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Mendes Pereira V, Rice H, De Villiers L, Sourour N, Clarencon F, Spears J, Tomasello A, Hernandez D, Cancelliere NM, Liu XYE, Nicholson P, Costalat V, Gascou G, Mordasini P, Gralla J, Martínez-Galdámez M, Galvan Fernandez J, Killer-Oberpfalzer M, Liebeskind DS, Turner RD, Blanc R, Piotin M. Evaluation of effectiveness and safety of the CorPath GRX robotic system in endovascular embolization procedures of cerebral aneurysms. J Neurointerv Surg 2024; 16:405-411. [PMID: 37793795 PMCID: PMC10958306 DOI: 10.1136/jnis-2023-020161] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/07/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Robotic-assisted neurointervention was recently introduced, with implications that it could be used to treat neurovascular diseases. OBJECTIVE To evaluate the effectiveness and safety of the robotic-assisted platform CorPath GRX for treating cerebral aneurysms. METHODS This prospective, international, multicenter study enrolled patients with brain aneurysms that required endovascular coiling and/or stent-assisted coiling. The primary effectiveness endpoint was defined as successful completion of the robotic-assisted endovascular procedure without any unplanned conversion to manual treatment with guidewire or microcatheter navigation, embolization coil(s) or intracranial stent(s) deployment, or an inability to navigate vessel anatomy. The primary safety endpoint included intraprocedural and periprocedural events. RESULTS The study enrolled 117 patients (74.4% female) with mean age of 56.6 years from 10 international sites,. Headache was the most common presenting symptom in 40/117 (34.2%) subjects. Internal carotid artery was the most common location (34/122, 27.9%), and the mean aneurysm height and neck width were 5.7±2.6 mm and 3.5±1.4 mm, respectively. The overall procedure time was 117.3±47.3 min with 59.4±32.6 min robotic procedure time. Primary effectiveness was achieved in 110/117 (94%) subjects with seven subjects requiring conversion to manual for procedure completion. Only four primary safety events were recorded with two intraprocedural aneurysm ruptures and two strokes. A Raymond-Roy Classification Scale score of 1 was achieved in 71/110 (64.5%) subjects, and all subjects were discharged with a modified Rankin Scale score of ≤2. CONCLUSIONS This first-of-its-kind robotic-assisted neurovascular trial demonstrates the effectiveness and safety of the CorPath GRX System for endovascular embolization of cerebral aneurysm procedures. TRIAL REGISTRATION NUMBER NCT04236856.
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Affiliation(s)
- Vitor Mendes Pereira
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Hal Rice
- Department of Neurointervention, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Laetitia De Villiers
- Department of Neurointervention, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Nader Sourour
- Department of Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Frédéric Clarencon
- Department of Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Julian Spears
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alejandro Tomasello
- Department of Neurointervention, Hospital Vall d'Hebron, Barcelona, Catalunya, Spain
| | - David Hernandez
- Department of Neurointervention, Hospital Vall d'Hebron, Barcelona, Catalunya, Spain
| | - Nicole M Cancelliere
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Xiao Yu Eileen Liu
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Nicholson
- Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vincent Costalat
- Department of Neuroradiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Pasquale Mordasini
- Department of Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Jan Gralla
- Department of Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Mario Martínez-Galdámez
- Department of Interventional Neuroradiology and Endovascular Neurosurgery, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Jorge Galvan Fernandez
- Department of Interventional Neuroradiology and Endovascular Neurosurgery, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Raymond D Turner
- Division of Neurosurgery, Prisma Health, Greenville, South Carolina, USA
| | - Raphael Blanc
- Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France
| | - Michel Piotin
- Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France
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Pineda-Castillo SA, Jones ER, Laurence KA, Thoendel LR, Cabaniss TL, Zhao YD, Bohnstedt BN, Lee CH. Systematic Review and Meta-Analysis of Endovascular Therapy Effectiveness for Unruptured Saccular Intracranial Aneurysms. STROKE (HOBOKEN, N.J.) 2024; 4:e001118. [PMID: 38846323 PMCID: PMC11152505 DOI: 10.1161/svin.123.001118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/13/2023] [Indexed: 06/09/2024]
Abstract
Background Currently, endovascular treatment of intracranial aneurysms (ICAs) is limited by low complete occlusion rates. The advent of novel endovascular technology has expanded the applicability of endovascular therapy; however, the superiority of novel embolic devices over the traditional Guglielmi detachable coils (GDCs) is still debated. We performed a systematic review of literature that reported Raymond-Roy occlusion classification (RROC) rates of modern endovascular devices to determine their immediate and follow-up occlusion effectiveness for the treatment of unruptured saccular ICAs. Methods A search was conducted using electronic databases (PUBMED, Cochrane, ClinicalTrials.gov, Web of Science). We retrieved studies published between 2000-2022 reporting immediate and follow-up RROC rates of subjects treated with different endovascular ICA therapies. We extracted demographic information of the treated patients and their reported angiographic RROC rates. Results A total of 80 studies from 15 countries were included for data extraction. RROC rates determined from angiogram were obtained for 21,331 patients (72.5% females, pooled mean age: 58.2 (95% CI: 56.8-59.6), harboring 22,791 aneurysms. The most frequent aneurysm locations were the internal carotid artery (46.4%, 95% CI: 41.9%-50.9%), the anterior communicating artery (26.4%, 95% CI: 22.5%-30.8%), the middle cerebral artery (24.5%, 95% CI:19.2%-30.8%) and the basilar tip (14.4%, 95% CI:11.3%-18.3%). The complete occlusion probability (RROC-I) was analyzed for GDCs, the Woven EndoBridge (WEB), and flow diverters. The RROC-I rate was the highest in balloon-assisted coiling (73.9%, 95% CI: 65.0%-81.2%) and the lowest in the WEB (27.8%, 95% CI:13.2%-49.2%). The follow-up RROC-I probability was homogenous in all analyzed devices. Conclusions We observed that the coil-based endovascular therapy provides acceptable rates of complete occlusion, and these rates are improved in balloon-assisted coils. Out of the analyzed devices, the WEB exhibited the shortest time to achieve >90% probability of follow-up complete occlusion (~18 months). Overall, the GDCs remain the gold standard for endovascular treatment of unruptured saccular aneurysms.
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Affiliation(s)
- Sergio A. Pineda-Castillo
- Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, OK, USA
| | - Evan R. Jones
- Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, OK, USA
| | - Keely A. Laurence
- Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, OK, USA
| | - Lauren R. Thoendel
- Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, OK, USA
| | - Tanner L. Cabaniss
- Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, OK, USA
| | - Yan D. Zhao
- Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Bradley N. Bohnstedt
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chung-Hao Lee
- Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, OK, USA
- Department of Bioengineering, University of California Riverside, Riverside, CA, USA
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Park SY, Kim SA, An YH, Kim SW, Kim S, Lee JM, Jung Y. Risk Factor Analysis of Complications and Mortality Following Coil Procedures in Patients with Intracranial Unruptured Aneurysms Using a Nationwide Health Insurance Database. J Clin Med 2024; 13:1094. [PMID: 38398408 PMCID: PMC10889784 DOI: 10.3390/jcm13041094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Unruptured intracranial aneurysm (UIA) occurs in 1-2% of the population and is being increasingly detected. Patients with UIA are treated with close observation, endovascular coiling or surgical clipping. The proportion of endovascular coiling has been rising. However, complications such as cerebral infarction (CI), intracranial hemorrhage (ICRH), and death remain crucial issues after coil treatment. (2) Methods: We analyzed the incidence and risk factors of complications after the use of coil in patients with UIA based on the patients' characteristics. We utilized the Health Insurance Review and Assessment (HIRA) database. Patients treated with coils for UIA between 1 January 2015 and 1 December 2021 were retrospectively analyzed. (3) Results: Of the total 35,140 patients, 1062 developed ICRH, of whom 87 died, with a mortality rate of 8.2%. Meanwhile, 749 patients developed CI, of whom 29 died, with a mortality rate of 3.9%. The overall mortality rate was 1.8%. In a univariate analysis of the risk factors, older age, males, a higher Charlson Comorbidity Index (CCI) score, and diabetes increase the risk of CI. Meanwhile, males with higher CCI scores and hemiplegia or paraplegia show increased ICRH risk. Older age, males and metastatic solid tumors relate to increased mortality risk. (4) Conclusions: This study is significant in that the complications based on the patient's underlying medical condition were analyzed.
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Affiliation(s)
- So Yeon Park
- Department of Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
| | - So An Kim
- Department of Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
| | - Yu Hyeon An
- Department of Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
| | - Sang Won Kim
- Medical Research Center, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
| | - Saeyoon Kim
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea;
| | - Jae Min Lee
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea;
| | - Youngjin Jung
- Department of Neurosurgery, Yeungnam University Medical Center, Daegu 42415, Republic of Korea
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Aoki K, Murayama Y, Tanaka Y, Ishibashi T, Irie K, Fuga M, Kato N, Kan I, Nishimura K, Nagayama G. Risk factors and management of intraprocedural rupture during coil embolization of unruptured intracranial aneurysms: role of balloon guiding catheter. Front Neurol 2024; 15:1343137. [PMID: 38299017 PMCID: PMC10828020 DOI: 10.3389/fneur.2024.1343137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024] Open
Abstract
Introduction Intraprocedural rupture (IPR) is a serious complication of endovascular coil embolization of unruptured intracranial aneurysms (UIAs). Although outcomes after IPR are poor, methods to prevent subsequent neurological deterioration have not yet been investigated. We evaluated the risk factors and management strategies for IPR, particularly the role of balloon guiding catheters (BGCs) in rapid hemostasis. Methods We retrospectively reviewed all UIA cases treated with coil embolization at three institutions between 2003 and 2021, focusing on preoperative radiological data, operative details, and outcomes. Results In total, 2,172 aneurysms were treated in 2026 patients. Of these, 19 aneurysms in 19 patients (0.8%) ruptured during the procedure. Multivariate analysis revealed that aneurysms with a bleb (OR: 3.03, 95% CI: 1.21 to 7.57, p = 0.017), small neck size (OR: 0.56, 95% CI: 0.37 to 0.85, p = 0.007), and aneurysms in the posterior communicating artery (PcomA) (OR: 4.92, 95% CI: 1.19 to 20.18, p = 0.027) and anterior communicating artery (AcomA) (OR: 12.08, 95% CI: 2.99 to 48.79, p < 0.001) compared with the internal carotid artery without PcomA were significantly associated with IPR. The incidence of IPR was similar between the non-BGC and BGC groups (0.9% vs. 0.8%, p = 0.822); however, leveraging BGC was significantly associated with lower morbidity and mortality rates after IPR (0% vs. 44%, p = 0.033). Discussion The incidence of IPR was relatively low. A bleb, small aneurysm neck, and location on PcomA and AcomA are independent risk factors for IPR. The use of BGC may prevent fatal clinical deterioration and achieve better clinical outcomes in patients with IPR.
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Affiliation(s)
- Ken Aoki
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
- Department of Neurosurgery, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshihiro Tanaka
- Division of Epidemiology, Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Koreaki Irie
- Department of Neurosurgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Michiyasu Fuga
- Department of Neurosurgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Naoki Kato
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Issei Kan
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Kengo Nishimura
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Gota Nagayama
- Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan
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Carvalho V, Vilarinho A, Polónia P, Silva ML, Vaz R, Alberto Silva P. The impact of selection bias in the treatment for ruptured anterior communicating artery aneurysms: different results or different patients? World Neurosurg X 2024; 21:100255. [PMID: 38169854 PMCID: PMC10758962 DOI: 10.1016/j.wnsx.2023.100255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 06/15/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Background Anterior communicating artery is one of the most frequent locations for the development of intracranial aneurysm. The availability and advances of different treatments modalities allows for case-specific selection, but potentially impacts our ability to assess equipoise among them. Objective Investigate and compare clinical and morphological variables among surgical and endovascular treatment groups with ruptured anterior communicating artery aneurysms. Methods Data from patients from a single university hospital treated for ruptured anterior communicating aneurysms after multidisciplinary discussion in a period from January 2009 to January 2020 were retrospectively reviewed. Demographics, clinical status, aneurysm morphologic features and in-hospital complications were registered for each treatment (endovascular coiling vs. microsurgical clipping). Clinical assessment was made from outpatient evaluation at 1-year follow-up. Results A total of 119 patients was obtained adding surgical (n = 80) and endovascular (n = 39) treatment groups. No significant changes between groups were detected regarding gender, age of treatment or other risk factors. Global complication rate (p = 0.335, p = 0.225, p = 0.428) and clinical outcome (p = 0.802) was similar among both groups. Univariate and multivariate analysis revealed statistically significant differences between endovascular and surgical treatment groups regarding dome orientation (p = 0.011), aneurysm height (p < 0.001) and maximum diameter (p < 0.001), aspect-ratio (p < 0.001), dome-to-neck ratio (p < 0.001) and dome diameter (p = 0.014). Conclusions Despite similar clinical outcomes and rate of complications, morphological differences highlight the presence of a selection bias and high heterogeneity, which hampers inferential analysis when comparing both techniques.
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Affiliation(s)
- Vasco Carvalho
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
| | - António Vilarinho
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
| | - Patrícia Polónia
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
| | - Maria Luís Silva
- Neuroradiology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Rui Vaz
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
| | - Pedro Alberto Silva
- Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Portugal
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6
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Wang Z, Peng Z, Chen L, Li W, Wang Y. Mechanical compression management of the right middle cerebral artery inferior trunk using a stent during coil embolization of middle cerebral artery aneurysms: A case report and literature review. J Interv Med 2023; 6:126-129. [PMID: 37846337 PMCID: PMC10577055 DOI: 10.1016/j.jimed.2022.10.004] [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: 06/23/2022] [Revised: 10/13/2022] [Accepted: 10/31/2022] [Indexed: 01/13/2023] Open
Abstract
Endovascular coil embolization is a minimally invasive, rapid, and effective method for the treatment of intracranial aneurysms. However, complications associated with coil embolization, such as intraoperative aneurysm rupture or arterial occlusion, should be promptly managed during the procedure to avoid catastrophic consequences. This study presents a case of mechanical compression management of the right middle cerebral artery (MCA) inferior trunk during coil embolization for bilateral MCA aneurysms. The inferior trunk of the right MCA was abruptly occluded due to mechanical compression during coil embolization of the right MCA bifurcation aneurysm. A Solitaire AB stent (4 × 20 mm, Covidien/Medtronic, Dublin, Ireland) was implanted in the inferior trunk of the right MCA after tirofiban was injected via a microcatheter, and the right inferior trunk was recanalized. The patient also underwent coil embolization of the left MCA bifurcation aneurysm, without any complications. It is crucial to recognize compressive occlusion of adjacent aneurysm branches to avoid severe complications during intracranial aneurysm embolization. Stent placement is a rescue treatment option for recanalization of an occluded artery.
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Affiliation(s)
- Zhengyu Wang
- Department of Interventional Radiology, The Sixth People's Hospital South Campus, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiqing Peng
- Department of Interventional Radiology, The Sixth People's Hospital South Campus, Shanghai Jiao Tong University, Shanghai, China
| | - Liang Chen
- Department of Interventional Radiology, The Sixth People's Hospital South Campus, Shanghai Jiao Tong University, Shanghai, China
| | - Wanbin Li
- Department of Interventional Radiology, The Sixth People's Hospital South Campus, Shanghai Jiao Tong University, Shanghai, China
| | - Yongli Wang
- Department of Interventional Radiology, The Sixth People's Hospital South Campus, Shanghai Jiao Tong University, Shanghai, China
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7
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Safety of coil embolisation in small (smaller than 5 mm) unruptured intracranial aneurysms: A retrospective multicentre analysis. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2022.101678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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8
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Osuki T, Ikeda H, Uezato M, Kinosada M, Chin M. Aneurysm Perforation Due to Advancement of the Coil Delivery Wire During Stent-Assisted Embolization. Cureus 2022; 14:e28063. [PMID: 36120259 PMCID: PMC9477159 DOI: 10.7759/cureus.28063] [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] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
We report a case of intraprocedural aneurysm rupture during coil embolization caused by a coil delivery wire. A 68-year-old woman underwent stent-assisted coil embolization for an unruptured aneurysm in the internal carotid artery (ICA). A low profile visible intraluminal support device was deployed at the aneurysm neck. Coil embolization was performed with a jailing technique. After deflection of the jailed microcatheter was released, a coil was placed in the aneurysm against resistance to coil insertion. The movement of the microcatheter tip was restricted with the stent. A coil delivery wire that was advanced after coil detachment perforated the aneurysm. Hemostasis was achieved, and coil embolization was finished with a slight neck remnant. Complete occlusion of the aneurysm was confirmed on angiography six months later. Advancement of a coil alignment marker after coil detachment may cause aneurysm perforation due to coil delivery wire advancement. In stent-assisted coil embolization, when the movement of the microcatheter tip in the aneurysm is restricted by the stent and there is resistance to coil insertion, the risk of perforation due to the coil delivery wire after coil detachment should be noted.
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9
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Nakagawa N, Fukawa N, Tsuji K, Furukawa K, Watanabe A, Izumoto S. Evaluation of the Safety and Effectiveness of Coil Embolization for Anterior Communicating and Anterior Cerebral Artery Aneurysms. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:19-25. [PMID: 37502028 PMCID: PMC10370626 DOI: 10.5797/jnet.oa.2020-0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 04/02/2021] [Indexed: 07/29/2023]
Abstract
Objective Endovascular coil embolization for anterior communicating artery (ACoA) and anterior cerebral artery (ACA) aneurysms is associated with high total and near-total occlusion rates, but the complication rate is high. The development of newer endovascular technologies may improve the clinical outcomes. This study investigated the status of endovascular treatment of ACoA and ACA aneurysms by comparing our results with past reports. Methods Between January 2006 and December 2018, we investigated 50 patients who were followed for 12 months or longer to clarify the outcomes of coil embolization. The outcomes of embolization were evaluated using time-of-flight MRA. The safety was evaluated based on procedure-related complications that affected clinical outcomes. Results Initial assessments demonstrated complete obliteration in 84% (42 of 50 patients) and a residual neck in 14% (7 of 50 patients). Procedure-related complications developed in 12% (6 of 50 patients). The procedure-related morbidity rate was 2% (1 of 50 patients) and there was no procedure-related death. Recanalization was noted in 14% (7 of 50 patients, median follow-up period, 57 months). The recanalized aneurysms were significantly smaller than the stable aneurysms in maximum size (4.3 mm vs. 5.8 mm; p = 0.017) and height (3.7 mm vs. 4.3 mm; p = 0.035). Conclusion We demonstrated the safety and effectiveness of endovascular coil embolization for ACoA and ACA aneurysms. The small size of aneurysms may be related to recanalization.
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Affiliation(s)
- Nobuhiro Nakagawa
- Department of Neurosurgery, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Norihito Fukawa
- Department of Neurosurgery, Kindai University Hospital, Osakasayama, Osaka, Japan
| | - Kiyoshi Tsuji
- Department of Neurosurgery, Kindai University Hospital, Osakasayama, Osaka, Japan
| | - Kentaro Furukawa
- Department of Neurosurgery, Kindai University Hospital, Osakasayama, Osaka, Japan
| | - Akira Watanabe
- Department of Neurosurgery, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Shuichi Izumoto
- Department of Neurosurgery, Kindai University Nara Hospital, Ikoma, Nara, Japan
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Hosoo H, Tsuruta W, Katsumata M, Ishigami D, Ishikawa E, Matsumaru Y, Matsumura A. Long-term Durability of Coil Embolization for Unruptured Aneurysm after Introduction of the Neck-bridge Stent: Comparison between the Pre-stent Era and the Stent Era. Neurol Med Chir (Tokyo) 2021; 61:204-210. [PMID: 33504732 PMCID: PMC7966204 DOI: 10.2176/nmc.oa.2020-0221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
More complex aneurysms can be treated by coil embolization with neck-bridge stent assistance. However, concerns about postprocedural ischemic or hemorrhagic complications remain. In this study, we assessed the long-term durability after introduction of neck-bridge stent in the context of coil embolization for unruptured aneurysm by comparing re-treatment and neurological events between the pre-stent and stent eras. Unruptured aneurysms treated by coil embolization between April 2005 and May 2018 were analyzed retrospectively. We divided cases into two groups: the pre-stent era and the stent era. The cumulative rate of re-treatment and neurological events were assessed and compared. During the period, 177 aneurysms were treated in the pre-stent era and 354 aneurysms were treated in the stent era. The median follow-up was 55 months. In the stent era, the dome/neck (D/N) ratio was significantly lower (P <0.001) and the number of aneurysms located at the posterior circulation was higher (P <0.001). A stent was used in 31.92% of cases in the stent era. The cumulative rate of re-treatment was significantly higher in the pre-stent era than it was in the stent era in univariate and multivariate analyses (P = 0.008, P = 0.008, respectively). The cumulative rate of neurological events was not significantly different between the two groups. The re-treatment rate has been improved without increasing neurological complications after introduction of the neck-bridge stent.
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Affiliation(s)
- Hisayuki Hosoo
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Wataro Tsuruta
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Masahiro Katsumata
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Daiichiro Ishigami
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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11
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Terakado T, Nakai Y, Ikeda G, Uemura K, Matsumaru Y. The Relationships between Anatomical Factors and Treatment Procedures for the Endovascular Treatment of Anterior Communicating Artery Aneurysms. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 15:142-149. [PMID: 37502729 PMCID: PMC10370672 DOI: 10.5797/jnet.oa.2020-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/23/2020] [Indexed: 07/29/2023]
Abstract
Objective Endovascular treatment of anterior communicating artery aneurysms is difficult due to their complex anatomical structure. We retrospectively analyzed the relationships among the anatomical features, initial microcatheter positions, and initial occlusion outcomes. Methods In all, 66 cases were treated at our hospital. We investigated the relationships among the anatomical features of the aneurysm and A1 segment of the anterior cerebral artery (ACA), treatment procedures, and initial occlusion outcomes. We divided the initial microcatheter positions into greater and lesser curvatures based on the curvature from A1 to the aneurysm, and evaluated the outcomes. Results In total, 54 out of 66 patients (82%) achieved complete obliteration (CO) or had residual neck (RN) aneurysms, and 12 had residual aneurysms (RAs: 18%). Neck diameters and superior position aneurysms were correlated with initial occlusion outcomes in the multivariate analysis. The relationship between initial occlusion outcomes and initial microcatheter positions in superior position aneurysms (37 patients) was then examined. Eleven out of 26 patients (42.3%) had residual aneurysms at the greater curvature microcatheter position, whereas no residual aneurysms were detected at the lesser curvature microcatheter position. The A1 angle was not correlated with the outcomes. Conclusion Wide-necked aneurysms and superior position aneurysms were identified as factors leading to incomplete occlusion in the endovascular treatment of anterior communicating artery aneurysms. The microcatheter position at the greater curvature in superior position aneurysms was a factor for incomplete occlusion. This suggests that guiding the microcatheter to the lesser curvature position of A1 is important in the treatment of superior position aneurysms.
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Affiliation(s)
- Toshitsugu Terakado
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
- Department of Neurosurgery, Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Yasunobu Nakai
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
- Intravascular Treatment Center, Yokohama Brain and Spine Center, Yokohama, Kanagawa, Japan
| | - Go Ikeda
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Kazuya Uemura
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Bsat S, Bsat A, Tamim H, Chanbour H, Alomari SO, Houshiemy MNE, Moussalem C, Omeis I. Safety of stent-assisted coiling for the treatment of wide-necked ruptured aneurysm: A systematic literature review and meta-analysis of prevalence. Interv Neuroradiol 2020; 26:547-556. [PMID: 32741229 DOI: 10.1177/1591019920945059] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Stent-assisted coil embolization of ruptured wide-necked aneurysms is a controversial treatment modality due to concerns on the peri-procedural safety of anti-platelet therapy in the setting of acute subarachnoid hemorrhage. Our aim was to systematically review the literature on stent-assisted coil embolization of acutely ruptured wide-neck aneurysms to calculate the pooled prevalence of clinical outcome, thromboembolic and hemorrhagic complication rates and overall mortality. METHODS We searched PubMed and Google Scholar for articles published between 2009 and 2019 and stratified selected articles based on risk of publication bias. Data on thromboembolic and hemorrhagic complications, clinical outcomes and mortality rates were analyzed using quality-effects model and double arcsine transformation. RESULTS 24 articles were included featuring a total of 1582 patients. Thromboembolic and hemorrhagic complication rates were witnessed in 9.1% [95% CI: 6.0% - 12.7%; I2 = 72.8%] and 8.7% [95% CI: 5.4 - 12.6%; I2 = 77.2%] of patients, respectively. 245 patients received external ventricular drains, of which 33 (13.5%) had EVD-related hemorrhages. Total complication rate was 20.8% [95% CI: 14.2 - 28.1%; I2 = 87.0%]. 57% of aneurysms were completely occluded and a favorable clinical outcome was reported in 74.7% [95% CI: 66.4 - 82.2%; I2 = 86.0] of patients. Overall mortality rate came at 7.8% [95% CI: 4.8 - 11.6%; I2 = 76.9%]. CONCLUSION Stent-assisted coiling of ruptured intracranial aneurysm is a technically feasible procedure with controlled thromboembolic complication rate but may be associated with higher hemorrhagic and total complication rates compared to coiling alone. While stent-assisted coiling of ruptured wide-necked aneurysm seems to yield a lower rate of favorable clinical outcome, overall mortality is comparable to that of endovascular coiling alone.
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Affiliation(s)
- Shadi Bsat
- Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ayman Bsat
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Chanbour
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Safwan Omar Alomari
- Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Charbel Moussalem
- Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ibrahim Omeis
- Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
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13
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Rizvi A, Seyedsaadat SM, Alzuabi M, Murad MH, Kadirvel R, Brinjikji W, Kallmes DF. Long-Term Rupture Risk in Patients with Unruptured Intracranial Aneurysms Treated with Endovascular Therapy: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2020; 41:1043-1048. [PMID: 32467181 DOI: 10.3174/ajnr.a6568] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/19/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Surveillance imaging of previously unruptured, coiled aneurysms remains routine even though reports of rupture of these aneurysms are extremely rare. PURPOSE We performed meta-analysis to examine long-term rupture risk over ≥1-year follow-up duration in patients with unruptured intracranial aneurysm who underwent endovascular therapy. DATA SOURCES Multiple databases were searched for relevant publications between 1995 and 2018. STUDY SELECTION Studies reporting outcome of long-term rupture risk over ≥1-year follow-up in treated patients with unruptured intracranial aneurysms were included. DATA ANALYSIS Random effects meta-analysis was used, and results were expressed as long-term rupture rate per 100 patient-year with respective 95% CIs. For ruptured aneurysms during follow-up, data were collected on size and completeness of initial Treatment. DATA SYNTHESIS Twenty-four studies were identified. Among 4842 patients with a mean follow-up duration of 3.2 years, a total of 12 patients (0.25%) experienced rupture of previous unruptured intracranial aneurysms after endovascular treatment. Nine of these 12 patients harbored aneurysms that were large, incompletely treated, or both. A total of 2 anterior circulation, small, completely coiled aneurysms subsequently ruptured. The long-term rupture rate per 100 patient-year for unruptured intracranial aneurysms treated with endovascular therapy was 0.48 (95% CI, 0.45-0.51). Retreatment was carried out in 236 (4.9%) of these 4842 patients. LIMITATIONS A limitation of the study is that a lack of systematic nature of follow-up and mean follow-up duration of 3.2 years are not sufficient to make general recommendations about aneurysm followup paradigms. CONCLUSIONS Given a 5% retreatment rate, postcoil embolization spontaneous rupture of previously unruptured, small- and medium-sized, well-treated aneurysms is exceedingly rare.
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Affiliation(s)
- A Rizvi
- From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.) .,Department of Medicine (A.R.), University of Texas Medical Branch, Galveston, Texas
| | - S M Seyedsaadat
- From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.)
| | - M Alzuabi
- From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.)
| | - M H Murad
- Evidence-Based Practice Center (M.H.M.), Mayo Clinic, Rochester, Minnesota
| | - R Kadirvel
- From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.)
| | - W Brinjikji
- From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.).,Joint Department of Medical Imaging (W.B.), Toronto Western Hospital, Toronto, Ontario, Canada
| | - D F Kallmes
- From the Department of Radiology (A.R., S.M.S., M.A., R.K., W.B., D.F.K.)
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Zheng J, Sun X, Zhang X. Influence of Age-Related Complications on Clinical Outcome in Patients With Small Ruptured Cerebral Aneurysms. Front Neurol 2020; 11:131. [PMID: 32194496 PMCID: PMC7066075 DOI: 10.3389/fneur.2020.00131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 02/05/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Small ruptured cerebral aneurysms (≤5 mm) account for the majority of aneurysmal subarachnoid hemorrhages, and its clinical management remains a challenge. The aim of this study was to identify the effect of age-related complications on the outcome of patients with small ruptured aneurysm. Methods: A retrospective review was performed in patients with small ruptured aneurysms who underwent microsurgical clipping or endovascular coiling from September 2012 to December 2018. According to their ages, the patients were divided into the elderly group and the non-elderly group. Baseline characteristics, clinical complications, and outcome of patients were analyzed between the two groups. A multivariate logistic regression analysis was used to determine the risk factors associated with the poor outcome of the elderly patients. Results: In the elderly group, 83 patients were treated with clipping and 50 were treated with coiling. In the non-elderly group, 188 patients were treated with clipping and 117 were treated with coiling. The incidence of neurological complications with neurologic deficit in the elderly group was significantly higher compared with that in the non-elderly group (P = 0.006). The elderly patients had a longer hospital stay (P = 0.032) and a poorer outcome (P = 0.001) compared with the non-elderly patients. A multivariate analysis showed that irregular aneurysms (P = 0.045) and ischemic events (P < 0.001) were independent risk factors associated with poor outcome in the elderly. Conclusions: Neurological complications with neurologic deficit, especially ischemic complications, were clearly more common in the elderly patients. Irregular small aneurysms or postoperative ischemic events should be paid attention as the higher risk of poor outcome in the elderly.
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Affiliation(s)
- Jianfeng Zheng
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaochuan Sun
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaodong Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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15
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Oleynik A, Ivanova N, Oleynik E, Ivanov A. Quality of life of patient with multiple cerebral aneurysms after endovascular treatment: assessment by the criteria of international classification of functioning. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2019. [DOI: 10.24075/brsmu.2019.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The rate of mortality and disability associated with aneurysmal subarachnoid hemorrhage (SAH) is high. Patients with multiple cerebral aneurysms (MCA) require repeated surgeries more often and they are likely to develop aneurysms de novo and suffer their rupture. This study aimed to apply the International Classification of Functioning (ICF) to assess the quality of life (QOL) of MCA patients after endovascular treatment, late postoperative period. The study involved patients who underwent endovascular treatment and had multiple (>2) cerebral aneurysms (141 people). All patients underwent 1–6 endovascular surgeries; complications developed in 7.1% (10/141) of cases. The patients' QOL was assessed against the ICF 6 to 24 months post-surgery. We found that at such time points treatment results deteriorate in a number of domains, namely those associated with pain, memory, motor coordination, limb strength. Patients with ruptured aneurysms showed worse results for locomotion-related domains than patients with unruptured aneurysms (p < 0.05), in patients with aneurysms having a pseudotumor type of flow, by domains associated with dysfunction of the cranial nerves responsible for innervation of the eye muscles (p < 0.001) (p < 0.001). Patients with ruptured MCA were more active in the late post-surgery period, which was revealed by comparing that period's data to the baseline pre-surgery records (p < 0.05). The severity of activity disorders depended on surgery complications, patient age (p < 0.05), complications that developed during the acute SAH stage (p < 0.001).
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Affiliation(s)
- A.A. Oleynik
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Saint-Peterburg, Russia
| | - N.E. Ivanova
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Saint-Peterburg, Russia
| | - E.A. Oleynik
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Saint-Peterburg, Russia
| | - A.Yu. Ivanov
- St.Petersburg State Pediatric Medical University, Saint-Peterburg, Russia; Mechnikov North-Western State Medical University, Saint-Peterburg, Russia
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Blackburn SL, Cawley CM, Guzman R. Wider Adoption of Flow Diversion for Intracranial Aneurysms. Stroke 2019; 50:3333-3334. [PMID: 31587661 DOI: 10.1161/strokeaha.119.027086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Spiros L Blackburn
- From the Department of Neurosurgery, University of Texas Health Science Center, Houston, TX (S.L.B.)
| | - C Michael Cawley
- Department of Neurosurgery, Emory University, Atlanta, GA (C.M.C.)
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital Basel, Switzerland (R.G.)
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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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18
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Endovascular treatment of small (< 5 mm) unruptured middle cerebral artery aneurysms. Pol J Radiol 2019; 84:e198-e204. [PMID: 31481991 PMCID: PMC6717937 DOI: 10.5114/pjr.2019.84829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 02/18/2019] [Indexed: 01/09/2023] Open
Abstract
Purpose We report our experience with endovascular treatment of these lesions, with special consideration of angiographic and clinical outcomes and periprocedural complications. Material and methods The analysis included treatment results of 19 patients with 20 aneurysms. The aneurysm size ranged from 1.9 to 4.7 mm (mean 3.8, SD 0.7). Clinical examinations with the use of modified Rankin Score and angiographic outcomes were evaluated initially postembolisation and at a minimum follow-up of six months. Results Initial post-treatment complete and near-complete aneurysm occlusion was achieved in 19 (95%) cases and incomplete occlusion in one (5%) case. Imaging follow-up, performed in 17 (89.4%) patients, showed no change in the degree of occlusion in 16 (94.1%) patients and coil compaction in one (5.9%). There were no retreatment procedures. The procedure-related mortality rate was 5% (1/20) and was associated with intraprocedural aneurysm rupture. There was a case of a clinically silent coil prolapse into the parent artery. The clinical follow-up evaluation achieved in 17 (89.4%) patients showed no change in clinical status in all followed patients. Conclusions Endovascular treatment of small unruptured middle cerebral artery aneurysms is feasible and effective. The procedure-related complications are not negligible, especially in terms of the benign natural course of these lesions.
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19
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Mori K, Wada K, Otani N, Tomiyama A, Toyooka T, Takeuchi S, Yamamoto T, Nakao Y, Arai H. Keyhole strategy aiming at minimizing hospital stay for surgical clipping of unruptured middle cerebral artery aneurysms. J Neurosurg 2019; 130:1359-1366. [PMID: 29676694 DOI: 10.3171/2017.10.jns171973] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/19/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Aneurysms of the middle cerebral artery (MCA) are still most often treated by clipping through standard craniotomy, but a longer hospital stay is one of the main drawbacks of this treatment. The authors developed a pterional keyhole clipping strategy for unruptured MCA aneurysms with the intention of minimizing hospital stay. In this paper, they report on their experience with this approach and analyze the long-term neurological and radiological outcomes. METHODS A total of 160 relatively small unruptured MCA aneurysms (mean 6.4 mm) were clipped through the pterional keyhole approach (19-30 mm, mean 24.6 mm) in 149 patients (aged 34-79 years, mean 62 years). Neurological and cognitive function were examined by several scales, including the modified Rankin Scale (mRS) and Mini-Mental State Examination (MMSE). Patients' level of depression was assessed using the Beck Depression Inventory and Hamilton Depression Scale. The state of clipping was assessed at 1 year and then every few years after the operation. RESULTS The mean duration of postoperative hospitalization was 2.3 ± 3.4 days; in 31.3% of the cases, the patients were discharged on the day after the operation (overnight hospital stay) and in 93.2% within 3 days. Of the patients younger than 60 years, 40.4% required only an overnight stay. Complete aneurysm neck clipping was confirmed in 157 cases (98.1%). None of the completely clipped aneurysms showed any recurrence during the mean follow-up period of 5.0 years. The mean length of clinical follow-up was 5.4 years. After 2 (1.3%) of the surgical procedures, the patients showed persistent neurological deficits, defined as mRS score 1, but the overall operative morbidity based on the International Study of Unruptured Intracranial Aneurysms (ISUIA) definition (mRS score ≥ 2 or MMSE score < 24) was 0% at the last examination. Depression scores were significantly improved after surgery, and in 85.6% of the cases the patients were satisfied with their cosmetic results. CONCLUSIONS Pterional keyhole clipping is less invasive than clipping via standard craniotomy, minimizes hospital stay, and achieves durable treatment for relatively small unruptured MCA aneurysms.
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Affiliation(s)
- Kentaro Mori
- 1Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Kojiro Wada
- 1Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Naoki Otani
- 1Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Arata Tomiyama
- 1Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Terushige Toyooka
- 1Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Satoru Takeuchi
- 1Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama
| | - Takuji Yamamoto
- 2Department of Neurosurgery, Juntendo University, Shizuoka Hospital, Izunokuni, Shizuoka; and
| | - Yasuaki Nakao
- 2Department of Neurosurgery, Juntendo University, Shizuoka Hospital, Izunokuni, Shizuoka; and
| | - Hajime Arai
- 3Department of Neurosurgery, Juntendo University, Tokyo, Japan
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Li L, Zhang X, Feng Z, Zhao R, Hong B, Xu Y, Huang Q, Liu J. Risk Factors for Intraprocedural Rupture in the Endovascular Treatment of Unruptured Intracranial Aneurysms: A Single-Center Experience with 1232 Procedures. World Neurosurg 2019; 123:e9-e14. [DOI: 10.1016/j.wneu.2018.09.164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
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21
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Algra AM, Lindgren A, Vergouwen MDI, Greving JP, van der Schaaf IC, van Doormaal TPC, Rinkel GJE. Procedural Clinical Complications, Case-Fatality Risks, and Risk Factors in Endovascular and Neurosurgical Treatment of Unruptured Intracranial Aneurysms: A Systematic Review and Meta-analysis. JAMA Neurol 2019; 76:282-293. [PMID: 30592482 PMCID: PMC6439725 DOI: 10.1001/jamaneurol.2018.4165] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/02/2018] [Indexed: 01/16/2023]
Abstract
Importance The risk of procedural clinical complications and the case-fatality rate (CFR) from preventive treatment of unruptured intracranial aneurysms varies between studies and may depend on treatment modality and risk factors. Objective To assess current procedural clinical 30-day complications and the CFR from endovascular treatment (EVT) and neurosurgical treatment (NST) of unruptured intracranial aneurysms and risk factors of clinical complications. Data Sources We searched PubMed, Excerpta Medica Database, and the Cochrane Database for studies published between January 1, 2011, and January 1, 2017. Study Selection Studies reporting on clinical complications, the CFR, and risk factors, including 50 patients or more undergoing EVT or NST for saccular unruptured intracranial aneurysms after January 1, 2000, were eligible. Data Extraction and Synthesis Per treatment modality, we analyzed clinical complication risk and the CFR with mixed-effects logistic regression models for dichotomous data. For studies reporting data on complication risk factors, we obtained risk ratios (RRs) or odds ratios (ORs) with 95% CIs and pooled risk estimates with weighted random-effects models. Main Outcomes and Measures Clinical complications within 30 days and the CFR. Results We included 114 studies (106 433 patients with 108 263 aneurysms). For EVT (74 studies), the pooled clinical complication risk was 4.96% (95% CI, 4.00%-6.12%), and the CFR was 0.30% (95% CI, 0.20%-0.40%). Factors associated with complications from EVT were female sex (pooled OR, 1.06 [95% CI, 1.01-1.11]), diabetes (OR, 1.81 [95% CI, 1.05-3.13]), hyperlipidemia (OR, 1.76 [95% CI, 1.3-2.37]), cardiac comorbidity (OR, 2.27 [95% CI, 1.53-3.37]), wide aneurysm neck (>4 mm or dome-to-neck ratio >1.5; OR, 1.71 [95% CI, 1.38-2.11]), posterior circulation aneurysm (OR, 1.42 [95% CI, 1.15-1.74]), stent-assisted coiling (OR, 1.82 [95% CI, 1.16-2.85]), and stenting (OR, 3.43 [95% CI, 1.45-8.09]). For NST (54 studies), the pooled complication risk was 8.34% (95% CI, 6.25%-11.10%) and the CFR was 0.10% (95% CI, 0.00%-0.20%). Factors associated with complications from NST were age (OR per year increase, 1.02 [95% CI, 1.01-1.02]), female sex (OR, 0.43 [95% CI, 0.32-0.85]), coagulopathy (OR, 2.14 [95% CI, 1.13-4.06]), use of anticoagulation (OR, 6.36 [95% CI, 2.55-15.85]), smoking (OR, 1.95 [95% CI, 1.36-2.79]), hypertension (OR, 1.45 [95% CI, 1.03-2.03]), diabetes (OR, 2.38 [95% CI, 1.54-3.67]), congestive heart failure (OR, 2.71 [95% CI, 1.57-4.69]), posterior aneurysm location (OR, 7.25 [95% CI, 3.70-14.20]), and aneurysm calcification (OR, 2.89 [95% CI, 1.35-6.18]). Conclusions and Relevance This study identifies risk factors for procedural complications. Large data sets with individual patient data are needed to develop and validate prediction scores for absolute complication risks and CFRs from EVT and NST modalities.
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Affiliation(s)
- Annemijn M. Algra
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Antti Lindgren
- Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mervyn D. I. Vergouwen
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jacoba P. Greving
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Irene C. van der Schaaf
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Tristan P. C. van Doormaal
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gabriel J. E. Rinkel
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Bae IS, Yi HJ, Ko Y, Kim YS, Chun HJ, Choi KS. Practical Incidence of Complications and Degree of Patient Satisfaction After Endovascular Coil Embolization for Unruptured Intracranial Saccular Aneurysm Based on Patients' Surveys. World Neurosurg 2019; 127:e76-e85. [PMID: 30831292 DOI: 10.1016/j.wneu.2019.02.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Endovascular treatment for unruptured intracranial aneurysms (UIAs) has been regarded as second to none management nowadays as the result of its proven efficacy and need for less-invasive treatment. Most researchers have focused on the anatomical outcome after endovascular treatment, so in this study we estimated the real incidence of untoward effect and degree of patients' satisfaction based on s survey. METHODS This retrospective study was approved by the institutional review board, and 112 patients treated for saccular UIAs were evaluated among a total of 135 patients. After informed consent was obtained, these patients were sent a questionnaire regarding treatment effectiveness, complications, and patient satisfaction. These data were collected and compared with angiographic and clinical outcome. RESULTS The response rate was 87.5% (98/112). Intracranial complications occurred in 10 aneurysms (10.2%): 7 ischemic and 3 hemorrhagic strokes. Other complications occurred in 30 patients (30.6%): 17 alopecia, 15 bleeding tendency, and 3 puncture-site complications. Overall, 89 (90.8%) patients reported being satisfied with their treatment. Patient satisfaction was closely correlated with clinically successful outcome of treatment. CONCLUSIONS Ninety percent of patients were satisfied with the results after endovascular treatment of UIAs. Endovascular coil embolization was effective and safe procedure, with high clinical success rate and degree of satisfaction.
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Affiliation(s)
- In-Suk Bae
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea.
| | - Yong Ko
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Young Soo Kim
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Hyoung-Joon Chun
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
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Park YK, Yi HJ, Choi KS, Lee YJ, Chun HJ. Intraprocedural Rupture During Endovascular Treatment of Intracranial Aneurysm: Clinical Results and Literature Review. World Neurosurg 2018; 114:e605-e615. [DOI: 10.1016/j.wneu.2018.03.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
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Ihn YK, Shin SH, Baik SK, Choi IS. Complications of endovascular treatment for intracranial aneurysms: Management and prevention. Interv Neuroradiol 2018; 24:237-245. [PMID: 29466903 DOI: 10.1177/1591019918758493] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Endovascular coiling for intracranial aneurysms has become an accepted treatment with good clinical results and provides adequate protection against rebleeding and rupture of aneurysms. However, despite the experience, preparation, or skill of the physician, complications during endovascular treatment still occur. The main complications of endovascular coiling are: procedural aneurysmal perforations by the microcatheter, micro-guidewire, or coil, and thromboembolic events. Such situations are unexpected, complex, and can have devastating consequences. In this article, we present a comprehensive review of the two most common complications, aneurysmal perforation and thromboembolism during endovascular coiling, and how we can prevent or overcome these complications to achieve a satisfactory outcome. In addition, as the flow diverter has been become an important tool for management of large, wide necked, and other anatomically challenging aneurysms, we also describe complications stemming from the use of the tool, which remains a novel treatment option for complex aneurysms.
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Affiliation(s)
- Yon Kwon Ihn
- 1 Department of Radiology, St. Vincent's hospital, The Catholic University of Korea, Suwon, Korea
| | - Shang Hun Shin
- 2 Department of Radiology, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seung Kug Baik
- 3 Department of Radiology, Pusan National University School of Medicine, Yangsan, Korea
| | - In Sup Choi
- 4 Department of Radiology, Lahey Hospital and Medical Center, Burlington, USA
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Kocur D, Przybyłko N, Bażowski P, Baron J. Rupture during coiling of intracranial aneurysms: Predictors and clinical outcome. Clin Neurol Neurosurg 2018; 165:81-87. [PMID: 29331871 DOI: 10.1016/j.clineuro.2018.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/03/2018] [Accepted: 01/07/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The intraprocedural aneurysm rupture (IPR) is one of the most feared adverse effect associated with the coil embolization therapy. The aim of the study was to identify predisposing factors for IPR, as well as to define patient groups with worse clinical outcome following IPR. PATIENTS AND METHODS From February 2008 to March 2015, 273 consecutive patients were treated at our institution via endovascular coil embolization. Patient medical records were reviewed with emphasis on procedure description, potential risk factors and clinical outcomes related to IPR. The IPR occurred in 14 (5.13%) cases. Multivariate logistic regression models were used to determine independent predictors of IPR. Clinical outcome was analyzed using the Glasgow Outcome Scale (GOS). RESULTS Multivariate analysis showed that aneurysm location at posterior communicating artery is an independent risk factor for IPR (p = 0.035; OR 3.5; 95%CI 1.09-11.26). The frequencies of favorable disability (GOS 4-5), severe disability (GOS 2-3), and mortality (GOS 1) between patients with IPR and without IPR were significantly different in the general study population (p < 0.001, p < 0.001 and p = 0.023, respectively) and in patients with previously unruptured aneurysms (p < 0.001, p = 0.006 and p = 0.003, respectively) but not in patients with previously ruptured aneurysms (p = 0.187, p = 0.089 and p = 1.0, respectively). CONCLUSION Posterior communicating artery aneurysm location is an independent predictor for IPR. IPR is associated with a significant clinical deterioration in a subgroup of patients with previously unruptured aneurysms, but not in patients with ruptured aneurysms.
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Affiliation(s)
- Damian Kocur
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Katowice, Poland.
| | - Nikodem Przybyłko
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Katowice, Poland
| | - Piotr Bażowski
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Katowice, Poland
| | - Jan Baron
- Medical University of Silesia, School of Medicine in Katowice, Department of Radiology and Nuclear Medicine, Katowice, Poland
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Kawabata S, Imamura H, Adachi H, Tani S, Tokunaga S, Funatsu T, Suzuki K, Sakai N. Risk factors for and outcomes of intraprocedural rupture during endovascular treatment of unruptured intracranial aneurysms. J Neurointerv Surg 2017; 10:362-366. [PMID: 28710085 DOI: 10.1136/neurintsurg-2017-013156] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/24/2017] [Accepted: 06/26/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND PURPOSE The risk factors for intraprocedural rupture (IPR) of unruptured intracranial aneurysms (UIAs) and the outcomes of IPR itself are unclear. This study was performed to identify the independent risk factors for and outcomes of IPR. MATERIALS AND METHODS We retrospectively evaluated the medical records and radiologic data of 1375 patients (1406 UIAs) who underwent coil embolization from January 2001 to October 2016. RESULTS IPR occurred in 20 aneurysms of 20 patients (1.4%). Univariate analyses showed that the rate of IPR was significantly higher in the treatment of aneurysms with a small dome size, aneurysms in the anterior communicating artery (AcomA) (6.6%), and patients with a medical history of dyslipidemia. Multivariate analyses showed that a small dome size and aneurysms in the AcomA were independently associated with IPR (p=0.0096 and p=0.0001, respectively). IPR induced by a microcatheter was associated with a higher risk of severe subarachnoid hemorrhage than other causes of IPR (57% vs 0%, respectively). Thromboembolic complications occurred in seven (35%) patients with IPR. Six (30%) patients required external ventricular drainage placement after developing symptoms of acute hydrocephalus. The overall morbidity and mortality rates from IPR were 0.22% and 0.15%, respectively. CONCLUSIONS Aneurysms in the AcomA and with a small dome size are likely to be risk factors for IPR. IPR induced by microcatheters can result in poor outcomes. The rate of IPR-associated thromboembolic complications is high, and IPR itself is associated with acute hydrocephalus. If managed appropriately, however, most patients with IPR can survive without neurological deterioration.
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Affiliation(s)
- Shuhei Kawabata
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hidemitsu Adachi
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shoichi Tani
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - So Tokunaga
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takayuki Funatsu
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Keita Suzuki
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan.,Division of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation Hospital, Kobe, Japan
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Bernat AL, Clarençon F, André A, Nouet A, Clémenceau S, Sourour NA, Di Maria F, Degos V, Golmard JL, Cornu P, Boch AL. Risk factors for angiographic recurrence after treatment of unruptured intracranial aneurysms: Outcomes from a series of 178 unruptured aneurysms treated by regular coiling or surgery. J Neuroradiol 2017; 44:298-307. [PMID: 28602498 DOI: 10.1016/j.neurad.2017.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/13/2017] [Accepted: 05/03/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term stability after intracranial aneurysm exclusion by coiling is still a matter of debate; after surgical clipping little is known. OBJECTIVE To study outcome after endovascular and surgical treatments for unruptured intracranial aneurysms in terms of short- and long-term angiographic exclusion and risk factors for recanalization. METHODS From 2004 and 2009, patients treated for unruptured berry intracranial aneurysms by coiling or clipping were reviewed. Aneurysmal exclusion was evaluated using the Roy-Raymond grading scale; immediate clinical outcome was also assessed. Clinical outcome, recanalization, risk factors for recurrence and bleeding during the follow-up period were analyzed by groups; "surgery" and "embolization". RESULTS From 2004 to 2009, 178 consecutive unruptured aneurysms were treated. The post-procedure angiographic results for "surgery" were: total exclusion 75.6%; residual neck 13.5%; residual aneurysm 10.8%. For "embolization", the results were, respectively: 72%; 20.7%; and 7.2%. Morbidity was 3% for "surgery" and 1.6% for "embolization" (P=0.74); mortality was nil. Mean clinical and angiographic follow-up was 5years. Recurrence rate was of 11.5% for "surgery" vs. 44% for "embolization" with a mean follow-up of 4 and 5.75years, respectively (P=1.10-5). The retreatment rate was 8.4%. Two significant risk factors for recanalization were identified: maximum diameter of the aneurysm sac (P=0.0038) and pericallosal location (P=0.0388). No bleeding event occurred. CONCLUSION Both techniques are safe. The rate of aneurismal recurrence was significantly higher for embolization, especially for large diameter aneurysms and pericallosal locations. No bleeding event occurred after recanalization.
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Affiliation(s)
- Anne-Laure Bernat
- Department of Neurosurgery, Lariboisière University Hospital, AP-HP, 75010 Paris, France; Paris VII University, Paris Diderot, Paris, France.
| | - Frédéric Clarençon
- Department of Interventional Neuroradiology, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France; Paris VI University, Pierre-et-Marie-Curie, Paris, France
| | - Arthur André
- Department of Neurosurgery, Lariboisière University Hospital, AP-HP, 75010 Paris, France; Paris VI University, Pierre-et-Marie-Curie, Paris, France
| | - Aurélien Nouet
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Stéphane Clémenceau
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Nader-Antoine Sourour
- Department of Interventional Neuroradiology, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Federico Di Maria
- Department of Interventional Neuroradiology, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Vincent Degos
- Paris VI University, Pierre-et-Marie-Curie, Paris, France; Department of Anesthesia and Perioperative Care, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Jean-Louis Golmard
- Paris VI University, Pierre-et-Marie-Curie, Paris, France; Department of Biomedical Statistics, Pitié-Salpêtrière University Hospital, AP-HP, 75013 Paris, France
| | - Philippe Cornu
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France; Paris VI University, Pierre-et-Marie-Curie, Paris, France
| | - Anne-Laure Boch
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
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Petr O, Brinjikji W, Cloft H, Kallmes DF, Lanzino G. Current Trends and Results of Endovascular Treatment of Unruptured Intracranial Aneurysms at a Single Institution in the Flow-Diverter Era. AJNR Am J Neuroradiol 2016; 37:1106-13. [PMID: 26797138 DOI: 10.3174/ajnr.a4699] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/18/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE During the past several years, the number of unruptured aneurysms treated with endovascular techniques has increased. Traditionally, coil embolization was the treatment of choice for these lesions; however, recently flow diversion has become a viable, and in some cases superior, treatment option. The current single-center study presents results and trends of endovascular treatment with flow diversion and coil embolization in an unselected group of patients with unruptured intracranial aneurysms in a "real world" setting during the flow-diverter era. MATERIALS AND METHODS Three hundred ten patients with 318 treated unruptured aneurysms from June 2009 to May 2015 were included. Patient demographics, clinical characteristics, aneurysm/treatment characteristics, and outcomes were collected prospectively. We studied the following: intensive care unit admission/reasons, perioperative and mid-/long-term complications, target aneurysm rupture, retreatment/recurrence rates, and long-term neurologic outcome using the mRS. RESULTS The flow-diverter group had a larger mean aneurysm size (12.3 ± 8.6 mm versus 8.7 ± 6.3 mm, P < .0001). There were no significant differences in the immediate (P = .43) and mid-/long-term complication rates (P = .54) between groups. Periprocedural neurologic morbidity and mortality rates were 2.1% and 0.5% in the coiling group and 2.5% and 1.6% in the flow-diverter group. Patients with coiling were more likely to be retreated than those with flow diversion (14.8% versus 5.7%, P = .009). Worsening of the mRS due to the target aneurysm was noted in only 3.2% of patients. CONCLUSIONS The endovascular treatment of unruptured aneurysms can be performed with very low rates of neurologic complications. Both flow-diverter and coil therapy were safe and effective.
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Affiliation(s)
- O Petr
- From the Departments of Neurologic Surgery (O.P., G.L.) Department of Neurosurgery, (O.P.), Medical University, Innsbruck, Austria
| | - W Brinjikji
- Radiology (W.B., H.C., D.F.K., G.L.), Mayo Clinic, Rochester, Minnesota
| | - H Cloft
- Radiology (W.B., H.C., D.F.K., G.L.), Mayo Clinic, Rochester, Minnesota
| | - D F Kallmes
- Radiology (W.B., H.C., D.F.K., G.L.), Mayo Clinic, Rochester, Minnesota
| | - G Lanzino
- From the Departments of Neurologic Surgery (O.P., G.L.) Radiology (W.B., H.C., D.F.K., G.L.), Mayo Clinic, Rochester, Minnesota
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29
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Zhang X, Zhong J, Gao H, Xu F, Bambakidis NC. Endovascular treatment of intracranial aneurysms with the LVIS device: a systematic review. J Neurointerv Surg 2016; 9:553-557. [PMID: 27206450 DOI: 10.1136/neurintsurg-2016-012403] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/27/2016] [Accepted: 05/02/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Despite promising initial results, current knowledge regarding the use of the Low-profile Visualized Intraluminal Support (LVIS) device to treat wide-necked intracranial aneurysms is still limited. Our aim is to evaluate the feasibility, efficacy, and safety of the LVIS device in stent-assisted coiling of intracranial aneurysms. METHODS We conducted a systematic review by searching PubMed, EMBASE, and Cochrane Library for all published studies on the treatment of intracranial aneurysms with the LVIS device up to March 2016. Feasibility was evaluated by the technical success rate during the procedure, efficacy was evaluated by the rate of complete aneurysm occlusion at follow-up angiography, and safety was assessed by procedure-related morbidity and mortality. RESULTS A total of nine studies were included in the analysis, including 384 patients with 390 aneurysms. The overall technical success rate was 96.8% (95% CI 94.4% to 99.1%). The aneurysmal complete occlusion rate was 54.6% (95% CI 31.8% to 77.4%) on immediate control and 84.3% (95% CI 78.9% to 89.7%) at follow-up angiography. Procedural-related morbidity and mortality were 1.4% (95% CI 0.2% to 2.6%) and 0% (95% CI 0%), respectively. The thromboembolic event rate was 4.9% (95% CI 1.9% to 7.9%) and the hemorrhagic event rate was 2.1% (95% CI 0.7% to 3.5%), with 0.9% (95% CI 0% to 1.8%) experiencing neurologic hemorrhagic complications and 1.9% (95% CI 0.5% to 3.2%) experiencing non-neurologic hemorrhagic complications. CONCLUSIONS Our systematic review suggests that endovascular treatment of intracranial aneurysms with the LVIS device is feasible, safe, and effective in the short term. However, the rate of thromboembolic complications is not negligible. Further prospective studies are needed to evaluate the long-term efficacy and safety of the LVIS device.
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Affiliation(s)
- Xiaoguang Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Henan University, Henan, China
| | - Junjie Zhong
- Department of Neurosurgery, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, China
| | - Heng Gao
- Department of Neurosurgery, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, China
| | - Feng Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Nicholas C Bambakidis
- Department of Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA
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Cheng XQ, Chen Q, Zhou CS, Li JR, Zhang ZJ, Zhang LJ, Huang W, Lu GM. Whole-brain CT perfusion combined with CT angiography for ischemic complications following microsurgical clipping and endovascular coiling of ruptured intracranial aneurysms. J Clin Neurosci 2016; 26:50-6. [PMID: 26775148 DOI: 10.1016/j.jocn.2015.05.067] [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: 03/13/2015] [Revised: 05/13/2015] [Accepted: 05/22/2015] [Indexed: 10/22/2022]
Abstract
Ischemic complications associated with microsurgical clipping and endovascular coiling affects the outcome of patients with intracranial aneurysms. We prospectively evaluated 58 intracranial aneurysm patients who had neurological deterioration or presented with poor grade (Hunt-Hess grades III and IV), aneurysm size >13 mm and multiple aneurysms after clipping or coiling. Thirty patients had ischemic complications (52%) as demonstrated by whole-brain CT perfusion (WB-CTP) combined with CT angiography (CTA). Half of these 30 patients had treatment-associated reduction in the diameter of the parent vessels (n=6), ligation of the parent vessels or perforating arteries (n=2), and unexplained or indistinguishable vascular injury (n=7); seven of these 15 (73%) patients suffered infarction. The remaining 15 patients had disease-associated cerebral ischemia caused by generalized vasospasm (n=6) and focal vessel vasospasm (n=9); six of these 15 (40%) patients developed infarction. Three hemodynamic patterns of ischemic complications were found on WB-CTP, of which increased time to peak, time to delay and mean transit time associated with decreased cerebral blood flow and cerebral blood volume were the main predictors of irreversible ischemic lesions. In conclusion, WB-CTP combined with CTA can accurately determine the cause of neurological deterioration and classify ischemic complications. This combined approach may be helpful in assessing hemodynamic patterns and monitoring operative outcomes.
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Affiliation(s)
- Xiao Qing Cheng
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province 210002, China
| | - Qian Chen
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province 210002, China
| | - Chang Sheng Zhou
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province 210002, China
| | - Jian Rui Li
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province 210002, China
| | - Zong Jun Zhang
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province 210002, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province 210002, China
| | - Wei Huang
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province 210002, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province 210002, China.
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Alshafai N, Falenchuk O, Cusimano MD. Practises and controversies in the management of asymptomatic aneurysms: Results of an international survey. Br J Neurosurg 2015; 29:758-64. [DOI: 10.3109/02688697.2015.1096906] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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32
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ITO H, ONODERA H, WAKUI D, UCHIDA M, SASE T, MORISHIMA H, OSHIO K, TANAKA Y. Impact of Aneurysmal Neck Position in Endovascular Therapy for Anterior Communicating Artery Aneurysms. Neurol Med Chir (Tokyo) 2015; 56:21-6. [PMID: 26458847 PMCID: PMC4728145 DOI: 10.2176/nmc.oa.2015-0201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 09/27/2015] [Indexed: 11/29/2022] Open
Abstract
Anterior communicating artery (ACoA) aneurysms have a complex architecture and many variations, making endovascular therapy more difficult in some cases. The aim of this study was to investigate whether the neck position of an aneurysm was identifiable for determining the immediate angiographic success and procedural complications in the coiling of the ACoA aneurysms. We conducted a retrospective case review of 40 patients with ACoA aneurysms treated by endovascular therapy from 2008 to 2015. The mean age was 66.8 years. Thirty-five aneurysms were ruptured; five were unruptured. For the analysis, the patients were divided into two groups according to the neck position of aneurysms: the true ACoA group, 9 patients with the neck located on the ACoA itself; and the other ACoA group, 31 patients with the neck at the junction of the A1 and A2 portions of an anterior cerebral artery. Morphological characteristics (dome size, dome direction, rate of wide neck, and angulation of aneurysms in relation to the parent artery) were analyzed along with immediate angiographic results, volume embolization ratio (VER), and procedural complications. Small aneurysms with superior dome projection and acute angulation of the aneurysm direction occurred more often in the true ACoA group. The rates of complete obliteration, VER, and procedural complications were 33.3%, 32.3%, and 22.2% in the true ACoA group and 54.8%, 36.3%, and 6.5% in the other ACoA group, respectively. True ACoA aneurysms could present an anatomical difficulty in endovascular coiling. Aneurysmal neck position should be accurately assessed to achieve successful embolization of the ACoA aneurysms.
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Affiliation(s)
- Hidemichi ITO
- St. Marianna University School of Medicine, Kawasaki, Kanagawa
| | | | - Daisuke WAKUI
- St. Marianna University School of Medicine, Kawasaki, Kanagawa
| | - Masashi UCHIDA
- St. Marianna University School of Medicine, Kawasaki, Kanagawa
| | - Taigen SASE
- St. Marianna University School of Medicine, Kawasaki, Kanagawa
| | | | - Kotaro OSHIO
- St. Marianna University School of Medicine, Kawasaki, Kanagawa
| | - Yuichiro TANAKA
- St. Marianna University School of Medicine, Kawasaki, Kanagawa
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Sadato A, Adachi K, Hayakawa M, Kato Y, Hirose Y. Effects of anatomic characteristics of aneurysms on packing density in endovascular coil embolization: analysis of a single center's experience. Neurosurg Rev 2015. [PMID: 26223542 DOI: 10.1007/s10143-015-0658-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
When embolizing cerebral aneurysms, dense coil packing may prevent recanalization but this may be influenced by the aneurysm morphology. We have analyzed retrospectively the relationship between anatomic features and the volumetric coil packing density. We analyzed 452 aneurysms in 434 patients treated by coil embolization without stenting, expressing packing density as volume embolization ratio (VER, volume of inserted coils/aneurysm volume). Six morphological variables (neck width, height, maximum diameter, dome to neck ratio (DNR), and aspect ratio), aneurysm location, and whether the aneurysm was ruptured or unruptured were analyzed with respect to dense (VER ≥20%) or loose (VER <20%) packing densities, using logistic regression analysis and ROC analysis. Among 452 aneurysms, VERs >20% were achieved for 272 aneurysms, with a mean VER of 24.7%. The mean VER of the remaining 180 aneurysms was 15.6%. In univariate analyses, the predictors for dense packing were having an anterior circulation, DNR, aspect ratio, and neck width. In multivariate analysis, the independent predictors were smaller neck width (odds ratio (OR) 0.8735; 95% confidence interval (CI) 0.7635-0.9993) and larger aspect ratio (OR 1.6679; 95% CI 1.0460-2.6594). ROC analysis showed optimal cutoff values for an aspect ratio of 1.35 (sensitivity 69.5%, specificity 51.7%) and a neck width of 3.13 mm (sensitivity 51.1%, specificity 27.8%). Although dense coil packing is still difficult to achieve in wide-necked aneurysms without the use of stents, packing with VER >20% is expected to be achieved when the height is 1.35 times larger than the neck width.
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Affiliation(s)
- Akiyo Sadato
- Department of Neurosurgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Kazuhide Adachi
- Department of Neurosurgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Motoharu Hayakawa
- Department of Neurosurgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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Eisen SH, Hindman BJ, Bayman EO, Dexter F, Hasan DM. Elective Endovascular Treatment of Unruptured Intracranial Aneurysms. Anesth Analg 2015; 121:188-197. [DOI: 10.1213/ane.0000000000000699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Larrew T, Pryor W, Weinberg J, Webb S, Battenhouse H, Turk AS, Chaudry I, Spiotta A, Turner R. Aneurysmal subarachnoid hemorrhage: a statewide assessment of outcome based on risk factors, aneurysm characteristics, and geo-demography. J Neurointerv Surg 2014; 7:855-60. [DOI: 10.1136/neurintsurg-2014-011359] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 08/20/2014] [Indexed: 11/04/2022]
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Oishi H, Yamamoto M, Nonaka S, Shimizu T, Yoshida K, Mitsuhashi T, Arai H. Treatment results of endosaccular coil embolization of asymptomatic unruptured intracranial aneurysms in elderly patients. J Neurointerv Surg 2014; 7:660-5. [PMID: 25034903 PMCID: PMC4552889 DOI: 10.1136/neurintsurg-2014-011305] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 07/02/2014] [Indexed: 11/22/2022]
Abstract
Background and purpose We report the results of endosaccular coil embolization of asymptomatic unruptured intracranial aneurysms (UIAs) in elderly patients (≥65 years). Materials There were 375 elderly patients with 400 asymptomatic UIAs. Patients were divided into two groups: group A included patients aged 65–74 years and group B patients aged ≥75 years. Results Endovascular procedures were completed in 97.8% of patients. Immediate anatomical outcomes showed complete occlusion in 53.7%, residual neck in 18.9%, and residual aneurysm in 27.4%. Anatomical follow-ups (mean 36.3±28.1 months) were unchanged in 55.7%, improved in 22.6%, minor recurrence in 11.5%, and major recurrence in 10.2%. Procedure related complications occurred in 31 patients (8.3%). 15 patients had ischemic and 10 hemorrhagic complications. Retreatments were performed in 16 patients (4.3%). Among 366 patients technically completed, 363 (99.2%) showed a favorable clinical outcome (modified Rankin Scale (mRS) score <1) at 30 days. The remaining three patients showed a worsening of mRS >0 at 30 days. The latest clinical follow-up outcomes showed: mRS score 0 in 362 patients; mRS score 1 in one; mRS score 3 in one; mRS score 4 in one; and mRS score 5 in one patient. Permanent morbidity and mortality rates were 1.1% and 0%, respectively. There were no statistically significant differences in gender, comorbidities, aneurysm size, neck width, dome-to-neck ratio, immediate anatomical outcomes, anatomical follow-up outcomes, or procedure related complications between the groups. Conclusions Endosaccular coil embolization is safe and feasible for elderly patients with asymptomatic UIAs. Old age itself should not be a contraindication.
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Affiliation(s)
- Hidenori Oishi
- Department of Neuroendovascular Therapy, Juntendo University School of Medicine, Tokyo, Japan
| | - Munetaka Yamamoto
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Senshu Nonaka
- Department of Neurosurgery, Juntendo Urayasu Hospital, Tokyo, Japan
| | - Takashi Shimizu
- Department of Neurosurgery, Juntendo Nerima Hospital, Tokyo, Japan
| | - Kensaku Yoshida
- Department of Neurosurgery, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | | | - Hajime Arai
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
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Endovascular and Surgical Treatment of Unruptured MCA Aneurysms: Meta-Analysis and Review of the Literature. Stroke Res Treat 2014; 2014:348147. [PMID: 24800103 PMCID: PMC3988829 DOI: 10.1155/2014/348147] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 01/30/2014] [Indexed: 12/31/2022] Open
Abstract
Introduction. The best treatment for unruptured middle cerebral artery (MCA) aneurysms is unclear. We perform a meta-analysis of recent publications to evaluate the results of unruptured MCA aneurysms treated with surgical clipping and endovascular coiling. Methods. A PubMed search for articles published between January 2004 and November 2013 was performed. The R statistical software package was used to create a random effects model for each desired incidence rate. Cochran's Q test was used to evaluate possible heterogeneity among the rates observed in each study. Results. A total of 1891 unruptured MCA aneurysms, 1052 clipped and 839 coiled, were included for analysis. The complete occlusion rate at 6–9 months mean follow-up was 95.5% in the clipped group and 67.8% in the coiled group (P < 0.05). The periprocedural thromboembolism rate in the clipping group was 1.8% compared with 10.7% in the aneurysms treated by coiling (P < 0.05). The recanalization rate was 0% for clipping and 14.3% for coiling (P = 0.05). Modified Rankin scores of 0–2 were obtained in 98.9% of clipped patients compared to 95.5% of coiled (NS). Conclusions. This review weakly supports clipping as the preferred treatment of unruptured MCA aneurysms. Clinical outcomes did not differ significantly between the two groups.
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Stetler WR, Wilson TJ, Al-Holou WN, Chaudhary N, Gemmete JJ, Thompson BG, Pandey AS. Conventional endovascular treatment of small intracranial aneurysms is not associated with additional risks compared with treatment of larger aneurysms. J Neurointerv Surg 2014; 7:262-5. [PMID: 24623836 DOI: 10.1136/neurintsurg-2014-011133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Endovascular treatment of small intracranial aneurysms has historically been technically challenging and has been associated with high rates of complications and intraprocedural rupture. In this study, we compared complication and recurrence rates for treatment of small aneurysms (≤ 4 mm) versus large aneurysms in the context of the advent of improvements in endovascular techniques and technologies. METHODS A retrospective cohort study was performed to include all patients who underwent coiling of an intracranial aneurysm between 2005 and 2012. Small aneurysms were defined as any aneurysm 4.0 mm or smaller in all dimensions. The primary outcome was a composite outcome of the occurrence of an intraoperative rupture or a perioperative thromboembolic event. The secondary outcome of interest was aneurysm recurrence. RESULTS During the study period, 483 patients were treated using endovascular techniques; 85 (17.6%) of these patients had small aneurysms. In the small aneurysm group, there was only one (1.2%) intraoperative rupture, three (3.5%) perioperative thromboembolic events, and 11 (12.9%) incidents of aneurysm recurrence. Both the primary and secondary outcomes of interest were similar in patients presenting with small or large aneurysms. Small aneurysm size was not a risk factor for either the composite primary outcome or aneurysm recurrence in multivariate analysis. CONCLUSIONS Treatment of small intracranial aneurysms via conventional endovascular coiling techniques is not inferior to endovascular treatment of larger aneurysms based on our single institution experience. While technically challenging, such aneurysms may be treated safely and effectively with acceptable rates of complications and recurrence.
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Affiliation(s)
- William R Stetler
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas J Wilson
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Wajd N Al-Holou
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Neeraj Chaudhary
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Joseph J Gemmete
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - B Gregory Thompson
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
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Safety and long-term efficacy of endovascular treatment of small posterior communicating artery aneurysms by coiling with or without stent: A single center retrospective study. Clin Neurol Neurosurg 2013; 115:2502-7. [DOI: 10.1016/j.clineuro.2013.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 10/08/2013] [Indexed: 11/20/2022]
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Sedat J, Chau Y, Mondot L, Chemla R, Lonjon M, Padovani B. Is eptifibatide a safe and effective rescue therapy in thromboembolic events complicating cerebral aneurysm coil embolization? Single-center experience in 42 cases and review of the literature. Neuroradiology 2013; 56:145-53. [PMID: 24281387 DOI: 10.1007/s00234-013-1301-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/02/2013] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Thromboembolic complications are the most frequent perioperative complications of endovascular treatment of intracranial aneurysms. Even if the effectiveness of glycoprotein IIb/IIIa inhibitors has been reported, the outcomes in published clinic data are contradictory. This study aims to assess the effectiveness and the safety of eptifibatide in thromboembolic complications during intracranial aneurysm embolization procedure. METHODS Between 2006 and 2012, 650 patients with intracranial aneurysm were treated using endovascular coil embolization, and in 62 cases (9.5 %), an intra-arterial thrombus developed. Glycoprotein IIb/IIIa inhibitor was administrated in 45 of them who required a rescue treatment. These 45 patients were treated with an intra-arterial bolus (0.2 mg/kg) of eptifibatide. We respectively reviewed the angiographic and clinical outcomes, and the periprocedural complications of the rescue treatment. RESULTS No intra- or early postoperative (48 h) bleeding was observed after treatment. A total recovery of the entire arterial tree (TICI 3) was established in 28 cases (62.2 %), a partial revascularization in 13 cases (28.8 %) (5 TICI 2A and 8 TICI 2B), and no revascularization or reperfusion (TICI 0 or TICI 1) in 4 cases (9 %). Eptifibatide was more effective on proximal obstructions and in-stent occlusions than on peripheral distal thrombus, which were completely disintegrated one time out of three. CONCLUSION Intra-operative intra-arterial use of eptifibatide does not imply an increase of hemorrhagic events. Even if eptifibatide allows for a high rate of arterial recanalization, its effectiveness seems to be less important in cases of distal occlusions.
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Affiliation(s)
- Jacques Sedat
- Unité de Neurointerventionnelle, Hôpital Saint-Roch, 5 rue Pierre Devoluy, Nice, 06000, France,
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Shigematsu T, Fujinaka T, Yoshimine T, Imamura H, Ishii A, Sakai C, Sakai N. Endovascular Therapy for Asymptomatic Unruptured Intracranial Aneurysms. Stroke 2013; 44:2735-42. [DOI: 10.1161/strokeaha.111.000609] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
National registration studies (the Japanese Registry of Neuroendovascular Therapy [JR-NET] and JR-NET2) have determined the current status and outcomes of neuroendovascular therapy (neuro-EVT). We analyzed short-term outcomes of EVT for asymptomatic unruptured intracranial aneurysms (UIAs).
Methods—
We extracted periprocedural information about EVT for 4767 asymptomatic UIAs from 31 968 registered procedural records of all EVT in the JR-NET and JR-NET2 databases. We assessed the features of the aneurysms and procedures, immediate radiographic findings, procedure-related complications, and clinical outcomes at 30 days after the procedures.
Results—
We located 80.0% of UIAs in the anterior circulation, and the most frequent were paraclinoid. The diameter of 2.5%, 32.9%, 51.9%, 12.0%, and 0.7% of the UIAs was <3, 3 to 4, 5 to 9, 10 to 19, and >20 mm, respectively. EVT failed in only 2.1%. Adjunctive techniques were applied in 54.8% of procedures. Pre- and postprocedural antiplatelet agents were prescribed in 85.6% and 84.0%, respectively, of the procedures. The immediate radiographic outcomes of 57.7%, 31.9%, and 10.0% of the UIAs comprised complete occlusion, residual necks, and residual aneurysms, respectively. Complications that were associated with 9.1% of procedures comprised 2.0% hemorrhagic and 4.6% ischemic, and the 30-day morbidity and mortality rates were 2.12% and 0.31%, respectively.
Conclusions—
The radiographic results of EVT for asymptomatic UIAs in Japan were acceptable, with low mortality and morbidity rates.
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Affiliation(s)
- Tomoyoshi Shigematsu
- From the Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Japan (T.S., T.F., T.Y.); Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan (H.I., N.S.); Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan (A.I.); and Division of Neuroendovascular Treatment, Institute of Biomedical Research and Innovation, Kobe, Japan (C.S.)
| | - Toshiyuki Fujinaka
- From the Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Japan (T.S., T.F., T.Y.); Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan (H.I., N.S.); Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan (A.I.); and Division of Neuroendovascular Treatment, Institute of Biomedical Research and Innovation, Kobe, Japan (C.S.)
| | - Toshiki Yoshimine
- From the Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Japan (T.S., T.F., T.Y.); Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan (H.I., N.S.); Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan (A.I.); and Division of Neuroendovascular Treatment, Institute of Biomedical Research and Innovation, Kobe, Japan (C.S.)
| | - Hirotoshi Imamura
- From the Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Japan (T.S., T.F., T.Y.); Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan (H.I., N.S.); Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan (A.I.); and Division of Neuroendovascular Treatment, Institute of Biomedical Research and Innovation, Kobe, Japan (C.S.)
| | - Akira Ishii
- From the Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Japan (T.S., T.F., T.Y.); Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan (H.I., N.S.); Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan (A.I.); and Division of Neuroendovascular Treatment, Institute of Biomedical Research and Innovation, Kobe, Japan (C.S.)
| | - Chiaki Sakai
- From the Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Japan (T.S., T.F., T.Y.); Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan (H.I., N.S.); Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan (A.I.); and Division of Neuroendovascular Treatment, Institute of Biomedical Research and Innovation, Kobe, Japan (C.S.)
| | - Nobuyuki Sakai
- From the Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Japan (T.S., T.F., T.Y.); Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan (H.I., N.S.); Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan (A.I.); and Division of Neuroendovascular Treatment, Institute of Biomedical Research and Innovation, Kobe, Japan (C.S.)
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Moscato G, Cirillo L, Dall'olio M, Princiotta C, Simonetti L, Leonardi M. Management of unruptured brain aneurysms: retrospective analysis of a single centre experience. Neuroradiol J 2013; 26:315-9. [PMID: 23859289 DOI: 10.1177/197140091302600311] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 02/20/2013] [Indexed: 11/16/2022] Open
Abstract
Embolization is very effective in preventing bleeding of unruptured aneurysms with lower rates of mortality and morbidity than surgical treatment. Neurosurgery remains, however, a good alternative. This retrospective analysis examined data stored the digital database of Bellaria Hospital Radiology Department, evaluating patients, treatments and devices used as well as outcomes and complications. Therapy should be tailored to each individual case to offer each patient the best treatment. Out of 265 unruptured intracranial aneurysms detected, 182 were treated by embolization. 16 cases presented complications (12 only radiologically found); severe clinical consequences occurred in 3%: one ischaemia and five haemorrhages. Conservative treatment was adopted in 21 patients. Long-term follow-up is mandatory as aneurysms could increase their size and develop an irregular morphology in ten years' time. Endovascular embolization is a very effective treatment with positive outcomes in the majority of cases and a percentage of retreatments of 8%. In order to increase the number of successful cases, a multidisciplinary cooperation with neurosurgeons is strongly recommended.
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Affiliation(s)
- G Moscato
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
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Pérez Falero RA, Piloto OL. When dealing with unruptured aneurysms, what do low morbidity and mortality mean? AJNR Am J Neuroradiol 2012; 33:E120; author reply E121. [PMID: 22936098 DOI: 10.3174/ajnr.a3314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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