scholarly journals Angiographic Follow-up of Embolization Using Guglielmi Detachable Coils for Cerebral Aneurysms

2003 ◽  
Vol 9 (1_suppl) ◽  
pp. 47-50 ◽  
Author(s):  
Y. Nakai ◽  
M. Sonobe ◽  
K. Sugita ◽  
Y. Matsumaru
Keyword(s):  
Morphological Changes ◽  
Cerebral Aneurysms ◽  
Guglielmi Detachable Coils ◽  
Complete Occlusion ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Detachable Coils ◽  
Aneurysm Occlusion

The purpose of this study is to evaluate the mid or long-term angiographical stability of Guglielmi Detachable Coils (GDC) after embolization for cerebral aneurysms. Between march 1997 and november 2001, 164 aneurysms, including 116 ruptured and 48 unruptured aneurysms, were treated using GDC at Mito National Hospital. Cerebral angiograms over one month after embolization were obtained in 111 aneurysms, including 71 ruptured and 40 unruptured aneurysms. At the time of initial GDC embolization of the 71 ruptured aneurysms, complete occlusion was achieved in 31 aneurysms, neck remnant in 18 aneurysms, and body filling in 22 aneurysms. Morphological changes were observed in 26 aneurysms (37%) in follow-up. Progressive thrombosis was obtained in 12 out of 71 aneurysms, no changes were shown in 45, and recanalizations occurred in 14. In the initial embolization of the 40 unruptured aneurysms, complete occlusion was achieved in 15 aneurysms, neck remnant in five and body filling in 20 aneurysms respectively. Morphological changes were observed in 12 aneurysms (30%), in which 12 aneurysms showed progressive thrombosis and 28 aneurysms were unchanged. There were significant differences of the long-term angiographical stability between ruptured and unruptured aneurysms. Rigorous follow-up angiography is mandatory when complete aneurysm occlusion is not achieved in ruptured aneurysms.

scholarly journals Angiographical Change of Guglielmi Detachable Coils

2004 ◽  
Vol 10 (1_suppl) ◽  
pp. 161-166 ◽  
Author(s):  
Y. Nakai ◽  
M. Sonobe ◽  
T. Takigawa ◽  
T. Yamazaki ◽  
S. Okamoto ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Medical Condition ◽  
Cerebral Aneurysms ◽  
Acute Stage ◽  
Guglielmi Detachable Coils ◽  
Unruptured Aneurysms ◽  
Detachable Coils

Acute angiographical changes for preventing acute rebleeding on GDC treated cerebral aneurysms were evaluated. From December 2000 to November 2002, 48 total aneurysms in 44 consecutive patients with acute SAH. Acute angiographical evaluations were carried out in 46 aneurysms, including 42 ruptured and 4 unruptured aneurysms. Two cases were excluded because of poor medical condition. In this series, there were no rebleeding cases in acute stage. In the initial embolization for the 46 aneurysms, CO was achieved in eight aneurysms, NR in 15 aneurysms and BF in 23 aneurysms. Acute angiographical observations showed progressive thrombosis in 17 aneurysms (37%). No changes were observed in remaining 29. No recanalization was observed in this series. Only one case of BF, inside the aneurysm bleb was still observed during follow up. Additional embolization was carried out. Progressive thrombosis was frequently observed in GDC treated cerebral aneurysms during acute stage. This angiographical finding seems to show prevention of rebleeding, which is considered important for the management of GDC treatment in acutely ruptured cerebral aneurysm.

Endovascular embolization of 150 basilar tip aneurysms with Guglielmi detachable coils: results of the Food and Drug Administration multicenter clinical trial

1998 ◽  
Vol 89 (1) ◽  
pp. 81-86 ◽  
Author(s):  
Joseph M. Eskridge ◽  
Joon K. Song ◽  
_ _
Keyword(s):  
Clinical Trial ◽  
Drug Administration ◽  
Guglielmi Detachable Coils ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Platinum Coil ◽  
Detachable Coils ◽  
Fine Print

Object. To assess the safety and efficacy of aneurysm embolization performed using Guglielmi detachable coils (GDCs), the authors reviewed the results of a cohort of 150 patients with either ruptured (83 patients) or unruptured (67 patients) basilar tip aneurysms treated with these detachable platinum coil devices in the early part of the United States multicenter GDC clinical trial that led to Food and Drug Administration approval for the device. Methods. The most common presentation in this cohort of patients was headache (53%). All patients were entered into the trial after neurosurgical assessment excluded them as candidates for surgical clipping of their aneurysms. Greater than 90% coil packing was achieved in 75% of the patients. For those patients in whom follow-up information was available, the mean angiographic and clinical evaluation follow-up time for 61 patients with ruptured aneurysms was 13.7 months (range 0–43 months) and that for the 49 patients with unruptured aneurysms was 9.8 (range 0–40 months). Conservative mortality rates included up to 23% for the ruptured aneurysm group and up to 12% for the unruptured aneurysm group; the rebleeding rate for treated ruptured aneurysms was up to 3.3% and the bleeding rate for unruptured aneurysms up to 4.1%. Permanent deficits due to stroke in patients with ruptured or unruptured aneurysms occurred in up to 5% and 9%, respectively. Vasospasm occurred in 8% of the patients; it was associated with two deaths. Periprocedural mortality was 2.7% (four patients with ruptured aneurysms). Conclusions. Detachable platinum coil embolization is a promising treatment for ruptured basilar tip aneurysms that are not surgically clippable; in selected patients it offers lower incidences of morbidity and mortality compared with conservative medical management. The role of this procedure in unruptured basilar tip aneurysms is unclear with less supportive results. More long-term follow-up evaluation is necessary and results are expected to improve.

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.

NEUROFORM STENT-ASSISTED COIL EMBOLIZATION OF WIDE-NECK INTRACRANIAL ANEURYSMS

Neurosurgery ◽  
2007 ◽  
Vol 61 (3) ◽  
pp. 460-469 ◽  
Author(s):  
Alessandra Biondi ◽  
Vallabh Janardhan ◽  
Jeffrey M. Katz ◽  
Kimberly Salvaggio ◽  
Howard A. Riina ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Effective Technique ◽  
Stent Deployment ◽  
Unruptured Aneurysms ◽  
Aneurysm Occlusion ◽  
Neuroform Stent ◽  
Wide Neck

Abstract OBJECTIVE To evaluate the midterm results of intracranial stent-assisted coil embolization in the treatment of wide-necked cerebral aneurysms and to assess the efficacy of various strategies used in stent deployment. METHODS A retrospective study of 42 patients with 46 wide-necked cerebral aneurysms enrolled in a prospective single-center registry of patients treated with a Neuroform stent (Boston Scientific/Target, Fremont, CA), a flexible self-expanding nitinol stent, was performed. Twenty-seven of 46 aneurysms were unruptured aneurysms, 14 were recanalized aneurysms, and five were acutely ruptured. Thirty-nine aneurysms were located in the anterior and seven in the posterior circulation. Mean aneurysm size was 9.8 mm. Stenting before coiling was performed in 13 of 45 aneurysms (29%), coiling before stenting in 27 of 45 aneurysms (60%), and stenting alone in five of 45 aneurysms (11%). The balloon remodeling technique for coiling before stenting was performed in 77% of patients. Angiographic and clinical follow up was available in 31 patients with 33 aneurysms and ranged from 3 to 24 months. RESULTS Neuroform stenting was attempted in 46 wide-necked aneurysms (42 patients). Forty-nine stent sessions were performed, including three poststent retreatments. In 46 of 49 sessions (94%), successful deployment of 47 stents for 45 aneurysms was obtained. In 40 aneurysms treated with stent-assisted coiling, angiographic results showed 14 (35%) aneurysm occlusions, 18 (45%) neck remnants, and eight (20%) residual aneurysms. In five recanalized aneurysms treated with stenting alone, no changes were observed in four (80%) aneurysms and one (20%) neck remnant reduced in size. At angiographic follow-up in 30 aneurysms treated with stent-assisted coiling, there were 17 (57%) aneurysm occlusions, seven (23%) neck remnants, and six (20%) residual aneurysms. In three recanalized aneurysms treated with stent alone, two (67%) neck remnants remained unchanged and one (33%) neck remnant decreased in size. Procedural morbidity was observed in two of 42 patients (4.8%) and one patient died. On clinical follow-up, the modified Rankin Scale score was 0 in 27 patients (87%), 1 in three patients (10%), and 2 (3%) in one patient. No aneurysm bled during the follow-up period. CONCLUSION These results indicate that Neuroform stent-assisted coil embolization is a safe and effective technique in the treatment of wide-necked cerebral aneurysms. Further studies are needed to evaluate the long-term durability of stent-assisted aneurysm occlusion and tolerance to the stent.

Endovascular embolization of 150 basilar tip aneurysms with Guglielmi detachable coils: results of the Food and Drug Administration multicenter clinical trial

1998 ◽  
Vol 5 (4) ◽  
pp. E3 ◽  
Author(s):  
Joseph M. Eskridge ◽  
Joon K. Song ◽  
_ _
Keyword(s):  
Clinical Trial ◽  
Drug Administration ◽  
Food And Drug Administration ◽  
The United States ◽  
Guglielmi Detachable Coils ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Platinum Coil ◽  
Detachable Coils

To assess the safety and efficacy of aneurysm embolization performed using Guglielmi detachable coils (GDCs), the authors reviewed the results of a cohort of 150 patients with either ruptured (83 patients) or unruptured (67 patients) basilar tip aneurysms treated with these detachable platinum coil devices in the early part of the United States multicenter GDC clinical trial that led to Food and Drug Administration approval for the device. The most common presentation in this cohort of patients was headache (53%). All patients were entered into the trial after neurosurgical assessment excluded them as candidates for surgical clipping of their aneurysms. Greater than 90% coil packing was achieved in 75% of the patients. For those patients in whom follow-up information was available, the mean angiographic and clinical evaluation follow-up time for 61 patients with ruptured aneurysms was 13.7 months (range 0-43 months) and that for the 49 patients with unruptured aneurysms was 9.8 (range 0-40 months). Conservative mortality rates included up to 23% for the ruptured aneurysm group and up to 12% for the unruptured aneurysm group; the rebleeding rate for treated ruptured aneurysms was up to 3.3% and the bleeding rate for unruptured aneurysms up to 4.1%. Permanent deficits due to stroke in patients with ruptured or unruptured aneurysms occurred in up to 5% and 9%, respectively. Vasospasm occurred in 8% of the patients; it was associated with two deaths. Periprocedural mortality was 2.7% (four patients with ruptured aneurysms). Detachable platinum coil embolization is a promising treatment for ruptured basilar tip aneurysms that are not surgically clippable; in selected patients it offers lower incidences of morbidity and mortality compared with conservative medical management. The role of this procedure in unruptured basilar tip aneurysms is unclear with less supportive results. More long-term follow-up evaluation is necessary and results are expected to improve.

Follow-up Angiography of Intracranial Aneurysms Treated with Endovascular Placement of Guglielmi Detachable Coils

Neurosurgery ◽  
2002 ◽  
Vol 50 (2) ◽  
pp. 239-250 ◽  
Author(s):  
John Thornton ◽  
Gerard M. Debrun ◽  
Victor A. Aletich ◽  
Qasim Bashir ◽  
Fady T. Charbel ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Endovascular Coiling ◽  
Guglielmi Detachable Coils ◽  
Detachable Coils ◽  
Aneurysm Occlusion ◽  
Male Patients ◽  
The Mean ◽  
Angiographic Findings

ABSTRACT OBJECTIVE The success of endovascular treatment of intracranial aneurysms with Guglielmi detachable coils (GDCs) is dependent on the long-term exclusion of the aneurysm from the circulation. We reviewed our experience with the long-term angiographic follow-up monitoring of aneurysms that had been treated with GDCs. METHODS All patients whose aneurysms had been treated with GDCs between January 1995 and August 1999 and who subsequently underwent follow-up angiography at 6 months or more were included in this study. We reviewed all of the angiographic findings, to determine the percentage of aneurysm occlusion on the initial angiograms and on the last available follow-up angiograms. The categories of aneurysm occlusion used were 100%, ≥95%, and less than 95% occlusion. RESULTS One hundred thirty patients with 141 aneurysms underwent 143 endovascular coiling procedures and subsequently underwent angiographic follow-up monitoring of 6 months or more. There were 102 female and 28 male patients. The mean angiographic follow-up period was 16.7 months (range, 6–62 mo). The initial rates of occlusion were 100% for 56 aneurysms (39%), ≥95% for 65 aneurysms (46%), and less than 95% for 22 aneurysms (15%). Recurrence of one aneurysm (1.8%) was observed. Of the 87 aneurysms that were incompletely occluded initially, there was progressive thrombosis in 40 (46%), stable neck remnants in 23 (26%), and enlargement of the residual neck in 24 (28%). The final occlusion rates, determined on the last available angiograms, were 100% for 88 aneurysms (61%), ≥95% for 31 aneurysms (22%), and less than 95% for 24 aneurysms (17%). No patient experienced repeat or new subarachnoid hemorrhage more than 6 months after the initial treatment. CONCLUSION Late angiographic follow-up monitoring of aneurysms that have been treated with GDCs demonstrates the durability of the treatment. Aneurysms with large residual neck remnants were subjected to further treatment, whereas aneurysms with small residual neck remnants remain under observation.

scholarly journals Long-Term Follow-up Study of Endovascularly Treated Intracranial Aneurysms

2010 ◽  
Vol 16 (3) ◽  
pp. 231-239 ◽  
Author(s):  
L.M. Pyysalo ◽  
L.H. Keski-Nisula ◽  
T.T. Niskakangas ◽  
V.J. Kähärä ◽  
J.E. Öhman
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Bleeding Rate ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Follow Up Study ◽  
Long Term Follow Up ◽  
Rebleeding Rate

Long-term follow-up studies after endovascular treatment for intracranial aneurysm are still rare and inconclusive. The aim of this study was to assess the long-term clinical and angiographic outcome of patients with endovascularly treated aneurysms. The clinical outcome of all 185 patients with endovascularly treated aneurysms were analyzed and 77 out of 122 surviving patients were examined with MRI and MRA nine to 16 years (mean 11 years) after the initial endovascular treatment. Sixty-three patients were deceased at the time of follow-up. The cause of death was aneurysm-related in 34 (54%) patients. The annual rebleeding rate from the treated aneurysms was 1.3% in the ruptured group and 0.1% in the unruptured group. In long-term follow-up MRA 18 aneurysms (53%) were graded as complete, 11 aneurysms (32%) had neck remnants and five aneurysms (15%) were incompletely occluded in the ruptured group. The occlusion grade was lower in the unruptured group with 20 aneurysms (41%) graded as complete, 11 (22%) had neck remnants and 18 (37%) were incomplete. However, only three aneurysms were unstable during the follow-up period and needed retreatment. Endovascular treatment of unruptured aneurysms showed incomplete angiographic outcome in 37% of cases. However, the annual bleeding rate was as low as 0.1%. Endovascular treatment of ruptured aneurysms showed incomplete angiographic outcome in 15% of cases and the annual rebleeding rate was 1,3%.

scholarly journals Very delayed discontinuation of telescoped Pipeline embolization devices: a case report

2018 ◽  
Vol 25 (2) ◽  
pp. 182-186
Author(s):  
Manoj Bohara ◽  
Kosuke Teranishi ◽  
Kenji Yatomi ◽  
Takashi Fujii ◽  
Takayuki Kitamura ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Flow Diversion ◽  
Total Occlusion ◽  
Pipeline Embolization Device ◽  
Complete Occlusion ◽  
Radiological Features ◽  
Long Term Follow Up ◽  
Aneurysm Occlusion

Background Flow diversion with the Pipeline embolization device (PED) is a widely accepted treatment modality for aneurysm occlusion. Previous reports have shown no recanalization of aneurysms on long-term follow-up once total occlusion has been achieved. Case description We report on a 63-year-old male who had a large internal carotid artery cavernous segment aneurysm. Treatment with PED resulted in complete occlusion of the aneurysm. However, follow-up angiography at four years revealed recurrence of the aneurysm due to disconnection of the two PEDs placed in telescoping fashion. Conclusion Herein, we present the clinico-radiological features and discuss the possible mechanisms resulting in the recanalization of aneurysms treated with flow diversion.

scholarly journals Safety of Abciximab injection during endovascular treatment of ruptured aneurysms

2015 ◽  
Vol 21 (3) ◽  
pp. 332-336 ◽  
Author(s):  
Jean-Christophe Gentric ◽  
Joelle Brisson ◽  
André Lima Batista ◽  
Jimmy Ghostine ◽  
Jean Raymond ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Hemorrhage ◽  
Cerebral Aneurysms ◽  
Bleeding Complications ◽  
World Federation ◽  
Consecutive Series ◽  
Ruptured Aneurysms ◽  
Grade Ii

Background and purpose We aimed to determine the safety of intra-arterial Abciximab injection in the management of thromboembolic complications during endovascular treatment of ruptured cerebral aneurysms. Methods In a monocentric consecutive series of endovascular treatment of 783 ruptured aneurysms, 42 (5.3%) patients received Abciximab after the aneurysm was secured. Bleeding complications were registered and dichotomized as follows: new intracranial hemorrhage and peripheral bleeding. For each patient, World Federation of Neurosurgery (WFNS) subarachnoid hemorrhage (SAH) grade, shunting, and clinical outcomes in the post-operative period and at 3–6 months were recorded. Results SAH WFNS grades were as follows: grade I n = 14, grade II n = 10, grade III n = 11, grade IV n = 4, grade V n = 3. Ten patients had intracranial hematoma additionally to the SAH prior to embolization. Four patients (9.5%) presented more blood on the post-embolization CT but only one suffered a new clinically relevant intracranial hemorrhage. Two patients (4.8%) experienced significant peripheral bleeding but none were associated with long-term disabilities. Fourteen patients had a shunt installed less than 24 h prior to Abciximab injection and one less than 48 h later. At 3–6-month follow-up, 31 patients (74%) achieved a modified Rankin Scale score (mRS) of 2 or less, six patients (14%) had a mRS of 3–5, three were dead (7%), and two were lost at follow-up. Conclusion When the aneurysm is secured, intra-arterial Abciximab injection is a low complication rate treatment modality for thromboembolic events during embolization of cerebral ruptured aneurysm.

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