Wall enhancement, edema, and hydrocephalus after endovascular coil occlusion of intradural cerebral aneurysms

2008 ◽  
Vol 108 (6) ◽  
pp. 1074-1086 ◽  
Author(s):  
Noel F. Fanning ◽  
Robert A. Willinsky ◽  
Karel G. terBrugge
Keyword(s):  
Mr Imaging ◽  
De Novo ◽  
Cerebral Aneurysms ◽  
Unruptured Aneurysms ◽  
Aneurysm Wall ◽  
Coil Occlusion ◽  
Platinum Coil ◽  
Bare Platinum Coils ◽  
Platinum Coils

Object Symptomatic local inflammation, aseptic meningitis, and hydrocephalus are reported in a group of patients treated with second generation/modified platinum coils. The purpose of this study was to define the frequency and determinants of magnetic resonance (MR) imaging findings of aneurysm wall enhancement, perianeurysmal edema, and hydrocephalus in a cohort of coil-embolized intradural cerebral aneurysms treated with bare platinum or modified platinum coils (Matrix or HydroCoils). Methods The authors retrospectively reviewed 359 Gd-enhanced MR follow-up studies of 181 treated aneurysms (125 ruptured) for mural enhancement. Univariate and multivariate logistic regression analyses were used to define mural enhancement associations with demographic, clinical, angiographic, treatment, and follow-up data. Embolization-related edema and hydrocephalus were defined in 95 MR imaging studies of 56 unruptured aneurysms. Results Asymptomatic wall enhancement was observed in lesions treated with all coil types, occurring in 21 (18.6%) of 113 bare platinum coil–treated aneurysms. Independent associations were HydroCoil treatment (odds ratio [OR] 9.75, 95% confidence interval [CI] 3.45–30.75) and increasing aneurysm size (OR 3.58, 95% CI 1.99–6.95). Five (8.9%) unruptured aneurysms had asymptomatic de novo edema, and 3 (5.3%) demonstrated hydrocephalus; all had been treated with HydroCoils. Hydrocephalus presentation was delayed (8–31 months) and symptomatic in 2 patients. Conclusions Asymptomatic aneurysm wall enhancement occurred in 18.6% of embolizations performed with bare platinum coils, and probably represents a normal healing response. Perimural edema and hydrocephalus were observed only in patients treated with HydroCoils, but have been reported in patients treated with other modified platinum coils. These symptoms appear to represent an exaggerated inflammatory response during aneurysm healing. Increased vigilance for delayed hydrocephalus is required. Judicious clinical use of modified platinum coils is warranted until results of randomized trials are published.

Follow-up Study on Intra-Aneurysmal Embolization for Unruptured Cerebral Aneurysms

1999 ◽  
Vol 5 (1_suppl) ◽  
pp. 89-92 ◽  
Author(s):  
Y. Kaku ◽  
S. Yoshimura ◽  
K. Hayashi ◽  
T. Ueda ◽  
N. Sakai
Keyword(s):  
Lower Incidence ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Neurological Deficits ◽  
Safe Treatment ◽  
Unruptured Aneurysms ◽  
Follow Up Study ◽  
Platinum Coil ◽  
Unruptured Cerebral Aneurysms

We describe follow-up clinical and angiographical results in patients with unruptured cerebral aneurysms treated with IDC or GDC. In 28 patients who underwent intra-aneurysmal occlusion for unruptured aneurysms, there were no permanent neurological deficits in the periprocedural period, while three transient neurological deficits were observed. On the angiograms obtained immediately after the procedure, complete aneurysmal occlusion was achieved in three patients (10.7%), a small neck remnant was detected in two cases (7.1%), a body filling in 12 cases (42.9%) and both of them were detected in 11 patients (39.3%). On the follow up angiograms (median angiographical follow-up period 15.6 months), 46.4% of incompletely obliterated aneurysms showed aneurysmal recanalization, and a incompletely embolized aneurysm ruptured 15 months after initial embolization. Detachable platinum coil embolization is a safe treatment for unruptured aneurysms with a lower incidence of peri-procedural morbidity, wheareas follow-up results are less satisfactory in cases involving incompletely obliterated lesions. With this limitation in mind, patients need to be very carefully chosen for GDC embolization and strict follow-up angiography is mandatory when a complete embolization is not achieved.

scholarly journals Transvenous Occlusion of a Dural Cavernous Sinus Fistula Using a New Expandable Hydrogel-Platinum Coil (Hydrocoil®)

2004 ◽  
Vol 10 (2) ◽  
pp. 151-154 ◽  
Author(s):  
H. Morsi ◽  
G. Benndorf ◽  
R. Klucznik ◽  
M. Mawad
Keyword(s):  
Cavernous Sinus ◽  
Clinical Investigation ◽  
Cerebral Aneurysms ◽  
Parent Vessel ◽  
Arteriovenous Fistulas ◽  
Type D ◽  
Complex Aneurysms ◽  
Platinum Coil ◽  
Bare Platinum Coils ◽  
Platinum Coils

Hydrogel-coated platinum coils (Hydrocoils®) are currently under clinical investigation for their efficacy to improve anatomic results of endovascular occlusion of cerebral aneurysms. A case is presented in which this new expandable coil type was added to bare platinum coils in order to accelerate the transvenous occlusion of a dural cavernous sinus fistula (DCSF). A 53-year -old woman presenting with mild left-sided eye redness and diplopia due to a DCSF (type D) underwent transvenous occlusion using bare platinum coils (Trufill®) and hydrogel coated coils (Hydrocoil®). After successful catherization of the cavernous sinus, bare platinum coils were densely packed and eventually combined with Hydrocoils® which resulted in immediate and complete occlusion of the fistula. No technical or clinical complication occurred. The new expansile hydrogel-coated platinum coil (Hydrocoil®) can be successfully combined with bare platinum coils to accelerate transvenous occlusion of an AV-shunting lesion. Controlled volume expansion after deployment of this device offers potential benefits for occlusion of dural arteriovenous fistulas in other locations or for parent vessel occlusions in the treatment of giant or large complex aneurysms.

scholarly journals The Importance of Long Term Follow-up Angiography after Clipping for the Cerebral Aneurysms: Focusing on "de novo" and Enlarged Unruptured Aneurysms.

2001 ◽  
Vol 29 (5) ◽  
pp. 357-363 ◽  
Author(s):  
Akihiko KURASHIMA ◽  
Akira OTSUKA ◽  
Takafumi SAITO ◽  
Tazunu ODA ◽  
Satoru AOKI ◽  
...  
Keyword(s):  
De Novo ◽  
Cerebral Aneurysms ◽  
Unruptured Aneurysms ◽  
Long Term Follow Up

Hydrogel coil–related delayed hydrocephalus in patients with unruptured aneurysms

2008 ◽  
Vol 109 (2) ◽  
pp. 186-190 ◽  
Author(s):  
Edward M. Marchan ◽  
Raymond F. Sekula ◽  
Andrew Ku ◽  
Robert Williams ◽  
Brent R. O'Neill ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Unruptured Aneurysm ◽  
Ventricular Size ◽  
Imaging Studies ◽  
Size Change ◽  
Unruptured Aneurysms ◽  
The Difference ◽  
Bare Platinum Coils ◽  
Platinum Coils

Object Because of high recanalization rates associated with wide-necked intracranial aneurysms treated with bare platinum coils, hydrogel coils (HydroCoil, MicroVention, Inc.) have been developed. Hydrogel coils undergo progressive expansion once exposed to the physiological environment of blood and increase overall aneurysm filling. Methods The authors retrospectively reviewed their series of patients with unruptured aneurysms treated between 1998 and 2006 and who underwent placement of bare platinum and hydrogel coils for cerebral aneurysms. They examined the incidence of delayed hydrocephalus as related to coil type. In a subgroup of patients in which preand postprocedure CT and MR imaging studies were available, the authors quantitatively analyzed the ventricular size change after hydrogel coils were placed. Results Four of 29 patients treated with hydrogel coils developed symptomatic hydrocephalus 2–6 months after the intervention compared with 0 of 26 treated with bare platinum coils alone. The difference in ventricular size between the subgroups in which pre- and postprocedure imaging was performed was found to be statistically significant (p < 0.05). All 4 HydroCoil-treated patients in whom hydrocephalus developed required placement of a shunt. Conclusions A 14% incidence (95% confidence interval 3.9–31.7%) of hydrocephalus in patients with unruptured aneurysm undergoing embolization with hydrogel coils was discovered. This incidence is much higher than previously reported. The mechanism by which hydrogel coils may induce hydrocephalus remains poorly understood.

scholarly journals Long Term Angiographical Follow-up of Cerebral Aneurysms after Coil Embolization

2001 ◽  
Vol 7 (1_suppl) ◽  
pp. 149-154 ◽  
Author(s):  
Y. Kaku ◽  
K. Hayashi ◽  
M. Sawada ◽  
N. Sakai
Keyword(s):  
Special Reference ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Complete Obliteration ◽  
Long Term Follow Up ◽  
Platinum Coils

We evaluated long-term angiographical follow-up of cerebral aneurysms treated with detachable platinum coils with special reference to the long-term morphological outcomes of incompletely obliterated aneurysms. Serial long-term follow-up cerebral angiograms (>1 year) were obtained in 47 cases out of 134 cases treated with GDCs or IDCs from 1994 to 1999. In 47 patients, intial angiographical results demonstrated ten complete aneurysmal occlusion, seven aneurysms with a small neck remnant, twenty aneurysms with body filling and ten aneurysms with both of neck remnant and body filling. In the ten completely obliterated aneurysms, follow-up angiograms revealed no aneurysmal recanalization. In seven aneurysms with neck remnant, three remained unchanged, four showed enlargement of contrast filling in the part of the neck of the aneurysm. In twenty aneurysms with body filling, five had developed into complete obliteration, three remained unchanged, 11 had recanalization, and one aneurysm displayed regrowth. In ten aneurysms with both of neck remnant and body filling, two remained unchanged, five had recanalization, and three aneurysms displayed regrowth. Long-term angiographical follow-up results are less satisfactory in cases involving incompletely obliterated lesions. A higher incidence of recanalizations were promoted in cases with neck remnant and/or body filling. Strict follow-up angiography is mandatory when a complete obliteration is not achieved.

scholarly journals Angiographical Change of Guglielmi Detachable Coils

2004 ◽  
Vol 10 (1_suppl) ◽  
pp. 161-166 ◽  
Author(s):  
Y. Nakai ◽  
M. Sonobe ◽  
T. Takigawa ◽  
T. Yamazaki ◽  
S. Okamoto ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Medical Condition ◽  
Cerebral Aneurysms ◽  
Acute Stage ◽  
Guglielmi Detachable Coils ◽  
Unruptured Aneurysms ◽  
Detachable Coils

Acute angiographical changes for preventing acute rebleeding on GDC treated cerebral aneurysms were evaluated. From December 2000 to November 2002, 48 total aneurysms in 44 consecutive patients with acute SAH. Acute angiographical evaluations were carried out in 46 aneurysms, including 42 ruptured and 4 unruptured aneurysms. Two cases were excluded because of poor medical condition. In this series, there were no rebleeding cases in acute stage. In the initial embolization for the 46 aneurysms, CO was achieved in eight aneurysms, NR in 15 aneurysms and BF in 23 aneurysms. Acute angiographical observations showed progressive thrombosis in 17 aneurysms (37%). No changes were observed in remaining 29. No recanalization was observed in this series. Only one case of BF, inside the aneurysm bleb was still observed during follow up. Additional embolization was carried out. Progressive thrombosis was frequently observed in GDC treated cerebral aneurysms during acute stage. This angiographical finding seems to show prevention of rebleeding, which is considered important for the management of GDC treatment in acutely ruptured cerebral aneurysm.

DELAYED VISUAL DEFICITS AND MONOCULAR BLINDNESS AFTER ENDOVASCULAR TREATMENT OF LARGE AND GIANT PARAOPHTHALMIC ANEURYSMS

Neurosurgery ◽  
2008 ◽  
Vol 63 (3) ◽  
pp. 469-475 ◽  
Author(s):  
Raymond D. Turner ◽  
James V. Byrne ◽  
Michael E. Kelly ◽  
Aristotelis P. Mitsos ◽  
Vivek Gonugunta ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Coil Embolization ◽  
Case Series ◽  
Mass Effect ◽  
Endovascular Coiling ◽  
Visual Deterioration ◽  
Paraclinoid Aneurysms ◽  
Bare Platinum Coils ◽  
Platinum Coils

ABSTRACT OBJECTIVE Paraophthalmic aneurysms may exert mass effect on the optic apparatus. Although surgical clipping and endovascular coiling of these aneurysms can be complicated by immediate postoperative visual deterioration, endovascular coil embolization has the unique risk of visual complications later (&gt;24 h) in the perioperative period. METHODS Six patients with a delayed onset of vision loss after technically successful coil embolization of paraophthalmic region aneurysms were identified. All available clinical, angiographic, and cross sectional imaging for these patients, in addition to histopathological data, were reviewed. RESULTS Six patients who underwent endovascular treatment of paraclinoid aneurysms at our institutions developed delayed postoperative visual decline. Four were treated with combination hydrogel-coated and bare platinum coils, one with hydrogel-coated coils, and one with bare platinum coils. Three patients presented with some degree of visual impairment caused by their aneurysms. Catheter angiography performed after the visual decline revealed no etiology in any of the cases. Magnetic resonance imaging was performed in all patients and was unremarkable in two. At follow-up, two had improved, three remained unchanged, and one patient died before any follow-up assessment of her vision. CONCLUSION Both acute and delayed visual disturbances can present after the endovascular treatment of carotid artery paraophthalmic aneurysms. Delayed visual deterioration can be observed up to 35 days after embolization. Although the cause is still undefined, it is likely that the more delayed visual deterioration can be attributed to progression of mass effect and/or perianeurysmal inflammatory change. Our case series raises the possibility that this phenomenon may be more likely with HydroCoil (HydroCoil Embolic System; MicroVention, Aliso Viejo, CA). This possibility should be taken into account by neurointerventionists when selecting a coil type to treat large paraophthalmic aneurysms.

Intracranial aneurysm coiling with PGLA-coated coils versus bare platinum coils: long-term anatomic follow-up

2011 ◽  
Vol 54 (4) ◽  
pp. 345-348 ◽  
Author(s):  
Michel Piotin ◽  
Silvia Pistocchi ◽  
Bruno Bartolini ◽  
Raphaël Blanc
Keyword(s):  
Intracranial Aneurysm ◽  
Bare Platinum Coils ◽  
Platinum Coils ◽  
Aneurysm Coiling

Electron Microscopic Analysis of Cerebral Aneurysms

2000 ◽  
Vol 6 (S2) ◽  
pp. 586-587
Author(s):  
M. Grove-Sullivan ◽  
H. Yonas ◽  
S. Watkins
Keyword(s):  
Cerebral Aneurysms ◽  
Microscopic Analysis ◽  
Electron Microscopic ◽  
Unruptured Aneurysms ◽  
Arterial Walls ◽  
Surgical Clip ◽  
Middle Cerebral Artery Aneurysms ◽  
The Brain ◽  
Small Aneurysms ◽  
Platinum Coils

A cerebral aneurysm is a dome or sac-like structure budding from weakened arterial walls in the brain. Cerebral aneurysms have no known specific cause currently. Considering the risks of surgery, when surgery should be performed on unruptured aneurysms is a very controversial issue. Some clinicians feel that an aneurysm should be surgically removed immediately upon discovery regardless of the size, if surgery is possible. While others feel that small aneurysms should be watched or treated with endovascular insertion of soft platinum coils, avoiding the risks associated with any brain surgery. To further study this question examination was done of specimens from surgical clip ligation of middle cerebral artery aneurysms and normal specimens.Specimens of ruptured and unruptured aneurysm as well as normal artery removed from surgical patients were immediately preserved in cold 2.5% glutaraldehyde in 0.1 M PBS. The specimens were rinsed in PBS, post-fixed in 1% Osmium Tetroxide with 0.1% potassium ferricyanide,

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