Endovascular treatment of very small intracranial aneurysms

2010 ◽  
Vol 112 (3) ◽  
pp. 551-556 ◽  
Author(s):  
Ioannis Ioannidis ◽  
Shivendra Lalloo ◽  
Rufus Corkill ◽  
Wilhelm Kuker ◽  
James V. Byrne
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Endovascular Procedures ◽  
Thromboembolic Events ◽  
Technical Challenge ◽  
Angiographic Evidence ◽  
Intraoperative Rupture ◽  
Small Aneurysms

Object Endovascular treatment of very small aneurysms poses a significant technical challenge for endovascular therapists. The authors review their experience with a series of patients who had intracranial aneurysms smaller than 3 mm in diameter. Methods Between 1995 and 2006, 97 very small aneurysms (defined for purposes of this study as < 3 mm in diameter) were diagnosed in 94 patients who were subsequently referred for endovascular treatment. All patients presented after subarachnoid hemorrhage, which was attributed to the very small aneurysms in 85 patients. The authors reviewed the endovascular treatment, the clinical and angiographic results of the embolization, and the complications. Results Five (5.2%) of the 97 endovascular procedures failed, and these patients underwent craniotomy and clip ligation. Of the 92 aneurysms successfully treated by coil embolization, 64 (69.6%) were completely occluded and 28 (30.4%) showed minor residual filling or neck remnants on the immediate postembolization angiogram. Complications occurred in 7 (7.2%) of 97 procedures during the treatment (3 thromboembolic events [3.1%] and 4 intraprocedural ruptures [4.1%]). Seventy-six patients were followed up angiographically; 4 (5.3%) of these 76 showed angiographic evidence of recanalization that required retreatment. The clinical outcomes for the 76 patients were also graded using the Glasgow Outcome Scale. In 61 (80.3%) cases the outcomes were graded 4 or 5, whereas in 15 (19.7%) they were graded 3. Seven patients (7.4%) died (GOS Grade 1), 2 due to procedure-related complications (intraoperative rupture) and 5 due to complications related to the presenting subarachnoid hemorrhage. Conclusions Endosaccular coil embolization of very small aneurysms is associated with relatively high rates of intraprocedural rupture, especially intraoperative rupture. With the advent of more sophisticated endovascular materials (microcatheters and microguidewires, soft and ultrasoft coils, and stents) endovascular procedures have become feasible and can lead to a good angiographic outcome.

Endovascular Treatment of Intracranial Aneurysms in the Elderly: Single-Center Experience in 63 Consecutive Patients

Neurosurgery ◽  
2005 ◽  
Vol 57 (6) ◽  
pp. 1096-1102 ◽  
Author(s):  
YiLing Cai ◽  
Laurent Spelle ◽  
Huan Wang ◽  
Michel Piotin ◽  
Charbel Mounayer ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Endovascular Procedures ◽  
The Elderly ◽  
High Grade ◽  
Single Center ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms

Abstract OBJECTIVE: With a globally aging population, it is imperative to develop specific treatment strategies for intracranial aneurysms in the elderly. However, the optimal management of intracranial aneurysms in the elderly remains controversial, particularly for the unruptured aneurysms. Although endovascular treatment is increasingly being used for the management of aneurysms, large endovascular series in the elderly population are relatively lacking, especially with regard to the unruptured aneurysms. We present our single-center endovascular experience in treating intracranial aneurysms in 63 consecutive patients 70 years of age and older. METHODS: Between November 1998 and December 2003, among a total of 990 patients with intracranial aneurysms treated endovascularly at our center, 63 patients (6%) were 70 years of age or older. Forty-one patients presented with subarachnoid hemorrhage (SAH), and 22 presented with symptomatic unruptured aneurysms. A total of 84 aneurysms were detected in these 63 patients. Only those responsible for either the subarachnoid hemorrhage or clinical symptoms (68 aneurysms) were treated. The aneurysm characteristics, endovascular procedures and techniques, angiographic and clinical outcomes, and complications were reviewed. RESULTS: Selective embolization failed in three aneurysms (4%). In the remaining 65 aneurysms, complete occlusion was achieved in 33 aneurysms (51%), neck remnant was observed in 17 aneurysms (27%), and residual aneurysmal filling was observed in six aneurysms (9%). Parent vessel occlusion was used in the treatment of nine aneurysms (13%). Thirteen procedure-related complications occurred (19%), six of which resulted in clinical complications (9%). Nine deaths (14%) occurred; three (5%) were directly related to the endovascular procedures, and six (9%) were related to the medical complications of SAH. The remaining 54 patients had a mean clinical follow-up time of 13 months (range, 1–47 mo). Ninety-one percent (20 out of 22) of the patients with unruptured aneurysms and 89% (25/28) of the patients with low-grade (Hunt and Hess Grade I and II) ruptured aneurysms achieved excellent outcomes (modified Rankin Scale score, 0–1), whereas 77% (10 out of 13) of the patients with high-grade (Hunt and Hess Grade ≥ III) ruptured aneurysms either died or had very poor outcomes (modified Rankin Scale score, 4–5). Angiographic follow-up (mean, 11 mo; range, 3–38 mo) was obtained in 34 of the 54 living patients (63%). Two aneurysms demonstrated minor changes that required no further treatment (5%). Five aneurysms showed major recurrences (17%), all of which were successfully retreated endovascularly. CONCLUSION: The elderly patients should merit strong consideration for endovascular treatment of both ruptured and symptomatic unruptured intracranial aneurysms. However, in elderly patients with high-grade subarachnoid hemorrhage, morbidity and mortality rates remain high.

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.

Murphey’s teat: history and insight into an enigmatic cerebrovascular eponym

2020 ◽  
Vol 133 (2) ◽  
pp. 369-373
Author(s):  
Daniel M. Heiferman ◽  
Daphne Li ◽  
Joseph C. Serrone ◽  
Matthew R. Reynolds ◽  
Anand V. Germanwala ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Important Work ◽  
Multiple Intracranial Aneurysms ◽  
Angiographic Evidence ◽  
Insight Into

Dr. Francis Murphey of the Semmes-Murphey Clinic in Memphis recognized that a focal sacculation on the dome of an aneurysm may be angiographic evidence of a culpable aneurysm in the setting of subarachnoid hemorrhage with multiple intracranial aneurysms present. This has been referred to as a Murphey’s “teat,” “tit,” or “excrescence.” With variability in terminology, misspellings in the literature, and the fact that Dr. Murphey did not formally publish this important work, the authors sought to clarify the meaning and investigate the origins of this enigmatic cerebrovascular eponym.

125 Staged Endovascular Treatment of Ruptured Intracranial Aneurysms: Acute Coiling Followed By Delayed Flow Diversion

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 228-228
Author(s):  
Erick Michael Westbroek ◽  
Matthew Bender ◽  
Narlin B Beaty ◽  
Bowen Jiang ◽  
Risheng Xu AB ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Complication Rate ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Major Complication ◽  
Flow Diversion ◽  
Neurological Deficits ◽  
Major Complication Rate ◽  
Ruptured Intracranial Aneurysms

Abstract INTRODUCTION ISAT demonstrated that coiling is effective for aneurysm treatment in subarachnoid hemorrhage (SAH); however, complete occlusion of wide-necked aneurysms frequently requires adjuvants relatively contraindicated in SAH. As such, a limited “dome occlusive” strategy is often pursued in the setting of SAH. We report a single institution series of coiling of acutely ruptured aneurysms followed by delayed flow diversion for definitive, curative occlusion. METHODS A prospectively collected IRB-approved database was screened for patients with aneurysmal SAH who were initially treated by coil embolization followed by planned flow diversion at a single academic medical institution. Peri-procedural outcomes, complications, and angiographic follow-up were analyzed. RESULTS >50 patients underwent both acute coiling followed by delayed, planned flow diversion. Average aneurysm size on initial presentation was 9.5 mm. Common aneurysm locations included Pcomm (36%), Acomm (30%), MCA (10%), ACA (10%), and vertebral (5%). Dome occlusion was achieved in all cases following initial coiling. Second-stage implantation of a flow diverting stent was achieved in 49/50 cases (98%). Follow-up angiography was available for 33/50 patients (66%), with mean follow-up of 11 months. 27 patients (82%) had complete angiographic occlusion at last follow up. All patients with residual filling at follow-up still had dome occlusion. There were no mortalities (0%). Major complication rate for stage I coiling was 2% (1 patient with intra-procedural aneurysm re-rupture causing increase in a previous ICH). Major complication rate for stage 2 flow diversion was 2% (1 patient with ischemic stroke following noncompliance with dual antiplatelet regimen). Minor complications occurred in 2 additional patients (4%) with transient neurological deficits. CONCLUSION Staged endovascular treatment of ruptured intracranial aneurysms with acute dome-occlusive coil embolization followed by delayed flow diversion is a safe and effective treatment strategy.

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

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.

Neonatal intracranial aneurysms: case report and review of the literature

2018 ◽  
Vol 21 (5) ◽  
pp. 471-477 ◽  
Author(s):  
Jeewaka E. Mohotti ◽  
Nicole S. Carter ◽  
Victor Jia Wei Zhang ◽  
Leon T. Lai ◽  
Christopher Xenos ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Time Of Flight ◽  
Review Of The Literature ◽  
Microsurgical Treatment ◽  
Enhanced Mri ◽  
Contrast Enhanced ◽  
Mca Aneurysm ◽  
Contrast Enhanced Mri

Intracranial aneurysms in the neonate, presenting in the first 4 weeks of life, are exceedingly rare. They appear to have characteristics, including presentation and location, that vary from those found in adults. The authors present a case of a 28-day-old neonate with a ruptured distal middle cerebral artery (MCA) aneurysm. Initial noninvasive imaging with transfontanelle ultrasound and CT confirmed intraparenchymal and subarachnoid hemorrhage. Contrast-enhanced MRI revealed a 14-mm ruptured fusiform MCA aneurysm that was not identified on time-of-flight magnetic resonance angiography (MRA). Microsurgical treatment was performed with partial neurological recovery. A comprehensive review of the literature from 1949 to 2017 revealed a total of 40 aneurysms in 37 neonates, including the present case. The most common presenting symptom was seizure. Although subarachnoid hemorrhage was the most common form of hemorrhage, 40% had intraparenchymal hemorrhage. The median aneurysm size was 10 mm (range 2–30 mm) and the most common location was the MCA, with two-thirds of cases involving the distal intracranial vasculature. Over the last 10 years, there has been a trend of increasing noninvasive diagnosis of ruptured cerebral aneurysms in neonates, with CT angiography and contrast-enhanced MRI being the most useful diagnostic modalities. The use of contrast-enhanced MRI may improve sensitivity over time-of-flight MRA. Microsurgical treatment was the most common treatment modality overall, with increased use of endovascular treatment in the last decade. Most patients underwent microsurgical vessel ligation or endovascular parent vessel occlusion. There were high rates of neurological recovery after microsurgical or endovascular treatment, particularly for patients with distal aneurysms.

scholarly journals Complications of endovascular treatment for intracranial aneurysms: Management and prevention

2018 ◽  
Vol 24 (3) ◽  
pp. 237-245 ◽  
Author(s):  
Yon Kwon Ihn ◽  
Shang Hun Shin ◽  
Seung Kug Baik ◽  
In Sup Choi
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Clinical Results ◽  
Flow Diverter ◽  
Endovascular Coiling ◽  
Thromboembolic Events ◽  
Comprehensive Review ◽  
Complex Aneurysms ◽  
Novel Treatment ◽  
Satisfactory Outcome

Endovascular coiling for intracranial aneurysms has become an accepted treatment with good clinical results and provides adequate protection against rebleeding and rupture of aneurysms. However, despite the experience, preparation, or skill of the physician, complications during endovascular treatment still occur. The main complications of endovascular coiling are: procedural aneurysmal perforations by the microcatheter, micro-guidewire, or coil, and thromboembolic events. Such situations are unexpected, complex, and can have devastating consequences. In this article, we present a comprehensive review of the two most common complications, aneurysmal perforation and thromboembolism during endovascular coiling, and how we can prevent or overcome these complications to achieve a satisfactory outcome. In addition, as the flow diverter has been become an important tool for management of large, wide necked, and other anatomically challenging aneurysms, we also describe complications stemming from the use of the tool, which remains a novel treatment option for complex aneurysms.

Balloon-assisted coil embolization of small intracranial aneurysms

2014 ◽  
Vol 37 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Peng Roc Chen
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Case Examples ◽  
Link Type ◽  
Aneurysm Embolization ◽  
Small Aneurysms ◽  
Small Aneurysm

It is generally considered difficult and risky to treat a small aneurysm (less than 4 mm) by use of coil embolization. The main issues are related to the following factors: frequently broad-based aneurysm with shallow dome, complex in shape, difficult to maintain microcatheter stability in an aneurysm, difficult to achieve complete coil packing, and higher risk of intra-procedure rupture hemorrhage. However, routine use of balloon-assisted coiling technique will enable us to achieve successful aneurysm embolization with safety. This video demonstrates some key nuances in the balloon-assisted coil embolization of small aneurysms via three case examples.The video can be found here: http://youtu.be/E1il3oPnUD8.

Intracranial Aneurysms in Children with Sickle-Cell Anemia

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4756-4756
Author(s):  
Manoelle Kossorotoff ◽  
Valentine Brousse ◽  
David Grevent ◽  
Michel Zerah ◽  
Olivier Naggara ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Brain Mri ◽  
Posterior Circulation ◽  
Moyamoya Syndrome ◽  
Stenotic Lesion ◽  
Concurrent Development

Abstract Abstract 4756 Background: Intracranial aneurysms in sickle-cell anemia (SCA) have been reported in about 50 adult patients, mostly presenting with subarachnoid hemorrhage (SAH). Aneurysms in those patients tend to be multiple (50%), to involve the posterior circulation more frequently than in the general population (33% vs 14%) and to be diagnosed at a younger age. In pediatric SCA patients, SAH has scarcely been reported, without evident link with stenotic cerebral vasculopathy. An associated intracranial aneurysm has only been demonstrated once in a teenager. Case reports: We report the cases of 2 children with sickle-cell anemia (HbSS) with intracranial aneurysms. The first patient was a 5-year old girl with abnormal transcranial Doppler (TCD) screening for cerebral vasculopathy: left middle cerebral artery time-averaged mean velocity (MCA TAMV) 208cm/sec, right MCA TAMV 196cm/sec. She had normal neurological assessment. On her brain MRA, no stenotic lesion was found within the Circle of Willis and the Internal Carotid arteries. A 6mm distal left posterior cerebral artery unruptured saccular aneurysm was observed. The brain MRI revealed a left thalamic lacunar infarction likely due to asymptomatic embolic infarction from the aneurysm. Longitudinal MR imaging showed spontaneous but incomplete thrombotic aneurysm occlusion. The second patient, an 11 year-old boy with slight cognitive delay and normal annual TCD procedures, presented with a non-traumatic SAH. Brain MRI showed several small silent cerebral infarctions in the white matter watershed territories. Brain MRA revealed multiple aneurysms without any stenotic lesion. A ruptured aneurysm was located on the basilar artery termination. Four unruptured aneurysms were found: 3 on the posterior cerebral arteries (1 right, 2 left) and 1 on the ophthalmic artery ostium. Endovascular coil embolization resulted in angiographic occlusion of the 2 accessible aneurysms. Clinical outcome was excellent. Discussion: Hemorrhagic strokes are more frequent than ischemic strokes in young adult SCA patients. Two main mechanisms are described: intracerebral or intraventricular hemorrhage due to major occlusive vasculopathy (moyamoya syndrome) or subarachnoid hemorrhage due to aneurysm rupture or leak. Our pediatric patients have no evidence for moyamoya syndrome. Their intracranial aneurysms bear similar characteristics with adult SCA patients': possibility of multiple aneurysms and posterior circulation involvement. They are observed at a very young age and are associated with mild cerebral vasculopathy: abnormal TCD without MRA stenosis in one case, silent cerebral infarcts without MRA stenosis in the other case. These findings plead for a possible concurrent development of vascular lesions leading either to ischemic or hemorrhagic stroke. This hypothesis is supported by similar histopathological findings in both aneurysms and cerebrovascular occlusive lesions in SCA: intimal hyperplasia, smooth-muscle layer hyalinization and elastic lamina fragmentation. This challenges the supposedly sequential pathophysiology of strokes in SCA, based on the high prevalence of infarctive strokes in children and hemorrhagic strokes in young adults. Conclusion: This report of pediatric intracranial aneurysms, associated with mild cerebral vasculopathy in both patients, supports the hypothesis of a common pathophysiological mechanism and the possible concurrent development of stenotic lesions and dilatations. This is also the first report of successful coil embolization in a pediatric SCA patient. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Endovascular Surgery for Ruptured Aneurysms with Vasospasm

2007 ◽  
Vol 13 (1_suppl) ◽  
pp. 48-52 ◽  
Author(s):  
A. Kurata ◽  
S. Suzuki ◽  
J. Niki ◽  
H. Ozawa ◽  
M. Yamada ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Coil Embolization ◽  
Preliminary Report ◽  
Endovascular Procedures ◽  
Neurological Deficits ◽  
Parent Artery ◽  
Ruptured Aneurysms ◽  
Number Of Patients ◽  
Endovascular Coil Embolization ◽  
The One

With the existence of vasospasm, it is recommended that direct clipping surgery for a ruptured aneurysm be delayed until its disappearance, but this may be associated with aneurysmal re-rupture resulting in a poor outcome for the patients. Indications for endovascular coil embolization in such cases are discussed. Since November in 2003, we have applied endovascular coil embolization in 11 consecutive patients with ruptured aneurysms and apparent vasospasm of the parent artery from two to 17 days (average: eight days) after initial subarachnoid hemorrhage. Three patients had aneurysmal re-rupture before treatment, but the other eight had only experienced the one episode of subarachnoid hemorrhage. With one exception, all endovascular procedures could be successfully performed, resulting in complete occlusion of aneurysms and remarkable dilatation of inserted spastic vessels without technical complications or aneurysmal re-rupture. For the one case of failure because of a tortuous artery, direct clipping surgery was performed after disappearance of vasospasm. Cerebral infarction occurred in four, but only one correlated with the distribution of catheterization, and neurological deficits had completely disappeared three months after the onset. This preliminary report concerning a small number of patients suggests that endovascular coil embolization is not contra-indicated for aneurysms with vasospasm requiring catheterization. A large study for confirmation is now warranted.

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