scholarly journals Anatomical and Clinical Outcomes after Endovascular Treatment for Unruptured Cerebral Aneurysms

2002 ◽  
Vol 8 (4) ◽  
pp. 367-376 ◽  
Author(s):  
B. J. Kwon ◽  
M. H. Han ◽  
C.W. Oh ◽  
K. H. Kim ◽  
K-H Chang
Keyword(s):  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Cerebral Aneurysms ◽  
Neurological Status ◽  
Neurological Deficits ◽  
Anterior Circulation ◽  
Unruptured Aneurysms ◽  
Unruptured Cerebral Aneurysms ◽  
Anatomical Outcomes

To describe the immediate and follow-up anatomical outcomes as well as procedure-related morbidity after endovascular procedures for unruptured cerebral aneurysms, we reviewed 68 patients with 78 unruptured aneurysms treated with detachable coils from may 1996 to february 2002. Angiograms were retrospectively reviewed for the nature of the aneurysms and the degree of therapeutic obliteration. Periprocedural complications, immediate clinical outcome and long-term neurological status were analyzed. Immediate anatomical outcomes were complete in 35 aneurysms (45%); residual neck in 24 (31%), partial contrast filling in 17 (22%), and failed embolization in two (2%). Of 27 aneurysms with follow-up angiography, 12 of the 13 aneurysms that were completely occluded in the initial treatment were still completely occluded at the end of a mean follow-up period of 17 months. Periprocedural complications were thromboembolic (n = 6), haemorrhagic (n = 3), coil protrusion (n = 7) and other unrelated complications (n = 3). Only two patients, with thromboembolic complications were moderately disabled with permanent neurological deficits in immediate clinical outcome, and their condition improved to independent in 1.5 and three months each. Small aneurysms and posterior circulation location showed more protective immediate results than aneurysms of large and anterior circulation after endovascular treatment (p values: 0.01 and 0.02). Our experiences of endovascular treatment for unruptured cerebral aneurysms were comparable to the results of recent series. Endovascular treatment for small posteriorly located aneurysms produced significantly better results than for large anteriorly located lesions.

Follow-up Study on Intra-Aneurysmal Embolization for Unruptured Cerebral Aneurysms

1999 ◽  
Vol 5 (1_suppl) ◽  
pp. 89-92 ◽  
Author(s):  
Y. Kaku ◽  
S. Yoshimura ◽  
K. Hayashi ◽  
T. Ueda ◽  
N. Sakai
Keyword(s):  
Lower Incidence ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Neurological Deficits ◽  
Safe Treatment ◽  
Unruptured Aneurysms ◽  
Follow Up Study ◽  
Platinum Coil ◽  
Unruptured Cerebral Aneurysms

We describe follow-up clinical and angiographical results in patients with unruptured cerebral aneurysms treated with IDC or GDC. In 28 patients who underwent intra-aneurysmal occlusion for unruptured aneurysms, there were no permanent neurological deficits in the periprocedural period, while three transient neurological deficits were observed. On the angiograms obtained immediately after the procedure, complete aneurysmal occlusion was achieved in three patients (10.7%), a small neck remnant was detected in two cases (7.1%), a body filling in 12 cases (42.9%) and both of them were detected in 11 patients (39.3%). On the follow up angiograms (median angiographical follow-up period 15.6 months), 46.4% of incompletely obliterated aneurysms showed aneurysmal recanalization, and a incompletely embolized aneurysm ruptured 15 months after initial embolization. Detachable platinum coil embolization is a safe treatment for unruptured aneurysms with a lower incidence of peri-procedural morbidity, wheareas follow-up results are less satisfactory in cases involving incompletely obliterated lesions. With this limitation in mind, patients need to be very carefully chosen for GDC embolization and strict follow-up angiography is mandatory when a complete embolization is not achieved.

scholarly journals Intraaneurysmal Embolization for Wide-Necked Aneurysms Remodeling Technique, Combined Neck-Clipping and Coiling Therapy, Scaffolding Technique

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 95-101 ◽  
Author(s):  
T. Nakahara ◽  
T. Hidaka ◽  
M. Kutsuna ◽  
M. Yamanaka ◽  
K. Sakoda
Keyword(s):  
Endovascular Treatment ◽  
Neurological Deficits ◽  
Circulation System ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Detachable Coil ◽  
Obliteration Rate ◽  
Guglielmi Detachable Coil ◽  
Scaffolding Technique

We reported the results of the endovascular treatment using Guglielmi detachable coil (GDC) for wide-necked aneurysms. Fourteen aneurysms were treated with remodeling technique. One aneurysm was performed endovascular treatment followed by partial neck clipping. The other was treated with scaffolding technique. All aneurysms could not be performed by conventional GDC treatment initially because of coil protrusion into the parent artery due to wide neck of these aneurysms. These aneurysms sited at anterior circulation system in 10 cases, and at posterior circulation system in 6 cases. Immediately after the procedure, the obliteration rate could be obtained complete occlusion in 3 cases, > 95% occlusion in 7 cases, > 90% occlusion in 3 cases and < 90% occlusion in 3 cases. In 14 patients follow-up angiography or magnetic resonance image (MRI) was carried out. The angiographic follow-up period is range from 2 to 19 months (mean: 10 months). The results of angiographical follow-up indicated increasing obliteration rate with all aneurysms except for 2 cases. In these 2 cases, the reembolization was needed for recanalization of the aneurysm. The clinical follow-up period is range form one to 26 months (mean: 15 months). There is no evidence of aneurysmal rupture and all cases have been survival without any permanent neurological deficits. The GDC treatment with additional technique (remodeling technique, combined neck-clipping and coiling therapy, scaffolding technique) provides safety and effectiveness, even if there are wide-necked aneurysms.

Expanding the use of flow diverters beyond their initial indication: treatment of small unruptured aneurysms

2017 ◽  
Vol 10 (3) ◽  
pp. 245-248 ◽  
Author(s):  
J M Pumar ◽  
A Mosqueira ◽  
H Cuellar ◽  
B Dieguez ◽  
L Guimaraens ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Clinical Findings ◽  
Anterior Circulation ◽  
Unruptured Aneurysms ◽  
Patient Demographics ◽  
Delayed Hemorrhage ◽  
Mean Size ◽  
Unruptured Cerebral Aneurysms

BackgroundExperience with the endovascular treatment of unruptured small intracranial aneurysms by flow diverter devices is still limited.ObjectiveTo assess the safety and efficacy of the SILK flow diverter (SFD) in the treatment of small unruptured cerebral aneurysms (<10 mm).MethodsWe performed a retrospective review of a prospectively maintained database of patients treated with a SFD between July 2008 and December 2013 at 4 institutions in Spain to identify all patients with small unruptured aneurysms (<10 mm). Data for patient demographics, aneurysm characteristics, and technical procedures were analyzed. Angiographic and clinical findings were recorded during the procedure and at 6- and 12-month follow-ups.ResultsA total of 109 small aneurysms were treated with a SFD in 104 patients (78 women; 26 men; mean, median, and range of age: 55.2, 57.1, and 19–80 years, respectively). A total of 60 patients were asymptomatic (57.7%). All except 7 aneurysms (6.4%) arose from the anterior circulation. The mean size of the aneurysms was 4.7±1.9 mm. At 6 months, the neuromorbidity and neuromortality rates were 2.9% and 0.9%, respectively. Imaging at the 12-month follow-up showed complete occlusion, neck remnants, and residual aneurysm in 88.5% (69/78), 7.7% (6/78), and 3.3% (3/78) of cases, respectively. No delayed hemorrhage occurred.ConclusionsThe findings suggest that the indications for SFD can be safely extended to small intracranial aneurysms.

Prevalence of asymptomatic incidental aneurysms: review of 4568 arteriograms

2002 ◽  
Vol 96 (1) ◽  
pp. 43-49 ◽  
Author(s):  
H. Richard Winn ◽  
John A. Jane ◽  
James Taylor ◽  
Donald Kaiser ◽  
Gavin W. Britz
Keyword(s):  
Prevalence Rate ◽  
Cerebral Aneurysms ◽  
Anterior Circulation ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Incidental Aneurysms ◽  
Unruptured Cerebral Aneurysms ◽  
The University ◽  
Yearly Rate ◽  
Fine Print

Object. The prevalence of unruptured cerebral aneurysms is unknown, but is estimated to be as high as 5%. The goal of this study was to determine the prevalence of asymptomatic incidental aneurysms. Methods. The authors studied all cerebral arteriography reports produced at a single institution, the University of Virginia, between April 1969 and January 1980. A review of 3684 arteriograms demonstrated 24 cases of asymptomatic aneurysms, yielding a prevalence rate of 0.65%. The majority (67%) of the 24 patients harboring unruptured aneurysms were women. More than 90% of the unruptured aneurysms were located in the anterior circulation and in locations similar to those found in patients with ruptured aneurysms. Nearly 80% of the aneurysms were smaller than 1 cm in their greatest diameter. The frequency of asymmetrical unruptured aneurysms (0.6–1.5%) was constant throughout all relevant age ranges (35–84 years). Conclusions. While keeping in mind appropriate caveats in extrapolating from these data, the prevalence rate of asymptomatic unruptured aneurysms found in the present study allows an estimation of the yearly rate of rupture of these lesions. The authors suggest that this yearly rate of rupture falls within the range of 1 to 2%.

FRED Italian Registry: a multicenter experience with the flow re-direction endoluminal device for intracranial aneurysms

2020 ◽  
Vol 133 (1) ◽  
pp. 174-181 ◽  
Author(s):  
Mariangela Piano ◽  
Luca Valvassori ◽  
Emilio Lozupone ◽  
Guglielmo Pero ◽  
Luca Quilici ◽  
...  
Keyword(s):  
Adverse Event ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Anterior Circulation ◽  
Cross Sectional ◽  
Safety And Efficacy ◽  
Mortality And Morbidity

OBJECTIVEThe introduction of flow-diverter devices (FDDs) has revolutionized the endovascular treatment of intracranial aneurysms. Here the authors present their Italian multicenter experience using the flow re-direction endoluminal device (FRED) in the treatment of cerebral aneurysms, evaluating both short- and long-term safety and efficacy of this device.METHODSBetween February 2013 and December 2014, 169 consecutive aneurysms treated using FRED in 166 patients were entered into this study across 30 Italian centers. Data collected included patient demographics, aneurysm location and characteristics, baseline angiography, adverse event and serious adverse event information, morbidity and mortality rates, and pre- and posttreatment modified Rankin Scale scores, as well as angiographic and cross-sectional CT/MRI follow-up at 3–6 months and/or 12–24 months per institutional standard of care. All images were reviewed and adjudicated by an independent core lab.RESULTSOf the 169 lesions initially entered into the study, 4 were later determined to be extracranial or nonaneurysmal by the core lab and were excluded, leaving 165 aneurysms in 162 patients treated in 163 procedures. Ninety-one (56.2%) patients were asymptomatic with aneurysms found incidentally. Of the 165 aneurysms, 150 (90.9%) were unruptured. One hundred thirty-four (81.2%) were saccular, 27 (16.4%) were fusiform/dissecting, and the remaining 4 (2.4%) were blister-like. One hundred thirty-seven (83.0%) arose from the anterior circulation.FRED deployment was impossible in 2/163 (1.2%) cases, and in an additional 4 cases (2.5%) the device was misdeployed. Overall mortality and morbidity rates were 4.3% and 7.3%, respectively, with rates of mortality and morbidity potentially related to FRED of up to 2.4% and 6.2%, respectively. Neuroimaging follow-up at 3–6 months showed complete or nearly complete occlusion of the aneurysm in 94% of cases, increasing to 96% at 12–24 months’ follow-up. Aneurysmal sac shrinkage was observed in 78% of assessable aneurysms.CONCLUSIONSThis preliminary experience using FRED for endovascular treatment of complex unruptured and ruptured aneurysms showed a high safety and efficacy profile that is comparable to those of other FDDs currently in use.

HyperForm balloon remodeling in the endovascular treatment of anterior cerebral, middle cerebral, and anterior communicating artery aneurysms: clinical and angiographic follow-up results in 800 consecutive patients

2011 ◽  
Vol 114 (4) ◽  
pp. 944-953 ◽  
Author(s):  
H. Saruhan Cekirge ◽  
Kivilcim Yavuz ◽  
Serdar Geyik ◽  
Isil Saatci
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Neurological Deficits ◽  
Anterior Communicating Artery ◽  
Severe Bleeding ◽  
Negative Consequences ◽  
Anterior Circulation ◽  
Anterior Communicating Artery Aneurysms

Object The purpose of this paper was to present the safety, efficacy, and clinical/angiographic follow-up results of HyperForm balloon-assisted endosaccular coil occlusion of distal anterior circulation bifurcation aneurysms. Methods Over a 7-year period, the authors treated 864 middle cerebral artery, distal anterior cerebral artery bifurcation, and anterior communicating artery aneurysms by means of coil embolization with HyperForm balloon assistance in 800 patients. In 37 aneurysms, 2 HyperForm balloons were used simultaneously for remodeling. Results The overall mortality rate was 7.1%, including 1.4% procedural mortality. Various neurological deficits were present at discharge in 8.9% of the patients, and 4.4% had permanent disabling morbidity 6 months posttreatment (modified Rankin Scale score ≥ 2). Thromboembolic complications developed during the treatment of 15 aneurysms (1.7%) causing morbidity or mortality in 10 cases (1.3%). There were 14 intraoperative perforations (1.6%). In all 14 cases, the HyperForm balloon saved patients from severe bleeding. The perforation led to morbidity or mortality in 3 cases (0.4%); there were no negative consequences in 11. There were 726 patients with 757 aneurysms (87.6%) available for follow-up. Control angiograms were obtained at 6 months in 386 patients, at 1 year in 267, and at 2 years in 104, revealing an 82% complete obliteration rate according to the most recent follow-up angiograms. Conclusions The satisfactory results obtained in this experience demonstrate that HyperForm balloon remodeling provides strong benefits for the endovascular management of middle cerebral, anterior cerebral, and anterior communicating artery aneurysms without increasing the risk of treatment. Not only does this technique allow for the safe treatment of these aneurysms, but it also expands the indications of endovascular treatment to include aneurysms that otherwise cannot be treated with simple coil embolization.

scholarly journals Reduction of thromboembolic complications during the endovascular treatment of unruptured aneurysms by employing a tailored dual antiplatelet regimen using aspirin and prasugrel

2021 ◽  
pp. neurintsurg-2020-016994
Author(s):  
Saeko Higashiguchi ◽  
Akiyo Sadato ◽  
Ichiro Nakahara ◽  
Shoji Matsumoto ◽  
Motoharu Hayakawa ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Cerebral Aneurysms ◽  
Poor Response ◽  
Perioperative Period ◽  
Thromboembolic Complications ◽  
Unruptured Aneurysms ◽  
Verifynow Assay ◽  
Unruptured 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.

scholarly journals Treatment of Intracranial Aneurysms Using the New Silk Vista Flow Diverter: Safety Outcomes at Short-Term Follow-Up

2021 ◽  
Vol 12 ◽  
Author(s):  
José M. Pumar ◽  
Antonio Mosqueira ◽  
Jorge Olier ◽  
Claudio Rodriguez-Fernandez ◽  
Pedro Vega ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Parent Artery ◽  
Short Term ◽  
Unruptured Aneurysms ◽  
Brain Aneurysms ◽  
New Generation ◽  
Flow Diverters

Background: Flow diverters are widely used as the first endovascular treatment option for complex brain aneurysms due to their high percentage of occlusion and low morbi-mortality. The Silk Vista device is a new generation of flow diverters designed to facilitate full visibility, improve apposition to the vessel wall, and enhance navigability. Indeed, its greatest advantage is that it enables the easier navigation of stents between 3.5 and 4.75 mm through a 0.021 microcatheter. The objective of this study was to evaluate the safety and effectiveness of Silk Vista systems for treating cerebral aneurysms.Methods: This prospective observational study included 25 consecutive patients with 27 wide-necked unruptured aneurysms treated with SILK Vista who were retrospectively analyzed for safety and efficacy.Results: Endovascular treatment was successfully performed in all patients. The final morbidity and mortality rates were both 0.0%. Short-term (3–5 months) angiographic follow-up revealed 21 complete occlusions and 6 near-complete occlusions. No significant parent artery stenosis was observed.Conclusions: This report demonstrates the efficacy of Silk Vista in treating brain aneurysms, although longer experiences should be carried out to confirm our results.

scholarly journals Endovascular recanalization of symptomatic non–acute intracranial artery occlusion: Procedural and mid-term clinical outcomes in the anterior circulation

2019 ◽  
Vol 25 (4) ◽  
pp. 380-389
Author(s):  
Zhen Yu Jia ◽  
Yun Sun Song ◽  
Jae Jon Sheen ◽  
Joong Goo Kim ◽  
Deok Hee Lee
Keyword(s):  
Endovascular Treatment ◽  
Arterial Occlusion ◽  
Neurological Status ◽  
Artery Occlusion ◽  
Final Outcome ◽  
Arterial Stenosis ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Proper Patient Selection

Objective Symptomatic non–acute intracranial arterial occlusion (NAICO) is not uncommon. We report a single-center experience of the feasibility and safety of endovascular treatment of anterior circulation NAICO and summarize the outcomes of patient groups with successful or failed recanalization. Methods Patients who underwent endovascular therapy for intracranial arterial stenosis between January 2010 and May 2017 were retrospectively reviewed. Thirty-eight patients with symptomatic NAICO (symptom onset > 24 hours) in the anterior circulation were identified. Results Successful recanalization was achieved in 76.3% of patients (29/38). Intraprocedural events occurred in 10.5% (4/38), including intima dissection ( n = 1), parent artery rupture ( n = 1) and acute in-stent thrombosis ( n = 2). Mean follow-up duration after successful recanalization was 36.5 months. One patient died 68 days after the procedure because of a newly developed posterior circulation stroke. Acute reocclusion was observed in two patients (6.7%); subacute or delayed reocclusion was observed in three patients (10%). Good final outcome (modified Rankin Scale score ≤ 2) was achieved in 25 of 28 patients (89.3%) at three months. Mean follow-up duration of the nine patients with failed recanalization was 41.4 months. Three patients underwent extra–intracranial bypass for worsening symptoms. The other six patients showed stable or improved neurological status with antiplatelet medications. Good final outcome was achieved in eight of nine patients (88.9%) at three months. Conclusions Endovascular revascularization can be a viable option with an acceptable safety profile in selected patients with symptomatic NAICO in the anterior circulation. Further characterization of aborted cases would facilitate proper patient selection for endovascular treatment.

scholarly journals Recanalization Rates after Endovascular Coil Embolization in a Cohort of Matched Ruptured and Unruptured Cerebral Aneurysms

2011 ◽  
Vol 17 (1) ◽  
pp. 27-35 ◽  
Author(s):  
I.Y.L. Tan ◽  
R.F. Agid ◽  
R.A. Willinsky
Keyword(s):  
Multivariate Logistic Regression Analysis ◽  
Group Versus ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Treatment Rate ◽  
Unruptured Aneurysms ◽  
Neck Size ◽  
Ruptured Aneurysms ◽  
Unruptured Cerebral Aneurysms

The aim of this study was to retrospectively assess the recanalization rate, factors associated with and time taken for recanalization to occur in a matched ruptured and unruptured aneurysm population that were treated with endovascular coiling. Ruptured and unruptured aneurysms treated between 2002 and 2007 were matched for aneurysm location, diameter and neck size. Recanalization rate, time to recanalize, re-treatment rate and clinical outcome were analysed. Ninety-eight matched ruptured and unruptured aneurysms (49 aneurysms in each group) were studied. 46.8% of aneurysms in the ruptured group achieved complete obliteration on the initial post treatment angiogram versus 34.7% in the unruptured group. The ruptured group had a higher rate of recanalization (40.4% versus 20.4%). 25.5% of aneurysms had significant recanalization in the ruptured group versus 6.1% in the unruptured group (p=0.009). The retreatment rate was higher in the ruptured group (21.3% versus 6%). Ruptured aneurysms took a shorter time to recanalize with a mean time of 5.3±3.8 months versus 12.4±7.7months (p=0.003). Multivariate logistic regression analysis found neck size (p=0.0098), wide neck morphology (p=0.0174), aneurysm diameter (p< 0.0001) and ruptured aneurysms (p=0.0372) were significant predictors of recanalization. The majority of patients in both groups had a good outcome with GOS=5 (85.7% and 83.7%) but two deaths occurred in the ruptured group. Ruptured and unruptured aneurysms showed significant differences in rate, degree and timing of recanalization, thus requiring different protocols for imaging follow-up post endovascular treatment. Earlier and more frequent imaging follow-up is recommended for ruptured aneurysms.

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