Aneurismi intracranici problematici Chirurgia e terapia endovascolare a confronto

2003 ◽  
Vol 16 (1) ◽  
pp. 157-164 ◽  
Author(s):  
M. Skrap ◽  
M. Vindigni ◽  
P.P. Janes ◽  
B. Petralia
Keyword(s):  
Endovascular Treatment ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Difficult Problem ◽  
Routine Procedure ◽  
Upper Limits ◽  
Detachable Coils ◽  
Grade 3 ◽  
Aneurismi Intracranici ◽  
Endovascular Technology

The surgical technique used for cerebral aneurysms is still considered a delicate procedure but surgeons' skill yields excellent results in the majority of regular aneurysms. Moreover, the endovascular treatment with detachable coils has become a routine procedure and at present the discussion about the best indication for treating the aneurysms is lively. We present our series of 361 aneurysms treated in six years with 267 surgical procedures and 94 endovascular treatments. The indication for endovascular treatment in our Department is usually put for aneurysms of the basilar trunk, basilar bifurcation, infraclionid tract of the Internal Carotid artery, in patients with higher H&H grade (3–4) and in older patients with poor general condition. The global mortality of endovascular cases was 21% while in the surgical series the global mortality was 15%. We must consider that 60% of endovascular cases were in grade 3–4 of Hunt&Hess while in the surgical series only 40% were in the same situation. Only 2.7% of the cases (10 patients) were a really difficult problem for each separate technique. In these cases a combination of surgical and endovascular procedure was adopted and in only five cases was it possible to treat the aneurysms properly. In our opinion, a combined approach can be useful only in some selected cases but we should take into account the fact that nowadays surgery has reached the upper limits of its technique while, on the contrary, the endovascular technology is still in progress.

scholarly journals MTI (Dendron) Variable Detachable Coils

2003 ◽  
Vol 9 (1) ◽  
pp. 47-52
Author(s):  
J. Thammaroj ◽  
V. Jayakrishnan ◽  
S. Lamin ◽  
S. Jenkins ◽  
E. Teasdale ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Feasibility Study ◽  
Clinical Experience ◽  
Cerebral Aneurysms ◽  
Detachable Coils ◽  
Formed Part ◽  
Small Aneurysms ◽  
Initial Clinical Experience

We present our initial clinical experience of Dendron Variable Detachable System (VDS) coils, now Sapphire VDS from MTI, in the endovascular treatment of cerebral aneurysms. VDS coils, uniquely, can be detached at variable points along their length, allowing placement of as much or as little as desired of the coil within the aneurysm. Our ten patients formed part of a multicentre feasibility study. VDS coils were successfully deployed in all but one aneurysm. The electrolytic detachment mechanism with practice is both simple to use and reliable. The coils are however slightly stiffer than standard coils limiting their use in small aneurysms. This remains a technology in evolution.

scholarly journals Endovascular Treatment of Direct Carotid-Cavernous Fistulas Using Detachable Coils

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 125-129
Author(s):  
I. Naito ◽  
T. Iwai ◽  
M. Negishi ◽  
T. Sasaki
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Alternative Treatment ◽  
Internal Carotid ◽  
Endovascular Technique ◽  
Detachable Coils ◽  
Incomplete Closure ◽  
Carotid Cavernous Fistulas ◽  
Balloon Embolization

Five direct carotid-cavernous fistulas (direct CCFs) in four patients were treated by an endovascular technique using detachable coils. The embolizations were performed according to one of two strategies. 1) By embolizing the fistula, that is the compartment of the cavernous sinus adjacent to the fistula orifice, after embolization of the draining veins. 2) By embolizing the fistula only. The former strategy was used to treat first two cases and the latter to treat other three cases. In two of the cases in which only the fistula was embolized, a microcatheter was placed in the draining vein via a transvenous route before-hand, in the event that the embolization resulted in an incomplete closure and the draining veins became inaccessible. In four cases, a complete cure was achieved with preservation of the internal carotid artery and in one case, the internal carotid artery containing the fistula was occluded. The embolization of direct CCFs with detachable coils, which are suitable for both transarterial and transvenous approaches, has several advantages over balloon embolization. We believe this procedure will become an alternative treatment.

Surgical Management of Cerebral Aneurysms in Comparison with Endovascular Treatment

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 149-152 ◽  
Author(s):  
H. Ohnishi ◽  
N. Kosimae
Keyword(s):  
Endovascular Treatment ◽  
Skull Base ◽  
Surgical Management ◽  
Skull Base Surgery ◽  
Cerebral Aneurysms ◽  
Surgical Results ◽  
Aneurysm Surgery ◽  
Mortality And Morbidity ◽  
Detachable Coils ◽  
Carotid Aneurysms

We report our surgical results of 92 intrabasal (below the ophthalmic segment) carotid aneurysms and 16 basilar aneurysms after the era of skull base surgery. These lesions were the most difficult location for neck clipping of aneurysms. Mortality, surgery associated mortality and morbidity of intrabasal carotid aneurysm surgery were 2.2%, 0% and 9.7% respectively. Mortality and morbidity of basilar ameurysm surgery were 0% and 6.2% respectively. Although endovascular treatment of cerebral aneurysms with detachable coils is premising treatment due to its convenience and less invasiveness, results of this treatment must be superior to the results of microsurgery for it to become a widely accepted therapy.

scholarly journals Use of Distal Intracranial Catheters for Better Working View of Cerebral Aneurysms Hidden by Parent Artery or Its Branches: A Technical Note

2021 ◽  
Author(s):  
Ehab Mahmoud ◽  
Samuel Lenell ◽  
Christoffer Nyberg ◽  
Ljubisa Borota
Keyword(s):  
Endovascular Treatment ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Technical Note ◽  
Parent Artery ◽  
Endovascular Techniques ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Class 1 ◽  
Procedural Outcomes

A good working view is critical for safe and successful endovascular treatment of cerebral aneurysms. In a few cases, endovascular treatment of cerebral aneurysms may be challenging due to difficulty in obtaining a proper working view. In this report of 6 cases, we described the advantage of using a distal intracranial catheter (DIC) to achieve better visualization of cerebral aneurysms hidden by a parent artery or its branches. Between September 2017 and January 2021, we treated 390 aneurysms with endovascular techniques. In 6 cases in which it was difficult to obtain a proper working view, the DIC was placed distally close to the aneurysm in order to remove the parent artery projection from the working view and obtain better visualization of the aneurysm. Clinical and procedural outcomes and complications were evaluated. The position of the DIC was above the internal carotid artery siphon in the 6 cases. All aneurysms were successfully embolized. Raymond–Roy class 1 occlusion was achieved in all 4 unruptured aneurysms, while the result was class 2 in the 2 ruptured aneurysms. Placement of the DIC was atraumatic without dissections or significant catheter-induced vasospasm in all patients. Transient dysphasia was seen in 2 cases and transient aphasia in 1. Using this technique, we have found it possible to better visualize the aneurysm sac or neck and thereby treat cases we otherwise would have considered untreatable.

Magnetic Resonance Angiography for Evaluation of Intracranial Aneurysms Treated with Guglielmi Detachable Coils

1998 ◽  
Vol 11 (1) ◽  
pp. 19-25 ◽  
Author(s):  
E. Cotroneo ◽  
M. Dazzi ◽  
R. Gigli ◽  
G. Guidetti ◽  
G.P. Cantore ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Mr Angiography ◽  
Cerebral Aneurysms ◽  
Digital Subtraction ◽  
Contrast Injection ◽  
Guglielmi Detachable Coils ◽  
Non Invasive ◽  
Mri Angiography ◽  
Detachable Coils

Thirteen cases of cerebral aneurysms submitted to endovascular treatment using Guglielmi detachable coils (GDC) are described. Control MRI-angiography 3D TOF was performed three and six months later. In order to spare patients the discomfort and risks related to repeated trauma and iodate contrast injection, we examined the possibility of an alternative non-invasive diagnostic method. For this purpose, the digital subtraction angiograms performed three and six months after embolisation were compared with the MR-angiograms obtained in the same period, all using the same tomograph at middle field intensity (0.5T). We discuss the outcome of this comparison and the limits of the MR-angiography method in the follow-up of aneurysms submitted to endovascular treatment.

Endovascular treatment of cerebral aneurysms following incomplete clipping

1997 ◽  
Vol 87 (2) ◽  
pp. 184-189 ◽  
Author(s):  
Kent R. Thielen ◽  
Douglas A. Nichols ◽  
Jimmy R. Fulgham ◽  
David G. Piepgras
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Aneurysms ◽  
Surgical Clipping ◽  
Content Type ◽  
Coil Occlusion ◽  
Neurological Morbidity ◽  
Posterior Circulation Aneurysm ◽  
Detachable Coils ◽  
Fine Print

✓ The authors report their experience using electrolytically detachable coils for the treatment of residual cerebral aneurysms following incomplete surgical clipping. Eight patients were treated for six anterior and two posterior circulation aneurysm remnants. All patients were referred for endovascular treatment by experienced cerebrovascular neurosurgeons at the authors' institution. Patients underwent follow-up angiography immediately after endovascular treatment. In seven of the eight patients, additional follow-up angiographic studies were obtained at periods ranging from 7 weeks to 2 years posttreatment. The latest follow-up angiograms demonstrated that six of the eight aneurysm remnants were 100% occluded, with near-complete occlusion of the other two aneurysm remnants. There was no permanent neurological or non-neurological morbidity or mortality associated with the treatment. There was no incidence of aneurysm hemorrhage during or after treatment. Endovascular treatment of cerebral aneurysm remnants following prior surgical clipping can be accomplished with acceptable morbidity and mortality rates. Endovascular coil occlusion can play an important adjunctive role in the treatment of those aneurysms that have been incompletely obliterated by surgical clipping.

scholarly journals Endovascular Treatment for Internal Carotid-ophthalmic Aneurysms using Detachable Coils

1997 ◽  
Vol 6 (6) ◽  
pp. 363-368
Author(s):  
Keiko Irie ◽  
Waro Taki ◽  
Ichiro Nakahara ◽  
Nobuyuki Sakai ◽  
Fumiaki Isaka ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Internal Carotid ◽  
Detachable Coils

scholarly journals Endovascular Treatment of Anterior Circulation Cerebral Aneurysms by Using Guglielmi Detachable Coils

2007 ◽  
Vol 17 (2) ◽  
pp. 98-107
Author(s):  
Jana Wolynski ◽  
Pasquale Mordasini ◽  
Gerhard Schroth ◽  
Alain Barth ◽  
Rolf W. Seiler ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Aneurysms ◽  
Guglielmi Detachable Coils ◽  
Anterior Circulation ◽  
Detachable Coils

scholarly journals Histological Investigation of Endothelial Cell Proliferation on the Coil Surface after Endovascular Treatment Using FactorXIII

2001 ◽  
Vol 7 (1) ◽  
pp. 29-33 ◽  
Author(s):  
K. Hino ◽  
Y. Konishi ◽  
A. Shimada ◽  
E. Sato ◽  
M. Hara ◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Endovascular Treatment ◽  
Factor Xiii ◽  
Cerebral Aneurysms ◽  
Coagulation Factor ◽  
Endothelial Cell Proliferation ◽  
Coil Embolisation ◽  
Electron Microscopic ◽  
Scanning Electron Microscopic ◽  
Detachable Coils

Recently, endovascular treatment of coil embolisation has been widely used for obliterating cerebral aneurysms. However, the process of endothelial cell growth within aneurysms to prevent aneurysmal rupture associated with endovascular coil embolisation remains unclear. Fourteen aneurysms were produced in seven matured swine and embolised with Guglielmi Detachable coils (GDCs). The aneurysms were resected either immediately or three weeks after coil embolisation, and subjected to histological and scanning electron microscopic examinations. Blood coagulation factor XIII was administered in four animals on the day of embolisation and on the following four days. These aneurysms were also resected three weeks after the embolisation and investigated histologically. Marked fibroblast proliferation and growth of endothelial cells on the intraluminal surface of the coil were observed more often in the group administered factor XIII than in those not given factor XIII. These results suggest that administration of factor XIII may contribute to more effective aneurysm obliteration during coil embolisation.

Repositioning of Displaced Guglielmi Detachable Coils after Endosaccular Embolisation Using a Modification of the Neck Plastic Technique

1998 ◽  
Vol 4 (4) ◽  
pp. 317-322
Author(s):  
J.C. Chaloupka ◽  
D.C. Huddle
Keyword(s):  
Endovascular Treatment ◽  
Internal Carotid ◽  
Parent Artery ◽  
Guglielmi Detachable Coils ◽  
Coil Embolisation ◽  
Surgical Clipping ◽  
Detachable Coils

After undergoing prior partial surgical clipping of an acutely ruptured internal carotid aneurysm, a 29-year-old woman was referred for endovascular treatment of the gradually enlarging aneurysm remnant. The aneurysm had a somewhat peculiar ellipsoid configuration due to placement of the clip, with the largest dimension measuring less than 4 mm, and the neck measuring approximately 2 mm. Using the conventional endosaccular coil embolisation technique, two small electrolytically detachable coils were carefully folded into the aneurysm sac to produce excellent tight packing. However, immediately after detachment, a loop of the second coil inadvertently herniated out of the aneurysm into the center of the parent artery, exhibiting substantial pulse synchronous displacement. This created a potentially unstable situation for the remaining coils within the embolised aneurysm. To correct this problem we attempted to reposition the loop into the aneurysm using a modification of the previously described neck plastic technique. This technique succeeded without untoward complication. Although there are theoretical risks and limitations, the modified neck plastic technique may be useful in selective cases of inadvertent coil misplacement during endosaccular coil embolisation of aneurysms with the GDC system.

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