scholarly journals Rapid ventricular pacing for clip reconstruction of complex unruptured intracranial aneurysms: results of an interdisciplinary prospective trial

2018 ◽  
Vol 128 (6) ◽  
pp. 1741-1752 ◽  
Author(s):  
Juergen Konczalla ◽  
Johannes Platz ◽  
Stephan Fichtlscherer ◽  
Haitham Mutlak ◽  
Ulrich Strouhal ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Prospective Trial ◽  
Ventricular Pacing ◽  
Reconstruction Procedure ◽  
Safety And Efficacy ◽  
Surgical Clip ◽  
Unruptured Intracranial Aneurysms ◽  
Clip Application ◽  
Aneurysm Occlusion ◽  
Rapid Ventricular Pacing

OBJECTIVETo date, treatment of complex unruptured intracranial aneurysms (UIAs) remains challenging. Therefore, advanced techniques are required to achieve an optimal result in treating these patients safely. In this study, the safety and efficacy of rapid ventricular pacing (RVP) to facilitate microsurgical clip reconstruction was investigated prospectively in a joined neurosurgery, anesthesiology, and cardiology study.METHODSPatients with complex UIAs were prospectively enrolled. Both the safety and efficacy of RVP were evaluated by recording cardiovascular events and outcomes of patients as well as the amount of aneurysm occlusion after the surgical clip reconstruction procedure. A questionnaire was used to evaluate aneurysm preparation and clip application under RVP.RESULTSTwenty patients (mean age 51.6 years, range 28–66 years) were included in this study. Electrode positioning was easy in 19 (95%) of 20 patients, and removal of electrodes was easily accomplished in all patients (100%). No complications associated with the placement of the pacing electrodes occurred, such as cardiac perforation or cardiac tamponade. RVP was applied in 16 patients. The mean aneurysm size was 11.1 ± 5.5 mm (range 6–30 mm). RVP proved to be a very helpful tool in aneurysm preparation and clip application in 15 (94%) of 16 patients. RVP was used for a mean duration of 60 ± 25 seconds, a mean heart rate of 173 ± 23 bpm (range 150–210 bpm), and a reduction of mean arterial pressure to 35–55 mm Hg. RVP leads to softening of the aneurysm sac facilitating its mobilization, clip application, and closure of the clip blades. In 2 patients, cardiac events were documented that resolved without permanent sequelae in both. In every patient with successful RVP (n = 14) a total or near-total aneurysm occlusion was documented. In the 1 patient in whom the second RVP failed due to pacemaker electrode dislocation, additional temporary clipping was required to secure the aneurysm, but was not as sufficient as RVP. This led to an incomplete clipping of the aneurysm and finally a remnant on postoperative digital subtraction angiography. A pacemaker lead dislocation occurred in 3 (19%) of 16 patients, but intraoperative repositioning requires less than 20 seconds. Outcome was favorable in all patients according to the modified Rankin Scale.CONCLUSIONSTo the best of the authors’ knowledge this is the first prospective interdisciplinary study of RVP use in patients with UIAs. RVP is an elegant technique that facilitates clip reconstruction in complex UIAs. The safety of the procedure is good. However, because this procedure requires extensive preoperative cardiological workup of the patient and an experienced neurosurgery and neuroanesthesiology team with much cerebrovascular expertise, actually it remains reserved for selected elective cases and highly specialized centers.Clinical trial registration no.: NCT02766972 (clinicaltrials.gov)

scholarly journals Rapid Ventricular Pacing as a Safe Procedure for Clipping of Complex Ruptured and Unruptured Intracranial Aneurysms

2021 ◽  
Vol 10 (22) ◽  
pp. 5406
Author(s):  
Josefin Grabert ◽  
Stefanie Huber-Petersen ◽  
Tim Lampmann ◽  
Lars Eichhorn ◽  
Hartmut Vatter ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Troponin T ◽  
Surgical Reconstruction ◽  
Anesthesia Induction ◽  
Safe Procedure ◽  
Ventricular Pacing ◽  
Ruptured Intracranial Aneurysm ◽  
Unruptured Intracranial Aneurysms ◽  
Rapid Ventricular Pacing

Surgical treatment of intracranial aneurysm requires advanced technologies to achieve optimal results. Recently, rapid ventricular pacing (RVP) has been described to be an elegant technique that facilitates clip reconstruction of complex unruptured intracranial aneurysm (uIA). However, there is also a growing need for intraoperative tools to ensure safe clip reconstruction of complex ruptured intracranial aneurysm (rIA). We conducted a retrospective analysis of 17 patients who underwent RVP during surgical reconstruction of complex aneurysms. Nine patients had uIA while eight patients underwent surgery for rIA suffering from consecutive subarachnoid hemorrhage (SAH). Hemodynamic data, critical events, laboratory results, and anesthesia-related complications were evaluated. No complications were reported concerning anesthesia induction and induction times were similar between patients exhibiting uIA or rIA (p = 0.08). RVP induced a significant decline of median arterial pressure (MAP) in both groups (p < 0.0001). However, median MAP before and after RVP was not different in both groups (uIA group: p = 0.27; rIA group: p = 0.18). Furthermore, high-sensitive Troponin T (hsTnT) levels were not increased after RVP in any group. One patient in the rIA group exhibited ventricular fibrillation and required cardiopulmonary resuscitation, but has presented with cardiac arrest due to SAH. Otherwise, no arrhythmias or complications occurred. In summary, our data suggest RVP to be feasible in surgery for ruptured intracranial aneurysms.

Safety and efficacy of the Derivo Embolization Device for the treatment of unruptured intracranial aneurysms: a multicentric study

2018 ◽  
Vol 11 (1) ◽  
pp. 68-73 ◽  
Author(s):  
Bastian Kraus ◽  
Lukas Goertz ◽  
Bernd Turowski ◽  
Jan Borggrefe ◽  
Marc Schlamann ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Tertiary Care ◽  
Flow Diverter ◽  
Morbidity Rate ◽  
Multicentric Study ◽  
Safety And Efficacy ◽  
Flow Diverter Stent ◽  
Unruptured Intracranial Aneurysms ◽  
Aneurysm Occlusion

BackgroundThe Derivo Embolization Device (DED) is a novel flow diverter stent that provides increased x-ray visibility, an improved delivery system, and potentially reduced thrombogenicity. The objective of this study was to evaluate the early safety and efficacy of the second-generation DED.MethodsWe retrospectively analyzed all patients with unruptured intracranial aneurysms (UIAs) treated with the DED between November 2015 and December 2017 in three German tertiary care centers. Procedural details, complications, and morbidity within 30 days after treatment, as well as the aneurysm occlusion rates after 6 months (O’Kelly–Marotta scale, OKM), were evaluated.ResultsImplantation of the DED was attempted in 42 patients with 42 aneurysms. All procedures were technically successful. Multiple DEDs were used in three aneurysms (7.2%) and adjunctive coiling in 11 (26.2%). Procedure-related complications occurred in four cases (9.5%) including three thromboembolic events and one aneurysm perforation. The morbidity rate was 2.4% and there was no mortality. One patient suffered an ischemic stroke with persistent aphasia at 30-day follow-up due to a thromboembolic infarct (modified Rankin Scale score 1). Among 33 patients (78.6%) available for angiographic follow-up, complete (OKM D) and favorable (OKM C+D) aneurysm occlusion was obtained in 72.7% (24/33) and 87.9% (29/33), respectively.ConclusionsEndovascular treatment of UIAs with the DED is associated with high procedural safety and adequate occlusion rates. Examinations at 1- and 2-year follow-up will provide data on the long-term safety and angiographic outcomes of this device.

Safety and efficacy of a pre-treatment antiplatelet regimen of unruptured intracranial aneurysms: a single-center experience

2020 ◽  
Vol 62 (8) ◽  
pp. 1029-1041
Author(s):  
Anthony Peret ◽  
Benjamin Mine ◽  
Thomas Bonnet ◽  
Noémie Ligot ◽  
Jason Bouziotis ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Single Center ◽  
Safety And Efficacy ◽  
Single Center Experience ◽  
Unruptured Intracranial Aneurysms ◽  
Pre Treatment

Use of the Pipeline embolization device for recurrent and residual cerebral aneurysms: a safety and efficacy analysis with short-term follow-up

2016 ◽  
Vol 9 (12) ◽  
pp. 1208-1213 ◽  
Author(s):  
Anna Luisa Kühn ◽  
Katyucia de Macedo Rodrigues ◽  
J Diego Lozano ◽  
David E Rex ◽  
Francesco Massari ◽  
...  
Keyword(s):  
Intimal Hyperplasia ◽  
Cerebral Aneurysms ◽  
Device Performance ◽  
Anterior Circulation ◽  
Pipeline Embolization Device ◽  
Safety And Efficacy ◽  
Efficacy Analysis ◽  
Unruptured Intracranial Aneurysms ◽  
Aneurysm Occlusion

ObjectiveEvaluation of the safety and efficacy of the Pipeline embolization device (PED) when used as second-line treatment for recurrent or residual, pretreated ruptured and unruptured intracranial aneurysms (IAs).MethodsRetrospective review of our database to include all patients who were treated with a PED for recurrent or residual IAs following surgical clipping or coiling. We evaluated neurological outcome and angiograms at discharge, 6- and 12-months’ follow-up and assessed intimal hyperplasia at follow-up.ResultsTwenty-four patients met our inclusion criteria. Most IAs were located in the anterior circulation (n=21). No change of preprocedure modified Rankin Scale score was seen at discharge or at any scheduled follow-up. Complete or near-complete aneurysm occlusion on 6- and 12-month angiograms was seen in 94.4% (17/18 cases) and 93.3% (14/15 cases), respectively. Complete or near-complete occlusion was seen in 100% of previously ruptured and 85.7% (6/7 cases) and 83.3% (5/6 cases) of previously unruptured cases at the 6- and 12-months’ follow-up, respectively. One case of moderate intimal hyperplasia was observed at 6 months and decreased to mild at the 12-months’ follow-up. No difference in device performance was observed among pretreated unruptured or ruptured IAs.ConclusionsTreatment of recurrent or residual IAs with a PED after previous coiling or clipping is feasible and safe. There is no difference in device performance between ruptured or unruptured IAs.

Clipping of very large or giant unruptured intracranial aneurysms in the anterior circulation: an outcome study

2008 ◽  
Vol 109 (6) ◽  
pp. 1012-1018 ◽  
Author(s):  
Erik F. Hauck ◽  
Bryan Wohlfeld ◽  
Babu Guai Welch ◽  
Jonathan A. White ◽  
Duke Samson
Keyword(s):  
Older Patients ◽  
Intracranial Aneurysms ◽  
Aneurysm Rupture ◽  
Anterior Circulation ◽  
Intraoperative Angiography ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Acceptable Risks ◽  
Temporary Occlusion ◽  
Aneurysm Occlusion

Object Patients with very large or giant unruptured intracranial aneurysms present with ischemic stroke and progressive disability. The aneurysm rupture risk in these patients is extreme—up to 50% in 5 years. In this study the authors investigated the outcome of surgical treatment for these very large aneurysms in the anterior circulation. Methods Clinical data on 62 patients who underwent surgery for unruptured aneurysms (20–60 mm) between 1998 and 2006 were reviewed. Results Complete aneurysm occlusion (100%) was achieved in 90% of cases, near complete occlusion (90–99%) in 5%. The surgical risk in patients younger than 50 years of age was 8% (Glasgow Outcome Scale score of 1 or 3 within 1 year after surgery). In older patients, the risk increased with advancing age. Conclusions The treatment of very large or giant unruptured intracranial aneurysms is hazardous and complex and thus best performed only at major cerebrovascular centers with an experienced team of neurosurgeons, interventional neuroradiologists, neurologists, and neuroanesthesiologists. Surgery, with acceptable risks and excellent occlusion rates, is typically the treatment of choice in patients younger than 50 years of age. In older patients, the benefits of endovascular treatment versus surgery versus no treatment must be carefully weighed individually. Minimizing temporary occlusion and the consequent use of intraoperative angiography may help reduce surgical complications.

Comparison of WEB Embolization and Coiling in Unruptured Intracranial Aneurysms: Safety and Efficacy Based on a Propensity Score Analysis

2019 ◽  
Vol 126 ◽  
pp. e937-e943 ◽  
Author(s):  
Christoph Kabbasch ◽  
Lukas Goertz ◽  
Eberhard Siebert ◽  
Moriz Herzberg ◽  
Jan Borggrefe ◽  
...  
Keyword(s):  
Propensity Score ◽  
Intracranial Aneurysms ◽  
Propensity Score Analysis ◽  
Safety And Efficacy ◽  
Score Analysis ◽  
Unruptured Intracranial Aneurysms

Complementary management of partially occluded aneurysms by using surgical or endovascular therapy

2002 ◽  
Vol 97 (4) ◽  
pp. 843-850 ◽  
Author(s):  
Siamak Asgari ◽  
Arnd Doerfler ◽  
Isabel Wanke ◽  
Beate Schoch ◽  
Michael Forsting ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Intracranial Aneurysms ◽  
Endovascular Embolization ◽  
Content Type ◽  
Aneurysm Neck ◽  
Surgical Clip ◽  
Clip Application ◽  
Detachable Coils ◽  
Partially Occluded ◽  
Fine Print

Object. The authors present a series of patients in whom partially occluded aneurysms were retreated using complementary surgical or endovascular therapy. Methods. During a period of 18 months, 301 patients with intracranial aneurysms were treated using either clip application (171 patients) or endovascular embolization with Guglielmi Detachable Coils ([GDCs] 130 patients). Routine posttreatment angiography studies revealed residual aneurysms in 21 of these patients, nine of whom were retreated using an endovascular or surgical method, with a mean treatment latency of 1.2 months. Four patients underwent primary surgical clip application, whereas five patients experienced GDC packing first. Among patients in the surgical group, the residual aneurysm neck was small and total elimination of the aneurysm was achieved by packing in GDCs. In patients in the endovascular group the authors incompletely packed the aneurysm because of its wide neck or fusiform component in two patients, perforation of a very small aneurysm in one patient, and coil dislocation in another patient. Typical coil compaction occurred in one case. Complete clip application was achieved in all patients. There was no complication in any patient due to the second treatment modality. Final outcome was excellent or good in six and fair in three. Conclusions. Following clip application or endovascular embolization of intracranial aneurysms, the use of complementary surgical or endovascular management is successful and associated with low morbidity.

Sign in / Sign up

Export Citation Format

Share Document