Rate of Recanalization and Safety of Endovascular Embolization of Intracranial Saccular Aneurysms Framed with GDC 360 Coils

Coil compaction and recanalization of cerebral aneurysms treated with coil embolization continue to be of great concern, especially in patients that presented with subarachnoid hemorrhage. The incidence of recanalization reported by previous studies ranges from 12 to 40 percent in experienced centers. We reviewed the incidence of recanalization requiring retreatment in patients treated with GDC 360 framing coils. A retrospective review of every patient who underwent coil embolization with GDC 360 coils for saccular aneurysms at our institution from December 2004 to March 2008 was performed. We studied the patients' demographics, clinical presentation, aneurysm size and configuration, type of coils used to embolize the aneurysm, the percentage of coils that were GDC 360 in any given aneurysm, the need for remodeling techniques like stent and/or balloon for embolization, immediate complications, cases in which we were unable to frame with the GDC 360 coil, and rate of recanalization on follow-up. A total of 110 patients (33 men, 77 women) and 114 aneurysms were treated with GDC 360 coils. Ninety-eight aneurysms were framed with the GDC 360 coils. There were two patients in whom the initial GDC 360 coil intended for framing had to be pulled out and exchanged for another type of coil. There were five procedure related complications (4.4%). Four patients required intra-arterial abciximab due to thrombus formation. One patient that presented with a grade III subarachnoid hemorrhage had aneurysm rupture while the coil was being advanced. A total of 50 patients (15 men and 35 women) underwent follow-up femoral cerebral angiograms at least six months after coiling (mean follow-up was 15 months). Forty-four of the patients with follow-up had the GDC 360 coil used as a framing coil. Three patients (6%) required retreatment due to recanalization. Every patient with recanalization requiring treatment had aneurysms of the anterior communicating complex that presented with subarachnoid hemorrhage. The rate of recanalization of cerebral aneurysms embolized with GDC 360 framing coils was lower in our case series compared to the existing literature reports. Patients with aneurysms of the anterior communicating artery were at increased incidence of recanalization in our patient cohort.

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Comaneci-Assisted Coiling as a Treatment Option for Acutely Ruptured Wide Neck Cerebral Aneurysm: Case Series of 118 Patients

Neurosurgery ◽

10.1093/neuros/nyaa200 ◽

2020 ◽

Author(s):

Alexander Sirakov ◽

Krasimir Minkin ◽

Marin Penkov ◽

Kristian Ninov ◽

Vasil Karakostov ◽

...

Keyword(s):

Cerebral Artery ◽

Coil Embolization ◽

Case Series ◽

Cerebral Aneurysms ◽

Morbidity Rate ◽

Anterior Communicating Artery ◽

Parent Artery ◽

Simultaneous Application ◽

Procedural Complications

Abstract Background Wide-necked cerebral aneurysms in the setting of acute subarachnoid hemorrhage (SAH) remain difficult to treat with endovascular methods despite recent progress in the neuroendovascular field. Objective To evaluate the effectiveness and safety of the Comaneci device (Rapid Medical, Israel) in endovascular coil embolization of acutely ruptured, wide-necked sidewall, or bifurcation cerebral aneurysms. Methods We retrospectively reviewed 45 anterior communicating artery, 24 internal carotid artery, 21 middle cerebral artery bifurcation, 15 anterior cerebral artery, and 13 posterior circulation aneurysms, which were treated using Comaneci-assisted coil embolization from August 2017 to January 2019. We evaluated procedural complications, clinical outcomes, and mid-term angiographic follow-up. Immediate and 90 d-clinical outcome and radiological follow-up were obtained in all patients. Results Comaneci-assisted coil embolization was performed in 118 acutely ruptured aneurysms. The technique was carried out successfully in all cases. Simultaneous application of 2 separated Comaneci devices was performed in 8/118 cases (6.77%). Periprocedural thromboembolic complications related to the device were seen in 7/118 cases (5.93%) and severe vasospasm of the parent artery after manipulation of the Comaneci device occurred in 5/118 cases (4.2%). The procedural-related morbidity rate was 2.54%, and there was no procedural related mortality. Among the available survivors, angiographic follow-ups were obtained at 3 and 6 mo, and complete aneurysmal obliteration was confirmed in 81/112 (72.3%) and 75/112 (66.9%) cases, respectively. Mid-term follow-up reviewed total recanalization rate of 14.28%. Conclusion Comaneci-assisted embolization of wide-necked intracranial aneurysms in patients presenting with acute SAH is associated with high procedural safety and adequate occlusion rates. Furthermore, dual antiplatelet therapy can be safely avoided in this patient group.

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Thromboembolic complications during endovascular treatment of ruptured cerebral aneurysms

Interventional Neuroradiology ◽

10.1177/1591019917739448 ◽

2017 ◽

Vol 24 (1) ◽

pp. 29-39 ◽

Cited By ~ 4

Author(s):

Motohiro Nomura ◽

Kentaro Mori ◽

Akira Tamase ◽

Tomoya Kamide ◽

Syunsuke Seki ◽

...

Keyword(s):

Cerebral Artery ◽

Thrombus Formation ◽

Antiplatelet Agent ◽

Cerebral Aneurysms ◽

Antiplatelet Agents ◽

Endovascular Embolization ◽

Aneurysm Rupture ◽

Anterior Communicating Artery ◽

Close Observation ◽

Anterior Choroidal

Background In cases of subarachnoid hemorrhage due to aneurysm rupture, the administration of an anticoagulant or antiplatelet agent involves the risk of rebleeding from the aneurysm. There is a possibility of inducing thromboembolic events during the endovascular embolization of ruptured cerebral aneurysms. Patients and methods From April 2006 to March 2017, we treated a total of 70 patients with ruptured cerebral aneurysms with an endovascular technique. Among them, five patients (7.1%) showed intra-arterial thrombus formation. The aneurysms were located at the anterior communicating artery and basilar artery in two patients each, and on the internal carotid artery at the bifurcation of the anterior choroidal artery (AChoA) in one. In these patients, the clinical course, radiological findings, and management were retrospectively reviewed. Results Thrombus formation was observed in the posterior cerebral artery, anterior cerebral artery (A2), AChoA, and middle cerebral artery. The timing of thrombus formation was during coil delivery in four cases, and guiding catheter advancement in one. As for thrombus management, for all patients, administrations of heparin and antiplatelet agents were performed. For four patients, urokinase injection into the affected arteries was added after the completion of embolization. Cerebral infarction was postoperatively identified in two patients, but no hemorrhage was noted. Conclusion Administrations of heparin and antiplatelet drugs should be performed appropriately during procedures, and close observation of the arterial condition on angiography is necessary. Once thromboembolism occurs during the endovascular embolization of ruptured cerebral aneurysms, adequate heparinization, and antiplatelet therapy should first be performed.

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LVIS Blue as a low porosity stent and coil adjuvant

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2017-013608 ◽

2018 ◽

Vol 10 (7) ◽

pp. 682-686 ◽

Cited By ~ 7

Author(s):

Matthew J Koch ◽

Christopher J Stapleton ◽

Scott B Raymond ◽

Susan Williams ◽

Thabele M Leslie-Mazwi ◽

...

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Posterior Inferior Cerebellar Artery ◽

Endovascular Embolization ◽

Superior Cerebellar Artery ◽

Anterior Communicating Artery ◽

Aneurysm Neck ◽

Proximal Internal Carotid Artery ◽

Cerebellar Artery

IntroductionThe LVIS Blue is an FDA-approved stent with 28% metallic coverage that is indicated for use in conjunction with coil embolization for the treatment of intracranial aneurysms. Given a porosity similar to approved flow diverters and higher than currently available intracranial stents, we sought to evaluate the effectiveness of this device for the treatment of intracranial aneurysms.MethodsWe performed an observational single-center study to evaluate initial occlusion and occlusion at 6-month follow-up for patients treated with the LVIS Blue in conjunction with coil embolization at our institution using the modified Raymond–Roy classification (mRRC), where mRRC 1 indicates complete embolization, mRRC 2 persistent opacification of the aneurysm neck, mRRC 3a filling of the aneurysm dome within coil interstices, and mRRC 3b filling of the aneurysm dome.ResultsSixteen aneurysms were treated with the LVIS Blue device in conjunction with coil embolization with 6-month angiographic follow-up. Aneurysms were treated throughout the intracranial circulation: five proximal internal carotid artery (ICA) (ophthalmic or communicating segments), two superior cerebellar artery, two ICA terminus, two anterior communicating artery, two distal middle cerebral artery, one posterior inferior cerebellar artery, and two basilar tip aneurysms. Post-procedurally, there was one mRRC 1 closure, five mRRC 2 closures, and 10 mRRC 3a or 3b occlusion. At follow-up, all the mRRC 1 and mRRC 3a closures, 85% of the mRRC 3b closures and 75% of the mRRC 2 closures were stable or improved to an mRRC 1 or 2 at follow-up.ConclusionsThe LVIS Blue represents a safe option as a coil adjunct for endovascular embolization within both the proximal and distal anterior and posterior circulation.

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Surgically Treated Aneurysms Previously Coiled: Lessons Learned

Neurosurgery ◽

10.1227/01.neu.0000103223.90054.c2 ◽

2004 ◽

Vol 54 (2) ◽

pp. 300-305 ◽

Cited By ~ 47

Author(s):

Erol Veznedaroglu ◽

Ronald P. Benitez ◽

Robert H. Rosenwasser

Keyword(s):

Coil Embolization ◽

Patient Population ◽

Cerebral Aneurysms ◽

Lessons Learned ◽

Anterior Communicating Artery ◽

Unique Problem ◽

Aneurysm Neck ◽

Cerebellar Artery ◽

Patient Groups

Abstract OBJECTIVE Intravascular coil embolization of cerebral aneurysms has proved to be a safe and effective treatment in certain patient groups; however, this treatment is relatively new, and the long-term outcomes are unknown. One of the known complications is refilling of the aneurysm dome, which is seen in follow-up studies. This patient population poses unique technical difficulties for the neurosurgeon. We present a series of 18 patients who underwent surgery for residual aneurysms after coil remobilization. METHODS During a 5-year period, we performed surgery in 18 patients who had previously undergone coil embolization for their aneurysms. Of these aneurysms, four were in the anterior communicating artery, five were in the posterior communicating artery, three were in the internal carotid artery, three were in the posteroinferior cerebellar artery, and three were in the middle cerebral artery. One patient presented with rupture, one presented with acute IIIrd cranial nerve palsy, and the rest of the aneurysms were found on routine follow-up angiograms. Fifteen aneurysms were clipped, and in three patients, they were wrapped because the clip could not be placed adequately. RESULTS There were no major complications in any of the patients, and all had uneventful recoveries. The presence of coils in the aneurysm dome and/or neck made clipping and exposure of the aneurysm neck difficult, resulting in incomplete neck obliteration in three patients. CONCLUSION Operative clipping after previous coil embolization in aneurysms poses a unique problem for neurosurgeons. With the increasing use of coil embolization, this patient population will undoubtedly increase. The neurosurgeon should be aware of the difficulties and pitfalls encountered in these patients.

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Nautilus-assisted coil embolization for a complex AcomA wide-necked aneurysm in the setting of acute subarachnoid hemorrhage

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017670 ◽

2021 ◽

pp. neurintsurg-2021-017670

Author(s):

Alexander Sirakov ◽

Svetozar Matanov ◽

Pervinder Bhogal ◽

Stanimir Sirakov

Keyword(s):

Subarachnoid Hemorrhage ◽

Coil Embolization ◽

Cerebral Aneurysms ◽

Anterior Communicating Artery ◽

New Approach ◽

Content Type ◽

Acute Subarachnoid Hemorrhage ◽

Inner Diameter ◽

Aneurysmal Neck ◽

Video Player

Numerous devices and sophisticated strategies have been developed to further increase the number of aneurysms amenable to endovascular treatment.1–4 Despite the superfluity of available neurovascular armamentarium, wide-necked bifurcation aneurysms can still pose a significant technical challenge to the treating clinician.5–7 Neck bridging is a conceptually new approach, which provides increased occlusion rates with lower recurrence and complications rates.8–10 The Nautilus (EndoStream Medical) is an intrasaccular bridging device intended to assist in coil embolization of wide-necked cerebral aneurysms. This CE-marked device, available in various sizes, consists of flexible-layers, and is a nitinol-based, detachable implant. The device is delivered through a standard microcatheter with a minimal 0.0165" inner diameter and is fully radiopaque and completely resheathable.Owing to its unique ‘tornado’ like shape the device entirely reconstructs the aneurysmal neck, which facilitates the following coil embolization. In this video 1, we demonstrate the use of Nautilus - assisted coil embolization for a complex anterior communicating artery (AcomA) wide-necked aneurysm in the setting of acute subarachnoid hemorrhage.Video 1

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Stent-assisted coil embolization of anterior communicating artery aneurysms using the LVIS Jr stent

Interventional Neuroradiology ◽

10.1177/1591019918798144 ◽

2018 ◽

Vol 25 (1) ◽

pp. 12-20 ◽

Cited By ~ 2

Author(s):

Alejandro Santillan ◽

Justin Schwarz ◽

Srikanth Boddu ◽

Y Pierre Gobin ◽

Jared Knopman ◽

...

Keyword(s):

Coil Embolization ◽

Aneurysm Rupture ◽

Anterior Communicating Artery ◽

Technical Failure ◽

Thromboembolic Complications ◽

Ruptured Aneurysms ◽

Neurological Morbidity ◽

Aneurysm Occlusion

Background and purpose This retrospective study evaluates the safety and mid-term and long-term effectiveness of stent-assisted coil embolization of anterior communicating artery (Acomm) aneurysms treated with the LVIS Jr stent. Materials and methods All patients treated with the LVIS Jr stent for Acomm aneurysms between June 2015 and March 2018 were included in the analysis. Details of the procedure’s periprocedural adverse events, immediate aneurysm occlusion rates, and clinical and angiographic follow-up assessment were collected. Results A total of 25 patients with 25 aneurysms were included. Eighteen aneurysms were found incidentally. Seven patients presented with seven ruptured aneurysms: Six were remotely ruptured and one acutely ruptured. Twenty-four patients were treated successfully and one technical failure is reported. The parent arteries measured 1.4 mm to 2.9 mm in diameter (mean, 2.3 mm). Intraprocedural thromboembolic complications occurred in two patients (8%) and an intraoperative aneurysm rupture in one patient (4%). Immediate complete aneurysm occlusion was noted in 18 out of 25 patients (72%). Clinical follow-up ranged from three months to 36 months (mean, 15.8 months) and the imaging follow-up ranged from two to 35 months (mean, 14.2 months). Complete aneurysm occlusion was achieved in 14 out of 20 patients (70%) at last angiographic follow-up. Of the two patients with in-stent thrombosis, one patient had an acutely ruptured aneurysm and the other patient was treated with an LVIS Jr stent in a Y configuration. Neurological morbidity and mortality rate were 0%. Conclusions Complex, wide-necked Acomm aneurysms can be effectively treated with stent-assisted embolization using LVIS Jr stents.

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Safety and efficacy of endovascular treatment of ruptured tiny cerebral aneurysms compared with ruptured larger aneurysms

Interventional Neuroradiology ◽

10.1177/1591019919897446 ◽

2020 ◽

Vol 26 (3) ◽

pp. 283-290 ◽

Cited By ~ 1

Author(s):

Ji-Wei Wang ◽

Cong-Hui Li ◽

Yang-Yang Tian ◽

Xin-Yu Li ◽

Jian-Feng Liu ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Aneurysms ◽

Endovascular Embolization ◽

Anterior Communicating Artery ◽

Related Complication ◽

Before And After ◽

Angiographic Data ◽

Group A ◽

Group B ◽

Incomplete Occlusion

Purpose To investigate the effect and safety of endovascular embolization of tiny aneurysms (≤3 mm) within 72 h of subarachnoid hemorrhage compared with larger ones. Materials and methods Patients with intracranial aneurysms treated with endovascular embolization within 72 h were retrospectively enrolled and divided into group A ( n = 33) with ruptured tiny aneurysms (≤3 mm) and group B ( n = 244) with ruptured larger aneurysms (>3 mm). The clinical and angiographic data before and after embolization were analyzed. Results Most tiny aneurysms were located at the posterior communicating artery (36.4%) followed by anterior communicating artery (18.2%). The stent-assisted coiling technique was used mostly in group A with 18 stents deployed (51.5%), but only 24 (9.8%) patients had stent-assisted coiling in group B, with the stent-assisted coiling technique more significantly ( P < 0.001) frequently used in group A. No significant ( P > 0.05) difference existed in the total, subtotal and incomplete occlusion of aneurysms in two groups. The procedure-related complication rate was not significantly ( P > 0.05) different between groups A (24.2%) and B (17.0%). At discharge, no significant ( P > 0.05) difference existed in the neurological abnormality between the two groups. Follow-up was performed in 64.5% (20/31) in group A and 75.6% (177/234) in group B. No significant ( P > 0.05) difference existed in the aneurysm recurrence rate, deaths, and prognosis. Conclusion Early embolization of tiny cerebral aneurysms within 72 h of subarachnoid hemorrhage is safe and effective compared with ruptured large aneurysms treated in the same manner.

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Retrospective review of 290 small carotid cave aneurysms over 17 years

Journal of Neurosurgery ◽

10.3171/2019.7.jns191471 ◽

2020 ◽

Vol 133 (5) ◽

pp. 1473-1477 ◽

Cited By ~ 1

Author(s):

Aravind G. Kalluri ◽

Madhav Sukumaran ◽

Pouya Nazari ◽

Pedram Golnari ◽

Sameer A. Ansari ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Internal Carotid ◽

Case Series ◽

Aneurysm Rupture ◽

Medial Aspect ◽

Retrospective Case ◽

Risk Of Rupture ◽

History Of ◽

Benign Nature

OBJECTIVEThe carotid cave is a unique intradural region located along the medial aspect of the internal carotid artery. Small carotid cave aneurysms confined within this space are bound by the carotid sulcus of the sphenoid bone and are thought to have a low risk of rupture or growth. However, there is a lack of data on the natural history of this subset of aneurysms.METHODSThe authors present a retrospective case series of 290 small (≤ 4 mm) carotid cave aneurysms evaluated and managed at their institution between January 2000 and June 2017.RESULTSNo patient presented with a subarachnoid hemorrhage attributable to a carotid cave aneurysm, and there were no instances of aneurysm rupture or growth during 911.0 aneurysm-years of clinical follow-up or 726.3 aneurysm-years of imaging follow-up, respectively.CONCLUSIONSThis series demonstrates the benign nature of small carotid cave aneurysms.

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Pseudoaneurysm formation due to rupture of intracranial aneurysms: Case series and literature review

The Neuroradiology Journal ◽

10.1177/1971400916684667 ◽

2017 ◽

Vol 30 (2) ◽

pp. 129-137 ◽

Cited By ~ 8

Author(s):

Motohiro Nomura ◽

Kentaro Mori ◽

Akira Tamase ◽

Tomoya Kamide ◽

Syunsuke Seki ◽

...

Keyword(s):

Case Series ◽

Cerebral Aneurysms ◽

Aneurysm Rupture ◽

Anterior Communicating Artery ◽

Parent Artery ◽

Traumatic Aneurysm ◽

Radiological Findings ◽

True Aneurysm ◽

Pseudoaneurysm Formation ◽

Severe Stage

Background Intracranial pseudoaneurysm formation due to a ruptured non-traumatic aneurysm is extremely rare. We describe the radiological findings and management of pseudoaneurysms due to ruptured cerebral aneurysms in our case series and previously reported cases. Patients and methods Four additional and 20 reported patients presenting with subarachnoid hemorrhage (SAH) are included. Radiological findings and clinical features of these patients were reviewed. Results In our series, three-dimensional computed tomographic angiography (3D-CTA) and/or angiography showed an irregular- or snowman-shaped cavity extending from the parent artery. The radiological examination additionally revealed delayed filling and retention of contrast medium. These findings were the same as previously reported cases. One patient underwent direct clipping of the true aneurysm. For the other three patients with aneurysms at the basilar and anterior communicating arteries, the true portion of the aneurysm was embolized with platinum coils. During the procedures, care was taken not to insert the coils into the distal pseudoaneurysm portion to prevent rupture. The review of 24 cases revealed that the location of the aneurysms was most frequent in the anterior communicating artery (41.7%), and 86.7% of patients were in a severe stage of SAH (>Grade 3 in WFNS or Hunt & Kosnik grading) implying abundant SAH. Conclusions Pseudoaneurysm formation in SAH after non-traumatic aneurysm rupture is rare. However, in cases with an irregular-shaped aneurysm cavity, pseudoaneurysm formation should be taken into consideration.

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Coil Retrieval following Embolization of Cerebral Aneurysms

Interventional Neuroradiology ◽

10.1177/15910199030090s121 ◽

2003 ◽

Vol 9 (1_suppl) ◽

pp. 149-155 ◽

Cited By ~ 1

Author(s):

T. Kojima ◽

S. Miyachi ◽

M. Negoro ◽

K. Nakabayashi ◽

K. Fukui ◽

...

Keyword(s):

Coil Embolization ◽

Cerebral Aneurysms ◽

Mass Effect ◽

Visual Disturbance ◽

Aneurysm Rupture ◽

Motor Deficit ◽

Anterior Communicating Artery ◽

Complex Anatomy ◽

Detachable Coils ◽

And Migration

Failed coil embolization of cerebral aneurysms may be occasionally followed by direct surgical treatment. We had 5 patients who underwent coil retrieval and surgical clipping after coil embolization because of periprocedural complications. The patients, ranging in age from 40 to 71, had wide-neck aneurysms located at the anterior communicating artery (AcomA) in 3 patients, the middle cerebral artery (MCA) in 1, and the internal carotid-ophthalmic artery (IC-Ophthalmic) in 1. They were embolized with Guglielmi detachable coils (GDCs), which had to be retrieved within 8 days because of coil protrusion and migration in 3 patients, aneurysm rupture in 1, and increased mass effect due to coil compaction in 1. Coils were successfully removed with aneurysmotomy or arteriotomy under temporary trapping, aneurysms were then clipped or trapped. Three patients had a good outcome, but one suffered permanent visual disturbance and the other had a motor deficit. Our study revealed that a small AcomA aneurysm had a high risk of complication in a case of complex anatomy of the AcomA-A1-A2 complex with its difficult access. In addition, insufficient packing of the inflow zone in a large and symptomatic aneurysm may cause coil compaction and regrow with increasing mass effect. The indication and treatment strategy for these aneurysms should be carefully determined.

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