Modified balloon-assisted coiling instead of acute stenting in the treatment of ruptured wide necked intracranial aneurysms

Initial experiences of the Optima™ coil system in intracranial aneurysm treatment: surgical and interventional approach to safety and efficacy in terms of cerebral arteries

PURPOSE

To evaluate the angiographic outcomes of the Optima™ coil system in the endovascular treatment of saccular intracranial aneurysms to present real-world experiences.

METHODS

The study encompassed patients with both ruptured and unruptured aneurysms who underwent treatment with the Optima™ coil system. A retrospective analysis was conducted to examine patient and aneurysm characteristics, complication rates, and angiographic outcomes.

RESULTS

The total of 326 Optima™ coil implantations was performed in 64 aneurysms, with a mean maximum diameter of 7.49 ± 3.08 mm (range: 2.5-16.5 mm), among 64 patients (37 females and 27 males, mean age: 53.34 ± 14 years old). The average number of implanted coils was 5.06 ± 1.73. The mean packing density was 26.2% (range = 19.2-34.6), observed to be significantly higher in aneurysms with complete occlusion and neck remnants compared to those with a residual dome (p < 0.01). The mean follow-up period was 15.9 ± 8.1 months. One case (1.5%) reported a coil malfunction attributed to coil stretching. The mortality rate was 3.1% (n = 2).

CONCLUSION

The Optima™ coil system exhibited safety and efficacy in the endovascular treatment of both ruptured and unruptured intracranial aneurysms, demonstrating favorable angiographic outcomes. Nevertheless, further studies are necessary to validate these results over the long term.

Evaluating the Balloon-Assisted Rapid Intermittent Sequential Coiling Technique for the Treatment of Wide-Neck Cerebral Aneurysms

BACKGROUND

 Balloon-assisted coiling (BAC) is acknowledged as an auxiliary method for the endovascular treatment of difficult wide-necked cerebral aneurysms (WNCAs). An intracranial stent may be necessary as a supportive scaffold when the anatomical conditions are unfavorable, as BAC alone may be inadequate to avoid coil protrusion into the parent artery. We aimed to evaluate the safety of the balloon-assisted rapid intermittent sequential coiling technique (BARISCT) and the effectiveness of BARISCT in reducing the risk of coil prolapse in the primary artery during the coiling of WNCA.

METHODOLOGY

 From March 2021 to April 2023, a quasi-experimental investigation was conducted on more than 19 patients with WNCA who visited the Neurointervention Unit at Suez Canal University Hospital and fulfilled the inclusion criteria of WNCA, specifically defined by an unfavorable dome-to-neck ratio of less than 2 or a neck length exceeding 4 mm.

RESULTS

 BARISCT has proven to be a safe and successful tool for occluding ruptured and unruptured WNCA, with a full occlusion rate of roughly 73% with minimum sequelae and no major complications.

CONCLUSION

 BARISCT seems to be a method that is both safe and successful for the endovascular treatment of wide-neck intracranial aneurysms (WNCA), with no concern regarding the potential for an increase in the likelihood of complications.

Emerging Treatments for Subarachnoid Hemorrhage

The current landscape of therapeutic strategies for subarachnoid hemorrhage (SAH), a significant adverse neurological event commonly resulting from the rupture of intracranial aneurysms, is rapidly evolving. Through an in-depth exploration of the natural history of SAH, historical treatment approaches, and emerging management modalities, the present work aims to provide a broad overview of the shifting paradigms in SAH care. By synthesizing the historical management protocols with contemporary therapeutic advancements, patient-specific treatment plans can be individualized and optimized to deliver outstanding care for the best possible SAH-related outcomes.

Stenting-assisted embolization of a saccular aneurysm of the azygos anterior cerebral artery associated with fenestration at its beginning

Aneurysms of the azygos anterior cerebral artery (AACA) associated with fenestration are exceptional. We reported such a case. A 61-year-old woman presented with subarachnoid hemorrhage. Computed tomography angiography and digital subtraction angiography showed an aneurysm at the distal end of the AACA with a fenestration at its beginning. Stenting-assisted coiling of the aneurysm was performed. The postoperative recovery was uneventful. Follow-up DSA showed complete coiling of the aneurysm. By this case report and review of the literature, we found that the coexistence of the aneurysm and fenestration on the AACA was exceptional. Endovascular treatment of saccular AACA aneurysms is an appealing option.