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Mansourian E, Pavlin-Premrl D, Friedman J, Jhamb A, Khabaza A, Brooks M, Asadi H, Maingard J. High-frequency optical coherence tomography for endovascular management of cerebral aneurysms. J Med Imaging Radiat Oncol 2024; 68:447-456. [PMID: 38654682 DOI: 10.1111/1754-9485.13660] [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: 01/17/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024]
Abstract
Endovascular management of intracranial aneurysms has become the mainstay of treatment in recent years; however, retreatment rates remain as high as 1 in 5. High-frequency optical coherence tomography (HF-OCT) is an emerging imaging modality for the assessment, treatment and follow-up of cerebral aneurysms. EMBASE and SCOPUS databases were searched for studies relating to the management of intracranial aneurysm with OCT. A combination of keywords were used including 'cerebral aneurysm', 'intracranial aneurysm', 'high-frequency optical coherence tomography', 'optical coherence tomography', and 'optical frequency domain imaging'. There were 23 papers included in this review. For the assessment of intracranial aneurysm, OCT was able to accurately assess aneurysm morphology as well as detailed analysis of arterial wall layers. During IA treatment, OCT was used to assess and troubleshoot stent placement to optimise successful isolation from the circulation. In the follow-up period, endothelial growth patterns were visualised by OCT imaging. OCT shows promise for the treatment of IAs at all stages of management. Due to the novel development of HF-OCT, there is limited longitudinal data in human studies. Further research in this area is required with a focus specifically on long-term treatment outcomes in humans.
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Affiliation(s)
- Elizabeth Mansourian
- Radiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Davor Pavlin-Premrl
- Radiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Neurointerventional Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Joshua Friedman
- Radiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Ash Jhamb
- Radiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Ali Khabaza
- Radiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Neurointerventional Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Mark Brooks
- Radiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Neurointerventional Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Hamed Asadi
- Radiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Neurointerventional Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
- Interventional Neuroradiology Department, Monash Health, Clayton, Victoria, Australia
- School of Medicine, Faculty of Health, Deakin University, Warun Ponds, Victoria, Australia
| | - Julian Maingard
- Radiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Neurointerventional Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
- School of Medicine, Faculty of Health, Deakin University, Warun Ponds, Victoria, Australia
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Lauzier DC, Cler SJ, Chatterjee AR, Osbun JW, Moran CJ, Kansagra AP. Retreatment of previously flow diverted intracranial aneurysms with the pipeline embolization device. Interv Neuroradiol 2023; 29:710-714. [PMID: 35758311 PMCID: PMC10680950 DOI: 10.1177/15910199221111284] [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: 04/24/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Flow diversion of intracranial aneurysms with the Pipeline Embolization Device (PED) is frequently performed, but the outcomes of retreatment for aneurysms that failed to occlude after prior treatment with PED have not been well studied. Here, we report the safety and efficacy of PED retreatment after initial failure to occlude. MATERIALS AND METHODS Clinical and angiographic data from eligible patients were retrospectively assessed for demographics, aneurysm occlusion status, and clinical outcomes. Patients were included in this study if they underwent PED retreatment to treat an aneurysm that had previously been treated with PED. RESULTS Retreatment of previously flow-diverted aneurysms with PED was performed in 42 cases. At final angiographic follow-up, angiographic improvement was observed after 45% (19/42) of retreatments and complete aneurysm occlusion was observed following 26% (11/42). Significant clinical complications occurred in 10% (4/42) of PED retreatments. CONCLUSIONS Retreatment of intracranial aneurysms with PED following initial failure to achieve aneurysm occlusion has a low rate of subsequent complete aneurysm occlusion.
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Affiliation(s)
- David C Lauzier
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Samuel J Cler
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Arindam R Chatterjee
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua W Osbun
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher J Moran
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Akash P Kansagra
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
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Ma C, Zhu H, Liang S, Liang F, Han J, Jia Z, Zhang Y, Jiang C. Pipeline for the treatment of distal cerebral circulation aneurysms: A multicenter study focusing on periprocedural Complications. Interv Neuroradiol 2022; 28:708-718. [PMID: 34913765 PMCID: PMC9706258 DOI: 10.1177/15910199211063703] [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: 08/31/2021] [Accepted: 11/11/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND AIM Distal cerebral circulation aneurysms (DCCAs) remain treatment challenges for neurointervention. The off-label use of the pipeline embolization device (PED) for these aneurysms remains controversial. This study aimed to evaluate the safety and efficacy of PED for DCCAs in a multicenter cohort of patients. METHODS Between March 2016 and June 2021, we retrospectively analyzed the neurointerventional data on the clinical and radiological records of all patients undergoing PED treatment of DCCAs at three medical centers. RESULTS A total of 53 consecutive patients with 53 DCCAs were treated with PED. The mean aneurysm size was 12.3 ± 5.7 mm. In total, 75.4% (40/53) were fusiform and 24.5% (13/53) were saccular. Of these, 17.0% (9/53) were recurrent aneurysms that were previously treated with endovascular or microsurgical approaches. The technical success rate was 100%, among which 81.1% (43/53) procedures were completed with a single PED, and the rest (10/53, 18.8%) required telescoping with two devices. Angiographic follow-up data were available for 51 patients, with a median follow-up time of 12 months. At the latest follow-up, 46/51 (90.2%) aneurysms showed complete obliteration, and 4/51 (7.8%) showed reduced filling. Periprocedural complications such as hemorrhage were observed in two patients with MCA aneurysms (3.8%, 2/53), and ischemic events occurred in six patients (11.3%, 6/53). The overall mortality and morbidity rates were 7% (4/53). CONCLUSIONS PED is a viable option for treating DCCAs, especially for recurrent aneurysms. Coverage of bifurcation branches and perforator may increase the risk of complications.
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Affiliation(s)
- Chao Ma
- Interventional Neuroradiology Center, Beijing Neurosurgical
Institute, Capital Medical University, Beijing, China
| | - Haoyu Zhu
- Interventional Neuroradiology Center, Beijing Neurosurgical
Institute, Capital Medical University, Beijing, China
| | - Shikai Liang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital,
School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Fei Liang
- Interventional Neuroradiology Center, Beijing Neurosurgical
Institute, Capital Medical University, Beijing, China
| | - Jintao Han
- Department of Vascular Surgery and Interventional Radiology, Peking University Third
Hospital, Beijing, China
| | - Zichang Jia
- Department of Vascular Surgery and Interventional Radiology, Peking University Third
Hospital, Beijing, China
| | - Yupeng Zhang
- Interventional Neuroradiology Center, Beijing Neurosurgical
Institute, Capital Medical University, Beijing, China
| | - Chuhan Jiang
- Interventional Neuroradiology Center, Beijing Neurosurgical
Institute, Capital Medical University, Beijing, China
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Han YF, Jiang P, Tian ZB, Chen XH, Liu J, Wu ZX, Gao BL, Ren CF. Risk factors for repeated recurrence of cerebral aneurysms treated with endovascular embolization. Front Neurol 2022; 13:938333. [PMID: 36247772 PMCID: PMC9556764 DOI: 10.3389/fneur.2022.938333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/02/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose To explore the risk factors of recurrence after second endovascular embolization of recurrent aneurysms and the characteristics of recurrent refractory aneurysms to help clinical decision-making. Materials and methods Forty-nine patients with recurrent aneurysms who underwent repeated embolization were retrospectively enrolled and divided into the recurrent and non-recurrent group. The risk factors of recurrence, complications and follow-up results of repeated embolization, and characteristics of recurrent refractory aneurysms were analyzed. Results Among the 49 patients with the second embolization, 5 were lost to follow-up, 9 recurred, and 35 did not. Univariate analysis showed that aneurysm size (P = 0.022), aneurysm classification (P = 0.014), and Raymond-Roy grade after the second embolization (P = 0.001) were statistically different between the two groups. Multivariate analysis demonstrated the Raymond-Roy grade as an independent risk factor for the recurrence of aneurysms after the second embolization (P = 0.042). The complication rate after the second embolization was 4%. There were five recurrent refractory aneurysms with an average aneurysm size of 23.17 ± 10.45 mm, including three giant aneurysms and two large aneurysms. To achieve complete or near-complete embolization of the recurrent refractory aneurysms, multiple treatment approaches were needed with multiple stents or flow diverting devices. Conclusion Aneurysm occlusion status after the second embolization is an independent risk factor for the recurrence of intracranial aneurysms. Compared with near-complete occlusion, complete occlusion can significantly reduce the risk of recurrence after second embolization. In order to achieve complete or near-complete occlusion, recurrent refractory aneurysms need multiple treatments with the use of multiple stents or flow diverting devices.
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Affiliation(s)
- Yong-Feng Han
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Peng Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Peng Jiang
| | - Zhong-Bin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xi-Heng Chen
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhong-Xue Wu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bu-Lang Gao
- Department of Neurosurgery, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Chun-Feng Ren
- Zhengzhou University First Affiliated Hospital, Zhengzhou, China
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Ma C, Zhu H, Liang S, Liang F, Sun J, Zhang Y, Jiang C. Comparison of Pipeline Embolization Device and Traditional Endovascular Therapeutic Approaches in Distal Cerebral Circulation Aneurysms Using Propensity Score Matching Analysis. Front Neurol 2022; 13:755122. [PMID: 35665044 PMCID: PMC9157485 DOI: 10.3389/fneur.2022.755122] [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: 08/08/2021] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Coiling and stent-assisted coiling remain the first-line treatments for distal cerebral circulation aneurysms (DCCAs). The off-label use of the pipeline embolization device (PED) for these aneurysms has been explored recently but remains controversial. Objective To compare traditional endovascular therapeutic approaches (coiling and stent-assisted coiling) and PED for DCCAs in a multicenter cohort of patients. Methods A multicenter, retrospective cohort comparison study was conducted that included consecutive patients with unruptured DCCAs treated with either traditional endovascular therapeutic approaches or PED placement at three centers between 2016 and 2020. Propensity score matching analysis was applied to adjust for baseline risk factors between the PED and TET groups. Matching was based on age, sex, aneurysm size, location, morphology, adjunctive coiling, treatment history, and preoperative mRS score. Results In total, 209 patients with DCCAs treated with PED or traditional endovascular therapeutic approaches were identified. Thirty-seven patients underwent PED treatment, and 172 patients underwent traditional endovascular therapeutic approaches. After propensity score matching, 37 aneurysm pairs were matched, and the baseline characteristics of the patients were balanced between the groups. The complete occlusion rate between PED and traditional endovascular therapeutic approach in both matched cohorts (91.7 vs. 92.3%, p > 0.78) was similar. The rate of periprocedural treatment-related complications in both the PED and traditional endovascular therapeutic groups was 13.5%. Univariate analysis identified average parent vessel diameter as the only predictor of complete occlusion (p = 0.038). Conclusions PED is a viable option for treating DCCAs by providing occlusion and complication rates similar to those of traditional endovascular therapeutic approaches. A rigid patient selection procedure and proper planning should be undertaken to reduce treatment-related complications.
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Affiliation(s)
- Chao Ma
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Haoyu Zhu
- Interventional Neuroradiology Center, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shikai Liang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Fei Liang
- Interventional Neuroradiology Center, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jidian Sun
- Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yupeng Zhang
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Yupeng Zhang
| | - Chuhan Jiang
- Interventional Neuroradiology Center, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Chuhan Jiang
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Metayer T, Lechanoine F, Bougaci N, de Schlichting E, Terrier L, Derrey S, Barbier C, Papagiannaki C, Ashraf A, Tahon F, Leplus A, Gay E, Emery E, Briant AR, Vivien D, Gaberel T. Retreatment of previously treated intracranial aneurysm: Procedural complications and risk factors for complications. Neurochirurgie 2021; 68:150-155. [PMID: 34487752 DOI: 10.1016/j.neuchi.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Intracranial aneurysm (IA) is a frequent vascular malformation that can be managed by endovascular treatment (EVT) or microsurgery. A previously treated IA can recanalize, which may require further treatment. The aim of our study was to evaluate procedural complications related to IA retreatment and their risk factors. METHODS All patients retreated for IA between 2007 and 2017 in 4 hospitals were included. We retrospectively reviewed the frequency of procedural complications of IA retreatment, defined as death or≥1-point increase in modified Rankin score 24h after the procedure. We then screened for risk factors of procedural complications by comparing the characteristics of patients with and without complications. RESULTS During the inclusion period, 4,997 IAs were treated in our 4 institutions. Of these, 237 (4.7%) were retreated. 29 (12.2%) had≥1 procedural complication. However, severe complications, defined as death or dependency at 1 month, occurred only in 3 patients (1.3%). The only risk factor for complications was microsurgical clipping as retreatment. CONCLUSIONS Procedural complications during IA retreatment were frequent but, in most cases, retreatment did not lead to death or severe disability. The only risk factor for complications of IA retreatment was clipping as retreatment. However, the design of the study did not allow any conclusion to be drawn as to the optimal means of aneurysm retreatment, and further studies are needed.
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Affiliation(s)
- T Metayer
- Department of Neurosurgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14000 Caen, France; Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France.
| | - F Lechanoine
- Department of Neurosurgery, University Hospital of Grenoble, 38000 Grenoble, France
| | - N Bougaci
- Department of Neurosurgery, University Hospital of Nice, 06000 Nice, France
| | - E de Schlichting
- Department of Neurosurgery, University Hospital of Grenoble, 38000 Grenoble, France
| | - L Terrier
- Department of Neurosurgery, University Hospital of Rouen, 76000 Rouen, France
| | - S Derrey
- Department of Neurosurgery, University Hospital of Nice, 06000 Nice, France
| | - C Barbier
- Department of Neurosurgery, University Hospital of Rouen, 76000 Rouen, France; Department of Biostatistics, University Hospital of Caen, Caen, France
| | - C Papagiannaki
- Department of Neuroradiology, University Hospital of Caen, 14000 Caen, France
| | - A Ashraf
- Department of Neurosurgery, University Hospital of Grenoble, 38000 Grenoble, France
| | - F Tahon
- Department of Neuroradiology, University Hospital of Rouen, 76000 Rouen, France
| | - A Leplus
- Department of Neurosurgery, University Hospital of Nice, 06000 Nice, France
| | - E Gay
- Department of Neurosurgery, University Hospital of Grenoble, 38000 Grenoble, France
| | - E Emery
- Department of Neurosurgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14000 Caen, France; Department of Neuroradiology, University Hospital of Grenoble, 38000 Grenoble, France
| | - A R Briant
- Medical School, University of Caen Normandy, 14000 Caen, France; Department of Biostatistics, University Hospital of Caen, Caen, France
| | - D Vivien
- Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France; Department of Neuroradiology, University Hospital of Grenoble, 38000 Grenoble, France
| | - T Gaberel
- Department of Neurosurgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14000 Caen, France; Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France.
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da Silva Júnior NR, Trivelato FP, Nakiri GS, Rezende MTS, de Castro-Afonso LH, Abud TG, Vanzin JR, Manzato LB, Ulhôa AC, Abud DG, Giannetti AV. Endovascular treatment of residual or recurrent intracranial aneurysms after surgical clipping. J Cerebrovasc Endovasc Neurosurg 2021; 23:221-232. [PMID: 34470100 PMCID: PMC8497721 DOI: 10.7461/jcen.2021.e2021.03.001] [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: 03/16/2020] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Total aneurysm occlusion is crucial for the prevention of rebleeding of a ruptured aneurysm or to avoid rupture of an unruptured lesion. Both surgical and endovascular embolization fail to achieve complete aneurysm occlusion in all the cases. The objective of the study was to establish the safety and efficacy of endovascular treatment for previously clipped residual or recurrent aneurysms. METHODS This was an observational, retrospective study of patients harboring incompletely occluded intracranial aneurysms after clipping who underwent endovascular treatment. Patients were treated using 4 different techniques: (1) simple coiling, (2) balloon remodeling, (3) stent-assisted coiling, and (4) flow diversion. Analyses were performed to identify predictors of total aneurysm occlusion, recanalization and complications. RESULTS Between May 2010 and September 2018, 70 patients harboring incompletely occluded intracranial aneurysms after clipping met the inclusion criteria in 5 centers. The mean residual aneurysm size was 7.5 mm. Fifty-nine aneurysms were unruptured. Total aneurysm occlusion was achieved in 75.3% of the aneurysms after 1 year. All aneurysms treated with flow diversion revealed complete occlusion according to control angiography. Recanalization was observed in 14.5%. Permanent morbidity and mortality occurred in 2.9% and 1.4% of the patients, respectively. CONCLUSIONS Endovascular treatment of recurrent or residual aneurysms after surgical clipping was safe and efficacious. Flow diversion seems to be associated with better anatomical results. A more rigid study, a larger group of patients, and longterm follow-up are required to provide stronger conclusions about the best approach for residual clipped aneurysms.
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Affiliation(s)
| | - Felipe Padovani Trivelato
- Division of Interventional Neuroradiology, Felício Rocho Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Guilherme Seizem Nakiri
- Division of Interventional Neuroradiology, Hospital das Clínicas, Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Luís Henrique de Castro-Afonso
- Division of Interventional Neuroradiology, Hospital das Clínicas, Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Thiago Giansante Abud
- Division of Interventional Neuroradiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - José Ricardo Vanzin
- Division of Interventional Neuroradiology, Hospital de Clínicas, Passo Fundo, Rio Grande do Sul, Brazil
| | - Luciano Bambini Manzato
- Division of Interventional Neuroradiology, Hospital de Clínicas, Passo Fundo, Rio Grande do Sul, Brazil
| | - Alexandre Cordeiro Ulhôa
- Division of Interventional Neuroradiology, Felício Rocho Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Daniel Giansante Abud
- Division of Interventional Neuroradiology, Hospital das Clínicas, Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Alexandre Varella Giannetti
- Department of Neurosurgery, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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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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9
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Li W, Zhu W, Sun X, Liu J, Wang Y, Wang K, Zhang Y, Yang X, Zhang Y. Retreatment With Flow Diverters and Coiling for Recurrent Aneurysms After Initial Endovascular Treatment: A Propensity Score-Matched Comparative Analysis. Front Neurol 2021; 12:625652. [PMID: 34149588 PMCID: PMC8209336 DOI: 10.3389/fneur.2021.625652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Flow diverters and conventional coiling are established modalities for the retreatment of intracranial recurrent aneurysms after initial endovascular treatment. We aimed to compare the efficacy of these techniques. Methods: We retrospectively analyzed data for patients with recurrent aneurysms after initial endovascular treatment retreated in our center with either a pipeline embolization device (PED) or conventional coil embolization from January 2012 to July 2020. We performed 1:2 propensity score matching (PSM) using the nearest neighbor method. We controlled for: initial treatment strategy, aneurysm size, neck diameter, symptom presentation, history of aneurysm rupture, age, sex, fusiform-dissecting aneurysm, bifurcation aneurysm, and aneurysm location. The clinical and morphological factors of all patients at initial treatment and the angiographic and clinical results at the second treatment were collected and compared between the propensity-matched pairs. Results: A total of 105 intracranial aneurysms were identified; 18 patients (17.1%) were treated with a PED, and 87 (82.9%) were treated via conventional coil embolization. PSM resulted in 12 matched pairs (12 patients in the PED group and 24 in the coiling group). There was no significant difference of ischemic and hemorrhagic complications between the groups, the obliteration rate of branches covered by stent, or modified Rankin Scale scores at the last clinical follow-up. Importantly, the retreatment strategy in the PED group provided significantly different results vs. the coiling group (P < 0.001), with a lower recurrence rate (0.0 vs. 29.2%, respectively; P = 0.037). However, the procedural failure rate and the parent artery stenosis were more frequently in PED group compared with coiling group (both were 16.7 vs. 0.0%; P = 0.040). Conclusions: Endovascular retreatment for recurrent aneurysms after initial endovascular treatment might be safe and effective. Flow diverters might be associated with reduced risk of recanalization and an increased risk of procedural failure and mild parent artery stenosis.
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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
| | - Wei Zhu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinguo Sun
- Department of Neurosurgery, Binzhou People's Hospital, Binzhou, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Wang
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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10
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Harker P, Regenhardt RW, Alotaibi NM, Vranic J, Robertson FC, Dmytriw AA, Ku JC, Koch M, Stapleton CJ, Leslie-Mazwi TM, Serna N, Pabon B, Mejia JA, Patel AB. The Woven EndoBridge device for ruptured intracranial aneurysms: international multicenter experience and updated meta-analysis. Neuroradiology 2021; 63:1891-1899. [PMID: 34031704 DOI: 10.1007/s00234-021-02727-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/26/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The Woven EndoBridge (WEB) can be used to treat wide-necked aneurysms without antiplatelet medications, suggesting it may have advantages in the setting of aneurysmal subarachnoid hemorrhage (aSAH). The goal was assessment of safety and efficacy of WEB in aSAH given the delayed nature of aneurysmal thrombosis. METHODS An international retrospective analysis of patients with aSAH treated with WEB was conducted at 7 tertiary centers from 2016 to 2020. Outcomes included rates of rebleeding, retreatment, complications, and complete occlusion. Furthermore, a systematic review and meta-analysis was conducted from 2011 to 2020 assessing the same outcomes. All pooled event rates were calculated using a random effect model. RESULTS Consecutive patients with aSAH harbored 25 aneurysms that were treated with 29 WEB devices. The mean age was 53 years, and 65% were female. Zero experienced rebleeding, 2 were retreated, 2 experienced complications, 16 were completely occluded at 3 months, and 21 were completed occluded at 9-12 months. Meta-analysis of 309 WEB treatments for aSAH from 7 case series revealed 2.5% (95% CI 1-5%) had rebleeding, 9% (95% CI 4-17%) were retreated, 17% (95% CI 10-30%) had complications, and 61% (95% CI 51-71%) were completely occluded at 3-6 months. CONCLUSION WEB embolization in the setting of aSAH provides similar protection against rebleeding with comparable retreatment rates to traditional approaches. However, there is a higher rate of incomplete radiographic occlusion and operative complications compared to WEB embolization of unruptured aneurysms. Long-term prospective studies are needed to fully delineate the role of WEB embolization in aSAH.
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Affiliation(s)
- Pablo Harker
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Neuroendovascular Program, 55 Fruit St, WAC 745, Boston, MA, USA
| | - Robert W Regenhardt
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Neuroendovascular Program, 55 Fruit St, WAC 745, Boston, MA, USA
| | - Naif M Alotaibi
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Neuroendovascular Program, 55 Fruit St, WAC 745, Boston, MA, USA.,Department of Neurosurgery, King Fahad Medical City, National Neuroscience Institute, Riyadh, Saudi Arabia
| | - Justin Vranic
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Neuroendovascular Program, 55 Fruit St, WAC 745, Boston, MA, USA
| | - Faith C Robertson
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Neuroendovascular Program, 55 Fruit St, WAC 745, Boston, MA, USA
| | - Adam A Dmytriw
- Neuroradiology & Neurointervention Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Departments of Medical Imaging and Neurosurgery, University of Toronto, Toronto, ON, Canada.
| | - Jerry C Ku
- Departments of Medical Imaging and Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - Matthew Koch
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Neuroendovascular Program, 55 Fruit St, WAC 745, Boston, MA, USA
| | - Christopher J Stapleton
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Neuroendovascular Program, 55 Fruit St, WAC 745, Boston, MA, USA
| | - Thabele M Leslie-Mazwi
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Neuroendovascular Program, 55 Fruit St, WAC 745, Boston, MA, USA
| | - Nelson Serna
- AngioTeam Cerebrovascular, Endovascular Neurosurgery and Neuroradiology, Medellin, Colombia
| | - Boris Pabon
- AngioTeam Cerebrovascular, Endovascular Neurosurgery and Neuroradiology, Medellin, Colombia
| | - Juan A Mejia
- AngioTeam Cerebrovascular, Endovascular Neurosurgery and Neuroradiology, Medellin, Colombia
| | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Neuroendovascular Program, 55 Fruit St, WAC 745, Boston, MA, USA
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11
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Metayer T, Terrier L, de Schlichting E, Lechanoine F, Bougaci N, Derrey S, Barbier C, Papagiannaki C, Ashraf A, Tahon F, Leplus A, Naveau M, Gay E, Emery E, Lonjon M, Vivien D, Gaberel T. Rate of Rebleed and Retreatment of Previously Treated Intracranial Aneurysms. World Neurosurg 2021; 148:e650-e657. [PMID: 33497825 DOI: 10.1016/j.wneu.2021.01.050] [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: 11/15/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intracranial aneurysms (IAs) can be treated through endovascular treatment (EVT) or microsurgery (MS). Treated IAs can recanalize, which can lead to rupture or retreatment. OBJECTIVE The aim of our study was to evaluate the natural history of previously treated IA, by evaluating the risk of rupture and the risk of retreatment. METHODS All patients treated for an IA between 2007 and 2017 in 4 hospitals were included. The rate of (recurrent) hemorrhage and the rate of prophylactic retreatment were retrospectively evaluated. Kaplan-Meier survival analysis with log-rank tests was used to compare the rates of rupture or retreatment. Patients with ruptured and unruptured aneurysms were separated, and we compared the risk of retreatment between EVT and the surgical treatment. RESULTS A total of 4997 IAs were included in the study, corresponding to 20,489 patient-years. Overall, 28 (0.6%) aneurysms that had been previously treated demonstrated hemorrhage. Moreover, 237 (4.7%) aneurysms were retreated for recanalization without hemorrhage. The rate of retreatment was higher in the EVT-treated IAs as compared with the MS-treated IAs (LogRank: P < 0.0001) and higher in the previously ruptured IAs versus unruptured IAs (LogRank: P < 0.0001). However, the rate of posttreatment hemorrhage/IA rupture was similar for both groups. CONCLUSIONS The rate of IA retreatment is low; however, the rate of hemorrhage/rupture from treated IAs is even lower. A higher rate of retreatment was noted in EVT-treated IAs versus MS-treated IAs and in ruptured IAs versus unruptured IAs; however, the rate of hemorrhage or rerupture was comparable between the groups.
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Affiliation(s)
- Thomas Metayer
- Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie University, Cyceron, France.
| | - Laura Terrier
- Department of Neurosurgery, University Hospital, Rouen, France
| | | | | | - Nassim Bougaci
- Department of Neurosurgery, University Hospital, Nice, France
| | - Stephane Derrey
- Department of Neurosurgery, University Hospital, Rouen, France
| | - Charlotte Barbier
- Department of Neuroradiology, University Hospital of Caen, Caen, France
| | | | - Ahmad Ashraf
- Department of Neurosurgery, University Hospital, Grenoble, France
| | - Florence Tahon
- Department of Neuroradiology, University Hospital, Grenoble, France
| | - Aurelie Leplus
- Department of Neurosurgery, University Hospital, Nice, France
| | - Mikaël Naveau
- Normandie University, Cyceron, France; UMS 3408 Cyceron, CNRS, University of Caen Normandy, GIP CYCERON, Caen, France
| | - Emmanuel Gay
- Department of Neurosurgery, University Hospital, Grenoble, France
| | - Evelyne Emery
- Department of Neurosurgery, University Hospital of Caen, Caen, France; Medical School, University of Caen Normandy, Caen, France
| | - Michel Lonjon
- Department of Neurosurgery, University Hospital, Nice, France
| | - Denis Vivien
- Normandie University, Cyceron, France; UMS 3408 Cyceron, CNRS, University of Caen Normandy, GIP CYCERON, Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie University, Cyceron, France
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12
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Sharma RK, Asiri A, Yamada Y, Kawase T, Kato Y. Recurrence of Previously Clipped Anterior Communicating Aneurysm: The Surgical Techniques and Strategies: A Case Series. Asian J Neurosurg 2020; 15:120-125. [PMID: 32181184 PMCID: PMC7057874 DOI: 10.4103/ajns.ajns_107_19] [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: 04/16/2019] [Accepted: 10/04/2019] [Indexed: 11/06/2022] Open
Abstract
Background: Microsurgical aneurysm (MSA) clipping is considered as the standard therapy with the endovascular coiling. Microsurgical clipping is considered superior to endovascular in terms of the recurrence rate. The management of recurrent aneurysm following previous microsurgical clipping is challenging. The management of recurrent aneurysm following previous microsurgical clipping is challenging. This study aims to explore the management of recurrent aneurysm of the anterior communicating artery (ACoM). Materials and Methods: This is a case series of three elder women who had a recurrence of ACoM aneurysm after MSA clipping. All the three patients were operated with microsurgical clipping. We studied the preoperative images of the first surgery of all the patients. The detailed case-by-case analysis was performed based on preoperative, postoperative, and follow-up radiologic examinations and operative findings. Results: All three patients who had a recurrence after MSA clipping of ACoM aneurysm and were asymptomatic. At presentation, they were diagnosed at the postoperative imaging at follow-up. The earliest recurrence was 1 year while in one patient; the recurrence was detected 8 years after the initial MSA clipping. The cerebral aneurysms were posteriorly directed in the initial preoperative images in all the cases. Conclusion: This study revealed the recurrence as the residual neck or the enlargement of the aneurysm even after MSA in these cases of ACoM aneurysm. Even with the complete clipping, there can be recurrence at the clip site due to the change in hemodynamics over the time. We should follow-up the patients regularly even after microsurgical clipping.
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Affiliation(s)
- Rajan Kumar Sharma
- Department of Neurosurgery, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.,Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya, Japan
| | - Ahmed Asiri
- Department of Neurosurgery, King Faisal Medical City, Abha, Saudi Arabia
| | - Yasuhiro Yamada
- Department of Neurosurgery, King Faisal Medical City, Abha, Saudi Arabia
| | - Tsukasa Kawase
- Department of Neurosurgery, King Faisal Medical City, Abha, Saudi Arabia
| | - Yoko Kato
- Department of Neurosurgery, King Faisal Medical City, Abha, Saudi Arabia
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13
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Han Y, Liu J, Tian Z, Lv M, Yang X, Wu Z, Gao BL. Factors affecting recurrence and management of recurrent cerebral aneurysms after initial coiling. Interv Neuroradiol 2020; 26:300-308. [PMID: 31992106 DOI: 10.1177/1591019919901037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate factors affecting recurrence and effects and safety of endovascular retreatment for aneurysms recurrent after embolization. METHODS Among 815 aneurysms treated with embolization, recurrence was in 114 aneurysms (14.0%). Forty-three recurrent aneurysms were managed with re-embolization. Procedural complications, angiographic, and clinical results of retreatment were analyzed. RESULTS Patients with recurrent aneurysms were significantly (P < 0.01) younger than without recurrence (51.09 ± 10.46 vs. 53.88 ± 9.61 years). Recurrent aneurysms (n = 114) were significantly (P = 0.00) greater (11.12 ± 8.35 vs. 5.81 ± 3.44 mm) with a significantly (P = 0.00) greater neck (4.34 ± 2.26 vs. 2.90 ± 1.44 mm) than without recurrence. The rupture status of aneurysms significantly (P = 0.00) affected recurrence at follow-up. Significantly (P = 0.00) more aneurysms without recurrence were treated with advanced embolization techniques (81.0% vs. 62.3%) and got complete occlusion at the first embolization than those with recurrence (93.7% vs. 36.8%). In treating 43 recurrent aneurysms, stent-assisted recoiling was used in 48.8% in the first retreatment and 50% in the second and third retreatment procedures. Angiographic follow-up in 38 (88.4%) cases showed complete or near complete occlusion in 30 aneurysms, with the rest eight aneurysms experiencing a second recurrence (21.1%). Of the eight aneurysms with the second recurrence, five underwent the second endovascular retreatment, with complete aneurysm occlusion achieved in three cases (60%), near-complete occlusion in one (20%), and incomplete occlusion in one case at immediate angiography and six-month follow-up. Procedure-related complications occurred in three patients. CONCLUSIONS Endovascular retreatment of recurrent previously coiled aneurysms is safe and effective even though advanced embolization techniques are frequently involved especially for large and giant aneurysms.
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Affiliation(s)
- Yongfeng Han
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Shijiazhuang First Hospital, Shijiazhuang, Hebei, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongbin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongxue Wu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bu-Lang Gao
- Department of Neurosurgery, Shijiazhuang First Hospital, Shijiazhuang, Hebei, China
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14
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Satow T, Ikeda G, Takahashi JC, Iihara K, Sakai N. Coil Embolization for Unruptured Intracranial Aneurysms at the Dawn of Stent Era: Results of the Japanese Registry of Neuroendovascular Therapy (JR-NET) 3. Neurol Med Chir (Tokyo) 2020; 60:55-65. [PMID: 31956171 PMCID: PMC7040433 DOI: 10.2176/nmc.st.2019-0210] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Endosaccular coiling is recognized as a feasible method for treating unruptured intracranial aneurysms (UIAs). We retrospectively reviewed cases of UIAs treated by coiling in the Japanese Registry of Neuroendovascular Therapy (JR-NET) 3, a nationwide survey of NET between 2010 and 2014, the beginning period of intracranial stents in Japan. Data were extracted for 6844 UIAs (6619 procedures) from 40,169 registered records of all NETs in the JR-NET 3 databases. The features of the aneurysms and procedures, immediate radiographic findings, procedure-related complications, and clinical outcomes at 30 days after the procedures were assessed. Of 6844 UIAs, 81.8% were located in the anterior circulation. The mean patient age was 61.3 years (72.4% females). Compared with the preceding JR-NET 1 and 2, there were significant increases (P <0.05) in the rates of the following in JR-NET 3: wide-necked and small UIAs measuring <10 mm (from 56.4% to 58.8%), adjunctive techniques (54.8% to 71.8%), and stent usage (1.1% to 22.1%). Both pre- (85.6% to 96.7%) and post-procedural (84.0% to 94.6%) antiplatelet therapy were more frequently administered in JR-NET 3. Although procedure-related complication rates did not differ between the two groups, ischemic complication rates increased from 4.6% to 5.9%, leading to an increase in the 30-day morbidity (modified Rankin Scale >2) from 2.1% to 2.8%. In conclusion, introduction of neck-bridge stent was associated with an increase in cases of wide-necked aneurysms. However, the ischemic complication rate increased despite the greater use of periprocedural antiplatelet therapy.
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Affiliation(s)
- Tetsu Satow
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Go Ikeda
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Jun C Takahashi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital
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15
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Munich SA, Cress MC, Rangel-Castilla L, Sonig A, Ogilvy CS, Lanzino G, Petr O, Mocco J, Morone PJ, Snyder KV, Hopkins LN, Siddiqui AH, Levy EI. Neck Remnants and the Risk of Aneurysm Rupture After Endovascular Treatment With Coiling or Stent-Assisted Coiling: Much Ado About Nothing? Neurosurgery 2019. [PMID: 29528449 DOI: 10.1093/neuros/nyy056] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neck remnants are not uncommon after endovascular treatment of cerebral aneurysms. Critics of endovascular treatments for cerebral aneurysms cite neck remnants as evidence in favor of microsurgical clipping. However, studies have failed to evaluate the true clinical significance of aneurysm neck remnants following endovascular therapies. OBJECTIVE To assess the clinical significance of residual aneurysm necks and to determine the rate of subsequent rupture following coiling or stent-assisted coiling of cerebral aneurysms. METHODS We retrospectively reviewed the records of 1292 aneurysm cases that underwent endovascular treatment at 4 institutions. Aneurysms treated by primary coiling or stent-assisted coiling were included in the study; those treated by flow diversion were excluded Aneurysms with residual filling (i.e., Raymond-Roy Occlusion Classification II, neck remnant; or III, residual aneurysm filling) were assessed for their risk of subsequent rupture. RESULTS A total of 626 aneurysms were identified as having residual filling immediately posttreatment. Of these, 13 aneurysms (2.1%) ruptured during the follow-up period (mean 7.3 mo; range 1-84 mo). Eleven of the 13 (84.6%) were ruptured at presentation. Rupture at presentation, the size of the aneurysm, and the increasing age of the patient were predictive of posttreatment rupture. CONCLUSION We found that unruptured aneurysms with residual necks following endovascular treatment posed a very low risk of rupture (0.6%). However, patients presenting with ruptured aneurysms had a higher risk of rerupture from a neck remnant (3.4%). These results highlight the importance of achieving complete angiographic occlusion of ruptured aneurysms.
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Affiliation(s)
- Stephan A Munich
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Marshall C Cress
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Department of Neurosurgery, Orlando Health, Orlando, Florida
| | - Leonardo Rangel-Castilla
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Ashish Sonig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York
| | - Christopher S Ogilvy
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Ondra Petr
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - J Mocco
- Department of Neurosurgery, Mount Sinai School of Medicine, New York City, New York
| | - Peter J Morone
- Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Department of Neurology, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York.,Toshiba Stroke and Vascular Research Center at University at Buffalo, Buffalo, New York
| | - L Nelson Hopkins
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Toshiba Stroke and Vascular Research Center at University at Buffalo, Buffalo, New York.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York.,Jacobs Institute, Buffalo, New York
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Toshiba Stroke and Vascular Research Center at University at Buffalo, Buffalo, New York.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York.,Jacobs Institute, Buffalo, New York
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York.,Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.,Toshiba Stroke and Vascular Research Center at University at Buffalo, Buffalo, New York.,Department of Radiology, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York
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16
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Murakami T, Nishida T, Asai K, Kadono Y, Nakamura H, Fujinaka T, Kishima H. Long-Term Results and Follow-Up Examinations after Endovascular Embolization for Unruptured Cerebral Aneurysms. AJNR Am J Neuroradiol 2019; 40:1191-1196. [PMID: 31248865 DOI: 10.3174/ajnr.a6101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/13/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The appropriate period of follow-up examinations after endovascular embolization for cerebral aneurysms using time-of-flight MR angiography is not well-known. We retrospectively investigated long-term results after endovascular embolization for unruptured cerebral aneurysms and evaluated the periods from embolization to recanalization and retreatment. MATERIALS AND METHODS Between April 2006 and March 2011, one hundred forty-eight unruptured aneurysms were treated with endovascular coil embolization. Among them, we investigated 116 unruptured aneurysms, which were followed up for >5 years. Time-of-flight MR angiography was performed at 1 day, 3-6 months, 1 year after the procedure, and every year thereafter. RESULTS The mean follow-up period was 7.0 ± 1.4 years. Recanalization was observed in 19 (16.3%) aneurysms within 2 years. Among them, retreatment for recanalization was performed in 8 (6.8%) aneurysms. No recanalization was detected in any aneurysms that had been stable in the first 2 years after embolization. A larger maximum aneurysm size was significantly correlated with recanalization (P = .019). CONCLUSIONS Aneurysms in which recanalization was not observed within 2 years after endovascular coil embolization were stable during a mean follow-up of 7 years. This result may be helpful in considering the appropriate span or frequency of follow-up imaging for embolized cerebral aneurysms.
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Affiliation(s)
- T Murakami
- From the Department of Neurosurgery (T.M., T.N., K.A., Y.K., H.N., H.K.), Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Neurosurgery (T.M.), Osaka Neurological Institute, Osaka, Japan
| | - T Nishida
- From the Department of Neurosurgery (T.M., T.N., K.A., Y.K., H.N., H.K.), Osaka University Graduate School of Medicine, Osaka, Japan
| | - K Asai
- From the Department of Neurosurgery (T.M., T.N., K.A., Y.K., H.N., H.K.), Osaka University Graduate School of Medicine, Osaka, Japan
| | - Y Kadono
- From the Department of Neurosurgery (T.M., T.N., K.A., Y.K., H.N., H.K.), Osaka University Graduate School of Medicine, Osaka, Japan
| | - H Nakamura
- From the Department of Neurosurgery (T.M., T.N., K.A., Y.K., H.N., H.K.), Osaka University Graduate School of Medicine, Osaka, Japan
| | - T Fujinaka
- Department of Neurosurgery (T.F.), Osaka National Hospital, Osaka, Japan
| | - H Kishima
- From the Department of Neurosurgery (T.M., T.N., K.A., Y.K., H.N., H.K.), Osaka University Graduate School of Medicine, Osaka, Japan
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17
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Wu J, Tong X, Liu Q, Cao Y, Zhao Y, Wang S. Microsurgical ligation for incompletely coiled or recurrent intracranial aneurysms: a 17-year single-center experience. Chin Neurosurg J 2019; 5:7. [PMID: 32922907 PMCID: PMC7398258 DOI: 10.1186/s41016-019-0153-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background In this retrospective single-center study, we presented our experience in the microsurgical management of incompletely coiled or recurrent aneurysms after initial endovascular coiling. Methods During a 17-year period, 48 patients underwent microsurgical clipping of incompletely coiled or recurrent aneurysms after coiling (Gurian group B). The clinical data, surgical technique, and postoperative outcome were recorded and analyzed. Results Before coiling, 42 patients (87.5%) experienced aneurysm rupture. Most of the aneurysms (46/48, 96%) were located in the anterior circulation. After coiling, 6 patients had incompletely coiled aneurysms and 42 patients had recurrent aneurysms, with a mean time of 20.2 months from coiling to recurrence. Coil extrusion occurred in none of the incompletely coiled aneurysms and 71% (30/42) of the recurrent aneurysms. Clipping techniques are direct microsurgical clipping without coil removal in 16 patients, partial coil removal in 14 patients, and total coil removal in 18 patients. Postoperative and follow-up angiography revealed complete occlusion of the aneurysms in all patients. No patient died during postoperative follow-up period (mean, 78.9 months; range, 10-190 months). Good outcomes (GOS of 4 or 5) were achieved in 87.5% (42/48) of the patients at the final follow-up. Conclusions Microsurgical clipping is effective for incompletely coiled or recurrent aneurysms after initial coiling. For recurrent aneurysms that have coils in the neck, have no adequate neck for clipping, or cause mass effects on surrounding structures, partial or total removal of coiled mass can facilitate surgical clipping and lead to successful obliteration of the aneurysms.
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Affiliation(s)
- Jun Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Xianzeng Tong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingyuan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Yuanli Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China
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Raj R, Rautio R, Pekkola J, Rahi M, Sillanpää M, Numminen J. Treatment of Ruptured Intracranial Aneurysms Using the Woven EndoBridge Device: A Two-Center Experience. World Neurosurg 2019; 123:e709-e716. [DOI: 10.1016/j.wneu.2018.12.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
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19
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Kabbasch C, Goertz L, Siebert E, Herzberg M, Hamisch C, Mpotsaris A, Dorn F, Liebig T. Treatment strategies for recurrent and residual aneurysms after Woven Endobridge implantation. J Neurointerv Surg 2018; 11:390-395. [DOI: 10.1136/neurintsurg-2018-014230] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 11/03/2022]
Abstract
BackgroundWoven Endobridge (WEB) embolization is a safe and efficient technique for endovascular treatment of intracranial aneurysms. However, the management of aneurysm recurrence after WEB placement has not been well described to date. We present our multicenter experience of endovascular retreatment of aneurysm recurrence after WEB implantation.MethodsThis is a multicenter study of patients who underwent endovascular retreatment after WEB implantation in three German tertiary care centers. Treatment strategies, complications, and angiographic outcome were retrospectively assessed.ResultsAmong 122 aneurysms treated with the WEB device, 15 were retreated. Of these, six were initially treated with the WEB only, two were pretreated by coiling, and seven large aneurysms were treated in a multimodality approach. Ten were true aneurysm remnants and five were neck remnants. The reasons for retreatment were WEB migration (n=6), initial incomplete occlusion (n=5), and WEB compression (n=4). Retreatment strategies included coiling (n=4), stent-assisted coiling (n=7), flow diversion (n=3), and placement of an additional WEB (n=1). All procedures were technically successful and there were no procedure-related complications. Among 11 patients available for follow-up after retreatment, three were retreated again. At last angiographic follow-up, available in 11/15 cases at a median of 23 months, complete occlusion was obtained in eight cases and neck remnants in three.ConclusionsThis pilot study shows that endovascular retreatment of recurrent or residual aneurysms after WEB implantation can be done safely and can achieve adequate occlusion rates.
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Safety and Efficacy of Endovascular Treatment of Previously Clipped Aneurysms: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 114:e137-e150. [DOI: 10.1016/j.wneu.2018.02.103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 02/16/2018] [Accepted: 02/17/2018] [Indexed: 01/04/2023]
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Lee J, Lim JW, Cho YD. Follow-Up Outcomes After Re-Embolization for Recanalized Aneurysms After Initial Coiling: Further Recurrence Rates and Related Risk Factors. World Neurosurg 2018. [PMID: 29530696 DOI: 10.1016/j.wneu.2018.03.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although it is well known that coiled aneurysms can recanalize over time, long-term outcomes of re-embolization for recurred aneurysms have not been adequately investigated. We studied the retreatment outcomes of re-embolized aneurysms during follow-up monitoring and assessed the risk factors related to further recanalization. METHODS A total of 129 patients with 133 aneurysms were retrospectively reviewed. Each aneurysm was subjected to re-embolization because of major recanalization after initial coil embolization and underwent midterm and extended monitoring after retreatment. Cumulative medical records and radiologic data were assessed. Repeat recurrence rates and related risk factors were assessed by binary logistic regression analysis. RESULTS A total of 47 aneurysms (35.3%) showed re-recanalization at 6 months after re-embolization, with 17 and 30 instances of minor and major recanalization, respectively. Multivariate analysis indicated that posterior circulation (hazard ratio [HR], 6.129; P = 0.010), large aneurysm (>7 mm) (HR, 13.598; P < 0.001), and incomplete occlusion at the second coiling (HR, 9.975; P = 0.001) were significant factors for repeat recanalization. Of 86 aneurysms showing complete occlusion at the midterm, 76 were further evaluated (≥12 months), showing 18 aneurysms (23.7%) of delayed re-recanalization during a follow-up of 230.1 aneurysm-years. Of 15 aneurysms with minor recanalization at 6 months, 6 (40.0%) progressed to major recanalization during a follow-up of 44.0 aneurysm-years. CONCLUSIONS Most re-coiled aneurysms (64.7%) showed complete occlusion at the 6-month follow-up. However, posterior circulation, large aneurysm (>7 mm), and incomplete occlusion at the second coiling were risks for further recanalization. The midterm and delayed re-recanalization rates of the re-embolized aneurysms seem to be higher than those of the initial aneurysms.
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Affiliation(s)
- Jeongjun Lee
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Ilsan, Korea
| | - Jeong Wook Lim
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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“Coil mainly” policy in management of intracranial ACoA aneurysms: single-centre experience with the systematic review of literature and meta-analysis. Neurosurg Rev 2017; 41:825-839. [DOI: 10.1007/s10143-017-0932-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 11/20/2017] [Indexed: 12/11/2022]
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23
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Gawlitza M, Soize S, Januel AC, Mihalea C, Metaxas GE, Cognard C, Pierot L. Treatment of recurrent aneurysms using the Woven EndoBridge (WEB): anatomical and clinical results. J Neurointerv Surg 2017; 10:629-633. [PMID: 29054913 PMCID: PMC6031282 DOI: 10.1136/neurintsurg-2017-013287] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/27/2017] [Accepted: 09/30/2017] [Indexed: 11/16/2022]
Abstract
Background The safety and efficacy of the Woven EndoBridge (WEB) for the treatment of naïve intracranial aneurysms has been confirmed. Purpose To analyze the safety and efficacy of the WEB in the treatment of recurrent aneurysms. Methods Anatomical and clinical results in consecutive patients with a recurrent aneurysm, who were treated using the WEB device in two French neurointerventional centers, were evaluated. Results Seventeen patients with 17 aneurysms were included. Treatment was feasible in 16 patients. In seven patients (41.2%), ancillary devices were used. Permanent morbidity due to a thromboembolic complication occurred in one patient (5.9%). There was no mortality. Follow-up angiographic studies were available for 15 patients after a mean of 12.1±6.1 months. Rates of complete occlusion, neck remnant, and aneurysm remnant were 33.3%, 40.0%, and 26.7%, respectively. Conclusions Treatment of recurrent aneurysms using the WEB device may be reasonably safe and effective.
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Affiliation(s)
- Matthias Gawlitza
- Service de Neuroradiologie, Hôpital Maison Blanche, CHU de Reims, Reims, France
| | - Sebastien Soize
- Service de Neuroradiologie, Hôpital Maison Blanche, CHU de Reims, Reims, France
| | - Anne-Christine Januel
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Purpan, CHU de Toulouse, Toulouse, France
| | - Cristian Mihalea
- Service de Neuroradiologie Interventionnelle, NEURI, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Christophe Cognard
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Purpan, CHU de Toulouse, Toulouse, France
| | - Laurent Pierot
- Service de Neuroradiologie, Hôpital Maison Blanche, CHU de Reims, Reims, France
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Zuckerman SL, Lakomkin N, Magarik JA, Vargas J, Stephens M, Akinpelu B, Spiotta AM, Ahmed A, Arthur AS, Fiorella D, Hanel R, Hirsch JA, Hui FK, James RF, Kallmes DF, Meyers PM, Niemann DB, Rasmussen P, Turner RD, Welch BG, Mocco J. Evaluation of previously embolized intracranial aneurysms: inter-and intra-rater reliability among neurosurgeons and interventional neuroradiologists. J Neurointerv Surg 2017; 10:462-466. [PMID: 28918386 DOI: 10.1136/neurintsurg-2017-013231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The angiographic evaluation of previously coiled aneurysms can be difficult yet remains critical for determining re-treatment. OBJECTIVE The main objective of this study was to determine the inter-rater reliability for both the Raymond Scale and per cent embolization among a group of neurointerventionalists evaluating previously embolized aneurysms. METHODS A panel of 15 neurointerventionalists examined 92 distinct cases of immediate post-coil embolization and 1 year post-embolization angiographs. Each case was presented four times throughout the study, along with alterations in demographics in order to evaluate intra-rater reliability. All respondents were asked to provide the per cent embolization (0-100%) and Raymond Scale grade (1-3) for each aneurysm. Inter-rater reliability was evaluated by computing weighted kappa values (for the Raymond Scale) and intraclass correlation coefficients (ICC) for per cent embolization. RESULTS 10 neurosurgeons and 5 interventional neuroradiologists evaluated 368 simulated cases. The agreement among all readers employing the Raymond Scale was fair (κ=0.35) while concordance in per cent embolization was good (ICC=0.64). Clinicians with fewer than 10 years of experience demonstrated a significantly greater level of agreement than the group with greater than 10 years (κ=0.39 and ICC=0.70 vs κ=0.28 and ICC=0.58). When the same aneurysm was presented multiple times, clinicians demonstrated excellent consistency when assessing per cent embolization (ICC=0.82), but moderate agreement when employing the Raymond classification (κ=0.58). CONCLUSIONS Identifying the per cent embolization in previously coiled aneurysms resulted in good inter- and intra-rater agreement, regardless of years of experience. The strong agreement among providers employing per cent embolization may make it a valuable tool for embolization assessment in this patient population.
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Affiliation(s)
- Scott L Zuckerman
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nikita Lakomkin
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Jordan A Magarik
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jan Vargas
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Marcus Stephens
- Department of Neurosurgery, University of Arkansas, Little Rock, Arkansas, USA
| | | | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Azam Ahmed
- Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Adam S Arthur
- Department of Neurosurgery, Semmes-Murphey Clinic, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - David Fiorella
- Department of Neurosurgery, Cerebrovascular Center, Stony Brook University Medical Center, Stony Brook, New York, USA
| | - Ricardo Hanel
- Department of Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Joshua A Hirsch
- Neurointerventional Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ferdinand K Hui
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Robert F James
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - David F Kallmes
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Philip M Meyers
- Columbia University Medical Center, Departments of Neurosurgery and Radiology, New York, USA
| | - David B Niemann
- Department of Neurosurgery, University of Arkansas, Little Rock, Arkansas, USA
| | - Peter Rasmussen
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Raymond D Turner
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Babu G Welch
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
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Zhang Y, Huang QH, Fang Y, Yang P, Xu Y, Hong B, Liu J. A Novel Flow Diverter (Tubridge) for the Treatment of Recurrent Aneurysms: A Single-Center Experience. Korean J Radiol 2017; 18:852-859. [PMID: 28860903 PMCID: PMC5552469 DOI: 10.3348/kjr.2017.18.5.852] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/20/2016] [Indexed: 11/30/2022] Open
Abstract
Objective The Tubridge flow diverter (FD) is a novel device aimed at reconstructing the parent artery and occluding complex aneurysms. Retreatment of recurrent aneurysms using the FD is challenging. We report our initial experience in the repair of aneurysm recurrence with the FD. Materials and Methods A database was reviewed prospectively, and 8 patients with 8 recurrent aneurysms (mean size, 16.7 mm) were identified. Four aneurysms had previously ruptured. The previous aneurysm treatment consisted of coiling in 1 aneurysm and single-stent-assisted coiling in 7 aneurysms. The procedural complications and clinical and angiographic outcomes were analyzed. Results Six aneurysms were treated by using a single Tubridge FD alone, while the remaining 2 were treated with FD + coiling. The immediate results of the 8 aneurysms were that they all showed incomplete occlusion. Neither major ischemic nor hemorrhagic complications occurred; however, 1 patient experienced a vasospasm. Follow-up angiographies were available for 7 aneurysms; the mean follow-up was 16.9 months (7–36 months). Five aneurysms were completely occluded, whereas 2 had a residual neck. Severe asymptomatic stenosis of 1 parent artery of a vertebral artery dissecting aneurysm was found. All visible branches covered by the FD were patent. All patients were clinically assessed as having attained a favorable outcome (modified Rankin Scale score ≤ 2) at discharge and follow-up. Conclusion In selected patients, the Tubridge FD can provide a safe and efficient option for the retreatment of recurrent aneurysms. Nevertheless, attention should be paid to several technical points.
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Affiliation(s)
- Yongxin Zhang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Qing-Hai Huang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Yibin Fang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Pengfei Yang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Yi Xu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Bo Hong
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
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Wang HW, Sun ZH, Wu C, Xue Z, Yu XG. Surgical management of recurrent aneurysms after coiling treatment. Br J Neurosurg 2016; 31:96-100. [PMID: 27596271 DOI: 10.1080/02688697.2016.1226255] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Aneurysms that recur after coiling treatment are difficult to manage. The microsurgical technique in these cases differs significantly from that in regular aneurysm clipping. We present our experience in surgical management of aneurysms that recurred more than 1 month after coiling in a series of 19 patients. MATERIALS AND METHODS Between January 2004 and December 2014, 1437 patients were treated surgically for intracranial aneurysms in our institution. We performed a retrospective review of the clinical records, operation videos, and cerebral angiograms. We focused on patients in whom the initial aneurysm was treated by coiling, but the results were incomplete or the aneurysm recurred. RESULTS Nineteen patients underwent surgical clipping for recurrent aneurysm more than 1 month after initial coiling treatment. The sex ratio (male:female) was 0.9, and the average age was 51.3 years (range 35-72 years). One aneurysm was classified as giant (≥ 25 mm), two as large (10-25 mm), and 18 as small (≤ 10 mm). A good outcome (Glasgow Outcome Scale 4 or 5) was observed in 16 of 19 patients (84.2%). CONCLUSION Microsurgical clipping can be safe and effective in the management of previously coiled residual and recurrent aneurysms.
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Affiliation(s)
- Hua-Wei Wang
- a Department of Neurosurgery , Chinese PLA General Hospital , Beijing , PR China
| | - Zheng-Hui Sun
- a Department of Neurosurgery , Chinese PLA General Hospital , Beijing , PR China
| | - Chen Wu
- a Department of Neurosurgery , Chinese PLA General Hospital , Beijing , PR China
| | - Zhe Xue
- a Department of Neurosurgery , Chinese PLA General Hospital , Beijing , PR China
| | - Xin-Guang Yu
- a Department of Neurosurgery , Chinese PLA General Hospital , Beijing , PR China
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Gross BA, Albuquerque FC, Moon K, Ducruet AF, McDougall CG. Endovascular treatment of previously clipped aneurysms: continued evolution of hybrid neurosurgery. J Neurointerv Surg 2016; 9:169-172. [DOI: 10.1136/neurintsurg-2016-012625] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 07/14/2016] [Accepted: 07/19/2016] [Indexed: 11/04/2022]
Abstract
Background/objectiveThe optimal management of residual or recurrent clipped aneurysms is infrequently addressed in the literature.MethodsWe reviewed our endovascular database from January 1998 to May 2016 to identify patients with clipped aneurysms undergoing subsequent endovascular treatment, evaluating treatment approach, and clinical and angiographic outcomes.Results60 patients underwent endovascular treatment of residual/recurrent clipped aneurysms; 7 rebled prior to endovascular therapy. Treatment was via coiling alone (n=25, 42%), stent assisted coiling (n=15, 25%), balloon assisted coiling (n=8, 13%), flow diversion (n=8, 13%), stenting alone (n=3, 5%), or flow diversion with coiling (n=1, 2%). The procedural permanent neurological morbidity and mortality rates were 3% and 2%, respectively. Over a clinical follow-up of 253.4 patient years (median 3.9 years), there was one rebleed in a patient who had declined further treatment. For 43 patients with at least 1 month of digital subtraction angiographic follow-up (median 3.4 years), complete aneurysm occlusion was seen in 79% of cases. Neck remnants were observed in 14%, and stable small dome remnants were observed in 7% of cases. In a subgroup of 18 patients with ‘clip induced’ narrow neck aneurysms, all domes were initially coil occluded (Raymond 1 or 2); there was no permanent procedural morbidity and no aneurysms required retreatment or recanalized over a median follow-up of 3.9 years.ConclusionsEndovascular treatment of residual or recurrent clipped aneurysms is an excellent treatment approach in well selected patients; ‘clip induced’ narrow neck aneurysms fare particularly well after treatment both angiographically and clinically.
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Daou B, Chalouhi N, Starke RM, Barros G, Ya'qoub L, Do J, Tjoumakaris S, Rosenwasser RH, Jabbour P. Clipping of previously coiled cerebral aneurysms: efficacy, safety, and predictors in a cohort of 111 patients. J Neurosurg 2016; 125:1337-1343. [PMID: 26894462 DOI: 10.3171/2015.10.jns151544] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE With the increasing number of aneurysms treated with endovascular coiling, more recurrences are being encountered. The aim of this study was to evaluate the efficacy and safety of microsurgical clipping in the treatment of recurrent, previously coiled cerebral aneurysms and to identify risk factors that can affect the outcomes of this procedure. METHODS One hundred eleven patients with recurrent aneurysms whose lesions were managed by surgical clipping between January 2002 and October 2014 were identified. The rates of aneurysm occlusion, retreatment, complications, and good clinical outcome were retrospectively determined. Univariate and multivariate logistic regressions were performed to identify factors associated with these outcomes. RESULTS The mean patient age was 50.5 years, the mean aneurysm size was 7 mm, and 97.3% of aneurysms were located in the anterior circulation. The mean follow-up was 22 months. Complete aneurysm occlusion, as assessed by intraoperative angiography, was achieved in 97.3% of aneurysms (108 of 111 patients). Among patients, 1.8% (2 of 111 patients) had a recurrence after clipping. Retreatment was required in 4.5% of patients (5 of 111) after clipping. Major complications were observed in 8% of patients and mortality in 2.7%. Ninety percent of patients had a good clinical outcome. Aneurysm size (OR 1.4, 95% CI 1.08-1.7; p = 0.009) and location in the posterior circulation were significantly associated with higher complications. All 3 patients who had coil extraction experienced a postoperative stroke. Aneurysm size (OR 1.2, 95% CI 1.02-1.45; p = 0.025) and higher number of interventions prior to clipping (OR 5.3, 95% CI 1.3-21.4; p = 0.019) were significant predictors of poor outcome. An aneurysm size > 7 mm was a significant predictor of incomplete obliteration and retreatment (p = 0.018). CONCLUSIONS Surgical clipping is safe and effective in treating recurrent, previously coiled cerebral aneurysms. Aneurysm size, location, and number of previous coiling procedures are important factors to consider in the management of these aneurysms.
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Affiliation(s)
- Badih Daou
- Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | - Nohra Chalouhi
- Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | | | - Guilherme Barros
- Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | - Lina Ya'qoub
- Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | - John Do
- Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | - Stavropoula Tjoumakaris
- Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | - Robert H Rosenwasser
- Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
| | - Pascal Jabbour
- Departments of Neurosurgery, 1 Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; and
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Hur CW, Choi CH, Cha SH, Lee TH, Jeong HW, Lee JI. Eleven Year's Single Center Experience of Endovascular Treatment of Anterior Communicating Artery Aneurysms: Focused on Digital Subtraction Angiography Follow-Up Results. J Korean Neurosurg Soc 2015; 58:184-91. [PMID: 26539259 PMCID: PMC4630347 DOI: 10.3340/jkns.2015.58.3.184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 06/24/2015] [Accepted: 08/04/2015] [Indexed: 11/27/2022] Open
Abstract
Objective Anterior communicating artery (AcomA) aneurysms represent the most common intracranial aneurysms and challenging to treat due to complex vascularity. The purpose of this study was to report our experience of endovascular treatment of AcomA aneurysms. Methods Between January 2003 and December 2013, we retrospectively reviewed the medical records of 134 AcomA aneurysm patients available more than 6 months conventional angiographic and clinical follow-up results. We focused on aneurismal or AcomA vascular characters, angiographic and clinical follow-up results, and retreatment. Results The rate of ruptured cases was 75.4%, and the small (<10 mm) aneurysms were 96.3%. Based on the subtypes defined by dominance of A1, 79 patients (59%) had contralateral A1 hypoplasia or agenesis. The immediate post-procedural angiography confirmed complete occlusion in 75.4%, partial occlusion in 24.6%. Procedure related complications were observed in 25 (18.6%) patients. Most of the adverse events were asymptomatic. Follow-up conventional angiography at ≥6 months was performed in all patients (mean 16.3 months) and major recanalization was noted in 6.7% and regrowth in one case. The aneurysm size (p=0.016), and initial treatment results (p=0.00) were statistically significant risk factors related to aneurysm recurrence. An overall improvement in mRS was observed during the clinical follow-up period and no rebleeding episode occurred. Conclusion This study demonstrated that endovascular treatment is an effective treatment modality for AcomA aneurysms with low morbidity. Patients should take long term clinical and angiographic follow-up in order to assess the recurrence and warrant retreatment, especially ruptured, large, and initially incomplete occluded aneurysms.
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Affiliation(s)
- Chae Wook Hur
- Department of Neurosurgery, Medical Research Institute, Pusan National University School of Medicine, University Pusan National University Hospital, Busan, Korea
| | - Chang Hwa Choi
- Department of Neurosurgery, Medical Research Institute, Pusan National University School of Medicine, University Pusan National University Hospital, Busan, Korea
| | - Seung Heon Cha
- Department of Neurosurgery, Medical Research Institute, Pusan National University School of Medicine, University Pusan National University Hospital, Busan, Korea
| | - Tae Hong Lee
- Department of Diagnostic Radiology, Medical Research Institute, Pusan National University School of Medicine, University Pusan National University Hospital, Busan, Korea
| | - Hae Woong Jeong
- Department of Diagnostic Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae Il Lee
- Department of Neurosurgery, Medical Research Institute, Pusan National University School of Medicine, University Pusan National University Hospital, Busan, Korea
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Daou B, Starke RM, Chalouhi N, Tjoumakaris S, Khoury J, Hasan D, Rosenwasser RH, Jabbour PM. The Use of the Pipeline Embolization Device in the Management of Recurrent Previously Coiled Cerebral Aneurysms. Neurosurgery 2015; 77:692-7; discission 697. [DOI: 10.1227/neu.0000000000000901] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
The biggest downside of cerebral aneurysm coiling is the high rates of recurrence and retreatments. With the increasing number of aneurysm recurrences after failed coiling procedures, the best retreatment strategy remains unknown.
OBJECTIVE:
To assess the efficacy and safety of the Pipeline Embolization Device (PED) in the treatment of recurrent previously coiled aneurysms.
METHODS:
Thirty-three patients who underwent treatment with the PED of a recurrent previously coiled aneurysm were retrospectively identified. Efficacy was assessed in terms of angiographic occlusion at the latest cerebral angiogram, recurrence and retreatment rates after PED placement, and clinical outcome at the latest follow-up. Safety was assessed by looking at the complications, morbidity, and mortality after PED treatment.
RESULTS:
The mean patient age was 53 years. The mean percent recurrence from coiling to PED placement was 34%. The mean time from coiling to PED placement was 40 months. PED treatment resulted in complete aneurysm occlusion in 76.7% of patients and near-complete aneurysm occlusion (≥90%) in 10%, for a total rate of complete and near-complete aneurysm occlusion of 86.7%. All patients, including those with incomplete aneurysm occlusion, had a significant reduction in aneurysm size. Two aneurysms required another retreatment after PED placement (6.2%). Ninety-seven percent of patients had a good clinical outcome. Complications were observed in 1 patient (3%), who suffered an intracerebral hemorrhage. There were no mortalities.
CONCLUSION:
The use of the PED in the management of recurrent, previously coiled aneurysms is safe and effective in achieving aneurysm occlusion.
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Affiliation(s)
- Badih Daou
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Robert M. Starke
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Nohra Chalouhi
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Stavropoula Tjoumakaris
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Jean Khoury
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - David Hasan
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa
| | | | - Pascal M. Jabbour
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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Mascitelli JR, Oermann EK, Mocco J, Fifi JT, Paramasivam S, Stapleton CJ, Patel AB. Predictors of success following endovascular retreatment of intracranial aneurysms. Interv Neuroradiol 2015; 21:426-32. [PMID: 26092439 DOI: 10.1177/1591019915590070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Although approximately one in every 10 patients undergoing coil embolization of intracranial aneurysms requires retreatment, the factors that are associated with outcome following retreatment remain to be fully elucidated. METHODS This is a single-center, retrospective review of 43 patients with 58 intracranial aneurysms that were retreated from 2004 to 2014. Aneurysms undergoing first time or microsurgical retreatment were excluded. Retreatment types were grouped into those without permanent parent vessel support (stand-alone and balloon-assisted coiling) versus those with permanent parent vessel support (stent-assisted coiling, stand-alone stenting, and flow diversion). The Modified Raymond Roy Classification was used to group aneurysms at all angiographic follow-up points either in the successful outcome group (Class I or II) or the unsuccessful outcome group (Class IIIa or IIIb). RESULTS Of aneurysms with follow-up, 50% were in the successful group and 50% in the unsuccessful group. In univariate analysis, small aneurysm size (p < 0.001), previous treatment type (p = 0.022), retreatment type (p = 0.001), and initial occlusion class (p = 0.005) were all associated with angiographic outcome. In multivariate analysis, small aneurysm size (p = 0.005, odds ratio (OR) 24.56, confidence interval (CI) 2.68-225.4) and retreatment type with permanent parent vessel support, namely stent-assisted coiling (p = 0.017, OR 31.1, CI 1.89-517.7), were associated with retreatment success. CONCLUSIONS Small aneurysm size and retreatment with permanent parent vessel support, namely stent-assisted coiling, are predictors of success following endovascular retreatment of intracranial aneurysms. These findings could be useful in the effort to both prevent and predict treatment failure following endovascular retreatment.
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Affiliation(s)
- Justin R Mascitelli
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Eric K Oermann
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Christopher J Stapleton
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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Izumo T, Matsuo T, Morofuji Y, Hiu T, Horie N, Hayashi K, Nagata I. Microsurgical Clipping for Recurrent Aneurysms After Initial Endovascular Coil Embolization. World Neurosurg 2015; 83:211-8. [DOI: 10.1016/j.wneu.2014.08.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/08/2014] [Accepted: 08/06/2014] [Indexed: 11/28/2022]
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Clark JC, Spetzler RF. Dealing with the aneurysmal remnants after endovascular treatment. World Neurosurg 2014; 83:149-51. [PMID: 25238679 DOI: 10.1016/j.wneu.2014.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 09/13/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Justin C Clark
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Robert F Spetzler
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Rosenwasser RH, Chalouhi N, Tjoumakaris S, Jabbour P. Open vs Endovascular Approach to Intracranial Aneurysms. Neurosurgery 2014; 61 Suppl 1:121-9. [DOI: 10.1227/neu.0000000000000377] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Robert H. Rosenwasser
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Nohra Chalouhi
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Stavropoula Tjoumakaris
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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Qureshi AI, Chaudhry SA, Tekle WG, Suri MFK. Comparison of Long-term Outcomes Associated With Endovascular Treatment vs Surgical Treatment Among Medicare Beneficiaries With Unruptured Intracranial Aneurysms. Neurosurgery 2014; 75:380-6; discussion 386-7. [DOI: 10.1227/neu.0000000000000450] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Abstract
BACKGROUND:
Long-term outcomes associated with endovascular and surgical treatments for unruptured intracranial aneurysms are not well studied to date.
OBJECTIVE:
To determine the 5-year risk of new intracranial hemorrhage, second procedure, and all-cause mortality in elderly patients with unruptured intracranial aneurysms who underwent either surgical or endovascular treatment.
METHODS:
The study cohort included a representative sample of fee-for-service Medicare beneficiaries aged ≥65 years who underwent endovascular or surgical treatment for unruptured intracranial aneurysms with postprocedure follow-up of 4.7 (±3.0) years. Cox proportional hazards analysis was used to assess the relative risk (RR) of all-cause mortality, new intracranial hemorrhage, or second procedure for patients who underwent endovascular treatment compared with those who underwent surgical treatment after adjusting for potential confounders. The 5-year survival was estimated for both treatment groups by using Kaplan-Meier survival methods.
RESULTS:
A total of 688 patients with unruptured intracranial aneurysms were treated with either endovascular (n = 398) or surgical treatment (n = 290). The rate of immediate postprocedural neurological complications (10.3% vs 3.5%, P = .001) was higher among patients treated with surgery than among those who underwent endovascular treatment. The estimated 5-year survival was 92.8% and 94.8% in patients who underwent surgical and endovascular treatments, respectively. After adjusting for age, sex, and race/ethnicity, the RRs of all-cause mortality (RR, 0.6; 95% confidence interval, 0.3-1.1) and new intracranial hemorrhage (RR, 0.4; 95% confidence interval, 0.2-0.8) were lower with endovascular treatment.
CONCLUSION:
In elderly patients with unruptured intracranial aneurysms, endovascular treatment was associated with lower rates of acute adverse events and long-term all-cause mortality and new intracranial hemorrhages.
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Chalouhi N, Tjoumakaris S, Gonzalez LF, Dumont AS, Starke RM, Hasan D, Wu C, Singhal S, Moukarzel LA, Rosenwasser R, Jabbour P. Coiling of large and giant aneurysms: complications and long-term results of 334 cases. AJNR Am J Neuroradiol 2014; 35:546-52. [PMID: 23945229 DOI: 10.3174/ajnr.a3696] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Large and giant intracranial aneurysms are increasingly treated with endovascular techniques. The goal of this study was to retrospectively analyze the complications and long-term results of coiling in large and giant aneurysms (≥ 10 mm) and identify predictors of outcome. MATERIALS AND METHODS A total of 334 large or giant aneurysms (≥ 10 mm) were coiled in our institution between 2004 and 2011. Medical charts and imaging studies were reviewed to determine baseline characteristics, procedural complications, and clinical/angiographic outcomes. Aneurysm size was 15 mm on average. Two hundred twenty-five aneurysms were treated with conventional coiling; 88, with stent-assisted coiling; 14, with parent vessel occlusion; and 7, with balloon-assisted coiling. RESULTS Complications occurred in 10.5% of patients, with 1 death (0.3%). Aneurysm location and ruptured aneurysms predicted complications. Angiographic follow-up was available for 84% of patients at 25.4 months on average. Recanalization and retreatment rates were 39% and 33%, respectively. Larger aneurysm size, increasing follow-up time, conventional coiling, and aneurysm location predicted both recurrence and retreatment. The annual rebleeding rate was 1.9%. Larger aneurysm size, increasing follow-up time, and aneurysm location predicted new or recurrent hemorrhage. Favorable outcomes occurred in 92% of patients. Larger aneurysm size, poor Hunt and Hess grades, and new or recurrent hemorrhage predicted poor outcome. CONCLUSIONS Coiling of large and giant aneurysms has a reasonable safety profile with good clinical outcomes, but aneurysm reopening remains very common. Stent-assisted coiling has lower recurrence, retreatment, and new or recurrent hemorrhage rates with no additional morbidity compared with conventional coiling. Aneurysm size was a major determinant of recanalization, retreatment, new or recurrent hemorrhage, and poor outcome.
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Affiliation(s)
- N Chalouhi
- From the Department of Neurosurgery (N.C., S.T., L.F.G., A.S.D., R.M.S., C.W., S.S., L.A.M., R.R., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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Abstract
As neuroendovascular interventions for both ruptured and unruptured intracranial aneurysms have come to the forefront, careful follow-up and strategies for retreatment of aneurysmal recurrences have become increasingly important. Endovascular approaches have also proven to be valuable adjuncts for managing recurrent aneurysms previously treated by open microsurgical approaches. Fortunately, retreatment of recurrent aneurysms can be performed safely, and the use of stents during retreatment has increased the proportion of durably retreated aneurysms. More recently, the spectrum of recurrent aneurysms readily amenable to endovascular therapy has been expanded by the widespread introduction of flow diverters.
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Gruber A, Dorfer C, Knosp E. Recurrent and incompletely treated aneurysms. ACTA NEUROCHIRURGICA. SUPPLEMENT 2014; 119:13-20. [PMID: 24728626 DOI: 10.1007/978-3-319-02411-0_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Endovascular treatment of intracranial aneurysms has become an established technique that can provide stable permanent occlusion in over 85 % of the cases. Even those aneurysms considered untreatable by endovascular means can now often be managed by the use of adjunctive measures, e.g., balloon protection devices, intracranial stents, and semipermeable stents, i.e., "flow diverters." In those cases, in which relevant aneurysm recurrences are documented upon angiographic follow-up, both endovascular and surgical techniques can be employed. In rare cases, combined treatment strategies including parent artery occlusion under bypass protection can be performed. At our center, the majority of relevant aneurysm recurrences after initial coil embolization are managed by a second endovascular procedure. In some cases, e.g., aneurysm recurrences not feasible for endovascular re-treatment, documented aneurysmal growth, bleeding from a previously embolized aneurysm, and acute hemorrhagic or ischemic complications during endovascular procedures, surgical management may be necessary. This report briefly outlines the most frequent treatment scenarios.
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Affiliation(s)
- Andreas Gruber
- Department of Neurosurgery, Medical University Vienna, General Hospital Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria,
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Mortimer AM, Bradley MD, Mews P, Molyneux AJ, Renowden SA. Endovascular treatment of 300 consecutive middle cerebral artery aneurysms: clinical and radiologic outcomes. AJNR Am J Neuroradiol 2013; 35:706-14. [PMID: 24231847 DOI: 10.3174/ajnr.a3776] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE There is controversy as to the best mode of treating MCA aneurysms. We report the results of a large endovascular series of patients treated at our center. MATERIALS AND METHODS This study was a retrospective analysis of a prospectively acquired data base. All patients with saccular MCA aneurysms treated between November 1996 and June 2012 were included. World Federation of Neurosurgical Societies grade, aneurysm site, size, and aneurysm neck size were recorded, along with clinical outcome assessed with the Glasgow Outcome Scale and radiographic occlusion assessed with the Raymond classification at 6 months and 2.5 years. RESULTS A total of 295 patients with 300 MCA aneurysms were treated including 244 ruptured aneurysms (80.7%). The technical failure rate was 4.3% (13 patients). Complete occlusion or neck remnant was achieved in 264 (91.4%). Complications included rupture in 15 patients (5%), thromboembolism in 17 patients (5.7%), and early rebleeding in 3 patients (1%). Overall permanent procedural-related morbidity and mortality were seen in 12 patients (7.8%). Of the ruptured aneurysms, 189 (79.4%) had a favorable clinical outcome (Glasgow Outcome Scale score, 4-5). A total of 33 patients (13.6%) died. On initial angiographic follow-up, aneurysm remnant was seen in 18 aneurysms (8.1%). A total of 13 patients (4.3%) were re-treated. CONCLUSIONS Our experience demonstrates that endovascular treatment of MCA aneurysms has an acceptable safety profile with low rates of technical failure and re-treatment. Therefore, coiling is acceptable as the primary treatment of MCA aneurysms.
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Affiliation(s)
- A M Mortimer
- From the Department of Neuroradiology, Frenchay Hospital, Bristol, United Kingdom
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40
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Teleb MS, Pandya DJ, Castonguay AC, Eckardt G, Sweis R, Lazzaro MA, Issa MA, Fitzsimmons BF, Lynch JR, Zaidat OO. Safety and predictors of aneurysm retreatment for remnant intracranial aneurysm after initial endovascular embolization. J Neurointerv Surg 2013; 6:490-4. [DOI: 10.1136/neurintsurg-2013-010836] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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41
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Tähtinen OI, Manninen HI, Vanninen RL, Rautio R, Haapanen A, Seppänen J, Niskakangas T, Rinne J, Keski-Nisula L. Stent-assisted embolization of recurrent or residual intracranial aneurysms. Neuroradiology 2013; 55:1221-31. [DOI: 10.1007/s00234-013-1234-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/01/2013] [Indexed: 11/29/2022]
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Crobeddu E, Lanzino G, Kallmes DF, Cloft HJ. Review of 2 decades of aneurysm-recurrence literature, part 2: Managing recurrence after endovascular coiling. AJNR Am J Neuroradiol 2013; 34:481-5. [PMID: 22422182 PMCID: PMC7964895 DOI: 10.3174/ajnr.a2958] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cerebral aneurysms are treated to prevent hemorrhage or rehemorrhage. Angiographic recurrences following endovascular therapy have been a problem since the advent of this treatment technique, even though posttreatment hemorrhage remains rare. Notwithstanding its unclear clinical significance, angiographic recurrence remains not only a prime focus in the literature but also frequently leads to potentially risky retreatments. The literature regarding aneurysm recurrence following endovascular therapy, spanning 2 decades, is immense and immensely confusing. We review the topic of recurrence following endovascular treatment of cerebral aneurysms in an effort to distill it down to fundamental material relevant to clinical practice.
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Affiliation(s)
- E Crobeddu
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA
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43
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Islak C. The retreatment: indications, technique and results. Eur J Radiol 2013; 82:1659-64. [PMID: 23369856 DOI: 10.1016/j.ejrad.2012.12.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 12/18/2012] [Accepted: 12/19/2012] [Indexed: 11/24/2022]
Abstract
Durability of endovascular treatment of intracranial aneurysms has always been an issue and a very strong point of criticism. Although studies on long-term results have made it clear that endovascular treatment safe and effective they, nonetheless showed retreatment after endovascular treatment is nearly 5-10 times more frequent than surgical clipping. Risk factors predisposing high probability of retreatment are aneurysm with dissecting nature, incomplete coiling, sac size larger than 10mm and localization at the bifurcations such as basilar tip. The indications for retreatment after endovascular treatment are not clear yet, although certain morphologic criteria can be used. Retreatment appears not to negate the initial advantage of endovascular treatment over surgical treatment and can be performed very small morbi-mortality numbers.
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Affiliation(s)
- Civan Islak
- Istanbul University, Cerrahpasa Medical Faculty, Department of Radiology, Division of Neuroradiology, Kocamustafapasa, Istanbul 34098, Turkey.
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44
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Chalouhi N, Chitale R, Starke RM, Jabbour P, Tjoumakaris S, Dumont AS, Rosenwasser RH, Gonzalez LF. Treatment of recurrent intracranial aneurysms with the Pipeline Embolization Device. J Neurointerv Surg 2013; 6:19-23. [PMID: 23345630 DOI: 10.1136/neurintsurg-2012-010612] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The treatment of recurrent aneurysms after previous surgery or embolization is challenging. Little is known regarding the use of the Pipeline Embolization Device (PED) for recurrent aneurysms. OBJECTIVE To analyze the safety and results of PED therapy for recurrent aneurysms. METHODS Fifteen patients with recurrent intracranial aneurysms after previous embolization or surgical clipping were treated with the PED at our institution between 2011 and 2012. Procedural complications and clinical and angiographic outcomes were analyzed. RESULTS Median aneurysm size was 12 mm. Previous aneurysm treatment consisted of coiling in eight patients, stent coiling in four, a telescoping stent technique in two and surgical clipping in one. Major procedural complications (leaving significant morbidity) occurred in one patient (6.7%) and minor procedural or technical complications (no or minor morbidity) occurred in four patients (26.7%). Fourteen of the 15 patients (93.3%) had a favorable outcome (modified Rankin Scale score 0-2). Of 14 patients with angiographic follow-up, nine (64.3%) had complete aneurysm occlusion (100%), four (28.6%) had near-complete occlusion (≥90%) and only one (7.1%) had incomplete occlusion (<90%). Four of the five patients with less than 100% occlusion at follow-up had a previous stent in situ. CONCLUSIONS Treatment of recurrent aneurysms with the PED appears to be effective, but patients with a previous stent in situ may achieve lower obliteration rates. The morbidity rate associated with PED therapy may be higher than with more standard endovascular techniques using historical data. Larger studies are needed to assess this question better.
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Affiliation(s)
- Nohra Chalouhi
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
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Rozenfeld MN, Ansari SA, Shaibani A, Russell EJ, Mohan P, Hurley MC. Should patients with autosomal dominant polycystic kidney disease be screened for cerebral aneurysms? AJNR Am J Neuroradiol 2013; 35:3-9. [PMID: 23292526 DOI: 10.3174/ajnr.a3437] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Autosomal dominant polycystic kidney disease is a genetic disorder affecting 1 in 1000 people worldwide and is associated with an increased risk of intracranial aneurysms. It remains unclear whether there is sufficient net benefit to screening this patient population for IA, considering recent developments in imaging and treatment and our evolving understanding of the natural history of unruptured aneurysms. There is currently no standardized screening protocol for IA in patients with ADPCKD. Our review of the literature focused on the above issues and presents our appraisal of the estimated value of screening for IA in the setting of ADPCKD.
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Affiliation(s)
- M N Rozenfeld
- Department of Radiology, St. Francis Hospital, Evanston, Illinois
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Jia J, Lv X, Liu A, Wu Z, Li Y. Enterprise stent-assisted coiling of wide-necked intracranial aneurysms: clinical and angiographic follow-up. Interv Neuroradiol 2012; 18:426-31. [PMID: 23217637 PMCID: PMC3520556 DOI: 10.1177/159101991201800408] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 09/23/2012] [Indexed: 02/05/2023] Open
Abstract
We evaluate and report our clinical and angiographic outcomes associated with stent-assisted coil embolization of wide-necked intracranial aneurysms using the Enterprise stent. One hundred sixty-nine patients diagnosed with 182 wide-necked intracranial aneurysms underwent placement of the Enterprise stent between April 2009 and October 2011. Demographic information, procedural data, procedure-related complications, angiographic results, and clinical outcomes were reviewed and evaluated. Stent deployment was successful in 166 out of 169 procedures (98.2%). Four patients had acute procedure-related complications, including th romboembolism in three patients and aneurysm perforation resulting in the death of one patient. Immediate angiographic results showed complete occlusion in 101 aneurysms (56.4%) and near-complete occlusion in 55 aneurysms (30.7%). Follow-up angiography was performed in 108 patients with 119 aneurysms at a mean of 8.1 months: complete occlusion was observed in 95 aneurysms (79.8%) and near-complete occlusion was found in 12 aneurysms (10.1%). Delayed intra-stent thromboses were observed in two patients, and asymptomatic in-stent stenosis was observed in one patient. Ten aneurysms (8.4%, 10/119) demonstrated recanalization, all of which were subsequently recoiled successfully. Clinical follow-up was obtained for 132 patients at a mean of 11.4 months, out of which 118 (89.4%) had favorable clinical outcomes as determined using a modified Rankin Scale (mRS) ≤ 1. The rates of procedure-related mortality and permanent morbidity were 0.6% (1/169) and 2.3%( 3/132), respectively. This study adds to the current body of evidence supporting the Enterprise stent as an effective and safe tool for the treatment of wide-necked intracranial aneurysms because it results in more complete occlusion and lower complication rates.
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Affiliation(s)
- J Jia
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, China
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Jahshan S, Abla AA, Natarajan SK, Drummond PS, Kan P, Karmon Y, Snyder KV, Hopkins LN, Siddiqui AH, Levy EI. Results of Stent-Assisted vs Non-Stent-Assisted Endovascular Therapies in 489 Cerebral Aneurysms. Neurosurgery 2012; 72:232-9. [DOI: 10.1227/neu.0b013e31827b93ea] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Whether the addition of stenting to intracranial aneurysm coil embolization results in benefit in terms of occlusion rates or additional risk in terms of periprocedural adverse events is not clear.
OBJECTIVE:
To report retrospectively analyzed results of endovascular aneurysm treatment comparing stent-assisted coiling with coiling without stents at our hospital from 2005 to 2009.
METHODS:
In this retrospectively reviewed case series, aneurysms were grouped as intent-to-treat or initially treated with stent-assisted coiling (A) vs coiling alone (B) or as-treated—those that ultimately received a stent (C) or not (D). Complication and occlusion rates were compared between groups. Some patients crossed from group B to C after receiving stent placement at a later treatment following the initial therapeutic modality (without a stent).
RESULTS:
In 459 patients, 489 aneurysms were treated by group as follows: A = 181, B = 308, C = 225, and D = 264. In stent groups (A and C), there were significantly lower frequencies of ruptured aneurysms (A vs B = 11% vs 62%, P < .001; C vs D = 20.4% vs 62.5%, P < .001) and more giant aneurysms (A vs B = 7.3% vs 1.0%, P = .001; C vs D = 5.9% vs 1.1%, P < .001). There was no statistically significant difference in permanent event-related morbidity (A vs B = 4.4% vs 4.2%, P = 1.0; C vs D = 4.4% vs 4.2%, P = 1.0). Average angiographic follow-up after last treatment was 18.2 ± 15 months (median = 14). Higher rates of complete occlusion at last angiographic follow-up were observed in stented aneurysms (A vs B = 64.6% vs 49.7%, P = .001; C vs D = 62.7% vs 48.9%, P = .003).
CONCLUSION:
Stent-assisted aneurysm treatment resulted in higher total occlusion rates than non-stent-assisted treatment, with acceptable, comparable periprocedural event rates.
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Affiliation(s)
- Shady Jahshan
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
| | - Adib A. Abla
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
| | - Sabareesh K. Natarajan
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
| | - Patrick S. Drummond
- School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Peter Kan
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
| | - Yuval Karmon
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
| | - Kenneth V. Snyder
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
- Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York
- Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York
| | - L. Nelson Hopkins
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
- Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York
- Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York
- Jacobs Institute, Buffalo, New York
| | - Adnan H. Siddiqui
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
- Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York
- Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York
| | - Elad I. Levy
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York
- Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York
- Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York
- Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York
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Chalouhi N, Teufack S, Chandela S, Dalyai R, Tjoumakaris S, Hasan DM, Dumont AS, Gonzalez LF, Rosenwasser RH, Jabbour PM. Aneurysmal subarachnoid hemorrhage in patients under 35-years-old: a single-center experience. Clin Neurol Neurosurg 2012; 115:665-8. [PMID: 22858084 DOI: 10.1016/j.clineuro.2012.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 07/02/2012] [Accepted: 07/15/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Aneurysmal subarachnoid hemorrhage (SAH) is relatively uncommon in young adults. There is a paucity of data pertaining to the management of aneurysmal SAH in young patients, especially with endovascular therapy. METHODS We reviewed all SAH patients under the age of 35 years treated at Jefferson Hospital for Neuroscience, Philadelphia, USA, from 2004 to 2009. RESULTS A total of 40 patients (15 males and 25 females) under the age of 35 were treated for aneurysmal SAH. The average patient age was 30 years (17-35 yo); 25 (62.5%) were smokers. Seventeen patients presented with a Hunt and Hess Grade I or II (42.5%), 20 with a Grade III (50%), and 3 with a Grade IV (7.5%). Thirty-two aneurysms (80%) were located in the anterior circulation and 8 (20%) in the posterior circulation. Thirty-five patients (87.5%) were treated with coil embolization versus 5 with craniotomy and clipping. The endovascular and microsurgical occlusion rates were 90.6% and 100%, respectively. There were no procedural complications with endovascular therapy. Of 35 patients undergoing endovascular treatment, 24 (68.6%) had excellent outcomes at time of discharge with a Glasgow outcome scale of 5. There were no deaths in the series. No patient experienced a rehemorrhage after endovascular treatment. CONCLUSION Smoking, female sex, and anterior circulation aneurysms are highly prevalent in young adults with SAH. Endovascular treatment resulted in an overall favorable outcome with no rehemorrhages in patients under the age of 35 years. Our results suggest that endovascular therapy is a reasonable treatment for young patients with SAH.
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Affiliation(s)
- Nohra Chalouhi
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA 19107, United States
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Corns R, Zebian B, Tait MJ, Walsh D, Hampton T, Deasy N, Tolias C. Prevalence of recurrence and retreatment of ruptured intracranial aneurysms treated with endovascular coil occlusion. Br J Neurosurg 2012; 27:30-3. [DOI: 10.3109/02688697.2012.701676] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Roy D. Aneurysm recurrence after endovascular treatment. Neurochirurgie 2012; 58:97-102. [PMID: 22464902 DOI: 10.1016/j.neuchi.2012.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 02/13/2012] [Indexed: 10/28/2022]
Abstract
While the risk of haemorrhage related to aneurysm recurrence after endovascular treatment is not well established, concerns about it lead to imaging follow-up and further treatments that have a real impact on patients' lives. These concerns are also the motor of technological developments aiming at reducing the recurrence rate but also having the potential to increase the complication rate of initial treatment. This article will address some issues related to aneurysm recurrence in view of the actual literature.
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Affiliation(s)
- D Roy
- CHUM Notre-Dame Hospital, 1560 Sherbrooke east, Simard Z12909, Montreal, Canada H2L4M1.
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