Clinical Outcomes of Coil Embolization for Acutely Ruptured Aneurysm

The purpose of this prospective study was to evaluate clinical results in patients with acutely ruptured cerebral aneurysm treated by neck clipping (NC) or coil embolization (CE) when CE was considered the first option. Between 1998 and 2003, 280 patients with acutely ruptured cerebral aneurysms excluding intracerebral hematoma were evaluated. Patients were managed prospectively according to the following protocol: primary treatment modality was CE (n =179). NC (n=101) was selected for the patients with aneurysms that were small (less than 2 mm) or an unsuitable shape for CE. Surgical complication rates were 4.5% for CE and 16.8% for NC. Symptomatic vasospasm occurred in 8.4% of CE patients and 29% of NC patients. Good recovery on the Glasgow Outcome Scale was achieved by 71% of CE patients and 50% of NC patients at discharge. Surgical complications and symptomatic vasospasm were significantly reduced in CE compared to NC. Clinical outcome at discharge was also better with CE. Although 18.3% of CE patients showed various degrees of aneurysmal recanalization and 7% of CE patients required additional treatment (re-CE or NC), aneurysmal rebleeding occurred in only one patient during follow-up (mean, 3.95 years).

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Acute Operation and Preventive Nimodipine Improve Outcome in Patients with Ruptured Cerebral Aneurysms

Neurosurgery ◽

10.1227/00006123-198407000-00011 ◽

1984 ◽

Vol 15 (1) ◽

pp. 57-66 ◽

Cited By ~ 154

Author(s):

Ludwig M. Auer

Keyword(s):

Surgical Complication ◽

Cerebral Aneurysms ◽

Intracerebral Hematoma ◽

Improve Outcome ◽

Symptomatic Vasospasm ◽

Postoperative Control ◽

Intraventricular Bleeding ◽

Subarachnoid Blood ◽

Clinical Grading ◽

Control Angiography

Abstract Sixty-five patients with ruptured aneurysms were operated upon within 48 to 72 hours after subarachnoid hemorrhage (SAH) and were treated with a regimen of intra- and postoperative nimodipine for the prevention of symptomatic vasospasm. The clinical grading (Hunt and Hess) was I to III in 49 patients and IV or V in 16. The SAH was mild in 15 patients, moderate in 27, and severe in 23; 12 patients harbored an intracerebral hematoma, and 6 had intraventricular bleeding. Acute hydrocephalus was observed on preoperative computed tomography (CT) in 19 patients. On CT 3 days postoperatively (i.e., Day 3-4 after SAH), 30 of 65 patients still had subarachnoid blood; however, severe symptomatic vasospasm as the deciding threatening event during the delayed postoperative period was not encountered in this series. Transient symptoms of ischemia were noted in 2 patients (3%) and were accompanied by angiographic spasm in 1. Irreversible neurological deficit occurred in 2 patients (3%); in 1 of these, it was a complication of postoperative control angiography. Of the patients preoperatively graded I or II, 96% had an excellent to fair outcome 6 months postoperatively, and 1 patient (4%) had died because of a surgical complication. Among patients preoperatively graded III or IV, 86% had an excellent to fair outcome, and the remaining 14% had a poor outcome. Shunt-dependent hydrocephalus developed in 7% of the patients. Acute surgical repair of ruptured cerebral aneurysms and preventive topical and intravenous administration of nimodipine reduce management complications and improve outcome; above all, ischemic lesions from symptomatic vasospasm are reduced to a minimum.

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Treatment of cerebral aneurysms in children: analysis of the Kids' Inpatient Database

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.4.peds13464 ◽

2014 ◽

Vol 14 (1) ◽

pp. 23-30 ◽

Cited By ~ 23

Author(s):

Aws Alawi ◽

Randall C. Edgell ◽

Samer K. Elbabaa ◽

R. Charles Callison ◽

Yasir Al Khalili ◽

...

Keyword(s):

Hospital Mortality ◽

Coil Embolization ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Cerebral Aneurysms ◽

Endovascular Coiling ◽

Complication Rates ◽

Surgical Clipping ◽

Treatment Groups ◽

Risk Of Death ◽

Inpatient Database

Object Endovascular coiling and surgical clipping are viable treatment options of cerebral aneurysms. Outcome data of these treatments in children are limited. The objective of this study was to determine hospital mortality and complication rates associated with surgical clipping and coil embolization of cerebral aneurysms in children, and to evaluate the trend of hospitals' use of these treatments. Methods The authors identified a cohort of children admitted with the diagnoses of cerebral aneurysms and aneurysmal subarachnoid hemorrhage from the Kids' Inpatient Database for the years 1998 through 2009. Hospital-associated complications and in-hospital mortality were compared between the treatment groups and stratified by aneurysmal rupture status. A multivariate regression analysis was used to identify independent variables associated with in-hospital mortality. The Cochrane-Armitage test was used to assess the trend of hospital use of these operations. Results A total of 1120 children were included in this analysis; 200 (18%) underwent aneurysmal clipping and 920 (82%) underwent endovascular coiling. Overall in-hospital mortality was higher in the surgical clipping group compared with the coil embolization group (6.09% vs 1.65%, respectively; adjusted odds ratio [OR] 2.52, 95% CI 0.97–6.53, p = 0.05). The risk of postoperative stroke or hemorrhage was similar between the two treatment groups (p = 0.86). Pulmonary complications and systemic infection were higher in the surgical clipping population (p < 0.05). The rate of US hospitals' use of endovascular coiling has significantly increased over the years included in this study (p < 0.0001). Teaching hospitals were associated with a lower risk of death (OR 0.13, 95% CI 0.03–0.46; p = 0.001). Conclusions Although both treatments are valid, endovascular coiling was associated with fewer deaths and shorter hospital stays than clip placement. The trend of hospitals' use of coiling operations has increased in recent years.

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Angiographic findings of in-stent intimal hyperplasia after stent-assisted coil embolization: are they permanent findings?

Journal of Neurosurgery ◽

10.3171/2015.2.jns142557 ◽

2016 ◽

Vol 124 (2) ◽

pp. 328-333 ◽

Cited By ~ 10

Author(s):

Young Soo Kim ◽

Sang Won Lee ◽

Jeong A Yeom ◽

Chang Hyo Yoon ◽

Seung Kug Baik

Keyword(s):

Stent Implantation ◽

Coil Embolization ◽

Cerebral Aneurysms ◽

Additional Treatment ◽

Parent Artery ◽

Related Factors ◽

Conventional Angiography ◽

Unruptured Aneurysms ◽

Luminal Narrowing

OBJECT Stent-assisted coil embolization for the treatment of intracranial aneurysms has been used widely. This study aimed to investigate the effect of stent implantation in the nonatherosclerotic parent artery with cerebral aneurysms. The authors evaluated luminal changes and the related factors following stent-assisted coil embolization. METHODS This study included 97 patients harboring a total of 99 unruptured aneurysms of the distal internal carotid artery (ICA) who underwent single-stent implantation and more than 1 session of conventional angiography during follow-up (midterm follow-up only, n = 70; midterm and long-term follow-up, n = 29) between January 2009 and April 2014. The luminal narrowing point was measured using a local thickness map (ImageJ plug-in). RESULTS Stent-assisted coil embolization caused dynamic luminal narrowing of approximately 82% of the parent artery diameter on average after 8 months, which was reversed to 91% after 25 months. In addition, luminal narrowing greater than 40% was noticed in 2 (7%) of the 29 patients who experienced spontaneous reversion without additional management during follow-up. Most luminal narrowing changes seen were diffuse. CONCLUSIONS Luminal narrowing after aneurysm stent-assisted coil embolization is a dynamic process and appears to be a spontaneously reversible event. Routine management of luminal narrowing may not cause adverse events that require additional treatment.

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Cerebral Vasospasm in Patients over 80 Years Treated by Coil Embolization for Ruptured Cerebral Aneurysms

BioMed Research International ◽

10.1155/2014/253867 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

Tomohito Hishikawa ◽

Yuji Takasugi ◽

Tomohisa Shimizu ◽

Jun Haruma ◽

Masafumi Hiramatsu ◽

...

Keyword(s):

Clinical Outcomes ◽

Coil Embolization ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Cerebral Aneurysms ◽

Patient Characteristics ◽

Age Group ◽

Older Patient ◽

Symptomatic Vasospasm ◽

Group A ◽

Group B

Object. The effect on clinical outcomes of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage (SAH) in patients over 80 years who underwent coil embolization was evaluated.Methods. Forty-four cases were reviewed and divided into two groups according to patient age: Group A, 79 years or younger, and Group B, 80 or older. Patient characteristics, prevalence of symptomatic vasospasm, modified Rankin Scale (mRS) scores at discharge and frequency of symptomatic vasospasm in patients with mRS scores of 3–6 were analyzed.Results. Thirty-two (73%) of the 44 cases were categorized as Group A and 12 (27%) as Group B. Group B had a significantly higher prevalence of symptomatic vasospasm compared to Group A(P=0.0040). mRS scores at discharge were significantly higher in Group B than in Group A(P=0.0494). Among cases with mRS scores of 3–6, there was a significantly higher frequency of symptomatic vasospasm in Group B than in Group A(P=0.0223).Conclusions. In our cohort of aneurysmal SAH patients treated by coil embolization, patients over 80 years of age were more likely to suffer symptomatic vasospasm, which significantly correlated with worse clinical outcomes, than those 79 years and under.

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Comparison of Clinical Results Between a 4-point Scleral Fixation of Intraocular Lenses Using Gore-tex Suture and a 2-point Fixation Using Prolene Suture

10.21203/rs.3.rs-1182568/v1 ◽

2022 ◽

Author(s):

Jeong Mo Han ◽

Dong Min Cha ◽

Hee Chan Ku ◽

Dong Kwon Lim ◽

Eun Koo Lee ◽

...

Keyword(s):

Surgical Complication ◽

Good Alternative ◽

Clinical Results ◽

Intraocular Lenses ◽

Complication Rates ◽

Scleral Fixation ◽

Average Prediction Error ◽

Refractive Outcomes ◽

Significant Difference ◽

Prolene Suture

Abstract Purpose: To compare clinical outcomes between a 4-point scleral fixation of intraocular lenses (IOLs) using Gore-Tex suture or a 2-point scleral fixation using Prolene sutureMethods: In this multicenter, retrospective cohort study, patients were enrolled who had undergone a pars plana vitrectomy and either a 4-point scleral fixation using Gore-Tex suture or a 2-point scleral fixation using Prolene suture. Preoperative biometrics, postoperative refractive outcomes, and postoperative surgical complication rates were evaluated.Results: Thirty-seven eyes underwent scleral fixation with Gore-Tex suture, while 44 eyes underwent scleral fixation with Prolene suture. Postoperative best corrected visual acuity was 0.20 (± 0.34) in the Gore-Tex group and 0.21 (± 0.28) in the Prolene group (logMAR, 20/32 on the Snellen scale) (p = 0.691). No significant difference was found in the average prediction error between the Gore-Tex (-0.13 ± 0.68 D) and Prolene (-0.21 ± 1.27 D) groups (p = 0.077). The postoperative complication rate was lower in the Gore-Tex group (17%) than in the Prolene group (41%) (p = 0.023).Conclusion: A 4-point scleral fixation using Gore-Tex suture may be a good alternative to a conventional scleral fixation using Prolene suture for IOL implantations in eyes without capsular support, with a lower risk of postoperative complications.

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Treatment of Cerebral Aneurysms: Surgical Clipping and Coil Embolization

Interventional Neuroradiology ◽

10.1177/15910199070130s109 ◽

2007 ◽

Vol 13 (1_suppl) ◽

pp. 68-72 ◽

Cited By ~ 5

Author(s):

Y. Kaku ◽

H. Watarai ◽

J. Kokuzawa ◽

T. Tanaka ◽

T. Andoh

Keyword(s):

Coil Embolization ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Cerebral Aneurysms ◽

Endovascular Embolization ◽

Favorable Outcome ◽

Treatment Modalities ◽

Team Approach ◽

Complication Rates ◽

Surgical Clipping ◽

Significant Difference

The present series provides a balanced overview of the treatment of aneurysms in surgical clipping and coil embolization. Between January 2004 and March 2006, 76 consecutive patients with cerebral aneurysms underwent endovascular embolization and/or surgical clipping. Of these, 42 patients suffered an aneurysmal subarachnoid hemorrhage (SAH), while the remaining 34 patients had nonruptured cerebral aneurysms. Of the 23 surgically treated patients, 17 (73.9%) achieved a favorable outcome. Of the 19 patients who underwent endovascular embolization, 12 (63.2%) achieved a favorable outcome. Three patients (15.8%) who underwent endovascular embolization needed to undergo re-treatments, while no re-treatment was needed in the surgically treated patients. Of the 34 nonruptured aneurysms, 12 (35.3%) were treated using surgical clipping, while 22 (64.7%) underwent endovascular embolization. The complication rates of the two treatment modalities demonstrated no significant difference. A combined microsurgical-endovascular team approach is thus considered to provide the most effective means to achieve favorable outcomes for patients with cerebral aneurysms.

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Limitation of Endovascular Treatment for Ruptured Cerebral Aneurysms: Results from the Protocol “GDC as the First Choice”

Interventional Neuroradiology ◽

10.1177/15910199000060s104 ◽

2000 ◽

Vol 6 (1_suppl) ◽

pp. 43-47 ◽

Cited By ~ 4

Author(s):

M. Mase ◽

K. Yamada ◽

N. Aihara ◽

T. Banno ◽

K. Watanabe

Keyword(s):

Endovascular Treatment ◽

Coil Embolization ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Anticoagulation Therapy ◽

Cerebral Aneurysms ◽

Primary Treatment ◽

Endovascular Embolization ◽

Acute Stage ◽

Morbidity Rate ◽

First Choice

Since October, 1997, endovascular embolization using GDC has been our primary treatment for ruptured cerebral aneurysms in the acute stage. According to our protocol, an aneurysm more than 3 mm in diameter, without a wide-neck or massive intracranial hematoma is indicated for endovascular therapy. Under this protocol, we experienced 35 consecutive patients with aneurysmal subarachnoid hemorrhage, and 22 of them (62.8%) were treated endovascularly. The most common reason for the contra-indication of coil embolization was wide-necked aneurysm (9 cases). We experienced two cases with embolic stroke and one case with post-embolization hemorrhage as a complication after endovascular treatment. Morbidity rate due to the complications was 9.1%. In conclusion, a system that allows both surgical and endovascular treatments to be performed in any given case is necessary for the appropriate treatment of ruptured aneurysm. In order to avoid ischemic embolic complications, postoperative anticoagulation therapy is crucial. The safety of coil embolization for very thin-walled aneurysm is questionable.

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The impact of surgeon experience on perioperative complications and operative measures following thoracolumbar 3-column osteotomy for adult spinal deformity: overcoming the learning curve

Journal of Neurosurgery Spine ◽

10.3171/2019.7.spine19656 ◽

2020 ◽

Vol 32 (2) ◽

pp. 207-220 ◽

Cited By ~ 4

Author(s):

Darryl Lau ◽

Vedat Deviren ◽

Christopher P. Ames

Keyword(s):

Blood Loss ◽

Operative Time ◽

Surgical Complication ◽

Perioperative Complications ◽

Adult Spinal Deformity ◽

Neurological Deficits ◽

Complication Rates ◽

Years Of Experience ◽

Surgeon Experience ◽

Operative Measures

OBJECTIVEPosterior-based thoracolumbar 3-column osteotomy (3CO) is a formidable surgical procedure. Surgeon experience and case volume are known factors that influence surgical complication rates, but these factors have not been studied well in cases of adult spinal deformity (ASD). This study examines how surgeon experience affects perioperative complications and operative measures following thoracolumbar 3CO in ASD.METHODSA retrospective study was performed of a consecutive cohort of thoracolumbar ASD patients who underwent 3CO performed by the senior authors from 2006 to 2018. Multivariate analysis was used to assess whether experience (years of experience and/or number of procedures) is associated with perioperative complications, operative duration, and blood loss.RESULTSA total of 362 patients underwent 66 vertebral column resections (VCRs) and 296 pedicle subtraction osteotomies (PSOs). The overall complication rate was 29.4%, and the surgical complication rate was 8.0%. The rate of postoperative neurological deficits was 6.2%. There was a trend toward lower overall complication rates with greater operative years of experience (from 44.4% to 28.0%) (p = 0.115). Years of operative experience was associated with a significantly lower rate of neurological deficits (p = 0.027); the incidence dropped from 22.2% to 4.0%. The mean operative time was 310.7 minutes overall. Both increased years of experience and higher case numbers were significantly associated with shorter operative times (p < 0.001 and p = 0.001, respectively). Only operative years of experience was independently associated with operative times (p < 0.001): 358.3 minutes from 2006 to 2008 to 275.5 minutes in 2018 (82.8 minutes shorter). Over time, there was less deviation and more consistency in operative times, despite the implementation of various interventions to promote fusion and prevent construct failure: utilization of multiple-rod constructs (standard, satellite, and nested rods), bone morphogenetic protein, vertebroplasty, and ligament augmentation. Of note, the use of tranexamic acid did not significantly lower blood loss.CONCLUSIONSSurgeon years of experience, rather than number of 3COs performed, was a significant factor in mitigating neurological complications and improving quality measures following thoracolumbar 3CO for ASD. The 3- to 5-year experience mark was when the senior surgeon overcame a learning curve and was able to minimize neurological complication rates. There was a continuous decrease in operative time as the surgeon’s experience increased; this was in concurrence with the implementation of additional preventative surgical interventions. Ongoing practice changes should be implemented and can be done safely, but it is imperative to self-assess the risks and benefits of those practice changes.

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The impact of statin therapy after surgical or endovascular treatment of cerebral aneurysms

Journal of Neurosurgery ◽

10.3171/2019.3.jns183500 ◽

2020 ◽

Vol 133 (1) ◽

pp. 182-189

Author(s):

Tae-Jin Song ◽

Seung-Hun Oh ◽

Jinkwon Kim

Keyword(s):

Statin Therapy ◽

Coil Embolization ◽

Primary Outcome ◽

Cox Regression ◽

Cerebral Aneurysms ◽

Time Dependent ◽

Lipid Lowering ◽

Surgical Clipping ◽

The Impact

OBJECTIVECerebral aneurysms represent the most common cause of spontaneous subarachnoid hemorrhage. Statins are lipid-lowering agents that may expert multiple pleiotropic vascular protective effects. The authors hypothesized that statin therapy after coil embolization or surgical clipping of cerebral aneurysms might improve clinical outcomes.METHODSThis was a retrospective cohort study using the National Health Insurance Service–National Sample Cohort Database in Korea. Patients who underwent coil embolization or surgical clipping for cerebral aneurysm between 2002 and 2013 were included. Based on prescription claims, the authors calculated the proportion of days covered (PDC) by statins during follow-up as a marker of statin therapy. The primary outcome was a composite of the development of stroke, myocardial infarction, and all-cause death. Multivariate time-dependent Cox regression analyses were performed.RESULTSA total of 1381 patients who underwent coil embolization (n = 542) or surgical clipping (n = 839) of cerebral aneurysms were included in this study. During the mean (± SD) follow-up period of 3.83 ± 3.35 years, 335 (24.3%) patients experienced the primary outcome. Adjustments were performed for sex, age (as a continuous variable), treatment modality, aneurysm rupture status (ruptured or unruptured aneurysm), hypertension, diabetes mellitus, household income level, and prior history of ischemic stroke or intracerebral hemorrhage as time-independent variables and statin therapy during follow-up as a time-dependent variable. Consistent statin therapy (PDC > 80%) was significantly associated with a lower risk of the primary outcome (adjusted hazard ratio 0.34, 95% CI 0.14–0.85).CONCLUSIONSConsistent statin therapy was significantly associated with better prognosis after coil embolization or surgical clipping of cerebral aneurysms.

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Complications and Revisions After Spine Surgery in Patients With Skeletal Dysplasia: Have We Improved?

Global Spine Journal ◽

10.1177/2192568221994786 ◽

2021 ◽

pp. 219256822199478

Author(s):

Karim Shafi ◽

Francis Lovecchio ◽

Maria Sava ◽

Michael Steinhaus ◽

Andre Samuel ◽

...

Keyword(s):

Spine Surgery ◽

Skeletal Dysplasia ◽

Spinal Surgery ◽

Cardiovascular Health ◽

Surgical Complication ◽

Case Series ◽

Neurologic Complication ◽

Complication Rates ◽

Retrospective Case ◽

Average Patient

Study Design: Retrospective case series. Objective: To report contemporary rates of complications and subsequent surgery after spinal surgery in patients with skeletal dysplasia. Methods: A case series of 25 consecutive patients who underwent spinal surgery between 2007 and 2017 were identified from a single institution’s skeletal dysplasia registry. Patient demographics, medical history, surgical indication, complications, and subsequent surgeries (revisions, extension to adjacent levels, or for pathology at a non-contiguous level) were collected. Charlson comorbidity indices were calculated as a composite measure of overall health. Results: Achondroplasia was the most common skeletal dysplasia (76%) followed by spondyloepiphyseal dysplasia (20%); 1 patient had diastrophic dysplasia (4%). Average patient age was 53.2 ± 14.7 years and most patients were in excellent cardiovascular health (88% Charlson Comorbidity Index 0-4). Mean follow up after the index procedure was 57.4 ± 39.2 months (range). Indications for surgery were mostly for neurologic symptoms. The most commonly performed surgery was a multilevel thoracolumbar decompression without fusion (57%). Complications included durotomy (36%), neurologic complication (12%), and infection requiring irrigation and debridement (8%). Nine patients (36%) underwent a subsequent surgery. Three patients (12%) underwent a procedure at a non-contiguous anatomic zone, 3 (12%) underwent a revision of the previous surgery, and another 3 (12%) required extension of their previous decompression or fusion. Conclusions: Surgical complication rates remain high after spine surgery in patients with skeletal dysplasia, likely attributable to inherent characteristics of the disease. Patients should be counseled on their risk for complication and subsequent surgery.

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