Emerging Concepts in the Treatment of Intracranial Aneurysms: Stents, Coated Coils, and Liquid Embolic Agents

Neurosurgery ◽  
2005 ◽  
Vol 57 (3) ◽  
pp. 449-459 ◽  
Author(s):  
Giuseppe Lanzino ◽  
Yassine Kanaan ◽  
Paolo Perrini ◽  
Hayan Dayoub ◽  
Kenneth Fraser
Keyword(s):  
Endovascular Treatment ◽  
Effective Treatment ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Clinical Experiences ◽  
Endovascular Techniques ◽  
Future Directions ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Embolic Materials

ABSTRACT ENDOVASCULAR TECHNIQUES FOR the treatment of intracranial aneurysms are rapidly evolving. Modifications of more traditional coils have been introduced. Such modifications include newer coils coated with various polymers to increase both coil thrombogenicity and degree of aneurysm packing. In addition, newer coil designs aimed at improving the conformability of the coil to the aneurysm have been used with promising preliminary results. The availability of a newer generation of stents specifically designed for intracranial navigation allows for more effective treatment of aneurysms with wide necks, which usually have been considered unsuitable for optimal endovascular treatment. Endovascular alternatives to coil embolization, such as liquid embolic materials, also have been explored for the treatment of intracranial aneurysms, with varying results. We summarize the rationale for use of these newer devices and early clinical experiences. Areas of current research and future directions of endovascular aneurysm treatment also are discussed.

125 Staged Endovascular Treatment of Ruptured Intracranial Aneurysms: Acute Coiling Followed By Delayed Flow Diversion

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 228-228
Author(s):  
Erick Michael Westbroek ◽  
Matthew Bender ◽  
Narlin B Beaty ◽  
Bowen Jiang ◽  
Risheng Xu AB ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Complication Rate ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Major Complication ◽  
Flow Diversion ◽  
Neurological Deficits ◽  
Major Complication Rate ◽  
Ruptured Intracranial Aneurysms

Abstract INTRODUCTION ISAT demonstrated that coiling is effective for aneurysm treatment in subarachnoid hemorrhage (SAH); however, complete occlusion of wide-necked aneurysms frequently requires adjuvants relatively contraindicated in SAH. As such, a limited “dome occlusive” strategy is often pursued in the setting of SAH. We report a single institution series of coiling of acutely ruptured aneurysms followed by delayed flow diversion for definitive, curative occlusion. METHODS A prospectively collected IRB-approved database was screened for patients with aneurysmal SAH who were initially treated by coil embolization followed by planned flow diversion at a single academic medical institution. Peri-procedural outcomes, complications, and angiographic follow-up were analyzed. RESULTS >50 patients underwent both acute coiling followed by delayed, planned flow diversion. Average aneurysm size on initial presentation was 9.5 mm. Common aneurysm locations included Pcomm (36%), Acomm (30%), MCA (10%), ACA (10%), and vertebral (5%). Dome occlusion was achieved in all cases following initial coiling. Second-stage implantation of a flow diverting stent was achieved in 49/50 cases (98%). Follow-up angiography was available for 33/50 patients (66%), with mean follow-up of 11 months. 27 patients (82%) had complete angiographic occlusion at last follow up. All patients with residual filling at follow-up still had dome occlusion. There were no mortalities (0%). Major complication rate for stage I coiling was 2% (1 patient with intra-procedural aneurysm re-rupture causing increase in a previous ICH). Major complication rate for stage 2 flow diversion was 2% (1 patient with ischemic stroke following noncompliance with dual antiplatelet regimen). Minor complications occurred in 2 additional patients (4%) with transient neurological deficits. CONCLUSION Staged endovascular treatment of ruptured intracranial aneurysms with acute dome-occlusive coil embolization followed by delayed flow diversion is a safe and effective treatment strategy.

scholarly journals Endovascular Coil Embolization of a Posterior Communicating Artery Aneurysm: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (6) ◽  
pp. E597-E598
Author(s):  
Maureen A Darwal ◽  
Zakaria Hakma ◽  
Mandy J Binning ◽  
Adam Arthur ◽  
Bain Mark ◽  
...  
Keyword(s):  
New York ◽  
Endovascular Treatment ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Posterior Communicating Artery ◽  
International Subarachnoid Aneurysm Trial ◽  
Endovascular Coil Embolization ◽  
Posterior Communicating Artery Aneurysm ◽  
Set Up

Abstract Since the International Subarachnoid Aneurysm Trial,1 endovascular treatment has been the favored treatment for appropriate ruptured intracranial aneurysms. While our endovascular technology has advanced to allow us to treat the majority of intracranial aneurysms, simple coil embolization is still the most common modality. This video demonstrates the fundamentals of aneurysm catheterization and coiling for safe treatment. In addition, the set-up and devices are detailed. This video is to add to the library of basic techniques that will aid a large number of practitioners. This patient consented to endovascular treatment. The video demonstrates endovascular coil embolization of a posterior communicating artery aneurysm in a 76-yr-old female who presented with a subarachnoid hemorrhage. Image of biplane suite in video used courtesy of Siemens Medical Solutions USA, Inc. Illustration at 5:12 reprinted from Yasargil MG, et al, Microneurosurgery IV B, p. 9, Thieme, New York, 1995.

Management of direct carotid-cavernous sinus fistulas with the use of ethylene-vinyl alcohol (Onyx) only: preliminary results

2010 ◽  
Vol 112 (3) ◽  
pp. 595-602 ◽  
Author(s):  
Marco Zenteno ◽  
Jorge Santos-Franco ◽  
Vladimir Rodríguez-Parra ◽  
Jorge Balderrama ◽  
Yolanda Aburto-Murrieta ◽  
...  
Keyword(s):  
Case Series ◽  
Endovascular Techniques ◽  
Embolic Material ◽  
Ethylene Vinyl Alcohol ◽  
Sole Agent ◽  
Novel Approach ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Carotid Cavernous Fistulas

Object So-called direct carotid-cavernous fistulas (CCFs) are commonly treated by detachable balloons or coils to occlude the shunt while sparing the carotid artery. Liquid embolic agents have been rarely used, and in particular, to the authors' knowledge, the use of Onyx as the sole agent has never been reported in an indexed publication. Methods The authors describe a case series of 5 patients with posttraumatic CCF in whom embolization with Onyx was prospectively used as the sole strategy of management. Results Complete occlusion was obtained at the end of the procedure in 4 cases, and the lesion in the remaining patient subsequently occluded at the 6-month follow-up evaluation. Conclusions As endovascular techniques for treatment of direct CCFs continue to evolve, this novel approach with Onyx as the sole embolic material seems promising in treating these lesions.

Stent Induced Changes to the Radius of Curvature of the Cerebrovasculature

2012 ◽  
Author(s):  
Robert M. King ◽  
Juyu Chueh ◽  
Imramsjah M. J. van der Bom ◽  
Christine F. Silva ◽  
Ajay K. Wakhloo ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Stent Implantation ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Significant Error ◽  
Radius Of Curvature ◽  
Anterior Communicating Artery ◽  
Parent Artery ◽  
Hemodynamic Changes ◽  
Induced Changes

Stent implantation has expanded the endovascular treatment of intracranial aneurysms to those with widenecks, that were previously unfavorable to coil embolization. Past studies have found that several mechanisms including stent-induced endothelization and hemodynamic changes due to alteration in vessel geometry may contribute to stable clot formation within the aneurysmal sac and aid in aneurismal healing [1,2]. Change in the angle of the parent arteries after stent-assisted coil embolization of anterior communicating artery (Acom) aneurysms has been measured on projection angiograms; however, use of 2D angiographic datasets to describe changes of vessel angle in 3D may result in significant error. The goal of this study was to quantitatively characterize the change in the radius of curvature (RC) of the parent artery induced by the implantation of an intracranial stent in 3D.

scholarly journals “Waffle Cone” Technique for Intra/Extra-Aneurysmal Stent Placement for the Treatment of Complex and Wide-Necked Bifurcation Aneurysm

2008 ◽  
Vol 14 (2_suppl) ◽  
pp. 49-52 ◽  
Author(s):  
Tzu-Hsien Yang ◽  
Ho-Fai Wong ◽  
Ming-Shiang Yang ◽  
Chang-Hsien Ou ◽  
Tzu-Lung Ho
Keyword(s):  
Endovascular Treatment ◽  
Stent Placement ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Three Dimensional ◽  
Parent Vessel ◽  
Surgical Clipping ◽  
Selective Embolization ◽  
Bifurcation Aneurysm

Endovascular treatment of intracranial aneurysms by coiling has become an accepted alternative to surgical clipping 1. In cases of wide-necked and sidewall aneurysms, selective embolization is difficult because of the risk of coil protrusion into the parent vessel. The use of three-dimensional coils, stents 2, and balloon remodeling have all aided the attempt to adequately manage such lesions. However, compared with sidewall aneurysms, bifurcation aneurysms are more challenging from an endovascular standpoint. Because of their specific anatomy and hemodynamics, the tendency to recur and rerupture is higher. Several authors have reported successful treatment of these complex and wide-necked bifurcation aneurysms by using Y-configured dual stent-assisted coil embolization 3,4, the double microcatheter technique 5, a more compliant balloon remodeling technique6, the TriSpan neck-bridge device7, or the waffle cone technique8. We describe two cases of wide-necked bifurcation aneurysms in which the waffle cone technique was used for coil embolization. The waffle cone technique was first described in 2006; however, the small number of published cases and the lack of follow-up prevent one from assessing this technique's durability and the probability of recanalization. We report the cases of two patients harboring unruptured wide-necked bifurcation aneurysms that were treated and followed-up for six months.

Combined surgical/endovascular treatment of a complex dural arteriovenous fistula in 21-month-old

2009 ◽  
Vol 3 (6) ◽  
pp. 501-506 ◽  
Author(s):  
R. Webster Crowley ◽  
Avery J. Evans ◽  
Mary E. Jensen ◽  
Neal F. Kassell ◽  
Aaron S. Dumont
Keyword(s):  
Endovascular Treatment ◽  
Transarterial Embolization ◽  
Treatment Options ◽  
Endovascular Techniques ◽  
Vascular Abnormalities ◽  
Arteriovenous Fistulas ◽  
The Past ◽  
Endovascular Approach ◽  
Embolic Materials ◽  
Extensive Surgery

The treatment of intracranial dural arteriovenous fistulas (AVF) has progressed considerably over the past few decades. With the introduction of new embolic materials and refinement of endovascular techniques, lesions that in the past may have required extensive surgery, or were considered untreatable, have increasingly become curable. Despite improvements in technology, not every condition is amenable to an endovascular treatment, including those patients with preexisting vascular abnormalities that preclude an endovascular approach. In these cases, the patient may be left with suboptimal treatment options with higher associated risks. The authors here report on the treatment of a dural AVF in a pediatric patient in whom prior procedures rendered his cerebrovascular anatomy unnavigable using traditional endovascular techniques. To circumvent these vascular abnormalities the patient underwent combined surgical/endovascular treatment that included surgical exposure and cannulation of the cervical carotid artery, as well as simultaneous femoral artery access, with subsequent successful transarterial embolization of the dural AVF.

scholarly journals Indications and practical application of strategies in the endovascular management of intracranial aneurysms

2013 ◽  
Vol 20 (3) ◽  
pp. 221-239
Author(s):  
Marco Antonio Zenteno ◽  
Jorge Arturo Santos-Franco ◽  
Ángel Lee ◽  
Fernando Vinuela ◽  
Jose-Maria Modenesi Freitas ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Endovascular Management ◽  
Practical Application ◽  
Endovascular Techniques ◽  
Endovascular Technique ◽  
Rational Choices ◽  
Pros And Cons

Abstract The occlusion of intracranial aneurysms is more successful and stable by properly planning the approach and application of endovascular techniques. The next step is a relentless analysis of the different indications of endovascular treatment, tailoring a strategy suitable for the specific case, and making more rational choices for the management of aneurysms. Indications and strategies according to the analysis of the aneurysmal complex are given, as well as pros and cons of the endovascular technique according to different anatomical locations

scholarly journals Endovascular treatment of wide-neck intracranial bifurcation aneurysms with ‘Y’-configuration, double Neuroform® stents-assisted coiling technique: Experience in a single center

2017 ◽  
Vol 23 (4) ◽  
pp. 362-370 ◽  
Author(s):  
C Castaño ◽  
M Terceño ◽  
S Remollo ◽  
MR García-Sort ◽  
C Domínguez
Keyword(s):  
Endovascular Treatment ◽  
Medical Records ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Anterior Communicating Artery ◽  
Single Center ◽  
Endovascular Approach ◽  
Double Stent ◽  
Wide Neck

Background Intracranial wide-neck aneurysms at the arterial bifurcations, especially in the aneurysms where the bifurcating branches emanate directly from the base of the aneurysm, have been particularly difficult on which to perform endovascular treatment. The ‘Y’-configuration, double stent-assisted coil embolization is an option for the treatment of these difficult aneurysms, allowing the closure of the aneurysm, preserving the parent arteries. Material and methods In a nine-year period, 546 intracranial aneurysms in 493 patients were treated at our center by endovascular approach. We have reviewed the medical records and arteriographies from November 2007 to January 2017 of 45 patients who were treated using ‘Y’-configuration double Neuroform® stent-assisted coil embolization. Results All patients were successfully treated. The location of the aneurysms were: middle cerebral artery (MCA) 20 (44.4%), anterior communicating artery (AComA) 17 (37.7%), basilar four (8.9%), internal carotid artery (ICA) bifurcation three (6.6%) and posterior communicating artery (PComA) one (2.2%). The mRS at hospital discharge was: mRS 0: 42 (93.3%), mRS 1: 1 (2.2%), mRS 2: 1 (2.2%) and mRS 5: 1 (2.2%). The Modified Raymond-Roy Occlusion Classification, in the control at six months, was: Class I: 41 (91.1%), Class II: 2 (4.4%), Class IIIa: 1 (2.2%) and Class IIIb: 1 (2.2%). Forty-four (97.8%) patients had a good outcome (mRS < 2) at six months. One (2.2%) patient had a poor outcome (mRS > 2) at six months that was due to sequelae of SAH. There was no mortality at six months. Conclusions This technique is safe and effective for the endovascular treatment of difficult wide-neck bifurcation aneurysms, allowing the stable closure of the aneurysm, preserving the parent arteries.

scholarly journals Endovascular treatment of a basilar artery dissecting aneurysm

2007 ◽  
Vol 65 (4a) ◽  
pp. 1012-1014 ◽  
Author(s):  
Cristiane Borges Patroclo ◽  
Paulo Puglia Jr ◽  
Claudia da Costa Leite ◽  
Fabio Iuji Yamamoto ◽  
Jovana Gobbi Marchesi Ciríaco ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Effective Treatment ◽  
Basilar Artery ◽  
Coil Embolization ◽  
Clinical Course ◽  
Dissecting Aneurysm ◽  
High Morbidity ◽  
Hemorrhagic Complications ◽  
Clinical And Radiological Results ◽  
Dissecting Aneurysms

Basilar artery (BA) dissecting aneurysms pose difficulties to treatment because both bleeding and thrombosis can happen in the same patient, clinical course is unpredictable and high morbidity is usual. We report the case of a 37-year-old woman with a BA aneurysm probably caused by arterial dissection, presenting embolic and hemorrhagic complications. The aneurysm was submitted to endovascular treatment with stenting and coil embolization. Clinical and radiological results were excellent and no complications were observed, suggesting that BA stenting and coil embolization may be a safe and effective treatment for this condition.

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