Stereotactic direct-coiling of aneurysms—a feasibility study

Abstract Aim of the study Endovascular coiling has gained worldwide acceptance in the management of intracranial aneurysms. However, not all aneurysms can be coiled. Direct aneurysm puncture with aneurysm thrombosis has been performed, using coils for extracranial aneurysms and iron filings for intracranial aneurysms. Therefore, the feasibility of stereotactic aneurysm coiling with direct aneurysm puncture using Nester-coils was studied in an in vitro model. Methods and findings Twenty-eight aneurysms measuring 9–21 mm in diameters (median 14 mm) were made using 0.1 mm vinyl film that was connected to a monometer with 73 cm of water column. Twenty-three aneurysms were coiled through direct puncture of the aneurysms using a stereotactic frame. Five were coiled using a hand-held probe carrier. Statistical analysis of the data was conducted by data analysis feature of Microsoft Excel. Findings The study showed that needle puncture of the aneurysm and coiling of the aneurysm through the needle can be done with ease and without any significant fluid leak from the puncture site. It also shows that the coil will stay within the aneurysm without entering the neck. The study also shows that this method can be done using free-hand technique. Furthermore, it shows that the probe holder for the needle can also be used as an aneurysm stabilizer and as a tamponade.

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Endovascular coiling of intracranial aneurysms using bioactive coils: a single-center study

Acta Radiologica ◽

10.1080/02841850701308360 ◽

2007 ◽

Vol 48 (5) ◽

pp. 565-576 ◽

Cited By ~ 11

Author(s):

S. Rossitti

Keyword(s):

Intracranial Aneurysms ◽

Endovascular Coiling ◽

Single Center ◽

Detachable Coil ◽

Class 1 ◽

The Matrix ◽

Single Operator ◽

Bare Platinum Coils ◽

Aneurysm Coiling

Background: Some degree of recanalization is reported in up to one-third of intracranial aneurysms treated with endovascular coiling. A technical development potentially effective in avoiding recanalization is the Matrix Detachable Coil (MDC), which is covered with a biodegradable polymeric material that enhances intra-aneurysmal clot organization and fibrosis. Purpose: To report the initial clinical experience of MDC for endovascular aneurysm coiling in a single-center, single-operator, and well-defined population setting. Material and Methods: 118 aneurysms in 104 patients (73 with subarachnoid hemorrhage, SAH) were embolized with MDC alone ( n = 52) or combined with bare platinum coils ( n = 66). Results: Initial aneurysm obliteration was class 1 (complete obliteration) in 45 aneurysms (38.1%), class 2 (residual neck) in 44 (37.3%), and class 3 (residual aneurysm) in 29 (24.6%). Procedure-related morbidity was 4.8%, and mortality 0.96%. Clinical follow-up of 61 patients with SAH (mean 5.9 months, range 1–17 months) showed good outcome (Glasgow Outcome Scale, GOS 4–5) in 39 (63.9%), and poor outcome or death (GOS 1–3) in 22 (36.1%). Imaging follow-up of 73 aneurysms (average 6.5 months, range 1–17 months) showed class 1 in 47 (64.4%), class 2 in 18 (24.7%), and class 3 in eight (10.9%). Recanalization occurred in 11 aneurysms (15%), of which four (5.5%) required re-treatment. Conclusion: This study confirms that aneurysm coiling with MDC is feasible, effective, and safe.

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Microsurgical Clipping of Intracranial Aneurysms following Unsuccessful Endovascular Treatment

Interventional Neuroradiology ◽

10.1177/159101991001600103 ◽

2010 ◽

Vol 16 (1) ◽

pp. 23-30 ◽

Cited By ~ 1

Author(s):

J.-L. Yu ◽

K. Xu ◽

H.-L. Wang ◽

B. Wang ◽

Q. Luo

Keyword(s):

Computed Tomography ◽

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Cranial Computed Tomography ◽

Endovascular Coiling ◽

Digital Subtraction ◽

Microsurgical Clipping ◽

Improved Outcomes ◽

Aneurysm Coiling

The purpose of the current study was to examine the reasons for failed endovascular aneurysm coiling and to determine the outcome of immediate microsurgical clipping. From July 2006 to July 2008, 198 patients underwent endovascular coiling at our institute; among them, ten cases were unsuccessful. All of the patients were diagnosed with intracranial aneurysms (ICAs) by cranial computed tomography angiography (CTA), and all underwent endovascular treatment without digital subtraction angiography (DSA). When endovascular coiling failed, the patients were immediately transferred to the operating room for microsurgical clipping under the same anesthetic. The ten patients were divided into three groups based on the cause of endovascular failure and associated clinical features. The clinical follow-up period was between 6–12 months, and all 10 patients had good outcomes following the surgery. Taken together, the results of this study suggest that immediate microsurgical clipping after failed endovascular coiling is efficient and may provide improved outcomes by preventing rebleeding.

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Microcatheter Shaping for Intracranial Aneurysm Coiling Using Artificial Intelligence-Assisted Technique

Neurosurgery ◽

10.1093/neuros/nyz310_438 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Wei Ni

Keyword(s):

Artificial Intelligence ◽

Intracranial Aneurysms ◽

Three Dimensional ◽

Average Diameter ◽

Dorsal Side ◽

Endovascular Coiling ◽

3D Images ◽

3 Dimensional ◽

And Training ◽

Aneurysm Coiling

Abstract INTRODUCTION A precise microcatheter shaping is critically necessary for the successful coiling of intracranial aneurysms. Currently, the development of artificial intelligence (AI)-based on technologies in medicine in advancing rapidly. The use of AI may have practical values in aiding the endovascular treatment of intracranial aneurysms. In this study, we tested the hypothesis that application of AI for analyzing parameters from three dimensional images, could warrant more accuracy and stability in microcatheter shaping during the treatment of intracranial aneurysms. METHODS Based on the 3-dimensional (3D) images of the digital subtraction angiography (DSA), we first segmented the vessels and the target aneurysms using a deep-learning-based method. Then the centerline of all vessels was extracted using a 3D thinning algorithm and the surface was calculated from the segmented binary maps. The simulated microcatheter path was then displayed in a 3D fashion together with the segmented vessels and aneurysms to assist the surgical planning and training process. After path simulation, the tip of the path was extracted and used to guide the steam-based shaping. The surgeons could then refer to the guidance during actual shaping. RESULTS A total of 22 patients with 22 aneurysms were treated with this technique. The average diameter of these aneurysms was 5.2 ± 2.9 mm. All of preplanned microcatheters matched vessel structures and aneurysm anatomy. Appropriate positioning was achieved in 15 (68.2%)patients without microguidewire assistance. In 5 cases (22.7%), microguidewire was used for microcatheter navigation and microcatheter reached the appropriate position. In 2 cases (9.1%) of ophthalmic aneurysm in the dorsal side of internal carotid artery, the microcatheter required modification for the initial shaping with reference to AI. During the operation, only 1 microcatheter (4.5%) required repositioning due to kick back during coil deployment. CONCLUSION AI-assisted microcatheter shaping techniques may be promising for faciliating easier and safer procedures in endovascular coiling of intracranial aneurysms.

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Room C, 10/17/2000 9: 00 AM - 11: 00 AM (PS) Thrombin Reduces Fluid Leak Through Punctured Dura Mater in an In Vitro Model

Anesthesiology ◽

10.1097/00000542-200009001-00358 ◽

2000 ◽

Vol 93 (3A) ◽

pp. A-358

Author(s):

Dario A. Grisales ◽

Dan Paoli ◽

Conny Frosth ◽

Rehana Nawab

Keyword(s):

Dura Mater ◽

In Vitro Model ◽

Vitro Model ◽

Fluid Leak

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An in vitro model for investigation of vitamin A effects on wound healing

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000692 ◽

2021 ◽

pp. 1-6

Author(s):

Hoda Keshmiri Neghab ◽

Mohammad Hasan Soheilifar ◽

Gholamreza Esmaeeli Djavid

Keyword(s):

Wound Healing ◽

Endothelial Cell ◽

Vitamin A ◽

In Vitro Model ◽

Cellular Proliferation ◽

Endothelial Cell Migration ◽

Normal Fibroblast ◽

Anti Inflammatory ◽

Vitro Model

Abstract. Wound healing consists of a series of highly orderly overlapping processes characterized by hemostasis, inflammation, proliferation, and remodeling. Prolongation or interruption in each phase can lead to delayed wound healing or a non-healing chronic wound. Vitamin A is a crucial nutrient that is most beneficial for the health of the skin. The present study was undertaken to determine the effect of vitamin A on regeneration, angiogenesis, and inflammation characteristics in an in vitro model system during wound healing. For this purpose, mouse skin normal fibroblast (L929), human umbilical vein endothelial cell (HUVEC), and monocyte/macrophage-like cell line (RAW 264.7) were considered to evaluate proliferation, angiogenesis, and anti-inﬂammatory responses, respectively. Vitamin A (0.1–5 μM) increased cellular proliferation of L929 and HUVEC (p < 0.05). Similarly, it stimulated angiogenesis by promoting endothelial cell migration up to approximately 4 fold and interestingly tube formation up to 8.5 fold (p < 0.01). Furthermore, vitamin A treatment was shown to decrease the level of nitric oxide production in a dose-dependent effect (p < 0.05), exhibiting the anti-inflammatory property of vitamin A in accelerating wound healing. These results may reveal the therapeutic potential of vitamin A in diabetic wound healing by stimulating regeneration, angiogenesis, and anti-inﬂammation responses.

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