scholarly journals Risk factors for coil protrusion into the parent artery and associated thrombo-embolic events following unruptured cerebral aneurysm embolization

2015 ◽  
Vol 21 (2) ◽  
pp. 178-183 ◽  
Author(s):  
Hideaki Ishihara ◽  
Shoichiro Ishihara ◽  
Jun Niimi ◽  
Hiroaki Neki ◽  
Yoshiaki Kakehi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Flow ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Operation Time ◽  
Vascular Reconstruction ◽  
Parent Artery ◽  
Unruptured Cerebral Aneurysm ◽  
Aneurysm Embolization ◽  
Wide Neck

Objective Advances in vascular reconstruction devices and coil technologies have made coil embolization a popular and effective strategy for treatment of relatively wide-neck cerebral aneurysms. However, coil protrusion occurs occasionally, and little is known about the frequency, the risk factors and the risk of thrombo-embolic complications. Method We assessed the frequency and the risk factors for coil protrusion in 330 unruptured aneurysm embolization cases, and examined the occurrence of cerebral infarction by diffusion-weighted magnetic resonance imaging (DW-MRI). Result Forty-four instances of coil protrusion were encountered during coil embolization (13.3% of cases), but incidence was reduced to 33 (10% of cases) by balloon press or insertion of the next coil. Coil protrusion occurred more frequently during the last phase of the procedure, and both a wide neck (large fundus to neck ratio) (OR = 1.84, P = 0.03) and an inadequately stable neck frame (OR = 5.49, P = 0.0007) increased protrusion risk. Coil protrusions did not increase the incidence of high-intensity lesions (infarcts) on DW-MRI (33.3% vs 29% of cases with no coil protrusion). However, longer operation time did increase infarct risk ( P = 0.0003). Thus, tail or loop type coil protrusion did not increase the risk of thrombo-embolic complications, if adequate blood flow was maintained. Conclusion Coil protrusion tended to occur more frequently in cases of wide-neck aneurysms with loose neck framing. Moderate and less coil protrusion carries no additional thrombo-embolic risk, if blood flow is maintained, which can be aided by additional post-operative antiplatelet therapy.

SPONTANEOUS DELAYED PROXIMAL MIGRATION OF ENTERPRISE STENT AFTER STAGED TREATMENT OF WIDE- NECKED BASILAR ANEURYSM

Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. 1012-1012 ◽  
Author(s):  
Sean D. Lavine ◽  
Philip M. Meyers ◽  
E. Sander Connolly ◽  
Robert S. Solomon
Keyword(s):  
Endovascular Treatment ◽  
Delivery System ◽  
Coil Embolization ◽  
Vascular Anatomy ◽  
Cerebral Aneurysms ◽  
Vascular Reconstruction ◽  
Adjunctive Treatment ◽  
Parent Artery ◽  
Proximal Migration ◽  
Intravascular Stent

Abstract OBJECTIVE To document a unique technical issue with a relatively newly released intravascular stent used for adjunctive treatment of wide-necked cerebral aneurysms. CLINICAL PRESENTATION A 48-year-old woman with a sister who had a large unruptured wide-necked basilar aneurysm underwent screening evaluation that revealed a nearly identical aneurysm. She also harbored small unruptured right superior cerebellar and left anterior cerebral artery aneurysms. INTERVENTION Endovascular treatment of the 11.5-mm basilar aneurysm was performed in a staged manner. Stent placement was performed first, followed by delayed coil embolization of the aneurysm 9 weeks later. Follow-up angiography at the time of the second procedure revealed significant spontaneous proximal migration of the Enterprise Vascular Reconstruction Device and Delivery System (Cordis Neurovascular, Inc., Miami Lakes, FL) with the distal extent of the device migrating from the right P2 segment into the neck of the aneurysm. Coil embolization was performed despite migration of the vascular reconstruction device. CONCLUSION The use of stents in the endovascular treatment of cerebral aneurysms has vastly improved our ability to treat complex lesions. Technical issues remain with these devices, and description of this event may alter the way we use the Enterprise Vascular Reconstruction Device and Delivery System in terms of staging procedures, and when evaluating the particular vascular anatomy of the individual patient with special attention to parent artery vessel size.

Factors related to adverse events during endovascular coil embolization for ruptured cerebral aneurysms

2020 ◽  
Vol 12 (6) ◽  
pp. 605-609 ◽  
Author(s):  
Hirotoshi Imamura ◽  
Nobuyuki Sakai ◽  
Tetsu Satow ◽  
Koji Iihara
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Initial Result ◽  
World Federation ◽  
Ischemic Complications ◽  
Endovascular Coil Embolization ◽  
Ischemic Complication ◽  
Wide Neck

Background and purposeThe risk factors for adverse events for example, intraprocedural rupture (IPR), ischemic complication within 24 hours, and rebleeding after endovascular coil embolization for a ruptured cerebral aneurysm remain unclear. The aim of this study was to identify significant associated risk factors.MethodsWe retrospectively evaluated data from 5358 patients listed on the Japanese Registry of Neuroendovascular Therapy 3 during 2010–2014.ResultsIPR, ischemic complications, and rebleeding occurred during or after 221 (4.1%), 226 (4.2%), and 63 (1.2%) treatments, respectively. All of the adverse events were significantly associated with the patients’ poor outcomes at 30 days. Multivariate analysis revealed the factors independently related to these adverse events as follows: (1) for IPR: female sex, bifurcation type, <5 mm aneurysm, emergent surgery, local anesthesia, a balloon-assisted technique; (2) for an ischemic complication: poor World Federation World Federation of Neurological Societies (WFNS) grade, wide neck, and stent-assisted technique; (3) for rebleeding: poor WFNS grade, bifurcation type, wide neck, and body filling as the initial result.ConclusionsKnowledge of the risk factors of endovascular coil embolization and paying attention to them are essential for patients’ safe treatment and good outcomes.

Abstract WP33: Early Lessons Learned From the WEB Device: Feasibility, Technique and Complications—A Real Life Experience

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Nikolaos Mouchtouris ◽  
David Hasan ◽  
Fadi Al Saiegh ◽  
Ahmad Sweid ◽  
Mario Zanaty ◽  
...  
Keyword(s):  
Real Life ◽  
Cerebral Aneurysms ◽  
High Volume ◽  
Additional Treatment ◽  
Lessons Learned ◽  
Parent Vessel ◽  
Aneurysm Embolization ◽  
Web Device ◽  
Wide Neck ◽  
The Web

Introduction: Wide-neck bifurcation cerebral aneurysms have always posed a treatment challenge and have historically required either clip ligation, or stent vs. balloon-assisted coil embolization. This predicament led to the development of the newly FDA-approved Woven EndoBridge (WEB) aneurysm embolization system (Sequent Medical Inc, Aliso Viejo, CA) Which is a self-expanding mesh that achieves intrasaccular flow disruption and does not require antithrombotic medications. In this study, we report our experience with the first 64 consecutive aneurysms treated via WEB embolization at two high-volume institutions. Methods: We reviewed our first 61 consecutive patients with 64 cerebral aneurysms who underwent WEB embolization from February-August 2019. We collected data on patient demographics and clinical presentation, aneurysm characteristics, device and procedural details, and functional outcomes. Results: A total of 64 aneurysms were included in our study. Fifteen patients (24.1%) presented with acutely ruptured aneurysm while the rest were unruptured. The majority of patients (82.8%) required only one attempt for successful device deployment, while a stent was necessary as an adjunct treatment in 4 patients (6.3%) due to WEB herniation. Two patients had residual aneurysm that had to undergo additional treatment; one of them underwent second WEB embolization and one underwent clip ligation. One patient with a PICA aneurysm had device dislodgment with injury to the parent vessel—Onyx and coils were used to deconstruct the vertebral artery. Conclusions: The advent of the WEB device has significantly impacted the surgical decision-making for the treatment of bifurcation, wide-neck aneurysms. We discuss in detail the lessons learned from patient selection, device size selection, technique, and complications from two institutions with high-volume endovascular and microsurgical aneurysm treatment experience.

Cinematic Angiography for Measurements of Blood Flow in Cerebral Aneurysms With Stents

2007 ◽  
Author(s):  
Makoto Ohta ◽  
Naoko Fujimura ◽  
Luca Augsburger ◽  
Hasan Yilmaz ◽  
Daniel A. Ru¨fenacht
Keyword(s):  
Blood Flow ◽  
High Speed ◽  
Cerebral Aneurysms ◽  
Flow Speed ◽  
Circulation System ◽  
Parent Artery ◽  
Vortex Center ◽  
System A ◽  
Before And After ◽  
Movement Distance

Background and Purpose: The assessment of blood flow speed by imaging modalities is important for endovascular treatments, such as stent implantation, of cerebral aneurysms. The subtracted vortex centers path line method (SVC method) is one of the ways of determining flow speed quantitatively using the image sequence. And a cinematic angiography (CA) is a high speed image acquisition system using X-ray and contrast media integrated in Digital Subtraction Angiography (DSA) for endovascular therapy. The combination of SVC and CA may useful for determining the blood flow speed during the operation using DSA. In this study, we applied this combination to analyze hemodynamic changes before and after stenting. Methods: A transparent tubular model was constructed of silicone which included an aneurysm 10 mm in diameter and having a 5 mm neck on a straight parent artery with a diameter of 3.5 mm. The model was integrated into a pulsatile circulation system. A double layer stent was placed in the parent artery on the aneurysm. By CA, successive images at 25 frames per second with injection of contrast were obtained. Results and conclusion: Rotating vortexes of contrast, which advanced along the wall of the aneurysm, were observed in successive images of the aneurysm cavity. The movement distance of the vortex center was measured and the results show that the vortex speed decrease after stenting. This indicates the possibility of applying the SVC method to medical imaging equipment for analysis of the flow in aneurysms containing stent.

scholarly journals Lyophilizing thrombin powder-based treatment for hemostasis during coil embolization of ruptured cerebral aneurysm: Two case reports

2019 ◽  
Vol 25 (4) ◽  
pp. 454-459
Author(s):  
Changchun Jiang ◽  
Wei Wang ◽  
Baojun Wang ◽  
Yuechun Li ◽  
Guorong Liu ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Coil Embolization ◽  
Case Reports ◽  
Balloon Catheter ◽  
Treatment Strategies ◽  
Cerebral Aneurysms ◽  
Interventional Therapy ◽  
Parent Artery ◽  
Clinical Practices ◽  
Detachable Coils

Background Rupture of cerebral aneurysm is an inevitable complication during embolization, followed by subsequent acute subarachnoid hemorrhage or intracranial hematoma, and results in the aggravation of a patient’s condition. In particular, for patients who have had a ruptured aneurysm, urgent treatment strategies are required during operation. The most common hemostatic methods seen in clinical practices are as follows: after lowering the blood pressure, we continue to embolize the aneurysms with detachable coils as soon as possible or inject with Glubran/Onyx embolization liquids, as well as use a balloon catheter to temporarily block the blood supply. If the conditions are permissible, a balloon guiding catheter may even be used to restrict the proximal blood flow. At times, due to limitations of these methods, neurosurgeons are requested to perform craniotomy to treat the hemostasis. However, the delayed transition often leads to rapid deterioration of the patient’s condition and even death due to cerebral hernia. Case description We herein presented two cases of ruptured cerebral aneurysms to provide an alternative method for hemostasis and to save the lives of patients as much as possible. In an extremely urgent situation (conventional treatment is ineffective), we successfully saved the patient’s life by injecting lyophilizing thrombin powder (LTP) solution into the aneurysmal sac and the parent artery through a microcatheter. Conclusions To our knowledge, this is the first report of successful hemostasis during coil embolization of ruptured cerebral aneurysm with LTP. Further prospective studies are needed to confirm the safety and efficacy of LTP in cerebrovascular interventional therapy.

3D CT Angiography as a Pre-Embolization Study for Embolization of Cerebral Aneurysms

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 142-148 ◽  
Author(s):  
K. Fukasaku ◽  
M. Negoro ◽  
M. Bundo ◽  
N. Kourogi ◽  
K. Yamano ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Three Dimensional ◽  
Cerebral Aneurysms ◽  
Parent Artery ◽  
3D Images ◽  
Image Guide ◽  
Laser Lithography ◽  
Real Model ◽  
Aneurysm Embolization ◽  
3D Ct Angiography

An image guide for aneurysm embolization based on three dimensional CT angiography is reported. Multiplanner reformation (MPR) can measure the neck and dome of the aneurysm accurately enough to select the first coils for aneurysms. For neck evaluation, cut model and virtual endoscope are helpful because we can observe the neck from inside of dome or parent artery. Proximal arteries are visualized by 3D images and MPR if needed. Using laser lithography, we can get a real model of aneurysm and parent artery through which we can insert microcatheters and coils. 3D CTA is a dependable modality for embolization of cerebral aneurysms.

The Effects of High Porosity Stent Configurations on Cerebral Aneurysm Hemodynamics

2011 ◽  
Author(s):  
Haithem Babiker ◽  
Justin Ryan ◽  
L. Fernando Gonzalez ◽  
Felipe Albuquerque ◽  
Daniel Collins ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Aneurysm ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
High Porosity ◽  
Incomplete Filling ◽  
Aneurysmal Neck ◽  
Treatment For Cerebral Aneurysms ◽  
Wide Neck

Coil embolization is the most common endovascular treatment for cerebral aneurysms at many centers [1]. Nevertheless, the coiling of wide-neck aneurysms is a challenge. Incomplete filling of the aneurysmal sac due to coil configuration challenges and aneurysmal growth can often lead to recurrence. To assist treatment with coils, clinicians may deploy a high porosity stent in a staged process to act as a supporting bridge for coils. The stent is first deployed across the aneurysmal neck, and multiple coils are then deployed into the aneurysmal sac 6–8 weeks later [2]. Under certain circumstances, coil deployment is not possible and high porosity stents alone are used for treatment [2–3].

Abstract 1122‐000015: Differences of Morphological and Hemodynamic Rupture Risk Factors in Cerebral Aneurysms Between Pre‐ and Post‐Rupture

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Yuma Yamanaka ◽  
Hiroyuki Takao ◽  
Soichiro Fujimura ◽  
Yuya Uchiyama ◽  
Shota Sunami ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Flow ◽  
Shear Stress ◽  
Wall Shear Stress ◽  
Cerebral Aneurysms ◽  
Aneurysm Rupture ◽  
Morphological Parameters ◽  
Rupture Risk ◽  
Parent Vessel ◽  
Cfd Simulations

Introduction : Morphological and hemodynamic characteristics have been reported to be involved in the rupture of cerebral aneurysms. Therefore, geometrical measurements of cerebral aneurysms and blood flow analysis using computational fluid dynamics (CFD) have been conducted. Some previous studies investigated the rupture risk factors from cerebral arterial geometries that were taken before the rupture (pre‐rupture), and the others used geometries taken after the rupture (post‐rupture). However, aneurysm rupture may alter arterial geometries and CFD simulation results. The aim of this study is to evaluate the morphological and hemodynamic alternations due to cerebral aneurysm rupture. Methods : We identified 21 cerebral aneurysms (ICA: 9, MCA: 3, ACA: 4, BA: 3, VA: 2) which had ruptured during the follow‐up terms. Each case had at longest two‐years term between the rupture date and the latest angiographic date before the aneurysm rupture (pre‐rupture). The post‐rupture arterial geometries were acquired preoperatively for subarachnoid hemorrhage. We used the arterial geometries reconstructed from computed tomography angiography or digital subtraction angiography images for conducting morphological measurements and CFD simulations. We performed transient blood flow simulations for two heart pulse cycles in the CFD simulations. We obtained five morphological parameters and 24 hemodynamic parameters considered as the rupture risk factors. Finally, we conducted Wilcoxon’s signed‐rank sum test between the parameters obtained from pre‐ and post‐rupture aneurysms to specify altered parameters due to the aneurysm rupture. We also calculated the change rate (CR) based on the value in pre‐rupture for parameters that had a statistical significance to investigate the alternation in detail. Results : The aneurysmal volume ( V ), height ( H ), aspect ratio ( AR ), and spatial averaged, maximum, and minimum wall shear stress of the aneurysm dome normalized by the spatially averaged wall shear stress of the parent vessel ( NWSSave , NWSSmax , and NWSSmin ) were significantly altered between pre‐ and post‐rupture. In particular, the morphological parameters increased after the rupture (average CR of V , H , and AR were 25.8 %, 13.4 %, and 15.9 %, respectively). These results indicate that the aneurysm shapes tended to increase lengthwise after the rupture. On the other hand, the NWSS tended to decrease (average CR of NWSSave , NWSSmax , and NWSSmin  were ‐21.0 %, ‐13.7 %, and ‐22.7 %, respectively). These results imply that the aneurysm rupture altered the aneurysm to a more complicated shape, and thereby the blood flow became stagnated that introduced lower WSS . In contrast, there were some cases in which NWSS increased, and these cases had vasospasm at their parent arteries caused by the rupture (i.e., 5 of 21 cases had vasospasm, and the average CR of NWSSave was 14.1 %). The parent vessel proximal to the aneurysm was shrunk due to the vasospasm, resulting in increased flow velocity and thus increased NWSS . Conclusions : The cerebral aneurysm rupture deformed the aneurysms into longitudinal and led to increased volumes. The NWSSs in CFD simulations using post‐rupture geometries tended to decrease in comparison with pre‐rupture. When studying rupture factors of cerebral aneurysms using geometrical measurements and CFD simulations, special attention should be paid to the clinical image and rupture characteristics standardization criteria.

The Woven EndoBridge (WEB) device: feasibility, techniques, and outcomes after FDA approval

2021 ◽  
pp. 1-7
Author(s):  
Nikolaos Mouchtouris ◽  
David Hasan ◽  
Edgar A. Samaniego ◽  
Fadi Al Saiegh ◽  
Ahmad Sweid ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Arterial Phase ◽  
Unruptured Aneurysms ◽  
Fda Approval ◽  
Aneurysm Embolization ◽  
Woven Endobridge ◽  
Web Device ◽  
Wide Neck ◽  
The Web

OBJECTIVE Wide-neck bifurcation cerebral aneurysms have historically required either clip ligation or stent- or balloon-assisted coil embolization. This predicament led to the development of the Woven EndoBridge (WEB) aneurysm embolization system, a self-expanding mesh device that achieves intrasaccular flow disruption and does not require antithrombotic medications. The authors report their operative experience and 6-month follow-up occlusion outcomes with the first 115 aneurysms they treated via WEB embolization. METHODS The authors reviewed the first 115 cerebral aneurysms they treated by WEB embolization after FDA approval of the WEB embolization device (from February 2019 to January 2021). Data were collected on patient demographics and clinical presentation, aneurysm characteristics, procedural details, postembolization angiographic contrast stasis, and functional outcomes. RESULTS A total of 110 patients and 115 aneurysms were included in our study (34 ruptured and 81 unruptured aneurysms). WEB embolization was successful in 106 (92.2%) aneurysms, with a complication occurring in 6 (5.5%) patients. Contrast clearance was seen in the arterial phase in 14 (12.2%) aneurysms, in the capillary phase in 16 (13.9%), in the venous phase in 63 (54.8%), and no contrast was seen in 13 (11.3%) of the aneurysms studied. Follow-up angiography was performed on 60 (52.6%) of the aneurysms, with complete occlusion in 38 (63.3%), neck remnant in 14 (23.3%), and aneurysmal remnant in 8 (13.3%). Six (5.5%) patients required re-treatment for persistent aneurysmal residual on follow-up angiography. CONCLUSIONS The WEB device has been successfully used for the treatment of both unruptured and ruptured wide-neck bifurcation aneurysms by achieving intrasaccular flow diversion. Here, the authors have shared their experience with its unique technical considerations and device size selection, as well as critically reviewed complications and aneurysm occlusion rates.

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