scholarly journals Solitaire AB Stent-Assisted Coiling of Wide-Necked Intracranial Aneurysms

Neurosurgery ◽  
2014 ◽  
Vol 75 (3) ◽  
pp. 215-219 ◽  
Author(s):  
Benjamin Gory ◽  
Joachim Klisch ◽  
Alain Bonafé ◽  
Charbel Mounayer ◽  
Remy Beaujeux ◽  
...  
Keyword(s):  
Prospective Study ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Mean Width ◽  
Mean Diameter ◽  
The Mean ◽  
Wide Neck

Abstract BACKGROUND: Endovascular treatment of intracranial aneurysms can be technically difficult when the neck is wide. The Solitaire AB stent (Covidien, Irvine, California), the only fully retrieved stent, assists in the coiling of wide-neck intracranial aneurysms. OBJECTIVE: To evaluate the mid-term angiographic follow-up of wide-necked aneurysms treated with the Solitaire AB stent. METHODS: SOLARE (SOLitaire Aneurysm Remodeling) is a consecutive, prospective study conducted in 7 European centers. A core laboratory evaluated the postoperative and mid-term (6 month ± 15 days) angiographic results by using the Raymond classification Scale. Recanalization was defined as worsening, and progressive thrombosis was defined as improvement in the Raymond scale score. RESULTS: The mean width of the aneurysm sac was 7.5 mm, and the mean diameter of the aneurysm neck was 4.7 mm. Angiographic mid-term follow-up was obtained in 55 of 65 aneurysms (85.9%). Complete occlusion was achieved in 33 aneurysms (60%); a neck remnant was seen in 16 aneurysms (29.1%) and an aneurysm remnant in 6 aneurysms (10.9%). Of 55 aneurysms, recanalization was observed in 8 aneurysms (14.5%), and progressive thrombosis was observed in 17 aneurysms (30.9%). No bleeding or rebleeding was observed during the follow-up period. CONCLUSION: Stent-assisted coiling of wide-necked intracranial aneurysms was found to be safe and effective with the Solitaire AB stent at 6-month follow-up. Angiographic results improve with time due to progressive thrombosis of the aneurysm.

scholarly journals Hemodynamic analysis for endovascular treatment in small unruptured intracranial aneurysms: a matched comparison study of flow diverter versus LVIS

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Jian Liu ◽  
Wenqiang Li ◽  
Yisen Zhang ◽  
Kun Wang ◽  
Xinjian Yang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Clinical Analysis ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Unruptured Intracranial Aneurysms ◽  
Occlusion Rate ◽  
Two Parameters

Abstract Background We compared the treatment of small unruptured intracranial aneurysms (UIAs) with flow diverter and LVIS-assisted coiling to determine the effects of hemodynamic changes caused by different stent and coil packing in endovascular treatment. Methods Fifty-one UIAs in 51 patients treated with pipeline embolization device (PED) were included in this study and defined as the PED group. We matched controls 1:1 and enrolled 51 UIAs who were treated with LVIS stent, which were defined as the LVIS group. Computational fluid dynamics were performed to assess hemodynamic alterations between PED and LVIS. Clinical analysis was also performed between these two groups after the match. Results There was no difference in procedural complications between the two groups (P = 0.558). At the first angiographic follow-up, the complete occlusion rate was significantly higher in the LVIS group compared with that in the PED group (98.0% vs. 82.4%, P = 0.027). However, during the further angiographic follow-up, the complete occlusion rate in the PED group achieved 100%, which was higher than that in the LVIS group (98.0%). Compared with the LVIS group after treatment, cases in the PED group showed a higher value of velocity in the aneurysm (0.03 ± 0.09 vs. 0.01 ± 0.01, P = 0.037) and WSS on the aneurysm (2.32 ± 5.40 vs. 0.33 ± 0.47, P = 0.011). Consequently, the reduction ratios of these two parameters also showed statistical differences. These parameters in the LVIS group showed much higher reduction ratios. However, the reduction ratio of the velocity on the neck plane was comparable between two groups. Conclusions Both LVIS and PED were safe and effective for the treatment of small UIAs. However, LVIS-assisted coiling produced greater hemodynamic alterations in the aneurysm sac compared with PED. The hemodynamics in the aneurysm neck may be a key factor for aneurysm outcome.

Contour-Assisted coiling with jailed microcatheter May result in better occlusion (CoCoJaMBO) in wide-necked intracranial aneurysms: Proof of principle and immediate angiographic results

2022 ◽  
pp. 159101992110697
Author(s):  
Fritz Wodarg ◽  
Yigit Oezpeynirci ◽  
Johannes Hensler ◽  
Olav Jansen ◽  
Thomas Liebig
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Dome Height ◽  
Parent Vessel ◽  
Complete Occlusion ◽  
Acute Subarachnoid Hemorrhage ◽  
The Mean ◽  
Large And Giant Aneurysms ◽  
Platinum Coils

Purpose Wide-necked bifurcation aneurysms, partially thrombosed, and recurrences of large and giant aneurysms are challenging to treat. We report our preliminary experience with a Contour-assisted coiling technique and discuss the periprocedural safety, feasibility, and effectiveness of the approach. Methods We retrospectively reviewed consecutive patients who received endovascular treatment for intracranial aneurysms with an intra-aneurysmal flow disruptor (Contour) at two neurovascular centres between October 2018 and December 2020 and identified patients treated with a combination of Contour and platinum coils. Clinical and procedural data were recorded. Results For this analysis, 8 patients (5 female) aged 60.1  ±  9.2 years on average were identified. Three of 8 aneurysms were associated with previous acute subarachnoid hemorrhage (SAH). The mean average dome height was 12.8  ±  7.6 mm, mean maximum dome width 10.3  ±  5.4 mm, and neck width 5.5  ±  2.5 mm. The mean dome-to-neck ratio was 1.9  ±  1.0. Immediate complete occlusion of the aneurysm was seen in 5 of 8 cases. In one SAH patient, a parent vessel was temporarily occluded but could be reopened rapidly. One device detached prematurely without any sequelae. No other procedural adverse events were recorded. Conclusion From this initial experience, Contour with adjunctive coiling is a safe and technically feasible method for endovascular treatment of large, wide-necked, partially thrombosed, recurrent, or ruptured bifurcation aneurysms. Further studies with larger numbers of patients and longer follow-up are needed to confirm our results.

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.

The pCONus device for the endovascular treatment of wide neck bifurcation aneurysms

2015 ◽  
Vol 8 (9) ◽  
pp. 940-944 ◽  
Author(s):  
Boris Lubicz ◽  
Ricardo Morais ◽  
Faisal Alghamdi ◽  
Benjamin Mine ◽  
Laurent Collignon ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Ethics Committees ◽  
Initial Experience ◽  
New Device ◽  
Technical Issues ◽  
Wide Neck ◽  
Anatomical Outcomes ◽  
Angiographic Findings

Background and purposeThe pCONus is a new stent featuring a distal end that opens like a blossoming flower with four petals. The device is implanted in the aneurysm sac at the level of the neck. We report our initial experience in a series of patients treated with this device.MethodsThis retrospective study was approved by the authors’ ethics committees. 18 patients with 19 unruptured wide neck bifurcation intracranial aneurysms (IA) were treated by pCONus placement and coiling. Technical issues, immediate post treatment angiographic findings, and clinical and imaging follow-up were assessed.ResultsEmbolization was successful in all patients. There were 11 women and 7 men with a mean age of 60 years. Median aneurysm size was 9 mm (range 5.5–25 mm). The device was precisely placed and detached in all cases, allowing for subsequent coiling. Two patients experienced a symptomatic complication, one of which, a thromboembolism, was related to the use of the pCONus. This patient had a slight hand paresis. 16 patients had a normal neurological examination at discharge. Immediate anatomical results were 13 complete occlusions, 2 neck remnants, and 4 incomplete occlusions. Imaging follow-up was obtained in 12 patients (mean 9.5 months, range 2–24 months) and showed 9 stable occlusions and 3 recanalizations, of which 2 were retreated.ConclusionsIn this initial series of patients, endovascular treatment of wide neck bifurcation IAs with the pCONus was feasible, with acceptable clinical and anatomical outcomes. Further studies are needed to evaluate the indications, safety, and efficacy of this new device.

scholarly journals Long-term occlusion results with SILK flow diversion in 28 aneurysms: Do recanalizations occur during follow-up?

2015 ◽  
Vol 21 (3) ◽  
pp. 300-310 ◽  
Author(s):  
Anastasios Mpotsaris ◽  
Martin Skalej ◽  
Oliver Beuing ◽  
Bernd Eckert ◽  
Daniel Behme ◽  
...  
Keyword(s):  
Prospective Study ◽  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Success Rates ◽  
Imaging Data ◽  
Complete Occlusion ◽  
Complex Aneurysms ◽  
Multicenter Prospective Study

Background and purpose The purpose of this article is to report on the long-term success rates of Silk flow-diverter (FD) treatment in a multicenter prospective study for the treatment of complex aneurysms. Methods Between May 2008 and January 2011, all consecutive patients featuring complex intracranial aneurysms eligible for FD treatment with the Silk in three neurovascular centers were included. Clinical and imaging data were assessed during hospitalization and follow-up. Results Five patients were initially asymptomatic, 20 patients showed various neurological symptoms. Twenty-eight FDs were implanted in 25 patients treating 28 aneurysms. The immediate procedure-related morbidity was 8% (two of 25), mortality 0%. One procedure-related death was observed during follow-up (in-stent thrombosis). Compared to the immediate result nearly two of three aneurysms improved during follow-up; all angiographically confirmed inflow changes took place within six months after treatment. Final anatomic outcome in 24 aneurysms of 22 patients comprised 14 (59%) with complete occlusion, seven (29%) with a neck remnant, two (8%) with residual filling <50%, none with residual filling >50% and one (4%) unchanged in comparison to its pretreatment status. Postinterventional recanalizations were seen in three of 13 (23%) aneurysms treated with FD alone; none were observed in 15 aneurysms treated with adjunctive coiling. Conclusion Anatomic presentation and location are key for successful FD treatment. The rate of successful occlusion increases during follow-up. Postinterventional monitoring for at least six months is paramount, as anatomic outcome is not reliably predictable and recanalizations may occur in initially completely occluded aneurysms.

scholarly journals Preliminary experience of stent-assisted coiling of wide-necked intracranial aneurysms with a single microcatheter

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Keun Young Park ◽  
Chang Ki Jang ◽  
Jae Whan Lee ◽  
Dong Joon Kim ◽  
Byung Moon Kim ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Complete Occlusion ◽  
Unruptured Aneurysms

Abstract Background The purpose of this study was to report our preliminary experience of stent-assisted coiling (SAC) of wide-necked intracranial aneurysms with a single microcatheter in patients with parent arteries that were small-caliber, with stenosis, or a very tortuous course. Methods Between March 2018 and December 2018, we treated 394 aneurysms in 359 patients with endovascular treatment. Among 197 aneurysms treated by SAC, there were 16 cases (all wide-necked unruptured aneurysms) treated by SAC with a single microcatheter and a Neuroform Atlas stent. Follow-up angiography was performed at 6 to 12 months after SAC, and clinical follow-up was performed from 6 to 12 months in all patients. Results The reasons for SAC with a single 0.0165-in. microcatheter were small-caliber (n = 4), stenosis (n = 2), and very tortuous course (n = 10) of the parent arteries. There was no complication related to delivering or deploying the Neuroform Atlas stent as well as no failure of selecting aneurysm by cell-through technique. All patients had a modified Rankin score of 0 at discharge and at follow-up. Initial angiographic results showed six cases (37.5%) of complete occlusion. In follow-up angiographies, 12 cases (75.0%) achieved compete occlusion. Conclusion When performing SAC of wide-necked intracranial aneurysms in parent arteries with small-caliber, stenosis, or a very tortuous course, cell-through SAC using a single microcatheter and a Neuroform Atlas stent within a 5 Fr- (or smaller) guiding or intermediate catheter might be a useful option.

scholarly journals The role of endovascular treatment in unruptured basilar tip aneurysms

2016 ◽  
Vol 23 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Huijian Ge ◽  
Xianli Lv ◽  
Hengwei Jin ◽  
Zhihua Tian ◽  
Youxiang Li ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Endovascular Treatment ◽  
Potential Risk ◽  
Complete Occlusion ◽  
Delayed Hemorrhage ◽  
Hemorrhagic Events ◽  
Occlusion Rate ◽  
The Mean ◽  
Incomplete Occlusion

Objective This study was to evaluate the safety and efficiency of endovascular treatment of unruptured basilar tip aneurysms. Methods We retrospectively reviewed consecutive 79 cases of unruptured basilar tip aneurysms in our center between 2009 and 2014. The patients’ clinical and imaging information were recorded. Complications, initial occlusion rate, clinical outcomes and the predictors were retrospectively analyzed. Results Thirty-five cases received conservative treatment and 44 cases were treated by endovascular embolization. In the conservative treatment group, six (19.4%) of 31 basilar tip aneurysms ruptured and resulted in five deaths (16.1%) during the mean 18.1-month follow-up (range from 1 to 60 months). Among the endovascularly treated cases, 24 (54.5%) achieved initial complete occlusion and no delayed hemorrhagic events occurred during the mean 33.6-month follow-up (range from 10 to 68 months). For 20 (45.5%) incompletely occluded cases, five postoperative or delayed hemorrhagic events and two mass effect events resulted in six deaths. There were no statistical significant differences in hemorrhagic events ( p = 0.732) and mortality ( p = 0.502) between the incomplete occlusion group and untreated group. Large aneurysm size (≥10 mm) was an independent predictor for incomplete occlusion ( p = 0.002), which had a potential risk of postoperative or delayed hemorrhage. On univariate analysis, initial occlusion rate and aneurysm size were found to be associated with clinical outcomes ( p = 0.042 and 0.015). Conclusion Complete occlusion for unruptured basilar tip aneurysm proved to be a safe and effective therapeutic method that could eliminate the potential risk of postoperative or delayed hemorrhage.

EVALUATION OF ONYX HD-500 EMBOLIC SYSTEM IN THE TREATMENT OF 84 WIDE-NECK INTRACRANIAL ANEURYSMS

Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. E865-E875 ◽  
Author(s):  
Ronie L. Piske ◽  
Luis H. Kanashiro ◽  
Eric Paschoal ◽  
Celso Agner ◽  
Sergio S. Lima ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
High Rate ◽  
Anterior Circulation ◽  
Complete Occlusion ◽  
Aneurysm Occlusion ◽  
Incomplete Occlusion ◽  
Wide Neck ◽  
Small Aneurysms ◽  
Platinum Coils

Abstract OBJECTIVE We report our results using Onyx HD-500 (Micro Therapeutics, Inc., Irvine, CA) in the endovascular treatment of wide-neck intracranial aneurysms, which have a high rate of incomplete occlusion and recanalization with platinum coils. METHODS Sixty-nine patients with 84 aneurysms were treated. Most of the aneurysms were located in the anterior circulation (80 of 84 aneurysms), were unruptured (74 of 84 aneurysms), and were incidental. Ten presented with subarachnoid hemorrhage, and 15 were symptomatic. All aneurysms had wide necks (neck &gt;4 mm and/or dome-to-neck ratio &lt;1.5). Fifty aneurysms were small (&lt;12 mm), 30 were large (12 to &lt;25 mm) and 4 were giant. Angiographic follow-up was available for 65 of the 84 aneurysms at 6 months, for 31 of the 84 aneurysms at 18 months, and for 5 of the 84 aneurysms at 36 months. RESULTS Complete aneurysm occlusion was seen in 65.5% of aneurysms on immediate control, in 84.6% at 6 months, and in 90.3% at 18 months. The rates of complete occlusion were 74%, 95.1%, and 95.2% for small aneurysms and 53.3%, 70%, and 80% for large aneurysms at the same follow-up periods. Progression from incomplete to complete occlusion was seen in 68.2% of all aneurysms, with a higher percentage in small aneurysms (90.9%). Aneurysm recanalization was observed in 3 patients (4.6%), with retreatment in 2 patients (3.3%). Procedural mortality was 2.9%. Overall morbidity was 7.2%. CONCLUSION Onyx embolization of intracranial wide-neck aneurysms is safe and effective. Morbidity and mortality rates are similar to those of other current endovascular techniques. Larger samples and longer follow-up periods are necessary.

WingSpan Stent System in the endovascular treatment of intracranial aneurysms: clinical experience with midterm follow-up results

2008 ◽  
Vol 109 (3) ◽  
pp. 445-453 ◽  
Author(s):  
Kivilcim Yavuz ◽  
Serdar Geyik ◽  
Isil Saatci ◽  
H. Saruhan Cekirge
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Treatment Strategies ◽  
Radial Force ◽  
Parent Artery ◽  
Aneurysm Neck ◽  
Stent System ◽  
Thrombosis Rate ◽  
Dissecting Aneurysms

Object The WingSpan stent is a new self-expandable neurovascular stent designed for endovascular treatment of intracranial atheromatous lesions. The authors report their experience with the use of this stent for the endovascular treatment of intracranial aneurysms. Methods Thirty-seven patients with 40 wide-necked intracranial aneurysms were treated using the WingSpan stent. Twenty-two aneurysms (55%) were small and 18 (45%) were large or giant. In all but 4 aneurysms, embolization was completed by packing the aneurysm sac with platinum coils. In 4 dissecting aneurysms that were fusiform or too small and wide necked to be catheterized, the stent was used alone. In these cases, the stent bridged the aneurysm neck to allow for flow redirection and the potential stent-induced endothelization effect. Results Follow-up angiograms obtained in 3 of 4 aneurysms, treated with only stent placement, demonstrated aneurysmal thrombosis and parent artery remodeling in 2 patients and moderate decrease in size in 1. Follow-up angiography obtained at 6 months to 1 year in 31 aneurysms after stent-supported coil embolization demonstrated complete occlusion in 23 aneurysms (74.2%) with a progressive thrombosis rate of 66.7% (10 of 15 aneurysms), and a recanalization rate of 16.1%. Conclusions In treating wide-necked intracranial aneurysms, the WingSpan Stent System is very flexible, secure, and effective. Its delivery system is very easy and exact in that it exerts higher outward radial force, thus providing an excellent conformability and a strong scaffold to hold the coils in place. It may offer an effective treatment when used alone in some fusiform or very wide-necked, small dissecting aneurysms in which other surgical or endovascular treatment strategies are not deemed feasible.

Clinical and angiographic long-term follow-up of completely coiled intracranial aneurysms using endovascular technique

2010 ◽  
Vol 112 (3) ◽  
pp. 575-581 ◽  
Author(s):  
Dae Seob Choi ◽  
Mun Chul Kim ◽  
Seon Kyu Lee ◽  
Robert A. Willinsky ◽  
Karel G. Terbrugge
Keyword(s):  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Glasgow Outcome Scale ◽  
Intracranial Aneurysms ◽  
Endovascular Embolization ◽  
Morbidity Rate ◽  
Neck Size ◽  
Aneurysm Neck ◽  
Surface Modified

Object The anatomical evolution and clinical outcome of completely coiled intracranial aneurysms after endovascular embolization have rarely been studied separately. From their prospective database, the authors reviewed follow-up angiography and clinical outcome of 87 patients whose aneurysms were designated as 100% obliterated on immediate postembolization angiography. Methods Ninety-one aneurysms (56 ruptured and 35 unruptured) in 87 patients were included in this study. Clinical outcome was evaluated using the Glasgow Outcome Scale. Follow-up angiographic findings were assessed and categorized as 1 of the following: no recanalization, recanalization with a neck remnant, or recanalization with a body remnant. For statistical analysis, the recanalization rate was correlated with: clinical presentation; the largest aneurysm diameter, aneurysm neck size, and dome-to-neck ratio; aneurysm location; and use of special techniques such as usage of a surface modified coil, balloon remodeling technique, or stent. Results At the latest clinical evaluation (mean 34.3 months), 81 (93.1%) of the 87 patients (91 aneurysms) had good clinical outcomes (Glasgow Outcome Scale Score 5). The procedure-related morbidity rate (permanent neurological deficit) was 2.3% (2 of 87), and there were no procedure-related deaths. On the latest follow-up angiography (mean 26.4 months), the recanalization rate was 26.4% (24 of 91 aneurysms): 16 (17.6%) with neck remnants and 8 (8.8%) with body remnants. The neck size of the recanalized aneurysms was statistically significantly larger than that of the nonrecanalized aneurysms (p = 0.006), and aneurysms with wide necks (≥4 mm) had a higher recanalization rate than those with a narrow neck (< 4 mm) (p = 0.002). There was no bleeding after endovascular treatment during the follow-up period. Conclusions Completely coiled aneurysms after endovascular embolization demonstrated good clinical outcome, and there was no bleeding episode after endovascular treatment; however, there was a relatively high recanalization rate.

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