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.

Gross and microscopic histopathological findings in aneurysms of the human brain treated with Guglielmi detachable coils

1999 ◽  
Vol 91 (2) ◽  
pp. 284-293 ◽  
Author(s):  
Gerhard Bavinzski ◽  
Volkan Talazoglu ◽  
Monika Killer ◽  
Bernd Richling ◽  
Andreas Gruber ◽  
...  
Keyword(s):  
Blood Clot ◽  
Fibrous Tissue ◽  
Guglielmi Detachable Coils ◽  
Open Spaces ◽  
Content Type ◽  
Long Term Result ◽  
Detachable Coils ◽  
Fine Print

Object. The histopathological characteristics of aneurysms obtained at autopsy or surgery 3 days to 54 months after being treated with Guglielmi detachable coils (GDCs) were assessed.Methods. Seventeen aneurysms were obtained at autopsy and one was removed at surgery. Fourteen were examined histologically with the coils in situ. Naked coils embedded in an unorganized thrombus were found in those aneurysms that had been treated with coils within 1 week earlier. An incomplete replacement of the intraluminal blood clot by fibrous tissue and a partial membranous covering at the aneurysm orifice were observed in those aneurysms that had been treated with coils between 2 and 3 weeks prior to examination. One small aneurysm treated 6 weeks before harvesting showed formation of an endothelium-lined layer of connective tissue at the orifice. Collagen-rich vascularized tissue surrounding the coils was found in an aneurysm removed at surgery 54 months after coil implantation. Interestingly, six (50%) of 12 aneurysms (two small, three large, and one giant) that had been deemed 100% occluded on initial angiography showed tiny open spaces between the coils at the neck on gross examination.Conclusions. Endothelialization of the aneurysm orifice following placement of GDCs can occur; however, it appears to be the exception rather than the rule. In large aneurysms the process of intraaneurysm clot organization seems to be delayed and incomplete; tiny open spaces between the coils and an incomplete membranous covering in the region of the neck are frequently encountered. Further longitudinal studies are required to establish the spectrum of healing profiles that may direct our efforts in modifying the GDC system to produce a more stable long-term result.

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.

Long-term prognosis in surgically treated intracranial aneurysms

1981 ◽  
Vol 54 (1) ◽  
pp. 26-34 ◽  
Author(s):  
Lydia Artiola i Fortuny ◽  
Luis Prieto-Valiente
Keyword(s):  
Mortality Rate ◽  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Advanced Age ◽  
Content Type ◽  
Long Term Prognosis ◽  
Neurological State ◽  
Fine Print

✓ A series of 265 consecutive cases of intracranial aneurysm were reviewed to assess mortality and its causes. Preoperative and postoperative factors were considered in isolation and in combination. The mortality rate was 20%. Postoperative generalized vasospasm was found to be the major cause of mortality. Advanced age, hypertension, and a poor neurological state at operation were associated with poor results. The study emphasizes the importance of considering variables in combination rather than singly in the assessment of prognosis.

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.

Significance of vasospasm in the treatment of ruptured intracranial aneurysms

1977 ◽  
Vol 47 (3) ◽  
pp. 412-429 ◽  
Author(s):  
Isamu Saito ◽  
Yasuichi Ueda ◽  
Keiji Sano
Keyword(s):  
Intracranial Aneurysms ◽  
Surgical Intervention ◽  
Blood Clot ◽  
Timing Of Surgery ◽  
Neurological Deficits ◽  
Aneurysm Surgery ◽  
Content Type ◽  
Ruptured Intracranial Aneurysm ◽  
Ruptured Intracranial Aneurysms ◽  
Fine Print

✓ The authors have analyzed a total of 96 consecutive cases in which vasospasm followed subarachnoid hemorrhage (SAH). The SAH was caused by ruptured intracranial aneurysm or developed after aneurysm surgery. Usually at least 4 days elapsed between SAH and the onset of vasospasm. Vasospasm subsided an average of 2 weeks after onset. Of 68 patients with preoperative vasospasm, eight died due to cerebral edema resulting from ischemia, and 49% of the survivors had neurological deficits. Preoperative vasospasm was not aggravated by surgical intervention when operations were carried out more than 7 days after the onset of vasospasm. Postoperative vasospasm was found in 25 of 52 patients who underwent operation within 1 week after SAH (excluding cases in Grade V). Five of these patients died, all of whom underwent surgery between the fourth and seventh day after SAH (the day of SAH was counted as the first day). There were no deaths among 20 patients operated on within the first 3 days after SAH. Postoperative vasospasm was always mild in these cases, when it occurred, probably because blood clot or blood-stained cerebrospinal fluid was removed by operative procedures. In all cases, 4 to 11 days elapsed between the last SAH and the onset of postoperative vasospasm regardless of the timing of surgery.

Cyanoacrylate encasement of intracranial aneurysms

1971 ◽  
Vol 34 (5) ◽  
pp. 709-713 ◽  
Author(s):  
David Yashon ◽  
Robert J. White ◽  
Belisario A. Arias ◽  
William E. Hegarty
Keyword(s):  
Biological Effect ◽  
Intracranial Aneurysms ◽  
Long Term Results ◽  
Operative Field ◽  
Content Type ◽  
Broad Base ◽  
Fibrous Reaction ◽  
Fine Print

✓ Some intracranial aneurysms, because of their broad base or incorporation of essential nutritive vessels, must be treated by adhesive reinforcement. The authors report successful results with cyanoacrylate adhesives in five patients. The unique quality of this material permits maximum adhesion in a moist operative field. This adhesive is nonviscous and will coat the entire aneurysm, obviating problems related to incomplete coating. Excellent long-term results are apparently due to the biological effect of this adhesive in which a proliferative fibrous reaction occurs and counteracts recognized erosive properties.

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.

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.

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.

Balloon-assisted coil placement in wide-necked aneurysms

1997 ◽  
Vol 86 (4) ◽  
pp. 724-727 ◽  
Author(s):  
David I. Levy ◽  
Andrew Ku
Keyword(s):  
Gold Standard ◽  
Intracranial Aneurysms ◽  
Ophthalmic Artery ◽  
Standard Of Care ◽  
Parent Artery ◽  
Guglielmi Detachable Coils ◽  
Initial Attempt ◽  
Content Type ◽  
Detachable Coils ◽  
Fine Print

✓ Saccular intracranial aneurysms are a common and often fatal lesion. Whereas surgical treatment of these aneurysms continues to be the gold standard of care, certain situations arise for which surgery may not be the best option. In some of these cases, electrolytically detachable coils have been proven to provide outcomes superior to those seen for medical management alone. The authors present two cases of ophthalmic artery aneurysms that would not hold the Guglielmi detachable coils on the initial attempt. One aneurysm was 7 mm and one 4 mm, both with wide necks relative to the aneurysm sac. By using a balloon-assisted technique and blocking the parent artery with a nondetachable balloon, the coils could be safely placed in these aneurysms without herniation when the balloon was deflated. Both patients exhibited embolic symptoms after the procedure, one with a mild but permanent deficit. Although this technique requires manipulation of a second microcatheter and balloon, which increases its technical difficulties and is a higher risk procedure than standard coil placement, it has utility in patients who are not candidates for surgery.

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