Preliminary report of a hollow-centered balloon for intravascular occlusion of intracranial aneurysms or arteriovenous fistulas

1980 ◽  
Vol 53 (2) ◽  
pp. 262-265 ◽  
Author(s):  
Milton D. Heifetz ◽  
Grant B. Hieshima ◽  
C. Mark Mehringer
Keyword(s):  
Arteriovenous Fistula ◽  
Preliminary Report ◽  
Intracranial Aneurysms ◽  
Giant Aneurysm ◽  
Parent Artery ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Preliminary Study ◽  
Intravascular Occlusion ◽  
Fine Print

✓ A doughnut-shaped balloon has been designed that can be inserted intravascularly by catheter to occlude the orifice of an intracranial berry or giant aneurysm or arteriovenous fistula. The blood in the parent artery can continue to flow uninterrupted through the hole in the balloon. In a preliminary study, an arteriovenous fistula was successfully obliterated in a dog. The technique for placing the balloon is described.

Transvenous embolization for a purely intraorbital arteriovenous fistula

2005 ◽  
Vol 103 (4) ◽  
pp. 756-759 ◽  
Author(s):  
Jun Deguchi ◽  
Makoto Yamada ◽  
Ryusuke Ogawa ◽  
Toshihiko Kuroiwa
Keyword(s):  
Arteriovenous Malformation ◽  
Arteriovenous Fistula ◽  
Visual Function ◽  
Clinical Management ◽  
Ophthalmic Artery ◽  
Transvenous Embolization ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Fine Print

✓ Purely intraorbital arteriovenous fistulas (AVFs) are rare, and their clinical management is controversial. The authors successfully treated a patient with an intraorbital AVF by transvenous embolization alone. An accurate distinction between an arteriovenous malformation (AVM), which is characterized by the existence of a nidus, and an AVF, which has no nidus, is important and requires superselective ophthalmic artery angiography. Treatment of an intraorbital AVF by transvenous embolization can improve visual function.

Detachable balloon embolization therapy of posterior circulation intracranial aneurysms

1989 ◽  
Vol 71 (4) ◽  
pp. 512-519 ◽  
Author(s):  
Randall T. Higashida ◽  
Van V. Halbach ◽  
Leslie D. Cahan ◽  
Grant B. Hieshima ◽  
Yoshifumi Konishi
Keyword(s):  
Basilar Artery ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Parent Artery ◽  
Parent Vessel ◽  
Detachable Balloon ◽  
Content Type ◽  
Aneurysm Neck ◽  
Balloon Embolization ◽  
Fine Print

✓ Treatment of complex and surgically difficult intracranial aneurysms of the posterior circulation is now being performed with intravascular detachable balloon embolization techniques. The procedure is carried out under local anesthesia from a transfemoral arterial approach, which allows continuous neurological monitoring. Under fluoroscopic guidance, the balloon is propelled by blood flow through the intracranial circulation and, in most cases, can be guided directly into the aneurysm, thus preserving the parent vessel. If an aneurysm neck is not present, test occlusion of the parent vessel is performed and, if tolerated, the balloon is detached. Twenty-six aneurysms in 25 patients have been treated by this technique. The aneurysms have involved the distal vertebral artery (five cases), the mid-basilar artery (six cases), the distal basilar artery (11 cases), and the posterior cerebral artery (four cases). The aneurysms varied in size and included three small (< 12 mm), 15 large (12 to 25 mm), and eight giant (> 25 mm). Fifteen patients (60%) presented with hemorrhage and 10 patients (40%) with mass effect. In 17 cases (65%) direct balloon embolization of the aneurysm was achieved with preservation of the parent artery. In nine cases (35%), because of aneurysm location and size, occlusion of the parent vessel was performed. Complications from therapy included three cases of transient cerebral ischemia which resolved, three cases of stroke, and five deaths due to immediate or delayed aneurysm rupture. The follow-up period has ranged from 2 months to 43 months (mean 22.5 months). In cases where posterior circulation aneurysms have been difficult to treat by conventional neurosurgical techniques, intravascular detachable balloon embolization may offer an alternative therapeutic option.

Treatment of traumatic aneurysms and arteriovenous fistulas of the skull base by using endovascular stents

2001 ◽  
Vol 95 (3) ◽  
pp. 412-419 ◽  
Author(s):  
Gary Redekop ◽  
Thomas Marotta ◽  
Alain Weill
Keyword(s):  
Skull Base ◽  
Stent Placement ◽  
Vascular Lesions ◽  
Definitive Treatment ◽  
Parent Artery ◽  
Base Region ◽  
Endovascular Stents ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Fine Print

Object. The authors describe their preliminary clinical experience with the use of endovascular stents in the treatment of traumatic vascular lesions of the skull base region. Because adequate distal exposure and direct surgical repair of these lesions are not often possible, conventional treatment has been deliberate arterial occlusion. The purpose of this report is to demonstrate the safety and efficacy as well as limitations of endovascular stent placement in the management of craniocervical arterial injuries. Methods. Six patients with vascular injuries were treated using endovascular stents. There were two arteriovenous fistulas and two pseudoaneurysms of the distal extracranial internal carotid or vertebral arteries resulting from penetrating trauma, and two petrous carotid pseudoaneurysms associated with basal skull fractures. In one patient a porous stent placement procedure was undertaken as well as coil occlusion of an aneurysm, whereas in the remaining five patients covered stent grafts were used as definitive treatment. There were no procedural complications. One patient in whom there was extensive traumatic arterial dissection was found to have asymptomatic stent thrombosis when angiography was repeated 1 week postoperatively. This was the only patient whose associated injuries precluded routine antithrombotic or antiplatelet therapy. Follow-up examinations in the remaining five patients included standard angiography (four patients) or computerized tomography angiography (one patient), which were performed 3 to 6 months postoperatively, and clinical assessments ranging from 3 months to 1 year in duration (mean 9 months). In all five cases the vascular injury was successfully treated and the parent artery remained widely patent. No patient experienced aneurysm recurrence or hemorrhage, and there were no thromboembolic complications. Conclusions. The authors' experience demonstrates that endovascular treatment of traumatic vascular lesions of the skull base region is both feasible and safe. The advantages of minimally invasive stent placement and parent artery preservation make this procedure for repair of neurovascular injuries a potentially important addition to existing methods.

Ruptured giant intracranial aneurysms. Part I. A study of rebleeding

1998 ◽  
Vol 88 (3) ◽  
pp. 425-429 ◽  
Author(s):  
Vini G. Khurana ◽  
David G. Piepgras ◽  
Jack P. Whisnant
Keyword(s):  
Mayo Clinic ◽  
Intracranial Aneurysms ◽  
Management Strategies ◽  
Giant Aneurysm ◽  
Cumulative Frequency ◽  
Content Type ◽  
Giant Aneurysms ◽  
Giant Intracranial Aneurysms ◽  
Intracranial Circulation ◽  
Fine Print

Object. The present study was conducted to estimate the frequency and timing of rebleeding after initial subarachnoid hemorrhage (SAH) from ruptured giant aneurysms. Methods. The authors reviewed records of 109 patients who suffered an initial SAH from a giant aneurysm and were treated at the Mayo Clinic between 1973 and 1996. They represented 25% of patients with giant intracranial aneurysms seen at this institution during that 23-year period. Seven of the patients were residents of Rochester, Minnesota, and the rest were referred from other institutions. The aneurysms ranged from 25 to 60 mm in diameter, and 74% were located on arteries of the anterior intracranial circulation. The cumulative frequency of rebleeding at 14 days after admission was 18.4%. Cerebrospinal fluid drainage, cerebral angiography, and delayed aneurysm recurrence were implicated in rebleeding in some of the patients. Rebleeding was not precluded by intraaneurysm thrombosis. Among those who suffered recurrent SAH at the Mayo Clinic, 33% died in the hospital. Conclusions. Rebleeding from giant aneurysms occurs at a rate comparable to that associated with smaller aneurysms, a finding that should be considered in management strategies.

Intracranial vertebral arteriovenous fistula

1993 ◽  
Vol 79 (4) ◽  
pp. 589-591 ◽  
Author(s):  
Andrea L. Halliday ◽  
Christopher S. Ogilvy ◽  
Robert M. Crowell
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Arteriovenous Fistula ◽  
Surgical Management ◽  
Surgical Approach ◽  
Venous System ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Open Surgical Approach ◽  
Fine Print

✓ True intracranial arteriovenous fistulas are rare. The authors report a case of a direct fistula between the intracranial portion of the vertebral artery and the lateral medullary venous system. The patient initially presented with a subarachnoid hemorrhage. An open surgical approach with clip obliteration of the lesion was used. The anatomy of this lesion and its surgical management are described.

Giant aneurysm arising from a single arteriovenous fistula in a child

1984 ◽  
Vol 60 (5) ◽  
pp. 1085-1088 ◽  
Author(s):  
Rafael Carrillo ◽  
Luis Miguel Carreira ◽  
José Prada ◽  
Cesareo Rosas ◽  
Guillermo Egas
Keyword(s):  
Brain Stem ◽  
Arteriovenous Fistula ◽  
Posterior Cerebral Artery ◽  
Giant Aneurysm ◽  
Vein Of Galen ◽  
Feeding Artery ◽  
Content Type ◽  
The Right ◽  
The Brain ◽  
Fine Print

✓ A case is presented of a child with an arteriovenous fistula and a giant aneurysm located beside the brain stem under the right temporal lobe. It was successfully treated by clipping its feeding artery, a branch of the right posterior cerebral artery. The similarities to, and the differences from, aneurysms of the vein of Galen are discussed.

Bioabsorbable polymeric material coils for embolization of intracranial aneurysms: a preliminary experimental study

2001 ◽  
Vol 94 (3) ◽  
pp. 454-463 ◽  
Author(s):  
Yuichi Murayama ◽  
Fernando Viñuela ◽  
Satoshi Tateshima ◽  
Joon K. Song ◽  
Nestor R. Gonzalez ◽  
...  
Keyword(s):  
Polymeric Material ◽  
Intracranial Aneurysms ◽  
Blood Clot ◽  
Fibrous Tissue ◽  
Clinical Manifestations ◽  
Embolic Agent ◽  
Parent Artery ◽  
Content Type ◽  
Fine Print

Object. A new embolic agent, bioabsorbable polymeric material (BPM), was incorporated into Guglielmi detachable coils (GDCs) to improve long-term anatomical results in the endovascular treatment of intracranial aneurysms. The authors investigated whether BPM-mounted GDCs (BPM/GDCs) accelerated the histopathological transformation of unorganized blood clot into fibrous connective tissue in experimental aneurysms created in swine. Methods. Twenty-four experimental aneurysms were created in 12 swine. In each animal, one aneurysm was embolized using BPM/GDCs and the other aneurysm was embolized using standard GDCs. Comparative angiographic and histopathological data were analyzed at 2 weeks and 3 months postembolization. At 14 days postembolization, angiograms revealed evidence of neck neointima in six of eight aneurysms treated with BPM/GDCs compared with zero of eight aneurysms treated with standard GDCs (p < 0.05). At 3 months postembolization, angiograms demonstrated that four of four aneurysms treated with BPM/GDC were smaller and had neck neointima compared with zero of four aneurysms treated with standard GDCs (p = 0.05). At 14 days, histological analysis of aneurysm healing favored BPM/GDC treatment (all p < 0.05): the grade of cellular reaction around the coils was 3 ± 0.9 (mean ± standard deviation) for aneurysms treated using BPM/GDCs compared with 1.6 ± 0.7 for aneurysms treated using GDCs alone; the percentage of unorganized thrombus was 16 ± 12% compared with 37 ± 15%, and the neck neointima thickness was 0.65 ±0.26 mm compared with 0.24 ±0.21 mm, respectively. At 3 months postembolization, only neck neointima thickness was significantly different (p < 0.05): 0.73 ± 0.37 mm in aneurysms filled with BPM/GDCs compared with 0.16 ± 0.14 mm in aneurysms filled with standard GDCs. Conclusions. In experimental aneurysms in swine, BPM/GDCs accelerated aneurysm fibrosis and intensified neck neointima formation without causing parent artery stenosis or thrombosis. The use of BPM/GDCs may improve long-term anatomical outcomes by decreasing aneurysm recanalization due to stronger in situ anchoring of coils by organized fibrous tissue. The retraction of this scar tissue may also decrease the size of aneurysms and clinical manifestations of mass effect observed in large or giant aneurysms.

Excimer laser—assisted bypass in aneurysm treatment: short-term outcomes

2002 ◽  
Vol 97 (5) ◽  
pp. 1029-1035 ◽  
Author(s):  
Eva H. Brilstra ◽  
Gabriel J. E. Rinkel ◽  
Catharina J. M. Klijn ◽  
Albert van der Zwan ◽  
Ale Algra ◽  
...  
Keyword(s):  
Excimer Laser ◽  
Clinical Condition ◽  
Intracranial Aneurysms ◽  
High Flow ◽  
Parent Artery ◽  
Content Type ◽  
Poor Outcome ◽  
Risk Of Rupture ◽  
Clip Application ◽  
Fine Print

Object. If clip application or coil placement for treatment of intracranial aneurysms is not feasible, the parent vessel can be occluded to induce thrombosis of the aneurysm. The Excimer laser—assisted anastomosis technique allows the construction of a high-flow bypass in patients who cannot tolerate such an occlusion. The authors assessed the complications of this procedure and clinical outcomes after the construction of high-flow bypasses in patients with intracranial aneurysms. Methods. Data were retrospectively collected on patient and aneurysm characteristics, procedural complications, and functional outcomes in 77 patients in whom a high-flow bypass was constructed. Logistic regression analysis was used to quantify the relationships between patient and aneurysm characteristics on the one hand and outcome measures on the other. Fifty-one patients harbored a giant aneurysm, 24 patients suffered from a ruptured aneurysm, and 35 patients from an unruptured symptomatic aneurysm. In 22 patients (29%; 95% confidence interval [CI] 19–40%) a permanent deficit developed from an operative complication. At a median follow-up period of 2.5 months, 25 patients (32%; 95% CI 22–44%) were dependent or had died; in 10 of these patients (13% of all patients; 95% CI 6–23%) operative complications were the single cause of this poor outcome. Univariate analysis demonstrated that a poor clinical condition before treatment (odds ratio [OR] 4.7; 95% CI 1.7–13.3) and a history of cardiovascular disease (OR 4.1; 95% CI 1–16.2) increased the risk of poor outcome. Multivariate analysis demonstrated that only the clinical condition before treatment was significantly related to outcome (OR 4; 95% CI 1.3–11.9). Conclusions. In patients with an intracranial aneurysm that cannot be treated by clip application or coil placement, and in whom occlusion of the parent artery cannot be tolerated, the construction of a high-flow bypass should be considered. This procedure carries a considerable risk of complications, but this should be weighed against the disabling or life-threatening effects of compression, the high risk of rupture, and the substantial chance of poor outcome after the rupture of such aneurysms.

A proposed parent vessel geometry—based categorization of saccular intracranial aneurysms: computational flow dynamics analysis of the risk factors for lesion rupture

2005 ◽  
Vol 103 (4) ◽  
pp. 662-680 ◽  
Author(s):  
Tamer Hassan ◽  
Eugene V. Timofeev ◽  
Tsutomu Saito ◽  
Hiroaki Shimizu ◽  
Masayuki Ezura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracranial Aneurysms ◽  
Aneurysm Rupture ◽  
Flow Dynamics ◽  
Low Flow ◽  
Parent Artery ◽  
Dynamics Analysis ◽  
Content Type ◽  
Computational Flow Dynamics ◽  
Fine Print

Object. The authors created a simple, broadly applicable classification of saccular intracranial aneurysms into three categories: sidewall (SW), sidewall with branching vessel (SWBV), and endwall (EW) according to the angiographically documented patterns of their parent arteries. Using computational flow dynamics analysis (CFDA) of simple models representing the three aneurysm categories, the authors analyzed geometry-related risk factors such as neck width, parent artery curvature, and angulation of the branching vessels. Methods. The authors performed CFDAs of 68 aneurysmal geometric formations documented on angiograms that had been obtained in patients with 45 ruptured and 23 unruptured lesions. In successfully studied CFDA cases, the wall shear stress, blood velocity, and pressure maps were examined and correlated with aneurysm rupture points. Statistical analysis of the cases involving aneurysm rupture revealed a statistically significant correlation between aneurysm depth and both neck size (p < 0.0001) and caliber of draining arteries (p < 0.0001). Wider-necked aneurysms or those with wider-caliber draining vessels were found to be high-flow lesions that tended to rupture at larger sizes. Smaller-necked aneurysms or those with smaller-caliber draining vessels were found to be low-flow lesions that tended to rupture at smaller sizes. The incidence of ruptured aneurysms with an aspect ratio (depth/neck) exceeding 1.6 was 100% in the SW and SWBV categories, whereas the incidence was only 28.75% for the EW aneurysms. Conclusions. The application of standardized categories enables the comparison of results for various aneurysms' geometric formations, thus assisting in their management. The proposed classification system may provide a promising means of understanding the natural history of saccular intracranial aneurysms.

Endovascular treatment of giant and large intracranial aneurysms by using a combination of stent placement and liquid polymer injection

2002 ◽  
Vol 96 (3) ◽  
pp. 474-482 ◽  
Author(s):  
Michel E. Mawad ◽  
Saruhan Cekirge ◽  
Elisa Ciceri ◽  
Isil Saatci
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Parent Artery ◽  
Metallic Stent ◽  
Content Type ◽  
Liquid Polymer ◽  
Arterial Lumen ◽  
Small Series ◽  
Fine Print

Object. The aim of this study was to test the feasibility, safety, and efficacy of a new endovascular method for the treatment of giant intracranial aneurysms. This new method consists of combining a metallic stent with a liquid polymer; the stent is first placed across the neck of the aneurysm to reconstruct a tubular arterial lumen, followed by obliteration of the fundus of the aneurysm with an ethyl vinyl alcohol polymer. During its injection, the liquid polymer is contained within the aneurysm by temporarily inflating an occlusion balloon in the parent artery. Methods. Eleven patients harboring a giant aneurysm were successfully treated using this procedure. All aneurysms were excluded from the circulation, with preservation of the parent artery. In nine of the 11 patients, the 6-month follow-up angiogram demonstrated no recanalization of the aneurysm. In one patient who had a giant and partially clotted internal carotid artery bifurcation aneurysm, the follow-up angiogram demonstrated minimal recanalization. The complications in this series of patients included one death and one case of transient hemiparesis caused by watershed ischemia. Conclusions. The initial anatomical results and the clinical outcome in this small series of patients are very encouraging. The mortality and morbidity rates associated with this new endovascular treatment are superior to those associated with surgical clipping of giant aneurysms.

Sign in / Sign up

Export Citation Format

Share Document