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Zimny M, Paździora P, Kocur D, Błaszczyk B, Gendosz de Carrillo D, Baron J, Jędrzejowska-Szypułka H, Rudnik A. Analysis of Serum Markers of Perioperative Brain Injury and Inflammation Associated with Endovascular Treatment of Intracranial Aneurysms: A Preliminary Study. Brain Sci 2023; 13:1308. [PMID: 37759909 PMCID: PMC10526942 DOI: 10.3390/brainsci13091308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/03/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Embolization is the preferred method for treating intracranial aneurysms due to its less invasive nature. However, recent findings suggest that even uncomplicated embolization may cause structural damage to the brain through ischemic or inflammatory mechanisms. This study aimed to find possible biomarkers of brain injury and inflammation in patients suffering from intracranial aneurysms who underwent endovascular treatment by measuring serological markers indicating brain damage. The study involved 26 patients who underwent uncomplicated intravascular stenting for unruptured intracranial aneurysms between January 2020 and December 2021. Blood samples were collected before the procedure, at 6-12 h, and at 24 h after the procedure. The following protein biomarkers levels were tested with ELISA: S100B, hNSE, TNF, hsCRP, FABP7, NFL, and GP39. Statistical analysis of the results revealed significant increases in serum levels for the four biomarkers: FABP7-before 0.25 (ng/mL) vs. 6-12 h 0.26 (p = 0.012) and vs. 24 h 0.27 (p < 0.001); GP39-before 0.03 (pg/mL) vs. 6-12 h 0.64 (p = 0.011) and vs. 24 h 0.57 (p = 0.001); hsCRP-before 1.65 (μg/mL) vs. 24 h 4.17 (p = 0.037); NFL-before 0.01 (pg/mL) vs. 6-12 h 3.99 (p = 0.004) and vs. 24 h 1.86 (p = 0.033). These biomarkers are recognized as potential indicators of neurovascular damage and should be monitored in clinical settings. Consequently, serum levels of NFL, GP39, hsCRP, and FABP7 measured before and 24 h after endovascular procedures can serve as important markers for assessing brain damage and indicate avenues for further research on biomarkers of neurovascular injury.
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Affiliation(s)
- Mikołaj Zimny
- Department of Neurosurgery, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Piotr Paździora
- Department of Neurosurgery, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Damian Kocur
- Department of Neurosurgery, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Bartłomiej Błaszczyk
- Department of Neurosurgery, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Daria Gendosz de Carrillo
- Department of Physiology, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
- Department of Histology and Cell Pathology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Jan Baron
- Department of Radiodiagnostics, Interventional Radiology and Nuclear Medicine, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | | | - Adam Rudnik
- Department of Neurosurgery, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
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Antkowiak L, Stogowski P, Klepinowski T, Balinski T, Mado H, Sumislawski P, Niedbala M, Rucinska M, Nowaczyk Z, Rogalska M, Kocur D, Kasperczuk A, Sordyl R, Kloc W, Kaspera W, Kammler G, Sagan L, Rudnik A, Tabakow P, Westphal M, Mandera M. External validation of the Chicago Chiari Outcome Scale in adults with Chiari malformation type I. Neurosurg Focus 2023; 54:E3. [PMID: 36857789 DOI: 10.3171/2022.12.focus22625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/29/2022] [Indexed: 03/03/2023]
Abstract
OBJECTIVE The Chicago Chiari Outcome Scale (CCOS) serves as a standardized clinical outcome evaluation tool among patients with Chiari malformation type I (CM-I). While the reliability of this scale has been proven for pediatric patients, the literature lacks CCOS validation when used solely in adults. Therefore, this study aimed to determine the validity of the CCOS in an external cohort of adult patients. METHODS The authors retrospectively analyzed the medical records of symptomatic patients with CM-I who underwent posterior fossa decompression between 2010 and 2018 in six neurosurgical departments. Each patient was clinically assessed at the latest available follow-up. Gestalt outcome was determined as improved, unchanged, or worsened compared with the preoperative clinical state. Additionally, the CCOS score was calculated for each patient based on the detailed clinical data. To verify the ability of the CCOS to determine clinical improvement, the area under the receiver operating characteristic (AUROC) curve was evaluated. A logistic regression analysis using all four components of the CCOS (pain symptoms, nonpain symptoms, functionality, and complications) was performed to establish predictors of the improved outcome. RESULTS Seventy-five individuals with a mean age of 42 ± 15.32 years were included in the study. The mean follow-up duration was 52 ± 33.83 months. Considering gestalt outcome evaluation, 41 patients (54.7%) were classified as improved, 24 (32%) as unchanged, and 10 (13.3%) as worsened. All patients with a CCOS score of 14 or higher improved, while all those with a CCOS score of 8 or lower worsened. The AUROC was 0.986, suggesting almost perfect accuracy of the CCOS in delineating clinical improvement. A CCOS score of 13 showed high sensitivity (0.93) and specificity (0.97) for identifying patients with clinical improvement. Additionally, a meaningful correlation was found between higher CCOS scores in each component and better outcomes. Patient stratification by total CCOS score showed that those categorized as improved, unchanged, and worsened scored prevalently between 13 and 16 points, 10 and 12 points, and 4 and 9 points, respectively. CONCLUSIONS In this adult cohort, the CCOS was found to be almost perfectly accurate in reflecting postoperative clinical improvement. Moreover, all four CCOS components (pain symptoms, nonpain symptoms, functionality, and complications) significantly correlated with patient clinical outcomes.
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Affiliation(s)
- Lukasz Antkowiak
- 1Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland
| | - Piotr Stogowski
- 2Department of Neurosurgery, Copernicus Medical Center, Gdansk, Poland
| | - Tomasz Klepinowski
- 3Department of Neurosurgery, Pomeranian Medical University Hospital No. 1, Szczecin, Poland
| | - Tristan Balinski
- 4Department of Neurosurgery, Wroclaw Medical University, Wroclaw, Poland
| | - Hubert Mado
- 1Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland
| | - Piotr Sumislawski
- 5Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcin Niedbala
- 6Department of Neurosurgery, Medical University of Silesia in Katowice, Regional Hospital, Sosnowiec, Poland
| | - Michalina Rucinska
- 1Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland
| | - Zuzanna Nowaczyk
- 3Department of Neurosurgery, Pomeranian Medical University Hospital No. 1, Szczecin, Poland
| | - Marta Rogalska
- 7Faculty of Medicine, Medical University of Warsaw, Poland
| | - Damian Kocur
- 8Department of Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland
| | - Anna Kasperczuk
- 9Faculty of Mechanical Engineering, Institute of Biomedical Engineering, Bialystok University of Technology, Bialystok, Poland
| | - Ryszard Sordyl
- 1Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland
| | - Wojciech Kloc
- 2Department of Neurosurgery, Copernicus Medical Center, Gdansk, Poland.,10Department of Psychology and Sociology of Health and Public Health, School of Public Health, Collegium Medicum, University of Warmia-Mazury in Olsztyn, Poland; and
| | - Wojciech Kaspera
- 6Department of Neurosurgery, Medical University of Silesia in Katowice, Regional Hospital, Sosnowiec, Poland
| | - Gertrud Kammler
- 5Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Leszek Sagan
- 3Department of Neurosurgery, Pomeranian Medical University Hospital No. 1, Szczecin, Poland.,11Department of Pediatric Neurosurgery, Zdroje Hospital, Szczecin, Poland
| | - Adam Rudnik
- 8Department of Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland
| | - Pawel Tabakow
- 4Department of Neurosurgery, Wroclaw Medical University, Wroclaw, Poland
| | - Manfred Westphal
- 5Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marek Mandera
- 1Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland
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Kocur D, Paździora P, Baron J, Rudnik A. Role of transcranial Doppler ultrasonography in assessing stenosis after flow diversion. Clin Neurol Neurosurg 2020; 198:106219. [PMID: 32932030 DOI: 10.1016/j.clineuro.2020.106219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/23/2020] [Accepted: 09/05/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Patients after implantation of flow diverters (FD) due to intracranial aneurysms require radiological and clinical follow-up in view of in-stent stenosis. The aim of the study was to evaluate transcranial Doppler ultrasonography (TCD) as an alternative to more invasive digital subtraction angiography in monitoring patients with FD. PATIENTS AND METHODS Twenty-five patients after FD deployment due to internal carotid artery (ICA) aneurysms were reviewed. The degree stenosis found on TCD was compared with the results of catheter angiography. The TCD examinations were recorded from two sides at the extracranial ICA and the most proximal and distal segment of intracranial ICA. Analyzed TCD factors included: peak systolic blood flow velocity, end diastolic velocity, mean velocity, pulsatility index, and resistivity index. The side-to-side differences and ratios between particular TCD indices were calculated. RESULTS The cumulative frequency of angiographic in-stent stenosis was 5 of 25 (20 %). The analysis showed that pulsatility index measured on the most proximal intracranial segment of ICA is a predictor for angiographic instent stenosis (AUC = 0.854; p = 0.04; 95 % CI 0.59-1.00). The threshold of pulsatility index separating stenosis and non-stenosis groups was 1.05 with a sensitivity of 50 % and a specificity of 100 %. As the cut-off threshold of PI was set 0.75 the sensitivity and specificity was 100 % and 16.7 %, respectively. CONCLUSIONS The increased TCD-derived pulsatility index measured on the most proximal intracranial segment of ICA is associated with in-stent stenosis demonstrated on angiograms.
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Affiliation(s)
- Damian Kocur
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Katowice, Poland.
| | - Piotr Paździora
- 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
| | - Adam Rudnik
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Katowice, Poland
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Kocur D, Przybyłko N, Niedbała M, Rudnik A. Alternative Definitions of Cerebral Aneurysm Morphologic Parameters Have an Impact on Rupture Risk Determination. World Neurosurg 2019; 126:e157-e164. [DOI: 10.1016/j.wneu.2019.01.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
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Hofman M, Jamróz T, Jakutowicz I, Jarski P, Masarczyk W, Niedbała M, Przybyłko N, Kocur D, Baron J. Endovascular treatment of complex intracranial aneurysms. Pol J Radiol 2018; 83:e109-e114. [PMID: 30038686 PMCID: PMC6047096 DOI: 10.5114/pjr.2018.74968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 12/20/2017] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Complex intracranial aneurysms (CIA) are heterogenous group of intracranial vascular malformations. Due to its giant size, difficult location, broad neck, branches arising from the aneurysm, wall structure, calcification, presence of intraluminal thrombus or previous treatments it requires more careful approach. The aim of this study was to evaluate endovascular treatment results of CIA in our Department. MATERIAL AND METHODS In order to differentiate CIA from all the aneurysms, treated endovascularly in years 2008-2014, authors proposed their own qualification criteria. Additionally, subgroup of patients with CIA with simultaneous subarachnoid haemorrhage (SAH) was divided. Clinical outcomes of patients were assessed with Glasgow Outcome Scale (GOS), while radiological outcomes were assessed with Montreal Scale. Aneurysm localization, incidence of aborted procedures, intraoperative complications were also evaluated. RESULTS Internal carotid artery was the most common localization in both CIA and non-complex (nCIA) groups. Incidence of aborted procedures was significantly higher in CIA group than in nCIA (25% vs. 7%; p < 0.01). CIA group had worse Montreal scores then nCIA group (1.90 vs. 1.49; p < 0.01). Clinical outcome in GOS scale in patients with SAH and CIA was significantly worse than in SAH and nCIA (2.86 vs. 4.06; p = 0.04). CONCLUSIONS To conclude, proposed criteria of CIA should be taken into consideration during diagnosis and qualification to invasive treatment. Classifying aneurysm as CIA is related to greater possibility of aborting endovascular procedure due to technical difficulties.
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Affiliation(s)
- Mariusz Hofman
- Department of Neurosurgery, Medical University of Silesia, Katowice, Poland
| | - Tomasz Jamróz
- Department of Neurosurgery, Medical University of Silesia, Katowice, Poland
| | - Izabela Jakutowicz
- Department of Neurosurgery, Medical University of Silesia, Katowice, Poland
| | - Paweł Jarski
- Department of Neurosurgery, Medical University of Silesia, Katowice, Poland
| | - Wilhelm Masarczyk
- Department of Neurosurgery, Medical University of Silesia, Katowice, Poland
| | - Marcin Niedbała
- Department of Neurosurgery, Medical University of Silesia, Katowice, Poland
| | - Nikodem Przybyłko
- Department of Neurosurgery, Medical University of Silesia, Katowice, Poland
| | - Damian Kocur
- Department of Neurosurgery, Medical University of Silesia, Katowice, Poland
| | - Jan Baron
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kocur D, Ślusarczyk W, Przybyłko N, Hofman M, Jamróz T, Suszyński K, Baron J, Kwiek S. Endovascular Approach to Glomus Jugulare Tumors. Pol J Radiol 2017; 82:322-326. [PMID: 28685005 PMCID: PMC5487373 DOI: 10.12659/pjr.901141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/06/2016] [Indexed: 11/17/2022] Open
Abstract
Background Paragangliomas are benign neuroendocrine tumors derived from the glomus cells of the vegetative nervous system. Typically, they are located in the region of the jugular bulb and middle ear. The optimal management is controversial and can include surgical excision, stereotactic radiosurgery and embolization. Case Report We report the endovascular approach to three patients harboring glomus jugulare paragangliomas. In all cases incomplete occlusion of the lesions was achieved and recanalization in the follow-up period was revealed. Two patients presented no clinical improvement and the remaining one experienced a transient withdrawal of tinnitus. Conclusions It is technically difficult to achieve complete obliteration of glomus jugulare tumors with the use of embolization and the subtotal occlusion poses a high risk of revascularization and is not beneficial in terms of alleviating clinical symptoms.
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Affiliation(s)
- Damian Kocur
- Department of Neurosurgery, prof. Gibiński Central Clinical Hospital, Katowice, Poland
| | - Wojciech Ślusarczyk
- Department of Physiology, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Nikodem Przybyłko
- Department of Neurosurgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Mariusz Hofman
- Department of Neurosurgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Tomasz Jamróz
- Department of Neurosurgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Krzysztof Suszyński
- Department of Sports Medicine and Physiology of Physical Effort, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Jan Baron
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Stanisław Kwiek
- Department of Neurosurgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
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Kocur D, Zbroszczyk M, Przybyłko N, Hofman M, Jamróz T, Baron J, Bażowski P, Kwiek S. Stent-assisted embolization of wide-neck anterior communicating artery aneurysms: Review of consecutive 34 cases. Neurol Neurochir Pol 2016; 50:425-431. [PMID: 27546894 DOI: 10.1016/j.pjnns.2016.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 06/20/2016] [Accepted: 07/19/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We report our experience with stent-assisted coiling of anterior communicating artery aneurysms with special consideration of angiographic and clinical outcomes, retreatment rate and periprocedural complications. MATERIALS AND METHODS The analysis included 34 consecutive ruptured and unruptured wide-neck aneurysms. The aneurysm size ranged from 2 to 18mm (mean 5.47). Clinical examinations with the use of modified Rankin Score and angiographic outcomes were evaluated initially post-embolization and at a minimum follow-up of 6 months. RESULTS Initial post-treatment complete and near-complete aneurysm occlusion was achieved in 32 (94%) and 2 (6%) cases, respectively. Imaging follow-up, performed in 28 (82%) patients, showed no change in the degree of occlusion in 25 (89%) cases and coil compaction in 3 (11%) patients. Of these, one (3.6%) patient underwent a second coil embolization. The periprocedural severe complication rate was 2.9% (1/35) and was associated with prolonged attempt of retrieval of migrated coil resulting in anterior cerebral artery infarct with serious clinical consequences. In another 3 patients periprocedural adverse events without delayed clinical consequences were noticed. The clinical follow-up evaluation achieved in 33 (97%) patients showed no change in 30 (91%) cases, one patient (3%) with clinical improvement and two (6%) cases of neurological deterioration. CONCLUSIONS The use of stent is feasible and effective for coil embolization of wide-necked anterior communicating artery aneurysms. Although periprocedural complications resulting in severe morbidity are rare, they should be noted, since in terms of thromboembolic events some of them presumably have a potential to be avoidable.
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Affiliation(s)
- Damian Kocur
- Department of Neurosurgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
| | - Miłosz Zbroszczyk
- Department of Radiology and Nuclear Medicine, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Nikodem Przybyłko
- Department of Neurosurgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Mariusz Hofman
- Department of Neurosurgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Tomasz Jamróz
- Department of Neurosurgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Jan Baron
- Department of Radiology and Nuclear Medicine, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Piotr Bażowski
- Department of Neurosurgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Stanisław Kwiek
- Department of Neurosurgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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Kocur D, Zbroszczyk M, Przybyłko N, Hofman M, Jamróz T, Baron J, Bażowski P, Kwiek S. Stand-alone coil embolization of anterior communicating artery aneurysms: Efficacy and technical issues. Neuroradiol J 2016; 29:361-7. [PMID: 27531863 PMCID: PMC5033104 DOI: 10.1177/1971400916665388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We report our experience with endovascular coiling of anterior communicating artery aneurysms with special consideration of angiographic and clinical outcomes and periprocedural complications. MATERIALS AND METHODS The analysis included treatment results of 28 patients with ruptured and unruptured aneurysms. The aneurysm size ranged from 1.8 to 9.8 mm (mean 5.2, SD 1.7). Clinical examinations with the use of modified Rankin Score and angiographic outcomes were evaluated initially post-embolization and at a minimum follow-up of six months. RESULTS Initial post-treatment complete and near-complete aneurysm occlusion was achieved in 27 (96%) cases and incomplete occlusion in one (4%) case. Imaging follow-up, performed in 15 (53.6%) patients, showed no change in the degree of occlusion in 11 (73%), coil compaction in one (7%) and progressive occlusion in three (20%) patients. Three (20%) patients underwent a second coil embolization. The procedure-related severe morbidity and mortality rate was 6.4% (2/31). Coil prolapse was present in one (3.2%) case and intraprocedural aneurysm rupture in three (9.6%) cases. The clinical follow-up evaluation achieved in 19 (67.9%) patients showed no change in 17 (89.5%) patients and improvement in two (10.5%) patients. CONCLUSIONS Although the efficacy of coil embolization of anterior communicating artery aneurysms is unquestionable and the procedure-related complications are acceptable, they should not be neglected. Further investigations are needed to better understand protective factors, as well as to establish unequivocally appropriate management strategy of these complications.
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Affiliation(s)
- Damian Kocur
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Poland
| | - Miłosz Zbroszczyk
- Medical University of Silesia, School of Medicine in Katowice, Department of Radiology and Nuclear Medicine, Poland
| | - Nikodem Przybyłko
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Poland
| | - Mariusz Hofman
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Poland
| | - Tomasz Jamróz
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Poland
| | - Jan Baron
- Medical University of Silesia, School of Medicine in Katowice, Department of Radiology and Nuclear Medicine, Poland
| | - Piotr Bażowski
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Poland
| | - Stanisław Kwiek
- Medical University of Silesia, School of Medicine in Katowice, Department of Neurosurgery, Poland
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Kocur D, Ślusarczyk W, Przybyłko N, Bażowski P, Właszczuk A, Kwiek S. Stent-Assisted Endovascular Treatment of Anterior Communicating Artery Aneurysms - Literature Review. Pol J Radiol 2016; 81:374-9. [PMID: 27559426 PMCID: PMC4981124 DOI: 10.12659/pjr.896818] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/07/2016] [Indexed: 11/23/2022] Open
Abstract
The anterior cerebral artery is a common location of intracranial aneurysms. The standard coil embolization technique is limited by its inability to occlude wide-neck aneurysms. Stent deployment across the aneurysm neck supports the coil mass inside the aneurysmal sac, and furthermore, has an effect on local hemodynamic and biologic changes. In this article, various management strategies and techniques as well as angiographic outcomes and complications related to stent-assisted endovascular treatment of anterior communicating artery aneurysms are presented. This treatment method is safe and associated with low morbidity and mortality rates.
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Affiliation(s)
- Damian Kocur
- Department of Neurosurgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Wojciech Ślusarczyk
- Department of Neurosurgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland; Department of Physiology, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Nikodem Przybyłko
- Department of Neurosurgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Piotr Bażowski
- Department of Neurosurgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Adam Właszczuk
- Department of Physiology, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - Stanisław Kwiek
- Department of Neurosurgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
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