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Shibuya K, Hasegawa H, Suzuki T, Fujiwara H, Shibuma S, Shida K, Oishi M. Usefulness of Y-shaped PulseRider-assisted coil embolization for basilar artery tip aneurysm with a misaligned axis: A case report. Surg Neurol Int 2023; 14:300. [PMID: 37680930 PMCID: PMC10481857 DOI: 10.25259/sni_449_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023] Open
Abstract
Background Endovascular treatment of wide-necked bifurcation aneurysms remains challenging. Although the advent of PulseRider and Web has expanded treatment options, aneurysms with a large deviation from the parent artery axis remains difficult to treat. We present the case of a wide-necked bifurcation aneurysm that was misaligned with the angle between the long axis of the parent artery and the aneurysm and was successfully treated with Y-shaped PulseRider-assisted coil embolization. Case Description A 64-year-old woman presented with an unruptured basilar tip aneurysm. Cerebral angiography showed a wide-necked aneurysm measuring 8.1 mm × 6.1 mm, neck 5.7 mm. The aneurysm was strongly tilted to the right and posterior relative to the basilar artery, and the bilateral posterior cerebral artery (PCA) and superior cerebellar artery (SCA) diverged from the aneurysm body. PulseRider-assisted coil embolization was performed. A Y-shaped PulseRider was selected to be placed in a hybrid fashion with the right arch in the aneurysm and the left arch in the branch. Adequate coil embolization with preservation of the bilateral PCA and SCA was possible, and cerebral angiography immediately after the treatment showed slight dome filling. Cerebral angiography 6 months after the procedure showed that the embolic status had improved to complete occlusion. Conclusion For wide-neck bifurcation aneurysms with a misaligned axis, a Y-shaped PulseRider used in a hybrid fashion, in which the leaflet on the side with the tilted axis is placed in the aneurysm, allows the PulseRider to be deployed more closely to the aneurysm, thereby enabling good coil embolization.
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Affiliation(s)
- Kohei Shibuya
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
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Li S, Zeng C, Tao W, Huang Z, Yan L, Tian X, Chen F. The Safety and Efficacy of Flow Diversion versus Conventional Endovascular Treatment for Intracranial Aneurysms: A Meta-analysis of Real-world Cohort Studies from the Past 10 Years. AJNR Am J Neuroradiol 2022; 43:1004-1011. [PMID: 35710123 DOI: 10.3174/ajnr.a7539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/16/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although the flow diverter has advantages in the treatment of intracranial aneurysms, pooled studies that directly compare it with conventional endovascular treatments are rare. PURPOSE Our aim was to compare the safety and efficacy of flow-diverter and conventional endovascular treatments in intracranial aneurysms. DATA SOURCES We performed a comprehensive search of the literature using PubMed, EMBASE, and the Cochrane Database. STUDY SELECTION We included only studies that directly compared the angiographic and clinical outcomes of flow-diverter and conventional endovascular treatments. DATA ANALYSIS Random effects or fixed effects meta-analysis was used to pool the cumulative rate of short- and long-term angiographic and clinical outcomes. DATA SYNTHESIS Eighteen studies with 1001 patients with flow diverters and 1133 patients with conventional endovascular treatments were included; 1015 and 1201 aneurysm procedures were performed, respectively. The flow-diverter group had aneurysms of a larger size (standard mean difference, 0.22; 95% CI, 0.03-0.41; P = .026). There was a higher risk of complications in the flow-diverter group compared with the conventional endovascular group (OR, 1.4; 95% CI, 1.01-1.96; P = .045) during procedures. The follow-up angiographic results of flow-diverter treatment indicated a higher rate of complete occlusion (OR, 2.55; 95% CI, 1.70-3.83; P < .001) and lower rates of recurrence (OR, 0.24; 95% CI, 0.12-0.46; P < .001) and retreatment (OR, 0.31; 95% CI, 0.21-0.47; P < .001). LIMITATIONS Limitations include a retrospective, observational design in some studies, high heterogeneity, and selection bias. CONCLUSIONS Compared with the conventional endovascular treatments, the placement of a flow diverter may lead to more procedure-related complications, but there is no difference in safety, and it is more effective in the long term.
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Affiliation(s)
- S Li
- From the Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - C Zeng
- From the Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - W Tao
- From the Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Z Huang
- From the Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - L Yan
- From the Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - X Tian
- From the Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - F Chen
- From the Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
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Sakata H, Ezura M, Kimura N, Ishida T, Inoue T, Uenohara H, Tominaga T. Preservation of Branching Vessel Using Super Compliant Double-Lumen Balloon Microcatheter: Bulging Neck Plasty Technique and Other Options. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 15:310-315. [PMID: 37501908 PMCID: PMC10370972 DOI: 10.5797/jnet.oa.2020-0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/29/2020] [Indexed: 07/29/2023]
Abstract
Objective There are several methods to treat wide-neck aneurysms. We survey the cases that were treated using a super-compliant double-lumen balloon microcatheter (Super-Masamune) for preservation of the branching vessel originating proximal to the aneurysm, especially in the bulging neck plasty (BNP) technique. Methods We assessed 10 cases in which branching vessel preservation was performed using Super-Masamune. The cases were categorized into three groups: (1) ordinary neck plasty (ONP): balloon microcatheter was navigated to the branch that should be preserved; (2) BNP: another branch was preserved by inflating balloon bulging without cannulation; (3) protection during parent artery occlusion (PPO): the balloon microcatheter was navigated to the vessel to be occluded. The balloon preserves a branch originating near the aneurysm without cannulating to the branch. Results The aneurysm locations were as follows: internal carotid artery (ICA), three cases; anterior communicating artery (AcomA), one case; basilar artery (BA), three cases; and vertebral artery (VA), three cases. Four cases were ruptured aneurysms, while six cases were unruptured or ruptured in chronic stage. The ONP, BNP, and PPO groups contained two, five, and three cases, respectively. Embolization resulted in complete obliteration in six cases, neck remnant in two cases and body filling in two cases. No rupture/rerupture was noted in this series. One case showed an intraoperative rupture. Conclusion Super-Masamune is useful for neck plasty, especially BNP, in wide-neck aneurysms. Super-Masamune is also useful for parent artery occlusion when an important branch originates proximal to the aneurysm.
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Affiliation(s)
- Hiroyuki Sakata
- Department of Neurosurgery, NHO Sendai Medical Center, Sendai, Miyagi, Japan
| | - Masayuki Ezura
- Department of Neurosurgery, NHO Sendai Medical Center, Sendai, Miyagi, Japan
| | - Naoto Kimura
- Department of Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
| | - Tomohisa Ishida
- Department of Neurosurgery, NHO Sendai Medical Center, Sendai, Miyagi, Japan
| | - Takashi Inoue
- Department of Neurosurgery, NHO Sendai Medical Center, Sendai, Miyagi, Japan
| | - Hiroshi Uenohara
- Department of Neurosurgery, NHO Sendai Medical Center, Sendai, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Spiotta AM, Sattur MG, Kan P, Crowley RW. Bifurcation Aneurysm Treatment with PulseRider: Technical Nuances, Device Selection, Positioning Strategies, and Overcoming Geometric Challenges. World Neurosurg 2020; 142:339-351. [PMID: 32360671 DOI: 10.1016/j.wneu.2020.04.126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Endovascular therapy is a viable alternative to surgical clipping for the treatment of intracranial aneurysms; however, aneurysms arising at bifurcations remain a challenge. The purpose of this technical report is to share the nuances of treating aneurysms with the PulseRider (PR), including device selection and positioning strategy, from authors who are highly experienced in its use. METHODS We offer a comprehensive guide for neuroendovascular surgeons less experienced with PR applications to include design, general coil embolization technique, principles of deployment and detachment, positioning options, and geometric challenges and their solutions. RESULTS In our experience, the PR is well suited for addressing the challenges of treating bifurcation aneurysms. CONCLUSIONS PR use is intuitive and straightforward for use in bifurcation aneurysms with ideal favorable. PR can also be safely and effectively used to address a much broader and more challenging range of geometries.
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Affiliation(s)
- Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Mithun G Sattur
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
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5
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Sakai N, Imamura H, Arimura K, Funatsu T, Beppu M, Suzuki K, Adachi H, Okuda T, Matsui Y, Kawabata S, Akiyama R, Horiuchi K, Tani S, Adachi H, Sakai C, Kaneko N, Tateshima S. PulseRider-Assisted Coil Embolization for Treatment of Intracranial Bifurcation Aneurysms: A Single-Center Case Series with 24-Month Follow-up. World Neurosurg 2019; 128:e461-e467. [PMID: 31042599 DOI: 10.1016/j.wneu.2019.04.177] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although endovascular coiling of unruptured aneurysms is widely accepted, the endovascular treatment of wide-neck bifurcation aneurysms remains one of the most challenging morphologies. Our purpose was to describe our experience with 24-month follow-up for the treatment of unruptured intracranial bifurcation aneurysms using the PulseRider (Cerenovus, New Brunswick, NJ). METHODS This study is a single-center, single-arm registry performed under institutional review board control to evaluate efficacy and safety of the PulseRider. Patients with bifurcation aneurysms were identified and enrolled prospectively. Angiography immediately after treatment and at 6 months, and magnetic resonance imaging and magnetic resonance angiography at 12- and 24-month follow-up were retrospectively analyzed. A modified Rankin score was obtained prior to procedure, at discharge, and at 6-, 12- and 24-month follow-up visits. RESULTS Eight patients with a mean age of 66 years were treated with the PulseRider. All patients had bifurcation aneurysms (2 anterior communicating, 2 carotid terminus, and 4 basilar apex). The aneurysm diameters ranged from 4.6 to 13.6 mm (mean 7.4 mm) with dome/neck ratio ranging from 1.4 to 2.2 (mean 1.6). In all cases, the PulseRider was successfully deployed. Complete occlusion was demonstrated at 6-month follow-up on 6 of 8 (75%), near complete occlusion in 1 of 8 (12.5%), and residual aneurysm in 1 of 8 (12.5%) patients. There was no change or recurrence on magnetic resonance angiography, nor clinical complication after the procedure through 24-month follow-up. CONCLUSIONS Our experience with 24-month follow-up demonstrated favorable efficacy in the treatment of intracranial wide-neck bifurcation aneurysms using the PulseRider.
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Affiliation(s)
- Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Koichi Arimura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takayuki Funatsu
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Mikiya Beppu
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Keita Suzuki
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiromasa Adachi
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tomohiro Okuda
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yuichi Matsui
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shuhei Kawabata
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ryo Akiyama
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazufumi Horiuchi
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shoichi Tani
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hidemitsu Adachi
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Chiaki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Naoki Kaneko
- Division of Interventional Neuroradiology, Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Satoshi Tateshima
- Division of Interventional Neuroradiology, Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
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Wallace AN, Samaniego E, Kayan Y, Derdeyn CP, Delgado Almandoz JE, Dandapat S, Fease JL, Thomas M, Milner AM, Scholz JM, Ortega-Gutiérrez S. Balloon-assisted coiling of cerebral aneurysms with the dual-lumen Scepter XC balloon catheter: Experience at two high-volume centers. Interv Neuroradiol 2019; 25:414-418. [PMID: 30922198 DOI: 10.1177/1591019919828677] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The Scepter XC is a dual-lumen balloon catheter that accommodates a 0.014-inch microwire and can be used for balloon-assisted coiling of cerebral aneurysms. We describe our experience with the use of this device. METHODS Two high-volume institution neurointerventional databases were retrospectively reviewed for cerebral aneurysms treated with balloon-assisted coiling using the Scepter XC balloon catheter. Patient demographics, aneurysm characteristics, and procedural details were recorded. Major procedure-related neurologic complications were defined as events that caused an increase in modified Rankin Scale that persisted for more than 1 week after the procedure. Follow-up aneurysm occlusion was assessed using the Raymond-Roy classification. RESULTS During the study period, 231 aneurysms were treated in 219 patients (152 women, 67 men) with a mean age of 58.4 ± 12.2 years. Mean aneurysm size was 6.1 ± 3.1 mm, with a mean neck diameter of 3.1 ± 1.3 mm. In total, 77.5% of aneurysms were wide necked, and 39.8% were treated in the setting of subarachnoid hemorrhage. The major complication rate was 0.9% (2/231) per treated aneurysm, including one stroke and one death related to intraoperative aneurysm rupture. Excluding patients who died, angiographic follow up was available for 85.3% (191/224) of aneurysms. During a mean follow up of 17.4 ± 13.0 months (range, 1.7-66.5 months), Raymond-Roy 1 and 2 occlusion rates were 56.5% (108/191) and 35.6% (68/191), respectively. The retreatment rate was 12.6% (24/191). CONCLUSION Our experience using the coaxial dual-lumen Scepter XC for balloon-assisted coiling demonstrates acceptable aneurysm occlusion and complication rates.
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Affiliation(s)
- Adam N Wallace
- 1 Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, and Department of Radiology, University of Iowa, Iowa City, United States of America.,2 University of Iowa, Department of Radiology, Iowa City, United States of America
| | - Edgar Samaniego
- 3 University of Iowa, Department of Neurology, Iowa City, United States of America
| | - Yasha Kayan
- 1 Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, and Department of Radiology, University of Iowa, Iowa City, United States of America
| | - Colin P Derdeyn
- 2 University of Iowa, Department of Radiology, Iowa City, United States of America
| | - Josser E Delgado Almandoz
- 1 Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, and Department of Radiology, University of Iowa, Iowa City, United States of America
| | - Sudeepta Dandapat
- 3 University of Iowa, Department of Neurology, Iowa City, United States of America
| | - Jennifer L Fease
- 1 Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, and Department of Radiology, University of Iowa, Iowa City, United States of America
| | - Mary Thomas
- 1 Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, and Department of Radiology, University of Iowa, Iowa City, United States of America
| | - Anna M Milner
- 1 Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, and Department of Radiology, University of Iowa, Iowa City, United States of America
| | - Jill M Scholz
- 1 Division of Neurointerventional Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, and Department of Radiology, University of Iowa, Iowa City, United States of America
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Naragum V, AbdalKader M, Nguyen TN, Norbash A. Balloon-Assisted Cannulation for Difficult Anterior Cerebral Artery Access. INTERVENTIONAL NEUROLOGY 2018; 7:48-52. [PMID: 29628945 DOI: 10.1159/000481542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The anterior communicating artery is a common location for intracranial aneurysms. Compared to surgical clipping, endovascular coiling has been shown to improve outcomes for patients with ruptured aneurysms and we have seen a paradigm shift favoring this technique for treating aneurysms. Access to the anterior cerebral artery can be challenging, especially in patients with tortuous anatomy or subarachnoid hemorrhage or in patients presenting with vasospasm. We present a technique for cannulating the anterior cerebral artery using a balloon inflated in the proximal middle cerebral artery as a rebound surface.
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Affiliation(s)
- Varun Naragum
- Department of Neurology and Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Mohamad AbdalKader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Thanh N Nguyen
- Department of Neurology and Radiology, Boston Medical Center, Boston, Massachusetts, USA.,Department of Neurology, Neurosurgery Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Alexander Norbash
- Department of Department of Radiology, University of California, San Diego, California, USA
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8
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Symptomatic delayed coil migration after balloon assisted embolization: An underreported adverse event? Neurocirugia (Astur) 2018; 30:87-93. [PMID: 29625853 DOI: 10.1016/j.neucir.2018.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/27/2018] [Accepted: 02/18/2018] [Indexed: 11/22/2022]
Abstract
Microsurgical clipping is still regarded as the gold-standard treatment for broad-neck intracranial aneurysms. New endovascular techniques like balloon or stent assisted coiling are quickly rising to the challenge and showing promising outcomes. As a result, broad-neck aneurysms are increasingly addressed by these techniques despite they have not been tested against clipping in a randomized controlled trial and long-term complications might be unknown yet. Intraprocedural coil migration has been well documented in the literature, but the same complication in a delayed fashion is scarcely reported. We present a case of delayed coil migration occurring after a balloon-assisted embolization of a wide-necked intracranial aneurysm and we perform a literature review for similar cases. We discuss how, despite seeming an extremely rare complication, with new endovascular techniques increasingly perceived as the safer option in any aneurysm, potential adverse events may become more frequent. Strategies proposed to address this developing scenario are also reviewed.
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Spiotta AM, Chaudry MI, Turner RD, Turk AS, Derdeyn CP, Mocco J, Tateshima S. An Update on the Adjunctive Neurovascular Support of Wide-Neck Aneurysm Embolization and Reconstruction Trial: 1-Year Safety and Angiographic Results. AJNR Am J Neuroradiol 2018; 39:848-851. [PMID: 29599174 DOI: 10.3174/ajnr.a5599] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/10/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE The safety and efficacy of the PulseRider for the treatment of wide-neck, bifurcation aneurysms at the basilar and carotid terminus locations were studied in a prospective trial, the Adjunctive Neurovascular Support of Wide-Neck Aneurysm Embolization and Reconstruction (ANSWER) trial, reporting on initial 6-month angiographic and clinical results. This report provides insight into the longer term durability and safety with 12-month data. MATERIALS AND METHODS Aneurysms treated with the PulseRider among enrolled sites were prospectively studied. Updated 12-month data on clinical and imaging end points are included. RESULTS Thirty-four patients were enrolled (29 women, 5 men) with a mean age of 60.9 years. The mean aneurysm height ranged from 2.4 to 15.9 mm with a mean neck size of 5.2 mm (range, 2.3-11.6 mm). At 1 year, there were no device migrations or symptomatic in-stent stenoses. Raymond-Roy I occlusion was achieved in 53% of cases at the time of treatment and progressed to 61% and 67% at 6 and 12 months, respectively. Adequate occlusion (Raymond-Roy I/II) progressed from 88% at 6 months to 90% at 12 months. No recanalizations were observed. There was 1 delayed ischemic event. Good outcome (mRS 0-2) was achieved in 90% of patients. CONCLUSIONS The updated 1-year results from the ANSWER trial demonstrate aneurysm stability and an acceptable safety profile for aneurysms treated at the basilar apex and carotid terminus. Prospective data from a larger set of aneurysms treated at other locations are required to assess how treatment with PulseRider compares with alternatives for treating wide-neck bifurcation aneurysms.
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Affiliation(s)
- A M Spiotta
- From the Department of Neurosurgery (A.M.S., M.I.C., R.D.T., A.S.T.), Medical University of South Carolina, Charleston, South Carolina
| | - M I Chaudry
- From the Department of Neurosurgery (A.M.S., M.I.C., R.D.T., A.S.T.), Medical University of South Carolina, Charleston, South Carolina
| | - R D Turner
- From the Department of Neurosurgery (A.M.S., M.I.C., R.D.T., A.S.T.), Medical University of South Carolina, Charleston, South Carolina
| | - A S Turk
- From the Department of Neurosurgery (A.M.S., M.I.C., R.D.T., A.S.T.), Medical University of South Carolina, Charleston, South Carolina
| | - C P Derdeyn
- Department of Radiology (C.P.D.), University of Iowa, Iowa City, Iowa
| | - J Mocco
- Department of Neurosurgery (J.M.), Mount Sinai Hospital, New York, New York
| | - S Tateshima
- Department of Radiology (S.T.), University of California, Los Angeles, Los Angeles, California
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Lee SH, Park IS, Lee JM, Lee K, Park H, Lee CH. Stent-Assisted Coil Embolization Using Only a Glycoprotein IIb/IIIa Inhibitor (Tirofiban) for Ruptured Wide-Necked Aneurysm Repair. J Cerebrovasc Endovasc Neurosurg 2018; 20:14-23. [PMID: 30370235 PMCID: PMC6196134 DOI: 10.7461/jcen.2018.20.1.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/06/2018] [Accepted: 03/15/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the safety and efficacy of stent-assisted coil embolization using only a glycoprotein IIb/IIIa inhibitor (tirofiban). MATERIALS AND METHODS We retrospectively reviewed patients with a subarachnoid hemorrhage due to ruptured wide-necked intracranial aneurysms who were treated by stent-assisted coil embolization. In all patients, the glycoprotein IIb/IIIa inhibitor tirofiban was administered just before stent deployment. Electronic medical records for these patients were reviewed for peri-procedural complications and extra-ventricular drainage catheter related hemorrhage, as well as Glasgow outcome scale (GOS) at discharge, 3 months, and 6 months follow-up were recorded. RESULTS Fifty-one aneurysms in 50 patients were treated. The mean patient age was 64.9 years. Eighteen patients (36%) received a World Federation of Neurosurgical Societies grade of 4 or 5. The mean aneurysm size was 9.48 mm and mean dome-to-neck ratio was 1.06. No intraoperative aneurysm ruptures occurred, although five (10%) episodes of asymptomatic stent thrombosis did occur. Three patients experienced a delayed thrombo-embolic event and two a delayed hemorrhagic event. Immediate radiologic assessment indicated a complete occlusion in 29 patients, a residual neck in 19, and a residual sac in 3. Four patients (8%) died. Sixteen patients (32%) experienced a poor GOS (< 4). Two aneurysms were recanalized during the follow-up period (mean, 19 months for clinical and 18 months for angiographic follow-up). CONCLUSION Treatment of ruptured wide-necked intracranial aneurysms via stent-assisted coil embolization with a glycoprotein IIb/IIIa inhibitor alone was found to be relatively safe and efficient.
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Affiliation(s)
- Sang Hyub Lee
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - In Sung Park
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ja Myoung Lee
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kwangho Lee
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hyun Park
- Department of Neurosurgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Chul Hee Lee
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
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11
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Dabus G, Brinjikji W, Amar AP, Delgado Almandoz JE, Diaz OM, Jabbour P, Hanel R, Hui F, Kelly M, Layton KF, Miller JW, Levy EI, Moran CJ, Suh DC, Woo H, Sellar R, Hoh B, Evans A, Kallmes DF. Angiographic and clinical outcomes of balloon remodeling versus unassisted coil embolization in the ruptured aneurysm cohort of the GEL THE NEC study. J Neurointerv Surg 2017; 10:446-450. [PMID: 28821627 DOI: 10.1136/neurintsurg-2017-013326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 07/27/2017] [Accepted: 08/01/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND PURPOSE GEL THE NEC (GTN) was a multicenter prospective registry developed to assess the safety and efficacy of HydroSoft coils in treating intracranial aneurysms. We compared the angiographic and clinical outcomes of aneurysms treated with balloon assisted coil embolization (BACE) versus unassisted coil embolization (CE) in the ruptured aneurysm cohort. MATERIALS AND METHODS GTN was performed at 27 centers in five countries. Patients aged 21-90 years with a ruptured aneurysm 3-15 mm in size were eligible for enrollment. We analyzed demographics/comorbidities, aneurysm location, and geometry, including maximum diameter, neck size, and dome to neck ratio, immediate and long term angiographic outcomes (graded by an independent core laboratory using the modified Raymond Scale), and procedure related adverse events. Angiographic and clinical outcomes were studied using χ2and t tests. RESULTS Of the 599 patients in the GTN, 194 met the inclusion criteria. 84 were treated with BACE and 110 with CE. There were more prior smokers in the BACE group (p=0.01). The BACE group also had more vertebrobasilar aneurysms (p=0.006) and a larger mean neck size (p=0.02). More aneurysms were immediately completely occluded in the BACE group (p=0.02) Procedure- related major morbidity and mortality were no different between the techniques (p=0.4 and p=1, respectively). CONCLUSIONS In this prospective ruptured aneurysm cohort from the GTN, BACE resulted in greater occlusion rates compared with unassisted CE with similar morbi-mortality.
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Affiliation(s)
- Guilherme Dabus
- NeuroInterventional Surgery, Miami Cardiac & Vascular Institute and Baptist Neuroscience Center, Miami, Florida, USA
| | - Waleed Brinjikji
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Arun P Amar
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | | | - Orlando M Diaz
- Division of Interventional Neuroradiology, Methodist Hospital, Houston, Texas, USA.,Department of Neurosurgery, Weill Cornell Medical College, New York City, New York, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ricardo Hanel
- Department of Cerebrovascular and Stroke, Baptist Health System, Jacksonville, Florida, USA
| | - Ferdinand Hui
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Michael Kelly
- Department of Neurosurgery, Univeristy of Saskatchewan, Saskatoon, Canada
| | - Kennith F Layton
- Department of Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | - Jeffrey W Miller
- Department of Neurosurgery, Western Michigan University, Kalamazoo, Michigan, USA
| | - Elad I Levy
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
| | - Christopher J Moran
- Department of Radiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Dae Chul Suh
- Department of Radiology, Asan Medical Center, Seoul, Republic of Korea
| | - Henry Woo
- Departments of Radiology and Neurosurgery, Stony Brook University Medical Center, Stony Brook, New York, USA
| | - Robbin Sellar
- Department of Minimally Invasive Surgery, Edinburgh University, Edinburgh, UK
| | - Brian Hoh
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Avery Evans
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - David F Kallmes
- Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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Spiotta AM, Derdeyn CP, Tateshima S, Mocco J, Crowley RW, Liu KC, Jensen L, Ebersole K, Reeves A, Lopes DK, Hanel RA, Sauvageau E, Duckwiler G, Siddiqui A, Levy E, Puri A, Pride L, Novakovic R, Chaudry MI, Turner RD, Turk AS. Results of the ANSWER Trial Using the PulseRider for the Treatment of Broad-Necked, Bifurcation Aneurysms. Neurosurgery 2017; 81:56-65. [DOI: 10.1093/neuros/nyx085] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 04/05/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: The safety and probable benefit of the PulseRider (Pulsar Vascular, Los Gatos, California) for the treatment of broad-necked, bifurcation aneurysms was studied in the context of the prospective, nonrandomized, single arm clinical trial—the Adjunctive Neurovascular Support of Wide-neck aneurysm Embolization and Reconstruction (ANSWER) Trial.
OBJECTIVE: To present the results of the United States cases employing the PulseRider device as part of the ANSWER clinical trial.
METHODS: Aneurysms treated with the PulseRider device among sites enrolling in the ANSWER trial were prospectively studied and the results are summarized. Aneurysms arising at either the carotid terminus or basilar apex that were relatively broad necked were considered candidates for inclusion into the ANSWER study.
RESULTS: Thirty-four patients were enrolled (29 female and 5 male) with a mean age of 60.9 years (27 basilar apex and 7 carotid terminus). Mean aneurysm height ranged from 2.4 to 15.9 mm with a mean neck size of 5.2 mm (range 2.3-11.6 mm). In all patients, the device was delivered and deployed. Immediate Raymond I or II occlusion was achieved in 82.4% and progressed to 87.9% at 6-month follow-up. A modified Rankin Score of 2 or less was seen in 94% of patients at 6 months.
CONCLUSION: The results from the ANSWER trial demonstrate that the PulseRider device is safe and offers probable benefit as for the treatment of bifurcation aneurysms arising at the basilar apex or carotid terminus. As such, it represents a useful addition to the armamentarium of the neuroendovascular specialist.
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Affiliation(s)
- Alejandro M. Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Colin P. Derdeyn
- Department of Radiolo-gy, Neurology and Neurosurgery, Univer-sity of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Satoshi Tateshima
- Department of Radiology, UCLA Medical Center, Santa Monica, Cali-fornia
| | - Jay Mocco
- Department of Neurosurgery, Mount Sinai Medical Center, Miami Beach, Florida
| | - R. Webster Crowley
- Department of Neuro-surgery, Rush University Medical Center, Chicago, Illinois
| | - Kenneth C. Liu
- Department of Neuro-surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Lee Jensen
- De-partment of Radiology, University of Vir-ginia School of Medicine, Charlottesville, Virginia
| | - Koji Ebersole
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Alan Reeves
- Department of Ra-diology, University of Kansas Medical Center, Kansas City, Kansas
| | - Demetrius K. Lopes
- Department of Neuro-surgery, Rush University Medical Center, Chicago, Illinois
| | - Ricardo A. Hanel
- Depart-ment of Neurosurgery, Baptist Health, Jacksonville, Florida
| | - Eric Sauvageau
- Depart-ment of Neurosurgery, Baptist Health, Jacksonville, Florida
| | - Gary Duckwiler
- Department of Radiology, UCLA Medical Center, Santa Monica, Cali-fornia
| | - Adnan Siddiqui
- Department of Neurosurgery, University at Buffalo, Buf-falo, New York
| | - Elad Levy
- Department of Neurosurgery, University at Buffalo, Buf-falo, New York
| | - Ajit Puri
- Department of Ra-diology, UMass Memorial Medical Cen-ter, Worcester, Massachusetts
| | - Lee Pride
- Depart-ment of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Roberta Novakovic
- Depart-ment of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - M. Imran Chaudry
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Raymond D. Turner
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | - Aquilla S. Turk
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
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Spiotta AM, Fargen KM, Lena J, Chaudry I, Turner RD, Turk AS, Huddle D, Loy D, Bellon R, Frei D. Initial Technical Experience with the SMART Coil for the Embolization of Intracranial Aneurysms. World Neurosurg 2017; 97:80-85. [DOI: 10.1016/j.wneu.2016.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/02/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
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Mukherjee S, Chandran A, Gopinathan A, Putharan M, Goddard T, Eldridge PR, Patankar T, Nahser HC. PulseRider-assisted treatment of wide-necked intracranial bifurcation aneurysms: safety and feasibility study. J Neurosurg 2016; 127:61-68. [PMID: 27689454 DOI: 10.3171/2016.2.jns152334] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The goal of this study was to assess the safety and feasibility of PulseRider, a novel endovascular stent, in the treatment of intracranial bifurcation aneurysms with wide necks. The authors present the initial results of the first 10 cases in which the PulseRider device was used. METHODS Patients whose aneurysms were intended to be treated with the PulseRider device at 2 institutions in the United Kingdom were identified prospectively. Patient demographics, procedural details, immediate neurological and clinical status, and immediate angiographic outcomes and 6-month clinical and imaging follow-up were recorded prospectively. RESULTS At the end of the procedure, all 10 patients showed complete aneurysm occlusion (Raymond Class 1). There were no significant intraprocedural complications except for an occurrence of thromboembolism without clinical sequelae. There was no occurrence of aneurysm rupture or vessel dissection. At 6-month follow-up, 7 and 3 patients had modified Rankin Scale scores of 0 and 1, respectively. All 10 patients had stable aneurysm occlusion (Raymond Class 1) and daughter vessel intraluminal patency on 6-month follow-up catheter angiography. CONCLUSIONS The authors' early experience with the PulseRider device demonstrates that it is a safe and effective adjunct in the treatment of bifurcation aneurysms with wide necks arising at the middle cerebral artery bifurcation, anterior cerebral artery, basilar apex, and carotid terminus. It works by providing a scaffold at the neck of the bifurcation aneurysm, enabling neck remodeling and coil support while maintaining parent vessel intraluminal patency. Early clinical and radiological follow-up showed good functional outcome and stable occlusion rates, respectively. Further data are needed to assess medium- and long-term outcomes with PulseRider.
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Affiliation(s)
| | | | - Anil Gopinathan
- Interventional Neuroradiology, Leeds General Infirmary, Leeds;,Departments of 2 Neuroradiology and
| | | | - Tony Goddard
- Interventional Neuroradiology, Leeds General Infirmary, Leeds
| | - Paul R Eldridge
- Neurosurgery, The Walton Centre, Lower Lane, Fazakerley, Liverpool, United Kingdom
| | - Tufail Patankar
- Interventional Neuroradiology, Leeds General Infirmary, Leeds
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Hirota N, Musacchio M, Cardoso M, Villarejo F, Requelme C, Tournade A. Angiographic and Clinical Results after Endovascular Treatment for Middle Cerebral Artery Berry Aneurysms. Neuroradiol J 2016; 20:89-101. [DOI: 10.1177/197140090702000116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2006] [Accepted: 01/15/2007] [Indexed: 11/16/2022] Open
Abstract
Sixty-five middle cerebral artery (MCA) aneurysms in 59 patients treated by endovascular treatment (EVT) without the remodelling technique were analyzed. For ruptured aneurysms, the patients in bad condition are predominant and those with Fisher group four is 47.8% and with Hunt and Hess grade (HHG) IV or V are 43.5%. The clinical result is that 58.7% is in mRS 0–3, 21.7% in 4–5 and 19.6% in death. Contrary, 92.3% of the patients in HHG I-III resulted in mRS 0–3. Re-rupture was observed in two cases (4.4%). For all the aneurysms, thromboembolic complications were observed in 12.3% and those were predominant in the aneurysms greater than 10mm in diameter (p<0.05). Hemorrhagic ones occurred in 6.2% which were predominant in the aneurysms less than 10mm in diameter. No mortality was observed by the accidents. In follow-up angiography, Raymond classification was employed and Complete Obliteration or Dog Ear was observed in 24 of 43 cases (55.8%). Recanalization occurred in 10.5% of the cases with complete or almost complete obliterated aneurysms. These results suggested that EVT for the ruptured MCA aneurysms with good grade or the unruptured ones is feasible. Strict follow-up is important like the other aneurysms.
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Affiliation(s)
- N. Hirota
- Department of Neuroradiology, Hôpitaux Civils de Colmar; Colmar, France
| | - M. Musacchio
- Department of Neuroradiology, Hôpitaux Civils de Colmar; Colmar, France
| | - M. Cardoso
- Department of Neuroradiology, Hôpitaux Civils de Colmar; Colmar, France
| | - F. Villarejo
- Department of Neuroradiology, Hôpitaux Civils de Colmar; Colmar, France
| | - C. Requelme
- Department of Neuroradiology, Hôpitaux Civils de Colmar; Colmar, France
| | - A. Tournade
- Department of Neuroradiology, Hôpitaux Civils de Colmar; Colmar, France
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You J, Ma Z, Zhang F, Li G. Treatment of a Giant Fusiform Basilar Aneurysm with Partial Intra-Aneurysmal Embolization Combined with Mid-Basilar Artery Occlusion in a Child. Clin Neuroradiol 2016; 26:243-8. [PMID: 27116216 PMCID: PMC4914515 DOI: 10.1007/s00062-015-0451-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/05/2015] [Indexed: 11/27/2022]
Affiliation(s)
- J You
- Department of Neurosurgery, Cerebrovascular Center, the Second Affiliated Hospital, Guangzhou University of Chinese Medicine, 111 Dade Road, 510120, Guangzhou, Guangdong, P.R. China
| | - Z Ma
- Department of Neurosurgery, Cerebrovascular Center, the Second Affiliated Hospital, Guangzhou University of Chinese Medicine, 111 Dade Road, 510120, Guangzhou, Guangdong, P.R. China
| | - F Zhang
- Department of Neurosurgery, Cerebrovascular Center, the Second Affiliated Hospital, Guangzhou University of Chinese Medicine, 111 Dade Road, 510120, Guangzhou, Guangdong, P.R. China
| | - G Li
- Department of Neurosurgery, Cerebrovascular Center, the Second Affiliated Hospital, Guangzhou University of Chinese Medicine, 111 Dade Road, 510120, Guangzhou, Guangdong, P.R. China.
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17
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Quadri SA, Ramakrishnan V, Hariri O, Taqi MA. Early Experience with the TransForm™ Occlusion Balloon Catheter: A Single-Center Study. INTERVENTIONAL NEUROLOGY 2015; 3:174-83. [PMID: 26279664 DOI: 10.1159/000431329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 05/07/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Balloon-assisted coil embolization has become an important adjunct in the endovascular treatment of intracranial aneurysms. The management of broad-necked cerebral aneurysms is technically perplexed due to a variety of factors, which include the difficulty in defining the aneurysm-parent vessel interface angiographically and problems in achieving complete aneurysmal occlusion. This could later predispose to regrowth or recanalization. We sought to determine the safety and efficacy of the TransForm™ occlusion balloon catheter (TOBC) for the coiling of intracranial aneurysms at our institute. METHODS A retrospective review was performed to identify TOBC cases between May 1, 2013, and April 30, 2014. RESULTS A total of 24 TOBC cases were identified. In 23 cases, the TOBC was used for balloon-remodeled coil embolization, and in 1 case, it was used for vasospasm treatment alone. Out of the total 24 cases in which the TOBC was used, 16 (66.6%) were ruptured aneurysms. Stents were used in 6/23 (26%) cases. In all cases, the balloon could be placed as intended. The inflation and deflation times ranged from 3 to 4 s. No serious complications were noted. In the experience of the authors, the balloon performed the intended role in most cases. CONCLUSIONS This series shows that the TOBC is feasible, safe and useful in the treatment of cerebral aneurysms. The balloon was traceable to the intended site and the preparation, inflation and deflation times were short. We believe that the TOBC has effective utility in treating broad-necked and small aneurysms.
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Affiliation(s)
- Syed A Quadri
- Department of Neuroscience, Desert Regional Medical Center, Palm Springs, Calif., USA
| | - Vivek Ramakrishnan
- Department of Neuroscience, Desert Regional Medical Center, Palm Springs, Calif., USA
| | - Omid Hariri
- Department of Neuroscience, Desert Regional Medical Center, Palm Springs, Calif., USA
| | - M Asif Taqi
- Department of Neuroscience, Desert Regional Medical Center, Palm Springs, Calif., USA
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18
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Spiotta AM, Chaudry MI, Turk AS, Turner RD. Initial experience with the PulseRider for the treatment of bifurcation aneurysms: report of first three cases in the USA. J Neurointerv Surg 2015; 8:186-9. [DOI: 10.1136/neurintsurg-2014-011531] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 12/12/2014] [Indexed: 12/21/2022]
Abstract
IntroductionThe PulseRider is a novel device intended for use in the treatment of aneurysms arising at bifurcations. We present the initial results of the first three cases in the USA employing the PulseRider device.MethodsAneurysms intended to be treated with the PulseRider device at a single institution were identified prospectively. Aneurysms arising at either the carotid terminus or basilar apex that were relatively broad-necked were considered candidates for treatment with the novel device.ResultsPatients were pretreated with dual antiplatelet therapy. All cases were performed under general endotracheal anesthesia. An appropriately sized PulseRider device was deployed across the neck of the aneurysm. A microcatheter was then navigated over a 0.014 inch microwire through the device into the aneurysm. Complete occlusion of the aneurysm was achieved in all cases without intraprocedural complications.ConclusionsWe have found in our early experience with the Pulse Rider device that its use is safe and effective as an adjunct in the treatment of bifurcation aneurysms arising at the basilar apex or carotid terminus. As such, it represents a useful addition to the armamentarium of the neuroendovascular specialist.
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19
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Durst CR, Starke RM, Gaughen JR, Geraghty S, Kreitel KD, Medel R, Demartini N, Liu KC, Jensen ME, Evans AJ. Single-center experience with a dual microcatheter technique for the endovascular treatment of wide-necked aneurysms. J Neurosurg 2014; 121:1093-101. [DOI: 10.3171/2014.7.jns132237] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The endovascular treatment of wide-necked aneurysms can be technically challenging due to distal coil migration or impingement of the parent vessel. In this paper, the authors illustrate an alternative method for the treatment of wide-necked intracranial aneurysms using a dual microcatheter technique.
Methods
The authors' first 100 consecutive patients who underwent coil embolization of a wide-necked aneurysm using a dual microcatheter technique are reported. With this technique, 2 microcatheters are used to introduce coils into the aneurysm. The coils are deployed either sequentially or concurrently to form a stable construct and prevent coil herniation or migration. Angiographic and clinical outcomes are reported.
Results
The technical success rate of the dual microcatheter technique is 91% with a morbidity and mortality of 1% and 2%, respectively. Clinical outcomes are excellent with 93% of patients demonstrating a modified Rankin Scale score of 0–2 at long-term follow-up regardless of their score at presentation. Retreatment rates are 18%.
Conclusions
The dual microcatheter technique may be a safe and efficacious first line of treatment for widenecked aneurysms.
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Affiliation(s)
| | - Robert M. Starke
- 2Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | | | | | | | - Ricky Medel
- 5Department of Neurological Surgery, Tulane University, New Orleans, Louisiana; and
| | | | - Kenneth C. Liu
- 1Departments of Radiology and Medical Imaging and
- 2Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Mary E. Jensen
- 1Departments of Radiology and Medical Imaging and
- 2Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Avery J. Evans
- 1Departments of Radiology and Medical Imaging and
- 2Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
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Seo DH, Yoon SM, Park HR, Shim JJ, Bae HG, Yun IG. Thromboembolic event detected by diffusion weighted magnetic resonance imaging after coil embolization of cerebral aneurysms. J Cerebrovasc Endovasc Neurosurg 2014; 16:175-83. [PMID: 25340018 PMCID: PMC4205242 DOI: 10.7461/jcen.2014.16.3.175] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/14/2014] [Accepted: 07/24/2014] [Indexed: 11/23/2022] Open
Abstract
Objective The purpose of this study was to evaluate the occurrence rate of diffusion positive lesions (DPLs), and to assess the peri-procedural risk factors for the occurrence of DPLs in patients who underwent coil embolization of cerebral aneurysms. Materials and Methods A total of 304 saccular aneurysms were embolized during a seven-year period from Jan 2007 to Dec 2013. Of these, postoperative diffusion-weighted images were obtained in 186 procedures. There were 100 ruptured aneurysm and 86 unruptured aneurysms. The coiling procedures were as follows: simple coiling in 96, balloon assisted coiling (BAC) in 39, and stent assisted coiling (SAC) in 51 aneurysms. Clinical, angiographic and procedural factors were analyzed in relation to the occurrence of DPLs. Results Overall, DPLs were observed in 50.5%. In unruptured aneurysms, DPLs occurred in 23.5% of BAC, 41.9% of SAC and 57.7% of simple coiling (p = 0.08). Among ruptured aneurysms, DPLs occurred in 63.6% of BAC, 62.5% of SAC and 54.3% of simple coiling (p = 0.71). DPLs had a tendency to increase in ruptured aneurysms compared with unruptured aneurysms (57% vs. 43%, p = 0.077). Logistic regression analysis revealed that age > 55 years was the only independent risk factor for the occurrence of DPLs. Conclusion DPLs occured more frequently in ruptured aneurysm and at an older age. Although most DPLs are asymptomatic, careful manipulation of cerebral or extracerebral arteries using various endovascular devices is important to reducing the occurrence of DPLs. BAC appeared to reduce occurrence of TE events in patient with unruptured aneurysm.
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Affiliation(s)
- Dong-Ho Seo
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Seok-Mann Yoon
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hye-Ran Park
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jai-Joon Shim
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hack-Gun Bae
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Il-Gyu Yun
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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Takigawa T, Suzuki K, Sugiura Y, Suzuki R, Takano I, Shimizu N, Tanaka Y, Hyodo A. Thromboembolic events associated with single balloon-, double balloon-, and stent-assisted coil embolization of asymptomatic unruptured cerebral aneurysms: evaluation with diffusion-weighted MR imaging. Neuroradiology 2014; 56:1079-86. [PMID: 25185529 DOI: 10.1007/s00234-014-1421-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 08/25/2014] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The introduction of the balloon remodeling and stent-assisted technique has revolutionized the approach to coil embolization for wide-neck aneurysms. The purpose of this study was to determine the frequency of thromboembolic events associated with single balloon-assisted, double balloon-assisted, and stent-assisted coil embolization for asymptomatic unruptured aneurysms. METHODS A retrospective review was undertaken by 119 patients undergoing coiling with an adjunctive technique for unruptured saccular aneurysms (64 single balloon, 12 double balloon, 43 stent assisted). All underwent diffusion-weighted imaging (DWI) within 24 h after the procedure. RESULTS DWI showed hyperintense lesions in 48 (40%) patients, and ten (21%) of these patients incurred neurological deterioration (permanent, two; transient, eight). Hyperintense lesions were detected significantly more often in procedures with the double balloon-assisted technique (7/12, 58%) than with the single balloon-assisted technique (16/64, 25%, p = 0.05). Occurrence of new lesions was significantly higher with the use of stent-assisted technique (25/43, 58%) than with the single balloon-assisted technique (p = 0.001). Symptomatic ischemic rates were similar between the three groups. The increased number of microcatheters was significantly related to the DWI abnormalities (two microcatheters, 15/63 (23.8%); three microcatheters, 20/41 (48.8%) (p = 0.008); four microcatheters, 12/15 (80%) (p = 0.001)). CONCLUSION Thromboembolic events detected on DWI related to coil embolization for unruptured aneurysms are relatively common, especially in association with the double balloon-assisted and stent-assisted techniques. Furthermore, the number of microcatheters is highly correlated with DWI abnormalities. The high rate of thromboembolic events suggests the need for evaluation of platelet reactivity and the addition or change of antiplatelet agents.
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Affiliation(s)
- Tomoji Takigawa
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan,
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Ikeda DS, Marlin ES, Shaw A, Sauvageau E, Powers CJ. Endovascular Management of Anterior Communicating Artery Aneurysms. Neurosurg Clin N Am 2014; 25:437-54. [DOI: 10.1016/j.nec.2014.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Chung J, Lim YC, Suh SH, Shim YS, Kim YB, Joo JY, Kim BS, Shin YS. Stent-assisted coil embolization of ruptured wide-necked aneurysms in the acute period: incidence of and risk factors for periprocedural complications. J Neurosurg 2014; 121:4-11. [PMID: 24834945 DOI: 10.3171/2014.4.jns131662] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED OBJECT.: The purpose of this study was to report the authors' experiences in stent-assisted coil embolization (SAC) of ruptured wide-necked aneurysms in the acute period and to evaluate the incidence of and risk factors for periprocedural complications. METHODS A total of 72 patients were recruited for this study between March 2007 and June 2012. All patients met the following criteria: 1) the presence of ruptured intracranial wide-necked saccular aneurysms, and 2) the patient underwent SAC for treatment of those aneurysms within 72 hours of rupture. All of the patients with clinically poor grades or acute hydrocephalus underwent external ventricular drainage (EVD) before SAC. The incidence of and risk factors for periprocedural complications were retrospectively evaluated. RESULTS Of the 72 patients included in this study, periprocedural complications occurred in 14 (19.4%), including asymptomatic complications in 4 (5.6%) and symptomatic complications in 10 (13.9%); there were symptomatic thromboembolic complications in 5 patients (6.9%), and symptomatic hemorrhagic complications in 5 (6.9%). The authors observed no subacute or delayed thromboembolic complications during the follow-up period of 18.8 months. Use of EVD (OR 1.413, 95% CI 0.088-2.173; p = 0.046) was the only independent risk factor for periprocedural complications on multivariate logistic regression analysis. CONCLUSIONS The periprocedural complication rate during SAC was 19.4% among 72 patients. Because of the high complication rate, microsurgical clipping or endovascular treatment with another technique (multiple-microcatheter or balloon-assisted technique) may be a more appropriate option for first-line treatment than SAC, especially in patients requiring EVD.
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Gruber A, Dorfer C, Knosp E. Recurrent and incompletely treated aneurysms. ACTA NEUROCHIRURGICA. SUPPLEMENT 2014; 119:13-20. [PMID: 24728626 DOI: 10.1007/978-3-319-02411-0_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Endovascular treatment of intracranial aneurysms has become an established technique that can provide stable permanent occlusion in over 85 % of the cases. Even those aneurysms considered untreatable by endovascular means can now often be managed by the use of adjunctive measures, e.g., balloon protection devices, intracranial stents, and semipermeable stents, i.e., "flow diverters." In those cases, in which relevant aneurysm recurrences are documented upon angiographic follow-up, both endovascular and surgical techniques can be employed. In rare cases, combined treatment strategies including parent artery occlusion under bypass protection can be performed. At our center, the majority of relevant aneurysm recurrences after initial coil embolization are managed by a second endovascular procedure. In some cases, e.g., aneurysm recurrences not feasible for endovascular re-treatment, documented aneurysmal growth, bleeding from a previously embolized aneurysm, and acute hemorrhagic or ischemic complications during endovascular procedures, surgical management may be necessary. This report briefly outlines the most frequent treatment scenarios.
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Affiliation(s)
- Andreas Gruber
- Department of Neurosurgery, Medical University Vienna, General Hospital Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria,
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Liang G, Gao X, Li Z, Wei X, Xue H. Neuroform stent-assisted coiling of intracranial aneurysms: a 5 year single-center experience and follow-up. Neurol Res 2013; 32:721-7. [DOI: 10.1179/016164109x12445616596409] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kai Y, Ohmori Y, Watanabe M, Kaku Y, Morioka M, Hirano T, Yano S, Kawano T, Hamada JI, Kuratsu JI. A 6-fr guiding catheter (slim guide(®)) for use with multiple microdevices. An experimental study. Interv Neuroradiol 2013; 19:7-15. [PMID: 23472717 PMCID: PMC3601621 DOI: 10.1177/159101991301900101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 09/23/2012] [Indexed: 11/16/2022] Open
Abstract
A modified technique is required in patients with wide-necked aneurysms whose treatment by the single microcatheter technique is difficult. We developed a 6-Fr guiding catheter (Slim Guide(®)) that features a large lumen (0.072 inch) for performing the modified technique. To evaluate the usefulness of Slim Guide(®) we carried out experiments using three types of 6-Fr guiding catheter. In experiment 1, the shaft hardness and kink resistance were compared among three different guiding catheters (Slim Guide(®), Launcher(®), Envoy(®)). In experiment 2, we inserted a microballoon catheter and a microcatheter into the three different guiding catheters and recorded the maximal infusion pressure. In experiment 3, we inserted 13 different types of microdevices into the three different guiding catheters and evaluated the resistance of the microdevices. Although the shaft of the Slim Guide(®) was softer than that of the other two guiding catheters, its kink resistance was comparable. The maximal infusion pressure was significantly lower than with Launcher(®) or Envoy(®) catheters. Furthermore, with Slim Guide(®), in 136 of 143 microdevice combinations examined (95.1%) there was no resistance; this was true for 125 (87.4%) and 116 (81.1%) combinations using the Launcher(®) - and the Envoy(®) guiding catheters, respectively. There was a significant difference between Slim Guide(®) and the other two guiding catheters with respect to their accommodation of double microsystems (p<0.05). Although the inner diameter of Slim Guide(®) is slightly larger than of the other two guiding catheters, it significantly increased the combination of microdevices that could be used for the coil embolization of difficult aneurysms.
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Affiliation(s)
- Y Kai
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
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27
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Sim SY, Shin YS. Silent microembolism on diffusion-weighted MRI after coil embolization of cerebral aneurysms. Neurointervention 2012; 7:77-84. [PMID: 22970416 PMCID: PMC3429848 DOI: 10.5469/neuroint.2012.7.2.77] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 06/25/2012] [Indexed: 11/29/2022] Open
Abstract
Purpose The purpose of this study was to investigate the frequency and risk factors of procedure-related thromboembolism on diffusion-weighted imaging (DWI) associated with aneurysmal coil embolization. Materials and Methods We prospectively evaluated 39 consecutive patients with a cerebral aneurysm with DWI after coil embolization. All hyperintense lesions on DWI with a drop of apparent diffusion coefficient values were classified into acute thromboembolic infarction (larger than 5 mm in maximal diameters, and located in the vascular territory of the parent artery) and silent microembolism (single or multiple tiny dot-like lesion, less than 5 mm, usually 1-2 mm in size). Possible risk factors for thromboembolic events included vascular risk factors, aneurysmal factors, and procedure-related factors. Results Hyperintense lesions on DWI were seen in 17 (43.6%) patients and symptomatic DWI positive lesions were four (10.3%). Acute thromboembolic infarction was observed in seven (17.9%) patients and silent microembolism in 14 (35.9%) patients. Numbers of silent microembolism ranged from 1 to 15 (mean: 2.86, standard deviation: 3.74). Silent microembolisms were located at ipsilateral (n=3, 21.4%), contralateral (n=5, 35.7%), bilateral (n=4, 28.6%), and not related (n=2, 14.3%) to the procedure site. There were no statistical significant risk factors in acute thromboembolic infarction. However, incidence of silent microembolisms was significantly correlated with left side approach (odds ratio, 4.44, 95% confidence interval, 1.08-18.36; P=0.03). Conclusion Left side approach may have increased the likelihood of asymptomatic multiple scattered microemboli after aneurysmal coiling procedures. Particular care must be taken in the handling of guiding catheters, especially when proving left side great vessels.
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Affiliation(s)
- Sook Young Sim
- Department of Neurosurgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Kai Y, Ohmori Y, Watanabe M, Kaku Y, Morioka M, Hirano T, Yano S, Kawano T, Hamada JI, Kuratsu JI. A 6-Fr guiding catheter (Slim Guide(®)) for use with multiple microdevices. Surg Neurol Int 2012; 3:59. [PMID: 22754724 PMCID: PMC3385052 DOI: 10.4103/2152-7806.97003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 04/12/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We developed a new 6-Fr guiding catheter (Slim Guide(®)) that features a large lumen (0.072 inch) for performing advanced techniques as are required in patients with wide-necked aneurysms whose treatment with a single microcatheter is difficult. METHODS The Slim Guide was used to address 30 saccular and 20 dissecting aneurysms. All 50 patients presented with subarachnoid hemorrhage. To perform the advanced techniques we used SL-10(®) or Excel 14(®) and Hyperform(®) balloon microcatheters. RESULTS Of the 30 patients with saccular aneurysms, 20 were treated with the double microcatheter- and the other 10 with the balloon assist technique. All 20 patients with dissecting aneurysms were treated with the double microcatheter technique. We encountered slight interference during the treatment of one saccular aneurysm with the balloon assist technique using the Slim Guide guiding catheter; another patient with a saccular aneurysm treated with the balloon assist technique suffered a minor transient ischemic complication. CONCLUSIONS With the Slim Guide, the risks inherent in the application of advanced techniques may be decreased. Its use facilitates the coil embolization of aneurysms that pose treatment challenges.
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Affiliation(s)
- Yutaka Kai
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Department of Cerebrovascular Disease and Acute Coronary Syndrome, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuki Ohmori
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masaki Watanabe
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuyuki Kaku
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Motohiro Morioka
- Department of Neurosurgery, Graduate School of Medical Sciences, Kurume University, Kurume, Japan
| | - Teruyuki Hirano
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shigetoshi Yano
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takayuki Kawano
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Jun-ichiro Hamada
- Department of Neurosurgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Jun-ichi Kuratsu
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Dorfer C, Gruber A, Standhardt H, Bavinzski G, Knosp E. Management of Residual and Recurrent Aneurysms After Initial Endovascular Treatment. Neurosurgery 2011; 70:537-53; discussion 553-4. [DOI: 10.1227/neu.0b013e3182350da5] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background:
Coil instability possibly translating into higher delayed rebleeding rates remains a concern in the endovascular management of cerebral aneurysms.
Objective:
To report on 127 patients with endovascular aneurysmal remnants who underwent re-treatment over an 18 year period.
Methods:
Patients presenting with aneurysm residuals >20% of the original lesion, unstable neck remnants, aneurysmal regrowth, or new aneurysmal daughter sacs were treated by an individualized approach, using both endovascular and surgical techniques.
Results:
Seventy-five aneurysmal remnants (59.1%) were treated by further re-embolization. Standard coil embolization was used in 65 cases, stent-protected coiling in 9 cases, and balloon remodeled coiling in 1 case, respectively. Fifty-two (40.9%) aneurysmal remnants were treated surgically. Standard microsurgical clipping was used in 44 patients, parent artery occlusion or trapping under bypass protection in 5 cases, deliberate clipping of the basilar artery trunk in 2 cases, and aneurysm wrapping in one case, respectively. Mechanisms of aneurysm recurrence were coil compaction in 93 cases and regrowth in 34 cases. A single reembolization was sufficient to occlude 78.7% of recurrences from coil compaction, but only 14.3% of recurrences from aneurysm regrowth.
Conclusion:
The individualized approach resulted in complete occlusion of 114 aneurysms (89.7%), with neck remnants and residual aneurysms detectable in 11 (8.7%) and 2 (1.6%) cases, respectively. Treatment morbidity was 11.9%, without significant differences between surgical (15.6%) and endovascular (9.3%) patients (P = .09). Recurrences from coil compaction were safely treated by re-embolization, whereas recurrences from aneurysmal regrowth may best be managed surgically when technically feasible.
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Affiliation(s)
- Christian Dorfer
- Medical University of Vienna, Department of Neurosurgery, Waehringer Guertel, Vienna, Austria
| | - Andreas Gruber
- Medical University of Vienna, Department of Neurosurgery, Waehringer Guertel, Vienna, Austria
| | - Harald Standhardt
- Medical University of Vienna, Department of Neurosurgery, Waehringer Guertel, Vienna, Austria
| | - Gerhard Bavinzski
- Medical University of Vienna, Department of Neurosurgery, Waehringer Guertel, Vienna, Austria
| | - Engelbert Knosp
- Medical University of Vienna, Department of Neurosurgery, Waehringer Guertel, Vienna, Austria
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Yasuda R, Arat A, Strother CM, Aagaard-Kienitz B, Niemann D, Mohamed A, Royalty K, Pulfer K, Taki W, Mawad ME. Aneurysm ostium angle: a predictor of the need for stent as assistance for endovascular aneurysm coiling in internal carotid artery sidewall aneurysms. AJNR Am J Neuroradiol 2011; 32:1216-20. [PMID: 21700791 DOI: 10.3174/ajnr.a2515] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There is no satisfactory parameter that can predict the need for assistant devices for endovascular aneurysm coiling. Our aim was to evaluate the utility of MOA as a predictor of the need for stent-assisted coiling in ICA sidewall aneurysms. MATERIALS AND METHODS From a retrospective review of an internal data base, 55 consecutive ICA sidewall aneurysms were identified. Thirty-two of the aneurysms were treated by using endovascular techniques. Because 23 of the 55 aneurysms were either untreated or clipped, 3 experienced interventionalists reviewed the 3D images of these aneurysms and then made a decision as to whether stent-assisted coiling would have been required. Thirty-one of the 55 aneurysms would have required stent-assisted coiling, while 24 would not. Neck width, DNR, AR, and MOA were obtained from each aneurysm by using prototype software. These parameters were then correlated with the requirement of stent-assisted coiling. RESULTS MOA and neck width of aneurysms requiring stent-assisted coiling were significantly larger than those not requiring stent-assisted coiling (P < .001 and <0.001, respectively). Although the DNR and AR of aneurysms requiring stent-assisted coiling were smaller than those not requiring it, the difference was not significant (P = .22 and 0.12, respectively). ROC analysis revealed that MOA was the parameter that best correlated with the need for stent-assisted coiling. Inclusion of MOA with the rest of the parameters significantly increased the predictive performance regarding the need for stent-assisted coiling (P = .005). CONCLUSIONS In this small study, MOA was a useful parameter to predict the need for stent-assisted coiling in ICA sidewall aneurysms. Further prospective study of this parameter for aneurysms at multiple locations is required to determine its ultimate value.
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Affiliation(s)
- R Yasuda
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Pukenas B, Albuquerque FC, Weigele JB, Hurst RW, Stiefel MF. Use of a new double-lumen balloon catheter for single-catheter balloon-assisted coil embolization of intracranial aneurysms: technical note. Neurosurgery 2011; 69:ons8-12; discussion ons12-3. [PMID: 21441840 DOI: 10.1227/neu.0b013e3182181e3a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The prevalence of intracranial aneurysms is approximately 2% with an annual rupture rate of 0.7%. OBJECTIVE We describe our initial feasibility experience using a new double-lumen balloon catheter for single-catheter balloon-assisted coil embolization of wide-neck intracranial aneurysms. METHODS Two patients with large wide-neck intracranial aneurysms were referred for endovascular therapy. Endovascular treatment in the form of coil embolization alone was not feasible given the angioarchitecture of the aneurysms. Balloon-assisted coil embolization was planned. RESULTS The patients underwent balloon-assisted coil embolization using the Ascent double-lumen balloon catheter (Micrus, San Jose, California). The balloon portion of the catheter was placed into the proximal neck of the aneurysm. The balloon was inflated and coil embolization performed through the inner lumen of the catheter. There were no procedural complications. CONCLUSION Both aneurysms were successfully coiled by using the Ascent balloon occlusion catheter. The single-catheter balloon-assisted coil embolization technique can be performed safely and effectively with the Ascent double-lumen balloon catheter.
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Affiliation(s)
- Bryan Pukenas
- Division of Interventional Neuroradiology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
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Spiotta AM, Gupta R, Fiorella D, Gonugunta V, Lobo B, Rasmussen PA, Moskowitz SI. Mid-term Results of Endovascular Coiling of Wide-Necked Aneurysms Using Double Stents in a Y Configuration. Neurosurgery 2011; 69:421-9. [PMID: 21389887 DOI: 10.1227/neu.0b013e318214abbd] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Double stenting in a Y configuration may be used to treat a subset of wide-necked aneurysms not amenable to reconstruction with a single stent.
OBJECTIVE:
We studied the feasibility, safety, and mid-term angiographic outcome of patients treated using this technique.
METHODS:
A retrospective review was undertaken of all coil embolizations of wide-necked aneurysms using double stents in a Y configuration.
RESULTS:
Nineteen patients were identified from 2002 to 2010 (14 women, 5 men) with a mean age of 57.4 years. Stents were deployed in a Y configuration achieving complete occlusion (5/19), residual neck (5/19), and residual aneurysm filling (9/19). Angiographic follow-up was available for a mean of 16 months, and clinical follow up was available for a mean of 21.4 months. The incidence of complications at the initial treatment was 6 of 19 (31.6%), and delayed thromboembolic complications occurred in 2 of 19 (10.5%). An angiographic neck recurrence requiring retreatment developed in only 1 of the patients in whom complete occlusion was obtained with the initial treatment. Spontaneous thrombosis and complete occlusion on follow-up imaging were found in 6 patients in whom initial neck or aneurysm filling was observed. Ultimately, 12 of the aneurysms (63.2%) were completely occluded on follow-up angiography.
CONCLUSION:
Y-stent reconstruction enables the endovascular management of otherwise complex, wide-necked cerebral aneurysms and can be performed safely in experienced hands with satisfactory mid-term results, even in cases requiring retreatment.
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Affiliation(s)
- Alejandro M. Spiotta
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi Gupta
- Vanderbilt Stroke Center, The Vanderbilt Clinic, Nashville, Tennessee
| | | | - Vivekananda Gonugunta
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bjorn Lobo
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Peter A. Rasmussen
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shaye I. Moskowitz
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
- Vanderbilt Stroke Center, The Vanderbilt Clinic, Nashville, Tennessee
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Pierot L, Cognard C, Spelle L, Moret J. Safety and efficacy of balloon remodeling technique during endovascular treatment of intracranial aneurysms: critical review of the literature. AJNR Am J Neuroradiol 2011; 33:12-5. [PMID: 21349960 DOI: 10.3174/ajnr.a2403] [Citation(s) in RCA: 160] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The balloon remodeling technique was initially designed for the endovascular treatment of anatomically complex aneurysms, specifically wide-neck aneurysms. A nondetachable balloon is inflated in front of the aneurysm neck during coil deposition and removed at the end of the procedure. Some controversies regarding the safety of the technique were introduced by the recent publication of a series showing a much higher rate of complications with the remodeling technique compared with the standard coiling technique. However, recent data from the literature review and from the large ATENA and CLARITY series show that the safety of standard coiling and remodeling is quite similar. Anatomic results are also probably better after remodeling. Finally, due to equivalent safety and better anatomic results, the remodeling technique can be widely used in the management of both ruptured and unruptured aneurysms.
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Affiliation(s)
- L Pierot
- Department of Neuroradiology, CHU Reims, Maison Blanche Hospital, France.
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Spiotta AM, Bhalla T, Hussain MS, Sivapatham T, Batra A, Hui F, Rasmussen PA, Moskowitz SI. An analysis of inflation times during balloon-assisted aneurysm coil embolization and ischemic complications. Stroke 2011; 42:1051-5. [PMID: 21311066 DOI: 10.1161/strokeaha.110.602276] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The introduction of balloon remodeling has revolutionized the approach to coiling of wide-neck aneurysms. We studied the effects of balloon inflation during coil embolization on ischemic complications. METHODS A retrospective review was undertaken of the most recent 147 patients undergoing balloon remodeling for unruptured intracranial aneurysm coil embolization at a single institution (81 balloon, 66 unassisted). All underwent postprocedural MRI. RESULTS Among patients in the "balloon" group, the mean total inflation time was 18 minutes (range, 1-43), a mean number of inflations of 4 (range, 1-9), a mean maximum single inflation time of 7 minutes (range, 1-19), a mean reperfusion time of 2.2 minutes between inflations, and an average procedure time of 2 hours and 10 minutes. Asymptomatic diffusion-weighted imaging abnormalities were detected on postprocedural MRI in 21.5% of patients and symptomatic lesions were identified in 3.8%. Both silent and symptomatic ischemic rates were similar in the internal control group. Patients with ischemic findings were older and more likely have diabetes; no differences were found with respect to total balloon inflation time, number of inflations, maximum inflation time, or reperfusion times. CONCLUSIONS We found no significant relationship between balloon inflation practices and ischemic events. Older and diabetic patients were more likely to have ischemic events develop.
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Affiliation(s)
- Alejandro M Spiotta
- Department of Neurological Surgery, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, S40, Cleveland, OH 44195, USA.
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Pierot L, Cognard C, Anxionnat R, Ricolfi F. Remodeling technique for endovascular treatment of ruptured intracranial aneurysms had a higher rate of adequate postoperative occlusion than did conventional coil embolization with comparable safety. Radiology 2010; 258:546-53. [PMID: 21131582 DOI: 10.1148/radiol.10100894] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare the safety and efficacy of the remodeling technique with that of conventional coil embolization in a large multicenter series involving the endovascular treatment of ruptured intracranial aneurysms, the CLARITY study (Clinical and Anatomic Results in the Treatment of Ruptured Intracranial Aneurysms). MATERIALS AND METHODS The institutional review board approved the CLARITY study, and written informed consent was obtained from all patients. A total of 768 patients (age range, 19-80 years; mean age ± standard deviation, 51.0 years ± 11.1) with 768 ruptured aneurysms were treated with either conventional coil embolization (608 patients, 79.2%) or the remodeling technique (160 patients, 20.8%). Patient and aneurysm characteristics, the rate of adverse events related to the treatment or initial intracranial hemorrhage, and patient outcome were compared between treatment groups by using the χ(2), Fisher exact, or Student t test. RESULTS The overall rate of treatment-related complications, with or without clinical manifestations, was 17.4% (106 of 608 patients) with coil embolization and 16.9% (27 of 160 patients) with remodeling (P = .999). The difference in the rates of thromboembolic events, intraoperative rupture, and early repeat bleeding between the treatment groups was not statistically significant. The cumulative morbidity and mortality rate related to the treatment in the remodeling group (3.8%, six of 160 patients) was similar to that in the coil embolization group (5.1%, 31 of 608 patients) (P = .678). Likewise, the global cumulative morbidity and mortality rates related to both the treatment and the initial hemorrhage did not differ significantly between groups (16.2% [26 of 160 patients] with remodeling and 19.6% [119 of 608 patients] with coil embolization, P = .366). The rate of adequate aneurysm occlusion, however, was significantly higher in the remodeling group (94.9%, 150 of 158 aneurysms) than in the coil embolization group (88.7%, 534 of 602 aneurysms) (P = .017). CONCLUSION In our large series of patients treated for ruptured aneurysms, the remodeling technique-despite being performed in aneurysms with unfavorable characteristics-was as safe as conventional coil embolization and more efficacious in terms of the rate of adequate postoperative occlusion. These results indicate that the remodeling technique can be routinely used in the treatment of ruptured aneurysms.
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Affiliation(s)
- Laurent Pierot
- Department of Neuroradiology, Reims University, Hôpital Maison-Blanche, 45 rue Cognacq-Jay, 51092 Reims, France.
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Maldonado IL, Machi P, Costalat V, Mura T, Bonafé A. Neuroform stent-assisted coiling of unruptured intracranial aneurysms: short- and midterm results from a single-center experience with 68 patients. AJNR Am J Neuroradiol 2010; 32:131-6. [PMID: 20966053 DOI: 10.3174/ajnr.a2245] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE Intracranial stent placement assists in the coiling of wide-neck aneurysms and aids in reconstructing and protecting the parent artery. In this study, we analyze our experience in the use of the Neuroform system. MATERIALS AND METHODS Records of patients treated with a Neuroform stent from June 2003 to September 2007 were retrieved from a data base for analysis of population characteristics, occurrence of complications, and acute and midterm angiographic results. RESULTS Sixty-eight patients harboring 76 aneurysms located primarily in the anterior circulation were treated. There were 5 cases (6.6%) of clot formation after deployment (1 with a permanent neurologic deficit), 1 case of perioperative stent displacement with hemorrhage, and 5 cases (6.6%) of transient neurologic deficit due to thromboembolic events. The morbidity-mortality rate at discharge was 2.9%. One patient presented with a delayed in-stent thrombosis, and 3 others, with silent stenosis. Twenty-four aneurysms (31.6%) were completely occluded in the initial embolization. However, a marked increase in the occlusion rate was observed, with 44 of the 68 aneurysms (64.7%) examined at the 18-month follow-up and 26 of the 46 aneurysms (56.5%) examined in the 3-year follow-up presenting with complete occlusion. At the end of the study, a neck remnant was present in 6 aneurysms (13%) and a residual sac, in 7 (15.2%). Mean follow-up time was 25.7 months. CONCLUSIONS The present series demonstrates the relative safety and feasibility of the Neuroform stent-assisted coiling technique, which seems to provide better results over coiling alone for wide-neck aneurysms. Angiographic results improve with time due to progressive thrombosis of the aneurysm.
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Affiliation(s)
- I L Maldonado
- Department of Neuroradiology, Montpellier University Hospital, Montpellier, France.
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Youn SO, Lee JI, Ko JK, Lee TH, Choi CH. Endovascular Treatment of Wide-Necked Intracranial Aneurysms Using Balloon-Assisted Technique with HyperForm Balloon. J Korean Neurosurg Soc 2010; 48:207-12. [PMID: 21082046 DOI: 10.3340/jkns.2010.48.3.207] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 08/04/2010] [Accepted: 09/17/2010] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the feasibility, safety, and effectiveness of the balloon-assisted technique with HyperForm balloon in the endovascular treatment of wide-necked intracranial aneurysms. METHODS A total of 34 patients with 34 wide-necked intracranial aneurysms were treated with endovascular coil embolization using balloon-assisted technique with Hyperform balloon. Twenty-nine aneurysms (85.3%) were located in the anterior circulation. The group of patients was comprised of 16 men and 18 women, aged 33 to 72 years (mean : 60.6 years). The size of aneurysms was in the range of 2.0 to 22.0 mm (mean 5.5 mm) and one of neck was 2.0 to 11.9 mm (mean 3.8 mm). The dome to neck ratio was ranged from 0.83 to 1.43 (1.15). Sixteen patients were treated for unruptured aneurysms and the remaining 18 presented with a subarachnoid hemorrhage. RESULTS In the 34 aneurysms treated by the remodeling technique with HyperForm balloon, immediate angiographic results consisted of total occlusion in 31 cases (91.2%) and partial occlusion in three cases (8.8%). There were five procedure-related complications (14.7%), including two coil protrusions and three thromboembolisms; Except one patient, all were successfully resolved without permanent neurologic deficit. No new bleeding occurred during the follow-up. Twenty patients (59%) underwent angiographic follow-up from 2 to 33 months (mean 9.2 months) after treatment. Focal recanalization with coil compaction of the neck portion was observed in 5 cases (25%). Only one case showed major recanalization and underwent stent-assisted coil embolization. CONCLUSION The balloon-assisted technique with Hyperform balloon is a feasible, safe, and effective endovascular treatment of wide-necked cerebral aneurysms.
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Affiliation(s)
- Sang O Youn
- Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
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Kwon BJ, Im SH, Park JC, Cho YD, Kang HS, Kim JE, Han MH. Shaping and Navigating Methods of Microcatheters for Endovascular Treatment of Paraclinoid Aneurysms. Neurosurgery 2010; 67:34-40; discussion 40. [PMID: 20559090 DOI: 10.1227/01.neu.0000370891.67129.2f] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
To determine whether the use of a specific shape and a navigating method of microcatheters are suitable for placement at paraclinoid aneurysms.
METHODS
The clinical data from 122 patients with 132 paraclinoid aneurysms that underwent endovascular treatments during a 2.5-year period were retrospectively reviewed. Microcatheter shapes were classified as “straight,” “primary curves” (45, 90, and J), “preshaped-C,” “pigtail” (simple, right, and left), and “S” (simple, right, left, and preshaped). The navigating methods were classified as antegrade/retrograde microcatheter shift, wire-steering, looping, and coil/wire guiding. The shapes and navigating methods were compared among 3 aneurysm groups, which were categorized as superior, medial, and other, based on direction.
RESULTS
Shapes were significantly different between the 3 groups; the most commonly engaged shape in the superior group, medial group, and other group was S (55%), pigtail (60%), and primary (56%), respectively. The straight and S shapes were used in 5 (83%) and 18 (86%) cases, respectively, in the superior group, whereas the pigtail shape was used in 50 (86%) cases in the medial group. Aside from pigtail-simple shape, the side of pigtail, right vs left, coincided with the side of the internal carotid artery involved in every case of the medial group. The navigating methods were not significantly different among the 3 groups.
CONCLUSION
A specific shape by paraclinoid aneurysm direction tends to be suitable for the first trial of microcatheter shapes. Operators may reduce unnecessary struggling time of intra-aneurysmal placement of microcatheters by practicing the use of that shape.
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Affiliation(s)
- Bae Ju Kwon
- Department of Radiology, Seoul National University College of Medicine, and Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
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Connors JJ, Sacks D, Furlan AJ, Selman WR, Russell EJ, Stieg PE, Hadley MN, Wojak JC, Koroshetz WJ, Heros RC, Strother CM, Duckwiler GR, Durham JD, Tom-sick TO, Rosenwasser RH, McDougall CG, Haughton VM, Derdeyn CP, Wechsler LR, Hudgins PA, Alberts MJ, Raabe RD, Gomez CR, Cawley CM, Krol KL, Futrell N, Hauser RA, Frank JI. Training, competency, and credentialing standards for diagnostic cervicocerebral angiography, carotid stenting, and cerebrovascular intervention: a joint statement from the American Academy of Neurology, the American Association of Neurological Surgeons, the American Society of Interventional and Therapeutic Neuroradiology, the American Society of Neuroradiology, the Congress of Neurological Surgeons, the AANS/CNS Cerebrovascular Section, and the Society of Interventional Radiology. J Vasc Interv Radiol 2009; 20:S292-301. [PMID: 19560013 DOI: 10.1016/j.jvir.2009.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Matsubara N, Miyachi S, Nagano Y, Ohshima T, Hososhima O, Izumi T, Tsurumi A, Wakabayashi T, Sakaguchi M, Sano A, Fujimoto H. A novel pressure sensor with an optical system for coil embolization of intracranial aneurysms. Laboratory investigation. J Neurosurg 2009; 111:41-7. [PMID: 19249935 DOI: 10.3171/2009.1.jns081181] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT In endovascular coil embolization for an intracranial aneurysm, the excessive pressure created during coil insertion into an aneurysm can cause a catastrophic rupture or dislodge a microcatheter tip from the aneurysm dome, resulting in insufficient embolization. Such undue mechanical pressure can only be subjectively detected by the subtle tactile feedback the surgeon experiences. Therefore, the authors of this study developed a new sensor device to measure the coil insertion pressure via an optical system. METHODS This novel sensor system consists of a hemostatic valve connected to the proximal end of a microcatheter (Y-connector). The sensor principle is based on an optical system composed of a light-emitting diode (LED) and a line sensor. The latter measures how much the coil-delivery wire slightly bends in response to the insertion pressure by detecting the wire shadow. This information is translated into a given force level. Experimental aneurysm embolization was performed using this optical sensor. A silicone aneurysm model and an in vivo model (porcine aneurysm model) were used in this study. Several surgeons manually performed the coil insertions. The sensor continuously monitored the mechanical force during the insertions. RESULTS The sensor adequately recorded the coil insertion pressure during embolization. The presence of the sensor did not hinder the embolization procedure in any way. During embolization in the silicone aneurysm model, a sinusoid pattern of pressure occurred, reflecting actual clinical experience. Similar results were obtained in the in vivo study. CONCLUSIONS This new sensor device adequately measures coil insertion pressure. This system provides potentially safer and more reliable aneurysm embolizations.
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Affiliation(s)
- Noriaki Matsubara
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Seifert V, Gerlach R, Raabe A, Güresir E, Beck J, Szelényi A, Setzer M, Vatter H, Du Mesnil de Rochemont R, Zanella F, Sitzer M, Berkefeld J. The interdisciplinary treatment of unruptured intracranial aneurysms. DEUTSCHES ARZTEBLATT INTERNATIONAL 2009; 105:449-56. [PMID: 19626180 DOI: 10.3238/arztebl.2008.0449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Accepted: 02/06/2008] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The purpose of this article is to present the results of microsurgical clipping or endovascular coil obliteration of unruptured intracranial aneurysms (UIA), in a single cerebrovascular center with regard to successful obliteration and periprocedural complications. METHODS Data concerning patients with UIA were recorded in the neurovascular database of the neurosurgical department at the University of Frankfurt. The outcome of treatment was assessed with the modified Rankin Scale. RESULTS 126 patients were treated by open surgery and 74 patients by endovascular coil obliteration. After treatment, the rate of new, mostly transient neurological deficits was 5%, and there were no deaths related to any treatment in this series. The outcome was good in 124 (98.4%) of the surgically treated patients and 73 (98.6%) of the endovascularly treated patients, and only 3 patients (1.5%) had a treatment-related unfavorable outcome. 98% of the treated aneurysms were satisfactorily obliterated. Seven endovascularly treated patients required retreatment because of coil compaction leading to recanalization of the aneurysm. CONCLUSIONS The majority of patients with unruptured intracranial aneurysms, even complex ones, can be treated by microsurgery or endovascular aneurysm obliteration with very good clinical results and a very low percentage of unfavorable outcomes. With careful patient selection and individualized assignment of the best form of treatment to each patient, we were able to achieve a low overall complication rate and a very high rate of obliteration in our specialized neurovascular center.
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Affiliation(s)
- Volker Seifert
- Klinik für Neurochirurgie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Schleusenweg 2-16, Frankfurt/Main, Germany
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Suzuki S, Tateshima S, Jahan R, Duckwiler GR, Murayama Y, Gonzalez NR, Viñuela F. Endovascular treatment of middle cerebral artery aneurysms with detachable coils: angiographic and clinical outcomes in 115 consecutive patients. Neurosurgery 2009; 64:876-88; discussion 888-9. [PMID: 19287326 DOI: 10.1227/01.neu.0000343534.05655.37] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Because of their anatomic configuration, middle cerebral artery (MCA) aneurysms are most often treated with surgical clipping. However, endovascular coil embolization of these aneurysms is an increasingly used alternative. We retrospectively reviewed the anatomic and clinical outcomes of patients with MCA aneurysms who underwent endovascular treatment at our institution. METHODS One hundred fifteen MCA aneurysms in 115 patients (mean age, 55.1 years) were treated by an endovascular technique from April 1990 to March 2007. Forty-eight patients (42%) presented with acute subarachnoid hemorrhage, and 67 patients (58%) had unruptured aneurysms. Fifty-three aneurysms (46%) were small with a small neck, 28 (24%) were small with a wide neck, 22 (19%) were large, and 12 (11%) were giant. RESULTS Angiographic results immediately after embolization showed complete occlusion in 53 aneurysms (46%), a neck remnant in 51 (44%), and incomplete occlusion in 3 (3%). Because of anatomic difficulties, we could not embolize 8 aneurysms (7%). Thirteen patients underwent combined treatment that included endovascular and extracranial-intracranial bypass surgery. Morbidity and mortality rates were 6.9% (8 patients) and 3% (3 patients), respectively. Procedure-related complications were encountered in 10 patients (9%). Seventy patients had long-term follow- up angiograms. Seven aneurysms (10%) were recanalized; all were large or giant. One partially embolized large aneurysm ruptured 13 months after embolization. CONCLUSION In this series, endovascular coil embolization of MCA aneurysms has morbidity and mortality rates comparable to those of conventional surgical clipping. Combined treatment of endovascular and bypass surgery can successfully treat large or giant complex fusiform MCA aneurysms.
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Affiliation(s)
- Shuichi Suzuki
- Division of Interventional Neuroradiology, Department of Radiological Sciences, University of California, Los Angeles School of Medicine, Los Angeles, California 90095-1721, USA.
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Jin SC, Ahn JS, Kwun BD, Kwon DH. Analysis of clinical and radiological outcomes in microsurgical and endovascular treatment of basilar apex aneurysms. J Korean Neurosurg Soc 2009; 45:224-30. [PMID: 19444348 DOI: 10.3340/jkns.2009.45.4.224] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Accepted: 04/05/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We aimed to analyze clinical and radiological outcomes retrospectively in patients with basilar apex aneurysms treated by coiling or clipping. METHODS Outcomes of basilar bifurcation aneurysms were assessed retrospectively in 77 consecutive patients (61 women, 16 men), ranging in age from 25 to 79 years (mean, 53.7 years) from 1999 to 2007. RESULTS Forty-nine patients out of 77 patients (63.6%) presented with subarachnoid hemorrhages of the 49 patients treated with coiling, 27 (55.1%) showed complete occlusion of the aneurysm sac. Of these, 13 patients (26.5%) developed coil compaction on angiographic or MRI follow-up, with recoiling required in 9 patients (18.4%). Procedural complications of coiling were acute infarction in nine patients and the bleeding of the aneurysms in six patients. The remaining 28 patients underwent microsurgery: twenty-six of these (92.9%) with microsurgery followed up with conventional angiography. Complete occlusion of the aneurysm sac was achieved in 19 patients (73.1%). Operation-related complications of microsurgery were thalamoperforating artery injuries in three patients, retraction venous injury in two, postoperative epidural hemorrhage (EDH) in one, and transient partial or complete occulomotor palsy in 14 patients. Glasgow Outcome Scores (GOS) were 4 or 5 in 21 of 28 (75%) patients treated with microsurgery at discharge, and at 6 month follow-up, 20 of 28 (70.9%) maintained the same GOS. In comparison, GOS of four or 5 was observed in 36 of 49 (73.5%) patients treated with coiling at discharge and at 6 month follow-up, 33 of 49 patients (67.3%) maintained the GOS from discharge. CONCLUSION Basilar top aneurysms were still challenging lesions based on our series. Endovascular or microsurgery endowed with its inborn risks and procedural complications for the treatment of basilar apex aneurysms individually. Microsurgery provided better outcome in some specific basilar apex aneurysms. For reaching the most favorable outcome, endovascular modality as well as microsurgery was inevitably considered for each specific basilar apex aneurysm.
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Affiliation(s)
- Sung-Chul Jin
- Department of Neurological Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Pierot L, Spelle L, Leclerc X, Cognard C, Bonafé A, Moret J. Endovascular treatment of unruptured intracranial aneurysms: comparison of safety of remodeling technique and standard treatment with coils. Radiology 2009; 251:846-55. [PMID: 19318586 DOI: 10.1148/radiol.2513081056] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To analyze the safety of the remodeling technique compared with the safety of the standard treatment with coils for endovascular treatment of unruptured intracranial aneurysms in a large multicenter series of patients as part of the Analysis of Treatment by Endovascular Approach of Nonruptured Aneurysms (ATENA) study. MATERIALS AND METHODS The medical ethics committee approved the ATENA study, and all patients gave informed consent for participation in the study. The ATENA study was performed in 27 institutions. For each patient group, we recorded aneurysm characteristics, rate of adverse events related to the treatment, and patient outcome. RESULTS In this study, 547 patients (383 women, 164 men; mean age, 51.0 years +/- 11.1 [standard deviation]; range, 22-83 years) with 572 aneurysms were included; 325 patients were treated with coils alone and 222 patients were treated with the remodeling technique. The overall rate of adverse events related to the treatment-regardless of whether the adverse events led to clinical consequences-was 10.8% (35 of 325) for treatment with coils alone and 11.7% (26 of 222) for the remodeling technique. Thromboembolic events, intraoperative rupture, and device-related problems were encountered in 20 (6.2%), seven (2.2%), and eight (2.5%) of 325 patients in the standard treatment group and in 12 (5.4%), seven (3.2%), and seven (3.2%) of 222 patients in the remodeling technique group, respectively. The morbidity and mortality rates did not differ significantly between groups: 2.2% (seven of 325) and 0.9% (three of 325) in the standard treatment group and 2.3% (five of 222) and 1.4% (three of 222) in the remodeling technique group, respectively. CONCLUSION The remodeling technique was associated with a similar rate of adverse events and morbidity and mortality combined compared with the standard treatment with coils, and, thus, the remodeling technique is as safe as the standard treatment with coils.
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Affiliation(s)
- Laurent Pierot
- Department of Neuroradiology, Reims University, Hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
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Bederson JB, Connolly ES, Batjer HH, Dacey RG, Dion JE, Diringer MN, Duldner JE, Harbaugh RE, Patel AB, Rosenwasser RH. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 2009; 40:994-1025. [PMID: 19164800 DOI: 10.1161/strokeaha.108.191395] [Citation(s) in RCA: 911] [Impact Index Per Article: 60.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Greer DM. Management of subarachnoid hemorrhage, unruptured cerebral aneurysms, and arteriovenous malformations. HANDBOOK OF CLINICAL NEUROLOGY 2009; 94:1239-1249. [PMID: 18793898 DOI: 10.1016/s0072-9752(08)94061-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- David M Greer
- Havard Medical School, Massachussetts General Hospital, Boston, MA, USA.
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Kim SR, Vora N, Jovin TG, Gupta R, Thomas A, Kassam A, Lee K, Gologorsky Y, Jankowitz B, Panapitiya N, Aleu A, Sandhu E, Crago E, Hricik A, Gallek M, Horowitz MB. Anatomic results and complications of stent-assisted coil embolization of intracranial aneurysms. Interv Neuroradiol 2008; 14:267-84. [PMID: 20557724 PMCID: PMC3396013 DOI: 10.1177/159101990801400307] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Accepted: 07/23/2008] [Indexed: 11/16/2022] Open
Abstract
SUMMARY The purpose of this study was to evaluate and report our anatomic results and complications associated with stent-assisted coil embolization of intracranial aneurysms using the Neuroform stent. From September 2003 to August 2007, 127 consecutive patients (ruptured 50, 39.4%; unruptured 77, 60.6%) underwent 129 stent-assisted coil embolization procedures to treat 136 aneurysms at our institution. Anatomic results at follow-up, procedure-related complications, and morbidity/mortality were retrospectively reviewed. Stent deployment was successful in 128 out of 129 procedures (99.2%). Forty-seven patients presented with 53 procedure-related complications (37.0%, 47/127). Thromboembolic events (n=17, 13.4%) were the most common complications, followed by intraoperative rupture (n=8, 6.3%), coil herniation (n=5, 3.9%), and postoperative rupture (n=4, 3.1%). For thromboembolic events, acute intra-procedural instent thromboses were observed in two patients and subacute or delayed in-stent thromboses in three patients. Overall mortality rate was 16.5% (21/127) and procedure-related morbidity and mortality rates were 5.5% (7/127) and 8.7% (11/127) retrospectively. Patients with poor grade subarachnoid hemorrhage (Hunt and Hess grade IV or V; 25/127, 19.7%) exhibited 56% (14/25) overall mortality rate and 24% (6/25) procedure-related mortality rate. Immediate angiographic results showed complete occlusion in 31.7% of aneurysms, near-complete occlusion in 45.5%, and partial occlusion in 22.8%. Sixty nine patients in 70 procedures with 77 aneurysms underwent angiographic followup at six months or later. Mean follow-up period was 13.7 months (6 to 45 months). Complete occlusion was observed in 57 aneurysms (74.0%) and significant in-stent stenosis was not found. Thromboembolism and intra/postoperative aneurysm ruptures were the most common complications and the main causes of procedure-related morbidity and mortality. Patients with poor grade subarachnoid hemorrhage showed poor clinical outcomes. Since most complications were induced by stent manipulation and deployment, it is mandatory to utilize these devices selectively and cautiously. While the follow- up angiographic results are promising, further studies are essential to evaluate safety, efficacy, and durability of the Neuroform stent.
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Affiliation(s)
- S R Kim
- Department of Neurosurgery, Holy Family Hospital, The Catholic University of Korea, Department of Neurosurgery,Minimally Invasive Endo-Neurosurgery Center, Presbyterian Hospital,University of Pittsburgh Medical Center, U.S.A -
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49
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Kurre W, Berkefeld J. Materials and techniques for coiling of cerebral aneurysms: how much scientific evidence do we have? Neuroradiology 2008; 50:909-27. [PMID: 18802691 DOI: 10.1007/s00234-008-0446-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 08/07/2008] [Indexed: 11/30/2022]
Affiliation(s)
- W Kurre
- Department of Neuroradiology, University of Frankfurt, Frankfurt, Germany.
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Spelle L, Piotin M, Blanc R, Moret J. Remodeling Technique in the Treatment of Intracranial Aneurysms: Indications, Limits and Non-indications. Interv Neuroradiol 2008; 14 Suppl 1:52-9. [PMID: 20557775 DOI: 10.1177/15910199080140s110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 08/10/2008] [Indexed: 11/17/2022] Open
Affiliation(s)
- L Spelle
- Department of Functional and Interventional Neuroradiology, Fondation Rothschild Hospital, University of Paris; Paris, France -
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