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Minh Nguyen A, Quoc Tran T, Minh Trinh T, Viet Nguyen H. Endovascular treatment of unruptured cavernous carotid aneurysms using flow diverter devices in Vietnam: a single-center prospective study. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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2
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Svoboda N, Malik J, Charvat F, Netuka D. Transcirculation Approach for Matricidal Carotid Cavernous Aneurysm: Not a Good Choice - A Case Report of Unsuccessful Endovascular Treatment of Matricidal Carotid Cavernous Aneurysm. Case Rep Neurol 2023; 15:215-221. [PMID: 37901130 PMCID: PMC10601690 DOI: 10.1159/000533832] [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: 11/10/2022] [Accepted: 07/29/2023] [Indexed: 10/31/2023] Open
Abstract
Matricidal carotid cavernous aneurysm (CCA) is a rare and dangerous condition. The treatment failure of the endovascular approach like flow diversion, coiling, or stent-coiling is relatively high with considerable morbidity and mortality. The transcirculation approach is an alternative treatment option, but in case of matricidal CCAs, the results are not well documented in the literature. The authors present a complicated case of an unsuccessful transcirculation approach for matricidal CCA finally treated with sacrifice of the parent artery and high-flow bypass.
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Affiliation(s)
- Norbert Svoboda
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Military University Hospital and Charles University, Prague, Czech Republic
| | - Jozef Malik
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Military University Hospital and Charles University, Prague, Czech Republic
| | - Frantisek Charvat
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Military University Hospital and Charles University, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Military University Hospital and Charles University, Prague, Czech Republic
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Abstract
Epistaxis is not uncommon, with up to 60% of the population suffering from at least one episode in their lifetime and as many as 6% presenting for medical attention. An analysis of emergency room (ER) visits in the United States between 2009 and 2011 identified 1.2 million encounters for epistaxis, accounting for 0.32% of ER visits. Approximately 6% of patients will require more aggressive, invasive management in the form of transnasal ligation of the sphenopalatine artery or endovascular embolization. This article reviews the epidemiology, rationale for endovascular treatment, strategy for treatment, endovascular technique, postprocedural follow-up, and complications and their management.
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Affiliation(s)
- Joan C Wojak
- Department of Radiology, Our Lady of Lourdes Regional Medical Center, Lafayette, Louisiana.,Department of Radiology, Louisiana State University School of Medicine, New Orleans, Louisiana
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Castaño-Leon AM, Alen JF, Lagares A. Opening of unusual vascular collaterals leads to early recanalization of a giant intracavernous carotid artery aneurysm following common carotid artery occlusion: A Case report and literature review. Surg Neurol Int 2020; 11:62. [PMID: 32363057 PMCID: PMC7193203 DOI: 10.25259/sni_597_2019] [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: 12/19/2019] [Accepted: 03/12/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Parent artery occlusion (PAO) with or without bypass surgery is a feasible treatment for large intracavernous carotid artery (ICCA) aneurysms. The ideal occlusion site (internal or common carotid artery [CCA]) and ischemic complications after PAO have received special attention since the description of the technique. Unfrequently, some patients can also develop unusual external carotid artery-internal carotid artery collateral pathways distal to the ligation site that can explain the failure to aneurysm size reduction. Case Description: We describe a rare case of delayed refilling of a large ICCA aneurysm partially thrombosed which early recanalized after surgical ligation of the cervical CCA through an unusual collateral pathway. Conclusion: Based on our experience, we recommend periodic long-term follow-up neuroimaging, especially in those cases where potential collateral branches have not been clearly identified in the preoperative studies.
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Affiliation(s)
- Ana M Castaño-Leon
- Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avda Cordoba SN, Madrid, Spain
| | - Jose F Alen
- Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avda Cordoba SN, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avda Cordoba SN, Madrid, Spain
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Ding D, Buell TJ, Chen CJ, Raper DM, Liu KC, Vollmer DG. Staged Multimodality Treatment of a Large Ruptured Fusiform Supraclinoid Internal Carotid Artery Aneurysm: Microsurgical Clip-assisted Endovascular Coiling. J Neurosci Rural Pract 2019; 8:668-671. [PMID: 29204037 PMCID: PMC5709900 DOI: 10.4103/jnrp.jnrp_293_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
In the contemporary era of aneurysm management, large fusiform aneurysms presenting with subarachnoid hemorrhage (SAH) remain particularly challenging lesions to successfully manage. We describe a staged, multimodal treatment strategy for a 71-year-old patient who presented with a large ruptured fusiform aneurysm of the supraclinoid internal carotid artery (ICA) and a fetal posterior communicating artery which originated from the inferomedial aspect of the aneurysm. In the first stage, we performed a partial microsurgical clip reconstruction of the fusiform aneurysm and secured its rupture site, which was identified intraoperatively. This left two residual saccular components of the aneurysm, which were targeted with endovascular coiling in the same hospitalization after the patient had convalesced from the SAH and was beyond the vasospasm window. We believe that this combined approach of clip-assisted coiling can be employed instead of endovascular flow diversion or microsurgical bypass for appropriately selected patients with ruptured fusiform ICA aneurysms.
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Affiliation(s)
- Dale Ding
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ 85013, USA
| | - Thomas J Buell
- Department of Neurosurgery, University of Virginia, Charlottesville, VA 22908, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, University of Virginia, Charlottesville, VA 22908, USA
| | - Daniel M Raper
- Department of Neurosurgery, University of Virginia, Charlottesville, VA 22908, USA
| | - Kenneth C Liu
- Department of Neurosurgery, University of Virginia, Charlottesville, VA 22908, USA
| | - Dennis G Vollmer
- Department of Neurosurgery, University of Virginia, Charlottesville, VA 22908, USA
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Ding D, Starke RM, Hope A, Brew S. Flow-diverting Stent-assisted Coil Embolization of a Ruptured Internal Carotid Artery Blister Aneurysm with the Pipeline Flex Embolization Device. J Neurosci Rural Pract 2019; 8:664-667. [PMID: 29204036 PMCID: PMC5709899 DOI: 10.4103/jnrp.jnrp_336_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Internal carotid artery (ICA) blister aneurysms are rare and challenging to successfully treat, using contemporary surgical or endovascular approaches, without partial or complete compromise of the parent vessel. We describe the use of a resheathable flow diverter, the Pipeline Flex Embolization Device (PFED) to perform stent-assisted coiling of a ruptured supraclinoid ICA blister aneurysm in a 56-year-old female who presented with a high-grade subarachnoid hemorrhage (SAH). The first PFED was deployed across the aneurysm neck to jail a microcatheter within the aneurysm dome, and then, two small coils were delivered into the aneurysm. After removing the coiling microcatheter, the second PFED was telescoped into the first PFED. There were no postprocedural complications, and follow-up magnetic resonance angiography 15 months after embolization showed complete aneurysm obliteration. Flow-diverting stent-assisted coiling should be considered as a reconstructive, vessel-preserving, endovascular treatment option for appropriately selected patients with ruptured ICA blister aneurysms. However, future studies are necessary to assess the periprocedural safety in the setting of acute SAH.
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Affiliation(s)
- Dale Ding
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Ayton Hope
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand
| | - Stefan Brew
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand
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Dacus MR, Nickele C, Welch BG, Ban VS, Ringer AJ, Kim LJ, Levitt MR, Lanzino G, Kan P, Arthur AS. Matricidal cavernous aneurysms: a multicenter case series. J Neurointerv Surg 2019; 11:584-590. [DOI: 10.1136/neurintsurg-2018-014562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 11/04/2022]
Abstract
BackgroundCavernous carotid artery aneurysms (CCAs) represent a unique subset of intracranial aneurysms due to their distinct natural history and the anatomy of the cavernous sinus. Enlarging CCAs can cause elastic compression of the parent internal carotid artery (ICA). We suggest defining aneurysms that cause luminal stenosis of their parent vessels as ‘matricidal aneurysms.’Though many patients are asymptomatic, presenting symptoms of CCAs include ophthalmoplegia with resulting diplopia, vision changes, pain, ptosis, facial numbness, and cavernous-carotid fistula. Less commonly, patients with CCAs can present with epistaxis, subarachnoid hemorrhage, and—in cases of matricidal aneurysms—ischemia due to stenosis. The proper management of stenosis caused by a matricidal CCA is not well established and may not be intuitive.MethodsWe present a multicenter retrospective case series of patients with matricidal CCAs.ResultsForty patients with matricidal aneurysms presented with both asymptomatic and symptomatic stenosis. These patients were either treated with conservative medical management, coiling, flow diversion, or endovascular sacrifice of the parent artery. Planned treatment modalities were not executed in 11 cases (28% treatment failure rate). Presenting symptoms, patient outcomes, and follow-up data are presented for all cases.ConclusionMatricidal aneurysms require careful consideration and planning. The restricted anatomy of the cavernous sinus can make successful execution of endovascular interventions more difficult. Direct elastic compression of the parent artery does not respond to angioplasty and stenting in the same way atherosclerotic stenosis does. Because of this, planning for the possibility of parent vessel sacrifice is important.
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Sharma M, Ugiliweneza B, Fortuny EM, Khattar NK, Andaluz N, James RF, Williams BJ, Boakye M, Ding D. National trends in cerebral bypass for unruptured intracranial aneurysms: a National (Nationwide) Inpatient Sample analysis of 1998–2015. Neurosurg Focus 2019; 46:E15. [DOI: 10.3171/2018.11.focus18504] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/08/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe development and recent widespread dissemination of flow diverters may have reduced the utilization of surgical bypass procedures to treat complex or giant unruptured intracranial aneurysms (UIAs). The aim of this retrospective cohort study was to observe trends in cerebral revascularization procedures for UIAs in the United States before and after the introduction of flow diverters by using the National (Nationwide) Inpatient Sample (NIS).METHODSThe authors extracted data from the NIS database for the years 1998–2015 using the ICD-9/10 diagnostic and procedure codes. Patients with a primary diagnosis of UIA with a concurrent bypass procedure were included in the study. Outcomes and hospital charges were analyzed.RESULTSA total of 216,212 patients had a primary diagnosis of UIA during the study period. The number of patients diagnosed with a UIA increased by 128% from 1998 (n = 7718) to 2015 (n = 17,600). Only 1328 of the UIA patients (0.6%) underwent cerebral bypass. The percentage of patients who underwent bypass in the flow diverter era (2010–2015) remained stable at 0.4%. Most patients who underwent bypass were white (51%), were female (62%), had a median household income in the 3rd or 4th quartiles (57%), and had private insurance (51%). The West (33%) and Midwest/North Central regions (30%) had the highest volume of bypasses, whereas the Northeast region had the lowest (15%). Compared to the period 1998–2011, bypass procedures for UIAs in 2012–2015 shifted entirely to urban teaching hospitals (100%) and to an elective basis (77%). The median hospital stay (9 vs 3 days, p < 0.0001), median hospital charges ($186,746 vs $66,361, p < 0.0001), and rate of any complication (51% vs 17%, p < 0.0001) were approximately threefold higher for the UIA patients with bypass than for those without bypass.CONCLUSIONSDespite a significant increase in the diagnosis of UIAs over the 17-year study period, the proportion of bypass procedures performed as part of their treatment has remained stable. Therefore, advances in endovascular aneurysm therapy do not appear to have affected the volume of bypass procedures performed in the UIA population. The authors’ findings suggest a potentially ongoing niche for bypass procedures in the contemporary treatment of UIAs.
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Deng D, Du J, Liu F, Zhong B, Qiao Y, Liu Y. Clinical characteristics of internal carotid artery pseudoaneurysms in the sphenoid sinus. Am J Otolaryngol 2019; 40:106-109. [PMID: 30472125 DOI: 10.1016/j.amjoto.2018.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Internal carotid artery (ICA) pseudoaneurysms are associated with high mortality if lack of proper management. Patients with ICA pseudoaneurysms in the sphenoid sinus often visit a hospital's ear, nose and throat (ENT) department due to nasal bleeding. In such cases, simple examination and therapy will lead to misdiagnosis. OBJECTIVE This study sought to investigate the clinical characteristics, diagnostic methods and treatment of ICA pseudoaneurysms in the sphenoid sinus. METHODS Various data, including clinical features, imaging examination results, and treatment and prognosis information, were collected and analyzed for 8 patients who visited the Department of Otolaryngology, Head & Neck Surgery of West China Hospital from March 2008 to January 2017. RESULTS The patients included 6 males and 2 females (ages 16 to 56 years). Repeated epistaxis was a common symptom in six of the eight patients (6/8), whereas monocular blindness and binocular blindness were observed in the other two patients. Head trauma was found to play a role in the induction of ICA pseudoaneurysms, given that five patients (5/8) exhibited a specific history of head injury. CT examination tended to result in misdiagnosis, whereas MRI and digital subtraction angiography (DSA) were helpful for obtaining a definite diagnosis with all diagnoses were confirmed via DSA. Coated stent intervention was performed in five patients, while carotid artery ligation was performed in two patients in emergency situations: one of whom exhibited paraplegia, but recovery was ultimately observed after rehabilitation. Moreover, failure of coated stent intervention in one patient was resolved via additional unilateral common carotid artery ligation. Furthermore, one patient with vision loss experienced vision restoration. One patient discontinued treatment for personal reasons and was lost to follow-up. No recurrence was observed in the other 7 patients. CONCLUSION ICA pseudoaneurysms in the sphenoid sinus are uncommon. To accurately identify ICA pseudoaneurysms, collaboration between otolaryngologists and imaging specialists is essential. On the other hand, both surgical and interventional treatments can achieve good results; therefore, otolaryngologists should enhance their cooperation with neurosurgery and intervention departments. Accurate diagnosis and rapid treatment are keys to managing ICA pseudoaneurysms.
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Affiliation(s)
- Di Deng
- Department of Otorhinolaryngology Head & Neck surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Jintao Du
- Department of Otorhinolaryngology Head & Neck surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
| | - Feng Liu
- Department of Otorhinolaryngology Head & Neck surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Bing Zhong
- Department of Otorhinolaryngology Head & Neck surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Yixin Qiao
- Department of Otorhinolaryngology Head & Neck surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Yafeng Liu
- Department of Otorhinolaryngology Head & Neck surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
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Sokolowski JD, Ilyas A, Buell TJ, Taylor DG, Chen CJ, Ding D, Raper DMS, Liu KC. SMART coils for intracranial aneurysm embolization: Follow-up outcomes. J Clin Neurosci 2018; 59:93-97. [PMID: 30414808 DOI: 10.1016/j.jocn.2018.10.132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/27/2018] [Indexed: 11/19/2022]
Abstract
The SMART coil (Penumbra Inc., Alameda, CA, USA) is a new microcoil designed to enhance deliverability. Although prior studies have described its perioperative safety and efficacy, the follow-up outcomes after embolization of intracranial aneurysms using SMART coils have not been reported. Therefore, the aim of this retrospective cohort study is to assess the angiographic outcomes at interim follow-up after aneurysm embolization with SMART coils. We reviewed data from consecutive patients with intracranial aneurysms who underwent endovascular treatment using SMART coils between June 2016 and August 2017. Baseline data and follow-up angiographic outcomes using the modified Raymond-Roy classification (MRRC) were recorded. The study cohort comprised 33 patients with 34 aneurysms who underwent SMART coil embolization and had sufficient follow-up data. The mean age was 57 years, and 82% were female. The mean aneurysm maximum diameter and neck width were 6.1 ± 2.2 mm and 3.2 ± 1.2 mm, respectively, and 14.7% of aneurysms were ruptured. The overall complication rate was 12%. Initial mean coil packing density was 26%, and the initial MRRC was I, II, IIIa, and IIIb in 24%, 26%, 35%, and 15%, respectively. At last follow-up (mean duration 7.7 ± 3.2 months), the MRRC was I, II, IIIa, and IIIb in 62%, 26%, 3%, and 9%, respectively. The retreatment rate was 14.7%. The SMART coil is efficacious for the treatment of appropriately selected aneurysms, with an acceptable risk profile. The majority of residual aneurysms after the initial embolization procedure will progress to complete or near-complete occlusion at interim follow-up.
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Affiliation(s)
- Jennifer D Sokolowski
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States.
| | - Adeel Ilyas
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Thomas J Buell
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Davis G Taylor
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Dale Ding
- Department of Neurosurgery, University of Louisville, Louisville, KY, United States
| | - Daniel M S Raper
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Kenneth C Liu
- Department of Neurological Surgery, Pennsylvania State University, Hershey, PA, United States
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Paisan GM, Ding D, Xu Z, Liu KC. Effect of Dual Antiplatelet Therapy on Shunt Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Matched Cohort Pilot Study. Cureus 2018; 10:e2383. [PMID: 29850378 PMCID: PMC5973489 DOI: 10.7759/cureus.2383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective: The aim of this retrospective, matched cohort study is to determine the effect of dual antiplatelet therapy (DAPT) on shunt-related complications and long-term functional outcomes in endovascularly treated aneurysmal subarachnoid hemorrhage (aSAH) patients. Materials and Method: We retrospectively analyzed an institutional database of aSAH patients from 2000-2015. Patients who underwent endovascular treatment with stent-assisted coiling (DAPT cohort) were matched in a 1:4 ratio to those who underwent coiling alone (no-DAPT cohort) based on the presenting patient and aneurysm factors. A favorable outcome was defined as a modified Rankin scale of <2. Statistical analyses were performed to compare the shunt-related and functional outcomes between the DAPT and no-DAPT cohorts. Results: After applying the selection criteria and performing the matching process, the overall study cohort comprised 25 aSAH patients who underwent endovascular treatment, including five in the DAPT and 20 in the no-DAPT cohorts. The mean age, World Federation of Neurological Surgeons grade, aneurysm size, and follow-up duration of the overall study cohort were 52.3 years, 2.9, 7.4 mm, and 32.7 months, respectively. The mean time from aSAH to shunt placement was significantly higher for patients in the DAPT cohort (5.6 vs. 0.7 months; p=0.026). The shunt complication rates (p=0.562) and functional outcomes at last follow-up (p=0.924) were not significantly different between the two cohorts. Conclusion: Patients receiving DAPT after the stent-assisted coiling of acutely ruptured aneurysms do not have an increased risk of shunt-related complications or unfavorable long-term functional outcomes compared to endovascularly treated aSAH patients not taking DAPT. These results suggest that further study is warranted.
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Affiliation(s)
- Gabriella M Paisan
- Department of Neurological Surgery, University of Virginia, Charlottesville, USA
| | - Dale Ding
- Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia, Charlottesville, USA
| | - Kenneth C Liu
- Department of Neurological Surgery, University of Virginia, Charlottesville, USA
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Ilyas A, Buell TJ, Chen CJ, Ding D, Raper DMS, Taylor DG, Sokolowski JD, Liu KC. SMART coils for intracranial aneurysm embolization: Initial outcomes. Clin Neurol Neurosurg 2017; 164:87-91. [PMID: 29216501 DOI: 10.1016/j.clineuro.2017.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/11/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Endovascular technology for the treatment of intracranial aneurysms continues to rapidly evolve. The SMART coil (Penumbra Inc., Alameda, CA, USA) is a novel microcoil designed to enhance deliverability. The aim of this single-center, retrospective cohort study is to assess the initial outcomes after aneurysm embolization using SMART coils. PATIENTS AND METHODS We reviewed consecutive patients with intracranial aneurysms who underwent endovascular embolization using SMART coils from June 2016 to January 2017. Baseline and initial outcomes data were analyzed. RESULTS The study cohort was comprised of 32 patients with 33 aneurysms. The mean age was 55.8 years. The majority (85%) of aneurysms were located in the anterior circulation. The mean aneurysm maximum diameter and neck width were 6.0mm and 3.1mm, respectively. Dome irregularity and fusiform aneurysm morphology were noted in 33% and 9% of aneurysms, respectively, and 15% presented with subarachnoid hemorrhage. No serious procedural complications occurred, including microcatheter prolapse, intraprocedural aneurysm rupture, or thromboembolism. Device malfunction occurred in one case (3%). The mean packing density was 25%, and the degree of immediate post-embolization aneurysm occlusion was a modified Raymond-Roy grade I, II, IIIa, and IIIb in 48%, 27%, 18%, and 6%, respectively. CONCLUSION Our preliminary findings suggest that the SMART coil has a favorable initial risk to benefit profile for the embolization of appropriately selected aneurysms. Additional studies of larger cohorts are necessary to determine the mid-term and long-term clinical and angiographic outcomes of aneurysm patients treated with the SMART coil.
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Affiliation(s)
- Adeel Ilyas
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Thomas J Buell
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Dale Ding
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Daniel M S Raper
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Davis G Taylor
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Jennifer D Sokolowski
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Kenneth C Liu
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
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13
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Ding D, Starke RM, McGuinness B, Brew S. Double-barrel Y-configuration Stenting for Flow Diversion of a Giant Recurrent Basilar Apex Aneurysm with the Pipeline Flex Embolization Device. J Neurosci Rural Pract 2017; 7:S99-S102. [PMID: 28163518 PMCID: PMC5244076 DOI: 10.4103/0976-3147.196439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Giant basilar apex aneurysms are extremely challenging to successfully manage. The Pipeline Flex embolization device (PFED) is a new generation flow-diverting stent with a modified delivery system which allows resheathing of the stent after partial deployment. We describe a case of double-barrel Y-configuration stenting of a giant, recurrent basilar apex aneurysm using the PFED. A 73-year-old male was previously treated for an unruptured 11-mm basilar apex aneurysm with stent-assisted coiling using a Neuroform stent. The aneurysm was retreated twice with repeat coiling. After the third recurrence and persistent aneurysm growth into a giant, symptomatic lesion, we decided to proceed with flow diversion. We performed Y-stenting of the basilar bifurcation using three PFEDs, and was recoiled the aneurysm sac. Due to the low porosity of the flow diverters, a side-by-side double-barrel configuration was necessary in the basilar artery. Without the PFED's resheathable capability, it would not have been possible to perform Y-stenting with flow diverters.
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Affiliation(s)
- Dale Ding
- Department of Neurosurgery, University of Virginia, Charlottesville, VA 22908, USA; Department of Neurosurgery, Auckland City Hospital, Auckland 1142, New Zealand
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami, Miami, FL 33136, USA
| | - Ben McGuinness
- Department of Radiology, Auckland City Hospital, Auckland 1142, New Zealand
| | - Stefan Brew
- Department of Radiology, Auckland City Hospital, Auckland 1142, New Zealand
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