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Bae JW, Oh HS, Hong CE, Kim KM, Yoo DH, Kang HS, Cho YD. Extended monitoring of re-coiled cerebral aneurysms after initial postcoiling recanalization: Safety and durability of repeat coil embolization. J Neuroradiol 2024; 51:59-65. [PMID: 37247754 DOI: 10.1016/j.neurad.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/26/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE In the endovascular era, postcoiling recanalization of cerebral aneurysms is occurring with greater frequency. Repeat coiling is usually done to prevent rebleeding, although long-term outcomes of re-embolization have yet to be adequately investigated. The present study was undertaken to assess clinical and radiographic outcomes of re-embolization in recanalized aneurysms, focusing on procedural safety, efficacy, and durability. METHOD In this retrospective review, we examined 308 patients with 310 recurrent aneurysms. All lesions were re-coiled, once major recanalization (after initial coil embolization) was established. Medical records and radiologic data amassed during extended follow-up were then subject to review. Cox proportional hazards regression analysis was undertaken to identify risk factors for subsequent recurrence. RESULT During a lengthy follow-up (mean, 40.2 ± 33.0 months), major recanalization developed again in 87 aneurysms (28.1%). Multivariable Cox regression analysis linked re-recanalization to initial saccular neck width (p=.003) and autosomal dominant polycystic kidney disease (ADPKD; p<.001). Stent implantation (p=.038) and successful occlusion at second coiling (p=.012) were protective against later recanalization in this setting. The more recent the second embolization was performed, the lower the risk of further recurrence (p=.023). Procedure-related complications included asymptomatic thromboembolism (n = 9), transient ischemic neurologic deficits (n = 2), procedural bleeding (n = 1), and coil migration (n = 1), but there were no residual effects or deaths. CONCLUSION Repeat coil embolization is a safe therapeutic option for recanalized cerebral aneurysms. Wide-necked status and ADPKD emerged as risks for subsequent recanalization, whereas successful occlusion and stent implantation seemed to reduce the likelihood of recurrence after re-embolization procedures.
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Affiliation(s)
- Jin Woo Bae
- Department of Neurosurgery, Inha University Hospital, Incheon, Korea
| | - Han San Oh
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chang-Eui Hong
- Department of Neurosurgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Kang Min Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hyun Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Dae Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Echeverría D, Rivera R, Giacaman P, Sordo JG, Einersen M, Badilla L. A novel self-expanding shape memory polymer coil for intracranial aneurysm embolization: 1 year follow-up in Chile. J Neurointerv Surg 2023; 15:781-786. [PMID: 35831177 PMCID: PMC10359521 DOI: 10.1136/jnis-2022-018996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/21/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Aneurysm recurrence remains a challenge when coiling cerebral aneurysms. Development of next generation coils has focused on accelerating thrombus maturation and increasing coil packing density. Ultra low density shape memory polymer is a novel embolic material designed for this purpose. The polymer is crimped over a platinum-tungsten coil for catheter delivery and self-expands to a predefined volume on contact with blood. METHODS This prospective study in humans evaluated aneurysms 5-16 mm (inclusive) in diameter that were indicated for endovascular coil embolization. At least 70% coil volume was required to be shape memory polymer coils. Patients were followed-up according to standard of care for 12 months. RESULTS Nine patients (89% women, mean age 55.8±11.7 years) were treated with shape memory polymer coils and completed 12 months of follow-up. Aneurysms were all unruptured and were in the ophthalmic segment of the internal carotid artery (n=7), posterior communicating artery, and anterior cerebral artery A1-A2 segment. Aneurysms were a mean of 7.8±2.9 mm in diameter (range 5.2-14.9 mm). The mean packing density based on unexpanded polymer was 17±6%. Packing density based on expanded polymer was 43±13%. At 12 months, no recurrence had occurred, and a Raymond-Roy occlusion classification of 1 (n=5) or 2 (n=4) was observed. No serious adverse events related to the study device occurred over the 12 months after the procedure. CONCLUSIONS Shape memory polymer coils were safe and effective in treating intracranial aneurysms over 12 months in this first study in human subjects.
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Affiliation(s)
- Daniel Echeverría
- Neuroradiology, Instituto de Neurocirugía Dr Alfonso Asenjo, Santiago, Chile
- Department of Radiology, Universidad de Valparaíso, Valparaíso, Chile
| | - Rodrigo Rivera
- Neuroradiology, Instituto de Neurocirugía Dr Alfonso Asenjo, Santiago, Chile
- Department of Radiology, Universidad de Valparaíso, Valparaíso, Chile
| | - Pablo Giacaman
- Neurovascular Unit, Imaging Service, Hospital Clínico Regional Guillermo Grant Benavente, Concepción, Chile
| | - Juan Gabriel Sordo
- Neuroradiology, Instituto de Neurocirugía Dr Alfonso Asenjo, Santiago, Chile
- Department of Radiology, Universidad de Valparaíso, Valparaíso, Chile
| | - Martín Einersen
- Neurovascular Unit, Imaging Service, Hospital Clínico Regional Guillermo Grant Benavente, Concepción, Chile
- Faculty of Medicine, Department of Specialties (Imaging), Universidad de Concepción, Concepción, Chile
| | - Lautaro Badilla
- Neuroradiology, Instituto de Neurocirugía Dr Alfonso Asenjo, Santiago, Chile
- Department of Radiology, Universidad de Valparaíso, Valparaíso, Chile
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Begley SL, White TG, Shah KA, Turpin J, Toscano D, Dehdashti AR, Teron I, Link T, Patsalides A, Woo HH. A comparison of endovascular coil systems for the treatment of small intracranial aneurysms. Interv Neuroradiol 2023:15910199231182456. [PMID: 37312530 DOI: 10.1177/15910199231182456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Endovascular coiling of small, intracranial aneurysms remains controversial and difficult, despite advances in technology. METHODS We retrospectively reviewed data for 62 small aneurysms (<3.99 mm) in 59 patients. Occlusion rates, complications rates, and coil packing densities were compared between subgroups based upon coil type and rupture status. RESULTS Ruptured aneurysms predominated (67.7%). Aneurysms measured 2.99 ± 0.63 mm by 2.51 ± 0.61 mm with an aspect ratio of 1.21 ± 0.34 mm. Brands included Optima (Balt) (29%), MicroVention Hydrogel (24.2%), and Penumbra SMART (19.4%) coil systems. Average packing density was 34.3 ± 13.5 mm3. Occlusion rate was 100% in unruptured aneurysms; 84% utilized adjuvant devices. For ruptured aneurysms, complete occlusion or stable neck remnant was achieved in 88.6% while recanalization occurred in 11.4%. No rebleeding occurred. Average packing density (p = 0.919) and coil type (p = 0.056) did not impact occlusion. Aspect ratio was smaller in aneurysms with technical complications (p = 0.281), and aneurysm volume was significantly smaller in those with coil protrusion (p = 0.018). Complication rates did not differ between ruptured and unruptured aneurysms (22.6 vs. 15.8%, p = 0.308) or coil types (p = 0.830). CONCLUSION Despite advances in embolization devices, coiling of small intracranial aneurysms is still scrutinized. High occlusion rates are achievable, especially in unruptured aneurysms, with coil type and packing density suggesting association with complete occlusion. Technical complications may be influenced by aneurysm geometry. Advances in endovascular technologies have revolutionized small aneurysm treatment, with this series demonstrating excellent aneurysm occlusion especially in unruptured aneurysms.
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Affiliation(s)
- Sabrina L Begley
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Timothy G White
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Kevin A Shah
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Justin Turpin
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Daniel Toscano
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Amir R Dehdashti
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Ina Teron
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Thomas Link
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Athos Patsalides
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Henry H Woo
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
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Khairallah MK, Morgan RA, Das R. Technical considerations of endovascular management of true visceral artery aneurysms. CVIR Endovasc 2023; 6:31. [PMID: 37284993 DOI: 10.1186/s42155-023-00368-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/18/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND True visceral artery aneurysms are potentially complex to treat but with advances in technology and increasing interventional radiology expertise over the past decade are now increasingly the domain of the interventional radiologist. BODY: The interventional approach is based on localization of the aneurysm and identification of the anatomical determinants to treat these lesions to prevent aneurysm rupture. Several different endovascular techniques are available and should be selected carefully, dependent on the aneurysm morphology. Standard endovascular treatment options include stent-graft placement and trans-arterial embolisation. Different strategies are divided into parent artery preservation and parent artery sacrifice techniques. Endovascular device innovations now include multilayer flow-diverting stents, double-layer micromesh stents, double-lumen balloons and microvascular plugs and are also associated with high rates of technical success. CONCLUSION Complex techniques such as stent-assisted coiling and balloon-remodeling techniques are useful techniques and require advanced embolisation skills and are further described.
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Affiliation(s)
- M K Khairallah
- Department of Radiology, St.George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
- Assiut University Hospital, Assiut, Egypt
| | - R A Morgan
- Department of Radiology, St.George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK
| | - R Das
- Department of Radiology, St.George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK.
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Wu D, Sheng B, Fang X, Li Z. Risk factors of recurrence after endovascular embolization of posterior communicating artery aneurysms. Interv Neuroradiol 2022; 28:562-567. [PMID: 34713742 PMCID: PMC9511616 DOI: 10.1177/15910199211054715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/05/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE To determine the risk factors for recurrence after endovascular embolization of posterior communicating artery aneurysms (PcomA). METHODS We retrospectively analyzed a cohort of 163 patients harboring 172 PocmAs who were treated with endovascular embolization from January 2019 to December 2020. The patients were divided into recurrence and stable groups depending on outcome. Univariate and logistic regression analyses were performed to determine the potential risk factors of recurrence during follow-up. RESULTS Of the total 163 patients harboring 172 aneurysms, 107 were treated with simple coil occlusion and 65 were treated with stent-assisted coil embolization. There were significant differences in aneurysm sizes and use of non-stent-assisted coil embolizations between the groups (P < 0.05). The incidence of saccular aneurysm and Raymond grade were significantly higher in the recurrent group than in the stable group (P < 0.01). After variable selection, Raymond grade, aneurysm size, saccular aneurysm and non-stent-assisted coil embolization were included in further analysis. Binary logistic regression analysis revealed significant associations with non-stent-assisted coil embolization (P = 0.007), packing density (P < 0.001) and Raymond grades II (P < 0.001) and III (P = 0.002). CONCLUSION Non-stent-assisted coil embolization, as well as packing density and Raymond grades II grade III are associated with recurrence after endovascular treatment of PcomA.
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Affiliation(s)
- Degang Wu
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Bin Sheng
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xinggen Fang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Zhenbao Li
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
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Wu Q, Li C, Xu S, Wang C, Ji Z, Qi J, Li Y, Sun B, Shi H, Wu P. Flow Diversion vs. Stent-Assisted Coiling in the Treatment of Intradural Large Vertebrobasilar Artery Aneurysms. Front Neurol 2022; 13:917002. [PMID: 35785346 PMCID: PMC9242619 DOI: 10.3389/fneur.2022.917002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo compare the safety, angiographic, and long-term clinical outcomes of intradural large vertebrobasilar artery (VBA) aneurysms following flow diversion (FD) or conventional stent-assisted coiling (SAC).MethodsWe performed a retrospective study of 66 consecutive patients with intradural large VBA aneurysms between 2014 and 2021 who underwent FD or SAC. Patients' characteristics, postprocedural complications, and clinical and angiographic outcome details were reviewed.ResultsA total of 66 intradural large VBA aneurysms were included, including 42 (63.6%), which were treated with SAC (SAC group) and 24 (36.4%), which were treated with FD (FD group). Clinical follow-up was obtained at the median of 24.0 [interquartile range (IQR) 12.0–45.0] months, with 34 (81.0%) patients achieved the modified Rankin Scale (mRS) ≤ 2 in the SAC group and 21 (87.5%) patients in the FD group. Thirteen (19.7%) patients experienced neurological complications, of which 9 (13.6%) patients first occurred during the periprocedural phase and 4 (6.1%) patients first occurred during follow-up. The overall complication rate and periprocedural complication rate were both higher in the SAC group, but did not reach statistical significance (23.8 vs. 12.5%, P = 0.430; 16.7 vs. 8.3%, P = 0.564). The mortality rates were similar between the groups (11.9 vs. 12.5%). Angiographic follow-up was available for 46 patients at the median of 7 (IQR 6–14) months, with a numerically higher complete occlusion rate in the SAC group (82.1 vs. 55.6%, P = 0.051) and similar adequate aneurysm occlusion rates between the groups (85.7 vs. 83.3%, P = 1.000). In the multivariate analysis, ischemic onset (P = 0.019), unilateral vertebral artery sacrifice (P = 0.008), and older age (≥60 years) (P = 0.031) were significantly associated with complications.ConclusionThere was a trend toward lower complication rate and lower complete occlusion rate for intradural large VBA aneurysms following FD as compared to SAC. FD and SAC have comparable mortality rates and favorable outcomes. Ischemic onset, unilateral vertebral artery sacrifice, and older age could increase the risk of complications.
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EFFECTS OF THE ANEURYSM TREATMENT METHOD ON COIL PACKING DENSITY AND ITS RELATIONSHIP WITH THE OSTIUM AREA. J Vasc Interv Radiol 2022; 33:631-638. [PMID: 35283278 DOI: 10.1016/j.jvir.2021.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To test the following hypotheses: (1) balloon or stent assistance increases coil packing density (CPD) in the endovascular treatment of intracranial aneurysms and (2) CPD is related to the ostium area and volume of the aneurysm. MATERIALS AND METHODS This retrospective study included 60 ruptured and unruptured (54 and 6, respectively) aneurysms treated between August 2017 and December 2019 in the authors' institution with simple coiling (n=18), balloon-assisted coiling (n=7), or stent-assisted coiling (n=35). Aneurysm volume and ostium area measurements were obtained using commercial software from three-dimensional digital subtraction angiography images. Coil sizes were retrieved from patient files, and coil volume measurements were obtained using https://www.angiocalc.com/. Analysis of covariance, multivariable covariance analysis, and Pearson's correlation analyses were performed. RESULTS The median values for the aneurysm volume, coil volume, CPD, and ostium area were 63.4 (range 5.5-1771.4) mm3, 23.13 (2.03-296.95) mm3, 33.29% (13.41%-81.02%), and 10.7 (2.7-49.9) mm2, respectively. Multivariate analysis showed that the CPD values were not significantly different among the treatment groups, although the ostium area differed significantly between the simple and stent-assisted coiling groups (P<.05). Pearson's correlations showed that similar to aneurysm volume, the ostium area was negatively correlated with CPD (r=-0.321, P<.05). CONCLUSION In cerebral aneurysms treated with balloon- or stent-assisted coiling, the CPD value does not differ from that in aneurysms treated with simple coiling.
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Optimal Woven EndoBridge (WEB) Device Size Selection Using Automated Volumetric Software. Brain Sci 2021; 11:brainsci11070901. [PMID: 34356135 PMCID: PMC8307121 DOI: 10.3390/brainsci11070901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Selecting the appropriate Woven EndoBridge (WEB) device sizing for the treatment of wide-neck bifurcation aneurysms (WNBAs) remains challenging. The aim of this study was to evaluate different volumetric-based imaging methodologies to predict an accurate WEB device size selection to result in a successful implantation. METHODS All consecutive patients treated with WEB devices for intracranial aneurysms from January 2019 to June 2020 were included. Aneurysm dimensions to calculate aneurysm volumes were measured using three different modalities: automated three-dimensional (3D) digital subtraction angiography (DSA), manual 3D DSA, and two-dimensional (2D) DSA. The device-aneurysm volume (DAV) ratio was defined as device volume divided by the aneurysm volume. WEB volumes and the DAV ratios were used for assessing the device implantation success and follow-up angiographic outcomes at six months. Pearson correlation, Wilcoxon Rank Sum test, and density approximations were used for estimating the WEB volumes and the imaging modality volumes for successful implantation. RESULTS A total of 41 patients with 43 aneurysms were included in the study. WEB device and aneurysm volume correlation coefficient was highest for 3D automatic (r = 0.943), followed by 3D manual (r = 0.919), and 2D DSA (r = 0.882) measurements. Measured median volumes were significantly different for 3D automatic and 2D DSA (p = 0.017). The highest rate of successful implantation (87.5%) was between 0.6 and 0.8 DAV ratio. CONCLUSION Pre-procedural assessment of DAV ratios may increase WEB device implantation success. Our results suggest that volumetric measurements, especially using automated 3D volumes of the aneurysms, can assist in accurate WEB device size selection.
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Spiotta AM, Park MS, Bellon RJ, Bohnstedt BN, Yoo AJ, Schirmer CM, DeLeacy RA, Fiorella DJ, Woodward BK, Hawk HE, Nanda A, Zaidat OO, Sunenshine PJ, Liu KC, Kabbani MR, Snyder KV, Sivapatham T, Dumont TM, Reeves AR, Starke RM. The SMART Registry: Long-Term Results on the Utility of the Penumbra SMART COIL System for Treatment of Intracranial Aneurysms and Other Malformations. Front Neurol 2021; 12:637551. [PMID: 33927680 PMCID: PMC8076606 DOI: 10.3389/fneur.2021.637551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/12/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Penumbra SMART COIL® (SMART) System is a novel generation embolic coil with varying stiffness. The study purpose was to report real-world usage of the SMART System in patients with intracranial aneurysms (ICA) and non-aneurysm vascular lesions. Materials and Methods: The SMART Registry is a post-market, prospective, multicenter registry requiring ≥75% Penumbra Coils, including SMART, PC400, and/or POD coils. The primary efficacy endpoint was retreatment rate at 1-year and the primary safety endpoint was the procedural device-related serious adverse event rate. Results: Between June 2016 and August 2018, 995 patients (mean age 59.6 years, 72.1% female) were enrolled at 68 sites in the U.S. and Canada. Target lesions were intracranial aneurysms in 91.0% of patients; 63.5% were wide-neck and 31.8% were ruptured. Adjunctive devices were used in 55.2% of patients. Mean packing density was 32.3%. Procedural device-related serious adverse events occurred in 2.6% of patients. The rate of immediate post-procedure adequate occlusion was 97.1% in aneurysms and the rate of complete occlusion was 85.2% in non-aneurysms. At 1-year, the retreatment rate was 6.8%, Raymond Roy Occlusion Classification (RROC) I or II was 90.0% for aneurysms, and Modified Rankin Scale (mRS) 0-2 was achieved in 83.1% of all patients. Predictors of 1-year for RROC III or retreatment (incomplete occlusion) were rupture status (P < 0.0001), balloon-assisted coiling (P = 0.0354), aneurysm size (P = 0.0071), and RROC III immediate post-procedure (P = 0.0086) in a model that also included bifurcation aneurysm (P = 0.7788). Predictors of aneurysm retreatment at 1-year was rupture status (P < 0.0001). Conclusions: Lesions treated with SMART System coils achieved low long-term retreatment rates. Clinical Trial Registration:https://www.clinicaltrials.gov/, identifier NCT02729740.
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Affiliation(s)
- Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, United States
| | - Min S Park
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States
| | - Richard J Bellon
- Department of Interventional Neuro Radiology, Swedish Medical Center, Denver, CO, United States
| | | | - Albert J Yoo
- Department of Interventional Neuroradiology, Texas Stroke Institute, Dallas, TX, United States
| | | | | | - David J Fiorella
- Stony Brook University Medical Center, Cerebrovascular Center, New York, NY, United States
| | | | - Harris E Hawk
- Erlanger Health System, Chattanooga, TN, United States
| | - Ashish Nanda
- SSM Health Medical Group, Fenton, MO, United States
| | - Osama O Zaidat
- St Vincent Mercy Health Medical Center, Toledo, OH, United States
| | | | - Kenneth C Liu
- Penn State Milton S. Hershey Medical Center, Hershey, PA, United States
| | | | - Kenneth V Snyder
- Department of Neurosurgery, University of Buffalo, Buffalo, NY, United States
| | | | - Travis M Dumont
- Department of Surgery, University of Arizona, Tucson, AZ, United States
| | - Alan R Reeves
- Department of Radiology, University of Kansas, Kansas City, KS, United States
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami Hospital, Miami, FL, United States
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ÖNAL Y, VELİOĞLU M. Balon ya da stent yardımlı intrakranial anevrizma tedavisi stabil okluzyonunda koil paket dansitesinin rolü. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.689986] [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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Risk factors for recurrence and retreatment after endovascular treatment of intracranial saccular aneurysm larger than 8 mm. Acta Neurochir (Wien) 2019; 161:939-946. [PMID: 30903289 DOI: 10.1007/s00701-019-03877-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Large intracranial aneurysm is challenging for both surgical and endovascular treatment. High recurrence and retreatment rates are still limitations for endovascular treatment. Analysing risk factors of recurrence after endovascular treatment can be useful for planning future treatment strategies. METHOD We retrospectively reviewed patients with intracranial saccular aneurysm (≥ 8 mm) who underwent endovascular treatment from 2008 to 2017 at our institution. The demographic features, clinical information and angiographic results were analysed to reveal the risk factors for recurrence and retreatment. Subgroup analysis was performed according to packing density (PD) and stent insertion status. RESULTS The total recurrence and retreatment rates were 25.7% (44/171) and 10.5% (18/171), respectively. Independent risk factors for recurrence after endovascular treatment were larger aneurysm size (OR 1.32; 95% CI 1.17-1.51; p < 0.001), ruptured status (OR 3.91; 95%CI 1.44-10.90; p = 0.008), initial incomplete occlusion (OR 2.72; 95%CI 1.18-6.41; p = 0.020), and low dome-to-neck ratio (OR 0.61; 95%CI 0.36-0.97; p = 0.047). The recurrence rate for the no-stent with low PD (< 17.5%) group was 50% (14/28); 37.5% (6/16) for stent-assisted coil (SAC) with low PD group, 22.0% (20/91) for no-stent with high PD group and 11.1% (4/36) for SAC with high PD group. CONCLUSION The independent risk factors for recurrence after endovascular treatment in large (≥ 8 mm) intracranial saccular aneurysm were larger aneurysm size, ruptured status, low dome-to-neck ratio and initial incomplete occlusion state. SAC is a useful method for lowering recurrence after endovascular treatment for relatively large (≥ 8 mm) cerebral aneurysm.
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Velasco González A, Stracke P, Nordmeyer H, Heddier M, Saleme S, Sauerland C, Berkemeyer S, Buerke B, Heindel W, Chapot R. Low rates of recanalization for wide-necked aneurysms treated with stenting after balloon-assisted coiling: combination of techniques delivers stable and improved results during follow-up. Neuroradiology 2018; 60:1223-1230. [DOI: 10.1007/s00234-018-2088-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/21/2018] [Indexed: 11/28/2022]
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