Risk of Hemorrhage in Combined Neuroform Stenting and Coil Embolization of Acutely Ruptured Intracranial Aneurysms

Stenting as adjuvant therapy for the coiling of acutely ruptured aneurysms remains controversial due to the necessity of anticoagulation and antiplatelet medications. We report our experience using the Neuroform stent in the management of 41 aneurysms in 40 patients over a period of three years. For aneurysms whose open surgical risk remains excessive with a morphology that would preclude complete embolization, the risks of stenting may be warranted.

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Comparison of stent-assisted and no-stent coil embolization for safety and effectiveness in the treatment of ruptured intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/2019.5.jns19988 ◽

2020 ◽

Vol 133 (3) ◽

pp. 814-820 ◽

Cited By ~ 2

Author(s):

Haewon Roh ◽

Junwon Kim ◽

Heejin Bae ◽

Kyuha Chong ◽

Jong Hyun Kim ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

High Risk ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Viable Option ◽

Safety And Efficacy ◽

Ruptured Aneurysms ◽

Hemorrhagic Complications ◽

Acute Subarachnoid Hemorrhage ◽

Ruptured Intracranial Aneurysms

OBJECTIVEThe safety of the stent-assisted coil embolization (SAC) technique for acutely ruptured aneurysms has not been established yet. SAC is believed to be associated with a high risk of thromboembolic and hemorrhagic complications in acute subarachnoid hemorrhage (SAH). The aim of this study was to evaluate the safety and efficacy of the SAC technique in the setting of acutely ruptured aneurysm.METHODSA total of 102 patients who received endovascular treatment for acute SAH between January 2011 and December 2017 were enrolled. The SAC technique was performed in 38 of these patients, whereas the no-stent coil embolization (NSC) technique was performed in 64. The safety and efficacy of the SAC technique in acute SAH was evaluated as compared with the NSC technique by retrospective analysis of radiological and clinical outcomes.RESULTSThere were no significant differences in clinical or angiographic outcomes between the SAC and NSC techniques in patients with acute SAH. The rate of ventriculostomy-related hemorrhagic complications was higher in the SAC group than that in the NSC group (63.6% vs 12.5%; OR 12.25, 95% CI 1.78–83.94, p = 0.01). However, all these complications were asymptomatic and so small that they were only able to be diagnosed with imaging.CONCLUSIONSRuptured wide-necked aneurysms could be effectively and safely treated with the SAC technique, which showed clinical and angiographic outcomes similar to those of the NSC technique. Hence, the SAC technique with dual-antiplatelet drugs may be a viable option even in acute SAH.

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Rescue mechanical thrombectomy using a retrievable stent for thromboembolic occlusion occurring during coil embolization of ruptured intracranial aneurysms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012457 ◽

2016 ◽

Vol 9 (3) ◽

pp. 244-249 ◽

Cited By ~ 7

Author(s):

Jun Hyong Ahn ◽

Hyo Sub Jun ◽

Joon Ho Song ◽

Byung Moon Cho ◽

Ho Kook Lee ◽

...

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Mechanical Thrombectomy ◽

Thromboembolic Complications ◽

Parent Vessel ◽

Safety And Efficacy ◽

Ruptured Aneurysms ◽

Hemorrhagic Complications ◽

Ruptured Intracranial Aneurysms ◽

Retrievable Stent

ObjectiveTo examine the safety and efficacy of mechanical thrombectomy using a retrievable stent for thromboembolic occlusion occurring during coil embolization of ruptured intracranial aneurysms.MethodsBetween June 2011 and June 2015, 631 consecutive patients with ruptured intracranial aneurysms underwent coil embolization at 6 hospitals. Among 53 patients who had thromboembolic complications, 15 patients harboring 15 aneurysms underwent rescue mechanical thrombectomy with a retrievable stent for the treatment of thromboembolic occlusion during the coiling of ruptured aneurysms. The patients' clinical and radiologic outcomes were retrospectively reviewed.ResultsOf the 15 aneurysms, coiling alone was used for 13 (86.7%), and stent-assisted coiling was performed for 2 (13.3%). Thromboembolic occlusion most frequently occurred distal to the aneurysm (n=10, 66.7%), followed by proximal to the aneurysm (n=3, 20%), and at the coil−parent vessel interface (n=2, 13.3%). All patients underwent mechanical thrombectomy with a retrievable stent, including 5 patients who were initially treated with an IA tirofiban infusion. Complete recanalization (Thrombolysis in Cerebral Infarction (TICI) 3) was obtained in 13 (86.7%) and partial recanalization (TICI 2b) in 2 (13.3%). Two patients who had received IA tirofiban before mechanical thrombectomy had hemorrhagic complications. At 6 months after discharge, 9 patients had a modified Rankin Scale (mRS) score of 1, 3 patients were mRS 2, 1 patient was mRS 3, 1 patient was mRS 4, and 1 patient was mRS 6.ConclusionsRescue mechanical thrombectomy using a retrievable stent can be a useful treatment for thromboembolic occlusion occurring during coil embolization of ruptured intracranial aneurysms.

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Porous Media Computational Fluid Dynamics and the Role of the First Coil in the Embolization of Ruptured Intracranial Aneurysms

Journal of Clinical Medicine ◽

10.3390/jcm10071348 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1348

Author(s):

Karol Wiśniewski ◽

Bartłomiej Tomasik ◽

Zbigniew Tyfa ◽

Piotr Reorowicz ◽

Ernest Bobeff ◽

...

Keyword(s):

Fluid Dynamics ◽

Computational Fluid Dynamics ◽

Porous Media ◽

Packing Density ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Patient Specific ◽

Computational Fluid Dynamics Analysis ◽

Ruptured Intracranial Aneurysms ◽

Statistical Results

Background: The objective of our project was to identify a late recanalization predictor in ruptured intracranial aneurysms treated with coil embolization. This goal was achieved by means of a statistical analysis followed by a computational fluid dynamics (CFD) with porous media modelling approach. Porous media CFD simulated the hemodynamics within the aneurysmal dome after coiling. Methods: Firstly, a retrospective single center analysis of 66 aneurysmal subarachnoid hemorrhage patients was conducted. The authors assessed morphometric parameters, packing density, first coil volume packing density (1st VPD) and recanalization rate on digital subtraction angiograms (DSA). The effectiveness of initial endovascular treatment was visually determined using the modified Raymond–Roy classification directly after the embolization and in a 6- and 12-month follow-up DSA. In the next step, a comparison between porous media CFD analyses and our statistical results was performed. A geometry used during numerical simulations based on a patient-specific anatomy, where the aneurysm dome was modelled as a separate, porous domain. To evaluate hemodynamic changes, CFD was utilized for a control case (without any porosity) and for a wide range of porosities that resembled 1–30% of VPD. Numerical analyses were performed in Ansys CFX solver. Results: A multivariate analysis showed that 1st VPD affected the late recanalization rate (p < 0.001). Its value was significantly greater in all patients without recanalization (p < 0.001). Receiver operating characteristic curves governed by the univariate analysis showed that the model for late recanalization prediction based on 1st VPD (AUC 0.94 (95%CI: 0.86–1.00) is the most important predictor of late recanalization (p < 0.001). A cut-off point of 10.56% (sensitivity—0.722; specificity—0.979) was confirmed as optimal in a computational fluid dynamics analysis. The CFD results indicate that pressure at the aneurysm wall and residual flow volume (blood volume with mean fluid velocity > 0.01 m/s) within the aneurysmal dome tended to asymptotically decrease when VPD exceeded 10%. Conclusions: High 1st VPD decreases the late recanalization rate in ruptured intracranial aneurysms treated with coil embolization (according to our statistical results > 10.56%). We present an easy intraoperatively calculable predictor which has the potential to be used in clinical practice as a tip to improve clinical outcomes.

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Intraarterial Tirofiban Thrombolysis for Thromboembolisms During Coil Embolization for Ruptured Intracranial Aneurysms

Journal of Cerebrovascular and Endovascular Neurosurgery ◽

10.7461/jcen.2012.14.1.5 ◽

2012 ◽

Vol 14 (1) ◽

pp. 5 ◽

Cited By ~ 10

Author(s):

Jin Sue Jeon ◽

Seung Hun Sheen ◽

Gyojun Hwang ◽

Suk Hyung Kang ◽

Dong Hwa Heo ◽

...

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Ruptured Intracranial Aneurysms

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125 Staged Endovascular Treatment of Ruptured Intracranial Aneurysms: Acute Coiling Followed By Delayed Flow Diversion

Neurosurgery ◽

10.1093/neuros/nyx417.125 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 228-228

Author(s):

Erick Michael Westbroek ◽

Matthew Bender ◽

Narlin B Beaty ◽

Bowen Jiang ◽

Risheng Xu AB ◽

...

Keyword(s):

Endovascular Treatment ◽

Complication Rate ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Major Complication ◽

Flow Diversion ◽

Neurological Deficits ◽

Major Complication Rate ◽

Ruptured Intracranial Aneurysms

Abstract INTRODUCTION ISAT demonstrated that coiling is effective for aneurysm treatment in subarachnoid hemorrhage (SAH); however, complete occlusion of wide-necked aneurysms frequently requires adjuvants relatively contraindicated in SAH. As such, a limited “dome occlusive” strategy is often pursued in the setting of SAH. We report a single institution series of coiling of acutely ruptured aneurysms followed by delayed flow diversion for definitive, curative occlusion. METHODS A prospectively collected IRB-approved database was screened for patients with aneurysmal SAH who were initially treated by coil embolization followed by planned flow diversion at a single academic medical institution. Peri-procedural outcomes, complications, and angiographic follow-up were analyzed. RESULTS >50 patients underwent both acute coiling followed by delayed, planned flow diversion. Average aneurysm size on initial presentation was 9.5 mm. Common aneurysm locations included Pcomm (36%), Acomm (30%), MCA (10%), ACA (10%), and vertebral (5%). Dome occlusion was achieved in all cases following initial coiling. Second-stage implantation of a flow diverting stent was achieved in 49/50 cases (98%). Follow-up angiography was available for 33/50 patients (66%), with mean follow-up of 11 months. 27 patients (82%) had complete angiographic occlusion at last follow up. All patients with residual filling at follow-up still had dome occlusion. There were no mortalities (0%). Major complication rate for stage I coiling was 2% (1 patient with intra-procedural aneurysm re-rupture causing increase in a previous ICH). Major complication rate for stage 2 flow diversion was 2% (1 patient with ischemic stroke following noncompliance with dual antiplatelet regimen). Minor complications occurred in 2 additional patients (4%) with transient neurological deficits. CONCLUSION Staged endovascular treatment of ruptured intracranial aneurysms with acute dome-occlusive coil embolization followed by delayed flow diversion is a safe and effective treatment strategy.

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Stent salvage using the Enterprise stent for procedure-related complication during coil embolization of ruptured intracranial aneurysms

Acta Neurochirurgica ◽

10.1007/s00701-012-1528-5 ◽

2012 ◽

Vol 155 (2) ◽

pp. 223-229 ◽

Cited By ~ 7

Author(s):

Joonho Chung ◽

Yong Bae Kim ◽

Chang-Ki Hong ◽

Jin Yang Joo ◽

Yong Sam Shin ◽

...

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Related Complication ◽

Ruptured Intracranial Aneurysms

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Neurological outcomes following intraprocedural rerupture during coil embolization of ruptured intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/2014.9.jns14616 ◽

2015 ◽

Vol 122 (1) ◽

pp. 128-135 ◽

Cited By ~ 14

Author(s):

Christopher J. Stapleton ◽

Brian P. Walcott ◽

William E. Butler ◽

Christopher S. Ogilvy

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Aneurysmal Subarachnoid Hemorrhage ◽

External Ventricular Drain ◽

Endovascular Coiling ◽

Neurological Outcomes ◽

Symptomatic Vasospasm ◽

Increased Risk ◽

Ruptured Intracranial Aneurysms

OBJECT Intraprocedural rerupture (IPR) of intracranial aneurysms during coil embolization is associated with significant periprocedural disability and death. However, whether this morbidity and mortality are secondary to an increased risk of vasospasm and hydrocephalus is unknown. The authors undertook this study to determine the in-hospital and long-term neurological outcomes for patients with aneurysmal subarachnoid hemorrhage (SAH) treated with coil embolization who suffer aneurysm rerupture during treatment. METHODS The records of 156 patients admitted with SAH from previously untreated, ruptured, intracranial aneurysms and treated with endovascular coiling between January 2007 and January 2014 were retrospectively reviewed. Twelve patients (7.7%) experienced IPR during coil embolization. RESULTS Compared with the cohort of patients with uncomplicated coil embolization procedures, patients with aneurysm rerupture were more likely to require external ventricular drain (EVD) placement (91.7% vs 58.3%, p = 0.02) and postprocedural EVD placement (36.4% vs 7.1%, p = 0.01), to undergo permanent ventriculoperitoneal shunt placement (50.0% vs 18.8%, p = 0.02), to develop symptomatic vasospasm (50.0% vs 18.1%, p = 0.02), and to have longer lengths of hospital stay (median 21.5 days vs 15.0 days, p = 0.04). Admission Hunt and Hess, modified Fisher, and Barrow Neurological Institute grades did not differ between the 2 cohorts, nor did long-term functional neurological outcomes as assessed by the modified Rankin Scale. CONCLUSIONS Intraprocedural rerupture during coil embolization for ruptured intracranial aneurysms is associated with an increased risk of symptomatic vasospasm and need for temporary and permanent cerebrospinal fluid diversion for hydrocephalus.

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