Clinical Results and Problems in Embolization for Intracranial Aneurysms Using Electrically Detachable Coils

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 71-73
Author(s):  
M. Tsuura ◽  
T. Terada ◽  
H. Yokote ◽  
Y. Kinoshita ◽  
K. Nakai ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Clinical Results ◽  
Thromboembolic Complications ◽  
Complete Occlusion ◽  
Detachable Coils ◽  
Incomplete Occlusion

Nineteen patients with intracranial aneurysm were treated using electrically detachable coils (GDC or IEDC) and angiographic results and complications were assessed. In 18 aneurysms treated by endosaccular occlusion, 11 (61%), 3 (17%) and 4 (22%) resulted in complete occlusion, neck remnant and dome filling, respectively. Neither haemorrhagic nor thromboembolic complications occurred in 19 patients. Embolization using electrically detachable coils seemed to be a safe and useful procedure without complications, but we should give attention to avoiding complications and incomplete occlusion in particular in a case of 1) wide-necked, 2) small (> 3 mm) or 3) complex-shaped aneurysms.

EVALUATION OF ONYX HD-500 EMBOLIC SYSTEM IN THE TREATMENT OF 84 WIDE-NECK INTRACRANIAL ANEURYSMS

Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. E865-E875 ◽  
Author(s):  
Ronie L. Piske ◽  
Luis H. Kanashiro ◽  
Eric Paschoal ◽  
Celso Agner ◽  
Sergio S. Lima ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
High Rate ◽  
Anterior Circulation ◽  
Complete Occlusion ◽  
Aneurysm Occlusion ◽  
Incomplete Occlusion ◽  
Wide Neck ◽  
Small Aneurysms ◽  
Platinum Coils

Abstract OBJECTIVE We report our results using Onyx HD-500 (Micro Therapeutics, Inc., Irvine, CA) in the endovascular treatment of wide-neck intracranial aneurysms, which have a high rate of incomplete occlusion and recanalization with platinum coils. METHODS Sixty-nine patients with 84 aneurysms were treated. Most of the aneurysms were located in the anterior circulation (80 of 84 aneurysms), were unruptured (74 of 84 aneurysms), and were incidental. Ten presented with subarachnoid hemorrhage, and 15 were symptomatic. All aneurysms had wide necks (neck >4 mm and/or dome-to-neck ratio <1.5). Fifty aneurysms were small (<12 mm), 30 were large (12 to <25 mm) and 4 were giant. Angiographic follow-up was available for 65 of the 84 aneurysms at 6 months, for 31 of the 84 aneurysms at 18 months, and for 5 of the 84 aneurysms at 36 months. RESULTS Complete aneurysm occlusion was seen in 65.5% of aneurysms on immediate control, in 84.6% at 6 months, and in 90.3% at 18 months. The rates of complete occlusion were 74%, 95.1%, and 95.2% for small aneurysms and 53.3%, 70%, and 80% for large aneurysms at the same follow-up periods. Progression from incomplete to complete occlusion was seen in 68.2% of all aneurysms, with a higher percentage in small aneurysms (90.9%). Aneurysm recanalization was observed in 3 patients (4.6%), with retreatment in 2 patients (3.3%). Procedural mortality was 2.9%. Overall morbidity was 7.2%. CONCLUSION Onyx embolization of intracranial wide-neck aneurysms is safe and effective. Morbidity and mortality rates are similar to those of other current endovascular techniques. Larger samples and longer follow-up periods are necessary.

scholarly journals Coil Migration under Stent-Assisted Embolization

2006 ◽  
Vol 12 (1) ◽  
pp. 65-68 ◽  
Author(s):  
C.S. Cho
Keyword(s):  
Intracranial Aneurysm ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Effective Treatment Option ◽  
Parent Vessel ◽  
Complex Aneurysms ◽  
Delayed Complication ◽  
Detachable Coils ◽  
Neuroform Stent ◽  
Coil Migration

Detachable coils are established as a safe and effective treatment option for some patients with intracranial aneurysms. However this treatment is not useful for the treatment of certain types of complicated aneurysms. Wide-necked or broad-based aneurysms are still complicated to embolize because of the risk of coil migration or coil protrusion into the parent vessel. The Neuroform stent has recently been introduced for the treatment of complex aneurysms. The stent functions primarily to provide durable parent vessel protection during embolization. This report demonstrates coil migration occurring as a delayed complication of Neuroform stent-assisedt coil embolization of a small intracranial aneurysm.

GEL THE NEC: a prospective registry evaluating the safety, ease of use, and efficacy of the HydroSoft coil as a finishing device

2017 ◽  
Vol 10 (1) ◽  
pp. 83-87 ◽  
Author(s):  
Waleed Brinjikji ◽  
Arun P Amar ◽  
Josser E Delgado Almandoz ◽  
Orlando Diaz ◽  
Pascal Jabbour ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Perioperative Complications ◽  
Major Complication ◽  
Clinical Results ◽  
Ease Of Use ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Registration Number ◽  
Occlusion Rate

Background and purposeThe HydroSoft coil was developed as a finishing coil, ideally to be placed along the aneurysm neck to enhance intracranial aneurysm healing. The GEL THE NEC (Gaining Efficacy Long Term: Hydrosoft, an Emerging, New, Embolic Coil) multicenter registry was developed to assess the safety and efficacy of HydroSoft coils in treating intracranial aneurysms. We report angiographic and clinical results of this prospective registry.Materials and methodsGEL THE NEC was performed at 27 centers in five countries. Patients aged 21–90 years with a ruptured or unruptured aneurysm 3–15 mm in size were eligible for enrollment. The following variables were obtained: demographics/comorbidities, aneurysm geometry, adjunctive devices used, proportion of patients in whom HydroSoft coils were successfully placed, and long-term angiographic outcomes (graded by an independent core laboratory using the Modified Raymond Scale), and procedure-related adverse events. Predictors of good angiographic outcome were studied using χ2 and t-tests.ResultsA total of 599 patients with 599 aneurysms were included in this study. HydroSoft coils were successfully deployed in 577 (96.4%) patients. Procedure-related major morbidity and mortality were 0.5% (3/599) and 1.3% (8/599), respectively. The most common perioperative complications were iatrogenic vasospasm (30/599, 5.0%), thromboemboli (27/599, 4.5%), and aneurysm perforation (16/599, 2.7%). At last angiographic follow-up (mean 9.0±6.3 months), the complete occlusion rate was 63.2% (280/442) and near complete occlusion rate was 25.2% (107/442). The core laboratory read recanalization rate was 10.8% (46/425) and the retreatment rate was 3.4% (20/599).ConclusionsEndovascular treatment of intracranial aneurysms with HydroSoft coils resulted in complete/near complete occlusion rates of 88% and a major complication rate of 1.8%.Trial registration numberNCT01000675.

scholarly journals The safety and outcomes of acutely ruptured intracranial aneurysms with incomplete occlusion after coiling: a case-control study

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jianhe Yue ◽  
Yuan Xie ◽  
Xiaolin Zhang ◽  
Yongxiang Jiang ◽  
Weifu Chen ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Intracranial Aneurysms ◽  
Multivariable Analysis ◽  
Complete Occlusion ◽  
Significant Difference ◽  
Complications Rate ◽  
Progressive Occlusion ◽  
Incomplete Occlusion ◽  
Ruptured Intracranial Aneurysms

Abstract Background Incomplete aneurysmal occlusion is a common feature of immediate posttreatment angiography. The safety and outcomes of acutely ruptured intracranial aneurysms (RIAs) with incomplete occlusion after stent-assisted coiling (SAC) and no-stent coiling (NSC) have not been well clarified. Progressive occlusion of stents can promote the complete occlusion of intracranial aneurysms (IAs), but it remains to be determined if progressive occlusion in acutely RIAs with incomplete occlusion after coiling may be enhanced by protective stenting. This study aimed to evaluate the safety and outcomes of those aneurysms after SAC and NSC; And to discover whether the stents can promote progressive aneurysm occlusion in such lesions or not. Methods We reviewed 199 patients with acutely RIAs underwent endovascular coiling and developed incomplete occlusion in the past seven years. The patients’ clinical and imaging information were recorded and analyzed. Univariate and multivariate analyses were performed to determine the association of recurrence rate with potential risk factors. Results SAC group had wider aneurysms neck (3.471 mm vs 2.830 mm, P = 0.009) and smaller dome-to-neck ratio (1.536 vs 2.111, P = 0.001) than in NSC group. There was no significant difference between the two groups in total procedure-related complications rate (31.7% vs 23.5%, P = 0.195), procedure-related mortality (6.9% vs 2.0%, P = 0.170) and modified Rankin Scale (mRS) score at 6-month follow-up (P > 0.05). However, SAC group had significantly higher ischemic complications rate (21.8% vs 8.2%, P = 0.007) and complete occlusion rate (65.6% vs 48.3%, P = 0.020), and lower recurrence rate (15.6% vs 28.1%, P = 0.042) than NSC group based on 6-month follow-up angiograms. Additionally, Multivariable analysis showed NSC was an independent risk factor for aneurysm recurrence (Odds Ratio [OR]: 4.061; P = 0.018). Conclusions Acutely RIAs with incomplete occlusion after SAC is associated with higher complications rate and mortality, but has an acceptable safety profile and similar clinical outcome compared to NSC, as well as gives patients superior angiography outcome by progressive occlusion of stents.

Coil Embolization of Intracranial Aneurysms

Neurosurgery ◽  
2003 ◽  
Vol 52 (5) ◽  
pp. 1125-1130
Author(s):  
Bernard R. Bendok ◽  
Ricardo A. Hanel ◽  
L. Nelson Hopkins
Keyword(s):  
Intracranial Aneurysm ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Fellowship Training ◽  
Guglielmi Detachable Coils ◽  
Detachable Coils ◽  
Aneurysm Coiling

Abstract SINCE THE INTRODUCTION of Guglielmi detachable coils more than a decade ago, the coiling technique for the treatment of intracranial aneurysms has been enhanced with technical and technological refinements. Both neurosurgeons and neuroradiologists have participated in this process. Stents and nondetachable balloons have been useful in the coiling of some wide-necked aneurysms. An increasing number of neurosurgeons are pursuing fellowship training in neuroendovascular techniques. Moreover, most neurosurgeons work closely with neurointerventionists. In this communication, technical preferences developed during our experience with intracranial aneurysm coiling are summarized.

Intracranial Aneurysm Embolization Using Interlocking Detachable Coils

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 125-128 ◽  
Author(s):  
K. Satoh ◽  
S. Matsubara ◽  
H. Hondoh ◽  
S. Nagahiro
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Primary Coil ◽  
Aneurysm Embolization ◽  
Detachable Coils ◽  
The Relationship ◽  
Coil Volume

The relationship between volume embolization ratio and coil compaction on the intracranial aneurysm occluded using interlocking detachable coils (IDCs) was determined. From February 1994 to October 1996, 7 intracranial aneurysms were embolized using IDCs. Aneurysm capacity (volume) was calculated assuming that aneurysms are ellipsoid of the diameter in 3 planes. Coil volume was calculated assuming that IDCs are cylinders of primary coil. Coil compaction was observed in aneurysms embolized at a volume embolization ratio under 25%. There was no coil compaction in aneurysms embolized at a volume embolization ratio of over 25%. Measurement of the volume embolization ratio is useful to predict coil compaction. Intracranial aneurysms should be embolized at a volume embolization ratio of 25–33%.

scholarly journals Factors affecting recurrence and management of recurrent cerebral aneurysms after initial coiling

2020 ◽  
Vol 26 (3) ◽  
pp. 300-308
Author(s):  
Yongfeng Han ◽  
Jian Liu ◽  
Zhongbin Tian ◽  
Ming Lv ◽  
Xinjian Yang ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Clinical Results ◽  
Factors Affecting ◽  
Complete Occlusion ◽  
Giant Aneurysms ◽  
Procedural Complications ◽  
Aneurysm Occlusion ◽  
Large And Giant Aneurysms ◽  
Incomplete Occlusion

Objective To investigate factors affecting recurrence and effects and safety of endovascular retreatment for aneurysms recurrent after embolization. Methods Among 815 aneurysms treated with embolization, recurrence was in 114 aneurysms (14.0%). Forty-three recurrent aneurysms were managed with re-embolization. Procedural complications, angiographic, and clinical results of retreatment were analyzed. Results Patients with recurrent aneurysms were significantly ( P < 0.01) younger than without recurrence (51.09 ± 10.46 vs. 53.88 ± 9.61 years). Recurrent aneurysms ( n = 114) were significantly ( P = 0.00) greater (11.12 ± 8.35 vs. 5.81 ± 3.44 mm) with a significantly ( P = 0.00) greater neck (4.34 ± 2.26 vs. 2.90 ± 1.44 mm) than without recurrence. The rupture status of aneurysms significantly ( P = 0.00) affected recurrence at follow-up. Significantly ( P = 0.00) more aneurysms without recurrence were treated with advanced embolization techniques (81.0% vs. 62.3%) and got complete occlusion at the first embolization than those with recurrence (93.7% vs. 36.8%). In treating 43 recurrent aneurysms, stent-assisted recoiling was used in 48.8% in the first retreatment and 50% in the second and third retreatment procedures. Angiographic follow-up in 38 (88.4%) cases showed complete or near complete occlusion in 30 aneurysms, with the rest eight aneurysms experiencing a second recurrence (21.1%). Of the eight aneurysms with the second recurrence, five underwent the second endovascular retreatment, with complete aneurysm occlusion achieved in three cases (60%), near-complete occlusion in one (20%), and incomplete occlusion in one case at immediate angiography and six-month follow-up. Procedure-related complications occurred in three patients. Conclusions Endovascular retreatment of recurrent previously coiled aneurysms is safe and effective even though advanced embolization techniques are frequently involved especially for large and giant aneurysms.

Long-term outcomes of wide-necked intracranial bifurcation aneurysms treated with T-stent–assisted coiling

2021 ◽  
Vol 134 (1) ◽  
pp. 39-48 ◽  
Author(s):  
Kubilay Aydin ◽  
Christian Paul Stracke ◽  
Mehmet Barburoglu ◽  
Elif Yamac ◽  
Mynzhylky Berdikhojayev ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Clinical Results ◽  
Long Term Results ◽  
Thromboembolic Complications ◽  
Short Term ◽  
Complete Occlusion ◽  
Permanent Morbidity ◽  
Double Stent

OBJECTIVEThe endovascular treatment of complex bifurcation aneurysms possessing a neck that incorporates multiple side branches remains a surgical challenge. Double-stent–assisted coiling techniques, such as those with stents in an X and Y configuration, enable the endovascular treatment of wide-necked complex intracranial bifurcation aneurysms. However, the intraluminal struts at the intersection point in X- and Y-stents are not amenable to endothelialization, which may lead to thromboembolic complications. Stenting in the T configuration is a relatively new double-stent coiling technique. T-stenting differs from X- or Y-stenting in that there are no overlapping or intersecting stent segments. Promising short-term results of T-stent–assisted coiling were recently reported. However, the long-term results have not yet been demonstrated. This retrospective study investigated the long-term angiographic and clinical results in patients with wide-necked complex intracranial bifurcation aneurysms treated with T-stent–assisted coiling.METHODSA retrospective review was performed to identify patients with wide-necked complex intracranial bifurcation aneurysms treated with T-stent–assisted coiling at 4 institutions. The technical success and the initial and follow-up clinical and angiographic outcomes were assessed. Aneurysm filling status was assessed according to the Raymond classification. Periprocedural and delayed complications were reviewed. The neurological status of the patients was evaluated using the modified Rankin Scale (mRS).RESULTSOne hundred two aneurysms in 102 patients (54 females), whose mean age was 57.9 ± 13.0 years, were included in the study. T-stenting was performed successfully in all patients. Immediate postprocedural angiography revealed complete occlusion in 83.3% of patients. Periprocedural complications developed in 13.7%, resulting in permanent morbidity in 1.9% and death in 1%. Eighty patients (78.4%) had at least one follow-up DSA examination performed at 6 months or later following the endovascular procedure. The mean duration of angiographic follow-up was 30.0 ± 16.3 months. The last follow-up examinations showed complete occlusion in 90.0% of patients. During the follow-up period, only 1 patient (1.3%) required retreatment. Delayed thromboembolic complications were observed in 4 patients (3.9%) without permanent morbidity. The mRS scores of all patients at the last clinical follow-up were between 0 and 2.CONCLUSIONSThe short-term angiographic findings showed that T-stent–assisted coiling is a feasible and effective endovascular method to treat wide-necked complex bifurcation aneurysms. The long-term angiographic follow-up results suggest that T-stent–assisted coiling provides a durable treatment for wide-necked complex bifurcation aneurysms with favorable clinical outcomes, demonstrating the long-term safety of T-stent–assisted coiling.

Postoperative occlusion degree after flow-diverter placement with adjunctive coiling: analysis of complications

2021 ◽  
pp. neurintsurg-2021-017445
Author(s):  
Huibin Kang ◽  
Bin Luo ◽  
Jianmin Liu ◽  
Hongqi Zhang ◽  
Tianxiao Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcomes ◽  
Intracranial Aneurysms ◽  
Independent Predictor ◽  
Flow Diverter ◽  
Complete Occlusion ◽  
Post Market ◽  
Aneurysm Occlusion ◽  
Incomplete Occlusion

BackgroundAlthough coiling with a flow diverter may provide immediate dome protection, no studies have evaluated the effect on complications of postoperative occlusion degree immediately postoperatively. The purpose of this study was to determine whether postoperative occlusion degree immediately after flow-diverter placement with adjunctive coiling was associated with complications.MethodsAll patients’ data were collected from the post-market multi-center cohort study of embolization of intracranial aneurysms with a pipeline embolization device (PED) in China (PLUS) registry. We divided patients into those treated with a PED alone (PED-only (PO) group), those treated with a PED with coils and incomplete occlusion (PED + coils + incomplete occlusion (PCIO) group), and those treated with a PED with coils and complete occlusion (PED + coils + complete occlusion (PCCO) group).ResultsWe evaluated 1171 consecutive patients with 1322 aneurysms treated with a PED: 685 aneurysms were treated with PO, 444 with PCIO, and 193 with PCCO. The PCCO group had a higher rate of aneurysm occlusion at the last follow-up than the PCIO and PO groups (P<0.0001). Multivariate analysis of the predictors of ischemic stroke and modified Rankin Scale score (mRS) deterioration showed that PCCO was an independent predictor of ischemic stroke (HR, 2.03; 95% CI, 1.12 to 3.67; P=0.019) and mRS deterioration (HR, 2.59; 95% CI, 1.57 to 4.26; P<0.0001).ConclusionsAlthough postoperative complete occlusion with a PED and adjunctive coiling can increase the rate of aneurysm occlusion, this approach may also increase the risk of ischemic stroke and lead to poor postoperative functional outcomes.

scholarly journals Significance of Volume Embolization Ratio as a Predictor of Recanalization on Endovascular Treatment of Cerebral Aneurysms with Guglielmi Detachable Coils

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 59-63 ◽  
Author(s):  
N. Uchiyama ◽  
S. Kida ◽  
M. Nomura ◽  
M. Hasegawa ◽  
T. Yamashima ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Aneurysms ◽  
Treatment Result ◽  
Guglielmi Detachable Coils ◽  
Complete Occlusion ◽  
Neck Size ◽  
Detachable Coils ◽  
Large Aneurysm ◽  
Incomplete Occlusion ◽  
The Relationship

The purposes of this study are, firstly, to define the relationship between volume embolization ratio (VER) and degree of angiographical occlusion in endovascular treatment with Guglielmi detachable coils, and secondly, to examine influences of neck and dome sizes of aneurysms on the VER and the angiographical treatment result, and thirdly, to determine the relationship between the VER and the recanalization of coiled aneurysms. Fifty-two aneurysms in 46 patients were examined. VER ranged 8.1–31.9% (mean 18.5%). The mean VERs of each categories based on angiographical treatment results were 23.1% in complete occlusion, 16.1% in neck remnant and 12.2% in incomplete occlusion, respectively. The VER correlated significantly with both neck and dome size, while the angiographical treatment result was only affected by neck size. Five aneurysms showed aneurysmal recanalization among followed-up 41 aneurysms. All recanalized aneurysms were large, and their VERs were in range of 10.4–17.6%. Measurement of VER is useful to estimate the degree of occlusion objectively and to predict the aneurysmal recanalization. A small aneurysms with a small neck is relatively easy to achieve high VER and angiographical complete occlusion, with the consequence of less recanalization. On the other hand, a large aneurysm is liable to recanalize due to low VER, even if there was little filling of contrast medium in the aneurysmal cavity.

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