Long-Term Results and Follow-Up Examinations after Endovascular Embolization for Unruptured Cerebral Aneurysms

Abstract BACKGROUND: The Enterprise Vascular Reconstruction Device and Delivery System (Cordis; the Enterprise stent) was approved for use in conjunction with coiling of wide-necked aneurysms in 2007. No published long-term aneurysm occlusion or complication data exist for the Enterprise system. OBJECTIVE: We compiled data on consecutive patients treated with Enterprise stent-assisted coiling of aneurysms from 9 high-volume neurointerventional centers. METHODS: A 9 center registry was created to evaluate large volume data on the delayed safety and efficacy of the Enterprise stent system. Pooled data were compiled for consecutive patients undergoing Enterprise stent-assisted coiling at each institution prior to May 2009. RESULTS: Two-hundred twenty-nine patients with 229 aneurysms, 32 of which were ruptured aneurysms, were included in the study. Mean clinical and angiographic follow-up was 619.6 ± 26.4 days and 655.7 ± 25.2 days, respectively. Mean aneurysm size was 9.2 ± 0.4 mm. Fifty-nine percent of patients demonstrated 100% coil obliteration and 81% had 90% or higher occlusion at last follow-up angiography. A total of 19 patients (8.3%) underwent retreatment of their aneurysms during the follow-up period. Angiographic in-stent stenosis was seen in 3.4% and thromboembolic events occurred in 4.4%. Overall, 90% of patients who underwent Enterprise-assisted coiling had a modified Rankin Scale score of 2 or less at last follow-up. A poor modified Rankin Scale score was strongly associated with rupture status (P < .001). CONCLUSION: Although this study is limited by its retrospective nature, the Enterprise stent system appears to be an effective, safe, and durable treatment for intracranial aneurysms when used in conjunction with coiling.

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Long-term Follow-up after Treatment for Cerebrovascular Disease. Semi-long-term Follow-up Results for the Treatment of the Unruptured Cerebral Aneurysms.

Surgery for Cerebral Stroke ◽

10.2335/scs.30.83 ◽

2002 ◽

Vol 30 (2) ◽

pp. 83-87 ◽

Cited By ~ 3

Author(s):

Katsumi MATSUMOTO ◽

Katsuhito AKAGI ◽

Makoto ABEKURA ◽

Tateo SAKAGUCHI ◽

Takahiro TOMISHIMA ◽

...

Keyword(s):

Cerebrovascular Disease ◽

Cerebral Aneurysms ◽

Long Term Follow Up ◽

Unruptured Cerebral Aneurysms

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E-012 Long-Term Follow-Up of Unruptured Cerebral Aneurysms without Treatment; Compared with Those Treated by Endovascular Surgery

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2013-010870.70 ◽

2013 ◽

Vol 5 (Suppl 2) ◽

pp. A38.2-A39

Author(s):

S Nemoto

Keyword(s):

Cerebral Aneurysms ◽

Endovascular Surgery ◽

Long Term Follow Up ◽

Unruptured Cerebral Aneurysms

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Retrospective analysis of intracranial aneurysms after flow diverter treatment including color-coded imaging (syngo iFlow) as a predictor of aneurysm occlusion

Interventional Neuroradiology ◽

10.1177/15910199211024056 ◽

2021 ◽

pp. 159101992110240

Author(s):

Andreas Simgen ◽

Christine Mayer ◽

Michael Kettner ◽

Ruben Mühl-Benninghaus ◽

Wolfgang Reith ◽

...

Keyword(s):

Cerebral Aneurysms ◽

Flow Diverter ◽

Complication Rates ◽

Long Term Follow Up ◽

Aneurysm Growth ◽

Short And Long Term ◽

Aneurysm Occlusion ◽

Unruptured Cerebral Aneurysms

Purpose Flow Diverters (FD) have immensely extended the treatment of cerebral aneurysms in the past years. Complete aneurysm occlusion is a process that often takes a certain amount of time and is usually difficult to predict. Our aim was to investigate different syngo iFlow parameters in order to predict aneurysm occlusion. Methods Between 2014 and 2018 patients with unruptured cerebral aneurysms treated with a FD were reviewed. Aneurysm occlusion and complication rates have been assessed. In addition, various quantitative criteria were assessed using syngo iFlow before, after the intervention, and after short and long-term digital subtraction angiography (DSA). Results A total of 66 patients hosting 66 cerebral aneurysms were included in this study. 87.9% (n = 58) aneurysms in the anterior and 12.1% (n = 8) in the posterior circulation were treated. Adequate aneurysm occlusion at long-term follow-up (19.05 ± 15.1 months) was achieved in 90.9% (n = 60). Adequately occluded aneurysm revealed a significantly greater peak intensity delay (PI-D, p = 0.008) and intensity decrease ratio (ID-R, p < 0.001) compared to insufficiently occluded aneurysms. Increased intra-aneurysmal contrast agent intensity (>100%) after FD implantation resulted in an ID-R < 1, which was associated with aneurysm growth during follow-up DSA. Retreatment with another FD due to foreshortening and/or aneurysm growth was performed in 10.6% (n = 7). Overall morbidity and mortality rates were 1.5% (n = 1) and 0%. Conclusion The applied syngo iFlow parameters were found to be useful in predicting adequate aneurysm occlusion and foresee aneurysm growth, which might indicate the implantation of another FD.

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Long-term Results of Endovascular Embolization of Cerebral Aneurysms

Journal of Neuroendovascular Therapy ◽

10.5797/jnet.4.133 ◽

2010 ◽

Vol 4 (3) ◽

pp. 133-139 ◽

Cited By ~ 3

Author(s):

Hirotoshi IMAMURA ◽

Nobuyuki SAKAI ◽

Hidemitsu ADACHI ◽

Yasushi UENO ◽

Takeharu KUNIEDA ◽

...

Keyword(s):

Cerebral Aneurysms ◽

Endovascular Embolization ◽

Long Term Results

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Angiographical Follow-up Results of Cerebral Aneurysms Treated by Guglielmi Detachable Coil System

Interventional Neuroradiology ◽

10.1177/15910199010070s120 ◽

2001 ◽

Vol 7 (1_suppl) ◽

pp. 137-142 ◽

Cited By ~ 1

Author(s):

T. Hyogo ◽

T. Kataoka ◽

K. Hayase ◽

H. Nakamura

Keyword(s):

Cerebral Aneurysms ◽

Side Wall ◽

Long Term Results ◽

Partial Occlusion ◽

Detachable Coil ◽

Complete Occlusion ◽

Guglielmi Detachable Coil ◽

Wide Neck

To examine the long term results of endovascular treatment of cerebral aneurysms with the Guglielmi detachable coil (GDC) system, follow-up (F/U) angiography was performed at 6, 12 and 24 months after the procedure. We analyzed 45 cases, 49 procedures of GDC treated cerebral aneurysms from 1997.6. to 2000.5. Follow-up angiography was achieved at 6M 43/45 (96%), 12M 29/33 (87%) and 24M 22/25 (88%). Angiographical changes were found 23/43 (53%) of the cases at 6M F/U. There were angiographical improvements in 12 cases (CP: complete occlusion, NR: neck remnant, PA: partial occlusion, PA-CP; 8, NR-CP; 1, PA-NR; 3) and angiographical worsening in 11 cases (CP-NR; 5, CP-PA; 3, PA-PA; 3) at 6M F/U. Two cases had been demonstrating progressive angiographical worsening at 6M and 12MF/U (CP-NR-PA). No angiographical change was found at 24MF/U. There was no case of hemorrhage or re-hemorrhage after GDC treatment. In cases of side-wall aneurysm, tight packing of the inflow side of the aneurysm and small neck aneurysm were thought to be causes of the angiographical improvements. In patients with wide neck aneurysms with partial occlusion result were angiographic worsening at the F/U. Other factors of angiographical worsening were improper working angle at the procedure and improper follow-up angle at the angiography and the intraluminal clot in the case of ruptured aneurysm.

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Long-Term Results of Ruptured Cerebral Aneurysms Embolized in Acute Stage with Interlocking Detachable Coils

Interventional Neuroradiology ◽

10.1177/15910199970030s224 ◽

1997 ◽

Vol 3 (2_suppl) ◽

pp. 118-120

Author(s):

H. Manabe ◽

S. Fujita ◽

K. Akasaka ◽

S. Suzuki

Keyword(s):

Cerebral Aneurysms ◽

Critical Factor ◽

Dissecting Aneurysm ◽

Acute Stage ◽

Saccular Aneurysm ◽

Long Term Results ◽

Complete Occlusion ◽

Detachable Coils

We report on a series of eight patients presenting with SAH secondary to ruptured saccular (n=7) or dissecting (n=1) aneurysm, treated in the acute stage (within 14 days) by embolization with interlocking detachable coils (IDCs) who survived at least 3 months following initial hemorrhage. Embolization resulted in complete occlusion in 2 of 7 cases of saccular aneurysm, 90–95% occlusion was obtained in the remaining 5 cases of saccular aneurysm. Proximal occlusion with intra-aneurysmal coil packing was achieved in 1 case of dissecting aneurysm. In all 5 cases with partial occlusion, follow-up angiograms taken 2–4 months after the embolization showed partial recanalization due to coil compaction, while no recanalization was recognized in cases with complete occlusion in follow-up angiograms at 5 and 9 months respectively. Clinical disability, at 9 months after the embolization was rated as none in 4 cases, moderate in 1, and severe in 1. Two patients died of re-rupture at 4 and 8 months respectively after the embolization. Of the other 3 cases with partial recanalization, 2 were retreated by re-embolization or surgical clipping, one has been followed clinically and angiographically. Histological findings of the re-ruptured aneurysm showed neither endothelialization of the aneurysmal orifice nor organization of the clot around the coils. Aneurysmal re-rupture secondary to coil compaction related recanalization remains a critical factor in long-term clinical outcome and prognosis.

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Long-term follow-up of unruptured intracranial aneurysms repaired in California

Journal of Neurosurgery ◽

10.3171/2014.3.jns131159 ◽

2014 ◽

Vol 120 (6) ◽

pp. 1349-1357 ◽

Cited By ~ 22

Author(s):

David D. Gonda ◽

Alexander A. Khalessi ◽

Brandon A. McCutcheon ◽

Logan P. Marcus ◽

Abraham Noorbakhsh ◽

...

Keyword(s):

Cerebral Aneurysms ◽

Endovascular Coiling ◽

Treatment Groups ◽

Unruptured Intracranial Aneurysms ◽

Significant Difference ◽

Long Term Follow Up ◽

Unruptured Cerebral Aneurysms ◽

Aneurysm Repair

Object Using a database that enabled longitudinal follow-up, the authors assessed the long-term outcomes of unruptured cerebral aneurysms repaired by clipping or coiling. Methods An observational analysis of the California Office of Statewide Health Planning and Development (OSHPD) database, which follows patients longitudinally in time and through multiple hospitalizations, was performed for all patients initially treated for an unruptured cerebral aneurysm in the period from 1998 to 2005 and with follow-up data through 2009. Results Nine hundred forty-four cases (36.5%) were treated with endovascular coiling, 1565 cases (60.5%) were surgically clipped, and 76 cases were treated with both coiling and clipping. There was no significant difference in any demographic variable between the two treatment groups except for age (median: 55 years for the clipped group, 58 years for the coiled group, p < 0.001). Perioperative (30-day) mortality was 1.1% in patients with coiled aneurysms compared with 2.3% in those with clipped aneurysms (p = 0.048). The median follow-up was 7 years (range 4–12 years). At the last follow-up, 153 patients (16.2%) in the coiled group had died compared with 244 (15.6%) in the clipped group (p = 0.693). The adjusted hazard ratio for death at the long-term follow-up was 1.14 (95% CI 0.9–1.4, p = 0.282) for patients with endovascularly treated aneurysms. The incidence of intracranial hemorrhage was similar in the two treatment groups (5.9% clipped vs 4.8% coiled, p = 0.276). One hundred ninety-three patients (20.4%) with coiled aneurysms underwent additional hospitalizations for aneurysm repair procedures compared with only 136 patients (8.7%) with clipped aneurysms (p < 0.001). Cumulative hospital costs per patient for admissions involving aneurysm repair procedures were greater in the clipped group (median cost $98,260 vs $81,620, p < 0.001) through the follow-up. Conclusions For unruptured cerebral aneurysms, an observed perioperative survival advantage for endovascular coiling relative to that for surgical clipping was lost on long-term follow-up, according to data from an administrative database of patients who were not randomly allocated to treatment type. A cost advantage of endovascular treatment was maintained even though endovascularly treated patients were more likely to undergo subsequent hospitalizations for additional aneurysm repair procedures. Rates of aneurysm rupture following treatment were similar in the two groups.

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Postprocedural, midterm, and long-term results of cerebral aneurysms treated with flow-diverter devices: 7-year experience at a single center

Neurosurgical FOCUS ◽

10.3171/2017.3.focus1732 ◽

2017 ◽

Vol 42 (6) ◽

pp. E3 ◽

Cited By ~ 21

Author(s):

Francesco Briganti ◽

Giuseppe Leone ◽

Luigi Cirillo ◽

Oreste de Divitiis ◽

Domenico Solari ◽

...

Keyword(s):

Cerebral Aneurysms ◽

Flow Diverter ◽

Long Term Results ◽

Parent Artery ◽

Long Term Follow Up ◽

Ischemic Complications ◽

Flow Diverter Devices ◽

Aneurysm Occlusion

OBJECTIVEFlow diversion has emerged as a viable treatment option for selected intracranial aneurysms and recently has been gaining traction. The aim of this study was to evaluate the safety and effectiveness of flow-diverter devices (FDDs) over a long-term follow-up period.METHODSThe authors retrospectively reviewed all cerebral aneurysm cases that had been admitted to the Division of Neurosurgery of the Università degli Studi di Napoli between November 2008 and November 2015 and treated with an FDD. The records of 60 patients (48 females and 12 males) harboring 69 cerebral aneurysms were analyzed. The study end points were angiographic evidence of complete aneurysm occlusion, recanalization rate, occlusion of the parent artery, and clinical and radiological evidence of brain ischemia. The occlusion rate was evaluated according to the O’Kelly-Marotta (OKM) Scale for flow diversion, based on the degree of filling (A, total filling; B, subtotal filling; C, entry remnant; D, no filling). Postprocedural, midterm, and long-term results were strictly analyzed.RESULTSComplete occlusion (OKM D) was achieved in 63 (91%) of 69 aneurysms, partial occlusion (OKM C) in 4 (6%), occlusion of the parent artery in 2 (3%). Intraprocedural technical complications occurred in 3 patients (5%). Postprocedural complications occurred in 6 patients (10%), without neurological deficits. At the 12-month follow-up, 3 patients (5%) experienced asymptomatic cerebral infarction. No further complications were observed at later follow-up evaluations (> 24 months). There were no reports of any delayed aneurysm rupture, subarachnoid or intraparenchymal hemorrhage, ischemic complications, or procedure- or device-related deaths.CONCLUSIONSEndovascular treatment with an FDD is a safe treatment for unruptured cerebral aneurysms, resulting in a high rate of occlusion. In the present study, the authors observed effective and stable aneurysm occlusion, even at the long-term follow-up. Data in this study also suggest that ischemic complications can occur at a later stage, particularly at 12–18 months. On the other hand, no other ischemic or hemorrhagic complications occurred beyond 24 months.

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Neuroform Stent-Assisted Embolization of Incidental Anterior Communicating Artery Aneurysms: Long-term Clinical and Angiographic Follow-up

Neurosurgery ◽

10.1227/neu.0b013e31820edbb6 ◽

2011 ◽

Vol 69 (1) ◽

pp. 27-37 ◽

Cited By ~ 32

Author(s):

Ahmed M Raslan ◽

Murat Oztaskin ◽

Eric M Thompson ◽

Aclan Dogan ◽

Bryan Petersen ◽

...

Keyword(s):

Endovascular Embolization ◽

Long Term Results ◽

Anterior Communicating Artery ◽

Procedural Complications ◽

Aneurysm Occlusion ◽

Low Incidence ◽

Ischemic Attack ◽

Neuroform Stent

Abstract BACKGROUND: Anterior communicating artery (A-comm) aneurysm is one of the most common intracranial aneurysms. Treatments include neurosurgical clipping or endovascular embolization. OBJECTIVE: To retrospectively examine the long-term results of Neuroform stent-assisted coil embolization of incidental A-comms, with a focus on stent-associated stenosis, long-term angiographic aneurysm occlusion outcome, delayed stent-related thromboembolus, subsequent subarachnoid hemorrhage from the treated aneurysm, and procedural complications. METHODS: Between January 7, 2003 and June 16, 2009, 44 Neuroform stents were placed as an adjunct to embolization of A-comms. Patient charts were reviewed retrospectively. Angiographic follow-up of at least 3 months (up to 6.5 years, mean 65 weeks) was available for 33 patients. Aneurysm occlusion success was determined using the Raymond classification for aneurysm remnants. RESULTS: Referencing the last angiogram in the follow-up course, complete occlusion, dog-ear residual, residual neck, and residual aneurysm were found in 24, 2, 3, and 4 patients, respectively. Stenosis (45% and asymptomatic) of the artery where the stent had been placed was found in 1 patient. One patient had delayed transient ischemic attack after dual antiplatelet therapy was stopped prematurely. Retreatment based on the presence of residual aneurysm was performed or recommended in 2 patients. In 2 patients with residual or recurrent aneurysm filling, their age or clinical condition did not warrant retreatment. CONCLUSION: Neuroform stent-assisted embolization provides long-term control of A-comms with a low incidence of aneurysm growth after treatment. The need for retreatment is uncommon, and retreatment is safe if performed. Subsequent bleeding from treated aneurysms was not observed in this study.

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