1
|
Nabizadeh F, Valizadeh P, Balabandian M. Stent-assistant versus non-stent-assistant coiling for ruptured and unruptured intracranial aneurysms: A meta-analysis and systematic review. World Neurosurg X 2024; 21:100243. [PMID: 38221954 PMCID: PMC10787302 DOI: 10.1016/j.wnsx.2023.100243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/04/2023] [Indexed: 01/16/2024] Open
Abstract
Background Several different endovascular and non-invasive treatment methods are suggested for the various types of intracranial aneurysms including simple, balloon-assisted, and stent-assisted coiling (SAC). Previous studies investigated the safety and efficacy of SAC versus non-stent-assisted coiling (non-SAC) but the results were controversial. We aim to perform a systematic review and meta-analysis to compare the efficacy and safety of SAC with non-SAC technique in stratifying by the ruptured and unruptured aneurysms. Methods PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were searched in April 2022 for studies investigated the efficacy and safety of SAC versus non-SAC. Results Overall, 26 studies entered into our qualitative and quantitative synthesis. We found that there was overall lower recurrence rate in SAC versus non-SAC significant (RR: 0.43, 95%CI: 0.33, 0.53). Furthermore, the comparisons were significant in unruptured (RR: 0.63, 95%CI: 0.40, 0.86), ruptured (RR: 0.29, 95%CI), and combination aneurysms (RR: 0.42, 95%CI: 0.30, 0.54). Also, we found higher risk of intraprocedural rupture for SAC versus non-SAC in unruptured aneurysms (RR: 1.40, 95%CI: 1.31, 1.50). Investigating hemorrhagic events risk showed that there was significant difference in ruptured (RR: 1.73, 95%CI: 1.12, 2.34) and combination aneurysms (RR: 0.60, 95%CI: 0.37, 0.82). There was no significant difference in immediate occlusion rate, complete occlusion, and risk of ischemic events in our analysis. Conclusion Overall, our findings demonstrated that SAC may have higher efficacy in term of recurrence rate, but also may have a higher risk of complications in the treatment of intracranial aneurysms. As there are several factors affecting the outcomes and safety of these interventions, further RCTs controlled for multiple factors are required better guide the neurointerventionists choose the best strategy.
Collapse
Affiliation(s)
- Fardin Nabizadeh
- Neuroscience Research Group (NRG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Parya Valizadeh
- School of Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Balabandian
- Neuroscience Research Group (NRG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
Jeong EO, Jeong HW, Lee HJ, Kim KH, Koh HS, Kwon HJ. Distal stenting technique for coil embolization of early branch aneurysms of middle cerebral artery. J Neuroradiol 2023:S0150-9861(23)00225-0. [PMID: 37553050 DOI: 10.1016/j.neurad.2023.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/28/2023] [Accepted: 08/05/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND AND PURPOSE Stent-assisted coil embolization of early branch aneurysms of the middle cerebral artery (MCA) can sometimes be challenging due to the small diameter and acute angle of the branches. This study aimed to analyze the treatment results and report the feasibility and outcomes of the distal stenting technique for these aneurysms. MATERIALS AND METHODS The distal stenting technique was used for 15 wide-neck MCA aneurysms (females, 10; males, 5; mean age, 65.1 years) originating from the early branch between December 2018 and October 2021. The average sizes of the dome, depth, and neck of the aneurysms were 4.17 mm (range: 2.99-6.21 mm), 2.86 mm (range: 1.82-3.72 mm), and 3.42 mm (range: 2.44-4.32 mm), respectively. RESULTS The average diameter of the stents was 4.0 mm (3.0 mm, 3; 4.0 mm, 6; 4.5 mm, 6). Stents were successfully deployed in all 15 aneurysms (100%). The average length of the procedure was 69 min (range: 45-117 min). On postoperative angiography, nine (60.0%) aneurysms were completely occluded, four (26.7%) had neck remnants, and two (13.3%) had contrast flow in the sac. During the procedure, vasospasm and thrombus formation occurred in one case each, but no neurological sequelae were observed. On follow-up digital subtraction angiography of the 10 aneurysms after an average of 13.7 months (range: 12-18 months), the branches were well preserved, and neck remnants were noted in four aneurysms (40.0%). No thromboembolic events occurred during the clinical follow-up. CONCLUSION The distal stenting technique using an open-cell stent can be a good option for coil embolization of early branch MCA aneurysms.
Collapse
Affiliation(s)
- Eun-Oh Jeong
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Hee-Won Jeong
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Han-Joo Lee
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Kyung Hwan Kim
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Neurosurgery, Chungnam National University School of Medicine, Deajeon, Republic of Korea
| | - Hyeon-Song Koh
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Neurosurgery, Chungnam National University School of Medicine, Deajeon, Republic of Korea
| | - Hyon-Jo Kwon
- Department of Neurosurgery, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Neurosurgery, Chungnam National University School of Medicine, Deajeon, Republic of Korea.
| |
Collapse
|
3
|
Wang J, Zhang L, Dong L, Zhang S, Zhu H, Jiang C, Lv M. Endovascular Treatment for Aneurysms Located in the Posterior Communicating Artery (PCoA) by the Swinging-Tail Technique: A Technical Note. J Clin Med 2022; 11:jcm11195955. [PMID: 36233822 PMCID: PMC9570506 DOI: 10.3390/jcm11195955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSES A stent-assisted coil (SAC) is a safe and effective treatment modality for some complex intracranial aneurysms, especially for wide neck aneurysms. However, some wide neck aneurysms with a tough angle and located in the posterior communicating artery (PCoA) are challenging to treat with a SAC. This study aimed to examine and discuss the swinging-tail technique for treating wide neck aneurysms located in the PCoA using a SAC by Prof. Lv. MATERIALS AND METHODS We retrospectively reviewed our institutional clinical database and identified nine patients with neck aneurysms located in the PCoA, and these patients underwent the swinging-tail technique by Prof. Lv, which is a novel technique of releasing a stent, from June 2016 to September 2021. RESULTS In this study, nine patients underwent SAC treatment using the swinging-tail technique by Prof. Lv. Aneurysmal complete occlusion was observed in every patient without any complications, as shown by immediate postoperative angiography. Additionally, the modified Rankin scale was monitored for clinical outcomes in the follow-up. One patient died postoperatively due to severe SAH with an intraventricular hemorrhage. Four of nine patients underwent imaging follow-up, demonstrating the complete occlusion of aneurysms; eight patients underwent clinical follow-up and achieved a favorable clinical outcome (modified Rankin scale score: 0-2). CONCLUSION The SAC treatment for wide neck aneurysms located in the PCoA can be challenging for operators because of the specific location, resulting in inadequate vessel wall apposition by antegrade stenting via the ipsilateral vessel. In this circumstance, the swinging-tail technique may be a feasible and effective choice.
Collapse
Affiliation(s)
- Jiejun Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Longhui Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Linggen Dong
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Shuai Zhang
- Department of Neurosurgery, Beijing Jingmei Group General Hospital, Beijing 100042, China
| | - Haoyu Zhu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Chuhan Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Correspondence: (C.J.); (M.L.)
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Correspondence: (C.J.); (M.L.)
| |
Collapse
|
4
|
Wu D, Sheng B, Fang X, Li Z. Risk factors of recurrence after endovascular embolization of posterior communicating artery aneurysms. Interv Neuroradiol 2022; 28:562-567. [PMID: 34713742 PMCID: PMC9511616 DOI: 10.1177/15910199211054715] [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: 07/22/2021] [Revised: 09/05/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE To determine the risk factors for recurrence after endovascular embolization of posterior communicating artery aneurysms (PcomA). METHODS We retrospectively analyzed a cohort of 163 patients harboring 172 PocmAs who were treated with endovascular embolization from January 2019 to December 2020. The patients were divided into recurrence and stable groups depending on outcome. Univariate and logistic regression analyses were performed to determine the potential risk factors of recurrence during follow-up. RESULTS Of the total 163 patients harboring 172 aneurysms, 107 were treated with simple coil occlusion and 65 were treated with stent-assisted coil embolization. There were significant differences in aneurysm sizes and use of non-stent-assisted coil embolizations between the groups (P < 0.05). The incidence of saccular aneurysm and Raymond grade were significantly higher in the recurrent group than in the stable group (P < 0.01). After variable selection, Raymond grade, aneurysm size, saccular aneurysm and non-stent-assisted coil embolization were included in further analysis. Binary logistic regression analysis revealed significant associations with non-stent-assisted coil embolization (P = 0.007), packing density (P < 0.001) and Raymond grades II (P < 0.001) and III (P = 0.002). CONCLUSION Non-stent-assisted coil embolization, as well as packing density and Raymond grades II grade III are associated with recurrence after endovascular treatment of PcomA.
Collapse
Affiliation(s)
- Degang Wu
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Bin Sheng
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xinggen Fang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Zhenbao Li
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| |
Collapse
|
5
|
Three-dimensional printing-assisted precision microcatheter shaping in intracranial aneurysm coiling. Neurosurg Rev 2022; 45:1773-1782. [PMID: 34993691 DOI: 10.1007/s10143-021-01703-1] [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: 08/14/2021] [Revised: 11/07/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
Optimal microcatheter shaping is essential for successful endovascular coiling procedures which is sometimes challenging. Our aim was not only to introduce a new shaping method using three-dimensional (3D) printed vessel models but also to prove its feasibility, efficiency and superiority. This was a retrospective cohort study. From September 2019 to March 2021, 32 paraclinoid aneurysms managed with endovascular coiling were retrospectively included and identified. Sixteen aneurysms were coiled using 3D microcatheter shaping method (3D shaping group), and traditional manual shaping method using shaping mandrels was adopted for another 16 patients (control group). The cost and angiographical and clinical outcomes between the two groups were compared, and the feasibility and effectiveness of the new 3D shaping method were evaluated and described in detail. With technical success achieved in 93.75%, most of the 16 shaped microcatheters using new shaping method could be automatically navigated into the target aneurysms without the assistance of microguidewires and could be assessed with favorable accessibility, positioning and stability. Twenty-seven out of 32 aneurysms (84.38%) were completely occluded with the rate of perioperative complications being 12.50%. Although there was no significant difference between the occlusion rates and complication rates of the two groups, the new shaping method could dramatically decrease the number of coils deployed and reduce the overall procedure time. Patient specific shaping of microcatheters using 3D printing may facilitate easier and safer procedures in coil embolization of intracranial aneurysms with shorter surgery time and less coils deployed.
Collapse
|
6
|
Tian Z, Liu J, Zhang Y, Zhang Y, Zhang X, Zhang H, Yang M, Yang X, Wang K. Risk Factors of Angiographic Recurrence After Endovascular Coil Embolization of Intracranial Saccular Aneurysms: A Retrospective Study Using a Multicenter Database. Front Neurol 2020; 11:1026. [PMID: 33041975 PMCID: PMC7522362 DOI: 10.3389/fneur.2020.01026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 08/06/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Endovascular therapy of intracranial aneurysms has a high recurrence rate. This study aimed to evaluate the risk factors of recurrence after endovascular coil embolization of intracranial aneurysms. Methods: From January 2014 to May 2015, 504 patients with 558 intracranial aneurysms who were treated by endovascular therapy were recruited from four high-volume centers. We used multivariate Cox proportional hazard regression to evaluate the risk factors associated with the angiographic recurrence of intracranial saccular aneurysms after endovascular coil embolization. Results: Angiographic follow-up was available for 504 patients (558 aneurysms), with a mean duration of 11.42 months. Of the 558 aneurysms, 57 (10.2%) aneurysms showed recurrence. Aneurysm size (p = 0.028), therapy (non-stent assisted coiling or stent-assisted coiling) (p = 0.008), the Raymond scale (p = 0.040), aneurysm rupture status (p < 0.001), and packing density (p < 0.001) showed significant associations with angiographic follow-up outcome. A low packing density was independently associated with aneurysmal recurrence after multivariate Cox proportional hazard regression analysis (p < 0.001). Conclusion: Endovascular treatment is effective for these lesions. Multiple factors could attribute to the aneurysmal recurrence after endovascular coil embolization. The low packing density is the independent risk factor for aneurysmal recurrence. These findings should be verified by larger multicenter and multi-population studies.
Collapse
Affiliation(s)
- Zhongbin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaolong Zhang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Ming Yang
- Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Command, Southern Medical University, Wuhan, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
7
|
Sedat J, Chau Y, Gaudart J, Sachet M, Beuil S, Lonjon M. Stent-assisted coiling of intracranial aneurysms using LEO stents: long-term follow-up in 153 patients. Neuroradiology 2017; 60:211-219. [PMID: 29273960 DOI: 10.1007/s00234-017-1965-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 12/15/2017] [Indexed: 01/31/2023]
Abstract
PURPOSE Coiling associated with placement of a self-expandable intracranial stent has improved the treatment of intracranial wide-necked aneurysms. Little is known, however, about the durability of this treatment. The purpose of this report is to present our experience with the LEO stent and to evaluate the complications, effectiveness, and long-term results of this technique. METHODS We analyzed the records of 155 intracranial unruptured aneurysms that were treated by stent-assisted coiling with a LEO stent between 2008 and 2012. Procedural, early post-procedural, and delayed complications were recorded. Clinical and angiographic follow-up of patients was conducted over a period of at least 36 months. RESULTS No procedural mortality was observed. One-month morbidity was observed in 14 out of 153 patients (9,15%). One hundred thirty-eight patients (with 140 aneurysms) had clinical and angiographic follow-up for more than 36 months. No aneurysm rupture was observed during follow-up. Four patients presented an intra-stent stenosis at 8 months, and 6 patients who had an early recurrence were retreated. Final results showed 85% complete occlusion, 13% neck remnants, and 2% stable incomplete occlusion. CONCLUSION Stent-assisted coiling with the LEO stent is a safe and effective treatment for unruptured intracranial aneurysms. The long-term clinical outcomes with the LEO stent are excellent with a high rate of complete occlusion that is stable over time.
Collapse
Affiliation(s)
- Jacques Sedat
- Unité de NeuroInterventionnelle, Hôpital Pasteur 2, 06000, Nice, France.
| | - Yves Chau
- Unité de NeuroInterventionnelle, Hôpital Pasteur 2, 06000, Nice, France
| | - Jean Gaudart
- Aix Marseille University, IRD, INSERM, SESSTIM, Marseille, France
| | - Marina Sachet
- Unité de NeuroInterventionnelle, Hôpital Pasteur 2, 06000, Nice, France
| | | | - Michel Lonjon
- Unité de Neurochirurgie, Hôpital Pasteur 2, Nice, France
| |
Collapse
|
8
|
Lim JW, Lee J, Cho YD. Progressive Occlusion of Small Saccular Aneurysms Incompletely Occluded After Stent-Assisted Coil Embolization : Analysis of Related Factors and Long-Term Outcomes. Clin Neuroradiol 2017; 28:569-577. [PMID: 28791434 DOI: 10.1007/s00062-017-0612-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/18/2017] [Indexed: 12/23/2022]
Abstract
PURPOSE Incompletely occluded aneurysms after coil embolization are subject to recanalization but occasionally progress to a totally occluded state. Deployed stents may actually promote thrombosis of coiled aneurysms. We evaluated outcomes of small aneurysms (<10 mm) wherein saccular filling with contrast medium was evident after stent-assisted coiling, assessing factors implicated in subsequent progressive occlusion. METHODS Between September 2012 and June 2016, a total of 463 intracranial aneurysms were treated by stent-assisted coil embolization. Of these, 132 small saccular aneurysms displayed saccular filling with contrast medium in the immediate aftermath of coiling. Progressive thrombosis was defined as complete aneurysmal occlusion at the 6‑month follow-up point. Rates of progressive occlusion and factors predisposing to this were analyzed via binary logistic regression. RESULTS In 101 (76.5%) of the 132 intracranial aneurysms, complete occlusion was observed in follow-up imaging studies at 6 months. Binary logistic regression analysis indicated that progressive occlusion was linked to smaller neck diameter (odds ratio [OR] = 1.533; p = 0.003), hyperlipidemia (OR = 3.329; p = 0.036) and stent type (p = 0.031). The LVIS stent is especially susceptible to progressive thrombosis, more so than Neuroform (OR = 0.098; p = 0.008) or Enterprise (OR = 0.317; p = 0.098) stents. In 57 instances of progressive thrombosis, followed for ≥12 months (mean 25.0 ± 10.7 months), 56 (98.2%) were stable, with minor recanalization noted once (1.8%) and no major recanalization. CONCLUSION Aneurysms associated with smaller diameter necks, hyperlipidemic states and LVIS stent deployment may be inclined to possible thrombosis, if occlusion immediately after stent-assisted coil embolization is incomplete. In such instances, excellent long-term durability is anticipated.
Collapse
Affiliation(s)
- Jeong Wook Lim
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea (Republic of)
| | - Jeongjun Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, 03080, Jongno-gu, Seoul, Korea (Republic of)
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, 03080, Jongno-gu, Seoul, Korea (Republic of).
| |
Collapse
|
9
|
Nakazaki M, Nonaka T, Nomura T, Onda T, Yonemasu Y, Takahashi A, Hashimoto Y, Honda O, Oka S, Sasaki M, Daibo M, Honmou O. Cerebral aneurysm neck diameter is an independent predictor of progressive occlusion after stent-assisted coiling. Acta Neurochir (Wien) 2017; 159:1313-1319. [PMID: 28488070 DOI: 10.1007/s00701-017-3199-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/24/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Some intracranial aneurysms treated by stent-assisted coiling (SAC) with incomplete occlusion undergo progressive occlusion (PO) during follow-up period. We analyzed the predictors for the occurrence of PO. METHODS Among 74 cerebral aneurysms treated by SAC using the Enterprise or Neuroform stents from 2010 to 2015, we included 43 aneurysms with occlusion grade of neck remnant (NR, n = 36) or residual aneurysm (RA, n = 7) at the post-procedure. We defined PO as improvement in occlusion grade from RA to NR, or from NR or RA to complete occlusion on angiographic follow-up imaging at 6 months after the procedure. We analyzed the independent predictors for PO using a multivariate logistic regression model and receiver operating characteristic (ROC) curve analysis. RESULTS Forty-three aneurysms were analyzed, with mean volume embolization ratio of 30.3 ± 6.7%. Twenty aneurysms (47%) achieved PO. Univariate analysis found that the median neck diameter of the aneurysms was smaller in aneurysms with PO than others. Multivariate logistic regression analysis also found that the odds ratio of neck diameter of the aneurysm for PO was 0.44 (95% CI, 0.19-0.82, p < 0.01). Moreover, ROC curve analysis for PO found that the optimal cut-off value of the neck diameter was 5.5 mm, with a sensitivity of 95%, specificity of 57% (p < 0.01). CONCLUSIONS Incompletely occluded aneurysms with a neck diameter of 5.5 mm or less might be more likely to develop PO within 6 months after SAC by using Enterprise or Neuroform stents.
Collapse
Affiliation(s)
- Masahito Nakazaki
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8556, Japan.
| | - Tadashi Nonaka
- Department of Neuroendovascular Therapy, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, 003-0026, Japan
- Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, 003-0026, Japan
| | - Tatsufumi Nomura
- Department of Neuroendovascular Therapy, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, 003-0026, Japan
- Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, 003-0026, Japan
| | - Toshiyuki Onda
- Department of Neuroendovascular Therapy, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, 003-0026, Japan
- Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, 003-0026, Japan
| | - Yasuyuki Yonemasu
- Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, 003-0026, Japan
| | - Akira Takahashi
- Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, 003-0026, Japan
| | - Yuji Hashimoto
- Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, 003-0026, Japan
| | - Osamu Honda
- Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, 003-0026, Japan
| | - Shinichi Oka
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8556, Japan
| | - Masanori Sasaki
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8556, Japan
| | - Masahiko Daibo
- Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, 003-0026, Japan
| | - Osamu Honmou
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, 060-8556, Japan
| |
Collapse
|
10
|
Reduced Efficacy of the Pipeline Embolization Device in the Treatment of Posterior Communicating Region Aneurysms with Fetal Posterior Cerebral Artery Configuration. Neurosurgery 2017; 82:695-700. [DOI: 10.1093/neuros/nyx293] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/02/2017] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Aneurysms at the origin of the posterior communicating artery (PcommA) have been demonstrated to be effectively treated with the pipeline embolization device (PED). Much less is known about the efficacy of the PED for aneurysms associated with a fetal posterior cerebral artery (fPCA) variant.
OBJECTIVE
To study PED treatment efficacy of PcommA aneurysms, including fPCA aneurysms.
METHODS
A prospectively maintained university database of aneurysm patients treated with the PED was retrospectively reviewed. Demographics, treatment details, and imaging were reviewed for all PcommA and fPCA aneurysms.
RESULTS
Out of a total of 285 patients treated with PED, 50 patients (mean age 57.5 ± 12.2 yr, 42 females) with unruptured PcommA (9 fPCA) aneurysms were identified. Mean follow-up duration was 14.0 ± 11.6 mo (48 patients). Roy-Raymond class I occlusion on follow-up magnetic resonance or catheter angiography (mean time 11.7 ± 6.8 mo) was achieved in 30 patients (62.5%), class II occlusion in 11 patients (22.9%) and class III occlusion in 7 patients (14.5%). The PcommA was occluded in 56% of patients without any clinical symptoms. No deaths or permanent neurological complications occurred. In fPCA aneurysms, class I occlusion was seen in 1 patient, class 2 occlusion in 2 patients, and class III occlusion in 6 patients. Multivariate analysis revealed an independent association between incomplete occlusion and fPCA configuration (OR 73.65; 95% CI: 5.84-929.13; P = .001).
CONCLUSION
The PED is a safe and effective treatment for PcommA aneurysms, although fetal anatomy should increase consideration of traditional endovascular techniques or surgical clipping.
Collapse
|
11
|
Thiarawat P, Jahromi BR, Kozyrev DA, Intarakhao P, Teo MK, Choque-Velasquez J, Hernesniemi J. Microneurosurgical Management of Posterior Communicating Artery Aneurysm: A Contemporary Series from Helsinki. World Neurosurg 2017; 101:379-388. [PMID: 28213191 DOI: 10.1016/j.wneu.2017.02.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objectives of this study were to analyze microsurgical techniques and to determine correlations between microsurgical techniques and the radiographic findings in the microneurosurgical treatment of posterior communicating artery aneurysms (PCoAAs). METHODS We retrospectively analyzed radiographic findings and videos of surgeries in 64 patients with PCoAAs who underwent microsurgical clipping by the senior author from August 2010 to 2014. RESULTS From 64 aneurysms, 30 (47%) had acute subarachnoid hemorrhage (SAH) that necessitated lamina terminalis fenestration (odds ratio [OR], 67.67; P < 0.001) and Liliequist membrane fenestration (OR, 19.62; P < 0.001). The low-lying aneurysms significantly necessitated the coagulation of the dura covering the anterior clinoid process (ACP) (OR, 7.43; P = 0.003) or anterior clinoidectomy (OR, 91.0; P < 0.001). We preferred straight clips in 45 (83%) of 54 posterolateral projecting aneurysms (OR, 45.0; P < 0.001), but preferred curved clips for posteromedial projecting aneurysms (OR, 6.39; P = 0.008). The mean operative time from the brain retraction to the final clipping was 17 minutes and 43 seconds. Postoperative computed tomography angiography revealed complete occlusion of 60 (94%) aneurysms. Three (4.6%) patients with acute SAH suffered postoperative lacunar infarction. CONCLUSIONS For ruptured aneurysms, lamina terminalis and Liliequist membrane fenestration are useful for additional cerebrospinal fluid drainage. For low-lying aneurysms, coagulation of the dura covering the ACP or tailored anterior clinoidectomy might be necessary for exposing the proximal aneurysm neck. Type of clips depends on the direction of projection. The microsurgical clipping of the PCoAAs can achieve good immediate complete occlusion rate with low postoperative stroke rate.
Collapse
Affiliation(s)
- Peeraphong Thiarawat
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Surgery, Naresuan University, Phitsanulok, Thailand.
| | | | - Danil A Kozyrev
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, North-Western State Medical University, Saint Petersburg, Russia
| | - Patcharin Intarakhao
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Anesthesiology, Naresuan University, Phitsanulok, Thailand
| | - Mario K Teo
- Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, North Bristol University Hospital, Bristol, United Kingdom
| | | | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
12
|
Feng MT, Wen WL, Feng ZZ, Fang YB, Liu JM, Huang QH. Endovascular Embolization of Intracranial Aneurysms: To Use Stent(s) or Not? Systematic Review and Meta-analysis. World Neurosurg 2016; 93:271-8. [DOI: 10.1016/j.wneu.2016.06.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/03/2016] [Accepted: 06/06/2016] [Indexed: 11/27/2022]
|
13
|
Phan K, Huo YR, Jia F, Phan S, Rao PJ, Mobbs RJ, Mortimer AM. Meta-analysis of stent-assisted coiling versus coiling-only for the treatment of intracranial aneurysms. J Clin Neurosci 2016; 31:15-22. [PMID: 27344091 DOI: 10.1016/j.jocn.2016.01.035] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 01/26/2016] [Indexed: 10/21/2022]
|
14
|
Predictors of recurrence after stent-assisted coil embolization of paraclinoid aneurysms. J Clin Neurosci 2016; 33:173-176. [PMID: 27575747 DOI: 10.1016/j.jocn.2016.03.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/27/2016] [Indexed: 11/21/2022]
Abstract
Stent-assisted coil embolization has been increasingly used to treat paraclinoid aneurysms. The study was aimed to evaluate safety and efficacy of stent-assisted coil embolization for paraclinoid aneurysms and explore the factors influencing the long-term outcomes. Under an institutional review board approved protocol, the clinical and angiographic data of 129 paraclinoid aneurysms in 120 patients (Male:Female=36:84; median age, 52years; range, 21-84) treated by stent-assisted coil embolization were reviewed retrospectively. Clinical status, aneurysmal morphology, treatment strategy and results were analyzed using Chi-squared tests in the univariate analysis and further analyzed using backward stepwise logistic regression. The univariate analysis indicated significance between the groups regarding hypertension, ruptured aneurysms, size, wide neck and immediate treatment results (P<0.05). Multivariate logistic regression analysis found that ruptured aneurysms (odds ratio [OR]=5.893, 95% confidence interval [CI], 1.512-23.054; p=0.011), larger size (OR=2.339; 95%CI, 1.148-4.781; p=0.020) and hypertension (OR=6.143; 95%CI, 1.560-24.183; p=0.009) might be predictors of recurrence. Stent-assisted coil embolization of paraclinoid aneurysm has a risk of recurrence. Ruptured aneurysms, larger size and hypertension may be the risk factors for recurrence.
Collapse
|
15
|
Ding D. Endovascular treatment approaches for posterior communicating artery aneurysms: effect of stents on outcomes. Clin Neurol Neurosurg 2014; 119:134-5. [PMID: 24529475 DOI: 10.1016/j.clineuro.2013.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 12/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Dale Ding
- University of Virginia, Department of Neurosurgery, Charlottesville 22908, USA.
| |
Collapse
|
16
|
Yao PF, Liu JM, Huang QH. Reply to letter to the editor. Clin Neurol Neurosurg 2014; 119:135. [PMID: 24529476 DOI: 10.1016/j.clineuro.2013.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Peng-Fei Yao
- Department of Neurosurgery, Lanzhou General Hospital of Lanzhou Military Command, Lanzhou 730070, China
| | - Jian-Min Liu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China.
| | - Qing-Hai Huang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
| |
Collapse
|