White-collar sign as a predictor of outcome after endovascular treatment for cerebral aneurysms

2017 ◽  
Vol 126 (3) ◽  
pp. 831-837 ◽  
Author(s):  
Kenji Fukuda ◽  
Toshio Higashi ◽  
Masakazu Okawa ◽  
Mitsutoshi Iwaasa ◽  
Tsutomu Yoshioka ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
White Collar ◽  
Negative Group ◽  
Positive Group ◽  
Complete Occlusion ◽  
Neck Size ◽  
Aneurysm Neck ◽  
Endovascular Coil Embolization

OBJECTIVE The white-collar sign (WCS) is known as a thick neointimal tissue formation at the aneurysm neck after endovascular coil embolization of cerebral aneurysms, which may prevent aneurysm recanalization. The purpose of this study was to evaluate factors involved in the appearance of WCS and to identify radiological and clinical outcomes of treated aneurysms with WCS. METHODS The study included 140 patients with 149 aneurysms in which it was possible to confirm the aneurysm neck between the aneurysm sac and parent artery by using conventional angiography. The WCS was defined as a radiolucent band at the aneurysm neck on the angiogram at 6 months after initial embolization. The radiological outcome was evaluated using MR angiography. RESULTS In 23 of 149 aneurysms (15.4%), a WCS appeared. The WCS-positive group had a significantly smaller neck size (3.3 ± 0.8 mm vs 4.2 ± 1.1 mm, p < 0.001) and smaller aneurysm size (4.3 ± 0.9 mm vs 6.0 ± 2.1 mm, p < 0.001) than the WCS-negative group. Multivariate analysis revealed that WCS appearance was associated with small neck size (OR 0.376, 95% CI 0.179–0.787; p = 0.009). In 106 of 149 aneurysms, the rate of complete occlusion was significantly higher in the WCS-positive group (18/18, 100%) than in the WCS-negative group (n = 54/88, 61.4%; p = 0.001) in the mean follow-up period of 31.0 ± 9.7 months (range 5–52 months). Neither major recanalization nor rupture of the aneurysm occurred in the WCS-positive group. CONCLUSIONS Appearance of the WCS was associated with complete occlusion and good clinical outcome after endovascular coil embolization. The WCS would help to determine the prognosis of cerebral aneurysms after endovascular treatment.

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.

Repeat Endovascular Treatment in Post-Embolization Recurrent Intracranial Aneurysms

Neurosurgery ◽  
2006 ◽  
Vol 58 (1) ◽  
pp. 60-70 ◽  
Author(s):  
Hyun-Seung Kang ◽  
Moon Hee Han ◽  
Bae Ju Kwon ◽  
O-Ki Kwon ◽  
Sung Hyun Kim
Keyword(s):  
Endovascular Treatment ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Time Interval ◽  
Effective Treatment Option ◽  
Technical Problems ◽  
Complete Occlusion ◽  
Endovascular Coil Embolization ◽  
Previously Treated

Abstract OBJECTIVE: The purpose of this study was to describe clinical situations requiring repeat embolization in patients previously treated by endovascular coil embolization for intracranial aneurysms, and to report on our experiences of repeat embolization (RE). METHODS: A total of 466 patients harboring 522 intracranial aneurysms were treated by endovascular coil embolization at our institution during the period between December 1992 and August 2004. We studied 32 patients who underwent repeat coil embolization (RE) owing to recanalization or aneurysm recurrence. Radiological and clinical data were reviewed to determine the reasons, results, and technical problems of RE. RESULTS: Thirty-nine sessions of RE were performed in 32 patients; four patients underwent RE twice and another patient three times. The major reason for RE was asymptomatic aneurysmal recanalization owing to coil compaction and/or loosening. The time interval between RE and the previous embolization was 12 months or less in 27 sessions. Complete or near complete occlusion of the aneurysm was achieved in all cases without procedure-related morbidity or mortality. Radiolucent gaps between the coil masses were observed in 17 cases. CONCLUSION: RE is a safe and effective treatment option in cases of recanalized or recurrent aneurysms. Close follow-up evaluation is essential in patients with intracranial aneurysms after coil embolization.

scholarly journals Significance of Volume Embolization Ratio as a Predictor of Recanalization on Endovascular Treatment of Cerebral Aneurysms with Guglielmi Detachable Coils

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 59-63 ◽  
Author(s):  
N. Uchiyama ◽  
S. Kida ◽  
M. Nomura ◽  
M. Hasegawa ◽  
T. Yamashima ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Aneurysms ◽  
Treatment Result ◽  
Guglielmi Detachable Coils ◽  
Complete Occlusion ◽  
Neck Size ◽  
Detachable Coils ◽  
Large Aneurysm ◽  
Incomplete Occlusion ◽  
The Relationship

The purposes of this study are, firstly, to define the relationship between volume embolization ratio (VER) and degree of angiographical occlusion in endovascular treatment with Guglielmi detachable coils, and secondly, to examine influences of neck and dome sizes of aneurysms on the VER and the angiographical treatment result, and thirdly, to determine the relationship between the VER and the recanalization of coiled aneurysms. Fifty-two aneurysms in 46 patients were examined. VER ranged 8.1–31.9% (mean 18.5%). The mean VERs of each categories based on angiographical treatment results were 23.1% in complete occlusion, 16.1% in neck remnant and 12.2% in incomplete occlusion, respectively. The VER correlated significantly with both neck and dome size, while the angiographical treatment result was only affected by neck size. Five aneurysms showed aneurysmal recanalization among followed-up 41 aneurysms. All recanalized aneurysms were large, and their VERs were in range of 10.4–17.6%. Measurement of VER is useful to estimate the degree of occlusion objectively and to predict the aneurysmal recanalization. A small aneurysms with a small neck is relatively easy to achieve high VER and angiographical complete occlusion, with the consequence of less recanalization. On the other hand, a large aneurysm is liable to recanalize due to low VER, even if there was little filling of contrast medium in the aneurysmal cavity.

A novel endovascular clip system for the treatment of intracranial aneurysms: technology, concept, and initial experimental results

2008 ◽  
Vol 108 (6) ◽  
pp. 1230-1240 ◽  
Author(s):  
Thomas R. Marotta ◽  
Thorsteinn Gunnarsson ◽  
Ian Penn ◽  
Donald R. Ricci ◽  
Ian Mcdougall ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Delivery System ◽  
Intracranial Aneurysms ◽  
Balloon Catheter ◽  
Cerebral Aneurysms ◽  
Histopathological Analysis ◽  
Parent Vessel ◽  
Flow Models ◽  
Aneurysm Neck ◽  
Novel Device

Object The authors describe a novel device for the endovascular treatment of intracranial aneurysms, the endovascular clip system (eCLIPs). Descriptions of the device and its delivery system as well as the results of flow model tests and the treatment of experimental aneurysms are provided. Methods The eCLIPs comprises a flexible hybrid implantable device (an anchor and a covered leaf) and a balloon catheter delivery system, designed to be positioned and activated in the parent vessel in such a way that the covered portion will abut the aneurysm neck. The eCLIPs was subjected to testing in glass, elastomeric, and cadaveric flow models to determine its navigability, orientation, and activation compared with commercially available stents. In a second experiment, 8 carotid artery sidewall aneurysms in swine were treated using eCLIPs. The degree of occlusion was observed on angiography immediately following and 30 days after device activation, and a histological analysis was performed at 30 days. Results The device could navigate tortuous glass models and human cadaveric vessels. Compared with commercially available stents, the eCLIPs performed well. It could be navigated, oriented, and activated easily and reliably. With regard to the 8 porcine experimental aneurysms, immediate postactivation angiograms confirmed complete occlusion of 4 lesions and near occlusion of the other 4. Angiographic follow-up at 30 days postactivation showed occlusion of all 8 aneurysms and patency of all parent vessels. Histopathological analysis revealed aneurysm healing, with smooth-muscle cells growing across the lesion neck to allow reendothelialization. Conclusions Aneurysm occlusion with a single extrasaccular endovascular device has potential advantages. The authors believe that eCLIPs may prove to be a useful tool in the endovascular treatment of cerebral aneurysms. The system should reduce risks associated with coiling, procedure time, costs, and radiation exposure. The device satisfactorily occluded 8 experimental sidewall aneurysms. The observed healing pattern is similar to that seen after microsurgical clipping.

scholarly journals Intraprocedural Angiographic CT as a Valuable Tool in the Course of Endovascular Treatment of Direct Sinus Cavernous Fistulas

2012 ◽  
Vol 18 (3) ◽  
pp. 326-332 ◽  
Author(s):  
P. Gölitz ◽  
T. Struffert ◽  
M. Arc Saake ◽  
F. Knossalla ◽  
A. Doerfler
Keyword(s):  
Endovascular Treatment ◽  
Coil Embolization ◽  
Parent Artery ◽  
Angiographic Ct ◽  
Complex Anatomy ◽  
Procedural Complications ◽  
Endovascular Coil Embolization ◽  
Contrast Medium Injection ◽  
Carotid Cavernous Fistulas ◽  
Coil Migration

This investigation aimed to demonstrate the potential of intraprocedural angiographic CT in monitoring complex endovascular coil embolization of direct carotid cavernous fistulas. Angiographic CT was performed as a dual rotational 5 s run with intraarterial contrast medium injection in two patients during endovascular coil embolization of direct carotid cavernous fistulas. Intraprocedural angiographic CT was considered helpful if conventional 2D series were not conclusive concerning coil position or if a precise delineation of the parent artery was impossible due to a complex anatomy or overlying coil material. During postprocessing multiplanar reformatted and dual volume images of angiographic CT were reconstructed. Angiographic CT turned out to be superior in the intraprocedural visualization of accidental coil migration into the parent artery where conventional 2D-DSA series failed to reliably detect coil protrusion. The delineation of coil protrusion by angiographic CT allowed immediate correct coil repositioning to prevent parent artery compromising. Angiographic CT can function as a valuable intraprocedurally feasible tool during complex coil embolizations of direct carotid cavernous fistulas. It allows the precise visualization of the cerebral vasculature and any accidental coil protrusion can be determined accurately in cases where conventional 2D-DSA series are unclear or compromised. Thus angiographic CT might contribute substantially to reduce procedural complications and to increase safety in the management of endovascular treatment of direct carotid cavernous fistulas.

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.

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