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.

scholarly journals Use of Distal Intracranial Catheters for Better Working View of Cerebral Aneurysms Hidden by Parent Artery or Its Branches: A Technical Note

2021 ◽  
Author(s):  
Ehab Mahmoud ◽  
Samuel Lenell ◽  
Christoffer Nyberg ◽  
Ljubisa Borota
Keyword(s):  
Endovascular Treatment ◽  
Internal Carotid ◽  
Cerebral Aneurysms ◽  
Technical Note ◽  
Parent Artery ◽  
Endovascular Techniques ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Class 1 ◽  
Procedural Outcomes

A good working view is critical for safe and successful endovascular treatment of cerebral aneurysms. In a few cases, endovascular treatment of cerebral aneurysms may be challenging due to difficulty in obtaining a proper working view. In this report of 6 cases, we described the advantage of using a distal intracranial catheter (DIC) to achieve better visualization of cerebral aneurysms hidden by a parent artery or its branches. Between September 2017 and January 2021, we treated 390 aneurysms with endovascular techniques. In 6 cases in which it was difficult to obtain a proper working view, the DIC was placed distally close to the aneurysm in order to remove the parent artery projection from the working view and obtain better visualization of the aneurysm. Clinical and procedural outcomes and complications were evaluated. The position of the DIC was above the internal carotid artery siphon in the 6 cases. All aneurysms were successfully embolized. Raymond–Roy class 1 occlusion was achieved in all 4 unruptured aneurysms, while the result was class 2 in the 2 ruptured aneurysms. Placement of the DIC was atraumatic without dissections or significant catheter-induced vasospasm in all patients. Transient dysphasia was seen in 2 cases and transient aphasia in 1. Using this technique, we have found it possible to better visualize the aneurysm sac or neck and thereby treat cases we otherwise would have considered untreatable.

scholarly journals Endovascular treatment of cerebral aneurysms: a retrospective study of 163 embolized aneurysms

2007 ◽  
Vol 65 (2b) ◽  
pp. 411-415 ◽  
Author(s):  
João Renato Figueiredo Souza ◽  
Marcelo Otoch ◽  
Sérgio Pouchain Ribeiro ◽  
Francisco Ramos Júnior ◽  
João Paulo Cavalcante de Almeida ◽  
...  
Keyword(s):  
Public Health ◽  
Retrospective Study ◽  
Endovascular Treatment ◽  
Public Health System ◽  
Arterial Occlusion ◽  
Cerebral Aneurysms ◽  
Partial Occlusion ◽  
Endovascular Techniques ◽  
Endovascular Technique ◽  
Ruptured Aneurysms

OBJECTIVE: To present the results of cerebral aneurysms treated by endovascular technique. METHOD: Retrospective analysis of patient files of Hospital Geral de Fortaleza, Brazil. RESULTS: We report the results of 163 cerebral aneurysms treated by endovascular techniques from January 2002 to October 2005. Patients with ruptured aneurysms (87.2%), according to Hunt-Hess scale were: 33.7% HH I, 28.4% HH II, 24.1% HH III, 13.8% HH IV. The Fisher scale grade IV was the most common (39.7%). Remodeling, coil embolization, arterial occlusion and histoacryl embolization were the techniques employed. Effective occlusion was achieved in 87.7%, partial occlusion in 5.3% and non-effective occlusion in 7.0% of the patients. Glasgow outcome scale results were: 76.3% GOS 5, 5.0% GOS 4, 5.8% GOS 3, 1.4% GOS 2 and 11.5% GOS 1. CONCLUSION: Endovascular treatment seems to be feasible within Brazilian public health system, with results as good as those obtained in larger international centers.

scholarly journals Expanding Endovascular Therapy of Very Small Ruptured Aneurysms with the 1.5-mm Coil

2015 ◽  
Vol 4 (1-2) ◽  
pp. 59-63 ◽  
Author(s):  
Thanh N. Nguyen ◽  
Hesham Masoud ◽  
Nicholas Tarlov ◽  
James Holsapple ◽  
Lawrence S. Chin ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Endovascular Therapy ◽  
Coil Embolization ◽  
Significant Risk ◽  
Transverse Diameter ◽  
Surgical Clipping ◽  
Excellent Outcome ◽  
Ruptured Aneurysms ◽  
Aneurysm Treatment ◽  
Small Aneurysms

Background: Very small ruptured aneurysms (≤3 mm) demonstrate a significant risk for procedural rupture with endovascular therapy. Since 2007, 1.5-mm-diameter coils have been available (Micrus, Microvention, and ev3), allowing neurointerventionalists the opportunity to offer patients with very small aneurysms endovascular treatment. In this study, we review the clinical and angiographic outcome of patients with very small ruptured aneurysms treated with the 1.5-mm coil. Methods: This is a retrospective cohort study in which we examined consecutive ruptured very small aneurysms treated with coil embolization at a single institution. The longest linear aneurysm was recorded, even if the first coil was sized to a smaller transverse diameter. Very small aneurysms were defined as ≤3 mm. Descriptive results are presented. Results: From July 2007 to March 2015, 81 aneurysms were treated acutely with coils in 78 patients presenting with subarachnoid hemorrhage. There were 5 patients with 3-mm aneurysms, of which the transverse diameter was ≤2 mm in 3 patients. In all 5 patients, a balloon was placed for hemostatic prophylaxis in case of rupture, and a single 1.5-mm coil was inserted for aneurysm treatment without complication. Complete aneurysm occlusion was achieved in 1 patient, residual neck in 2, and residual aneurysm in 2 patients. Aneurysm recanalization was present in 2 patients with an anterior communicating artery aneurysm; a recoiling attempt was unsuccessful in 1 of these 2 patients due to inadvertent displacement and distal coil embolization, but subsequent surgical clipping was successful. Another patient was retreated by surgical clipping for a residual wide-neck carotid terminus aneurysm. One patient died of ventriculitis 3 weeks after presentation; all 4 other patients had an excellent outcome with no rebleed at follow-up (mean 21 months, range 1-62). Conclusion: The advent of the 1.5-mm coil may be used in the endovascular treatment of patients with very small ruptured aneurysms, providing a temporary protection to the site of rupture in the acute phase. If necessary, bridging with elective clipping may provide definitive aneurysm treatment.

scholarly journals Endovascular Coil Embolization for Cerebral Aneurysms Solely Using Ultrasoft Coils

2006 ◽  
Vol 12 (1_suppl) ◽  
pp. 101-104
Author(s):  
T. Tsumoto ◽  
T. Terada ◽  
H. Yamaga ◽  
T. Itakura
Keyword(s):  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Ruptured Aneurysms ◽  
Endovascular Coil Embolization ◽  
Small Aneurysms

We report a series of coil embolizations for small aneurysms solely using GDC ultrasoft coils and discuss the advantages of this method. Seven small aneurysms (<4.0 mm) were embolized solely with ultrasoft coils. Ultrasoft coils were sequentially inserted into aneurysms. Immediately after embolization, five aneurysms were completely occluded, and two exhibited body filling. All cases were treated successfully without any complications. In conclusion, ultrasoft coils were found efficacious for the treatment of small, irregular-shaped, and ruptured aneurysms; their softness and malleability facilitated their compaction into an aneurysm.

scholarly journals Endovascular Surgery as the First-Choice Treatment for Ruptured Cerebral Aneurysms: How Far Has it Come?

2004 ◽  
Vol 10 (2_suppl) ◽  
pp. 41-47 ◽  
Author(s):  
O. Tone ◽  
H. Tomita ◽  
M. Tamaki ◽  
Y. Satoh ◽  
Y. Matsuoka ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Coil Embolization ◽  
Internal Carotid ◽  
Anterior Cerebral Artery ◽  
Cerebral Aneurysms ◽  
Poor Grade ◽  
Ruptured Aneurysms ◽  
First Choice ◽  
Middle Cerebral Artery Aneurysms ◽  
Small Aneurysms

One hundred and seventy patients with ruptured cerebral aneurysms were treated by coil embolization from September 1997 to December 2002. After January 2000, coil embolization was selected as the first-choice treatment for ruptured aneurysms. During this period, the authors investigated the number of aborted cases, the number of complications, and how many patients could be treated by coil embolization according to the locations of ruptured cerebral aneurysms. One hundred and ninety-five sessions were performed on 170 patients, and 13 sessions (6.7%) were aborted mainly because of the difficulty of the approach and the wide necks of the aneurysms. In four patients, although procedural perforation and haemorrhage occurred, the outcome was good or excellent. Eight poor-grade patients experienced haemorrhage after coil embolization and seven patients died. The volume embolization ratios of small and large aneurysms were 27% and 21%, and the recanalization of small and large aneurysms occurred in 9% and 38% of patients, respectively. From January 2000 to December 2002, 119 (66%) of 180 ruptured cerebral aneurysms were treated by coil embolization. According to the location of aneurysms, 89% vertebrobasilar, 87% anterior cerebral, 65% internal carotid and 24% middle cerebral artery aneurysms could be treated by coil embolization. Because the tight packing of large aneurysms was difficult, the recanalization rate of large aneurysms was high. However, the results of small aneurysms were satisfactory. Almost 90% of vertebrobasilar and anterior cerebral artery aneurysms could be treated by coil embolization.

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.

scholarly journals Limitation of Endovascular Treatment for Ruptured Cerebral Aneurysms: Results from the Protocol “GDC as the First Choice”

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 43-47 ◽  
Author(s):  
M. Mase ◽  
K. Yamada ◽  
N. Aihara ◽  
T. Banno ◽  
K. Watanabe
Keyword(s):  
Endovascular Treatment ◽  
Coil Embolization ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Anticoagulation Therapy ◽  
Cerebral Aneurysms ◽  
Primary Treatment ◽  
Endovascular Embolization ◽  
Acute Stage ◽  
Morbidity Rate ◽  
First Choice

Since October, 1997, endovascular embolization using GDC has been our primary treatment for ruptured cerebral aneurysms in the acute stage. According to our protocol, an aneurysm more than 3 mm in diameter, without a wide-neck or massive intracranial hematoma is indicated for endovascular therapy. Under this protocol, we experienced 35 consecutive patients with aneurysmal subarachnoid hemorrhage, and 22 of them (62.8%) were treated endovascularly. The most common reason for the contra-indication of coil embolization was wide-necked aneurysm (9 cases). We experienced two cases with embolic stroke and one case with post-embolization hemorrhage as a complication after endovascular treatment. Morbidity rate due to the complications was 9.1%. In conclusion, a system that allows both surgical and endovascular treatments to be performed in any given case is necessary for the appropriate treatment of ruptured aneurysm. In order to avoid ischemic embolic complications, postoperative anticoagulation therapy is crucial. The safety of coil embolization for very thin-walled aneurysm is questionable.

scholarly journals MTI (Dendron) Variable Detachable Coils

2003 ◽  
Vol 9 (1) ◽  
pp. 47-52
Author(s):  
J. Thammaroj ◽  
V. Jayakrishnan ◽  
S. Lamin ◽  
S. Jenkins ◽  
E. Teasdale ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Feasibility Study ◽  
Clinical Experience ◽  
Cerebral Aneurysms ◽  
Detachable Coils ◽  
Formed Part ◽  
Small Aneurysms ◽  
Initial Clinical Experience

We present our initial clinical experience of Dendron Variable Detachable System (VDS) coils, now Sapphire VDS from MTI, in the endovascular treatment of cerebral aneurysms. VDS coils, uniquely, can be detached at variable points along their length, allowing placement of as much or as little as desired of the coil within the aneurysm. Our ten patients formed part of a multicentre feasibility study. VDS coils were successfully deployed in all but one aneurysm. The electrolytic detachment mechanism with practice is both simple to use and reliable. The coils are however slightly stiffer than standard coils limiting their use in small aneurysms. This remains a technology in evolution.

scholarly journals Endovascular management of intracranial aneurysms during pregnancy in three cases and review of the literature

2015 ◽  
Vol 21 (6) ◽  
pp. 654-658 ◽  
Author(s):  
Peng Liu ◽  
Xianli Lv ◽  
Youxiang Li ◽  
Ming Lv
Keyword(s):  
Cesarean Section ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Review Of The Literature ◽  
Endovascular Techniques ◽  
Healthy Baby ◽  
Unruptured Aneurysms ◽  
Gestational Week ◽  
Basilar Tip Aneurysm ◽  
Case Basis

We present three cases of cerebral aneurysms (1 unruptured; 2 ruptured) treated with endovascular techniques in pregnancies. The first ruptured case is a 28-year-old female on 20th gestational week. After the endovascular coiling, the patient suffered persistent hemiparesis and delivered a healthy baby by cesarean section. The second ruptured case is a 25-year-old female on 36th week of pregnancy. She died of aneurysm re-rupture after delivery of a healthy baby by cesarean section. The third unruptured case is a 31-year-old woman on the 26th gestational week of pregnancy who died of a giant basilar tip aneurysm after stent-assisted coiling. Ruptured aneurysm obliteration should be prioritized followed by vaginal delivery or cesarean section. The decision regarding the treatment of unruptured aneurysms should be carefully considered on a case-by-case basis. Stent-assisted coiling may be applicable to aneurysm during pregnancy.

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