scholarly journals Ticagrelor versus clopidogrel in stent-assisted coil embolization of unruptured intracranial aneurysms

2021 ◽  
pp. 159101992110549
Author(s):  
Shuo-Chi Chien ◽  
Ching-Chang Chen ◽  
Chun-Ting Chen ◽  
Alvin Yi-Chou Wang ◽  
Po-Chuan Hsieh ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Systemic Review ◽  
Bleeding Tendency ◽  
Unruptured Intracranial Aneurysms ◽  
Low Dose Aspirin ◽  
Hemorrhagic Events ◽  
One Year

Background Dual antiplatelet therapy is widely used for stent-assisted coil embolization (SACE) for unruptured intracranial aneurysms (UIAs) to prevent thromboembolic events (TEs). Compared to clopidogrel associated with aspirin, knowledge of the safety and efficacy of ticagrelor is lacking in large studies to date. Methods A retrospective cohort study was conducted from January 2016 to December 2018 with at least one year of follow-up in a single institution and systemic review. Results Altogether, 153 patients with UIA receiving SACE were separated into two groups: 113 patients receiving clopidogrel plus aspirin and 40 patients receiving ticagrelor plus aspirin. Acute in-stent thrombotic events were noted in two patients in the clopidogrel group (1.77%) and none in the ticagrelor group (0%). Additionally, one patient (0.88%) in the clopidogrel group had an early ischemic stroke (<3 months). Delayed ischemic stroke was noted in 6 patients (5.31%) in the clopidogrel group and 3 patients (7.50%) in the ticagrelor group. There were no major hemorrhagic events in either group. The two groups showed no significant differences with regard to ischemic stroke or hemorrhagic stroke. Conclusion Compared to the clopidogrel based regimen, ticagrelor can also reduce TEs without increasing bleeding tendency for SACE of UIAs. Ticagrelor combined with low-dose aspirin is a safe and effective alternative option for SACE.

scholarly journals Ticagrelor versus Clopidogrel in Stent-assisted Coil Embolization of Unruptured Intracranial Aneurysms

2021 ◽  
Author(s):  
Shuo-Chi Chien ◽  
Ching-Chang Chen ◽  
Chun-Ting Chen ◽  
Alvin Yi-Chou Wang ◽  
Po-Chuan Hsieh ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Hemorrhagic Stroke ◽  
Systemic Review ◽  
Bleeding Tendency ◽  
Thromboembolic Events ◽  
Hemorrhagic Event ◽  
Unruptured Intracranial Aneurysms ◽  
One Year

Abstract Background: In order to prevent thromboembolic events, dual antiplatelet therapy (DAPT) is widely used in stent-assisted coil embolization (SACE) for unruptured intracranial aneurysms (UIAs). Compared to clopidogrel associated with aspirin, knowledge of the safety and efficacy of ticagrelor are lacking in large studies to this date.Methods: A retrospective cohort study from January 2016 to December 2018 with at least one year follow in a single institution and systemic review.Results: Altogether 153 patients with UIA receiving SACE were separated into two groups: 113 patients receiving clopidogrel plus aspirin and 40 patients receiving ticagrelor plus aspirin. Acute in-stent thrombosis events were noted in 2 patients in the clopidogrel group (1.77%) and none in the ticagrelor group (0%). Another 1 patient (0.88%) in the clopidogrel group had an early ischemic stroke (<3 months). Delayed ischemic stroke was noted in 6 patients (5.31%) in the clopidogrel group and 3 patients (7.50%) in the ticagrelor group. There was no major hemorrhagic event in either group. The two groups had no significant differences with regard to ischemic stroke or hemorrhagic stroke.Conclusion: Compared to the clopidogrel based regimen, ticagrelor can reduce thromboembolic events without increasing bleeding tendency for stent-assisted coil embolization of unruptured intracranial aneurysms. Ticagrelor plus aspirin is a safe and effective alternative option for SACE.

scholarly journals Long-term outcomes of coil embolization of unruptured intracranial aneurysms

2018 ◽  
Vol 129 (6) ◽  
pp. 1492-1498 ◽  
Author(s):  
Masaomi Koyanagi ◽  
Akira Ishii ◽  
Hirotoshi Imamura ◽  
Tetsu Satow ◽  
Kazumichi Yoshida ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Additional Treatment ◽  
Long Term Outcomes ◽  
Unruptured Intracranial Aneurysms ◽  
Risk Of Rupture ◽  
Long Term Follow Up ◽  
Multiple Stroke

OBJECTIVELong-term follow-up results of the treatment of unruptured intracranial aneurysms (UIAs) by means of coil embolization remain unclear. The aim of this study was to analyze the frequency of rupture, retreatment, stroke, and death in patients with coiled UIAs who were followed for up to 20 years at multiple stroke centers.METHODSThe authors retrospectively analyzed data from cases in which patients underwent coil embolization between 1995 and 2004 at 4 stroke centers. In collecting the late (≥ 1 year) follow-up data, postal questionnaires were used to assess whether patients had experienced rupture or retreatment of a coiled aneurysm or any stroke or had died.RESULTSOverall, 184 patients with 188 UIAs were included. The median follow-up period was 12 years (interquartile range 11–13 years, maximum 20 years). A total of 152 UIAs (81%) were followed for more than 10 years. The incidence of rupture was 2 in 2122 aneurysm-years (annual rupture rate 0.09%). Nine of the 188 patients with coiled UIAs (4.8%) underwent additional treatment. In 5 of these 9 cases, the first retreatment was performed more than 5 years after the initial treatment. Large aneurysms were significantly more likely to require retreatment. Nine strokes occurred over the 2122 aneurysm-years. Seventeen patients died in this cohort.CONCLUSIONSThis study demonstrates a low risk of rupture of coiled UIAs with long-term follow-up periods of up to 20 years. This suggests that coiling of UIAs could prevent rupture for a long period of time. However, large aneurysms might need to be followed for a longer time.

scholarly journals Aneurysm Study of Pipeline in an Observational Registry (ASPIRe)

2016 ◽  
Vol 5 (1-2) ◽  
pp. 89-99 ◽  
Author(s):  
David F. Kallmes ◽  
Waleed Brinjikji ◽  
Edoardo Boccardi ◽  
Elisa Ciceri ◽  
Orlando Diaz ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mortality Rate ◽  
Adverse Events ◽  
Intracranial Aneurysms ◽  
Morbidity And Mortality ◽  
Parent Artery ◽  
Complete Occlusion ◽  
Unruptured Intracranial Aneurysms ◽  
Neurological Morbidity

Background and Objective: Few prospective studies exist evaluating the safety and efficacy of the Pipeline Embolization Device (PED) in the treatment of intracranial aneurysms. The Aneurysm Study of Pipeline In an observational Registry (ASPIRe) study prospectively analyzed rates of complete aneurysm occlusion and neurologic adverse events following PED treatment of intracranial aneurysms. Materials and Methods: We performed a multicenter study prospectively evaluating patients with unruptured intracranial aneurysms treated with PED. Primary outcomes included (1) spontaneous rupture of the Pipeline-treated aneurysm; (2) spontaneous nonaneurysmal intracranial hemorrhage (ICH); (3) acute ischemic stroke; (4) parent artery stenosis, and (5) permanent cranial neuropathy. Secondary endpoints were (1) treatment success and (2) morbidity and mortality at the 6-month follow-up. Vascular imaging was evaluated at an independent core laboratory. Results: One hundred and ninety-one patients with 207 treated aneurysms were included in this registry. The mean aneurysm size was 14.5 ± 6.9 mm, and the median imaging follow-up was 7.8 months. Twenty-four aneurysms (11.6%) were small, 162 (78.3%) were large and 21 (10.1%) were giant. The median clinical follow-up time was 6.2 months. The neurological morbidity rate was 6.8% (13/191), and the neurological mortality rate was 1.6% (3/191). The combined neurological morbidity/mortality rate was 6.8% (13/191). The most common adverse events were ischemic stroke (4.7%, 9/191) and spontaneous ICH (3.7%, 7/191). The complete occlusion rate at the last follow-up was 74.8% (77/103). Conclusions: Our prospective postmarket study confirms that PED treatment of aneurysms in a heterogeneous patient population is safe with low rates of neurological morbidity and mortality. Patients with angiographic follow-up had complete occlusion rates of 75% at 8 months.

Aspect ratio is associated with recanalization after coiling of unruptured intracranial aneurysms

2021 ◽  
Author(s):  
Takeshi Hara ◽  
Tetsu Satow ◽  
Eika Hamano ◽  
Naoki Hashimura ◽  
Masatake Sumi ◽  
...  
Keyword(s):  
Aspect Ratio ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Neck Width ◽  
Tof Mra ◽  
Unruptured Intracranial Aneurysms ◽  
The Mean

Abstract Background The rate of recanalization after coil embolization for unruptured intracranial aneurysms (UIAs) is reported to occur around 11.3-49%. Aim of this study is to investigated the factors that influence the recanalization after coil embolization for unruptured intracranial aneurysms (UIAs) in our institution. Methods We retrospectively investigated 307 UIAs in 296 patients treated at our institution between April 2004 and December 2016. The stent used cases were excluded. Cerebral angiography and 3D TOF MRA were used for evaluation of the postoperative occlusion status. Volume embolization ratio (VER), aneurysmal size, neck width, and aspect ratio (AR) were compared between the recanalized and non-recanalized groups. Results The mean follow-up period ranged from 6 to 172 months (mean: 79.0±39.8 months). Recanalization was noted in 87 (28.3%) aneurysms, and 19 (6.2%) aneurysms required retreatment. There was no aneurysmal rupture during the follow-up period. Univariate analysis showed that the aneurysm size (p < 0.001), neck width (p = 0.002), AR (p = 0.003), and VER (p = 0.027) were associated with recanalization. Multivariate logistic regression analysis showed that the AR (p =0.004) and VER (p =0.015) were significant predictors of recanalization. Conclusions In our study, AR and VER were significant predictors of recanalization after coil embolization for UIAs.

scholarly journals Time Course of Cerebrovascular Reactivity in Patients Treated for Unruptured Intracranial Aneurysms: A One-Year Transcranial Doppler and Acetazolamide Follow-Up Study

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Marianne Lundervik Bøthun ◽  
Øystein Ariansen Haaland ◽  
Nicola Logallo ◽  
Frode Svendsen ◽  
Lars Thomassen ◽  
...  
Keyword(s):  
Transcranial Doppler ◽  
Intracranial Aneurysms ◽  
Time Course ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebrovascular Reactivity ◽  
Ipsilateral Side ◽  
Mean Values ◽  
Unruptured Intracranial Aneurysms ◽  
One Year

Background. Cerebrovascular reactivity (CVR) is often impaired in the early phase after aneurysmal subarachnoid hemorrhage. There is, however, little knowledge about the time course of CVR in patients treated for unruptured intracranial aneurysms (UIA). Methods. CVR, assessed by transcranial Doppler and acetazolamide test, was examined within the first postoperative week after treatment for UIA and reexamined one year later. Results. Of 37 patients initially assessed, 34 were reexamined after one year. Bilaterally, baseline and acetazolamide-induced blood flow velocities were higher in the postoperative week compared with one year later (p<0.001). CVR on the ipsilateral side of treatment was lower in the initial examination compared with follow-up (58.9% versus 66.1%, p=0.04). There was no difference in CVR over time on the contralateral side (63.4% versus 65.0%, p=0.65). When mean values of right and left sides were considered there was no difference in CVR between exams. Larger aneurysm size was associated with increased change in CVR (p=0.04), and treatment with clipping was associated with 13.8%-point increased change in CVR compared with coiling (p=0.03). Conclusion. Patients with UIA may have a temporary reduction in CVR on the ipsilateral side after aneurysm treatment. The change in CVR appears more pronounced for larger-sized aneurysms and in patients treated with clipping. We recommend that ipsilateral and contralateral CVR should be assessed separately, as mean values can conceal side-differences.

scholarly journals Prevalence of intracranial aneurysms among acute ischemic stroke patients

2020 ◽  
Vol 11 ◽  
pp. 341
Author(s):  
Jiroje Jiranukool ◽  
Peeraphong Thiarawat ◽  
Waneerat Galassi
Keyword(s):  
Ischemic Stroke ◽  
General Population ◽  
Acute Ischemic Stroke ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Demographic Data ◽  
Genetic Diseases ◽  
Stroke Patients ◽  
Unruptured Intracranial Aneurysms

Background: The prevalence of unruptured intracranial aneurysms varies with age, sex, and genetic diseases, including atherosclerotic diseases. The objectives of this study are to determine the prevalence of intracranial aneurysms among acute ischemic stroke patients and the clinical outcomes of the patients. Methods: The authors included patients with acute ischemic stroke within 7 days of onset. Demographic data, stroke subtypes, risk factors, and modified Rankin scale (mRS) scores at 6 months after stroke were collected. Magnetic resonance angiography was performed to diagnose intracranial aneurysms. The occurrence of aneurysmal subarachnoid hemorrhage (aSAH) was recorded during the follow-up at 6 months. Results: Thirteen (7%) of the 186 patients were found to have incidental intracranial aneurysms. Age and sex were not different between the patients with and without aneurysms (P > 0.999, P > 0.999). Ten patients (76.9%) had a saccular aneurysm. The most common site of the aneurysm was the cavernous part of the internal carotid artery (n = 6). Nine patients (69.2%) had very small (<4 mm) aneurysms. No aSAH was detected until 6 months after stroke. Favorable outcomes (mRS 0–2) at 6 months were not different between the patients with and without aneurysms (69.2% vs. 75.1%, P = 0.665). Conclusion: A higher prevalence of intracranial aneurysms was observed among acute ischemic stroke patients than among the general population. However, the variability of the general population should be considered. The functional outcomes of acute ischemic stroke patients are not affected by the presence of an intracranial aneurysm.

One-Year Morbidity and Mortality Rates Associated with Clipping Unruptured Intracranial Aneurysms

2019 ◽  
Author(s):  
Khodayar Goshtasbi ◽  
Ronald Sahyouni ◽  
Alice Wang ◽  
Edward Choi ◽  
Gilbert Cadena ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Unruptured Intracranial Aneurysms ◽  
One Year

Unruptured intracranial aneurysms in children: 18 years’ experience in a tertiary care pediatric institution

2019 ◽  
Vol 24 (2) ◽  
pp. 184-189 ◽  
Author(s):  
Daniel-Alexandre Bisson ◽  
Peter Dirks ◽  
Afsaneh Amirabadi ◽  
Manohar M. Shroff ◽  
Timo Krings ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Natural History ◽  
Internal Carotid Artery ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Tertiary Care ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Mean Size

OBJECTIVEThere are little data in the literature on the characteristics and natural history of unruptured intracranial aneurysms in children. The authors analyzed their experience with unruptured intracranial aneurysms in the pediatric population at their tertiary care pediatric institution over the last 18 years. The first objective was to assess the imaging characteristics and natural history of these aneurysms in order to help guide management strategies in the future. A second objective was to evaluate the frequency of an underlying condition when an incidental intracranial aneurysm was detected in a child.METHODSThe authors conducted a Research Ethics Board–approved retrospective review of incidental intracranial aneurysms in patients younger than 18 years of age who had been treated at their institution in the period from 1998 to 2016. Clinical (age, sex, syndrome) and radiological (aneurysm location, type, size, thrombus, mass effect) data were recorded. Follow-up imaging was assessed for temporal changes.RESULTSSixty intracranial aneurysms occurred in 51 patients (36 males, 15 females) with a mean age of 10.5 ± 0.5 years (range 9 months–17 years). Forty-five patients (88.2%) had a single aneurysm, while 2 and 3 aneurysms were found in 3 patients each (5.8%). Syndromic association was found in 22 patients (43.1%), most frequently sickle cell disease (10/22 [45.5%]). Aneurysms were saccular in 43 cases (71.7%; mean size 5.0 ± 5.7 mm) and fusiform in the remaining 17 (28.3%; mean size 6.5 ± 2.7 mm). Thirty-one aneurysms (51.7%) arose from the internal carotid artery (right/left 1.4), most commonly in the cavernous segment (10/31 [32.3%]). Mean size change over the entire follow-up of 109 patient-years was a decrease of 0.6 ± 4.2 mm (range −30.0 to +4.0 mm, rate −0.12 ± 9.9 mm/yr). Interval growth (2.0 ± 1.0 mm) was seen in 8 aneurysms (13.3%; 4 saccular, 4 fusiform). An interval decrease in size (8.3 ± 10.7 mm) was seen in 6 aneurysms (10%). There was an inverse relationship between aneurysm size and growth rate (r = −0.82, p < 0.00001). One aneurysm was treated endovascularly with internal carotid artery sacrifice.CONCLUSIONSUnruptured pediatric intracranial aneurysms are most frequently single but can occur in multiples in a syndromic setting. None of the cases from the study period showed clinical or imaging signs of rupture. Growth over time, although unusual and slow, can occur in a proportion of these patients, who should be identified for short-term imaging surveillance.

scholarly journals Evaluation of the Accero Stent for Stent-Assisted Coiling of Unruptured Wide-Necked Intracranial Aneurysm Treatment with Short-Term Follow-Up

2020 ◽  
Vol 9 (9) ◽  
pp. 2808
Author(s):  
Wojciech Poncyljusz ◽  
Kinga Kubiak ◽  
Leszek Sagan ◽  
Bartosz Limanówka ◽  
Katarzyna Kołaczyk
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Clinical Results ◽  
Class I ◽  
Unruptured Aneurysms ◽  
Patient Demographics ◽  
Stent Deformation ◽  
Unruptured Intracranial Aneurysms ◽  
Occlusion Rate

Background: Stent-assisted coiling is an effective method of treating intracranial aneurysms. The aim of the study was to assess the safety and efficacy of the new Accero stent for the treatment of intracranial aneurysms. Materials and Methods: It was a retrospective, single-center study. Eighteen unruptured intracranial aneurysms were treated using the stent-assisted coiling method with the Accero stent. Patient demographics, aneurysm characteristics, procedural parameters, grade of occlusion, complications, and clinical results were analyzed. Follow-up magnetic resonance (MR) was performed 6 months after intervention. Results: Seventeen patients with 18 incidental unruptured aneurysms were electively treated with coiling and the Accero stent. The aneurysms were located on internal carotid artery (ICA), middle cerebral artery (MCA) and basilar artery (BA). All stents were deployed successfully. Immediate complete occlusion rate Raymond-Roy occlusion classification (RROC) class I was achieved in 13 cases and class II in 4 cases. Complications occurred in 2/17 treatments and included guidewire stent perforation with subarachnoid hemorrhage (SAH) and stent deformation. Vascular spasm in the subarachnoid hemorrhage (SAH) patient subsided before discharge. Ninety days after intervention, the modified Rankin Scale (mRS) value was 0. RROC class I was observed in 88.23% of cases in follow-up. Conclusion: The Accero stent provides excellent support for coil mass. It constitutes an efficacious device with good initial occlusion rate for treating wide-necked unruptured intracranial aneurysms.

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