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Gu W, Zhou G, Aldiyarova A, Liu T, Zhang Y, Liu W, Meng L, Gu B, Li M, Su M, Su C, Liu A, Wang W. Stent-assisted coiling of intracranial carotid ophthalmic segment aneurysm segment aneurysms: Long-term follow-up from a single center. J Interv Med 2023; 6:116-120. [PMID: 37846339 PMCID: PMC10577061 DOI: 10.1016/j.jimed.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 10/18/2023] Open
Abstract
Background To evaluate the efficacy of stent-assisted coiling (SAC) for the treatment of carotid ophthalmic segment aneurysm segment aneurysms (OSAs) of the internal carotid artery (ICA) through detailed long-term follow-up of a large patient cohort. Methods We retrospectively analyzed 88 consecutive patients with OSAs between January 2009 and January 2020 at our center. Angiographic results were evaluated using the modified Raymond grading system and clinical outcomes were evaluated using the mRS scale. The primary endpoints were major aneurysm recurrence and poor clinical outcomes for at least 18 months of follow-up. The patients were asked to attend clinical follow-up assessments and possibly undergo DSA or MR via telephone. Results We enrolled 88 patients with 99 OSAs treated with coiling, of whom 76 were treated with SAC. The coiling procedures were successful in all 88 patients. Overall, complications occurred in 8 patients (9.1%). No procedure-related mortality was observed. 67 (76.1%) experienced immediate aneurysm occlusion at the end of the procedure. Long-term angiographic follow-up (18 months) was available in 45/88 aneurysms (51%) (average 18.7 ± 5.2 months). Four patients continued their follow-up for 5 years after initial aneurysm treatment. After a clinical follow-up time of 28.7 months (range, 12-51 months), 85 patients (95.5%) achieved favorable clinical outcomes (mRS scores of 0-2). Conclusions This study indicates that SAC treatment is a safe and effective therapeutic alternative for ruptured and unruptured OSAs. The procedural risks are low with relatively long-term effectiveness.
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Affiliation(s)
- Wenquan Gu
- Department of Radiology, Shanghai Punan Hospital, Shanghai, 200125, China
| | - Geng Zhou
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Aizada Aldiyarova
- Chemotherapy Department, Multidisciplinary Medical Center of the Akimat of Astana, Astana, 010009, Kazakhstan
| | - Tengyue Liu
- Department of Orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin, 130041, China
| | - Yi Zhang
- Department of Interventional Radiology & Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, Nanjing, 210000, China
| | - Weidong Liu
- Department of Radiology, Shanghai Punan Hospital, Shanghai, 200125, China
| | - Lingping Meng
- Department of Radiology, Shanghai Sixth People's Hospital Jinshan Branch, Shanghai, 201599, China
| | - Binxian Gu
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - MingHua Li
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Ming Su
- Shandong Academy of Traditional Chinese Medicine, 7 Yanzishan West Road, Jinan, Shandong, 250014, China
| | - Chen Su
- Department of Oncology, Jinan Central Hospital, Central Hospital Affiliated to Shandong First Medical University, No.105, Jie Fang Road, Jinan, 250013, Shandong, China
| | - Aihua Liu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Wu Wang
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
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Medani K, Hussain A, Quispe Espíritu JC, Mayeku J, Avilés-Rodríguez GJ, Sikka A, Lopez-Gonzalez M. Basilar apex aneurysm systematic review: Microsurgical versus endovascular treatment. Neurochirurgie 2022; 68:661-673. [PMID: 35965246 DOI: 10.1016/j.neuchi.2022.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Both microsurgical and endovascular techniques continued to be treatment options for basilar apex aneurysms (BAA). We conducted a systematic review to compare both treatment options in terms of both clinical and radiological outcomes. METHODS The PRISMA method was used to identify related articles. Data collected from each article and the two treatment approaches were compared in terms of favorable clinical outcome and complete/near complete occlusion rate. Subgroup analysis was done based on the size and the rupture status of BAA. RESULTS Fifty-nine (59) and 32 articles reported a measurable clinical and radiological outcome respectively. The weighted average favorable clinical outcome was significantly higher in the endovascular group (86.4% vs 79.6%, P<0.0001), while the weighted average complete/near complete occlusion rate was significantly higher in the surgical group (92.6% vs 83.8%, P<0.0001). In the subgroup analysis, the favorable clinical outcome remained significantly higher in the endovascular group for the ruptured, unruptured and giant/large BAA (P<0.001), but not in the small BAA subgroup (P=0.26). The occlusion rate remained significantly higher in the surgical group for all subgroups (P<0.001). CONCLUSION Treatment of BAA remains in a trade-off between favorable clinical outcome and complete or near-complete occlusion depending on the treatment modality selected. Careful selection of cases and judicial discussion between open surgical and endovascular team is warranted for treatment optimization.
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Affiliation(s)
- Khalid Medani
- Department of Preventive Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA.
| | - Abid Hussain
- Department of Family Medicine, Memorial Medical Center, Las Cruces, NM, USA
| | | | - Julie Mayeku
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Gener J Avilés-Rodríguez
- Escuela de Ciencias de la Salud, Universidad Autonoma de Baja California, Ensenada, Baja California, Mexico
| | - Anshuman Sikka
- Department of Neurosurgery, Safdarjung Hospital, New Delhi, India
| | - Miguel Lopez-Gonzalez
- Department of Neurological Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA.
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Moshayedi H, Omofoye OA, Yap E, Oyekunle TO, Sasaki-Adams DM, Solander SY. Factors Affecting the Obliteration Rate of Intracranial Aneurysms Treated with a Single Pipeline Embolization Device. World Neurosurg 2017; 104:205-212. [PMID: 28457931 DOI: 10.1016/j.wneu.2017.04.111] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/14/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the clinical and angiographic outcomes of intracranial aneurysm treatment using a single Pipeline embolization device (PED), and to evaluate the factors affecting aneurysm obliteration rate. METHODS The demographic characteristics and anatomic features of 58 aneurysms in 47 patients treated with a single PED were reviewed retrospectively. All aneurysms treated with a PED at a single center and with follow-up angiograms for at least 6 months were included in this study. RESULTS The overall rate of complete and near-complete occlusion was 84% (49 of 58) after a mean follow-up period of 18.3 months. The rate of complete aneurysm obliteration was lower in aneurysms with an arterial branch arising from the aneurysm neck compared with aneurysms without an arterial branch (13% [1 of 8] vs. 68% [34 of 50]; P = 0.0075). The overall rate of complete and near-complete aneurysm occlusion was 90% (45 of 50) in aneurysms without an arterial branch arising from its neck. There were no statistically significant associations between obliteration rate and aneurysm neck width, size, or type, or history of previous coil embolization. CONCLUSIONS Our data suggest that a single PED is sufficient to induce complete or near-complete obliteration of most aneurysms. The presence of a branching artery arising from the aneurysm neck is highly predictive of incomplete occlusion after treatment with a single PED.
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Affiliation(s)
- Hanieh Moshayedi
- Division of Interventional Neuroradiology, Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Oluwaseun A Omofoye
- Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
| | - Edward Yap
- Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Taofik O Oyekunle
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Deanna M Sasaki-Adams
- Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sten Y Solander
- Division of Interventional Neuroradiology, Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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