Problems in Endovascular Procedures in Acute Ruptured Intracranial Aneurysms

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 121-124 ◽  
Author(s):  
T. Shibuya ◽  
H. Kushi ◽  
K. Kinoshita ◽  
T. Saito ◽  
N. Hayashi
Keyword(s):  
Intracranial Aneurysms ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Artery Aneurysm ◽  
Endovascular Procedure ◽  
Parent Artery ◽  
Internal Carotid Artery Aneurysm ◽  
Ruptured Intracranial Aneurysm ◽  
Severe Atherosclerosis ◽  
Ruptured Intracranial Aneurysms

Fifteen patients with acute ruptured intracranial aneurysms were treated with interlocking detachable coil (IDC) embolization. All graded poorly, i.e., Hunt & Kosnik grades IV and V. Aneurysm occurred in the anterior circulation in 14 patients and at the basilar tip in one, of these, 13 were small and 2 large. The endovascular procedure was conducted in a transfemoral approach under local anesthesia. Aneurysmal obliteration was examined transitionally after embolization. Final outcome was evaluated using the Glasgow outcome scale (GOS). Total aneurysmal occlusion was observed immediately after IDC embolization in 11 patients. Two cases of coil migration to the parent artery occurred during endovascular procedure in patients with severe atherosclerosis. Aneurysmal rupture occurred during the endovascular procedure in a small internal carotid artery aneurysm when coil detachment failed. Follow-up angiography showed coil compaction in 2 patients, one patient experienced deterioration when the aneurysm ruptured. Eleven patients (73.3%) retained total aneurysmal occlusion and had no rebleeding. The overall GOS indicated good recovery in 5 patients, severe disability in 2, persistent vegetative state in 2, and death in 6. IDC embolization in severe acute ruptured intracranial aneurysm successfully prevented rebleeding, but our series was limited by the very small aneurysm size and the presence of severe atherosclerosis.

Endovascular treatment of complex intracranial aneurysms using Acandis Acclino stents

2016 ◽  
Vol 9 (9) ◽  
pp. 854-859 ◽  
Author(s):  
Friedhelm Brassel ◽  
Dominik Grieb ◽  
Dan Meila ◽  
Martin Schlunz-Hendann ◽  
Björn Greling ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Demographic Data ◽  
Artery Aneurysm ◽  
Parent Artery ◽  
Complication Rates ◽  
Safe Procedure ◽  
Internal Carotid Artery Aneurysm ◽  
Dissecting Aneurysms

ObjectiveTo determine the safety and effectiveness of a new low-profile, laser-cut, closed-cell stent system in the treatment of complex intracranial aneurysms.MethodsA total number of 43 patients with complex intracranial aneurysms were treated using 60 Acandis Acclino stent systems (follow-up 2012–2016; mean 11 months). 36 patients presented with wide-necked intracranial aneurysms, dissecting aneurysms were seen in 7 patients. 39 patients received stent-assisted coiling. We analyzed demographic data and follow-up results.ResultsSixty stents were successfully deployed. In one paraophthalmic internal carotid artery aneurysm the stent could not be placed. Thirty-three wide necked aneurysms were treated by single or multiple stent-assisted coiling. Complete occlusion was achieved in 31 of those cases (94% Raymond−Roy occlusion classification, RROC 1). Two patients showed stable residual aneurysmal filling (RROC 3). In three wide-necked aneurysms, sole stenting was the preferred treatment. For dual stent-assisted procedures the kissing-Y stenting technique was successfully performed in 11 aneurysms. In all dissecting aneurysms constructive therapy with stenting and preservation of the affected parent artery was achieved. Additional subsequent coil embolization was intentionally planned and successfully performed in 6 of the 7 dissecting aneurysms. The overall directly procedure-related complication rate was 7%, including one death.ConclusionsEndovascular treatment of complex intracranial aneurysms using Acclino stents is a feasible and safe procedure with low complication rates. Even severe cases can be treated among others using the kissing-Y stenting technique, with good mid-term results.

scholarly journals Staged Endovascular Management of a Ruptured Intracranial Aneurysm

1999 ◽  
Vol 5 (1) ◽  
pp. 45-49
Author(s):  
P. Morris ◽  
M. Bednar ◽  
C. Gross
Keyword(s):  
Endovascular Procedures ◽  
Artery Aneurysm ◽  
Balloon Occlusion ◽  
Definitive Treatment ◽  
Parent Artery ◽  
Endovascular Techniques ◽  
Parent Vessel ◽  
Ruptured Intracranial Aneurysm ◽  
Ruptured Intracranial Aneurysms ◽  
Intracranial Circulation

The goal of treatment of ruptured intracranial aneurysms is the exclusion of the aneurysm from the intracranial circulation. Recently endovascular techniques have provided an alternative to open surgery in selected patients. Herein, we present a patient who underwent staged endovascular procedures to achieve definitive treatment of an intracranial fusiform vertebral artery aneurysm. Definitive immediate therapy for the aneurysm was not possible at first presentation because of the aneurysm location and configuration, and because of absence of collateral circulation. The first stage involved coiling a daughter bleb suspected of being the source of haemorrhage. This provided acute protection against rebleeding without sacrificing the parent artery. The second and more definitive stage, delayed for 31 days, involved balloon occlusion of a fusiform aneurysm by sacrificing the parent vessel.

Rupture of previously documented small asymptomatic saccular intracranial aneurysms

1992 ◽  
Vol 76 (6) ◽  
pp. 1019-1024 ◽  
Author(s):  
Wouter I. Schievink ◽  
David G. Piepgras ◽  
Fremont P. Wirth
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Careful Consideration ◽  
Middle Cerebral Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Cerebellar Artery ◽  
Cerebral Artery Aneurysm

✓ In a recent study from the Mayo Clinic on the natural history of intact saccular intracranial aneurysms, none of the aneurysms smaller than 10 mm in diameter ruptured. It was concluded that these aneurysms carry a negligible risk for future hemorrhage and that surgery for their repair could not be recommended. These findings and recommendations have been the subject of much controversy. The authors report three patients with previously documented asymptomatic intact saccular intracranial aneurysms smaller than 5 mm in diameter that subsequently ruptured. In Case 1, a 70-year-old man bled from a 4-mm middle cerebral artery aneurysm that had been discovered incidentally 2½ years previously during evaluation of cerebral ischemic symptoms. A 10-mm internal carotid artery aneurysm and a contralateral 4-mm middle cerebral artery aneurysm had not ruptured. Case 2 was that of a 66-year-old woman who bled from a 4-mm pericallosal aneurysm that had been present 9½ years previously when she suffered subarachnoid hemorrhage (SAH) from a 7 × 9-mm posterior inferior cerebellar artery aneurysm. Although the pericallosal aneurysm had not enlarged in the intervening years, a daughter aneurysm had developed. The third patient was a 45-year-old woman who bled from a 4- to 5-mm posterior inferior cerebellar artery aneurysm that had measured approximately 2 mm on an angiogram obtained 4 years previously; at that time she had suffered SAH due to rupture of a 5 × 12-mm posterior communicating artery aneurysm. These cases show that small asymptomatic intact saccular intracranial aneurysms are not innocuous and that careful consideration must be given to their surgical repair and long-term follow-up study.

scholarly journals Late Thromboembolic Events after Treatment of Intracranial Aneurysms with Guglielmi Detachable Coils

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 356-357
Author(s):  
Colin P Derdeyn ◽  
Christopher J Moran ◽  
DeWitte T Cross ◽  
Michael R Chicoine ◽  
Ralph G Dacey
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Additional Patient ◽  
Superior Cerebellar Artery ◽  
Parent Artery ◽  
Imaging Data ◽  
Guglielmi Detachable Coils ◽  
Kaplan Meier ◽  
Detachable Coils

P98 Purpose: Thrombo-embolic complications associated with the endovascular treatment of intracranial aneurysms with Guglielmi Detachable Coils (GDC) generally occur at the time of the procedure or soon after. The purpose of this report is to determine the frequency of late thrombo-embolic events after GDC. Methods: The records of 189 patients who underwent GDC repair of one or more intracranial aneurysms at our institution were reviewed. The occurence of an ischemic event referrable to a coiled aneurysm was determined by clinical, angiographic, and imaging data. Events occuring within 2 days of the endovascular procedure were considered peri-procedural. Kaplan-Meier analysis of ischemic events over time was performed. Results: Two patients suffered documented thrombo-embolic events. One patient presented 5 weeks after coiling with a transient ischemic attack. Angiography demonstrated thrombus on the surface of the coils at the neck of a large ophthalmic artery aneurysm. The second patient presented with a posterior circulation stroke 4 weeks after coiling of a large superior cerebellar artery aneurysm. Angiography showed no significant proximal disease, with thrombus beginning at the neck of the treated aneurysm and extending out both P1 segments. No intra-procedural problems during the initial coiling had occured with either patient. There was no evidence for protrusion of coils into the parent artery in either patient. Both patients had been receiving daily aspirin (325 mg). One additional patient reporting symptoms suggesting possible ischemics event was evaluated and diagnosed as having atypical migraines. The frequency of a clinical thromboembolic event during the first year after coiling (excluding procedural complications) was 1.1%. Conclusions: Thrombo-embolic events may occur as late as 5 weeks after endovascular treatment of aneurysms with GDC.

scholarly journals Endovascular Treatment of Small Ruptured Intracranial Aneurysms (<5 mm)

2019 ◽  
Vol 30 (4) ◽  
pp. 817-826
Author(s):  
Fei Peng ◽  
Xin Feng ◽  
Xin Tong ◽  
Baorui Zhang ◽  
Luyao Wang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Cox Proportional Hazards ◽  
Parent Artery ◽  
Parent Vessel ◽  
Fisher Grade ◽  
Wide Neck ◽  
Ruptured Intracranial Aneurysms

Abstract Purpose To investigate the long-term clinical and angiographic outcomes and their related predictors in endovascular treatment (EVT) of small (<5 mm) ruptured intracranial aneurysms (SRA). Methods The study retrospectively reviewed patients with SRAs who underwent EVT between September 2011 and December 2016 in two Chinese stroke centers. Medical charts and telephone call follow-up were used to identify the overall unfavorable clinical outcomes (OUCO, modified Rankin score ≤2) and any recanalization or retreatment. The independent predictors of OUCO and recanalization were studied using univariate and multivariate analyses. Multivariate Cox proportional hazards models were used to identify the predictors of retreatment. Results In this study 272 SRAs were included with a median follow-up period of 5.0 years (interquartile range 3.5–6.5 years) and 231 patients with over 1171 aneurysm-years were contacted. Among these, OUCO, recanalization, and retreatment occurred in 20 (7.4%), 24 (12.8%), and 11 (7.1%) patients, respectively. Aneurysms accompanied by parent vessel stenosis (AAPVS), high Hunt-Hess grade, high Fisher grade, and intraoperative thrombogenesis in the parent artery (ITPA) were the independent predictors of OUCO. A wide neck was found to be a predictor of recanalization. The 11 retreatments included 1 case of surgical clipping, 6 cases of coiling, and 4 cases of stent-assisted coiling. A wide neck and AAPVS were the related predictors. Conclusion The present study demonstrated relatively favorable clinical and angiographic outcomes in EVT of SRAs in long-term follow-up of up to 5 years. THE AAPVS, as a morphological indicator of the parent artery for both OUCO and retreatment, needs further validation.

Cerebral circulation time with ruptured intracranial aneurysms

1974 ◽  
Vol 41 (4) ◽  
pp. 415-420 ◽  
Author(s):  
Shige-Hisa Okawara ◽  
Jun Kimura ◽  
Joo Y. Hahn
Keyword(s):  
Intracranial Aneurysms ◽  
Blood Circulation ◽  
Circulation Time ◽  
Arterial Phase ◽  
Preoperative Treatment ◽  
Content Type ◽  
Arterial Perfusion ◽  
Ruptured Intracranial Aneurysm ◽  
Ruptured Intracranial Aneurysms ◽  
Cerebral Blood Circulation

✓ The cerebral blood circulation time (CT), including the length of the arterial phase, was obtained from rapid serial angiograms in 114 patients with ruptured intracranial aneurysms. The average CT of 7.2 sec, with a mean arterial phase of 3.1 sec, was much longer than the normal average CT of 5.4 sec with its 2.4 sec arterial phase. Longer circulation times were observed with the higher Botterell grades of clinical condition, high arterial perfusion and CSF pressures, and in cases with angiographic evidence of arterial spasm, hematoma, or hydrocephalus. Values of CT greater than 8.0 sec were associated with increased mortality and morbidity and vice versa. The value of the cerebral blood circulation time as a guide to preoperative treatment and to the prognosis of cases of ruptured intracranial aneurysm is suggested.

Delayed appearance of a traumatic intracranial aneurysm

2001 ◽  
Vol 94 (4) ◽  
pp. 637-641 ◽  
Author(s):  
Mokbel K. Chedid ◽  
John R. Vender ◽  
Steven J. Harrison ◽  
Dennis E. McDonnell
Keyword(s):  
Vietnam War ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Treatment Options ◽  
Artery Aneurysm ◽  
Imaging Studies ◽  
Content Type ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Traumatic Aneurysms

✓ Giant traumatic intracranial aneurysms are rare, and thus their incidence and clinical behavior are poorly understood. In most cases, traumatic aneurysms develop and become symptomatic within months following injury. The authors present the case of a 46-year-old war veteran, in whom a giant internal carotid artery aneurysm developed as a result of a penetrating cranial shrapnel injury sustained 25 years earlier during the Vietnam war. The aneurysm had not been evident on previous imaging studies. At surgery, a piece of shrapnel was found embedded in the dome of the aneurysm. The presentation, diagnosis, management, and treatment options related to this lesion are discussed.

Transradial Access or Simmons Shaped 8F Guide Enables Delivery of Flow Diverters in Patients With Large Intracranial Aneurysms and Type III Aortic Arch: Technical Case Report

2012 ◽  
Vol 73 (suppl_1) ◽  
pp. onsE111-onse116 ◽  
Author(s):  
Carolin Dietrich ◽  
Gesa H. Hauck ◽  
Luca Valvassori ◽  
Erik F. Hauck
Keyword(s):  
Carotid Artery ◽  
Aortic Arch ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Acute Onset ◽  
Third Nerve Palsy ◽  
Type Iii ◽  
Complex Aneurysms ◽  
Transradial Access ◽  
Internal Carotid Artery Aneurysm

Abstract BACKGROUND AND IMPORTANCE: Flow diversion with the pipeline embolization device (PED) is an emerging endovascular technology allowing curative embolization of very large and giant intracranial aneurysms. Many patients with these complex aneurysms are older. The presence of a tortuous type III aortic arch reduces the chances of successful PED delivery and increases the risk of complications. We report 2 technical nuances regarding the delivery of the PED in older patients with a complex aortic arch. CLINICAL PRESENTATION: In case 1, an 87-year-old woman presented with acute-onset left third nerve palsy. Workup demonstrated an 18-mm left posterior carotid wall aneurysm with a large daughter aneurysm on its dome. Endovascular access was complicated by a type III aortic arch with a hyperacute angle at the origin of the left common carotid artery. An 8F Simmons II shaped guide formed a stable platform, allowing successful PED delivery. In case 2, a 76-year-old woman experienced a transient ischemic attack. She harbored a right-sided 20-mm cavernous internal carotid artery aneurysm. She was treated with 2 PEDs deployed via a transradial approach. CONCLUSION: Transradial access or guide support with the 8F Simmons II catheter grants stable access for curative embolization with the PED in elderly patients with a large intracranial aneurysm and a complex aortic arch.

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