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Cao R, Mattar A, Torche E, Riva R, Laubacher M, Moreno-Gomez R, Turjman F, Falini A, Panni P, Eker OF. Clinical and angiographic characteristics of ruptured and unruptured distal cerebral aneurysms: a review of a large series of cases in a high-volume center. J Neurointerv Surg 2024:jnis-2023-021164. [PMID: 38443187 DOI: 10.1136/jnis-2023-021164] [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: 11/01/2023] [Accepted: 02/12/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To evaluate clinical, angiographic features, and endovascular approach of ruptured and unruptured distal intracranial aneurysms (DIAs). METHODS From January 2013 to February 2022, details of all consecutive intracranial aneurysms (IAs) treated endovascularly in our center were collected and retrospectively reviewed. IAs involving the anterior cerebral artery, middle cerebral artery, and posterior cerebral artery (distal to anterior communicating artery, limen insula, and P1 segment, respectively), and those distal to superior cerebellar artery, anterior-inferior cerebellar artery, and posterior inferior cerebellar artery's first segment were classified based on their etiology, location, size, and shape. Demographic, clinical, angiographic, and procedural variables, as well as follow-up outcomes were evaluated. RESULTS Of 2542 IAs, 151 (5.9%) DIAs were counted (average size 5.4±2.9 mm), including 61 (40.4%) unruptured and 90 (59.6%) ruptured. No difference in the aneurysmal size was observed, but aneurysms smaller than 4 mm were observed more frequently in the ruptured group (36.7% vs 18%; P=0.01). In addition, ruptured DIAs were more often non-saccular (40% vs 18%; P=0.004) and irregular (93.3% vs 59%; P<0.001), They were treated mostly by coiling, glue, and parent artery sacrifice (P=0.02, P=0.006, and P=0.001), whereas unruptured DIAs were treated by stent-assisted coiling and flow-diverter stents (P=0.001 and P<0.001, respectively), without any differences in occlusion (81.6% vs 82.5%) and recanalization (21.1% vs 17.5%) rates. Procedure-related complications occurred in 20/151 (13.2%) patients, without any differences between subgroups. Ruptured DIAs were more often re-treated (18.4% vs 5.3%, P=0.02). In multivariate analyses, irregular shape appeared as an independent predictor of ruptured presentation (OR=8.1, 95% CI 3.0 to 21.7; P<0.001). CONCLUSIONS Compared with unruptured DIAs, ruptured DIAs were more often non-saccular, irregular, and smaller than 4 mm. Despite different therapeutical approaches, ruptured and unruptured DIAs presented comparable occlusion and recanalization rates.
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Affiliation(s)
- Roberta Cao
- Hôpital Pierre Wertheimer, Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
- Department of Neuroradiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Adonis Mattar
- Hôpital Pierre Wertheimer, Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Esteban Torche
- Hôpital Pierre Wertheimer, Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Roberto Riva
- Hôpital Pierre Wertheimer, Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Morgane Laubacher
- Hôpital Pierre Wertheimer, Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Ricardo Moreno-Gomez
- Hôpital Pierre Wertheimer, Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Francis Turjman
- Hôpital Pierre Wertheimer, Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Andrea Falini
- Department of Neuroradiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Pietro Panni
- Department of Neuroradiology and Neurosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Omer F Eker
- Hôpital Pierre Wertheimer, Department of Neuroradiology, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
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Jang T, Kim ST, Lee J, Lee WH, Lee KS, Pyo SY, Ko J, Lee H, Jeong YG. Microsurgical treatment of distal middle cerebral artery aneurysm: A single-center review. J Cerebrovasc Endovasc Neurosurg 2024; 26:37-45. [PMID: 37789514 PMCID: PMC10995470 DOI: 10.7461/jcen.2023.e2023.06.005] [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: 06/23/2023] [Revised: 08/12/2023] [Accepted: 08/16/2023] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVE To review the characteristics of distal middle cerebral artery (MCA) aneurysm treated by microsurgery, the detailed surgical options, and the clinical result. METHODS We retrospectively reviewed cerebral aneurysm in the M2 and M3 segments of the MCA surgically treated between January 2015 and December 2022. The demographic data, aneurysm-related findings, type of surgical approach, surgical technique, and clinical outcomes of the enrolled patients were analyzed. RESULTS Sixteen distal MCA aneurysms were treated with microneurosurgery (incidence, 1.0%; female, 12; mean age, 58.1 years; ruptured, three). Twelve aneurysms were in the M2 segment (insular segment), two aneurysms at the M2-M3 junction, and two aneurysms in the M3 segment (opercular segment). Twelve aneurysms were saccular (average size, 4.9 mm; multiplicity, 50%; average aneurysms, 3.0; partially thrombosed, 1; sidewall aneurysm, 2). Three aneurysms were fusiform, of which two were ruptured. Of the ruptured aneurysms, one was a ruptured dissecting aneurysm. The trans-sylvian and trans-sulcal approaches were used in fourteen and two patients, respectively. Neck clipping, wrap clipping, and surgical trapping were performed in twelve, one, and one patient, respectively. Proximal occlusion was performed in one patient. Bypass technique was required in two patients (neck clipping and proximal occlusion). The modified Rankin Score was 6 in the two patients with ruptured aneurysms. The remaining patients did not show further neurological deterioration after microneurosurgery. CONCLUSIONS Distal MCA aneurysms had a high incidence of being diagnosed with multiple other aneurysms and were relatively non-saccular.
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Affiliation(s)
- Taehoon Jang
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Sung-Tae Kim
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Jin Lee
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Won-Hee Lee
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Keun-Soo Lee
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Se-Young Pyo
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Junghae Ko
- Department of Endocrinology, Haundae Paik Hospital, Inje University, School of Medicine, Busan, Korea
| | - Hangwoo Lee
- Department of Neurosurgery, Busan St. Mary’s Hospital, Busan, Korea
| | - Yeong Gyun Jeong
- Department of Neurosurgery, Busan Paik Hospital, Inje University, School of Medicine, Busan, Korea
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Sharma GR, Karki P, Joshi S, Paudel P, Shah DB, Baburam P, Bidhan G. Factors Affecting the Outcome after Surgical Clipping of Ruptured Distal Anterior Cerebral Artery (DACA) Aneurysms. Asian J Neurosurg 2023; 18:557-566. [PMID: 38152539 PMCID: PMC10749838 DOI: 10.1055/s-0043-1771371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Objective The purpose of this study is to assess demographic, clinical, and unique morphological characteristics of distal anterior cerebral artery (DACA) aneurysm. The relation of outcome included Glasgow Outcome Scale (GOS) using various independent variables, Hunt and Hess clinical grade (H&H), Miller Fischer grade, intraoperative rupture, and comparison of outcomes at discharge and last follow-up. Methods Demographic data, aneurysm characteristics, and treatment outcomes were evaluated in 28 ruptured DACA aneurysms operated over a period of 13 years. Association between independent variables and dependent variables (GOS) at discharge and at last follow-up (13 years) was analyzed, and the interrelationship between these factors and outcome was evaluated. GOS was used to assess functional outcomes. Results Over a period of 13 years, 500 patients harboring ruptured intracranial aneurysms were surgically clipped, and out of them 28 patients (5.6%) had ruptured DACA aneurysms. In this series, 20 (71.4%) patients had low grade and 8 (28.6%) had high grade H&H. Out of the 28 patients, 19 (67.8%) had good recovery, 6 (21.5%) were severely disabled, and 3 (10.7%) died at the time of discharge. On the last follow-up (13 years), smoking ( p -value 0.03) and use of temporary clip ( p -value 0.00) were significant predictors for unfavorable outcome. Conclusion The results of our case series show that even with ruptured aneurysm excellent overall outcome after microsurgical clipping can be achieved, even though among cerebral aneurysms, DACA aneurysm is considered to have less favorable outcome. Alcohol consumption and use of temporary clip were the predictors for unfavorable outcome at the time of discharge. On the last follow-up, smoking and use of temporary clip were found to be the risk factors for unfavorable outcome. Although the small sample size of this study is a limitation, smoking and use of temporary clip play an important role on the overall outcome. The aim of this study was to analyze data to determine factors which may influence outcome after surgical clipping of ruptured DACA aneurysms.
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Affiliation(s)
| | - Prasanna Karki
- Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Sumit Joshi
- Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Prakash Paudel
- Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
| | | | - Pokharel Baburam
- Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Gyawali Bidhan
- Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
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Singh DK, Sharma PK, Singh AK, Chand VK. Ruptured mirror DACA aneurysm: A rare case report and review of literature. J Cerebrovasc Endovasc Neurosurg 2023; 25:340-346. [PMID: 36647234 PMCID: PMC10555628 DOI: 10.7461/jcen.2023.e2022.07.004] [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: 07/10/2022] [Revised: 10/16/2022] [Accepted: 11/07/2022] [Indexed: 01/18/2023] Open
Abstract
Bilateral distal anterior cerebral artery (DACA) aneurysms also called "kissing aneurysms" or "mirror aneurysm" are extremely rare, accounting for only 0.2% of all intracranial aneurysms. There have only been a few examples of mirror DACA aneurysms reported in the literature. Here, we report a rare case of mirror DACA aneurysm in a middle aged female with its successful clipping. Patient was admitted with severe headache and altered sensorium. Computed tomography (CT) head was suggestive of anterior inter-hemispheric hematoma. Digital subtraction angiography (DSA) was done which was suggestive of two distal anterior cerebral artery aneurysms located at same anatomical position. It was treated through microsurgical clipping. Mirror image DACA aneurysms are rare occurrence. All patients with ruptured DACA aneurysms should have angiography with 3D reconstruction studies. This aids in determining the aneurysm's morphology and planning treatment accordingly.
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Affiliation(s)
- Deepak Kumar Singh
- Department of Neurosurgery, DR. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Prevesh Kumar Sharma
- Department of Neurosurgery, DR. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Arun Kumar Singh
- Department of Neurosurgery, DR. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Vipin Kumar Chand
- Department of Neurosurgery, DR. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
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Menon G, Srinivasan S, Pai A, Hegde A. Mini anterior interhemispheric approach for A3 segment distal anterior cerebral artery aneurysms. Clin Neurol Neurosurg 2023; 226:107598. [PMID: 36706678 DOI: 10.1016/j.clineuro.2023.107598] [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: 11/21/2022] [Revised: 12/28/2022] [Accepted: 01/15/2023] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Aneurysms of the A3 segment of the distal anterior cerebral artery (DACA), in relation to the genu of the corpus callosum, are specific sub-group which pose unique surgical challenges due to their discrete anatomical location. We describe a mini-anterior interhemispheric approach which can be safely utilised to clip these aneurysms rather than the traditional bifrontal approach. METHODS Retrospective analysis of the clinical and radiological data of ruptured DACA-A3 aneurysms operated between 2014 and 2021 at our institute. A curvilinear scalp incision within the hairline followed by raising small, unilateral, free frontal bone flap, avoiding the opening of frontal sinus. Superior sagittal sinus is displaced medially, inter-hemispheric dissection carried out with posterior trajectory and small callosotomy is performed. DACA is skeletonised, proximal control is established, and the A3 aneurysm is dissected and clipped. RESULT Our cohort of 18 patients had a definite female preponderance (F:M::2:1) with mean age of 55.6 years. On admission three patients were categorized as WFNS Grade I, thirteen in Grade II, and two in Grade III for subarachnoid haemorrhage. All the patients had evidence of blood in the interhemispheric fissure; intraparenchymal haemorrhage was seen in seven, with intraventricular haemorrhage in six patients. Within the A3 segment six aneurysms were infragenu (inferior), eight were at the genu (anterior) and four were supragenu (superior). Two (11.1%) elderly patients succumbed post-surgery following ischemic infarcts and associated complications. At the time of follow-up at 3 months of the remaining sixteen (72.2%) patients, thirteen had a good outcome (mRS 0-3) and three (16.7%) had a poor outcome (mRS > 3). CONCLUSION The mini anterior interhemispheric is an effective minimally invasive alternative for A3 segments aneurysms and helps to avoid the complications of the conventional bifrontal interhemispheric approach.
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Affiliation(s)
- Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher education, Manipal, India
| | - Siddharth Srinivasan
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher education, Manipal, India
| | - Ashwin Pai
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher education, Manipal, India
| | - Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher education, Manipal, India.
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Endovascular treatment of challenging aneurysms with FRED Jr flow diverter stents: a single-center experience. Jpn J Radiol 2023; 41:322-334. [PMID: 36315360 PMCID: PMC9619020 DOI: 10.1007/s11604-022-01354-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 10/20/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE To analyze clinical safety and efficacy of flow re-direction endoluminal device (FRED) Jr flow diverter for treatment of unruptured, ruptured, or recanalyzed aneurysms. MATERIALS AND METHODS Between October 2019 and February 2022, 25 patients with 31 aneurysms treated with FRED Jr were included in the study. Clinical and radiological records, procedural details, and follow-up outcomes were retrospectively evaluated. Eighteen (72%) patients were female. Median age was 48.8 (age range 9-85). Mean follow-up was 21 months (6-28 months). Location of the aneurysms were as follows; 13 in middle cerebral artery (MCA), 7 in anterior cerebral artery (ACA), 4 in posterior cerebral artery (PCA), 3 in true posterior communicating artery (PCom), 2 in anterior communicating artery (ACom), 1 in superior cerebellar artery (SCA), 1 in true ophthalmic artery. Five patients (20%) presented with acute subarachnoid hemorrhage (aSAH). RESULTS In all procedures, FRED Jr was successfully deployed. Three true Pcom aneurysms and a true ophthalmic aneurysm were treated with FRED Jr. Three patients with two adjacent aneurysms were treated with a single FRED Jr. In two (8%) patients in-stent thrombosis occurred intraoperatively, they were treated with iv tirofiban and thrombectomy without any sequelae. Post-discharge 2 weeks later, intraparenchymal hemorrhage occurred in a patient. He was treated with surgical drainage, the clinical course was modified Rankin score (mRS) 2. Digital subtraction angiography (DSA) was performed on 16 (64%) patients with 21 (67%) aneurysms. Near complete-complete occlusion (O'Kelly-Morata grading scale (OKM C-D) was documented in 15/16 (93.7%) patients, 20/21 (95.2%) aneurysms. In nine (36%) patients, no residual filling was observed in the magnetic resonance angiography (MRA). Good clinical outcome (mRS 0-1) was achieved in 24/25 (96%) of patients. CONCLUSION Endovascular treatment of small cerebral aneurysms with FRED Jr is safe and effective even in complex and challenging morphologies allowing high rates of aneurysm occlusion with low periprocedural complications. Our cohort, consisting of a rate 20% acute ruptured aneurysms, is the major additive data to the published literature.
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Treatment outcome of coil embolization for distal anterior cerebral artery aneurysms: A single-center experience. J Stroke Cerebrovasc Dis 2022; 31:106811. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022] Open
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Fukutome K, Ohnishi H, Kuga Y, Ohnishi H. Coil Embolization of Unruptured Distal Anterior Cerebral Artery Aneurysm Using a Marathon Microcatheter. Cureus 2022; 14:e24841. [PMID: 35702456 PMCID: PMC9177230 DOI: 10.7759/cureus.24841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Marathon is rarely used in coil embolization for an aneurysm; particularly, there have been no reports about distal anterior cerebral artery aneurysms. We have reported a case of successful use of Marathon in coil embolization in case of a distal anterior cerebral artery aneurysm. The patient was an 83-year-old woman. She had undergone coil embolization for an unruptured distal anterior cerebral artery aneurysm, which was discovered by chance. Our initial approach involved the use of a combination of Traxcess and Excelsior SL-10, but the use of SL-10 could not follow Traxcess because the right anterior cerebral artery from the right internal carotid artery had a sharp bifurcation. However, by switching to a combination of TENROU and Marathon, we could access the aneurysm. We thereby decided to continue the use of Marathon in order to complete the coil embolization. In coil embolization for an aneurysm, Marathon was found to be useful, depending on the location of the aneurysm and access route.
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Endovascular treatment of distal anterior cerebral artery aneurysm presenting with acute subdural hematoma. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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10
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Furtado SV, Jayakumar D, Perikal PJ, Mohan D. Contemporary Management of Distal Anterior Cerebral Artery Aneurysms: A Dual-Trained Neurosurgeon's Perspective. J Neurosci Rural Pract 2021; 12:711-717. [PMID: 34737505 PMCID: PMC8559076 DOI: 10.1055/s-0041-1735823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Objectives Distal anterior cerebral artery (DACA) aneurysms are a subset of aneurysms located in the anterior circulation but away from the circle of Willis. We analyze the clinical presentation and outcomes of two treatment groups-surgical and endovascular-for DACA aneurysms managed by a dual-trained neurosurgeon. Material and Methods A retrospective evaluation of radiological and operative/interventional data of 34 patients with 35 DACA aneurysms over a 12-year period was analyzed. Twenty-seven patients underwent surgery, whereas seven underwent endovascular coiling of the aneurysms. Modified Fisher grade and World Federation of Neurosurgical Societies scale (WFNS) were used to note the subarachnoid hemorrhage (SAH) severity. Statistical Analysis Categorical data were presented as frequency and percentage, while noncategorical data were represented as mean ± SD. Statistical significance for difference in outcome between the two groups was analyzed using Chi-square test, and p < 0.05 was considered statistically significant. Results Of 34 patients, 33 presented with a bleed and 23.5% patients were noted to have another aneurysm in addition to the DACA aneurysm. Patients who underwent clipping for another aneurysm along with the DACA aneurysm in a single surgical exercise had a poor outcome compared with those who underwent surgery for the lone DACA aneurysm (7 vs. 20, p = 0.015). Most patients in both surgical (70.37%) and endovascular (85.71%) groups had good outcome (mRS ≤ 2). Conclusions A good outcome can be achieved with either surgery or endovascular coiling in the management of DACA aneurysms. In patients with multiple aneurysms, SAH with aneurysmal rupture of DACA should be managed first; the other unruptured aneurysm may be operated after an interval to avoid morbidity.
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Affiliation(s)
- Sunil V Furtado
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Dravya Jayakumar
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Parichay J Perikal
- Department of Neurosurgery, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
| | - Dilip Mohan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
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Dung LV, Duc NM, Binh NT, Linh LT, Luu DT, My TTT, Huy TD, Thong PM. A case report of pericallosal aneurysm successfully treated with flow diverter stents. Radiol Case Rep 2021; 16:2447-2449. [PMID: 34257777 PMCID: PMC8260752 DOI: 10.1016/j.radcr.2021.05.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 11/17/2022] Open
Abstract
Pericallosal artery aneurysm (PAA) is a relatively uncommon type of intracranial aneurysm that tends to rupture more frequently and cause higher mortality rates than other types of cerebral aneurysms. Surgery to address PAA is difficult due to its deep-seated location, the size of the aneurysmal sac, and the limited surgical field. In recent years, with the development of percutaneous interventions, endovascular treatment has become the preferred, minimally invasive intervention method for the treatment of pericallosal aneurysms. In this article, we present a case of PAA that was successfully treated with flow diversion therapy in a 51-year-old male.
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Affiliation(s)
- Le Viet Dung
- Department of Radiology, Ha Noi Medical University Hospital, Ha Noi, Viet Nam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam.,Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Viet Nam.,Department of Radiology, Ha Noi Medical University, Ha Noi, Viet Nam
| | - Nguyen Thai Binh
- Department of Radiology, Ha Noi Medical University Hospital, Ha Noi, Viet Nam.,Department of Radiology, Ha Noi Medical University, Ha Noi, Viet Nam
| | - Le Tuan Linh
- Department of Radiology, Ha Noi Medical University Hospital, Ha Noi, Viet Nam.,Department of Radiology, Ha Noi Medical University, Ha Noi, Viet Nam
| | - Doan Tien Luu
- Department of Radiology, Ha Noi Medical University Hospital, Ha Noi, Viet Nam.,Department of Radiology, Ha Noi Medical University, Ha Noi, Viet Nam
| | - Thieu-Thi Tra My
- Department of Radiology, Ha Noi Medical University, Ha Noi, Viet Nam
| | - Tran Duc Huy
- Department of Radiology, Ha Noi Medical University, Ha Noi, Viet Nam
| | - Pham Minh Thong
- Department of Radiology, Ha Noi Medical University, Ha Noi, Viet Nam
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Nakagawa N, Fukawa N, Tsuji K, Furukawa K, Watanabe A, Izumoto S. Evaluation of the Safety and Effectiveness of Coil Embolization for Anterior Communicating and Anterior Cerebral Artery Aneurysms. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:19-25. [PMID: 37502028 PMCID: PMC10370626 DOI: 10.5797/jnet.oa.2020-0143] [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: 07/13/2020] [Accepted: 04/02/2021] [Indexed: 07/29/2023]
Abstract
Objective Endovascular coil embolization for anterior communicating artery (ACoA) and anterior cerebral artery (ACA) aneurysms is associated with high total and near-total occlusion rates, but the complication rate is high. The development of newer endovascular technologies may improve the clinical outcomes. This study investigated the status of endovascular treatment of ACoA and ACA aneurysms by comparing our results with past reports. Methods Between January 2006 and December 2018, we investigated 50 patients who were followed for 12 months or longer to clarify the outcomes of coil embolization. The outcomes of embolization were evaluated using time-of-flight MRA. The safety was evaluated based on procedure-related complications that affected clinical outcomes. Results Initial assessments demonstrated complete obliteration in 84% (42 of 50 patients) and a residual neck in 14% (7 of 50 patients). Procedure-related complications developed in 12% (6 of 50 patients). The procedure-related morbidity rate was 2% (1 of 50 patients) and there was no procedure-related death. Recanalization was noted in 14% (7 of 50 patients, median follow-up period, 57 months). The recanalized aneurysms were significantly smaller than the stable aneurysms in maximum size (4.3 mm vs. 5.8 mm; p = 0.017) and height (3.7 mm vs. 4.3 mm; p = 0.035). Conclusion We demonstrated the safety and effectiveness of endovascular coil embolization for ACoA and ACA aneurysms. The small size of aneurysms may be related to recanalization.
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Affiliation(s)
- Nobuhiro Nakagawa
- Department of Neurosurgery, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Norihito Fukawa
- Department of Neurosurgery, Kindai University Hospital, Osakasayama, Osaka, Japan
| | - Kiyoshi Tsuji
- Department of Neurosurgery, Kindai University Hospital, Osakasayama, Osaka, Japan
| | - Kentaro Furukawa
- Department of Neurosurgery, Kindai University Hospital, Osakasayama, Osaka, Japan
| | - Akira Watanabe
- Department of Neurosurgery, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Shuichi Izumoto
- Department of Neurosurgery, Kindai University Nara Hospital, Ikoma, Nara, Japan
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Take Y, Kamide T, Kikkawa Y, Ikegami M, Teranishi A, Ehara T, Shibata A, Suzuki K, Ikeda T, Iihoshi S, Kohyama S, Kurita H. Current treatment options and prognostic factors for ruptured distal anterior cerebral artery aneurysms. Surg Neurol Int 2021; 12:171. [PMID: 34084599 PMCID: PMC8168794 DOI: 10.25259/sni_223_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/31/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Distal anterior cerebral artery (ACA) aneurysms are rare, representing 1–9% of all intracranial aneurysms. The best treatment strategy for these aneurysms continues to be debated. We clarified the clinical features and treatment outcomes of patients with ruptured distal ACA aneurysms according to the treatment options at our institute. Methods: Thirty-seven consecutive patients (26 women; mean age, 65.2 years) with ruptured distal ACA aneurysms who underwent surgical clipping or coil embolization between 2012 and 2018 were included in the study. Clinical presentations, radiographic findings, and outcomes were retrospectively reviewed and compared between patients who underwent either surgical clipping or coil embolization. Risk factors associated with poor outcomes (modified Rankin Scale 4–6) were analyzed using multiple regression analysis. Results: Nineteen patients (51.4%) had World Federation Neurological Surgeons (WFNS) Grade IV-V, 18 (48.7%) had frontal lobe hematomas, and 13 (35.1%) had multiple aneurysms. Surgical clipping and endovascular coiling were performed in 28 (75.7%) and nine (24.3%) patients, respectively. Aneurysms located at the A4-5 portions were mainly treated by surgical clipping (P = 0.04). There were no significant between-group differences in procedure-related morbidity and mortality; however, the complete occlusion rate was higher in the surgical group (P < 0.01). Overall, a favorable neurological outcome at discharge (mRS 0–3) was obtained in 23 patients (62.5%). Multiple regression analysis revealed that WFNS Grade IV-V and frontal lobe hematomas were risk factors for poor outcomes (mRS 4–6). Conclusion: Acceptable outcomes were obtained in 62.5% of cases, and there were no significant between-group differences in treatment results between clipping and coiling. A poor WFNS grade and intracerebral hematomas were risk factors for a poor prognosis.
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Affiliation(s)
- Yushiro Take
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tomoya Kamide
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yuichiro Kikkawa
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Masaki Ikegami
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Akio Teranishi
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Takuro Ehara
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Aoto Shibata
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kaima Suzuki
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Toshiki Ikeda
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Satoshi Iihoshi
- Department of Neuroendovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Shinya Kohyama
- Department of Neuroendovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hiroki Kurita
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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Sturiale CL, Rapisarda A, Marchese E, Puca A, Olivi A, Albanese A. Surgical Treatment of Middle Cerebral Artery Aneurysms: Hints and Precautions for Young Cerebrovascular Surgeons. J Neurol Surg A Cent Eur Neurosurg 2021; 83:75-84. [PMID: 33641137 DOI: 10.1055/s-0040-1720996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Clipping is still considered the treatment of choice for middle cerebral artery (MCA) aneurysms due to their angioarchitectural characteristics as they are often bifurcation dysplasias, needing a complex reconstruction rather than a simple exclusion. Thus, maintaining this surgical expertise is of paramount importance to train of young cerebrovascular surgeons. To balance for the increasingly limited experience due the worldwide general inclination toward the endovascular approaches, it is important to provide to the young neurosurgeons rules and operative nuances to guide this complex surgery. We describe the technical algorithm we use to teach our residents to approach ruptured and unruptured MCA aneurysms, which may help to develop a procedural memory useful to perform an effective and safe surgery. MATERIALS AND METHODS We reviewed our last 10 years' institutional experience of about 400 cases of ruptured and unruptured MCA aneurysms clipping, analyzing our technical refinements and the difficulties in residents and young neurosurgeons teaching, to establish fundamental key-points and design a didactic algorithm that includes operative instructions and safety rules. RESULTS We recognized seven pragmatic technical key points regarding craniotomy, sylvian fissure opening, basal cisternostomy, proximal vessel control, lenticulostriate arteries preservation, aneurysm neck microdissection, and clipping to use as a didactic algorithm for teaching residents, and as operative instructions for inexperienced neurosurgeons. CONCLUSION In the setting of clipping MCA aneurysms, respect for surgical rules is of paramount importance to perform an effective and safe procedure, ensure the best aneurysm exclusion, and preserve the flow in collaterals and perforators.
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Affiliation(s)
- Carmelo Lucio Sturiale
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia - Neurosurgery, Roma, Lazio, Italy
| | - Alessandro Rapisarda
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia - Neurosurgery, Roma, Lazio, Italy
| | - Enrico Marchese
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia - Neurosurgery, Roma, Lazio, Italy
| | - Alfredo Puca
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia - Neurosurgery, Roma, Lazio, Italy
| | - Alessandro Olivi
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia - Neurosurgery, Roma, Lazio, Italy
| | - Alessio Albanese
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia - Neurosurgery, Roma, Lazio, Italy
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15
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Sturiale CL, Ricciardi L, Marchese E, Puca A, Olivi A, Albanese A. Surgical Treatment of Anterior Communicating Artery Aneurysms: Hints and Precautions for Young Cerebrovascular Surgeons. J Neurol Surg A Cent Eur Neurosurg 2020; 81:463-471. [DOI: 10.1055/s-0039-3401985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract
Background Anterior communicating artery (AComA) aneurysms are the most common intracranial aneurysm, accounting for 25 to 38% of all cases. In spite of the advent of modern neurointerventional treatments, they still represent a strong indication for clipping in certain anatomical and clinical conditions. However, AComA aneurysms are the deepest located aneurysms of the anastomotic circle of Willis, with a complex spatial orientation, and they are fed by bilateral branches of the anterior circulations. Although, on one hand, these aneurysms represent the most complex ones of the anterior circulation, on the other hand, the experience of young neurosurgeons is increasingly limited. Therefore, respecting operative guidelines is crucial to achieve the best aneurysm exclusion and avoid fatal intraoperative complications.
Study Objective We describe the technical algorithm we use to teach young neurosurgeons how to approach AComA aneurysms and help them to develop a procedural memory needed to perform an efficient and safe surgery.
Materials and Methods We reviewed our last 10 years of institutional experience of > 200 cases of clipping ruptured and unruptured AComA aneurysms, analyzing our technical refinements and the difficulties in teaching residents and young neurosurgeons how to establish fundamental key points and design a didactic algorithm that includes operative instructions and safety rules.
Results We identified seven pragmatic technical key points regarding craniotomy, cisternostomy, gyrus rectus corticectomy, proximal control, perforators and Heubner preservation, aneurysm neck dissection, and clipping to use in a didactic algorithm for teaching residents and as operative instructions for inexperienced neurosurgeons.
Conclusion In the setting of clipping AComA aneurysms, respect for surgical rules is of paramount importance to perform an efficacious and safe procedure and ensure the best aneurysm exclusion and preservation of neurovascular structures.
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Affiliation(s)
- Carmelo Lucio Sturiale
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Roma, Italy
| | - Luca Ricciardi
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Roma, Italy
| | - Enrico Marchese
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Roma, Italy
| | - Alfredo Puca
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Roma, Italy
| | - Alessandro Olivi
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Roma, Italy
| | - Alessio Albanese
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Roma, Italy
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Lin JS, Murad MH, Leas B, Treadwell JR, Chou R, Ivlev I, Kansagara D. A Narrative Review and Proposed Framework for Using Health System Data with Systematic Reviews to Support Decision-making. J Gen Intern Med 2020; 35:1830-1835. [PMID: 32239462 PMCID: PMC7280421 DOI: 10.1007/s11606-020-05783-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/06/2020] [Indexed: 12/14/2022]
Abstract
Systematic reviews are a necessary, but often insufficient, source of information to address the decision-making needs of health systems. In this paper, we address when and how the use of health system data might make systematic reviews more useful to decision-makers. We describe the different ways in which health system data can be used with systematic reviews, identify scenarios in which the addition of health system data may be most helpful (i.e., to improve the strength of evidence, to improve the applicability of evidence, and to inform the implementation of evidence), and discuss the importance of framing the limitations and considerations when using unpublished health system data in reviews. We developed a framework to guide the use of health system data alongside systematic reviews based on a narrative review of the literature and empirical experience. We also offer recommendations to improve the transparency of reporting when using health system data alongside systematic reviews including providing rationale for employing additional data, details on the data source, critical appraisal to understand study design biases as well as limitations in data and information quality, and how the unpublished data compares to the systematically reviewed data. Future methodological work on how best to handle internal and external validity concerns of health system data in the context of systematically reviewed data and work on developing infrastructure to do this type of work is needed.
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Affiliation(s)
- Jennifer S Lin
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Portland, OR, USA. .,The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
| | - M Hassan Murad
- Mayo Clinic Evidence-based Practice Center, Rochester, MN, USA
| | - Brian Leas
- ECRI Institute-Penn Medicine Evidence-based Practice Center, Plymouth Meeting, PA, USA
| | - Jonathan R Treadwell
- ECRI Institute-Penn Medicine Evidence-based Practice Center, Plymouth Meeting, PA, USA
| | - Roger Chou
- Pacific Northwest Evidence-based Practice Center, Portland, OR, USA
| | - Ilya Ivlev
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Portland, OR, USA
| | - Devan Kansagara
- Veterans Health Administration Health Services Research Department Evidence Synthesis Program, Portland, OR, USA
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17
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Cagnazzo F, Fanti A, Lefevre PH, Derraz I, Dargazanli C, Gascou G, Riquelme C, Ahmed R, Bonafe A, Costalat V. Distal anterior cerebral artery aneurysms treated with flow diversion: experience of a large-volume center and systematic review of the literature. J Neurointerv Surg 2020; 13:42-48. [PMID: 32457222 DOI: 10.1136/neurintsurg-2020-015980] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Evidence about the safety and the efficacy of flow diversion for distal anterior cerebral artery (DACA) aneurysms is scant. To provide further insight into flow diversion for aneurysms located at, or distal to, the A2 segment. METHODS Consecutive patients receiving flow diversion for DACA aneurysms were retrieved from our prospective database (2014-2020). A PRISMA guidelines-based systematic review of the literature was performed. Aneurysm occlusion (O'Kelly-Marotta=OKM) and clinical outcomes were evaluated. RESULTS Twenty-three patients and 25 unruptured saccular DACA aneurysms treated with flow diversion were included. Aneurysm size ranged from 2 mm to 9 mm (mean size 4.5 mm, SD ±1.6). Mean parent artery diameter was 1.8 mm (range, 1.2-3 mm, SD ±0.39). Successful stent deployment was achieved in all cases. Angiographic adequate occlusion (OKM C-D) at follow-up (14 months) was 79% (19/24 available aneurysms). No cases of aneurysm rupture or retreatment were reported. Univariate analysis showed a significant difference in diameter among aneurysms with adequate (4 mm) vs incomplete occlusion (7 mm) (P=0.006).There was one transient perioperative in-stent thrombosis, and three major events causing neurological morbidity: two stent thromboses (one attributable to the non-adherence of the patient to the antiplatelet therapy); and one acute occlusion of a covered calloso-marginal artery.Results from systematic review (12 studies and 107 A2-A3 aneurysms) showed 78.6% (95% CI=70-86) adequate occlusion, 7.5% (95% CI=3.6-14) complications, and 2.8%, (3/107, 95% CI=0.6-8.2) morbidity. CONCLUSIONS Flow diversion among DACA aneurysms is effective, especially among small lesions. However, potential morbidity related to in-stent thrombosis and covered side branches should be considered when planning this strategy.
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Affiliation(s)
- Federico Cagnazzo
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Andrea Fanti
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Pierre-Henri Lefevre
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Imad Derraz
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Cyril Dargazanli
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Gregory Gascou
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Carlos Riquelme
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Raed Ahmed
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Alain Bonafe
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Vincent Costalat
- Neuroradiology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
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18
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Shin DS, Carroll CP, Elghareeb M, Hoh BL, Kim BT. The Evolution of Flow-Diverting Stents for Cerebral Aneurysms; Historical Review, Modern Application, Complications, and Future Direction. J Korean Neurosurg Soc 2020; 63:137-152. [PMID: 32120455 PMCID: PMC7054118 DOI: 10.3340/jkns.2020.0034] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 12/12/2022] Open
Abstract
In spite of the developing endovascular era, large (15–25 mm) and giant (>25 mm) wide-neck cerebral aneurysms remained technically challenging. Intracranial flow-diverting stents (FDS) were developed to address these challenges by targeting aneurysm hemodynamics to promote aneurysm occlusion. In 2011, the first FDS approved for use in the United States market. Shortly thereafter, the Pipeline of Uncoilable or Failed Aneurysms (PUFS) study was published demonstrating high efficacy and a similar complication profile to other intracranial stents. The initial FDA instructions for use (IFU) limited its use to patients 22 years old or older with wide-necked large or giant aneurysms of the internal carotid artery (ICA) from the petrous segment to superior hypophyseal artery/ophthalmic segment. Expanded IFU was tested in the Prospective Study on Embolization of Intracranial Aneurysms with PipelineTM Embolization Device (PREMIER) trial. With further post-approval clinical data, the United States FDA expanded the IFU to include patients with small or medium, wide-necked saccular or fusiform aneurysms from the petrous ICA to the ICA terminus. However, IFU is more restrictive in South Korea than in United States. Several systematic reviews and meta-analyses have sought to evaluate the overall efficacy of FDS for the treatment of cerebral aneurysms and consistently identify FDS as an effective technique for the treatment of aneurysms broadly with complication rates similar to other traditional techniques. A growing body of literature has demonstrated high efficacy of FDS for small aneurysms; distal artery aneurysms; non-saccular aneurysms posterior circulation aneurysms and complication rates similar to traditional techniques. In the short interval since the Pipeline Embolization Device was first introduced, FDS has been firmly entrenched as a powerful tool in the endovascular armamentarium. As new FDS are developed, established FDS are refined, and delivery systems are improved the uses for FDS will only expand further. Researchers continue to work to optimize the mechanical characteristics of the FDS themselves, aiming to optimize deploy ability and efficacy. With expanded use for small to medium aneurysms and posterior circulation aneurysms, FDS technology is firmly entrenched as a powerful tool to treat challenging aneurysms, both primarily and as an adjunct to coil embolization. With the aforementioned advances, the ease of FDS deployment will improve and complication rates will be further minimized. This will only further establish FDS deployment as a key strategy in the treatment of cerebral aneurysms.
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Affiliation(s)
- Dong-Seong Shin
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Christopher P Carroll
- Department of Brain & Spine Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, USA.,Department of Surgery, Uniformed Services University, Bethesda, MD, USA
| | | | - Brian L Hoh
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Bum-Tae Kim
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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19
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Endovascular treatment of distal anterior cerebral artery aneurysms: Long-term results. J Neuroradiol 2020; 47:33-37. [DOI: 10.1016/j.neurad.2018.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/07/2018] [Accepted: 12/08/2018] [Indexed: 11/18/2022]
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20
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Zhai XD, Yu JX, Li CJ, Ren J, Ji Z, He C, Ye M, Hu P, Zhang HQ. Morphological Characteristics of Pericallosal Artery Aneurysms and Their High Propensity for Rupture. World Neurosurg 2019; 133:e320-e326. [PMID: 31520758 DOI: 10.1016/j.wneu.2019.09.003] [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] [Received: 04/30/2019] [Revised: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Compared with intracranial aneurysms (IAs) at other locations, pericallosal artery aneurysms (PAAs) have demonstrated an extremely high risk of rupture. However, owing to their rarity, our understanding of their morphological characteristics has been limited, and whether the morphological characteristics of PAAs contribute to this high rupture risk has remained unexplored. In the present study, we aimed to provide a detailed description of the morphological characteristics of PAAs and investigate the association between its morphology and rupture risk compared with anterior circulation IAs at other locations. METHODS A total of 40 patients with 45 PAAs and 348 patients with 392 anterior circulation IAs at other locations were recruited. The clinical and radiological data for these patients were retrospectively reviewed. The differences in the morphological parameters, including the aneurysm diameter, neck width, height, width, parent artery diameter, inflow angle, aspect ratio (AR), size ratio (SR), and aneurysm diameter/width ratio, between PAAs and other IA groups were compared. RESULTS Of the 45 PAAs, 22 (48.9%) had ruptured. The proportion of ruptured aneurysms was greater for PAAs than for anterior circulation IAs at other locations. For both ruptured and unruptured anterior circulation IAs, PAAs had the highest AR and SR among all IA groups and had the largest inflow angle. CONCLUSION The morphological characteristics of PAAs are unique. Compared with other anterior circulation IAs, PAAs have significantly increased ARs, SRs, and inflow angles, which, ultimately, promote their high propensity toward rupture.
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Affiliation(s)
- Xiao-Dong Zhai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China
| | - Jia-Xing Yu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China
| | - Chuan-Jie Li
- Department of Neurosurgery, Shunyi District Hospital, Beijing, China
| | - Jian Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China
| | - Zhe Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China
| | - Chuan He
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China
| | - Ming Ye
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China
| | - Peng Hu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China
| | - Hong-Qi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute, Beijing, China.
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21
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Kiyofuji S, Sora S, Graffeo CS, Perry A, Link MJ. Anterior interhemispheric approach for clipping of subcallosal distal anterior cerebral artery aneurysms: case series and technical notes. Neurosurg Rev 2019; 43:801-806. [PMID: 31187343 DOI: 10.1007/s10143-019-01126-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/16/2019] [Accepted: 05/23/2019] [Indexed: 11/28/2022]
Abstract
Distal anterior cerebral artery (DACA) aneurysms are rare, accounting for 1-9% of all intracranial aneurysms. Previous systematic reviews have highlighted that given the markedly increased incidence of major complications after endovascular treatment, microsurgical clipping is the more attractive treatment option with generally excellent clinical outcomes. Subcallosal DACA aneurysms constitute a rare subset of these aneurysms, requiring special anatomic considerations-particularly with regard to the approach. The aim of this study is to review the technical nuances of microsurgical treatment of subcallosal DACA aneurysms, including review of contemporary techniques through presentation of a microneurosurgical operative video. This is a retrospective case series and intraoperative microsurgical videos review. Three subcallosal DACA aneurysms were identified via retrospective query of our institutional neurosurgical database from December 2017 to May 2018. Two were female; median age was 74 years (range 70-83); all 3 underwent bifrontal craniotomy via bicoronal skin incision for aneurysm clipping. Aneurysms were located in left pericallosal-callosomarginal artery junction, bifurcation of azygos A2, and pericallosal artery related with azygos A2, and the anterior interhemispheric approach was used in all 3 operations. No acute stroke, hemorrhage, or major complications occurred, and all patients remained neurologically intact at the time of last follow-up (median 3 months, range 1-6). Although DACA aneurysms are rare, they represent an important variant for cerebrovascular neurosurgeons where microsurgical clipping can have better angiographic outcomes than endovascular treatment. Detail-oriented anterior interhemispheric arachnoid dissection through bifrontal craniotomy with its lower margin sitting at the superior orbital rim maximizes safe and effective clipping of subcallosal DACA aneurysms.
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Affiliation(s)
- Satoshi Kiyofuji
- Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. .,Department of Neurosurgery, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan.
| | - Shigeo Sora
- Department of Neurosurgery, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan
| | - Christopher S Graffeo
- Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Avital Perry
- Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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22
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Zhou J, Wang Y, Wang D, Chen Q, Wang H, Gao L. Endovascular Treatment for Ruptured Aneurysms at Distal Cerebral Arteries. World Neurosurg 2018; 123:e387-e392. [PMID: 30500584 DOI: 10.1016/j.wneu.2018.11.178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 11/17/2018] [Accepted: 11/19/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the feasibility and efficacy of endovascular treatment for ruptured aneurysms at distal cerebral arteries. METHODS A total of 30 ruptured aneurysms at distal cerebral arteries in 30 patients received endovascular treatment (EVT). Distal cerebral arteries were defined as arteries distal to the A2 or M2 segmentations in the anterior circulation, distal to the P2 segmentation in the posterior circulation, or other small branches or perforating arteries. Aneurysm occlusion was assessed using Raymond classification immediately after the procedure and during angiographic follow-up. Clinical follow-up data were retrospectively analyzed and categorized using the modified Rankin scale (MRS). RESULTS Thirty aneurysms were classified as distal anterior circulation in 17 aneurysms and posterior circulation in 13 aneurysms. EVT technically succeeded in all 30 (100%) aneurysms, with stent assistance in 1 aneurysm and coiling only in 29. Aneurysm sac coiling was done in 25 aneurysms, whereas parent artery occlusion was done in 5 aneurysms. Raymond I occlusion were immediately achieved in 19 of 30 (63.3%) aneurysms. Complications occurred in 1 patient because of aneurysm rupture. Angiographic and clinical follow-up data were obtained from 28 patients. Follow-up angiography (mean, 10.14 ± 5.31 months) revealed Raymond I classification in 22 aneurysms (78.6%). At the end of clinical follow-up (mean, 11.89 ± 5.07 months), clinical monitoring using the MRS showed a score of 0 in 18 patients, score of 1 in 5 patients, score of 2 in 2 patients, score of 3 in 2 patients, and score of 4 in 1 patient. CONCLUSIONS EVT is a feasible and effective therapy to treat ruptured aneurysms located at distal cerebral arteries.
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Affiliation(s)
- Jiang Zhou
- Department of Neurosurgery, The Tenth Affiliated People's Hospital of Shanghai Tong Ji University, Shanghai, China
| | - Yanlong Wang
- Department of Neurosurgery, Ningbo Yinzhou No. 2 Hospital, Ningbo, China
| | - Dongfeng Wang
- Department of Neurosurgery, Ningbo City Medical Treatment Center Lihuili Hospital, Ningbo, China
| | - Qifeng Chen
- Department of Neurosurgery, Ningbo City Medical Treatment Center Lihuili Hospital, Ningbo, China
| | - Hongcai Wang
- Department of Neurosurgery, Ningbo City Medical Treatment Center Lihuili Hospital, Ningbo, China
| | - Liang Gao
- Department of Neurosurgery, The Tenth Affiliated People's Hospital of Shanghai Tong Ji University, Shanghai, China.
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Ravindran K, Enriquez-Marulanda A, Kan PTM, Renieri L, Limbucci N, Mangiafico S, Salem MM, Alturki AY, Moore JM, Ogilvy CS, Thomas AJ. Use of Flow Diversion for the Treatment of Distal Circulation Aneurysms: A Multicohort Study. World Neurosurg 2018; 118:e825-e833. [PMID: 30026147 DOI: 10.1016/j.wneu.2018.07.062] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/06/2018] [Accepted: 07/07/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The safety and efficacy of flow diversion for distal circulation aneurysms of the cerebral vasculature has not been well evaluated. The objective of this study was to assess the use of flow diversion for distal circulation aneurysms (defined as at or beyond the M1, P1, and A1 segments of the middle cerebral artery, posterior cerebral artery, and anterior cerebral artery, respectively) in an international multicenter cohort. METHODS Clinical and radiologic records from all patients undergoing flow diversion treatment of distal circulation aneurysms at 3 academic centers (2 in the USA and 1 in Europe) from 2014 until 2017 were retrospectively reviewed. RESULTS Forty-six patients (mean age, 58.2 years; 33 women) harboring 46 aneurysms who underwent treatment with either the Pipeline Embolization Device (Medtronic Inc., Dublin, Ireland) or the Flow Re-Direction Endoluminal Device (MicroVention, Tustin, California, USA) were included in these analyses. Thirty-four aneurysms (74%) were located in the anterior circulation and 12 (26%) were located in the posterior circulation. With a mean follow-up of 13.0 months, complete (100%) and near-complete (90%-99%) occlusion was noted in 36 aneurysms (78.2%). Angiographic evidence of side branch or perforator vessel coverage was present in 35 aneurysms (76.1%) but was not associated with failure to occlude at follow-up (P = 0.06). All patients had good functional outcomes after treatment (modified Rankin Scale score 0-2). There were 2 cases (4.3%) of perforator vessel stroke and no hemorrhagic complications. CONCLUSIONS Flow diversion for aneurysms beyond the circle of Willis has occlusion rates comparable to alternative treatments and low morbidity. The clinical significance of flow limitation through covered side branches requires further investigation.
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Affiliation(s)
- Krishnan Ravindran
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Peter T M Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Leonardo Renieri
- Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy
| | - Nicola Limbucci
- Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy
| | | | - Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Abdulrahman Y Alturki
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, The National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Cagnazzo F, Cappucci M, Dargazanli C, Lefevre PH, Gascou G, Riquelme C, Bonafe A, Costalat V. Treatment of Distal Anterior Cerebral Artery Aneurysms with Flow-Diverter Stents: A Single-Center Experience. AJNR Am J Neuroradiol 2018; 39:1100-1106. [PMID: 29650782 DOI: 10.3174/ajnr.a5615] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/06/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Flow diversion for aneurysms beyond the circle of Willis is still debated. Our aim was to evaluate the safety and efficacy of flow diversion treatment of distal anterior cerebral artery aneurysms. MATERIALS AND METHODS Consecutive patients with distal anterior cerebral artery aneurysms treated from January 2014 to October 2017 were evaluated retrospectively with prospectively maintained data. Treatment was performed only for unruptured or recanalized aneurysms after coiling. Technical feasibility, procedural complications, aneurysm occlusion (O'Kelly-Marotta grading scale), and clinical outcome were evaluated. RESULTS Fifteen patients were included in the study, with 17 distal anterior cerebral artery saccular aneurysms treated with flow-diverter stents. Mean aneurysm size was 4.25 ± 3.9 mm; range, 2-9 mm. Flow diversion was used as retreatment among 6 previously coiled aneurysms (5 ruptured and coiled in the acute phase, and 1 unruptured and recanalized). Stent deployment was technically successful in all cases. During the perioperative period, 1 patient experienced a transient minor stroke (6%), whereas 2 patients reported acute in-stent thrombosis with disabling ischemic complications (13%). Fourteen patients and 16 aneurysms were available during a mean radiologic follow-up of 12 months (range, 3-24 months). Overall, 12 (75%) aneurysms were completely occluded (O'Kelly-Marotta grading scale score D), 1 aneurysm (6%) showed near-complete occlusion (O'Kelly-Marotta grading scale score C), and 3 aneurysms (19%) were incompletely occluded (O'Kelly-Marotta grading scale, score B). All 6 aneurysms previously coiled were completely occluded after flow diversion, whereas 70% of aneurysms treated with flow diverters alone showed complete/near-complete occlusion (O'Kelly-Marotta grading scale C-D). There were no cases of aneurysm rupture, in-stent occlusion, or retreatment during long-term follow-up. CONCLUSIONS Treatment of distal anterior cerebral artery aneurysms with flow-diverter stents is feasible and effective, with high rates of aneurysm occlusion. Flow diversion plus coiling, in the retreatment of lesions previously coiled, allowed higher rates of occlusion compared with flow diverters alone. However, the risk of ischemic complications is not negligible, and flow-diversion treatment should be evaluated only for aneurysms not amenable to simple coil embolization.
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Affiliation(s)
- F Cagnazzo
- From the Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France.
| | - M Cappucci
- From the Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - C Dargazanli
- From the Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - P-H Lefevre
- From the Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - G Gascou
- From the Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - C Riquelme
- From the Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - A Bonafe
- From the Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - V Costalat
- From the Neuroradiology Department, University Hospital Güi-de-Chauliac, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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25
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Husain S, Andhitara Y, Jena SP, Padilla J, Aritonang S, Letsoin I. Endovascular Management of Ruptured Distal Anterior Cerebral Artery (DACA) Aneurysms: A Retrospective Review Study. World Neurosurg 2017; 107:588-596. [PMID: 28823655 DOI: 10.1016/j.wneu.2017.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Distal anterior cerebral artery (DACA) aneurysms are rare, and their treatment by either surgical clipping or endovascular treatment poses technical difficulties. Earlier studies have reported higher complication rates in DACA aneurysms compared with other aneurysms in the circle of Willis. Therefore, endovascular management of DACA aneurysms still remains a challenge. The aim of this report is to review clinical presentation, angiographic presentation of DACA aneurysms, complications, and outcome of their endovascular treatment in our institutional experience. METHODS A retrospective review of 186 patients with intracranial aneurysms treated with endovascular management from September 2009 to December 2013 in the Max Superspecialty Hospital, New Delhi, India, 11 patients (5.9%) with 12 DACA aneurysms were studied retrospectively. We report the clinical presentations, cerebral angiographic findings, endovascular treatment, complications, and outcomes. The clinical and angiographic outcomes were assessed using modified Rankin scales and the Raymond scale, respectively. RESULTS Of 11 patients, 54.5% were female and 45.5% were male; the mean age was 48.4 years (range, 33-65 years). All patients had subarachnoid hemorrhage that indicated ruptured DACA aneurysm. All the DACA aneurysms were small. Postcoiling angiograms showed complete occlusion in 9 patients. Two patients had intraprocedural aneurysm rupture but without any clinical sequelae, and 1 patient had thrombus formation, which was thrombolysed at the end of coiling. All patients had good outcomes. CONCLUSIONS Our experience with 11 patients showed that endovascular management of small DACA aneurysms, though associated with higher intraprocedural events, is associated with good outcome.
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Affiliation(s)
- Shakir Husain
- Department of Interventional Neurology and Stroke, Institute of Neurosciences, Max Super-Specialty Hospital, Saket, New Delhi, India; Interventional Neurology and Stroke Fellowship Program, Neo Hospital, Noida, India.
| | - Yovita Andhitara
- Department of Neurology, Dr. Kariadi General Hospital/Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Somnath Prasad Jena
- Interventional Neurology and Stroke, Stroke and Neurointervention Foundation, Max Super-Specialty Hospital, Saket, New Delhi, India
| | - Jorge Padilla
- Neurology, Cotabato Regional and Medical Center, Cotabato City, Philippines
| | - Sahat Aritonang
- Department of Neurology, Tangerang General Hospital Indonesia, Interventional Neurology and Stroke, Saket City Hospital, New Delhi, India
| | - Igor Letsoin
- Department of Neurology, Jayapura General Hospital/Cendrawasih University, Jayapura, Indonesia
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Fotakopoulos G, Tsianaka E, Fountas K, Makris D, Spyrou M, Hernesniemi J. Clipping Versus Coiling in Anterior Circulation Ruptured Intracranial Aneurysms: A Meta-Analysis. World Neurosurg 2017; 104:482-488. [PMID: 28526647 DOI: 10.1016/j.wneu.2017.05.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/04/2017] [Accepted: 05/06/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate open surgical versus endovascular repair of anterior circulation ruptured intracranial aneurysms based on operative mortality, permanent neurologic deficit, late mortality, and need for reintervention. METHODS This meta-analysis included articles published since December 6, 2016, that compared outcomes of the 2 methods. Extracted data were organized in a standard table format, including first author, country, covered study period, publication year, number of patients and patients at follow-up, operative mortality rate (with 30 days from treatment), permanent neurologic deficit (appearing after surgery), late mortality (after 1 month), and reintervention (surgery or coiling) for both groups of patients. Follow-up was at least 1 year. RESULTS There were 8 articles that matched our study criteria. The study population was 628 patients; 374 were treated with surgical clipping, and 254 were treated with endovascular coiling. Pooled results showed no statistically significant difference between the 2 groups in terms of operative mortality, permanent neurologic deficit, late mortality, and need for reintervention. CONCLUSIONS Selection of the appropriate procedure must be made on the basis of the special characteristics of each case.
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Affiliation(s)
- George Fotakopoulos
- Department of Neurosurgery, University Hospital of Thessaly, University Hospital of Larissa, Larissa, Thessaly, Greece.
| | - Eleni Tsianaka
- Department of Neurosurgery, University Hospital of Thessaly, University Hospital of Larissa, Larissa, Thessaly, Greece
| | - Kostas Fountas
- Department of Neurosurgery, University Hospital of Thessaly, University Hospital of Larissa, Larissa, Thessaly, Greece
| | - Demosthenes Makris
- Department of Head of Critical Care, University of Thessaly, University Hospital of Larissa, Larissa, Thessaly, Greece
| | | | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
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27
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Petr O, Coufalová L, Bradáč O, Rehwald R, Glodny B, Beneš V. Safety and Efficacy of Surgical and Endovascular Treatment for Distal Anterior Cerebral Artery Aneurysms: A Systematic Review and Meta-Analysis. World Neurosurg 2016; 100:557-566. [PMID: 27923755 DOI: 10.1016/j.wneu.2016.11.134] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Aneurysms of the distal anterior cerebral artery (DACA) are rare, representing between 1% and 9% of all intracranial aneurysms. The best treatment strategy for these aneurysms continues to be debated. OBJECTIVE We conducted a systematic review of the literature to evaluate the safety and efficacy of treatment strategies of DACA aneurysms. METHODS A systematic search of Medline, Embase, Scopus, and Web of Science was performed for studies published from January 2000 to August 2015. We included studies describing treatment of DACA aneurysms with ≥10 patients. Random effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, periprocedural morbidity/mortality and stroke rates, aneurysm recurrence/rebleed, and long-term neurologic morbidity/mortality. RESULTS Thirty studies with 1329 DACA aneurysms were included. Complete occlusion was 95% (95% confidence interval [CI], 91.0%-97.0%) in the surgical group and 68% (95% CI, 56.0%-78.0%) in the endovascular group (P < 0.0001). Aneurysm recurrence occurred in 3% (95% CI, 2.0%-4.0%) after surgery and in 19.1% (95% CI, 12.0%-27.0%) after endovascular treatment (P < 0.0001). Overall neurologic morbidity and mortality were 15% (95% CI, 11.0%-21.0%) and 9% (95% CI, 7.0%-11.0%) after surgery and 14% (95% CI, 10.0%-19.0%) (P = 0.725) and 7% (95% CI, 5.0%-10.0%) (P = 0.422) after endovascular treatment, respectively. Overall long-term favorable neurologic outcome was 80% and it was equal in both groups (80%; 95% CI, 73.0%-85.0% in the surgical group and 80%; 95% CI, 72.0%-87.0% in the endovascular group) (P = 0.892). CONCLUSIONS Our meta-analysis showed that both treatment modalities are technically feasible and effective with sufficient long-term aneurysm occlusion and acceptable recurrence/rebleed rates. Surgical treatment is associated with superior angiographic outcomes. There were no substantial differences in procedure-related morbidity and mortality. These findings are important because they suggest that therapy of DACA aneurysms should be performed on a selective, case-by-case basis to maximize patient benefits.
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Affiliation(s)
- Ondra Petr
- Department of Neurosurgery, Medical University Innsbruck, Austria; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Lucie Coufalová
- Department of Neurosurgery, Resuscitation and Intensive Care, 1(st) Faculty of Medicine, Charles University in Prague, Military University Hospital Střešovice, Střešovice, Czech Republic; Department of Anesthesiology, Resuscitation and Intensive Care, 1(st) Faculty of Medicine, Charles University in Prague, Military University Hospital Střešovice, Střešovice, Czech Republic
| | - Ondřej Bradáč
- Department of Neurosurgery, Resuscitation and Intensive Care, 1(st) Faculty of Medicine, Charles University in Prague, Military University Hospital Střešovice, Střešovice, Czech Republic
| | - Rafael Rehwald
- Department of Radiology, Medical University Innsbruck, Austria
| | - Berharnd Glodny
- Department of Radiology, Medical University Innsbruck, Austria
| | - Vladimír Beneš
- Department of Neurosurgery, Resuscitation and Intensive Care, 1(st) Faculty of Medicine, Charles University in Prague, Military University Hospital Střešovice, Střešovice, Czech Republic
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28
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Ko JK, Kim HS, Choi HJ, Lee TH, Yun EY, Choi CH. Endovascular Treatment of Ruptured Pericallosal Artery Aneurysms. J Korean Neurosurg Soc 2015; 58:197-204. [PMID: 26539261 PMCID: PMC4630349 DOI: 10.3340/jkns.2015.58.3.197] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 04/08/2015] [Accepted: 04/13/2015] [Indexed: 11/27/2022] Open
Abstract
Objective Aneurysms arising from the pericallosal artery (PA) are uncommon and challenging to treat. The aim of this study was to report our experiences of the endovascular treatment of ruptured PA aneurysms. Methods From September 2003 to December 2013, 30 ruptured PA aneurysms in 30 patients were treated at our institution via an endovascular approach. Procedural data, clinical and angiographic results were retrospectively reviewed. Results Regarding immediate angiographic control, complete occlusion was achieved in 21 (70.0%) patients and near-complete occlusion in 9 (30.0%). Eight procedure-related complications occurred, including intraprocedural rupture and early rebleeding in three each, and thromboembolic event in two. At last follow-up, 18 patients were independent with a modified Rankin Scale (mRS) score of 0-2, and the other 12 were either dependent or had expired (mRS score, 3-6). Adjacent hematoma was found to be associated with an increased risk of poor clinical outcome. Seventeen of 23 surviving patients underwent follow-up conventional angiography (mean, 16.5 months). Results showed stable occlusion in 14 (82.4%), minor recanalization in two (11.8%), and major recanalization, which required recoiling, in one (5.9%). Conclusion Our experiences demonstrate that endovascular treatment for a ruptured PA aneurysms is both feasible and effective. However, periprocedural rebleedings were found to occur far more often (20.0%) than is generally suspected and to be associated with preoperative contrast retention. Analysis showed existing adjacent hematoma is predictive of a poor clinical outcome.
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Affiliation(s)
- Jun Kyeung Ko
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hwan Soo Kim
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyuk Jin Choi
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Tae Hong Lee
- Department of Diagnostic Radiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eun Young Yun
- Department of Biostatistics, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Chang Hwa Choi
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
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29
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Yang W, Huang J. Treatment of middle cerebral artery (MCA) aneurysms: a review of the literature. Chin Neurosurg J 2015. [DOI: 10.1186/s41016-015-0001-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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30
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Aboukaïs R, Zairi F, Bourgeois P, Boustia F, Leclerc X, Lejeune JP. Pericallosal aneurysm: A difficult challenge for microsurgery and endovascular treatment. Neurochirurgie 2015; 61:244-9. [PMID: 26072225 DOI: 10.1016/j.neuchi.2015.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 03/23/2015] [Accepted: 03/29/2015] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Pericallosal artery aneurysms (PAA) represent 2 to 9% of intracranial aneurysms and their management remains difficult. OBJECTIVE We aimed to report our experience to evaluate the outcome of patients with ruptured and unruptured PAA, when the treatment modality is decided in a multidisciplinary fashion. MATERIALS AND METHODS In this retrospective study, we included 28 patients (8 men and 20 women) treated for a PAA in our institution between 2002 and 2012, among the 2430 patients who underwent the treatment of an intracranial aneurysm in the same period. Fifteen patients harbored a ruptured aneurysm while 13 benefited from a prophylactic treatment. The mean age at diagnosis was 52 years (range 37 to 75 SD: ± 5) in patients with ruptured aneurysm and 54.2 years (range 35 to 66 SD: ± 5) in patients with unruptured aneurysm. Endovascular treatment has been performed in 9 patients while 19 patients underwent a microsurgical treatment. Clinical outcome has been assessed using the modified Rankin scale (mRS) at 3 months. Long-term imaging follow-up included a CT angiography at 36 months for clipped aneurysms and MR angiography at 6, 18 and 36 months for coiled aneurysms. RESULTS The median follow-up was 3.4 years (range 2.8 to 4.2). The mRS was ≤ 2 in all patients with unruptured aneurysms. In patients with ruptured aneurysm, the mRS was ≤ 2 at 3 months in 13 patients (87%). Persistent cognitive disorders were noted in 8 patients with ruptured aneurysm, 2 of them were considered as possibly related to the treatment. Aneurysm recurrence has been depicted in 4 patients (at 6 months in 3 patients and 1 year in 1 patient) requiring further treatment in all cases; all of them had an aneurysm remnant on immediate conventional angiography. No recurrence was noted in patients without remnant on immediate post-treatment angiography. CONCLUSION Both endovascular and microsurgical treatment are challenged in this location. Multidisciplinary discussion is essential to optimize the management of patients with PAA.
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Affiliation(s)
- R Aboukaïs
- Department of neurosurgery, Lille university hospital, rue E.-Laine, 59037 Lille cedex, France.
| | - F Zairi
- Department of neurosurgery, Lille university hospital, rue E.-Laine, 59037 Lille cedex, France
| | - P Bourgeois
- Department of neurosurgery, Lille university hospital, rue E.-Laine, 59037 Lille cedex, France
| | - F Boustia
- Department of neuroradiology, Lille university hospital, rue E.-Laine, 59037 Lille cedex, France
| | - X Leclerc
- Department of neuroradiology, Lille university hospital, rue E.-Laine, 59037 Lille cedex, France
| | - J-P Lejeune
- Department of neurosurgery, Lille university hospital, rue E.-Laine, 59037 Lille cedex, France
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