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Matsukawa H, Orscelik A, Elawady SS, Sowlat MM, Cunningham CM, Al Kasab S, Uchida K, Yoshimura S, Spiotta AM. Endovascular Coiling of Ruptured Tiny Saccular Intracranial Aneurysms: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 187:e414-e446. [PMID: 38663736 DOI: 10.1016/j.wneu.2024.04.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND The safety and efficacy of endovascular coiling of ruptured tiny saccular intracranial aneurysms (IAs) (≤3 mm) remain unknown. METHODS A comprehensive search of PubMed, Embase, Web of Science, and Scorpus databases up to November 15, 2023 was performed. Pooled prevalence was calculated for occlusion rates, recanalization, retreatment, long-term favorable outcome, and procedure-related complications and mortality. Pooled odds ratios were calculated to compare these outcomes between coiling and stent-assisted coiling (SAC). RESULTS Forty-two studies with 2166 ruptured tiny saccular IAs treated with coiling were included. The follow-up complete aneurysm occlusion rate was 83.9% (95% CI: 77.2-88.9%). The rates of recanalization and retreatment were 7.7% (95% CI: 5.7-10.2%) and 5.8% (95% CI: 4.5-7.5%). The range of median Hunt and Hess grades was 1.4-2.9 and the favorable outcome rate was 85.6% (95% CI: 81.1-89.2%). The rates of thromboembolism, intraprocedural rupture, and mortality were 4.6% (95% CI: 3.6-5.8%), 5.4% (95% CI: 4.1-7.0%), and 5.6% (95% CI: 4.4-7.2%), respectively. Comparison of coiling and SAC revealed no significant difference, except for a higher likelihood of follow-up complete aneurysm occlusion in SAC (odds ratio [OR] 0.37, 95% CI: 0.17-0.80) and recanalization in the coiling (OR, 3.21 [95% CI, 1.37-7.51]). CONCLUSIONS Our meta-analysis demonstrates that coiling for ruptured tiny saccular IA is a feasible, effective, and safe approach that is associated with favorable clinical outcomes in both the short and long term for patients with mild to moderate Hunt and Hess grades.
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Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA; Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Atakan Orscelik
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sameh Samir Elawady
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohammad-Mahdi Sowlat
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Conor M Cunningham
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan; Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
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AngioSuite-Assisted Volume Calculation and Coil Use Prediction in the Endovascular Treatment of Tiny Volume Intracranial Aneurysms. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5514608. [PMID: 34368348 PMCID: PMC8342139 DOI: 10.1155/2021/5514608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/21/2021] [Accepted: 07/11/2021] [Indexed: 11/18/2022]
Abstract
Methods Thirty-three consecutive patients with 34 TVIAs were prospectively recruited and treated with endovascular techniques. The volume of TVIAs and the required length of coils were calculated by the AngioSuite software before embolization. The treatment efficacy of TVIAs was assessed using the Raymond scale (Rs) and the modified Rankin scale (mRs). Results Of the 34 aneurysms with an average volume of 7.16 mm3, 13 aneurysms were treated with sole coil embolization, 19 by stent-assisted embolization, and 2 by balloon-assisted embolization. The average coil length was 5.32 cm, and the average packing density was 41.21%. The immediate DSA showed that total occlusion (Rs = 1) was achieved in 15 aneurysms, subtotal (Rs = 2) in 9, and partial (Rs = 3) in 11. Total occlusion was achieved in 30 aneurysms and subtotal in the other 4 aneurysms at 6-month follow-up. Baseline volume and diameter of aneurysms were significantly correlated with the coil length (r = 0.801, P < 0.001; r = 0.711, P < 0.001). Conclusions Coil embolization of TVIAs was easy to achieve high packing density. According to the data from AngioSuite, relative few coils can increase the safety in procedure and stenting may reduce risk of aneurysmal recurrence.
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Cox M, Song JW, Nabavizadeh SA, Kung D, Loevner L, Choudhri O. Detection of Angiographically Occult Ruptured Basilar Sidewall Perforator Aneurysm by Vessel Wall MR Imaging. Neurohospitalist 2021; 11:156-159. [PMID: 33791061 DOI: 10.1177/1941874420963648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Basilar artery perforator aneurysms are rare with a prevalence of less than 1%. These are particularly challenging to detect given their small size and tendency to intermittently thrombose. We describe a case of a ruptured basilar artery sidewall perforator aneurysm that was angiographically occult on computed tomographic angiogram and cerebral catheter angiogram. One day after the initial diagnostic work-up, intracranial vessel wall MR imaging (VWI) was performed which revealed a small outpouching along the right posterolateral basilar arterial wall with a punctate enhancing focus suggestive of a thrombosed basilar perforator artery aneurysm. Thrombus within the small aneurysm sac likely contributed to the poor opacification of the aneurysm sac on conventional lumen-based imaging techniques. Ruptured aneurysms have high morbidity and mortality due to their tendency to rebleed, making their expedient detection and treatment imperative. This case highlights the role VWI can play in detecting small ruptured aneurysms that intermittently thrombose and are otherwise challenging to diagnose with conventional vessel imaging.
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Affiliation(s)
- Mougnyan Cox
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jae W Song
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - David Kung
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Laurie Loevner
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Omar Choudhri
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
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Zhao B, Xing H, Fan L, Tan X, Zhong M, Pan Y, Wan J. Endovascular Coiling versus Surgical Clipping of Very Small Ruptured Anterior Communicating Artery Aneurysms. World Neurosurg 2019; 126:e1246-e1250. [DOI: 10.1016/j.wneu.2019.03.074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/16/2022]
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Kim JH, Choi CH, Lee JI, Lee TH, Ko JK. Endovascular treatment of ruptured tiny aneurysms. J Cerebrovasc Endovasc Neurosurg 2019; 21:67-76. [PMID: 31886142 PMCID: PMC6911774 DOI: 10.7461/jcen.2019.21.2.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 06/18/2019] [Accepted: 06/20/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Endovascular coiling of ruptured tiny aneurysms (RTAs) in the brain has been known to be technically challenging owing to the higher rate of adverse events, such as thromboembolism and intraoperative rupture. The aim of this study was to report our ex-periences of endovascular treatment of RTAs (size, ≤3 mm). METHODS From January 2006 to December 2017, 35 RTAs in 35 patients were treated at our institution with an endosaccular coiling. Procedural data and clinical and angiographic results were retrospectively reviewed. RESULTS The mean size of the RTAs was 2.53 mm (SD: 0.38). The neck remodeling technique was applied to 14 aneurysms, including stent-assisted coiling (n=7) and balloon-assisted coiling (n=7). Procedure-related complications included intraprocedural rupture (n=2), thromboembolic event (n=1), and early rebleeding (n=2), which needed recoiling. Regarding immediate angiographic control, complete occlusion was achieved in 25 aneurysms (71.4%), small neck remnant in 5 (14.3%), and definite remnant in 5 (14.3%). At the end of follow-up, 31 of the 35 patients (88.6%) were able to function independently. Twenty-two of the 35 patients underwent follow-up conventional angiography (mean, 468 days). Stable occlusion was achieved in 20 of the 22 patients (90.9%), minor recanalization in 1 (4.5%), and major recanalization, which required recoiling, in 1 (4.5%). CONCLUSION Our experiences demonstrate that endovascular treatment for RTAs is both feasible and effective. However, periprocedural rebleedings were found to occur more often (11.4%) than what is generally suspected.
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Affiliation(s)
- Joon Hyuk Kim
- Department of Neurosurgery, Diagnostic Radiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Chang Hwa Choi
- Department of Neurosurgery, Diagnostic Radiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jae Il Lee
- Department of Neurosurgery, Diagnostic Radiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Tae Hong Lee
- Department of Neurosurgery, Diagnostic Radiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jun Kyeung Ko
- Department of Neurosurgery, Diagnostic Radiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea
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“Coil mainly” policy in management of intracranial ACoA aneurysms: single-centre experience with the systematic review of literature and meta-analysis. Neurosurg Rev 2017; 41:825-839. [DOI: 10.1007/s10143-017-0932-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 11/20/2017] [Indexed: 12/11/2022]
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Intraprocedural Rupture of Unruptured Cerebral Aneurysms During Coil Embolization: A Single-Center Experience. World Neurosurg 2017; 105:177-183. [DOI: 10.1016/j.wneu.2017.05.147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/22/2017] [Accepted: 05/24/2017] [Indexed: 11/21/2022]
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Anokwute MC, Braca JA, Bohnstedt B, DeNardo A, Scott J, Cohen-Gadol A, Sahlein DH. Endovascular treatment of ruptured tiny (⩽3mm) intracranial aneurysms in the setting of subarachnoid hemorrhage: A case series of 20 patients and literature review. J Clin Neurosci 2017; 40:52-56. [PMID: 28347681 DOI: 10.1016/j.jocn.2017.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/22/2017] [Indexed: 11/24/2022]
Abstract
Successful endovascular coiling of ruptured tiny saccular intracranial aneurysms (⩽3mm) is technically challenging and traditionally has been associated with technical failures, as well as morbidity related to thromboembolic events and high intraoperative rupture rates. This study analyzes the feasibility, technical efficacy, and clinical outcomes of coil embolization of ruptured tiny intracranial aneurysms using current coil and microcatheter technology and techniques. We performed a retrospective review of 20 patients with 20 ruptured tiny aneurysms treated with endovascular coil embolization from 2013 to 2016 at a single high-volume academic tertiary care practice. The mean aneurysm size was 2.4mm (median 2.5mm, 1-3). Complete occlusion was achieved in 12 of 20 patients (60%), the remaining 7 of 20 patients (35%) had a small neck remnant, and there was 1 failure (5%) converted to microsurgical clipping. Two patients had a failed attempted surgical clip reconstruction and were subsequently coiled. There was 1 intraprocedural rupture (5%) and 1 severe parent artery vasospasm (5%) during coiling. At discharge, 60% of patients were living independently. At follow-up three patients were deceased. Mean angiographic follow-up was 139days (SD 120). There were no aneurysm recurrences among occluded patients and there were no retreatments among those with neck remnants. Coiling of ruptured aneurysms ⩽3mm is feasible with high occlusion rates and low complication rates. The availability of softer coils with flexible detachment zones has led to safe and effective endovascular treatment of tiny ruptured aneurysms.
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Affiliation(s)
| | - John A Braca
- Indiana University School of Medicine, Indianapolis, IN, United States; Department of Neurosurgery, Indiana University School of Medicine, IN, United States; Goodman Campbell Brain and Spine, Indianapolis, IN, United States.
| | | | - Andrew DeNardo
- Department of Neurosurgery, Indiana University School of Medicine, IN, United States; Goodman Campbell Brain and Spine, Indianapolis, IN, United States.
| | - John Scott
- Department of Neurosurgery, Indiana University School of Medicine, IN, United States; Goodman Campbell Brain and Spine, Indianapolis, IN, United States.
| | - Aaron Cohen-Gadol
- Indiana University School of Medicine, Indianapolis, IN, United States; Department of Neurosurgery, Indiana University School of Medicine, IN, United States; Goodman Campbell Brain and Spine, Indianapolis, IN, United States.
| | - Daniel H Sahlein
- Indiana University School of Medicine, Indianapolis, IN, United States; Department of Neurosurgery, Indiana University School of Medicine, IN, United States; Goodman Campbell Brain and Spine, Indianapolis, IN, United States.
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Li J, Su L, Ma J, Kang P, Ma L, Ma L. Endovascular Coiling Versus Microsurgical Clipping for Patients With Ruptured Very Small Intracranial Aneurysms: Management Strategies and Clinical Outcomes of 162 Cases. World Neurosurg 2017; 99:763-769. [DOI: 10.1016/j.wneu.2015.11.079] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/25/2015] [Accepted: 11/26/2015] [Indexed: 11/26/2022]
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Kocur D, Zbroszczyk M, Przybyłko N, Hofman M, Jamróz T, Baron J, Bażowski P, Kwiek S. Stand-alone coil embolization of anterior communicating artery aneurysms: Efficacy and technical issues. Neuroradiol J 2016; 29:361-7. [PMID: 27531863 PMCID: PMC5033104 DOI: 10.1177/1971400916665388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We report our experience with endovascular coiling of anterior communicating artery aneurysms with special consideration of angiographic and clinical outcomes and periprocedural complications. MATERIALS AND METHODS The analysis included treatment results of 28 patients with ruptured and unruptured aneurysms. The aneurysm size ranged from 1.8 to 9.8 mm (mean 5.2, SD 1.7). Clinical examinations with the use of modified Rankin Score and angiographic outcomes were evaluated initially post-embolization and at a minimum follow-up of six months. RESULTS Initial post-treatment complete and near-complete aneurysm occlusion was achieved in 27 (96%) cases and incomplete occlusion in one (4%) case. Imaging follow-up, performed in 15 (53.6%) patients, showed no change in the degree of occlusion in 11 (73%), coil compaction in one (7%) and progressive occlusion in three (20%) patients. Three (20%) patients underwent a second coil embolization. The procedure-related severe morbidity and mortality rate was 6.4% (2/31). Coil prolapse was present in one (3.2%) case and intraprocedural aneurysm rupture in three (9.6%) cases. The clinical follow-up evaluation achieved in 19 (67.9%) patients showed no change in 17 (89.5%) patients and improvement in two (10.5%) patients. CONCLUSIONS Although the efficacy of coil embolization of anterior communicating artery aneurysms is unquestionable and the procedure-related complications are acceptable, they should not be neglected. Further investigations are needed to better understand protective factors, as well as to establish unequivocally appropriate management strategy of these complications.
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Affiliation(s)
- Damian Kocur
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Poland
| | - Miłosz Zbroszczyk
- Medical University of Silesia, School of Medicine in Katowice, Department of Radiology and Nuclear Medicine, Poland
| | - Nikodem Przybyłko
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Poland
| | - Mariusz Hofman
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Poland
| | - Tomasz Jamróz
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Poland
| | - Jan Baron
- Medical University of Silesia, School of Medicine in Katowice, Department of Radiology and Nuclear Medicine, Poland
| | - Piotr Bażowski
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Poland
| | - Stanisław Kwiek
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Poland
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Stent-assisted coiling of very small wide-necked intracranial aneurysms: Complications, anatomical results and clinical outcomes. Neurol Neurochir Pol 2016; 50:410-417. [PMID: 27491459 DOI: 10.1016/j.pjnns.2016.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 06/28/2016] [Accepted: 07/19/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Treatment of very small (≤3mm) wide-necked intracranial aneurysms remains controversial, we investigated the efficacy and safety of stent-assisted coiling of such aneurysms. METHODS From September 2008 to December 2012, 112 very small wide-necked intracranial aneurysms in 108 patients were embolized with stent-assisted coiling. We assessed the initial neurological conditions, complications and anatomic results. The follow-up results were evaluated with DSA and mRS. RESULTS Stent deployment was successful in 104 of 108 procedures (96.3%). 11 complications (10.2%) occurred during procedures, including 5 events of aneurysm rupture, 3 events of thromboembolism. The rate of complication, rupture and thromboembolism was not statistically different between the ruptured and unruptured patients (P=0.452, P=0.369, P=1.000, respectively). The initial aneurysmal occlusion was Raymond scale (RS) 1 in 34 patients (31.5%), RS2 in 53 patients (49.1%), and RS3 in 21 patients (19.4%). 79 aneurysms were available for anatomic follow-up of 12-47 months, stable occlusion in 45 aneurysms (57.0%), progressive complete occlusion in 34 aneurysms (43.0%). 95 patients(88.0%) were available for a clinical follow-up of 12-52 months, 92 patients (96.8%) had favorable clinical outcomes (mRS ≤2), 3 patients (3.2%) had morbidity (mRS: 3-5). The morbidity was not statistically different between the ruptured and unruptured patients (P=1.000). CONCLUSIONS Stent-assisted coiling of very small wide-necked intracranial aneurysms may be effective and safe. Because of low risk of rupture in such aneurysms, the coiling of unruptured such aneurysms must be selective. The long-term efficacy and safety of coiling such aneurysms remains to be determined in larger prospective series.
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Fan L, Tan X, Xiong Y, Zheng K, Li Z, Liu D, Zhong M, Zhao B. Stent-assisted coiling versus coiling alone of ruptured anterior communicating artery aneurysms: A single-center experience. Clin Neurol Neurosurg 2016; 144:96-100. [PMID: 27037864 DOI: 10.1016/j.clineuro.2016.03.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Endovascular coiling of anterior communicating artery (ACoA) aneurysms has evolved; however, stent-assisted coiling of ruptured aneurysms remains controversial. We aimed to compare periprocedural complications, angiographic and clinical outcomes after stent-assisted coiling with coiling alone of ruptured ACoA aneurysms. METHODS We performed a retrospective review of consecutive 222 patients with ruptured ACoA aneurysms treated with endovascular coiling within 7 days after ictus. Patients were grouped into stent-assisted coiling and coiling alone groups. Baseline characteristics, periprocedural complications, clinical outcomes, and angiographic results were compared between the two groups. RESULTS 63 (28.4%) patients underwent stent-assisted coiling and 159 (71.6%) underwent coiling alone. There were no statistically significant differences in age, sex, clinical grading and Fisher grade. Larger aneurysms (P=0.002) and wider-neck aneurysms (P<0.001) were more often treated with stent-assisted coiling within 72h (P=0.025). Intraprocedural aneurysm rupture occurred in 6 (9.5%) patients treated with stent-assisted coiling compared with in 5 (3.1%) treated with coiling alone (P<0.048). Thrombus formation occurred in 10 (15.9%) patients after stent-assisted coiling compared with 6 (3.8%) after coiling alone (P=0.002). Stent-assisted coiling achieved a lower rate of immediate occlusion than coiling alone (P=0.045). Postoperative complications, clinical outcomes, and follow-up aneurysm occlusion did not significantly differ. CONCLUSIONS Stent-assisted coiling of ruptured ACoA aneurysms was associated with a higher rate of intraprocedural complications and associated with a lower immediate occlusion rate. However, Postoperative complications and clinical outcomes did not differ. Long-term angiographic results require further study.
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Affiliation(s)
- Lianghao Fan
- Department of Interventional Radiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xianxi Tan
- Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ye Xiong
- Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kuang Zheng
- Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zequn Li
- Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dajun Liu
- Department of Neurosurgery, the Second Renmin Hospital of Taizhou, Taizhou, China
| | - Ming Zhong
- Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bing Zhao
- Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
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Asif KS, Sattar A, Lazzaro MA, Fitzsimmons BF, Lynch JR, Zaidat OO. Consecutive Endovascular Treatment of 20 Ruptured Very Small (<3 mm) Anterior Communicating Artery Aneurysms. INTERVENTIONAL NEUROLOGY 2016; 5:57-64. [PMID: 27610122 DOI: 10.1159/000444662] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Small aneurysms located at the anterior communicating artery carry significant procedural challenges due to a complex anatomy. Recent advances in endovascular technologies have expanded the use of coil embolization for small aneurysm treatment. However, limited reports describe their safety and efficacy profiles in very small anterior communicating artery aneurysms. OBJECTIVE We sought to review and report the immediate and long-term clinical as well as radiographic outcomes of consecutive patients with ruptured very small anterior communicating artery aneurysms treated with current endovascular coil embolization techniques. METHODS A prospectively maintained single-institution neuroendovascular database was accessed to identify consecutive cases of very small (<3 mm) ruptured anterior communicating artery aneurysms treated endovascularly between 2006 and 2013. RESULTS A total of 20 patients with ruptured very small (<3 mm) anterior communicating artery aneurysms were consecutively treated with coil embolization. The average maximum diameter was 2.66 ± 0.41 mm. Complete aneurysm occlusion was achieved for 17 (85%) aneurysms and near-complete aneurysm occlusion for 3 (15%) aneurysms. Intraoperative perforation was seen in 2 (10%) patients without any clinical worsening or need for an external ventricular drain. A thromboembolic event occurred in 1 (5 %) patient without clinical worsening or radiologic infarct. Median clinical follow-up was 12 (±14.1) months and median imaging follow-up was 12 (±18.4) months. CONCLUSION This report describes the largest series of consecutive endovascular treatments of ruptured very small anterior communicating artery aneurysms. These findings suggest that coil embolization of very small aneurysms in this location can be performed with acceptable rates of complications and recanalization.
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Affiliation(s)
- Kaiz S Asif
- Departments of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA
| | - Ahsan Sattar
- Departments of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA
| | - Marc A Lazzaro
- Departments of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA; Departments of Neurosurgery, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA
| | - Brian-Fred Fitzsimmons
- Departments of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA; Departments of Neurosurgery, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA; Departments of Radiology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA
| | - John R Lynch
- Departments of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA; Departments of Neurosurgery, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA; Departments of Radiology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA
| | - Osama O Zaidat
- Departments of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA; Neuroscience and Stroke Center, Mercy Health St Vz Medical Center, Toledo, Ohio, USA
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Wei M, Ren H, Yin L. The combinational use of dual microcatheter technique and new hypersoft helical coil for endovascular treatment of tiny intracranial aneurysm with difficult geometry. Interv Neuroradiol 2015; 22:18-25. [PMID: 26508090 DOI: 10.1177/1591019915609124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/06/2015] [Indexed: 11/17/2022] Open
Abstract
The endovascular coiling of very small ruptured aneurysms with difficult geometry presents a significant treatment challenge because of potential dangerous complications, such as intraprocedural ruptures. We report our initial experience with the use of a dual microcatheter technique, combined with new hypersoft helical coils, for the treatment of these difficult lesions. Fourteen very small aneurysms with a maximum diameter of ≤3 mm that presented difficult configurations, such as a wide neck or an important branch vessel arising from the fundus, were identified using digital subtraction angiography. These lesions were successfully treated using a dual microcatheter technique and new hypersoft helical coils. There were no intraprocedural ruptures or procedure-related thromboembolisms. Complete or near-complete occlusions were achieved in all of the lesions. A Raymond score of RS 1 was achieved in eight of the aneurysms (57.1%) and an RS 2 was achieved in six of the aneurysms (42.9%). The mean packing density was 35.5%. At the last post-procedure clinical follow-up, a good clinical outcome (a modified Rankin scale score of 0-2) was observed in 11 of the patients (91.7%). The result of angiographic follow up in 11 cases showed two recanalized aneurysms. The use of the dual microcatheter technique and new hypersoft helical coil allowed for stable coil framing and good packing in geometrically difficult tiny aneurysms and presented a low rate of adverse events related to the procedure. The technique provided an efficient strategy for treating very small aneurysms with difficult configurations and high risks.
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Affiliation(s)
- Ming Wei
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China Department of Neurosurgery, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Hecheng Ren
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Long Yin
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
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Predictor's analysis of anterior circulation cerebral infarction after the endovascular treatment of anterior communicating artery aneurysms. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2014; 19:304-9. [PMID: 25097601 PMCID: PMC4115344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 12/11/2013] [Accepted: 02/26/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Despite increasing acceptance of endovascular coiling for treating anterior communicating artery (ACoA) aneurysms, anterior circulation cerebral infarction (ACI) after embolization remains a limitation. With higher incidence, higher morbidity and higher mortality, it is one of the main factors influencing the ACoA aneurysms prognosis. Determining the risk factors leading to ACI after embolization will have clinical significance. Through retrospective case analysis, this study investigated the risk factors related to ACI after embolization in order to provide information to serve the clinical practice. MATERIALS AND METHODS A retrospective review was performed of patients who had undergone coiling of ACoA aneurysms from 2008 to 2012. All patients had ruptured prior to the completion of embolization. Cases with acute stroke symptoms without alternative diagnoses after embolization were diagnosed as ACI. A total of 32 risk factors such as age, sex, hypertension, diabetes mellitus, modified Fisher grade, Hunt-Hess grade, ventricular hemorrhage, etc. were analyzed using univariate and logistic regression analysis. RESULTS Univariate analysis showed that negative fluid volume balance (P = 0.041 <0.05) and modified Fisher grade (P = 0.049 <0.05) reached statistical significance, suggesting that they might be risk factors for ACI after embolization. Multiple logistic regression analysis showed that modified Fisher grade was significantly associated with ACI after embolization, suggesting that it was an independent risk factor (odds ratios (OR): 4.968, 95% confidence intervals (CI): 1.013-24.360, P = 0.048). CONCLUSION Modified Fisher grade is an independent risk factor for ACI after embolization.
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16
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Management for the case of twice ruptured anterior communicating artery aneurysm: from nursing perspective. JOURNAL OF VASCULAR NURSING 2013; 31:107-10. [PMID: 23953859 DOI: 10.1016/j.jvn.2012.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 12/15/2012] [Accepted: 12/16/2012] [Indexed: 11/22/2022]
Abstract
The anterior communicating artery (ACoA) is the most common site of cerebral aneurysms, accounting for as much as 36% of aneurysms. Microsurgical clipping and coil embolization are treatment modalities for ruptured and nonruptured cerebral aneurysms. Compared with surgical clipping, coil embolization has a relatively lower mortality and incidence of cognitive impairment in patients. However, successful management of the patient with twice ruptured ACoA aneurysm is facing critical challenges.This article has described a case of twice ruptured aneurysm with the first rupture occurring when the patient was admitted and the second rupture occurring during coil embolization. Perioperative nursing assessment, monitoring, intervention, patient teaching, and the nurse's role are discussed from a nursing perspective.
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Zhao R, Shen J, Huang QH, Nie JH, Xu Y, Hong B, Yang PF, Zhao WY, Liu JM. Endovascular treatment of ruptured tiny, wide-necked posterior communicating artery aneurysms using a modified stent-assisted coiling technique. J Clin Neurosci 2013; 20:1377-81. [PMID: 23890412 DOI: 10.1016/j.jocn.2012.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 11/25/2012] [Accepted: 12/01/2012] [Indexed: 11/19/2022]
Abstract
The endovascular treatment of patients with tiny, wide-necked aneurysms is technically challenging, due to the small volume for microcatheterization and coil stabilization inside the aneurysm sac. We performed a retrospective study to evaluate the feasibility, effectiveness, and safety of stent-assisted embolization for patients with ruptured, tiny, wide-necked posterior communicating artery (PcomA) aneurysms. Between January 2007 and August 2011, 17 tiny, wide-necked PcomA aneurysms that had ruptured were treated at our institution using a modified stent-assisted technique, with delivery of the first coil inside the aneurysm followed by placement of a self-expanding stent via a second microcatheter. All patients were treated successfully using this modified stent-assisted coiling technique. Initial results showed aneurysm occlusion of Raymond Class 1 in 10 patients, Class 2 in four patients, and Class 3 in three patients. The angiographic follow-up results for 13 patients (mean, 12.5 months) showed that all aneurysms remained stable or improved, without any in-stent stenosis or recurrence. Of the other four patients, three refused angiography for economic or personal reasons, and one was lost in follow-up. Clinical follow-up of 16 patients for a mean of 23.8 months showed no death or rebleeding. These results imply that endovascular treatment of ruptured tiny, wide-necked PcomA aneurysms using our modified stent-assisted coiling technique is safe and feasible. This technique improves the long-term outcomes of these aneurysms by increasing the packing density and diverting the intra-aneurysmal blood flow.
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Affiliation(s)
- Rui Zhao
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
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18
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Chung KHC, Herwadkar A, Laitt R, Patel HC. Rate and clinical impact of intra-procedural complications during coil embolisation of ruptured small (3 mm or less) cerebral aneurysms. Clin Neurol Neurosurg 2013; 115:1356-61. [PMID: 23332943 DOI: 10.1016/j.clineuro.2012.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/26/2012] [Accepted: 12/23/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Coiling of small (≤3 mm) cerebral aneurysms can be technically challenging and is associated with increased procedural-related morbidity and mortality. The authors report the clinical and radiological results following coiling of ruptured small cerebral aneurysms in a single-institution, and define the rates of intra-procedural rupture and thromboembolism. METHODS A retrospective analysis was conducted on consecutive patients from 01/01/2008 to 31/12/2010 with subarachnoid haemorrhage (SAH) from ruptured cerebral aneurysms (≤3 mm) managed in a tertiary neurosurgical institution in the United Kingdom. RESULTS Of the 108 patients identified, 72 patients (66.7%) underwent coil embolisation. A favourable outcome, defined as a Glasgow outcome score of 4-5, was achieved in 63 (87.5%) of these patients. Intra-procedural complications were observed in 11.1% (±7.3% 95% CI) of cases, wherein the rate of intra-procedural rupture was determined to be 8.3% (±6.4% 95% CI) and intra-procedural thromboembolism to be 2.8% (±3.8% 95% CI). CONCLUSION Although coil embolisation of small ruptured cerebral aneurysms is technically feasible and an efficacious means of treatment, it is associated with an increased rate of intra-procedural complications. This should be taken into account when embarking upon treatment of patients with ruptured small cerebral aneurysms.
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Affiliation(s)
- K H Carlos Chung
- Department of Neurosurgery, Greater Manchester Neurosciences Centre, Salford Royal Foundation Trust, Salford M6 8HD, United Kingdom.
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19
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Signorelli F, Scholtes F, Bojanowski MW. [Very small intracranial aneurysms: Clip or coil]. Neurochirurgie 2012; 58:156-9. [PMID: 22481028 DOI: 10.1016/j.neuchi.2012.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION It is not unusual for very small aneurysms (≤3mm) to be responsible for subarachnoid haemorrhage. In addition, modern imaging has increased diagnosis of those that are asymptomatic. Because of their spatial configuration and thin and fragile walls, very small aneurysms can be a sizeable challenge for both open surgical and endovascular treatment. Based on recent literature data, the present manuscript reviews treatment indications and the choice of treatment strategy to occlude these particular aneurysms. METHODS Literature review concerning surgical and endovascular treatment of very small aneurysms (≤3mm). Arterial dissections and blister aneurysms were excluded. RESULTS We found no study that systematically and specifically assessed surgical treatment of very small aneurysms. Investigations of endovascular treatment are almost exclusively retrospective, usually evaluating a small number of patients, and are limited by selection bias. Despite often contradictory results, it appears that very small aneurysms carry a higher risk of rupture during endovascular procedures and higher ensuing mortality, as compared to larger aneurysms. The use of more flexible coils and additional endovascular tools appears to reduce this risk. There is no study comparing surgical to endovascular treatment. CONCLUSION Very small aneurysms carry higher treatment risks than larger aneurysms. A prospective randomised trial is justified for those very small aneurysms for which treatment is indicated.
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Affiliation(s)
- F Signorelli
- Division of Neurosurgery, Department of Surgery, hôpital Notre-Dame, centre hospitalier de l'université de Montréal, 1560, Sherbrooke St. East, Montreal, Quebec, Canada H2L 4M1
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20
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Hong B, Yang PF, Zhao R, Huang QH, Xu Y, Yang ZG, Liu J. Endovascular treatment of ruptured tiny intracranial aneurysms. J Clin Neurosci 2011; 18:655-60. [PMID: 21414787 DOI: 10.1016/j.jocn.2010.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 09/13/2010] [Accepted: 09/22/2010] [Indexed: 11/17/2022]
Abstract
Endovascular treatment of ruptured tiny intracranial aneurysms (RTIA) is technically challenging. We retrospectively collected and analyzed the clinical data of 51 patients with RTIA who underwent attempted endovascular treatment at our institution between November 2000 and April 2009. Forty-nine patients were successfully treated by coiling alone (29 patients), stent-assisted coiling (11 patients) or stent placement alone (nine patients). Procedural complications occurred in five patients. One patient died from a severe initial hemorrhage and poor clinical condition. At the time of discharge, 44 patients (89.8%) had recovered in good condition (Glasgow Outcome Scale [GOS] score 5), two were moderately disabled (GOS score 4) and two were severely disabled (GOS score 3). Angiographic follow-up (mean follow-up time=14 months) was available for 33 patients, and two were re-treated. None of the 46 patients who were clinically followed up (mean=54.2 months) experienced re-bleeding. Our results suggest that RTIA is not uncommon and can be safely treated endovascularly.
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Affiliation(s)
- Bo Hong
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
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21
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Schuette AJ, Hui FK, Spiotta AM, Obuchowski NA, Gupta R, Moskowitz SI, Tong FC, Dion JE, Cawley CM. Endovascular Therapy of Very Small Aneurysms of the Anterior Communicating Artery: Five-fold Increased Incidence of Rupture. Neurosurgery 2011; 68:731-7; discussion 737. [PMID: 21164380 DOI: 10.1227/neu.0b013e3182077373] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
BACKGROUND:
Intraprocedural rupture is a dangerous complication of endovascular treatment. Small ruptured anterior communicating artery (ACoA) aneurysms and microaneurysms present a challenge for both surgical and endovascular therapies to achieve obliteration. An understanding of the complication rates of treating ruptured ACoA microaneurysms may help guide therapeutic options.
OBJECTIVE:
To report the largest cohort of ACoA microaneurysms treated with endovascular therapy over the course of the past 10 years.
METHODS:
We performed a retrospective review of 347 ACoA aneurysms treated in 347 patients at Cleveland Clinic and Emory University over a 10-year period. Patient demographics, aneurysmal rupture, size, use of balloon remodeling, patient outcomes, intraprocedural rupture, and rerupture were reviewed.
RESULTS:
Rupture rates were examined by size for all patients and subgroups and dichotomized to evaluate for size ranges associated with increased rupture rates. The highest risk of rupture was noted in aneurysms less than 4 mm. Of 347 aneurysms, 74 (21%) were less than 4 mm. The intraprocedural rupture rate was 5% (18/347) for ACoA aneurysms of any size. There was an intraprocedural rupture rate of 2.9% (8/273) among ACoA aneurysms greater than 4 mm compared with 13.5% (10/74) in less than 4-mm aneurysms. Procedural rupture was a statistically significant predictor of modified Rankin score after adjusting for Hunt and Hess grades (HH).
CONCLUSION:
ACoA aneurysms less than 4 mm have a 5-fold higher incidence of intraprocedural rerupture during coil embolization. Outcome is negatively affected by intraprocedural rerupture after adjusting for HH grade.
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Affiliation(s)
| | - Ferdinand K Hui
- Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Rishi Gupta
- Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Shaye I Moskowitz
- Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Frank C Tong
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Jacques E Dion
- Department of Neurosurgery, Emory University, Atlanta, Georgia
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Fang C, Li MH, Zhu YQ, Tan HQ, Zhang PL, Wang J. Treatment of complex ruptured anterior communicating arterial aneurysms by endovascular coil embolisation of the anterior communicating artery. Br J Neurosurg 2011; 25:591-5. [PMID: 21344968 DOI: 10.3109/02688697.2010.546898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The current study evaluates the feasibility and safety of coil embolisation of the anterior communicating artery (ACoA) for the treatment of complicated anterior communicating arterial aneurysms (ACoAAs). METHODS AND MATERIALS Five patients presented with a subarachnoid haemorrhage caused by a ruptured ACoAA. The ACoAA morphologies were well defined by three-dimensional digital subtraction angiography (3D-DSA) and magnetic resonance angiography (MRA). Two of the ACoAAs were tiny (<3 mm in diameter), and the remaining three ACoAAs were small (3-5 mm in diameter). All of the aneurysms were localised to the ACoA. The projection of the aneurysm dome was defined as being oriented superiorly or posteriorly in all five aneurysms. We performed a superselective catheterisation of each aneurysm, and we subsequently performed coil embolisation with balloon, stent or microcatheter assistance. Angiography and clinical follow-up occurred 3-6 months after the procedure. Clinical follow-up data were collected and retrospectively analysed, and patient responses were categorised as fully recovered, improved, unchanged or aggravated. RESULTS All five patients with ACoAA were treated successfully using coil embolisation. In three patients, both the aneurysm sac and the ACoA were embolised using coils, and in two patients, only the ACoA was embolised. Acute angiography showed occlusion of the aneurysm and ACoA. Follow-up angiography confirmed complete occlusion of the aneurysm sac, and no ACoAA recurrence was detected in any of the patients. In clinical follow-up visits, none of the patients had haemorrhaged or had a stroke. CONCLUSION Combined coil embolism of the aneurysm sac and the ACoA could be a feasible and safe method for the treatment of complicated ACoAAs without bilateral aplasia of the A1 segment.
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Affiliation(s)
- Chun Fang
- Department of Radiology, Shanghai East Hospital, Affiliated Tong Ji University, Shanghai, China
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Gil A, Vega P, Murias E, Cuellar H. Balloon-assisted extrasaccular coil embolization technique for the treatment of very small cerebral aneurysms. J Neurosurg 2010; 112:585-8. [PMID: 19499982 DOI: 10.3171/2009.4.jns081291] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Treatment of very small ruptured cerebral aneurysms (< 2 mm) continues to present a challenge. These lesions are difficult to treat both with neurosurgical and endovascular techniques. A neurosurgical approach is still the treatment of choice for these lesions at many centers because of high rupture rates related to endovascular treatment; however, there are clinical circumstances in which the neurosurgical option cannot be offered. In their review of the literature, the authors did not find any series reporting endovascular treatment of these very small aneurysms. In the present study, the authors report their experience with the endovascular treatment of a series of 4 ruptured aneurysms smaller than 2 mm from neck to dome. They describe their technique of using a remodelling balloon to stabilize the tip of the microcatheter in the neck of the aneurysm without entering it at any time, and of inserting the coil from outside the sac to minimize the risk of intraoperative rupture, which is very high when conventional endovascular embolization is performed.
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Affiliation(s)
- Alberto Gil
- Department of Neuroradiology, Hospital Universitario Central de Asturias, Oviedo, Spain.
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Guglielmi G, Viñuela F, Duckwiler G, Jahan R, Cotroneo E, Gigli R. Endovascular treatment of 306 anterior communicating artery aneurysms: overall, perioperative results. J Neurosurg 2009; 110:874-9. [PMID: 19199457 DOI: 10.3171/2008.10.jns081005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT A series of 306 consecutive patients with an anterior communicating artery (ACoA) aneurysm is presented. The goal in this study was to report the results of endovascular treatment of ACoA aneurysms in these patients. METHODS The aneurysms were managed with an endovascular approach in which detachable coils were used. A brief anatomical description of the ACoA and its branches as well as a review of the surgical and endovascular literature is presented. The "ACoA Syndrome" (that is, amnesia and personality changes), which may occur after subarachnoid hemorrhage, is briefly reviewed and described. Recent technical developments that can lead to improved results are also discussed. RESULTS Of the 306 aneurysms, 268 (87.5%) were small, 30 (10%) were large, and 8 (2.6%) were giant. One hundred ninety-three aneurysms (63%) had a small neck, whereas 113 (37%) had a wide neck. Sixty-five lesions (21%) were incidental, 5 (2%) presented with symptoms of mass effect, and 236 (77%) presented with a subarachnoid hemorrhage. A complete aneurysm occlusion was attained in 139 cases (45.5%), a neck remnant was detected in 145 (47.5%), and in 22 cases (7%) a residual filling of the aneurysm was observed. Regarding the clinical neurological outcome, 280 patients (91.5%) remained neurologically intact, improved, or unchanged from their initial clinical status. Two large, wide-necked, subtotally occluded aneurysms ruptured 3-7 months after the procedure, with subsequent death of the patients. The procedure-related morbidity and mortality rates were 3.5% (11 cases) and 1% (3 cases), respectively. CONCLUSIONS The inherently lower risk of injuring or occluding the delicate branches and perforating vessels arising from the ACoA makes the endovascular approach attractive, interesting, and elegant.
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Affiliation(s)
- Guido Guglielmi
- Division of Interventional Neuroradiology, University of California at Los Angeles, California; and
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Huang Q, Xu Y, Hong B, Zhao R, Zhao W, Liu J. Stent-assisted embolization of wide-neck anterior communicating artery aneurysms: review of 21 consecutive cases. AJNR Am J Neuroradiol 2009; 30:1502-6. [PMID: 19461055 DOI: 10.3174/ajnr.a1618] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Anterior communicating artery (AcomA) aneurysm is the most frequent form of aneurysm. Stent placement is particularly difficult and of limited use for AcomA aneurysms. We report our experience with stent-assisted embolization for wide-neck AcomA aneurysms in 21 patients. Particular attention is given to the morphologic characteristics and strategy of stent deployment. MATERIALS AND METHODS Between January 2005 and February 2008, stent-assisted coiling was performed in 21 patients with wide-neck AcomA aneurysms. Patient demographics, aneurysm morphology, procedures, and clinical and angiographic outcomes were retrospectively reviewed. RESULTS Successful deployment of the stent in the targeted artery was achieved in all patients. Nineteen Neuroform 2 or Neuroform 3 stents and 2 LEO stents were used. The distal segment of the stent was positioned in the ipsilateral A2 in 12 patients, in the contralateral A2 across the AcomA in 5 patients, and into the aneurysm sac in 4 patients. Complete occlusion was achieved in 18 patients; near-complete occlusion, in 2 patients; and partial occlusion, in 1 patient. Intraoperative perforation of the aneurysm developed in 1 patient, which was secured by subsequent coiling. Angiographic follow-up in 12 patients for 6.9 months showed 1 recanalization and no in-stent stenosis. CONCLUSIONS Our preliminary results suggest that stent-assisted embolization for wide-neck AcomA aneurysms is technically feasible and safe. Further follow-up is needed for long-term efficacy of stent placement.
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Affiliation(s)
- Q Huang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Changhai Road 168, Shanghai, China
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