scholarly journals Flow Diverter Device for Treatment of Cerebral Aneurysm with Short-Term Follow Up: Two Case Reports

2021 ◽  
Vol 36 (2) ◽  
pp. 193-199
Author(s):  
Jung Hyun Park
Keyword(s):  
Cerebral Aneurysm ◽  
Case Reports ◽  
Cerebral Aneurysms ◽  
Treatment Method ◽  
Flow Diverter ◽  
Dissecting Aneurysm ◽  
Short Term ◽  
Unruptured Cerebral Aneurysm ◽  
Flow Diverter Device

The flow diverter device (FDD) is an important treatment method for cerebral aneurysms, especially for intracranial dissecting aneurysms. This paper is the result of FDD treatment for two cases of vertebral dissecting aneurysm (VADA) patients and short-term follow-up at 3 months. All two cases were targeted for unruptured cerebral aneurysm, and 4-vessel angiography was performed as a follow-up examination for 3 months after receiving the procedure. As result, it was possible to shorten the period of use of antiplatelet drugs. In the case of VADA, there are limitations in general coiling procedures or conventional surgical treatment methods. In that sense, the FDD treatment method can be a very effective alternative treatment of VADA

Flow Re-direction Endoluminal Device in treatment of cerebral aneurysms: initial experience with short-term follow-up results

2014 ◽  
Vol 120 (5) ◽  
pp. 1158-1171 ◽  
Author(s):  
Naci Kocer ◽  
Civan Islak ◽  
Osman Kizilkilic ◽  
Burak Kocak ◽  
Muzaffer Saglam ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Short Term ◽  
Radiological Data ◽  
Procedural Complication ◽  
Long Term Follow Up ◽  
Permanent Morbidity ◽  
Additional Device

Object Flow diverter (FD) stents are relatively new and important devices in the treatment of cerebral aneurysms. The Flow Re-Direction Endoluminal Device has been recently released for clinical use. The authors' aim in this paper is to report their initial single-center FRED experience with short-term results. Methods Between February 2012 and May 2013, 33 patients with 37 aneurysms (35 unruptured and 2 previously ruptured aneurysms) were treated with the FRED. Clinical and radiological data of the patients were retrospectively reviewed. Results In all patients only 1 device was used without any additional device or material, such as a stent or coil. All procedures were successfully performed. The procedural complication rate was 3% (1 of 33). Thirty patients underwent clinical and radiological follow-up. During the follow-up period, changes in stent morphology, such as “fish mouth” and “foreshortening” phenomena, occurred in 5 patients. The mortality and permanent morbidity rates were 0%. The complete occlusion rates were 32% (6 of 19) at 0–1 month, 67% (8 of 12) at 2–3 months, 80% (4 of 5) at 4–6 months, and 100% (8 of 8) at 7–12 months. The rates for some aneurysms were assessed at more than one time point. Conclusions The FRED has an ability to serve neurointerventionalists in the treatment of cerebral aneurysms with its different technical advantages. The occlusion rates with FRED are similar to those with other FD devices. However, these short-term results need to be confirmed with mid- and long-term follow-up results of multicenter large series.

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

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.

Stent-assisted coil embolization followed by a stent-within-a-stent technique for ruptured dissecting aneurysms of the intracranial vertebrobasilar artery

2009 ◽  
Vol 111 (1) ◽  
pp. 48-52 ◽  
Author(s):  
Sang Hyun Suh ◽  
Byung Moon Kim ◽  
Sung Il Park ◽  
Dong Ik Kim ◽  
Yong Sam Shin ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Therapeutic Option ◽  
Direct Consequence ◽  
Treatment Method ◽  
Dissecting Aneurysm ◽  
High Rate ◽  
Parent Artery ◽  
Vertebrobasilar Artery ◽  
Complete Obliteration

Object A ruptured dissecting aneurysm of the vertebrobasilar artery (VBA-DA) is a well-known cause of acute subarachnoid hemorrhage (SAH) with a high rate of early rebleeding. Internal trapping of the parent artery, including the dissected segment, is one of the most reliable techniques to prevent rebleeding. However, for a ruptured VBA-DA not suitable for internal trapping, the optimal treatment method has not been well established. The authors describe their experience in treating ruptured VBA-DAs not amenable to internal trapping of the parent artery with stent-assisted coil embolization (SAC) followed by a stent-within-a-stent (SWS) technique. Methods Eleven patients—6 men and 5 women with a mean age of 48 years and each with a ruptured VBA-DA not amenable to internal trapping of the parent artery—underwent an SAC-SWS between November 2005 and October 2007. The feasibility and clinical and angiographic outcomes of this combined procedure were retrospectively evaluated. Results The SAC-SWS was successful without any treatment-related complications in all 11 patients. Immediate posttreatment angiograms revealed complete obliteration of the DA sac in 3 patients, near-complete obliteration in 7, and partial obliteration in 1. One patient died as a direct consequence of the initial SAH. All 10 surviving patients had excellent clinical outcomes (Glasgow Outcome Scale Score 5) without posttreatment rebleeding during a follow-up period of 8–24 months (mean follow-up 15 months). Angiographic follow-up at 6–12 months after treatment was possible at least once in all surviving patients. Nine VBA-DAs showed complete obliteration; the other aneurysm, which had appeared partially obliterated immediately after treatment, demonstrated progressive obliteration on 2 consecutive follow-up angiography studies. There was no in-stent stenosis or occlusion of the branch or perforating vessels. Conclusions The SAC-SWS technique seems to be a feasible and effective reconstructive treatment option for a ruptured VBA-DA. The technique may be considered as an alternative therapeutic option in selected patients with ruptured VBA-DAs unsuitable for internal trapping of the parent artery.

Galeazzi-equivalent Fractures: Report of Two Cases and Literature Review

2017 ◽  
Vol 22 (02) ◽  
pp. 232-235
Author(s):  
Seigo Suganuma ◽  
Kaoru Tada ◽  
Daiki Yamamoto ◽  
Hiroyuki Tsuchiya
Keyword(s):  
Emergency Surgery ◽  
Case Reports ◽  
Growth Arrest ◽  
Short Term ◽  
Rare Injury ◽  
First Case ◽  
Long Term Follow Up ◽  
Epiphyseal Injury

The Galeazzi-equivalent fracture is a rare injury that occurs in children. The most important issue is the distal ulnar epiphyseal injury. Although there have been some case reports, most of them performed only short term follow-up. This article describes two cases of this fracture with long term follow-up until epiphyseal closure. First case is a 12-year-old girl who sustained a Galeazziequivalent fracture of her right forearm and underwent emergency surgery. At follow-up of 5 years and 10 months postsurgery, radiographs show ulnar growth arrest of one mm and she has mild pain. Second case is a 15-year-old boy who sustained an open Galeazzi-equivalent fracture of his left forearm and underwent emergency surgery. At follow-up of 3 years and 3 months postsurgery, radiographs show no growth arrest of the distal ulna. He has no residual complaint. Long term follow-up is absolutely necessary to monitor ulnar growth.

Transient in-stent stenosis: a common finding after flow diverter implantation

2018 ◽  
Vol 11 (2) ◽  
pp. 196-199 ◽  
Author(s):  
Ruben Mühl-Benninghaus ◽  
Alena Haußmann ◽  
Andreas Simgen ◽  
Toshiki Tomori ◽  
Wolfgang Reith ◽  
...  
Keyword(s):  
Flow Diverter ◽  
Common Finding ◽  
Short Term ◽  
Long Term Follow Up ◽  
Incomplete Occlusion ◽  
Flow Diverters ◽  
Stent Stenosis ◽  
Related Mortality

Background and purposeIn recent years, implantation of flow diverters has emerged as an option for the endovascular treatment of intracranial aneurysms. One complication of treatment with flow diverters is the occurrence of in-stent stenosis, which has been reported to be partially reversible. The purpose of our study was to assess the incidence and dynamics of in-stent stenosis on angiographic short term and long term follow-up after treatment with flow diverters.MethodsA retrospective review of our prospectively maintained database identified all patients with intracranial internal carotid artery (ICA) aneurysms treated by flow diverters at our institution between 2014 and 2017. Clinical charts, procedural data, and angiographic results were reviewed.Results18 patients were included. The mean short term follow-up was 92±19 days and mean long term follow-up was 449±120 days after treatment. No neurologic complications were observed. There was no procedure related mortality. Long term angiographic results showed complete occlusion in 83.3%, neck remnants in 11.1%, and incomplete occlusion in 5.5% of cases. In-stent stenosis was observed in all cases. Mean stenosis improved significantly from 30% on short term follow-up to 12% on long-term follow-up (P<0.0001).ConclusionIn-stent stenosis is a common finding on short term follow-up after the treatment with flow diverters but improves over time.

scholarly journals Lyophilizing thrombin powder-based treatment for hemostasis during coil embolization of ruptured cerebral aneurysm: Two case reports

2019 ◽  
Vol 25 (4) ◽  
pp. 454-459
Author(s):  
Changchun Jiang ◽  
Wei Wang ◽  
Baojun Wang ◽  
Yuechun Li ◽  
Guorong Liu ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Coil Embolization ◽  
Case Reports ◽  
Balloon Catheter ◽  
Treatment Strategies ◽  
Cerebral Aneurysms ◽  
Interventional Therapy ◽  
Parent Artery ◽  
Clinical Practices ◽  
Detachable Coils

Background Rupture of cerebral aneurysm is an inevitable complication during embolization, followed by subsequent acute subarachnoid hemorrhage or intracranial hematoma, and results in the aggravation of a patient’s condition. In particular, for patients who have had a ruptured aneurysm, urgent treatment strategies are required during operation. The most common hemostatic methods seen in clinical practices are as follows: after lowering the blood pressure, we continue to embolize the aneurysms with detachable coils as soon as possible or inject with Glubran/Onyx embolization liquids, as well as use a balloon catheter to temporarily block the blood supply. If the conditions are permissible, a balloon guiding catheter may even be used to restrict the proximal blood flow. At times, due to limitations of these methods, neurosurgeons are requested to perform craniotomy to treat the hemostasis. However, the delayed transition often leads to rapid deterioration of the patient’s condition and even death due to cerebral hernia. Case description We herein presented two cases of ruptured cerebral aneurysms to provide an alternative method for hemostasis and to save the lives of patients as much as possible. In an extremely urgent situation (conventional treatment is ineffective), we successfully saved the patient’s life by injecting lyophilizing thrombin powder (LTP) solution into the aneurysmal sac and the parent artery through a microcatheter. Conclusions To our knowledge, this is the first report of successful hemostasis during coil embolization of ruptured cerebral aneurysm with LTP. Further prospective studies are needed to confirm the safety and efficacy of LTP in cerebrovascular interventional therapy.

scholarly journals Angiographical Change of Guglielmi Detachable Coils

2004 ◽  
Vol 10 (1_suppl) ◽  
pp. 161-166 ◽  
Author(s):  
Y. Nakai ◽  
M. Sonobe ◽  
T. Takigawa ◽  
T. Yamazaki ◽  
S. Okamoto ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Medical Condition ◽  
Cerebral Aneurysms ◽  
Acute Stage ◽  
Guglielmi Detachable Coils ◽  
Unruptured Aneurysms ◽  
Detachable Coils

Acute angiographical changes for preventing acute rebleeding on GDC treated cerebral aneurysms were evaluated. From December 2000 to November 2002, 48 total aneurysms in 44 consecutive patients with acute SAH. Acute angiographical evaluations were carried out in 46 aneurysms, including 42 ruptured and 4 unruptured aneurysms. Two cases were excluded because of poor medical condition. In this series, there were no rebleeding cases in acute stage. In the initial embolization for the 46 aneurysms, CO was achieved in eight aneurysms, NR in 15 aneurysms and BF in 23 aneurysms. Acute angiographical observations showed progressive thrombosis in 17 aneurysms (37%). No changes were observed in remaining 29. No recanalization was observed in this series. Only one case of BF, inside the aneurysm bleb was still observed during follow up. Additional embolization was carried out. Progressive thrombosis was frequently observed in GDC treated cerebral aneurysms during acute stage. This angiographical finding seems to show prevention of rebleeding, which is considered important for the management of GDC treatment in acutely ruptured cerebral aneurysm.

scholarly journals Unruptured cerebral aneurysm clipping: association of combined open and endovascular expertise with outcomes

2015 ◽  
Vol 8 (9) ◽  
pp. 977-981 ◽  
Author(s):  
Kimon Bekelis ◽  
Dan Gottlieb ◽  
George Bovis ◽  
Yin Su ◽  
Stavropoula Tjoumakaris ◽  
...  
Keyword(s):  
Propensity Score ◽  
Cerebral Aneurysm ◽  
Readmission Rate ◽  
Cerebral Aneurysms ◽  
Postoperative Mortality ◽  
Fee For Service ◽  
Aneurysm Clipping ◽  
Unruptured Cerebral Aneurysm ◽  
Procedural Volume ◽  
Unruptured Cerebral Aneurysms

BackgroundIt is often questioned if one physician can conduct both open and endovascular techniques successfully and safely.ObjectiveTo investigate the association of combined open and endovascular expertise with the outcomes of unruptured cerebral aneurysm clipping.MethodsWe performed a cohort study of 100% of Medicare fee-for-service claims data for elderly patients who underwent surgical clipping for unruptured cerebral aneurysms between 2007 and 2012. To control for confounding we used propensity score conditioning, and controlled for clustering at the physician level.ResultsDuring the study, 3247 patients underwent clipping for unruptured cerebral aneurysms, and met the inclusion criteria. Of these, 766 (23.6%) underwent treatment by hybrid neurosurgeons, and 2481 (76.4%) by proceduralists, who performed only clipping. Multivariable regression analysis with propensity score adjustment demonstrated a lack of association of combined practice with 1-year postoperative mortality (OR=0.81; 95% CI 0.51 to 1.28), discharge to rehabilitation (OR=0.95; 95% CI 0.72 to 1.25), length of stay (adjusted difference 0.85 days; 95% CI −0.31 to 2.00), or 30-day readmission rate (OR=1.05; 95% CI 0.80 to 1.39). Higher procedural volume was independently associated with improved outcomes.ConclusionsIn a cohort of Medicare patients with unruptured aneurysms, we did not demonstrate a difference in mortality, discharge to rehabilitation, or readmission rate between hybrid neurosurgeons and surgeons performing only clipping.

Size is the Most Important Predictor of Aneurysm Rupture Among Multiple Cerebral Aneurysms: Post Hoc Subgroup Analysis of Unruptured Cerebral Aneurysm Study Japan

Neurosurgery ◽  
2017 ◽  
Vol 82 (6) ◽  
pp. 864-869 ◽  
Author(s):  
Masaaki Shojima ◽  
Akio Morita ◽  
Hirofumi Nakatomi ◽  
Shinjiro Tominari
Keyword(s):  
Cerebral Aneurysm ◽  
Cerebral Aneurysms ◽  
Aneurysm Rupture ◽  
Ruptured Aneurysm ◽  
Clinical Value ◽  
Total Cohort ◽  
Unruptured Cerebral Aneurysm ◽  
Specific Factors ◽  
Unruptured Cerebral Aneurysms ◽  
Post Hoc

Abstract BACKGROUND Multiple cerebral aneurysms are encountered in approximately 15% to 35% of patients harboring unruptured cerebral aneurysms. It would be of clinical value to determine which of them is most likely to rupture. OBJECTIVE To characterize features of the ruptured aneurysm relative to other concomitant fellow aneurysms in patients with multiple cerebral aneurysms. METHODS From a total of 5720 patients who were prospectively registered in the Unruptured Cerebral Aneurysm Study in Japan, a subgroup of patients with multiple cerebral aneurysms who developed subarachnoid hemorrhage was extracted for this post hoc analysis. Intrapatient comparisons of each aneurysm were carried out using aneurysm-specific factors such as size, location, and shape to identify predictors of rupture among the fellow aneurysms in a patient with multiple cerebral aneurysms. RESULTS Twenty-five patients with 62 aneurysms were identified from the total cohort of 5720 patients. With the distinctiveness in size, which means the aneurysm was the single largest among the multiple aneurysms, the ruptured aneurysm in each case was discriminated from the other coexisting aneurysms with a sensitivity of 0.76 and specificity of 0.86. CONCLUSION Our results suggest that the largest aneurysm is likely to rupture among coexisting aneurysms in a patient with multiple cerebral aneurysms.

Long-term catheter angiography after aneurysm coil therapy: results of 209 patients and predictors of delayed recurrence and retreatment

2014 ◽  
Vol 121 (5) ◽  
pp. 1102-1106 ◽  
Author(s):  
Nohra Chalouhi ◽  
Cory D. Bovenzi ◽  
Vismay Thakkar ◽  
Jeremy Dressler ◽  
Pascal Jabbour ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Cerebral Aneurysms ◽  
Short Term ◽  
Unruptured Intracranial Aneurysms ◽  
Long Term Follow Up ◽  
Major Shortcoming ◽  
Male Sex ◽  
A Minor

Object Aneurysm recurrence after coil therapy remains a major shortcoming in the endovascular management of cerebral aneurysms. The need for long-term imaging follow-up was recently investigated. This study assessed the diagnostic yield of long-term digital subtraction angiography (DSA) follow-up and determined predictors of delayed aneurysm recurrence and retreatment. Methods Inclusion criteria were as follows: 1) available short-term and long-term (> 36 months) follow-up DSA images, and 2) no or only minor aneurysm recurrence (not requiring further intervention, i.e., < 20%) documented on short-term follow-up DSA images. Results Of 209 patients included in the study, 88 (42%) presented with subarachnoid hemorrhage. On shortterm follow-up DSA images, 158 (75%) aneurysms showed no recurrence, and 51 (25%) showed minor recurrence (< 20%, not retreated). On long-term follow-up DSA images, 124 (59%) aneurysms showed no recurrence, and 85 (41%) aneurysms showed recurrence, of which 55 (26%) required retreatment. In multivariate analysis, the predictors of recurrence on long-term follow-up DSA images were as follows: 1) larger aneurysm size (p = 0.001), 2) male sex (p = 0.006), 3) conventional coil therapy (p = 0.05), 4) aneurysm location (p = 0.01), and 5) a minor recurrence on short-term follow-up DSA images (p = 0.007). Ruptured aneurysm status was not a predictive factor. The sensitivity of short-term follow-up DSA studies was only 40.0% for detecting delayed aneurysm recurrence and 45.5% for detecting delayed recurrence requiring further treatment. Conclusions The results of this study highlight the importance of long-term angiographic follow-up after coil therapy for ruptured and unruptured intracranial aneurysms. Predictors of delayed recurrence and retreatment include large aneurysms, recurrence on short-term follow-up DSA images (even minor), male sex, and conventional coil therapy.

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