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Enomoto Y, Matsubara H, Ishihara T, Shoda K, Mizutani D, Egashira Y, Ishii A, Sakamoto M, Sumita K, Nakagawa I, Higashi T, Yoshimura S. Optimal duration of dual antiplatelet therapy for stent-assisted coiling or flow diverter placement. J Neurointerv Surg 2024; 16:491-497. [PMID: 37344176 PMCID: PMC11041548 DOI: 10.1136/jnis-2023-020285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/04/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Dual antiplatelet therapy (DAPT) is necessary to prevent thromboembolic complications after stent-assisted coiling (SAC) or flow-diversion (FD) for cerebral aneurysms, but the optimal antiplatelet regimen remains unclear. OBJECTIVE To determine the optimal DAPT duration in patients with SAC/FD. METHODS This multicenter cohort study enrolled patients who received SAC/FD for cerebral aneurysms at seven Japanese institutions between January 2010 and December 2020. The primary outcome was the time from procedure to the occurrence of a composite of target vessel-related thromboembolic events, procedure-unrelated major bleeding events, or death. The cumulative event-free survival rates were analyzed using a Kaplan-Meier curve, and the differences in each outcome between the groups dichotomized by the duration of DAPT were analyzed using the log-rank test. RESULTS Of 632 patients (median observational period, 646 days), primary outcome occurred in 63 patients (10.0%), most frequently within 30 days after the procedure. The cumulative event-free survival rates at 30 days, 1 year, and 2 years after the procedure were 93.3% (91.4 to 95.3%), 91.5% (89.3 to 93.7%), and 89.5% (87.0 to 92.0%), respectively. The cumulative event-free survival rates after switching to monotherapy were similar for the >91 and <90 days DAPT groups in the population limited to patients who were switched from DAPT to monotherapy without major clinical events. CONCLUSIONS Thromboembolic events rarely occurred beyond 30 days after SAC/FD. The duration of DAPT may be shortened if patients have a periprocedural period without events. Further prospective studies are warranted to determine the optimal duration of antiplatelet therapy. TRIAL REGISTRATION NUMBER UMIN000044122 :https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000050384.
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Affiliation(s)
- Yukiko Enomoto
- Neurosurgery, Gifu Univeristy Graduate School of Medicine, Gifu, Japan
| | | | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan
| | - Kenji Shoda
- Neurosurgery, Gifu Univeristy Graduate School of Medicine, Gifu, Japan
| | - Daisuke Mizutani
- Neurosurgery, Gifu Univeristy Graduate School of Medicine, Gifu, Japan
| | - Yusuke Egashira
- Neurosurgery, Gifu Univeristy Graduate School of Medicine, Gifu, Japan
| | - Akira Ishii
- Neurosurgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Makoto Sakamoto
- Division of Neurosurgery, Department of Neurological Sciences, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Kazutaka Sumita
- Endovascular surgery, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Ichiro Nakagawa
- Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Toshio Higashi
- Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Japan
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Cortez GM, Benalia VHC, Sauvageau E, Aghaebrahim A, Pederson JM, Hanel RA. Diffusion-weighted imaging lesions after intracranial aneurysm treatment with Pipeline Flex and Pipeline Flex with Shield technology: a retrospective cohort analysis. J Neurointerv Surg 2024; 16:385-391. [PMID: 37197932 DOI: 10.1136/jnis-2023-020250] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/03/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND The Pipeline Flex embolization device with Shield technology (PED Shield) is the first flow diverter for brain aneurysm treatment approved in the United States using surface-modified technology. The effect of PED Shield on decreasing perioperative diffusion-weighted imaging positive (DWI+) hits, as a marker for in-human decrease thrombogenicity, is unclear. OBJECTIVE To determine if the number of periprocedural DWI+ lesions differs between patients with an aneurysm treated with PED Flex and PED Shield. METHODS This retrospective study compares the outcomes of consecutive patients with an aneurysm treated with PED Flex and PED Shield. The primary outcome of interest was the occurrence of DWI+ lesions. We also assessed potential predictors of DWI+ lesions and compared the outcomes between on-label and off-label treatment indications. RESULTS 89 patients were included, 48 (54%) treated with PED Flex and 41 (46%) with PED Shield. After matching, the incidence of DWI+ lesions was 61% and 62% for the PED Flex and PED Shield groups, respectively. Results were consistent across each model with no significant differences in DWI+ lesions between treatment groups, and effect sizes ranging from OR=1.08 (95% CI 0.41 to 2.89) after propensity score matching to OR=1.84 (95% CI 0.65 to 5.47) after multivariable regression. Multivariable models demonstrated reduced DWI+ lesions with balloon-assisted therapies and posterior circulation treatment, while a significant linear relationship was encountered with fluoroscopy time. CONCLUSION There was no significant difference in the incidence of perioperative DWI+ lesions between patients with an aneurysm treated with PED Flex and PED Shield. Larger cohorts are likely needed to demonstrate differences between the devices.
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Affiliation(s)
- Gustavo M Cortez
- Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Victor H C Benalia
- Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Eric Sauvageau
- Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Amin Aghaebrahim
- Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - John Michael Pederson
- Superior Medical Experts, Inc, St. Paul, Minnesota, USA
- Nested Knowledge, Inc, St. Paul, Minnesota, USA
| | - Ricardo A Hanel
- Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
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Shin S, Hwangbo L, Lee TH, Ko JK. Silent Embolic Infarction after Neuroform Atlas Stent-Assisted Coiling of Unruptured Intracranial Aneurysms. J Korean Neurosurg Soc 2024; 67:42-49. [PMID: 37661088 PMCID: PMC10788554 DOI: 10.3340/jkns.2023.0091] [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: 05/09/2023] [Revised: 06/18/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE There is still controversy regarding whether neck remodeling stent affects the occurrence of silent embolic infarction (SEI) after aneurysm coiling. Thus, the aim of the present study is to investigate the incidence of SEI after stent-assisted coiling (SAC) using Neuroform Atlas Stent (NAS) and possible risk factors. This study also includes a comparison with simple coiling group during the same period to estimate the impact of NAS on the occurrence of SEI. METHODS This study included a total of 96 unruptured intracranial aneurysms in 96 patients treated with SAC using NAS. Correlations of demographic data, aneurysm characteristics, and angiographic parameters with properties of SEI were analyzed. The incidence and characteristics of SEI were investigated in 28 patients who underwent simple coiling during the same period, and the results were compared with the SAC group. RESULTS In the diffusion-weighted imaging obtained on the 1st day after SAC, a total of 106 SEI lesions were observed in 48 (50%) of 96 patients. Of these 48 patients, 38 (79.2%) had 1-3 lesions. Of 106 lesions, 74 (69.8%) had a diameter less than 3 mm. SEI occurred more frequently in older patients (≥60 years, p=0.013). The volume of SEI was found to be significantly increased in older age (≥60 years, p=0.032), hypertension (p=0.036), and aneurysm size ≥5 mm (p=0.047). The incidence and mean volume of SEI in the SAC group (n=96) were similar to those of the simple coiling group (n=28) during the same period. CONCLUSION SEIs are common after NAS-assisted coiling. Their incidence in SAC was comparable to that in simple coiling. They occurred more frequently at an older age. Therefore, the use of NAS in the treatment of unruptured intracranial aneurysm does not seem to be associated with an increased risk of thromboembolic events if antiplatelet premedication has been performed well.
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Affiliation(s)
- Seungho Shin
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea
| | - Lee Hwangbo
- Department of Diagnostic Radiology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea
| | - Tae-Hong Lee
- Department of Diagnostic Radiology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea
| | - Jun Kyeung Ko
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea
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Habtezghi AB, Ghozy S, Bilgin C, Kobeissi H, Kadirvel R, Kallmes DF. DWI-Detected Ischemic Lesions after Endovascular Treatment for Cerebral Aneurysms: An Updated Systematic Review and Meta-analysis. AJNR Am J Neuroradiol 2023; 44:1256-1261. [PMID: 37827721 PMCID: PMC10631525 DOI: 10.3174/ajnr.a8024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/08/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND PURPOSE DWI-detected ischemic lesions are potential complications of endovascular procedures that are performed to treat intracranial aneurysms. We completed a systematic review and meta-analysis to identify the occurrence of DWI-detected ischemic lesions after endovascular treatment for intracranial aneurysms. MATERIALS AND METHODS A systematic literature search of PubMed, the Web of Science, EMBASE, and Scopus between January 2000 and June 2022 of post-endovascular procedures for intracranial aneurysm studies was conducted using the Nested Knowledge AutoLit software. The main outcome was DWI-detected ischemic lesions within 5 days of the procedures. Information regarding associated risk factors such as the type of procedure, patient demographics, and aneurysm characteristics was also collected. RESULTS Twenty-nine studies with 2686 patients were included. The overall incidence of DWI ischemic lesions was 47.0% (95% CI, 39.6%-55.8%). The highest rate of lesions was seen with flow diversion at 62.4% (95% CI, 48.4%-80.5%), followed by complex procedures at 49.3% (95% CI, 29.5%-82.1%), stent-assisted coiling at 47.5% (95% CI, 34.6%-65.3%), simple coiling at 47.1% (95% CI, 35.7%-62.3%), and balloon-assisted coiling at 37.0% (95% CI, 28.3%-48.4%). The differences among different techniques were not statistically significant; however, there was significant heterogeneity and a significant risk of publication bias among included studies. CONCLUSIONS Many patients who undergo endovascular procedures for intracranial aneurysms present with new postprocedural DWI-detected ischemic lesions, regardless of the endovascular procedure used. Future studies and meta-analyses are needed to investigate early and long-term outcomes of such small infarcts.
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Affiliation(s)
- Abiel Berhe Habtezghi
- From the Department of Radiology (A.B.H., S.G., C.B., H.K., R.K., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - Sherief Ghozy
- From the Department of Radiology (A.B.H., S.G., C.B., H.K., R.K., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - Cem Bilgin
- From the Department of Radiology (A.B.H., S.G., C.B., H.K., R.K., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - Hassan Kobeissi
- From the Department of Radiology (A.B.H., S.G., C.B., H.K., R.K., D.F.K.), Mayo Clinic, Rochester, Minnesota
| | - Ramanathan Kadirvel
- From the Department of Radiology (A.B.H., S.G., C.B., H.K., R.K., D.F.K.), Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery (R.K.), Mayo Clinic, Rochester, Minnesota
| | - David F Kallmes
- From the Department of Radiology (A.B.H., S.G., C.B., H.K., R.K., D.F.K.), Mayo Clinic, Rochester, Minnesota
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Kanazawa R, Yoshihara T, Uchida T, Higashida T, Arai N, Ohbuchi H, Takahashi Y. Thromboembolic complications during and after embolization of unruptured aneurysms: A chronological outcome in periprocedural thromboembolic events. Surg Neurol Int 2023; 14:362. [PMID: 37941641 PMCID: PMC10629294 DOI: 10.25259/sni_625_2023] [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: 07/25/2023] [Accepted: 09/13/2023] [Indexed: 11/10/2023] Open
Abstract
Background Ischemic complications develop after elective coil embolization procedures at a certain rate. The prevention of these events has been a longstanding issue for many interventional neuroradiologists. This study aimed to clarify whether procedural ischemic events after unruptured aneurysm embolization decrease over time with perioperative anti-thromboembolic treatment or surgical experience. Methods This study included patients with cerebral aneurysms in our institution between July 2012 and June 2020. Dual-antiplatelet therapy (DAPT) was performed (Phase 1). Thromboembolic events developed at a certain rate; thus, rivaroxaban was administered with single-antiplatelet therapy (SAPT) to improve thromboembolic results (Phase 2), showing better outcomes than in Phase 1. Subsequently, DAPT was administered again (Phase 3). Ischemic complications were evaluated in each phase or compared between the DAPT group and the direct oral anticoagulant (DOAC) with the clopidogrel (DOAC+SAPT) group. Results Relatively, fewer symptomatic ischemic events were noted in Phase 2 or the DOAC+SAPT group, but the outcome was not better in Phase 3 than in Phase 2. Symptomatic complications were more common in Phase 3 than in Phases 1 and 2. Conclusion Ischemic complications occurred at a certain rate after endovascular procedures for unruptured aneurysms. The incidence did not decrease over time; particularly, standard DAPT plus postoperative anti-thromboembolic medication did not adequately decrease complications in Phase 3 compared to Phases 1 and 2. Therefore, accumulated experience or a learning curve could not explain the results. DOAC administration might decrease the risk of these events, but further accumulation of evidence or prospective investigation is warranted.
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Affiliation(s)
| | - Tomoyuki Yoshihara
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, Osaka, Japan
| | - Takanori Uchida
- Department of Neurosurgery, Nagareyama Central Hospital, Chiba, Japan
| | | | - Naoyuki Arai
- Department of Neurosurgery, Medical Center Adachi, Tokyo Women’s Medical University, Tokyo, Japan
| | - Hidenori Ohbuchi
- Department of Neurosurgery, Medical Center Adachi, Tokyo Women’s Medical University, Tokyo, Japan
| | - Yuichi Takahashi
- Department of Neurosurgery, Sassa General Hospital, Nishitokyo, Japan
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Pettersson SD, Khorasanizadeh M, Maglinger B, Garcia A, Wang SJ, Taussky P, Ogilvy CS. Trends in the Age of Patients Treated for Unruptured Intracranial Aneurysms from 1990 to 2020. World Neurosurg 2023; 178:233-240.e13. [PMID: 37562685 DOI: 10.1016/j.wneu.2023.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND The decision for treatment for unruptured intracranial aneurysms (UIAs) is often difficult. Innovation in endovascular devices have improved the benefit-to-risk profile especially for elderly patients; however, the treatment guidelines from the past decade often recommend conservative management. It is unknown how these changes have affected the overall age of the patients selected for treatment. Herein, we aimed to study potential changes in the average age of the patients that are being treated over time. METHODS A systematic search of the literature was performed to identify all studies describing the age of the UIAs that were treated by any modality. Scatter diagrams with trend lines were used to plot the age of the patients treated over time and assess the presence of a potential significant trend via statistical correlation tests. RESULTS A total of 280 studies including 83,437 UIAs treated between 1987 and 2021 met all eligibility criteria and were entered in the analysis. Mean age of the patients was 55.5 years, and 70.7% were female. There was a significant increasing trend in the age of the treated patients over time (Spearman r: 0.250; P < 0.001), with a 1-year increase in the average age of the treated patients every 5 years since 1987. CONCLUSIONS The present study indicates that based on the treated UIA patient data published in the literature, older UIAs are being treated over time. This trend is likely driven by safer treatments while suggesting that re-evaluation of certain UIA treatment decision scores may be of great interest.
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Affiliation(s)
- Samuel D Pettersson
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - MirHojjat Khorasanizadeh
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Benton Maglinger
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alfonso Garcia
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - S Jennifer Wang
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Philipp Taussky
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Li W, Wang A, Ma C, Wang Y, Zhao Y, Zhang Y, Wang K, Zhang Y, Wang Y, Yang X, Liu J, Liu X. Antiplatelet therapy adjustment improved the radiomic characteristics of acute silent cerebral infarction after stent-assisted coiling in patients with high on-treatment platelet reactivity: A prospective study. Front Neurosci 2023; 17:1068047. [PMID: 36845416 PMCID: PMC9948085 DOI: 10.3389/fnins.2023.1068047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
Background We aimed to investigate the effects of high on-treatment platelet reactivity (HPR) and antiplatelet therapy adjustment on high-risk radiomic features in patients with antiplatelet therapy adjustment on acute silent cerebral infarction (ASCI) who had unruptured intracranial aneurysms (UIA) after stent placement. Methods This single-institution study prospectively included 230 UIA patients who had ACSI after stent placement in our hospital between January 2015 and July 2020. All patients underwent magnetic resonance imaging with diffusion-weighted imaging (MRI-DWI) after stent placement and 1,485 radiomic features were extracted from each patient. The least absolute shrinkage and selection operator regression methods were used for selection of high-risk radiomic features associated with clinical symptoms. In addition, 199 patients with ASCI were classified into three groups: controls without HPR (n = 113), HPR patients with standard antiplatelet therapy (n = 63) and HPR patients with antiplatelet therapy adjustment (n = 23). We compared high-risk radiomic features between three groups. Results Of the patients who had acute infarction after MRI-DWI, 31 (13.5%) exhibited clinical symptoms. Eight risk radiomic features associated with clinical symptoms were selected, and the radiomics signature exhibited good performance. In ASCI patients, compared with controls, the radiomic characteristics of ischemic lesion in HPR patients were consistent with the following high-risk radiomic features associated with clinical symptoms: higher gray-level values, greater variance in intensity values, and greater homogeneity. However, the adjustment of antiplatelet therapy in HPR patients modified the high-risk radiomic features, which showed lower gray-level values, less variance in intensity values, and more heterogeneous texture. The radiomic shape feature of elongation showed no notable difference between three groups. Conclusion Adjustment of antiplatelet therapy might reduce the high-risk radiomic features of UIA patients with HPR after stent placement.
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Affiliation(s)
- Wenqiang Li
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Ma
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanmin Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yapeng Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yisen Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kun Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yang Wang
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China,*Correspondence: Xinjian Yang,
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Jian Liu,
| | - Xianzhi Liu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,Xianzhi Liu,
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Mo L, Yue J, Yu W, Liu X, Tan C, Peng W, Ding X, Chen L. Diffusion-weighted imaging lesions after endovascular treatment of cerebral aneurysms: A network meta-analysis. Front Surg 2023; 9:964191. [PMID: 36726950 PMCID: PMC9885006 DOI: 10.3389/fsurg.2022.964191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/21/2022] [Indexed: 01/17/2023] Open
Abstract
Background Thromboembolism is one of the common complications in endovascular treatments including coiling alone, stent-assisted coiling (SAC), balloon-assisted coiling (BAC), and flow-diverting (FD) stents. Such treatments are widely used in intracranial aneurysms (IAs), which usually present as positive lesions in diffusion-weighted imaging (DWI). Whether these adjunctive techniques increase postprocedural DWI-positive lesions after endovascular treatment remains unclear. Methods A thorough electronic search for the literature published in English between January 2000 and October 2022 was conducted on PubMed, Medline, and EMBASE. Eighteen studies (3 cohort studies and 15 case-control studies) involving 1,843 patients with unruptured IAs (UIAs) were included. We performed a frequentist framework network meta-analysis (NMA) to compare the rank risks of cerebral thromboembolism of the above four endovascular treatments. The incoherence test was used to analyze the statistical disagreement between direct and indirect evidence. Funnel plots were used to analyze publication bias. Results The incidences of DWI lesions in patients who received FD stents, SAC, BAC, and coiling alone were 66.1% (109/165), 37.6% (299/795), 31.1% (236/759), and 25.6% (236/921). The incidence of DWI lesions in patients who received FD stents was higher than that in patients who received SAC [OR: 2.40; 95% CI (1.15, 5.00), P < 0.05], BAC [OR: 2.62; 95% CI (1.19, 5.77), P < 0.05], or coiling alone [OR: 2.77; 95% CI (1.26, 6.07), P < 0.05]. The incoherence test showed preferable consistency in this NMA. No obvious publication bias was found in the funnel plot. Conclusion FD stent placement brings more ischemic lesions identified by DWI than any other procedures for patients with UIA. The characteristics of FD stents may result in a high incidence of DWI lesions.
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Affiliation(s)
- Lijuan Mo
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jianhe Yue
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wanli Yu
- Department of Neurosurgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xi Liu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Changhong Tan
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wuxue Peng
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xueying Ding
- Department of Neurology, Shenzhen University General Hospital, Shenzhen, China
| | - Lifen Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China,Correspondence: Lifen Chen
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Nariai Y, Takigawa T, Hyodo A, Suzuki K. Thromboembolic Events Detected by Diffusion-Weighted Magnetic Resonance Imaging after Flow Diverter Treatment: The Impact of Procedure Time. World Neurosurg 2022; 167:e1241-e1252. [PMID: 36089273 DOI: 10.1016/j.wneu.2022.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Periprocedural thromboembolism is a serious complication of endovascular treatment for intracranial aneurysms. In addition to symptomatic ischemia, asymptomatic postprocedural diffusion-weighted image-positive lesions (DPLs) are considered important. However, few studies have reported significant risk factors associated with DPLs and symptomatic ischemic stroke after flow diverter (FD) treatment. This study aimed to investigate the frequency and risk factors associated with DPLs after FD treatment. METHODS Between November 2015 and December 2021, 84 patients harboring 85 untreated, unruptured intracranial aneurysms treated with FD were enrolled. RESULTS DPLs after FD treatment were confirmed in 74 patients (87.1%), among whom 69 (93.2%) were clinically asymptomatic. In the univariate analyses, age >55 years (P = 0.040), smoking (P = 0.023), preprocedural P2Y12 reaction unit value of >185 (P = 0.030), larger dome size of >9.3 mm (P = 0.013), and prolonged procedure time >80 minutes (P < 0.001) were significantly associated with postprocedural DPLs. In the multiple logistic regression model, only prolonged procedure time >80 minutes (odds ratio, 10.72; 95% confidence interval, 1.346-233.899; P = 0.023) was statistically significant. The mediator effect showed that the association between procedure time and the occurrence of DPLs was not significantly modified by any other factors, although only adjunctive coiling showed a tendency (P-value for interaction = 0.070). CONCLUSIONS Prolonged procedure time >80 minutes was the only identifiable factor related to postprocedural DPLs. Adjunctive coiling tended to mediate the effects of a prolonged procedure time on the occurrence of DPLs after FD treatment.
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Affiliation(s)
- Yasuhiko Nariai
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.
| | - Tomoji Takigawa
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Akio Hyodo
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Kensuke Suzuki
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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10
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Aguiar G, Caroff J, Mihalea C, Cortese J, Girot JB, Elawady A, Vergara Martinez J, Ikka L, Gallas S, Chalumeau V, Ozanne A, Moret J, Spelle L. WEB device for treatment of posterior communicating artery aneurysms. J Neurointerv Surg 2021; 14:362-365. [PMID: 33975921 DOI: 10.1136/neurintsurg-2021-017405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Woven EndoBridge (WEB) device treatment of wide-neck bifurcation aneurysms has proved to be safe and effective, but the use of these devices in sidewall aneurysms has been reported only in a small number of case series. OBJECTIVE To report our results in a cohort of consecutive patients in whom a WEB device was used as first-line treatment for posterior communicating artery (PComA) aneurysms. METHODS We conducted a retrospective analysis of a prospectively maintained database of PComA aneurysms treated with a WEB device in our institution from June 1, 2012 to November 15, 2020. Clinical and radiological findings were evaluated at immediate and last follow-up. RESULTS A total of 219 aneurysms were treated with a WEB device, including 15 PComA aneurysms in 15 patients, 10 of which were ruptured. Aneurysms were wide necked, with a mean aspect ratio of 1.6 (range 0.7-3.0) and a mean neck size of 4.2 mm (range 2.6-7.4 mm). No intraoperative rupture occurred and only one thromboembolic event was noted. Among the group with at least a 3-month digital subtraction angiography (DSA) follow-up, complete and adequate occlusion were obtained in 54% and 72%, respectively (average follow-up 13 months). Re-treatment was needed for two initially ruptured aneurysms. No procedure-related morbidity or mortality was reported. CONCLUSION This series suggests the high safety profile of WEB devices even when used in off-label indications. Treatment with these devices seems to be a valuable strategy for ruptured wide-neck PComA aneurysms, avoiding the need for antiplatelet medication. However, occlusion rates should be investigated in further larger studies.
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Affiliation(s)
- Guilherme Aguiar
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Jildaz Caroff
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Cristian Mihalea
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Jonathan Cortese
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Jean-Baptiste Girot
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Ahmed Elawady
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Jeickson Vergara Martinez
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Léon Ikka
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Sophie Gallas
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Vanessa Chalumeau
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Augustin Ozanne
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Jacques Moret
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France
| | - Laurent Spelle
- NEURI - Neurointerventional Radiology, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicetre, France.,Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicetre, France
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11
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Martínez-Galdámez M, Onal Y, Cohen JE, Kalousek V, Rivera R, Sordo JG, Echeverria D, Pereira VM, Blasco J, Mardighian D, Velioglu M, van Adel B, Wang BH, Gomori JM, Filioglo A, Čulo B, Lynch J, Binboga AB, Onay M, Galvan Fernandez J, Schüller Arteaga M, Guio JD, Bhogal P, Makalanda L, Wong K, Aggour M, Gentric JC, Gavrilovic V, Navia P, Fernandez Prieto A, González E, Aldea J, López JL, Lorenzo-Gorriz A, Madelrieux T, Rouchaud A, Mounayer C. First multicenter experience using the Silk Vista flow diverter in 60 consecutive intracranial aneurysms: technical aspects. J Neurointerv Surg 2021; 13:1145-1151. [PMID: 33832971 PMCID: PMC8606442 DOI: 10.1136/neurintsurg-2021-017421] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 12/16/2022]
Abstract
Background The aim of this study was to assess the technical success and procedural safety of the new Silk Vista device (SV) by evaluating the intraprocedural and periprocedural complication rate after its use in several institutions worldwide. Methods The study involved a retrospective review of multicenter data regarding a consecutive series of patients with intracranial aneurysms, treated with the SV between September 2020 and January 2021. Clinical, intra/periprocedural and angiographic data, including approach, materials used, aneurysm size and location, device/s, technical details and initial angiographic aneurysm occlusion, were analyzed. Results 60 aneurysms were treated with SV in 57 procedures. 66 devices were used, 3 removed and 63 implanted. The devices opened instantaneously in 60 out of 66 (91%) cases and complete wall apposition was achieved in 58 out of 63 (92%) devices implanted. In 4 out of 66 (6%) devices a partial opening of the distal end occurred, and in 5 (8%) devices incomplete apposition was reported. There were 3 (5%) intraprocedural thromboembolic events managed successfully with no permanent neurological morbidity, and 4 (7%) postprocedural events. There was no mortality in this study. The initial occlusion rates in the 60 aneurysms were as follows: O’Kelly–Marotta (OKM) A in 34 (57%) cases, OKM B in 15 (25%) cases, OKM C in 6 (10%) cases, and OKM D in 5 (8%) cases. Conclusions Our study demonstrated that the use of the new flow diverter Silk Vista for the treatment of intracranial aneurysms is feasible and technically safe.
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Affiliation(s)
- Mario Martínez-Galdámez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Yilmaz Onal
- Radiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - José E Cohen
- Neurosurgery & Radiology, Hadassah-Hebrew Univ Med Ctr, Jerusalem, Israel
| | - Vladimir Kalousek
- Department of Radiology, Clinical Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Rodrigo Rivera
- Neuroradiology, Instituto de Neurocirugia, Dr. Asenjo, Santiago, Chile
| | | | - Daniel Echeverria
- Neuroradiology, Instituto de Neurocirugia, Dr. Asenjo, Santiago, Chile
| | - Vitor M Pereira
- Interventional Neuroradiology, Radiology Department, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jordi Blasco
- Neurointerventional Department C.D.I, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Dikran Mardighian
- Neuroradiology, Radiological imaging department, Spedali Civili of Brescia, Brescia, Italy
| | - Murat Velioglu
- Radiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Brian van Adel
- Department of Surgery/Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Bill Hao Wang
- Department of Surgery/Medicine, McMaster University, Hamilton, Ontario, Canada
| | - J Moshe Gomori
- Radiology, Hadassah-Hebrew Univ Med Ctr, Jerusalem, Israel
| | | | - Branimir Čulo
- Department of Radiology, Clinical Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Jeremy Lynch
- Interventional Neuroradiology, Radiology Department, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Ali Burak Binboga
- Radiology, Dr Ersin Arslan Training and Research Hospital, Sahinbey, Gaziantep, Turkey
| | - Mehmet Onay
- Radiology, Dr Ersin Arslan Training and Research Hospital, Sahinbey, Gaziantep, Turkey
| | - Jorge Galvan Fernandez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Miguel Schüller Arteaga
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Jose David Guio
- Neurointerventional Department C.D.I, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, Royal London Hospital, London, London, UK
| | - Levan Makalanda
- Department of Interventional Neuroradiology, Royal London Hospital, London, London, UK
| | - Ken Wong
- Department of Interventional Neuroradiology, Royal London Hospital, London, London, UK
| | - Mohamed Aggour
- Department of Interventional Neuroradiology, Royal London Hospital, London, London, UK
| | | | - Vladimir Gavrilovic
- Interventional Radiology, Azienda Sanitaria Universitaria Friuli Centrale, UDINE, Ud, Italy
| | - Pedro Navia
- Radiology- Interventional Neuroradiology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Eva González
- Interventional Neuroradiology. Radiology, Hospital de Cruces, Barakaldo, País Vasco, Spain
| | - Jesus Aldea
- Interventional Neuroradiology, Hospital Universitario de Burgos, Burgos, Castilla y León, Spain
| | - Jose Luis López
- Interventional Neuroradiology, Hospital Universitario de Burgos, Burgos, Castilla y León, Spain
| | - Antonio Lorenzo-Gorriz
- Interventional Neuroradiology, Hospital General Universitario de Castellon, Valencia, Castellon, Spain
| | - Thomas Madelrieux
- Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France.,University Limoges, CNRS, XLIM, UMR 7252, Limoges, France
| | - Aymeric Rouchaud
- Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France.,University Limoges, CNRS, XLIM, UMR 7252, Limoges, France
| | - Charbel Mounayer
- Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France.,University Limoges, CNRS, XLIM, UMR 7252, Limoges, France
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12
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Onda T, Nonaka T, Nomura T, Inamura S, Honda O, Daibou M. Usefulness of Preoperative Simulation Using a Stereolithographic 3D Printer in Cerebral Aneurysm Coil Embolization. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 15:736-740. [PMID: 37502266 PMCID: PMC10371000 DOI: 10.5797/jnet.tn.2020-0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/17/2021] [Indexed: 07/29/2023]
Abstract
Objective We present a preoperative simulation of cerebral aneurysm coil embolization using a hollow model of cerebral blood vessels created by a stereolithography (SLA) 3D printer. Case Presentation The patient was a 66-year-old woman. During follow-up, coil embolization was planned for an expanding paraclinoid aneurysm. A hollow cerebral vascular model was created preoperatively using an SLA 3D printer. The catheter was malleable and inserted into the hollow model, which enabled the surgeons to confirm its movement, stability, and ease of insertion. In the surgical procedure, the catheter was easily inserted into the aneurysm without reshaping. The procedure was completed without stability problems. Conclusion The use of a hollow model of cerebral blood vessels was useful as a preoperative simulation and improved the safety of the procedure.
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Affiliation(s)
- Toshiyuki Onda
- Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Tadashi Nonaka
- Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Tatsufumi Nomura
- Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Shigeru Inamura
- Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Osamu Honda
- Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Masahiko Daibou
- Department of Neurosurgery, Sapporo Shiroishi Memorial Hospital, Sapporo, Hokkaido, Japan
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13
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Pierot L, Soize S, Cappucci M, Manceau PF, Riva R, Eker OF. Surface-modified flow diverter p48-MW-HPC: Preliminary clinical experience in 28 patients treated in two centers. J Neuroradiol 2020; 48:195-199. [PMID: 33340638 DOI: 10.1016/j.neurad.2020.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Flow diversion is increasingly used for endovascular treatment of distal intracranial aneurysms and has led to the development of small diameter flow diverters such as p48-MW (phenox, Bochum, Germany). Use of flow diverters is limited, however, as patients require dual antiplatelet treatment to avoid thromboembolic complications. Hydrophilic Polymer Coating was developed to reduce platelet aggregation on the p48-MW (p48-MW-HPC). This study reports preliminary experience with p48-MW-HPC in aneurysm treatment in two centers. MATERIALS AND METHODS Patients with ruptured, unruptured, and recanalized aneurysms treated with p48-MW-HPC were prospectively included and retrospectively analyzed for safety and efficacy. Safety was evaluated by analyzing intra- and postoperative complications as well as thromboembolic events depicted by DWI in the 72 h post-procedure. Efficacy was evaluated at 6 months based on aneurysm occlusion. RESULTS From April 2019 to May 2020, 28 patients aged 25-82 years with 29 aneurysms were treated. Two thromboembolic events (7.1%) were reported with good clinical outcome. Final morbidity and mortality were both 0.0%. Post-operative DWI-MRI was depicting lesions in 70.0% of patients. Short-term (6 months) anatomical results were complete aneurysm occlusion in 87.0% of aneurysms, neck remnant in 8.7%, and aneurysm remnant in 4.3%. CONCLUSION This preliminary clinical evaluation conducted in a relatively small sample size shows high feasibility (100.0%) of p48-MW-HPC aneurysm treatment, without morbidity or mortality, and high efficacy (complete occlusion in 90.0%). Additional larger comparative studies are needed to confirm these results and optimize perioperative antiplatelet treatment.
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Affiliation(s)
- Laurent Pierot
- Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France.
| | - Sébastien Soize
- Hôpital Maison-Blanche, Université Reims-Champagne-Ardenne, Reims, France
| | - Matteo Cappucci
- Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | | | - Roberto Riva
- Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Omer Faruk Eker
- Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
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14
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Yamagami K, Hatano T, Nakahara I, Ishii A, Ando M, Chihara H, Ogura T, Suzuki K, Kondo D, Kamata T, Higashi E, Sakai S, Sakamoto H, Iihara K, Nagata I. Long-term Outcomes After Intraprocedural Aneurysm Rupture During Coil Embolization of Unruptured Intracranial Aneurysms. World Neurosurg 2019; 134:e289-e297. [PMID: 31629140 DOI: 10.1016/j.wneu.2019.10.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The long-term outcomes of patients with intraprocedural aneurysm rupture (IPR) during endovascular coiling of unruptured intracranial aneurysms (UIAs) remain unclear. We investigated the long-term outcomes and predictors of neurological outcomes in patients who sustained IPR during coil embolization of UIAs. METHODS We retrospectively analyzed the medical record of 312 untreated UIAs in 284 patients who underwent endovascular coiling between April 2013 and July 2018. RESULTS The mean follow-up period for the entire cohort was 25.6 months. Twelve patients (3.8%) experienced IPR. The mean aneurysm size in the IPR cohort was significantly smaller than that in the no-IPR cohort (P = 0.045). The IPR cohort had a higher percentage of earlier subarachnoid hemorrhage from another aneurysm (P = 0.019), anterior communicating artery (AComA) aneurysm (P < 0.001), and basilar artery (BA) aneurysm (P = 0.022) than the no-IPR cohort. Neurologic deterioration was observed in 3 patients. The morbidity and mortality rates of the IPR cohort were 25% and 8.3%, respectively. Patients with IPR during coil embolization for AComA aneurysm did not develop neurological deterioration. Two of the 3 patients (66.7%) with a BA aneurysm had neurological deterioration. The proportion of patients with an mRS score of 0-2 at the last follow-up did not differ between the 2 cohorts (P = 0.608). CONCLUSIONS The proportion of functionally independent patients did not differ between patients with and without IPR. Patients with BA aneurysms who developed an IPR tended to exhibit more unfavorable clinical courses than patients with AcomA aneurysms.
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Affiliation(s)
- Keitaro Yamagami
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Taketo Hatano
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Ichiro Nakahara
- Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Akira Ishii
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mitsushige Ando
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Hideo Chihara
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Takenori Ogura
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Keita Suzuki
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Daisuke Kondo
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Takahiko Kamata
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Eiji Higashi
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Shota Sakai
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Hiroki Sakamoto
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Izumi Nagata
- Stroke Center, Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
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