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Shim HK, Lee BJ, Lee CH, Sohn MJ, Shim SY, Choi CY, Han SR, Kim KH, Koo HW. The safety and efficacy of double microcatheter technique in small and tiny ruptured aneurysms: A single center study. J Cerebrovasc Endovasc Neurosurg 2024; 26:141-151. [PMID: 37907062 PMCID: PMC11220299 DOI: 10.7461/jcen.2023.e2023.08.002] [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: 07/18/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE Double microcatheter technique (dMC) can be the alternative to Single microcatheter technique (sMC) for challenging cases, but there is lack of studies comparing dMC to sMC especifically for small ruptured aneurysms. Our objective was to compare the safety and efficacy of dMC to sMC in treating small (≤5 mm) and tiny (≤3 mm) ruptured aneurysms. METHODS This study focused on 91 out of 280 patients who had ruptured aneurysms and underwent either single or double microcatheter coil embolization. These patients were treated with either single or double microcatheter coil embolization. We divided the patients into two groups based on the procedural method and evaluated clinical features and outcomes. Subgroup analyses were conducted specifically for tiny aneurysms, comparing the two methods, and within the dMC group, we also examined whether the aneurysm was tiny or not. In addition, univariate logistic regression analysis was performed to assess the impact of coil packing density. RESULTS The mean values for most outcome measures in the dMC group were higher than those in the sMC group, but these differences did not reach statistical significance (coil packing density, 45.739% vs. 39.943%; procedural complication, 4.17% vs. 11.94%; recanalization, 8.3% vs. 10.45%; discharge discharge modified Rankin Scale (mRS), 1.83 vs. 1.97). The comparison between tiny aneurysms and other sizes within the dMC group did not reveal any significant differences in terms of worse outcomes or increased risk. The only factor that significantly influenced coil packing density in the univariate logistic regression analysis was the size of the aneurysm (OR 0.309, 95% CI 0.169-0.566, p=0.000). CONCLUSIONS The dMC proved to be a safe and viable alternative to the sMC for treating small ruptured aneurysms in challenging cases.
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Affiliation(s)
- Hyeong Kyun Shim
- Department of Neurosurgery, Inje University, Ilsan Paik Hospital, Goyang, Korea
| | - Byung Jou Lee
- Department of Neurosurgery, Inje University, Ilsan Paik Hospital, Goyang, Korea
| | - Chae Heuck Lee
- Department of Neurosurgery, Inje University, Ilsan Paik Hospital, Goyang, Korea
| | - Moon Jun Sohn
- Department of Neurosurgery, Inje University, Ilsan Paik Hospital, Goyang, Korea
| | - Sook Young Shim
- Department of Neurosurgery, Inje University, Ilsan Paik Hospital, Goyang, Korea
| | - Chan Young Choi
- Department of Neurosurgery, Inje University, Ilsan Paik Hospital, Goyang, Korea
| | - Sung Rok Han
- Department of Neurosurgery, Inje University, Ilsan Paik Hospital, Goyang, Korea
| | - Kwang Hyeon Kim
- Department of Neurosurgery, Inje University, Ilsan Paik Hospital, Goyang, Korea
| | - Hae Won Koo
- Department of Neurosurgery, Inje University, Ilsan Paik Hospital, Goyang, Korea
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Procedural Complications and Factors Influencing Immediate Angiographic Results after Endovascular Treatment of Small (<5 mm) Ruptured Intracranial Aneurysms. J Stroke Cerebrovasc Dis 2020; 29:104624. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/20/2019] [Accepted: 12/22/2019] [Indexed: 11/21/2022] Open
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Brunet MC, Simonyan D, Carrondo Cottin S, Morin F, Milot G, Audet MÈ, Gariépy JL, Lavoie P. Effect of aneurysm size on procedure-related rupture in patients with subarachnoid hemorrhage treated with coil occlusion. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kühn AL, Gounis MJ, Puri AS. Introduction: History and Development of Flow Diverter Technology and Evolution. Neurosurgery 2019; 86:S3-S10. [DOI: 10.1093/neuros/nyz307] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/15/2019] [Indexed: 11/12/2022] Open
Abstract
AbstractThe introduction of flow diverter technology to the field of neurointervention has revolutionized the treatment of intracranial aneurysms. The therapy approach has shifted from intrasaccular aneurysm treatment to exclusion of the aneurysm from the blood circulation with remodeling of the parent artery. Previously, “difficult”-to-treat aneurysms including fusiform and blister aneurysms, but also aneurysms arising from a diseased vessel segment, can now be safely and permanently treated with flow diverters. A little over a decade ago, after extensive bench testing and refinement of the flow diverter concept, the device was eventually available for clinical use and today it has become a standard treatment for intracranial aneurysms. Currently, United States Food and Drug Administration (FDA)-approved flow diverters are the Pipeline Embolization Device (Medtronic) and the Surpass Streamline Flow Diverter (Stryker). The devices can either be delivered or deployed via a standard femoral artery approach or a radial artery approach. Other considerations for catheter setup and device deployment strategies depending on aneurysm location or vessel anatomy are described.
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Affiliation(s)
- Anna Luisa Kühn
- Division of Neuroradiology, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Matthew J Gounis
- Division of Neuroimaging and Intervention, New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
| | - Ajit S Puri
- Division of Neuroimaging and Intervention, New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
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Kim JH, Choi CH, Lee JI, Lee TH, Ko JK. Endovascular treatment of ruptured tiny aneurysms. J Cerebrovasc Endovasc Neurosurg 2019; 21:67-76. [PMID: 31886142 PMCID: PMC6911774 DOI: 10.7461/jcen.2019.21.2.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 06/18/2019] [Accepted: 06/20/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Endovascular coiling of ruptured tiny aneurysms (RTAs) in the brain has been known to be technically challenging owing to the higher rate of adverse events, such as thromboembolism and intraoperative rupture. The aim of this study was to report our ex-periences of endovascular treatment of RTAs (size, ≤3 mm). METHODS From January 2006 to December 2017, 35 RTAs in 35 patients were treated at our institution with an endosaccular coiling. Procedural data and clinical and angiographic results were retrospectively reviewed. RESULTS The mean size of the RTAs was 2.53 mm (SD: 0.38). The neck remodeling technique was applied to 14 aneurysms, including stent-assisted coiling (n=7) and balloon-assisted coiling (n=7). Procedure-related complications included intraprocedural rupture (n=2), thromboembolic event (n=1), and early rebleeding (n=2), which needed recoiling. Regarding immediate angiographic control, complete occlusion was achieved in 25 aneurysms (71.4%), small neck remnant in 5 (14.3%), and definite remnant in 5 (14.3%). At the end of follow-up, 31 of the 35 patients (88.6%) were able to function independently. Twenty-two of the 35 patients underwent follow-up conventional angiography (mean, 468 days). Stable occlusion was achieved in 20 of the 22 patients (90.9%), minor recanalization in 1 (4.5%), and major recanalization, which required recoiling, in 1 (4.5%). CONCLUSION Our experiences demonstrate that endovascular treatment for RTAs is both feasible and effective. However, periprocedural rebleedings were found to occur more often (11.4%) than what is generally suspected.
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Affiliation(s)
- Joon Hyuk Kim
- Department of Neurosurgery, Diagnostic Radiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Chang Hwa Choi
- Department of Neurosurgery, Diagnostic Radiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jae Il Lee
- Department of Neurosurgery, Diagnostic Radiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Tae Hong Lee
- Department of Neurosurgery, Diagnostic Radiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jun Kyeung Ko
- Department of Neurosurgery, Diagnostic Radiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea
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Anokwute MC, Braca JA, Bohnstedt B, DeNardo A, Scott J, Cohen-Gadol A, Sahlein DH. Endovascular treatment of ruptured tiny (⩽3mm) intracranial aneurysms in the setting of subarachnoid hemorrhage: A case series of 20 patients and literature review. J Clin Neurosci 2017; 40:52-56. [PMID: 28347681 DOI: 10.1016/j.jocn.2017.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/22/2017] [Indexed: 11/24/2022]
Abstract
Successful endovascular coiling of ruptured tiny saccular intracranial aneurysms (⩽3mm) is technically challenging and traditionally has been associated with technical failures, as well as morbidity related to thromboembolic events and high intraoperative rupture rates. This study analyzes the feasibility, technical efficacy, and clinical outcomes of coil embolization of ruptured tiny intracranial aneurysms using current coil and microcatheter technology and techniques. We performed a retrospective review of 20 patients with 20 ruptured tiny aneurysms treated with endovascular coil embolization from 2013 to 2016 at a single high-volume academic tertiary care practice. The mean aneurysm size was 2.4mm (median 2.5mm, 1-3). Complete occlusion was achieved in 12 of 20 patients (60%), the remaining 7 of 20 patients (35%) had a small neck remnant, and there was 1 failure (5%) converted to microsurgical clipping. Two patients had a failed attempted surgical clip reconstruction and were subsequently coiled. There was 1 intraprocedural rupture (5%) and 1 severe parent artery vasospasm (5%) during coiling. At discharge, 60% of patients were living independently. At follow-up three patients were deceased. Mean angiographic follow-up was 139days (SD 120). There were no aneurysm recurrences among occluded patients and there were no retreatments among those with neck remnants. Coiling of ruptured aneurysms ⩽3mm is feasible with high occlusion rates and low complication rates. The availability of softer coils with flexible detachment zones has led to safe and effective endovascular treatment of tiny ruptured aneurysms.
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Affiliation(s)
| | - John A Braca
- Indiana University School of Medicine, Indianapolis, IN, United States; Department of Neurosurgery, Indiana University School of Medicine, IN, United States; Goodman Campbell Brain and Spine, Indianapolis, IN, United States.
| | | | - Andrew DeNardo
- Department of Neurosurgery, Indiana University School of Medicine, IN, United States; Goodman Campbell Brain and Spine, Indianapolis, IN, United States.
| | - John Scott
- Department of Neurosurgery, Indiana University School of Medicine, IN, United States; Goodman Campbell Brain and Spine, Indianapolis, IN, United States.
| | - Aaron Cohen-Gadol
- Indiana University School of Medicine, Indianapolis, IN, United States; Department of Neurosurgery, Indiana University School of Medicine, IN, United States; Goodman Campbell Brain and Spine, Indianapolis, IN, United States.
| | - Daniel H Sahlein
- Indiana University School of Medicine, Indianapolis, IN, United States; Department of Neurosurgery, Indiana University School of Medicine, IN, United States; Goodman Campbell Brain and Spine, Indianapolis, IN, United States.
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Li J, Su L, Ma J, Kang P, Ma L, Ma L. Endovascular Coiling Versus Microsurgical Clipping for Patients With Ruptured Very Small Intracranial Aneurysms: Management Strategies and Clinical Outcomes of 162 Cases. World Neurosurg 2017; 99:763-769. [DOI: 10.1016/j.wneu.2015.11.079] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/25/2015] [Accepted: 11/26/2015] [Indexed: 11/26/2022]
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Asif KS, Sattar A, Lazzaro MA, Fitzsimmons BF, Lynch JR, Zaidat OO. Consecutive Endovascular Treatment of 20 Ruptured Very Small (<3 mm) Anterior Communicating Artery Aneurysms. INTERVENTIONAL NEUROLOGY 2016; 5:57-64. [PMID: 27610122 DOI: 10.1159/000444662] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Small aneurysms located at the anterior communicating artery carry significant procedural challenges due to a complex anatomy. Recent advances in endovascular technologies have expanded the use of coil embolization for small aneurysm treatment. However, limited reports describe their safety and efficacy profiles in very small anterior communicating artery aneurysms. OBJECTIVE We sought to review and report the immediate and long-term clinical as well as radiographic outcomes of consecutive patients with ruptured very small anterior communicating artery aneurysms treated with current endovascular coil embolization techniques. METHODS A prospectively maintained single-institution neuroendovascular database was accessed to identify consecutive cases of very small (<3 mm) ruptured anterior communicating artery aneurysms treated endovascularly between 2006 and 2013. RESULTS A total of 20 patients with ruptured very small (<3 mm) anterior communicating artery aneurysms were consecutively treated with coil embolization. The average maximum diameter was 2.66 ± 0.41 mm. Complete aneurysm occlusion was achieved for 17 (85%) aneurysms and near-complete aneurysm occlusion for 3 (15%) aneurysms. Intraoperative perforation was seen in 2 (10%) patients without any clinical worsening or need for an external ventricular drain. A thromboembolic event occurred in 1 (5 %) patient without clinical worsening or radiologic infarct. Median clinical follow-up was 12 (±14.1) months and median imaging follow-up was 12 (±18.4) months. CONCLUSION This report describes the largest series of consecutive endovascular treatments of ruptured very small anterior communicating artery aneurysms. These findings suggest that coil embolization of very small aneurysms in this location can be performed with acceptable rates of complications and recanalization.
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Affiliation(s)
- Kaiz S Asif
- Departments of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA
| | - Ahsan Sattar
- Departments of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA
| | - Marc A Lazzaro
- Departments of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA; Departments of Neurosurgery, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA
| | - Brian-Fred Fitzsimmons
- Departments of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA; Departments of Neurosurgery, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA; Departments of Radiology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA
| | - John R Lynch
- Departments of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA; Departments of Neurosurgery, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA; Departments of Radiology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA
| | - Osama O Zaidat
- Departments of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wis., USA; Neuroscience and Stroke Center, Mercy Health St Vz Medical Center, Toledo, Ohio, USA
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Heo YJ, Yang KH, Jung SC, Park JC, Lee DH. "Two-coil technique" for embolization of small internal carotid artery aneurysms incorporating the origin of the anterior choroidal artery. Interv Neuroradiol 2016; 22:396-401. [PMID: 26888963 DOI: 10.1177/1591019916632368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/21/2016] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this article is to evaluate the efficacy, safety and stability of the "two-coil technique." MATERIALS AND METHODS We evaluated a single-center experience by using a two-coil technique, which is a variation of the multiple-microcatheter technique in the treatment of a small internal carotid artery aneurysm with its sac incorporated with the origin of the anterior choroidal artery. Six consecutive patients with small ICA aneurysms with its sac incorporated with origin of the anterior choroidal artery and treated with the two-coil technique were included in this study. We finished the embolization with only two coils introduced via two different microcatheters without any other device assistance in all cases. Embolization status was determined at immediate postoperative and follow-up angiography after six months. RESULTS The two-coil technique was technically successful in five of six cases; one case was converted to surgical clipping because of persistent occlusion of the anterior choroidal artery after several attempts. On follow-up study, all five cases showed stable occlusion status without recanalization or residual aneurysm. CONCLUSIONS The two-coil technique has potential to be used for coiling small aneurysms, particularly where there is an important branch incorporated into the sac or neck of the aneurysm.
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Affiliation(s)
- Young Jin Heo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Korea Department of Radiology, Busan Paik Hospital, Inje University, Korea
| | - Ku Hyun Yang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Sung Chul Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Deok Hee Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Korea
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Yamaki VN, Brinjikji W, Murad MH, Lanzino G. Endovascular Treatment of Very Small Intracranial Aneurysms: Meta-Analysis. AJNR Am J Neuroradiol 2015; 37:862-7. [PMID: 26721770 DOI: 10.3174/ajnr.a4651] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/10/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Outcomes of endovascular treatment of very small intracranial aneurysms are still not well-characterized. Recently, several series assessing coil embolization of tiny aneurysms have presented new promising results. Thus, we performed a systematic review and meta-analysis of studies evaluating endovascular treatment of very small intracranial aneurysms. MATERIALS AND METHODS We conducted a computerized search of Scopus, Medline, and the Web of Science for studies on endovascular treatment of very small (≤3 mm in diameter) intracranial aneurysms published between January 1996 and May 2015. Using a random-effects model, we evaluated clinical and angiographic outcomes. RESULTS Twenty-two studies with 1105 tiny aneurysms (844 ruptured and 261 unruptured) endovascularly treated were included. Postoperative and long-term complete occlusion was achieved in 85% (95% CI, 78%-90%) and 91% (95% CI, 87%-94%) of aneurysms, respectively. The recanalization rate was 6% (95% CI, 4%-11%) and retreatment occurred in 7% (95% CI, 5%-9%) of cases. Seventy-nine percent (95% CI, 64%-89%) of patients had good neurologic outcome at long-term follow-up. Intraprocedural rupture occurred in 7% (95% CI, 5%-9%) of the coiling procedures, while thromboembolic complications occurred in 4% (95% CI, 3%-6%). CONCLUSIONS Coil embolization of very small intracranial aneurysms can be performed safely and effectively. In the case of unruptured aneurysms, procedure-related complications are not negligible. Patients and providers should consider such risks when engaged in a shared decision-making process.
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Affiliation(s)
- V N Yamaki
- From the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Foundation (V.N.Y.), Ministry of Education of Brazil, Brasilia, Brazil
| | | | - M H Murad
- Center for Science of Healthcare Delivery (M.H.M.)
| | - G Lanzino
- Department of Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota
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Kiran NAS, Jahromi BR, Velasquez JC, Hijazy F, Goehre F, Kivisaari R, Siangprasertkij C, Munoz Gallegos LF, Lehto H, Hernesniemi J. Double-clip technique for the microneurosurgical management of very small (< 3 mm) intracranial aneurysms. Neurosurgery 2014; 11 Suppl 2:3-7. [PMID: 25251196 DOI: 10.1227/neu.0000000000000557] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The treatment of very small (≤ 3 mm) aneurysms is technically challenging. Mini-clips used for clipping these small aneurysms have a smaller closing force compared with standard clips. OBJECTIVE To describe the double-clip technique for very small aneurysms. METHODS The double-clip technique, a parallel duplication clipping technique of booster clipping, is used by the senior author for clipping very small aneurysms with morphology suitable for the application of 2 clips. The aneurysm is clipped after application of temporary clip(s), administration of adenosine, or both. An initial mini-clip is applied, leaving a small residual neck sufficient for application of the second mini-clip. A second mini-clip of the same size and shape is applied on the residual neck parallel to the initial clip. The initially applied mini-clip, which is in close contact with the second clip, supports the second clip and prevents its slippage. This technique was retrospectively reviewed over a 13-year period (1997-2009). There were 3246 patients with 4757 aneurysms treated in the same period. RESULTS The outcomes of 39 patients with 40 very small aneurysms clipped with the double-clip technique were analyzed. None of the patients had technique-related complications. Postoperative angiograms revealed complete aneurysm occlusion of 39 aneurysms and a small residual neck in 1 aneurysm. No parent artery obstruction was observed in the postoperative angiogram. CONCLUSION The double-clip technique is a safe and effective variation of booster clipping in the treatment of very small aneurysms with suitable morphology.
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Abstract
With recent advancement in medical imaging, techniques, and endovascular tools more patients are diagnosed with unruptured intracranial aneurysms. The main aim of offering aneurysm treatment is to ameliorate the risk of future aneurysm bleeding, while not posing additional risks on the patient from the treatment itself. We discuss in this paper our approach of selecting patients for treatment (simple coiling, balloon-assisted, stent-assisted, vessel sacrifice, or flow-divertion stents). Our decision-making is based on the published data and our center experience. Risks of all option are compared to each other and weighed against natural history of intracranial aneurysms. In this paper, literature is cited and case illustrations are presented to support this approach. Factors that affect our decision-making are aneurysm location, presentation, size, aneurysm geometry, parent vessel anatomy, and relevant co-morbidities.
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13
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Zhao R, Shen J, Huang QH, Nie JH, Xu Y, Hong B, Yang PF, Zhao WY, Liu JM. Endovascular treatment of ruptured tiny, wide-necked posterior communicating artery aneurysms using a modified stent-assisted coiling technique. J Clin Neurosci 2013; 20:1377-81. [PMID: 23890412 DOI: 10.1016/j.jocn.2012.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 11/25/2012] [Accepted: 12/01/2012] [Indexed: 11/19/2022]
Abstract
The endovascular treatment of patients with tiny, wide-necked aneurysms is technically challenging, due to the small volume for microcatheterization and coil stabilization inside the aneurysm sac. We performed a retrospective study to evaluate the feasibility, effectiveness, and safety of stent-assisted embolization for patients with ruptured, tiny, wide-necked posterior communicating artery (PcomA) aneurysms. Between January 2007 and August 2011, 17 tiny, wide-necked PcomA aneurysms that had ruptured were treated at our institution using a modified stent-assisted technique, with delivery of the first coil inside the aneurysm followed by placement of a self-expanding stent via a second microcatheter. All patients were treated successfully using this modified stent-assisted coiling technique. Initial results showed aneurysm occlusion of Raymond Class 1 in 10 patients, Class 2 in four patients, and Class 3 in three patients. The angiographic follow-up results for 13 patients (mean, 12.5 months) showed that all aneurysms remained stable or improved, without any in-stent stenosis or recurrence. Of the other four patients, three refused angiography for economic or personal reasons, and one was lost in follow-up. Clinical follow-up of 16 patients for a mean of 23.8 months showed no death or rebleeding. These results imply that endovascular treatment of ruptured tiny, wide-necked PcomA aneurysms using our modified stent-assisted coiling technique is safe and feasible. This technique improves the long-term outcomes of these aneurysms by increasing the packing density and diverting the intra-aneurysmal blood flow.
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Affiliation(s)
- Rui Zhao
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
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Lee JI, Ko JK, Lee TH, Choi CH, Lee SW, Cho WH. Sole stenting technique for the treatment of uncoilable very small aneurysms in the intracranial internal carotid artery. Neurol Med Chir (Tokyo) 2013; 53:310-7. [PMID: 23708222 DOI: 10.2176/nmc.53.310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The treatment of very small aneurysms with diameter of less than 3 mm remains a challenge for both endovascular and surgical treatment. Endovascular treatment of these lesions may be difficult and is associated with a high risk of complications because of their small size. The present study evaluated the safety, feasibility, and efficacy of the endovascular treatment using sole stenting technique for uncoilable very small aneurysms of the intracranial internal carotid artery (ICA). From August 2004 through January 2010, eight very small aneurysms of intracranial ICA in eight patients were treated with endovascular sole stenting technique. All very small aneurysms were ruptured (n = 3) or aneurysms associated with another ruptured (n = 2) and unruptured aneurysms (n = 3) in the same artery. Stents were Neuroform and balloon expandable coronary stents. Stent deployment was carried out without difficulty in all patients. Single stent deployment was done for six aneurysms, and double stents in two aneurysms. The immediate angiographic results were partial occlusion in one case and no occlusion in seven cases. One direct carotid-cavernous fistula occurred during coronary stenting without permanent neurological deficit. No neurological deterioration or hemorrhagic complication was seen during the follow-up period in seven patients. Follow-up angiography (mean 9 months) was available in six patients and revealed complete occlusion in four and no occlusion in two cases. Sole stenting technique may be a feasible and effective therapeutic alternative for uncoilable very small aneurysms. The long-term efficacy and durability of stenting for these lesions remains to be determined in a large series.
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Affiliation(s)
- Jae Il Lee
- Department of Neurosurgery, Pusan National University Hospital, Medical Research Institute, Busan, Republic of Korea
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15
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Kan P, Yashar P, Ionita CN, Jain A, Rudin S, Levy EI, Siddiqui AH. Endovascular coil embolization of a very small ruptured aneurysm using a novel microangiographic technique: technical note. J Neurointerv Surg 2013; 5:e2. [PMID: 22266790 PMCID: PMC3477289 DOI: 10.1136/neurintsurg-2011-010154] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Endovascular treatment of very small aneurysms is technically difficult, although recent advances with coils, microcatheters and adjunctive techniques such as balloon- or stent-assisted coiling have improved the outcomes. The microangiographic fluoroscope (MAF) is a new high-resolution x-ray detector developed for neurointerventional procedures in which superior resolution is required within a small field of view. We report the successful coil embolization of a very small ruptured anterior communicating artery aneurysm using the MAF technique. The use of the MAF facilitated the precision of the coiling procedure and was helpful in preventing catheter- and coil-related intraprocedural complications.
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Affiliation(s)
- Peter Kan
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA
- Department of Neurosurgery, Millard Fillmore Gates Circle Hospital, Kaleida Health, Buffalo, New York, USA
| | - Parham Yashar
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA
- Department of Neurosurgery, Millard Fillmore Gates Circle Hospital, Kaleida Health, Buffalo, New York, USA
| | - Ciprian N Ionita
- Department of Neurosurgery, Millard Fillmore Gates Circle Hospital, Kaleida Health, Buffalo, New York, USA
- Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York, USA
- Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Amit Jain
- Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York, USA
- Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Stephen Rudin
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA
- Department of Neurosurgery, Millard Fillmore Gates Circle Hospital, Kaleida Health, Buffalo, New York, USA
- Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York, USA
- Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
- Departments of Physiology and Biophysics, University at Buffalo, State University of New York, Buffalo, New York, USA
- Mechanical and Aerospace Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA
- Department of Neurosurgery, Millard Fillmore Gates Circle Hospital, Kaleida Health, Buffalo, New York, USA
- Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York, USA
- Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA
- Department of Neurosurgery, Millard Fillmore Gates Circle Hospital, Kaleida Health, Buffalo, New York, USA
- Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York, USA
- Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
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Meilán Martínez A, Murias Quintana E, Gil García A, Vega Valdés P, Saiz Ayala A. Assisted techniques for the endovascular treatment of complex or atypical cerebral aneurysms. RADIOLOGIA 2013. [DOI: 10.1016/j.rxeng.2011.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Mansour O, Megahed M, Schumacher M, Weber J, Khalil M. Coiling of ruptured tiny cerebral aneurysms, feasibility, safety, and durability at midterm follow-up, and individual experience. Clin Neuroradiol 2012. [PMID: 23197366 DOI: 10.1007/s00062-012-0182-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The tiny size of cerebral aneurysms represents one of the challenging facets for endovascular treatment, with a high risk for intraoperative rupture (IOR). We report on the treatment of tiny ruptured saccular cerebral aneurysms by coil embolization. All cases were that of £ 2-3 mm aneurysms with at least one of the dimensions < 2 mm. MATERIALS AND METHODS Between April 2008 and December 2010, we performed a retrospective analysis of nine consecutive cases of tiny aneurysms treated by coil embolization in our institution. RESULTS Coil embolization was successfully performed in nine cases, whereas in one case, intraoperative rupture (IOR) of the fundus was encountered before complete obliteration of the aneurysm expected to be achieved with two coils. Complete occlusion (in n = 7 aneurysms) or near-complete immediate occlusion (in n = 2 aneurysms) was achieved. A total of 18 coils was used for coiling of the nine aneurysms, wherein five aneurysms were coiled with two coils each, two aneurysms with three coils each, and two aneurysms with only one coil each to achieve accepted results. Balloon assistance was used in three cases. Although a minimal coil projection in the parent vessel was seen in three cases, no untoward clinical complications were seen. At mean follow-up (6.7 months, interquartile range (IQR) 3-12 months), digital subtraction angiography (DSA) and magnetic resonance angiography (MRA) in nine patients demonstrated persistent complete occlusion in six of the aneurysms; one aneurysm showed marked filling of the fundus, and two showed neck remnant but did not need retreatment. All patients with available follow-up were independent in day-to-day activities with a modified Rankin score (mRS) of 0 or 1. CONCLUSIONS Coil embolization of tiny ruptured cerebral aneurysms is feasible. Careful consideration of the technical issues in treatment of such aneurysms is essential to achieve technical success while avoiding complications.
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Affiliation(s)
- O Mansour
- Neurology Department, Alexandria University, Alexandria, Egypt.
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18
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Meilán Martínez A, Murias Quintana E, Gil García A, Vega Valdés P, Saiz Ayala A. [Assisted techniques for the endovascular treatment of complex or atypical cerebral aneurysms]. RADIOLOGIA 2012; 55:118-29. [PMID: 22727618 DOI: 10.1016/j.rx.2011.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/03/2011] [Accepted: 11/07/2011] [Indexed: 11/24/2022]
Abstract
In the last ten years, the endovascular approach to the management of cerebral aneurysms has gone from being an alternative to surgery to being the first-choice technique in the vast majority of cases. The continuous development of new assisted techniques and of new materials for embolization have multiplied its therapeutic possibilities, so that safe and efficacious endovascular treatment is now possible for aneurysms that would have required surgery only a few years ago. These continuous technological advances require the professionals that treat patients with cerebral aneurysms to achieve a high degree of specialization and to keep up to date through continuous training. In this article, we review some of the most widely used assisted techniques in the endovascular treatment of cerebral aneurysms, discussing their main indications, their advantages over conventional embolization techniques, and their possible limitations.
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Affiliation(s)
- A Meilán Martínez
- Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
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19
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Wong GKC, Ng RYT, Poon WS. Endovascular treatment of very small (≤ 3 mm) intracranial aneurysms: An updated systemic review. SURGICAL PRACTICE 2012. [DOI: 10.1111/j.1744-1633.2012.00590.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Signorelli F, Scholtes F, Bojanowski MW. [Very small intracranial aneurysms: Clip or coil]. Neurochirurgie 2012; 58:156-9. [PMID: 22481028 DOI: 10.1016/j.neuchi.2012.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION It is not unusual for very small aneurysms (≤3mm) to be responsible for subarachnoid haemorrhage. In addition, modern imaging has increased diagnosis of those that are asymptomatic. Because of their spatial configuration and thin and fragile walls, very small aneurysms can be a sizeable challenge for both open surgical and endovascular treatment. Based on recent literature data, the present manuscript reviews treatment indications and the choice of treatment strategy to occlude these particular aneurysms. METHODS Literature review concerning surgical and endovascular treatment of very small aneurysms (≤3mm). Arterial dissections and blister aneurysms were excluded. RESULTS We found no study that systematically and specifically assessed surgical treatment of very small aneurysms. Investigations of endovascular treatment are almost exclusively retrospective, usually evaluating a small number of patients, and are limited by selection bias. Despite often contradictory results, it appears that very small aneurysms carry a higher risk of rupture during endovascular procedures and higher ensuing mortality, as compared to larger aneurysms. The use of more flexible coils and additional endovascular tools appears to reduce this risk. There is no study comparing surgical to endovascular treatment. CONCLUSION Very small aneurysms carry higher treatment risks than larger aneurysms. A prospective randomised trial is justified for those very small aneurysms for which treatment is indicated.
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Affiliation(s)
- F Signorelli
- Division of Neurosurgery, Department of Surgery, hôpital Notre-Dame, centre hospitalier de l'université de Montréal, 1560, Sherbrooke St. East, Montreal, Quebec, Canada H2L 4M1
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21
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Lee YS, Chang HS, Park CS. Intracranial incidental lesions on neck CT scans in thyroid cancer patients. ANZ J Surg 2011; 81:406-8. [PMID: 22022884 DOI: 10.1111/j.1445-2197.2011.05773.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yong Sang Lee
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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22
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Iskandar A, Nepper-Rasmussen J. Endovascular treatment of very small intracranial aneurysms. Interv Neuroradiol 2011; 17:299-305. [PMID: 22005691 DOI: 10.1177/159101991101700304] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 06/25/2011] [Indexed: 11/15/2022] Open
Abstract
The endovascular treatment of intracranial aneurysms 3 mm or less is considered controversial. The purpose of this study is to report angiographic and clinical results following coiling of such aneurysms and compare them to those of larger aneurysms (> 3 mm).Between November 1999 and November 2009 endovascular treatment was attempted in 956 consecutive intracranial aneurysms. Of 956 aneurysms, 111 aneurysms were very small aneurysms with a maximal diameter of 3 mm or less. We conducted a retrospective analysis of angiographic and clinical outcome following coiling of very small aneurysms and subsequently comparing it to the results of larger aneurysms.Coiling initially failed in eight aneurysms. In the remaining 103 aneurysms endovascular treatment was accomplished and immediate angiographic results showed complete aneurysm occlusion in 43 aneurysms, nearly complete aneurysm occlusion in 54 aneurysms and less than 90% aneurysm occlusion in six aneurysms. Complications occurred in the treatment of 15 aneurysms, including eight procedural ruptures, six thromboembolic events and one case of early hemorrhage. Compared with larger aneurysms, treatment of very small aneurysms was associated with a higher rate of procedural ruptures (7.2% versus 4.4%) and procedural mortality (4.7% versus 2.7%) but a lower procedural morbidity (1.9% versus 4.0%). However none of these differences reached statistical significance (p = 0.186, p= 0.388, respectively). The retreatment rate was higher for the larger aneurysms (8.2% and 6.3%), but this was not significant either (p= 0. 496). At nine-month follow-up significantly more small aneurysms were found to have a stable occlusion grade compared to large aneurysms.Endovascular treatment of very small aneurysms is feasible with a lower retreatment rate compared to large aneurysms (> 3 mm). However the data also suggest that endovascular treatment of very small aneurysms might be associated with an increased risk of procedural ruptures and mortality. At nine-month follow-up results indicate significantly less compaction in the very small aneurysms.
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Affiliation(s)
- A Iskandar
- Department of Radiology, Odense University Hospital; Odense C, Denmark.
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23
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Hong B, Yang PF, Zhao R, Huang QH, Xu Y, Yang ZG, Liu J. Endovascular treatment of ruptured tiny intracranial aneurysms. J Clin Neurosci 2011; 18:655-60. [PMID: 21414787 DOI: 10.1016/j.jocn.2010.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 09/13/2010] [Accepted: 09/22/2010] [Indexed: 11/17/2022]
Abstract
Endovascular treatment of ruptured tiny intracranial aneurysms (RTIA) is technically challenging. We retrospectively collected and analyzed the clinical data of 51 patients with RTIA who underwent attempted endovascular treatment at our institution between November 2000 and April 2009. Forty-nine patients were successfully treated by coiling alone (29 patients), stent-assisted coiling (11 patients) or stent placement alone (nine patients). Procedural complications occurred in five patients. One patient died from a severe initial hemorrhage and poor clinical condition. At the time of discharge, 44 patients (89.8%) had recovered in good condition (Glasgow Outcome Scale [GOS] score 5), two were moderately disabled (GOS score 4) and two were severely disabled (GOS score 3). Angiographic follow-up (mean follow-up time=14 months) was available for 33 patients, and two were re-treated. None of the 46 patients who were clinically followed up (mean=54.2 months) experienced re-bleeding. Our results suggest that RTIA is not uncommon and can be safely treated endovascularly.
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Affiliation(s)
- Bo Hong
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China
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24
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Schuette AJ, Hui FK, Spiotta AM, Obuchowski NA, Gupta R, Moskowitz SI, Tong FC, Dion JE, Cawley CM. Endovascular Therapy of Very Small Aneurysms of the Anterior Communicating Artery: Five-fold Increased Incidence of Rupture. Neurosurgery 2011; 68:731-7; discussion 737. [PMID: 21164380 DOI: 10.1227/neu.0b013e3182077373] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
BACKGROUND:
Intraprocedural rupture is a dangerous complication of endovascular treatment. Small ruptured anterior communicating artery (ACoA) aneurysms and microaneurysms present a challenge for both surgical and endovascular therapies to achieve obliteration. An understanding of the complication rates of treating ruptured ACoA microaneurysms may help guide therapeutic options.
OBJECTIVE:
To report the largest cohort of ACoA microaneurysms treated with endovascular therapy over the course of the past 10 years.
METHODS:
We performed a retrospective review of 347 ACoA aneurysms treated in 347 patients at Cleveland Clinic and Emory University over a 10-year period. Patient demographics, aneurysmal rupture, size, use of balloon remodeling, patient outcomes, intraprocedural rupture, and rerupture were reviewed.
RESULTS:
Rupture rates were examined by size for all patients and subgroups and dichotomized to evaluate for size ranges associated with increased rupture rates. The highest risk of rupture was noted in aneurysms less than 4 mm. Of 347 aneurysms, 74 (21%) were less than 4 mm. The intraprocedural rupture rate was 5% (18/347) for ACoA aneurysms of any size. There was an intraprocedural rupture rate of 2.9% (8/273) among ACoA aneurysms greater than 4 mm compared with 13.5% (10/74) in less than 4-mm aneurysms. Procedural rupture was a statistically significant predictor of modified Rankin score after adjusting for Hunt and Hess grades (HH).
CONCLUSION:
ACoA aneurysms less than 4 mm have a 5-fold higher incidence of intraprocedural rerupture during coil embolization. Outcome is negatively affected by intraprocedural rerupture after adjusting for HH grade.
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Affiliation(s)
| | - Ferdinand K Hui
- Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Rishi Gupta
- Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Shaye I Moskowitz
- Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Frank C Tong
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Jacques E Dion
- Department of Neurosurgery, Emory University, Atlanta, Georgia
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25
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Endovascular coil embolization of very small intracranial aneurysms. Neuroradiology 2010; 53:349-57. [DOI: 10.1007/s00234-010-0735-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 06/14/2010] [Indexed: 10/19/2022]
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26
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Gil A, Vega P, Murias E, Cuellar H. Balloon-assisted extrasaccular coil embolization technique for the treatment of very small cerebral aneurysms. J Neurosurg 2010; 112:585-8. [PMID: 19499982 DOI: 10.3171/2009.4.jns081291] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Treatment of very small ruptured cerebral aneurysms (< 2 mm) continues to present a challenge. These lesions are difficult to treat both with neurosurgical and endovascular techniques. A neurosurgical approach is still the treatment of choice for these lesions at many centers because of high rupture rates related to endovascular treatment; however, there are clinical circumstances in which the neurosurgical option cannot be offered. In their review of the literature, the authors did not find any series reporting endovascular treatment of these very small aneurysms. In the present study, the authors report their experience with the endovascular treatment of a series of 4 ruptured aneurysms smaller than 2 mm from neck to dome. They describe their technique of using a remodelling balloon to stabilize the tip of the microcatheter in the neck of the aneurysm without entering it at any time, and of inserting the coil from outside the sac to minimize the risk of intraoperative rupture, which is very high when conventional endovascular embolization is performed.
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Affiliation(s)
- Alberto Gil
- Department of Neuroradiology, Hospital Universitario Central de Asturias, Oviedo, Spain.
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27
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Kim YJ. Sole stenting technique for treatment of complex aneurysms. J Korean Neurosurg Soc 2009; 46:545-51. [PMID: 20062570 DOI: 10.3340/jkns.2009.46.6.545] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 10/11/2009] [Accepted: 11/09/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Complex aneurysms such as fusiform and very small aneurysms (< 3 mm) are challenging in neurovascular and endovascular surgery. Author reports follow-up results of 9 cases treated by sole stent technique with pertinent literature review. METHODS A retrospective study was made of 9 patients who were treated by sole stenting technique for cerebral aneurysm between January 2003 and January 2009. Two of them had fusiform aneurysm, 5 had very small aneurysm, and 2 had small saccular aneurysm. Five patients had ruptured aneurysms and four had unruptured aneurysms. Seven aneurysms were located in the internal carotid artery (ICA), 1 in the middle cerebral artery (MCA) and 1 in the basilar artery. Follow-up cerebral angiography was performed at post-procedure 3 months, 6 months, and 12 months. Mean follow-up period is 30 months (ranged from 3 days to 30 months). RESULTS Aneurysm size was decreased in 6 of 9 cases on follow-up images and was not changed in 3 cases. Although total occlusion was not seen, patients had stable neurological condition and angiographic result. The procedural complication occurred in 2 cases. One was coil migration and the other was suboptimal deployment of stent, and both were asymptomatic. Re-bleeding and thromboembolic complication had not been occurred. CONCLUSION Sole stenting technique is relatively effective and safe as an alternative treatment for fusiform and very small aneurysms.
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Affiliation(s)
- Young-Joon Kim
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
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28
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The effectiveness and feasibility of endovascular coil embolization for very small cerebral aneurysms: mid- and long-term follow-up. Ann Vasc Surg 2009; 24:400-7. [PMID: 20036498 DOI: 10.1016/j.avsg.2009.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Revised: 09/05/2009] [Accepted: 10/12/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND Endovascular embolization for very small cerebral aneurysms (VSCAs) is still controversial. We report our experience with endovascular coil embolization for these lesions and assess the feasibility and effectiveness. METHODS We conducted a review of our experience with endovascular treatment of a series of 19 patients with 20 VSCAs, located at the supraclinoid segment of the internal cranial artery (ICA) in seven, the cavernous ICA segment in three, the anterior communicating artery in five, vertebral artery-posterior inferior cerebellar artery in two, bifurcation of the middle cerebral artery in one, the pericallosal artery in one, and the P2 segment in one. The World Federation of Neurosurgical Societies classification before treatment was grade I in 14 patients and grade II in five patients. The strategy of endovascular treatment included coil occlusion, balloon-assisted coiling, and stent-assisted coiling. Occlusion rate was divided into (1) total/near total, occlusion rate 95-100%; (2) subtotal, occlusion rate 80-95%; and (3) partial, occlusion rate<80%. Clinical outcome of patients with ruptured aneurysm was ascertained according to the Glasgow Outcomes Scale. RESULTS All patients were successfully treated with coil embolization; immediate angiography determined occlusion of the aneurysm, including total occlusion in five, subtotal occlusion in nine, and partial occlusion in six. During 1-2 years of follow-up, all aneurysms were confirmed as complete occlusion by control angiography. No recurrence or coil compaction occurred. No rehemorrhage or ischemic stroke occurred. CONCLUSION Endovascular coil embolization for VSCAs is effective and feasible. Initial subtotal or partial aneurysm occlusion might progress to total occlusion.
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29
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Brinjikji W, Lanzino G, Cloft HJ, Rabinstein A, Kallmes DF. Endovascular treatment of very small (3 mm or smaller) intracranial aneurysms: report of a consecutive series and a meta-analysis. Stroke 2009; 41:116-21. [PMID: 19926837 DOI: 10.1161/strokeaha.109.566356] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We performed a meta-analysis of published studies on the endovascular treatment of very small intracranial aneurysms, including 71 patients treated at our institution. METHODS We conducted a computerized MEDLINE search of the literature for reports on the treatment of intracranial aneurysms with a maximum dimension of </=3 mm by using the search terms "small," "tiny," "intracranial aneurysm," "endovascular," and "coil." A total of 7 studies, including our institution's consecutive case series of 71 intracranial aneurysms, were included in this study. We extracted information regarding intraoperative complications, procedural mortality and morbidity, immediate- and long-term angiographic outcomes, and retreatment rate. The meta-analysis was performed with the statistical package Comprehensive Meta-Analysis. RESULTS Approximately 61% of the aneurysms in this meta-analysis presented as ruptured, whereas 39% of the aneurysms were unruptured. Procedural rupture rates for very small aneurysms was 8.3% (95% CI, 6.0% to 11.4%). The mortality rate due to procedural rupture was 2.4% (95% CI, 1.2% to 4.7%). The morbidity rate due to thromboembolic complications was 1.9% (95% CI, 0.9% to 3.9%). Subarachnoid hemorrhage within 1 month of treatment occurred in 1.6% (95% CI, 0.6% to 3.7%) of cases. There was no statistically significant difference between unruptured and ruptured aneurysms for any of these outcomes. CONCLUSIONS Our meta-analysis suggests that treatment of very small aneurysms is feasible and effective in >90% of treated aneurysms. However, the risk of periprocedural rupture is higher than that reported for larger aneurysms. Similarly, the combined rate of periprocedural mortality and morbidity is not negligible (7.3%) and should be considered when considering the best therapeutic option for these aneurysms.
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Affiliation(s)
- Waleed Brinjikji
- Mayo Medical School, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
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30
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Sarikaya B. Rupture of very small aneurysms. Stroke 2009; 40:e410; author reply e411. [PMID: 19342605 DOI: 10.1161/strokeaha.109.547604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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31
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Fang C, Li MH, Zhang PL, Wang W, Tan HQ, Xu HW, Zhou B. Endovascular Treatment for Very Small Supraclinoid Aneurysms with Stent-Assisted Coiling. Long-Term Follow-up in Six Cases. Interv Neuroradiol 2009; 15:37-44. [PMID: 20465927 PMCID: PMC3306147 DOI: 10.1177/159101990901500106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 10/05/2008] [Indexed: 11/15/2022] Open
Abstract
SUMMARY The endovascular treatment of very small aneurysms (lesions less than 3 mm in maximum diameter) with wide necks remains a challenge for saccular embolization. We retrospectively analyzed our data using Neuroform stent-assisted coiling for very small supraclinoid aneurysms with wide neck to evaluate the feasibility and efficacy of endovascular treatment of these lesions. We conducted a review of our experience and results of endovascular treatments in six patients with seven very small aneurysms. All aneurysms were located at the side wall of the supraclinoid segment of the ICA. They were ruptured in two patients and unruptured in four. The technique of stent-assisted coiling was used in all cases with coiling before stenting and additional coils after deployment of the stent in the same session. All patients were successfully embolized with stent-assisted coiling. The coils were introduced into the lumen for subtotal occlusion in five aneurysms and for partial occlusion in two. During one to two years follow-up angiography, all aneurysms were completely occluded and no recurrence occurred. No complications were observed. Endovascular stent-assisted coil embolization of supraclinoid very small aneurysms with wide necks is effective and feasible. Subtotal aneurysm occlusion might progress to total occlusion.
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Affiliation(s)
- C Fang
- Shanghai 6th Peoples' Hospital; Shanghai, China -
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32
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Sarikaya B, Oksuz E, Deniz FE, Firat MM. Endovascular treatment of a ruptured aneurysm at a very rare location. Distal azygos anterior cerebral artery. Interv Neuroradiol 2008; 14:457-60. [PMID: 20557747 DOI: 10.1177/159101990801400413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2008] [Accepted: 09/07/2008] [Indexed: 11/15/2022] Open
Abstract
SUMMARY We describe a patient with a small ruptured azygos anterior cerebral artery aneurysm located at a non-bifurcation distal site on the artery treated successfully with simple coiling.
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Affiliation(s)
- B Sarikaya
- Gaziosmanpasa University Medical Faculty, Egitim Alayi Yani, Tokat, Turkey -
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