1
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Szatmáry Z, Bardet SM, Mounier J, Janot K, Cortese J, Perrin ML, Couquet C, Deniau G, Hauquier F, Migneret R, Guenin E, Maire M, Michel JB, Forestier G, Le Flahec A, Leger-Bretou C, Mounayer C, Chaubet F, Rouchaud A. Fucoidan-coated coils improve healing in a rabbit elastase aneurysm model. J Neurointerv Surg 2024; 16:824-829. [PMID: 37491380 DOI: 10.1136/jnis-2023-020596] [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: 06/12/2023] [Accepted: 07/13/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Recanalization of coiled aneurysms remains unresolved. To limit aneurysm recanalization after embolization with coils, we propose an innovative approach to optimize aneurysm healing using fucoidan-coated coils. OBJECTIVE To evaluate the short-term efficacy and long-term safety of the new coil system with conventional angiography, histology, and multiphoton microscopy for follow-up of fibrosis and neointima formation. METHODS We conducted a feasibility study on rabbit elastase-induced aneurysms. Embolization was carried out with bare platinum coils, fucoidan-coated coils, or dextran-coated coils. Aneurysms were controlled after 1 month by digital subtraction angiography (DSA). Aneurysm samples were collected and processed for histological analysis. Aneurysm healing and fibrosis were measured by quantifying collagen according to the histological healing score by combining standard light microscopy and multiphoton imaging. We divided 27 rabbits into three groups: bare platinum group, fucoidan group, and dextran group as controls. RESULTS Angiographic grading showed a trend toward less recanalization in the fucoidan group, although there were no significant differences among the three groups (P=0.21). Histological healing was significantly different according to the presence of more collagen in the neck area of aneurysms in the fucoidan group versus the bare platinum group (P=0.011), but not in the dextran group. Histological index was significantly better at the aneurysm neck in the fucoidan group than in the bare platinum group (P=0.004). Collagen organization index was also significantly better in the fucoidan group than in the bare platinum group (P=0.007). CONCLUSION This proof-of-concept study demonstrated the feasibility and efficacy of treatment with fucoidan-coated coils to improve aneurysm healing. The results in this rabbit in vivo model showed that fucoidan-coated coils have the potential to improve healing following endovascular treatment.
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Affiliation(s)
- Zoltán Szatmáry
- Department of Interventional Neuroradiology, Limoges University, Limoges, France
- CNRS, XLIM, UMR 7252, Limoges University, Limoges, France
| | | | - Jérémy Mounier
- CNRS, XLIM, UMR 7252, Limoges University, Limoges, France
| | - Kevin Janot
- CNRS, XLIM, UMR 7252, Limoges University, Limoges, France
- Department of Interventional Neuroradiology, CHRU Tours CPU, Tours, France
| | - Jonathan Cortese
- CNRS, XLIM, UMR 7252, Limoges University, Limoges, France
- Department of Interventional Neuroradiology-NEURI Brain Vascular Center APHP, Hospital Bicetre, Le Kremlin-Bicêtre, France
| | | | - Cladue Couquet
- CNRS, XLIM, UMR 7252, Limoges University, Limoges, France
| | - Guy Deniau
- UMR CEA, CNRS 3685, NIMBE, LICSEN, Paris-Saclay University, Gif-sur-Yvette, France
| | - Fanny Hauquier
- UMR CEA, CNRS 3685, NIMBE, LICSEN, Paris-Saclay University, Gif-sur-Yvette, France
- Department of Chemistry and Health and Life Sciences, CNAM, Paris, France
| | - Rodolphe Migneret
- INSERM, UMRS 1148, LVTS, Paris, France
- Institut Galilée, Sorbonne North Paris University, Villetaneuse, France
| | - Erwann Guenin
- Laboratoire TIMR, Centre de Recherche Royallieu Rue du Dr Schweitzer - CS 6031960200, Compiègne, France
| | - Murielle Maire
- INSERM, UMRS 1148, LVTS, Paris, France
- Institut Galilée, Sorbonne North Paris University, Villetaneuse, France
| | | | - Géraud Forestier
- Department of Interventional Neuroradiology, Limoges University, Limoges, France
- CNRS, XLIM, UMR 7252, Limoges University, Limoges, France
| | | | | | - Charbel Mounayer
- Department of Interventional Neuroradiology, Limoges University, Limoges, France
- CNRS, XLIM, UMR 7252, Limoges University, Limoges, France
| | - Frederic Chaubet
- INSERM, UMRS 1148, LVTS, Paris, France
- Institut Galilée, Sorbonne North Paris University, Villetaneuse, France
| | - Aymeric Rouchaud
- Department of Interventional Neuroradiology, Limoges University, Limoges, France
- CNRS, XLIM, UMR 7252, Limoges University, Limoges, France
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Nevzati E, Rey J, Spiessberger A, Moser M, Roethlisberger M, Grüter BE, Widmer HR, Coluccia D, Marbacher S. Aneurysm healing following treatment with biodegradable embolization materials: assessment in a rat sidewall aneurysm model. J Neurointerv Surg 2024:jnis-2023-021260. [PMID: 38262729 DOI: 10.1136/jnis-2023-021260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Biodegradable materials that dissolve after aneurysm healing are promising techniques in the field of neurointerventional surgery. We investigated the effects of various bioabsorable materials in combination with degradable magnesium alloy stents and evaluated aneurysm healing in a rat aneurysm model. METHODS Saccular aneurysms were created by end-to-side anastomosis in the abdominal aorta of Wistar rats. Untreated arterial grafts were immediately transplanted (vital aneurysms) whereas aneurysms with loss of mural cells were chemically decellularized before implantation. All aneurysms were treated with biodegradable magnesium stents. The animals were assigned to vital aneurysms treated with stent alone or decellularized aneurysms treated with stent alone, detachable coil, or long-term or short-term biodegradable thread. Aneurysm healing, rated microscopically and macroscopically at follow-up days 7 and 21, was defined by both neointima formation and absence of aneurysm volume increase over time. RESULTS Of 56 animals included, significant increases in aneurysm volume 7 days after surgery were observed in aneurysms with vital and decellularized walls treated with a stent only (P=0.043 each group). Twenty-one days after surgery an increase in aneurysm volume was observed in decellularized aneurysms treated with long- and short-term biodegradable threads (P=0.027 and P=0.028, respectively). Histological changes associated with an increase in aneurysm volume were seen for aneurysm wall inflammation, periadventitial fibrosis, and luminal thrombus. CONCLUSIONS An increase in aneurysm volume was associated with an absence of intrasaccular embolization material (early phase) and the breakdown of intrasaccular biodegradable material over time (late phase). Thrombus remnant and aneurysm wall inflammation promote aneurysm volume increase.
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Affiliation(s)
- Edin Nevzati
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
- Neurosurgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
- University of Basel, Faculty of Medicine, Basel, Switzerland
| | - Jeannine Rey
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
- Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Alexander Spiessberger
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
- Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Manuel Moser
- Neurosurgery, Cantonal Hospital of Graubuenden, Chur, Switzerland
| | - Michel Roethlisberger
- University of Basel, Faculty of Medicine, Basel, Switzerland
- Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Basil Erwin Grüter
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
- Division of Neuroradiology, Department of Radiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Hans Rudolf Widmer
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Daniel Coluccia
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
- Neurosurgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Serge Marbacher
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
- Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland
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Grüter BE, Canzanella G, Hägler J, Rey J, Wanderer S, von Gunten M, Galvan JA, Grobholz R, Widmer HR, Remonda L, Andereggen L, Marbacher S. Topographic distribution of inflammation factors in a healing aneurysm. J Neuroinflammation 2023; 20:182. [PMID: 37533024 PMCID: PMC10394867 DOI: 10.1186/s12974-023-02863-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Healing of intracranial aneurysms following endovascular treatment relies on the organization of early thrombus into mature scar tissue and neointima formation. Activation and deactivation of the inflammation cascade plays an important role in this process. In addition to timely evolution, its topographic distribution is hypothesized to be crucial for successful aneurysm healing. METHODS Decellularized saccular sidewall aneurysms were created in Lewis rats and coiled. At follow-up (after 3 days (n = 16); 7 days (n = 19); 21 days (n = 8)), aneurysms were harvested and assessed for healing status. In situ hybridization was performed for soluble inflammatory markers (IL6, MMP2, MMP9, TNF-α, FGF23, VEGF), and immunohistochemical analysis to visualize inflammatory cells (CD45, CD3, CD20, CD31, CD163, HLA-DR). These markers were specifically documented for five regions of interest: aneurysm neck, dome, neointima, thrombus, and adjacent vessel wall. RESULTS Coiled aneurysms showed enhanced patterns of thrombus organization and neointima formation, whereas those without treatment demonstrated heterogeneous patterns of thrombosis, thrombus recanalization, and aneurysm growth (p = 0.02). In coiled aneurysms, inflammation markers tended to accumulate inside the thrombus and in the neointima (p < 0.001). Endothelial cells accumulated directly in the neointima (p < 0.0001), and their presence was associated with complete aneurysm healing. CONCLUSION The presence of proinflammatory cells plays a crucial role in aneurysm remodeling after coiling. Whereas thrombus organization is hallmarked by a pronounced intra-thrombotic inflammatory reaction, neointima maturation is characterized by direct invasion of endothelial cells. Knowledge concerning topographic distribution of regenerative inflammatory processes may pave the way for future treatment modalities which enhance aneurysm healing after endovascular therapy.
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Affiliation(s)
- Basil E Grüter
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, C/o NeuroResearch Office,Tellstrasse 1, 5001, Aarau, Switzerland.
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland.
| | - Gwendoline Canzanella
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Joshua Hägler
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Jeannine Rey
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Stefan Wanderer
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Michael von Gunten
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
- Institute of Pathology Laenggasse, Ittigen, Switzerland
| | - José A Galvan
- Translational Research Unit (TRU), Institute of Pathology, University of Bern, Bern, Switzerland
| | - Rainer Grobholz
- Institute of Pathology, Kantonsspital Aarau, Aarau, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Hans-Rudolf Widmer
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Luca Remonda
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, C/o NeuroResearch Office,Tellstrasse 1, 5001, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Program for Regenerative Neuroscience, Department for BioMedical Research, University of Bern, Bern, Switzerland
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Aydin K, Puthuran M, Onal Y, Barburoglu M, Chandran A, Berdikhojayev M, Gravino G, Senturk YE, Aygun S, Velioglu M, Sencer S. The Angiographic and Clinical Follow-up Outcomes of the Wide-Necked and Complex Intracranial Aneurysms Treated With LVIS EVO-Assisted Coiling. Neurosurgery 2023; 92:827-836. [PMID: 36729762 DOI: 10.1227/neu.0000000000002283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/30/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The Low Profile Visible Intraluminal Support EVO (LVIS EVO) is a self-expandable braided stent, which was recently introduced for the treatment of intracranial aneurysms. Full visibility of the stent and a relatively high metal coverage ratio are the unique features of the LVIS EVO. OBJECTIVE To assess the safety, efficacy, and midterm durability of LVIS EVO stent-assisted coiling for the treatment of wide-necked intracranial aneurysms. METHODS The endovascular databases were reviewed to identify patients treated with LVIS EVO-assisted coiling. The technical success and immediate clinical/angiographic outcomes were assessed. Periprocedural and delayed complications were evaluated. The follow-up angiographic/clinical outcomes were investigated. The preprocedural/follow-up neurological statuses were assessed with the modified Rankin Scale. RESULTS One hundred three aneurysms in 103 patients (63 females) with a mean age of 54.9 ± 11.3 years were included. The mean maximum sac diameter was 6.2 ± 2.9 mm. The procedural technical success rate was 100%. Immediate postprocedural angiography showed complete occlusion in 77.7%. The mean duration of the angiographic follow-up was 8.8 ± 3.6 months. Follow-up angiography showed complete aneurysm occlusion in 89% of the 82 patients with angiographic follow-up. Recanalization was observed in 7.3% of 82 patients. Two patients (2.4%) required retreatment. In addition, 8.7% of the patients had at least 1 complication, and 2.9% of the patients developed a permanent morbidity. All patients had mRS scores ≤2. CONCLUSION The results of this study demonstrate that SAC with LVIS EVO is a relatively safe, efficient, and durable treatment for wide-necked and complex intracranial aneurysms.
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Affiliation(s)
- Kubilay Aydin
- Department of Interventional Radiology, Koc University Hospital, Topkapi, Istanbul, Turkey
- Department of Neuroradiology, Istanbul University, Istanbul Faculty of Medicine, Capa, Istanbul, Turkey
| | - Mani Puthuran
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Yilmaz Onal
- Department of Neurosurgery, JSC Central Hospital, Almaty, Kazakhstan
| | - Mehmet Barburoglu
- Department of Neuroradiology, Istanbul University, Istanbul Faculty of Medicine, Capa, Istanbul, Turkey
| | - Arun Chandran
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | | | - Gilbert Gravino
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Yunus Emre Senturk
- Department of Interventional Radiology, Koc University Hospital, Topkapi, Istanbul, Turkey
| | - Serhat Aygun
- Department of Interventional Radiology, Koc University Hospital, Topkapi, Istanbul, Turkey
| | - Murat Velioglu
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Serra Sencer
- Department of Neuroradiology, Istanbul University, Istanbul Faculty of Medicine, Capa, Istanbul, Turkey
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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] [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.
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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.
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6
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Marbacher S, Grüter BE, Wanderer S, Andereggen L, Cattaneo M, Trost P, Gruber P, Diepers M, Remonda L, Steiger HJ. Risk of intracranial aneurysm recurrence after microsurgical clipping based on 3D digital subtraction angiography. J Neurosurg 2023; 138:717-723. [PMID: 35907194 DOI: 10.3171/2022.5.jns22424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/16/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Current knowledge of recurrence rates after intracranial aneurysm (IA) surgery relies on 2D digital subtraction angiography (DSA), which fails to detect more than 75% of small aneurysm remnants. Accordingly, the discrimination between recurrence and growth of a remnant remains challenging, and actual assessment of recurrence risk of clipped IAs could be inaccurate. The authors report, for the first time, 3D-DSA-based long-term durability and risk factor data of IA recurrence and remnant growth after microsurgical clipping. METHODS Prospectively collected data for 305 patients, with a total of 329 clipped IAs that underwent baseline 3D-DSA, were evaluated. The incidence of recurrent IA was described by Kaplan-Meier curves. Risk factors for IA recurrence were analyzed by multivariable Cox proportional hazards and logistic regression models. RESULTS The overall observed proportion of IA recurrence after clipping was 2.7% (9 of 329 IAs) at a mean follow-up of 46 months (0.7% per year). While completely obliterated IAs did not recur during follow-up, incompletely clipped aneurysms (76 of 329) demonstrated remnant growth in 11.8% (3.4% per year). Young age and large initial IA size significantly increased the risk of IA recurrence. CONCLUSIONS The findings support those in previous studies that hypothesized that completely clipped IAs have an extremely low risk of recurrence. Conversely, the results highlight the significant risk posed by incompletely clipped IAs. Young patients with initial large IAs and incomplete obliteration have an especially high risk for IA recurrence and therefore should be monitored more closely.
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Affiliation(s)
- Serge Marbacher
- 1Department of Neurosurgery, Kantonsspital Aarau, University of Bern
| | - Basil Erwin Grüter
- 1Department of Neurosurgery, Kantonsspital Aarau, University of Bern.,2Division of Neurosurgery, Kantonsspital Aarau, University of Bern, and
| | - Stefan Wanderer
- 1Department of Neurosurgery, Kantonsspital Aarau, University of Bern
| | - Lukas Andereggen
- 1Department of Neurosurgery, Kantonsspital Aarau, University of Bern
| | - Marco Cattaneo
- 3Clinical Trial Unit, Department of Clinical Research, University of Basel, University Hospital Basel, Switzerland
| | - Patricia Trost
- 1Department of Neurosurgery, Kantonsspital Aarau, University of Bern
| | - Philipp Gruber
- 2Division of Neurosurgery, Kantonsspital Aarau, University of Bern, and
| | - Michael Diepers
- 2Division of Neurosurgery, Kantonsspital Aarau, University of Bern, and
| | - Luca Remonda
- 2Division of Neurosurgery, Kantonsspital Aarau, University of Bern, and
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Zoltan S, Jonathan C, Jeremy M, Marie-Laure P, Kevin J, Claude C, Le Flahec A, Claire LB, Charbel M, Aymeric R, Bardet SM. A novel histological occlusion classification for coiled aneurysms based on multiphoton microscopy. Interv Neuroradiol 2023:15910199231157926. [PMID: 36803150 DOI: 10.1177/15910199231157926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE Intracranial aneurysm (IA) coiling remains the most commonly used endovascular approach for ruptured and unruptured IA, and recanalization is a common drawback that impairs treatment success. Angiographic occlusion and aneurysm healing are not synonymous, and histological evaluation of embolized aneurysms remains a challenge. We propose here an experimental study of coil embolization in animal models by multiphoton microscopy (MPM) in comparison with conventional histological staining. The purpose of his work is to analyze coil healing process using histological sections of aneurysms. METHODS Based on a rabbit elastase model, 27 aneurysms were fixed, embedded in resin, and cut in thin histological sections 1 month after coils implantation and after angiographic control. Hematoxylin and eosin (H&S) staining were realized. Non-stained adjacent slices were imaged for multiphoton excited autofluorescence (AF) and second-harmonic generation (SHG) to construct three-dimensional (3D) projections of sequentially and axially acquired images. RESULTS The contrast provided by the combination of these two imaging modalities can be used to distinguish five levels of aneurysm healing, based on a combination of thrombus evolution and increased extracellular matrix (ECM) deposit. CONCLUSION RDPC:\Users\SHAHUL\RDP6|We have established a novel histological scale from a rabbit elastase aneurysm model after coiling with a classification of five different stages thanks to nonlinear microscopy. This classification is an actualized tool in order to obtain a more precise evaluation of occlusion device efficacy in the scope of new innovative microscopy for research.
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Affiliation(s)
- Szatmary Zoltan
- Neuroradiology Department, 27025Limoges University, Dupuytren Hospital, Limoges, France
- XLIM UMR CNRS 7252 Limoges, Aquitaine, France
| | - Cortese Jonathan
- XLIM UMR CNRS 7252 Limoges, Aquitaine, France
- Neuroradiology Department, Hôpital Bicêtre Interventional, Le Kremlin Bicêtre, Ile-de-France, France
| | - Mounier Jeremy
- XLIM UMR CNRS 7252 Limoges, Aquitaine, France
- 27025Medical Faculty, Limoges University, Limoges, France
| | | | - Janot Kevin
- XLIM UMR CNRS 7252 Limoges, Aquitaine, France
- Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Couquet Claude
- 27025Medical Faculty, Limoges University, Limoges, France
| | | | | | - Mounayer Charbel
- Neuroradiology Department, 27025Limoges University, Dupuytren Hospital, Limoges, France
- XLIM UMR CNRS 7252 Limoges, Aquitaine, France
| | - Rouchaud Aymeric
- Neuroradiology Department, 27025Limoges University, Dupuytren Hospital, Limoges, France
- XLIM UMR CNRS 7252 Limoges, Aquitaine, France
| | - Sylvia M Bardet
- XLIM UMR CNRS 7252 Limoges, Aquitaine, France
- 27025Medical Faculty, Limoges University, Limoges, France
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8
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Abramyan AA, Pilipenko YV, Belousova OB, Shmelev ND, Eliava SS. [Microsurgical and endovascular treatment of residual and recurrent cerebral aneurysms]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:107-115. [PMID: 37650283 DOI: 10.17116/neiro202387041107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Cerebral aneurysms are characterized by high risk of adverse outcome due to severe intracranial hemorrhages and their consequences. Aneurysm remnants after incomplete exclusion can cause hemorrhage. Filling of these fragments immediately after surgery is usually defined as residual aneurysms. Recurrent aneurysms develop in the area of excluded aneurysm in long-term period after surgery. The authors analyze foreign and national literature data on the diagnosis and management of residual and recurrent aneurysms. Risk factors, the most common classifications, diagnostic methods and surgical treatment are presented.
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Affiliation(s)
| | | | | | - N D Shmelev
- Burdenko Neurosurgical Center, Moscow, Russia
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9
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Han HJ, Lee W, Kim J, Park KY, Park SK, Chung J, Kim YB. Incidence rate and predictors of recurrent aneurysms after clipping: long-term follow-up study of survivors of subarachnoid hemorrhage. Neurosurg Rev 2022; 45:3209-3217. [PMID: 35739336 DOI: 10.1007/s10143-022-01828-x] [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: 03/11/2022] [Revised: 06/08/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
Recurrent aneurysms are a major cause of re-aneurysmal subarachnoid hemorrhage (aSAH), but information on long-term clip durability and predictors is insufficient. This study aimed to present the incidence rate of > 10 years and investigate predictors of a recurrent aneurysm in aSAH survivors. We included 1601 patients admitted with aSAH and treated by microsurgical clipping between January 1993 and May 2010. Of these patients, 435 aSAH survivors were included in this study (27.2%). The total follow-up time was 5680.9 patient-years, and the overall incidence rate was 0.77% per patient-year. The cumulative probability of recurrence without residua and regrowth of the neck remnant was 0.7% and 13.9% at 10 years, respectively. Neck remnant (hazard ratio [HR], 10.311; 95% confidence interval [CI], 5.233-20.313) and alcohol consumption over the moderate amount (HR, 3.166; 95% CI, 1.313-7.637) were independent risk factors of recurrent aneurysm. Current smoking and multiplicity at initial aSAH presentation were significant factors in a univariate analysis. Furthermore, de novo intracranial aneurysms (DNIAs) were more common in the recurrent group than in the non-recurrent group (40.9% vs. 11.5%, P < 0.001). In the present study, we noted the long-term clip durability and predictor of recurrence after microsurgical clipping. These findings can assist clinicians in identifying patients at a high risk of recurrent aneurysm and recommending selective long-term surveillance after microsurgical clipping.
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Affiliation(s)
- Hyun Jin Han
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Woosung Lee
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Junhyung Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Keun Young Park
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sang Kyu Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joonho Chung
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Bae Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Efficacy and Safety of Different Bioactive Coils in Intracranial Aneurysm Interventional Treatment, a Systematic Review and Bayesian Network Meta-Analysis. Brain Sci 2022; 12:brainsci12081062. [PMID: 36009125 PMCID: PMC9405728 DOI: 10.3390/brainsci12081062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/07/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Bioactive coils have been used for nearly 20 years to improve aneurysm treatments. Previous studies are inadequate for comparing the efficacy and safety between different coils. The aim of this study was to investigate the safety and efficacy of different coils by comparing the percentage of people with different modified Raymond scale grades, re-rupture rates, and mortality in patients with intracranial aneurysms embolized with different coils. Method: Randomized controlled trials (RCTs) containing coils for aneurysm interventional treatment were collected from Web of Science, PubMed, and the Cochrane Library up to December 2021. Bayesian network meta-analysis with a randomized or fixed model was performed to compare the efficacy and safety among different bioactive coils and bare platinum coils. Results: We pooled 3362 patients from eight RCTs. No significant differences were found between coils in the proportion of patients with a three-grade classification assessed with the modified Raymond scale immediately after surgery. Hydrogel coils did not show a significant difference in the percentage of patients with a modified Raymond scale grade I postoperatively compared with bare platinum coils (OR, −0.1080; 95% CI, −0.4201–0.2423), but at follow-up, the percentage of patients with modified Raymond scale grade I was significantly higher with hydrogel coils than with bare platinum coils (OR, 0.4957; 95% CI, 0.0060–0.9442). There were no statistical differences between these four coils in terms of aneurysm rupture or re-rupture rate and mortality. Conclusion: Though there was no significant difference in the embolization effect between the several coils in the postoperative period, complete embolization was more likely to be achieved with hydrogel coils compared to bare platinum coils at follow-up. There were no significant differences in safety between the several coil materials.
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Ding YH, Ghozy S, Dai D, Brinjikji W, Kallmes DF, Kadirvel R. Rabbit Elastase Aneurysm Model Mimics the Recurrence Rate of Human Intracranial Aneurysms following Platinum Coil Embolization. AJNR Am J Neuroradiol 2022; 43:741-747. [PMID: 35483907 PMCID: PMC9089251 DOI: 10.3174/ajnr.a7497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/09/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial aneurysms treated with coils have been associated with incomplete occlusion, particularly in large or wide-neck aneurysms. This study aimed to validate the accuracy of the rabbit elastase model in predicting aneurysm recurrence in humans treated with platinum coils. MATERIALS AND METHODS Elastase-induced saccular aneurysms were induced in rabbits and embolized with conventional platinum coils. The recurrence rates of aneurysms were retrospectively analyzed. Morphologic characteristics of aneurysms, angiographic outcomes, and histologic healing were evaluated. RESULTS A total of 28 (15.3%) of 183 aneurysms recurred. The aneurysm recurrence rate observed in this study (15.3%) is similar to those reported in multiple analyses of aneurysm recurrence rates in humans (7%-27%). The rate of recurrence was higher in aneurysms treated without balloon assistance (19/66, 28.8%) compared with those treated with balloon assistance (9/117, 7.7%). Aneurysms treated with balloon-assisted coiling had a lower recurrence rate (OR = 0.17; 95% CI, 0.05-0.47; P = .001) and higher occlusion rate (OR = 6.88; 95% CI, 2.58-20.37; P < .001) compared with those treated without balloon-assisted coiling. In this rabbit elastase-induced aneurysm model, packing density and aneurysm volume were weak predictors of aneurysm recurrence; however, the packing density was a good predictor of the occlusion rate (OR = 1.05; 95% CI, 1.02-1.10; P = .008). CONCLUSIONS The rabbit elastase aneurysm model may mimic aneurysm recurrence rates observed in humans after platinum coil embolization. Moreover, balloon assistance and high packing densities were significant predictors of aneurysm recurrence and occlusion.
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Affiliation(s)
- Y-H Ding
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - S Ghozy
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - D Dai
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - W Brinjikji
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - D F Kallmes
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - R Kadirvel
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
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12
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Halter M, Wanderer S, Grüter B, Anon J, Diepers M, Gruber P, Andereggen L, Remonda L, Marbacher S. Interrater and intrarater agreement superior for three-dimensional digital subtraction angiography (3D-DSA) over 2D-DSA classification for detecting remnants after intracranial aneurysm clipping, a GRRAS Reliability and Agreement Study. Acta Neurochir (Wien) 2022; 164:2173-2179. [PMID: 35239014 DOI: 10.1007/s00701-022-05156-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/07/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Growing evidence suggests that three-dimensional digital subtraction angiography (3D-DSA) is superior to 2D-DSA in detection of intracranial aneurysm (IA) remnants after clipping. With a simple, practical quantitative scale proposed to measure maximal remnant dimension on 3D-DSA, this study provides a rigorous interrater and intrarater reliability and agreement study comparing this newly established scale with a commonly used (Sindou) 2D-DSA scale. METHOD Records of 43 patients with clipped IAs harboring various sized remnants who underwent 2D- and 3D-DSA between 2012 and 2018 were evaluated. Using the 2D and 3D scales, six raters scored these remnants and repeated the scoring task 8 weeks later. Interrater and intrarater agreement for both grading schemes were calculated using kappa (κ) statistics. RESULTS Interrater agreement was highly significant, yielding κ-values at 95% CI (p = 0.000) of 0.225 for the first [0.185; 0.265] and 0.368 s [0.328; 0.408] time points for 2D-DSA and values of 0.700 for the first [0.654; 0.745] and 0.776 s [0.729; 0.822] time points for 3D-DSA. Intrarater agreement demonstrated κ-values between 0.139 and 0.512 for 2D-DSA and between 0.487 and 0.813 for 3D-DSA scores. CONCLUSION Interrater and intrarater agreement was minimal or weak for 2D-DSA scores, but strong for 3D-DSA scores. We propose that baseline 3D-DSA characterization may prove more reliable when categorizing clipped IA remnants for purposes of risk stratification and lifelong follow-up.
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Wan H, Lu G, Ge L, Huang L, Jiang Y, Leng X, Xiang J, Zhang X. Hemodynamic Effects of Stent-Induced Straightening of Parent Artery vs. Stent Struts for Intracranial Bifurcation Aneurysms. Front Neurol 2022; 12:802413. [PMID: 35211076 PMCID: PMC8862758 DOI: 10.3389/fneur.2021.802413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Objective This study aims to compare the hemodynamic impact of stent-mesh and stent-induced straightening of the parent artery in intracranial bifurcation aneurysms using finite element method simulation. Material and Methods Three intracranial bifurcation aneurysms treated with different stent-assisted coil embolization were evaluated. Simulation using the finite element method was conducted for Solitaire, LVIS and Neuroform stents. Four models of each stent were established, including a pre-treatment baseline, stenting without parent artery straightening (presented as stent-mesh effect), no-stent with parent artery reconstruction (to reveal the straightening impact), and stenting with straightening (categorized as Models I–IV respectively). Hemodynamic characteristics of the four models for each stent were compared. Results In the Neuroform stent, compared with the pre-treatment model (100%), the mean WSS decreased to 82.3, 71.4, and 57.0% in Models II-IV, velocity to 88.3, 74.4, and 62.8%, and high flow volume (HFV, >0.3 m/s) to 77.7, 44.0, and 19.1%. For the LVIS stent, the mean WSS changed to 105.0, 40.2, and 39.8% in Models II to IV; velocity to 91.2, 58.1, and 52.5%, and HFV to 92.0, 56.1, and 43.9%. For the Solitaire stent, compared with the pre-treatment model (100%), the mean WSS of Models II-IV changed altered by 105.7, 42.6, and 39.4%, sac-averaged velocity changed to 111.3, 46.6, and 42.8%, and HFV 115.6, 15.1, and 13.6%. Conclusion The hemodynamic effect of straightening the parent artery of intracranial bifurcation aneurysms by stenting was noticeably improved over stent mesh diversion in all three stents tested. Therefore stent-induced remodeling of the parent artery appears to be the best method of decreasing recurrence in intracranial bifurcation aneurysms.
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Affiliation(s)
- Hailin Wan
- Huashan Hospital, Fudan University, Shanghai, China
| | - Gang Lu
- Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Ge
- Huashan Hospital, Fudan University, Shanghai, China
| | - Lei Huang
- Huashan Hospital, Fudan University, Shanghai, China
| | - Yeqing Jiang
- Huashan Hospital, Fudan University, Shanghai, China
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Sato T, Matsushige T, Chen B, Gembruch O, Dammann P, Jabbarli R, Forsting M, Junker A, Maderwald S, Quick HH, Ladd ME, Sure U, Wrede KH. Correlation Between Thrombus Signal Intensity and Aneurysm Wall Thickness in Partially Thrombosed Intracranial Aneurysms Using 7T Magnetization-Prepared Rapid Acquisition Gradient Echo Magnetic Resonance Imaging. Front Neurol 2022; 13:758126. [PMID: 35250805 PMCID: PMC8894319 DOI: 10.3389/fneur.2022.758126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The objective of this study is to investigate the relationship between the thrombus signal intensity and aneurysm wall thickness in partially thrombosed intracranial aneurysms in vivo with magnetization-prepared rapid acquisition gradient echo (MPRAGE) taken using 7T magnetic resonance imaging (MRI) and correlate the findings to wall instability. Methods Sixteen partially thrombosed intracranial aneurysms were evaluated using a 7T whole-body MR system with nonenhanced MPRAGE. To normalize the thrombus signal intensity, its highest signal intensity was compared to that of the anterior corpus callosum of the same subject, and the signal intensity ratio was calculated. The correlation between the thrombus signal intensity ratio and the thickness of the aneurysm wall was analyzed. Furthermore, aneurysmal histopathological specimens from six tissue samples were compared with radiological findings to detect any correlation. Results The mean thrombus signal intensity ratio was 0.57 (standard error of the mean [SEM] 0.06, range 0.25–1.01). The mean thickness of the aneurysm wall was 1.25 (SEM 0.08, range 0.84–1.55) mm. The thrombus signal intensity ratio significantly correlated with the aneurysm wall thickness (p < 0.01). The aneurysm walls with the high thrombus signal intensity ratio were significantly thicker. In histopathological examinations, three patients with a hypointense thrombus had fewer macrophages infiltrating the thrombus and a thin degenerated aneurysmal wall. In contrast, three patients with a hyperintense thrombus had abundant macrophages infiltrating the thrombus. Conclusion The thrombus signal intensity ratio in partially thrombosed intracranial aneurysms correlated with aneurysm wall thickness and histologic features, indicating wall instability.
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Affiliation(s)
- Taku Sato
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
- *Correspondence: Taku Sato
| | - Toshinori Matsushige
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Bixia Chen
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Oliver Gembruch
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Philipp Dammann
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Andreas Junker
- Institute of Neuropathology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Stefan Maderwald
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Harald H. Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
- High Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Mark E. Ladd
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Physics and Astronomy and Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Karsten H. Wrede
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
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Repeated Aneurysm Intervention. Adv Tech Stand Neurosurg 2022; 44:277-296. [PMID: 35107686 DOI: 10.1007/978-3-030-87649-4_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Over the past 25 years the endovascular treatment of cerebral aneurysms has gained preference in some countries over the traditional surgical procedures. The review part of the article clearly demonstrates that the clinical results of both modalities are similar and the difference is seen only in technical effectivity. Surgical techniques fail far less frequently than the endovascular ones. Incompletely occluded or growing aneurysms after the endovascular approach expose the patient to the risk of rebleeding with all possible consequences. Markedly repeated procedures are much more common for endovascularly treated aneurysms, again with all the risks.In the authors institution over the past 20 years, a total of 2032 aneurysms were treated. In 1263 endovascularly managed aneurysms the regrowth or inclomplete initial occlusion necessitated 159 repeated propcedures (12.6%). In surgical group the total of 27 aneurysms needed retreatment (3.5%). The difference is statistically significant. In nine patients in endovascular group the rebleeding was the reason for repeated procedures. No rebleeding was seen in the surgical group.This fact, also shown in the review part of the article, is important in patients counseling. Given the similar clinical results of both modalities the patient should be advised on the necessity of repeated follow-ups and of possible technical failure and eventual repeated procedure which is more likely if endovascular procedure is chosen.
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16
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Clinical outcomes of first- and second-generation hydrogel coils compared with bare platinum coils: a systematic literature review. Neurosurg Rev 2022; 45:1873-1882. [PMID: 35031898 DOI: 10.1007/s10143-021-01632-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 05/19/2021] [Accepted: 06/19/2021] [Indexed: 10/19/2022]
Abstract
Endovascular coiling has revolutionized intracranial aneurysm treatment; however, recurrence continues to represent a major limitation. The hydrogel coil was developed to increase packing density and improve neck healing and therefore decrease recurrence rates. In this paper, we review treatment outcomes of first- (1HCs) and second-generation (2HCs) hydrogel coils and compare them to those of bare platinum coils (BPC). A query of multiple databases was performed. Articles with at least 10 aneurysms treated with either 1HC or 2HC were selected for analysis. Collected data included aneurysm size, rupture status, initial occlusion, initial residual neck/aneurysm, packing density, mortality, morbidity, recurrence, and retreatment rates. The primary endpoint was recurrence at final follow-up. Secondary endpoints included residual neck and dome rates as well as procedure-related complications and functional dependence at final follow-up. Studies that compared 1HC to BPC showed significant lower recurrence (24% vs. 30.8%, p = 0.02) and higher packing density (58.5% vs. 24.1%, p < 0.001) in 1HC but no significant difference in initial occlusion rate (p = 0.08). Studies that compared 2HC to BPC showed lower recurrence (6.3% vs. 14.3%, p = 0.007) and retreatment rates (3.4% vs. 7.7%, p = 0.010) as well as higher packing density (36.4% vs. 29.2%, p = 0.002) in 2HC, with similar initial occlusion rate (p = 0.86). The rate of complications was not statistically different between HC (25.5%) and BPC (22.6%, p = 0.06). Based on our review, the 1HC and 2HC achieved higher packing density and lower recurrence rates compared to BPC. The safety profile was similar between both groups.
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Paul A, MacDonell J, Field N, Entezami P, Yamamoto J, Boulos A, Dalfino J. Comparison of hydrogel coils versus bare platinum coils for the treatment of anterior communicating artery aneurysms. Brain Circ 2022; 8:6-9. [PMID: 35372730 PMCID: PMC8973442 DOI: 10.4103/bc.bc_18_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/21/2021] [Accepted: 10/06/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION: METHODS: RESULTS: CONCLUSIONS:
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18
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Jesser J, Alberalar ND, Kizilkilic O, Saatci I, Baltacioglu F, Özlük E, Killer-Oberpfalzer M, Vollherbst DF, Islak C, Cekirge SH, Bendszus M, Möhlenbruch M, Koçer N. Safety and Efficacy of the FRED Jr Flow Re-Direction Endoluminal Device for Intracranial Aneurysms: Retrospective Multicenter Experience With Emphasis on Midterm Results. Front Neurol 2021; 12:722183. [PMID: 34659086 PMCID: PMC8518710 DOI: 10.3389/fneur.2021.722183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/02/2021] [Indexed: 02/03/2023] Open
Abstract
Background and Purpose: Flow diversion is increasingly used as an endovascular treatment for intracranial aneurysms. In this retrospective multicenter study, we analyzed the safety and efficacy of the treatment of intracranial, unruptured, or previously treated but recanalized aneurysms using Flow Re-Direction Endoluminal Device (FRED) Jr with emphasis on midterm results. Materials and Methods: Clinical and radiological records of 150 patients harboring 159 aneurysms treated with FRED Jr at six centers between October 2014 and February 2020 were reviewed and consecutively included. Clinical outcome was measured by using the modified Rankin Scale (mRS). Anatomical results were assessed according to the O'Kelly-Marotta (OKM) scale and the Cekirge-Saatci Classification (CSC) scale. Results: The overall complication rate was 24/159 (16%). Thrombotic-ischemic events occurred in 18/159 treatments (11%). These resulted in long-term neurological sequelae in two patients (1%) with worsening from pre-treatment mRS 0–2 and mRS 4 after treatment. Complete or near-complete occlusion of the treated aneurysm according to the OKM scale was reached in 54% (85/158) at 6-month, in 68% (90/133) at 1-year, and in 83% (77/93) at 2-year follow-up, respectively. The rates of narrowing or occlusion of a vessel branch originating from the treated aneurysm according to the CSC scale were 11% (12/108) at 6-month, 20% (17/87) at 1-year, and 23% (13/57) at 2-year follow-up, respectively, with all cases being asymptomatic. Conclusions: In this retrospective multicenter study, FRED Jr was safe and effective in the midterm occlusion of cerebral aneurysms. Most importantly, it was associated with a high rate of good clinical outcome.
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Affiliation(s)
- Jessica Jesser
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Nilüfer D Alberalar
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Leipzig, Germany
| | - Osman Kizilkilic
- Department of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Isil Saatci
- Interventional Neuroradiology Section, Koru and Bayindir, Private Hospitals, Ankara, Turkey
| | - Feyyaz Baltacioglu
- Department of Radiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Enes Özlük
- Department of Radiology, Acibadem Atakent Hospital, Istanbul, Turkey
| | | | - Dominik F Vollherbst
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Civan Islak
- Department of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Saruhan H Cekirge
- Interventional Neuroradiology Section, Koru and Bayindir, Private Hospitals, Ankara, Turkey
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Naci Koçer
- Department of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Lv C, Wang J, Dai S, Chen Y, Jiang X, Li X. Long non-coding RNA NORAD induces phenotypic regulation of vascular smooth muscle cells through regulating microRNA-136-5p-targeted KDM1A. Cell Cycle 2021; 20:2137-2148. [PMID: 34583619 DOI: 10.1080/15384101.2021.1971351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Effect of long non-coding RNAs (lncRNAs) on intracranial aneurysm (IA) development has been identified, while the role of noncoding RNA activated by DNA damage (NORAD) in IA remains unexplored. We aimed to verify the impact of NORAD on IA through sponging microRNA-136-5p (miR-136-5p). METHODS Ruptured and unruptured IAs were harvested from IA patients, and expression of NORAD, miR-136-5p, and KDM1A was determined. The vascular smooth muscle cells (VSMCs) were cultured and, respectively, transfected with altered NORAD, miR-136-5p, or lysine-specific demethylase 1 (KDM1A) to observe their effect on biological functions, as well as on contraction and synthesis-specific indices of VSMCs. Interactions between NORAD and miR-136-5p, and between miR-136-5p and KDM1A were confirmed. RESULTS NORAD and KDM1A were upregulated while miR-136-5p was downregulated in IA, especially in ruptured IA. NORAD overexpression or miR-136-5p inhibition accelerated proliferation and migration, and decelerated phenotypic switching and apoptosis of VSMCs. The effects of overexpressed NORAD on VSMCs were reserved by miR-136-5p upregulation or KDM1A knockdown. NORAD functioned as a competing endogenous RNA of miR-136-5p and miR-136-5p targeted KDM1A. CONCLUSION NORAD suppressed miR-136-5p, thus upregulating KDM1A to participate in IA formation and rupture by inducing phenotypic regulation of VSMCs.
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Affiliation(s)
- Chao Lv
- Department of Neurosurgery, The First Affiliated Hospital of Airforce Medical University, Xi'an Shaanxi, China
| | - Jun Wang
- Department of Neurosurgery, The First Affiliated Hospital of Airforce Medical University, Xi'an Shaanxi, China
| | - Shuhui Dai
- Department of Neurosurgery, The First Affiliated Hospital of Airforce Medical University, Xi'an Shaanxi, China
| | - Yanwei Chen
- Department of Neurosurgery, The First Affiliated Hospital of Airforce Medical University, Xi'an Shaanxi, China
| | - Xiaofan Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Airforce Medical University, Xi'an Shaanxi, China
| | - Xia Li
- Department of Neurosurgery, The First Affiliated Hospital of Airforce Medical University, Xi'an Shaanxi, China
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20
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Marbacher S, Halter M, Vogt DR, Kienzler JC, Magyar CTJ, Wanderer S, Anon J, Diepers M, Remonda L, Fandino J. Value of 3-Dimensional Digital Subtraction Angiography for Detection and Classification of Intracranial Aneurysm Remnants After Clipping. Oper Neurosurg (Hagerstown) 2021; 21:63-72. [PMID: 33861324 PMCID: PMC8279834 DOI: 10.1093/ons/opab087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/24/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The current gold standard for evaluation of the surgical result after intracranial aneurysm (IA) clipping is two-dimensional (2D) digital subtraction angiography (DSA). While there is growing evidence that postoperative 3D-DSA is superior to 2D-DSA, there is a lack of data on intraoperative comparison. OBJECTIVE To compare the diagnostic yield of detection of IA remnants in intra- and postoperative 3D-DSA, categorize the remnants based on 3D-DSA findings, and examine associations between missed 2D-DSA remnants and IA characteristics. METHODS We evaluated 232 clipped IAs that were examined with intraoperative or postoperative 3D-DSA. Variables analyzed included patient demographics, IA and remnant distinguishing characteristics, and 2D- and 3D-DSA findings. Maximal IA remnant size detected by 3D-DSA was measured using a 3-point scale of 2-mm increments. RESULTS Although 3D-DSA detected all clipped IA remnants, 2D-DSA missed 30.4% (7 of 23) and 38.9% (14 of 36) clipped IA remnants in intraoperative and postoperative imaging, respectively (95% CI: 30 [ 12, 49] %; P-value .023 and 39 [23, 55] %; P-value = <.001), and more often missed grade 1 (< 2 mm) clipped remnants (odds ratio [95% CI]: 4.3 [1.6, 12.7], P-value .005). CONCLUSION Compared with 2D-DSA, 3D-DSA achieves a better diagnostic yield in the evaluation of clipped IA. Our proposed method to grade 3D-DSA remnants proved to be simple and practical. Especially small IA remnants have a high risk to be missed in 2D-DSA. We advocate routine use of either intraoperative or postoperative 3D-DSA as a baseline for lifelong follow-up of clipped IA.
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Affiliation(s)
- Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Matthias Halter
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Deborah R Vogt
- Department of Clinical Research, Clinical Trial Unit, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Jenny C Kienzler
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Stefan Wanderer
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Javier Anon
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Michael Diepers
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Luca Remonda
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
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21
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Szatmary Z, Mounier J, Janot K, Cortese J, Couquet C, Chaubet F, Kadirvel R, Bardet SM, Mounayer C, Rouchaud A. Bioactive refinement for endosaccular treatment of intracranial aneurysms. Neuroradiol J 2021; 34:534-541. [PMID: 34210195 DOI: 10.1177/19714009211024631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Endovascular treatment is the first-line therapy for most intracranial aneurysms; however, recanalisation remains a major limitation. Developments in bioengineering and material science have led to a novel generation of coil technologies for aneurysm embolisation that address clinical challenges of aneurysm recurrence. This review presents an overview of modified surface coil technologies and summarises the state of the art regarding their efficacy and limitations based on experimental and clinical results. We also present potential perspectives to develop biologically optimised devices.
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Affiliation(s)
- Zoltan Szatmary
- Department of Radiology, Dupuytren Hospital, Limoges University, France
- XLIM UMR CNRS No. 7252, Limoges University, France
| | | | - Kevin Janot
- XLIM UMR CNRS No. 7252, Limoges University, France
- Regional University Hospital Center Tours, Radiology, Diagnostic and Interventional Neuroradiology, France
| | - Jonathan Cortese
- XLIM UMR CNRS No. 7252, Limoges University, France
- Bicêtre Hospital, Interventionnel Neuroradiology, Paris, France
| | | | - Frédéric Chaubet
- Laboratory for Vascular Translational Science, UMRS 1148, INSERM, Université de Paris, France
- Université Sorbonne Paris Nord- Campus de Bobigny, France
| | | | | | - Charbel Mounayer
- Department of Radiology, Dupuytren Hospital, Limoges University, France
- XLIM UMR CNRS No. 7252, Limoges University, France
| | - Aymeric Rouchaud
- Department of Radiology, Dupuytren Hospital, Limoges University, France
- XLIM UMR CNRS No. 7252, Limoges University, France
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22
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The association between hemodynamics and wall characteristics in human intracranial aneurysms: a review. Neurosurg Rev 2021; 45:49-61. [PMID: 33913050 DOI: 10.1007/s10143-021-01554-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/02/2021] [Accepted: 04/20/2021] [Indexed: 12/28/2022]
Abstract
Hemodynamics plays a key role in the natural history of intracranial aneurysms (IAs). However, studies exploring the association between aneurysmal hemodynamics and the biological and mechanical characteristics of the IA wall in humans are sparse. In this review, we survey the current body of literature, summarize the studies' methodologies and findings, and assess the degree of consensus among them. We used PubMed to perform a systematic review of studies that explored the association between hemodynamics and human IA wall features using different sources. We identified 28 publications characterizing aneurysmal flow and the IA wall: 4 using resected tissues, 17 using intraoperative images, and 7 using vessel wall magnetic resonance imaging (MRI). Based on correlation to IA tissue, higher flow conditions, such as high wall shear stress (WSS) with complex pattern and elevated pressure, were associated with degenerated walls and collagens with unphysiological orientation and faster synthesis. MRI studies strongly supported that low flow, characterized by low WSS and high blood residence time, was associated with thicker walls and post-contrast enhancement. While significant discrepancies were found among those utilized intraoperative images, they generally supported that thicker walls coexist at regions with prolonged residence time and that thinner regions are mainly exposed to higher pressure with complex WSS patterns. The current body of literature supports a theory of two general hemodynamic-biologic mechanisms for IA development. One, where low flow conditions are associated with thickening and atherosclerotic-like remodeling, and the other where high and impinging flow conditions are related to wall degeneration, thinning, and collagen remodeling.
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23
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Grüter BE, Wanderer S, Strange F, Boillat G, Täschler D, Rey J, Croci DM, Grandgirard D, Leib SL, von Gunten M, Di Santo S, Widmer HR, Remonda L, Andereggen L, Nevzati E, Coluccia D, Fandino J, Marbacher S. Patterns of Neointima Formation After Coil or Stent Treatment in a Rat Saccular Sidewall Aneurysm Model. Stroke 2021; 52:1043-1052. [PMID: 33504186 DOI: 10.1161/strokeaha.120.032255] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular aneurysm treatment relies on a biological process, including cell migration for thrombus organization and growth of a neointima. To better understand aneurysm healing, our study explores the origin of neointima-forming and thrombus-organizing cells in a rat saccular sidewall aneurysm model. METHODS Saccular aneurysms were transplanted onto the abdominal aorta of male Lewis rats and endovascularly treated with coils (n=28) or stents (n=26). In 34 cases, GFP+ (green fluorescent protein)-expressing vital aneurysms were sutured on wild-type rats, and in 23 cases, decellularized wild-type aneurysms were sutured on GFP+ rats. Follow-up at 3, 7, 14, 21, and 28 days evaluated aneurysms by fluorescence angiography, macroscopic inspection, and microscopy for healing and inflammation status. Furthermore, the origin of cells was tracked with fluorescence histology. RESULTS In animals with successful functional healing, histological studies showed a gradually advancing thrombus organization over time characterized by progressively growing neointima from the periphery of the aneurysm toward the center. Cell counts revealed similar distributions of GFP+ cells for coil or stent treatment in the aneurysm wall (54.4% versus 48.7%) and inside the thrombus (20.5% versus 20.2%) but significantly more GFP+ cells in the neointima of coiled (27.2 %) than stented aneurysms (10.4%; P=0.008). CONCLUSIONS Neointima formation and thrombus organization are concurrent processes during aneurysm healing. Thrombus-organizing cells originate predominantly in the parent artery. Neointima formation relies more on cell migration from the aneurysm wall in coiled aneurysms but receives greater contributions from cells originating in the parent artery in stent-treated aneurysms. Cell migration, which allows for a continuous endothelial lining along the parent artery's lumen, may be a prerequisite for complete aneurysm healing after endovascular therapy. In terms of translation into clinical practice, these findings may explain the variability in achieving complete aneurysm healing after coil treatment and the improved healing rate in stent-assisted coiling.
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Affiliation(s)
- Basil E Grüter
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Stefan Wanderer
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Fabio Strange
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Gwendoline Boillat
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Dominik Täschler
- Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Jeannine Rey
- Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Davide M Croci
- Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Denis Grandgirard
- Neuroinfection Laboratory, Institute for Infectious Diseases (D.G., S.L.L.), University of Bern, Switzerland.,Cluster for Regenerative Neuroscience, Department for BioMedical Research (D.G., S.L.L., S.D.S., H.R.W.), University of Bern, Switzerland
| | - Stephen L Leib
- Neuroinfection Laboratory, Institute for Infectious Diseases (D.G., S.L.L.), University of Bern, Switzerland.,Cluster for Regenerative Neuroscience, Department for BioMedical Research (D.G., S.L.L., S.D.S., H.R.W.), University of Bern, Switzerland
| | | | - Stefano Di Santo
- Cluster for Regenerative Neuroscience, Department for BioMedical Research (D.G., S.L.L., S.D.S., H.R.W.), University of Bern, Switzerland.,Department of Neurosurgery, Bern University Hospital, Inselspital Bern, Switzerland (S.D.S., H.R.W.)
| | - Hans Rudolf Widmer
- Cluster for Regenerative Neuroscience, Department for BioMedical Research (D.G., S.L.L., S.D.S., H.R.W.), University of Bern, Switzerland.,Department of Neurosurgery, Bern University Hospital, Inselspital Bern, Switzerland (S.D.S., H.R.W.)
| | - Luca Remonda
- Division of Neuroradiology, Department of Radiology (L.R.), Kantonsspital Aarau, Switzerland
| | - Lukas Andereggen
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Edin Nevzati
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Daniel Coluccia
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Javier Fandino
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery (B.E.G., S.W., F.S., G.B., L.A., E.N., D.C., J.F., S.M.), Kantonsspital Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research (B.E.G., S.W., F.S., G.B., D.T., J.R., D.M.C., L.A., E.N., D.C., J.F., S.M.), University of Bern, Switzerland
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24
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Grüter BE, Marbacher S. The importance of wall degeneration in preclinical aneurysm models. J Neurointerv Surg 2020; 13:200-201. [PMID: 33188154 DOI: 10.1136/neurintsurg-2020-016926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Basil Erwin Grüter
- Department of Neurosurgery, Kantonsspital Aarau AG, Aarau, Aargau, Switzerland .,Department for BioMedical Research, Cerebrovascular Research Group, Bern, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau AG, Aarau, Aargau, Switzerland.,Department for BioMedical Research, Cerebrovascular Research Group, Bern, Switzerland
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25
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Chen L, Zhang Q. Predictive Value of Mean Platelet Volume for Aneurysm Recurrence in Patients with Aneurysmal Subarachnoid Hemorrhage After Endovascular Treatment. World Neurosurg 2020; 145:e32-e37. [PMID: 32916349 DOI: 10.1016/j.wneu.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND The purpose of this study was to explore the relationship between mean platelet volume (MPV) and aneurysm recurrence in aneurysmal subarachnoid hemorrhage (aSAH) patients who received endovascular treatment for intracranial aneurysms. METHODS Data were collected and analyzed from 204 aneurysms in 187 aSAH patients who received endovascular treatment at our institution between January 2014 and January 2019. All aneurysms were divided into 2 groups based on aneurysm recurrence. Univariate and multivariable analyses were performed to investigate whether MPV was an independent predictor of aneurysm recurrence. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were determined. RESULTS A total of 42 (20.6%) aneurysms recurred. Recurrent aneurysms had a lower rate of complete obliteration (P = 0.002) and lower MPV values on admission (P < 0.001) than nonrecurrent aneurysms. The multivariable analysis showed that the Raymond-Roy classification (odds ratio [OR]: 3.217, 95% confidence interval [CI]: 1.308-7.913, P = 0.011) and MPV (OR: 0.247, 95% CI: 0.151-0.402, P < 0.001) was significantly associated with aneurysm recurrence. The ROC curve analysis determined that MPV could predict aneurysm recurrence with an AUC of 0.846 (95% CI: 0.788-0.892, P < 0.001). An MPV ≤9.9 fL could predict aneurysm recurrence with a sensitivity of 80.95% and a specificity of 79.63%. CONCLUSIONS A low perioperative MPV may be associated with aneurysm recurrence in aSAH patients who receive endovascular treatment for intracranial aneurysms. Therefore, MPV can be used in clinical settings to screen for patients at high risk for aneurysm recurrence.
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Affiliation(s)
- Liuwei Chen
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Quanbin Zhang
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
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26
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Marbacher S, Strange F, Frösén J, Fandino J. Preclinical extracranial aneurysm models for the study and treatment of brain aneurysms: A systematic review. J Cereb Blood Flow Metab 2020; 40:922-938. [PMID: 32126875 PMCID: PMC7181093 DOI: 10.1177/0271678x20908363] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Animal models make an important contribution to our basic understanding of the pathobiology of human brain aneurysms, are indispensable in testing novel treatment approaches, and are essential for training interventional neuroradiologists and neurosurgeons. Researchers are confronted with a broad diversity of models and techniques in various species. This systematic review aims to summarize and categorize extracranial aneurysm models and their characteristics, discuss advantages and disadvantages, and suggest the best use of each model. We searched the electronical Medline/PubMed database between 1950 and 2020 to identify main models and their refinements and technical modifications for creation of extracranial aneurysms. Each study included was assessed for aneurysm-specific characteristics, technical details of aneurysm creation, and histological findings. Among more than 4000 titles and abstracts screened, 473 studies underwent full-text analysis. From those, 68 different techniques/models in five different species were identified, analyzed in detail, and then grouped into one of the five main groups of experimental models as sidewall, terminal, stump, bifurcation, or complex aneurysm models. This systematic review provides a compact guide for investigators in selecting the most appropriate model from a range of techniques to best suit their experimental goals, practical considerations, and laboratory environment.
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Affiliation(s)
- Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Fabio Strange
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Juhana Frösén
- Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.,Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern, Switzerland
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27
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Poupart O, Schmocker A, Conti R, Moser C, Nuss KM, Grützmacher H, Mosimann PJ, Pioletti DP. In vitro Implementation of Photopolymerizable Hydrogels as a Potential Treatment of Intracranial Aneurysms. Front Bioeng Biotechnol 2020; 8:261. [PMID: 32318555 PMCID: PMC7146053 DOI: 10.3389/fbioe.2020.00261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/13/2020] [Indexed: 12/19/2022] Open
Abstract
Intracranial aneurysms are increasingly being treated with endovascular therapy, namely coil embolization. Despite being minimally invasive, partial occlusion and recurrence are more frequent compared to open surgical clipping. Therefore, an alternative treatment is needed, ideally combining minimal invasiveness and long-term efficiency. Herein, we propose such an alternative treatment based on an injectable, radiopaque and photopolymerizable polyethylene glycol dimethacrylate hydrogel. The rheological measurements demonstrated a viscosity of 4.86 ± 1.70 mPa.s, which was significantly lower than contrast agent currently used in endovascular treatment (p = 0.42), allowing the hydrogel to be injected through 430 μm inner diameter microcatheters. Photorheology revealed fast hydrogel solidification in 8 min due to the use of a new visible photoinitiator. The addition of an iodinated contrast agent in the precursor contributed to the visibility of the precursor injection under fluoroscopy. Using a customized light-conducting microcatheter and illumination module, the hydrogel was implanted in an in vitro silicone aneurysm model. Specifically, in situ fast and controllable injection and photopolymerization of the developed hydrogel is shown to be feasible in this work. Finally, the precursor and the polymerized hydrogel exhibit no toxicity for the endothelial cells. Photopolymerizable hydrogels are expected to be promising candidates for future intracranial aneurysm treatments.
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Affiliation(s)
- Oriane Poupart
- Laboratory of Biomechanical Orthopedics, EPFL, Lausanne, Switzerland
| | - Andreas Schmocker
- Laboratory of Applied Photonics Devices, EPFL, Lausanne, Switzerland
- Department of Chemistry and Applied Biosciences, ETH, Zurich, Switzerland
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Riccardo Conti
- Department of Chemistry and Applied Biosciences, ETH, Zurich, Switzerland
| | - Christophe Moser
- Laboratory of Applied Photonics Devices, EPFL, Lausanne, Switzerland
| | - Katja M. Nuss
- Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | - Pascal J. Mosimann
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland
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28
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Grüter BE, Wanderer S, Strange F, Sivanrupan S, von Gunten M, Widmer HR, Coluccia D, Andereggen L, Fandino J, Marbacher S. Comparison of Aneurysm Patency and Mural Inflammation in an Arterial Rabbit Sidewall and Bifurcation Aneurysm Model under Consideration of Different Wall Conditions. Brain Sci 2020; 10:brainsci10040197. [PMID: 32230757 PMCID: PMC7226569 DOI: 10.3390/brainsci10040197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/15/2020] [Accepted: 03/25/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Biological processes that lead to aneurysm formation, growth and rupture are insufficiently understood. Vessel wall inflammation and degeneration are suggested to be the driving factors. In this study, we aimed to investigate the natural course of vital (non-decellularized) and decellularized aneurysms in a rabbit sidewall and bifurcation model. Methods: Arterial pouches were sutured end-to-side on the carotid artery of New Zealand White rabbits (vital [n = 6] or decellularized [n = 6]), and into an end-to-side common carotid artery bifurcation (vital [n = 6] and decellularized [n = 6]). Patency was confirmed by fluorescence angiography. After 28 days, all animals underwent magnetic resonance and fluorescence angiography followed by aneurysm harvesting for macroscopic and histological evaluation. Results: None of the aneurysms ruptured during follow-up. All sidewall aneurysms thrombosed with histological inferior thrombus organization observed in decellularized compared to vital aneurysms. In the bifurcation model, half of all decellularized aneurysms thrombosed whereas the non-decellularized aneurysms remained patent with relevant increase in size compared to baseline. Conclusions: Poor thrombus organization in decellularized sidewall aneurysms confirmed the important role of mural cells in aneurysm healing after thrombus formation. Several factors such as restriction by neck tissue, small dimensions and hemodynamics may have prevented aneurysm growth despite pronounced inflammation in decellularized aneurysms. In the bifurcation model, rarefication of mural cells did not increase the risk of aneurysm growth but tendency to spontaneous thrombosis.
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Affiliation(s)
- Basil Erwin Grüter
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
- Correspondence: ; Tel.: +41-62-838-41-41
| | - Stefan Wanderer
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
| | - Fabio Strange
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
| | - Sivani Sivanrupan
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
| | | | - Hans Rudolf Widmer
- Department of Neurosurgery, Neurocenter and Regenerative Neuroscience Cluster, Inseslspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Daniel Coluccia
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
| | - Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, 5000 Aarau, Switzerland; (S.W.); (F.S.); (D.C.); (L.A.); (J.F.); (S.M.)
- Cerebrovascular Research Group, Neurosurgery, Department of BioMedical Research, University of Bern, 3010 Bern, Switzerland;
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Marbacher S, Wanderer S, Strange F, Grüter BE, Fandino J. Saccular Aneurysm Models Featuring Growth and Rupture: A Systematic Review. Brain Sci 2020; 10:brainsci10020101. [PMID: 32069946 PMCID: PMC7071455 DOI: 10.3390/brainsci10020101] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/25/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Most available large animal extracranial aneurysm models feature healthy non-degenerated aneurysm pouches with stable long-term follow-ups and extensive healing reactions after endovascular treatment. This review focuses on a small subgroup of extracranial aneurysm models that demonstrated growth and potential rupture during follow-up. METHODS The literature was searched in Medline/Pubmed to identify extracranial in vivo saccular aneurysm models featuring growth and rupture, using a predefined search strategy in accordance with the PRISMA guidelines. From eligible studies we extracted the following details: technique and location of aneurysm creation, aneurysm pouch characteristics, time for model creation, growth and rupture rate, time course, patency rate, histological findings, and associated morbidity and mortality. RESULTS A total of 20 articles were found to describe growth and/or rupture of an experimentally created extracranial saccular aneurysm during follow-up. Most frequent growth was reported in rats (n = 6), followed by rabbits (n = 4), dogs (n = 4), swine (n = 5), and sheep (n = 1). Except for two studies reporting growth and rupture within the abdominal cavity (abdominal aortic artery; n = 2) all other aneurysms were located at the neck of the animal. The largest growth rate, with an up to 10-fold size increase, was found in a rat abdominal aortic sidewall aneurysm model. CONCLUSIONS Extracranial saccular aneurysm models with growth and rupture are rare. Degradation of the created aneurysmal outpouch seems to be a prerequisite to allow growth, which may ultimately lead to rupture. Since it has been shown that the aneurysm wall is important for healing after endovascular therapy, it is likely that models featuring growth and rupture will gain in interest for preclinical testing of novel endovascular therapies.
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Affiliation(s)
- Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau 5000, Switzerland (B.E.G.)
- Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern 3000, Switzerland
- Correspondence: ; Tel.: +41-62-838-5970
| | - Stefan Wanderer
- Department of Neurosurgery, Kantonsspital Aarau, Aarau 5000, Switzerland (B.E.G.)
- Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern 3000, Switzerland
| | - Fabio Strange
- Department of Neurosurgery, Kantonsspital Aarau, Aarau 5000, Switzerland (B.E.G.)
- Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern 3000, Switzerland
| | - Basil E. Grüter
- Department of Neurosurgery, Kantonsspital Aarau, Aarau 5000, Switzerland (B.E.G.)
- Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern 3000, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Aarau 5000, Switzerland (B.E.G.)
- Cerebrovascular Research Group, Department for BioMedical Research, University of Bern, Bern 3000, Switzerland
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Nevzati E, Rey J, Coluccia D, Grüter BE, Wanderer S, vonGunten M, Remonda L, Frosen J, Widmer HR, Fandino J, Marbacher S. Aneurysm wall cellularity affects healing after coil embolization: assessment in a rat saccular aneurysm model. J Neurointerv Surg 2019; 12:621-625. [DOI: 10.1136/neurintsurg-2019-015335] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 11/04/2022]
Abstract
Background and purposeDespite significant technical advances, recanalization rates after endovascular therapy of ruptured intracranial aneurysms (IAs) remain a clinical challenge. A histopathological hallmark of ruptured human IA walls is mural cell loss. Mural smooth muscle cells (SMCs) are known to promote intraluminal healing in thrombosed experimental aneurysms. In this rat model we assess the natural history and healing process after coil embolization in SMC-rich and decellularized aneurysms.MethodsSaccular aneurysms were created by end-to-side anastomosis of an arterial graft from the descending thoracic aorta of a syngeneic donor rat to the infrarenal abdominal aorta of recipient male Wistar rats. Untreated arterial grafts were immediately transplanted, whereas aneurysms with loss of mural cells were chemically decellularized before implantation. Aneurysms underwent coil implantation during aneurysm anastomosis. Animals were randomly assigned either to the non-decellularized or decellularized group and underwent macroscopic and histological analyses on days 3, 7, 21, or 90 post-coil implantation.ResultsA total of 55 rats underwent macroscopic and histologic analysis. After coil embolization, aneurysms with SMC-rich walls showed a linear course of thrombosis and neointima formation whereas decellularized aneurysms showed marked inflammatory wall degeneration with increased recanalization rates 21 days (p=0.002) and 90 days (p=0.037) later. The SMCs showed the ability to actively migrate into the intra-aneurysmal thrombus and participate in thrombus organization.ConclusionsCoil embolization of aneurysms with highly degenerated walls is prone to further wall degeneration, increased inflammation, and recanalization compared with aneurysms with vital SMC-rich walls.
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Amelot A, Saliou G, Benichi S, Alias Q, Boulouis G, Zerah M, Aghakhani N, Ozanne A, Blauwblomme T, Naggara O. Long-term Outcomes of Cerebral Aneurysms in Children. Pediatrics 2019; 143:peds.2018-3036. [PMID: 31068385 DOI: 10.1542/peds.2018-3036] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Our aim was to report the long-term clinical and imaging outcomes of ≤15-year-old children treated for ruptured or symptomatic cerebral aneurysms and to identify prognostic factors for clinical outcome, recurrence, and rebleeding. METHODS We retrospectively identified all pediatric cases of cerebral aneurysm from 2000 to 2015 and then prospectively evaluated long-term occlusion using brain MRI and clinical outcome measures: outcome was considered favorable if King's Outcome Scale for Childhood Head Injury score was ≥5. We performed univariate analysis and logistic binary regression to identify variables associated with clinical and imaging outcomes. RESULTS Fifty-one children (aged 8.5 ± 1.1 years [mean ± SD], with 37 ruptured and 14 symptomatic aneurysms) were included, and endovascular treatments (84%) or microsurgical procedures (16%) were performed. Despite a 19.6% death rate, at a mean follow-up of 8.3 years, 35 children (68.6%) had a favorable outcome. Annual bleeding and aneurysm recurrence rates were 1.4% ± 1.1% and 2.6% ± 1.8%, respectively. Cerebral ischemia, whether initial or delayed within the first month, was predictive of poor clinical outcome in multivariate analysis (odds ratio: 25; 95% confidence interval: 0.43-143; P < .0001), whereas aneurysm size >5 mm was the only factor associated with recurrence (odds ratio: 14.6; 95% confidence interval: 2.4-86.1; P = .003). CONCLUSIONS Two-thirds of studied ≤15-year-old children suffering from ruptured or symptomatic cerebral aneurysms had long-term favorable outcome. Annual bleeding and aneurysm recurrence rates have shown to be low after endovascular or surgical treatment. Long-term imaging follow-up helps to depict aneurysm recurrence or de novo aneurysm formation and to prevent rebleeding.
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Affiliation(s)
- Aymeric Amelot
- Department of Neurosurgery, La Pitié-Salpétrière Hospital, Université Paris Sorbonne, Paris, France; .,Departments of Pediatric Neurosurgery and
| | - Guillaume Saliou
- Departments of Neuroradiology and.,Department of Neuroradiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; and
| | | | | | - Grégoire Boulouis
- Pediatric Radiology, Necker Hospital for Sick Children, Université Paris Descartes, Paris, France.,Department of Neuroradiology, Sainte-Anne Hospital and Université Paris Descartes, INSERM UMR S894, Paris, France
| | | | - Nozar Aghakhani
- Neurosurgery, Kremlin-Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | | | | | - Olivier Naggara
- Pediatric Radiology, Necker Hospital for Sick Children, Université Paris Descartes, Paris, France.,Department of Neuroradiology, Sainte-Anne Hospital and Université Paris Descartes, INSERM UMR S894, Paris, France
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Jiang Y, Ge L, Di R, Lu G, Huang L, Li G, Leng X, Zhang S, Wan H, Geng D, Xiang J, Zhang X. Differences in hemodynamic characteristics under high packing density between the porous media model and finite element analysis in computational fluid dynamics of intracranial aneurysm virtual treatment. J Neurointerv Surg 2019; 11:853-858. [DOI: 10.1136/neurintsurg-2018-014218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 11/03/2022]
Abstract
ObjectiveThis study aimed to compare the hemodynamic differences among no sac (NOS), porous media (POM) and finite element analysis (FEA) models to investigate the recurrence-related risks for coiled intracranial aneurysms (IAs).MethodsThe study enrolled 10 patients with 11 IAs who received simple coiling treatment and hemodynamic simulations were performed for all IAs using the above three models. Velocity, wall shear stress (WSS) and residual flow volume (RFV) were calculated and compared in order to assess the model differences for both aneurysm sac and parent vessel regions.ResultsFor parent artery regions, all three models produced similar flow patterns and quantification analysis did not indicate differences in velocity and WSS (p>0.05). For aneurysm sac regions, the FEA model resulted in higher sac-maximized (0.18 m/s vs 0.06 m/s) and sac-averaged velocity (0.013 m/s vs 0.007 m/s), and higher sac-averaged (0.55 Pa vs 0.36 Pa, p=0.006) and sac-maximized WSS (12.1 Pa vs 6.6 Pa) than the POM model. The differences in RFV between the POM and FEA models under 11 different isovelocity thresholds (0.0001 m/s, 0.001 m/s, 0.002 m/s, 0.005 m/s, 0.01 m/s, 0.02 m/s, 0.05 m/s, 0.1 m/s, 0.2 m/s, 0.5 m/s, and 1 m/s) showed that the POM RFV was generally larger than those of the FEA model.ConclusionsCompared with the FEA model, the POM model provides a lower velocity and WSS and higher RFV for the aneurysm sac, which could lead to incorrect estimates of the recurrent risk of coiled IAs under high packing density.
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Marbacher S, Spiessberger A, Diepers M, Remonda L, Fandino J. Early Intracranial Aneurysm Recurrence after Microsurgical Clip Ligation: Case Report and Review of the Literature. J Neurol Surg Rep 2018; 79:e93-e97. [PMID: 30534511 PMCID: PMC6286179 DOI: 10.1055/s-0038-1676454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 09/20/2018] [Indexed: 12/25/2022] Open
Abstract
Microsurgical clip ligation is considered a definitive treatment for intracranial aneurysms (IAs), resulting in low rates of local recurrence that range from 0.2 to 0.5% and a latency period that averages about a decade. Our case report describes an early asymptomatic recurrence (i.e., without sentinel headache or seizure) less than 1 year after this 20-year-old woman underwent clip ligation of a ruptured anterior communicating artery (AComA) aneurysm. At recurrence, the patient underwent coiling of the regrowth; follow-up imaging at 6 and 18 months demonstrated complete IA occlusion. To review the putative risk factors of this rare phenomenon, the authors searched the PubMed database using the keywords "intracranial aneurysm," "recurrence," and "clipping" in various combinations. In the seven cases identified, all occurred in initially ruptured IA, which was often at the AComA, and six of seven patients were younger than 50 years old. Although most IA remnants grow slowly, early recurrence may represent a more aggressive biological behavior that warrants special attention in younger patients, positive rupture status, and unintended remnant of any size. In such a constellation, early imaging follow-up within the first 6 months may be warranted to rule out early IA recurrence.
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Affiliation(s)
- Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau (KSA), Aarau, Switzerland
| | | | - Michael Diepers
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau (KSA), Aarau, Switzerland
| | - Luca Remonda
- Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau (KSA), Aarau, Switzerland
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau (KSA), Aarau, Switzerland
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