scholarly journals Endovascular treatment of cerebral aneurysms: a retrospective study of 163 embolized aneurysms

2007 ◽  
Vol 65 (2b) ◽  
pp. 411-415 ◽  
Author(s):  
João Renato Figueiredo Souza ◽  
Marcelo Otoch ◽  
Sérgio Pouchain Ribeiro ◽  
Francisco Ramos Júnior ◽  
João Paulo Cavalcante de Almeida ◽  
...  
Keyword(s):  
Public Health ◽  
Retrospective Study ◽  
Endovascular Treatment ◽  
Public Health System ◽  
Arterial Occlusion ◽  
Cerebral Aneurysms ◽  
Partial Occlusion ◽  
Endovascular Techniques ◽  
Endovascular Technique ◽  
Ruptured Aneurysms

OBJECTIVE: To present the results of cerebral aneurysms treated by endovascular technique. METHOD: Retrospective analysis of patient files of Hospital Geral de Fortaleza, Brazil. RESULTS: We report the results of 163 cerebral aneurysms treated by endovascular techniques from January 2002 to October 2005. Patients with ruptured aneurysms (87.2%), according to Hunt-Hess scale were: 33.7% HH I, 28.4% HH II, 24.1% HH III, 13.8% HH IV. The Fisher scale grade IV was the most common (39.7%). Remodeling, coil embolization, arterial occlusion and histoacryl embolization were the techniques employed. Effective occlusion was achieved in 87.7%, partial occlusion in 5.3% and non-effective occlusion in 7.0% of the patients. Glasgow outcome scale results were: 76.3% GOS 5, 5.0% GOS 4, 5.8% GOS 3, 1.4% GOS 2 and 11.5% GOS 1. CONCLUSION: Endovascular treatment seems to be feasible within Brazilian public health system, with results as good as those obtained in larger international centers.

scholarly journals Use of Distal Intracranial Catheters for Better Working View of Cerebral Aneurysms Hidden by Parent Artery or Its Branches: A Technical Note

2021 ◽  
Author(s):  
Ehab Mahmoud ◽  
Samuel Lenell ◽  
Christoffer Nyberg ◽  
Ljubisa Borota
Keyword(s):  
Endovascular Treatment ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Technical Note ◽  
Parent Artery ◽  
Endovascular Techniques ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Class 1 ◽  
Procedural Outcomes

A good working view is critical for safe and successful endovascular treatment of cerebral aneurysms. In a few cases, endovascular treatment of cerebral aneurysms may be challenging due to difficulty in obtaining a proper working view. In this report of 6 cases, we described the advantage of using a distal intracranial catheter (DIC) to achieve better visualization of cerebral aneurysms hidden by a parent artery or its branches. Between September 2017 and January 2021, we treated 390 aneurysms with endovascular techniques. In 6 cases in which it was difficult to obtain a proper working view, the DIC was placed distally close to the aneurysm in order to remove the parent artery projection from the working view and obtain better visualization of the aneurysm. Clinical and procedural outcomes and complications were evaluated. The position of the DIC was above the internal carotid artery siphon in the 6 cases. All aneurysms were successfully embolized. Raymond–Roy class 1 occlusion was achieved in all 4 unruptured aneurysms, while the result was class 2 in the 2 ruptured aneurysms. Placement of the DIC was atraumatic without dissections or significant catheter-induced vasospasm in all patients. Transient dysphasia was seen in 2 cases and transient aphasia in 1. Using this technique, we have found it possible to better visualize the aneurysm sac or neck and thereby treat cases we otherwise would have considered untreatable.

Balloon-assisted extrasaccular coil embolization technique for the treatment of very small cerebral aneurysms

2010 ◽  
Vol 112 (3) ◽  
pp. 585-588 ◽  
Author(s):  
Alberto Gil ◽  
Pedro Vega ◽  
Eduardo Murias ◽  
Hugo Cuellar
Keyword(s):  
Endovascular Treatment ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Review Of The Literature ◽  
Endovascular Techniques ◽  
Ruptured Aneurysms ◽  
Intraoperative Rupture ◽  
Small Aneurysms ◽  
Very High

Treatment of very small ruptured cerebral aneurysms (< 2 mm) continues to present a challenge. These lesions are difficult to treat both with neurosurgical and endovascular techniques. A neurosurgical approach is still the treatment of choice for these lesions at many centers because of high rupture rates related to endovascular treatment; however, there are clinical circumstances in which the neurosurgical option cannot be offered. In their review of the literature, the authors did not find any series reporting endovascular treatment of these very small aneurysms. In the present study, the authors report their experience with the endovascular treatment of a series of 4 ruptured aneurysms smaller than 2 mm from neck to dome. They describe their technique of using a remodelling balloon to stabilize the tip of the microcatheter in the neck of the aneurysm without entering it at any time, and of inserting the coil from outside the sac to minimize the risk of intraoperative rupture, which is very high when conventional endovascular embolization is performed.

scholarly journals Safety of Abciximab injection during endovascular treatment of ruptured aneurysms

2015 ◽  
Vol 21 (3) ◽  
pp. 332-336 ◽  
Author(s):  
Jean-Christophe Gentric ◽  
Joelle Brisson ◽  
André Lima Batista ◽  
Jimmy Ghostine ◽  
Jean Raymond ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Hemorrhage ◽  
Cerebral Aneurysms ◽  
Bleeding Complications ◽  
World Federation ◽  
Consecutive Series ◽  
Ruptured Aneurysms ◽  
Grade Ii

Background and purpose We aimed to determine the safety of intra-arterial Abciximab injection in the management of thromboembolic complications during endovascular treatment of ruptured cerebral aneurysms. Methods In a monocentric consecutive series of endovascular treatment of 783 ruptured aneurysms, 42 (5.3%) patients received Abciximab after the aneurysm was secured. Bleeding complications were registered and dichotomized as follows: new intracranial hemorrhage and peripheral bleeding. For each patient, World Federation of Neurosurgery (WFNS) subarachnoid hemorrhage (SAH) grade, shunting, and clinical outcomes in the post-operative period and at 3–6 months were recorded. Results SAH WFNS grades were as follows: grade I n = 14, grade II n = 10, grade III n = 11, grade IV n = 4, grade V n = 3. Ten patients had intracranial hematoma additionally to the SAH prior to embolization. Four patients (9.5%) presented more blood on the post-embolization CT but only one suffered a new clinically relevant intracranial hemorrhage. Two patients (4.8%) experienced significant peripheral bleeding but none were associated with long-term disabilities. Fourteen patients had a shunt installed less than 24 h prior to Abciximab injection and one less than 48 h later. At 3–6-month follow-up, 31 patients (74%) achieved a modified Rankin Scale score (mRS) of 2 or less, six patients (14%) had a mRS of 3–5, three were dead (7%), and two were lost at follow-up. Conclusion When the aneurysm is secured, intra-arterial Abciximab injection is a low complication rate treatment modality for thromboembolic events during embolization of cerebral ruptured aneurysm.

Endovascular treatment of ruptured aneurysms in anterior cerebral circulation with double microcatheter technique

2020 ◽  
Author(s):  
Xintong Zhao ◽  
Jiaqiang Liu ◽  
Huifang Wang ◽  
Zihuan Zhang ◽  
Zhenbao Li
Keyword(s):  
Risk Factors ◽  
Optimal Strategy ◽  
Cerebral Circulation ◽  
Cerebral Aneurysms ◽  
Partial Occlusion ◽  
Ruptured Aneurysms ◽  
Permanent Morbidity ◽  
Clinical Records ◽  
Related Mortality

Abstract Purpose Single coiling may be the optimal strategy for ruptured aneurysms. But assisted techniques may be needed in some aneurysms. The authors report their experience of double microcatheter technique in the treatment of ruptured aneurysms in anterior cerebral circulation. Methods Between 2012 and 2018, 82 patients with ruptured aneurysms in anterior cerebral circulation were treated with double microcatheter technique. The clinical records, angiographic results, procedure-related complications were reviewed. Clinical and angiographic follow-up was performed. Results Completely occlusion, neck remnant and partial occlusion were achieved in 56.6%, 36.1% and 7.2% in the whole procedures, respectively. The overall rate of morbidity was 8.5% (7/82). The rate of permanent morbidity was 3.7% (3/82). Three patients (3.7%) died before discharge. There was no procedure-related mortality. The favorable outcomes were obtained in 75.6% (62/82) of the whole patients at discharge. High Hunt-Hess grade and suffering from craniotomy or EVD were risk factors for clinical outcomes at discharge. Sixty-eight patients received clinical follow-up at a mean interval of 15.75±12.71 months. Favorable outcomes were obtained in 61 (89.7%) patients. Angiographic follow-up was performed in 44 patients at an average of 13.16±13.12 months. The recurrence rate is 34.1%. Seven of them (15.9%) received retreatment. Conclusion Double microcatheter technique is a safe and effective method for treatment of ruptured aneurysms in anterior cerebral aneurysms with low morbidity. Recurrence remains a problem. Patients should be followed up regularly.

Endovascular Treatment of Cerebral Aneurysms

2002 ◽  
Vol 15 (5) ◽  
pp. 537-548 ◽  
Author(s):  
G.B. Bradač ◽  
G. Stura ◽  
M. Bergui
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Aneurysm ◽  
Essential Role ◽  
Cerebral Aneurysms ◽  
Balloon Occlusion ◽  
New Technique ◽  
Endovascular Techniques ◽  
Parent Vessel ◽  
Endovascular Approach

Balloon occlusion of parent vessel and direct coiling are the two endovascular techniques routinely used and commonly accepted as alternatives to surgery for treatment of the cerebral aneurysm in many patients. Based on our experience and what is reported in the literature, the various aspects concerning techniques, difficulties, risks, are described. In comparison to surgery, the endovascular approach is a relatively new technique, which is still in evolution. To date, there is no objective indication regarding the method to be used in a given case. The experience and attitude of the involved team still play an essential role.

Treatment of Cerebral Aneurysms: Surgical, Endovascular or Combined Intervention

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 153-158 ◽  
Author(s):  
H. Sano ◽  
Y. Kato ◽  
F.B. Singh ◽  
N. Kanaoka ◽  
K. Shankar ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Treatment Group ◽  
Intervention Group ◽  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Good Recovery ◽  
Surgical Clipping ◽  
Ruptured Aneurysms ◽  
Incidental Aneurysms ◽  
Combined Intervention

A retrospective study of 437 cases of cerebral aneurysms over a 4 year period is reported. Surgical clipping was performed in 322 cases (254 ruptured and 68 incidental aneurysms) and endovascular embolization was done in 50 cases (26 ruptured and 24 incidental aneurysms). No intervention (either surgical or endovascular) was performed in 65 patients. In the direct surgical treatment group, mortality was 1.5% in incidental and 9.8% in ruptured aneurysms and good recovery was seen in 98.5% and 74.8% cases respectively. In the endovascular intervention group, results were poor due to the severity of their neurological grading and older age. Mortality was 42.3% in ruptured and 4.2% in incidental aneurysms. Six out of 26 ruptured and 11 out 24 incidental aneurysm patients had complications in the endovascular treatment group. We have discussed the results and indications for both modes of treatment in our study.

scholarly journals Analysis of endovascular treatment of ruptured aneurysms of the middle cerebral artery compared to other anatomical locations

2016 ◽  
Vol 22 (6) ◽  
pp. 649-653 ◽  
Author(s):  
Eduardo Murias Quintana ◽  
Pedro Vega Valdés ◽  
Edison Morales Deza ◽  
Alberto Gil Garcia ◽  
Hugo Cuellar ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Complication Rates ◽  
Endovascular Technique ◽  
Ruptured Aneurysms ◽  
Occlusion Rate ◽  
Anatomic Locations

Objective The objective of this article is to compare the results of endovascular treatment of ruptured middle cerebral artery (MCA) aneurysms with ruptured aneurysms of other anatomic locations. Methods Fifty consecutive ruptured aneurysms of the MCA and 209 aneurysms at other anatomical locations were selected retrospectively. We compared epidemiological, clinical and radiological variables, prognosis and complications. Results The MCA aneurysms had a greater size and a poor dome/neck ratio. There were no significant differences in endovascular technique complications, occlusion rate or rebleeding between the two groups ( p > 0.1). There were no significant differences in the mortality and number of dependent patients after one month. Conclusion The endovascular treatment of ruptured MCA aneurysms without hematoma is as safe and effective as other aneurysm localizations. Complication rates, occlusion rates and rebleeding of ruptured MCA aneurysms are comparable to other locations.

Analysis of endovascular treatment of ruptured microaneurysms compared with ruptured larger aneurysms

2015 ◽  
Vol 8 (6) ◽  
pp. 586-590
Author(s):  
Eduardo Murias Quintana ◽  
Pedro Vega ◽  
Edison Morales ◽  
Alberto Gil ◽  
Hugo Cuellar ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Cerebral Aneurysms ◽  
Imaging Studies ◽  
Endovascular Techniques ◽  
Operator Experience ◽  
Time Period ◽  
Procedural Complications ◽  
Patient Prognosis ◽  
Epidemiologic Characteristics

ObjectiveTo retrospectively analyze the complications and outcome of the endovascular treatment of ruptured microaneurysms compared with the treatment of ruptured larger aneurysms.Methods40 ruptured cerebral microaneurysms treated by endovascular techniques were selected retrospectively and compared with 207 larger ruptured cerebral aneurysms treated by endovascular techniques during the same time period. Medical charts and imaging studies were reviewed to analyze baseline clinical and epidemiologic characteristics, procedural complications, and clinical outcomesResultsCerebral microaneurysms had a higher incidence of intraoperative technical ruptures (13.5% vs 2.9%, p<0.005). The number of thromboembolic complications was not increased. Patient prognosis was similar for the two groups (mean modified Rankin Scale score 1.81 vs 2.09, p>0.1).ConclusionsCoiling of cerebral microaneurysms has a reasonable safety profile with good clinical outcomes, similar to coiling of larger aneurysms. In our experience, the systematic use of remodeling balloons, operator experience, and the ability to manage complications are the reasons for the satisfactory results.

scholarly journals Indications and practical application of strategies in the endovascular management of intracranial aneurysms

2013 ◽  
Vol 20 (3) ◽  
pp. 221-239
Author(s):  
Marco Antonio Zenteno ◽  
Jorge Arturo Santos-Franco ◽  
Ángel Lee ◽  
Fernando Vinuela ◽  
Jose-Maria Modenesi Freitas ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Endovascular Management ◽  
Practical Application ◽  
Endovascular Techniques ◽  
Endovascular Technique ◽  
Rational Choices ◽  
Pros And Cons

Abstract The occlusion of intracranial aneurysms is more successful and stable by properly planning the approach and application of endovascular techniques. The next step is a relentless analysis of the different indications of endovascular treatment, tailoring a strategy suitable for the specific case, and making more rational choices for the management of aneurysms. Indications and strategies according to the analysis of the aneurysmal complex are given, as well as pros and cons of the endovascular technique according to different anatomical locations

scholarly journals A Patient with Eight Intracranial Aneurysms: Endovascular Treatment in Two Sessions

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Erol Akgul ◽  
Hasan Bilen Onan ◽  
Huseyin Tugsan Balli ◽  
Nuri Eralp Cetinalp
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Treatment Modalities ◽  
Review Of The Literature ◽  
Endovascular Techniques ◽  
Endovascular Technique ◽  
Anterior Circulation ◽  
First Choice ◽  
Flow Diverters

The frequency of multiple intracranial aneurysms seen in patients with or without subarachnoid hemorrhage is high. The advancement of the endovascular technique and devices has ensured that endovascular treatment of intracranial aneurysms is the first choice in most cases, especially in unruptured ones. Different combinations of treatment modalities and techniques can be used in the management of multiple aneurysms. But in selected patients without subarachnoid hemorrhage, treatment of all aneurysms in one or more sessions with endovascular techniques is less traumatic than that with surgery. In the literature, the maximum number of aneurysms in one patient treated endovascularly and/or surgically is seven. In this case report, we present, with a review of the literature, a patient with eight intracranial aneurysms, all of which were treated in two sessions with various endovascular techniques. A 40-year-old female patient was admitted due to headache. Angiography showed eight aneurysms in the posterior circulation and, bilaterally, in the anterior circulation. All aneurysms were treated endovascularly in two sessions. In the treatment of the aneurysms, different endovascular techniques were used including flow diverters stents, stent-assisted coiling, Y-stent-assisted coiling, and coiling alone.

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