Use of Distal Intracranial Catheters for Better Working View of Cerebral Aneurysms Hidden by Parent Artery or Its Branches: A Technical Note

A good working view is critical for safe and successful endovascular treatment of cerebral aneurysms. In a few cases, endovascular treatment of cerebral aneurysms may be challenging due to difficulty in obtaining a proper working view. In this report of 6 cases, we described the advantage of using a distal intracranial catheter (DIC) to achieve better visualization of cerebral aneurysms hidden by a parent artery or its branches. Between September 2017 and January 2021, we treated 390 aneurysms with endovascular techniques. In 6 cases in which it was difficult to obtain a proper working view, the DIC was placed distally close to the aneurysm in order to remove the parent artery projection from the working view and obtain better visualization of the aneurysm. Clinical and procedural outcomes and complications were evaluated. The position of the DIC was above the internal carotid artery siphon in the 6 cases. All aneurysms were successfully embolized. Raymond–Roy class 1 occlusion was achieved in all 4 unruptured aneurysms, while the result was class 2 in the 2 ruptured aneurysms. Placement of the DIC was atraumatic without dissections or significant catheter-induced vasospasm in all patients. Transient dysphasia was seen in 2 cases and transient aphasia in 1. Using this technique, we have found it possible to better visualize the aneurysm sac or neck and thereby treat cases we otherwise would have considered untreatable.

Download Full-text

Endovascular treatment of cerebral aneurysms: a retrospective study of 163 embolized aneurysms

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2007000300009 ◽

2007 ◽

Vol 65 (2b) ◽

pp. 411-415 ◽

Cited By ~ 2

Author(s):

João Renato Figueiredo Souza ◽

Marcelo Otoch ◽

Sérgio Pouchain Ribeiro ◽

Francisco Ramos Júnior ◽

João Paulo Cavalcante de Almeida ◽

...

Keyword(s):

Public Health ◽

Retrospective Study ◽

Endovascular Treatment ◽

Public Health System ◽

Arterial Occlusion ◽

Cerebral Aneurysms ◽

Partial Occlusion ◽

Endovascular Techniques ◽

Endovascular Technique ◽

Ruptured Aneurysms

OBJECTIVE: To present the results of cerebral aneurysms treated by endovascular technique. METHOD: Retrospective analysis of patient files of Hospital Geral de Fortaleza, Brazil. RESULTS: We report the results of 163 cerebral aneurysms treated by endovascular techniques from January 2002 to October 2005. Patients with ruptured aneurysms (87.2%), according to Hunt-Hess scale were: 33.7% HH I, 28.4% HH II, 24.1% HH III, 13.8% HH IV. The Fisher scale grade IV was the most common (39.7%). Remodeling, coil embolization, arterial occlusion and histoacryl embolization were the techniques employed. Effective occlusion was achieved in 87.7%, partial occlusion in 5.3% and non-effective occlusion in 7.0% of the patients. Glasgow outcome scale results were: 76.3% GOS 5, 5.0% GOS 4, 5.8% GOS 3, 1.4% GOS 2 and 11.5% GOS 1. CONCLUSION: Endovascular treatment seems to be feasible within Brazilian public health system, with results as good as those obtained in larger international centers.

Download Full-text

Balloon-assisted extrasaccular coil embolization technique for the treatment of very small cerebral aneurysms

Journal of Neurosurgery ◽

10.3171/2009.4.jns081291 ◽

2010 ◽

Vol 112 (3) ◽

pp. 585-588 ◽

Cited By ~ 15

Author(s):

Alberto Gil ◽

Pedro Vega ◽

Eduardo Murias ◽

Hugo Cuellar

Keyword(s):

Endovascular Treatment ◽

Coil Embolization ◽

Cerebral Aneurysms ◽

Endovascular Embolization ◽

Review Of The Literature ◽

Endovascular Techniques ◽

Ruptured Aneurysms ◽

Intraoperative Rupture ◽

Small Aneurysms ◽

Very High

Treatment of very small ruptured cerebral aneurysms (< 2 mm) continues to present a challenge. These lesions are difficult to treat both with neurosurgical and endovascular techniques. A neurosurgical approach is still the treatment of choice for these lesions at many centers because of high rupture rates related to endovascular treatment; however, there are clinical circumstances in which the neurosurgical option cannot be offered. In their review of the literature, the authors did not find any series reporting endovascular treatment of these very small aneurysms. In the present study, the authors report their experience with the endovascular treatment of a series of 4 ruptured aneurysms smaller than 2 mm from neck to dome. They describe their technique of using a remodelling balloon to stabilize the tip of the microcatheter in the neck of the aneurysm without entering it at any time, and of inserting the coil from outside the sac to minimize the risk of intraoperative rupture, which is very high when conventional endovascular embolization is performed.

Download Full-text

Initial Experience with LVIS EVO Stents for the Treatment of Intracranial Aneurysms

Journal of Clinical Medicine ◽

10.3390/jcm9123966 ◽

2020 ◽

Vol 9 (12) ◽

pp. 3966

Author(s):

Wojciech Poncyljusz ◽

Kinga Kubiak

Keyword(s):

Cerebral Artery ◽

Intracranial Aneurysms ◽

Internal Carotid ◽

Cerebral Aneurysms ◽

Thromboembolic Complication ◽

Anterior Communicating Artery ◽

Unruptured Aneurysms ◽

Low Profile ◽

Class 1 ◽

Occlusion Rate

Background: Over the years, a variety of intracranial stents have been developed, which has expanded the therapy options available for cerebral aneurysms. The Low profile visible intraluminal support (LVIS) EVO stents are new devices, which officially appeared on the market in 2020. The purpose of the study is to report the initial technical and clinical experience with the new stent in the treatment of intracranial aneurysms. Materials and Methods: Between February and September 2020, 30 patients with 35 intracranial aneurysms (29 unruptured and 6 ruptured) were treated using the LVIS EVO stent in our department. The aneurysms were located within internal carotid artery (ICA) (42.9%), middle cerebral artery (MCA) (31.4%), anterior communicating artery (AComA) (11.4%), basilar artery (BA) (11.4%) and anterior cerebral artery (ACA) (2.9%). Stent-assisted coil embolization was performed in all cases. Results: All stents were deployed successfully in the desired position. Immediate complete occlusion of the treated aneurysms, described as Raymond–Roy occlusion classification (RROC) class 1, was achieved in all cases. No technical complications were observed. One thromboembolic complication occurred in the group of unruptured aneurysms and one patient died due to cerebral edema from aneurysms rupture group. Conclusion: In our observation, the showed a satisfactory safety profile LVIS EVO stents seem to be very flexible, can be safely maneuvered and deployed in tortuous vessels. They showed a good initial occlusion rate when used for treating intracranial aneurysms with SAC (stent-assisted coiling).

Download Full-text

Treatment of Intracranial Aneurysms Using the New Silk Vista Flow Diverter: Safety Outcomes at Short-Term Follow-Up

Frontiers in Neurology ◽

10.3389/fneur.2021.713389 ◽

2021 ◽

Vol 12 ◽

Author(s):

José M. Pumar ◽

Antonio Mosqueira ◽

Jorge Olier ◽

Claudio Rodriguez-Fernandez ◽

Pedro Vega ◽

...

Keyword(s):

Endovascular Treatment ◽

Cerebral Aneurysms ◽

Flow Diverter ◽

Parent Artery ◽

Short Term ◽

Unruptured Aneurysms ◽

Brain Aneurysms ◽

New Generation ◽

Flow Diverters

Background: Flow diverters are widely used as the first endovascular treatment option for complex brain aneurysms due to their high percentage of occlusion and low morbi-mortality. The Silk Vista device is a new generation of flow diverters designed to facilitate full visibility, improve apposition to the vessel wall, and enhance navigability. Indeed, its greatest advantage is that it enables the easier navigation of stents between 3.5 and 4.75 mm through a 0.021 microcatheter. The objective of this study was to evaluate the safety and effectiveness of Silk Vista systems for treating cerebral aneurysms.Methods: This prospective observational study included 25 consecutive patients with 27 wide-necked unruptured aneurysms treated with SILK Vista who were retrospectively analyzed for safety and efficacy.Results: Endovascular treatment was successfully performed in all patients. The final morbidity and mortality rates were both 0.0%. Short-term (3–5 months) angiographic follow-up revealed 21 complete occlusions and 6 near-complete occlusions. No significant parent artery stenosis was observed.Conclusions: This report demonstrates the efficacy of Silk Vista in treating brain aneurysms, although longer experiences should be carried out to confirm our results.

Download Full-text

Peri-Procedural Morbidity and Mortality Associated with Stent-Assisted Coiling for Intracranial Aneurysms

Interventional Neuroradiology ◽

10.1177/159101991301900106 ◽

2013 ◽

Vol 19 (1) ◽

pp. 43-48 ◽

Cited By ~ 10

Author(s):

K. Wang ◽

Y. Sun ◽

A-M. Li

Keyword(s):

Intracranial Aneurysms ◽

Cerebral Aneurysms ◽

Mortality Rates ◽

Stent Migration ◽

Aneurysm Rupture ◽

Morbidity And Mortality ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Attractive Option ◽

Technological Improvements

Despite experience and technological improvements, stent-assisted coiling for intracranial aneurysms still has inherent risks. We evaluated peri-procedural morbidity and mortality associated with stent-assisted coiling for intracranial aneurysms. Patients with cerebral aneurysms that were broad-based (>4 mm) or had unfavorable dome/neck ratios (<1.5) were enrolled in this study between February and November 2011 at our center. Aneurysms were treated with the self-expanding neurovascular stents with adjunctive coil embolization. Seventy-two consecutive patients (27 men and 45 women; 22–78 years of age; mean age, 52.8 years) underwent 13 procedures for 13 ruptured aneurysms and 64 procedures for 73 unruptured aneurysms. Nine [11.7%, 95% CI(4.5%–18.9%)] procedure-related complications occurred: one and eight with initial embolization of ruptured and unruptured aneurysms, respectively. Complications included six acute in-stent thromboses, one spontaneous stent migration, one post-procedural aneurysm rupture, and one perforator occlusion. Three complications had no neurologic consequences. Two caused transient neurologic morbidity, two persistent neurologic morbidity, and two death. Procedure-related neurologic morbidity and mortality rates, respectively, were as follows: overall, 5.2% (95%CI, 0.2%–10.2%) and 2.6% (95%CI, 0%–6.2%); ruptured aneurysms, 7.7% (95%CI, 0%–36%) and 0% (95%CI, 0%–25%); unruptured aneurysms, 4.7% (95%CI, 0%–9.9%) and 3.1% (95%CI, 0%–7.3%). Combined procedure-related morbidity and mortality rates for ruptured and unruptured aneurysms were 7.7% (95%CI, 1.7%–13.7%) and 7.8% (95%CI, 1.8%–13.8%), respectively. Stent-assisted coiling is an attractive option for intracranial aneurysms. However, stent-assisted coiling for unruptured aneurysms is controversial for its comparable risk to natural history.

Download Full-text

Long-Term Follow-up Study of Endovascularly Treated Intracranial Aneurysms

Interventional Neuroradiology ◽

10.1177/159101991001600301 ◽

2010 ◽

Vol 16 (3) ◽

pp. 231-239 ◽

Cited By ~ 5

Author(s):

L.M. Pyysalo ◽

L.H. Keski-Nisula ◽

T.T. Niskakangas ◽

V.J. Kähärä ◽

J.E. Öhman

Keyword(s):

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Bleeding Rate ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Follow Up Study ◽

Long Term Follow Up ◽

Rebleeding Rate

Long-term follow-up studies after endovascular treatment for intracranial aneurysm are still rare and inconclusive. The aim of this study was to assess the long-term clinical and angiographic outcome of patients with endovascularly treated aneurysms. The clinical outcome of all 185 patients with endovascularly treated aneurysms were analyzed and 77 out of 122 surviving patients were examined with MRI and MRA nine to 16 years (mean 11 years) after the initial endovascular treatment. Sixty-three patients were deceased at the time of follow-up. The cause of death was aneurysm-related in 34 (54%) patients. The annual rebleeding rate from the treated aneurysms was 1.3% in the ruptured group and 0.1% in the unruptured group. In long-term follow-up MRA 18 aneurysms (53%) were graded as complete, 11 aneurysms (32%) had neck remnants and five aneurysms (15%) were incompletely occluded in the ruptured group. The occlusion grade was lower in the unruptured group with 20 aneurysms (41%) graded as complete, 11 (22%) had neck remnants and 18 (37%) were incomplete. However, only three aneurysms were unstable during the follow-up period and needed retreatment. Endovascular treatment of unruptured aneurysms showed incomplete angiographic outcome in 37% of cases. However, the annual bleeding rate was as low as 0.1%. Endovascular treatment of ruptured aneurysms showed incomplete angiographic outcome in 15% of cases and the annual rebleeding rate was 1,3%.

Download Full-text

Endovascular management of intracranial aneurysms during pregnancy in three cases and review of the literature

Interventional Neuroradiology ◽

10.1177/1591019915609134 ◽

2015 ◽

Vol 21 (6) ◽

pp. 654-658 ◽

Cited By ~ 4

Author(s):

Peng Liu ◽

Xianli Lv ◽

Youxiang Li ◽

Ming Lv

Keyword(s):

Cesarean Section ◽

Cerebral Aneurysms ◽

Endovascular Coiling ◽

Review Of The Literature ◽

Endovascular Techniques ◽

Healthy Baby ◽

Unruptured Aneurysms ◽

Gestational Week ◽

Basilar Tip Aneurysm ◽

Case Basis

We present three cases of cerebral aneurysms (1 unruptured; 2 ruptured) treated with endovascular techniques in pregnancies. The first ruptured case is a 28-year-old female on 20th gestational week. After the endovascular coiling, the patient suffered persistent hemiparesis and delivered a healthy baby by cesarean section. The second ruptured case is a 25-year-old female on 36th week of pregnancy. She died of aneurysm re-rupture after delivery of a healthy baby by cesarean section. The third unruptured case is a 31-year-old woman on the 26th gestational week of pregnancy who died of a giant basilar tip aneurysm after stent-assisted coiling. Ruptured aneurysm obliteration should be prioritized followed by vaginal delivery or cesarean section. The decision regarding the treatment of unruptured aneurysms should be carefully considered on a case-by-case basis. Stent-assisted coiling may be applicable to aneurysm during pregnancy.

Download Full-text

Safety of Abciximab injection during endovascular treatment of ruptured aneurysms

Interventional Neuroradiology ◽

10.1177/1591019915582001 ◽

2015 ◽

Vol 21 (3) ◽

pp. 332-336 ◽

Cited By ~ 3

Author(s):

Jean-Christophe Gentric ◽

Joelle Brisson ◽

André Lima Batista ◽

Jimmy Ghostine ◽

Jean Raymond ◽

...

Keyword(s):

Endovascular Treatment ◽

Intracranial Hemorrhage ◽

Cerebral Aneurysms ◽

Bleeding Complications ◽

World Federation ◽

Consecutive Series ◽

Ruptured Aneurysms ◽

Grade Ii

Background and purpose We aimed to determine the safety of intra-arterial Abciximab injection in the management of thromboembolic complications during endovascular treatment of ruptured cerebral aneurysms. Methods In a monocentric consecutive series of endovascular treatment of 783 ruptured aneurysms, 42 (5.3%) patients received Abciximab after the aneurysm was secured. Bleeding complications were registered and dichotomized as follows: new intracranial hemorrhage and peripheral bleeding. For each patient, World Federation of Neurosurgery (WFNS) subarachnoid hemorrhage (SAH) grade, shunting, and clinical outcomes in the post-operative period and at 3–6 months were recorded. Results SAH WFNS grades were as follows: grade I n = 14, grade II n = 10, grade III n = 11, grade IV n = 4, grade V n = 3. Ten patients had intracranial hematoma additionally to the SAH prior to embolization. Four patients (9.5%) presented more blood on the post-embolization CT but only one suffered a new clinically relevant intracranial hemorrhage. Two patients (4.8%) experienced significant peripheral bleeding but none were associated with long-term disabilities. Fourteen patients had a shunt installed less than 24 h prior to Abciximab injection and one less than 48 h later. At 3–6-month follow-up, 31 patients (74%) achieved a modified Rankin Scale score (mRS) of 2 or less, six patients (14%) had a mRS of 3–5, three were dead (7%), and two were lost at follow-up. Conclusion When the aneurysm is secured, intra-arterial Abciximab injection is a low complication rate treatment modality for thromboembolic events during embolization of cerebral ruptured aneurysm.

Download Full-text

Abstract 107: Early Change in Ferumoxytol-Enhanced Magnetic Resonance Imaging Signal Suggests Unstable Human Cerebral Aneurysm. A Pilot Study

Stroke ◽

10.1161/str.44.suppl_1.a107 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

David M Hasan ◽

donald hesitad

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Cerebral Aneurysm ◽

Cerebral Aneurysms ◽

Resonance Imaging ◽

Unruptured Aneurysms ◽

Ruptured Aneurysms ◽

Cyclooxygenase 1 ◽

Signal Changes ◽

Cox 2

Background: Imaging with magnetic resonance imaging (MRI) 72 hours after infusion of ferumoxytol demonstrated maximal uptake by macrophages in the wall of human cerebral aneurysms. The clinical significance of early (i.e. within the first 24 hours) uptake of ferumoxytol by macrophages in the wall of human cerebral aneurysms is not clear. The purpose of this study was to determine whether early uptake of ferumoxytol which may indicate inflammation, suggests unstable cerebral aneurysm. Methods: 30 unruptured aneurysms in 22 patients were imaged with MRI 24 hours after infusion of ferumoxytol. Eighteen aneurysms were also imaged 72 hours after infusion of ferumoxytol. Aneurysm dome tissue was collected from four patients with early MRI signal changes, five patients with late signal changes, and five other patients with ruptured aneurysms. The tissue was immunostained for expression of cyclooxygenase-1 (COX-1), cyclooxygenase-2 (COX-2), microsomal-prostaglandin-E2 synthase-1 (mPGES-1) and macrophages. Findings: In 23% (7/30) of aneurysms, there was pronounced early uptake of ferumoxytol. Four aneurysms were clipped. The remaining three aneurysms which were managed conservatively with observation, all ruptured within six months. In 89% (16/18) of aneurysms, there was pronounced uptake of ferumoxytol at 72 hours. Nine aneurysms were surgically clipped and nine were managed conservatively; none ruptured or increased in size in six months. With immunostaining, expression of COX-2, mPGES-1, and macrophages was similar in unruptured aneurysms with early uptake of ferumoxytol and ruptured aneurysms. Expression of these inflammatory molecules was significantly higher in aneurysms with early uptake of ferumoxytol than in aneurysms with late uptake. Interpretation: Uptake of ferumoxytol in aneurysm walls within the first 24 hours strongly suggests aneurysm instability and probability of rupture within six months, and may warrant intervention. Larger clinical studies are indicated to validate this preliminary observation.

Download Full-text

Endovascular Treatment of Cerebral Aneurysms

Rivista di Neuroradiologia ◽

10.1177/197140090201500508 ◽

2002 ◽

Vol 15 (5) ◽

pp. 537-548 ◽

Cited By ~ 7

Author(s):

G.B. Bradač ◽

G. Stura ◽

M. Bergui

Keyword(s):

Endovascular Treatment ◽

Cerebral Aneurysm ◽

Essential Role ◽

Cerebral Aneurysms ◽

Balloon Occlusion ◽

New Technique ◽

Endovascular Techniques ◽

Parent Vessel ◽

Endovascular Approach

Balloon occlusion of parent vessel and direct coiling are the two endovascular techniques routinely used and commonly accepted as alternatives to surgery for treatment of the cerebral aneurysm in many patients. Based on our experience and what is reported in the literature, the various aspects concerning techniques, difficulties, risks, are described. In comparison to surgery, the endovascular approach is a relatively new technique, which is still in evolution. To date, there is no objective indication regarding the method to be used in a given case. The experience and attitude of the involved team still play an essential role.

Download Full-text