Endovascular Coiling for Cerebral Aneurysms

Endovascular coil embolization of aneurysm neck for the treatment of ruptured intracranial aneurysm with bleb formation

Background

Ruptured intracranial aneurysm (ICA) with bleb formation (RICABF) is a special type of ruptured ICA. However, the exact role and effectiveness of endovascular coil embolization (ECE) in RICABF is unknown.

We aimed to investigate the effectiveness and safety of ECE of aneurysm neck for RICABF treatment.

Material/Methods

We retrospectively assessed consecutive patients who were hospitalized in our endovascular intervention center between October 2004 and May 2012. Overall, 86 patients underwent ECE of aneurysm neck for 86 RICABF. Treatments outcomes included secondary rupture/bleeding rate, aneurysm neck embolization rate, residual/recurrent aneurysm, intraoperative incidents, and post-embolization complications, as well as improvements in the Glasgow outcome scale (extended) (GOS-E).

Results

Complete occlusion was achieved in 72 aneurysms (72/86, 83.7%), while 12 aneurysms (12/86, 14.0%) had a residual neck, and 2 aneurysms (2/86, 2.3%) had a residual aneurysm. The postoperative GOS-E was 3 in 3 patients (3.5%), 4 in 10 patients (11.6%), and 5 in 73 patients (84.9%). Follow-up angiography was performed in all patients (mean 9.0 months, interquartile range of 9.0). Recurrence was found in 3 patients (3/86, 3.5%). No aneurysm rupture or bleeding was reported.

Conclusions

Our mid-term follow-up study showed that ECE of aneurysm neck was an effective and safe treatment modality for RICABF. The long-term effectiveness and safety of this interventional radiology technique need to be investigated in prospective and comparative studies.

Comparison of microsurgery and endovascular treatment on clinical outcome following poor-grade subarachnoid hemorrhage

Poor-grade (World Federation of Neurological Surgeons [WFNS] clinical grading scale grades IV and V) subarachnoid hemorrhage (SAH) is associated with significant morbidity and mortality. However, the correlation between the timing, modality of intervention (clipping or coiling) and the clinical outcome is not clear. This study aims to examine this correlation. Patients presenting with WFNS grades IV and V aneurysmal SAH between 1997 and 2008 to a single centre were studied. An aggressive policy of early intervention was followed, and the selection of endovascular versus microsurgical intervention was made according to angiographic rather than clinical features. Clinical outcomes were graded using the modified Rankin scale (mRS) at 6 month follow-up. One hundred and forty-three poor-grade patients (23.9% of all 598 aneurysmal SAH patients) were studied. Treatment was microsurgical in 83 (58.0%) and endovascular in 60 (42%) patients. Twenty patients (14.0%) were lost to follow-up. Good outcome (mRS 0-2) at 6 months was found in 45 microsurgical patients (63.3%) and 24 endovascular patients (46.1%). This trend towards better clinical outcomes in the microsurgical group was not statistically significant. With an aggressive early treatment policy more than half of the poor-grade SAH patients demonstrated a good clinical outcome. Microsurgery and endovascular treatment, when selected primarily according to angiographic features, were equally likely to achieve good outcome.

Development of a novel endothelial cell-seeded endovascular stent for intracranial aneurysm therapy

The metallic stent has been widely used in endovascular treatment of intracranial aneurysms and arterial stenosis. Endothelialization at the neck of the aneurysm or stenotic lesion after stent deployment plays a pivotal role in preventing aneurysm recurrence, as well as local thrombus formation and restenosis. To deliver autologous endothelial cells and to promote the endothelialization on the luminal wall of the parent artery, we established an endothelial cell-seeded intracranial stent device. Endothelial cells were isolated from canine jugular vein and identified by FACS assay and immunohistochemistry. We demonstrated that the seeded endothelial cells formed a confluent endothelial layer on the stent's surface. After being brushed with 100 dyne/cm(2) of shear stress, we found that this endothelial layer remained intact for at least 48 h on the heparinized polymer coated stent, rather than the poly-lactic-acid coated stent (p < 0.05). The results suggest that an autologous endothelial cell-seeded stent may be a feasible and optimal tool for endothelial delivery during stenting and may overcome some limitations of the traditional bare stent in the treatment of intracranial aneurysms and arterial stenosis.

Cerebral Aneurysm—Treatment and Perioperative Nursing Care

A cerebral aneurysm is a weakening and saccular outpouching of a cerebral artery. This life threatening condition affects approximately 10 million to 15 million Americans annually. Perioperative nurses must be aware of the incidence, clinical manifestations, pathophysiology, and treatments for cerebral aneurysm. This article details the perioperative care of patients undergoing craniotomy for surgical clipping or insertion of an endovascular coil. Although endovascular coiling is a relatively new procedure with unknown long-term results, this treatment option offers patients a minimally invasive alternative to craniotomy with a shorter hospital stay and decreased recovery time.

Use of Postanesthesia Care Unit for Purposes Other Than Postanesthesia Observation

Postanesthesia care units (PACUs) were originally developed to care for patients who needed monitoring until they recovered from anesthesia. As new treatment options are developing, however, the role of PACU is changing and the scope of PACU nurses is expanding. We performed a study to find out the proportion of patients who were admitted to the PACU for reasons other than postoperative observation and care and analyzed the resources, observation, and interventions these patients required in PACU facilities. These patients were a heterogeneous patient population who required variable monitoring, care, and nursing activities and, therefore, considerably increased the workload of PACU nurses. A small proportion of these patients suffered from problems that further increased the demand for special care.