scholarly journals Delayed Leukoencephalopathy and Foreign Body Reaction After Endovascular Treatment in Patients With Intracranial Aneurysms and Aneurysmal Subarachnoid Hemorrhage—A Systematic Review of the Literature

2021 ◽  
Vol 8 ◽  
Author(s):  
Sami Ridwan ◽  
Jörg Andreas Kandyba ◽  
Anita Schug ◽  
Elina Malsagov ◽  
Nikolaos Karageorgos ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Foreign Body ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Foreign Body Reaction ◽  
Artery Aneurysm ◽  
Corticosteroid Treatment ◽  
Published Data ◽  
High Dose ◽  
Extensive Literature

Background: Delayed leukoencephalopathy and foreign body reaction are rare complications after endovascular treatment of intracranial aneurysms. However, cases are increasingly being described, given the rising case numbers and complexity.Methods: Clinical presentation, differentials, diagnostics, treatment, and formerly published data were reviewed in light of available cases. A systematic search of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Results: This article provides an extensive literature review of previously described cases, and discusses the causes and management of this rare and delayed complication by referring to 17 articles on this topic, with a total of 50 cases with sufficient data in the literature. Furthermore, we present the case of a 53-year-old female patient with subarachnoid hemorrhage from a large anterior communicating artery aneurysm with tortuous cervical vessels who was treated with endovascular coiling and has suffered delayed leukoencephalopathy 6 weeks after discharge. Diagnostics, treatment, and clinical course of this rare complication are presented on this case and based on formerly published literature. The patient timely recovered under high dose corticosteroid treatment and follow up MRI showed almost complete remission of the described lesions within 10 days in accordance with previously published data.Conclusion: Foreign body reaction might result in delayed leukoencephalopathy, especially following complex endovascular aneurysm treatment. Early high dose followed by low dose ongoing corticosteroid treatment might result in timely remission.

scholarly journals Endovascular Coil Embolization of a Posterior Communicating Artery Aneurysm: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (6) ◽  
pp. E597-E598
Author(s):  
Maureen A Darwal ◽  
Zakaria Hakma ◽  
Mandy J Binning ◽  
Adam Arthur ◽  
Bain Mark ◽  
...  
Keyword(s):  
New York ◽  
Endovascular Treatment ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Posterior Communicating Artery ◽  
International Subarachnoid Aneurysm Trial ◽  
Endovascular Coil Embolization ◽  
Posterior Communicating Artery Aneurysm ◽  
Set Up

Abstract Since the International Subarachnoid Aneurysm Trial,1 endovascular treatment has been the favored treatment for appropriate ruptured intracranial aneurysms. While our endovascular technology has advanced to allow us to treat the majority of intracranial aneurysms, simple coil embolization is still the most common modality. This video demonstrates the fundamentals of aneurysm catheterization and coiling for safe treatment. In addition, the set-up and devices are detailed. This video is to add to the library of basic techniques that will aid a large number of practitioners. This patient consented to endovascular treatment. The video demonstrates endovascular coil embolization of a posterior communicating artery aneurysm in a 76-yr-old female who presented with a subarachnoid hemorrhage. Image of biplane suite in video used courtesy of Siemens Medical Solutions USA, Inc. Illustration at 5:12 reprinted from Yasargil MG, et al, Microneurosurgery IV B, p. 9, Thieme, New York, 1995.

scholarly journals Late Thromboembolic Events after Treatment of Intracranial Aneurysms with Guglielmi Detachable Coils

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 356-357
Author(s):  
Colin P Derdeyn ◽  
Christopher J Moran ◽  
DeWitte T Cross ◽  
Michael R Chicoine ◽  
Ralph G Dacey
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Additional Patient ◽  
Superior Cerebellar Artery ◽  
Parent Artery ◽  
Imaging Data ◽  
Guglielmi Detachable Coils ◽  
Kaplan Meier ◽  
Detachable Coils

P98 Purpose: Thrombo-embolic complications associated with the endovascular treatment of intracranial aneurysms with Guglielmi Detachable Coils (GDC) generally occur at the time of the procedure or soon after. The purpose of this report is to determine the frequency of late thrombo-embolic events after GDC. Methods: The records of 189 patients who underwent GDC repair of one or more intracranial aneurysms at our institution were reviewed. The occurence of an ischemic event referrable to a coiled aneurysm was determined by clinical, angiographic, and imaging data. Events occuring within 2 days of the endovascular procedure were considered peri-procedural. Kaplan-Meier analysis of ischemic events over time was performed. Results: Two patients suffered documented thrombo-embolic events. One patient presented 5 weeks after coiling with a transient ischemic attack. Angiography demonstrated thrombus on the surface of the coils at the neck of a large ophthalmic artery aneurysm. The second patient presented with a posterior circulation stroke 4 weeks after coiling of a large superior cerebellar artery aneurysm. Angiography showed no significant proximal disease, with thrombus beginning at the neck of the treated aneurysm and extending out both P1 segments. No intra-procedural problems during the initial coiling had occured with either patient. There was no evidence for protrusion of coils into the parent artery in either patient. Both patients had been receiving daily aspirin (325 mg). One additional patient reporting symptoms suggesting possible ischemics event was evaluated and diagnosed as having atypical migraines. The frequency of a clinical thromboembolic event during the first year after coiling (excluding procedural complications) was 1.1%. Conclusions: Thrombo-embolic events may occur as late as 5 weeks after endovascular treatment of aneurysms with GDC.

Intraoperative transaneurysmal coil-assisted clip occlusion of a complex anterior communicating artery aneurysm

2007 ◽  
Vol 107 (1) ◽  
pp. 202-205 ◽  
Author(s):  
Niklaus Krayenbühl ◽  
Ali F. Krisht
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Anterior Communicating Artery Aneurysm ◽  
Complete Obliteration ◽  
Clip Occlusion ◽  
First Time

✓The combination of surgical and endovascular treatment for complex intracranial aneurysms has previously been used in a staged fashion. To perfect the clipping process of a complex anterior communicating artery aneurysm and to avoid a second staged procedure, the authors used a method of direct intraoperative transaneurysmal coil-assisted clip occlusion of the aneurysm. To the authors' knowledge this is the first time direct intraoperative transaneurysmal coil-assisted clip occlusion has been reported. It should be kept in mind as one of the options to help in complete obliteration of complex intracranial aneurysms.

Neonatal intracranial aneurysms: case report and review of the literature

2018 ◽  
Vol 21 (5) ◽  
pp. 471-477 ◽  
Author(s):  
Jeewaka E. Mohotti ◽  
Nicole S. Carter ◽  
Victor Jia Wei Zhang ◽  
Leon T. Lai ◽  
Christopher Xenos ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Time Of Flight ◽  
Review Of The Literature ◽  
Microsurgical Treatment ◽  
Enhanced Mri ◽  
Contrast Enhanced ◽  
Mca Aneurysm ◽  
Contrast Enhanced Mri

Intracranial aneurysms in the neonate, presenting in the first 4 weeks of life, are exceedingly rare. They appear to have characteristics, including presentation and location, that vary from those found in adults. The authors present a case of a 28-day-old neonate with a ruptured distal middle cerebral artery (MCA) aneurysm. Initial noninvasive imaging with transfontanelle ultrasound and CT confirmed intraparenchymal and subarachnoid hemorrhage. Contrast-enhanced MRI revealed a 14-mm ruptured fusiform MCA aneurysm that was not identified on time-of-flight magnetic resonance angiography (MRA). Microsurgical treatment was performed with partial neurological recovery. A comprehensive review of the literature from 1949 to 2017 revealed a total of 40 aneurysms in 37 neonates, including the present case. The most common presenting symptom was seizure. Although subarachnoid hemorrhage was the most common form of hemorrhage, 40% had intraparenchymal hemorrhage. The median aneurysm size was 10 mm (range 2–30 mm) and the most common location was the MCA, with two-thirds of cases involving the distal intracranial vasculature. Over the last 10 years, there has been a trend of increasing noninvasive diagnosis of ruptured cerebral aneurysms in neonates, with CT angiography and contrast-enhanced MRI being the most useful diagnostic modalities. The use of contrast-enhanced MRI may improve sensitivity over time-of-flight MRA. Microsurgical treatment was the most common treatment modality overall, with increased use of endovascular treatment in the last decade. Most patients underwent microsurgical vessel ligation or endovascular parent vessel occlusion. There were high rates of neurological recovery after microsurgical or endovascular treatment, particularly for patients with distal aneurysms.

scholarly journals Direct Vertebral Artery Access for the Endovascular Treatment of Basilar Artery Aneurysms

2012 ◽  
Vol 18 (1) ◽  
pp. 29-32 ◽  
Author(s):  
J.R. Vanzin ◽  
L. Bambini Manzato ◽  
F. Slaviero ◽  
M. Strzelecki ◽  
R. D'Agostini Annes
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Basilar Artery ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Cervical Region ◽  
Alternative Route ◽  
Femoral Approach ◽  
Basilar Artery Aneurysm ◽  
Access Technique

The femoral approach has been considered the preferred technique for the endovascular treatment of intracranial aneurysms. Occasionally, aneurysms are not amenable to the standard femoral approach. We describe four cases of basilar artery aneurysm that were treated by the direct vertebral artery access of V1 at the cervical region. The direct vertebral artery access technique can provide an alternative route in selected cases for the treatment of basilar artery aneurysms.

Dissecting Aneurysm of the Posterior Spinal Artery

Neurosurgery ◽  
2012 ◽  
Vol 71 (3) ◽  
pp. E749-E756 ◽  
Author(s):  
Hyun Jeong Kim ◽  
In Sup Choi
Keyword(s):  
Abdominal Pain ◽  
Subarachnoid Hemorrhage ◽  
Arteriovenous Malformations ◽  
Intracranial Aneurysms ◽  
Clinical Presentation ◽  
Artery Aneurysm ◽  
Dissecting Aneurysm ◽  
Posterior Spinal Artery ◽  
Spinal Subarachnoid Hemorrhage ◽  
Distal Flow

Abstract BACKGROUND AND IMPORTANCE: Because of their rarity, the pathogenesis and clinical features of isolated spinal artery aneurysms are still unclear, and their diagnoses and treatments are challenging. We report a case of an isolated posterior spinal artery aneurysm and review previous reports thoroughly to identify the general features of isolated spinal aneurysms. CLINICAL PRESENTATION: A 52-year-old man presented with abdominal pain followed by back pain and radiculopathy from subarachnoid hemorrhage in the spinal canal. The spinal angiogram demonstrated the presence of a dissecting aneurysm of the posterior spinal artery. He was treated by endovascular occlusion of the origin of the radiculopial artery and recovered completely. CONCLUSION: Isolated spinal artery aneurysms are very rare lesions; however, they should be considered in patients with intracranial or spinal subarachnoid hemorrhage without evidence of arteriovenous malformations. Spinal aneurysms have different etiologies compared with intracranial aneurysms. Cervical aneurysms have worse outcomes than thoracolumbar aneurysms. The etiology and location of the lesion and distal flow to the lesion should be taken into consideration when planning the treatment.

Evaluation of the immediate and long-term results of endovascular treatment of ruptured vertebrobasilar artery aneurysms in an acute period of hemorrhage

2019 ◽  
Vol 20 (4) ◽  
pp. 31-37
Author(s):  
E. O. Ivankova ◽  
V. V. Darvin ◽  
M. A. Bessmertnykh
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Vegetative State ◽  
Good Condition ◽  
Artery Aneurysm ◽  
Long Term Results ◽  
Study Objective ◽  
Acute Period ◽  
Endovascular Occlusion ◽  
Vertebrobasilar Artery

The study objective is to evaluate the results of endovascular treatment of patients with subarachnoid hemorrhage due to rupture of the vertebrobasilar artery aneurysm.Materials and methods. From 2011 to 2017, 26 patients underwent endovascular occlusion of the ruptured vertebrobasilar artery aneurysm in an acute period of hemorrhage in Surgut Clinical Hospital for Traumatology.Results. Endovascular interventions were performed in 1–14 days after the episode of the primary subarachnoid hemorrhage. Among the patients 53.8 % were in good condition at admission (Hunt–Hess grade I–II), 46.2 % had moderate and severe neurologic disability (Hunt–Hess grade III–IV). A good and satisfactory degree of aneurysm occlusion was achieved in 18 (69.3 %). Favorable outcome (modified Rankin Scale (mRS) 0–2) was achieved in 21 (80.7 %); 1 (3.7 %) had severe disability (mRS 4), 2 (7.8 %) – vegetative state (mRS 5). Lethal outcome (mRS 6) occurred in 2 (7.8 %). Unfavorable outcomes were caused by a severe vasospasm.Conclusions. Endovascular occlusion of vertebrobasilar artery aneurysms in the acute period of hemorrhage is an effective and safe method of treatment in patients with Hunt–Hess grade I–IV.

Endovascular treatment of intracranial aneurysms and vasospasm after aneurysmal subarachnoid hemorrhage

2005 ◽  
Vol 16 (2) ◽  
pp. 317-353 ◽  
Author(s):  
Ricardo A. Hanel ◽  
Demetrius K. Lopes ◽  
J. Christopher Wehman ◽  
Eric Sauvageau ◽  
Elad I. Levy ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage

scholarly journals Radiological Changes in Infantile Dissecting Anterior Communicating Artery Aneurysm Treated Endovascularly

2014 ◽  
Vol 20 (6) ◽  
pp. 796-803 ◽  
Author(s):  
Kenji Yatomi ◽  
Hidenori Oishi ◽  
Munetaka Yamamoto ◽  
Yasuo Suga ◽  
Senshu Nonaka ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Blood Coagulation ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Dissecting Aneurysm ◽  
Anterior Communicating Artery ◽  
Anterior Communicating Artery Aneurysm ◽  
Radiological Changes ◽  
Dissecting Aneurysms

Intracranial aneurysms are extremely rare in infants, and to our knowledge only seven infants treated for ruptured spontaneous dissecting aneurysms have been reported. Good outcomes have been achieved with endovascular treatment of infantile aneurysm. We the endovascular treatment of a one-month-old girl for ruptured dissecting aneurysm located in the anterior communicating artery, and the unique radiological changes that were observed during the perioperative and follow-up periods. These changes suggest that blood coagulation and fibrinolytic response play a part in the repair and healing processes of dissecting aneurysms. Careful neuroradiological surveys are needed for pediatric dissecting aneurysms treated endovascularly.

Endovascular Treatment of Intracranial Aneurysms in the Elderly: Single-Center Experience in 63 Consecutive Patients

Neurosurgery ◽  
2005 ◽  
Vol 57 (6) ◽  
pp. 1096-1102 ◽  
Author(s):  
YiLing Cai ◽  
Laurent Spelle ◽  
Huan Wang ◽  
Michel Piotin ◽  
Charbel Mounayer ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Endovascular Procedures ◽  
The Elderly ◽  
High Grade ◽  
Single Center ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms

Abstract OBJECTIVE: With a globally aging population, it is imperative to develop specific treatment strategies for intracranial aneurysms in the elderly. However, the optimal management of intracranial aneurysms in the elderly remains controversial, particularly for the unruptured aneurysms. Although endovascular treatment is increasingly being used for the management of aneurysms, large endovascular series in the elderly population are relatively lacking, especially with regard to the unruptured aneurysms. We present our single-center endovascular experience in treating intracranial aneurysms in 63 consecutive patients 70 years of age and older. METHODS: Between November 1998 and December 2003, among a total of 990 patients with intracranial aneurysms treated endovascularly at our center, 63 patients (6%) were 70 years of age or older. Forty-one patients presented with subarachnoid hemorrhage (SAH), and 22 presented with symptomatic unruptured aneurysms. A total of 84 aneurysms were detected in these 63 patients. Only those responsible for either the subarachnoid hemorrhage or clinical symptoms (68 aneurysms) were treated. The aneurysm characteristics, endovascular procedures and techniques, angiographic and clinical outcomes, and complications were reviewed. RESULTS: Selective embolization failed in three aneurysms (4%). In the remaining 65 aneurysms, complete occlusion was achieved in 33 aneurysms (51%), neck remnant was observed in 17 aneurysms (27%), and residual aneurysmal filling was observed in six aneurysms (9%). Parent vessel occlusion was used in the treatment of nine aneurysms (13%). Thirteen procedure-related complications occurred (19%), six of which resulted in clinical complications (9%). Nine deaths (14%) occurred; three (5%) were directly related to the endovascular procedures, and six (9%) were related to the medical complications of SAH. The remaining 54 patients had a mean clinical follow-up time of 13 months (range, 1–47 mo). Ninety-one percent (20 out of 22) of the patients with unruptured aneurysms and 89% (25/28) of the patients with low-grade (Hunt and Hess Grade I and II) ruptured aneurysms achieved excellent outcomes (modified Rankin Scale score, 0–1), whereas 77% (10 out of 13) of the patients with high-grade (Hunt and Hess Grade ≥ III) ruptured aneurysms either died or had very poor outcomes (modified Rankin Scale score, 4–5). Angiographic follow-up (mean, 11 mo; range, 3–38 mo) was obtained in 34 of the 54 living patients (63%). Two aneurysms demonstrated minor changes that required no further treatment (5%). Five aneurysms showed major recurrences (17%), all of which were successfully retreated endovascularly. CONCLUSION: The elderly patients should merit strong consideration for endovascular treatment of both ruptured and symptomatic unruptured intracranial aneurysms. However, in elderly patients with high-grade subarachnoid hemorrhage, morbidity and mortality rates remain high.

Sign in / Sign up

Export Citation Format

Share Document