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Chen CG, Gao BL, Yang CB, Hao XH, Ren CF, Yang L, Han YF, Cao QY. Safety and effects of endovascular treatment of basilar tip aneurysms in patients with moyamoya diseases. Medicine (Baltimore) 2023; 102:e32777. [PMID: 36705360 PMCID: PMC9875987 DOI: 10.1097/md.0000000000032777] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The effect and safety of endovascular treatment of basilar tip aneurysms associated with moyamoya disease are unknown. This study was to investigate the safety and effect of endovascular treatment of basilar tip aneurysms associated with moyamoya disease. Patients with moyamoya disease concurrent with basilar tip aneurysms were retrospectively enrolled and treated with endovascular embolization. The clinical and angiographic data were analyzed. Thirty patients with a basilar tip aneurysm were enrolled, including 8 (26.67%) male and 22 (73.33%) female patients aged 38 to 72 years (mean 54.4 ± 8.15). Endovascular treatment was successfully performed in 29 (96.67%) patients but failed in 1 (3.33%). Immediately after embolization, aneurysm occlusion degree was Raymond-Roy grade I in 26 (89.66%), grade II in 2 (6.90%), and grade III in 1 (3.45%). Intraprocedural complications occurred in 2 (10%) patients, including aneurysm rupture in 1 (3.33%), leading to death of the patient, and stent thrombosis in 2 (6.67%) which was successfully treated with thrombolysis. At discharge, good clinical outcome (modified Rankin Scale 0-2) was achieved in 29 (96.67%) and death in 1 (3.03%). Follow-up was performed 6 to 26 months (median 15) in 27 (93.1%) patients. Aneurysm occlusion degree was Raymond-Roy grade I in 21 (77.78%) patients, grade II in 4 (14.81%), and grade III in 2 (7.41%), not significantly (P = .67) different from those immediately after embolization. Aneurysm recurrence was found in 4 patients (14.81%). The clinical outcome was modified Rankin Scale 0 to 2 in all 27 patients, not significantly different from that at discharge. Endovascular embolization can be performed safely and effectively for basilar tip aneurysms associated with moyamoya disease even though more advanced embolization techniques are necessary.
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Affiliation(s)
- Chun-Guang Chen
- Department of Neurosurgery, Liaoyang City Central Hospital, Liaoyang City, Liaoning Province, China
| | - Bu-Lang Gao
- Department of Neurosurgery, Shijiazhuang People’s Hospital, Liaoyang City, Liaoning Province, China
- * Correspondence: Bu-Lang Gao, Department of Neurosurgery, Shijiazhuang People’s Hospital, 365 South Jianhua Street, Shijiazhuang, Hebei Province 050011, China (e-mail: )
| | - Cheng-Bao Yang
- Department of Neurosurgery, Shijiazhuang People’s Hospital, Liaoyang City, Liaoning Province, China
| | - Xiao-Hong Hao
- Department of Neurosurgery, Shijiazhuang People’s Hospital, Liaoyang City, Liaoning Province, China
| | - Chun-Feng Ren
- Department of Laboratory Analysis, Zhengzhou University First Affiliated Hospital, Liaoyang City, Liaoning Province, China
| | - Lei Yang
- Department of Neurosurgery, Shijiazhuang People’s Hospital, Liaoyang City, Liaoning Province, China
| | - Yong-Feng Han
- Department of Neurosurgery, Shijiazhuang People’s Hospital, Liaoyang City, Liaoning Province, China
| | - Qin-Ying Cao
- Department of Neurosurgery, Shijiazhuang People’s Hospital, Liaoyang City, Liaoning Province, China
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Srinivasan VM, Srivatsan A, Spiotta AM, Hendricks BK, Ducruet AF, Albuquerque FC, Puri A, Amans MR, Hetts SW, Cooke DL, Ogilvy CS, Thomas AJ, Enriquez-Marulanda A, Rai A, Boo S, Carlson AP, Crowley RW, Rangel-Castilla L, Lanzino G, Chen PR, Diaz O, Bohnstedt BN, O'Connor KP, Burkhardt JK, Johnson JN, Chen SR, Kan P. Early postmarket results with PulseRider for treatment of wide-necked intracranial aneurysms: a multicenter experience. J Neurosurg 2019:1-10. [PMID: 31703202 DOI: 10.3171/2019.5.jns19313] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 02/03/2019] [Accepted: 05/08/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Traditionally, stent-assisted coiling and balloon remodeling have been the primary endovascular treatments for wide-necked intracranial aneurysms with complex morphologies. PulseRider is an aneurysm neck reconstruction device that provides parent vessel protection for aneurysm coiling. The objective of this study was to report early postmarket results with the PulseRider device. METHODS This study was a prospective registry of patients treated with PulseRider at 13 American neurointerventional centers following FDA approval of this device. Data collected included clinical presentation, aneurysm characteristics, treatment details, and perioperative events. Follow-up data included degree of aneurysm occlusion and delayed (> 30 days after the procedure) complications. RESULTS A total of 54 aneurysms were treated, with the same number of PulseRider devices, across 13 centers. Fourteen cases were in off-label locations (7 anterior communicating artery, 6 middle cerebral artery, and 1 A1 segment anterior cerebral artery aneurysms). The average dome/neck ratio was 1.2. Technical success was achieved in 52 cases (96.2%). Major complications included the following: 3 procedure-related posterior cerebral artery strokes, a device-related intraoperative aneurysm rupture, and a delayed device thrombosis. Immediately postoperative Raymond-Roy occlusion classification (RROC) class 1 was achieved in 21 cases (40.3%), class 2 in 15 (28.8%), and class 3 in 16 cases (30.7%). Additional devices were used in 3 aneurysms. For those patients with 3- or 6-month angiographic follow-up (28 patients), 18 aneurysms (64.2%) were RROC class 1 and 8 (28.5%) were RROC class 2. CONCLUSIONS PulseRider is being used in both on- and off-label cases following FDA approval. The clinical and radiographic outcomes are comparable in real-world experience to the outcomes observed in earlier studies. Further experience is needed with the device to determine its role in the neurointerventionalist's armamentarium, especially with regard to its off-label use.
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Affiliation(s)
| | | | - Alejandro M Spiotta
- 2Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina
| | | | - Andrew F Ducruet
- 3Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Ajit Puri
- 4Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | - Matthew R Amans
- 5Department of Radiology, University of California at San Francisco, San Francisco, California
| | - Steven W Hetts
- 5Department of Radiology, University of California at San Francisco, San Francisco, California
| | - Daniel L Cooke
- 5Department of Radiology, University of California at San Francisco, San Francisco, California
| | - Christopher S Ogilvy
- 6Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ajith J Thomas
- 6Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Ansaar Rai
- 7Department of Radiology, West Virginia University Hospital, Morgantown, West Virginia
| | - SoHyun Boo
- 7Department of Radiology, West Virginia University Hospital, Morgantown, West Virginia
| | - Andrew P Carlson
- 8Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - R Webster Crowley
- 9Department of Neurosurgery, Rush Medical College, Chicago, Illinois
| | | | | | - Peng Roc Chen
- 11Department of Neurosurgery, University of Texas Health Science Center, Houston, Texas
| | - Orlando Diaz
- 12The Cerebrovascular Center, Houston Methodist Hospital, Houston, Texas; and
| | - Bradley N Bohnstedt
- 13Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Kyle P O'Connor
- 13Department of Neurosurgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
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Sirakov S, Panayotova A, Sirakov A, Penkov M, Minkin K, Hristov H. Using the pCANvas neck-bridging device in treating a wide-necked aneurysm of the basilar tip. Neuroradiol J 2019; 32:193-199. [PMID: 30942655 PMCID: PMC6512211 DOI: 10.1177/1971400919839375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/01/2023] Open
Abstract
BACKGROUND AND IMPORTANCE The endovascular treatment of recurrent wide-necked bifurcation aneurysms at the basilar tip remains very challenging. Many different techniques and devices have emerged in recent years as potential options but results remain less than controversial. The pCANvas is a relatively new device wielding neck-bridging properties with a haemodynamically active membrane acting as blood flow disrupter. CLINICAL PRESENTATION We present the clinical case of a patient in whom multiple endovascular and microsurgical attempts failed to achieve the definitive treatment of a large and wide-necked basilar tip aneurysm. The patient underwent successful endovascular implantation of the novel pCANvas device across the recurrent aneurysm neck. The device limited the blood flow to the anerysmal lumen and thus promoted faster thrombosis. Third month follow-up confirmed complete obliteration of the aneurysm. CONCLUSION The application of the pCANvas device offers a potential treatment option in difficult and recurrent aneurysms. The endovascular flow disruption is a relatively new feature aiming to create conditions for intraluminal thrombosis and is certainly promising for the treatment of complex bifurcation aneurysms.
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Affiliation(s)
| | | | | | - Marin Penkov
- Radiology Department, UH St Ivan Rilski,
Bulgaria
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Sellin JN, Srinivasan VM, Navarro JC, Batjer HH, Van Loveren H, Duckworth EA. Transcavernous Approach to the Basilar Apex: A Cadaveric Prosection. Cureus 2018; 10:e2192. [PMID: 29682431 PMCID: PMC5908389 DOI: 10.7759/cureus.2192] [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] [Indexed: 11/05/2022] Open
Abstract
The transcavernous approach to the basilar artery, as initially described by Dolenc, is one of the most common and elegant approaches to the region. It affords a generous working and viewing angle, but it can be technically challenging and requires attention to detail at each step. We investigate this approach in this report via a cadaveric prosection with a focus on the value of each of the component steps in improving surgical view and exposure. The transcavernous approach steps are divided into extradural stages: orbitozygomatic osteotomy (a modern adjunct to Dolenc's original description), drilling of the lesser sphenoid wing, and anterior clinoidectomy; and intradural stages: wide splitting of the Sylvian fissure, unroofing of the oculomotor and trochlear nerves, and posterior clinoidectomy. The surgical windows afforded by each step in the approach are illustrated using microscopic images taken during the cadaveric prosection of a donor who happened to harbor a basilar apex aneurysm. An illustrative case and artist illustrations are used to emphasize the relative value of each step of the transcavernous exposure.
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Affiliation(s)
| | | | - Jovany C Navarro
- Department of Anesthesiology, Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Hunt H Batjer
- Department of Neurosurgery, UT Southwestern Medical Center, Dallas, TX
| | - Harry Van Loveren
- Department of Neurosurgery, University of South Florida Morsani College of Medicine
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Agarwal V, Zomorodi A, Mcdougal C, Babu R, Back A, Gonzalez LF. Transcirculation balloon-assisted stent-supported coil embolization of a basilar tip aneurysm. Neurosurg Focus 2014; 37:1. [PMID: 24983733 DOI: 10.3171/2014.v2.focus14182] [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] [Indexed: 11/06/2022]
Abstract
We present the case of a balloon-assisted, stent-supported coil embolization of a basilar tip aneurysm. Initially, a balloon extending from the basilar artery into the right PCA was placed. However, even with a more proximal purchase, coils were found to impinge on the left PCA. Subsequently, a transcirculation approach was performed, where the left posterior communicating artery was utilized as a conduit for balloon support and the coils were embolized from the ipsilateral vertebral artery. However, after this transcirculation approach was completed, there was a coil tail extruding from the aneurysm. The balloon was then removed over an exchange wire and a horizontal stent advanced, spanning the entire neck of the aneurysm, eliminating the extruded coil. The video can be found here: http://youtu.be/bMbtZoPnYvo .
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Affiliation(s)
- Vijay Agarwal
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina; and
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Colla R, Cirillo L, Princiotta C, Dall'olio M, Menetti F, Vallone S, Leonardi M. Treatment of wide-neck basilar tip aneurysms using the Web II device. Neuroradiol J 2013; 26:669-77. [PMID: 24355186 DOI: 10.1177/197140091302600610] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 08/12/2013] [Accepted: 11/12/2013] [Indexed: 11/17/2022] Open
Abstract
Endovascular treatment has assumed a major role in the management of intracranial aneurysms. Although current techniques have proven extremely effective in the embolization of a large number of intracranial aneurysms, wide-necked basilar tip aneurysms represent a subset that continues to pose technical challenges in treatment. This study reports our experience with WEB II, a new embolization device employed in four patients with this type of aneurysm.
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Affiliation(s)
- Ruben Colla
- Neuroradiology Department, IRCCS Institute of Neurological Sciences of Bologna; Bologna, Italy -
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