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.

Irregular-shaped ruptured aneurysms: pseudoaneurysm formation in a thrombus at rupture site

2000 ◽  
Vol 93 (6) ◽  
pp. 998-1002 ◽  
Author(s):  
Motohiro Nomura ◽  
Sinya Kida ◽  
Naoyuki Uchiyama ◽  
Tetsumori Yamashima ◽  
Jun Yoshikawa ◽  
...  
Keyword(s):  
Open Surgery ◽  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Endovascular Procedure ◽  
Pathological Examination ◽  
Content Type ◽  
Pseudoaneurysm Formation ◽  
Aneurysm Embolization ◽  
Operative Findings ◽  
Fine Print

Object. The authors describe the clinical, radiological, and pathological findings of ruptured cerebral aneurysms with irregular configurations.Methods. Eight patients with subarachnoid hemorrhage due to ruptured irregularly shaped aneurysms were examined. The preoperative radiological findings in these cases were compared with the pathological and operative findings of endovascular or open surgery.All of the aneurysms exhibited delayed opacification and delayed washout of contrast medium from the irregularly shaped portion of the aneurysm on digital subtraction angiography and/or helical computerized tomography scanning. Endovascular embolization with platinum coils was attempted in the first four patients who underwent treatment. In three of these patients the aneurysm ruptured again during the endovascular procedure. In the fourth patient an intraaneurysm thrombus was observed during the procedure and clipping was performed. In the subsequent four patients, three underwent clipping without complication and one underwent partial aneurysm embolization because of poor general status. A thrombus adjacent to the aneurysm dome was observed in the patients who underwent open surgery. Pathological examination of the operative specimens revealed a pseudoaneurysm-like cavity in the thrombus that was adherent to the aneurysm.Conclusions. Ruptured irregularly shaped aneurysms may be accompanied by fragile pseudoaneurysm-like cavities located at the rupture point. Because these aneurysms have a high risk of repeated rupture during an endovascular procedure, advancing microinstruments to the weaker portion of the aneurysm should be avoided.

scholarly journals Optical coherence tomography: a new method to assess aneurysm healing

2005 ◽  
Vol 102 (2) ◽  
pp. 348-354 ◽  
Author(s):  
William E. Thorell ◽  
Michael M. Chow ◽  
Richard A. Prayson ◽  
Mark A. Shure ◽  
Sung W. Jeon ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Coil Embolization ◽  
Imaging Modality ◽  
Cerebral Aneurysms ◽  
Biological Tissues ◽  
Optical Coherence ◽  
Content Type ◽  
Aneurysm Neck ◽  
Fine Print

Object. Aneurysmal subarachnoid hemorrhage affects approximately 10/100,000 people per year. Endovascular coil embolization is used increasingly to treat cerebral aneurysms and its safety and durability is rapidly developing. The long-term durability of coil embolization of cerebral aneurysms remains in question; patients treated using this modality require multiple follow-up angiography studies and occasional repeated treatments. Methods. Optical coherence tomography (OCT) is an emerging imaging modality that uses backscattered light to produce high-resolution tomography of optically accessible biological tissues such as the eye, luminal surface of blood vessels, and gastrointestinal tract. Vascular OCT probes in the form of imaging microwires are presently available—although not Food and Drug Administration—approved—and may be adapted for use in the cerebral circulation. In this study the authors describe the initial use of OCT to make visible the neck of aneurysms created in a canine model and treated with coil embolization. Optical coherence tomography images demonstrate changes that correlate with the histological findings of healing at the aneurysm neck and thus may be capable of demonstrating human cerebral aneurysm healing. Conclusions. Optical coherence tomography may obviate the need for subsequent follow-up angiography studies as well as aid in the understanding of endovascular tissue healing. Data in this study demonstrate that further investigation of in vivo imaging with such probes is warranted.

De novo dissecting aneurysm in a patient with a ruptured saccular lesion

2002 ◽  
Vol 97 (3) ◽  
pp. 701-704 ◽  
Author(s):  
Toshiki Ikeda ◽  
Hiroki Kurita ◽  
Yoshifumi Konishi ◽  
Mitsuyuki Fujitsuka ◽  
Ken Hino ◽  
...  
Keyword(s):  
De Novo ◽  
Dissecting Aneurysm ◽  
Saccular Aneurysm ◽  
Surgical Clipping ◽  
Content Type ◽  
Aneurysm Neck ◽  
Rare Association ◽  
The Right ◽  
Fine Print ◽  
Normal Artery

✓ Formation of a new saccular aneurysm after successful treatment of ruptured aneurysm has recently raised significant clinical concerns; however, de novo formation and rupture of a dissecting aneurysm has not been discussed. The authors report on a 42-year-old man who initially sought treatment for a ruptured saccular aneurysm of the right middle cerebral artery, which was successfully eliminated by surgical clipping of the aneurysm neck. Two years later, the patient presented with another subarachnoid hemorrhage and was found to have a dissecting aneurysm of the right vertebral artery, which arose from a previously angiographically documented normal artery. This rare association sheds light on the causes and growth of two distinct types of aneurysms, both clinically and pathologically.

Multimodal treatment of ruptured dissecting aneurysms of the vertebral artery during the acute stage

2003 ◽  
Vol 99 (6) ◽  
pp. 960-966 ◽  
Author(s):  
Jun-ichiro Hamada ◽  
Yutaka Kai ◽  
Motohiro Morioka ◽  
Shigetoshi Yano ◽  
Tatemi Todaka ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Treatment Options ◽  
Posterior Inferior Cerebellar Artery ◽  
Acute Stage ◽  
The Other ◽  
Content Type ◽  
Lateral Medullary Syndrome ◽  
Detachable Coils ◽  
Dissecting Aneurysms ◽  
Fine Print

Object. The goal of this study was to implement an algorithm for and assess the multimodal (endovascular and microsurgical) treatment of patients with ruptured dissecting aneurysms of the vertebral artery (VA) during the acute stage. Methods. During a 4-year period, the authors treated 19 ruptured dissecting aneurysms of the VA during the acute stage, within 3 days after the hemorrhage. Factors guiding management decisions were tolerance of the test occlusion and the site of the dissection. The algorithm takes into account these factors to select among treatment options, that is, trapping of the VA with Guglielmi Detachable Coils (GDCs); trapping of the VA and revascularization of the posterior inferior cerebellar artery (PICA); trapping of the VA and VA—posterior cerebral artery (PCA) anastomosis; and trapping of the VA, VA—PCA anastomosis, and revascularization of the PICA. Of the 15 aneurysms without PICA involvement, 14 were treated by trapping of the VA with GDCs and one by trapping of the VA and a VA—PCA bypass. The other four aneurysms with PICA involvement were treated by VA trapping and PICA revascularization. There was no episode of recurrent hemorrhage or ischemia during the posttreatment follow-up period. Although lateral medullary syndrome developed as a permanent complication in one patient, a good recovery was made by the other 18 patients by 6 months after the ictus. Conclusions. The factors that determine the appropriate treatment for ruptured dissecting aneurysms of the VA are tolerance of a test occlusion and the site of dissection. Favorable patient outcomes can be achieved when this algorithm is used.

Endovascular treatment of cerebral aneurysms following incomplete clipping

1997 ◽  
Vol 87 (2) ◽  
pp. 184-189 ◽  
Author(s):  
Kent R. Thielen ◽  
Douglas A. Nichols ◽  
Jimmy R. Fulgham ◽  
David G. Piepgras
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Aneurysms ◽  
Surgical Clipping ◽  
Content Type ◽  
Coil Occlusion ◽  
Neurological Morbidity ◽  
Posterior Circulation Aneurysm ◽  
Detachable Coils ◽  
Fine Print

✓ The authors report their experience using electrolytically detachable coils for the treatment of residual cerebral aneurysms following incomplete surgical clipping. Eight patients were treated for six anterior and two posterior circulation aneurysm remnants. All patients were referred for endovascular treatment by experienced cerebrovascular neurosurgeons at the authors' institution. Patients underwent follow-up angiography immediately after endovascular treatment. In seven of the eight patients, additional follow-up angiographic studies were obtained at periods ranging from 7 weeks to 2 years posttreatment. The latest follow-up angiograms demonstrated that six of the eight aneurysm remnants were 100% occluded, with near-complete occlusion of the other two aneurysm remnants. There was no permanent neurological or non-neurological morbidity or mortality associated with the treatment. There was no incidence of aneurysm hemorrhage during or after treatment. Endovascular treatment of cerebral aneurysm remnants following prior surgical clipping can be accomplished with acceptable morbidity and mortality rates. Endovascular coil occlusion can play an important adjunctive role in the treatment of those aneurysms that have been incompletely obliterated by surgical clipping.

Microsurgically produced bifurcation aneurysms in a rabbit model for endovascular coil embolization

1996 ◽  
Vol 85 (3) ◽  
pp. 488-495 ◽  
Author(s):  
Uwe Spetzger ◽  
Jürgen Reul ◽  
Joachim Weis ◽  
Helmut Bertalanffy ◽  
Armin Thron ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Histopathological Examination ◽  
Rabbit Model ◽  
Cerebral Aneurysms ◽  
Carotid Bifurcation ◽  
Content Type ◽  
Detachable Coils ◽  
Endovascular Coil Embolization ◽  
Basic Studies ◽  
Common Carotid Arteries

✓ The authors present a detailed account of the microsurgical production of bifurcation aneurysms in chinchilla rabbits for basic studies of endovascular coil embolization of aneurysms. End-to-side anastomoses of both common carotid arteries (CCAs) were performed, and a venous pouch was fitted into the newly created bifurcation. These experimental aneurysms closely mimic human cerebral aneurysms in size and hemodynamic features. Sixty-three animals underwent operation. Fifteen animals died in the course of the experiment and 15 were excluded because of a CCA occlusion within the carotid bifurcation. Electrical detachable platinum coils, also known as Guglielmi detachable coils (GDCs), and tungsten mechanical detachable coils (MDCs) were used for the endovascular occlusion of 26 bifurcation aneurysms (16 rabbits were treated with GDCs and 10 with MDCs). Initially, complete angiographic obliteration (95%–100% occlusion of the aneurysm) was achieved in nine rabbits and incomplete obliteration (< 95% occlusion) was seen in 17 animals. Final angiography 3 to 6 months later demonstrated complete occlusion in only four and partial occlusion in 22 aneurysms. At present, the histopathological examination of 17 embolized aneurysms has revealed incomplete obliteration of all aneurysms, even in those three cases that were thought to be completely embolized according to angiographic criteria. A general overestimation of the radiological degree of aneurysm obliteration was found.

Experimental model for induction of cerebral aneurysms in rats

1986 ◽  
Vol 65 (3) ◽  
pp. 398-400 ◽  
Author(s):  
Fernando Alvarez ◽  
José M. Roda
Keyword(s):  
Carotid Artery ◽  
Arterial Hypertension ◽  
Common Carotid Artery ◽  
Cerebral Aneurysms ◽  
Left Common Carotid Artery ◽  
Chi Square ◽  
Content Type ◽  
The Difference ◽  
The Right ◽  
Fine Print

✓ Two groups of rats with induced arterial hypertension were studied. One group underwent section of the left common carotid artery with an end-to-side anastomosis of the proximal segment to the right common carotid artery. The second group was subjected to ligation of the left common carotid artery. The number of aneurysms caused by the procedure in the first group was higher, the difference being statistically significant (p < 0.05, chi-square).

Rescue balloon procedure for an emergency situation during coil embolization for cerebral aneurysms

2002 ◽  
Vol 96 (2) ◽  
pp. 373-376 ◽  
Author(s):  
Kenji Sugiu ◽  
Jean-Baptiste Martin ◽  
Beatrix Jean ◽  
Daniel A. Rüfenacht
Keyword(s):  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Emergency Situation ◽  
Content Type ◽  
Emergency Situations ◽  
Fine Print

✓ In this article the authors describe a rescue balloon procedure for coil implantation in three cases. In each patient, the coil seemed likely to unravel. The coils stretched when attempts were made to remove the partially implanted but trapped device. The inflation of a nondetachable microballoon in front of the aneurysm orifice allowed the surgeons to complete implantation of the coil and to avoid a more forceful and potentially harmful retrieval. This rescue balloon method may be useful for emergency situations, such as coil stretching with or without migration.

Hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease) presenting with polymicrobial brain abscess

1994 ◽  
Vol 81 (2) ◽  
pp. 294-296 ◽  
Author(s):  
Walter A. Hall
Keyword(s):  
Family History ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Coil Embolization ◽  
Neurological Complications ◽  
Arteriovenous Fistulae ◽  
Content Type ◽  
Embolization Treatment ◽  
History Of ◽  
The Right ◽  
Fine Print

✓ A 26-year-old man presented with expressive aphasia, weakness of the right arm, and anemia but there was no family history of hereditary hemorrhagic telangiectasia. Computerized tomography (CT) of the head demonstrated an enhancing left frontal mass, which was aspirated and on culture yielded multiple organisms. Pulmonary arteriovenous fistulae identified in both lungs by chest radiography, CT, and angiography were treated with coil embolization. Treatment of pulmonary arteriovenous fistulae and prolonged surveillance are necessary to prevent future neurological complications.

Prospective analysis of aneurysm treatment in a series of 103 consecutive patients when endovascular embolization is considered the first option

2000 ◽  
Vol 93 (2) ◽  
pp. 175-182 ◽  
Author(s):  
Christian Raftopoulos ◽  
Pierre Mathurin ◽  
Dutcho Boscherini ◽  
Rudolf F. Billa ◽  
Michel Van Boven ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Clinical Status ◽  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Surgical Clipping ◽  
Anterior Circulation ◽  
Content Type ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. The aim of this study was to evaluate prospectively the results of treating cerebral aneurysms with coil embolization (CE) or with surgical clipping when CE was considered the first option.Methods. Whenever an aneurysm was to be treated, CE was first considered by our neurovascular team. Surgical clipping was reserved for cases excluded from CE or cases in which CE failed. The study consisted of 103 consecutive patients with 132 aneurysms, of which 127 were treated. Coil embolization was performed using Guglielmi detachable coils, and surgery was performed using Zeppelin clips. Three groups were defined: Group A consisted of 64 aneurysms that were treated by CE (neck/sac ratio < 1:3); Group B, 63 aneurysms that were surgically clipped; and Group C, 12 aneurysms that failed to be satisfactorily (≥ 95%) embolized and were subsequently clipped. The percentages of residual aneurysm were 31.2% in Group A, 1.6% in Group B, and 0% in Group C. The percentages of patients with poor Glasgow Outcome Scale (GOS) scores (GOS Scores 1–3) were 13.3% in Group A, 6.1% in Group B, and 8.3% in Group C. The percentages of poor outcome (GOS Scores 1–3) in patients with good clinical status before treatment were 10.7% in Group A, 0% in Group B, and 8.3% in Group C.Conclusions. Even with preselection, CE remains associated with a significant number of treatment failures and poor outcomes, even in patients with good preoperative clinical status. Surgical clipping can offer better results than CE, even for more complex aneurysms of the anterior circulation, especially for those involving the middle cerebral artery cases. However, because CE can be effective and causes less stress and invasiveness for the patient, it should be considered first in aneurysms strictly selected by a neurovascular team.

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