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.

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.

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.

scholarly journals Orbitozygomatic Craniotomy for Clipping a Complex Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (2) ◽  
pp. E33-E33
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Video Recording ◽  
Artery Aneurysm ◽  
Sylvian Fissure ◽  
Parent Artery ◽  
Parent Vessel ◽  
Institutional Review ◽  
Vessel Patency ◽  
Mca Aneurysm

Abstract Middle cerebral artery (MCA) aneurysms pose a surgical challenge because of the large caliber of the parent artery and the common need to dissect the sylvian fissure to permit access to the proximal and distal control. The neck of the aneurysm should be generously dissected to permit visualization of any adjacent lenticulostriate perforators. This patient demonstrated a left-sided wide-necked bilobed MCA aneurysm at the M1 bifurcation. The aneurysm was approached using a left orbitozygomatic craniotomy with distal sylvian fissure dissection. A single curved clip was applied for aneurysm occlusion, and postoperative angiography demonstrated aneurysm obliteration with parent vessel patency. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Endovascular Treatment of Cerebral Aneurysms

2002 ◽  
Vol 15 (5) ◽  
pp. 537-548 ◽  
Author(s):  
G.B. Bradač ◽  
G. Stura ◽  
M. Bergui
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Aneurysm ◽  
Essential Role ◽  
Cerebral Aneurysms ◽  
Balloon Occlusion ◽  
New Technique ◽  
Endovascular Techniques ◽  
Parent Vessel ◽  
Endovascular Approach

Balloon occlusion of parent vessel and direct coiling are the two endovascular techniques routinely used and commonly accepted as alternatives to surgery for treatment of the cerebral aneurysm in many patients. Based on our experience and what is reported in the literature, the various aspects concerning techniques, difficulties, risks, are described. In comparison to surgery, the endovascular approach is a relatively new technique, which is still in evolution. To date, there is no objective indication regarding the method to be used in a given case. The experience and attitude of the involved team still play an essential role.

scholarly journals Early Experiences of Neuroform Stent-Assisted Coiling in Ruptured Intracranial Aneurysms

2007 ◽  
Vol 13 (1) ◽  
pp. 31-44 ◽  
Author(s):  
Young-Joon Kim
Keyword(s):  
Intracranial Aneurysms ◽  
Three Dimensional ◽  
Parent Artery ◽  
Parent Vessel ◽  
Single Center Experience ◽  
Early Experiences ◽  
Detachable Coils ◽  
Neuroform Stent ◽  
Ruptured Intracranial Aneurysms

Endovascular treatment of ruptured intracranial aneurysms with detachable coils has proven a favorable alternative to surgical clipping. However, coiling has limitations in the treatment of complex or broad neck aneurysms because of possible coil prolapse or coil migration into the parent vessel and long-term angiographic recurrences. To achieve reconstruction of intracranial vessels with preservation of the parent artery, the use of stents has the greatest potential for assisted coil embolization. Three-dimensional coils and reconstructive techniques such as balloon-assisted remodeling may overcome these problems. But these methods had some drawbacks. The Neuroform stent is the most recently developed endovascular stent with self-expandable and micro-delivery properties that are specially designed for the treatment of unruptured intracranial broad neck aneurysms. Aim of the following working is to report a single center experience of stent-assisted coiling on ruptured intracranial aneurysms with assessment of its efficacy and safety, and follow-up findings.

scholarly journals Splenic artery aneurysm, case series of seven patients

2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Javad Salimi ◽  
Zahra Omrani ◽  
Roozbeh Cheraghali
Keyword(s):  
Splenic Artery ◽  
Endovascular Procedures ◽  
Case Series ◽  
Artery Aneurysm ◽  
Splenic Artery Aneurysm ◽  
Visceral Artery ◽  
Endovascular Techniques ◽  
Hybrid Surgery ◽  
First Choice ◽  
Visceral Artery Aneurysms

Abstract Splenic artery aneurysms (SAA) account for 46–60% of all visceral artery aneurysms. Small SAAs are usually asymptomatic, but giant aneurysms are more likely to cause symptoms and can result in life-threatening complications. Treatment of a splenic artery aneurysms includes laparotomy, laparoscopy or endovascular techniques. Case presentation: In this article, seven interesting cases of splenic artery aneurysms in different size and parts of artery and various interventions (open, endovascular and hybrid surgery) are discussed. Six of the patients were male. Five of them had giant SAAs (≥5 cm). Two patients underwent hybrid surgery. Coil embolization was carried out for one patient. All seven patients discharged with no procedure-related complications. Endovascular procedures considered as a first choice of treatment for splenic artery aneurysm. Open surgery is reserved mostly for the treatment of complications or if the endovascular techniques fail, lack of availability of endovascular procedures or allergy to contrast medium.

scholarly journals Fusiform superior cerebellar artery aneurysm treated with flow diversion: A case report

2020 ◽  
Vol 11 ◽  
pp. 330
Author(s):  
Yafell Serulle ◽  
Deepak Khatri ◽  
Jada Fletcher ◽  
Anna Pappas ◽  
Audrey Heidbreder ◽  
...  
Keyword(s):  
Artery Aneurysm ◽  
Flow Diversion ◽  
Superior Cerebellar Artery ◽  
Parent Artery ◽  
Fusiform Aneurysm ◽  
Parent Vessel ◽  
Pipeline Embolization Device ◽  
Head Ct ◽  
Cerebellar Artery ◽  
The Right

Background: Fusiform aneurysms of the distal superior cerebellar artery are rare and challenging to treat. Due to the rarity of these lesions, there is little consensus regarding their management. Treatment options have traditionally included parent artery sacrifice with either an endovascular approach or microsurgical clipping. Given the small diameter of the superior cerebellar artery, flow diversion has not been typically considered as a viable treatment option for these aneurysms. Case Description: A 67-year-old female presented complaining of severe sudden onset headache. Noncontrast head CT demonstrated no intracranial hemorrhage. Head CT angiogram demonstrated a 4.2 mm fusiform aneurysm in the distal right superior cerebellar artery. The patient underwent treatment with the Pipeline embolization device which was deployed in the right superior cerebellar artery covering the aneurysm. Six-month posttreatment follow-up angiogram demonstrated resolution of the aneurysm with patency of the parent vessel. Conclusion: To the best of our knowledge, this is the first report of a distal superior cerebellar artery aneurysm treated with the Pipeline embolization device. The use of a Pipeline stent to create flow diversion should be considered in a case of a fusiform aneurysm of the right superior cerebellar artery. Treatment with flow diversion may allow for the treatment of the aneurysm while preserving patency of the parent vessel.

Balloon Occlusion Testing to Assess Retinal Collateral and Predict Visual Outcomes in the Management of a Fusiform Intraorbital Ophthalmic Artery Aneurysm: Technical Note and Literature Review

2018 ◽  
Vol 16 (2) ◽  
pp. E60-E66 ◽  
Author(s):  
Mithun G Sattur ◽  
Matthew E Welz ◽  
Bernard R Bendok ◽  
Jeffrey W Miller
Keyword(s):  
Ophthalmic Artery ◽  
Artery Aneurysm ◽  
Artery Occlusion ◽  
Balloon Occlusion ◽  
Technical Note ◽  
Neurological Function ◽  
Optic Canal ◽  
Parent Artery ◽  
Parent Artery Occlusion ◽  
The Impact

Abstract BACKGROUND AND IMPORTANCE Aneurysms of the ophthalmic artery (OA) within the orbit and optic canal are extremely rare. Given the peripheral location of these aneurysms and the fact that most are fusiform, parent artery occlusion is preferred for symptomatic aneurysms. However, the impact of OA occlusion on vision is not always innocuous. Balloon occlusion testing (BOT) of the OA has the potential to gauge the possibility of visual compromise, in addition to assessing collaterals. While BOT has been assessed for carotid artery occlusion, its role in OA occlusion has not been well defined. CLINICAL PRESENTATION We describe a patient with a 6-mm intracanalicular OA aneurysm who was treated with endovascular coil embolization of the aneurysm and occlusion of the parent artery. We performed a 30-min balloon occlusion test, in which we verified intact visual and neurological function. Collateral vascularity was confirmed. Complete occlusion was achieved and the patient recovered with intact visual and neurological function. We provide a review of literature pertaining to parent artery occlusion of OA aneurysms that occur within optic canal and orbit. A brief note on anatomy of OA and collaterals is provided. CONCLUSION Endovascular parent artery occlusion is an effective treatment for OA aneurysms that occur in optic canal and orbit. Assessment of effect of occlusion on vision is important. BOT can assess this and provide valuable information. Recovery or preservation of visual function is highly dependent on preoperative visual status.

Treatment of Hemorrhagic Intracranial Dissections

Neurosurgery ◽  
2003 ◽  
Vol 53 (2) ◽  
pp. 289-301 ◽  
Author(s):  
René Anxionnat ◽  
João Ferreira de Melo Neto ◽  
Serge Bracard ◽  
Jean Christophe Lacour ◽  
Catherine Pinelli ◽  
...  
Keyword(s):  
Treatment Options ◽  
Clinical Status ◽  
Current Method ◽  
Artery Occlusion ◽  
Balloon Occlusion ◽  
Acute Stage ◽  
Parent Artery ◽  
Parent Vessel ◽  
Parent Artery Occlusion ◽  
Ischemic Complications

Abstract OBJECTIVE To analyze the treatment options in hemorrhagic intracranial dissections. METHODS This study involved a retrospective review of 27 patients with 29 dissections treated during a 16-year period, mainly by endovascular treatment (EVT). RESULTS EVT was performed in the acute stage in 12 of the 29 dissections, and occlusion was performed using coils at the dissection site in six dissections and with proximal balloon occlusion in six dissections. Wrapping was performed in one case. In the remaining 16 dissections, which were not treated, mainly for anatomic reasons, three patients died, one from rebleeding. Angiographic follow-up performed in the 13 surviving patients demonstrated an initially misdiagnosed lesion in one and worsening lesions in five that led to delayed EVT in five and surgical clipping in one. One of these dissections, which was located on a dominant vertebral artery, was treated after subsequent rupture using a stent and coils to preserve the patency of the parent vessel. Four ischemic complications related to EVT resulted in a moderate disability in two patients. No rebleeding occurred after EVT, but one patient died because of a poor initial clinical status; the other patients improved. In the 10 patients treated conservatively, four died, three from a poor initial clinical status and one from rebleeding, and six patients had a good clinical outcome. Of the 27 patients, three had rebleeding and one died as a result of that rebleeding. Seventeen patients (63%) had a good recovery, six (22%) had a moderate disability, and four (15%) died. CONCLUSION EVT provides effective protection against rebleeding. When possible, occlusion with coils at the dissection site is the current method of choice. Another option is parent artery occlusion with balloons, and the use of a stent may preserve vessel permeability in specific cases.

scholarly journals Endovascular treatment of wide-neck saccular renal artery aneurysm with waffle-cone technique

2021 ◽  
Vol 20 ◽  
Author(s):  
Paulo Eduardo Ocke Reis ◽  
Guilherme de Palma Abrão ◽  
Leonardo Roever
Keyword(s):  
Endovascular Procedures ◽  
Imaging Techniques ◽  
Artery Aneurysm ◽  
Visceral Artery ◽  
Endovascular Management ◽  
Endovascular Techniques ◽  
The Past ◽  
Visceral Artery Aneurysms ◽  
History Of ◽  
Wide Neck

Abstract In the past, treatment of visceral artery aneurysms (VAAs) was exclusively surgical. These aneurysms were rarely diagnosed in elective or emergency cases. Development of imaging techniques and endovascular procedures has changed the history of the therapeutic options for this pathology. Endovascular management of VAAs has arisen to advances in endovascular techniques and has achieved high efficacy.

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