An interesting case of reruptured endovascularly coiled aneurysm managed with clipping

Endovascular treatment has proven to be effective in the management of intracranial aneurysm, and can achieve permanent occlusion in up to 85% of cases, reducing the bleeding or rebleeding rate. A paradigm shift from microsurgical clipping to endovascular intervention has been observed since the publication of the International Subarachnoid Aneurysm Trial. Aneurysm recurrence after coil embolization remains both a major shortcoming of endovascular treatment and a daunting challenge for neurosurgeons without optimal management strategies.: We present a case report of a patient with history of previously endovascularly coiled and presenting with aneurysmal bleed. Microsurgical clipping is an effective intervention for managing reruptured previously coiled intracranial aneurysm.

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Rebleeding risk after treatment of ruptured intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/2011.1.jns101232 ◽

2011 ◽

Vol 114 (6) ◽

pp. 1778-1784 ◽

Cited By ~ 16

Author(s):

J. Brett Fleming ◽

Brian L. Hoh ◽

Scott D. Simon ◽

Babu G. Welch ◽

Robert A. Mericle ◽

...

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Large Scale ◽

Chart Review ◽

Cerebral Aneurysms ◽

Retrospective Chart Review ◽

Short Term ◽

International Subarachnoid Aneurysm Trial ◽

Rebleeding Rate ◽

Ruptured Intracranial Aneurysms

Object Postprocedural rebleeding is a significant source of morbidity following endovascular treatment of ruptured intracranial aneurysms. Previous large-scale reports include the Cerebral Aneurysm Rerupture After Treatment trial, the International Subarachnoid Aneurysm Trial, and the study on Early Rebleeding after Coiling of Ruptured Cerebral Aneurysms, which reported nonprocedural rebleeding rates within 30 days of treatment of 2.7%, 1.9%, and 1.4%, respectively. However, coiling of intracranial aneurysms is in a state of continual change due to advancing device design and evolving techniques. These studies included only patients initially treated prior to 2004. In the present study the authors assess the most recent short-term results with endovascular treatment of ruptured aneurysms. Methods A multicenter retrospective chart review was conducted of patients undergoing endovascular treatment for ruptured intracranial aneurysms between July 2004 and October 2009. The technique used, including the use of stent or balloon assistance, was evaluated. Demographic and clinical factors, such as sex, age, initial clinical presentation, aneurysm size, aneurysm location, and modified Raymond Classification following initial treatment, were also evaluated and compared between the groups in which rebleeding did and did not occur. Results A total of 469 patients underwent endovascular treatment for a ruptured aneurysm; nonprocedural rehemorrhage occurred within 30 days of the initial coiling in 4 cases (0.9%). Two patients (50%) died after rehemorrhage. Stent-assisted coiling was used during the original treatment in 1 (25%) of the 4 patients with a rerupture. However, no technical, clinical, or demographic factors were found to be statistically significant in association with rebleeding. Conclusions Recent data suggest that the periprocedural rebleeding rate may be improving over time.

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Risk of recurrent subarachnoid hemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up

Yearbook of Neurology and Neurosurgery ◽

10.1016/s0513-5117(09)79144-6 ◽

2010 ◽

Vol 2010 ◽

pp. 32-34

Author(s):

A. Rabinstein

Keyword(s):

Subarachnoid Hemorrhage ◽

Intracranial Aneurysm ◽

International Subarachnoid Aneurysm Trial ◽

Long Term Follow Up ◽

Standardised Mortality Ratios

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Clinical Case: Complications after Endovascular Treatment of Intracranial Aneurysm in a Patient after Subarachnoid Hemorrhage

International Journal of Anesthesiology Research ◽

10.31907/2310-9394.2020.08.02 ◽

2020 ◽

Vol 8 (1) ◽

pp. 9-15

Author(s):

Petrov Nikolay ◽

◽

Marinova R. ◽

Odiseeva Ev.

Keyword(s):

Intracranial Aneurysm ◽

Endovascular Treatment ◽

Clinical Case ◽

Endovascular Coiling ◽

Published Data ◽

Military Medical Academy ◽

Life Threatening ◽

Arachnoid Hemorrhage ◽

The Right ◽

Brain Artery

Abstract: Intracranial aneurysm is one of the most common neurovascular complications. During the recent years the accepted treatment of enraptured cranial aneurysm is noninvasive endovascular coiling. This technique is modern but it is not without complications which can be serious and life-threatening. A clinical case of a patient admitted to the ICU of Military Medical Academy - Sofia with sub arachnoid hemorrhage is described. After a positive clinical course, the check-up magnetic resonance showed intracranial aneurism of the right carotid artery. The patient underwent angiographic endovascular treatment. Vasospasm of the middle and right brain artery and thrombosis were detected during the procedure. Attempt of thromboaspiration was made without success. This article reviews published data on broad-spectrum researches concerning complications of endovascular coiling of intracranial aneurysms and the ways to prevent and reduce them.

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Acute occlusion of the fetal posterior cerebral artery: diagnosis and management paradigms

The Neuroradiology Journal ◽

10.1177/19714009211019383 ◽

2021 ◽

pp. 197140092110193

Author(s):

Mohamad Abdalkader ◽

Anurag Sahoo ◽

Julie G Shulman ◽

Elie Sader ◽

Courtney Takahashi ◽

...

Keyword(s):

Endovascular Treatment ◽

Cerebral Artery ◽

Mechanical Thrombectomy ◽

Posterior Cerebral Artery ◽

Management Strategies ◽

Artery Occlusion ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Cerebral Artery Occlusion

Background and purpose The diagnosis and management of acute fetal posterior cerebral artery occlusion are challenging. While endovascular treatment is established for anterior circulation large vessel occlusion stroke, little is known about the course of acute fetal posterior cerebral artery occlusions. We report the clinical course, radiological findings and management considerations of acute fetal posterior cerebral artery occlusion stroke. Methods We performed a retrospective review of consecutive patients presenting with acute large vessel occlusion who underwent cerebral angiogram and/or mechanical thrombectomy between January 2015 and January 2021. Patients diagnosed with fetal posterior cerebral artery occlusion were included. Demographic data, clinical presentation, imaging findings and management strategies were reviewed. Results Between January 2015 and January 2021, three patients with fetal posterior cerebral artery occlusion were identified from 400 patients who underwent angiogram and/or mechanical thrombectomy for acute stroke (0.75%). The first patient presented with concomitant fetal posterior cerebral artery and middle cerebral artery occlusions. Thrombectomy was performed with recanalisation of the fetal posterior cerebral artery but the patient died from malignant oedema. The second patient presented with isolated fetal posterior cerebral artery occlusion. No endovascular intervention was performed and the patient was disabled from malignant posterior cerebral artery infarct. The third patient presented with carotid occlusion and was found to have fetal posterior cerebral artery occlusion after internal carotid artery recanalisation. No further intervention was performed. The patient was left with residual contralateral homonymous hemianopia and mild left sided weakness. Conclusion Fetal posterior cerebral artery occlusion is a rare, but potentially disabling, cause of ischaemic stroke. Endovascular treatment is feasible. Further investigation is needed to compare the efficacy of medical versus endovascular management strategies.

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Patient-Reported Outcome for Endovascular Treatment versus Microsurgical Clipping in Aneurysmal Subarachnoid Hemorrhage

World Neurosurgery ◽

10.1016/j.wneu.2021.08.131 ◽

2021 ◽

Author(s):

Arshad Ali ◽

Talal Alrabayah ◽

Ibrahim Abdelhafez ◽

Abdul Salam ◽

Mukesh Thakur ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Endovascular Treatment ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Patient Reported Outcome ◽

Microsurgical Clipping ◽

Patient Reported

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Long-Term Follow-up Study of Endovascularly Treated Intracranial Aneurysms

Interventional Neuroradiology ◽

10.1177/159101991001600301 ◽

2010 ◽

Vol 16 (3) ◽

pp. 231-239 ◽

Cited By ~ 5

Author(s):

L.M. Pyysalo ◽

L.H. Keski-Nisula ◽

T.T. Niskakangas ◽

V.J. Kähärä ◽

J.E. Öhman

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Bleeding Rate ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Follow Up Study ◽

Long Term Follow Up ◽

Rebleeding Rate

Long-term follow-up studies after endovascular treatment for intracranial aneurysm are still rare and inconclusive. The aim of this study was to assess the long-term clinical and angiographic outcome of patients with endovascularly treated aneurysms. The clinical outcome of all 185 patients with endovascularly treated aneurysms were analyzed and 77 out of 122 surviving patients were examined with MRI and MRA nine to 16 years (mean 11 years) after the initial endovascular treatment. Sixty-three patients were deceased at the time of follow-up. The cause of death was aneurysm-related in 34 (54%) patients. The annual rebleeding rate from the treated aneurysms was 1.3% in the ruptured group and 0.1% in the unruptured group. In long-term follow-up MRA 18 aneurysms (53%) were graded as complete, 11 aneurysms (32%) had neck remnants and five aneurysms (15%) were incompletely occluded in the ruptured group. The occlusion grade was lower in the unruptured group with 20 aneurysms (41%) graded as complete, 11 (22%) had neck remnants and 18 (37%) were incomplete. However, only three aneurysms were unstable during the follow-up period and needed retreatment. Endovascular treatment of unruptured aneurysms showed incomplete angiographic outcome in 37% of cases. However, the annual bleeding rate was as low as 0.1%. Endovascular treatment of ruptured aneurysms showed incomplete angiographic outcome in 15% of cases and the annual rebleeding rate was 1,3%.

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Endovascular Coil Embolization of a Posterior Communicating Artery Aneurysm: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa278 ◽

2020 ◽

Vol 19 (6) ◽

pp. E597-E598

Author(s):

Maureen A Darwal ◽

Zakaria Hakma ◽

Mandy J Binning ◽

Adam Arthur ◽

Bain Mark ◽

...

Keyword(s):

New York ◽

Endovascular Treatment ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Artery Aneurysm ◽

Posterior Communicating Artery ◽

International Subarachnoid Aneurysm Trial ◽

Endovascular Coil Embolization ◽

Posterior Communicating Artery Aneurysm ◽

Set Up

Abstract Since the International Subarachnoid Aneurysm Trial,1 endovascular treatment has been the favored treatment for appropriate ruptured intracranial aneurysms. While our endovascular technology has advanced to allow us to treat the majority of intracranial aneurysms, simple coil embolization is still the most common modality. This video demonstrates the fundamentals of aneurysm catheterization and coiling for safe treatment. In addition, the set-up and devices are detailed. This video is to add to the library of basic techniques that will aid a large number of practitioners. This patient consented to endovascular treatment. The video demonstrates endovascular coil embolization of a posterior communicating artery aneurysm in a 76-yr-old female who presented with a subarachnoid hemorrhage. Image of biplane suite in video used courtesy of Siemens Medical Solutions USA, Inc. Illustration at 5:12 reprinted from Yasargil MG, et al, Microneurosurgery IV B, p. 9, Thieme, New York, 1995.

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Low-Dose 3D Rotational Angiography in Measuring the Size of Intracranial Aneurysm: In Vitro Feasibility Study Using Aneurysm Phantom

Neurointervention ◽

10.5469/neuroint.2020.00437 ◽

2021 ◽

Vol 16 (1) ◽

pp. 59-63

Author(s):

Hee Jong Ki ◽

Bum-soo Kim ◽

Jun-Ki Kim ◽

Jai Ho Choi ◽

Yong Sam Shin ◽

...

Keyword(s):

Intracranial Aneurysm ◽

Endovascular Treatment ◽

Low Dose ◽

Three Dimensional ◽

3D Measurement ◽

Rotational Angiography ◽

3D Rotational Angiography ◽

Conventional Dose ◽

Noninferiority Margin

Purpose: Three-dimensional (3D) measurement of intracranial aneurysms is important in planning endovascular treatment, and 3D rotational angiography (RA) is effective in accurate measurement. The purpose of this study was to evaluate the feasibility of low dose 3D RA (5 seconds 0.10 μGy/frame) in measuring an intracranial aneurysm using an in vitro phantom.Materials and Methods: We investigated an <I>in vitro</i> 3D phantom of an intracranial aneurysm with 10 acquisitions of 3D RA with a conventional dose (5 seconds 0.36 μGy/frame) and 10 acquisitions with a low-dose (5 seconds 0.10 μGy/frame). 3D size and neck diameters of the aneurysm were measured and compared between the 2 groups (conventional and low-dose) using noninferiority statistics.Results: The aneurysm measurements were well-correlated between the 2 readers, and noninferiority in the measurement of aneurysmal size of low-dose 3D RA was demonstrated, as the upper margin of the 1-sided 97.5% confidence interval did not cross the pre-defined noninferiority margin of 0.2 mm by the 2 readers.Conclusion: Low-dose (5 seconds 0.10 μGy/frame) cerebral 3D RA is technically feasible and not inferior in in vitro 3D measurement of an intracranial aneurysm. Thus, low-dose 3D RA is promising and needs further evaluation for its clinical utility in the planning of endovascular treatment of an intracranial aneurysm.

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