scholarly journals Comparative results of operative and endovascular treatment of intracranial aneurysms

2011 ◽  
Vol 58 (3) ◽  
pp. 49-57
Author(s):  
Igor Nikolic ◽  
Branislav Nestorovic ◽  
Goran Tasic ◽  
Miodrag Rakic ◽  
Vaso Antunovic ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Subarachnoid Haemorrhage ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
International Experience ◽  
Aneurysm Treatment ◽  
Patient Status ◽  
Treatment Analysis ◽  
Comparative Results

Terapeutic protoclol for intracranial aneurysm treatment is very complex. In depand of patient status and anviografic founding we determinate modality and time of treatment. Analysis included 137 patients who were treated in Neurosurgical clinic CCS because sponatenus subarachnoid haemorrhage rigine from aneurysm belading. We performed direct surgery (microsurgery) in 109 patients. In early termine we operated 28 patients (25.69%), in first 24 hours 5 of them. In interemdiare period we performed surgery in 9, and other 72 patient we operated in postpone period. Embolisation was performed in 22 patinet. GOS form embolised patient was 4.636+0.581 and in operated 4.113+1.106 (p<0.05). Cumulative experient of Neurisurgical Clinic CCS and sumation of international experience impose as the best treatment is the treatment which is best known for the physitan.

scholarly journals Diagnostic Validity of 3D-Computed Tomographic Angiography in Spontaneous Subarachnoid Haemorrhage

2019 ◽  
Vol 5 (1) ◽  
pp. 47-52
Author(s):  
Nur Mohammad ◽  
Jalal Uddin Mohammad Rumi ◽  
Sadia Jabeen Khan ◽  
Kalim Uddin ◽  
Patoary Mohammed Faruque
Keyword(s):  
Intracranial Aneurysm ◽  
Positive Predictive Value ◽  
Subarachnoid Haemorrhage ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Intracranial Aneurysms ◽  
Computed Tomographic Angiography ◽  
Diagnostic Validity ◽  
Computed Tomographic ◽  
Tomographic Angiography

Background: Diagnostic validity of different tests for the detection of spontaneous subarachnoid haemorrhage is an important issue. Objectives: The purpose of the present study was to validate 3D-Computed tomographic angiography in spontaneous subarachnoid haemorrhage. Methodology: This cross-sectional study was carried out in the Department of Neurosurgery and Cath Lab of DMCH in collaboration with private diagnostic centre from September 2013 to February 2015 for a period of six (06) months. Adult patients diagnosed as a case of spontaneous SAH based on clinical features and confirmed by plain CT evidence of subarachnoid blood were included as study population. Patients having current history of trauma, poor clinical grade and agitated patient, patient with renal insufficiency, known allergy to iodinated contrast agent and patients who were not willing participate in the study were excluded from this study. Then both CT angiography and DSA were performed to detect cause of bleeding and to make a treatment planning. In this study DSA was considered as reference standard for evaluation of CTA. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CTA were calculated per patient basis and per aneurysmal basis. Result: A total number of 37 patients presented with spontaneous subarachnoid haemorrhage were recruited for this study. The mean age of patients was 58.53±7.54 years. Sensitivity and specificity in depicting intracranial aneurysms were, 93.75% and 100% respectively on a per-patient basis. Positive predictive value and negative predictive value of CTA are 100% and 71.43% respectively. CTA had shown 94.59% accuracy in detection of intracranial aneurysm. Sensitivity and specificity in depicting intracranial aneurysms were 94.74% and 100% respectively on a per-aneurysm basis. Positive predictive value and negative predictive value of CTA are 100% and 71.43% respectively. CTA had shown 95.35% accuracy in detection of intracranial aneurysm. Conclusion: In conclusion CTA has high detection capacity of aneurysm among spontaneous subarachnoid haemorrhage patients. Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 47-52

scholarly journals Complications in the Treatment of Intracranial Aneurysms with Silk Stents: An Analysis of 30 Consecutive Patients

2012 ◽  
Vol 18 (4) ◽  
pp. 413-425 ◽  
Author(s):  
L. Cirillo ◽  
M. Leonardi ◽  
M. Dall'Olio ◽  
C. Princiotta ◽  
A. Stafa ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Mass Effect ◽  
Late Complications ◽  
Giant Aneurysms ◽  
Risk Of Bleeding ◽  
Carotid Siphon ◽  
Aneurysm Treatment ◽  
Vertebrobasilar Circulation

Flow-diverting stents (Silk and PED) have radically changed the approach to intracranial aneurysm treatment from the use of endosaccular materials to use of an extraaneurysmal endoluminal device. However, much debate surrounds the most appropriate indications for the use of FD stents and the problems raised by several possible complications. We analysed our technical difficulties and the early (less than ten days after treatment) and late complications encountered in 30 aneurysms treated comprising 13 giant lesions, 12 large, five with maximum diameters <10 mm and one blister-like aneurysm. In our experience the primary indications for the use of FD stents can be the symptomatic intracavernous giant aneurysms. Although the extracavernous carotid siphon aneurysms have major risk of bleeding, FD stents are indicated clearly explaining the risks to the patient in case of severe mass effect. There is a very complex assessment for aneurysms of the vertebrobasilar circulation.

Feasibility, Safety, and Periprocedural Complications of Pipeline Embolization for Intracranial Aneurysm Treatment Under Conscious Sedation: University at Buffalo Neurosurgery Experience

2015 ◽  
Vol 11 (3) ◽  
pp. 426-430 ◽  
Author(s):  
Leonardo Rangel-Castilla ◽  
Marshall C Cress ◽  
Stephan A Munich ◽  
Ashish Sonig ◽  
Chandan Krishna ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
General Anesthesia ◽  
Radiation Exposure ◽  
Intracranial Aneurysms ◽  
Conscious Sedation ◽  
Contrast Material ◽  
Neurological Complications ◽  
Safe Procedure ◽  
Aneurysm Treatment ◽  
The Mean

Abstract BACKGROUND Endovascular Pipeline Embolization Device (PED) placement for intracranial aneurysms is performed under general anesthesia at most centers because of perceived improved image quality and patient safety. OBJECTIVE To report the feasibility, safety, and outcomes associated with the use of the PED for intracranial aneurysms performed in awake patients after the administration of conscious sedation (CS) and a local anesthetic. METHODS Between March 2012 and September 2014, 130 patients with 139 intracranial aneurysms (8 ruptured) were treated with the PED under CS at our institution. Procedure details and time (including duration, radiation exposure, and fluoroscopy) and procedure-related complications were retrospectively reviewed. RESULTS A total of 155 PED deployment procedures were performed under CS. Treatment was successfully completed in all cases. Anesthesia was converted from CS to general anesthesia during 5 procedures. Mean interval from patient entry at the endovascular suite to procedure initiation was 18 minutes (range, 5 minutes-1 hour 10 minutes). Mean procedure length was 1 hour 25 minutes (range, 30 minutes-3 hours 51 minutes). Mean ± SD values for fluoroscopy time and radiation exposure were 36.17 ± 18.4 minutes and 1367 ± 897 mGy, respectively. The mean amount of contrast material administered was 211.37 ± 83.5 mL. Permanent neurological complications were seen in 4 patients (3%). CONCLUSION In our experience, CS for PED placement for intracranial aneurysm treatment is feasible and safe. Procedure and fluoroscopy times and amount of radiation exposure are similar to or less than described in reports of PED placement under general anesthesia. CS allows direct neurological evaluation and earlier detection of and response to intraprocedural complications.

scholarly journals Prevalence of thunderclap headache in patients with ruptured intracranial aneurysms: series of 60 cases

2019 ◽  
pp. 189-192
Author(s):  
Bruno Bertoli Esmanhotto ◽  
Elcio Juliato Piovesan ◽  
Marcos Christiano Lange
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysm ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Thunderclap Headache ◽  
Head Pain ◽  
Ruptured Intracranial Aneurysm ◽  
One Year ◽  
Time Of Admission ◽  
Ruptured Intracranial Aneurysms

Thunderclap headache (TCH) is a head pain that begins suddenly and is severe at onset. TCH might be the first sign of subarachnoid hemorrhage. This study was conducted to evaluate the presence of thunderclap headache (TCH) in patients with ruptured intracranial aneurysm (RIA) and endovascular treatment (EVT). We evaluated the pattern of headache in 60 patients who suffered a RIA and EVT at time of admission and prospectively evaluated the characteristics of previous headache within one year before the rupture. Thirty-one patients (51,7 %) had TCH related to the rupture. Aneurysm size does not affect the occurrence of thunderclap headache (p=0,08). The vascular aneurysm territory is not related to presence of TCH (p=0,527). The prevalence of TCH in this cohort was similar to previous studies. All patients with acute thunderclap headache should be evaluated for subarachnoid hemorrhage.

Abstract W P75: New Generation Hydrogel Endovascular Aneurysm Treatment Trial

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Samer G Zammar ◽  
Youssef J Hamade ◽  
Jennifer Ward ◽  
Byron K Yip ◽  
Nicole Reinholdt ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Packing Density ◽  
Intracranial Aneurysms ◽  
Recurrence Rates ◽  
2Nd Generation ◽  
Aneurysm Treatment ◽  
Unruptured Intracranial Aneurysms ◽  
Bare Platinum Coils ◽  
New Generation ◽  
Platinum Coils

Background: Endovascular treatment of intracranial aneurysms has seen significant advances. One major limitation of the endovascular approach is durability of treatment and aneurysm recanalization. To address this issue, one approach was the development of hydrogel-coated coils. Hydrogel expands upon exposure to blood and thus enhances coil packing density. Higher initial coil packing density may potentially result in lower rates of recurrence. Hypothesis: The 2nd Generation HydroCoil Embolic System allows for a higher packing density, higher initial occlusion, lower recanalization, and lower retreatment rates compared to bare platinum coils. Objective: To compare clinical and angiographic outcomes (initial complete occlusion, recanalization, retreatment, and adverse event rates) in patients receiving the 2nd Generation HydroCoil Embolic System versus patients receiving bare platinum coils. Methods: This is a randomized, controlled, multicenter, post-market clinical trial. Subjects between 18 and 75 years of age with ruptured or unruptured intracranial aneurysms (3-14 mm in size) who are amenable to endovascular treatment are randomly assigned 1:1 to one of two treatment arms: 1) the HydroCoil Embolic System (HES), or 2) bare platinum coils. No bioactive coils, 1st generation HydroCoils or liquid embolics are allowed in the study. In the HES arm, up to 10% of total coil length using bare platinum is allowed if deemed necessary by the investigator. Any type of bare platinum coil may be utilized in the bare platinum arm. Assist-devices can be used at the discretion of the investigator. The duration of the open enrollment phase will be 24 months or until the required number of subjects are enrolled (n = 600). Each subject will have a post-procedure follow-up of at least 18 months. Subjects will be recruited from up to 50 national and international centers. Each Investigational Site will be expected to enroll at least 20 Subjects. Results: A total of 368 patients have been enrolled to date in the study. The study is still ongoing. Conclusions: A limitation of endovascular aneurysm treatment is recurrence. This trial aims to answer the question of whether the new generation hydrogel coil reduces recurrence rates when compared to bare platinum coils.

Advances in Endovascular Approaches to Cerebral Aneurysms

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S17-S31 ◽  
Author(s):  
Travis M. Dumont ◽  
Jorge L. Eller ◽  
Maxim Mokin ◽  
Grant C. Sorkin ◽  
Elad I. Levy
Keyword(s):  
Endovascular Treatment ◽  
Medical Therapy ◽  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Diagnostic Tools ◽  
Aneurysm Treatment ◽  
Technical Advances

Abstract Recent advancements in all phases of endovascular aneurysm treatment, including medical therapy, diagnostics, devices, and implants, abound. Advancements in endovascular technologies and techniques have enabled treatment of a wide variety of intracranial aneurysms. In this article, technical advances in endovascular treatment of cerebral aneurysms are discussed, with an effort to incorporate a clinically relevant perspective. Advancements in diagnostic tools, medical therapy, and implants are reviewed and discussed.

scholarly journals Evaluation of clinical and anatomical outcome of staged stenting after acute coiling of ruptured intracranial aneurysms

2019 ◽  
Vol 26 (3) ◽  
pp. 260-267 ◽  
Author(s):  
Benjamin Mine ◽  
Thomas Bonnet ◽  
Juan Carlos Vazquez-Suarez ◽  
Noémie Ligot ◽  
Boris Lubicz
Keyword(s):  
Intracranial Aneurysm ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Clinical Status ◽  
Long Term Stability ◽  
Ruptured Intracranial Aneurysm ◽  
Improved Stability ◽  
Ruptured Intracranial Aneurysms ◽  
Anatomical Outcome

Introduction Stent-assisted coiling has widened indications and improved stability of endovascular treatment of intracranial aneurysms. However, stent-assisted coiling is usually not used to treat acutely ruptured intracranial aneurysms to avoid antiplatelet therapy. The objective of this study is to evaluate a strategy of staged endovascular treatment of ruptured intracranial aneurysms including coiling at the acute phase with complementary stenting with or without coiling at the subacute phase. Material and methods Between 2012 and 2017, we retrospectively identified, in our prospectively maintained database, all patients treated for a ruptured intracranial aneurysm based on this staged stenting strategy. Clinical charts and imaging follow-up were analyzed to assess the procedural safety and feasibility as well as clinical and anatomical outcome. Results We identified 23 patients with 23 intracranial aneurysms including 15 (65.2%) women with a mean age of 50 years (range 24–69 years). No rebleeding occurred during the mean delay of 24.3 days between initial coiling and stenting. All procedures were successful and additional coiling was performed in 5/23 procedures (21.7%). Clinical status was unchanged in all patients. At follow-up, the modified Rankin scale was graded 0 in 19/23 (82.6%), 1 in 2/23 (8.7%), and 2 in 2/23 (8.7%) patients, respectively. The rate of complete occlusion rose from 30.4% before the stenting procedure to 52.2% immediately after and 72.7% at follow-up. Conclusion This strategy of early staged stenting in selected patients is safe and improves immediate intracranial aneurysm occlusion and long-term stability in this population at high risk of intracranial aneurysm recurrence with coiling alone.

scholarly journals Concomitant Endovascular Treatment of Concomitant Extracranial Carotid Stenosis and Intracranial Aneurysm

2009 ◽  
Vol 15 (1) ◽  
pp. 53-59 ◽  
Author(s):  
J.I. Gallego León ◽  
L. Concepción Aramendía ◽  
F. Ballenilla Marco ◽  
J.C. Vázquez Suárez
Keyword(s):  
Intracranial Aneurysm ◽  
Endovascular Treatment ◽  
Carotid Stenosis ◽  
Intracranial Aneurysms ◽  
Carotid Stenting ◽  
Alternative Treatments ◽  
Single Procedure ◽  
Diagnosis Rate ◽  
Angioplasty And Stenting ◽  
Aneurysm Coiling

Angioplasty and stenting are emerging alternative treatments to endarterectomy for carotid stenosis. The increasing number of procedures performed carries an increased diagnosis rate of associated asymptomatic intracranial aneurysms, resulting in a clinical and therapeutic dilemma, not fully solved in the literature. When an incidental lesion is found, the first question is whether it is necessary to treat it or not? If treatment is decided, the next question is which should be treated first, the intra or the extracranial lesion? We review our experience and the literature and discuss our preferred approach of single-procedure carotid stenting and aneurysm coiling, which we believe is feasible, safe and effective constituting an option when confronted with this difficult therapeutic dilemma.

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