scholarly journals Proposal of a follow-up imaging strategy following Pipeline flow diversion treatment of intracranial aneurysms

2019 ◽  
Vol 131 (1) ◽  
pp. 32-39 ◽  
Author(s):  
Raghav Gupta ◽  
Christopher S. Ogilvy ◽  
Justin M. Moore ◽  
Christoph J. Griessenauer ◽  
Alejandro Enriquez-Marulanda ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Cumulative Incidence ◽  
Intracranial Aneurysms ◽  
Aneurysm Rupture ◽  
Digital Subtraction ◽  
Imaging Data ◽  
Unruptured Intracranial Aneurysms ◽  
Imaging Strategy ◽  
Aneurysm Occlusion

OBJECTIVEThere is currently no standardized follow-up imaging strategy for intracranial aneurysms treated with the Pipeline embolization device (PED). Here, the authors use follow-up imaging data for aneurysms treated with the PED to propose a standardizable follow-up imaging strategy.METHODSA retrospective review of all patients who underwent treatment for ruptured or unruptured intracranial aneurysms with the PED between March 2013 and March 2017 at 2 major academic institutions in the US was performed.RESULTSA total of 218 patients underwent treatment for 259 aneurysms with the PED and had undergone at least 1 follow-up imaging session to assess aneurysm occlusion status. There were 235 (90.7%) anterior and 24 posterior (9.3%) circulation aneurysms. On Kaplan-Meier analysis, the cumulative incidences of aneurysm occlusion at 6, 12, 18, and 24 months were 38.2%, 77.8%, 84.2%, and 85.1%, respectively. No differences in the cumulative incidence of aneurysm occlusion according to aneurysm location (p = 0.39) or aneurysm size (p = 0.81) were observed. A trend toward a decreased cumulative incidence of aneurysm occlusion in patients 70 years or older was observed (p = 0.088). No instances of aneurysm rupture after PED treatment or aneurysm recurrence after occlusion were noted. Sixteen (6.2%) aneurysms were re-treated with the PED; 11 of these had imaging follow-up data available, demonstrating occlusion in 3 (27.3%).CONCLUSIONSThe authors propose a follow-up imaging strategy that incorporates 12-month digital subtraction angiography and 24-month MRA for patients younger than 70 years and single-session digital subtraction angiography at 12 months in patients 70 years or older. For recurrent or persistent aneurysms, re-treatment with the PED or use of an alternative treatment modality may be considered.

Single-center experience with the new generation Derivo Embolization Device in ruptured dissecting and blister aneurysms

2019 ◽  
Vol 61 (1) ◽  
pp. 37-46 ◽  
Author(s):  
Marius Georg Kaschner ◽  
Athanasios Petridis ◽  
Bernd Turowski
Keyword(s):  
Digital Subtraction Angiography ◽  
Flow Diverter ◽  
High Morbidity ◽  
Digital Subtraction ◽  
Related Complication ◽  
Single Center Experience ◽  
Flow Diverter Stent ◽  
Aneurysm Occlusion ◽  
New Generation

Background Treatment of ruptured dissecting and blister aneurysms is technically challenging with potentially high morbidity and mortality. The Derivo Embolisation Device (Derivo) is a flow diverter stent designed for the treatment of intracranial aneurysms. Purpose To assess the safety and feasibility of the Derivo in the treatment of ruptured dissecting and blister aneurysms. Material and Methods We retrospectively analyzed all patients with ruptured dissecting and blister aneurysms treated with the Derivo between February 2016 and July 2018. Procedural details, complications, morbidity within 30 days, and angiographic aneurysm occlusion rates, initially and after six months, were assessed. Results In 10 patients 11 ruptured dissecting and blister aneurysms were treated with 12 Derivos as monotherapy. No aneurysm rebleeding was observed at follow-up. One treatment-related complication occurred including a coil perforation of an additionally treated aneurysm. One patient died due to brain edema. Initial digital subtraction angiography revealed complete (O’Kelly–Marotta [OKM] classification D) and favorable (OKM D+C) occlusion rate in three aneurysms. Six-month follow-up for digital subtraction angiography and clinical evaluation was available in 6/9 patients with complete (OKM D) occlusion in all aneurysms (6/6). Favorable (modified Rankin Scale [mRS] ≤ 2) and moderate (mRS 3) clinical outcome after a mean follow-up of 10 months was observed in six and two patients, respectively. Conclusion Endovascular treatment with the Derivo in ruptured dissecting and blister aneurysms revealed a sufficient initial division of aneurysms from the circulation without rebleeding. The Derivo is associated with high procedural and clinical short-term safety.

Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture

2008 ◽  
Vol 108 (5) ◽  
pp. 1052-1060 ◽  
Author(s):  
Seppo Juvela ◽  
Matti Porras ◽  
Kristiina Poussa
Keyword(s):  
Risk Factors ◽  
Intracranial Aneurysms ◽  
Smoking Status ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Aneurysm Rupture ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
History Of

Object The authors conducted a study to investigate the long-term natural history of unruptured intracranial aneurysms and the predictive risk factors determining subsequent rupture in a patient population in which surgical selection of cases was not performed. Methods One hundred forty-two patients with 181 unruptured aneurysms were followed from the 1950s until death or the occurrence of subarachnoid hemorrhage or until the years 1997 to 1998. The annual and cumulative incidence of aneurysm rupture as well as several potential risk factors predictive of rupture were studied using life-table analyses and Cox's proportional hazards regression models including time-dependent covariates. The median follow-up time was 19.7 years (range 0.8–38.9 years). During 2575 person-years of follow up, there were 33 first-time episodes of hemorrhage from previously unruptured aneurysms, for an average annual incidence of 1.3%. In 17 patients, hemorrhage led to death. The cumulative rate of bleeding was 10.5% at 10 years, 23% at 20 years, and 30.3% at 30 years after diagnosis. The diameter of the unruptured aneurysm (relative risk [RR] 1.11 per mm in diameter, 95% confidence interval [CI] 1–1.23, p = 0.05) and patient age at diagnosis inversely (RR 0.97 per year, 95% CI 0.93–1, p = 0.05) were significant independent predictors for a subsequent aneurysm rupture after adjustment for sex, hypertension, and aneurysm group. Active smoking status at the time of diagnosis was a significant risk factor for aneurysm rupture (RR 1.46, 95% CI 1.04–2.06, p = 0.033) after adjustment for size of the aneurysm, patient age, sex, presence of hypertension, and aneurysm group. Active smoking status as a time-dependent covariate was an even more significant risk factor for aneurysm rupture (adjusted RR 3.04, 95% CI 1.21–7.66, p = 0.02). Conclusions Cigarette smoking, size of the unruptured intracranial aneurysm, and age, inversely, are important factors determining risk for subsequent aneurysm rupture. The authors conclude that such unruptured aneurysms should be surgically treated regardless of their size and of a patient's smoking status, especially in young and middle-aged adults, if this is technically possible and if the patient's concurrent diseases are not contraindications. Cessation of smoking may also be a good alternative to surgery in older patients with small-sized aneurysms.

scholarly journals Cost-Effectiveness of Magnetic Resonance Angiography Versus Intra-arterial Digital Subtraction Angiography to Follow-Up Patients With Coiled Intracranial Aneurysms

Stroke ◽  
2010 ◽  
Vol 41 (8) ◽  
pp. 1736-1742 ◽  
Author(s):  
Joanna D. Schaafsma ◽  
Hendrik Koffijberg ◽  
Erik Buskens ◽  
Birgitta K. Velthuis ◽  
Yolanda van der Graaf ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Digital Subtraction Angiography ◽  
Intracranial Aneurysms ◽  
Digital Subtraction

scholarly journals Necessity of follow-up cerebral digital subtraction angiography after endovascular coiling or microsurgical cliping of ruptured intracranial aneurysms to exclude de novo or aneurysmal regrow and avoid its rupture: report of 2 cases

2019 ◽  
Vol 27 (1) ◽  
pp. 12-20
Author(s):  
D.J. Gunia ◽  
E.T. Ekvtimishvili ◽  
G.Z. Basiladze
Keyword(s):  
Digital Subtraction Angiography ◽  
Intracranial Aneurysms ◽  
De Novo ◽  
Anterior Communicating Artery ◽  
Digital Subtraction ◽  
Treatment Results ◽  
First Case ◽  
De Novo Aneurysm ◽  
Brain Aneurysms

Objective – to improve treatment results of patients with ruptured brain aneurysms using follow-up cerebral digital subtraction angiography to avoid de novo or aneurismal regrow.Materials and methods. Analysis of follow-up cerebral digital subtraction angiography and treatment results of two patient (60 and 64-year-old females) with brain anterior communicated artery de novo aneurysm and regrowed aneurysm of an anterior communicated artery after microsurgical clipping.Results. Two patient underwent endovascular treatment of ruptured brain aneurysms after non follow-up cerebral digital subtraction angiography. In first case de novo aneurysm of anterior communicating artery and in second – regrowed aneurys of anterior communicating artery after surgical clipping. Both patients were discharged from the clinic in I and IV modified Rankin scale. Conclusions. Digital subtraction angiography follow-up of intracranial aneurysms treated by endovascular or microsurgical approach is important for the detection and prediction for the risk of bleeding (aneurysm recurrence and de novo aneurysm). There exist no guidelines on the frequency of monitoring and imaging modality to adopt and the monitoring is adapted on a case-by-case basis. Digital subtraction angiography is the gold standard for the evaluation of aneurysmal occlusion after coiling and microsurgical clipping and remains also necessary for evaluating other devices.

scholarly journals Residuals, recurrences and re-treatment after endovascular repair of intracranial aneurysms: A retrospective methodological comparison

2019 ◽  
Vol 26 (1) ◽  
pp. 45-54 ◽  
Author(s):  
Jens J Froelich ◽  
Nicholas Cheung ◽  
Johan AB de Lange ◽  
Jessica Monkhorst ◽  
Michael W Carr ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Medical Records ◽  
Intracranial Aneurysms ◽  
Aneurysm Rupture ◽  
Flow Diversion ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Methodological Comparison

Objective Incomplete aneurysm occlusions and re-treatment rates of 52 and 10–30%, respectively, have been reported following endovascular treatment of intracranial aneurysms, raising clinical concerns regarding procedural efficacy. We compare residual, recurrence and re-treatment rates subject to different endovascular techniques in both ruptured and unruptured intracranial aneurysms at a comprehensive state-wide tertiary neurovascular centre in Australia. Methods Medical records, procedural and follow-up imaging studies of all patients who underwent endovascular treatment for intracranial aneurysms between July 2010 and July 2017 were reviewed retrospectively. Residuals, recurrences and re-treatment rates were assessed regarding initial aneurysm rupture status and applied endovascular technique: primary coiling, balloon- and stent-assisted coiling and flow diversion. Results Among 233 aneurysms, residual, recurrence and re-treatment rates were 27, 11.2 and 9.4%, respectively. Compared with unruptured aneurysms, similar residual and recurrence (p > .05), but higher re-treatment rates (4.5% vs. 19%; p < .001) were found for ruptured aneurysms. Residual, recurrence and re-treatment rates were: 13.3, 16 and 12% for primary coiling; 12, 12 and 10.7% for balloon-assisted coiling; 14.9, 7.5 and 4.5% for stent-assisted coiling; 91.9, 0 and 5.4% for flow diversion. Stent-assistance and flow-diversion were associated with lower recurrence and re-treatment rates, when compared with primary- and balloon-assisted coiling (p < .05). Conclusions Residuals and recurrences after endovascular treatment of intracranial aneurysms are less common than previously reported. Stent assistance and flow diversion seem associated with reduced recurrence- and re-treatment rates, when compared with primary- and balloon-assisted coiling. Restrained use of stents in ruptured aneurysms may be a contributing factor for higher recurrence/retreatment rates compared to unruptured aneurysms.

Preoperative Digital Subtraction Angiography in Incidental Unruptured Intracranial Aneurysms

2018 ◽  
Vol 28 (3) ◽  
pp. 429-435 ◽  
Author(s):  
Moriz Herzberg ◽  
Robert Forbrig ◽  
Christian Schichor ◽  
Hartmut Brückmann ◽  
Franziska Dorn
Keyword(s):  
Digital Subtraction Angiography ◽  
Intracranial Aneurysms ◽  
Digital Subtraction ◽  
Unruptured Intracranial Aneurysms
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