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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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Jin Y, Guo X, Quan T, Zhao R, Li T, Zhao Z, Yang H, Zhu X, Liang G, Leng B, Wu X, Wang Y, Guan S. Randomized, prospective, multicenter trial assessing the numen coil embolization system in the endovascular treatment of small intracranial aneurysms: outcomes from the CATCH Trial. BMC Surg 2023; 23:164. [PMID: 37328839 PMCID: PMC10276443 DOI: 10.1186/s12893-023-02049-9] [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: 09/27/2022] [Accepted: 05/20/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND AND PURPOSE The CATCH (Coil Application Trial in China) trial was designed to assess the safety and efficacy of the Numen Coil Embolization System in the treatment of intracranial aneurysms in comparison with the Axium coil (ev3/Medtronic). Although the endovascular treatment of small (< 5 mm) intracranial aneurysms has been reported with favorable long-term clinical and angiographic outcomes, randomized trials are still lacking. Data for aneurysms smaller than 5 mm were extracted from the CATCH trial. MATERIALS AND METHODS A randomized, prospective, multicenter trial was conducted at ten centers throughout China. Enrolled subjects with small intracranial aneurysms were randomly assigned to receive treatment with the Numen Coil or the Axium coil. The primary outcome was successful aneurysm occlusion at the 6-month follow-up. In contrast, the secondary outcomes included complete aneurysm occlusion, recurrence rate, clinical deterioration, and safety data at the 6-month and 12-month follow-ups. RESULTS A total of 124 patients were enrolled in the study. Overall, 58 patients were assigned to the Numen group, and 66 were assigned to the Axium group. At the 6-month follow-up, the successful aneurysm occlusion rate was 93.1% (54/58) in the MicroPort NeuroTech group and 97.0% (64/66) in the Axium group, with a common odds ratio of 0.208 (95% confidence interval, 0.023-1.914; P = 0.184). Complications were comparable between the groups. CONCLUSIONS Compared with the Aixum coil, the Numen coil is safe and effective in treating small intracranial aneurysms. TRIAL REGISTRATION (13/12/2016, NCT02990156).
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Affiliation(s)
- Yazhou Jin
- Department of Neurointervention, Zhengzhou University First Affiliated Hospital, No.1, Jianshe East Road, Erqi District, 450052, Zhengzhou, Henan, China
| | - Xinbin Guo
- Department of Neurointervention, Zhengzhou University First Affiliated Hospital, No.1, Jianshe East Road, Erqi District, 450052, Zhengzhou, Henan, China
| | - Tao Quan
- Department of Neurointervention, Zhengzhou University First Affiliated Hospital, No.1, Jianshe East Road, Erqi District, 450052, Zhengzhou, Henan, China
| | - Rui Zhao
- Department of Neurovascular Center, Changhai Hospital Affiliated to the Naval Medical University, Shanghai, China
| | - Tianxiao Li
- Department of Interventional Radiology, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Zhenwei Zhao
- Department of Neurosurgery, Tangdu Hospital Affiliated to Fourth Military Medical University, Baqiao, Xi'an, Shaanxi, China
| | - Hua Yang
- Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Yunyan, Guiyang City, Guizhou, China
| | - Xingen Zhu
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China
| | - Guobiao Liang
- Department of Neurosurgery, The General Hospital of Shenyang Military, Shenhe, Shenyang, China
| | - Bing Leng
- Department of Neurosurgery, Huashan Hospital, Shanghai, China
| | - Xin Wu
- Department of Neurosurgery, Yantai Yuhuangding Hospital, Zhifu, Yantai, Shandong, China
| | - Yang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Sheng Guan
- Department of Neurointervention, Zhengzhou University First Affiliated Hospital, No.1, Jianshe East Road, Erqi District, 450052, Zhengzhou, Henan, China.
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Results of Temporary Stent-assisted Coil Embolization (CATS) for the Treatment of Wide-neck Aneurysms : A 10-year Single Center Experience. Clin Neuroradiol 2023; 33:219-226. [PMID: 36028628 PMCID: PMC10014755 DOI: 10.1007/s00062-022-01206-6] [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: 01/30/2022] [Accepted: 07/22/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE In intracranial wide-neck aneurysms, simple coil embolization is often not a feasible treatment option. Balloon-assisted coiling comes with the drawback of blood flow impairment, whereas permanent stent placement requires long-term antiplatelet therapy. Temporary stent-assisted coiling (coiling assisted by temporary stenting, CATS) is an alternative that eliminates both disadvantages. Because prior studies included only small numbers of patients, it was our aim to analyze the safety and effectiveness of this technique in a larger cohort of patients. METHODS We retrospectively evaluated all endovascular aneurysm treatments at our institution from 2011 to 2020. Out of a total of 688 aneurysm treatments, we intended to perform 95 (14%) with temporary stent-assisted coiling and included them in our study. RESULTS Sixty-four (64)% of aneurysms were acutely ruptured, 3% were symptomatic but unruptured, and 33% were incidental. Successful stent recovery was possible in 93% of treatments. Initial complete and adequate occlusion rate were 53% and 82%, respectively. Long-term follow-up at 6 and 12 months was available for 71% and 44% of cases. Aneurysm recurrence was observed in 10% of cases after 6 months, and in 17% after 1 year or later. Periprocedural complications were noted in 12 cases (13%), of which only 1 complication was definitely associated with temporary stent-assisted coiling (1%). One of the periprocedural complications resulted in neurological damage, the other complications were asymptomatic. CONCLUSION Temporary stent-assisted coiling appears to be a safe and effective treatment method in intracranial wide-neck aneurysms. Procedural safety appears to be comparable with balloon remodeling or permanent stent-assisted coiling, but it comes with the further benefit of diminished need for posttreatment antiplatelet therapy, which may improve the outcome of patients. However, to define the true value and potential benefit of this technique, further prospective studies are required.
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Sumiyoshi A, Okamura A, Iwamoto M, Nagai H, Yamasaki T, Tanaka T, Tanaka K, Iwakura K, Fujii K. Aspiration After Sealing the Entrance by Stenting Is a Promising Method to Treat Subintimal Hematoma. JACC Case Rep 2021; 3:380-384. [PMID: 34317541 PMCID: PMC8311015 DOI: 10.1016/j.jaccas.2021.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/18/2020] [Accepted: 01/08/2021] [Indexed: 11/29/2022]
Abstract
Creation of a distal re-entry site is widely performed to treat subintimal hematoma. However, this method has a risk of further vessel damage. The present aspiration technique after sealing the entry site by stenting is more promising because the hematoma can be reduced without additional vessel damage. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Akinori Sumiyoshi
- Cardiovascular Vascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Astunori Okamura
- Cardiovascular Vascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Mutsumi Iwamoto
- Cardiovascular Vascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Hiroyuki Nagai
- Cardiovascular Vascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Tomohiro Yamasaki
- Cardiovascular Vascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Takamasa Tanaka
- Cardiovascular Vascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Kohta Tanaka
- Cardiovascular Vascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Katusomi Iwakura
- Cardiovascular Vascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Kenshi Fujii
- Cardiovascular Vascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
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Yıldırım İO, Kolu M, Durak MA, Tetik B, Paşahan R, Gürbüz Ş, Saraç K. Y-stent assisted coiling of ruptured wide neck intracranial aneurysm in the acute phase. Interv Neuroradiol 2021; 27:638-647. [PMID: 33779378 DOI: 10.1177/15910199211005331] [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: 11/16/2022] Open
Abstract
BACKGROUND The objective of the present study is to analyze the outcomes of patients with subarachnoid hemorrhage (SAH) in the acute phase after treatment with Y-stent-assisted coiling (YSAC) embolization. METHODS This retrospective study assessed of 30 patients with acutely ruptured wide-neck aneurysms following YSAC treatment between April 2013 and October 2019. The demographic data, aneurysm occlusion grade, procedural and periprocedural complications, and clinical outcomes were assessed. RESULTS The procedure was completed in 30 cases (90.1%) and technical failure occurred in 3 cases (9.1%). Immediate control angiography revealed that total occlusion Raymond-Ray Class 1 (RR1) was achieved in 21 (70%), neck filling (RR2) in eight (26.6%) and sac filling (RR1) in one (3.3%) aneurysm. Upon angiographic follow-up, RR1 occlusion was observed in 15 (71.4%) patients, RR2 in three (14.3%) patients and RR3 in three (14.3%) patients. In-stent thrombus developed in five (16.6%) patients; procedural ischemic events were observed in four (13.3%) patients; and two (6.6%) patients were symptomatic. A periprocedural asymptomatic intracranial hemorrhage was detected in two patients. At discharge, 17 (56.6%) patients were in good clinical condition, six (20%) were in a severe disability condition, and seven (23.3%) patients had died. At the final follow-up visit (mean: 18.9 months), 16 (76,2%) of 21 patients were in a good clinical condition and five (23.8%) had severe disabilities. CONCLUSIONS Y-stent assisted coiling in might be a feasible and promising option for treatment in acute phase in selected wide-necked ruptured intracranial aneurysms.
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Affiliation(s)
| | - Mehmet Kolu
- Department of Radiology, Harran University School of Medicine, Şanlıurfa, Turkey
| | - Mehmet Akif Durak
- Department of Neurosurgery, Inonu University School of Medicine, Malatya, Turkey
| | - Bora Tetik
- Department of Neurosurgery, Inonu University School of Medicine, Malatya, Turkey
| | - Ramazan Paşahan
- Department of Neurosurgery, Inonu University School of Medicine, Malatya, Turkey
| | - Şükrü Gürbüz
- Department of Emergency, Inonu University School of Medicine, Malatya, Turkey
| | - Kaya Saraç
- Department of Radiology, Inonu University School of Medicine, Malatya, Turkey
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Sirakov A, Minkin K, Penkov M, Ninov K, Karakostov V, Sirakov S. Comaneci-Assisted Coiling as a Treatment Option for Acutely Ruptured Wide Neck Cerebral Aneurysm: Case Series of 118 Patients. Neurosurgery 2020; 87:1148-1156. [PMID: 32453823 PMCID: PMC7666901 DOI: 10.1093/neuros/nyaa200] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 03/19/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Wide-necked cerebral aneurysms in the setting of acute subarachnoid hemorrhage (SAH) remain difficult to treat with endovascular methods despite recent progress in the neuroendovascular field. OBJECTIVE To evaluate the effectiveness and safety of the Comaneci device (Rapid Medical, Israel) in endovascular coil embolization of acutely ruptured, wide-necked sidewall, or bifurcation cerebral aneurysms. METHODS We retrospectively reviewed 45 anterior communicating artery, 24 internal carotid artery, 21 middle cerebral artery bifurcation, 15 anterior cerebral artery, and 13 posterior circulation aneurysms, which were treated using Comaneci-assisted coil embolization from August 2017 to January 2019. We evaluated procedural complications, clinical outcomes, and mid-term angiographic follow-up. Immediate and 90 d-clinical outcome and radiological follow-up were obtained in all patients. RESULTS Comaneci-assisted coil embolization was performed in 118 acutely ruptured aneurysms. The technique was carried out successfully in all cases. Simultaneous application of 2 separated Comaneci devices was performed in 8/118 cases (6.77%). Periprocedural thromboembolic complications related to the device were seen in 7/118 cases (5.93%) and severe vasospasm of the parent artery after manipulation of the Comaneci device occurred in 5/118 cases (4.2%). The procedural-related morbidity rate was 2.54%, and there was no procedural related mortality. Among the available survivors, angiographic follow-ups were obtained at 3 and 6 mo, and complete aneurysmal obliteration was confirmed in 81/112 (72.3%) and 75/112 (66.9%) cases, respectively. Mid-term follow-up reviewed total recanalization rate of 14.28%. CONCLUSION Comaneci-assisted embolization of wide-necked intracranial aneurysms in patients presenting with acute SAH is associated with high procedural safety and adequate occlusion rates. Furthermore, dual antiplatelet therapy can be safely avoided in this patient group.
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Affiliation(s)
| | | | | | | | | | - Stanimir Sirakov
- Correspondence: Stanimir Sirakov, MD, PhD UH St Ivan Rilski, Radiology Department, Bul. Akad. Ivan Geshov 15, Sofia, Bulgaria 1431.
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Geng J, Hu P, Ji Z, Li C, Li L, Shen J, Feng X, Wang W, Yang G, Li J, Zhang H. Accuracy and reliability of computer-assisted semi-automated morphological analysis of intracranial aneurysms: an experimental study with digital phantoms and clinical aneurysm cases. Int J Comput Assist Radiol Surg 2020; 15:1749-1759. [DOI: 10.1007/s11548-020-02218-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
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