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Sukumaran M, Cantrell DR, D'Agostino C, Jahromi BS, Ansari SA, Potts MB. Bivalirudin as a substitute for heparin in neurointervention for patients with heparin-induced thrombocytopenia. J Stroke Cerebrovasc Dis 2024; 33:107310. [PMID: 38636321 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107310] [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: 03/20/2023] [Revised: 07/20/2023] [Accepted: 08/15/2023] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVES Heparin-induced thrombocytopenia is a known complication of heparin exposure with potentially life-threatening sequelae. Direct thrombin inhibitors can be substituted for heparin in patients with heparin-induced thrombocytopenia that require anticoagulation. However, the use of direct thrombin inhibitors as a substitute for heparin has not been widely reported in the neuroendovascular literature. MATERIALS AND METHODS Here we report the first use of the direct thrombin inhibitor bivalirudin in a neuroendovascular procedure as a substitute for heparin in a patient with a ruptured pseudoaneurysm and heparin-induced thrombocytopenia, and review the literature on the use of bivalirudin and argatroban for such patients. RESULTS Bivalirudin was safely and effectively used in the case reported, with no thrombotic or hemorrhagic complications. Our literature review revealed a paucity of studies on the use of heparin alternatives, including bivalirudin, in neuroendovascular procedures in patients with heparin-induced thrombocytopenia. CONCLUSIONS Heparin-induced thrombocytopenia is an important iatrogenic disease process in patients undergoing neuroendovascular procedures, and developing protocols to diagnose and manage heparin-induced thrombocytopenia is important for healthcare systems. While further research needs to be done to establish the full range of anticoagulation options to substitute for heparin, our case indicates bivalirudin as a potential candidate.
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Affiliation(s)
- Madhav Sukumaran
- Clinical Fellow, Cerebrovascular and Endovascular Neurosurgery, Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02215, United States.
| | - Donald R Cantrell
- Departments of Radiology and Neurology, Northwestern Medicine, United States
| | | | - Babak S Jahromi
- Departments of Neurological Surgery, Neurology, and Radiology, Northwestern Medicine, United States
| | - Sameer A Ansari
- Departments of Neurological Surgery, Neurology, and Radiology, Northwestern Medicine, United States
| | - Matthew B Potts
- Departments of Neurological Surgery, Neurology, and Radiology, Northwestern Medicine, United States
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Łajczak PM, Jurek B, Jóźwik K, Nawrat Z. Bridging the gap: robotic applications in cerebral aneurysms neurointerventions - a systematic review. Neurosurg Rev 2024; 47:150. [PMID: 38600417 PMCID: PMC11006626 DOI: 10.1007/s10143-024-02400-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 04/12/2024]
Abstract
Cerebral aneurysm is a life-threatening condition, which requires high precision during the neurosurgical procedures. Increasing progress of evaluating modern devices in medicine have led to common usage of robotic systems in many fields, including cranial aneurysm operations. However, currently no systematic review describes up-to date knowledge of this topic. Following PRISMA guidelines, we have independently screened and extracted works from seven databases. Only studies fulfilling inclusion criteria were presented in this study. Device used, operation time, complications, aneurysm type and patient demographics were extracted from each work. We identified a total of 995 articles from databases. We have found six original works and one supplementary article eligible for this synthesis. Majority of works (4/6) have implemented CorPath GRX in cerebral aneurysm procedures. The procedures involved diverse aneurysm locations, utilizing flow diverters, stents, or coiling. One study described implementation of robot-assist on 117 patients and compared results to randomized clinical trials. One work with a small patient cohort described use of the magnetically-controlled microguidewire in the coiling procedures, without any complications. Additionally, one case-series study described use of a robotic arm for managing intraoperative aneurysm rupture. Currently, robotical devices for cerebral aneurysm treatment mainly lack jailing and haptic feedback feature. Further development of these devices will certainly be beneficial for operators and patients, allowing for more precise and remote surgeries.
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Affiliation(s)
- Paweł Marek Łajczak
- Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 18, Zabrze, 40-043, Poland.
| | - Bartłomiej Jurek
- Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 18, Zabrze, 40-043, Poland
| | - Kamil Jóźwik
- Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 18, Zabrze, 40-043, Poland
| | - Zbigniew Nawrat
- 2Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 18, Zabrze, 40-043, Poland
- 3Foundation of Cardiac Surgery Development, Zabrze, 41-808, Poland
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3
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Sadashiva N, Shukla D, Gupta A. Endovascular Management of a Basilar Artery Pseudoaneurysm After Iatrogenic Injury During Endoscopic Third Ventriculostomy: Case Report. Acta Neurochir Suppl 2023; 130:95-101. [PMID: 37548728 DOI: 10.1007/978-3-030-12887-6_12] [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] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Endoscopic third ventriculostomy (ETV) is a well-established neurosurgical procedure. However, it carries risks of intraoperative complications, among which major vascular injury is the most dangerous. Reportedly, prominent bleeding during ETV has been noted in <1% of cases. Herein, we describe a case of a 34-year-old woman with occlusive hydrocephalus caused by a quadrigeminal cistern arachnoid cyst, who developed a pseudoaneurysm after injury of the basilar artery apex during ETV. Complete obliteration of the pseudoaneurysm with endovascular balloon-assisted coiling was done on the first postoperative day, and the patient demonstrated gradual recovery, but approximately 4 weeks later, she suffered massive rebleeding, seemingly due to rupture of the weak pseudoaneurysm wall, which resulted in her death. Careful evaluation of sagittal T2-weighted magnetic resonance images before ETV may be invaluable for assessment of the basilar artery position in relation to the third ventricle floor. In addition, use of a blunt surgical instrument (instead of a sharp one or cautery) for fenestration may be safer for prevention of arterial injury. Finally, special care should be applied in cases with an opaque third ventricle floor and inability to visualize the basilar artery during ETV.
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Affiliation(s)
- Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and NeuroSciences (NIMHANS), Bangalore, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and NeuroSciences (NIMHANS), Bangalore, India.
| | - Arun Gupta
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and NeuroSciences (NIMHANS), Bangalore, India
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Joshi MV, Walke RR. A rare case of middle cerebral artery aneurysm. Pan Afr Med J 2021; 39:241. [PMID: 34659614 PMCID: PMC8498659 DOI: 10.11604/pamj.2021.39.241.30870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/02/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Medhavi Vivek Joshi
- Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India
| | - Rashmi Ramesh Walke
- Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha, Maharashtra, India
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Sattur MG, Al Kasab S, Porto GB, Spiotta AM. Endovascular Treatment of Basilar Bifurcation Aneurysms With PulseRider-Assisted Coiling: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E109-E110. [PMID: 33861344 DOI: 10.1093/ons/opab102] [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: 10/02/2020] [Accepted: 02/03/2021] [Indexed: 11/12/2022] Open
Abstract
Wide-necked bifurcation aneurysms pose technical and anatomical challenges to endovascular treatment, which make the simpler assisted (balloon or single stent) coiling techniques less effective.1 Consequently, unique endovascular solutions to treat such aneurysms have been devised.2,3 One such device is PulseRider (Cerenovus, New Brunswick, New Jersey), which is designed to provide neck support for a coil mass while protecting the bifurcation.3 The device comprises a body or stem that is deployed in the parent artery and a saddle component that sits at the aneurysm neck to keep the coil mass away from the bifurcation. There are several technical nuances involved in successful use of the device during positioning, deployment, and detachment.3 We present a surgical video detailing the steps of PulseRider-assisted coiling of unruptured basilar bifurcation (or basilar apex) aneurysms. The first case highlights index treatment at diagnosis and the second showcases treatment of a recurrent basilar apex aneurysm. Both patients provided informed consent to the procedure. We also briefly discuss the rationale for treating basilar apex aneurysms.4,5.
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Affiliation(s)
- Mithun G Sattur
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sami Al Kasab
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Guilherme B Porto
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
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6
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Abstract
Intracranial aneurysms are common in the adult population and carry a risk of rupture leading to catastrophic subarachnoid hemorrhage. Treatment of aneurysms has evolved significantly, with the introduction of new techniques and devices for minimally invasive and endovascular approaches. Follow-up imaging after aneurysm treatment is standard of care to monitor for recurrence or other complications, and the preferred imaging modality and schedule for follow-up are areas of active research. The modality and follow-up schedule should be tailored to treatment technique, aneurysm characteristics, and patient factors.
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Affiliation(s)
- Jason Hostetter
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD 21201, USA.
| | - Timothy R Miller
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD 21201, USA
| | - Dheeraj Gandhi
- Neurology and Neurosurgery, Department of Radiology, Interventional Neuroradiology, CMIT Center, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD 21201, USA
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Ohbuchi H, Hagiwara S, Arai N, Yoneyama T, Takahashi Y, Inazuka M, Kubota Y, Chernov M, Kasuya H. Optimal timing and safety of the external ventricular drainage in patients with high-grade aneurysmal subarachnoid hemorrhage treated with endovascular coiling. J Clin Neurosci 2021; 88:63-69. [PMID: 33992206 DOI: 10.1016/j.jocn.2021.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/30/2020] [Revised: 02/11/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
The presented retrospective analysis has evaluated the optimal timing and safety of external ventricular drainage (EVD) for acute hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH). The study cohort comprised 102 patients, 49 of whom underwent EVD at 3-120 h (mean, 16 h) after the clinical onset of aSAH, either before (N = 27) or after (N = 22) ruptured aneurysm coiling. Among those treated with EVD, favorable and fair outcomes at discharge (modified Rankin Scale [mRS] scores 0-3) were noted in 14 (29%) and unfavorable (mRS scores 4-6) in 35 (71%). The former was more common among women (P = 0.019) and patients without chronic arterial hypertension (P = 0.028). The cut-off value for optimal timing of EVD was defined at 13 h after the onset of aSAH. Favorable and fair outcomes were more frequent after early (≤13 h; N = 30) than late (>13 h; N = 19) EVD (40% vs. 11%; P = 0.026), whereas did not differ significantly between those in whom such procedure was done before or after ruptured aneurysm coiling (19% vs. 41%; P = 0.083). In the entire study cohort, 2 patients had re-rupture of the aneurysm, and while both of them were treated with EVD, neither case of complication was directly associated with the procedure and, in fact, preceded it. In conclusion, EVD for management of acute hydrocephalus in patients with high-grade aSAH should be preferably applied within 13 h after the clinical onset of stroke, which may be considered sufficiently safe regardless whether it is performed before or after ruptured aneurysm coiling.
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Affiliation(s)
- Hidenori Ohbuchi
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, Tokyo.
| | - Shinji Hagiwara
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, Tokyo
| | - Naoyuki Arai
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, Tokyo
| | - Taku Yoneyama
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, Tokyo
| | - Yuichi Takahashi
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, Tokyo; Department of Neurosurgery, Moriya Daiichi General Hospital, Ibaraki, Japan
| | - Mayuko Inazuka
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, Tokyo
| | - Yuichi Kubota
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, Tokyo
| | - Mikhail Chernov
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, Tokyo
| | - Hidetoshi Kasuya
- Department of Neurosurgery, Medical Center East, Tokyo Women's Medical University, Tokyo
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8
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Thaci B, Nuño M, Varshneya K, Gerndt CH, Kercher M, Dahlin BC, Waldau B. Three-dimensional aneurysm volume measurements show no correlation between coil packing density and recurrence. Heliyon 2020; 6:e05170. [PMID: 33083618 PMCID: PMC7551363 DOI: 10.1016/j.heliyon.2020.e05170] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/03/2020] [Accepted: 10/02/2020] [Indexed: 11/30/2022] Open
Abstract
Objective Endovascular treatment is the mainstay therapy for brain aneurysms. About 15% of patients need re-treatment within six months due to early recanalization. In this study, we investigate risk factors associated with treatment failure. Methods This retrospective cohort study includes endovascularly treated aneurysm cases between July 2012 and December 2015 at the University of California Davis Medical Center with pre-treatment and early post-treatment imaging. Thin cut 3D aneurysm volume rendering was used for morphologic analyses. Univariate and bivariate analyses were conducted to evaluate differences between patients and clinical factors by treatment failure. Results Of the 50 patients who met the inclusion criteria, 41 (82.0%) were female, with an average age of 61 years. Most aneurysms were on the anterior communicating artery (40%) or posterior communicating artery (22.0%), and 34 (68%) aneurysms were ruptured. Early treatment failure was observed in 14 (28.0%) of endovascularly treated patients. Raymond-Roy class (RRC) was significantly associated with treatment failure (p = 0.0052), with 10 out of the 14 cases (71.4%) with early recanalization having an RRC of 3. Coil packing density did not associate with aneurysm recanalization (p = 0.61). Conclusion In our single institution series, patient characteristics, aneurysm characteristics, or coil packing density did not affect early aneurysm recanalization. RRC was the best predictor of early recanalization; however, further confirmation with additional studies are required. Although this study focused on early treatment failure, late recanalization has been shown with longer follow up. Further investigation into factors associated with late treatment failure will need further investigation. New intrasaccular devices and flow diverters will also likely play a role in reducing recurrence in the future as these treatments gain usage.
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Affiliation(s)
- Bart Thaci
- Department of Neurological Surgery, University of California, Davis Medical Center, Sacramento, USA
| | - Miriam Nuño
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis, Davis, USA
| | - Kunal Varshneya
- Department of Neurosurgery, Stanford University School of Medicine, USA
| | - Clayton H Gerndt
- Department of Neurological Surgery, University of California, Davis Medical Center, Sacramento, USA
| | - Matthew Kercher
- Department of Neurological Surgery, University of California, Davis Medical Center, Sacramento, USA
| | - Brian C Dahlin
- Department of Interventional Radiology, University of California, Davis Medical Center, Sacramento, USA
| | - Ben Waldau
- Department of Neurological Surgery, University of California, Davis Medical Center, Sacramento, USA
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Naragum V, AbdalKader M, Nguyen TN, Norbash A. Balloon-Assisted Cannulation for Difficult Anterior Cerebral Artery Access. Interv Neurol 2018; 7:48-52. [PMID: 29628945 DOI: 10.1159/000481542] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The anterior communicating artery is a common location for intracranial aneurysms. Compared to surgical clipping, endovascular coiling has been shown to improve outcomes for patients with ruptured aneurysms and we have seen a paradigm shift favoring this technique for treating aneurysms. Access to the anterior cerebral artery can be challenging, especially in patients with tortuous anatomy or subarachnoid hemorrhage or in patients presenting with vasospasm. We present a technique for cannulating the anterior cerebral artery using a balloon inflated in the proximal middle cerebral artery as a rebound surface.
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Affiliation(s)
- Varun Naragum
- Department of Neurology and Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Mohamad AbdalKader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Thanh N Nguyen
- Department of Neurology and Radiology, Boston Medical Center, Boston, Massachusetts, USA.,Department of Neurology, Neurosurgery Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Alexander Norbash
- Department of Department of Radiology, University of California, San Diego, California, USA
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10
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Yamaguchi S, Ito O, Koyanagi Y, Iwaki K, Matsukado K. Microcatheter shaping using intravascular placement during intracranial aneurysm coiling. Interv Neuroradiol 2017; 23:249-254. [PMID: 28166669 DOI: 10.1177/1591019917689926] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The selection of a pre-shaped microcatheter or a shaping method must be carefully considered for successful aneurysm coiling. The objective of this report is to verify the use of intravascular placement to establish an appropriate microcatheter shape. Methods Fifteen patients (15 aneurysms) were included in this study because of the predicted difficulty of microcatheter insertion and stabilisation. The SL-10 straight microcatheter was inserted into the parent artery until the tip of the catheter passed through the neck of the aneurysm. After 5 minutes, the microcatheter was pulled out and the shape acquired from intravascular placement was confirmed and compared with the three-dimensional rotational angiography. In addition, the microcatheter tip was steam-shaped for coiling and coil embolisation was performed. A silicone flow model was also used to confirm our findings. The first experiment compared the bend angle in four different microcatheters placed in the model for 5 minutes. In the second experiment, the SL-10 straight microcatheter was placed in the model, and the bend angle was measured at 2.5, 5, 7.5 and 10 minutes to observe the changes in bend angle over time. Results The SL-10 straight microcatheter, in place for 5 minutes, acquired a shape similar to the patient's own vessel. Among the 15 patients included, 13 were treated using an intravascular shaped microcatheter. In the flow model experiments, the SL-10 most easily acquired the vessel shape, and the shape change stabilised after 5 minutes. Conclusion Shaping the SL-10 straight microcatheter using intravascular placement is an effective shaping method for aneurysm coil embolisation.
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Affiliation(s)
- Shinya Yamaguchi
- 1 Department of Neurosurgery, Steel Memorial Yawata Hospital, Japan
| | - Osamu Ito
- 2 Department of Neurosurgery, Shin Koga Hospital, Japan
| | - Yuya Koyanagi
- 1 Department of Neurosurgery, Steel Memorial Yawata Hospital, Japan
| | - Katsuma Iwaki
- 1 Department of Neurosurgery, Steel Memorial Yawata Hospital, Japan
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Salaud C, Hamel O, Riem T, Desal H, Buffenoir K. Management of aneurysmal subarachnoid haemorrhage with intracerebral hematoma: Is there an indication for coiling first? Study of 44 cases. Interv Neuroradiol 2015; 22:5-11. [PMID: 26634802 DOI: 10.1177/1591019915617320] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 10/03/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Aneurysmal subarachnoid haemorrhage (ASH) with intracerebral hematoma (ICH) has a poor prognosis. The treatment is to secure the aneurysm and do an ICH evacuation. OBJECTIVE The aim of the study was to determine if aneurysm coiling followed by ICH evacuation is a viable alternative treatment compared to exclusive surgery, regardless of the clinical or paraclinical presentations. METHODS A retrospective study was conducted between 2004 and 2014, which included 44 patients. The patients were divided up in four groups. Two were principal groups: The clipped group (aneurysm clipping with ICH evacuation) and the coiled group (aneurysm coiling, followed by ICH evacuation); and two were subgroups of the latter: Aneurysm coiling with ICH evacuation after 24 hours and ICH evacuation followed by aneurysm coiling. We studied the demographic and radiologic characteristics, and the 3-month outcome. RESULTS We included 17 patients in the coiled group: The outcome was better for the patients with World Federation of Neurosurgery (WFNS) scores of 1, 2 and 3; compared to the patients with WFNS scores 4 and 5. We included 16 patients in the clipped group: The outcome was better, compared the coiled group, for those patients with WFNS scores 4 and 5. Six patients were treated with aneurysm coiling, followed by ICH evacuation after 24 hours: 33% had a good outcome. Five patients were treated by ICH evacuation, followed by aneurysm coiling: None had a good outcome. CONCLUSIONS It was necessary to realise a prospective study to compare the outcomes of patients with WFNS scores of 1, 2 or 3; between those with aneurysm coiling followed by ICH evacuation and aneurysm clipping with ICH evacuation, to determine the potential of using the coiling first, for these patients.
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Affiliation(s)
- Céline Salaud
- Department of Neurosurgery, University of Nantes Medical Center, Nantes, France
| | - Olivier Hamel
- Department of Neurosurgery, University of Nantes Medical Center, Nantes, France
| | - Tanguy Riem
- Department of Neurosurgery, University of Nantes Medical Center, Nantes, France
| | - Hubert Desal
- Department of Neuroradiology, University of Nantes Medical Center, Nantes, France
| | - Kevin Buffenoir
- Department of Neurosurgery, University of Nantes Medical Center, Nantes, France
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Jeon JS, Sheen SH, Hwang G, Kang SH, Heo DH, Cho YJ. Intraarterial tirofiban thrombolysis for thromboembolisms during coil embolization for ruptured intracranial aneurysms. J Cerebrovasc Endovasc Neurosurg 2012; 14:5-10. [PMID: 23210024 PMCID: PMC3471250 DOI: 10.7461/jcen.2012.14.1.5] [Citation(s) in RCA: 12] [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: 12/01/2011] [Revised: 12/23/2011] [Accepted: 01/05/2012] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Thromboembolus can occur during endovascular coil embolization. The aim of our study was to show our experience of intraarterial (IA) tirofiban infusion for thromboembolism during coil embolization for ruptured intracranial aneurysms. METHODS This retrospective analysis was conducted in 64 patients with ruptured aneurysms who had emergent endovascular coil embolization from May 2007 to April 2011 at a single institute. Thromboembolic events were found in ten patients (15.6%). Anticoagulation treatment with intravenous heparin was started after the first coil deployment in ruptured aneurysmal sac. When a thrombus or embolus was found during the procedure, we tried to resolve them without delay with an initial dosage of 0.3 mg of tirofiban up to 1.2 mg. RESULTS Three patients of four with total occlusion had recanalizations of thrombolysis in myocardial infarction (TIMI) grade III and five of six with partial occlusion had TIMI grade III recanalizations. Eight patients showed good recovery, with modified Rankin Scale (mRS) score of 0 and one showed poor outcome (mRS 3 and 6). There was no hemorrhagic or hematologic complication. CONCLUSION IA tirofiban can be feasible when thromboembolic clots are found during coil embolization in order to get prompt recanalization, even in patients with subarachnoid hemorrhage.
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Affiliation(s)
- Jin Sue Jeon
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
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