1
|
Shi S, Long S, Hui F, Tian Q, Wei Z, Ma J, Yang J, Wang Y, Han X, Li T. Safety and Efficacy of LVIS Jr Stent-assisted Coiling of Intracranial Aneurysms in Small-diameter Parent Arteries : A Single-center Experience. Clin Neuroradiol 2024:10.1007/s00062-024-01397-0. [PMID: 38451269 DOI: 10.1007/s00062-024-01397-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/02/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE To investigate the safety and efficacy of LVIS Jr stent-assisted coiling (SAC) of intracranial aneurysms (IAs) in small-diameter parent arteries and determine the factors influencing incomplete aneurysm occlusion. MATERIAL AND METHODS Clinical and imaging data of 130 patients with IAs in small-diameter parent arteries that were treated with LVIS Jr SAC were retrospectively analyzed. Stent apposition was evaluated by high-resolution flat detector CT, and aneurysm embolization density was evaluated using 2D-DSA. Perioperative complications were recorded. Multivariate logistic regression analyses were performed to determine possible factors for incomplete aneurysm occlusion. RESULTS In this study, 130 patients (60 and 70 patients with ruptured and unruptured aneurysms, respectively) were successfully treated with LVIS Jr SAC. Immediate digital subtraction angiography (DSA) showed that the aneurysm occlusion was Raymond-Roy class I, II, IIIa, and IIIb in 93 (71.5%), 24 (18.5%), 8 (6.2%), and 5 (3.8%) cases, respectively. There were three cases of acute in-stent thrombosis and two cases of severe vasospasm observed during the perioperative period. The 6‑month follow-up angiograms indicated that complete aneurysm occlusion in 122 patients was 79.5% (97/122). Multivariate logistic regression analyses showed that an aneurysm size > 10.0 mm, parent artery mean diameter < 2.0 mm, and incomplete stent apposition at the aneurysm neck were possible risk factors for incomplete aneurysm occlusion. CONCLUSION The LVIS Jr SAC is effective for managing IAs in small-diameter parent arteries. An aneurysm size > 10.0 mm, parent artery mean diameter < 2.0 mm, and incomplete stent apposition at the aneurysm neck are possible risk factors for incomplete aneurysm occlusion.
Collapse
Affiliation(s)
- Shuailong Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jianshe Road No. 1, Er qi district, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Shuhai Long
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jianshe Road No. 1, Er qi district, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | | | - Qi Tian
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jianshe Road No. 1, Er qi district, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Zhuangzhuang Wei
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jianshe Road No. 1, Er qi district, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Ji Ma
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jianshe Road No. 1, Er qi district, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Jie Yang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jianshe Road No. 1, Er qi district, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Ye Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jianshe Road No. 1, Er qi district, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jianshe Road No. 1, Er qi district, Zhengzhou, Henan, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Tengfei Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jianshe Road No. 1, Er qi district, Zhengzhou, Henan, China.
- Interventional Institute of Zhengzhou University, Zhengzhou, China.
| |
Collapse
|
2
|
Shah R, Saraf R. Fusiform "True" Posterior Communicating Artery Aneurysm with Basilar Artery Occlusion: A Case Report. Neurointervention 2024; 19:57-60. [PMID: 38359946 PMCID: PMC10910176 DOI: 10.5469/neuroint.2023.00472] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024] Open
Abstract
Isolated posterior communicating artery (PCoA) aneurysms are rare, predominantly fusiform in morphology, and rarely present with subarachnoid hemorrhage. Endovascular management of this pathology is technically challenging due to extreme tortuosity, the artery course in the subarachnoid space, sharp angulations at PCoA junctions with the parent artery, and, at times, associations with either internal carotid artery or basilar artery occlusions. We present a case of a ruptured fusiform PCoA at the junction of middle and distal third with concomitant proximal basilar artery occlusion. The PCoA reforms the posterior circulation, making it a vital artery. Stent-assisted coiling was performed with extreme difficulty in achieving distal positioning of the stents in the basilar artery/posterior cerebral artery/distal PCoA due to artery tortuosity. There was technical difficulty in the stent deployment. After changing strategies to a larger diameter laser-cut stent, endovascular treatment could be performed. There were good angiographic and clinical outcomes with stable occlusion at 6-month-follow-up.
Collapse
Affiliation(s)
- Ritu Shah
- Department of Radiology, King Edward Memorial Hospital, Seth Gordhandas Sunderdas Medical College, Mumbai, India
| | - Rashmi Saraf
- Department of Radiology, King Edward Memorial Hospital, Seth Gordhandas Sunderdas Medical College, Mumbai, India
| |
Collapse
|
3
|
Goertz L, Zopfs D, Pennig L, Zaeske C, Timmer M, Turowski B, Kaschner M, Borggrefe J, Schönfeld M, Schlamann M, Kabbasch C. Comparative Analysis of the Low-Profile Acclino Stent and the Enterprise Stent for the Treatment of Unruptured Intracranial Aneurysms. World Neurosurg 2024; 182:e517-e524. [PMID: 38043742 DOI: 10.1016/j.wneu.2023.11.138] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE In preliminary studies, advanced intracranial stents appear to have a favorable safety profile for intracranial aneurysm treatment. This dual-center study is a head-to-head comparison of the low-profile Acandis Acclino stent (a third-generation stent) and the first- and second-generation Enterprise stent. METHODS Patients who underwent stent-assisted coiling with either the Enterprise or the Acclino stent for unruptured aneurysms during an 8-year period were enrolled and compared for complications, clinical outcomes, and angiographic results. Primary outcome measures were ischemic stroke rate and mid-term complete occlusion rate. Propensity score adjustment was performed to account for small differences between the groups. RESULTS Enterprise and Acclino stents were used in 48 cases each. The overall rate of thrombotic complications was higher in the Enterprise group than in the Acclino group (20.8% vs. 4.2%, HR: 6.6, 95%CI: 2.2-20.0, P = 0.01, adjusted P < 0.01), which translated into a higher rate of major ischemic stroke after Enterprise treatment (6.3% vs. 0%, HR: 2.1, 95%CI: 1.8-2.4, P = 0.08, adjusted P < 0.01). Mid-term and long-term angiographic follow-up showed complete occlusion rates of 83.3% and 75.0% for Enterprise and 89.2% and 75.9% for Acclino (both P > 0.05). Retreatment rates were 10.4% in the Enterprise group and 4.2% in the Acclino group (P = 0.42, adjusted P = 0.10). CONCLUSIONS The results indicate a favorable safety profile of the Acclino over the Enterprise, justifying the use of advanced stent systems in clinical practice. However, further comparative studies of the Acclino and other competing stent systems are needed to draw a definitive conclusion on the state of stent-assisted coiling.
Collapse
Affiliation(s)
- Lukas Goertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - David Zopfs
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Charlotte Zaeske
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marco Timmer
- Department of General Neurosurgery, Center for Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Bernd Turowski
- Department of Neuroradiology, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Marius Kaschner
- Department of Neuroradiology, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Michael Schönfeld
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marc Schlamann
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christoph Kabbasch
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
4
|
Nabizadeh F, Valizadeh P, Balabandian M. Stent-assistant versus non-stent-assistant coiling for ruptured and unruptured intracranial aneurysms: A meta-analysis and systematic review. World Neurosurg X 2024; 21:100243. [PMID: 38221954 PMCID: PMC10787302 DOI: 10.1016/j.wnsx.2023.100243] [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: 10/12/2022] [Accepted: 10/04/2023] [Indexed: 01/16/2024] Open
Abstract
Background Several different endovascular and non-invasive treatment methods are suggested for the various types of intracranial aneurysms including simple, balloon-assisted, and stent-assisted coiling (SAC). Previous studies investigated the safety and efficacy of SAC versus non-stent-assisted coiling (non-SAC) but the results were controversial. We aim to perform a systematic review and meta-analysis to compare the efficacy and safety of SAC with non-SAC technique in stratifying by the ruptured and unruptured aneurysms. Methods PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were searched in April 2022 for studies investigated the efficacy and safety of SAC versus non-SAC. Results Overall, 26 studies entered into our qualitative and quantitative synthesis. We found that there was overall lower recurrence rate in SAC versus non-SAC significant (RR: 0.43, 95%CI: 0.33, 0.53). Furthermore, the comparisons were significant in unruptured (RR: 0.63, 95%CI: 0.40, 0.86), ruptured (RR: 0.29, 95%CI), and combination aneurysms (RR: 0.42, 95%CI: 0.30, 0.54). Also, we found higher risk of intraprocedural rupture for SAC versus non-SAC in unruptured aneurysms (RR: 1.40, 95%CI: 1.31, 1.50). Investigating hemorrhagic events risk showed that there was significant difference in ruptured (RR: 1.73, 95%CI: 1.12, 2.34) and combination aneurysms (RR: 0.60, 95%CI: 0.37, 0.82). There was no significant difference in immediate occlusion rate, complete occlusion, and risk of ischemic events in our analysis. Conclusion Overall, our findings demonstrated that SAC may have higher efficacy in term of recurrence rate, but also may have a higher risk of complications in the treatment of intracranial aneurysms. As there are several factors affecting the outcomes and safety of these interventions, further RCTs controlled for multiple factors are required better guide the neurointerventionists choose the best strategy.
Collapse
Affiliation(s)
- Fardin Nabizadeh
- Neuroscience Research Group (NRG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Parya Valizadeh
- School of Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Balabandian
- Neuroscience Research Group (NRG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Zhang YB, Yao PS, Wang HJ, Xie BS, Wang JY, Zhu M, Wang DL, Yu LH, Lin YX, Gao B, Zheng SF, Kang DZ. Treatment with a flow diverter-assisted coil embolization for ruptured blood blister-like aneurysms of the internal carotid artery: a technical note and analysis of single-center experience with pooled data. Neurosurg Rev 2023; 46:305. [PMID: 37982900 DOI: 10.1007/s10143-023-02216-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/25/2023] [Accepted: 11/07/2023] [Indexed: 11/21/2023]
Abstract
Treatment of blood blister-like aneurysms (BBAs) of the supraclinoid internal carotid artery (ICA) with flow diverters (FDs) has become widespread in recent years. However, ruptured blood blister-like aneurysm (BBA) of ICA treatment with flow diverter-assisted coil embolization (FDAC) remains controversial. Moreover, limited direct comparative studies have been conducted between the two treatment modalities, FDs and FDAC, for BBAs. The purpose of this study was to document our experience and evaluate the effectiveness and safety of FDAC. We conducted a retrospective analysis of clinical and radiological information from ten patients who experienced ruptured BBAs of the supraclinoid ICA at our center from January 2021 to February 2023. The technical details of FDAC for ruptured BBAs were described, and the technical steps were named "pipeline embolization device (PED)-Individualized shaping(microcatheter)-Semi deploying-Rivet(coils)-Massage(microwire)" as the PEISSERM technique. Clinical outcomes were assessed using the modified Rankin Scale (mRS), whereas radiological results were determined through angiography. A pooled analysis was implemented, incorporating data from literature sources that reported perioperative and long-term clinical and angiographic outcomes of ruptured BBAs treated with FD and FDAC strategies, along with our data. Data in our analysis pool were categorized into FD and FDAC strategy groups to explore the preferred treatment modalities for BBAs. The PEISSERM technique was utilized to treat ten patients, seven males, and three females, with an average age of 41.7 years. A single PED was deployed in conjunction with coils in all ten patients. All PEDs were documented to have good wall apposition. The immediate postoperative angiograms demonstrated Raymond grade I in ten aneurysms. Angiographic follow-up of nine patients at 4-25 months showed total occlusion of the aneurysms. At the most recent follow-up, the mRS scores of nine patients hinted at a good prognosis. Pooled analysis of 233 ICA-BBA cases of FD revealed a technical success rate of 91% [95% confidence interval (CI), 0.88 to 0.95], a rate of complete occlusion of 79% (95% CI, 0.73 to 0.84), a recurrence rate of 2% (95% CI, 0.00 to 0.04), a rebleed rate of 2% (95% CI, 0.00 to 0.04), and the perioperative stroke rate was 8% (95% CI, 0.04 to 0.11). The perioperative mortality was 4% (95% CI, 0.01 to 0.07). The long-term good clinical outcome rate was 85% (95% CI, 0.80 to 0.90). The mortality rate was 6% (95% CI, 0.03 to 0.09). Results from the subgroup analysis illustrated that the FDAC strategy for BBAs had a significantly higher immediate postoperative complete occlusion rate (P < 0.001), total occlusion rate (P = 0.016), and a good outcome rate (P = 0.041) compared with the FD strategy. The FDAC strategy can yield a higher rate of good outcomes than the FD strategy. The PEISSERM technique employed by the FDAC is a reliable and effective treatment approach as it can minimize the hemodynamic burden of BBA's fragile dome, thereby achieving an excellent occlusion rate. The PEISSERM technique in the FDAC strategy contributes to understanding the BBA's treatment and offers a potentially optimal treatment for BBA.
Collapse
Affiliation(s)
- Yi-Bin Zhang
- Department of Neurosurgery, Neurosurgery Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Neurosurgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Pei-Sen Yao
- Department of Neurosurgery, Neurosurgery Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Neurosurgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Hao-Jie Wang
- Department of Neurosurgery, Neurosurgery Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Neurosurgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Bing-Sen Xie
- Department of Neurosurgery, Neurosurgery Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Neurosurgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Jia-Yin Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Mei Zhu
- Department of Neurosurgery, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, 350005, China
| | - Deng-Liang Wang
- Department of Neurosurgery, Neurosurgery Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Neurosurgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Liang-Hong Yu
- Department of Neurosurgery, Neurosurgery Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Neurosurgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Yuan-Xiang Lin
- Department of Neurosurgery, Neurosurgery Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Neurosurgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- Fujian Provincial Clinical Research Center for Neurological Diseases, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Fujian Provincial Institutes of Brain Disorders and Brain Sciences, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Bin Gao
- Fujian Provincial Institutes of Brain Disorders and Brain Sciences, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Shu-Fa Zheng
- Department of Neurosurgery, Neurosurgery Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
- Department of Neurosurgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
- Fujian Provincial Institutes of Brain Disorders and Brain Sciences, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
| | - De-Zhi Kang
- Department of Neurosurgery, Neurosurgery Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
- Department of Neurosurgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
- Fujian Provincial Clinical Research Center for Neurological Diseases, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
- Fujian Provincial Institutes of Brain Disorders and Brain Sciences, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
- Clinical Research and Translation Center, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Lim J, Monteiro A, Jacoby WT, Danziger H, Kuo CC, Alkhars H, Donnelly BM, Khawar WI, Lian MX, Iskander J, Davies JM, Snyder KV, Siddiqui AH, Levy EI. Coiling Variations for Treatment of Ruptured Intracranial Aneurysms: A Meta-Analytical Comparison of Comaneci-, Stent-, and Balloon-Coiling Assistance Techniques. World Neurosurg 2023; 175:e1324-e1340. [PMID: 37169072 DOI: 10.1016/j.wneu.2023.05.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Wide-necked aneurysms represent a challenge for treatment in the setting of acute subarachnoid hemorrhage. Stent-assisted coiling (SAC) and balloon-assisted coiling (BAC) are well-known techniques for treating wide-necked aneurysms. Comaneci-assisted coiling (CAC) is a newer technique involving temporary stent deployment to assist aneurysm coiling. We aim to present the first meta-analysis comparing these treatments of ruptured aneurysms. METHODS Following PRISMA guidelines, PubMed and Embase databases were queried from earliest records to July 2022 for literature reporting SAC, BAC, or CAC of ruptured intracranial aneurysms. A meta-analysis of identified articles was performed. RESULTS Of the 571 articles queried, 64 articles were included. One study reported BAC and SAC, 8 reported BAC, 52 reported SAC, and 3 reported CAC. These studies comprised 3153 patients with 3207 ruptured aneurysms treated with CAC (161 patients and aneurysms), BAC (330 patients and aneurysms), and SAC (2662 patients, 2716 aneurysms). Rates of periprocedural thromboembolic or hemorrhagic complications, overall or procedure-related mortality, immediate complete occlusion, retreatment, and length of angiographic follow-up did not differ significantly between SAC and BAC. Periprocedural thromboembolic (P = 0.03) and hemorrhagic (P = 0.01) complication rates were higher with BAC than CAC. Periprocedural thromboembolic (P = 0.03) and hemorrhagic (P < 0.0001) complication rates were higher with SAC than CAC. Complete aneurysm occlusion rates (P = 0.033) were higher with CAC than BAC. No significant differences were present in CAC versus BAC or SAC retreatment rates. CONCLUSIONS CAC was associated with lower hemorrhagic and thromboembolic complication rates and demonstrated similar complete occlusion and residual retreatment rates to those for BAC and SAC.
Collapse
Affiliation(s)
- Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Wady T Jacoby
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Hannah Danziger
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Hussain Alkhars
- George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Brianna M Donnelly
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Wasiq I Khawar
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Ming X Lian
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Joseph Iskander
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
| |
Collapse
|
8
|
Cheng R, Su K, Zhou X, Jiang X, Luo P, Zhang W, Qian X, Lai L. Does dual antiplatelet therapy increase the risk of haematoma enlargement in the acute stage? A retrospective study of the use of stent-assisted coiling versus coiling alone or balloon-assisted coiling for the treatment of ruptured intracranial aneurysms combined with intracranial haematoma. Neurosurg Rev 2023; 46:133. [PMID: 37266675 DOI: 10.1007/s10143-023-02036-x] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/12/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Abstract
This study aims to identify the efficacy and safety of stent-assisted coiling (SAC) treatment of ruptured intracranial aneurysms (RIAs) combined with intracranial haematoma (ICH) compared to coiling alone or balloon-assisted coiling (non-SAC). A retrospective analysis of 54 consecutive patients receiving endovascular therapy from 2014 to 2020 was performed. The data collected included baseline characteristics, angiographic results, perioperative complications, immediate aneurysm occlusion, clinical outcomes, follow-up at discharge and after 6 months, hospitalisation costs, and inpatient length of stay. Patients were categorised into the SAC group and the non-SAC group. Univariate and multivariate logistic regression analyses were used to identify risk factors related to clinical outcomes. Of the 54 patients harbouring RIAs with ICH, 22 (40.74%) and 32 (59.26%) patients were subject to SAC and non-SAC treatments, respectively. Postoperative rebleeding (1 [4.5%] and 3 [9.3%] in SAC and non-SAC groups, respectively, p > 0.05) and Hunt-Hess grade (IV-V) lesions (13.6% vs. 40.6%, p = 0.067) did not differ between the two groups. In total, 10 (45.5%) patients treated with SAC received a Fisher scale score of 0-3 compared with 6 (18.8%) patients treated with non-SAC methods (p = 0.035). Compared with the non-SAC group (7/21.9%), the rate of wide-necked aneurysms was increased in the SAC group (11/50%) (p = 0.031). No differences in poor outcomes (mRS > 2) were noted between the SAC and non-SAC groups (p > 0.05). Multivariate analysis revealed that ischaemic complication events (p = 0.016) represent the only independent risk factor for adverse outcomes, and a trend towards unfavourable clinical outcomes was noted for patients who smoke (p = 0.087). SAC is a safe and efficient treatment for RIAs combined with ICH when dual antiplatelet therapy (DAPT) is used in the perioperative period. In addition, SAC should be preferentially used in wide-neck RIAs. Ischaemic complications are a risk factor for poor clinical outcomes. Given the small sample size and retrospective bias of this study, these findings should be further verified in a study with a larger sample size or a randomised controlled trial (RCT).
Collapse
Affiliation(s)
- Ruoxi Cheng
- Queen Mary School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Kangtai Su
- The First Clinical Medical School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Xiaobing Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xin Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Peiyi Luo
- Queen Mary School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Weiyun Zhang
- Queen Mary School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Xiao Qian
- Queen Mary School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Lingfeng Lai
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| |
Collapse
|
9
|
Suleyman K, Korkmazer B, Kocer N, Islak C, Kızılkılıc O. Evaluation of short- and long-term results of Y- stent-assisted coiling with Leo stents in endovascular treatment of wide-necked intracranial bifurcation aneurysms. Neuroradiology 2023; 65:785-791. [PMID: 36651939 DOI: 10.1007/s00234-023-03116-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/23/2022] [Accepted: 01/06/2023] [Indexed: 01/19/2023]
Abstract
PURPOSE This study aimed to evaluate the feasibility, safety, and efficacy of Y-stent-assisted coiling (Y-SAC) using LEO Baby® stents in treating of bifurcation aneurysms. METHODS Patients who underwent Y-SAC using a braided stent (LEO Baby®, Montmorency, France) for wide-necked intracranial aneurysms between 2009 and 2019 and whose radiological and clinical follow-up data for at least 6 months could be obtained were evaluated. Data were obtained from patient records and analyzed retrospectively. RESULTS We evaluated 111 patients with a mean age of 56.0 ± 10.8 years (range, 25-88 years). Most of the aneurysms were detected incidentally. Three patients had ruptured aneurysms. LEO Baby deployment and coiling were successful in all patients. Immediate aneurysm occlusion rates were determined as modified Raymond-Roy classification (mRRC) I 95.5% (n = 106), mRRC II 3.6% (n = 4), mRRC IIIa 0.9% (n = 1). In the sixth month, aneurysm occlusion rates were found to be complete and nearly complete in all patients (mRRC I 94.6%, n = 105 and mRRC II 4.5%; n = 5, respectively). Follow-up data of 91 patients for > 2 years were obtained. Of these, 88 had MRRCI obstruction and 3 had MRRC II obstruction. The overall complication rate was 4.8%, and one patient died during the post-procedural follow-up. CONCLUSION The long-term follow-up results of Y-stenting with LEO Baby revealed that it provides stable closure of the aneurysm sac while preserving the main arterial structures. Therefore, it is a safe, durable, and effective method for treating wide-necked and complex bifurcation aneurysms.
Collapse
Affiliation(s)
- Kanullah Suleyman
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
| | - Bora Korkmazer
- Division of Neuroradiology, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Naci Kocer
- Division of Neuroradiology, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Civan Islak
- Division of Neuroradiology, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Osman Kızılkılıc
- Division of Neuroradiology, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
- Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical School, Kocamustafapasa, Istanbul, 34300, Turkey.
| |
Collapse
|
10
|
Han JT, Zhang YX, Jia ZC, Jiang CH, Liu L, Luan JY, Liang F, Zhao YQ. [Clinical application of Neuroform Atlas stent-assisted coiling in the treatment of unruptured wide-neck intracranial aneurysms]. Beijing Da Xue Xue Bao Yi Xue Ban 2023; 55:139-43. [PMID: 36718702 DOI: 10.19723/j.issn.1671-167X.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To assess the safety and efficacy of Neuroform Atlas stent used in treatment of unruptured wide-neck intracranial aneurysms. METHODS Clinical data of 62 patients with unruptured wide-neck intracranial aneurysms undergoing Neuroform Atlas stent-assisted coiling from August 2020 to September 2021 were retrospectively analyzed. There were 64 aneurysms in those 62 patients. Among them, 25 aneurysms were located at the bifurcation of M1 segment on middle cerebral artery, 16 at the anterior communicating artery, 10 at the C7 segment of internal carotid artery, 5 at the C6 segment of internal carotid artery, 4 at the apex of basilar artery, 3 at the A3 segment of anterior cerebral artery, and 1 at the M2 segment of middle cerebral artery. All the patients underwent Neuroform Atlas stent-assisted coiling, including 49 patients with single stent assisted coiling and 15 patients with dual stents assisted coiling (14"Y"style and 1"X"style). After the procedure, the immediate DSA was performed to evaluate the status of aneurysm occlusion and the parent artery patency. The clinical follow-up was performed 3 months after the operation and evaluated based on the modified Rankin Scale(mRS).DSA image was reviewed at 6 months after operation and Raymond grading scale was used to assess the status of aneurysm occlusion and the parent artery patency. RESULTS A total of 62 patients with 64 aneurysms were all achieved technical success(100%).The immediate post-procedural Raymond scale was assessed, including Raymond Ⅰ in 57 aneurysms(89.1%, 57/64), Raymond Ⅱ in 6 aneurysms(9.3%, 6/64) and Raymond Ⅲ in 1 aneurysm(1.6%, 1/64). The peri-procedural complications rate was 4.8%(3/62), 2 patients developed intraoperative thrombosis and 1 patient suffered from local subarachnoid hemorrhage. Among them, 55 patients obtained 3 months clinical follow-up after operation and all the patients had good outcomes (mRS≤2), 50 patients with 52 aneurysms were followed up with DSA 6 months after operation, including Raymond Ⅰ in 45 aneurysms(86.5%, 45/52), Raymond Ⅱ in 4 aneurysms(7.7%, 4/52) and Raymond Ⅲ in 3 aneurysms(5.8%, 3/52). CONCLUSION Neuroform Atlas stent for the treatment of unruptured wide-neck intracranial aneurysms has high safety and good efficacy, and has its advantages over other traditional stents.
Collapse
|
11
|
Yi MM, Do HP, Li YC, Wang R, Zhuang Z, Xu MM, Liu T, Shao TF, Ding LP, Ge WH. Ticagrelor versus Clopidogrel in the Dual Antiplatelet Regimen for Unruptured Intracranial Aneurysm Treated with Stent-Assisted Coil Embolization: A Single-Center Cohort Study. World Neurosurg 2023; 170:e755-e765. [PMID: 36442786 DOI: 10.1016/j.wneu.2022.11.102] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dual antiplatelet therapy (DAPT) of aspirin plus clopidogrel is commonly used in patients with unruptured intracranial aneurysms treated with stent-assisted coil (SAC) embolization. However, the unpredictable clopidogrel efficacy of the 5%-55% nonresponders limits its use. Ticagrelor, as a potential alternative of clopidogrel, is an antiplatelet agent with low resistance rates but uncertain efficacy and safety in these patients. METHODS A single-center cohort study was performed to compare the efficacy and safety of ticagrelor with clopidogrel in the DAPT regimen in patients with unruptured intracranial aneurysms and treated with SAC. The patients with clopidogrel resistance identified as inadequate adenosine diphosphate inhibition rate determined by thromboelastography were treated with ticagrelor instead, and both drugs achieved adequate suppression of platelet aggregation when stents were implanted. The occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) and bleeding events was recorded through 6 months follow-up. RESULTS Data from 86 patients with 99 unruptured intracranial aneurysms and treated by SAC with clopidogrel were compared with those from 108 patients with 111 aneurysms and treated with ticagrelor. Neither the baseline characteristics nor the incidence of the MACCE or bleeding events differed between the groups. Ticagrelor exerted significantly higher adenosine diphosphate inhibition rate than that of the clopidogrel. Multivariable logistic regression analysis showed that the incidence of MACCE was related to hematocrit and fibrinogen levels. CONCLUSIONS Ticagrelor seemed to be as effective and safe as clopidogrel for SAC in unruptured intracranial aneurysms. Hematocrit and fibrinogen levels were independent risk factors for the incidence of MACCE.
Collapse
Affiliation(s)
- Man-Man Yi
- Nanjing Drum Tower Hospital, China Pharmaceutical University, Nanjing, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China; Department of Pharmacy, the Drum Tower Hospital Affiliated to the Medical School of Nanjing University, Nanjing, China; Department of Neurosurgery, the Drum Tower Hospital Affiliated to the Medical School of Nanjing University, Nanjing, China; Nanjing Clinical Pharmacy Center, Nanjing, China
| | - Hong Phuoc Do
- Nanjing Drum Tower Hospital, China Pharmaceutical University, Nanjing, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China; Department of Pharmacy, the Drum Tower Hospital Affiliated to the Medical School of Nanjing University, Nanjing, China; Department of Neurosurgery, the Drum Tower Hospital Affiliated to the Medical School of Nanjing University, Nanjing, China; Nanjing Clinical Pharmacy Center, Nanjing, China
| | - Yi-Chen Li
- Nanjing Drum Tower Hospital, China Pharmaceutical University, Nanjing, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China; Department of Pharmacy, the Drum Tower Hospital Affiliated to the Medical School of Nanjing University, Nanjing, China; Department of Neurosurgery, the Drum Tower Hospital Affiliated to the Medical School of Nanjing University, Nanjing, China; Nanjing Clinical Pharmacy Center, Nanjing, China
| | - Rong Wang
- Nanjing Drum Tower Hospital, China Pharmaceutical University, Nanjing, China; Department of Neurosurgery, the Drum Tower Hospital Affiliated to the Medical School of Nanjing University, Nanjing, China
| | - Zong Zhuang
- Nanjing Drum Tower Hospital, China Pharmaceutical University, Nanjing, China; Department of Neurosurgery, the Drum Tower Hospital Affiliated to the Medical School of Nanjing University, Nanjing, China
| | - Man-Man Xu
- Nanjing Drum Tower Hospital, China Pharmaceutical University, Nanjing, China; Department of Neurosurgery, the Drum Tower Hospital Affiliated to the Medical School of Nanjing University, Nanjing, China
| | - Tao Liu
- Nanjing Drum Tower Hospital, China Pharmaceutical University, Nanjing, China; Department of Neurosurgery, the Drum Tower Hospital Affiliated to the Medical School of Nanjing University, Nanjing, China
| | - Teng-Fei Shao
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China; Nanjing Clinical Pharmacy Center, Nanjing, China
| | - Lan-Ping Ding
- Nanjing Clinical Pharmacy Center, Nanjing, China; Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei-Hong Ge
- Nanjing Drum Tower Hospital, China Pharmaceutical University, Nanjing, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China; Nanjing Clinical Pharmacy Center, Nanjing, China.
| |
Collapse
|
12
|
Zhu D, Li Z, Zou C, Cao W, Zhang P, Yu Y, Li Q, Zhao R, Huang Q, Yang P, Xu Y, Hong B, Liu J, Fang Y. Treatment of intracranial bifurcation aneurysms with "X" stent-assisted coiling: A case series and literature review. J Stroke Cerebrovasc Dis 2023; 32:106946. [PMID: 36527944 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106946] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/08/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To clarify the safety and efficacy of "X" stent-assisted coiling (X-stenting) for the treatment of intracranial bifurcation aneurysms and to review the literature. METHODS We retrospectively reported five consecutive patients with six intracranial bifurcation aneurysms who underwent X-stenting between June 2014 and June 2020. The clinical and angiographic results were analyzed. We also performed an extensive PubMed review of medical literature up to June 2021. RESULTS Endovascular procedures were successfully applied to all six aneurysms. No procedure-related complications were noted. Follow-up angiograms were available for all patients and revealed occlusion in five aneurysms and improvement in one aneurysm. Clinical follow-up was performed for all patients, and the mRS score at follow-up was 0 in all patients. Thus, good outcomes were achieved in all patients, and no ischemic or hemorrhagic events were observed. CONCLUSIONS X-stenting appears to be safe for treating intracranial bifurcation aneurysms and effective in immediate and short-term outcome. Further research is required with well-designed, prospective studies with large sample sizes.
Collapse
Affiliation(s)
- Deyuan Zhu
- Department of Neurovascular Disease, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Address: 1279 Sanmen Road, Shanghai 200080, China
| | - Zhe Li
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Chao Zou
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Wei Cao
- Department of Neurovascular Disease, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Address: 1279 Sanmen Road, Shanghai 200080, China
| | - Ping Zhang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Ying Yu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Qiang Li
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Rui Zhao
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Qinghai Huang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Pengfei Yang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yi Xu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Bo Hong
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jianmin Liu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yibin Fang
- Department of Neurovascular Disease, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Address: 1279 Sanmen Road, Shanghai 200080, China.
| |
Collapse
|
13
|
Yamazaki D, Hanaoka Y, Koyama JI, Fujii Y, Ogiwara T, Horiuchi T. Transradial Stent-Assisted Coiling Using "Dual-Jailing" Technique for Kissing Aneurysms of the Internal Carotid Artery: Technical Note and Literature Review. World Neurosurg 2023; 170:175-81. [PMID: 36368455 DOI: 10.1016/j.wneu.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Kissing aneurysms are an unusual type of multiple intracranial aneurysms having different origins with partially adherent walls. Although endovascular treatment is a useful alternative to surgical clipping, endovascular management for small wide-necked kissing aneurysms has not been adequately investigated to date. Herein, we present a case of small wide-necked kissing aneurysms successfully treated with transradial stent-assisted coiling (SAC) using the "dual-jailing" technique. We also performed a review of the relevant literature. CASE PRESENTATION A 64-year-old woman who was diagnosed with small wide-necked kissing aneurysms relating to the ophthalmic artery underwent SAC using the dual-jailing technique. After a 6F Simmons guiding sheath was delivered into the target common carotid artery via transradial access, a 6F intermediate catheter was navigated into the petrous internal carotid artery to achieve both triple microcatheter manipulation and contrast injection. Two coil-delivery microcatheters were cannulated into each aneurysm, followed by a Neuroform Atlas stent deployment over the aneurysm necks via a third stent-delivery microcatheter. By using the jailed microcatheters, SAC of the kissing aneurysms was successfully achieved, preserving the ophthalmic artery. The postprocedural course was uneventful. A follow-up magnetic resonance angiography showed no evidence of recanalization 2 years 3 months post procedure. CONCLUSIONS The dual-jailing technique may provide simple and time-saving SAC compared with previous reported method. This technique can be a useful treatment option for small wide-necked kissing aneurysms.
Collapse
|
14
|
Gozal YM, Abou-Al-Shaar H, Alzhrani G, Taussky P, Couldwell WT. Complications of Endovascular and Open Aneurysm Surgery in the Era of Flow Diversion. Acta Neurochir Suppl 2023; 130:85-94. [PMID: 37548727 DOI: 10.1007/978-3-030-12887-6_11] [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] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
The techniques used for treatment of intracranial aneurysms have progressed dramatically over the decades. The introduction of modern endovascular techniques and the continued refinement of progressively less invasive neurosurgical approaches have contributed to steadily improving clinical outcomes. Moreover, innovations such as flow-diverting stents have achieved dramatic success and have gained rapid widespread adoption. Particularly in lesions for which the application of conventional treatment techniques is difficult, flow diversion technology has revolutionized aneurysm management. This review provides a discussion on the morbidity and mortality encountered in the treatment of intracranial aneurysms in the modern era. Common adverse events faced in the management of these lesions with open surgery and various endovascular techniques are highlighted.
Collapse
Affiliation(s)
- Yair M Gozal
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
- Mayfield Clinic, Cincinnati, OH, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gmaan Alzhrani
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Philipp Taussky
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
| |
Collapse
|
15
|
Peters DR, Parish JM, Starnoni D, Giammattei L, Stetler WR, Wait SD, Bernard JD. Endovascular treatment of pediatric basilar artery aneurysms: case series and literature review. Childs Nerv Syst 2023; 39:25-34. [PMID: 36318284 DOI: 10.1007/s00381-022-05728-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/25/2022] [Indexed: 02/28/2023]
Abstract
PURPOSE Pediatric basilar artery aneurysms are rare and challenging to treat. Microsurgical options and standard endovascular coiling are often undesirable choices for treatment of this pathology. Additional endovascular strategies are needed. METHODS Presentation, diagnosis, and management of pediatric basilar aneurysms were reviewed, with an emphasis on endovascular treatment strategies. Our case series of 2 patients was presented in detail, one treated with flow diversion and vessel sacrifice and one treated with stent-assisted coiling. An extensive review of the literation was performed to find other examples of pediatric basilar artery aneurysms treated with endovascular techniques. RESULTS Twenty-nine studies met inclusion criteria. Fifty-nine aneurysms in 58 patients were treated using endovascular techniques. Mortality rate was 10.3% (6/58) and a poor outcome (GOS 1-3) occurred in 15.5% (9/58). There were 4 reported recurrences requiring retreatment; however, only 46.5% of patients had reported follow-up of at least 1 year. 71.1% (42/59) were dissecting aneurysms. CONCLUSION Basilar artery aneurysms in the pediatric population are rare, commonly giant and fusiform, and often not amenable to microsurgical or coiling techniques. The surrounding vasculature, location, size, and morphology of the aneurysm along with the durability of treatment must be considered in treatment decisions. With proper patient selection, stent-assisted coiling and flow diversion may increase the durability and safety of endovascular treatment in this population.
Collapse
|
16
|
Yarahmadi P, Kabiri A, Bavandipour A, Jabbour P, Yousefi O. Intra-procedural complications, success rate, and need for retreatment of endovascular treatments in anterior communicating artery aneurysms: a systematic review and meta-analysis. Neurosurg Rev 2022; 45:3157-3170. [PMID: 36029421 DOI: 10.1007/s10143-022-01853-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/20/2022] [Revised: 07/30/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022]
Abstract
In recent years, intracranial aneurysms have been widely treated with endovascular methods. The anterior communicating artery (Acom) is the most common site of intracranial aneurysms. Despite its effectiveness, endovascular interventions can be associated with various intra-procedural and post-procedural complications. A systematic review of the literature was performed through PubMed, Embase, Scopus, and Web of Sciences databases up to March 18, 2022. The pooled rates of intra-procedural complications, mortality, procedure-related morbidities, the immediate and late aneurysm occlusion, and also the necessity for retreatment were calculated by applying random-effects models. A total of 41 articles with 4583 patients were included in the meta-analysis. The pooled rate of overall intra-procedural complications was 9.6% (95% CI: 7.7 to 11.8%). The initial rupture status and also type of EVT procedure did not affect the overall complication rate. The pooled rate of intra-procedural thrombosis, aneurysm rupture, coil prolapse, and early aneurysm rebleeding were 6.1% (95% CI: 4.5 to 8.2%); 4.2% (95% CI: 3.4 to 5.2%), 4.7% (95% CI: 3.2 to 6.7%), and 2.2% (95% CI: 1.5 to 3.2%), respectively. Our analysis showed that intra-procedural mortality occurred in 1.7% (95% CI: 1.1 to 2.5%) and procedure-related permanent morbidities in 3.3% (95% CI: 2.3 to 4.7%) of patients. Endovascular methods achieved complete and near to complete aneurysm occlusion (Raymond-Roy occlusion classification 1 and 2) in 89.2% (95% CI: 86.4 to 92.5%) of cases post-procedure, and 9.5% (95% CI: 7.3 to 12.4%) of patients needed retreatment due to recanalization in follow-ups. Endovascular treatment can serve as an acceptable method for Acom aneurysms. However, improved endovascular treatment equipment and new techniques provide more satisfactory outcomes for complicated cases.
Collapse
Affiliation(s)
- Pourya Yarahmadi
- Faculty of Medicine, Tehran University of Medical Sciences, Medicine, Tehran, Iran
| | - Ali Kabiri
- Faculty of Medicine, Iran University of Medical Sciences, Medicine, Tehran, Iran
| | | | - Pascal Jabbour
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Omid Yousefi
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
17
|
Li G, Han Y, Ding S, Pan Y, Zhang X, Zhao B. Stent-assisted coiling of acutely ruptured cerebral aneurysm: a multicenter prospective registry study (SAVE). BMC Neurol 2022; 22:264. [PMID: 35850667 PMCID: PMC9290198 DOI: 10.1186/s12883-022-02800-4] [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: 07/05/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Stent-assisted coiling (SAC) has been reported as a feasible and effective treatment of wide-neck cerebral aneurysms. However, the evidence of SAC of ruptured cerebral aneurysm is lacking. There are no prospective multicenter studies regarding SAC of acutely ruptured aneurysms within 72 hours after subarachnoid hemorrhage. The purpose of the study is to evaluate the safety and efficiency of SAC of acutely ruptured cerebral aneurysms. Methods This study is a prospective, multicenter, and observation registry of consecutive patients with acutely ruptured cerebral aneurysms treated with SAC. Acutely ruptured aneurysms were confirmed within 72 h after the onset of the syndrome. This study will enroll at least 300 patients in 7 high-volume tertiary hospitals (more than 150 cerebral aneurysms treated per year). The primary outcomes are treatment-related thromboembolic complications within 30 days of the treatment. The secondary outcomes are any hemorrhagic complications and aneurysm recurrence at 6 months of angiographic follow-up. The clinical outcomes are measured with the Modified Rankin Scale (mRS) at discharge and at the 6 months of follow-up. The favorable outcomes are defined as an mRS of grades 0 and 2. Discussion We will perform a prospective, multicenter, and observational registry study of consecutive patients with wide-neck acutely ruptured cerebral aneurysms to improve the safety strategy of SAC of acutely ruptured cerebral aneurysms. Trial registration Chinese Clinic Trial Registry: ChiCTR2000036972; Registration date: Aug 26, 2020
Collapse
Affiliation(s)
- Gaozhi Li
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Pujian 160 Road, Shanghai, 200217, China
| | - Yongquan Han
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Pujian 160 Road, Shanghai, 200217, China.,Department of Neurosurgery, the Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, China
| | - Shenghao Ding
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Pujian 160 Road, Shanghai, 200217, China
| | - Yaohua Pan
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Pujian 160 Road, Shanghai, 200217, China
| | - Xiaohua Zhang
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Pujian 160 Road, Shanghai, 200217, China
| | - Bing Zhao
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Pujian 160 Road, Shanghai, 200217, China.
| |
Collapse
|
18
|
Kwon MY, Ko YS, Kwon SM, Kim CH, Lee CY. Evaluation of Stent Apposition in the LVIS Blue Stent-Assisted Coiling of Distal Internal Carotid Artery Aneurysms : Correlation with Clinical and Angiographic Outcomes. J Korean Neurosurg Soc 2022; 65:801-815. [PMID: 35728979 DOI: 10.3340/jkns.2022.0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/03/2022] [Accepted: 05/11/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the stent apposition of a low-profile visualized intraluminal support (LVIS) device in distal internal carotid artery (ICA) aneurysms, examine its correlation with clinical and angiographic outcomes, and determine the predictive factors of ischemic adverse events (IAEs) related to stent-assisted coiling. Methods We retrospectively analyzed a prospectively maintained database of 183 patients between January 2017 and February 2020. The carotid siphon from the cavernous ICA to the ICA terminus was divided into posterior, anterior, and superior bends. The anterior bends were categorized into angled (V) and non-angled (C, U, and S) types depending on the morphology and measured angles. Complete stent apposition (CSA) and incomplete stent apposition (ISA) were evaluated using unsubtracted angiography and flat-panel detector computed tomography. Dual antiplatelet therapy with aspirin 200 mg and clopidogrel 75 mg was administered. Clopidogrel resistance was defined as fewer responders (≥10%, <40%) and non-responders (<10%) based on the percent inhibition (%INH) of the VerifyNow system. These were counteracted by a dose escalation to 150 mg for fewer responders or substitution with cilostazol 200 mg for non-responders. IAEs included intraoperative in-stent thrombosis, transient ischemic attack, cerebral infarction, and delayed in-stent stenosis. A multivariate logistic regression analysis was used to determine the predictive factors for ISA and IAEs. Results There were 33 ISAs (18.0%) and 27 IAEs (14.8%). The anterior bend angle was narrower in ISA (-4.16°±25.18°) than in CSA (23.52°±23.13°) (p<0.001). The V- and S-types were independently correlated with the ISA (p<0.001). However, treatment outcomes, including IAEs (15.3% vs. 12.1%), aneurysmal complete occlusion (91.3% vs. 88.6%), and recanalization (none of them), did not differ between CSA and ISA (p>0.05). The %INH of 27 IAEs (13.78%±14.78%) was significantly lower than that of 156 non-IAEs (26.82%±20.23%) (p<0.001). Non-responders to clopidogrel were the only significant predictive factor for IAEs (p=0.001). Conclusion The angled and tortuous anatomical peculiarity of the carotid siphon caused ISA of the LVIS device; however, it did not affect clinical and angiographic outcomes, while the non-responders to clopidogrel affected the IAEs related to stent-assisted coiling.
Collapse
Affiliation(s)
- Min-Yong Kwon
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Young San Ko
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Sae Min Kwon
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Chang-Hyun Kim
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Chang-Young Lee
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| |
Collapse
|
19
|
Tang H, Shang C, Zhang G, Zuo Q, Zhang X, Xu F, Xu Y, Zhao R, Huang Q, Li Q, Liu J. Braided stents assisted coiling for endovascular management of posterior cerebral artery aneurysms: a preliminary mid-term experience. Neuroradiology 2022; 64:1847-1856. [PMID: 35441874 DOI: 10.1007/s00234-022-02956-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/10/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Posterior cerebral artery (PCA) aneurysms are rare. This study is to evaluate the preliminary experience of braided stents applied in PCA aneurysms treatment. METHODS Angiographic and clinical data of 28 PCA patients treated with braided stents from July 2016 and September 2020 were retrospectively analyzed. RESULTS A total of 28 PCA aneurysms were enrolled. 22 (78.6%) aneurysms were dissecting aneurysms, while 6 (21.4%) aneurysms were saccular aneurysms. Thirty-five braided stents were implanted with dual stents implanted in 7 cases. Immediate angiographic results show that Raymond class I was obtained in 13 patients (46.4%), Raymond class II was obtained in 4 patients (14.3%), and Raymond class III was obtained in 11 patients (39.3%). Perioperative hemorrhagic events occurred in 1 patient (3.6%). Twenty-four patients (85.7%) received angiographic follow-up, and the mean follow-up time was 11.2 ± 4.9 months. Two patients (8.3%) were confirmed with IA neck recurrence, and 3 patients (12.5%) were confirmed asymptomatic parent artery occlusion (PAO). The other 19 patients were confirmed promoted occlusion with 18 Raymond class I (75%) and 1 Raymond class II (4.2%). Twenty-seven patients (96.4%) received clinical follow-up, and the mean follow-up time was 32.2 ± 13.5 months. One patient (3.7%) confirmed the death event 2 weeks after discharge. The other 27 patients (96.3%) got favorable clinical outcomes with an mRS score of 0-2. CONCLUSIONS Braided stent-assisted coiling with a high occlusion rate and relatively low complication rate provides an alternative strategy in treating PCA aneurysms. Long-term outcomes need further randomized study with larger case numbers.
Collapse
Affiliation(s)
- Haishuang Tang
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China.,Naval Medical Center of PLA, Navy Military Medical University, Shanghai, 200050, People's Republic of China
| | - Chenghao Shang
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China
| | - Guanghao Zhang
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China
| | - Qiao Zuo
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China
| | - Xiaoxi Zhang
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China
| | - Fengfeng Xu
- Naval Medical Center of PLA, Navy Military Medical University, Shanghai, 200050, People's Republic of China
| | - Yi Xu
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China
| | - Rui Zhao
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China
| | - Qiang Li
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China.
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital, Navy Military Medical University, Shanghai, 200433, People's Republic of China
| |
Collapse
|
20
|
Matsuda Y, Terada T, Tetsuo Y, Tsumoto T. Partially thrombosed giant basilar tip aneurysm that remarkably decreased in size after stent-assisted coiling associated with the disappearance of neovascularization. Neuroradiology 2021; 64:837-841. [PMID: 34839378 DOI: 10.1007/s00234-021-02867-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 11/19/2021] [Indexed: 11/26/2022]
Abstract
Endovascular treatment for partially thrombosed giant basilar tip aneurysms has not been established because of its low cure rate and numerous associated comorbidities. Although some authors reported the growth mechanism of partially thrombosed aneurysm, there is no report for the process of its shrinkage after treatment. We describe a case of a partially thrombosed giant basilar tip aneurysm presenting with disturbance of consciousness because of a mass effect and brain edema. The patient underwent stent-assisted coiling using a low-profile visualized intraluminal support stent (Terumo). Although pre-operative magnetic resonance imaging (MRI) and angiography revealed prominent neovascularization of the inner aneurysmal layer, this vessel was absent on follow-up angiography 1 month after treatment. Repeat angiography demonstrated the gradual recanalization of the aneurysm. However, repeat MRI examinations showed remarkable shrinkage of the thrombosed aneurysm, and the complete disappearance of the thrombosed component was noted 6 months after treatment. The disappearance of neovascularization 1 month after the treatment may have contributed to the shrinkage of the thrombosed aneurysm. Stent-assisted coiling combined with alteration caused a hemodynamic change in this aneurysm, and the flow-diverting effect might have controlled this partially thrombosed giant aneurysm.
Collapse
Affiliation(s)
- Yoshikazu Matsuda
- Department of Neurosurgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aobaku, Yokohama City, Kanagawa, 227-8501, Japan.
| | - Tomoaki Terada
- Department of Neurosurgery, Showa University Northern Yokohama Hospital, Yokohama City, Kanagawa, Japan
| | - Yoshiaki Tetsuo
- Department of Endovascular Therapy, Yokohama Municipal Citizen's Hospital, Yokohama City, Kanagawa, Japan
| | - Tomoyuki Tsumoto
- Department of Neurosurgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aobaku, Yokohama City, Kanagawa, 227-8501, Japan
| |
Collapse
|
21
|
Nguyen AV, Reed LK, Lesley WS. PulseRider Treated Aneurysm with Significant Artifact on Postoperative Magnetic Resonance Angiography: A Case Report and Literature Review. Neurointervention 2021; 16:293-297. [PMID: 34425636 PMCID: PMC8561032 DOI: 10.5469/neuroint.2021.00241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/17/2021] [Accepted: 07/26/2021] [Indexed: 11/24/2022] Open
Abstract
The PulseRider is a neuroendovascular adjunct for wide-necked intracranial aneurysms. The decreased metal burden of the PulseRider theoretically reduces artifact on radiologic imaging. However, we report here on a case of a patient who underwent PulseRider-assisted stent-coiling of a basilar tip aneurysm. He returned 19 months later for intermittent diplopia and darkening of vision but was neurologically intact on exam. Both contrast-enhanced and time-of-flight magnetic resonance angiography (MRA) demonstrated absence of signal in the basilar artery in the proximal anchors of the PulseRider. Given his lack of reproducible symptoms and high functional status, it is presumed that the imaging reflected artifact and not thrombosis/stenosis. Although the PulseRider is a useful treatment option for wide-necked intracranial aneurysms, the clinician should be aware that even contrast-enhanced MRA can produce artifact that resembles thrombosis/stenosis. Non-angiogram radiologic imaging modalities may be appropriate for evaluation for residual aneurysm but not patency of the parent artery.
Collapse
Affiliation(s)
- Anthony V Nguyen
- Department of Neurosurgery, Baylor Scott & White Medical Center, Temple, TX, USA.,Department of Surgery, Texas A&M University College of Medicine, Temple, TX, USA
| | - Laura K Reed
- Department of Neurosurgery, Baylor Scott & White Medical Center, Temple, TX, USA.,Department of Surgery, Texas A&M University College of Medicine, Temple, TX, USA
| | - Walter S Lesley
- Department of Neurosurgery, Baylor Scott & White Medical Center, Temple, TX, USA.,Department of Surgery, Texas A&M University College of Medicine, Temple, TX, USA
| |
Collapse
|
22
|
Salem MM, Salih M, Nwajei F, Williams N, Thomas AJ, Moore JM, Ogilvy CS. Longitudinal Cost Profiles of Pipeline Embolization Device Versus Stent-Assisted Coiling in Propensity-Matched Unruptured Small Anterior Circulation Aneurysms. Neurosurgery 2021; 89:867-872. [PMID: 34383055 DOI: 10.1093/neuros/nyab304] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 06/09/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The cost profiles of stent-assisted coiling (SAC) vs Pipeline embolization device (PED) in small unruptured anterior circulation aneurysms have not been studied. OBJECTIVE To compare the 2 modalities cost profiles in a propensity-matched cohort controlling for potential technical complexity confounders including size and location. METHODS Patients treated with either SAC or PED at our institution were identified. Following propensity-score algorithm, 46 patients, 23 in each group were matched. The procedural and follow-up costs in each group were analyzed and compared. RESULTS Median maximal aneurysm size in the SAC and PED cohort were 5.3 vs 5.1 mm, respectively. Costs of access guide materials were significantly higher in the SAC group (P < .01). The average implant cost was not significantly different between the SAC and PED cohorts (${\$}$13973.2 ± ${\$}$2886.2 vs ${\$}$14,760.7 ± ${\$}$3782.1, respectively; P = .43). Similarly, total procedural costs were not different (${\$}$18341.5 ± 4104 vs ${\$}$17484.3 ± 2914.1, respectively, P = .42). Although there were significantly more total follow-ups (P = .02) and longer follow-up duration (P = .01) in SAC cohort, no significant difference in follow-up costs between the 2 groups was identified (${\$}$20557 ± ${\$}$9247 vs ${\$}$18958 ± ${\$}$9171.9, P = .56). Overall cost was similar between the SAC (${\$}$38898.9 ± ${\$}$9645.5) and PED groups (${\$}$36442.4 ± ${\$}$9076) (P = .38). CONCLUSION In small unruptured anterior circulation aneurysms (excluding anterior communicating artery aneurysms) matched for technical complexity confounders, SAC and PED offer an overall equivalent economic cost profile. Postprocedural noninvasive imaging was more frequent in the SAC group. However, follow-up costs and total costs were not significantly different.
Collapse
Affiliation(s)
- Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mira Salih
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Felix Nwajei
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie Williams
- 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
| | - 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
| |
Collapse
|
23
|
Sattur MG, Al Kasab S, Porto GB, Spiotta AM. Endovascular Treatment of Basilar Bifurcation Aneurysms With PulseRider-Assisted Coiling: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E109-E110. [PMID: 33861344 DOI: 10.1093/ons/opab102] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/03/2021] [Indexed: 11/12/2022] Open
Abstract
Wide-necked bifurcation aneurysms pose technical and anatomical challenges to endovascular treatment, which make the simpler assisted (balloon or single stent) coiling techniques less effective.1 Consequently, unique endovascular solutions to treat such aneurysms have been devised.2,3 One such device is PulseRider (Cerenovus, New Brunswick, New Jersey), which is designed to provide neck support for a coil mass while protecting the bifurcation.3 The device comprises a body or stem that is deployed in the parent artery and a saddle component that sits at the aneurysm neck to keep the coil mass away from the bifurcation. There are several technical nuances involved in successful use of the device during positioning, deployment, and detachment.3 We present a surgical video detailing the steps of PulseRider-assisted coiling of unruptured basilar bifurcation (or basilar apex) aneurysms. The first case highlights index treatment at diagnosis and the second showcases treatment of a recurrent basilar apex aneurysm. Both patients provided informed consent to the procedure. We also briefly discuss the rationale for treating basilar apex aneurysms.4,5.
Collapse
Affiliation(s)
- Mithun G Sattur
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sami Al Kasab
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Guilherme B Porto
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | | |
Collapse
|
24
|
Kim HS, Cho BM, Yoo CJ, Choi DH, Hyun DK, Shim YS, Song JH, Oh JK, Ahn JH, Kim JH, Chang IB. Comparison of Long-Term Angiographic Results of Wide-Necked Intracranial Aneurysms : Endovascular Treatment with Single-Microcatheter Coiling, Double-Microcatheter Coiling, and Stent-Assisted Coiling. J Korean Neurosurg Soc 2021; 64:751-762. [PMID: 34284563 PMCID: PMC8435641 DOI: 10.3340/jkns.2021.0010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/13/2021] [Accepted: 05/21/2021] [Indexed: 11/27/2022] Open
Abstract
Objective Endovascular treatment of intracranial aneurysms is challenging in case of wide-necked aneurysms because coils are prone to herniate into the parent artery, causing thromboembolic events or vessel occlusion. This study aims to compare long-term angiographic results of wide-necked aneurysms treated by stent-assisted, double-microcatheter, or single-microcatheter groups. Methods Between January 2003 and October 2016, 108 aneurysms that were treated with endovascular coil embolization with a neck size wider than 4 mm and a follow-up period of more than 3 years were selected. We performed coil embolization with singlemicrocatheter, double-microcatheter, and stent-assisted techniques. Angiographic results were evaluated using the Raymond-Roy occlusion classification (RROC). All medical and angiographic records were reviewed retrospectively. Results Clinical and angiographic analyses were conducted in 108 wide-necked aneurysms. The immediate post-procedural results revealed RROC class I (complete occlusion) in 66 cases (61.1%), class II (residual neck) in 36 cases (33.3%), and class III (residual sac) in six cases (5.6%). The final follow-up results revealed class I in 48 cases (44.4%), class II in 49 cases (45.4%), and class III in 11 cases (10.2%). Of a total of 45 (41.6%) radiologic recurrences, there were 21 cases (19.4%) of major recurrence that required additional treatment, and 24 cases (22.2%) of minor recurrence. The final follow-up angiographic results showed statistically significant differences between the stent-assisted group and the others (p<0.01). Conclusion Long-term follow-up angiography demonstrated that the stent-assisted technique had a better complete occlusion rate than the other two techniques.
Collapse
Affiliation(s)
- Hyun Sik Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Byung Moon Cho
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Chan Jong Yoo
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Dae Han Choi
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Dong Keun Hyun
- Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea
| | - Yu Shik Shim
- Department of Neurosurgery, College of Medicine, Inha University, Incheon, Korea
| | - Joon Ho Song
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jae Keun Oh
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jun Hyong Ahn
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - In Bok Chang
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| |
Collapse
|
25
|
Natrella M, Perazzini C, Cristoferi M, Furfaro D, Alessi M, Fanelli G. Neurovascular Neck-Bridging device in treatment of wide-necked splenic artery aneurysms. Radiol Case Rep 2021; 16:2404-2410. [PMID: 34257769 PMCID: PMC8260741 DOI: 10.1016/j.radcr.2021.05.064] [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: 04/24/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/16/2022] Open
Abstract
We report the cases of 2 female patients, 45-year-old and 49-year-old, affected by wide-necked splenic aneurysm. We embolized the 2 lesions assisted by a new scaffolding neurovascular device, the Cascade Net, an innovative –occlusive remodeling device for temporary bridging in endovascular coil embolization of intracranial aneurysms. Visceral artery aneurysms are rare with an estimated prevalence of 2%-3% in imaging series and up to 10% in autopsy series. Most are asymptomatic and their diagnosis is occasionally. Aneurysm spontaneous rupture has been demonstrated in 2%-10% of cases and it can result in significant morbidity and mortality. Conservative management and open repair were the preferred treatment options for many years. Endovascular repair has been increasingly used since 2000; and the most widespread method of treatment has been coiling. Because of tortuosity of the parent artery, wide neck, and unfavorable locations at arterial branch points, 6% of Visceral and renal artery aneurysms VRAA cannot be adequately treated by simple coiling and requires parent artery remodeling through balloon occlusion, stent placement or parent vessel occlusion, leading to, in the latter situation, a compromised organ perfusion. Increasingly, balloon-assisted, and stent-assisted approaches as well as novel scaffolding neurovascular devices such as the Cascade Net, have allowed wide necked aneurysms to be bridged during endovascular treatment with smaller delivery system, averting parent artery occlusion and risk of distal embolization.
Collapse
Affiliation(s)
| | - Chiara Perazzini
- Department of Radiology, Parini Hospital, Viale Ginevra, 3, 11100, Aosta, Italy
| | - Massimo Cristoferi
- Department of Radiology, Parini Hospital, Viale Ginevra, 3, 11100, Aosta, Italy
| | - Dany Furfaro
- Department of Radiology, Parini Hospital, Viale Ginevra, 3, 11100, Aosta, Italy
| | - Monica Alessi
- Department of Radiology, Parini Hospital, Viale Ginevra, 3, 11100, Aosta, Italy
| | - Gianluca Fanelli
- Department of Radiology, Parini Hospital, Viale Ginevra, 3, 11100, Aosta, Italy
| |
Collapse
|
26
|
Pflaeging M, Goertz L, Smyk MA, Turowski B, Mpotsaris A, Pennig L, Borggrefe J, Krischek B, Kabbasch C. Treatment of recurrent and residual aneurysms with the low-profile Acandis Acclino stent: Multi-center review of 19 patients. J Clin Neurosci 2021; 90:199-205. [PMID: 34275549 DOI: 10.1016/j.jocn.2021.05.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/11/2020] [Revised: 08/18/2020] [Accepted: 05/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of the low-profile Acandis Acclino microstent for embolization of recurrent and residual intracranial aneurysms. METHODS Consecutive patients treated with the Acclino for aneurysm remnants at three German neurovascular centers were enrolled. The technical success, complications, angiographic and clinical outcome were investigated. RESULTS Nineteen patients (median age: 53 years) with 19 aneurysm remnants (median size: 5 mm, anterior circulation: 14) were included. Initial aneurysm treatment consisted of stand-alone coiling in 14 cases, stent-assisted coiling in 4 and clipping in 1. Acclino stent-assisted coil embolization was performed technically successfully in all patients. Morbidity occurred in one patient (5.3%) due to aneurysm perforation. At the angiographic follow-up with a median follow-up duration of 21 months (range: 5-37 months), complete occlusion was obtained in 76.9%. The retreatment rate was 7.7%. CONCLUSIONS Retreatment of aneurysm remnants with the Acclino microstent was associated with high aneurysm occlusion rates and acceptable morbidity. Further studies will be necessary to draw a definite conclusion.
Collapse
Affiliation(s)
- Muriel Pflaeging
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Lukas Goertz
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Kerpener Strasse 62, 50937 Cologne, Germany; Department of Neuroradiology, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Michael Artur Smyk
- Department of Neuroradiology, University Hospital of Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany.
| | - Bernd Turowski
- Department of Neuroradiology, University Hospital of Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany.
| | - Anastasios Mpotsaris
- Department of Neuroradiology, University Hospital of Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - Lenhard Pennig
- Department of Neuroradiology, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Jan Borggrefe
- Department of Neuroradiology, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Boris Krischek
- University of Cologne, Medical Faculty and University Hospital, Center for Neurosurgery, Kerpener Strasse 62, 50937 Cologne, Germany; Department of Neurosurgery, Hôpitaux Robert Schuman, 9 Rue Edward Steichen, 2540 Luxembourg, Luxembourg.
| | - Christoph Kabbasch
- Department of Neuroradiology, University Hospital of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| |
Collapse
|
27
|
Abouelleil M, Lyons L, Restrepo A, Singer J. Commentary: Neuroform Atlas Stent for Treatment of Middle Cerebral Artery Aneurysms: 1-Year Outcomes From Neuroform Atlas Stent Pivotal Trial. Neurosurgery 2021; 89:E160-E161. [PMID: 34089320 DOI: 10.1093/neuros/nyab190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/22/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mohamed Abouelleil
- Department of Neurosurgery, Spectrum Health Medical Center/Michigan State University, Grand Rapids, Michigan, USA
| | - Leah Lyons
- Department of Neurosurgery, Spectrum Health Medical Center/Michigan State University, Grand Rapids, Michigan, USA
| | - Andres Restrepo
- Department of Neurosurgery, Spectrum Health Medical Center/Michigan State University, Grand Rapids, Michigan, USA
| | - Justin Singer
- Department of Neurosurgery, Spectrum Health Medical Center/Michigan State University, Grand Rapids, Michigan, USA
| |
Collapse
|
28
|
Pflaeging M, Kabbasch C, Schlamann M, Pennig L, Juenger ST, Grunz JP, Timmer M, Brinker G, Goldbrunner R, Krischek B, Goertz L. Microsurgical Clipping versus Advanced Endovascular Treatment of Unruptured Middle Cerebral Artery Bifurcation Aneurysms After a "Coil-First" Policy. World Neurosurg 2021; 149:e336-e344. [PMID: 33607288 DOI: 10.1016/j.wneu.2021.02.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/03/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Although intracranial aneurysms are increasingly treated endovascularly, microsurgical clipping has been the standard approach for middle cerebral artery (MCA) aneurysms. We compared microsurgical clipping and state-of-the-art endovascular treatment of unruptured MCA bifurcation aneurysms treated at a neurovascular center following a "coil-first" policy. METHODS This single-center study included 148 patients treated for 160 unruptured MCA bifurcation aneurysms. Technical success, complications, clinical outcome, and angiographic results were retrospectively compared. RESULTS Microsurgical clipping was performed for 120 MCA aneurysms (75%) and endovascular treatment for 40 (25%; conventional coiling: 8, stent-assisted coiling: 16, balloon-assisted coiling: 3, and flow-disruption: 13). Technical treatment success was higher in the clipping group (100%) than in the endovascular group (92.5%, P = 0.015). Overall, complications occurred in 16.7% for clipping and in 20.0% for endovascular treatment (P = 0.631). Major ischemic stroke rates were 4.2% in the clipping group and 7.5% in the endovascular group (P = 0.414). At 6 months, a favorable outcome was obtained by 99.2% after clipping and 95.0% after endovascular treatment (P = 0.154). The 6-month complete aneurysm occlusion rates were by trend higher in the clipping group (89.2%) than in the endovascular group (75.9%, P = 0.078). CONCLUSIONS Microsurgical clipping was associated with a higher technical success rate and tendentially higher complete occlusion than endovascular treatment, with no additional morbidity and similar clinical outcome. On the basis of these results, clipping proves to be the standard treatment option for MCA bifurcation aneurysms. However, endovascular treatment represents a safe and efficient alternative treatment option for patients.
Collapse
Affiliation(s)
- Muriel Pflaeging
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christoph Kabbasch
- Department of Neuroradiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marc Schlamann
- Department of Neuroradiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lenhard Pennig
- Department of Neuroradiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Theresa Juenger
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan-Peter Grunz
- Institute for Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Marco Timmer
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gerrit Brinker
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Roland Goldbrunner
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Boris Krischek
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Department of Neurosurgery, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - Lukas Goertz
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Department of Neuroradiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| |
Collapse
|
29
|
Ishida A, Asakuno K, Kato M, Shiramizu H, Yoshimoto H, Sato H, Nakase K, Hirayama M, Matsuo S, Yamada S. Treatment of an anterior cerebral artery pseudoaneurysm secondary to a transsphenoidal surgery using stent-assisted coiling. Surg Neurol Int 2021; 12:20. [PMID: 33500835 PMCID: PMC7827430 DOI: 10.25259/sni_860_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/01/2020] [Accepted: 12/25/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Injury of the internal carotid artery (ICA) during transsphenoidal surgery (TSS) is a rare but critical complication. There are several reports on endovascular treatment of ICA injury during TSS. With the recent flourishing of extended TSS, injuries to the distal arteries such as the anterior cerebral artery (ACA) are more likely to occur. Case Description: In the present case, we report a pseudoaneurysm of the right ACA due to injury during extended TSS for aggressive prolactinoma. Due to the absence of collateral vessels, the pseudoaneurysm had to be obliterated while preserving the parent artery. Hence, we decided to treat the pseudoaneurysm using stent-assisted coiling (SAC). The pseudoaneurysm was completely obliterated and he was discharged without any complications. Conclusion: To the best of our knowledge, this is the first case in which an ACA pseudoaneurysm caused by injury during the TSS was treated with SAC and the parent artery was preserved.
Collapse
Affiliation(s)
- Atsushi Ishida
- Department of Neurosurgery, Moriyama Memorial Hospital, Edogawa, Tokyo, Japan
| | - Keizoh Asakuno
- Department of Neurosurgery, Moriyama Memorial Hospital, Edogawa, Tokyo, Japan
| | - Masataka Kato
- Department of Neurosurgery, Moriyama Memorial Hospital, Edogawa, Tokyo, Japan
| | - Hideki Shiramizu
- Department of Neurosurgery, Moriyama Memorial Hospital, Edogawa, Tokyo, Japan
| | - Haruko Yoshimoto
- Department of Neurosurgery, Moriyama Memorial Hospital, Edogawa, Tokyo, Japan
| | - Hikari Sato
- Department of Neurosurgery, Moriyama Memorial Hospital, Edogawa, Tokyo, Japan
| | - Ko Nakase
- Department of Neurosurgery, Moriyama Memorial Hospital, Edogawa, Tokyo, Japan
| | - Masahiro Hirayama
- Department of Neurosurgery, Moriyama Memorial Hospital, Edogawa, Tokyo, Japan
| | - Seigo Matsuo
- Department of Neurosurgery, Moriyama Memorial Hospital, Edogawa, Tokyo, Japan
| | - Shozo Yamada
- Department of Neurosurgery, Moriyama Memorial Hospital, Edogawa, Tokyo, Japan
| |
Collapse
|
30
|
Arslan G, Maus V, Weber W, Berlis A, Maurer C, Fischer S. Two-center experience with Neuroform Atlas stent-assisted coil occlusion of broad-based intracranial aneurysms. Neuroradiology 2021; 63:1093-1101. [PMID: 33410946 DOI: 10.1007/s00234-020-02602-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/07/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Stent-assisted coiling (SAC) represents an established treatment option for broad-based intracranial aneurysms. Here we report our initial and follow-up experience with the Neuroform Atlas Stent, a hybrid open- and closed-cell low-profile stent in the treatment of broad-based aneurysms. METHODS All intracranial aneurysms treated by SAC with the intention to apply the Neuroform Atlas Stent between July 2015 and December 2019 were included. Angiographic and clinical results were analyzed including all follow-up examinations. RESULTS A total of 119 aneurysms (8 acutely ruptured) in 112 patients were included. In 19 cases (16.0%) re-catheterization of the aneurysm was performed in a second procedure after failure to re-cross the stent initially. Of all aneurysms, 83.2% (99/119) were completely occluded following the procedure. In 75.6% of all cases (90/119), a single microcatheter was used for both, implantation of the stent and coil occlusion of the aneurysm. At 3-6 and 12 months follow-up, the complete occlusion rates were 75.2 (79/105) and 81.3% (74/91). The thromboembolic (stent thrombosis) and hemorrhagic complication rate was 1.7 (2/119) and 0.8% (1/119), respectively, resulting in a procedure-related morbidity and mortality rate of 0.9 and 0.9% (1/112 patients). CONCLUSION SAC using the Neuroform Atlas Stent offers a safe and effective option to treat broad-based intracranial aneurysms with a high angiographic and clinical success rate. In the majority of procedures, the application of two mircocatheters is not required. Prospective comparative studies might help to identify the value of SAC using the Neuroform Atlas Stent among the growing treatment options for broad-based aneurysms.
Collapse
Affiliation(s)
- Gamze Arslan
- Knappschaftskrankenhaus Bochum - Universitätsklinik, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, In der Schornau 23-25, 44892, Bochum, Germany
| | - Volker Maus
- Knappschaftskrankenhaus Bochum - Universitätsklinik, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, In der Schornau 23-25, 44892, Bochum, Germany
| | - Werner Weber
- Knappschaftskrankenhaus Bochum - Universitätsklinik, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, In der Schornau 23-25, 44892, Bochum, Germany
| | - Ansgar Berlis
- Klinik für Diagnostische Radiologie und Neuroradiologie, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Christoph Maurer
- Klinik für Diagnostische Radiologie und Neuroradiologie, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Sebastian Fischer
- Knappschaftskrankenhaus Bochum - Universitätsklinik, Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie, Nuklearmedizin, In der Schornau 23-25, 44892, Bochum, Germany.
| |
Collapse
|
31
|
Sato K, Matsumoto Y, Kanoke A, Ito A, Fujimura M, Tominaga T. Y-Configuration Stenting for Coil Embolization of Complex Intracranial Aneurysms: Distinguishing Between Use of Crossing-Y and Kissing-Y. World Neurosurg 2020; 146:e1054-e1062. [PMID: 33246177 DOI: 10.1016/j.wneu.2020.11.092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 09/03/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Coil embolization with Y stenting is recognized as a suitable treatment for complex wide-necked aneurysms. Y stenting comprises crossing-Y stenting, in which a stent is passed through the interstices of another stent, and kissing-Y stenting, in which 2 stents are arranged in parallel. The purpose of this study was to elucidate how to distinguish between use of the 2 Y-stenting techniques. METHODS Clinical and angiographic data of patients who underwent coil embolization with Y stenting at our department from 2015 to 2019 were retrospectively analyzed. Basic characteristics, endovascular procedure, complications, and outcomes were compared between kissing-Y and crossing-Y stenting groups. RESULTS Thirty-eight intracranial aneurysms in 38 consecutive patients were included in this study. Nineteen patients (50%) were treated with coil embolization with kissing-Y stenting and 19 (50%) with crossing-Y. Endovascular procedures were successfully performed in all but 1 patient, in the kissing-Y group, who had stent migration. One hemorrhage (2.6%) recurred 12 months after coiling with kissing-Y stenting. Angiographic follow-up (mean, 15.8 months) was available in 35 patients. Adequate occlusion was shown in 14 patients (77.8%) and 13 patients (76.5%) in the kissing-Y and crossing-Y groups, respectively. Larger, wider-necked, and more proximal aneurysms were treated with kissing-Y stenting than with crossing-Y stenting, although there were no significant differences between the groups in complication rates or clinical outcomes. CONCLUSIONS Kissing-Y and crossing-Y stenting of intracranial aneurysms were both feasible and yielded reasonable angiographic and clinical results. The choice between the kissing-Y or crossing-Y-stenting technique should be decided according to the angioarchitecture of targeted aneurysms.
Collapse
Affiliation(s)
- Kenichi Sato
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan; Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
| | - Yasushi Matsumoto
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
| | - Atsushi Kanoke
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan; Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Ito
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan; Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
32
|
Yue J, Xie Y, Zhang X, Jiang Y, Chen W, Ma Y, Cheng Y. The safety and outcomes of acutely ruptured intracranial aneurysms with incomplete occlusion after coiling: a case-control study. BMC Neurol 2020; 20:412. [PMID: 33176706 PMCID: PMC7661196 DOI: 10.1186/s12883-020-01991-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Incomplete aneurysmal occlusion is a common feature of immediate posttreatment angiography. The safety and outcomes of acutely ruptured intracranial aneurysms (RIAs) with incomplete occlusion after stent-assisted coiling (SAC) and no-stent coiling (NSC) have not been well clarified. Progressive occlusion of stents can promote the complete occlusion of intracranial aneurysms (IAs), but it remains to be determined if progressive occlusion in acutely RIAs with incomplete occlusion after coiling may be enhanced by protective stenting. This study aimed to evaluate the safety and outcomes of those aneurysms after SAC and NSC; And to discover whether the stents can promote progressive aneurysm occlusion in such lesions or not. METHODS We reviewed 199 patients with acutely RIAs underwent endovascular coiling and developed incomplete occlusion in the past seven years. The patients' clinical and imaging information were recorded and analyzed. Univariate and multivariate analyses were performed to determine the association of recurrence rate with potential risk factors. RESULTS SAC group had wider aneurysms neck (3.471 mm vs 2.830 mm, P = 0.009) and smaller dome-to-neck ratio (1.536 vs 2.111, P = 0.001) than in NSC group. There was no significant difference between the two groups in total procedure-related complications rate (31.7% vs 23.5%, P = 0.195), procedure-related mortality (6.9% vs 2.0%, P = 0.170) and modified Rankin Scale (mRS) score at 6-month follow-up (P > 0.05). However, SAC group had significantly higher ischemic complications rate (21.8% vs 8.2%, P = 0.007) and complete occlusion rate (65.6% vs 48.3%, P = 0.020), and lower recurrence rate (15.6% vs 28.1%, P = 0.042) than NSC group based on 6-month follow-up angiograms. Additionally, Multivariable analysis showed NSC was an independent risk factor for aneurysm recurrence (Odds Ratio [OR]: 4.061; P = 0.018). CONCLUSIONS Acutely RIAs with incomplete occlusion after SAC is associated with higher complications rate and mortality, but has an acceptable safety profile and similar clinical outcome compared to NSC, as well as gives patients superior angiography outcome by progressive occlusion of stents.
Collapse
Affiliation(s)
- Jianhe Yue
- Department of Neurosurgery, Chongqing Medical University Affiliated Second Hospital, No.76 Linjiang road, Yuzhong District, Chongqing, 400010, China
| | - Yuan Xie
- Department of Neurosurgery, Chongqing Medical University Affiliated Second Hospital, No.76 Linjiang road, Yuzhong District, Chongqing, 400010, China
| | - Xiaolin Zhang
- Department of Neurosurgery, Chongqing Medical University Affiliated Second Hospital, No.76 Linjiang road, Yuzhong District, Chongqing, 400010, China
| | - Yongxiang Jiang
- Department of Neurosurgery, Chongqing Medical University Affiliated Second Hospital, No.76 Linjiang road, Yuzhong District, Chongqing, 400010, China.
| | - Weifu Chen
- Department of Neurosurgery, Chongqing Medical University Affiliated Second Hospital, No.76 Linjiang road, Yuzhong District, Chongqing, 400010, China
| | - Ying Ma
- Department of Neurosurgery, Chongqing Medical University Affiliated Second Hospital, No.76 Linjiang road, Yuzhong District, Chongqing, 400010, China
| | - Yuan Cheng
- Department of Neurosurgery, Chongqing Medical University Affiliated Second Hospital, No.76 Linjiang road, Yuzhong District, Chongqing, 400010, China
| |
Collapse
|
33
|
Feng X, Tong X, Peng F, Wang K, Niu H, Qi P, Lu J, Wu Z, Chen G, Liu A, Wang D. The Minimum Distance May Affect Perioperative Complications and Completed Occlusions of Endovascular Treatment for Tandem Intracranial Aneurysms: A Multi-Institutional Retrospective Study. Cerebrovasc Dis 2020; 49:609-618. [PMID: 33105132 DOI: 10.1159/000510749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/09/2020] [Accepted: 08/05/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tandem aneurysms (TAs) are a distinct type of multiple intracranial aneurysms (IAs), the treatment strategies for which remain controversial. We aimed to reveal the clinical and angiographic outcomes of endovascular treatment as well as their risk factors in these complex multiple IAs. METHODS This multicenter, retrospective follow-up study was carried out in 3 hospitals in China. In total, clinical and angiographical data of 137 patients with 145 lesions (7 patients had bilateral lesions) and 315 TAs were collected. The treatment strategies were divided into full or partial treatment, single- or multiple-session treatment, and coiling (including single coiling and stent-assisted coiling)- or flow-diverting stent (FDS) treatment. Perioperative complications, as well as angiographic and clinical outcomes and their risk factors, were analyzed using univariate analysis and a multiple regression model. RESULTS Of treated TA lesions, 17 (16.0%) perioperative complications were found. Significant differences were found between the single- and multiple-session treatment groups (p = 0.012). At the latest follow-up, there were no significant differences in the modified Raymond Scale scores between different treatment groups. Significant differences were found in the embolization degree between the coiling and FDS groups (p = 0.038) and between the single common stent (without coiling) and the other treatment groups (p < 0.001). In IAs managed by a single LVIS stent (without coiling), 60% achieved improved or completed occlusion. Multivariate regression analysis found that a shorter minimum distance (odds ratio [OR] 5.967, 95% confidence interval [CI] 1.366-26.074; p = 0.018), multiple-session treatment (OR 9.961, 95% CI 1.707-58.127; p = 0.011), and diabetes (OR 8.106, 95% CI 1.928-34.084; p = 0.004) were predictors of perioperative complications, while shorter minimum distance (OR 5.619, 95% CI 1.493-21.152; p = 0.011), greater diameter ratio (OR 3.621, 95% CI 1.014-12.937; p = 0.048), and greater size ratio (OR 2.424, 95% CI 1.007-5.834; p = 0.048) were predictors of low completed occlusion rate. CONCLUSIONS Both coiling and FDS can be utilized safely and can achieve similar clinical outcomes. FDS and LVIS are recommended for IAs that do not require embolization but cannot be prevented from being covered by stents. A multiple-session treatment may increase the treatment risk, and the minimum distance may affect the incidence of perioperative complications and completed occlusions. Further hemodynamic and prospective studies on such TAs in close proximity to one another are needed.
Collapse
Affiliation(s)
- Xin Feng
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Graduate School of Peking Union Medical College, Beijing, China
| | - Xin Tong
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Fei Peng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Kun Wang
- Southern Medical University, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Hao Niu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Graduate School of Peking Union Medical College, Beijing, China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Graduate School of Peking Union Medical College, Beijing, China
| | - Zhongxue Wu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Guangzhong Chen
- Southern Medical University, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Graduate School of Peking Union Medical College, Beijing, China,
| |
Collapse
|
34
|
Sweid A, Herial N, Sajja K, Chalouhi N, Velagapudi L, Doermann A, Kardon A, Tjoumakaris S, Zarzour H, Smith MJ, Choe H, Shah Q, Mackenzie L, Kozak O, Rosenwasser RH, Jabbour P, Gooch MR. Early Multicenter Experience With the Neuroform Atlas Stent: Feasibility, Safety, and Efficacy. Neurosurgery 2020; 87:E321-E335. [PMID: 32453816 DOI: 10.1093/neuros/nyaa143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/29/2019] [Accepted: 03/05/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Neuroform Atlas stent™ (by Stryker, Fremont, California) represents the most recent widely available upgrade to intracranial stenting, providing a laser cut open cell stent with a diameter of 3.0 to 4.5 mm that is delivered through an 0.017-inch microcatheter. OBJECTIVE To report our initial multicenter experience of the safety, efficacy, and feasibility of the Atlas stent used for treating aneurysms, as well as one case of intracranial stenosis and one carotid artery dissection as well as other pathologies. METHODS A retrospective multicenter study of subjects treated with Atlas stent during the period 2018 to 2019. RESULTS The total number of patients included in our analysis was 71 patients. The stent was utilized to treat 69 aneurysm cases. Of the aneurysms, 36% presented with acute rupture and 56% of the ruptured aneurysms were high grade. Mean aneurysm dimension was 7 mm with an average neck width of 4.1 mm. Around 30% had received prior treatment. Telescoping or Y-stent was used in 16% of cases. We did not observe any symptomatic major complications in our series. Asymptomatic major complications were seen in 7 patients (10.1%); technical complications occurred in 4.3%. Immediate modified Raymond-Roy-occlusion-outcome class I/II was observed in 87%, and this increased to 97.7% at latest follow-up, which was at 4 mo; 91.8% of patients achieved favorable clinical outcome, and mortality rate was 1.4%. CONCLUSION Our series demonstrates the safety, feasibility, and efficacy of the Atlas stent. The low complication rate and the high obliteration rate managing complex aneurysms, even in an acute ruptured setting, are notable.
Collapse
Affiliation(s)
- Ahmad Sweid
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Nabeel Herial
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Kalyan Sajja
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Nohra Chalouhi
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Lohit Velagapudi
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Allison Doermann
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Adam Kardon
- Department of Neurosurgery, Main Line Health, Philadelphia, Pennsylvania
| | - Stavropoula Tjoumakaris
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Hekmat Zarzour
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Michelle J Smith
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Hana Choe
- Department of Neurosurgery, Abington Jefferson Health, Philadelphia, Pennsylvania
| | - Qaisar Shah
- Department of Neurosurgery, Abington Jefferson Health, Philadelphia, Pennsylvania
| | - Larami Mackenzie
- Department of Neurosurgery, Abington Jefferson Health, Philadelphia, Pennsylvania
| | - Osman Kozak
- Department of Neurosurgery, Abington Jefferson Health, Philadelphia, Pennsylvania
| | - Robert H Rosenwasser
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - M Reid Gooch
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| |
Collapse
|
35
|
Ishigami D, Koizumi S, Ishikawa O, Shin M, Saito N. Stent-Assisted Coil Embolization of a Basilar Artery Dissecting Aneurysm Involved in Skull Base Chordoma Before Endoscopic Transsphenoidal Transclival Resection. World Neurosurg 2020; 143:466-470. [PMID: 32795685 DOI: 10.1016/j.wneu.2020.08.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/15/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Skull base chordomas will occasionally penetrate the clival dura mater and extend into the prepontine cistern, involving the basilar artery. Few reports have described cases of skull base chordoma accompanying a dissecting aneurysm of the basilar artery, and the treatment strategies have remained largely unknown. CASE DESCRIPTION A 28-year-old man was referred to our hospital with a complaint of severe headache. A skull base chordoma involving a basilar artery dissecting aneurysm was diagnosed. We initially performed endovascular surgery for the dissecting aneurysm after dual antiplatelet therapy before surgical resection of the tumor, which was successfully achieved without complications. Follow-up angiography 3 months after endovascular surgery disclosed obliteration of the dissecting aneurysm. We then stopped the dual antiplatelet therapy, and performed judicious resection using an endoscopic transclival approach. The residual tumor was treated with radiosurgery. At the last follow-up examination, the patient was stable, and the tumor remained sufficiently controlled. CONCLUSIONS We have reported a case of a dissecting aneurysm of the basilar artery with clival chordoma. Our findings suggest that chordoma with intradural vascular encasement has the potential to invade the vessel wall. To avoid rupture of those critical vascular structures, treatment strategies that minimize stress on the involved arteries and offer safe and sufficient surgical resection should be considered.
Collapse
Affiliation(s)
| | - Satoshi Koizumi
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Osamu Ishikawa
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan.
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
36
|
Imahori T, Mizobe T, Fujinaka T, Miura S, Sugihara M, Aihara H, Kohmura E. An Aneurysm at the Origin of a Duplicated Middle Cerebral Artery Treated by Stent-Assisted Coiling Using the "Wrapped-Candy" Low-Profile Visualized Intraluminal Support (LVIS) Technique: A Technical Case Report and Review of the Literature. World Neurosurg 2020; 143:353-359. [PMID: 32791218 DOI: 10.1016/j.wneu.2020.08.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/16/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aneurysms at the origin of a duplicated middle cerebral artery (DMCA) are quite rare. Here, we report a patient with such an aneurysm successfully treated endovascularly using our novel "wrapped-candy" low-profile visualized intraluminal support (LVIS) technique. CASE DESCRIPTION A 44-year-old woman underwent endovascular treatment for an unruptured wide-necked aneurysm at the origin of a DMCA that incorporated the origin of the DMCA into its neck. Stent-assisted coiling was performed using our newly developed "wrapped-candy" LVIS technique. To protect the origin of the DMCA and increase the stent metal density at the neck, an LVIS blue 3.5-mm × 22-mm stent was deployed by pushing the delivery wire aggressively to transform the visible wire components of the LVIS into a shape like "wrapped candy," maximizing the strut compaction at the neck of the aneurysm. Subsequently, the aneurysm component was coiled using a jailed microcatheter. The final procedural angiography demonstrated almost complete aneurysm occlusion with DMCA preservation. CONCLUSIONS Stent-assisted coiling can be a feasible treatment for an unruptured, usually wide-necked, aneurysm at the origin of a DMCA. The wrapped-candy LVIS technique may be useful in more challenging morphologies such as wide-necked aneurysms that incorporate the branch origin into the aneurysm neck.
Collapse
Affiliation(s)
- Taichiro Imahori
- Department of Neurosurgery, Hyogo Brain and Heart Center, Hyogo, Japan.
| | - Takashi Mizobe
- Department of Neurosurgery, Hyogo Brain and Heart Center, Hyogo, Japan
| | - Toshiyuki Fujinaka
- Department of Neurosurgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Shinichi Miura
- Department of Neurosurgery, Hyogo Brain and Heart Center, Hyogo, Japan
| | - Masahiro Sugihara
- Department of Neurosurgery, Hyogo Brain and Heart Center, Hyogo, Japan
| | - Hideo Aihara
- Department of Neurosurgery, Hyogo Brain and Heart Center, Hyogo, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| |
Collapse
|
37
|
Bsat S, Bsat A, Tamim H, Chanbour H, Alomari SO, Houshiemy MNE, Moussalem C, Omeis I. Safety of stent-assisted coiling for the treatment of wide-necked ruptured aneurysm: A systematic literature review and meta-analysis of prevalence. Interv Neuroradiol 2020; 26:547-556. [PMID: 32741229 DOI: 10.1177/1591019920945059] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Stent-assisted coil embolization of ruptured wide-necked aneurysms is a controversial treatment modality due to concerns on the peri-procedural safety of anti-platelet therapy in the setting of acute subarachnoid hemorrhage. Our aim was to systematically review the literature on stent-assisted coil embolization of acutely ruptured wide-neck aneurysms to calculate the pooled prevalence of clinical outcome, thromboembolic and hemorrhagic complication rates and overall mortality. METHODS We searched PubMed and Google Scholar for articles published between 2009 and 2019 and stratified selected articles based on risk of publication bias. Data on thromboembolic and hemorrhagic complications, clinical outcomes and mortality rates were analyzed using quality-effects model and double arcsine transformation. RESULTS 24 articles were included featuring a total of 1582 patients. Thromboembolic and hemorrhagic complication rates were witnessed in 9.1% [95% CI: 6.0% - 12.7%; I2 = 72.8%] and 8.7% [95% CI: 5.4 - 12.6%; I2 = 77.2%] of patients, respectively. 245 patients received external ventricular drains, of which 33 (13.5%) had EVD-related hemorrhages. Total complication rate was 20.8% [95% CI: 14.2 - 28.1%; I2 = 87.0%]. 57% of aneurysms were completely occluded and a favorable clinical outcome was reported in 74.7% [95% CI: 66.4 - 82.2%; I2 = 86.0] of patients. Overall mortality rate came at 7.8% [95% CI: 4.8 - 11.6%; I2 = 76.9%]. CONCLUSION Stent-assisted coiling of ruptured intracranial aneurysm is a technically feasible procedure with controlled thromboembolic complication rate but may be associated with higher hemorrhagic and total complication rates compared to coiling alone. While stent-assisted coiling of ruptured wide-necked aneurysm seems to yield a lower rate of favorable clinical outcome, overall mortality is comparable to that of endovascular coiling alone.
Collapse
Affiliation(s)
- Shadi Bsat
- Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ayman Bsat
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Chanbour
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Safwan Omar Alomari
- Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Charbel Moussalem
- Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ibrahim Omeis
- Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
38
|
Wang X, Xing H, Cai J, Jin D, Chen Y, Cui Y, Ding S, Wan J, Pan Y, Mao G, Zhao B. The safety and efficacy of the LVIS stent for the treatment of ruptured intracranial aneurysms within 24 hours: A multicenter retrospective study. Clin Neurol Neurosurg 2020; 197:106117. [PMID: 32745790 DOI: 10.1016/j.clineuro.2020.106117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/23/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Stent-assisted coiling is increasingly used in the treatment of acutely ruptured intracranial aneurysms. However, the optimal timing of the stent-assisted coiling remains unknown. We aimed to investigate the safety and efficacy of the Low Profile Visualized Intraluminal Support (LVIS) stent for ruptured aneurysms treatment within 24 h comparing to the treatment between 25 and 72 h of symptom onset. PATIENTS AND METHODS We conducted a multicenter retrospective study on 110 consecutive patients with ruptured intracranial aneurysms. These patients were treated with LVIS stent within 72 h in four tertiary hospitals between January 2017 and December 2017. The timing of treatment was grouped into the treatment within 24 h and the treatment between 25 and 72 h. Baseline characteristics, periprocedural complications, angiographic results, and clinical outcomes were compared between the two groups. RESULTS A total of 101 patients were included. 49 (48.5 %) patients were treated within 24 h and 52 (51.5 %) within between 25 and 72 h. Periprocedural complications occurred in 2 (4.1 %) patients treated within 24 h compared with those in 10 (19.2 %) treated between 25-72 h (P = 0.032). No early rebleeding occurred in both groups. 45 (91.8 %) of 49 aneurysms had complete occlusion on immediate angiography compared with 46 (88.5 %) of 52 aneurysms had complete occlusion. 2 (2.0 %) aneurysms were retreated. The clinical outcomes and angiographic results did not differ between the two groups. CONCLUSIONS The LVIS stent-assisted coiling may be safe and effective in the treatment of selected patients with ruptured aneurysms within 24 h of symptom onset.
Collapse
Affiliation(s)
- Xianggan Wang
- Department of Neurosurgery, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Haixia Xing
- Department of Pathology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Jing Cai
- Department of Neurosurgery, Linyi People's Hospital, Linyi, 276003, China
| | - Dianshi Jin
- Department of Neurosurgery, Dalian Central Hospital, Dalian 116033, China
| | - Yongchun Chen
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Yudi Cui
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Shenghao Ding
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Jieqing Wan
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Yaohua Pan
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Guohua Mao
- Department of Neurosurgery, the Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
| | - Bing Zhao
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
| |
Collapse
|
39
|
Saied A, Elsaid N, Joshi K, Gomaa M, Amer T, Saad M, Lopes D. Factors Affecting the Degree of Angular Remodeling in Stent-Assisted Coiling of Bifurcation Aneurysms. Interv Neurol 2020; 8:220-230. [PMID: 32508904 DOI: 10.1159/000502058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/11/2019] [Indexed: 11/19/2022]
Abstract
Background Stent-assisted coiling (SAC) leads to significant changes in the vascular angle altering the bifurcation geometry and the hemodynamics at the bifurcation apex. It is believed that the stent alone exerts this effect, but other possible factors have not been studied. Purpose To study the factors contributing to angular remodeling following SAC of bifurcation aneurysms including the anatomical, stent-related, and coil-related factors. Materials and Methods We reviewed 43 basilar and carotid bifurcation aneurysms treated by SAC using Neuroform EZ (n = 28), Enterprise (n = 8), and Lvis Jr. (n = 7) stents. The bifurcation angle between the mother and stented daughter vessel was measured in 4 settings: pretreatment, poststenting, postcoiling, and at delayed follow-up (6-12 months). The degree of stent-induced angular remodeling was calculated by subtracting the poststenting bifurcation angle from the pretreatment one, while the coil-induced angular remodeling was calculated as the difference between the postcoiling and poststenting bifurcation angle. The immediate postprocedural degree of angular remodeling is the sum of the stent- and coil-induced angular remodeling. We studied the effect of several factors including the pretreatment bifurcation angle, aneurysm site, diameter of parent vessel, stent type, stent length in the daughter vessel, postoperative actual in situ coil size, and packing density. Results The mean degree of stent-induced and coil-induced angular remodeling was 10.2 (0-47) and 4.53 (-7 to 30), respectively. The immediate postprocedural and delayed angular remodeling was 14.8 (-4 to 47) and 4.75 (-12 to 40), respectively. The degree of immediate remodeling was significantly affected by the actual in situ coil size (p = 0.017), and the pretreatment bifurcation angle (p = 0.024). Linear regression was carried out and the pretreatment bifurcation angle was defined as a predictor. The degree of delayed remodeling is significantly affected only by the pretreatment bifurcation angle (p = 0.011). Conclusion Immediate angular remodeling following SAC of bifurcation aneurysms can happen after stenting or coiling or both. This is the first study reporting the role of the coils as an additional factor beside the stent in inducing immediate angular changes; this effect is correlated to the size of the coils. The pretreatment bifurcation angle is the most consistent factor affecting the degree of both immediate and delayed angular remodeling.
Collapse
Affiliation(s)
- Ahmed Saied
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurology, Mansoura University, Mansoura, Egypt
| | - Nada Elsaid
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurology, Mansoura University, Mansoura, Egypt
| | - Krishna Joshi
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Mohamed Gomaa
- Department of Neurology, Mansoura University, Mansoura, Egypt
| | - Talal Amer
- Department of Radiology, Mansoura University, Mansoura, Egypt
| | - Mohamed Saad
- Department of Neurology, Mansoura University, Mansoura, Egypt
| | | |
Collapse
|
40
|
Pranata R, Yonas E, Deka H, Vania R, July J. Stent-Assisted Coiling of Intracranial Aneurysms Using a Nitinol-Based Stent (Neuroform Atlas): A Systematic Review and Meta-analysis. Cardiovasc Intervent Radiol 2020; 43:1049-1061. [PMID: 32405704 DOI: 10.1007/s00270-020-02502-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to synthesize the latest evidence on the efficacy and safety of Neuroform Atlas-assisted coiling of intracranial aneurysms. METHODS We performed a comprehensive search for articles that assessed the efficacy and safety of Neuroform Atlas-assisted coiling of intracranial aneurysms. The outcome measurement was adequate occlusion, defined as Raymond-Roy Class I (RR1) + Raymond-Roy Class II (RR2) by previous studies. RESULTS A total of 557 patients (568 aneurysms) from 13 studies were included. The rate of adequate occlusion after the procedure was 88% (83-94%, I2: 72.21%), and the rates of RR1 and RR2 were 68% (60-77%, I2: 81.87%) and 21% (15-27%, I2: 66.10%), respectively. The adequate occlusion rate at 6 months was 90% (81-99%, I2: 58.04%) and 93% (91-96%, I2: 0%) at the end of a mean of 9.03 ± 1.03 months of follow-up. Periprocedural complications occurred in 35 patients [5% (3-8%, I2: 21.28%)]. Subgroup analysis of unruptured aneurysms showed that the rates of adequate occlusion were 85% (78-93%), 90% (79-100%) (6-month follow-up), and 93% (90-96%) (at the end of follow-up). For the wide-necked aneurysm subgroup, the rate of adequate occlusion was 86% (80-93%) and was 93% (89-97%) at the end of follow-up. Meta-regression showed that initial adequate occlusion was influenced by mean aneurysm neck size (p = 0.034). CONCLUSION Neuroform Atlas-assisted coiling is associated with an initial adequate occlusion rate of 88% and a periprocedural complication rate of 6%. The rate of initial adequate occlusion was 85% in unruptured aneurysms and 86% in wide-necked aneurysms. LEVEL OF EVIDENCE Level 2, Systematic review of non-randomized and single-arm studies.
Collapse
Affiliation(s)
- Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Jl. Jend. Sudirman No. 20, Tangerang, Banten, 15810, Indonesia.
| | - Emir Yonas
- Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
| | - Hadrian Deka
- Faculty of Medicine, Universitas Gadjah Mada, Jogjakarta, Indonesia
| | - Rachel Vania
- Faculty of Medicine, Universitas Pelita Harapan, Jl. Jend. Sudirman No. 20, Tangerang, Banten, 15810, Indonesia
| | - Julius July
- Department of Neurosurgery, Neuroscience Centre Siloam Hospital, Medical Faculty of Pelita Harapan University, Lippo Village, Tangerang, Indonesia
| |
Collapse
|
41
|
Weinberg JH, Sweid A, Asada A, Abbas R, Joffe D, El Naamani K, Gooch MR, Herial N, Tjoumakaris S, Rosenwasser RH, Jabbour P, Zarzour H. Coil Embolization of Wide-Neck Bifurcation Aneurysms via Shouldering and Framing: A Safe Alternative to Conventional Techniques. World Neurosurg 2020; 139:e800-e806. [PMID: 32344137 DOI: 10.1016/j.wneu.2020.04.172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/04/2020] [Accepted: 04/22/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Double stent-assisted coiling of wide-neck bifurcation aneurysms (WNBAs) can be technically challenging with high thromboembolic rates. Single stent-assisted coiling (SSAC) decreases procedural complexity and thromboembolic risk but increases risk of coil prolapse and recanalization. In this study, we present our institution's experience with SSAC of WNBA performed via a "shouldering" and "framing" with a single Atlas stent and a spherical 3-dimensional (3D) Stryker coil. METHODS A retrospective review of 35 patients who underwent SSAC of WNBA performed via a shouldering and framing with a single Atlas stent and a spherical 3D Stryker coil from 2018 to 2019. Data collection were performed on baseline demographics, clinical presentation, aneurysm characteristics, angiographic and functional outcomes, and perioperative and postoperative complications. RESULTS Of 35 patients, the mean age was 59.9 ± 11.6 years and 25/35 (71.4%) were women. The mean aneurysm diameter was 6.3 ± 3.4 mm, the mean neck size was 3.9 ± 1.3 mm, and the mean dome-to-neck ratio was 1.5 ± 0.6. Initial complete/near-complete occlusion was demonstrated in 30/35 (85.7%) patients. On angiographic follow-up at a mean of 6 months, 9/24 (37.5%) patients showed progressive thrombosis, 13/24 (54.2%) showed stable occlusion, and 2/24 (8.5) showed recanalization. Thromboembolic events occurred in 2/35 (5.7%) patients, intraoperative technical complications occurred in 2/35 (5.7%) patients, and access-site complications occurred in 2/35 (5.7%) patients. The were no cases of retreatment, rehemorrhage, or procedural-related permanent morbidity or mortality. CONCLUSIONS Coil embolization performed via shouldering with a single Atlas stent and framing with a spherical 3D Stryker coil is a feasible, safe, and effective neuroendovascular treatment for WNBAs.
Collapse
Affiliation(s)
- Joshua H Weinberg
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ashlee Asada
- College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Rawad Abbas
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Daniel Joffe
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Michael Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nabeel Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Hekmat Zarzour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
42
|
Limaye K, Zanaty M, Hudson J, Nakagawa D, Al Kasab S, Alvarez C, Dandapat S, Kung DK, Ortega-Gutierrez S, Jabbour P, Samaniego EA, Hasan D. The Safety and Efficacy of Continuous Tirofiban as a Monoantiplatelet Therapy in the Management of Ruptured Aneurysms Treated Using Stent-Assisted Coiling or Flow Diversion and Requiring Ventricular Drainage. Neurosurgery 2020; 85:E1037-E1042. [PMID: 31298301 DOI: 10.1093/neuros/nyz226] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 09/27/2018] [Accepted: 01/23/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hemorrhagic complications are a major concern for aneurysmal subarachnoid hemorrhage patients treated with stenting or stent-assisted coiling and undergoing additional procedures such as shunting, ventriculostomy placement, and craniotomies/craniectomies. OBJECTIVE To assess the safety and efficacy of using a continuous infusion of tirofiban as a monoantiplatelet therapy in the management of ruptured aneurysms in the setting of either stent-assisted coiling (SAC) or flow diversion devices (FDD) in patients requiring either an external ventricular drain (EVD) or ventriculoperitoneal shunt (VPS). METHODS Aneurysmal subarachnoid hemorrhage (aSAH) patients between July 2017 and September 2018 who were treated with SAC or FDD were started on a continuous tirofiban infusion protocol (0.10 μg/kg/min) with no preceding loading dose as a monoantiplatelet therapy. Safety analysis was performed retrospectively to assess the complication rate, hemorrhagic rate, and rate of ischemic events. There were no hemorrhages related to the VPS surgery. RESULTS Nineteen subjects were included in the series. The patients received a total of 25 procedures that included 19 EVDs and 6 VPSs. Two patients (8.3%) developed small asymptomatic track hemorrhages after EVD placement. One patient developed a large retroperitoneal hemorrhage due to renal artery branch injury during procedure, and another patient developed an idiosyncratic transient thrombocytopenia which resolved after stopping the medication. One patient (4%) developed a transient ischemic attack, which resolved after a bolus of tirofiban. CONCLUSION Our study suggests that long-term use of intravenous tirofiban monotherapy in aSAH subjects for endovascular SAC or FDD is safe in the perioperative setting.
Collapse
Affiliation(s)
- Kaustubh Limaye
- Division of Cerebrovascular Diseases, Department of Neurology, University of Iowa, Iowa City, Iowa
| | - Mario Zanaty
- Departmnet of Neurosurgery, University of Iowa, Iowa City, Iowa
| | - Joseph Hudson
- Departmnet of Neurosurgery, University of Iowa, Iowa City, Iowa
| | - Daichi Nakagawa
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | - Sami Al Kasab
- Division of Cerebrovascular Diseases, Department of Neurology, University of Iowa, Iowa City, Iowa
| | - Carlos Alvarez
- Departmnet of Neurosurgery, University of Iowa, Iowa City, Iowa
| | - Sudeepta Dandapat
- Division of Cerebrovascular Diseases, Department of Neurology, University of Iowa, Iowa City, Iowa
| | - David K Kung
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Santiago Ortega-Gutierrez
- Division of Cerebrovascular Diseases, Department of Neurology, University of Iowa, Iowa City, Iowa.,Departmnet of Neurosurgery, University of Iowa, Iowa City, Iowa.,Department of Radiology, University of Iowa, Iowa City, Iowa
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Edgar A Samaniego
- Division of Cerebrovascular Diseases, Department of Neurology, University of Iowa, Iowa City, Iowa.,Departmnet of Neurosurgery, University of Iowa, Iowa City, Iowa.,Department of Radiology, University of Iowa, Iowa City, Iowa
| | - David Hasan
- Departmnet of Neurosurgery, University of Iowa, Iowa City, Iowa
| |
Collapse
|
43
|
Russo R, Bradac GB, Castellan L, Gallesio I, Garbossa D, Iannucci G, Mardighian D, Menozzi R, Pitrone A, Romano G, Venturi F, Bergui M. Neuroform Atlas stent-assisted coiling of ruptured intracranial aneurysms: A multicenter study. J Neuroradiol 2020; 48:479-485. [PMID: 32205256 DOI: 10.1016/j.neurad.2020.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 11/13/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess efficacy, safety and to discuss optimal medical therapy of stent-assisted coiling of ruptured intracranial aneurysms. METHODS Ruptured intracranial aneurysms treated with stent-assisted coiling in eight different institutions were retrospectively reviewed. Medical treatment regimens varied among the centers, mainly regarding heparin administration and post-procedural single or double antiplatelet therapy. Clinical and angiographic results, including complications and outcomes were analyzed and related to the different therapies. RESULTS Sixty-one consecutive patients (male/female 23/38), aged 59.1 years (36-86) underwent stent-assisted coiling for ruptured intracranial aneurysm without antiplatelet pre-medication. Intravenous acetylsalicylic acid (ASA) 500mg was administered to all patients immediately after stent deployment. At the same time heparin was given as bolus in 15 patients (24.6%) as part of local protocol. Intravenous glycoprotein 2b/3a inhibitors (antiGP2b3a) were used as bail-out therapy for stent thrombosis. Stent thrombosis occurred in 22 patients (36.1%), of which 4 (6.5%) lead to incomplete and 18 (29.6) to complete occlusion of the stent. Heparin administration had no effect on thrombosis rate. Thrombosis resolution occurred in all cases with intravenous antiGP2b3a (7 tirofiban, 15 abciximab), without increasing overall complication rate. Single antiplatelet therapy with ASA (28 patients, 45.9%) or double antiplatelet therapy including ASA and clopidogrel (33 patients, 54.1%) were administered after procedure, depending on local protocols and on neurointerventionists' experience. Overall complication rate, including ischemia and hemorrhage was higher in patients in which only ASA was administered (21.4% vs. 12.1%). No late stent thrombosis was seen, regardless of whether a single or double antiplatelet regimen was used. Nevertheless, the small sample size suggests caution in interpreting these results. Moreover, a possible bias may arise from the decision whether to modify the maintenance therapy or not depending on the severity of the intracranial hemorrhage in a case-by-case assessment. At three months, 34 out of 38 patients with HH grade 1-2 (89.4%), and 11 out of 23 with Hunt-Hess grade of 3-4 (47.8%) were independent (Modified Ranking Scale 0-2). CONCLUSION Stent assisted coiling of ruptured intracranial aneurysms is a feasible option when simple coiling is not possible. Optimal medical treatment is still controversial because balance between hemorrhagic and ischemic risks is difficult to evaluate. In our series, heparin bolus had no effect on subsequent stent thrombosis. In all cases peri-operative stent thrombosis was successfully managed using bail-out intravenous antiGP2b3a, which did not increase post-procedural hemorrhage rates. A non-significant trend towards increased complications rate was noticed in patients treated with single antiplatelet therapy versus double antiplatelet therapy.
Collapse
Affiliation(s)
- Riccardo Russo
- Department of Surgical Sciences, Radiology Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, corso bramante 88, Turin, Italy.
| | - Gianni Boris Bradac
- Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, Turin, Italy
| | - Lucio Castellan
- Neuroradiology Unit, IRCCS San Martino University Hospital, Genoa, Italy
| | - Ivan Gallesio
- Department of Radiology, Neuroradiological Unit, Azienda ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy
| | - Diego Garbossa
- Department of Neuroscience, Neurosurgery Section, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, Turin, Italy
| | | | | | - Roberto Menozzi
- Interventional Neuroradiology Unit, Azienda Ospedaliera Universitaria, Parma, Italy
| | - Antonio Pitrone
- Neuroradiology Unit, Biomedical Sciences and of Morphologic and Functional Images, AOU Policlinico G. Martino, Messina, Italy
| | - Giuseppe Romano
- Neuroradiology Unit, S. Croce e Carle Hospital, Cuneo, Italy
| | - Fabrizio Venturi
- Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, Turin, Italy
| | - Mauro Bergui
- Department of Neuroscience, Neuroradiological Unit, University of Turin, Azienda Ospedaliera Città della Salute e della Scienza Hospital, Turin, Italy
| |
Collapse
|
44
|
Goertz L, Smyk MA, Siebert E, Turowski B, Borggrefe J, Mpotsaris A, Bohner G, Schlamann M, Dorn F, Liebig T, Kabbasch C. Low-Profile Laser-Cut Stents for Endovascular Treatment of Intracranial Aneurysms : Incidence, Clinical Presentation and Risk Factors of Thromboembolic Events. Clin Neuroradiol 2020; 31:107-115. [PMID: 31970465 DOI: 10.1007/s00062-019-00874-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/20/2019] [Accepted: 12/27/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Low-profile intracranial stents are characterized by a miniaturized design that enables deployment via a 0.0165″ or 0.017″ internal diameter microcatheter, which is typically intended for coil delivery. This study analyzed the incidence, clinical relevance and risk factors of thromboembolic events (TEE) occurring during low-profile stent-assisted coiling of intracranial aneurysms. METHODS This was a retrospective, multicenter analysis of consecutive patients who underwent stent-assisted aneurysm coiling (SAC) with the laser-cut Acandis Acclino and Neuroform Atlas stents. The study evaluated the incidence of symptomatic and asymptomatic TEEs and the impact on functional outcome. Risk factors for TEEs were determined by univariate and bivariate logistic regression analyses. RESULTS Among 131 procedures (mean patient age 56.5 ± 12.8 years, mean aneurysm size: 6.7 ± 3.9 mm) TEEs occurred in 14 cases (10.7%) of which 2 patients (1.5%) developed ischemic stroke, while the remaining TEEs remained asymptomatic. Multivariate analysis revealed Y‑stenting as potential risk factor for TEEs (odds ratio: 3.9, 95% confidence interval: 1.0-16.5; p = 0.08). CONCLUSION The use of SAC with low-profile intracranial stents is associated with a favorable safety profile; however, Y‑stenting may carry an increased risk of TEEs, which needs to be considered during treatment planning.
Collapse
Affiliation(s)
- Lukas Goertz
- Department of Neuroradiology, University Hospital of Cologne, Kerpener Str. 67, 50937, Cologne, Germany. .,Center for Neurosurgery, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Str. 67, 50937, Cologne, Germany.
| | - Michael Artur Smyk
- Department of Neuroradiology, University Hospital of Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Eberhard Siebert
- Institute of Neuroradiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bernd Turowski
- Department of Neuroradiology, University Hospital of Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Jan Borggrefe
- Department of Neuroradiology, University Hospital of Cologne, Kerpener Str. 67, 50937, Cologne, Germany
| | - Anastasios Mpotsaris
- Department of Neuroradiology, University Hospital of Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Georg Bohner
- Institute of Neuroradiology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Marc Schlamann
- Department of Neuroradiology, University Hospital of Cologne, Kerpener Str. 67, 50937, Cologne, Germany
| | - Franziska Dorn
- Department of Neuroradiology, LMU University Hospital of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Thomas Liebig
- Department of Neuroradiology, LMU University Hospital of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christoph Kabbasch
- Department of Neuroradiology, University Hospital of Cologne, Kerpener Str. 67, 50937, Cologne, Germany
| |
Collapse
|
45
|
Goertz L, Smyk MA, Mpotsaris A, Borggrefe J, Dorn F, Liebig T, Schlamann M, Laukamp K, Krischek B, Turowski B, Kabbasch C. Long-term Angiographic Results of the Low-profile Acandis Acclino Stent for Treatment of Intracranial Aneurysms : A Multicenter Study. Clin Neuroradiol 2020; 30:827-34. [PMID: 31732750 DOI: 10.1007/s00062-019-00847-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The low-profile Acandis Acclino is a self-expandable nitinol microstent for stent-assisted coiling of intracranial aneurysms. This article reports long-term clinical and angiographic outcome in a multicenter setting. METHODS In this study 98 consecutive patients (mean age 55.4 ± 13.5 years) were treated with the Acclino for 98 aneurysms (28 unruptured, 20 recurrent, 50 ruptured) at 3 German tertiary care centers within a 6-year period. The technical success, complications, clinical outcome and angiographic results were retrospectively analyzed. RESULTS The technical success rate was 100% with immediate complete occlusion achieved in 89.8% of the patients. Among 65 patients (66.3%) available for a 6‑month follow-up, complete and near-complete occlusion rates were 92.3% and 98.5%, respectively. In 38 patients (38.8%) with long-term follow-up (mean: 21 months), complete and near-complete occlusion were achieved in 81.2% and 89.5%, respectively. Aneurysm recurrence between mid-term and long-term follow-up was observed in 14.3%. The retreatment rate was 11.3%. There were three thromboembolic events (3.1%), of which one resulted in ischemic stroke (1.0%). For unruptured aneurysms, the procedural and device-related morbidity rates were 2.1% and 0%, respectively. CONCLUSION In the present study, the Acclino was associated with a low risk of thromboembolic complications and high aneurysm occlusion rates at long-term follow-up. Due to incomplete angiographic follow-up in this series, prospective studies will be necessary to confirm the results.
Collapse
|
46
|
Abdennour L, Sourour N, Drir M, Premat K, Shotar E, Taylor G, Godier A, Mathout J, Lenck S, Bernard R, Carpentier A, Degos V, Clarençon F. Preliminary Experience with Cangrelor for Endovascular Treatment of Challenging Intracranial Aneurysms. Clin Neuroradiol 2019; 30:453-461. [PMID: 31309241 DOI: 10.1007/s00062-019-00811-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/27/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Cangrelor is a P2Y12 inhibitor that presents the advantage of having a short half-life. Its use may be helpful in the management of antiplatelet therapy for patients with intracranial aneurysms treated by stent-assisted coiling or flow-diverter stents. The purpose of this study was to report early experiences in using cangrelor for such indications. MATERIAL AND METHODS From October 2017 to November 2018, 7 consecutive patients (5 females, 2 males, mean age = 56 years) were managed with cangrelor as antiplatelet therapy, combined with aspirin, for stent-assisted coiling embolization and flow-diverter embolization of challenging intracranial aneurysms. Anti-aggregation protocols, including cangrelor, were systematically recorded. Treatment-related complications (minor/major hemorrhagic complications, ischemic complications) as well as clinical and angiographic outcomes (evaluated at 8.7 ± 4.2 and 8.75 ± 10 months, respectively) were retrospectively analyzed. RESULTS Of the aneurysms 71.4% (5 out of 7) were ruptured and treated in the acute phase. In one case cangrelor was used as an alternative to clopidogrel in an asymptomatic hemorrhagic complication after stent-assisted coiling for better control of a possible worsening of the intracranial bleeding. Of the patients, 1 (14%) with a complex ruptured MCA aneurysm treated with a flow-diverter stent experienced a severe intracranial hemorrhage, which occurred after switching the cangrelor to ticagrelor and eventually led to death. No hemorrhagic complications under cangrelor were recorded for the six remaining patients. No mRS worsening was observed at discharge, except for the patient who died and six out of the seven patients had a mRS ≤2 at follow-up. CONCLUSION Cangrelor is a new antiplatelet therapy with a P2Y12 inhibiting effect, with a rapid onset and offset of action, owing to its short half-life. This cases series presents a pilot experience with promising results in terms of antiplatelet management for challenging intracranial aneurysms treated by stent assisted coiling or flow-diverter stents.
Collapse
Affiliation(s)
- Lamine Abdennour
- Neuro-Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Nader Sourour
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47, Bd de l'Hôpital, 75013, Paris, France
| | - Mehdi Drir
- Neuro-Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Kévin Premat
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47, Bd de l'Hôpital, 75013, Paris, France.,Sorbonne University, Paris, France
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47, Bd de l'Hôpital, 75013, Paris, France
| | - Guillaume Taylor
- Neuro-Intensive Care Unit, Fondation A. de Rothschild, Paris, France
| | - Anne Godier
- Department of Anesthesiology, Hôpital Européen Georges Pompidou, INSERM UMRS-1140, université Paris Descartes, Paris, France
| | - Jugurtha Mathout
- Neuro-Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Stéphanie Lenck
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47, Bd de l'Hôpital, 75013, Paris, France
| | - Remy Bernard
- Neuro-Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Alexandre Carpentier
- Sorbonne University, Paris, France.,Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France
| | - Vincent Degos
- Neuro-Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris, France.,Sorbonne University, Paris, France
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47, Bd de l'Hôpital, 75013, Paris, France. .,Sorbonne University, Paris, France.
| |
Collapse
|
47
|
Henkes H, Bhogal P, Aguilar Pérez M, Lenz-Habijan T, Bannewitz C, Peters M, Sengstock C, Ganslandt O, Lylyk P, Monstadt H. Anti-thrombogenic coatings for devices in neurointerventional surgery: Case report and review of the literature. Interv Neuroradiol 2019; 25:619-627. [PMID: 31248313 PMCID: PMC6820329 DOI: 10.1177/1591019919858000] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Stent-assisted coiling and extra-saccular flow diversion require dual anti-platelet therapy due to the thrombogenic properties of the implants. While both methods are widely accepted, thromboembolic complications and the detrimental effects of dual anti-platelet therapy remain a concern. Anti-thrombogenic surface coatings aim to solve both of these issues. Current developments are discussed within the framework of an actual clinical case. CASE DESCRIPTION A 33-year-old male patient lost consciousness while doing sport and was administered 500 mg acetylsalicylic acid on site. Computed tomography revealed a massive subarachnoid haemorrhage, and digital subtraction angiography showed an aneurysm of the right middle cerebral artery. Stent-assisted coiling using a neck bridging device with a hydrophilic coating (pCONUS_HPC) was considered as an appropriate approach. Another 500 mg acetylsalicylic acid IV was given. After the single anti-platelet therapy was seen to be effective, a pCONUS_HPC was implanted, and the aneurysm sac subsequently fully occluded using coils. No thrombus formation was encountered. During the following days, 2 × 500 mg acetylsalicylic acid IV daily were required to maintain single anti-platelet therapy, monitored by frequent response testing. Follow-up digital subtraction angiography after 13 days confirmed the occlusion of the aneurysm and the patency of the middle cerebral artery. CONCLUSION A variety of ways to reduce the thrombogenicity of neurovascular stents is discussed. Hydrophilic surface coatings are a valid concept to improve the haemocompatibility of neurovascular implants while avoiding the use of dual anti-platelet therapy. Phosphorylcholine and phenox hydrophilic polymer coating are currently the most promising candidates. This concept is supported by anecdotal experience. However, formalised registries and randomised trials are currently being established.
Collapse
Affiliation(s)
- Hans Henkes
- Neuroradiological Clinic, Klinikum Stuttgart, Stuttgart, Germany.,Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, London, UK
| | | | | | | | - Marcus Peters
- Experimental Pneumology, Medical Faculty, Ruhr University, Bochum, Germany
| | - Christina Sengstock
- Surgical Research, BG University Hospital Bergmannsheil Bochum, Ruhr University, Bochum, Germany
| | | | - Pedro Lylyk
- Clinica La Sagrada Familia, ENERI, Buenos Aires, Argentina
| | | |
Collapse
|
48
|
Xin WQ, Xin QQ, Yuan Y, Chen S, Gao XL, Zhao Y, Zhang H, Li WK, Yang XY. Comparison of Flow Diversion and Coiling for the Treatment of Unruptured Intracranial Aneurysms. World Neurosurg 2019; 128:464-472. [PMID: 31132489 DOI: 10.1016/j.wneu.2019.05.149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/18/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND To systematically assess the efficacy and safety between flow diversion and coiling for patients with unruptured intracranial aneurysms. METHODS Potential academic articles were identified from Cochrane Library, Medline, PubMed, EMBASE, ScienceDirect, and other databases. The time range we retrieved from was the inception of electronic databases to February 2019. Gray studies were identified from the references of included literature reports. STATA version 11.0 was used to analyze the pooled data. RESULTS A total of 11 articles (10 retrospective studies and 1 prospective study) were involved in our study. The overall participants of the coiling group were 611, whereas 576 were in the flow diversion group. Our meta-analysis showed that flow diversion was preferable for unruptured intracranial aneurysms as its lower value of total cost per case (weighted mean difference, 5705.906; 95% confidence interval [CI], [4938.536, 6473236]; P < 0.001), fluoroscopy time per case (weighted mean difference, 25.786; 95% CI, 17.169-34.377; P < 0.001), and retreatment rates (odds ratio [OR], 7.127; 95% CI, [3.525, 14.410]; P < 0.001), at the same time, a higher rate of immediate completed occlusion (OR, 0.390; 95% CI, [0.224, 0.680]; P = 0.001) and follow-up completed occlusion (OR, 0.173; 95% CI, [0.080, 0.375]; P < 0.001) was demonstrated in the flow diversion group. There was no difference on intraoperative complication rates (P = 0.070), procedure-related mortality (P = 0.609) and rupture rates (P = 0.408), modified Rankin Scale (mRS) 0-2 at discharge (P = 0.077), and mRS 0-2 at follow-up (P = 0.484). CONCLUSIONS The use of flow diversion for the treatment of unruptured intracranial aneurysms may reduce total cost per case, fluoroscopy time per case, retreatment rates, and increases immediate completed occlusion and follow-up completed occlusion rates without affecting the results of mRS and intraoperative complication.
Collapse
Affiliation(s)
- Wen-Qiang Xin
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Qi-Qiang Xin
- Department of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, People's Republic of China
| | - Yan Yuan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Shi Chen
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Xiang-Liang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Yan Zhao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Hao Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Wen-Kui Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Xin-Yu Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.
| |
Collapse
|
49
|
Nishimura K, Otani K, Mohamed A, Dahmani C, Ishibashi T, Yuki I, Kaku S, Takao H, Murayama Y. Accuracy of Length of Virtual Stents in Treatment of Intracranial Wide-Necked Aneurysms. Cardiovasc Intervent Radiol 2019; 42:1168-1174. [PMID: 31076839 PMCID: PMC6597734 DOI: 10.1007/s00270-019-02230-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/19/2019] [Indexed: 11/25/2022]
Abstract
Background and Purpose Precise stent deployment is important for successful treatment of intracranial aneurysms by stent-assisted coiling (SAC). We evaluated the accuracy of virtual stents generated using commercial stent planning software by comparing the length of virtual and actually deployed intracranial laser cut stents on three-dimensional digital subtraction angiography (3D-DSA) images. Methods We retrospectively analyzed the data of 75 consecutive cases of intracranial wide-necked aneurysms treated with the SAC technique using laser cut stents. Based on 3D-DSA images acquired by C-arm CT, stent sizing and placement were intraoperatively simulated by a commercial software application. The difference in length of the stents was estimated by measuring proximal discrepancies between the end points of the virtual and actually deployed stents on fused pre-procedural and post-procedural 3D-DSA images. Discrepancies between distal stent end points were manually minimized. The Kruskal–Wallis test was applied to test whether stent location, type, and length had an effect on difference in length between virtual and real stent. Results The median difference in length between virtual and real stents was 1.58 mm with interquartile range 1.12–2.12 mm. There was no evidence for an effect of stent location (p = 0.23), stent type (p = 0.33), or stent length (p = 0.53) on difference in length between virtual and real stents. Conclusions Stent planning software allows 3D simulation of laser cut stents overlain on 3D-DSA images of vessels and may thus be useful for stent selection and deployment of laser cut stents during stent-assisted coiling of intracranial aneurysms.
Collapse
Affiliation(s)
- Kengo Nishimura
- Division of Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Jikei University, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Katharina Otani
- Siemens Healthcare K.K., Gate City Osaki West Tower, 1-11-1 Osaki, Shinagawa-ku, Tokyo, 141-8644 Japan
| | - Ashraf Mohamed
- Siemens Healthcare K.K., Gate City Osaki West Tower, 1-11-1 Osaki, Shinagawa-ku, Tokyo, 141-8644 Japan
| | - Chihebeddine Dahmani
- Siemens Healthcare Pte Ltd, Surgery Business Line, 60 MacPherson Road, Singapore, 348615 Singapore
| | - Toshihiro Ishibashi
- Division of Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Jikei University, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Ichiro Yuki
- Division of Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Jikei University, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Shogo Kaku
- Division of Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Jikei University, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Hiroyuki Takao
- Division of Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Jikei University, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| | - Yuichi Murayama
- Division of Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Jikei University, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan
| |
Collapse
|
50
|
Yi L, Zhao W, Krings T, Wang W, Chen J. High-Flow Extracranial-to-Intracranial Bypass for Treatment of Thrombotic Parent Vessel Occlusion After Stent-Assisted Aneurysm Coiling as a Potential Rescue Therapy. World Neurosurg 2019; 127:326-329. [PMID: 30878756 DOI: 10.1016/j.wneu.2019.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/13/2019] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Stent thrombosis (ST) is a known complication after intracranial stent implantation. The pathophysiology of ST is multifactorial, and standardized treatments for ST remain uncertain. CASE DESCRIPTION A patient harboring an unruptured aneurysm of the posterior communicating segment of the left internal carotid artery was treated with stent-assisted coil embolization while on dual antiaggregation therapy. Despite adherence to medication, ST occurred 8 days after the intervention. Following tirofiban infusion, the thrombus dissolved and clinical symptoms improved. However, after tirofiban was stopped, the patient experienced again ischemic symptoms. The patient underwent high-flow extracranial-to-intracranial bypass with good patency of the graft and resolution of symptoms. CONCLUSIONS In case of refractory ST, high-flow extracranial-to-intracranial bypass proved to be in this case a feasible and effective rescue option.
Collapse
Affiliation(s)
- Lei Yi
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wenyuan Zhao
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - Timo Krings
- Division of Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Wei Wang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| |
Collapse
|