Combined endovascular and microsurgical management of giant and complex unruptured aneurysms

2004 ◽  
Vol 17 (5) ◽  
pp. 1-7 ◽  
Author(s):  
Francisco A. Ponce ◽  
Felipe C. Albuquerque ◽  
Cameron G. McDougall ◽  
Patrick P. Han ◽  
Joseph M. Zabramski ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Combined Treatment ◽  
Neurological Deficits ◽  
Complex Nature ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Unruptured Intracranial Aneurysms

Object The purpose of this study was to assess the efficacy and describe the technical features of combined endovascular and microsurgical treatments for complex and giant unruptured intracranial aneurysms. Methods A prospectively maintained database was reviewed to identify all patients with unruptured intracranial aneurysms who were treated with combined techniques. Twenty-one lesions were treated in as many patients: six lesions involved the posterior cerebral artery (PCA); seven the cavernous portion of the internal carotid artery (ICA); two the basilar apex; two the basilar trunk; and one each the anterior communicating artery, anterior cerebral artery, petrous ICA, and cervical ICA. Aneurysms were treated with combined extracranial–intracranial bypass procedures and parent-vessel occlusion, flow redirection, or arterial transposition. Aneurysm occlusion was achieved in 20 patients. In the remaining patient the aneurysm recurred, requiring stent-assisted repeated coil placement. Three patients suffered permanent neurological deficits related to treatment, and three died, two of whom had basilar trunk aneurysms. Conclusions Certain complex aneurysms may be treated optimally by combining endovascular and surgical procedures. A low incidence of complications follows treatment of anterior circulation aneurysms. Treatment of complex posterior circulation aneurysms is associated with a higher incidence of complications, although this likely reflects the more complex nature of these lesions. The risks of this combined treatment strategy are likely lower than the risks associated with the natural history of this subset of aneurysms.

scholarly journals Prevalence of Unruptured Intracranial Aneurysms: A Single Center Experience using 3T Brain MR Angiography

2021 ◽  
Author(s):  
Jae Ho Kim ◽  
Kyung-Yul Lee ◽  
Sang Woo Ha ◽  
Sang Hyun Suh
Keyword(s):  
Magnetic Resonance ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Anterior Communicating Artery ◽  
Health Examination ◽  
Single Center ◽  
Single Center Experience ◽  
Institutional Review ◽  
Unruptured Intracranial Aneurysms

Purpose: The purpose of this study was to evaluate the prevalence and risk factors of unruptured intracranial aneurysms (UIAs), which can help establish guidelines of treatment for asymptomatic Korean adults using 3T magnetic resonance angiography (MRA).Materials and Methods: Our Institutional Review Board approved this retrospective study, and informed consent was waived. All patients consisted of healthy individuals who underwent brain MRA using 3T magnetic resonance imaging between January 2011 and December 2012 as part of a routine health examination. Patient data and follow-up results were obtained from medical records.Results: A total of 2,118 individuals (mean age=53.9±9.6 years, male:female=1,188:930) who had undergone brain MRA were enrolled in the study. UIAs were found in 80 patients with 105 UIAs (3.77%). Female predominance (55% in UIA versus 43.47% in non-UIA, P=0.0416) and hypertension were more common in the UIA group (43.75% <i>vs</i>. 28.8%, P=0.004, respectively). The mean size of the aneurysms was 3.10±1.62 mm, and they were all saccular in shape and asymptomatic. The UIAs were most common in the internal carotid artery (59.1%), internal carotid-posterior communicating artery (15.2%), middle cerebral artery (9.5%), anterior communicating artery (8.6%), anterior cerebral artery (4.8%), and vertebral artery (2.9%). Twenty-eight of 80 patients (35%) had multiple aneurysms. The incidence of UIAs increased significantly with age (P=0.014).Conclusion: In single center experience, we demonstrated the characteristics and prevalence of UIAs in asymptomatic adults, which may help establish guidelines or therapeutic standards for UIAs.

Early postmarket results with PulseRider for treatment of wide-necked intracranial aneurysms: a multicenter experience

2020 ◽  
Vol 133 (6) ◽  
pp. 1756-1765 ◽  
Author(s):  
Visish M. Srinivasan ◽  
Aditya Srivatsan ◽  
Alejandro M. Spiotta ◽  
Benjamin K. Hendricks ◽  
Andrew F. Ducruet ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Aneurysm Rupture ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Aneurysm Neck ◽  
Off Label ◽  
Fda Approval ◽  
Class 1

OBJECTIVETraditionally, stent-assisted coiling and balloon remodeling have been the primary endovascular treatments for wide-necked intracranial aneurysms with complex morphologies. PulseRider is an aneurysm neck reconstruction device that provides parent vessel protection for aneurysm coiling. The objective of this study was to report early postmarket results with the PulseRider device.METHODSThis study was a prospective registry of patients treated with PulseRider at 13 American neurointerventional centers following FDA approval of this device. Data collected included clinical presentation, aneurysm characteristics, treatment details, and perioperative events. Follow-up data included degree of aneurysm occlusion and delayed (> 30 days after the procedure) complications.RESULTSA total of 54 aneurysms were treated, with the same number of PulseRider devices, across 13 centers. Fourteen cases were in off-label locations (7 anterior communicating artery, 6 middle cerebral artery, and 1 A1 segment anterior cerebral artery aneurysms). The average dome/neck ratio was 1.2. Technical success was achieved in 52 cases (96.2%). Major complications included the following: 3 procedure-related posterior cerebral artery strokes, a device-related intraoperative aneurysm rupture, and a delayed device thrombosis. Immediately postoperative Raymond-Roy occlusion classification (RROC) class 1 was achieved in 21 cases (40.3%), class 2 in 15 (28.8%), and class 3 in 16 cases (30.7%). Additional devices were used in 3 aneurysms. For those patients with 3- or 6-month angiographic follow-up (28 patients), 18 aneurysms (64.2%) were RROC class 1 and 8 (28.5%) were RROC class 2.CONCLUSIONSPulseRider is being used in both on- and off-label cases following FDA approval. The clinical and radiographic outcomes are comparable in real-world experience to the outcomes observed in earlier studies. Further experience is needed with the device to determine its role in the neurointerventionalist’s armamentarium, especially with regard to its off-label use.

HyperForm balloon remodeling in the endovascular treatment of anterior cerebral, middle cerebral, and anterior communicating artery aneurysms: clinical and angiographic follow-up results in 800 consecutive patients

2011 ◽  
Vol 114 (4) ◽  
pp. 944-953 ◽  
Author(s):  
H. Saruhan Cekirge ◽  
Kivilcim Yavuz ◽  
Serdar Geyik ◽  
Isil Saatci
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Neurological Deficits ◽  
Anterior Communicating Artery ◽  
Severe Bleeding ◽  
Negative Consequences ◽  
Anterior Circulation ◽  
Anterior Communicating Artery Aneurysms

Object The purpose of this paper was to present the safety, efficacy, and clinical/angiographic follow-up results of HyperForm balloon-assisted endosaccular coil occlusion of distal anterior circulation bifurcation aneurysms. Methods Over a 7-year period, the authors treated 864 middle cerebral artery, distal anterior cerebral artery bifurcation, and anterior communicating artery aneurysms by means of coil embolization with HyperForm balloon assistance in 800 patients. In 37 aneurysms, 2 HyperForm balloons were used simultaneously for remodeling. Results The overall mortality rate was 7.1%, including 1.4% procedural mortality. Various neurological deficits were present at discharge in 8.9% of the patients, and 4.4% had permanent disabling morbidity 6 months posttreatment (modified Rankin Scale score ≥ 2). Thromboembolic complications developed during the treatment of 15 aneurysms (1.7%) causing morbidity or mortality in 10 cases (1.3%). There were 14 intraoperative perforations (1.6%). In all 14 cases, the HyperForm balloon saved patients from severe bleeding. The perforation led to morbidity or mortality in 3 cases (0.4%); there were no negative consequences in 11. There were 726 patients with 757 aneurysms (87.6%) available for follow-up. Control angiograms were obtained at 6 months in 386 patients, at 1 year in 267, and at 2 years in 104, revealing an 82% complete obliteration rate according to the most recent follow-up angiograms. Conclusions The satisfactory results obtained in this experience demonstrate that HyperForm balloon remodeling provides strong benefits for the endovascular management of middle cerebral, anterior cerebral, and anterior communicating artery aneurysms without increasing the risk of treatment. Not only does this technique allow for the safe treatment of these aneurysms, but it also expands the indications of endovascular treatment to include aneurysms that otherwise cannot be treated with simple coil embolization.

Abstract WP89: Preliminary Single-center Experience with Neuroform Atlas Stent-assisted Coiling for Unruptured Intracranial Aneurysms

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Gabriele Ciccio’ ◽  
Stanislas Smajda ◽  
Thomas Robert ◽  
Raphael Blanc ◽  
Hocine Redjem ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Posterior Inferior Cerebellar Artery ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Single Center Experience ◽  
Low Profile ◽  
Unruptured Intracranial Aneurysms ◽  
Cerebellar Artery ◽  
High Level ◽  
Cranial Arteries

Background and Purpose: Expandable stents have broadened the spectrum of endovascular treatment of intracranial aneurysms. The Neuroform ATLAS, a nitinol self-expanding, hybrid/open-cell stent, is the evolution of the Neuroform EZ supposing to ease the navigability of the system into intra-cranial arteries, through a low-profile 0.017 inch delivery catheter. We present herein our initial experience in the treatment of intracranial aneurysms with this stent. Materials and Method: We compiled data from consecutive patients of our institution from July 2015 to June 2016 who underwent stent-assisted coiling with the Neuroform ATLAS. Clinical and angiographic results were analyzed retrospectively. Results: Thirty-six intracranial saccular aneurysms (18 MCA, 10 AcoA, 4 ICA bifurcation, 2 basilar tip, 1 vertebral-PICA, 1 pericallosal artery) in 35 patients (24 women, 11 men, mean age 60 years) were consecutively treated. The stent was used in 32 previously untreated aneurysms, and in 4 cases of recanalization. One single stent was used in 15 aneurysms while 21 aneurysms (58.3%) were treated with 2 stents in a “Y” configuration. The immediate post-treatment angiography showed a complete occlusion in 19 cases (52.7%), a residual neck in 4 cases (11.1%) and a residual aneurysmal contrast filling in 13 cases (36.1%). Two complications occurred (5.5%), the first due to an associated aneurysm perforation (mRs 1), and the second due to parent vessel perforation (mRs 6). Both of them occurred after the stent implantation. We don’t report any case of attempted stenting treatment. Conclusion: The Neuroform ATLAS Delivery System is an effective device for treatment of complex intracranial aneurysms, allowing good conformability and stability with a high level of navigability. The 2 main advantages are its low profile and the cell-design allowing easy mesh crossing to perform Y-stenting procedures. Key words: Neuroform ATLAS, Neuroform EZ, Stent-assisted coiling, cerebral aneurysm. Abbreviations: mRs: modified Rankin Scale, AcoA: Anterior communicating artery, PICA: posterior inferior cerebellar artery.

Primary Epileptogenic Unruptured Intracranial Aneurysms

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. 1161-1165 ◽  
Author(s):  
Daniel Hänggi ◽  
Peter A. Winkler ◽  
Hans-Jakob Steiger
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Parahippocampal Gyrus ◽  
Anterior Communicating Artery ◽  
Middle Cerebral Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Unruptured Intracranial Aneurysms ◽  
Cerebral Artery Aneurysm

Abstract BACKGROUND Seizures as the unique initial manifestation of unruptured intracranial aneurysms have rarely been documented and not systematically described until now. OBJECTIVE The purpose of this large retrospective analysis was to focus on the incidence of primary epileptogenic aneurysms and the influence of treatment on epilepsy. METHODS Within a 16-year period, 347 unruptured aneurysms were surgically treated at centers in Munich (1992–2002) and Düsseldorf (2003–2008), Germany. Of this patient population, 9 patients presented exclusively with epileptic seizures or epileptic equivalents. In 3 of them, a high-lying internal carotid artery aneurysm was diagnosed that was buried in the parahippocampal gyrus. In 4 patients, a middle cerebral artery aneurysm also created contact with the mediotemporal lobe adjacent to the parahippocampal gyrus. An anterior communicating artery aneurysm and a pericallosal artery aneurysm were diagnosed in 2 additional patients. Two patients with a middle cerebral artery aneurysm were initially incompletely occluded with Guglielmi detachable coils and continued to have epilepsy after the intervention. In all but 1 patient, the aneurysms were clipped and completely removed. RESULTS In all 8 patients operated on, there was no sign of hemorrhage intraoperatively but cortical gliosis was seen around the dome of the aneurysm. In all cases, the aneurysm and the surrounding gliosis, if existent, were surgically removed. Freedom from seizures without medication resulted for all patients after microsurgery. DISCUSSION Seizures as a presenting symptom of unruptured intracranial aneurysms are rare. There seems to be a preponderance of aneurysms anatomically related to the temporomedial region. Elimination of the aneurysm and perifocal gliosis provides the possibility of a cure for the epilepsy.

Size and location of ruptured intracranial aneurysms: consecutive series of 1993 hospital-admitted patients

2017 ◽  
Vol 127 (4) ◽  
pp. 748-753 ◽  
Author(s):  
Miikka Korja ◽  
Riku Kivisaari ◽  
Behnam Rezai Jahromi ◽  
Hanna Lehto
Keyword(s):  
Intracranial Aneurysms ◽  
Maximum Diameter ◽  
Anterior Communicating Artery ◽  
Study Cohort ◽  
Consecutive Series ◽  
Anterior Circulation ◽  
Effective Prevention ◽  
Median Size ◽  
Unruptured Intracranial Aneurysms ◽  
Ruptured Intracranial Aneurysms

OBJECTIVELarge consecutive series on the size and location of ruptured intracranial aneurysms (RIAs) are limited, and therefore it has been difficult to estimate population-wide effects of size-based treatment strategies of unruptured intracranial aneurysms. The authors' aim was to define the size and location of RIAs in patients diagnosed with subarachnoid hemorrhage due to aneurysm rupture in a high-volume academic center.METHODSConsecutive patients admitted to a large nonprofit academic hospital with saccular RIAs between 1995 and 2009 were identified, and the size, location, and multiplicity of RIAs were defined and reported by patient sex.RESULTSIn the study cohort of 1993 patients (61% women) with saccular RIAs, the 4 most common locations of RIAs were the middle cerebral (32%), anterior communicating (32%), posterior communicating (14%), and pericallosal arteries (5%). However, proportional distribution of RIAs varied considerably by sex; for example, RIAs of the anterior communicating artery were more frequently found in men than in women. Anterior circulation RIAs accounted for 90% of all RIAs, and 30% of the patients had multiple intracranial aneurysms. The median size (measured as maximum diameter) of all RIAs was 7 mm (range 1–43 mm), but the size varied considerably by location. For example, RIAs of the ophthalmic artery had a median size of 11 mm, whereas the median size of RIAs of the pericallosal artery was 6 mm. Of all RIAs, 68% were smaller than 10 mm in maximum diameter.CONCLUSIONSIn this large consecutive series of RIAs, 83% of all RIAs were found in 4 anterior circulation locations. The majority of RIAs were small, but the size and location varied considerably by sex. The presented data may be of help in defining effective prevention strategies.

scholarly journals Combined surgical and endovascular treatment of a recurrent A3–A3 junction aneurysm unsuitable for standalone clip ligation or coil occlusion

2005 ◽  
Vol 18 (2) ◽  
pp. 1-4 ◽  
Author(s):  
Louis J. Kim ◽  
Felipe C. Albuquerque ◽  
Cameron McDougall ◽  
Robert F. Spetzler
Keyword(s):  
Treatment Plan ◽  
Cerebral Aneurysms ◽  
Anterior Communicating Artery ◽  
Parent Vessel ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Transcallosal Approach ◽  
Pericallosal Artery ◽  
Coil Occlusion ◽  
The Right

Recurrent aneurysms of the anterior circulation that are distal to the anterior communicating artery (ACoA) but proximal to the callosomarginal–pericallosal bifurcation can pose a treatment challenge. The authors present one such case, in which the patient was treated with pericallosal artery–pericallosal artery (PerA–PerA) side-to-side bypass, followed by endovascular obliteration of the proximal A2 parent vessel. This patient, in whom an ACoA aneurysm had been treated with clip ligation 5 years previously, presented with a new, mid-A2, right-sided aneurysm with the out-flow artery arising from the dome of the lesion. The treatment plan included two steps: an interhemispheric transcallosal approach for PerA–PerA side-to-side anastomosis; and endovascular coil embolization of the right A2 branch feeding the aneurysm. Postprocedure angiography demonstrated no ipsilateral aneurysm filling and excellent bilateral distal outflow from the anterior cerebral artery (ACA). The use of PerA–PerA side-to-side bypass for the treatment of an ACA aneurysm, followed by parent vessel occlusion, offers an elegant solution for the treatment of A2 aneurysms that are not amenable to stand-alone clip ligation or coil occlusion. Such combined methods are invaluable in the management of complex cerebral aneurysms.

Revascularization and Aneurysm Surgery: Current Status

Neurosurgery ◽  
1985 ◽  
Vol 16 (1) ◽  
pp. 111-116 ◽  
Author(s):  
Robert F. Spetzler ◽  
Philip L. Carter
Keyword(s):  
Intracranial Aneurysms ◽  
Current Status ◽  
Aneurysm Surgery ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Flow Measurements ◽  
Stump Pressure ◽  
Blood Flow Measurements ◽  
Vessel Ligation

Abstract Unclippable intracranial aneurysms are most effectively treated by hunterian ligation; however, the attendant risk of cerebral ischemia is significant. Many techniques have been used in an attempt to predict the safety of proximal vessel occlusion. Unfortunately, there is none that is risk-free and highly successful. A combination of stump pressure and cerebral blood flow measurements has been shown to be the most accurate in the acute assessment. In addition, recent studies have demonstrated that the long term risk of carotid ligation is significant. Extracranial-intracranial bypass grafting (EC-IC) has been shown to improve the safety of parent vessel ligation and is a low risk procedure. Whenever hunterian ligation is planned for the treatment of an intracranial aneurysm, EC-IC should be strongly considered. (Neurosurgery 16:111–116, 1985)

Traumatic dissecting pathology of posterior cerebral artery: a report of two cases—aneurysm and pial arteriovenous fistula

2021 ◽  
Vol 14 (5) ◽  
pp. e237722
Author(s):  
Vignesh Selvamurugan ◽  
Surya Nandan Prasad ◽  
Vivek Singh ◽  
Zafar Neyaz
Keyword(s):  
Arteriovenous Fistula ◽  
Cerebral Artery ◽  
Road Traffic ◽  
Posterior Cerebral Artery ◽  
Case Reports ◽  
Dissecting Aneurysm ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Parent Vessel Occlusion ◽  
Pial Arteriovenous Fistula

We present two cases of 17-year-old man and 10-year-old boy presenting with subarachnoid haemorrhage and a history of road traffic accident. One patient had dissecting aneurysm of the posterior cerebral artery (PCA), and the other patient had partially thrombosed aneurysm on CT angiography. On digital subtraction angiography of the second patient, there was formation of PCA pontomesencephalic vein pial arteriovenous fistula (PAVF). Both the patients underwent endovascular treatment: stent-assisted coiling for aneurysm and coiling with parent vessel occlusion for PAVF. There were no procedural complications. Follow-up angiography showed no residual aneurysm or fistula. Trauma is one of the recognised causes of dissection, and intracranial dissections can present as stenotic lesions, aneurysms or fistulas, depending on the pathology. Traumatic dissecting PCA aneurysm has been reported in only two case reports previously, and post-traumatic PAVF in PCA has not been reported.

scholarly journals Increased rupture risk in small intracranial aneurysms associated with methamphetamine use

2020 ◽  
pp. 159101992095953
Author(s):  
Dylan Noblett ◽  
Lotfi Hacein-Bey ◽  
Ben Waldau ◽  
Jordan Ziegler ◽  
Brian Dahlin ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Significant Risk ◽  
Retrospective Chart Review ◽  
Anterior Circulation ◽  
Unruptured Aneurysms ◽  
Methamphetamine Use ◽  
Aneurysm Size ◽  
Unruptured Intracranial Aneurysms ◽  
History Of

Background Aneurysmal subarachnoid hemorrhage (SAH) is the most common cause of nontraumatic SAH. Current guidelines generally recommend observation for unruptured intracranial aneurysms smaller than 7 mm, for those are considered at low risk for spontaneous rupture according to available scoring systems. Objective We observed a tendency for SAH in small intracranial aneurysms in patients who are methamphetamine users. A retrospective, single center study to characterize the size and location of ruptured and unruptured intracranial aneurysms in methamphetamine users was performed. Materials and methods Clinical characteristics and patient data were collected via retrospective chart review of patients with intracranial aneurysms and a history of methamphetamine use with a specific focus on aneurysm size and location. Results A total of 62 patients were identified with at least one intracranial aneurysm and a history of methamphetamine use, yielding 73 intracranial aneurysms (n = 73). The mean largest diameter of unruptured aneurysms (n = 44) was 5.1 mm (median 4.5, SD 2.5 mm), smaller than for ruptured aneurysms (n = 29) with a mean diameter of 6.3 mm (median 5.5, SD 2.5 mm). Aneurysms measuring less than 7 mm presented with SAH in 36.5%. With regard to location, 28% (n = 42) of anterior circulation aneurysms less than 7 mm presented with rupture, in contrast to 70% (n = 10) of posterior circulation aneurysms which were found to be ruptured. Conclusions Methamphetamine use may be considered a significant risk factor for aneurysmal SAH at a smaller aneurysm size than for other patients. These patients may benefit from a lower threshold for intervention and/or aggressive imaging and clinical follow-up.

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