scholarly journals Relationship between Focal Inflammation and Symptom Exacerbation after Endovascular Coil Embolization for Symptomatic Intracranial Aneurysms

2008 ◽  
Vol 14 (2) ◽  
pp. 179-184
Author(s):  
S. Suzuki ◽  
A. Kurata ◽  
K. Iwamoto ◽  
M. Yamada ◽  
J. Niki ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Cranial Nerve ◽  
Anticoagulation Therapy ◽  
Unruptured Aneurysms ◽  
Anti Platelet Therapy ◽  
Symptom Exacerbation ◽  
Endovascular Coil Embolization ◽  
Inflammatory Drugs ◽  
Continuous Injection

As endovascular surgery (EVS) of symptomatic unruptured aneurysms can result in symptom exacerbation due to intra-aneurysmal thrombosis or lump formation by coils, this treatment remains controversial. We present five women ranging in age from 58 to 76 years (mean 65.6 years) who suffered post-EVS symptom exacerbation attributable to local inflammation. The aneurysms measured from 8 to 25 mm (mean 19 mm) and were located at the cavernous portion in four patients and at the origin of the ophthalmic artery in one. All underwent endosaccular embolization under local anesthesia. Immediately after embolization, 24 h anticoagulation therapy was started via the continuous injection of heparin; they also received anti-platelet therapy. At one to three days post-EVS, all five patients manifested worsening of their cranial nerve symptoms. In three other patients the symptoms were improved after EVS. We posit that inflammation induced by coil embolization may worsen cranial nerve symptoms transiently. Our findings suggest that post-EVS follow-up is necessary and that patients exhibiting an inflammatory reaction be treated with anti-inflammatory drugs.

scholarly journals Early experience with a novel net temporary bridging device (Cascade) to assist endovascular coil embolization of intracranial aneurysms

2020 ◽  
pp. 1-9
Author(s):  
Alejandro Tomasello ◽  
David Hernandez ◽  
Laura Ludovica Gramegna ◽  
Sonia Aixut ◽  
Roger Barranco Pons ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Type I ◽  
Type Ii ◽  
Unruptured Aneurysms ◽  
Complete Obliteration ◽  
Acute Subarachnoid Hemorrhage ◽  
Endovascular Coil Embolization ◽  
The Mean

OBJECTIVEThe goal of this study was to evaluate the effectiveness and safety of a new noncompletely occlusive net-assisted remodeling technique in which the Cascade net device is used for temporary bridging of intracranial aneurysms.METHODSBetween July 2018 and May 2019, patients underwent coil embolization with the Cascade net device within 4 centers in Europe. Analysis of angiographic (modified Raymond-Roy classification [MRRC]) and clinical outcomes data was conducted immediately following treatment and at the 6-month follow-up.RESULTSFifteen patients were included in the study (mean age 58 ± 13 years, 11/15 [73.3%] female). Ten patients had unruptured aneurysms, and 5 presented with ruptured aneurysms with acute subarachnoid hemorrhage. The mean aneurysm dome length was 6.27 ± 2.33 mm and the mean neck width was 3.64 ± 1.19 mm. Immediately postprocedure, MRRC type I (complete obliteration) was achieved in 11 patients (73.3%), whereas a type II (residual neck) was achieved in 4 patients (26.7%). Follow-up examination was performed in 7/15 patients and showed stabilization of aneurysm closure with no thromboembolic complications and only 1 patient with an increased MRRC score (from I to II) due to coil compression.CONCLUSIONSInitial experience shows that the use of a new noncompletely occlusive net-assisted remodeling technique with the Cascade net device may be safe and effective for endovascular coil embolization of intracranial aneurysms.

INITIAL EXPERIENCE WITH BIOACTIVE CERECYTE DETACHABLE COILS

Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. 799-806 ◽  
Author(s):  
Erol Veznedaroglu ◽  
Christopher J. Koebbe ◽  
Adnan Siddiqui ◽  
Robert H. Rosenwasser
Keyword(s):  
Coil Embolization ◽  
Unruptured Aneurysms ◽  
Handling Characteristics ◽  
Platinum Coil ◽  
Detachable Coils ◽  
Mean Size ◽  
Endovascular Coil Embolization ◽  
The Mean ◽  
Permanent Neurological Deficit

Abstract OBJECTIVE Despite proven safety of endovascular coil embolization of intracranial aneurysms, the potential need for retreatment remains criticized. The goal of this prospective study was to assess the safety, durability, and effect on recanalization rates of the Cerecyte (Micrus Corp., Sunnyvale, CA) bioactive coil. METHODS Two hundred twelve ruptured and unruptured aneurysms in 176 patients were prospectively enrolled in a database registry during a 12-month period. Adverse clinical outcomes directly attributed to the use of the Cerecyte coil were documented. Angiographic outcomes were determined immediately after coil embolization and during follow-up studies. All patients who received stent assistance or a non-Cerecyte coil were excluded. Two independent endovascular surgeons reviewed follow-up films. Any discrepancy was deemed a recurrence. RESULTS After exclusion criteria, 81 patients with 89 aneurysms were available for a minimum of 6 months of follow-up. Of those 89 aneurysms, 65% were ruptured aneurysms and were treated in the acute setting. The mean size of the aneurysm was 7 mm. The mean angiographic follow-up period was 11.2 months. Recurrences requiring retreatment as a result of dome filling were identified in six aneurysms (6.7%). Four aneurysms (4%) developed compaction of more than 20%, which was defined as interstitial filling of the fundus. There was one thromboembolic event leading to permanent neurological deficit. No cases of chemical meningitis or delayed hydrocephalus occurred. CONCLUSION The Cerecyte bioactive coil seems to be safe and effective for use in both ruptured and unruptured aneurysms. The bioactive polymer within the coils allows similar handling characteristics of a bare platinum coil. Studies to assess long-term outcomes with direct comparison to platinum coils and alternative bioactive coils are warranted.

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 Spinal Cord Infarction is an Unusual Complication of Intracranial Neuroendovascular Intervention

2013 ◽  
Vol 19 (4) ◽  
pp. 500-505 ◽  
Author(s):  
Noriaki Matsubara ◽  
Shigeru Miyachi ◽  
Takeshi Okamaoto ◽  
Takashi Izumi ◽  
Takumi Asai ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Coil Embolization ◽  
Cranial Nerve ◽  
Cervical Spinal Cord ◽  
Posterior Circulation ◽  
Spinal Cord Infarction ◽  
Unusual Complication ◽  
Flow Restriction ◽  
Catheter Technique ◽  
Endovascular Coil Embolization

Spinal cord infarction is an unusual complication of intracranial neuroendovascular intervention. The authors report on two cases involving spinal cord infarction after endovascular coil embolization for large basilar-tip aneurysms. Each aneurysm was sufficiently embolized by the stent/balloon combination-assisted technique or double catheter technique. However, postoperatively, patients presented neurological symptoms without cranial nerve manifestation. MRI revealed multiple infarctions at the cervical spinal cord. In both cases, larger-sized guiding catheters were used for an adjunctive technique. Therefore, guiding catheters had been wedged in the vertebral artery (VA). The wedge of the VA and flow restriction may have caused thromboemboli and/or hemodynamic insufficiency of the spinal branches from the VA (radiculomedullary artery), resulting in spinal cord infarction. Spinal cord infarction should be taken into consideration as a complication of endovascular intervention for lesions of the posterior circulation.

Progressive thrombosis of unruptured aneurysms after coil embolization: analysis of 255 consecutive aneurysms

2019 ◽  
Vol 11 (11) ◽  
pp. 1113-1117 ◽  
Author(s):  
Yusuke Funakoshi ◽  
Hirotoshi Imamura ◽  
Shoichi Tani ◽  
Hidemitsu Adachi ◽  
Ryu Fukumitsu ◽  
...  
Keyword(s):  
Contrast Agent ◽  
Digital Subtraction Angiography ◽  
Coil Embolization ◽  
Endovascular Procedure ◽  
Digital Subtraction ◽  
Unruptured Aneurysms ◽  
Aneurysm Neck ◽  
Complete Obliteration ◽  
Neck Diameter

IntroductionWe have observed that aneurysms treated by insufficient coil embolization and filled with contrast agent immediately after the procedure are often completely occluded at follow-up. However, there are limited studies showing progressive thrombosis of aneurysms after coil embolization. Herein, we describe our experience with coil embolization for aneurysms, and discuss the factors involved in progressive thrombosis.MethodsA total of 255 aneurysms treated by coil embolization in our institute between January 2011 and June 2017 and observed >6 months were included. ‘Progressive thrombosis’ indicated that aneurysms that were neck remnant (NR) or dome filling (DF) immediately after coil embolization changed to complete obliteration (CO) at the 6-month follow-up digital subtraction angiography. The factors involved in progressive thrombosis were assessed.ResultsIn all aneurysms (n=255), 24 (9.4%) were CO, 82 (32.2%) were NR, and 149 (58.4%) were DF immediately after the procedure. At 6-month digital subtraction angiography, 123 (48.2%) were CO, 95 (37.3%) were NR, and 37 (14.5%) were DF. Retreatment for major recanalization was performed in eight cases (3.1%). One hundred and three aneurysms showed progressive thrombosis. There were significant differences in aneurysm location (P=0.0002), aneurysm dome diameter (P=0.0015), aneurysm neck diameter (P=0.0068), volume embolization ratio (P=0.0054), and endovascular procedure with stent (P=0.0264) between the progressive thrombosis and no thrombosis groups.ConclusionsProgressive thrombosis can occur in aneurysms after coil embolization depending on aneurysm location and size, and stent use. Thus, the degree of coil embolization and combination with a stent should be adjusted depending on aneurysm type.

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