Comparison of Clinical Outcomes Using 10 Coil Versus 14 Coil in Endovascular Coil Embolization for Small and Medium-sized Intracranial Aneurysms: Efficacy of 14 Coil

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.

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Early experience with a novel net temporary bridging device (Cascade) to assist endovascular coil embolization of intracranial aneurysms

Journal of Neurosurgery ◽

10.3171/2019.11.jns192477 ◽

2020 ◽

pp. 1-9

Author(s):

Alejandro Tomasello ◽

David Hernandez ◽

Laura Ludovica Gramegna ◽

Sonia Aixut ◽

Roger Barranco Pons ◽

...

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Type I ◽

Type Ii ◽

Unruptured Aneurysms ◽

Complete Obliteration ◽

Acute Subarachnoid Hemorrhage ◽

Endovascular Coil Embolization ◽

The Mean

OBJECTIVEThe goal of this study was to evaluate the effectiveness and safety of a new noncompletely occlusive net-assisted remodeling technique in which the Cascade net device is used for temporary bridging of intracranial aneurysms.METHODSBetween July 2018 and May 2019, patients underwent coil embolization with the Cascade net device within 4 centers in Europe. Analysis of angiographic (modified Raymond-Roy classification [MRRC]) and clinical outcomes data was conducted immediately following treatment and at the 6-month follow-up.RESULTSFifteen patients were included in the study (mean age 58 ± 13 years, 11/15 [73.3%] female). Ten patients had unruptured aneurysms, and 5 presented with ruptured aneurysms with acute subarachnoid hemorrhage. The mean aneurysm dome length was 6.27 ± 2.33 mm and the mean neck width was 3.64 ± 1.19 mm. Immediately postprocedure, MRRC type I (complete obliteration) was achieved in 11 patients (73.3%), whereas a type II (residual neck) was achieved in 4 patients (26.7%). Follow-up examination was performed in 7/15 patients and showed stabilization of aneurysm closure with no thromboembolic complications and only 1 patient with an increased MRRC score (from I to II) due to coil compression.CONCLUSIONSInitial experience shows that the use of a new noncompletely occlusive net-assisted remodeling technique with the Cascade net device may be safe and effective for endovascular coil embolization of intracranial aneurysms.

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Endovascular Coil Embolization of 435 Small Asymptomatic Unruptured Intracranial Aneurysms: Procedural Morbidity and Patient Outcome

American Journal of Neuroradiology ◽

10.3174/ajnr.a1290 ◽

2008 ◽

Vol 30 (1) ◽

pp. 79-84 ◽

Cited By ~ 57

Author(s):

S.-H. Im ◽

M.H. Han ◽

O.-K. Kwon ◽

B.J. Kwon ◽

S.H. Kim ◽

...

Keyword(s):

Patient Outcome ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Unruptured Intracranial Aneurysms ◽

Endovascular Coil Embolization

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Evaluation of the characteristics of various types of finishing coils for the embolization of intracranial aneurysms in an experimental model with radiolucent coils

Interventional Neuroradiology ◽

10.1177/1591019916685713 ◽

2017 ◽

Vol 23 (2) ◽

pp. 143-150 ◽

Cited By ~ 2

Author(s):

Keisuke Ota ◽

Noriaki Matsubara ◽

Shigeru Miyachi ◽

Takashi Izumi ◽

Masashi Ito ◽

...

Keyword(s):

Experimental Model ◽

Final Stage ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Multiple Comparisons ◽

X Ray ◽

Nylon Thread ◽

Significant Difference ◽

Area And Perimeter ◽

Endovascular Coil Embolization

In endovascular coil embolization of intracranial aneurysms, very soft coils, often called “finishing coils,” are usually selected in the final stage of coil embolization. The authors developed a radiolucent coil made of thin nylon thread to evaluate the performance of coils under a situation simulating the course of embolization. The characteristics of various types of finishing coils were investigated using radiolucent coils. Experimental embolization was performed with a silicone aneurysm filled with radiolucent coils simulating the final stage of embolization. Three indices, i.e. area, perimeter, and circularity of the inserted coils, were investigated on the X-ray images after coil insertion. The coils used were as follows: Target Ultra Helical, MicroPlex Hypersoft, Axium Helix, ED Coil Extrasoft, and DeltaPlush. In the analysis of area and perimeter, there were significant differences in multiple comparisons. There was no significant difference in circularity, although it was generally ranked in order by coil brand. Target Ultra and MicroPlex Hypersoft had higher scores for area and perimeter and lower scores for circularity, in contrast to DeltaPlush, which had lower scores for area and perimeter and a higher score for circularity. Based on these results, the finishing coils were divided into three groups: Target Ultra Helical and MicroPlex Hypersoft; Axium Helix and ED Coil Extrasoft; DeltaPlush. They are better for use in early, midst, and end of finishing, respectively. The characteristics of various finishing coils were evaluated, and the results obtained reflected actual clinical experience and provide useful information to appropriately select finishing coils.

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Endovascular coil embolization of unruptured intracranial aneurysms: a Korean multicenter study

Acta Neurochirurgica ◽

10.1007/s00701-014-2033-9 ◽

2014 ◽

Vol 156 (5) ◽

pp. 847-854 ◽

Cited By ~ 18

Author(s):

Soon Chan Kwon ◽

◽

O-Ki Kwon

Keyword(s):

Multicenter Study ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Unruptured Intracranial Aneurysms ◽

Endovascular Coil Embolization

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Single-Stage Coil Embolization of Multiple Intracranial Aneurysms: Technical Feasibility and Clinical Outcomes

Clinical Neuroradiology ◽

10.1007/s00062-014-0367-6 ◽

2014 ◽

Vol 26 (3) ◽

pp. 285-290 ◽

Cited By ~ 7

Author(s):

Y.D. Cho ◽

J.H. Ahn ◽

S.C. Jung ◽

C.H. Kim ◽

W.S. Cho ◽

...

Keyword(s):

Clinical Outcomes ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Single Stage ◽

Technical Feasibility ◽

Multiple Intracranial Aneurysms

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Endovascular coil embolization of intracranial aneurysms: important factors related to rates and outcomes of incomplete occlusion

Journal of Neurosurgery ◽

10.3171/jns.2005.102.4.0607 ◽

2005 ◽

Vol 102 (4) ◽

pp. 607-615 ◽

Cited By ~ 44

Author(s):

Max K. Kole ◽

David M. Pelz ◽

Paul Kalapos ◽

Donald H. Lee ◽

Irene B. Gulka ◽

...

Keyword(s):

Clinical Outcome ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Repeated Treatment ◽

Negative Events ◽

Content Type ◽

Cox Regression Analysis ◽

Endovascular Coil Embolization ◽

Angiographic Result ◽

Fine Print

Object. The authors report on important factors that influenced clinical and angiographically demonstrated outcomes in patients treated using coil embolization. Methods. This study included 160 consecutive patients who underwent endovascular coil embolization for treatment of intracranial aneurysms. Univariate and multivariate logistic regression analyses were performed to assess factors that influenced the immediate posttreatment angiographic result. Cox regression analysis was used to establish factors related to the occurrence of negative events as well as a curve indicating the time to a negative event. Negative events were defined as aneurysm remnant increase, repeated treatment, rebleeding, or death during periprocedural hospitalization. Seventy-three percent of the patients treated in this study were independent or demonstrated no deficit (Glasgow Outcome Scale [GOS] Score 4 or 5) at a mean follow up of 18.2 months. The annual delayed rebleeding rate was 0.45%. Fifty percent of patients (65 of 131) suffered a negative event within 13 ± 14 months (standard deviation). Statistically significant factors associated with the occurrence of negative events were rupture status (p = 0.0128) and immediate posttreatment angiographic result (p < 0.001). Overall clinical outcome assessed using the GOS was significantly related to the immediate posttreatment angiographic result (χ2 = 4.788, p = 0.029). The immediate posttreatment angiographic results were significantly influenced by catheter stability (p = 0.0012), aneurysm geometry (that is, simple or complex, p = 0.0053), and aneurysm neck diameter (p = 0.0205). Conclusions. A good or excellent clinical outcome can be obtained in most patients treated using endovascular coil embolization of intracranial aneurysms. Note, however, that a significant number of patients treated using traditional platinum coils will harbor unstable aneurysm remnants or require repeated treatment.

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Endovascular Coil Embolization of Very Small Intracranial Aneurysms

Korean Journal of Radiology ◽

10.3348/kjr.2010.11.5.536 ◽

2010 ◽

Vol 11 (5) ◽

pp. 536 ◽

Cited By ~ 19

Author(s):

Kil Sung Chae ◽

Pyoung Jeon ◽

Keon Ha Kim ◽

Sung Tae Kim ◽

Hyung Jin Kim ◽

...

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Endovascular Coil Embolization

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Highly Porous Shape Memory Nanocomposites for Applications in Biomedical Devices

Volume 3: Biomedical and Biotechnology Engineering ◽

10.1115/imece2019-10514 ◽

2019 ◽

Author(s):

Jishan Luo ◽

Robert Kunkel ◽

Jingyu Wang ◽

Bradley N. Bohnstedt ◽

Mrinal Saha ◽

...

Keyword(s):

Shape Memory ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Endovascular Embolization ◽

Biomedical Devices ◽

Risk Of Rupture ◽

Endovascular Coil Embolization ◽

Brain Artery ◽

Porous Nanocomposites ◽

Highly Porous

Abstract This paper presents the novel development of highly porous carbon nanotube (CNT)/shape memory polymer (SMP) nanocomposites for potential endovascular treatment of intracranial aneurysms (ICAs). Intracranial aneurysm is a cerebrovascular disorder that can significantly weaken the wall of a brain artery, resulting in a localized dilation of the blood vessel with risk of rupture and subarachnoid bleeding. Current therapeutic options include surgical clipping and endovascular coil embolization. Clipping of intracranial aneurysms is invasive, and, therefore, it has gradually been replaced by non-invasive endovascular embolization. Recent studies have shown that aneurysmal recanalization and incomplete occlusion are still emerging clinical challenges in endovascular coil embolization. Therefore, there is an urgent need to develop new medical devices and surgical procedure to treat intracranial aneurysms with improved long-term outcomes. CNT/SMP nanocomposites are fabricated by directly coating CNTs on sugar particles before fabricating the sugar template for porous nanocomposites. Pristine SMP prepolymer is infiltrated into the pores of sugar template. All the sugar is dissolved in water after the fully curing of PDMS, resulting in SMP based nanocomposites with well dispersed CNTs. The porous nanocomposites are characterized to identify key parameters, such as electrical resistivity and shape memory capability. A resistive-heating mechanism is developed to trigger shape recovery of the nanocomposites. The results of this work will lay a solid foundation for our subsequent development of new personalized biomedical devices to treat ICAs using a catheter-based endovascular embolization procedure.

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