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.

Antegrade recanalization of a completely embolized vertebral artery after endovascular treatment of a ruptured intracranial dissecting aneurysm

2005 ◽  
Vol 102 (1) ◽  
pp. 161-166 ◽  
Author(s):  
Motoshi Sawada ◽  
Yasuhiko Kaku ◽  
Shinichi Yoshimura ◽  
Masahiro Kawaguchi ◽  
Takashi Matsuhisa ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Cerebral Aneurysms ◽  
Systemic Circulation ◽  
Parent Artery ◽  
Content Type ◽  
Endovascular Occlusion ◽  
Aneurysmal Dilation ◽  
Dissecting Aneurysms ◽  
Fine Print

✓ Occlusion of the parent artery is a traditional method of treatment of unclippable cerebral aneurysms. Surgical or endovascular occlusion of the parent artery proximal to the aneurysm has been recommended for the treatment of dissecting aneurysms located in the vertebrobasilar circulation. Nevertheless, occlusion of the parent artery may not result in permanent exclusion of the aneurysm from the systemic circulation because, occasionally, postoperative rebleeding occurs after proximal occlusion. Alternatively, endovascular occlusion of the affected site, including the aneurysmal dilation, and parent artery, is a safe and reliable treatment for dissecting aneurysms. The authors present two rare cases of ruptured vertebral artery (VA) dissecting aneurysms that were treated by endovascular occlusion of the affected site including the aneurysm and parent artery by using Guglielmi detachable coils. In both cases the VA recanalized in an antegrade fashion during the follow-up period. Based on these unique cases, the authors suggest that a careful angiographic follow up of dissecting aneurysms is required, even in patients successfully treated with endovascular occlusion of the affected artery and aneurysm.

The remodeling technique of balloon-assisted Guglielmi detachable coil placement in wide-necked aneurysms: experience at the University of Illinois at Chicago

2000 ◽  
Vol 93 (3) ◽  
pp. 388-396 ◽  
Author(s):  
Victor A. Aletich ◽  
Gerard M. Debrun ◽  
Mukesh Misra ◽  
Fady Charbel ◽  
James I. Ausman
Keyword(s):  
Cerebral Aneurysms ◽  
Detachable Coil ◽  
Content Type ◽  
Guglielmi Detachable Coil ◽  
Alternative Approach ◽  
Long Term Follow Up ◽  
The University ◽  
Fine Print

Object. Reports in the literature have offered discussions of the feasibility, efficacy, and safety of balloon-assisted Guglielmi detachable coil (GDC) placement in wide-necked intracranial aneurysms, which was first described by Jacques Moret as the “remodeling technique.” In this article the authors summarize their results in a subset of aneurysms treated with GDCs using the remodeling technique.Methods. This report contains a retrospective analysis of 72 patients with 75 aneurysms who underwent 79 endovascular procedures performed using the remodeling technique. Morphological outcome was determined at the end of each procedure and by reviewing available follow-up angiograms. Clinical assessments and outcomes are reported using a modified Glasgow Outcome Scale.Coils were placed in 66 (88%) of 75 aneurysms selected for treatment. In eight aneurysms (11%) treatment failures occurred due to the tortuosity of the vessel used to reach the aneurysms or because of balloon inadequacies.Incorporating all available follow-up data the authors found that 50 (78%) of 64 aneurysms were completely or subtotally (> 95%) occluded and eight (12%) of 64 were incompletely (< 95%) occluded. Since the time of coil placement, eight aneurysms have progressed to complete occlusion and another five have exhibited progressive thrombosis on follow-up angiograms. In three aneurysms there has been neck remnant growth. Surgical clipping was performed to treat six aneurysms after an initial coil placement procedure. Permanent incidences of morbidity were limited to four patients and there were three deaths directly related to the procedure.Conclusions. The remodeling technique shows promise in increasing the number of cerebral aneurysms amenable to treatment by endovascular coil placement, and offers an alternative approach to aneurysms that have met with failed surgical treatment or are surgically inaccessible. Long-term follow-up review is needed to determine the final outcome of aneurysms treated by this technique.

Surgically Treated Aneurysms Previously Coiled: Lessons Learned

Neurosurgery ◽  
2004 ◽  
Vol 54 (2) ◽  
pp. 300-305 ◽  
Author(s):  
Erol Veznedaroglu ◽  
Ronald P. Benitez ◽  
Robert H. Rosenwasser
Keyword(s):  
Coil Embolization ◽  
Patient Population ◽  
Cerebral Aneurysms ◽  
Lessons Learned ◽  
Anterior Communicating Artery ◽  
Unique Problem ◽  
Aneurysm Neck ◽  
Cerebellar Artery ◽  
Patient Groups

Abstract OBJECTIVE Intravascular coil embolization of cerebral aneurysms has proved to be a safe and effective treatment in certain patient groups; however, this treatment is relatively new, and the long-term outcomes are unknown. One of the known complications is refilling of the aneurysm dome, which is seen in follow-up studies. This patient population poses unique technical difficulties for the neurosurgeon. We present a series of 18 patients who underwent surgery for residual aneurysms after coil remobilization. METHODS During a 5-year period, we performed surgery in 18 patients who had previously undergone coil embolization for their aneurysms. Of these aneurysms, four were in the anterior communicating artery, five were in the posterior communicating artery, three were in the internal carotid artery, three were in the posteroinferior cerebellar artery, and three were in the middle cerebral artery. One patient presented with rupture, one presented with acute IIIrd cranial nerve palsy, and the rest of the aneurysms were found on routine follow-up angiograms. Fifteen aneurysms were clipped, and in three patients, they were wrapped because the clip could not be placed adequately. RESULTS There were no major complications in any of the patients, and all had uneventful recoveries. The presence of coils in the aneurysm dome and/or neck made clipping and exposure of the aneurysm neck difficult, resulting in incomplete neck obliteration in three patients. CONCLUSION Operative clipping after previous coil embolization in aneurysms poses a unique problem for neurosurgeons. With the increasing use of coil embolization, this patient population will undoubtedly increase. The neurosurgeon should be aware of the difficulties and pitfalls encountered in these patients.

Enlargement of basilar artery aneurysms following balloon occlusion — “water-hammer effect”

1991 ◽  
Vol 75 (6) ◽  
pp. 963-968 ◽  
Author(s):  
Eddie S. K. Kwan ◽  
Carl B. Heilman ◽  
William A. Shucart ◽  
Richard P. Klucznik
Keyword(s):  
Basilar Artery ◽  
Water Hammer ◽  
Balloon Occlusion ◽  
Successful Therapy ◽  
Content Type ◽  
Aneurysm Neck ◽  
Water Hammer Effect ◽  
Fine Print

✓ Two patients with distal basilar aneurysms were treated with intra-aneurysmal balloon occlusion. After apparently successful therapy, follow-up angiograms demonstrated aneurysm enlargement with balloon migration distally in the sac. Geometric mismatch between the base of the balloons and the aneurysm neck together with transmitted pulsation through the 2-hydroxyl-ethylmethacrylate (HEMA)-filled balloon directly contributed to aneurysm enlargement. In this report, the authors discuss the problems of progressive aneurysm enlargement due to a “water-hammer effect” and the possibility of hemorrhage following subtotal occlusion.

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.

scholarly journals Treatment of wide-necked cerebral aneurysms with the Neuroform2 Treo stent

2005 ◽  
Vol 18 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Sepehr Sani ◽  
Kirk W. Jobe ◽  
Demetrius K. Lopes
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Technical Difficulty ◽  
Neurological Complications ◽  
Clinical Effects ◽  
Parent Vessel ◽  
Cerebral Angiogram ◽  
Aneurysm Neck

Object Until recently, wide-necked aneurysms were not considered amenable to treatment with coil embolization. The recent introduction of intracranial stents has provided a method of preventing coil migration out of wide-necked aneurysms. The Neuroform2 Treo is a modification of the Neuroform stent; the new version has a higher metal/artery ratio. The authors' initial experience with the use of this stent in combination with coil embolization to treat wide-necked intracranial aneurysms is reported and technical considerations are discussed. Methods The authors' first 10 consecutive patients with wide-necked intracranial aneurysms were included in this study. Inclusion criteria restricted the group to adult patients with wide-necked intracranial aneurysms (ruptured and unruptured lesions). A wide neck was defined as a dome/neck ratio of less than 2 or a neck that was 4 mm or wider as measured on angiograms. Immediate postprocedure angiography studies were performed to determine successful coil occlusion of the aneurysm as well as patency of the parent vessel. Six-month follow-up angiograms were obtained in all patients. Ten aneurysms with poor dome/neck ratios (< 2) were studied in 10 patients. In all cases the stent was delivered to the aneurysm site and positioned without difficulty. No branch artery compromise was observed. A technical difficulty occurred in one case, with prolapse of a coil into the parent vessel, which was successfully corrected with no adverse clinical effects. There were no clinical or neurological complications associated with endovascular treatment of aneurysms in this series. One patient required further coil embolization because of findings on the 6-month follow-up cerebral angiogram. Conclusions The Neuroform2 Treo navigates similarly to the Neuroform2, with the advantage of increased aneurysm neck coverage. This feature may lower the retreatment rates for wide-necked cerebral aneurysms.

Intraoperative factors associated with surgical outcome in patients with unruptured cerebral aneurysms: the experience of a single surgeon

2003 ◽  
Vol 99 (3) ◽  
pp. 452-457 ◽  
Author(s):  
Arthur A. Grigorian ◽  
Alvin Marcovici ◽  
Eugene S. Flamm
Keyword(s):  
Cerebral Artery ◽  
Cerebral Aneurysms ◽  
Predictive Tool ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Aneurysm Neck ◽  
Unruptured Cerebral Aneurysms ◽  
Unexpected Outcomes ◽  
Expected Outcomes ◽  
Fine Print

Object. Some well-known predictors of clinical outcomes in patients with ruptured aneurysms are not useful for forecasting outcome in patients with unruptured aneurysms. The goal of this study was to analyze outcomes in patients harboring unruptured cerebral aneurysms in different locations and to create a predictive tool for assessing both favorable outcome and morbidity in a large series of unruptured aneurysms. Methods. The authors analyzed data from 387 patients with nonruptured intracranial cerebral aneurysms who underwent surgery for clip placement. Intraoperative data were reviewed and seven factors that might influence outcomes were identified. These included the following: 1) aneurysm size larger than 10 mm; 2) presence of a broad aneurysm neck; 3) presence of plaque calcification near the aneurysm neck; 4) application of clips to more than one aneurysm during the same surgery; 5) temporary occlusion; 6) multiple clip applications and repositioning; and 7) use of multiple clips. The entire group of patients with unruptured aneurysms was divided into two subgroups on the basis of outcome. Each patient was subsequently assessed to formulate the factor accumulation index (FAI), the sum of different factors observed in a given patient. The subgroup of patients with expected outcomes was composed of 312 patients, whereas the subgroup of unexpected outcomes consisted of 31 patients. Depending on the anatomical locations of the aneurysms, the combined mortality—morbidity rate ranged from 5.7 to 25%, with the best results for patients harboring ophthalmic artery aneurysms and the worst results for those with vertebrobasilar system (VBS) aneurysms. The majority of patients with expected outcomes who harbored aneurysms of the middle cerebral artery, the internal carotid artery, and the VBS had a lower FAI, whereas the majority of patients with unexpected outcomes had a higher FAI. Conclusions. It is possible to predict outcomes in patients with unruptured cerebral artery aneurysms by calculating the FAI. The rate of postoperative morbidity increases with the FAI within the range of three to four factors.

Surgical treatment of middle cerebral artery aneurysms

1984 ◽  
Vol 61 (1) ◽  
pp. 17-23 ◽  
Author(s):  
Jiro Suzuki ◽  
Takashi Yoshimoto ◽  
Takamasa Kayama
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Surrounding Tissue ◽  
Surgical Results ◽  
Content Type ◽  
Aneurysm Neck ◽  
Social Lives ◽  
Middle Cerebral Artery Aneurysms ◽  
Fine Print

✓ The authors report their experience with the surgical therapy of middle cerebral artery (MCA) aneurysms in 413 cases, and describe their technique. After the M1 portion of the MCA is identified, the Sylvian fissure is opened. During the administration of 20% mannitol, temporary occluding clips are applied to the feeding and draining vessels of the aneurysm. The aneurysm is freed from all surrounding tissue, and the aneurysm neck is treated by ligation, clipping, or wrapping. Analysis of surgical results in 91 cases operated on after the surgical approach had become standardized indicates that more than 94% of patients have returned to useful social lives by the time of follow-up evaluation. Twenty-four percent of these patients were operated on within 48 hours after subarachnoid hemorrhage.

Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding

1999 ◽  
Vol 90 (4) ◽  
pp. 656-663 ◽  
Author(s):  
James V. Byrne ◽  
Min-Joo Sohn ◽  
Andrew J. Molyneux
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Content Type ◽  
Aneurysm Embolization ◽  
Aneurysm Occlusion ◽  
The Stability ◽  
Ruptured Intracranial Aneurysms ◽  
Fine Print

Object. During a 5-year period 317 patients presenting with aneurysmal subarachnoid hemorrhage were successfully treated by coil embolization within 30 days of hemorrhage. The authors followed patients to assess the stability of aneurysm occlusion and its longer-term efficacy in protecting patients against rebleeding.Methods. Patients were followed for 6 to 65 months (median 22.3 months) by clinical review, angiography performed at 6 months posttreatment, and annual questionnaires. Stable angiographic occlusion was evident in 86.4% of small and 85.2% of large aneurysms with recurrent filling in 38 (14.7%) of 259 aneurysms. Rebleeding was caused by aneurysm recurrence in four patients (between 11 and 35 months posttreatment) and by rupture of a coincidental untreated aneurysm in one patient. Annual rebleeding rates were 0.8% in the 1st year, 0.6% in the 2nd year, and 2.4% in the 3rd year after aneurysm embolization, with no rebleeding in subsequent years. Rebleeding occurred in three (7.9%) of 38 recurrent aneurysms and in one (0.4%) of 221 aneurysms that appeared stable on angiography.Conclusions. Periodic follow-up angiography after coil embolization is recommended to identify aneurysm recurrence and those patients at a high risk of late rebleeding.

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.

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