DEFINING THE RISK OF RETREATMENT FOR ANEURYSM RECURRENCE OR RESIDUAL AFTER INITIAL TREATMENT BY ENDOVASCULAR COILING

Neurosurgery ◽  
2009 ◽  
Vol 65 (2) ◽  
pp. 311-315 ◽  
Author(s):  
Andrew J. Ringer ◽  
Rafael Rodriguez-Mercado ◽  
Erol Veznedaroglu ◽  
Elad I. Levy ◽  
Ricardo A. Hanel ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Surgical Repair ◽  
The United States ◽  
Patient Treatment ◽  
Endovascular Coiling ◽  
Total Risk ◽  
Clinical Recurrence ◽  
Choice Of Treatment ◽  
Procedural Complications

Abstract OBJECTIVE Endovascular treatment of intracranial aneurysms is less invasive than surgical repair but poses a higher risk for aneurysm recurrence, which may necessitate retreatment, thus adding to the long-term risk. Cerebrovascular neurosurgeons from 8 institutions in the United States and Puerto Rico collaborated to assess the risk of retreatment for residual or recurrent aneurysms after the initial endovascular coiling. METHODS Data were prospectively recorded for 311 patients with coiled intracranial aneurysms who underwent 352 retreatment procedures after angiographic or clinical recurrence (hemorrhage after initial coiling). Results analyzed included procedural complications and procedure-related morbidity. Morbidity was classified as major (modified Rankin scale score > 3) or minor, and temporary (<30 days) or permanent (>30 days). RESULTS Retreatment mortality was 0.85% per procedure and 0.96% per patient. Treatment-related rates were 0.32% per patient (0.28% per procedure) for permanent or temporary major disability; 1.29% for permanent minor disability (1.14% per procedure); and 1.61% for temporary minor disability (1.42% per procedure). Total risk for death or permanent major disability was 1.28% per patient and 1.13% per procedure. CONCLUSION Retreatment poses a low risk for patients with recurrences of intracranial aneurysms after initial coiling; this risk is smaller than that posed by the initial endovascular therapy. The risk of disability associated with retreatment for aneurysm recurrence after coiling must be considered prospectively in the choice of treatment but with the recognition that its effects are low in the overall management risk.

scholarly journals Neurological outcomes following intraprocedural rerupture during coil embolization of ruptured intracranial aneurysms

2015 ◽  
Vol 122 (1) ◽  
pp. 128-135 ◽  
Author(s):  
Christopher J. Stapleton ◽  
Brian P. Walcott ◽  
William E. Butler ◽  
Christopher S. Ogilvy
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
External Ventricular Drain ◽  
Endovascular Coiling ◽  
Neurological Outcomes ◽  
Symptomatic Vasospasm ◽  
Increased Risk ◽  
Ruptured Intracranial Aneurysms

OBJECT Intraprocedural rerupture (IPR) of intracranial aneurysms during coil embolization is associated with significant periprocedural disability and death. However, whether this morbidity and mortality are secondary to an increased risk of vasospasm and hydrocephalus is unknown. The authors undertook this study to determine the in-hospital and long-term neurological outcomes for patients with aneurysmal subarachnoid hemorrhage (SAH) treated with coil embolization who suffer aneurysm rerupture during treatment. METHODS The records of 156 patients admitted with SAH from previously untreated, ruptured, intracranial aneurysms and treated with endovascular coiling between January 2007 and January 2014 were retrospectively reviewed. Twelve patients (7.7%) experienced IPR during coil embolization. RESULTS Compared with the cohort of patients with uncomplicated coil embolization procedures, patients with aneurysm rerupture were more likely to require external ventricular drain (EVD) placement (91.7% vs 58.3%, p = 0.02) and postprocedural EVD placement (36.4% vs 7.1%, p = 0.01), to undergo permanent ventriculoperitoneal shunt placement (50.0% vs 18.8%, p = 0.02), to develop symptomatic vasospasm (50.0% vs 18.1%, p = 0.02), and to have longer lengths of hospital stay (median 21.5 days vs 15.0 days, p = 0.04). Admission Hunt and Hess, modified Fisher, and Barrow Neurological Institute grades did not differ between the 2 cohorts, nor did long-term functional neurological outcomes as assessed by the modified Rankin Scale. CONCLUSIONS Intraprocedural rerupture during coil embolization for ruptured intracranial aneurysms is associated with an increased risk of symptomatic vasospasm and need for temporary and permanent cerebrospinal fluid diversion for hydrocephalus.

scholarly journals New Devices Designed to Improve the Long-Term Results of Endovascular Treatment of Intracranial Aneurysms

2004 ◽  
Vol 10 (2) ◽  
pp. 93-102 ◽  
Author(s):  
J. Raymond ◽  
P. Leblanc ◽  
M. Chagnon ◽  
G. Gévry ◽  
J.-P. Collet ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Controlled Trial ◽  
Long Term Results ◽  
Secondary Outcome ◽  
Endovascular Coiling ◽  
Double Blind Study ◽  
Double Blind ◽  
Term Efficacy

Endovascular coiling can improve the outcome of patients with ruptured intracranial aneurysms, but angiographic recurrences are frequent compared to surgical clipping. New coils or devices have been introduced to improve long-term results of endovascular treatment but none have been the object of a valid clinical trial. We have proposed a multicentric randomized double-blind study comparing radioactive and standard coil occlusion of aneurysms. The purpose of this article is to review issues that are specific to the design of clinical trials to assess embolic agents that could improve the long-term efficacy of endovascular treatment of intracranial aneurysms. The proposed trial is a randomized, multi-center, prospective, controlled trial comparing the new generation coils to standard platinum coils. Blinding, if at all possible, is preferable to minimize bias, at least for follow-up angiographic studies that should cover a period of 18 months. All patients with an intracranial aneurysm eligible for endovascular treatment would be proposed to participate. The study would enrol approximately 500 patients equally divided between the two groups, recruited within two years, to demonstrate a decrease in the recurrence rate, the primary outcome measure, from 20% to 10%. Secondary outcome measures should assure that complications, initial clinical and angiographic results remain unchanged. Independent data safety and monitoring committees are crucial to the credibility of trials and to ensure scientific rigor and objectivity. The scientific demonstration of an improved long-term efficacy, without significant compromise regarding safety, is mandatory before considering the widespread use of a new embolic device for the endovascular treatment of aneurysms.

Long-Term Follow-Up of Intracranial Aneurysms Treated With Endovascular Coiling

2012 ◽  
Vol 46 (4) ◽  
pp. 325-328 ◽  
Author(s):  
Peter Lindvall ◽  
Ljubisa Borota ◽  
Richard Birgander ◽  
Per Jonasson ◽  
Per-Åke Ridderheim
Keyword(s):  
Intracranial Aneurysms ◽  
Endovascular Coiling ◽  
Long Term Follow Up

Long-term Economic Impact of Coiling vs Clipping for Unruptured Intracranial Aneurysms

Neurosurgery ◽  
2013 ◽  
Vol 72 (6) ◽  
pp. 1000-1013 ◽  
Author(s):  
Shivanand P. Lad ◽  
Ranjith Babu ◽  
Michael S. Rhee ◽  
Robbi L. Franklin ◽  
Beatrice Ugiliweneza ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Intracranial Aneurysms ◽  
The United States ◽  
Endovascular Coiling ◽  
Complication Rates ◽  
Surgical Clipping ◽  
Unruptured Intracranial Aneurysms ◽  
Reoperation Rates

Abstract BACKGROUND: Treatment of unruptured intracranial aneurysms (UIAs) involves endovascular coiling or aneurysm clipping. While many studies have compared these treatment modalities with respect to various clinical outcomes, few studies have investigated the economic costs associated with each procedure. OBJECTIVE: To determine the reoperation rate, postoperative complications, and inpatient and outpatient costs associated with surgical or endovascular treatment of patients with UIAs in the United States. METHODS: We utilized the MarketScan database to examine patients who underwent surgical clipping or endovascular coiling procedures for UIAs from 2000 to 2009, comparing reoperation rates, complications, and angiogram and healthcare resource use. Propensity score matching techniques were used to match patients. RESULTS: We identified 4,504 patients with surgically treated UIAs, with propensity score matching of 3,436 patients. Reoperation rates were significantly lower in the clipping group compared to the coiling group at 1- (P < .001), 2- (P < .001), and 5 years (P < .001) following the procedure. However, postoperative complications (immediate, 30 and 90 days) were significantly higher in those undergoing surgical clipping. Although hospital length of stay and costs were higher in the clipping group for the index procedure, the number of postoperative angiograms and outpatient services used at 1, 2, and 5 years were significantly higher in the coiling group. CONCLUSION: Though surgical clipping resulted in lower reoperation rates, it was associated with higher complication rates and initial costs. However, overall costs at 2 and 5 years were similar to endovascular coiling due to the significantly higher number of follow-up angiograms and outpatient costs in these patients.

Abstract WP91: Long-Term Risk of Stroke after Stent-Assisted Coiling of Unruptured Intracranial Aneurysms

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Setareh Salehi Omran ◽  
Babak B Navi ◽  
Hooman Kamel
Keyword(s):  
Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Intracranial Aneurysms ◽  
Cox Regression ◽  
Endovascular Coiling ◽  
Subdural Hemorrhage ◽  
Administrative Claims ◽  
Unruptured Intracranial Aneurysms ◽  
Secondary Outcomes

Background: Long-term comparative data are limited regarding stent-assisted coiling versus coiling alone for unruptured intracranial aneurysms. We compared the risks of ischemic stroke and intracranial hemorrhage after stent-assisted coiling versus coiling without stenting. Methods: Using administrative claims data on all admissions to nonfederal acute care hospitals in CA, FL, and NY from 2005-2013, we identified adult patients who underwent stent-assisted coiling or coiling without stenting for an unruptured intracranial aneurysm. Our primary outcome was a composite of ischemic stroke or intracranial hemorrhage (intracerebral, subarachnoid, or subdural hemorrhage). Our secondary outcomes were ischemic stroke and intracranial hemorrhage. Outcomes were ascertained by previously validated ICD-9-CM diagnosis codes. To focus on the long-term safety of these techniques, we excluded patients with an outcome during the index hospitalization. Kaplan-Meier survival statistics and Cox regression were used to compare stroke risk after stent-assisted coiling versus coiling alone. Results: We identified 5,398 patients (mean age, 58 [±13] years; 79% female) treated with endovascular coiling, of whom 254 (4.7%) underwent stent-assisted coiling. Over 4.2 (±2.0) years of follow-up, 357 outcomes were identified (205 ischemic strokes, 152 intracranial hemorrhages). By 8 years, the cumulative rate of stroke or hemorrhage was 8.5% (95% confidence interval [CI], 5.3-13.6%) with stent-assisted coiling versus 9.2% (95% CI, 7.8-10.9%) with coiling alone. Most outcomes occurred in the first year (3.6% after stent-assisted coiling versus 3.9% after coiling alone). After adjustment for demographics and vascular risk factors, the risk of ischemic stroke or intracranial hemorrhage was similar after stent-assisted coiling compared to coiling alone (hazard ratio [HR], 1.1; 95% CI, 0.7-1.7). Our results were unchanged when assessing the secondary outcomes of ischemic stroke (HR, 1.4; 95% CI, 0.8-2.4) or intracranial hemorrhage (HR, 0.7; 95% CI, 0.3-1.7). Conclusions: After uncomplicated coiling of an unruptured aneurysm, long-term rates of stroke and intracranial hemorrhage were similar for stent-assisted coiling and coiling without stenting.

scholarly journals The significant impact of framing coils on long-term outcomes in endovascular coiling for intracranial aneurysms: how to select an appropriate framing coil

2016 ◽  
Vol 125 (3) ◽  
pp. 705-712 ◽  
Author(s):  
Wataru Ishida ◽  
Masayuki Sato ◽  
Tatsuo Amano ◽  
Yuji Matsumaru
Keyword(s):  
Multivariate Analysis ◽  
Packing Density ◽  
Intracranial Aneurysms ◽  
Endovascular Coiling ◽  
Long Term Outcomes ◽  
Aneurysm Size ◽  
Unruptured Intracranial Aneurysms ◽  
Coil Volume

OBJECTIVE The importance of a framing coil (FC)—the first coil inserted into an aneurysm during endovascular coiling, also called a lead coil or a first coil—is recognized, but its impact on long-term outcomes, including recanalization and retreatment, is not well established. The purposes of this study were to test the hypothesis that the FC is a significant factor for aneurysmal recurrence and to provide some insights on appropriate FC selection. METHODS The authors retrospectively reviewed endovascular coiling for 280 unruptured intracranial aneurysms and gathered data on age, sex, aneurysm location, aneurysm morphology, maximal size, neck width, adjunctive techniques, recanalization, retreatment, follow-up periods, total volume packing density (VPD), volume packing density of the FC, and framing coil percentage (FCP; the percentage of FC volume in total coil volume) to clarify the associated factors for aneurysmal recurrence. RESULTS Of 236 aneurysms included in this study, 33 (14.0%) had recanalization, and 18 (7.6%) needed retreatment during a mean follow-up period of 37.7 ± 16.1 months. In multivariate analysis, aneurysm size (odds ratio [OR] = 1.29, p < 0.001), FCP < 32% (OR 3.54, p = 0.009), and VPD < 25% (OR 2.96, p = 0.015) were significantly associated with recanalization, while aneurysm size (OR 1.25, p < 0.001) and FCP < 32% (OR 6.91, p = 0.017) were significant predictors of retreatment. VPD as a continuous value or VPD with any cutoff value could not predict retreatment with statistical significance in multivariate analysis. CONCLUSIONS FCP, which is equal to the FC volume as a percentage of the total coil volume and is unaffected by the morphology of the aneurysm or the measurement error in aneurysm length, width, or height, is a novel predictor of recanalization and retreatment and is more significantly predictive of retreatment than VPD. To select FCs large enough to meet the condition of FCP ≥ 32% is a potential relevant factor for better long-term outcomes. These findings support our hypothesis that the FC is a significant factor for aneurysmal recurrence.

scholarly journals Evaluation and management of traumatic rupture of the corpus cavrnosum

2007 ◽  
Vol 54 (2) ◽  
pp. 131-134 ◽  
Author(s):  
D. Milutinovic ◽  
Z. Dzamic ◽  
M. Acimovic ◽  
J. Hadzi-Djokic
Keyword(s):  
Conservative Therapy ◽  
Surgical Repair ◽  
Urethral Injury ◽  
Traumatic Rupture ◽  
Late Sequelae ◽  
Choice Of Treatment ◽  
Urethral Rupture

Fracture of the penis, or rupture of the corpus c avernosum is an uncommon injury, but probably under-reported entity. Only approximately 180 cases have been reported in the literature. Penile N fracture with urethral injury is even more uncommon, accounting for approximately 10 to 20% of the cases reported. Early reports on this injury suggest conservative therapy as the choice of treatment. Recent reports emphasize immediate surgical repair to prevent late sequelae of injury, especially those associated with urethral rupture. We review 5 cases with evaluation, treatment and follow-up. Delays in treatment lead to long-term complications. .

Follow-up Angiography of Intracranial Aneurysms Treated with Endovascular Placement of Guglielmi Detachable Coils

Neurosurgery ◽  
2002 ◽  
Vol 50 (2) ◽  
pp. 239-250 ◽  
Author(s):  
John Thornton ◽  
Gerard M. Debrun ◽  
Victor A. Aletich ◽  
Qasim Bashir ◽  
Fady T. Charbel ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Endovascular Coiling ◽  
Guglielmi Detachable Coils ◽  
Detachable Coils ◽  
Aneurysm Occlusion ◽  
Male Patients ◽  
The Mean ◽  
Angiographic Findings

ABSTRACT OBJECTIVE The success of endovascular treatment of intracranial aneurysms with Guglielmi detachable coils (GDCs) is dependent on the long-term exclusion of the aneurysm from the circulation. We reviewed our experience with the long-term angiographic follow-up monitoring of aneurysms that had been treated with GDCs. METHODS All patients whose aneurysms had been treated with GDCs between January 1995 and August 1999 and who subsequently underwent follow-up angiography at 6 months or more were included in this study. We reviewed all of the angiographic findings, to determine the percentage of aneurysm occlusion on the initial angiograms and on the last available follow-up angiograms. The categories of aneurysm occlusion used were 100%, ≥95%, and less than 95% occlusion. RESULTS One hundred thirty patients with 141 aneurysms underwent 143 endovascular coiling procedures and subsequently underwent angiographic follow-up monitoring of 6 months or more. There were 102 female and 28 male patients. The mean angiographic follow-up period was 16.7 months (range, 6–62 mo). The initial rates of occlusion were 100% for 56 aneurysms (39%), ≥95% for 65 aneurysms (46%), and less than 95% for 22 aneurysms (15%). Recurrence of one aneurysm (1.8%) was observed. Of the 87 aneurysms that were incompletely occluded initially, there was progressive thrombosis in 40 (46%), stable neck remnants in 23 (26%), and enlargement of the residual neck in 24 (28%). The final occlusion rates, determined on the last available angiograms, were 100% for 88 aneurysms (61%), ≥95% for 31 aneurysms (22%), and less than 95% for 24 aneurysms (17%). No patient experienced repeat or new subarachnoid hemorrhage more than 6 months after the initial treatment. CONCLUSION Late angiographic follow-up monitoring of aneurysms that have been treated with GDCs demonstrates the durability of the treatment. Aneurysms with large residual neck remnants were subjected to further treatment, whereas aneurysms with small residual neck remnants remain under observation.

scholarly journals Pipeline Embolization Device for Small Intracranial Aneurysms: Evaluation of Safety and Efficacy in a Multicenter Cohort

Neurosurgery ◽  
2017 ◽  
Vol 80 (4) ◽  
pp. 579-587 ◽  
Author(s):  
Christoph J. Griessenauer ◽  
Christopher S. Ogilvy ◽  
Paul M. Foreman ◽  
Michelle H. Chua ◽  
Mark R. Harrigan ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Intracranial Aneurysms ◽  
The United States ◽  
Complication Rates ◽  
Cumulative Number ◽  
Radiographic Outcome ◽  
Pipeline Embolization Device ◽  
Safety And Efficacy ◽  
Multicenter Cohort ◽  
Procedural Complications

Abstract BACKGROUND: To date, the use of the flow-diverting Pipeline Embolization Device (PED) for small intracranial aneurysms (≤ 7 mm) has been reported only in single-center series. OBJECTIVE: To evaluate the safety and efficacy of the PED in a multicenter cohort. METHODS: Five major academic institutions in the United States provided data on patient demographics, aneurysm features, and treatment characteristics of consecutive patients with aneurysms ≤ 7 mm treated with a PED between 2009 and 2015. Radiographic outcome was assessed with digital subtraction angiography. Clinical outcome was measured with the modified Rankin Scale. RESULTS: The cumulative number of aneurysms ≤ 7 mm treated with PED at the 5 institutions was 149 in 117 patients (age, 54 years [range, 29-87 years]; male to female, 1-5.9). Aneurysms were most commonly located in the paraophthalmic segment (67.1%) of the internal carotid artery. Radiographic outcome at last follow-up was available for 123 aneurysms (82.6%), with a complete occlusion rate of 87%. Thromboembolic and symptomatic procedural complications occurred in 8.7% and 6% of the aneurysms treated, respectively. There was 1 mortality (0.9%) unrelated to the PED procedure. Multivariable logistic regression identified size &lt; 4 mm, balloon angioplasty to open the device, and simultaneous treatment of multiple aneurysms as predictors of procedural complications. Good clinical outcome was achieved in 96% of electively treated patients. CONCLUSION: In the largest series on PED for small aneurysms to date, data suggest that treatment with the flow-diverting PED is safe and efficacious, with complication rates comparable to those for traditional endovascular techniques.

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