scholarly journals Safety and efficacy of a new outreach distal access catheter, TACTICS, for coil embolization of unruptured intracranial aneurysms

2018 ◽  
Vol 24 (5) ◽  
pp. 482-488 ◽  
Author(s):  
Toshinori Matsushige ◽  
Shigeyuki Sakamoto ◽  
Daizo Ishii ◽  
Katsuhiro Shinagawa ◽  
Koji Shimonaga ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Maximum Diameter ◽  
Initial Experience ◽  
Anterior Circulation ◽  
Unruptured Intracranial Aneurysms ◽  
Ischemic Complications ◽  
Procedural Complications ◽  
Endovascular Coil Embolization ◽  
Endovascular Coils

Background and purpose Current large-bore catheters can be easily and safely placed in the intracranial vessels for the stabilization of microcatheters in several neurointervention scenarios. We considered that a novel 3.4 French catheter (TACTICS, Technorat Corporation, Aichi, Japan) might be useful for intermediate/distal access in a triaxial system. Here, we present our initial experience using the TACTICS catheter for treatment of intracranial aneurysms. Materials and methods A total of 35 endovascular coils were placed to embolize unruptured intracranial aneurysms of the anterior circulation using the TACTICS catheter between December 2016 and November 2017. These procedures were retrospectively reviewed to assess aneurysmal obliteration (Raymond’s classification), the volume embolization ratio (VER) and procedural complications in comparison with 96 conventional coil treatments during the 3-year period up to 2016. Data were matched for aneurysmal morphology (location, maximum diameter and aspect ratio) by the propensity method. Results In all procedures, the TACTICS catheter was atraumatically landed beyond the carotid siphon. There were no hemorrhagic or symptomatic ischemic complications. After propensity matching, 68 procedures were assessed (34 in each group). Achievement of Raymond’s scale 1 (complete occlusion) showed the same frequency in both groups (50% vs. 50%, p = 0.23). The VER was significantly higher with the TACTICS catheter than with the conventional method (34.0% vs. 28.7%, p = 0.003). Conclusion We reviewed our initial experience of the TACTICS catheter. It can be used as an intermediate catheter for safe and effective endovascular coil embolization of anterior circulation aneurysms.

Surgical Clipping May Lead to Better Results than Coil Embolization: Results from a Series of 101 Consecutive Unruptured Intracranial Aneurysms

Neurosurgery ◽  
2003 ◽  
Vol 52 (6) ◽  
pp. 1280-1290 ◽  
Author(s):  
Christian Raftopoulos ◽  
Pierre Goffette ◽  
Geraldo Vaz ◽  
Najib Ramzi ◽  
Jean-Louis Scholtes ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Adverse Outcomes ◽  
Surgical Clipping ◽  
Anterior Circulation ◽  
Significant Discrepancy ◽  
Obliteration Rate ◽  
Unruptured Intracranial Aneurysms ◽  
A Prospective Study ◽  
Middle Cerebral Artery Aneurysms

Abstract OBJECTIVE Recent reports in the literature have described a significant discrepancy in adverse outcomes between coil embolization (CE; 10%) and surgical clipping (SC; 25%) for the management of unruptured intracranial aneurysms (UIA). This discrepancy led us to analyze our experience. METHODS In 1996, we designed a prospective study of patients with UIA in which CE was considered the treatment of choice and was performed if the interventional neuroradiologists deemed the aneurysm's fundus-to-neck ratio accessible for CE. SC was performed only if complete CE was unlikely to be achieved or in patients in whom CE already had failed. RESULTS CE was performed in 38 patients with at least one UIA (41 UIAs, 83% in the anterior circulation). SC was performed in 39 patients with at least one UIA unsuitable for CE (59 UIAs, including 6 after failed CE, 96.5% in the anterior circulation). For CE, the total obliteration rate was 56.1%, the subtotal was 14.6%, and CE failed in 29.3%. There were transient complications in 10% of the cases and permanent complications in 7.5%. Of the 12 failed CE procedures, 7 (58%) were performed for middle cerebral artery aneurysms. For SC, the total obliteration rate was 93.2%, the subtotal was 1.7%, and SC failed (wrapping) in 5.1%. There were transient complications in 16.3% of the patients and permanent complications in 1.7%. The success rate for CE was similar to that for SC only when CE was used for aneurysms with a fundus-to-neck ratio of at least 2.5. CONCLUSION SC can produce better results than CE in patients with UIA of the anterior circulation. CE as a first-line treatment should be reserved for patients with UIAs with a fundus-to-neck ratio of 2.5 or greater.

Treatment of distal unruptured intracranial aneurysms using a surface-modified flow diverter under prasugrel monotherapy: a pilot safety trial

2021 ◽  
pp. neurintsurg-2020-017262
Author(s):  
Luis Henrique de Castro-Afonso ◽  
Guilherme Seizem Nakiri ◽  
Thiago Giansante Abud ◽  
Lucas Moretti Monsignore ◽  
Rafael Kiyuze Freitas ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Anterior Circulation ◽  
Antiplatelet Medication ◽  
Unruptured Intracranial Aneurysms ◽  
Trial Treatment ◽  
Ischemic Complications ◽  
Carotid Aneurysms ◽  
Surface Modified

BackgroundFlow diverters (FDs) are effective in the treatment of carotid aneurysms. Compared with carotid aneurysms, the treatment of distal intracranial aneurysms with FDs has been associated with a relatively high incidence of complications. Low thrombogenic modified-surface FDs may reduce ischemic complications and allow for the use of a single antiplatelet medication. The aim of this study was to assess the safety and efficacy of the p48 MW HPC Flow Modulation Device (Phenox GmbH, Bochum, Germany) to treat distal intracranial aneurysms used in combination with prasugrel monotherapy.MethodsThis was a single-center, prospective, pivotal, open, single-arm study. Patients were included in this study from December 2019 to September 2020. The primary endpoints were the incidence of any neurologic deficit after treatment until 1 month of follow-up, defined as National Institutes of Health Stroke Scale (NIHSS) ≥1, and the incidence of acute ischemic lesions in magnetic resonance imagin (MRI) images 48 hours after treatment. The secondary endpoint was the rate of complete occlusion of the aneurysms at the 1-month follow-up.ResultsTwenty-one patients harboring 27 distal aneurysms of the anterior circulation were included. Mean age was 57.8 (SD 9.7) years, and 16 patients were female (80%). No patient had neurologic symptoms at the 1-month follow-up. Four patients (20%) had asymptomatic acute brain ischemic lesions on MRI. Complete aneurysm occlusion occurred in 9/27 (33.3%) aneurysms at the 1-month follow-up.ConclusionIn this pilot safety trial, treatment of distal intracranial aneurysms with p48 MW HPC under monotherapy with prasugrel appeared to be safe.

scholarly journals Endovascular Coil Embolization of Ruptured and Unruptured Intracranial Aneurysms: Review of a 13-year Single Center Experience

2017 ◽  
Author(s):  
Mustafa Belal Hafeez Chaudhry ◽  
Tanveer Ul Haq ◽  
Syed Naseer Ahmed ◽  
Waseem Akhtar Mirza ◽  
Waseem Akhtar Mirza ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Single Center ◽  
Single Center Experience ◽  
Unruptured Intracranial Aneurysms ◽  
Endovascular Coil Embolization

Single Center Experience With Pipeline Stent

Neurosurgery ◽  
2012 ◽  
Vol 71 (3) ◽  
pp. 679-691 ◽  
Author(s):  
Rohan Chitale ◽  
L. Fernando Gonzalez ◽  
Ciro Randazzo ◽  
Aaron S. Dumont ◽  
Stavropoula Tjoumakaris ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Single Center Experience ◽  
Endovascular Coil Embolization ◽  
Vertebrobasilar Junction ◽  
High Degree ◽  
Endovascular Skills ◽  
Pipeline Stent

Abstract BACKGROUND: Endovascular coil embolization is an established method of treatment for intracranial aneurysms. The pipeline embolization device (PED) is a low-porosity endovascular stent designed to reconstruct the parent artery and decrease blood flow into the aneurysm. OBJECTIVE: To report a series of 36 patients treated with the PED. METHODS: Thirty-six patients underwent PED placement for aneurysm at the Jefferson Hospital for Neuroscience from October 2010 to November 2011. Clinical charts were reviewed. RESULTS: Thirty-six patients with 42 aneurysms were treated (3 male; 33 female; ages, 34–82; mean age, 60.1 years). Forty-one aneurysms were located in the anterior circulation, whereas one was located at the vertebrobasilar junction. PED placement was successful in all patients and resulted in stasis within all treated aneurysms. Symptomatic postoperative complications were witnessed in 13.9% (n = 5) of patients. These complications included intracerebral hemorrhage (n = 4), dissection (n = 1), symptomatic stroke (n = 2), and death (n = 1). CONCLUSION: Treatment of simple or complex intracranial aneurysms with PEDs alone or in conjunction with coil embolization is technically feasible, and the deployment technique requires a high degree of endovascular skills. Major perioperative adverse events must be studied. Respect for the indications of the procedure is crucial to justify the risk.

Size and location of ruptured intracranial aneurysms: consecutive series of 1993 hospital-admitted patients

2017 ◽  
Vol 127 (4) ◽  
pp. 748-753 ◽  
Author(s):  
Miikka Korja ◽  
Riku Kivisaari ◽  
Behnam Rezai Jahromi ◽  
Hanna Lehto
Keyword(s):  
Intracranial Aneurysms ◽  
Maximum Diameter ◽  
Anterior Communicating Artery ◽  
Study Cohort ◽  
Consecutive Series ◽  
Anterior Circulation ◽  
Effective Prevention ◽  
Median Size ◽  
Unruptured Intracranial Aneurysms ◽  
Ruptured Intracranial Aneurysms

OBJECTIVELarge consecutive series on the size and location of ruptured intracranial aneurysms (RIAs) are limited, and therefore it has been difficult to estimate population-wide effects of size-based treatment strategies of unruptured intracranial aneurysms. The authors' aim was to define the size and location of RIAs in patients diagnosed with subarachnoid hemorrhage due to aneurysm rupture in a high-volume academic center.METHODSConsecutive patients admitted to a large nonprofit academic hospital with saccular RIAs between 1995 and 2009 were identified, and the size, location, and multiplicity of RIAs were defined and reported by patient sex.RESULTSIn the study cohort of 1993 patients (61% women) with saccular RIAs, the 4 most common locations of RIAs were the middle cerebral (32%), anterior communicating (32%), posterior communicating (14%), and pericallosal arteries (5%). However, proportional distribution of RIAs varied considerably by sex; for example, RIAs of the anterior communicating artery were more frequently found in men than in women. Anterior circulation RIAs accounted for 90% of all RIAs, and 30% of the patients had multiple intracranial aneurysms. The median size (measured as maximum diameter) of all RIAs was 7 mm (range 1–43 mm), but the size varied considerably by location. For example, RIAs of the ophthalmic artery had a median size of 11 mm, whereas the median size of RIAs of the pericallosal artery was 6 mm. Of all RIAs, 68% were smaller than 10 mm in maximum diameter.CONCLUSIONSIn this large consecutive series of RIAs, 83% of all RIAs were found in 4 anterior circulation locations. The majority of RIAs were small, but the size and location varied considerably by sex. The presented data may be of help in defining effective prevention strategies.

Incidence and risk factors of postoperative headache after endovascular coil embolization of unruptured intracranial aneurysms

2014 ◽  
Vol 156 (7) ◽  
pp. 1281-1287 ◽  
Author(s):  
Kyu-Sun Choi ◽  
Jung-Hyun Lee ◽  
Hyeong-Joong Yi ◽  
Hyoung-Joon Chun ◽  
Young-Jun Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Postoperative Headache ◽  
Endovascular Coil Embolization
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