Endovascular Treatment of a Large Aneurysm Arising From a Basilar Trunk Fenestration Using the Waffle-Cone Technique

2010 ◽  
Vol 67 (3) ◽  
pp. ons-ons ◽  
Author(s):  
Thomas J. Gruber ◽  
Christopher S. Ogilvy ◽  
Erik F. Hauck ◽  
Elad I. Levy ◽  
L. Nelson Hopkins ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Clinical Presentation ◽  
Parent Vessel ◽  
Blurred Vision ◽  
Aneurysm Neck ◽  
Vertebral Arteries ◽  
Flow Through ◽  
Large Aneurysm ◽  
The Right

Abstract OBJECTIVE: Endovascular treatment of large intracranial aneurysms arising from a fenestrated parent vessel may prove particularly difficult. We present a case of a large, broad-based aneurysm arising from a proximal basilar artery (BA) fenestration treated with the wafflecone technique. Technical nuances and indications for this treatment option are reviewed. CLINICAL PRESENTATION: A 38-year-old man presented with headache, blurred vision, and dizziness. Angiography demonstrated an 11 × 14-mm BA aneurysm associated with the proximal portion of a BA fenestration. TECHNIQUE: A 28 × 4.5-mm Enterprise stent was placed from the right vertebral artery directly into the aneurysm. The stent tines were allowed to flare out in the aneurysm neck creating the “waffle cone.” The aneurysm was then coiled with a series of Presidio coils. CONCLUSION: Use of the waffle-cone technique for stent placement resulted in nearly complete embolization of the aneurysm, retention of the entire coil mass in the dome, and preservation of flow through both vertebral arteries and both limbs of the fenestration.

A novel endovascular clip system for the treatment of intracranial aneurysms: technology, concept, and initial experimental results

2008 ◽  
Vol 108 (6) ◽  
pp. 1230-1240 ◽  
Author(s):  
Thomas R. Marotta ◽  
Thorsteinn Gunnarsson ◽  
Ian Penn ◽  
Donald R. Ricci ◽  
Ian Mcdougall ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Delivery System ◽  
Intracranial Aneurysms ◽  
Balloon Catheter ◽  
Cerebral Aneurysms ◽  
Histopathological Analysis ◽  
Parent Vessel ◽  
Flow Models ◽  
Aneurysm Neck ◽  
Novel Device

Object The authors describe a novel device for the endovascular treatment of intracranial aneurysms, the endovascular clip system (eCLIPs). Descriptions of the device and its delivery system as well as the results of flow model tests and the treatment of experimental aneurysms are provided. Methods The eCLIPs comprises a flexible hybrid implantable device (an anchor and a covered leaf) and a balloon catheter delivery system, designed to be positioned and activated in the parent vessel in such a way that the covered portion will abut the aneurysm neck. The eCLIPs was subjected to testing in glass, elastomeric, and cadaveric flow models to determine its navigability, orientation, and activation compared with commercially available stents. In a second experiment, 8 carotid artery sidewall aneurysms in swine were treated using eCLIPs. The degree of occlusion was observed on angiography immediately following and 30 days after device activation, and a histological analysis was performed at 30 days. Results The device could navigate tortuous glass models and human cadaveric vessels. Compared with commercially available stents, the eCLIPs performed well. It could be navigated, oriented, and activated easily and reliably. With regard to the 8 porcine experimental aneurysms, immediate postactivation angiograms confirmed complete occlusion of 4 lesions and near occlusion of the other 4. Angiographic follow-up at 30 days postactivation showed occlusion of all 8 aneurysms and patency of all parent vessels. Histopathological analysis revealed aneurysm healing, with smooth-muscle cells growing across the lesion neck to allow reendothelialization. Conclusions Aneurysm occlusion with a single extrasaccular endovascular device has potential advantages. The authors believe that eCLIPs may prove to be a useful tool in the endovascular treatment of cerebral aneurysms. The system should reduce risks associated with coiling, procedure time, costs, and radiation exposure. The device satisfactorily occluded 8 experimental sidewall aneurysms. The observed healing pattern is similar to that seen after microsurgical clipping.

scholarly journals Cerebral Aneurysm Perforations during Treatment with Detachable Coils

2006 ◽  
Vol 12 (1) ◽  
pp. 31-35 ◽  
Author(s):  
K.F. Layton ◽  
H.J. Cloft ◽  
D.F. Kallmes
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Aneurysm ◽  
Intracranial Aneurysms ◽  
Case Reports ◽  
Aneurysm Rupture ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Detachable Coils

Perforation of intracranial aneurysms during endovascular treatment with platinum micro-coils is a well-known and serious complication reported to occur in 2–4% of patients. Inflation of a remodelling balloon across the aneurysm neck or within the proximal parent vessel is an additional technique that theoretically might be useful to reduce flow within the aneurysm and achieve hemostasis. In the case reports that follow, we present our experience using this technique for managing intraprocedural aneurysm rupture.

scholarly journals The Rapid Pull-Back Technique for Navigation across a Wide-Necked Aneurysm

2013 ◽  
Vol 19 (1) ◽  
pp. 16-20 ◽  
Author(s):  
I. Oran ◽  
C. Çinar ◽  
H. Bozkaya ◽  
F.H. Beşir
Keyword(s):  
Endovascular Treatment ◽  
Small Diameter ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Giant Aneurysms ◽  
Inner Surface ◽  
The Future ◽  
Embolization Procedure

Embolization of wide-necked and/or giant aneurysms may fail due to the inability to pass across the aneurysm neck. We describe the rapid bull-back technique used in four patients in which a small diameter microcatheter with the aid of a hydrophilic microguidewire was navigated along the inner surface of the aneurysm, making a loop in the dome, exiting the neck to reach distal intracranial vessels. After withdrawal of microguidewire, the microcatheter is pulled back rapidly up to a predetermined length. This maneuver results in elimination of the loop, straightening the microcatheter to allow an exchange procedure for another device to cross the neck distally and continue the embolization procedure. The rapid pull-back technique is useful during the endovascular treatment of wide-necked and/or giant aneurysms as it helps to achieve reliable access to the distal parent vessel with the microcatheter. This is of increasing importance since an increasing number of aneurysms will be treated in the future with refinements in various intracranial stents.

scholarly journals Use of the Coupler Microanastomotic Device for the Treatment of a Distal Posterior Inferior Cerebellar Artery Aneurysm Via Excision and End-to-End Anastomosis—A Case Report

2020 ◽  
Vol 1 (2) ◽  
Author(s):  
Oded Goren ◽  
Raghuram Sampath ◽  
Akshal S Patel ◽  
Christoph J Griessenauer ◽  
Clemens M Schirmer ◽  
...  
Keyword(s):  
Case Report ◽  
Intracranial Aneurysms ◽  
Clinical Presentation ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Parent Vessel ◽  
First Case ◽  
Cerebellar Artery ◽  
End To End ◽  
Coupler Device

ABSTRACT BACKGROUND AND IMPORTANCE The Coupler microanastomotic device (Medical Companies Alliance, Birmingham, Alabama) aims at facilitating safe and efficient end-to-end reconstruction of the native vessel ends following resection of intracranial aneurysms. CLINICAL PRESENTATION We report the first case of the Coupler device used to treat a ruptured posterior inferior cerebellar artery (PICA) aneurysm. Following aneurysmal trapping and excision, the native parent vessel ends were connected in an end-to-end fashion. CONCLUSION The microanastomotic Coupler device is an acceptable option for end-to-end anastomosis and was successfully applied in the management of a ruptured fusiform PICA aneurysm.

scholarly journals Endovascular Treatment of Small Ruptured Intracranial Aneurysms (<5 mm)

2019 ◽  
Vol 30 (4) ◽  
pp. 817-826
Author(s):  
Fei Peng ◽  
Xin Feng ◽  
Xin Tong ◽  
Baorui Zhang ◽  
Luyao Wang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Cox Proportional Hazards ◽  
Parent Artery ◽  
Parent Vessel ◽  
Fisher Grade ◽  
Wide Neck ◽  
Ruptured Intracranial Aneurysms

Abstract Purpose To investigate the long-term clinical and angiographic outcomes and their related predictors in endovascular treatment (EVT) of small (<5 mm) ruptured intracranial aneurysms (SRA). Methods The study retrospectively reviewed patients with SRAs who underwent EVT between September 2011 and December 2016 in two Chinese stroke centers. Medical charts and telephone call follow-up were used to identify the overall unfavorable clinical outcomes (OUCO, modified Rankin score ≤2) and any recanalization or retreatment. The independent predictors of OUCO and recanalization were studied using univariate and multivariate analyses. Multivariate Cox proportional hazards models were used to identify the predictors of retreatment. Results In this study 272 SRAs were included with a median follow-up period of 5.0 years (interquartile range 3.5–6.5 years) and 231 patients with over 1171 aneurysm-years were contacted. Among these, OUCO, recanalization, and retreatment occurred in 20 (7.4%), 24 (12.8%), and 11 (7.1%) patients, respectively. Aneurysms accompanied by parent vessel stenosis (AAPVS), high Hunt-Hess grade, high Fisher grade, and intraoperative thrombogenesis in the parent artery (ITPA) were the independent predictors of OUCO. A wide neck was found to be a predictor of recanalization. The 11 retreatments included 1 case of surgical clipping, 6 cases of coiling, and 4 cases of stent-assisted coiling. A wide neck and AAPVS were the related predictors. Conclusion The present study demonstrated relatively favorable clinical and angiographic outcomes in EVT of SRAs in long-term follow-up of up to 5 years. THE AAPVS, as a morphological indicator of the parent artery for both OUCO and retreatment, needs further validation.

NOVEL SURGICAL TREATMENT OF A TRANSVERSE-SIGMOID SINUS ANEURYSM PRESENTING AS PULSATILE TINNITUS

Neurosurgery ◽  
2009 ◽  
Vol 64 (2) ◽  
pp. E393-E394 ◽  
Author(s):  
Yakov Gologorsky ◽  
Scott A. Meyer ◽  
Alexander F. Post ◽  
H. Richard Winn ◽  
Aman B. Patel ◽  
...  
Keyword(s):  
New York ◽  
Surgical Treatment ◽  
Sigmoid Sinus ◽  
Venous Aneurysm ◽  
Pulsatile Tinnitus ◽  
Aneurysm Neck ◽  
Suboccipital Craniectomy ◽  
History Of ◽  
Flow Through ◽  
The Right

Abstract OBJECTIVE Pulsatile tinnitus is a relatively common, potentially incapacitating condition that is often vascular in origin. We present a case of disabling pulsatile tinnitus caused by a transverse-sigmoid sinus aneurysm that was surgically treated with self-tying U-clips (Medtronic, Inc., Memphis, TN). We also review the literature and discuss other described interventions. CLINICAL PRESENTATION A 48-year-old woman presented with a 5-year history of progressive pulsatile tinnitus involving the right ear. Her physical examination was consistent with a lesion that was venous in origin. Angiography demonstrated a wide-necked venous aneurysm of the transverse-sigmoid sinus that had eroded the mastoid bone. INTERVENTION The patient underwent a retromastoid suboccipital craniectomy to expose the aneurysm and surrounding anatomy. The aneurysm dome was tamponaded and the aneurysm neck was coagulated until the dome had shrunk to a small remnant. The linear defect in the transverse sigmoid junction was then reconstructed with a series of U-clips and covered with Gelfoam hemostatic sponge (Pfizer, Inc., New York, NY). The patient awakened without neurological deficit and with immediate resolution of her tinnitus. A postoperative angiogram demonstrated obliteration of the aneurysm, with minimal stenosis in the region of the repair and good flow through the dominant right transverse-sigmoid junction. CONCLUSION This technical case report describes a novel definitive surgical treatment of venous sinus aneurysms. This technique does not necessitate long-term anticoagulation, has a low likelihood of reintervention, and provides immediate resolution of pulsatile tinnitus.

STENT REMODELING TECHNIQUE FOR COILING OF RUPTURED WIDE-NECK CEREBRAL ANEURYSMS: CASE REPORT

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. E1007-E1008 ◽  
Author(s):  
Demetrius K. Lopes ◽  
Kalani Wells
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Acute Subarachnoid Hemorrhage ◽  
The Right ◽  
Wide Neck ◽  
Cordis Corporation

Abstract OBJECTIVE To describe a novel stent remodeling technique for the coiling of ruptured wide-neck cerebral aneurysms. CLINICAL PRESENTATION A 46-year-old man presented with acute subarachnoid hemorrhage (Hunt and Hess grade IV), intracerebral hemorrhage, and hydrocephalus. Cerebral angiography revealed a wide-neck small anterior communicating artery aneurysm. Conventional coiling was not successful because of coil instability and compromise of the dominant anterior cerebral artery. TECHNIQUE A 6-French shuttle sheath (Cook Medical, Indianapolis, IN) was advanced from a right femoral approach into the right common carotid artery. To protect the parent vessel during coiling without compromising blood flow, a Prowler Select Plus catheter (Cordis Corporation, Bridgewater, NJ) was navigated across the aneurysm neck. Subsequently, an Enterprise stent (22-mm length; Cordis Corporation) was partially deployed across the aneurysm's wide neck. It was very important to watch the distal markers of the stent and lock the stent delivery wire to the Prowler Select Plus with a hemostatic valve once the stent was halfway deployed. This maneuver was essential to prevent further deployment of the stent. The SL-10 microcatheter and Synchro 14 wire (Boston Scientific, Natick, MA) were carefully navigated to the aneurysm passing through the partially deployed stent. Coils were then delivered to the aneurysm using the stent as a scaffold. After coiling, the SL-10 microcatheter was removed and the stent was recaptured into the Prowler Select Plus catheter. During the recapture, there was initial resistance. This was easily overcome after deploying the stent a little more before resheathing. During the procedure, the patient received 2000 U of heparin after the first coil was detached in the aneurysm. CONCLUSION The stent remodeling technique is a novel endovascular technique that can be used to treat ruptured wide-neck aneurysms and maintain patency of parent vessels, avoiding the use of antiplatelet therapy in acute subarachnoid hemorrhage.

Detachable balloon embolization therapy of posterior circulation intracranial aneurysms

1989 ◽  
Vol 71 (4) ◽  
pp. 512-519 ◽  
Author(s):  
Randall T. Higashida ◽  
Van V. Halbach ◽  
Leslie D. Cahan ◽  
Grant B. Hieshima ◽  
Yoshifumi Konishi
Keyword(s):  
Basilar Artery ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Parent Artery ◽  
Parent Vessel ◽  
Detachable Balloon ◽  
Content Type ◽  
Aneurysm Neck ◽  
Balloon Embolization ◽  
Fine Print

✓ Treatment of complex and surgically difficult intracranial aneurysms of the posterior circulation is now being performed with intravascular detachable balloon embolization techniques. The procedure is carried out under local anesthesia from a transfemoral arterial approach, which allows continuous neurological monitoring. Under fluoroscopic guidance, the balloon is propelled by blood flow through the intracranial circulation and, in most cases, can be guided directly into the aneurysm, thus preserving the parent vessel. If an aneurysm neck is not present, test occlusion of the parent vessel is performed and, if tolerated, the balloon is detached. Twenty-six aneurysms in 25 patients have been treated by this technique. The aneurysms have involved the distal vertebral artery (five cases), the mid-basilar artery (six cases), the distal basilar artery (11 cases), and the posterior cerebral artery (four cases). The aneurysms varied in size and included three small (< 12 mm), 15 large (12 to 25 mm), and eight giant (> 25 mm). Fifteen patients (60%) presented with hemorrhage and 10 patients (40%) with mass effect. In 17 cases (65%) direct balloon embolization of the aneurysm was achieved with preservation of the parent artery. In nine cases (35%), because of aneurysm location and size, occlusion of the parent vessel was performed. Complications from therapy included three cases of transient cerebral ischemia which resolved, three cases of stroke, and five deaths due to immediate or delayed aneurysm rupture. The follow-up period has ranged from 2 months to 43 months (mean 22.5 months). In cases where posterior circulation aneurysms have been difficult to treat by conventional neurosurgical techniques, intravascular detachable balloon embolization may offer an alternative therapeutic option.

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.

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