Endovascular trapping of giant serpentine aneurysms by using Guglielmi detachable coils. Successful reduction of mass effect

2001 ◽  
Vol 94 (5) ◽  
pp. 836-840 ◽  
Author(s):  
Goro Otsuka ◽  
Shigeru Miyachi ◽  
Takashi Handa ◽  
Makoto Negoro ◽  
Takeshi Okamoto ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Therapeutic Option ◽  
Complex Structure ◽  
Mass Effect ◽  
Collateral Flow ◽  
Guglielmi Detachable Coils ◽  
Content Type ◽  
Effective Therapeutic Option ◽  
Detachable Coils ◽  
The Right

✓ Giant serpentine aneurysms (GSAs) are defined as partially thrombosed giant aneurysms with persistent serpentine vascular channels. Surgical management of these rare lesions is difficult because of their large size, complex structure, and unique hemodynamics. The authors report two cases of patients harboring GSAs with mass effect, which were managed effectively with endovascular treatment. The first patient was a 48-year-old man who presented with left homonymous hemianopsia caused by a GSA involving the terminal portion of the right internal carotid artery. The second patient, a 10-year-old boy, presented with tetraparesis from compression of the cervicomedullary junction by a GSA of the right vertebral artery. In each case, after confirming collateral flow by temporarily occluding the proximal artery, the aneurysm was trapped by placement of Guglielmi detachable coils at the sites at which the serpentine channels entered and exited the aneurysm. The midportion of each channel was isolated completely without packing, to maximize resorption of the devascularized mass. Mass effect and clinical symptoms rapidly improved in both cases, with no associated morbidity. We recommend endovascular trapping as a safe and effective therapeutic option for GSAs.

Unruptured aneurysms presenting with mass effect sypmtoms: response to endosaccular treatment with Guglielmi detachable coils.

1998 ◽  
Vol 89 (6) ◽  
pp. 956-961 ◽  
Author(s):  
Tim W. Malisch ◽  
Guido Guglielmi ◽  
Fernando Viñuela ◽  
Gary Duckwiler ◽  
Y. Pierre Gobin ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Mass Effect ◽  
Guglielmi Detachable Coils ◽  
Intraluminal Thrombus ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Wall Calcification ◽  
Detachable Coils ◽  
Fine Print

Object. Embolization of intracranial aneurysms by using Guglielmi detachable coils (GDCs) is proving to be a safe method of protecting aneurysms from rupture. Occasionally, patients with unruptured intracranial aneurysms present with symptoms related to the aneurysm's mass effect on either the brain parenchyma or cranial nerves. In the present study, the authors conducted a retrospective review to evaluate the response to GDC embolization in a series of 19 patients presenting with cranial nerve dysfunction due to mass effect. Methods. Aneurysms were classified by size, shape, wall calcification, and amount of intraluminal thrombus. Patients were classified by duration of symptoms prior to GDC treatment (range < 1 month to > 10 years). Clinical assessment was performed within days of the GDC procedure and at later follow-up appointments (range 1–70 months, mean 24 months). In the immediate post-GDC period, four patients experienced worsening of cranial nerve deficits. Two of the four patients had transient worsening of visual acuity, which later improved to better than baseline status. Another patient who had presented with headache and seventh and eighth cranial nerve deficits from a vertebrobasilar junction aneurysm had improvement in these symptoms, but developed a new diplopia. The fourth patient had worsening of her visual acuity, which had not resolved at the 1-month follow-up examination; this patient later underwent surgical decompression. Conclusions. On late follow-up review, the response was classified as complete resolution of symptoms in six patients (32%), improvement in eight patients (42%), no significant change in four patients (21%), and symptom worsening in one patient (5%). Patients with smaller aneurysms and those with shorter pretreatment duration of symptoms were more likely to experience an improvement in their symptoms following GDC treatment, although statistical significance was not reached in this series (p = 0.603 and p = 0.111, respectively). The presence of aneurysmal wall calcification (six patients) or intraluminal thrombus (12 patients) showed no correlation with the response of mass effect symptoms in these patients.

Treatment of large and giant fusiform intracranial aneurysms with Guglielmi detachable coils

1996 ◽  
Vol 84 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Y. Pierre Gobin ◽  
Fernando Viñuela ◽  
John H. Gurian ◽  
Guido Guglielmi ◽  
Gary R. Duckwiler ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Mass Effect ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Guglielmi Detachable Coils ◽  
Parent Vessel ◽  
Content Type ◽  
Parent Artery Occlusion ◽  
Detachable Coils ◽  
Fine Print

✓ Results in nine patients with large or giant fusiform intracranial aneurysms that were treated with Guglielmi detachable coils (GDCs) are reported. There were six males and three females between the ages of 12 and 63. Four patients presented with subarachnoid hemorrhage (SAH) and four with mass effect; in one patient the aneurysm was asymptomatic and located in an arterial feeder of an arteriovenous malformation. Five aneurysms were supratentorial and four were in the posterior fossa. Five were giant and four were large. Selective occlusion with preservation of the parent artery was attempted in three cases, and complete occlusion of the aneurysm and the parent artery was performed in six patients. The tolerance to parent artery occlusion was assessed by angiography, balloon test occlusion, and amytal testing. Six aneurysms were permanently occluded and two partially recanalized. In one case, GDC embolization was not possible. The four patients who presented with SAH made an excellent clinical recovery. Three of the four patients presenting with mass effect recovered completely and one remained unchanged. The patient with an incidental aneurysm remained asymptomatic. There were no permanent complications. In conclusion, GDCs were useful for the occlusion of large and giant intradural fusiform aneurysms. Occlusion of the aneurysm and the parent artery afforded the greatest opportunity for a complete cure. Advantages of GDCs compared to balloons include: occlusion of a shorter segment of normal artery, no traction on the parent vessel, and safer and easier catheterization techniques.

Off-Pump Supraarterial Decompression Myotomy for Myocardial Bridging

2005 ◽  
Vol 8 (1) ◽  
pp. 49 ◽  
Author(s):  
Mersa M. Baryalei ◽  
Theodorus Tirilomis ◽  
Wolfgang Buhre ◽  
Stephan Kazmaier ◽  
Friedrich A. Schoendube ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Exercise Testing ◽  
Clinical Symptoms ◽  
Therapeutic Option ◽  
Median Sternotomy ◽  
Myocardial Bridging ◽  
Off Pump ◽  
Hemodynamic Compromise ◽  
Artery Disease ◽  
The Right

Background: Myocardial bridging of the left anterior descending (LAD) artery may result in clinical symptoms. Surgery with cardiopulmonary bypass (CPB) is a therapeutic option with considerable risk. We hypothesized that off-pump supraarterial myotomy could be an effective treatment modality. Methods: Between October 1998 and May 2000, 13 patients were referred for surgery. All were symptomatic despite medical therapy. Anteroseptal ischemia had been proven by thallium scintigraphy in all 13 patients, exercise testing was positive in 11. All patients were operated on with an off-pump approach after median sternotomy. Results: Mean patient age was 61 8 years (range, 43-71 years). Coronary artery disease mandating additional bypasses was present in 3 patients. The bypasses were done off pump in 2 patients. Conversion to on-pump surgery was necessary in 3 of 13 patients (23%) because of hemodynamic compromise (1 patient), opening of the right ventricle (1 patient), and injury to the LAD (1 patient). Supraarterial myotomy was performed in all patients. One patient who underwent surgery with CPB developed postoperative anteroseptal myocardial infarction. Postoperative exercise testing was performed in all patients and did not reveal any persistent ischemia. Mortality was 0%. All patients were free from symptoms and had not undergone repeat interventions after an average of 51 7 months of follow-up. Conclusions: Off-pump supraarterial myotomy effectively relieves coronary obstruction but has a certain periprocedural risk as evidenced by 1 myocardial infarction, 1 right ventricular injury, and 1 LAD injury. Long-term freedom from symptoms and from reintervention favor further investigation of this surgical therapy.

Acute cauda equina syndrome from a ruptured aneurysm in the sacral canal

1992 ◽  
Vol 77 (6) ◽  
pp. 945-948 ◽  
Author(s):  
Richard H. Schmidt ◽  
M. Sean Grady ◽  
Wendy Cohen ◽  
Sanford Wright ◽  
H. Richard Winn
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Signs And Symptoms ◽  
Vascular Supply ◽  
Ruptured Aneurysm ◽  
Collateral Flow ◽  
Content Type ◽  
Internal Iliac ◽  
The Right ◽  
Sacral Canal

✓ The case is presented of a young woman with acute cauda equina syndrome from a ruptured aneurysm in the sacral canal. The lesion was associated with pathological enlargement of the lateral sacral arteries bilaterally, which presumably occurred to provide cross-pelvic collateral flow in response to the diversion of the right internal iliac artery for renal transplantation. The patient presented with signs and symptoms of spontaneous spinal epidural hemorrhage. The radiographic features of this lesion are described. In addition to angiography and partial embolization of the vascular supply, contrast-enhanced high-resolution computerized tomography was essential in the diagnosis and treatment of this unique aneurysm.

scholarly journals Acute Stent Migration into the Right Ventricle in a Patient with Iliac Vein Stenting

2018 ◽  
Vol 07 (01) ◽  
pp. e7-e8 ◽  
Author(s):  
Torulv Holst ◽  
Thorsten Großwendt ◽  
Majd Laham ◽  
Mehdy Roosta-Azad ◽  
Afsaneh Zandi ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Heart Surgery ◽  
Therapeutic Option ◽  
Open Heart Surgery ◽  
Iliac Vein ◽  
Stent Migration ◽  
Endovascular Stent ◽  
Effective Therapeutic Option ◽  
Endovascular Stent Placement ◽  
The Right

AbstractEndovascular stent placement for chronic postthrombotic iliofemoral venous obstructive lesions is an effective therapeutic option and might be complicated by stent migration. We report a case of a venous stent that was lost from the iliac vein into the right ventricle rescued by emergent open-heart surgery.

Cerebral abscess as an unusual complication of coil embolization in a dural arteriovenous fistula

1997 ◽  
Vol 87 (1) ◽  
pp. 109-112 ◽  
Author(s):  
Adnan A. Rahman Zurin ◽  
Satoshi Ushikoshi ◽  
Kiyohiro Houkin ◽  
Yoichi Kikuchi ◽  
Hiroshi Abe ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Transverse Sinus ◽  
Cerebral Abscess ◽  
Unusual Complication ◽  
Content Type ◽  
Cortical Infarction ◽  
Retrograde Filling ◽  
Detachable Coils ◽  
The Right

This 63-year-old man presented with a right temporoparietal cortical infarction. A dural arteriovenous fistula involving the right transverse sinus was diagnosed on cerebral angiography. Transvenous embolization using detachable coils was performed; however, postembolization angiograms demonstrated retrograde filling of a cortical draining vein that was not seen on initial angiography. The patient subsequently developed a cerebral abscess in the region of the previous cortical infarction 2 months after the embolization. The abscess was successfully treated with drainage and antibiotic therapy. The authors report this case to illustrate an unusual complication associated with this procedure and the possible contribution of the cortical draining vein in the pathogenesis of the cerebral abscess.

scholarly journals Preliminary evaluation of the endovascular treatment of intracranial aneurysms with detachable coils in vigil patients

2006 ◽  
Vol 64 (4) ◽  
pp. 899-904
Author(s):  
José Roberto Falco Fonseca ◽  
Nitamar Abdala ◽  
Dárcio Roberto Nalli ◽  
Marcos Hideki Idagawa ◽  
João de Deus da Costa Alves Jr ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
General Anaesthesia ◽  
Intracranial Aneurysms ◽  
Clinical Symptoms ◽  
Therapeutic Option ◽  
Mortality Rates ◽  
Psychological Characteristics ◽  
Preliminary Evaluation ◽  
Detachable Coils

Endovascular treatment of intracranial aneurysms with coil embolization became the most important therapeutic option with better morbidity and mortality rates and quality of life. Following immobility, patients are treated with general anaesthesia. OBJECTIVE: To test viability of endovascular treatment on wake patients. METHOD: Considering clinical symptoms, psychological characteristics and aneurysmal morphology, four patients with five intracranial aneurysms were selected. RESULTS: Four among five cases were completed with this technique. Patient 1 was partially treated after 75 minutes presenting vesical stress. Patient 2 presented subarachnoid hemorrhage after aneurysmal re-rupture, and the procedure was completed under general anaesthesia. The other three patients presented no intercurrences during the treatment. CONCLUSION: Endovascular treatment on wake patients with intracranial aneurysm can be an alternative to a selected group of patients.

Chiari malformation with syringocephaly

1991 ◽  
Vol 75 (5) ◽  
pp. 791-794 ◽  
Author(s):  
Eric L. Rhoton ◽  
Albert L. Rhoton
Keyword(s):  
Chiari Malformation ◽  
Mass Effect ◽  
Chiari I Malformation ◽  
Cerebral Peduncle ◽  
Content Type ◽  
Suboccipital Craniectomy ◽  
Root Entry Zone ◽  
Dural Graft ◽  
Upper Cervical ◽  
The Right

✓ A 69-year-old white woman presented with a left hemiparesis which progressed to quadriparesis and encephalopathy. Computerized tomography and magnetic resonance imaging revealed a Chiari I malformation and a hydromyelic cavity extending from C-2 to T-6. Rostrally, the cavity extended through the ventral medulla, pons, and right cerebral peduncle into the right cerebral hemisphere, where the cavity enlarged and was associated with mass effect. The patient has made a dramatic neurological recovery following suboccipital craniectomy with insertion of a dural graft to decompress the Chiari malformation and upper cervical laminectomy and dorsal root entry zone myelotomy to decompress the hydromyelia.

Ruptured “blisterlike” aneurysm with a pseudoaneurysm formation requiring delayed intervention with endovascular coil embolization

2004 ◽  
Vol 101 (1) ◽  
pp. 159-162 ◽  
Author(s):  
Shuichi Tanoue ◽  
Hiro Kiyosue ◽  
Shunro Matsumoto ◽  
Masanori Yamashita ◽  
Hirofumi Nagatomi ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Treatment Options ◽  
Cerebral Aneurysms ◽  
Saccular Aneurysm ◽  
Content Type ◽  
Pseudoaneurysm Formation ◽  
Complete Obliteration ◽  
Detachable Coils ◽  
The Right ◽  
Fine Print

✓ A ruptured blisterlike aneurysm of the supraclinoid ICA rarely occurs. Nevertheless, it is recognized as a dangerous lesion because of the high risk of intraoperative bleeding associated with this lesion's wide fragile neck. There has been only one report of a blisterlike aneurysm treated by endosaccular packing after surgical wrapping. The authors describe the case of a ruptured blisterlike aneurysm with a pseudoaneurysm cavity, which was treated by coil embolization. This 63-year-old woman suffered a subarachnoid hemorrhage (SAH). Three cerebral aneurysms were identified on cerebral angiograms. A large saccular aneurysm at the ophthalmic portion of the right ICA was embolized with Guglielmi Detachable Coils (GDCs). Two small hemipherically shaped aneurysms on the C-2 and C-3 portions of the left ICA were observed conservatively. Thirteen days later, recurrent SAH was identified on computerized tomography scans. Angiography demonstrated the formation of a pseudoaneurysm from the aneurysm on the C-2 portion of the left ICA. Endosaccular embolization with GDCs was performed 40 days after admission. Disappearance of the pseudoaneurysm cavity and residual dome filling was seen immediately after the procedure. Follow-up angiography performed 9 months after embolization demonstrated complete obliteration of the aneurysm. This case illustrates that when treatment options for a blisterlike aneurysm with a pseudoaneurysm are unsuitable during the acute phase, coil embolization can be applied following progression of the lesion into a saccular aneurysm during the chronic stage.

Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils

1999 ◽  
Vol 90 (5) ◽  
pp. 853-856 ◽  
Author(s):  
Ikuya Yamaura ◽  
Eiichi Tani ◽  
Masayuki Yokota ◽  
Atsuhisa Nakano ◽  
Masahiro Fukami ◽  
...  
Keyword(s):  
Dissecting Aneurysm ◽  
Parent Artery ◽  
Retrograde Flow ◽  
Guglielmi Detachable Coils ◽  
Content Type ◽  
Endovascular Occlusion ◽  
Detachable Coils ◽  
Proximal Occlusion ◽  
Dissecting Aneurysms ◽  
Fine Print

Object. Surgical or endovascular occlusion of the parent artery proximal to an aneurysm has been recommended for treatment of dissecting aneurysms of the intracranial posterior circulation. However, dissecting aneurysms may rupture even after proximal occlusion because distal progression of thrombus is necessary to occlude the dissecting aneurysm completely, and this may be delayed by the presence of retrograde flow. In this article the authors present their experience in treating six patients with ruptured dissecting aneurysms.Methods. The authors report on six patients with a ruptured dissecting aneurysm in the posterior fossa who were successfully treated by endovascular occlusion of the aneurysm by using Guglielmi detachable coils. The procedure was particularly aimed at occluding the dissected site.Conclusions. At the present time, endovascular occlusion of the dissected site is a safe, minimally invasive, and reliable treatment for dissecting aneurysms when a test occlusion is tolerated and adequate collateral circulation is present.

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