1
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Ferreira T, Awuah WA, Tan JK, Adebusoye FT, Ali SH, Bharadwaj HR, Aderinto N, Fernandes C, Zahid MJ, Abdul-Rahman T. The current landscape of intracranial aneurysms in Africa: management outcomes, challenges, and strategies-a narrative review. Neurosurg Rev 2023; 46:194. [PMID: 37548805 DOI: 10.1007/s10143-023-02102-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/19/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
Intracranial aneurysms (IAs) pose complex and potentially life-threatening challenges in Africa, where limited resources, restricted access to specialised healthcare facilities, and disparities in healthcare provision amplify the difficulties of management. Timely diagnosis and treatment are pivotal in preventing complications, including subarachnoid haemorrhage. Treatment options encompass observation, surgical clipping, endovascular coiling, and flow diversion. Positive outcomes observed in IA management in Africa include high survival rates, favourable functional outcomes, successful treatment techniques, and the absence of complications in some cases. However, negative outcomes such as postoperative complications, reduced quality of life, perioperative mortality, and the risk of recurrence persist. Challenges in IA management encompass limited access to diagnostic tools, a scarcity of specialised healthcare professionals, and an unequal distribution of services. Addressing these challenges requires interventions focused on improving access to diagnostic tools, expanding the number of trained professionals, and establishing specialised IA treatment centres. Collaboration, research, and capacity-building efforts hold significant importance in improving patient outcomes and reducing disparities in IA management across Africa.
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Affiliation(s)
- Tomas Ferreira
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Wireko Andrew Awuah
- Faculty of Medicine, Sumy State University, Sanatorna St, 31, Sumy, Sumy Oblast, 40000, Ukraine
| | | | - Favour Tope Adebusoye
- Faculty of Medicine, Sumy State University, Sanatorna St, 31, Sumy, Sumy Oblast, 40000, Ukraine.
| | - Syed Hasham Ali
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Nicholas Aderinto
- Internal Medicine Department, LAUTECH Teaching Hospital, Oyo, Nigeria
| | | | | | - Toufik Abdul-Rahman
- Faculty of Medicine, Sumy State University, Sanatorna St, 31, Sumy, Sumy Oblast, 40000, Ukraine
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2
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Inci S, Karakaya D. Microsurgical Treatment of Previously Coiled Giant Aneurysms: Experience with 6 Cases and Literature Review. World Neurosurg 2023; 171:e336-e348. [PMID: 36513298 DOI: 10.1016/j.wneu.2022.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Surgical treatment of insufficiently embolized (coiled) or recurrent giant aneurysms has not been well established in the literature. The aim of this study is to bring up the surgical difficulties of these rare aneurysms and to offer solutions. METHODS A database was queried for giant aneurysms that had been previously embolized and subsequently required surgical treatment. We only found 29 aneurysms in the literature and here, we report 6 more surgical cases with patient characteristics, radiological studies, applied surgical techniques, and outcomes which were reviewed retrospectively. RESULTS Four females and 2 males, with a mean age of 45.6 years took part in the study. The most common aneurysm location was the middle cerebral artery. While 5 aneurysms were successfully clipped, 1 was excised and the neck was closed with micro sutures. The coils were compulsorily removed in 3 patients. Postoperative digital subtraction angiography confirmed total occlusion of the aneurysms in all cases. Overall morbidity was 16.6%. There was no mortality. No recurrence was observed in the angiographic follow-up (mean 22.6 months, range 7-47 months). The literature review also determined that 97.1% of 35 previously coiled giant aneurysms (including ours) were occluded using various surgical techniques, with 82.8% good outcome. CONCLUSIONS Surgical clipping is a safe and effective procedure for the treatment of insufficiently embolized or recurrent giant aneurysms after coiling. If possible, the coils should not be removed. However, if safe clipping is not possible due to the coils, the removal of the coils should not be avoided.
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Affiliation(s)
- Servet Inci
- Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey.
| | - Dicle Karakaya
- Department of Neurosurgery, Medical Faculty, Hacettepe University, Ankara, Turkey
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3
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Hu L, Quan K, Shi Y, Liu P, Song J, Tian Y, An Q, Liu Y, Li S, Yu G, Fan Z, Luo J, Gu Y, Xu B, Zhu W, Mao Y. Association of Preoperative Vascular Wall Imaging Patterns and Surgical Outcomes in Patients With Unruptured Intracranial Saccular Aneurysms. Neurosurgery 2023; 92:421-430. [PMID: 36637276 DOI: 10.1227/neu.0000000000002219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/31/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND MR vascular wall imaging (VWI) may have prognostic value in patients with unruptured intracranial aneurysms (UIAs). OBJECTIVE To evaluate the value of VWI as a predictor of surgical outcome in patients with UIAs. METHODS This prospective cohort study evaluated surgical outcomes in consecutive patients with UIAs who underwent surgical clipping at a single center. All participants underwent high-resolution VWI and were followed for at least 6 months. The primary clinical outcome was modified Rankin scale (mRS) score 6 months after surgery. RESULTS The number of patients in the no wall enhancement, uniform wall enhancement (UWE), and focal wall enhancement (FWE) groups was 37, 145, and 154, respectively. Incidence of postoperative complications was 15.5% in the FWE group, 12.4% in the UWE group, and 5.4% in the no wall enhancement group. The proportion of patients with mRS score >2 at the 6-month follow-up was significantly higher in the FWE group than in the UWE group (14.3% vs 6.9%; P = .0389). In the multivariate analysis, FWE (odds ratio, 2.573; 95% CI 1.001-6.612) and positive proximal artery remodeling (odds ratio, 10.56; 95% CI 2.237-49.83) were independent predictors of mRS score >2 at the 6-month follow-up. CONCLUSION Preoperative VWI can improve the surgeon's understanding of aneurysm pathological structure. Type of aneurysmal wall enhancement on VWI is associated with clinical outcome and incidence of salvage anastomosis and surgical complications.
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Affiliation(s)
- Liuxun Hu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Kai Quan
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Yuan Shi
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Peixi Liu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Jianping Song
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Yanlong Tian
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Qingzhu An
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Yingjun Liu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Sichen Li
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Guo Yu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Zhiyuan Fan
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Jianfeng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Yuxiang Gu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Bin Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Wei Zhu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China.,Neurosurgical Institute of Fudan University, Shanghai, China.,Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
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4
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Jin J, Guo G, Ren Y, Yang B, Wu Y, Wang S, Sun Y, Wang X, Wang Y, Zheng J. Risk Factors for Recurrence of Intracranial Aneurysm After Coil Embolization: A Meta-Analysis. Front Neurol 2022; 13:869880. [PMID: 35937054 PMCID: PMC9355382 DOI: 10.3389/fneur.2022.869880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Intracranial aneurysm is a severe cerebral disorder involving complicated risk factors and endovascular coiling is a common therapeutic selection for intracranial aneurysm. The recurrence is a clinical challenge in intracranial aneurysms after coil embolization. With this study, we provided a meta-analysis of the risk factors for the recurrence of intracranial aneurysm after coil embolization. Nine studies were included with a total of 1,270 studies that were retrieved from the database. The sample size of patients with intracranial aneurysms ranged from 241 to 3,530, and a total of 9,532 patients were included in the present meta-analysis. The intracranial aneurysms that occurred in middle cerebral artery (MCA) (OR = 1.09, 95% CI: 1.03–1.16, P = 0.0045) and posterior circulation (OR = 2.01, 95% CI: 1.55–2.60, P = 0.000) presented the significantly higher risk of recurrence after coil embolization. Meanwhile, intracranial aneurysms of size > 7 mm (OR = 5.38, 95%CI: 3.76–7.70, P = 0.000) had a significantly higher risk of recurrence after coil embolization. Moreover, ruptured aneurysm (OR = 2.86, 95% CI: 2.02–4.04, P = 0.000) and subarachnoid hemorrhage (SAH) (OR = 1.57, 95% CI: 1.20–2.06, P = 0.001) was positively correlated with the risk of recurrence after coil embolization. In conclusion, this meta-analysis identified the characteristics of intracranial aneurysms with MCA, posterior circulation, size > 7 mm, ruptured aneurysm, and SAH as the risk factors of recurrence after coil embolization for intracranial aneurysms.
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Affiliation(s)
- Ji Jin
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Geng Guo
- Department of Neurosurgery, The First Hospital, Shanxi Medical University, Taiyuan, China
- *Correspondence: Geng Guo
| | - Yeqing Ren
- Department of Neurosurgery, The First Hospital, Shanxi Medical University, Taiyuan, China
| | - Biao Yang
- Department of Neurosurgery, The First Hospital, Shanxi Medical University, Taiyuan, China
| | - Yongqiang Wu
- Department of Neurosurgery, The First Hospital, Shanxi Medical University, Taiyuan, China
| | - Shule Wang
- Department of Neurosurgery, The First Hospital, Shanxi Medical University, Taiyuan, China
| | - Yanqi Sun
- Department of Neurosurgery, The First Hospital, Shanxi Medical University, Taiyuan, China
| | - Xiaogang Wang
- Department of Neurosurgery, The First Hospital, Shanxi Medical University, Taiyuan, China
| | - Yuxiao Wang
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jianzhong Zheng
- School of Public Health, Shanxi Medical University, Taiyuan, China
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5
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Saqib R, Wuppalapati S, Sonwalkar H, Vanchilingam K, Chatterjee S, Roberts G, Gurusinghe N. Can further subdivision of the Raymond-Roy classification of intracranial aneurysms be useful in predicting recurrence and need for future retreatment following endovascular coiling? Surg Neurol Int 2022; 13:170. [PMID: 35509568 PMCID: PMC9062957 DOI: 10.25259/sni_991_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/14/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
The Raymond-Roy classification has been the standard for neck recurrences following endovascular coiling with three grades. Several modified classification systems with subdivisions have been reported in literature but it is unclear whether this adds value in predicting recurrence or retreatment. Our aim is to assess if these subdivisions aid in predicting recurrence and need for retreatment.
Methods:
A retrospective review of all patients undergoing endovascular coiling between 2013 and 2014. Patients requiring stent assistance or other embolization devices were excluded from the study. The neck residue was graded at time of coiling on the cerebral angiogram and subsequent 6, 24, and 60 months MRA. Correlation between grade at coiling and follow-up with need for subsequent retreatment was assessed.
Results:
Overall, 17/200 (8.5%) cases required retreatment within 5 years of initial coiling. 4/130 (3.1%) required retreatment within 5 years with initial Grade 0 at coiling, 6/24 cases (25%) of those Grade 2a, 4/20 cases (20%) Grade 2b, 3/8 (38%) Grade 3, and none of those with Grade 1. Large aneurysms ≥11 mm had an increased risk of aneurysm recurrence and retreatment. About 9.7% of ruptured aneurysms required retreatment versus 4.4% for unruptured. About 55% of carotid ophthalmic aneurysms were retreated.
Conclusion:
Although the modified classification system was significantly predictive of progressive recurrence and need for retreatment, no significant difference between the subdivisions of Grade 2 was observed. Similar predictive value was seen when using the Raymond-Roy classification compared to the new modified, limiting the usefulness of the new system in clinical practice.
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6
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Diana F, Pesce A, Toccaceli G, Muralidharan V, Raz E, Miscusi M, Raco A, Missori P, Peschillo S. Microsurgical clipping versus newer endovascular techniques in treatment of unruptured anterior communicating artery-complex aneurysms: a meta-analysis and systematic review. Neurosurg Rev 2022; 45:1089-1100. [PMID: 34622332 DOI: 10.1007/s10143-021-01647-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/26/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
The aim of this study is to compare occlusion rate, complication rate, and clinical outcome of microsurgical clipping (MC) and advanced endovascular techniques (EVT) in unruptured anterior communicating artery-complex aneurysms (ACoCAs). We reviewed the scientific literature reporting occlusion rate, time of occlusion assessment, and clinical outcome of MC and EVT in patients with unruptured ACoCAs, from January 2009 to December 2019. We included in our analysis 25 studies and 872 patients with unruptured ACoCAs (434 treated with endovascular techniques and 438 with MC). Ninety-three (10.7%), 320 (36.7%), 21 (2.4%), and 438 (50.2%) were treated with flow diverter (FD), stent-assisted coiling (SAC), endosaccular devices (ES), and microsurgical clipping (MC) respectively. FD, SAC, ES, and MC subgroups presented minor complications in 11.8%, 3.8%, 14.3%, and 7.1% of cases (p=.016), and major complications in 3.2%, 4.4%, 0%, and 7.1% (p=.136) of patients. A total occlusion rate post-treatment has been achieved in 4.3%, 87.1%, 47.6%, and 98.2% of cases (p=.000), while at 12 months' follow-up in 50%, 66%, 83.3%, and 80% of patients (p=.001). FD, SAC, ES, and MC subgroups had a good clinical outcome at 12 months in 93.5%, 90.5%, 100%, and 67.8% of cases. MC is associated with higher post-treatment total occlusion rate, but higher complication and lower good clinical outcome rates. EVT are promising in treating unruptured anterior cerebral artery aneurysms with high margin of safety and good clinical outcome, despite the lower total occlusion rate.
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Affiliation(s)
- F Diana
- Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - A Pesce
- Department of Neurosurgery, Ospedale Santa Maria Goretti, Latina, Italy
| | - G Toccaceli
- Department of Emergency Neurosurgery, Ospedale Civile "Santo Spirito" di Pescara, Pescara, Italy.
| | - V Muralidharan
- Division of Neurosurgery, Panimalar Medical College Hospital and Research Institute, Chennai, India
| | - E Raz
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - M Miscusi
- Operative Unit of Neurosurgery, AOSA, Department of NESMOS, Sapienza, Rome, Italy
| | - A Raco
- Operative Unit of Neurosurgery, AOSA, Department of NESMOS, Sapienza, Rome, Italy
| | - P Missori
- Department of Human Neurosciences, Neurosurgery, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - S Peschillo
- Department of Surgical Medical Sciences and Advanced Technologies "G.F. Ingrassia" - Endovascular Neurosurgery, University of Catania, Catania, Italy
- Pia Fondazione Cardinale Giovanni Panico Hospital, Tricase, LE, Italy
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7
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Yasuda R, Satow T, Hashimura N, Nishimura M, Takahashi JC, Kataoka H. Usefulness of Craniograms in Discriminating Coiled Intracranial Aneurysms Requiring Retreatment. Neurol Med Chir (Tokyo) 2021; 62:118-124. [PMID: 34880195 PMCID: PMC8918367 DOI: 10.2176/nmc.oa.2021-0225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
While endovascular coil embolization has become one of the major therapeutic modalities for intracranial aneurysms, long-term imaging follow-up is required because of the higher rate of retreatment compared with surgical clipping. The purpose of this study was to show the usefulness of craniograms to discriminate coiled intracranial aneurysms that required retreatment. Under the study protocol approved by institutional review board, a retrospective review of the medical record was done regarding coil embolization for intracranial aneurysms performed between January 2014 and December 2018. Coil embolization performed as the initial treatment and followed up for more than 1 year without additional treatment, and those performed as retreatment after the initial coil embolization performed at our institution were recruited. Craniograms obtained just after the initial treatment were compared with those obtained just before the additional treatment in the retreated cases and compared with the latest ones in the non-recurrence cases. Correlation between the morphological changes in the coil mass on the craniograms and retreatments was evaluated. During the study period, 288 coil embolization procedures for intracranial aneurysms were performed. From these, 191 treatments that were followed up for more than 1 year without any additional treatments and 30 retreatments were included. Morphological change of the coil mass was observed in 4 of the 191 non-recurrence treatments and 26 of the 30 retreatments, which was significantly correlated with retreatments (p <0.001). Craniogram was a useful modality in following up the coiled intracranial aneurysms to detect those required retreatments.
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Affiliation(s)
- Ryuta Yasuda
- Department of Neurosurgery, National Cerebral and Cardiovascular Center.,Department of Neurosurgery, Mie Graduate school of Medicine, Faculty of Medicine
| | - Tetsu Satow
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Naoki Hashimura
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Masaki Nishimura
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Jun C Takahashi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
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8
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Jesser J, Alberalar ND, Kizilkilic O, Saatci I, Baltacioglu F, Özlük E, Killer-Oberpfalzer M, Vollherbst DF, Islak C, Cekirge SH, Bendszus M, Möhlenbruch M, Koçer N. Safety and Efficacy of the FRED Jr Flow Re-Direction Endoluminal Device for Intracranial Aneurysms: Retrospective Multicenter Experience With Emphasis on Midterm Results. Front Neurol 2021; 12:722183. [PMID: 34659086 PMCID: PMC8518710 DOI: 10.3389/fneur.2021.722183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/02/2021] [Indexed: 02/03/2023] Open
Abstract
Background and Purpose: Flow diversion is increasingly used as an endovascular treatment for intracranial aneurysms. In this retrospective multicenter study, we analyzed the safety and efficacy of the treatment of intracranial, unruptured, or previously treated but recanalized aneurysms using Flow Re-Direction Endoluminal Device (FRED) Jr with emphasis on midterm results. Materials and Methods: Clinical and radiological records of 150 patients harboring 159 aneurysms treated with FRED Jr at six centers between October 2014 and February 2020 were reviewed and consecutively included. Clinical outcome was measured by using the modified Rankin Scale (mRS). Anatomical results were assessed according to the O'Kelly-Marotta (OKM) scale and the Cekirge-Saatci Classification (CSC) scale. Results: The overall complication rate was 24/159 (16%). Thrombotic-ischemic events occurred in 18/159 treatments (11%). These resulted in long-term neurological sequelae in two patients (1%) with worsening from pre-treatment mRS 0–2 and mRS 4 after treatment. Complete or near-complete occlusion of the treated aneurysm according to the OKM scale was reached in 54% (85/158) at 6-month, in 68% (90/133) at 1-year, and in 83% (77/93) at 2-year follow-up, respectively. The rates of narrowing or occlusion of a vessel branch originating from the treated aneurysm according to the CSC scale were 11% (12/108) at 6-month, 20% (17/87) at 1-year, and 23% (13/57) at 2-year follow-up, respectively, with all cases being asymptomatic. Conclusions: In this retrospective multicenter study, FRED Jr was safe and effective in the midterm occlusion of cerebral aneurysms. Most importantly, it was associated with a high rate of good clinical outcome.
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Affiliation(s)
- Jessica Jesser
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Nilüfer D Alberalar
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Leipzig, Germany
| | - Osman Kizilkilic
- Department of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Isil Saatci
- Interventional Neuroradiology Section, Koru and Bayindir, Private Hospitals, Ankara, Turkey
| | - Feyyaz Baltacioglu
- Department of Radiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Enes Özlük
- Department of Radiology, Acibadem Atakent Hospital, Istanbul, Turkey
| | | | - Dominik F Vollherbst
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Civan Islak
- Department of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Saruhan H Cekirge
- Interventional Neuroradiology Section, Koru and Bayindir, Private Hospitals, Ankara, Turkey
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Naci Koçer
- Department of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul, Turkey
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9
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Cooper JB, Li B, Kaur G, Gandhi CD, Santarelli JG. Pipeline embolization of ruptured, previously coiled cerebral aneurysms: Case series and considerations for management. Brain Circ 2021; 7:111-117. [PMID: 34189354 PMCID: PMC8191537 DOI: 10.4103/bc.bc_59_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 12/05/2022] Open
Abstract
PURPOSE: Aneurysmal recurrence represents a significant drawback of endovascular coiling, particularly in aneurysms that have previously ruptured. Given the high recurrence rate of coiled aneurysms and particularly the risk of posttreatment rupture in previously ruptured aneurysms that have been treated by coiling, the question of how best to treat ruptured aneurysms that recur postcoiling remains. MATERIALS AND METHODS: We conducted a retrospective analysis of twenty patients who underwent pipeline embolization of previously ruptured, coiled cerebral aneurysms. RESULTS: Pipeline embolization device (PED) treatment resulted in complete aneurysmal occlusion in 10 patients (62.5%) at first angiographic follow-up, and 11 patients (68.75%) at last follow-up. No PED-related complications were encountered and there were no peri-procedural or postprocedural hemorrhages, or symptomatic ischemic events following flow diversion. CONCLUSIONS: PED as a second-line treatment is a safe and effective modality for achieving aneurysmal occlusion in recurrent, previously ruptured, primarily coiled aneurysms. Additionally, a staged coil-to-PED approach may be considered for the management of acutely ruptured aneurysms to achieve aneurysmal obliteration in an effort to mitigate recurrence, and reduce the amount of postprocedural studies.
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Affiliation(s)
- Jared B Cooper
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Boyi Li
- School of Medicine, School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Gurmeen Kaur
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Chirag D Gandhi
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Justin G Santarelli
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
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Shao Q, Li Q, Wu Q, Li T, Li L, Chang K, He Y. Application of 3D T1-SPACE combined with 3D-TOF sequence for follow-up evaluation of stent-assisted coil embolization for intracranial aneurysm. J Interv Med 2021; 4:71-76. [PMID: 34805951 PMCID: PMC8562288 DOI: 10.1016/j.jimed.2021.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess 3D T1-SPACE combined with 3D-TOF sequence for follow-up evaluation of stent-assisted coil embolization for intracranial aneurysm. MATERIALS AND METHODS Between Oct 2018 and May 2019, we enrolled 25 patients with intracranial aneurysm who underwent stent-assisted coil embolization. All patients were followed up for 6 to10 months after endovascular treatment (EVT) using 3D-TOF MRA, 3D T1-SPACE and DSA to evaluate aneurysm occlusion and parent artery patency. RESULTS With regards to aneurysm occlusion, the specificity of 3D-TOF MRA was 86.9% (20/23) and the accuracy was 84% (21/25). There was no statistical significance (P = 0.409) compared with the DSA. The parent artery by 3D-TOF MRA showed that there were 14 patients with grade 3, 8 patients with grade 2 and 3 patients with grade 1. However, 3D T1-SPACE showed that all 25 patients were grade 4, and were clearly displayed without metal artifacts. The comparison of the two MR techniques demonstrated that 3D T1-SPACE was superior to 3D-TOF MRA in the evaluation of parent artery (P<0.001). CONCLUSIONS 3D T1-SPACE sequence provides better image quality and higher accuracy for evaluating stented parent arteries compared to TOF-MRA. This study also shows that 3D-TOF MRA has a merit to evaluate aneurysm occlusion. The combination of these two modalities can be used as an optional follow-up evaluation after EVT of intracranial aneurysms.
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Affiliation(s)
- Qiuji Shao
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
| | - Qiang Li
- Department of Radiology, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
| | - Qiaowei Wu
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
| | - Tianxiao Li
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
| | - Li Li
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
| | - Kaitao Chang
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
| | - Yingkun He
- Department of Cerebrovascular Disease, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Henan University People’s Hospital, Zhengzhou, 450003, Henan, China
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11
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Yamaguchi S, Ito O, Osaki M, Haruyama H, Nitta T, Sayama T, Arakawa S, Iihara K. Narrowing of the angle of the parent artery after coil embolization increases the risk for aneurysm recurrence. Clin Neurol Neurosurg 2021; 203:106568. [PMID: 33677365 DOI: 10.1016/j.clineuro.2021.106568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/05/2021] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Aneurysm recurrence after coiling is a major complication in some cases, including cases of repeated recurrences. In this study, we identified a relationship between the recurrence of a coiled aneurysm and angle change of the parent artery. METHODS From April 2008 to December 2019, we performed 283 coil embolizations to treat 256 aneurysms in 251 patients. Among these, 21 cases of recurrent saccular aneurysms were selected. The parent artery angle changes between the initial treatment and the first re-treatment were compared between those who underwent single re-treatment and showed no recurrence after the first re-treatment (Group SR, n = 14) and those who required multiple re-treatments (Group MR, n = 7). RESULTS The parent artery angles at the first treatment [medians (interquartile ranges)] were 121.6° (109.3-135.6°) in Group SR and 104.9° (89.9-131.0°) in Group MR; at the second treatment, these angles were 121.2° (105.5-132.7°) and 81.9° (67.0-111.4°), respectively, revealing angle changes of -2.2° (-4.0 to -0.4°) and -16.4° (-30.1 to -8.6°) in Groups SR and MR between the first and second treatments. The between-group differences in the parent artery angles at the second treatment and the changes in the parent artery angle between the first and second treatments were statistically significant. CONCLUSION In patients with recurrent aneurysms, simple aneurysm coiling is not effective when the angle of the parent artery becomes narrower after treatment, relative to that before treatment. Stent placement should be considered for straightening the parent artery or diverting blood flow.
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Affiliation(s)
- Shinya Yamaguchi
- Department of Neurosurgery, Steel Memorial Yawata Hospital, 1-1-1, Harunomachi, Yahatahigashi-Ku Kitakyushu, Fukuoka, 805-0050, Japan.
| | - Osamu Ito
- Department of Neurosurgery, Fukuoka Kieikai Hospital, 5-11-5 Chihaya, Higashi-ku, Fukuoka, 813-0044, Japan
| | - Masato Osaki
- Department of Cerebrovascular Disease, Steel Memorial Yawata Hospital, 1-1-1, Harunomachi, Yahatahigashi-Ku Kitakyushu, Fukuoka, 805-0050, Japan
| | - Hironori Haruyama
- Department of Neurosurgery, Steel Memorial Yawata Hospital, 1-1-1, Harunomachi, Yahatahigashi-Ku Kitakyushu, Fukuoka, 805-0050, Japan
| | - Tomohiko Nitta
- Department of Cerebrovascular Disease, Steel Memorial Yawata Hospital, 1-1-1, Harunomachi, Yahatahigashi-Ku Kitakyushu, Fukuoka, 805-0050, Japan
| | - Tetsuro Sayama
- Department of Neurosurgery, Steel Memorial Yawata Hospital, 1-1-1, Harunomachi, Yahatahigashi-Ku Kitakyushu, Fukuoka, 805-0050, Japan
| | - Shuji Arakawa
- Department of Cerebrovascular Disease, Steel Memorial Yawata Hospital, 1-1-1, Harunomachi, Yahatahigashi-Ku Kitakyushu, Fukuoka, 805-0050, Japan
| | - Koji Iihara
- National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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