scholarly journals Angiographical Follow-up Results of Cerebral Aneurysms Treated by Guglielmi Detachable Coil System

2001 ◽  
Vol 7 (1_suppl) ◽  
pp. 137-142 ◽  
Author(s):  
T. Hyogo ◽  
T. Kataoka ◽  
K. Hayase ◽  
H. Nakamura
Keyword(s):  
Cerebral Aneurysms ◽  
Side Wall ◽  
Long Term Results ◽  
Partial Occlusion ◽  
Detachable Coil ◽  
Complete Occlusion ◽  
Guglielmi Detachable Coil ◽  
Wide Neck

To examine the long term results of endovascular treatment of cerebral aneurysms with the Guglielmi detachable coil (GDC) system, follow-up (F/U) angiography was performed at 6, 12 and 24 months after the procedure. We analyzed 45 cases, 49 procedures of GDC treated cerebral aneurysms from 1997.6. to 2000.5. Follow-up angiography was achieved at 6M 43/45 (96%), 12M 29/33 (87%) and 24M 22/25 (88%). Angiographical changes were found 23/43 (53%) of the cases at 6M F/U. There were angiographical improvements in 12 cases (CP: complete occlusion, NR: neck remnant, PA: partial occlusion, PA-CP; 8, NR-CP; 1, PA-NR; 3) and angiographical worsening in 11 cases (CP-NR; 5, CP-PA; 3, PA-PA; 3) at 6M F/U. Two cases had been demonstrating progressive angiographical worsening at 6M and 12MF/U (CP-NR-PA). No angiographical change was found at 24MF/U. There was no case of hemorrhage or re-hemorrhage after GDC treatment. In cases of side-wall aneurysm, tight packing of the inflow side of the aneurysm and small neck aneurysm were thought to be causes of the angiographical improvements. In patients with wide neck aneurysms with partial occlusion result were angiographic worsening at the F/U. Other factors of angiographical worsening were improper working angle at the procedure and improper follow-up angle at the angiography and the intraluminal clot in the case of ruptured aneurysm.

The remodeling technique of balloon-assisted Guglielmi detachable coil placement in wide-necked aneurysms: experience at the University of Illinois at Chicago

2000 ◽  
Vol 93 (3) ◽  
pp. 388-396 ◽  
Author(s):  
Victor A. Aletich ◽  
Gerard M. Debrun ◽  
Mukesh Misra ◽  
Fady Charbel ◽  
James I. Ausman
Keyword(s):  
Cerebral Aneurysms ◽  
Detachable Coil ◽  
Content Type ◽  
Guglielmi Detachable Coil ◽  
Alternative Approach ◽  
Long Term Follow Up ◽  
The University ◽  
Fine Print

Object. Reports in the literature have offered discussions of the feasibility, efficacy, and safety of balloon-assisted Guglielmi detachable coil (GDC) placement in wide-necked intracranial aneurysms, which was first described by Jacques Moret as the “remodeling technique.” In this article the authors summarize their results in a subset of aneurysms treated with GDCs using the remodeling technique.Methods. This report contains a retrospective analysis of 72 patients with 75 aneurysms who underwent 79 endovascular procedures performed using the remodeling technique. Morphological outcome was determined at the end of each procedure and by reviewing available follow-up angiograms. Clinical assessments and outcomes are reported using a modified Glasgow Outcome Scale.Coils were placed in 66 (88%) of 75 aneurysms selected for treatment. In eight aneurysms (11%) treatment failures occurred due to the tortuosity of the vessel used to reach the aneurysms or because of balloon inadequacies.Incorporating all available follow-up data the authors found that 50 (78%) of 64 aneurysms were completely or subtotally (> 95%) occluded and eight (12%) of 64 were incompletely (< 95%) occluded. Since the time of coil placement, eight aneurysms have progressed to complete occlusion and another five have exhibited progressive thrombosis on follow-up angiograms. In three aneurysms there has been neck remnant growth. Surgical clipping was performed to treat six aneurysms after an initial coil placement procedure. Permanent incidences of morbidity were limited to four patients and there were three deaths directly related to the procedure.Conclusions. The remodeling technique shows promise in increasing the number of cerebral aneurysms amenable to treatment by endovascular coil placement, and offers an alternative approach to aneurysms that have met with failed surgical treatment or are surgically inaccessible. Long-term follow-up review is needed to determine the final outcome of aneurysms treated by this technique.

scholarly journals 5-Year Angiographic and Clinical Follow-up of Coil-Embolised Intradural Saccular Aneurysms

2002 ◽  
Vol 8 (4) ◽  
pp. 349-366 ◽  
Author(s):  
LL Batista ◽  
J. Mahadevan ◽  
M. Sachet ◽  
H. Alvarez ◽  
G. Rodesch ◽  
...  
Keyword(s):  
First Year ◽  
Coil Embolisation ◽  
Short Term ◽  
Detachable Coil ◽  
Complete Occlusion ◽  
Guglielmi Detachable Coil ◽  
Short And Long Term ◽  
Arterial Aneurysms

The purpose of the paper is the follow-up of embolised intradural saccular Arterial Aneurysms (AA), excluding giant, dissecting, inflammatory, fusiform or AA associated to BVAM. Since its introduction in 1991, the Guglielmi Detachable Coil has offered protection against aneurysmal rebleeding in the critical few days and months after SAH regardless of the grade. A number of questions remain: is complete angiographic obliteration necessary at first embolisation? What duration of clinical / angiographic follow-up (FU) is required to ensure the risk of haemorrhage has been eliminated? What is the long-term protection against rebleeding? One hundred and two patients with 160 intradural saccular AA embolised before april 1997 were selected for this study. They had at least 5-yrs clinical FU, of which 22 patients had a mid-term (3 years) and 45 patients had a 5-year or more angiographic FU (mean 67,7 months per patient). Twenty-eight embolised AAs with 100% occlusion at 1 year, remained unchanged on the 5-year angiograms. A further 14 patients with complete occlusion at 1 year showed persisting complete occlusion on angiogram at 3-years FU, which in our series means that complete occlusion after the first year post-embolisation implies that the aneurysm will remain completely occluded. All secondary spontaneous thromboses (27.6% of cases), occurred during the first year pos-embolisation. In six patients with subtotal or partial occlusion no change was seen for three consecutive years of FU; none showed later change at 5-year angiography. Below 80% occlusion our series does not provide enough information but we consider the situation instable. No mortality related to the procedure was observed in the unruptured AA group. No bleeding or re-bleeding has occurred since the beginning of our experience (1993) in saccular AA treated by GDC-Coil. Coil-embolisation of properly selected patients is effective in protecting against bleeding or re-bleeding at short and long-term with stable morphological results provided a strict follow-up control is established at short term.

Long-Term Results of Ruptured Cerebral Aneurysms Embolized in Acute Stage with Interlocking Detachable Coils

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 118-120
Author(s):  
H. Manabe ◽  
S. Fujita ◽  
K. Akasaka ◽  
S. Suzuki
Keyword(s):  
Cerebral Aneurysms ◽  
Critical Factor ◽  
Dissecting Aneurysm ◽  
Acute Stage ◽  
Saccular Aneurysm ◽  
Long Term Results ◽  
Complete Occlusion ◽  
Detachable Coils

We report on a series of eight patients presenting with SAH secondary to ruptured saccular (n=7) or dissecting (n=1) aneurysm, treated in the acute stage (within 14 days) by embolization with interlocking detachable coils (IDCs) who survived at least 3 months following initial hemorrhage. Embolization resulted in complete occlusion in 2 of 7 cases of saccular aneurysm, 90–95% occlusion was obtained in the remaining 5 cases of saccular aneurysm. Proximal occlusion with intra-aneurysmal coil packing was achieved in 1 case of dissecting aneurysm. In all 5 cases with partial occlusion, follow-up angiograms taken 2–4 months after the embolization showed partial recanalization due to coil compaction, while no recanalization was recognized in cases with complete occlusion in follow-up angiograms at 5 and 9 months respectively. Clinical disability, at 9 months after the embolization was rated as none in 4 cases, moderate in 1, and severe in 1. Two patients died of re-rupture at 4 and 8 months respectively after the embolization. Of the other 3 cases with partial recanalization, 2 were retreated by re-embolization or surgical clipping, one has been followed clinically and angiographically. Histological findings of the re-ruptured aneurysm showed neither endothelialization of the aneurysmal orifice nor organization of the clot around the coils. Aneurysmal re-rupture secondary to coil compaction related recanalization remains a critical factor in long-term clinical outcome and prognosis.

Y-stent assisted coiling of bifurcation aneurysms with Enterprise stent: long-term follow-up

2014 ◽  
Vol 8 (2) ◽  
pp. 158-162 ◽  
Author(s):  
Nicola Limbucci ◽  
Leonardo Renieri ◽  
Sergio Nappini ◽  
Arturo Consoli ◽  
Andrea Rosi ◽  
...  
Keyword(s):  
Long Term Results ◽  
Technical Failure ◽  
Complete Occlusion ◽  
Long Term Stability ◽  
Single Center Experience ◽  
Long Term Follow Up ◽  
Occlusion Rate ◽  
Wide Neck

BackgroundY-stent assisted coiling has been proposed for the treatment of wide-neck bifurcation aneurysms, but there are many technical variations. We report our single-center experience of Y-stent assisted coiling of bifurcation aneurysms with the closed cell Enterprise stent in order to evaluate the safety and long-term results of this technique. The literature on Y-stenting and its hemodynamic effects are reviewed.MethodsFifty-two consecutive patients with wide-neck bifurcation aneurysms underwent Y-stent assisted coiling with two Enterprise stents. The procedure was completed in 48 cases (92.3%) and technical failure occurred in 4 cases (7.3%). Cases performed with other stents were excluded. All procedures were performed under double antiplatelet therapy. Periodic clinical and neuroradiological follow-up was performed.ResultsMean neuroradiological follow-up time was 26 months. Complete immediate occlusion was obtained in 87.5% of patients. Two remnants had regrown at follow-up and were recoiled, achieving complete occlusion. The late neuroradiological occlusion rate was: complete occlusion 93.6%, neck remnant 4.3%, sac remnant 2.1%. No in-stent stenosis was detected at follow-up. Among the 48 procedures, two complications occurred (4.2%). Mortality was 2.1%. No delayed ischemic stroke occurred.ConclusionsY-stent assisted coiling has a high immediate occlusion rate and very good long-term stability. The procedure is relatively safe, although the complication and mortality rates are not negligible. Two Enterprise stents can be safely used for Y-stenting and, indeed, offer the advantage of easier catheterization, delivery and deployment into distal and tortuous vessels than open cell stents.

Medina embolization device for the treatment of intracranial aneurysms: 18 months’ angiographic results

2018 ◽  
Vol 11 (5) ◽  
pp. 516-522 ◽  
Author(s):  
Idriss Haffaf ◽  
Frédéric Clarençon ◽  
Eimad Shotar ◽  
Claudia Rolla-Bigliani ◽  
Saskia Vande Perre ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Thromboembolic Complication ◽  
Detachable Coil ◽  
Mean Delay ◽  
Scale Scores ◽  
Long Term Follow Up ◽  
Occlusion Rate ◽  
Wide Neck

Background and purposeThe Medina embolization device (MED) is a new flow disruption device combining the design of a detachable coil with an intrasaccular flow disrupter. Safety and short-term angiographic effectiveness of this device have recently been reported. However, long-term angiographic results are lacking. We report herein the 18 months’ angiographic outcome in patients treated for a wide-neck intracranial aneurysm with the MED.Materials and methodsNineteen patients (17 female, mean age 50 years) with 20 wide-neck intracranial aneurysms (six ruptured; 14 unruptured) were treated by the MED between January 2015 and June 2016. Procedure-related complications were systematically recorded; discharge and 6–9 months' follow-up modified Rankin Scale scores were assessed. Angiographic mid-term and long-term follow-up were performed with a mean delay of 6.4±1.5 months (n=16 aneurysms) and 17.7±4.2 months (n=15 aneurysms), respectively. Occlusion rates were evaluated after the procedure and at the mid-term and long-term follow-up using the Roy-Raymond scale.ResultsEmbolization with the MED was feasible in all except two cases (2/20, 10%). One per-procedural perforation was recorded (1/20, 5%) and one MED deployment failed because of the aneurysm’s shape (1/20, 5%). Three cases of thromboembolic complications were observed (3/20, 15%). Only one thromboembolic complication was responsible for clinical sequelae. Grade A occlusion rate was 61% (11/18) after the procedure, 75% at 6 months' follow-up (12/16), and 80% (12/15) at long-term follow-up. Two cases (2/18, 11%) of recanalization at mid-term were documented angiographically. No recanalization occurred between the mid-term and long-term follow-up.ConclusionMED is a hybrid embolization device, combining properties of a conventional coil with those of an intrasaccular flow disrupter. Our series focusing on long-term angiographic follow-up shows a satisfactory long-term occlusion rate. Larger series with longer angiographic follow-up times are warranted to confirm these preliminary results.

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 Results of Enterprise Stent-Assisted Coiling of Cerebral Aneurysms

Neurosurgery ◽  
2012 ◽  
Vol 71 (2) ◽  
pp. 239-244 ◽  
Author(s):  
Kyle M. Fargen ◽  
Brian L. Hoh ◽  
Babu G. Welch ◽  
G. Lee Pride ◽  
Giuseppe Lanzino ◽  
...  
Keyword(s):  
Scale Score ◽  
Cerebral Aneurysms ◽  
High Volume ◽  
Vascular Reconstruction ◽  
Long Term Results ◽  
Modified Rankin Scale ◽  
Volume Data ◽  
Stent System

Abstract BACKGROUND: The Enterprise Vascular Reconstruction Device and Delivery System (Cordis; the Enterprise stent) was approved for use in conjunction with coiling of wide-necked aneurysms in 2007. No published long-term aneurysm occlusion or complication data exist for the Enterprise system. OBJECTIVE: We compiled data on consecutive patients treated with Enterprise stent-assisted coiling of aneurysms from 9 high-volume neurointerventional centers. METHODS: A 9 center registry was created to evaluate large volume data on the delayed safety and efficacy of the Enterprise stent system. Pooled data were compiled for consecutive patients undergoing Enterprise stent-assisted coiling at each institution prior to May 2009. RESULTS: Two-hundred twenty-nine patients with 229 aneurysms, 32 of which were ruptured aneurysms, were included in the study. Mean clinical and angiographic follow-up was 619.6 ± 26.4 days and 655.7 ± 25.2 days, respectively. Mean aneurysm size was 9.2 ± 0.4 mm. Fifty-nine percent of patients demonstrated 100% coil obliteration and 81% had 90% or higher occlusion at last follow-up angiography. A total of 19 patients (8.3%) underwent retreatment of their aneurysms during the follow-up period. Angiographic in-stent stenosis was seen in 3.4% and thromboembolic events occurred in 4.4%. Overall, 90% of patients who underwent Enterprise-assisted coiling had a modified Rankin Scale score of 2 or less at last follow-up. A poor modified Rankin Scale score was strongly associated with rupture status (P &lt; .001). CONCLUSION: Although this study is limited by its retrospective nature, the Enterprise stent system appears to be an effective, safe, and durable treatment for intracranial aneurysms when used in conjunction with coiling.

Endovascular Treatment of Basilar Tip Aneurysms Using Guglielmi Detachable Coils: Anatomic and Clinical Outcomes in 73 Patients from a Single Institution

Neurosurgery ◽  
2000 ◽  
Vol 47 (6) ◽  
pp. 1332-1342 ◽  
Author(s):  
Satoshi Tateshima ◽  
Yuichi Murayama ◽  
Y. Pierre Gobin ◽  
Gary R. Duckwiler ◽  
Guido Guglielmi ◽  
...  
Keyword(s):  
Los Angeles ◽  
Clinical Outcomes ◽  
Medical Center ◽  
Clinical Status ◽  
Giant Aneurysm ◽  
Detachable Coil ◽  
Complete Occlusion ◽  
Unruptured Aneurysms ◽  
Guglielmi Detachable Coil

ABSTRACT OBJECTIVE Seventy-three consecutive patients with 75 basilar tip aneurysms were treated with Guglielmi detachable coil (GDC) technology. Their anatomic and clinical outcomes are discussed. METHODS Seventy-five basilar tip aneurysms were treated with the GDC system at the University of California, Los Angeles Medical Center from 1990 to 1999. The average age of the population was 48.3 years (range, 28–82 yr). Forty-two patients (57.5%) presented with acute subarachnoid hemorrhage, 8 patients (10.9%) had unruptured aneurysms with mass effect, and 23 patients (31.5%) had incidental aneurysms. Thirty-one aneurysms (41.3%) were small with a small neck, 18 (24%) were small with a wide neck, 16 (21.3%) were large, and 10 (13.3%) were giant aneurysms. RESULTS Immediate anatomic outcomes demonstrated complete or near-complete occlusion in 64 aneurysms (85.3%) and incomplete occlusion in 7 aneurysms (9.3%). Four aneurysms (5.3%) could not be embolized because of anatomic difficulties. Of the 69 patients treated with GDCs, 63 patients (91.3%) remained neurologically intact or unchanged from their initial clinical status. Procedure-related morbidity and mortality were 4.1% and 1.4%, respectively. Long-term follow-up angiograms were obtained in 41 patients with 42 aneurysms. Thirty aneurysms (71.4%) demonstrated complete or near-complete occlusion. One incompletely embolized giant aneurysm ruptured during the follow-up period. CONCLUSION In contrast to surgical clipping of basilar tip aneurysms, the main technical challenge of the Guglielmi detachable coiling procedure depends on the shape of the aneurysm, not its location. The results of this study indicate that endovascular GDC technology is an appropriate therapeutic alternative in ruptured or unruptured basilar tip aneurysms regardless of patient age, clinical presentation, clinical status, or timing of treatment.

scholarly journals Five-Years Angiographic Follow-Up of Wide-Neck Intracranial Aneurysms Treated With LEO Plus Stent

2021 ◽  
Vol 12 ◽  
Author(s):  
José M. Pumar ◽  
Paula Sucasas ◽  
Antonio Mosqueira ◽  
Pedro Vega ◽  
Eduardo Murias
Keyword(s):  
Intracranial Aneurysms ◽  
Clinical Findings ◽  
Morbidity And Mortality ◽  
Long Term Results ◽  
Patient Demographics ◽  
Results Of Treatment ◽  
Long Term Follow Up ◽  
Wide Neck

Background: This study aimed to evaluate the angiographic and clinical outcome, with an emphasis on long-term follow-up, of the LEO Plus stent for wide-neck intracranial aneurysms treated in a single center.Methods: We retrospectively examined a prospectively maintained database of patients treated with LEO Plus devices between January 2004 and December 2016. Data regarding patient demographics, aneurysm characteristics, and technical procedures were analyzed. Angiographic and clinical findings were recorded during the procedure and followed up over a period of at least 5 years.Results: We identified 101 patients with 116 aneurysms. In 16 patients, the stent could not safely be placed. Thus, a total of 97 LEO Plus devices were implanted in 97 aneurysms of 85 patients. Adverse events (acute and delayed) were observed in 21.6% of cases (17/85), and most were resolved (70.6%; 12/17). Moreover, 5 years after the procedure, total morbidity and mortality were 2.3% (2/85) and 3.5% (3/85), respectively. Long-term imaging follow-up showed complete occlusions, neck remnants, and residual aneurysms in 73.1% (57/78), 14.1% (11/78), and 12.8% (10/78) of cases, respectively.Conclusions: Long-term results of treatment of brain aneurysms with LEO stent show high rates of adequate and stable occlusion over time, with acceptable morbidity and mortality.

Natural history of the neck remnant of a cerebral aneurysm treated with the Guglielmi detachable coil system

2000 ◽  
Vol 93 (4) ◽  
pp. 561-568 ◽  
Author(s):  
Motoharu Hayakawa ◽  
Yuichi Murayama ◽  
Gary R. Duckwiler ◽  
Y. Pierre Gobin ◽  
Guido Guglielmi ◽  
...  
Keyword(s):  
Los Angeles ◽  
Medical Center ◽  
Detachable Coil ◽  
Content Type ◽  
Giant Aneurysms ◽  
Guglielmi Detachable Coil ◽  
Small Aneurysms ◽  
Fine Print

Object. The long-term durability of Guglielmi detachable coil (GDC) embolization of cerebral aneurysms is still unknown. The purpose of this study was to evaluate the anatomical evolution of neck remnants in aneurysms treated with GDCs.Methods. Of 455 aneurysms treated with GDCs from 1990 to 1998 at the University of California at Los Angeles Medical Center, 178 aneurysms (39%) had residual necks postembolization. Long-term follow-up angiograms were obtained in 73 of these aneurysms in 71 patients. The mean duration of angiographic follow up was 17.3 months. Twenty-four of the aneurysms were small with small necks, 24 were small with wide necks, 15 were large, and 10 were giant aneurysms.In small aneurysms with small necks, postembolization angiography revealed 12 aneurysms (50%) with progressive thrombosis, eight (33%) unchanged, and four (17%) with recanalization. In small aneurysms with wide necks, six (25%) had progressive thrombosis, eight (33%) remained unchanged, and 10 (42%) had recanalization. In large aneurysms, two (13%) were unchanged and 13 (87%) had recanalization. Of the giant aneurysms only one (10%) remained unchanged and nine (90%) had recanalization. Overall, 18 aneurysms (25%) exhibited progressive thrombosis, 19 (26%) remained unchanged, and 36 (49%) displayed recanalization on follow-up angiography. During the last 2 years of the study, the recanalization rate decreased and a higher rate of progressive thrombosis was noted in aneurysms with small necks. These positive changes are related to important new technical developments.Conclusions. Treatment with GDCs appears to be effective and the results permanent in most small aneurysms with small necks. However, there are important technical limitations in the current GDC technology that prevent recanalization in wide-necked or large or giant aneurysms.

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