Hemodynamic Effect of the Last Finishing Coils in Packing the Aneurysm Neck

Background: Using the finishing coils to densely pack the aneurysm neck is necessary. However, the exact hemodynamic effect of finishing coils in packing the aneurysm neck is unknown.Objective: To evaluate the hemodynamic characteristics of finishing coils to densely pack the aneurysm neck, using finite element method simulation.Methods: A computational study was performed based on a 44-year-old female patient with an unruptured wide-necked carotid-ophthalmic artery aneurysm treated with low-profile visualized intraluminal support stent-assisted coil embolization. Four computational fluid dynamics models including pre-treatment, post-stenting, common stent-assisted coil embolization (SACE), and common SACE with finishing coils were evaluated qualitatively and quantitatively.Results: Compared with the baseline of pretreatment model (100%), sac-averaged velocity in post-stenting, common SACE, and common SACE with finishing coil models decreased to 95.68%, 24.38%, and 13.20%, respectively; high flow volume (>0.1 m/s) around the aneurysm neck decreased to 92.19%, 9.59%, and 5.57%, respectively; and mean wall shear stress increased or decreased to 107%, 25.94%, and 23.89%, respectively.Conclusion: Finishing coils to densely pack the aneurysm neck can generate favorable hemodynamic modifications, which may decrease the recurrence.

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Low-profile visualized intraluminal support Blue stenting within a Neuroform Atlas stent for a large wide-necked aneurysm: A case report and a bench-top experiment

The Neuroradiology Journal ◽

10.1177/19714009211026900 ◽

2021 ◽

pp. 197140092110269

Author(s):

Tomoko Hayashi ◽

Hiroyuki Ikeda ◽

Ryota Ishibashi ◽

Toshio Fujiwara ◽

Ryosuke Kaneko ◽

...

Keyword(s):

Case Report ◽

Coil Embolization ◽

Cell Design ◽

Open Cell ◽

Aneurysm Neck ◽

Low Profile ◽

Closed Cell ◽

High Metal ◽

Silicon Tube ◽

Aneurysm Occlusion

Low-profile visualized intraluminal support deployment in an Enterprise has been reported; however, that in an Atlas has yet to be in detail. Enterprise has a closed-cell design, while Atlas has an open-cell design. We detail here a case of a large wide-necked aneurysm treated by coil embolization with low-profile visualized intraluminal support Blue deployment within a Neuroform Atlas and a bench-top experiment using a silicon tube to test low-profile visualized intraluminal support, Atlas, Enterprise, and their combinations. A better low-profile visualized intraluminal support expansion was achieved by simultaneously pushing the wire and the system within the Atlas placed at the aneurysm neck, which resulted in an increased metal coverage of the aneurysm neck and a shorter transition zone with low metal coverage at both ends of the aneurysm neck. This technique may enable a high metal coverage by low-profile visualized intraluminal support expansion without restriction by the Atlas and contribute to aneurysm occlusion by increasing the flow-diverting effect.

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Observation of Neointimal Coverage Around the Aneurysm Neck After Stent-Assisted Coil Embolization by Optical Frequency Domain Imaging: Technical Case Report

Operative Neurosurgery ◽

10.1093/ons/opw018 ◽

2016 ◽

Vol 13 (2) ◽

pp. 285-292 ◽

Cited By ~ 3

Author(s):

Rie Yako ◽

Hiroyuki Matsumoto ◽

Osamu Masuo ◽

Naoyuki Nakao

Keyword(s):

Frequency Domain ◽

Antiplatelet Therapy ◽

Coil Embolization ◽

Artery Aneurysm ◽

Vascular Wall ◽

Optical Frequency ◽

Optical Frequency Domain Imaging ◽

Aneurysm Neck ◽

Incomplete Stent Apposition ◽

Neointimal Coverage

Abstract BACKGROUND AND IMPORTANCE: Stent-assisted coil embolization has been established as a treatment option for wide-necked or complex aneurysms. However, concerns have been raised about the incidence of thromboembolic complications, which is higher for coil embolization without stent assistance. Long-term antiplatelet therapy is necessary to prevent acute or delayed ischemic events potentially associated with incomplete stent apposition after treatment with stent-assisted coil embolization. Optical frequency domain imaging (OFDI) provides excellent-resolution images of intraluminal structures, allowing evaluation of the outcomes of stent-assisted procedures in terms of stent apposition and neointimal coverage. We here describe the novel use of OFDI for the observation of intravascular tissue formation after stent-assisted coil embolization. CLINICAL PRESENTATION: Two patients were treated with stent-assisted coil embolization for unruptured vertebral artery aneurysm. At the 1- or 2-yr follow-up visit, routine angiography followed by OFDI were performed to evaluate neointimal coverage of the stent strut and stent apposition to the vascular wall. OFDI enabled clear visualization of the vessel wall structures and demonstrated complete coverage of the stent struts as well as full stent wall apposition in 1 patient and incomplete coverage near the aneurism neck as well as mallaposition of some struts in the other patient. CONCLUSION: OFDI represents a feasible modality for the evaluation of intracranial vasculature and the outcomes of stent-assisted coil embolization in terms of intimal healing of aneurysms, stent-vessel interactions, and neointimal coverage of the stent. Such information is helpful in determining the duration of antiplatelet therapy after stent-assisted coil embolization.

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Hemifacial spasm caused by vertebral artery aneurysm treated by endovascular coil embolization

Surgical Neurology International ◽

10.25259/sni_564_2020 ◽

2020 ◽

Vol 11 ◽

pp. 431

Author(s):

Yu Iida ◽

Kentaro Mori ◽

Yosuke Kawahara ◽

Issei Fukui ◽

Katsuya Abe ◽

...

Keyword(s):

Vertebral Artery ◽

Hemifacial Spasm ◽

Coil Embolization ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Artery Occlusion ◽

Parent Artery ◽

Aneurysm Neck ◽

Parent Artery Occlusion ◽

Endovascular Coil Embolization

Background: Hemifacial spasm (HFS) caused by vertebral artery (VA) aneurysms is rare. Several cases of HFS caused by VA aneurysms treated by endovascular parent artery occlusion (PAO) have been reported. Recently, we treated a rare case of HFS caused by a saccular VA aneurysm at the bifurcation of the posterior inferior cerebellar artery (PICA), which was successfully treated by endovascular coil embolization, preserving the parent artery, and PICA. We discuss endovascular treatment for HFS induced by VA aneurysms with a literature review. Case Description: A 59-year-old man presented with the left HFS persisting for 2 months. Magnetic resonance imaging revealed a left saccular VA-PICA aneurysm and demonstrated that a left facial nerve was compressed by the aneurysm at the root exit zone. Angiography revealed that the PICA was branching from the aneurysm neck. Endovascular coil embolization was performed using the balloon remodeling technique to preserve the left VA and PICA. HFS disappeared after treatment. Conclusion: Although microvascular decompression was commonly accepted for the standard treatment of HFS, coil embolization of aneurysms without PAO may be an effective treatment for HFS caused by VA aneurysms.

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Possibility of Worsening Flow Diversion Effect Due to Morphological Changes of a Stented Artery With Multiple Overlapping Stents for Partially Thrombosed Vertebral Artery Aneurysms

Frontiers in Neurology ◽

10.3389/fneur.2020.611124 ◽

2020 ◽

Vol 11 ◽

Author(s):

Tomoaki Suzuki ◽

Hitoshi Hasegawa ◽

Kazuhiro Ando ◽

Kouhei Shibuya ◽

Haruhiko Takahashi ◽

...

Keyword(s):

Vertebral Artery ◽

Morphological Changes ◽

Artery Aneurysm ◽

Flow Diversion ◽

Aneurysm Neck ◽

Low Profile ◽

Computational Fluid Dynamics Analysis ◽

Recurrent Case ◽

Negative Effect ◽

Altered Blood

Background: Morphological changes of a stented artery can cause a flow diversion effect to reduce intra-aneurysmal flow; however, there is a potential for the negative effect of increased intra-aneurysmal flow. We present cases with multiple overlapping stents for a partially thrombosed vertebral artery aneurysm and characterize the hemodynamic properties of a recurrent case by focusing on the morphological changes of the stented artery.Methods: Between October 2017 and April 2019, four consecutive cases of symptomatic unruptured large and giant partially thrombosed vertebral artery aneurysms were treated with multiple overlapping low-profile visualized intraluminal support stents and no coils. Both angiographic and clinical outcomes were assessed. Computational fluid dynamics analysis was performed to clarify hemodynamic features. The degree of pressure elevation was calculated as the pressure difference (Pd). Wall shear stress (WSS) was also calculated.Results: In three of the four cases, successful flow reduction was achieved with no morphological change of the stented arteries. The patients' symptoms were gradually improved. The remaining case required additional stents after the initial treatment. In the recurrent case, Pd was noticeably elevated at the aneurysm neck after treatment, and WSS was generally increased in the area due to altered blood flow into the aneurysm dome caused by morphological changes of the stented artery.Conclusion: Overlapping stents can be used for the treatment of large and giant thrombosed vertebral artery aneurysms with flow diversion effect; however, morphological changes of the stented artery requires careful attention as it may lead to an increase in the intra-aneurysmal flow, causing negative outcomes.

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Contralateral vertebral approach for stenting and coil embolization of a large, thrombosed vertebral–posterior inferior cerebellar artery aneurysm

Journal of Neurosurgery ◽

10.3171/jns-07/12/1214 ◽

2007 ◽

Vol 107 (6) ◽

pp. 1214-1216 ◽

Cited By ~ 8

Author(s):

Robert D. Ecker ◽

Ricardo A. Hanel ◽

Elad I. Levy ◽

L. Nelson Hopkins

Keyword(s):

Vertebral Artery ◽

Coil Embolization ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Ipsilateral Side ◽

Aneurysm Neck ◽

Cerebellar Artery

✓The authors report the successful staged stenting and coil embolization of a large vertebral artery–posterior inferior cerebellar artery (VA-PICA) aneurysm using the contralateral VA for access. A 67-year-old woman presented with a large ruptured VA-PICA aneurysm. Initial attempts to stent the wide-necked aneurysm from the ipsilateral side failed, so coil embolization of the dome was performed. During a second endovascular session, the aneurysm neck was successfully stented from the contralateral VA into the PICA. Six weeks later, coils were inserted into the aneurysm from the ipsilateral side. The coil result was stable at the 3-month follow-up examination.

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Assisted coiling using LEO Baby or LVIS Jr stents: Report of six cases

Interventional Neuroradiology ◽

10.1177/1591019915590098 ◽

2015 ◽

Vol 21 (5) ◽

pp. 566-574 ◽

Cited By ~ 10

Author(s):

Matías Negrotto ◽

Roberto Crosa ◽

Walter Casagrande

Keyword(s):

Endovascular Treatment ◽

Coil Embolization ◽

Chronic Phase ◽

Secondary Coil ◽

Anterior Communicating Artery ◽

Internal Diameter ◽

Good Decision ◽

Aneurysm Neck ◽

Low Profile

Background and purpose Endovascular treatment of broad-neck, complex cerebral aneurysms is a challenging issue. Placement of a stent over the aneurysm neck and secondary coil embolization prevents coil migration and allows dense packing of the coils. Another challenge is represented by distal aneurysms situated in small vessels. In these cases, the use of little stents, which we are going call ministents, could be a good decision. These low-profile intracranial ministents can be deployed into arteries with diameters between 1.5 and 3.10 mm and delivered through microcatheters with an internal diameter of 0.0165 inches, which allows easier navigation in small-sized, delicate vessels. We present six cases of wide-neck aneurysms, with small parental arteries less than 2.5 mm using a low-profile ministent system (LEO Baby and LVIS Jr) plus coil embolization. Materials and methods We retrospectively reviewed patients in whom LEO Baby or LVIS Jr stent was used for the treatment of intracranial aneurysms. Five aneurysms were treated during 2013–2014 in our service using the LEO Baby stent and one aneurysm using LVIS Jr. Stent-assisted coil embolization was performed using the jailing technique in all cases. Clinical and angiographic findings, procedural data, and follow-up are reported. Results Six consecutive patients were included in this study. Four patients presented with subarachnoid hemorrhage in the subacute–chronic phase and two patients had unruptured aneurysms. Two of the six aneurysms were located at branches of the sylvian artery, one at the basilar artery, two at the anterior communicating artery, and one at the P1–P2 artery. The procedures were successful. Six-month control digital subtraction angiograms were obtained in all cases; they demonstrated complete occlusion of the aneurysms in all instances. All patients had good clinical outcomes on follow-up, as measured with the Glasgow Outcome Scale and Modified Rankin Scale. Conclusions The results of this small study show that the LEO Baby and LVIS Jr ministents could be safe and efficient for endovascular treatment of intracranial broad-neck aneurysms situated in small arteries.

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Coil embolization with overlapping horizontal low-profile stents to treat a giant thrombosed fetal posterior cerebral artery aneurysm using contralateral approach through anterior communicating artery: Case report

Surgical Neurology International ◽

10.25259/sni_533_2021 ◽

2021 ◽

Vol 12 ◽

pp. 347

Author(s):

Yasuhisa Kanematsu ◽

Kenji Shimada ◽

Yoshiteru Tada ◽

Masaaki Korai ◽

Takeshi Miyamoto ◽

...

Keyword(s):

Cerebral Artery ◽

Coil Embolization ◽

Posterior Cerebral Artery ◽

Artery Aneurysm ◽

Flow Diverter ◽

Flow Diversion ◽

Endovascular Coiling ◽

Anterior Communicating Artery ◽

First Case ◽

Low Profile

Background: The treatment of internal carotid artery (ICA) – posterior communicating artery aneurysms (ICPC aneurysms) is challenging when a fetal posterior cerebral artery (PCA) arises from the saccular neck. This complex angioarchitecture renders endovascular approaches difficult. Giant thrombosed IC-PC aneurysms are also hard to treat by endovascular coiling because its flow-diversion effect is insufficient. Case Description: We report the first case of a ruptured giant thrombosed IC-PC aneurysm associated with a fetal PCA that was successfully treated by coil embolization with retrograde overlap horizontal stenting using low-profile stents introduced through the contralateral ICA. The aneurysm was completely occluded and follow-up MRI scans demonstrated the reduction of the aneurysmal size. Conclusion: Our technique is advantageous because low-profile stents can be used to treat lesions not accessible with flow-diverter stents due their presence in complex angioarchitectures, and overlap stenting may have flow-diversion effects that can result in the complete occlusion of giant thrombosed aneurysms.

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Treatment of a Middle Cerebral Artery Bifurcation Aneurysm Using a Double Neuroform Stent “Y” Configuration and Coil Embolization: Technical Case Report

Operative Neurosurgery ◽

10.1227/01.neu.0000163684.75204.cd ◽

2005 ◽

Vol 57 (suppl_1) ◽

pp. E209-E209 ◽

Cited By ~ 30

Author(s):

Sepehr Sani ◽

Demetrius Klee Lopes

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Coil Embolization ◽

Past History ◽

Cerebral Aneurysms ◽

Artery Aneurysm ◽

Parent Vessel ◽

Aneurysm Neck ◽

Bifurcation Aneurysm ◽

Neuroform Stent

Abstract OBJECTIVE AND IMPORTANCE: Wide-necked cerebral aneurysms have been particularly difficult to treat using coil embolization. The introduction of the first intracranial flexible stent (Neuroform stent; Boston Scientific/Target, Fremont, CA) has provided a great advantage to this dilemma by forming a bridge across the aneurysm neck and allowing the packing of coils. Despite this advancement, some parent vessel bifurcation aneurysms can still remain elusive to single stent and coiling technique. CLINICAL PRESENTATION: A 55-year-old woman presented for a routine follow-up angiogram. Her past history was significant for a subarachnoid hemorrhage and clipping of an anterior communicating aneurysm with full recovery. An incidental new right middle cerebral artery aneurysm was found on the angiogram. We report here a case of an unruptured asymptomatic wide-neck middle cerebral artery bifurcation aneurysm that was treated with a novel endovascular repair. INTERVENTION: The aneurysm was successfully treated using a double stent “Y” configuration and coil embolization technique using the Neuroform stent. Technical aspects are discussed. Perioperative management issues and potential pitfalls are also considered. CONCLUSION: Double stenting in “Y” configuration and coiling is feasible. This technique should increase the ability to endovascularly treat wide-necked aneurysms.

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