scholarly journals Stents and Stent Mimickers in Endovascular Management of Wide-neck Intracranial Aneurysms

Cureus ◽  
2018 ◽  
Author(s):  
Yasir J Khattak ◽  
Ayman A Sibaie ◽  
Muhammad Anwar ◽  
Raza Sayani
Keyword(s):  
Intracranial Aneurysms ◽  
Endovascular Management ◽  
Wide Neck

scholarly journals Balloon remodeling technique in endovascular treatment of intracranial aneurysms

2018 ◽  
Vol 23 (3) ◽  
pp. 205-210
Author(s):  
Lucas Alves Aurich ◽  
André Giacomelli Leal ◽  
Ricardo Ramina ◽  
Murilo Sousa De Meneses
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Endovascular Management ◽  
Retrospective Evaluation ◽  
Total Occlusion ◽  
Neck Size ◽  
Ruptured Aneurysms ◽  
The Mean ◽  
Complex Forms ◽  
Wide Neck

Objectives: Endovascular treatment of intracranial aneurysms demonstrates low rates of morbidity and mortality. However, aneurysms with complex forms and wide neck remain a therapeutic challenge. The aim of this study is to evaluate the endovascular management of a series of intracranial aneurysms using the balloon remodeling technique. Method: A retrospective evaluation was performed on patients with intracranial aneurysms having undergone endovascular treatment with balloon remodeling technique at the Instituto de Neurologia de Curitiba (from October, 2006 to June, 2011). Results: Thirty-four patients were evaluated. The mean age was 55.12 years and 78.79% were female. Thirteen patients had ruptured aneurysms (38.24%) and 8 had vasospasm (23,53%). The majority of the aneurysms (61.76%) had domemeasurements between 5 to 15mm and 41.18% had a neck size of greater than or equal to 4mm. Total occlusion was obtained in 29 aneurysms (85,29%) and partial occlusion in 2 (5.88%). One patient died from a procedure-related hemorrhage. Conclusion: Endovascular treatment with balloon remodeling techniques seems to be a safe and effective treatment for intracranial aneurysms, especially those with complex formsand wide neck. 

Improved Endovascular Coiling of Wide-Neck Intracranial Aneurysms in Elderly Patients by Double-Microcatheter Technique

2014 ◽  
Vol 71 (3) ◽  
pp. 1281-1286 ◽  
Author(s):  
Xiang Xu ◽  
Yu Zheng ◽  
Dayong Wang ◽  
Jianzhong Cui ◽  
Xiaoming Shang
Keyword(s):  
Elderly Patients ◽  
Intracranial Aneurysms ◽  
Endovascular Coiling ◽  
Wide Neck

Medina embolization device for the treatment of intracranial aneurysms: 18 months’ angiographic results

2018 ◽  
Vol 11 (5) ◽  
pp. 516-522 ◽  
Author(s):  
Idriss Haffaf ◽  
Frédéric Clarençon ◽  
Eimad Shotar ◽  
Claudia Rolla-Bigliani ◽  
Saskia Vande Perre ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Thromboembolic Complication ◽  
Detachable Coil ◽  
Mean Delay ◽  
Scale Scores ◽  
Long Term Follow Up ◽  
Occlusion Rate ◽  
Wide Neck

Background and purposeThe Medina embolization device (MED) is a new flow disruption device combining the design of a detachable coil with an intrasaccular flow disrupter. Safety and short-term angiographic effectiveness of this device have recently been reported. However, long-term angiographic results are lacking. We report herein the 18 months’ angiographic outcome in patients treated for a wide-neck intracranial aneurysm with the MED.Materials and methodsNineteen patients (17 female, mean age 50 years) with 20 wide-neck intracranial aneurysms (six ruptured; 14 unruptured) were treated by the MED between January 2015 and June 2016. Procedure-related complications were systematically recorded; discharge and 6–9 months' follow-up modified Rankin Scale scores were assessed. Angiographic mid-term and long-term follow-up were performed with a mean delay of 6.4±1.5 months (n=16 aneurysms) and 17.7±4.2 months (n=15 aneurysms), respectively. Occlusion rates were evaluated after the procedure and at the mid-term and long-term follow-up using the Roy-Raymond scale.ResultsEmbolization with the MED was feasible in all except two cases (2/20, 10%). One per-procedural perforation was recorded (1/20, 5%) and one MED deployment failed because of the aneurysm’s shape (1/20, 5%). Three cases of thromboembolic complications were observed (3/20, 15%). Only one thromboembolic complication was responsible for clinical sequelae. Grade A occlusion rate was 61% (11/18) after the procedure, 75% at 6 months' follow-up (12/16), and 80% (12/15) at long-term follow-up. Two cases (2/18, 11%) of recanalization at mid-term were documented angiographically. No recanalization occurred between the mid-term and long-term follow-up.ConclusionMED is a hybrid embolization device, combining properties of a conventional coil with those of an intrasaccular flow disrupter. Our series focusing on long-term angiographic follow-up shows a satisfactory long-term occlusion rate. Larger series with longer angiographic follow-up times are warranted to confirm these preliminary results.

Endovascular Management of Intracranial Aneurysms

2018 ◽  
pp. 357-363
Author(s):  
Rohan Chitale ◽  
David Kung ◽  
Stavropoula Tjoumakaris ◽  
Pascal Jabbour ◽  
Robert H. Rosenwasser
Keyword(s):  
Intracranial Aneurysms ◽  
Endovascular Management

scholarly journals Stent-assisted coiling of unruptured intracranial aneurysms with wide neck

2020 ◽  
Vol 15 (4) ◽  
pp. 821
Author(s):  
ConstantineNikolaos Antonopoulos ◽  
Filippos Papadopoulos ◽  
George Geroulakos
Keyword(s):  
Intracranial Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Wide Neck

scholarly journals Dual microcatheter technique for the treatment of a ruptured wide neck basilar tip aneurysm

2019 ◽  
pp. 116-121
Author(s):  
Rares Filep ◽  
Dorin Nicolae Gherasim ◽  
Septimiu Popescu ◽  
Botond Tokes ◽  
Lucian Marginean
Keyword(s):  
Intracranial Aneurysms ◽  
Therapeutic Option ◽  
Intraventricular Haemorrhage ◽  
Acute Onset ◽  
Alternative Methods ◽  
Neurological Deficits ◽  
Complication Rates ◽  
Unruptured Intracranial Aneurysms ◽  
Basilar Tip Aneurysm ◽  
Wide Neck

Endovascular treatment is a safe and efficient therapy for intracranial aneurysms with lower complication and mortality rates compared to surgical clipping. Wide-neck aneurysms still represent a challenge to complete and safe aneurysm occlusion in spite of techniques such as stent-assisted or balloon-assisted coiling, developed in order to achieve better occlusion rates. These techniques themselves may lead to further complications, so alternative methods such as the dual microcatheter technique were developed. This technique assumes that, via two microcatheters inserted into an aneurysm, simultaneous deployment of two coils achieves a stable coil frame without the use of adjunctive devices. The aim of this paper is to present a successfully treated basilar tip wide-neck aneurysm treated with the dual microcatheter technique.Case report. A 46-year-old male patient with acute onset of severe headache presented in the emergency room with altered state of consciousness. Non-enhanced CT scan showed subarachnoid and intraventricular haemorrhage. CT angiography revealed a wide-neck basilar tip aneurysm. Digital subtraction angiography confirmed the presence of an aneurysm with a wide, 4.9 mm neck.Dual microcatheter technique was chosen as the first treatment option, while a hypercompliant balloon was kept as backup. Two microcatheters were placed inside de aneurysm and two coils were introduced in order to form a stable framing coil mass that served as a support for further coils deployed in an alternately manner through each microcatheter. No procedural complication occurred, and the patient’s evolution was uneventful with no neurological deficits at discharge.Conclusion. The dual microcatheter technique is a safe and effective therapeutic option for wide-neck ruptured or unruptured intracranial aneurysms. Periprocedural complication rates are similar to simple coiling or balloon-assisted coiling, but lower than for stent-assisted coiling.

scholarly journals Reflections on the TEAM Trial: Why Clinical Care and Research Should be Reconciled

2011 ◽  
Vol 38 (2) ◽  
pp. 198-202 ◽  
Author(s):  
Jean Raymond
Keyword(s):  
Clinical Research ◽  
Intracranial Aneurysms ◽  
Potential Benefit ◽  
Clinical Care ◽  
Major Change ◽  
Management Team ◽  
Endovascular Management ◽  
Public Agencies ◽  
Research And Practice ◽  
Unruptured Intracranial Aneurysms

The current clinical and research environment is one that renders any true enquiry into the value of commonly performed surgical acts practically impossible. Drawing from the recent failure of Trial on Endovascular Aneurysm Management (TEAM), a trial on the endovascular management of unruptured intracranial aneurysms, I attempt to identify some principles that sustain the current ways of doing clinical research that have paradoxically become major obstacles to trials that aim to assess the potential benefit or harm due to interventions as currently practiced. Clinical research and practice must coalesce into “clinical care trials” if we are to provide patients with optimal, prudent care in the context of uncertainty. This may require a major change in the mentalities of clinicians, scientists, and patients alike, and the adoption of novel strategies for public agencies to support the integration of clinical research and care.

The 100 most cited articles in the endovascular management of intracranial aneurysms

2018 ◽  
Vol 10 (9) ◽  
pp. 859-868 ◽  
Author(s):  
Julian Maingard ◽  
Kevin Phan ◽  
Yifan Ren ◽  
Hong Kuan Kok ◽  
Vincent Thijs ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Intracranial Aneurysms ◽  
Citation Count ◽  
Relevant Information ◽  
Endovascular Coiling ◽  
Endovascular Management ◽  
Comprehensive Overview ◽  
Endovascular Interventions ◽  
Rank List ◽  
The Usa

IntroductionEndovascular interventions for intracranial aneurysms have evolved substantially over the past several decades. A citation rank list is used to measure the scientific and/or clinical impact of an article. Our objective was to identify and analyze the characteristics of the 100 most cited articles in the field of endovascular therapy for intracranial aneurysms.MethodsWe performed a retrospective bibliometric analysis between July and August 2017. Articles were searched on the Science Citation Index Expanded database using Web of Science in order to identify the most cited articles in the endovascular therapy of intracranial aneurysms since 1945. Using selected key terms (‘intracranial aneurysm’, ‘aneurysm’, ‘aneurysmal subarachnoid’, ‘endovascular’, ‘coiling’, ‘stent-assisted’, ‘balloon-assisted’, ‘flow-diversion’) yielded a total of 16 314 articles. The top 100 articles were identified and analyzed to extract relevant information, including citation count, authorship, article type, subject matter, institution, country of origin, and year of publication.ResultsCitations for the top 100 articles ranged from 133 to 1832. All articles were cited an average of 27 times per year. There were 45 prospective studies, including 7 level–II randomized controlled trials. Most articles were published in the 2000s (n=53), and the majority constituted level III or level IV evidence. Half of the top 100 articles arose from the USA.ConclusionThis study provides a comprehensive overview of the most cited articles in the endovascular management of intracranial aneurysms. It recognizes the contributions made by key authors and institutions, providing an important framework to an enhanced understanding of the evidence behind the endovascular treatment of aneurysms.

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