Aspect ratio is associated with recanalization after coiling of unruptured intracranial aneurysms

2021 ◽  
Author(s):  
Takeshi Hara ◽  
Tetsu Satow ◽  
Eika Hamano ◽  
Naoki Hashimura ◽  
Masatake Sumi ◽  
...  
Keyword(s):  
Aspect Ratio ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Neck Width ◽  
Tof Mra ◽  
Unruptured Intracranial Aneurysms ◽  
The Mean

Abstract Background The rate of recanalization after coil embolization for unruptured intracranial aneurysms (UIAs) is reported to occur around 11.3-49%. Aim of this study is to investigated the factors that influence the recanalization after coil embolization for unruptured intracranial aneurysms (UIAs) in our institution. Methods We retrospectively investigated 307 UIAs in 296 patients treated at our institution between April 2004 and December 2016. The stent used cases were excluded. Cerebral angiography and 3D TOF MRA were used for evaluation of the postoperative occlusion status. Volume embolization ratio (VER), aneurysmal size, neck width, and aspect ratio (AR) were compared between the recanalized and non-recanalized groups. Results The mean follow-up period ranged from 6 to 172 months (mean: 79.0±39.8 months). Recanalization was noted in 87 (28.3%) aneurysms, and 19 (6.2%) aneurysms required retreatment. There was no aneurysmal rupture during the follow-up period. Univariate analysis showed that the aneurysm size (p < 0.001), neck width (p = 0.002), AR (p = 0.003), and VER (p = 0.027) were associated with recanalization. Multivariate logistic regression analysis showed that the AR (p =0.004) and VER (p =0.015) were significant predictors of recanalization. Conclusions In our study, AR and VER were significant predictors of recanalization after coil embolization for UIAs.

Long-term Clinical and Angiographic Results of Neuroform Stent-Assisted Coil Embolization in Wide-Necked Intracranial Aneurysms

Neurosurgery ◽  
2011 ◽  
Vol 70 (5) ◽  
pp. 1232-1237 ◽  
Author(s):  
Alejandro Santillan ◽  
Edward Greenberg ◽  
Athos Patsalides ◽  
Kimberly Salvaggio ◽  
Howard A. Riina ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Univariate Analysis ◽  
High Rate ◽  
Long Term Results ◽  
Aneurysm Occlusion ◽  
The Mean ◽  
Neuroform Stent

Abstract BACKGROUND: Neuroform stent-assisted coil embolization facilitates the endovascular treatment of wide-necked intracranial aneurysms. However, the safety and efficacy of its long-term use have not been fully elucidated. OBJECTIVE: To retrospectively examine the long-term results of Neuroform stent usage in conjunction with coil embolization in wide-necked intracranial aneurysms. METHODS: Between November 2002 and December 2010, 79 patients harboring wide-necked intracranial aneurysms were treated with use of the Neuroform stent. The stenting procedure failed in 2 patients. Therefore, 77 patients harboring 79 intracranial aneurysms were included for analysis. Patient and aneurysm characteristics, progression of aneurysm occlusion, and occurrence of complications were analyzed. Follow-up imaging included digital subtraction angiography (DSA) or magnetic resonance angiography (MRA). Kaplan-Meier analysis, as well as univariate analysis were performed to determine the progression of aneurysm occlusion and to examine the predictive factors for complete aneurysm occlusion, respectively. RESULTS: Overall, complete aneurysm occlusion was observed in 42.4% of the cases immediately after treatment and progressed to 96.5% at 7-year follow-up. The mean angiographic follow-up time was 25.8 months (range, 0–84 months). Eleven aneurysms (14%) were re-treated. Sixty-eight patients (88.3%) had favorable clinical outcome with a modified Rankin Scale (mRS) ⩽ 1, 3 patients (3.9%) had an mRS of 2, and 5 patients (6.5%) did not have a clinical follow-up. The mean clinical follow-up time was 45.4 months (range, 3–92 months). One patient (1.3%) died of a procedure-related hemorrhage. CONCLUSION: Neuroform stent-assisted coil embolization of wide-necked intracranial aneurysms prevents hemorrhage and provides a high rate of aneurysm occlusion at long-term follow-up.

scholarly journals Early experience with a novel net temporary bridging device (Cascade) to assist endovascular coil embolization of intracranial aneurysms

2020 ◽  
pp. 1-9
Author(s):  
Alejandro Tomasello ◽  
David Hernandez ◽  
Laura Ludovica Gramegna ◽  
Sonia Aixut ◽  
Roger Barranco Pons ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Type I ◽  
Type Ii ◽  
Unruptured Aneurysms ◽  
Complete Obliteration ◽  
Acute Subarachnoid Hemorrhage ◽  
Endovascular Coil Embolization ◽  
The Mean

OBJECTIVEThe goal of this study was to evaluate the effectiveness and safety of a new noncompletely occlusive net-assisted remodeling technique in which the Cascade net device is used for temporary bridging of intracranial aneurysms.METHODSBetween July 2018 and May 2019, patients underwent coil embolization with the Cascade net device within 4 centers in Europe. Analysis of angiographic (modified Raymond-Roy classification [MRRC]) and clinical outcomes data was conducted immediately following treatment and at the 6-month follow-up.RESULTSFifteen patients were included in the study (mean age 58 ± 13 years, 11/15 [73.3%] female). Ten patients had unruptured aneurysms, and 5 presented with ruptured aneurysms with acute subarachnoid hemorrhage. The mean aneurysm dome length was 6.27 ± 2.33 mm and the mean neck width was 3.64 ± 1.19 mm. Immediately postprocedure, MRRC type I (complete obliteration) was achieved in 11 patients (73.3%), whereas a type II (residual neck) was achieved in 4 patients (26.7%). Follow-up examination was performed in 7/15 patients and showed stabilization of aneurysm closure with no thromboembolic complications and only 1 patient with an increased MRRC score (from I to II) due to coil compression.CONCLUSIONSInitial experience shows that the use of a new noncompletely occlusive net-assisted remodeling technique with the Cascade net device may be safe and effective for endovascular coil embolization of intracranial aneurysms.

scholarly journals Long-term outcomes of coil embolization of unruptured intracranial aneurysms

2018 ◽  
Vol 129 (6) ◽  
pp. 1492-1498 ◽  
Author(s):  
Masaomi Koyanagi ◽  
Akira Ishii ◽  
Hirotoshi Imamura ◽  
Tetsu Satow ◽  
Kazumichi Yoshida ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Additional Treatment ◽  
Long Term Outcomes ◽  
Unruptured Intracranial Aneurysms ◽  
Risk Of Rupture ◽  
Long Term Follow Up ◽  
Multiple Stroke

OBJECTIVELong-term follow-up results of the treatment of unruptured intracranial aneurysms (UIAs) by means of coil embolization remain unclear. The aim of this study was to analyze the frequency of rupture, retreatment, stroke, and death in patients with coiled UIAs who were followed for up to 20 years at multiple stroke centers.METHODSThe authors retrospectively analyzed data from cases in which patients underwent coil embolization between 1995 and 2004 at 4 stroke centers. In collecting the late (≥ 1 year) follow-up data, postal questionnaires were used to assess whether patients had experienced rupture or retreatment of a coiled aneurysm or any stroke or had died.RESULTSOverall, 184 patients with 188 UIAs were included. The median follow-up period was 12 years (interquartile range 11–13 years, maximum 20 years). A total of 152 UIAs (81%) were followed for more than 10 years. The incidence of rupture was 2 in 2122 aneurysm-years (annual rupture rate 0.09%). Nine of the 188 patients with coiled UIAs (4.8%) underwent additional treatment. In 5 of these 9 cases, the first retreatment was performed more than 5 years after the initial treatment. Large aneurysms were significantly more likely to require retreatment. Nine strokes occurred over the 2122 aneurysm-years. Seventeen patients died in this cohort.CONCLUSIONSThis study demonstrates a low risk of rupture of coiled UIAs with long-term follow-up periods of up to 20 years. This suggests that coiling of UIAs could prevent rupture for a long period of time. However, large aneurysms might need to be followed for a longer time.

scholarly journals Ticagrelor versus clopidogrel in stent-assisted coil embolization of unruptured intracranial aneurysms

2021 ◽  
pp. 159101992110549
Author(s):  
Shuo-Chi Chien ◽  
Ching-Chang Chen ◽  
Chun-Ting Chen ◽  
Alvin Yi-Chou Wang ◽  
Po-Chuan Hsieh ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Systemic Review ◽  
Bleeding Tendency ◽  
Unruptured Intracranial Aneurysms ◽  
Low Dose Aspirin ◽  
Hemorrhagic Events ◽  
One Year

Background Dual antiplatelet therapy is widely used for stent-assisted coil embolization (SACE) for unruptured intracranial aneurysms (UIAs) to prevent thromboembolic events (TEs). Compared to clopidogrel associated with aspirin, knowledge of the safety and efficacy of ticagrelor is lacking in large studies to date. Methods A retrospective cohort study was conducted from January 2016 to December 2018 with at least one year of follow-up in a single institution and systemic review. Results Altogether, 153 patients with UIA receiving SACE were separated into two groups: 113 patients receiving clopidogrel plus aspirin and 40 patients receiving ticagrelor plus aspirin. Acute in-stent thrombotic events were noted in two patients in the clopidogrel group (1.77%) and none in the ticagrelor group (0%). Additionally, one patient (0.88%) in the clopidogrel group had an early ischemic stroke (<3 months). Delayed ischemic stroke was noted in 6 patients (5.31%) in the clopidogrel group and 3 patients (7.50%) in the ticagrelor group. There were no major hemorrhagic events in either group. The two groups showed no significant differences with regard to ischemic stroke or hemorrhagic stroke. Conclusion Compared to the clopidogrel based regimen, ticagrelor can also reduce TEs without increasing bleeding tendency for SACE of UIAs. Ticagrelor combined with low-dose aspirin is a safe and effective alternative option for SACE.

scholarly journals Stent-Assisted Coiling of Ruptured Wide-Necked Intracranial Aneurysms

2013 ◽  
Vol 19 (3) ◽  
pp. 283-288 ◽  
Author(s):  
Conghui Li ◽  
Youxiang Li
Keyword(s):  
Mortality Rate ◽  
Clinical Outcome ◽  
Scale Score ◽  
Coil Embolization ◽  
Glasgow Outcome Scale ◽  
Intracranial Aneurysms ◽  
Related Complication ◽  
The Mean

This study aimed to report the results and outcome of stent-assisted coiling of ruptured wide-necked intracranial aneurysms. We retrospectively reviewed 19 consecutive patients (11 men, eight women; mean age, 59.5 years; range, 43–78 years) with acutely ruptured wide-necked intracranial aneurysms who were treated with stent-assisted coil embolization. The mean length of angiographic follow-up was 5.2 months (range, 3–10 months). There was no technique-related complication and the 30-day mortality rate was 10.5% (two of 19). There was one case of rebleeding, and clinical outcome was poor for the patient (5.3% [one of 19] who had a Glasgow Outcome Scale score of 2 at the end of the study period). Stent-assisted coiling is a feasible treatment for ruptured wide-necked intracranial aneurysms that are difficult to treat surgically or with balloon-assisted embolization.

Rupture of Intracranial Aneurysms during Endovascular Coiling: Management and Outcomes

Neurosurgery ◽  
2001 ◽  
Vol 49 (4) ◽  
pp. 807-813 ◽  
Author(s):  
Elad Levy ◽  
Christopher J. Koebbe ◽  
Michael B. Horowitz ◽  
Charles A. Jungreis ◽  
G. Lee Pride ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Demographic Data ◽  
Clinical Status ◽  
Endovascular Coiling ◽  
Aneurysmal Rupture ◽  
Detachable Coils ◽  
The Mean

Abstract OBJECTIVE In this study, the incidence, etiologies, and management with respect to clinical outcome of patients with iatrogenic aneurysmal rupture during attempted coil embolization of intracranial aneurysms are reviewed. METHODS A retrospective analysis was conducted of 274 patients with intracranial aneurysms treated with Guglielmi detachable coils over a 6-year period from 1994 to 2000. Patient medical records were examined for demographic data, aneurysm location, the number of coils deployed preceding and after aneurysmal rupture, the etiology of the rupture, and the clinical status on admission and at the time of discharge. RESULTS Of 274 patients with intracranial aneurysms treated with coil embolization, six (2%) had an intraprocedural rupture. Of these six, two were women and four were men. The mean age was 67 years (range, 52–85 yr). Mean follow-up time was 8 months (range, 0–25 mo). Aneurysmal rupture resulted from detachment of the last coil in three patients, detachment of the third coil (of four) in one patient, and insertion of the first coil in another patient. In one patient, the aneurysmal rupture was a result of catheter advancement before detachment of the last coil. The Glasgow Outcome Scale score at last follow-up examination was 1 in two patients, 2 in two patients, and 5 in two patients. CONCLUSION The rate of rupture of aneurysms during coil embolization is approximately 2 to 4%. The clinical outcome may be related to the timing of the rupture and the number of coils placed before rupture. If extravasation of contrast agent is seen, which suggests intraprocedural rupture, further coil deposition should be attempted if safely possible.

Abstract WP74: Long-term Outcome Of Cognition Related To Treatment And Observation In Unruptured Intracranial Aneurysms

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Andrea Holcombe ◽  
Irene Meissner ◽  
Jim Torner ◽  
David Piepgras ◽  
John Huston ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Linear Models ◽  
Treated Group ◽  
Cognitive Status ◽  
Cognitive Changes ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Unruptured Intracranial Aneurysms ◽  
The Mean

INTRODUCTION: Cognitive changes can occur following procedural interventions and subarachnoid hemorrhage in unruptured intracranial aneurysms (UIA). The International Study of Unruptured Intracranial Aneurysms conducted cognitive assessment using the Mini-Mental State Exam at baseline and the Telephone Interview Cognitive Status Exam (TICS) at follow-up. Hypothesis: The purpose of this analysis was to compare the 1 year and 5 year outcome in the treatment cohorts (surgery and endovascular) with those of the untreated subgroup. Methods: Patients were subdivided into the initial treatment and untreated cohorts based upon observation or treatment practices in 61 centers from 1991-1998. 1691 patients were in the observational cohort and 2388 in the treated cohort. The cohorts were followed annually with measures of neurological status, Rankin Scale and cognition (TICS). Outcomes were determined prospectively. Comparison of outcomes was done using continuous data and by categories. Covariate adjustment was done using general linear models. Stratified analysis was done by Rankin Score at the time of follow-up. Results: The mean TICS score at 1 year in the cohort was 33.4 with a median of 34 (maximum is 40). In the treated patients the mean was 33.5 and in the untreated patients it was 33.3 (P=0.644). However, Rankin Score at 1 year was significant with a higher percentage of 3-5 scores in the treated group (P=0.003) Categorical analysis of the TICS Score when stratified by Rankin Score at 1 year showed small but significant differences, P=0.03 for Rankin 0-2, and P=0.07 for Rankin 3-5. However after adjustment for baseline variables treatment TICS Score was no longer significant.. The 5 year results showed that the untreated patients did worse than the treated group in TICS. However after adjustment no differences were apparent. Conclusions: Cognitive changes associated with treatment may be minor source of disability post-treatment compared to observation and patient outcomes may be worse in the observation group over time. Differences in outcome also were better explained through the Rankin Score at follow-up than by cognitive deficits.

Usefulness of pointwise encoding time reduction with radial acquisition sequence in subtraction-based magnetic resonance angiography for follow-up of the Neuroform Atlas stent-assisted coil embolization for cerebral aneurysms

2020 ◽  
pp. 028418512095278
Author(s):  
Young Jin Heo ◽  
Hae Woong Jeong ◽  
Donghyun Kim ◽  
Jin Wook Baek ◽  
Ji-yeon Han ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Alternative Methods ◽  
Radial Acquisition ◽  
Tof Mra ◽  
Significant Difference ◽  
Time Reduction

Background Although time-of-flight magnetic resonance angiography (TOF-MRA) is widely used, it has limited usefulness for follow-up after stent-assisted coil embolization. Contrast-enhanced MRA (CE-MRA) and ultrashort echo time MRA have been suggested as alternative methods for visualization after this procedure. Purpose To compare efficacy and usefulness of pointwise encoding time reduction with radial acquisition (PETRA) sequence in subtraction-based MRA (qMRA), TOF-MRA, and CE-MRA during the follow-up after Neuroform Atlas stent-assisted coil embolization for intracranial aneurysms. Material and Methods This retrospective study included 23 patients with 24 aneurysms who underwent Neuroform Atlas stent-assisted coil embolization for intracranial aneurysms. All patients were evaluated with PETRA qMRA, TOF-MRA, and CE-MRA at the same follow-up session. The flow within stents, occlusion status, and presence of pseudo-stenosis were evaluated; inter-observer and intermodality agreements for the three methods were also graded. Results The mean score for flow visualization within the stents was significantly higher for PETRA qMRA and CE-MRA than for TOF-MRA (although no significant difference was found between PETRA qMRA and CE-MRA). Good inter-observer agreement was observed for each modality. PETRA qMRA and CE-MRA were more consistent with digital subtraction angiography (DSA) than TOF-MRA for aneurysm occlusion status. The intermodality agreement was better between PETRA qMRA and DSA, and between CE-MRA and DSA, than between DSA and TOF-MRA. Pseudo-stenosis was most frequently observed in TOF-MRA, followed by CE-MRA and PETRA qMRA. Conclusion PETRA qMRA is useful for evaluating the parent artery patency and occlusion status of aneurysms after Neuroform Atlas stent-assisted coil embolization.

Unruptured intracranial aneurysms in children: 18 years’ experience in a tertiary care pediatric institution

2019 ◽  
Vol 24 (2) ◽  
pp. 184-189 ◽  
Author(s):  
Daniel-Alexandre Bisson ◽  
Peter Dirks ◽  
Afsaneh Amirabadi ◽  
Manohar M. Shroff ◽  
Timo Krings ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Natural History ◽  
Internal Carotid Artery ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Tertiary Care ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Mean Size

OBJECTIVEThere are little data in the literature on the characteristics and natural history of unruptured intracranial aneurysms in children. The authors analyzed their experience with unruptured intracranial aneurysms in the pediatric population at their tertiary care pediatric institution over the last 18 years. The first objective was to assess the imaging characteristics and natural history of these aneurysms in order to help guide management strategies in the future. A second objective was to evaluate the frequency of an underlying condition when an incidental intracranial aneurysm was detected in a child.METHODSThe authors conducted a Research Ethics Board–approved retrospective review of incidental intracranial aneurysms in patients younger than 18 years of age who had been treated at their institution in the period from 1998 to 2016. Clinical (age, sex, syndrome) and radiological (aneurysm location, type, size, thrombus, mass effect) data were recorded. Follow-up imaging was assessed for temporal changes.RESULTSSixty intracranial aneurysms occurred in 51 patients (36 males, 15 females) with a mean age of 10.5 ± 0.5 years (range 9 months–17 years). Forty-five patients (88.2%) had a single aneurysm, while 2 and 3 aneurysms were found in 3 patients each (5.8%). Syndromic association was found in 22 patients (43.1%), most frequently sickle cell disease (10/22 [45.5%]). Aneurysms were saccular in 43 cases (71.7%; mean size 5.0 ± 5.7 mm) and fusiform in the remaining 17 (28.3%; mean size 6.5 ± 2.7 mm). Thirty-one aneurysms (51.7%) arose from the internal carotid artery (right/left 1.4), most commonly in the cavernous segment (10/31 [32.3%]). Mean size change over the entire follow-up of 109 patient-years was a decrease of 0.6 ± 4.2 mm (range −30.0 to +4.0 mm, rate −0.12 ± 9.9 mm/yr). Interval growth (2.0 ± 1.0 mm) was seen in 8 aneurysms (13.3%; 4 saccular, 4 fusiform). An interval decrease in size (8.3 ± 10.7 mm) was seen in 6 aneurysms (10%). There was an inverse relationship between aneurysm size and growth rate (r = −0.82, p < 0.00001). One aneurysm was treated endovascularly with internal carotid artery sacrifice.CONCLUSIONSUnruptured pediatric intracranial aneurysms are most frequently single but can occur in multiples in a syndromic setting. None of the cases from the study period showed clinical or imaging signs of rupture. Growth over time, although unusual and slow, can occur in a proportion of these patients, who should be identified for short-term imaging surveillance.

Sign in / Sign up

Export Citation Format

Share Document