 0.53 for PETRA-MRA) and had greater visibility of the adjacent vessels near the CAs (score of 1.25 ± 0.59 for TOF-MRA vs 2.27 ± 0.75 for PETRA-MRA, p < 0.0001). PETRA-MRA had greater visibility of vessels adjacent to less-clipped aneurysms (score of 2.39 ± 0.75 for less-clipped aneurysms vs 2.09 ± 0.72 for more-clipped aneurysms, p = 0.014). Of 73 CAs, aneurysm recurrence in 4 cases was detected using PETRA-MRA. CONCLUSIONS This study demonstrated that PETRA-MRA is superior to TOF-MRA for visualizing adjacent vessels near clips and can be an advantageous alternative to TOF-MRA for follow-up imaging of CAs.

Results and Problems on Direct Embolization of Cerebral Aneurysms Using Interlocking Detachable Coils

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 162-164
Author(s):  
S. Yoshimura ◽  
T. Ueda ◽  
Y. Kaku ◽  
Y. Nishimura ◽  
T. Andoh ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Clinical Results ◽  
Artery Occlusion ◽  
Neurological Deficits ◽  
Parent Artery ◽  
Neck Size ◽  
New Device ◽  
Parent Artery Occlusion ◽  
Detachable Coils ◽  
Wide Neck

The clinical results of direct embolization of cerebral aneurysms using interlocking detachable coils (IDCs) were analysed. In 27 patients who underwent direct embolization of the aneurysm, 19 patients (70%) were treated uneventfully. In the other 8 patients, symptomatic or asymptomatic complications occurred; parent artery occlusion in 3 patients, rupture of the aneurysm in 2 patients, distal embolism in 2 patients, and neurological deterioration due to enlargement of the aneurysm after embolization in 1 patient. In 5 of 8 patients in whom complications occurred, neurological deficits disappeared after additional embolizations or thrombolysis therapies. Permanent deficits were observed in 3 of all patients (11%). These deficits were caused by the parent artery occlusion due to protrusion of the detached coil in wide neck aneurysms. These results suggest that indication of direct embolization of the cerebral aneurysm should be decided according to neck size. Balloon-assisted coil placement in wide-necked aneurysms was useful but unable to prevent protrusion or migration of the coils after balloon withdrawal. Development of a new device, such as a stent for intracranial use, may make it possible.

Follow-up of intracranial aneurysms treated by flow diverter: comparison of three-dimensional time-of-flight MR angiography (3D-TOF-MRA) and contrast-enhanced MR angiography (CE-MRA) sequences with digital subtraction angiography as the gold standard

2014 ◽  
Vol 8 (1) ◽  
pp. 81-86 ◽  
Author(s):  
Jonathan Attali ◽  
Azzedine Benaissa ◽  
Sébastien Soize ◽  
Krzysztof Kadziolka ◽  
Christophe Portefaix ◽  
...  
Keyword(s):  
Gold Standard ◽  
Mr Angiography ◽  
Three Dimensional ◽  
Flow Diverter ◽  
Parent Artery ◽  
Digital Subtraction ◽  
Tof Mra ◽  
Contrast Enhanced ◽  
Aneurysm Occlusion

Background and purposeFollow-up of intracranial aneurysms treated by flow diverter with MRI is complicated by imaging artifacts produced by these devices. This study compares the diagnostic accuracy of three-dimensional time-of-flight MR angiography (3D-TOF-MRA) and contrast-enhanced MRA (CE-MRA) at 3 T for the evaluation of aneurysm occlusion and parent artery patency after flow diversion treatment, with digital subtraction angiography (DSA) as the gold standard.Materials and methodsPatients treated with flow diverters between January 2009 and January 2013 followed by MRA at 3 T (3D-TOF-MRA and CE-MRA) and DSA within a 48 h period were included in a prospective single-center study. Aneurysm occlusion was assessed with full and simplified Montreal scales and parent artery patency with three-grade and two-grade scales.ResultsTwenty-two patients harboring 23 treated aneurysms were included. Interobserver agreement using simplified scales for occlusion (Montreal) and parent artery patency were higher for DSA (0.88 and 0.61) and CE-MRA (0.74 and 0.55) than for 3D-TOF-MRA (0.51 and 0.02). Intermodality agreement was higher for CE-MRA (0.88 and 0.32) than for 3D-TOF-MRA (0.59 and 0.11). CE-MRA yielded better accuracy than 3D-TOF-MRA for aneurysm remnant detection (sensitivity 83% vs 50%; specificity 100% vs 100%) and for the status of the parent artery (specificity 63% vs 32%; sensitivity 100% vs 100%).ConclusionsAt 3 T, CE-MRA is superior to 3D-TOF-MRA for the evaluation of aneurysm occlusion and parent artery patency after flow diversion treatment. However, intraluminal evaluation remains difficult with MRA regardless of the sequence used.

scholarly journals Aneurysm Clipping after Partial Endovascular Embolization for Ruptured Cerebral Aneurysms

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 49-58 ◽  
Author(s):  
M. Nomura ◽  
S. Kida ◽  
N. Uchiyama ◽  
T. Yamashima ◽  
J. Yamashita ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Acute Stage ◽  
Endovascular Procedure ◽  
Anterior Communicating Artery ◽  
Parent Artery ◽  
Advantages And Disadvantages ◽  
Detachable Coils ◽  
Operative Findings ◽  
Clip Closure

The aim of this study was to investigate the advantages and disadvantages of a two-stage treatment for ruptured cerebral aneurysms; partial embolization in acute stage followed by clipping in chronic stage of subarachnoid hemorrhage. Between April 1997 and August 1999, twenty ruptured cerebral aneurysms were initially treated endovasculary using Guglielmi detachable coils in our institution. Among them, complete embolization could not be achieved in 6 lesions. For these lesions, subsequent clipping was added. The radiological and operative findings, and outcomes of these cases were retrospectively reviewed. In 1 case, rerupture occurred during the endovascular procedure. Rerupture was not observed in any cases in the postembolization period. In 2 cases, complications related to the clipping but not the endovascular procedure occurred. These complications included impaired visual acuity for unverified reasons, and memory disturbance due to sacrifice of a perforator arising from the anterior communicating artery. In 3 cases, coil extraction was needed during the clipping, because the loops of the coil extended into the residual neck. Complications related to coil extraction were not observed in these 3 cases. Acute partial embolization of ruptured aneurysm appears to be effective for the prevention of subsequent rerupture during the subacute period, in which treatment for vasospasm should be performed, and the clipping procedure. However, in the case of relatively large aneurysms, small arteries or other normal structures behind the aneurysm cannot be observed directly during surgery, because of the immovability of the embolized aneurysm. Further, complete clip closure is impossible when loops of coil herniate into the neck. In such situations, coil extraction with or without resection of the aneurysm might be necessary, and care must be taken not to damage parent artery and surrounding vessels.

scholarly journals Comparing the Accuracy of Digital Subtraction Angiography, CT Angiography and MR Angiography at Estimating the Volume of Cerebral Aneurysms

2008 ◽  
Vol 14 (2) ◽  
pp. 173-177 ◽  
Author(s):  
M. Hanley ◽  
W.J. Zenzen ◽  
M.D. Brown ◽  
J.R. Gaughen ◽  
A.J. Evans
Keyword(s):  
Digital Subtraction Angiography ◽  
Ct Angiography ◽  
Mr Angiography ◽  
Clinical Decision Making ◽  
Cerebral Aneurysms ◽  
Error Rates ◽  
Imaging Modalities ◽  
Parent Artery ◽  
Digital Subtraction ◽  
True Variance

While there are many studies that compare imaging modalities in the detection of cerebral aneurysms there are no existing studies that compare two dimensional digital subtraction angiography (DSA), CT angiography (CTA) and MR angiography (MRA) in calculating the volume of cerebral aneurysms. This study will compare these imaging modalities on seven in-vitro models of known volume. Seven silicone models of cerebral aneurysms were chosen representing slight variations in geometric shape and size. The volume of each model was measured by weighing the amount of water required to fill the aneurysm to the parent artery. Contrast enhanced images of the models were taken with DSA, CTA and MRA. The images were interpreted by four independent readers and the volumes were calculated. The measured volumes from the water weight analysis were compared to the volumes calculated from the interpreter's measurements. The accuracy of DSA, CTA and MRA were compared using the percent of absolute and true variance from the measured volume. The average percent absolute variance for DSA was 14.3%, CTA was 16.8% and MRA was 18.6%. While these differences were minimal, comparing the percent of true variance demonstrated an average variance of −1.9% for DSA, 16.1% for CTA and −15.9% for MRA. Calculating the volume of cerebral aneurysms, while increasingly important, is difficult and error prone. It is important to understand the limitations and inherent errors before relying on calculated volumes in clinical decision-making. Regardless of imaging modality, one should consider error rates of 14–19% for calculating volume while keeping in mind the tendency for CTA to overestimate volume, MRA to underestimate volume and DSA to both under and overestimate equally.

scholarly journals The Efficacy of Coil Embolization at the Dissection Site of Ruptured Dissecting Vertebral Aneurysms

2001 ◽  
Vol 7 (1_suppl) ◽  
pp. 73-82 ◽  
Author(s):  
A. Kurata ◽  
M. Yamada ◽  
T. Ohmomo ◽  
H. Hirayama ◽  
S. Suzuki ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Balloon Occlusion ◽  
Parent Artery ◽  
Vertebral Arteries ◽  
Coil Occlusion ◽  
Platinum Coil ◽  
Detachable Coils ◽  
Proximal Occlusion ◽  
Dissecting Aneurysms

Proximal occlusion of the parent artery has been widely used for treatment of vertebral dissecting ruptured aneurysms, but this does not always completely prevent re-rupture. In this series, the efficacy of occlusion at the dissection site using detachable coils was compared with proximal balloon occlusion. Over a five year period, 25 patients suffering from subarachnoid hemorrhage with dissecting vertebral aneurysms were treated by endovascular surgery. The first three of these 25 patients were treated with proximal balloon occlusion of the parent artery. The remainder underwent platinum coil occlusion at the affected site as early as possible after the diagnosis. In two of the three cases treated with proximal balloon occlusion, clipping or coating surgery were added because of progressive dissection. In all 22 cases of coil embolization, the intervention was successfully performed without complication. In one case with a dissection involving bilateral vertebral arteries, minor rebleeding from a contralateral dissection occurred after embolization. In the other 21 cases, rebleeding was not apparent (clinical follow-up: mean 24 months). Radiological findings showed complete occlusion of the dissection site and patency of the non affected artery (follow-up: mean ten months). We conclude that detachable platinum coil embolization at the dissection site is more effective than proximal occlusion for treatment of ruptured vertebral dissecting aneurysms because of immediate cessation of blood flow to the dissection site. However, in cases with bilateral dissections or hypoplastic contralateral vertebral arteries, preceding bypass surgery or stent treatment to preserve the affected vertebral artery may be needed.

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