Endovascular treatment of 306 anterior communicating artery aneurysms: overall, perioperative results

2009 ◽  
Vol 110 (5) ◽  
pp. 874-879 ◽  
Author(s):  
Guido Guglielmi ◽  
Fernando Viñuela ◽  
Gary Duckwiler ◽  
Reza Jahan ◽  
Enrico Cotroneo ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Clinical Status ◽  
Mass Effect ◽  
Anterior Communicating Artery ◽  
Technical Developments ◽  
Personality Changes ◽  
Detachable Coils ◽  
Endovascular Approach ◽  
Aneurysm Occlusion

Object A series of 306 consecutive patients with an anterior communicating artery (ACoA) aneurysm is presented. The goal in this study was to report the results of endovascular treatment of ACoA aneurysms in these patients. Methods The aneurysms were managed with an endovascular approach in which detachable coils were used. A brief anatomical description of the ACoA and its branches as well as a review of the surgical and endovascular literature is presented. The “ACoA Syndrome” (that is, amnesia and personality changes), which may occur after subarachnoid hemorrhage, is briefly reviewed and described. Recent technical developments that can lead to improved results are also discussed. Results Of the 306 aneurysms, 268 (87.5%) were small, 30 (10%) were large, and 8 (2.6%) were giant. One hundred ninety-three aneurysms (63%) had a small neck, whereas 113 (37%) had a wide neck. Sixty-five lesions (21%) were incidental, 5 (2%) presented with symptoms of mass effect, and 236 (77%) presented with a subarachnoid hemorrhage. A complete aneurysm occlusion was attained in 139 cases (45.5%), a neck remnant was detected in 145 (47.5%), and in 22 cases (7%) a residual filling of the aneurysm was observed. Regarding the clinical neurological outcome, 280 patients (91.5%) remained neurologically intact, improved, or unchanged from their initial clinical status. Two large, wide-necked, subtotally occluded aneurysms ruptured 3–7 months after the procedure, with subsequent death of the patients. The procedure-related morbidity and mortality rates were 3.5% (11 cases) and 1% (3 cases), respectively. Conclusions The inherently lower risk of injuring or occluding the delicate branches and perforating vessels arising from the ACoA makes the endovascular approach attractive, interesting, and elegant.

Terson sign:

2020 ◽  
Vol 2 (1) ◽  
pp. 38-43
Author(s):  
Luiz Severo Bem Junior ◽  
Gustavo De Souza Andrade ◽  
Joao Ribeiro Memória Júnior ◽  
Hildo Rocha Cirne de Azevedo Filho
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Early Recognition ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Case Reports ◽  
Clinical Status ◽  
Vitreous Hemorrhage ◽  
Anterior Communicating Artery ◽  
Inclusion Criteria ◽  
Relationship Of ◽  
The Relationship

Terson's sign (TS) is classically defined as vitreous hemorrhage associated with subarachnoid hemorrhage of aneurysmal origin, being an important predictor of severity, indicating greater morbidity and mortality when compared to patients without the sign. The objective of this study is to review the relationship of Terson syndrome/Terson sign with the prognosis of aneurysmal subarachnoid hemorrhage. A search for original articles, research and case reports was performed on the PubMed, Scielo, Cochrane and ScienceDirect platform, with the following descriptors: Terson sign and subarachnoid hemorrhage. Retrospective, prospective articles and case reports published in the last 5 years and which were in accordance with the established objective and inclusion criteria were selected. Ten (10) articles were selected, in which the available results show an unfavorable prognostic relationship of TS and subarachnoid hemorrhage, because these patients had a worse clinical status assessed on the Glasgow scales ≤ 8, Hunt & Hess > III, Fisher > 3, in addition to intracranial hypertension and location of the aneurysm in the anterior communicating artery complex. The early recognition of this condition described by Albert Terson in 1900 brought an important contribution to neurosurgery, being recognized until nowadays.

Endovascular Treatment of Complex Aneurysms at the Vertebrobasilar Junction With Flow-Diverting Stents

Neurosurgery ◽  
2013 ◽  
Vol 73 (3) ◽  
pp. 386-394 ◽  
Author(s):  
Stephan Meckel ◽  
William McAuliffe ◽  
David Fiorella ◽  
Christian A. Taschner ◽  
Constantine Phatouros ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Significant Risk ◽  
Mass Effect ◽  
Complex Aneurysms ◽  
Brainstem Compression ◽  
Ischemic Complications ◽  
Vertebrobasilar Junction ◽  
Alternative Approaches

Abstract BACKGROUND: Large or giant complex vertebrobasilar junction aneurysms have a dismal natural history and are often challenging to treat with standard endovascular or neurosurgical techniques. OBJECTIVE: To report initial experience with endovascular treatment of these aneurysms using flow-diverting stents (FDS). METHODS: Ten patients with FDS treatment of complex vertebrobasilar junction aneurysms were collected from 4 large cerebrovascular centers. Clinical/angiographic presentation and outcome were retrospectively analyzed. RESULTS: Of 10 aneurysms, 7 presented with brainstem compression, 2 with ischemia, and 1 with subarachnoid hemorrhage, and 3 were recurrent after stent-assisted treatments. Eight were giant. Morphology was fusiform in 5, fusiform dissecting in 1, and multilobulated saccular in 4. Six were partially thrombosed. In addition to FDS (mean number of devices, 3.9; range, 1-9), contralateral vertebral artery sacrifice and adjunctive coiling were performed in 9 and 5 of the 10 patients, respectively. At follow-up, 5 of 10 were completely occluded, 4 showed minimal residual filling, and 1 was retreated with an additional FDS. Postinterventionally, worsening mass effect and ischemic complications were seen in 2 and 4 of 10, respectively. Clinical outcome was good in 6 (modified Rankin Scale score, 0-2). Four fatalities were related to sequelae of subarachnoid hemorrhage, late FDS thrombosis, progressive mass effect, and delayed intracranial hemorrhage. CONCLUSION: FDS may be used to treat complex vertebrobasilar junction aneurysms with overall good angiographic outcome. A combined reconstructive/deconstructive approach appears useful to avoid endoleaks. FDS strategies, like other endovascular and neurosurgical approaches to these lesions, are associated with significant risk and therefore should be reserved for those cases in which alternative approaches either are deemed unsafe or are likely to be ineffective.

scholarly journals Endovascular treatment of bifurcation intracranial aneurysms with the WEB SL/SLS: 6-month clinical and angiographic results

2015 ◽  
Vol 21 (4) ◽  
pp. 462-469 ◽  
Author(s):  
Patricia Bozzetto Ambrosi ◽  
Benjamin Gory ◽  
Rotem Sivan-Hoffmann ◽  
Roberto Riva ◽  
Francesco Signorelli ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Single Layer ◽  
Additional Treatment ◽  
Anterior Communicating Artery ◽  
Neck Size ◽  
Aneurysm Occlusion ◽  
Web Device ◽  
The Web

Background The WEB device is a recent intrasaccular flow disruption technique developed for the treatment of wide-necked intracranial aneurysms. To date, a single report on the WEB Single-Layer (SL) treatment of intracranial aneurysms has been published with 1-months' safety results. The aim of this study is to report our experience and 6-month clinical and angiographic follow-up of endovascular treatment of wide-neck aneurysm with the WEB SL. Methods Ten patients with 10 unruptured wide-necked aneurysms were prospectively enrolled in this study. Feasibility, intraoperative and postoperative complications, and outcomes were recorded. Immediate and 6-month clinical and angiographic results were evaluated. Results Failure of WEB SL placement occurred in two cases. Eight aneurysms were successfully treated using one WEB SL without additional treatment. Three middle cerebral artery, four anterior communicating artery, and one basilar artery aneurysms were treated. Average dome width was 7.5 mm (range 5.4–10.7 mm), and average neck size was 4.9 mm (range 2.6–6.5 mm). No periprocedural complication was observed, and morbi-mortality at discharge and 6 months was 0.0%. Angiographic follow-up at 6 months demonstrated complete aneurysm occlusion in 2/8 aneurysms, neck remnant in 5/8 aneurysms, and aneurysm remnant in 1/8 aneurysm. Conclusions From this preliminary study, treatment of bifurcation intracranial aneurysms using WEB SL is feasible. WEB SL treatment seems safe at 6 months; however, the rate of neck remnants is not negligible due to compression of the WEB SL. Further technical improvements may be needed in order to ameliorate the occlusion in the WEB SL treatment.

scholarly journals Flow diversion and microvascular plug occlusion for the treatment of a complex unruptured basilar/superior cerebellar artery aneurysm: case report

2019 ◽  
Vol 130 (6) ◽  
pp. 1978-1983 ◽  
Author(s):  
Jan-Karl Burkhardt ◽  
Howard A. Riina ◽  
Omar Tanweer ◽  
Peyman Shirani ◽  
Eytan Raz ◽  
...  
Keyword(s):  
Case Report ◽  
Treatment Options ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Superior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Endovascular Approach ◽  
Aneurysm Occlusion ◽  
The Right

The authors present the unusual case of a complex unruptured basilar artery terminus (BAT) aneurysm in a 42-year-old symptomatic female patient presenting with symptoms of mass effect. Due to the fusiform incorporation of both the BAT and left superior cerebellar artery (SCA) origin, simple surgical or endovascular treatment options were not feasible in this case. A 2-staged (combined deconstructive/reconstructive) procedure was successfully performed: first occluding the left SCA with a Pipeline embolization device (PED) coupled to a microvascular plug (MVP) in the absence of antiplatelet coverage, followed by reconstruction of the BAT by deploying a second PED from the right SCA into the basilar trunk. Six-month follow-up angiography confirmed uneventful aneurysm occlusion. The patient recovered well from her neurological symptoms. This case report illustrates the successful use of a combined staged deconstructive/reconstructive endovascular approach utilizing 2 endoluminal tools, PED and MVP, to reconstruct the BAT and occlude a complex aneurysm.

Electrothrombosis of saccular aneurysms via endovascular approach

1991 ◽  
Vol 75 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Guido Guglielmi ◽  
Fernando Viñuela ◽  
Jacques Dion ◽  
Gary Duckwiler
Keyword(s):  
Subarachnoid Hemorrhage ◽  
High Risk ◽  
Clinical Presentation ◽  
New Technology ◽  
Parent Artery ◽  
Content Type ◽  
Detachable Coils ◽  
Endovascular Approach ◽  
Permanent Neurological Deficit ◽  
Saccular Aneurysms

✓ Fifteen patients with high-risk intracranial saccular aneurysms were treated using electrolytically detachable coils introduced via an endovascular approach. The patients ranged in age from 21 to 69 years. The most frequent clinical presentation was subarachnoid hemorrhage (eight cases). Considerable thrombosis of the aneurysm (70% to 100%) was achieved in all 15 patients, and preservation of the parent artery was obtained in 14. Although temporary neurological deterioration due to the technique was recorded in one patient, no permanent neurological deficit was observed in this series and there were no deaths. It is believed that this new technology is a viable alternative in the management of patients with high-risk intracranial saccular aneurysms. It may also play an important role in the occlusion of aneurysms in the acute phase of subarachnoid hemorrhage.

scholarly journals Endovascular treatment of wide-neck intracranial bifurcation aneurysms with ‘Y’-configuration, double Neuroform® stents-assisted coiling technique: Experience in a single center

2017 ◽  
Vol 23 (4) ◽  
pp. 362-370 ◽  
Author(s):  
C Castaño ◽  
M Terceño ◽  
S Remollo ◽  
MR García-Sort ◽  
C Domínguez
Keyword(s):  
Endovascular Treatment ◽  
Medical Records ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Anterior Communicating Artery ◽  
Single Center ◽  
Endovascular Approach ◽  
Double Stent ◽  
Wide Neck

Background Intracranial wide-neck aneurysms at the arterial bifurcations, especially in the aneurysms where the bifurcating branches emanate directly from the base of the aneurysm, have been particularly difficult on which to perform endovascular treatment. The ‘Y’-configuration, double stent-assisted coil embolization is an option for the treatment of these difficult aneurysms, allowing the closure of the aneurysm, preserving the parent arteries. Material and methods In a nine-year period, 546 intracranial aneurysms in 493 patients were treated at our center by endovascular approach. We have reviewed the medical records and arteriographies from November 2007 to January 2017 of 45 patients who were treated using ‘Y’-configuration double Neuroform® stent-assisted coil embolization. Results All patients were successfully treated. The location of the aneurysms were: middle cerebral artery (MCA) 20 (44.4%), anterior communicating artery (AComA) 17 (37.7%), basilar four (8.9%), internal carotid artery (ICA) bifurcation three (6.6%) and posterior communicating artery (PComA) one (2.2%). The mRS at hospital discharge was: mRS 0: 42 (93.3%), mRS 1: 1 (2.2%), mRS 2: 1 (2.2%) and mRS 5: 1 (2.2%). The Modified Raymond-Roy Occlusion Classification, in the control at six months, was: Class I: 41 (91.1%), Class II: 2 (4.4%), Class IIIa: 1 (2.2%) and Class IIIb: 1 (2.2%). Forty-four (97.8%) patients had a good outcome (mRS < 2) at six months. One (2.2%) patient had a poor outcome (mRS > 2) at six months that was due to sequelae of SAH. There was no mortality at six months. Conclusions This technique is safe and effective for the endovascular treatment of difficult wide-neck bifurcation aneurysms, allowing the stable closure of the aneurysm, preserving the parent arteries.

scholarly journals Endovascular Treatment of Unruptured A1 Segment Aneurysms

2013 ◽  
Vol 19 (2) ◽  
pp. 186-194 ◽  
Author(s):  
Huo Xiaochuan ◽  
Sun Xiaoyun ◽  
Li Youxiang ◽  
Guan Ning ◽  
Guo Wenshi ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Anterior Cerebral Artery ◽  
Therapeutic Option ◽  
Special Technique ◽  
Selective Embolization ◽  
Shaping Technique ◽  
Close Relationship ◽  
Endovascular Approach ◽  
Aneurysm Occlusion ◽  
Excellent Clinical Outcome

Aneurysms of the A1 segment of the anterior cerebral artery (A1A) are rare and challenging to treat. Less information is available regarding their management by endovascular approach. We evaluated our experience of endovascular treatment in 15 patients with unruptured A1As. We retrospectively reviewed unruptured A1As treated by embolization at our hospital. The clinical data and angiographic results were reviewed. A special technique involving shaping microcatheter tips was used for catheterization. From September 2009 to December 2012, 15 patients presenting with unruptured A1As were identified. All the patients were treated by selective embolization including five patients with balloon-assisted coiling (BAC) or stent-assisted coiling (SAC). These adjunctive techniques were used to catheterize the sac safely or to protect a branch at the neck. According to the location and direction of the aneurysm, “Z-shaped”, “S-Shaped” or “U-Shaped” microcatheter tip shaping was used for microcatheter positioning and stabilization. All patients showed an excellent clinical outcome. A complete aneurysm occlusion was obtained in all the patients. Endovascular treatment of A1As is feasible and associated with good results. Because of their location and close relationship with perforators, endovascular treatment of A1As sometimes requires the use of BAC or SAC. The microcatheter tip shaping technique is very important for coiling. Our results suggest that endovascular treatment is a suitable therapeutic option for unruptured A1As when the aneurysm size is optimal for embolization.

Intra-Aneurysmal Occlusion of Cerebral Aneurysms Using Detachable Coils: Correlation of Aneurysm Neck Size and Treatment Results

1997 ◽  
Vol 3 (2_suppl) ◽  
pp. 114-117
Author(s):  
K. Irie ◽  
W. Taki ◽  
I. Nakahara ◽  
N. Sakai ◽  
F. Isaka ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Treatment Results ◽  
Neck Size ◽  
Aneurysm Neck ◽  
Detachable Coils ◽  
Aneurysm Occlusion ◽  
Aneurysmal Neck ◽  
Wide Neck

The aneurysmal neck size seems to be an import ant factor in the endovascular treatment outcome4,5. The purpose of the present study was to measure aneurysm neck size on angiographic films, and compare the measured value with the extent of intra-aneurysmal occlusion performed with detachable coils. The subjects were 22 patients with intracranial aneurysms treated using detachable coils. The cases were divided into two groups according to the aneurysmal neck size, 4 mm being the discriminating value for small neck. The neck of the aneurysm was successfully occluded in 19 of 22 patients. Ten aneurysms had a small neck and 9 aneurysms had a wide neck. Complete aneurysm occlusion was observed in 70% of small neck aneurysms and 25% of wide neck aneurysms. The results support that the size of the aneurysm neck correlates well with the effectiveness of endovascular treatment.

scholarly journals Endovascular Treatment of Berry Intracranial Aneurysms Using a New Detachable Coil System

2001 ◽  
Vol 7 (2) ◽  
pp. 93-102 ◽  
Author(s):  
A. Tournade ◽  
C. Riquelme ◽  
M. Musacchio ◽  
F. Mont'Alverne
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Low Cost ◽  
Clinical Status ◽  
Stage Iv ◽  
Anterior Communicating Artery ◽  
Detachable Coil ◽  
Selective Embolization

We aimed to assess and to demonstrate the efficiency of a new mechanical system in the endovascular treatment of berry intracranial aneurysms. From September 1999 to October 2000, 38 patients with 40 aneurysms experienced selective embolization using Detach Coils (DCS® — Cook). They were 12 men and 26 women, aged 26 to 77 years, mean age 53.4. The clinical status of patients was graded by Hunt and Hess scale: Stage 0:8 — stage I:3 — Stage II: 11 — Stage III: 11 — Stage IV: 2 — Stage V: 3. The localization of aneurysms was as follows: internal carotid artery: 11; sylvian artery: 10; anterior communicating artery: 5; anterior cerebral artery A1-A2: 5; intra-cavernous carotid artery: 1; basilar trunk: 5; PICA: 2; posterior cerebral artery: 1. The size of the aneurysms ranged from 2 to 40 mm. For embolization of aneurysms, we utilized 242 coils (mean number 6.05). The shape and size of coils varied as follows: longest J 6.25 — shortest J 4–3 — longest S 10–20 — shortest S 2–2. The mean time of procedure was 43 minutes (max 180 minutes — min 7 minutes). We did not have any technical complications during the procedure and no immediate rebleeding occurred. Initial follow-up of the patients showed angiographic full occlusion. Detach Coils appear to be a very precise, reliable and rapid system, with high stability during coil detachment (in very small or very giant aneurysms) in the embolization of intracranial aneurysms, with an interesting aspect concerning the low cost of this new mechanical device.

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