scholarly journals Endovascular Surgery as the First-Choice Treatment for Ruptured Cerebral Aneurysms: How Far Has it Come?

2004 ◽  
Vol 10 (2_suppl) ◽  
pp. 41-47 ◽  
Author(s):  
O. Tone ◽  
H. Tomita ◽  
M. Tamaki ◽  
Y. Satoh ◽  
Y. Matsuoka ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Coil Embolization ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Cerebral Aneurysms ◽  
Poor Grade ◽  
Ruptured Aneurysms ◽  
First Choice ◽  
Middle Cerebral Artery Aneurysms ◽  
Small Aneurysms

One hundred and seventy patients with ruptured cerebral aneurysms were treated by coil embolization from September 1997 to December 2002. After January 2000, coil embolization was selected as the first-choice treatment for ruptured aneurysms. During this period, the authors investigated the number of aborted cases, the number of complications, and how many patients could be treated by coil embolization according to the locations of ruptured cerebral aneurysms. One hundred and ninety-five sessions were performed on 170 patients, and 13 sessions (6.7%) were aborted mainly because of the difficulty of the approach and the wide necks of the aneurysms. In four patients, although procedural perforation and haemorrhage occurred, the outcome was good or excellent. Eight poor-grade patients experienced haemorrhage after coil embolization and seven patients died. The volume embolization ratios of small and large aneurysms were 27% and 21%, and the recanalization of small and large aneurysms occurred in 9% and 38% of patients, respectively. From January 2000 to December 2002, 119 (66%) of 180 ruptured cerebral aneurysms were treated by coil embolization. According to the location of aneurysms, 89% vertebrobasilar, 87% anterior cerebral, 65% internal carotid and 24% middle cerebral artery aneurysms could be treated by coil embolization. Because the tight packing of large aneurysms was difficult, the recanalization rate of large aneurysms was high. However, the results of small aneurysms were satisfactory. Almost 90% of vertebrobasilar and anterior cerebral artery aneurysms could be treated by coil embolization.

scholarly journals Endovascular Coil Embolization for Cerebral Aneurysms Solely Using Ultrasoft Coils

2006 ◽  
Vol 12 (1_suppl) ◽  
pp. 101-104
Author(s):  
T. Tsumoto ◽  
T. Terada ◽  
H. Yamaga ◽  
T. Itakura
Keyword(s):  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Ruptured Aneurysms ◽  
Endovascular Coil Embolization ◽  
Small Aneurysms

We report a series of coil embolizations for small aneurysms solely using GDC ultrasoft coils and discuss the advantages of this method. Seven small aneurysms (<4.0 mm) were embolized solely with ultrasoft coils. Ultrasoft coils were sequentially inserted into aneurysms. Immediately after embolization, five aneurysms were completely occluded, and two exhibited body filling. All cases were treated successfully without any complications. In conclusion, ultrasoft coils were found efficacious for the treatment of small, irregular-shaped, and ruptured aneurysms; their softness and malleability facilitated their compaction into an aneurysm.

Balloon-assisted extrasaccular coil embolization technique for the treatment of very small cerebral aneurysms

2010 ◽  
Vol 112 (3) ◽  
pp. 585-588 ◽  
Author(s):  
Alberto Gil ◽  
Pedro Vega ◽  
Eduardo Murias ◽  
Hugo Cuellar
Keyword(s):  
Endovascular Treatment ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Review Of The Literature ◽  
Endovascular Techniques ◽  
Ruptured Aneurysms ◽  
Intraoperative Rupture ◽  
Small Aneurysms ◽  
Very High

Treatment of very small ruptured cerebral aneurysms (< 2 mm) continues to present a challenge. These lesions are difficult to treat both with neurosurgical and endovascular techniques. A neurosurgical approach is still the treatment of choice for these lesions at many centers because of high rupture rates related to endovascular treatment; however, there are clinical circumstances in which the neurosurgical option cannot be offered. In their review of the literature, the authors did not find any series reporting endovascular treatment of these very small aneurysms. In the present study, the authors report their experience with the endovascular treatment of a series of 4 ruptured aneurysms smaller than 2 mm from neck to dome. They describe their technique of using a remodelling balloon to stabilize the tip of the microcatheter in the neck of the aneurysm without entering it at any time, and of inserting the coil from outside the sac to minimize the risk of intraoperative rupture, which is very high when conventional endovascular embolization is performed.

Current Management of Middle Cerebral Artery Aneurysms

Neurosurgery ◽  
2012 ◽  
Vol 72 (3) ◽  
pp. 415-427 ◽  
Author(s):  
Ana Rodríguez-Hernández ◽  
Michael E. Sughrue ◽  
Sina Akhavan ◽  
Julian Habdank-Kolaczkowski ◽  
Michael T. Lawton
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Endovascular Therapy ◽  
Morbidity Rate ◽  
Surgical Morbidity ◽  
Unruptured Aneurysms ◽  
Poor Grade ◽  
Ruptured Aneurysms ◽  
Radiology Service ◽  
First Choice

Abstract BACKGROUND: One response to randomized trials like the International Subarachnoid Aneurysm Trial has been to adopt a “coil first” policy, whereby all aneurysms be considered for coiling, reserving surgery for unfavorable aneurysms or failed attempts. Surgical results with middle cerebral artery (MCA) aneurysms have been excellent, raising debate about the respective roles of surgical and endovascular therapy. OBJECTIVE: To review our experience with MCA aneurysms managed with microsurgery as the treatment of first choice. METHODS: Five hundred forty-three patients with 631 MCA aneurysms were managed with a “clip first” policy, with 115 patients (21.2%) referred from the Neurointerventional Radiology service and none referred from the Neurosurgical service for endovascular management. RESULTS: Two hundred eighty-two patients (51.9%) had ruptured aneurysms and 261 (48.1%) had unruptured aneurysms. MCA aneurysms were treated with clipping (88.6%), thrombectomy/clip reconstruction (6.2%), and bypass/aneurysm occlusion (3.3%). Complete aneurysm obliteration was achieved with 620 MCA aneurysms (98.3%); 89.7% of patients were improved or unchanged after therapy, with a mortality rate of 5.3% and a permanent morbidity rate of 4.6%. Good outcomes were observed in 92.0% of patients with unruptured and 70.2% with ruptured aneurysms. Worse outcomes were associated with rupture (P = .04), poor grade (P = .001), giant size (P = .03), and hemicraniectomy (P &lt; .001). CONCLUSION: At present, surgery should remain the treatment of choice for MCA aneurysms. Surgical morbidity was low, and poor outcomes were due to an inclusive policy that aggressively managed poor-grade patients and complex aneurysms. This experience sets a benchmark that endovascular results should match before considering endovascular therapy an alternative for MCA aneurysms.

scholarly journals The Choice of the Treatment Method for Cerebral Aneurysms of Different Locations in the Era of Advanced Endovascular Technologies: A Meta-Analysis

2016 ◽  
Vol 71 (1) ◽  
pp. 31-40 ◽  
Author(s):  
V. A. Byval’tsev ◽  
E. G. Belykh ◽  
I. A. Stepanov
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Meta Analysis ◽  
Cerebral Aneurysms ◽  
Microsurgical Treatment ◽  
Number Of Patients ◽  
Clinical Series

Relevance: Until recently, microsurgical clipping was the main method to eliminate cerebral aneurysms (CA) from the circulation. The rate of endovascular versus microsurgical treatment for CA of different locations in the era of rapidly emerging endovascular medicine is unknown. Aim: To study the frequency of microsurgical or endovascular techniques for the treatment of CA of different locations. Methods: Methods of treatment and localization of CA were studied in meta-analysis of clinical series published from 2003 to 2014. Case-control studies, studies with externally balanced number of patients in the groups, and the series in which a large number of patients were treated out the study were excluded. Results: 1 international, 2 American, 2 Japanese and 3 Russian clinical series (n=5254 CA) were included in the meta-analysis. The pooled rate of microsurgical treatment used for the CA of the internal carotid artery was 65% (95% CI 55−75), the anterior cerebral artery ― 65% (95% CI 46−84), the middle cerebral artery ― 90% (95% CI 82−98), and vertebrobasilar basin ― 39% (95% CI 41−64). Conclusions: In clinical series both methods of CA treatment were available but endovascular closure was used for the majority of vertebrobasilar basin aneurysms, and for more than a third of anterior cerebral artery or internal carotid artery aneurysms. Middle cerebral artery aneurysms, as opposed to CA of other locations, were subjected to microsurgical treatment in the most cases (90%). In some cases CA are not suitable for endovascular closure, or require microvascular reconstructive operations. In competition with less invasive but more expensive option of endovascular treatment, and under the conditions of decreasing volume and experience of open CA surgery, microsurgical techniques should be mastered to a high level which requires centralization of the patients in the specialized centers and microneurosurgical training. 

Giant Intracranial Aneurysms of the Anterior Circulation

Neurosurgery ◽  
1978 ◽  
Vol 3 (3) ◽  
pp. 356-363 ◽  
Author(s):  
Michael H. Lavyne ◽  
Kleefield Jonathan ◽  
Kenneth R. Davis ◽  
Robert G. Ojemann ◽  
Robert M. Crowell
Keyword(s):  
Ct Scan ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Contrast Material ◽  
Careful Analysis ◽  
Anterior Circulation ◽  
Iodinated Contrast ◽  
Middle Cerebral Artery Aneurysms

Abstract The computed tomography (CT) characteristics and clinical features of giant (globoid) aneurysms of the anterior circulation are reviewed. These lesions appear on the CT scan as smoothly encapsulated ovoid masses, within which a partially patent lumen is seen after the infusion of iodinated contrast material. With careful analysis of the CT scan it may be possible to differentiate giant internal carotid artery, anterior cerebral artery, and middle cerebral artery aneurysms from other parasellar and hemispheric lesions.

Anterior circulation aneurysms: anatomy and surgical techniques

2010 ◽  
pp. 573-580
Author(s):  
George Samandouras
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Surgical Techniques ◽  
Anterior Circulation ◽  
Middle Cerebral Artery Aneurysms ◽  
Anterior Circulation Aneurysms

Chapter 9.9 covers the anatomy and surgical techniques of anterior circulation aneurysms, internal carotid artery (ICA) aneurysms, anterior cerebral artery aneurysms, and middle cerebral artery aneurysms.

scholarly journals Predictive anatomical factors for rupture in middle cerebral artery mirror bifurcation aneurysms

2018 ◽  
Vol 128 (6) ◽  
pp. 1799-1807 ◽  
Author(s):  
Homajoun Maslehaty ◽  
Crescenzo Capone ◽  
Roman Frantsev ◽  
Igor Fischer ◽  
Ramazan Jabbarli ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Rupture Risk ◽  
Significance Level ◽  
Ruptured Aneurysms ◽  
Regular Shape ◽  
The Moment ◽  
The One ◽  
Aneurysm Shape

OBJECTIVEThe aim of this study was to define predictive factors for rupture of middle cerebral artery (MCA) mirror bifurcation aneurysms.METHODSThe authors retrospectively analyzed the data in patients with ruptured MCA bifurcation aneurysms with simultaneous presence of an unruptured MCA bifurcation mirror aneurysm treated in two neurosurgical centers. The following parameters were measured and analyzed with the statistical software R: neck, dome, and width of both MCA aneurysms—including neck/dome and width/neck ratios, shape of the aneurysms (regular vs irregular), inflow angle of both MCA aneurysms, and the diameters of the bilateral A1 and M1 segments and the frontal and temporal M2 trunks, as well as the bilateral diameter of the internal carotid artery (ICA).RESULTSThe authors analyzed the data of 44 patients (15 male and 29 female, mean age 50.1 years). Starting from the usual significance level of 0.05, the Sidak-corrected significance level is 0.0039. The diameter of the measured vessels was statistically not significant, nor was the inflow angle. The size of the dome was highly significant (p = 0.0000069). The size of the neck (p = 0.0047940) and the width of the aneurysms (p = 0.0056902) were slightly nonsignificant at the stated significance level of 0.0039. The shape of the aneurysms was bilaterally identical in 22 cases (50%). In cases of asymmetrical presentation of the aneurysm shape, 19 (86.4%) ruptured aneurysms were irregular and 3 (13.6%) had a regular shape (p = 0.001).CONCLUSIONSIn this study the authors show that the extraaneurysmal flow dynamics in mirror aneurysms are nonsignificant, and the aneurysmal geometry also does not seem to play a role as a predictor for rupture. The only predictors for rupture were size and shape of the aneurysms. It seems as though under the same conditions, one of the two aneurysms suffers changes in its wall and starts growing in a more or less stochastic manner. Newer imaging methods should enable practitioners to see which aneurysm has an unstable wall, to predict the rupture risk. At the moment one can only conclude that in cases of MCA mirror aneurysms the larger one, with or without shape irregularities, is the unstable aneurysm and that this is the one that needs to be treated.

scholarly journals Y-stent-assisted coil embolization of cerebral aneurysms

2014 ◽  
Vol 37 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Lee A. Tan ◽  
Andrew K. Johnson ◽  
Kiffon M. Keigher ◽  
Roham Moftakhar ◽  
Demetrius K. Lopes
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Complication Rate ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Link Type

Y-stent–assisted coiling is a technique used by neuroendovascular surgeons to treat complex, wide-necked, bifurcation aneurysms in locations such as basilar tip and middle cerebral artery bifurcation. Several recent studies have demonstrated low complication rate and favorable clinical and angiographic outcomes. The Y-stent technique is illustrated here in detail and the intraoperative nuances are also discussed to minimize potential complications associated with technique.The video can be found here: http://youtu.be/77pEmqx_fyQ.

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