Endovascular Treatment for Ruptured Cerebral Aneurysms in Acute Stage

1999 ◽  
Vol 5 (1_suppl) ◽  
pp. 195-198
Author(s):  
J. Ueno ◽  
K. Sugiyama ◽  
H. Naitou ◽  
N. Hirota ◽  
S. Karasawa ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Acute Stage ◽  
Technical Problems ◽  
Improved Outcomes ◽  
Detachable Coils ◽  
Grade Ii ◽  
Older Subjects ◽  
One Year ◽  
Definition Of

Since the introduction of endovascular embolization with Guglielmi Detachable Coils (GDC)1–3in April 1997, we have performed 56 endovascular treatments for ruptured cerebral aneurysms in the acute stage based on our definition of candidates for this modality. Overall outcomes are as follows. 1) Rebleeding within one year was limited to one case (2.5%). 2) Vasospasm occurrences: four cases (7.1%) infarction and three cases (5.4%) as transient ischemia. 3) H&K Grade IV; 60% of cases resulted in improved outcomes. 4) H&K Grade II: One case of rupture during an operation. 5) Three out of five older subjects (over 80 years old) resulted in GR or MD. In this study, we reviewed endovascular embolization in acute stage in terms of candidates and technical problems.

scholarly journals Aneurysm Clipping after Partial Endovascular Embolization for Ruptured Cerebral Aneurysms

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 49-58 ◽  
Author(s):  
M. Nomura ◽  
S. Kida ◽  
N. Uchiyama ◽  
T. Yamashima ◽  
J. Yamashita ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Acute Stage ◽  
Endovascular Procedure ◽  
Anterior Communicating Artery ◽  
Parent Artery ◽  
Advantages And Disadvantages ◽  
Detachable Coils ◽  
Operative Findings ◽  
Clip Closure

The aim of this study was to investigate the advantages and disadvantages of a two-stage treatment for ruptured cerebral aneurysms; partial embolization in acute stage followed by clipping in chronic stage of subarachnoid hemorrhage. Between April 1997 and August 1999, twenty ruptured cerebral aneurysms were initially treated endovasculary using Guglielmi detachable coils in our institution. Among them, complete embolization could not be achieved in 6 lesions. For these lesions, subsequent clipping was added. The radiological and operative findings, and outcomes of these cases were retrospectively reviewed. In 1 case, rerupture occurred during the endovascular procedure. Rerupture was not observed in any cases in the postembolization period. In 2 cases, complications related to the clipping but not the endovascular procedure occurred. These complications included impaired visual acuity for unverified reasons, and memory disturbance due to sacrifice of a perforator arising from the anterior communicating artery. In 3 cases, coil extraction was needed during the clipping, because the loops of the coil extended into the residual neck. Complications related to coil extraction were not observed in these 3 cases. Acute partial embolization of ruptured aneurysm appears to be effective for the prevention of subsequent rerupture during the subacute period, in which treatment for vasospasm should be performed, and the clipping procedure. However, in the case of relatively large aneurysms, small arteries or other normal structures behind the aneurysm cannot be observed directly during surgery, because of the immovability of the embolized aneurysm. Further, complete clip closure is impossible when loops of coil herniate into the neck. In such situations, coil extraction with or without resection of the aneurysm might be necessary, and care must be taken not to damage parent artery and surrounding vessels.

Embolisation of Ruptured Cerebral Aneurysms with Interlocking Detachable Coils in Acute Stage

1997 ◽  
Vol 3 (1) ◽  
pp. 49-63 ◽  
Author(s):  
H. Manabe ◽  
S. Fujita ◽  
T. Hatayama ◽  
H. Ohkuma ◽  
S. Suzuki ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Acute Stage ◽  
Good Recovery ◽  
Coil Embolisation ◽  
Detachable Coils ◽  
Occlusion Rate ◽  
Technical Complication ◽  
Proximal Occlusion ◽  
Coil Migration

Twelve cases of ruptured cerebral aneurysm were treated in acute stage with interlocking detachable coils (IDC, Target Therapeutics, Fremont, California) and the outcome was assessed. IDCs were placed intra-aneurysm for intra-aneurysmal occlusion, or intra-artery for proximal occlusion. Cases: age 36–84 (mean; 60) y.o., 11 females and 1male; 1, 5, 4 and 2 patients were categorised (Hunt and Hess) as grades 1, 2, 3 and 4 respectively. An intra-aneurysmal occlusion in ten cases and a proximal occlusion in two were performed on day 1–11 (mean 4). On angiograms and CT findings, the ruptured point seemed to have occluded in all cases. The occlusion rate was 100% in five cases, 95% in two, 90% in three, 80% in one, and less than 50% in one. There were two cases of technical complication, one a coil migration and the other an aneurysmal perforation with IDC. Their Glasgow Outcome Scale six months after embolisation was graded as good recovery in four cases, moderately disabled state in two, severely disabled state in one, and dead in five. Follow-up angiograms taken four to six months after embolisation showed an intra-aneurysmal coil compaction in five cases. Two of these were treated by a second embolisation or by neck clipping followed by aneurysmal resection, but another two were observed without any treatment and the last one died of rebleeding. Histological examination of the resected embolised aneurysm revealed slight organization around coils but no endothelialisation over the aneurysmal orifice. In our experience, coil embolisation with IDC for acute ruptured aneurysm is a promising means of preventing rerupture during subacute stage.

scholarly journals Angiographical Change of Guglielmi Detachable Coils

2004 ◽  
Vol 10 (1_suppl) ◽  
pp. 161-166 ◽  
Author(s):  
Y. Nakai ◽  
M. Sonobe ◽  
T. Takigawa ◽  
T. Yamazaki ◽  
S. Okamoto ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Medical Condition ◽  
Cerebral Aneurysms ◽  
Acute Stage ◽  
Guglielmi Detachable Coils ◽  
Unruptured Aneurysms ◽  
Detachable Coils

Acute angiographical changes for preventing acute rebleeding on GDC treated cerebral aneurysms were evaluated. From December 2000 to November 2002, 48 total aneurysms in 44 consecutive patients with acute SAH. Acute angiographical evaluations were carried out in 46 aneurysms, including 42 ruptured and 4 unruptured aneurysms. Two cases were excluded because of poor medical condition. In this series, there were no rebleeding cases in acute stage. In the initial embolization for the 46 aneurysms, CO was achieved in eight aneurysms, NR in 15 aneurysms and BF in 23 aneurysms. Acute angiographical observations showed progressive thrombosis in 17 aneurysms (37%). No changes were observed in remaining 29. No recanalization was observed in this series. Only one case of BF, inside the aneurysm bleb was still observed during follow up. Additional embolization was carried out. Progressive thrombosis was frequently observed in GDC treated cerebral aneurysms during acute stage. This angiographical finding seems to show prevention of rebleeding, which is considered important for the management of GDC treatment in acutely ruptured cerebral aneurysm.

Medium-Term Results Using the Leo Self-Expanding Stent in the Treatment of Complex Intracranial Aneurysms

2008 ◽  
Vol 21 (5) ◽  
pp. 704-711 ◽  
Author(s):  
M.I. Pardo ◽  
J.M. Pumar ◽  
M. Blanco ◽  
F. Vazquez ◽  
L. Guimaraens ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Arteries ◽  
Posterior Inferior Cerebellar Artery ◽  
Cerebral Aneurysms ◽  
Radial Force ◽  
Optimum Placement ◽  
Effective System ◽  
Detachable Coils ◽  
One Year ◽  
The Right

The preliminary experience with the Leo microstent in combination with detachable coils for the treatment of patients with wide-necked cerebral aneurysms is reported, and the technical complications and recommendations for optimum placement and deployment are discussed. Thirty two patients identified as harboring wide-necked aneurysm were selected for stent-assisted coiling. Aneurysms were paraophthalmic-cavernous in 13 cases, eight were located at the posterior communicating artery, four at the basilar artery, three at the vertebral arteries, two at the posterior cerebral arteries, one at the right middle artery, and one at the right posterior inferior cerebellar artery. After appropriate antiplatelet therapy, the Leo stent was delivered to the aneurysm site and positioned without difficulty, except in four cases requiring the use of steam to shape the tip of the Vasco microcatheter. Angiographic follow-up was undertaken at six months in 32 patients, at one year in 27 patients, and at two years in 20 patients. Stent placement in the desired position with complete or near complete occlusion of the aneurysm was feasible in all patients. In one patient, the stent was slightly displaced during microwire manipulation for aneurysm microcatheterization. Two-year angiography in 20 patients showed 18 complete occlusions and two aneurysms with a minimal residual neck. The Leo stent represents a significant advancement in the vascular treatment of intracranial aneurysms providing high radial force and an easy delivery system i.e., it is a feasible, secure and effective system.

Long-Term Results of Ruptured Cerebral Aneurysms Embolized in Acute Stage with Interlocking Detachable Coils

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 118-120
Author(s):  
H. Manabe ◽  
S. Fujita ◽  
K. Akasaka ◽  
S. Suzuki
Keyword(s):  
Cerebral Aneurysms ◽  
Critical Factor ◽  
Dissecting Aneurysm ◽  
Acute Stage ◽  
Saccular Aneurysm ◽  
Long Term Results ◽  
Complete Occlusion ◽  
Detachable Coils

We report on a series of eight patients presenting with SAH secondary to ruptured saccular (n=7) or dissecting (n=1) aneurysm, treated in the acute stage (within 14 days) by embolization with interlocking detachable coils (IDCs) who survived at least 3 months following initial hemorrhage. Embolization resulted in complete occlusion in 2 of 7 cases of saccular aneurysm, 90–95% occlusion was obtained in the remaining 5 cases of saccular aneurysm. Proximal occlusion with intra-aneurysmal coil packing was achieved in 1 case of dissecting aneurysm. In all 5 cases with partial occlusion, follow-up angiograms taken 2–4 months after the embolization showed partial recanalization due to coil compaction, while no recanalization was recognized in cases with complete occlusion in follow-up angiograms at 5 and 9 months respectively. Clinical disability, at 9 months after the embolization was rated as none in 4 cases, moderate in 1, and severe in 1. Two patients died of re-rupture at 4 and 8 months respectively after the embolization. Of the other 3 cases with partial recanalization, 2 were retreated by re-embolization or surgical clipping, one has been followed clinically and angiographically. Histological findings of the re-ruptured aneurysm showed neither endothelialization of the aneurysmal orifice nor organization of the clot around the coils. Aneurysmal re-rupture secondary to coil compaction related recanalization remains a critical factor in long-term clinical outcome and prognosis.

scholarly journals Spinal arteriovenous fistulae in patients with hereditary hemorrhagic telangiectasia: A case report and systematic review of the literature

2016 ◽  
Vol 22 (3) ◽  
pp. 354-361 ◽  
Author(s):  
Waleed Brinjikji ◽  
Deena M Nasr ◽  
Harry J Cloft ◽  
Vivek N Iyer ◽  
Giuseppe Lanzino
Keyword(s):  
Systematic Review ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Endovascular Embolization ◽  
Review Of The Literature ◽  
Type Iv ◽  
Detachable Coils ◽  
History Of ◽  
Spinal Arteriovenous Malformations ◽  
One Year ◽  
Surgical Treatments

Background Although rare, spinal arteriovenous malformations (AVMs) are thought to be more prevalent in the hereditary Hereditary Hemorrhagic Telangiectasia (HHT) population. Methods We report a case of a spinal AVM in a 37-year-old female with HHT treated with endovascular embolization. In addition, we report findings from a systematic review of the literature on the clinical characteristics, angioarchitecture, and clinical outcomes of HHT patients with spinal AVMs. Results The patient is a 37 year-old female with definite HHT who presented with a one-year history of progressive gait difficulty. The spinal fistula was incidentally detected on chest computed tomography (CT). Spinal angiography demonstrated a large perimedullary arteriovenous fistula was supplied by a posterolateral spinal artery. The fistula was treated with detachable coils. The patient made a complete neurological recovery. Our systematic review yielded 25 additional cases of spinal AVMs in HHT patients. All fistulae were perimedullary (100.0%). Treatments were described in 24 of the 26 lesions. Endovascular-only treatment was performed in 16 cases (66.6%) and surgical-only treatment was performed in five cases (20.8%). Complete or near-complete occlusion rates were 86.7% (13/15) for endovascular treated cases, 100.0% (4/4) for surgery and 66.6% (2/3) for combined treatments. Overall, 80.0% of patients (16/20) reported improvement in function following treatment, 100.0% (5/5) in the surgery group and 84.6% (11/13) reported improvement in the endovascular group. Conclusions Spinal fistulae in HHT patients are usually type IV perimedullary fistulae. Both endovascular and surgical treatments appeared to be effective in treating these lesions. However, it is clear that endovascular therapy has become the preferred treatment modality.

scholarly journals Spontaneous Thrombosis of Significant Aneurysm Recanalization in the Long Term Follow-up of Coiled Aneurysms: Observation in Two Cases

2005 ◽  
Vol 11 (2) ◽  
pp. 167-171 ◽  
Author(s):  
I. Saatchi ◽  
U. Kerimoglu ◽  
C. Barbaros ◽  
T. Haziroln ◽  
S. Cekirge
Keyword(s):  
Endovascular Treatment ◽  
Treatment Strategies ◽  
Cerebral Aneurysms ◽  
Spontaneous Thrombosis ◽  
Long Term Follow Up ◽  
Detachable Coils ◽  
One Year ◽  
Control Angiography

Endovascular treatment of cerebral aneurysms with detachable coils has now been proved to be a superior alternative to open microsurgery in terms of survival free of disability at one year according to the recently published large randomized International Subaracnoid Aneurysm Trial (ISAT). However, aneurysm recanalization secondary to coil compaction is still the main problem of this technique observed in the follow-up period but treatment strategies for these regrowths are not yet well established. We present two interesting cases in which we observed a significant aneurysm recanalization at six month control angiography that was found to be spontaneously thrombosed in the late follow-up angiograms at the second and fifth years consecutively.

Embolization of Ruptured Cerebral Aneurysms with GDC in Acute Stage

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 93-95
Author(s):  
K. Onizuka ◽  
M. Sonobe ◽  
K. Sugita ◽  
Y. Matsumaru ◽  
S. Takahashi
Keyword(s):  
Cerebral Aneurysms ◽  
Acute Stage ◽  
Guglielmi Detachable Coils ◽  
Detachable Coils ◽  
Occlusion Rate ◽  
Primary Hemorrhage

21 cases of 22 ruptured cerebral aneurysms were treated in acute stage with Guglielmi detachable coils and the outcome was assesed. GDCs were placed intra-aneurysm for intra-aneurysmal occlusion. Cases: age 42–80 (mean; 59) y. o., 7 male and 14 female; 4, 6, 8 and 3 patients were categorized (Hunt and Hess) as grades 1, 2, 3 and 4 respectively. GDC embolization was performed within 24 hours of primary hemorrhage in 11 patients, within 2 to 3 days in 4 patients and 5 to 19 days in 6 patients. The occlusion rate was 100% in 7 ANs, more than 75% in 9 ANs and less than 75% in 6 ANs. There were 7 cases of complications, two coil deposits, one embolism and 4 reruptures.

scholarly journals Limitation of Endovascular Treatment for Ruptured Cerebral Aneurysms: Results from the Protocol “GDC as the First Choice”

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 43-47 ◽  
Author(s):  
M. Mase ◽  
K. Yamada ◽  
N. Aihara ◽  
T. Banno ◽  
K. Watanabe
Keyword(s):  
Endovascular Treatment ◽  
Coil Embolization ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Anticoagulation Therapy ◽  
Cerebral Aneurysms ◽  
Primary Treatment ◽  
Endovascular Embolization ◽  
Acute Stage ◽  
Morbidity Rate ◽  
First Choice

Since October, 1997, endovascular embolization using GDC has been our primary treatment for ruptured cerebral aneurysms in the acute stage. According to our protocol, an aneurysm more than 3 mm in diameter, without a wide-neck or massive intracranial hematoma is indicated for endovascular therapy. Under this protocol, we experienced 35 consecutive patients with aneurysmal subarachnoid hemorrhage, and 22 of them (62.8%) were treated endovascularly. The most common reason for the contra-indication of coil embolization was wide-necked aneurysm (9 cases). We experienced two cases with embolic stroke and one case with post-embolization hemorrhage as a complication after endovascular treatment. Morbidity rate due to the complications was 9.1%. In conclusion, a system that allows both surgical and endovascular treatments to be performed in any given case is necessary for the appropriate treatment of ruptured aneurysm. In order to avoid ischemic embolic complications, postoperative anticoagulation therapy is crucial. The safety of coil embolization for very thin-walled aneurysm is questionable.

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