Endovascular Management of Hemorrhagic Stroke

Significant advances in endovascular neurosurgery tools, devices, and techniques are changing the approach to the management of acute hemorrhagic stroke. The endovascular treatment of intracranial aneurysms emerged in the early 1990s with Guglielmi detachable coils, and since then, it gained rapid popularity that surpassed open surgery. Stent-assisted coiling and balloon remodeling techniques have made the treatment of wide-necked aneurysms more durable. With the introduction of flow diverters and flow disrupters, many aneurysms with complex geometrics can now be reliably managed. Arteriovenous malformations and fistulae can also benefit from endovascular therapy by embolization using n-butyl cyanoacrylate (NBCA), Onyx, polyvinyl alcohol (PVA), and coils. In this article, we describe the role of endovascular treatment for the most common causes of intracerebral and subarachnoid hemorrhages, particularly ruptured aneurysms and vascular malformations.

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

Stroke ◽

10.1161/str.32.suppl_1.356-e ◽

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.

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Endovascular Treatment with Guglielmi Detachable Coils and Permanent Balloon Occlusion for Paraclinoid Aneurysms

Neurosurgery ◽

10.1097/00006123-199909000-00130 ◽

1999 ◽

Vol 45 (3) ◽

pp. 713-713

Author(s):

John Thornton ◽

Mukesh Misra ◽

Zachary Dovey ◽

Victor Aletich ◽

Gerard Debrun ◽

...

Keyword(s):

Endovascular Treatment ◽

Balloon Occlusion ◽

Guglielmi Detachable Coils ◽

Paraclinoid Aneurysms ◽

Detachable Coils

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Endovascular Treatment of Basilar Tip Aneurysms Using Guglielmi Detachable Coils: Anatomic and Clinical Outcomes in 73 Patients from a Single Institution

Neurosurgery ◽

10.1093/neurosurgery/47.6.1332 ◽

2000 ◽

Vol 47 (6) ◽

pp. 1332-1342 ◽

Cited By ~ 15

Author(s):

Satoshi Tateshima ◽

Yuichi Murayama ◽

Y. Pierre Gobin ◽

Gary R. Duckwiler ◽

Guido Guglielmi ◽

...

Keyword(s):

Endovascular Treatment ◽

Clinical Outcomes ◽

Single Institution ◽

Guglielmi Detachable Coils ◽

Detachable Coils

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Embolisation of Orbital Varix via the Superficial Temporal Vein

Interventional Neuroradiology ◽

10.1177/159101990000600209 ◽

2000 ◽

Vol 6 (2) ◽

pp. 137-140 ◽

Cited By ~ 1

Author(s):

N. Mavilio ◽

A. Pau ◽

R. Pisani ◽

A. Casasco ◽

M. Rosa

Keyword(s):

Endovascular Treatment ◽

Endovascular Management ◽

Guglielmi Detachable Coils ◽

Detachable Coils ◽

Orbital Varix

A case of orbital varix is presented, in which the lesion was successfully treated by means of embolisation with Guglielmi detachable coils, via the superficial temporal vein. Reports of endovascular treatment via transvenous route of orbital varix are lacking, only one case having previously been presented in the literature. We stress endovascular management for such an entity.

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Endovascular Treatment of Intracranial High-flow Arteriovenous Fistulas by Guglielmi Detachable Coils

Journal of the Chinese Medical Association ◽

10.1016/s1726-4901(09)70118-2 ◽

2006 ◽

Vol 69 (2) ◽

pp. 80-85 ◽

Cited By ~ 18

Author(s):

Chao-Bao Luo ◽

Michael Mu-Huo Teng ◽

Feng-Chi Chang ◽

Cheng-Yen Chang

Keyword(s):

Endovascular Treatment ◽

High Flow ◽

Guglielmi Detachable Coils ◽

Arteriovenous Fistulas ◽

Detachable Coils

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Magnetic Resonance Angiography for Evaluation of Intracranial Aneurysms Treated with Guglielmi Detachable Coils

Rivista di Neuroradiologia ◽

10.1177/197140099801100102 ◽

1998 ◽

Vol 11 (1) ◽

pp. 19-25 ◽

Cited By ~ 6

Author(s):

E. Cotroneo ◽

M. Dazzi ◽

R. Gigli ◽

G. Guidetti ◽

G.P. Cantore ◽

...

Keyword(s):

Endovascular Treatment ◽

Mr Angiography ◽

Cerebral Aneurysms ◽

Digital Subtraction ◽

Contrast Injection ◽

Guglielmi Detachable Coils ◽

Non Invasive ◽

Mri Angiography ◽

Detachable Coils

Thirteen cases of cerebral aneurysms submitted to endovascular treatment using Guglielmi detachable coils (GDC) are described. Control MRI-angiography 3D TOF was performed three and six months later. In order to spare patients the discomfort and risks related to repeated trauma and iodate contrast injection, we examined the possibility of an alternative non-invasive diagnostic method. For this purpose, the digital subtraction angiograms performed three and six months after embolisation were compared with the MR-angiograms obtained in the same period, all using the same tomograph at middle field intensity (0.5T). We discuss the outcome of this comparison and the limits of the MR-angiography method in the follow-up of aneurysms submitted to endovascular treatment.

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Endovascular Treatment of Anterior Communicating Artery Aneurysms with Guglielmi Detachable Coils

Journal of the Korean Radiological Society ◽

10.3348/jkrs.1999.40.5.811 ◽

1999 ◽

Vol 40 (5) ◽

pp. 811

Author(s):

Seok Hyun Son ◽

Moon Hee Han ◽

Sang Hoon Cha ◽

Hye Young Choi ◽

Kee Hyun Chang ◽

...

Keyword(s):

Endovascular Treatment ◽

Anterior Communicating Artery ◽

Guglielmi Detachable Coils ◽

Anterior Communicating Artery Aneurysms ◽

Detachable Coils

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Abstract TMP70: The Emergency Department Screen is Associated with Lower Rates of Pneumonia in Acute Hemorrhagic Stroke Patients

Stroke ◽

10.1161/str.48.suppl_1.tmp70 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Jon Schrock ◽

Benjamin Ball

Keyword(s):

Emergency Department ◽

Hemorrhagic Stroke ◽

Pulmonary Infiltrate ◽

Stroke Severity ◽

Group 13 ◽

Before And After ◽

Poor Outcomes ◽

Subarachnoid Hemorrhages ◽

Acute Hemorrhagic Stroke ◽

Very High

Introduction: Dysphagia is a common problem in acute hemorrhagic stroke (AHS) patients, predisposing them to pneumonia and leading to poor outcomes. The Joint Commission mandated that dysphagia screening be performed at hospital presentation, which for most patients with AHS is the Emergency Department (ED). No evidence exists to demonstrate if the use of an ED dysphagia screen is associated with lower rates of pneumonia. Hypothesis: We assessed the hypothesis that the use of our ED dysphagia screen would not be associated with lower rates of pneumonia in AHS patients. Methods: We performed a pre-post cohort study evaluating the rates of pneumonia in AHS patients presenting to our ED before and after instituting dysphagia screening in 2010. Our pre group were AHS patients presenting from 2005-2009 and our post group from 2011-2015. The presence of pneumonia was pre-defined as new pulmonary infiltrate treated with antibiotics. We collected demographic and clinical data including rates of dysphagia and stroke severity. Data are presented as frequencies and medians with interquartile ranges (IQR) where appropriate. Rates of pneumonia were compared using the t-test. Results: We evaluated 469 pre screen and 462 post screen AHS patients. Both groups were 53% male. The rates of parenchymal bleed in the pre and post groups were 78% and 82%, respectively, with the remainder comprising subarachnoid hemorrhages or combination bleeds. Mean ICH scores were similar, pre 2.0 (SD 1.5) post 1.7 (SD 1.4). Dysphagia was present in 65% of the pre group and 63% of the post group. Incidence of pneumonia in the post group (13%) was significantly lower than the pre group (19%, P<0.001). Conclusion: The use of an ED dysphagia screen is associated with a lower rate of pneumonia in AHS patients. This study was not designed to prove causation. Other factors not measured may have contributed to the reduction in rates of pneumonia. With the very high rates of dysphagia seen in this population, early dysphagia screening at ED presentation seems appropriate.

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