Preliminary evaluation of the endovascular treatment of intracranial aneurysms with detachable coils in vigil patients

Endovascular treatment of intracranial aneurysms with coil embolization became the most important therapeutic option with better morbidity and mortality rates and quality of life. Following immobility, patients are treated with general anaesthesia. OBJECTIVE: To test viability of endovascular treatment on wake patients. METHOD: Considering clinical symptoms, psychological characteristics and aneurysmal morphology, four patients with five intracranial aneurysms were selected. RESULTS: Four among five cases were completed with this technique. Patient 1 was partially treated after 75 minutes presenting vesical stress. Patient 2 presented subarachnoid hemorrhage after aneurysmal re-rupture, and the procedure was completed under general anaesthesia. The other three patients presented no intercurrences during the treatment. CONCLUSION: Endovascular treatment on wake patients with intracranial aneurysm can be an alternative to a selected group of patients.

Download Full-text

Endovascular treatment of intracranial aneurysms with detachable coils: correlation between aneurysm volume, packing, and angiographic recurrence

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2013-010920 ◽

2013 ◽

Vol 6 (8) ◽

pp. 595-599 ◽

Cited By ~ 40

Author(s):

Bing Leng ◽

Yongtao Zheng ◽

Jinma Ren ◽

Qiang Xu ◽

Yanlong Tian ◽

...

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Detachable Coils ◽

Aneurysm Volume

Download Full-text

Health-related quality of life outcomes and influencing factors in patients with unruptured intracranial aneurysms after endovascular treatment

Quality of Life Research ◽

10.1007/s11136-021-02904-3 ◽

2021 ◽

Author(s):

Xiao-Dong Zhai ◽

Yong-Jie Ma ◽

Jia-Xing Yu ◽

Chun-Xiu Wang ◽

Jie-Wen Geng ◽

...

Keyword(s):

Quality Of Life ◽

Endovascular Treatment ◽

Influencing Factors ◽

Intracranial Aneurysms ◽

Health Related Quality ◽

Life Outcomes ◽

Unruptured Intracranial Aneurysms ◽

Related Quality ◽

Health Related

Download Full-text

Late Thromboembolic Events after Treatment of Intracranial Aneurysms with Guglielmi Detachable Coils

Stroke ◽

10.1161/str.32.suppl_1.356-e ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 356-357

Author(s):

Colin P Derdeyn ◽

Christopher J Moran ◽

DeWitte T Cross ◽

Michael R Chicoine ◽

Ralph G Dacey

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Artery Aneurysm ◽

Additional Patient ◽

Superior Cerebellar Artery ◽

Parent Artery ◽

Imaging Data ◽

Guglielmi Detachable Coils ◽

Kaplan Meier ◽

Detachable Coils

P98 Purpose: Thrombo-embolic complications associated with the endovascular treatment of intracranial aneurysms with Guglielmi Detachable Coils (GDC) generally occur at the time of the procedure or soon after. The purpose of this report is to determine the frequency of late thrombo-embolic events after GDC. Methods: The records of 189 patients who underwent GDC repair of one or more intracranial aneurysms at our institution were reviewed. The occurence of an ischemic event referrable to a coiled aneurysm was determined by clinical, angiographic, and imaging data. Events occuring within 2 days of the endovascular procedure were considered peri-procedural. Kaplan-Meier analysis of ischemic events over time was performed. Results: Two patients suffered documented thrombo-embolic events. One patient presented 5 weeks after coiling with a transient ischemic attack. Angiography demonstrated thrombus on the surface of the coils at the neck of a large ophthalmic artery aneurysm. The second patient presented with a posterior circulation stroke 4 weeks after coiling of a large superior cerebellar artery aneurysm. Angiography showed no significant proximal disease, with thrombus beginning at the neck of the treated aneurysm and extending out both P1 segments. No intra-procedural problems during the initial coiling had occured with either patient. There was no evidence for protrusion of coils into the parent artery in either patient. Both patients had been receiving daily aspirin (325 mg). One additional patient reporting symptoms suggesting possible ischemics event was evaluated and diagnosed as having atypical migraines. The frequency of a clinical thromboembolic event during the first year after coiling (excluding procedural complications) was 1.1%. Conclusions: Thrombo-embolic events may occur as late as 5 weeks after endovascular treatment of aneurysms with GDC.

Download Full-text

In vitro and in vivo Studies of the Extent of Electrothrombotic Deposition of Blood Elements on the Surface of Electrolytically Detachable Coils

Interventional Neuroradiology ◽

10.1177/159101990401000301 ◽

2004 ◽

Vol 10 (3) ◽

pp. 189-201 ◽

Cited By ~ 7

Author(s):

H. Henkes ◽

S. Brew ◽

S. Felber ◽

E. Miloslavski ◽

G. Mogilevski ◽

...

Keyword(s):

Endovascular Treatment ◽

Intravenous Administration ◽

Direct Current ◽

Intracranial Aneurysms ◽

Thrombus Formation ◽

Applied Current ◽

Detachable Coils ◽

Platinum Coils

Endovascular treatment of intracranial aneurysms with electrolytically detachable coils is often claimed to be based on electrothrombosis, i.e. intra-aneurysmal thrombus formation through applied direct current. Despite the fact that this concept was described more than a century ago, the significance of electrothrombosis in the endovascular treatment of aneurysms remains debatable. Apart from electrothrombosis, mechanical obliteration of the aneurysmal lumen might be one of the many possible mechanisms to explain why and how detachable coils are effective in preventing aneurysms from (re-)rupture. The purpose of this experimental study was to investigate to what extent direct current comparable to that used for coil detachment would influence the adhesion of cellular and liquid blood components to the surface of electrolytically detachable platinum coils. For the in vitro study, electrolytically detachable platinum coils of various types were exposed to stagnant heparinised blood for a total of 16 h, without or with applied direct current for 30 or 90 s (1 mA, 4–6 V, coil as anode). For the in vivo study, electrolytically detachable platinum coils were exposed to flowing blood for 180 s, without or with applied direct current (2 mA, 4–6 V, coil as either anode or cathode), without anti-coagulation and after intravenous administration of 5000 U Heparin and again after the intravenous administration of 500 mg Aspisol in addition to Heparin. After exposure to blood according to these different experimental protocols, the coils were fixed in formalin solution, gold coated and examined by scanning electron microscopy. Thrombus formation on the surface of all unfibred coils was thin and highly variable both from coil to coil, and on different areas of any given coil. The application of direct current minimally enhanced thrombus formation in stagnant blood in vitro, but not in vivo. The cellular and fibrin adhesions on the coil surfaces without and with applied current did not effectively increase the diameter or volume of unfibred coils. Coils with attached nylon fibres, however, proved to be highly thrombogenic without or with application of current. In fibred coils, surface adhesions without and with applied current were voluminous enough to effectively increase the diameter of the coil, potentially important for the process of endosaccular aneurysm occlusion. Electrothrombosis plays no role in the endovascular treatment of intracranial aneurysms with electrolytically detachable coils. This explains why platinum coils with non-electrolytic detachment mechanisms show a similar efficiency and recurrence rate.

Download Full-text

Endovascular treatment of intracranial aneurysms as the first thérapeutic option

Journal of Neuroradiology ◽

10.1016/j.neurad.2007.07.001 ◽

2007 ◽

Vol 34 (4) ◽

pp. 250-259 ◽

Cited By ~ 12

Author(s):

B. Lubicz ◽

D. Balériaux ◽

F. Lefranc ◽

J. Brotchi ◽

M. Bruneau ◽

...

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Therapeutic Option

Download Full-text

Evolution of endovascular therapy for aneurysm treatment

Neurosurgical FOCUS ◽

10.3171/foc.2005.18.2.3 ◽

2005 ◽

Vol 18 (2) ◽

pp. 1-4 ◽

Cited By ~ 6

Author(s):

Yassine Kanaan ◽

David Kaneshiro ◽

Kenneth Fraser ◽

David Wang ◽

Giuseppe Lanzino

Keyword(s):

Endovascular Treatment ◽

19Th Century ◽

Endovascular Therapy ◽

Intracranial Aneurysms ◽

Therapeutic Option ◽

Historical Overview ◽

Stepping Stones ◽

Technological Advances ◽

The 19Th Century ◽

Work Done

The endovascular treatment of intracranial aneurysms has recently become an established therapeutic option. The foundation of this treatment modality was laid by the work done in ground-breaking cases, combined with technological advances since the first half of the 19th century. In this historical overview the authors describe the steps taken by the early pioneers and the results of their work, which was often done under challenging circumstances. The work of these predecessors established the stepping-stones for constant development and refinement for those who have come after them, eventually evolving into the procedures used today. Endovascular treatment of intracranial aneurysms is only possible because of the work of these innovators.

Download Full-text

Cerebral Aneurysm Perforations during Treatment with Detachable Coils

Interventional Neuroradiology ◽

10.1177/159101990601200106 ◽

2006 ◽

Vol 12 (1) ◽

pp. 31-35 ◽

Cited By ~ 9

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.

Download Full-text

Endovascular trapping of giant serpentine aneurysms by using Guglielmi detachable coils. Successful reduction of mass effect

Journal of Neurosurgery ◽

10.3171/jns.2001.94.5.0836 ◽

2001 ◽

Vol 94 (5) ◽

pp. 836-840 ◽

Cited By ~ 27

Author(s):

Goro Otsuka ◽

Shigeru Miyachi ◽

Takashi Handa ◽

Makoto Negoro ◽

Takeshi Okamoto ◽

...

Keyword(s):

Clinical Symptoms ◽

Therapeutic Option ◽

Complex Structure ◽

Mass Effect ◽

Collateral Flow ◽

Guglielmi Detachable Coils ◽

Content Type ◽

Effective Therapeutic Option ◽

Detachable Coils ◽

The Right

✓ Giant serpentine aneurysms (GSAs) are defined as partially thrombosed giant aneurysms with persistent serpentine vascular channels. Surgical management of these rare lesions is difficult because of their large size, complex structure, and unique hemodynamics. The authors report two cases of patients harboring GSAs with mass effect, which were managed effectively with endovascular treatment. The first patient was a 48-year-old man who presented with left homonymous hemianopsia caused by a GSA involving the terminal portion of the right internal carotid artery. The second patient, a 10-year-old boy, presented with tetraparesis from compression of the cervicomedullary junction by a GSA of the right vertebral artery. In each case, after confirming collateral flow by temporarily occluding the proximal artery, the aneurysm was trapped by placement of Guglielmi detachable coils at the sites at which the serpentine channels entered and exited the aneurysm. The midportion of each channel was isolated completely without packing, to maximize resorption of the devascularized mass. Mass effect and clinical symptoms rapidly improved in both cases, with no associated morbidity. We recommend endovascular trapping as a safe and effective therapeutic option for GSAs.

Download Full-text