Experience in Using the Excimer Laser–Assisted Nonocclusive Anastomosis Nonocclusive Bypass Technique for High-Flow Revascularization

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 49-55 ◽  
Author(s):  
Peter Vajkoczy ◽  
Miikka Korja ◽  
Marcus Czabanka ◽  
Ulf C. Schneider ◽  
Michael Reinert ◽  
...  
Keyword(s):  
Success Rate ◽  
Excimer Laser ◽  
High Flow ◽  
Posterior Circulation ◽  
Parent Artery ◽  
Modified Rankin Scale ◽  
Anterior Circulation ◽  
Intracranial Lesions ◽  
Posterior Circulation Aneurysms ◽  
Intent To Treat

Abstract BACKGROUND The excimer laser–assisted nonocclusive anastomosis (ELANA) technique enables large-caliber bypass revascularization without temporary occlusion of the parent artery. OBJECTIVE To present the surgical experience of 2 bypass centers using ELANA in the treatment of complex intracranial lesions. METHODS Between July 2002 and December 2007, 64 consecutive patients (37 in Germany and 27 in Finland) were selected for high-flow bypass surgery with ELANA. Modified Rankin Scale, a bypass success rate, and the success rate of the laser arteriotomy were assessed. RESULTS In 66 surgeries for 64 intent-to-treat patients, 58 ELANA procedures were completed successfully. A favorable outcome (postoperative modified Rankin Scale score less than or equal to preoperative modified Rankin Scale) at 3 months was achieved in 43 of 56 patients (77%) with anterior circulation lesions (37 of the 43 patients had aneurysms, 4 had ischemia, and 2 received a bypass before tumor removal) and only in 2 of 8 patients (25%) with posterior circulation aneurysms. Perioperative (< 7 days) mortality for anterior and posterior circulation aneurysms was 6% and 50%, respectively. At the 3-month follow-up, 12% and 63% of patients with anterior and posterior circulation aneurysms, respectively, were dead. The success rate of the laser arteriotomy was 70%. Another 14% were retrieved manually after a nearly complete laser arteriotomy. CONCLUSION The ELANA procedure requires a meticulous and careful operative technique. Morbidity and especially mortality rates, usually unrelated to ELANA, are comparable to those of contemporary series of conventional high-flow revascularization operations. This underscores the overall complexity of treating neurovascular pathologies by high-flow bypasses.

Abstract 120: Surpass Flow Diverter for Endovascular Treatment of Intracranial Aneurysms - A Multicenter Preliminary Clinical and Angiographic Experience in 161 Patients with 186 Aneurysms

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Ajay K Wakhloo ◽  
Pedro Lylyk ◽  
Joost de Vries ◽  
Matthew J Gounis ◽  
Alexandra Biondi ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Experimental Studies ◽  
Flow Diverter ◽  
Posterior Circulation ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Neck Size ◽  
Wide Range ◽  
New Generation

Objective: Validated through experimental studies a new generation of flow diverters (Surpass™ FD) was evaluated for treatment of intracranial aneurysms (IA). We present our multicenter preliminary clinical and angiographic experience. METHODS: To achieve the calculated flow disruption between the parent artery and aneurysm for thrombosis, single FDs were placed endovascularly in parent arteries. Implants measured 2.5-5.3mm in diameter with a length of 10-80mm. Patients were enrolled harboring a wide range large and giant wide-neck, fusiform and multiple small and blister-type aneurysm. Clinical and angiographic follow-up were performed at 1-3, 6, and 12 months. RESULTS: A total of 186 consecutive IA in 161 patients (mean age 57.1 years) were treated at 33 centers. Fifty-three aneurysms were smaller than 5 mm, 64 were 5-9.9mm in diameter, 47 were 10-20mm in diameter, and 22 were larger than 20mm (10.4±0.7mm, neck size 6.0±0.5mm [mean±SEM]) . The aneurysms originated in 63.4% from the internal carotid artery; 22% and 14.5% of the lesions were located in the anterior circulation distal to Circle of Willis and posterior circulation respectively. Technical success was achieved in 182 aneurysms (98%); average number of devices used per aneurysm was 1.05. Permanent morbidity and mortality during the follow-up period of mean 8.4months (range 1-24 months) including periprocedural complications for patients with aneurysms of the anterior circulation were encountered in 5 (3.7%) and 2 (1.5 %) patients respectively and 1 (3.7%) and 4 (14.8%) respectively for patients with aneurysms of the posterior circulation location. One-hundred-ten patients (70.5%) harboring 127 (70.2%) were available for clinical and angiographic follow-up and showed a complete or near complete aneurysm occlusion in 63 (81.8%) of the ICA. Aneurysms of the ICA≥10mm that were completely covered by FD and not previously stent-treated with a minimum of 6 months follow-up available in 16 patients showed a complete obliteration in 81.3% (n=13) and >90% occlusion in remaining 3 patients. CONCLUSION: Preliminary data demonstrate high safety and efficacy of a new generation of FD for a wide range of IA of the anterior and posterior circulation with a single implant.

Beware of Nihilism: Favorable Outcome despite Poor Admission Status in Posterior Circulation Aneurysms after Aneurysmal Subarachnoid Hemorrhage

2021 ◽  
Author(s):  
Nina Brawanski ◽  
Sepide Kashefiolasl ◽  
Sae-Yeon Won ◽  
Joachim Berkefeld ◽  
Elke Hattingen ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Posterior Inferior Cerebellar Artery ◽  
Posterior Circulation ◽  
Anterior Circulation ◽  
Ruptured Aneurysms ◽  
Admission Status ◽  
Posterior Circulation Aneurysms

Abstract Objective As shown in a previous study, aneurysm location seems to influence prognosis in patients with subarachnoid hemorrhage (SAH). We compared patients with ruptured aneurysms of anterior and posterior circulation, undergoing coil embolization, concerning differences in outcome and prognostic factors. Methods Patients with SAH were entered into a prospectively collected database. We retrospectively identified 307 patients with aneurysms of the anterior circulation (anterior cerebral artery, carotid bifurcation, and middle cerebral artery) and 244 patients with aneurysms of the posterior circulation (aneurysms of the basilar artery, posterior inferior cerebellar artery, posterior communicating artery and posterior cerebral artery). All patients underwent coil embolization. The outcome was assessed using the modified Rankin Scale (mRS; favorable [mRS 0–2] vs. unfavorable [mRS 3–6]) 6 months after SAH. Results In interventionally treated aneurysms of the anterior and posterior circulation, statistically significant risk factors for poor outcome were worse admission status and severe cerebral vasospasm. If compared with patients with ruptured aneurysms of the anterior circulation, patients with aneurysms of the posterior circulation had a significantly poorer admission status, and suffered significantly more often from an early hydrocephalus. Nonetheless, there were no differences in outcome or mortality rate between the two patient groups. Conclusion Patients with a ruptured aneurysm of the posterior circulation suffer more often from an early hydrocephalus and have a significantly worse admission status, possibly related to the untreated hydrocephalus. Nonetheless, the outcome and the mortality rate were comparable between ruptured anterior and posterior circulation aneurysms, treated by coil embolisation. Therefore, despite the poorer admission status of patients with ruptured posterior circulation aneurysms, treatment of these patients should be considered.

Endovascular treatment of ruptured posterior circulation aneurysms using electrolytically detachable coils

1997 ◽  
Vol 87 (3) ◽  
pp. 374-380 ◽  
Author(s):  
Douglas A. Nichols ◽  
Robert D. Brown ◽  
Kent R. Thielen ◽  
Fredric B. Meyer ◽  
John L. D. Atkinson ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Balloon Occlusion ◽  
Additional Treatment ◽  
Posterior Circulation ◽  
Parent Artery ◽  
Content Type ◽  
Detachable Coils ◽  
Posterior Circulation Aneurysms ◽  
Fine Print

✓ The authors report their experience using electrolytically detachable coils for the treatment of ruptured posterior circulation aneurysms. Twenty-six patients with 28 posterior circulation aneurysms were treated. All patients were referred for endovascular treatment by experienced vascular neurosurgeons. Patients underwent follow-up angiography immediately after treatment, 1 to 6 weeks posttreatment, and 6 months posttreatment. Six-month follow-up angiograms obtained in 19 patients with 20 aneurysms demonstrated that 18 (90%) of the 20 aneurysms were 99 to 100% occluded, one aneurysm (5%) was approximately 90% occluded, and one aneurysm (5%) was approximately 75% occluded. The patient with the aneurysm that was approximately 75% occluded needed additional treatment, consisting of parent artery balloon occlusion, and was considered a treatment failure (3.8% of patients). There was one treatment-associated mortality (3.8%) but no treatment-associated serious neurological or nonneurological morbidity in the patient group. There was no recurrent aneurysm rupture during treatment or during the mean 27-month follow-up period. Endovascular treatment of ruptured posterior circulation aneurysms with electrolytically detachable coils can be accomplished with low morbidity and mortality rates. The primary goal of treatment—preventing recurrent aneurysm—can be achieved over the short term. Endovascular coil occlusion will play an important role in the treatment of ruptured posterior circulation aneurysms, particularly if long-term efficacy in preventing recurrent aneurysm hemorrhage can be documented.

Expanding the Indications for Flow Diversion: Treatment of Posterior Circulation Aneurysms

Neurosurgery ◽  
2019 ◽  
Vol 86 (Supplement_1) ◽  
pp. S76-S84
Author(s):  
Nimer Adeeb ◽  
Christopher S Ogilvy ◽  
Christoph J Griessenauer ◽  
Ajith J Thomas
Keyword(s):  
Antiplatelet Agents ◽  
Posterior Circulation ◽  
Flow Diversion ◽  
High Morbidity ◽  
Complication Rates ◽  
Anterior Circulation ◽  
Risk Of Rupture ◽  
Lower Complication ◽  
Ischemic Complications ◽  
Posterior Circulation Aneurysms

Abstract Posterior circulation aneurysms are often associated with a higher risk of rupture and compressive symptoms compared to their anterior circulation counterpart. Due to high morbidity and mortality associated with microsurgical treatment of those aneurysms, endovascular therapy gained ascendance as the preferred method of treatment. Flow diversion has emerged as a promising treatment option for posterior circulation aneurysms with a higher occlusion rate compared to other endovascular techniques and a lower complication rate compared to microsurgery. While treatment of saccular and dissecting aneurysms is often associated with comparatively good outcomes, fusiform and dolichoectatic aneurysms should be carefully selected prior to treatment to avoid devastating thromboembolic complications. Occlusion of covered posterior circulation branches showed no correlation with ischemic complications, and appropriate antiplatelet regimen and switching Clopidogrel nonresponders to different antiplatelet agents were associated with lower complication rates following flow diversion of posterior circulation aneurysms.

Abstract P665: Different Predictive Factors for Early Neurological Deterioration Based on the Location of Single Subcortical Infarction

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ki-woong Nam ◽  
Hyung-min Kwon ◽  
Yong-Seok Lee
Keyword(s):  
Multivariable Analysis ◽  
Posterior Circulation ◽  
Neurological Deterioration ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Nihss Score ◽  
Early Neurological Deterioration ◽  
Artery Disease ◽  
Subcortical Infarction ◽  
Anterior Posterior

Introduction: Patients with single subcortical infarction (SSI) have relatively favorable prognosis, but they often experience early neurological deterioration (END) in a clinical course. In addition, SSI is considered to differ in its prognosis and mechanism depending on the location of the lesion. Hypothesis: We compared the predictors for END in patients with SSI according to the location of the lesion. Methods: We included consecutive patients with SSI within 72 hours of symptom onset between 2010 and 2016. END was defined as an increase of ≥ 2 in the total NIHSS score or ≥ 1 in the motor NIHSS score within the first 72 hours of admission. Along with the analysis of the entire SSI patients, we also analyzed the predictors for END in the proximal/distal SSI patients and the anterior/posterior circulation SSI patients. Results: A total of 438 patients with SSI were evaluated. In multivariable analysis, initial NIHSS score [adjusted odds ratio (aOR) = 1.36, 95% confidence interval (CI): 1.15-1.60], pulsatility index (PI) (aOR = 1.25, 95% CI: 1.03-1.52), parent artery disease (PAD) (aOR = 2.14, 95% CI: 1.06-4.33), and neutrophil to lymphocyte ratio (NLR) (aOR = 1.24, 95% CI: 1.04-1.49) were positively associated with END. In patients with proximal SSI, initial NIHSS score, PI, PAD, and NLR showed positive associations with END. Meanwhile, no variable related to END was found in distal SSI. When we compared the predictors for END based on the involved vascular territory, initial NIHSS score and NLR were significantly associated with END in the anterior circulation. On the other hand, patient with SSI in the posterior circulation showed PI and PAD as independent predictors of END. Conclusions: Initial NIHSS score, PI, PAD, and NLR were associated with END in patients with SSI. The frequency and predictors for END were different depending on the location of SSI lesion.

scholarly journals Surgical Treatment of Posterior Circulation Aneurysms – Anatomical Study and Surgical Technique

2018 ◽  
Vol 37 (01) ◽  
pp. 27-37
Author(s):  
Vitor Yamaki ◽  
Eric Paschoal ◽  
Manoel Teixeira ◽  
Eberval Figueiredo
Keyword(s):  
Surgical Treatment ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Posterior Circulation ◽  
Surgical Approaches ◽  
Superior Cerebellar Artery ◽  
Anterior Circulation ◽  
Cerebellar Artery ◽  
Risk Of Rupture ◽  
Posterior Circulation Aneurysms

AbstractPosterior circulation aneurysms represent 10–15% of intracranial aneurysms. The diagnosis is usually secondary to subarachnoid hemorrhage due to its initial asymptomatic presentation and higher risk of rupture compared with aneurysms in the anterior circulation. The surgical treatment of posterior circulation aneurysms is complex and challenging for neurosurgeons because of the particular anatomy of the posterior circulation with its close relation to the brainstem and cranial nerves and also because of the depth and narrowness of the surgical approach. Aneurysms from different locations have specific anatomical relationships and surgical approaches for better visualization and dissection. Therefore, a detailed anatomy knowledge of the posterior circulation is mandatory for an individualized preoperative planning and good neurological and angiographic outcomes. We selected the main aneurysm sites on the posterior circulation, such as: posterior inferior cerebellar artery, basilar trunk, basilar bifurcation, posterior cerebral artery (PCA) and superior cerebellar artery for a detailed description of the relevant anatomy related to aneurysm, and the main surgical approaches for its surgical treatment. Furthermore, we performed a literature review with the most recent outcomes regarding to the surgical treatment of posterior circulation aneurysms.

scholarly journals Intra-arterial Thrombectomy with Stent Retriever for Acute Ischemic Stroke – a Retrospective, Single-centered Study from Brazil

2017 ◽  
Vol 36 (04) ◽  
pp. 213-216
Author(s):  
Luana Gatto ◽  
Viviane Zétola ◽  
Zeferino Demartini Junior ◽  
Fábio Nascimento ◽  
Gelson Koppe
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mean Value ◽  
Posterior Circulation ◽  
Stent Retriever ◽  
National Institutes Of Health ◽  
Initial Experience ◽  
Modified Rankin Scale ◽  
Anterior Circulation ◽  
The Mean

Objective To report our initial experience with intra-arterial thrombectomy (IAT) with stent retriever for acute ischemic stroke. Methods We conducted a retrospective review of patients with acute ischemic stroke who underwent IAT from September 2010 to August 2016. Results Forty-one patients were included; mean age was 57 years (range: 29–85), and 54% were women. There were 32 anterior circulation occlusions, and 11 posterior circulation occlusions. The mean value of the National Institutes of Health Stroke Scale (NIHSS) upon admission (available in 9/41 patients) was 14 (range: 6–20). Nineteen patients had favorable outcomes (modified Rankin Scale [mRS]: 0–2 at 6 months), and 22 had unfavorable outcomes (mRS: 3–6 at 6 months). The mortality rate was 37% (15/41). Favorable outcomes were associated with revascularization within the first 360 minutes of the onset of symptoms (p = 0.000001), and satisfactory revascularization (thrombolysis in cerebral infarction [TICI] scale: 2b or 3) (p = 0.0018). Conclusion It is of paramount importance to educate stroke teams on the benefits of IAT for acute ischemic stroke and the population on identifying stroke and seeking immediate care following symptom onset.

The poor prognosis of ruptured intracranial aneurysms of the posterior circulation

1995 ◽  
Vol 82 (5) ◽  
pp. 791-795 ◽  
Author(s):  
Wouter I. Schievink ◽  
Eelco F. M. Wijdicks ◽  
David G. Piepgras ◽  
Chu-Pin Chu ◽  
W. Michael O'Fallon ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Initial Period ◽  
Posterior Circulation ◽  
Medical Record Linkage ◽  
Anterior Circulation ◽  
Content Type ◽  
Clinical Series ◽  
Posterior Circulation Aneurysms ◽  
Fine Print

✓ The first 48 hours after aneurysmal subarachnoid hemorrhage are critical in determining final outcome. However, most patients who die during this initial period are not included in hospital-based studies. We investigated the occurrence of subarachnoid hemorrhage in a population-based study to evaluate possible predictors of poor outcome. All patients diagnosed with aneurysmal subarachnoid hemorrhage between 1955 and 1984 were selected for analysis of mortality in the first 30 days using the medical record—linkage system employed for epidemiological studies in Rochester, Minnesota. One hundred and thirty-six patients were identified. The mean age of these 99 women and 37 men was 55 years. Rates for survival to 48 hours were 32% for the 19 patients with posterior circulation aneurysms, 77% for the 87 patients with anterior circulation aneurysms, and 70% for the 30 patients with a presumed aneurysm (p < 0.0001). Rates for survival to 30 days were 11%, 57%, and 53%, respectively, in these three patient groups (p < 0.0001). Clinical grade on admission to the hospital, the main variable predictive of death within 48 hours, was significantly worse in patients with posterior circulation aneurysms than in others (p < 0.0001). The prognosis of ruptured posterior circulation aneurysms is poor. The high early mortality explains why posterior circulation aneurysms are uncommon in most clinical series of patients with subarachnoid hemorrhage. The management of incidentally discovered intact posterior circulation aneurysms may be influenced by these findings.

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