Aneurysm Characteristics, Study Population, and Endovascular Techniques for the Treatment of Intracranial Aneurysms in a Large, Prospective, Multicenter Cohort: Results of the Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm Study

Abstract The occlusion of intracranial aneurysms is more successful and stable by properly planning the approach and application of endovascular techniques. The next step is a relentless analysis of the different indications of endovascular treatment, tailoring a strategy suitable for the specific case, and making more rational choices for the management of aneurysms. Indications and strategies according to the analysis of the aneurysmal complex are given, as well as pros and cons of the endovascular technique according to different anatomical locations

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Prevalence of thunderclap headache in patients with ruptured intracranial aneurysms: series of 60 cases

Headache Medicine ◽

10.48208/headachemed.2019.28 ◽

2019 ◽

pp. 189-192

Author(s):

Bruno Bertoli Esmanhotto ◽

Elcio Juliato Piovesan ◽

Marcos Christiano Lange

Keyword(s):

Subarachnoid Hemorrhage ◽

Intracranial Aneurysm ◽

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Thunderclap Headache ◽

Head Pain ◽

Ruptured Intracranial Aneurysm ◽

One Year ◽

Time Of Admission ◽

Ruptured Intracranial Aneurysms

Thunderclap headache (TCH) is a head pain that begins suddenly and is severe at onset. TCH might be the first sign of subarachnoid hemorrhage. This study was conducted to evaluate the presence of thunderclap headache (TCH) in patients with ruptured intracranial aneurysm (RIA) and endovascular treatment (EVT). We evaluated the pattern of headache in 60 patients who suffered a RIA and EVT at time of admission and prospectively evaluated the characteristics of previous headache within one year before the rupture. Thirty-one patients (51,7 %) had TCH related to the rupture. Aneurysm size does not affect the occurrence of thunderclap headache (p=0,08). The vascular aneurysm territory is not related to presence of TCH (p=0,527). The prevalence of TCH in this cohort was similar to previous studies. All patients with acute thunderclap headache should be evaluated for subarachnoid hemorrhage.

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Emerging Concepts in the Treatment of Intracranial Aneurysms: Stents, Coated Coils, and Liquid Embolic Agents

Neurosurgery ◽

10.1227/01.neu.0000170538.74899.7f ◽

2005 ◽

Vol 57 (3) ◽

pp. 449-459 ◽

Cited By ~ 43

Author(s):

Giuseppe Lanzino ◽

Yassine Kanaan ◽

Paolo Perrini ◽

Hayan Dayoub ◽

Kenneth Fraser

Keyword(s):

Endovascular Treatment ◽

Effective Treatment ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Clinical Experiences ◽

Endovascular Techniques ◽

Future Directions ◽

Embolic Agents ◽

Liquid Embolic ◽

Embolic Materials

ABSTRACT ENDOVASCULAR TECHNIQUES FOR the treatment of intracranial aneurysms are rapidly evolving. Modifications of more traditional coils have been introduced. Such modifications include newer coils coated with various polymers to increase both coil thrombogenicity and degree of aneurysm packing. In addition, newer coil designs aimed at improving the conformability of the coil to the aneurysm have been used with promising preliminary results. The availability of a newer generation of stents specifically designed for intracranial navigation allows for more effective treatment of aneurysms with wide necks, which usually have been considered unsuitable for optimal endovascular treatment. Endovascular alternatives to coil embolization, such as liquid embolic materials, also have been explored for the treatment of intracranial aneurysms, with varying results. We summarize the rationale for use of these newer devices and early clinical experiences. Areas of current research and future directions of endovascular aneurysm treatment also are discussed.

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Evaluation of clinical and anatomical outcome of staged stenting after acute coiling of ruptured intracranial aneurysms

Interventional Neuroradiology ◽

10.1177/1591019919891602 ◽

2019 ◽

Vol 26 (3) ◽

pp. 260-267 ◽

Cited By ~ 2

Author(s):

Benjamin Mine ◽

Thomas Bonnet ◽

Juan Carlos Vazquez-Suarez ◽

Noémie Ligot ◽

Boris Lubicz

Keyword(s):

Intracranial Aneurysm ◽

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Clinical Status ◽

Long Term Stability ◽

Ruptured Intracranial Aneurysm ◽

Improved Stability ◽

Ruptured Intracranial Aneurysms ◽

Anatomical Outcome

Introduction Stent-assisted coiling has widened indications and improved stability of endovascular treatment of intracranial aneurysms. However, stent-assisted coiling is usually not used to treat acutely ruptured intracranial aneurysms to avoid antiplatelet therapy. The objective of this study is to evaluate a strategy of staged endovascular treatment of ruptured intracranial aneurysms including coiling at the acute phase with complementary stenting with or without coiling at the subacute phase. Material and methods Between 2012 and 2017, we retrospectively identified, in our prospectively maintained database, all patients treated for a ruptured intracranial aneurysm based on this staged stenting strategy. Clinical charts and imaging follow-up were analyzed to assess the procedural safety and feasibility as well as clinical and anatomical outcome. Results We identified 23 patients with 23 intracranial aneurysms including 15 (65.2%) women with a mean age of 50 years (range 24–69 years). No rebleeding occurred during the mean delay of 24.3 days between initial coiling and stenting. All procedures were successful and additional coiling was performed in 5/23 procedures (21.7%). Clinical status was unchanged in all patients. At follow-up, the modified Rankin scale was graded 0 in 19/23 (82.6%), 1 in 2/23 (8.7%), and 2 in 2/23 (8.7%) patients, respectively. The rate of complete occlusion rose from 30.4% before the stenting procedure to 52.2% immediately after and 72.7% at follow-up. Conclusion This strategy of early staged stenting in selected patients is safe and improves immediate intracranial aneurysm occlusion and long-term stability in this population at high risk of intracranial aneurysm recurrence with coiling alone.

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A Patient with Eight Intracranial Aneurysms: Endovascular Treatment in Two Sessions

Case Reports in Neurological Medicine ◽

10.1155/2016/9637905 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Erol Akgul ◽

Hasan Bilen Onan ◽

Huseyin Tugsan Balli ◽

Nuri Eralp Cetinalp

Keyword(s):

Subarachnoid Hemorrhage ◽

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Treatment Modalities ◽

Review Of The Literature ◽

Endovascular Techniques ◽

Endovascular Technique ◽

Anterior Circulation ◽

First Choice ◽

Flow Diverters

The frequency of multiple intracranial aneurysms seen in patients with or without subarachnoid hemorrhage is high. The advancement of the endovascular technique and devices has ensured that endovascular treatment of intracranial aneurysms is the first choice in most cases, especially in unruptured ones. Different combinations of treatment modalities and techniques can be used in the management of multiple aneurysms. But in selected patients without subarachnoid hemorrhage, treatment of all aneurysms in one or more sessions with endovascular techniques is less traumatic than that with surgery. In the literature, the maximum number of aneurysms in one patient treated endovascularly and/or surgically is seven. In this case report, we present, with a review of the literature, a patient with eight intracranial aneurysms, all of which were treated in two sessions with various endovascular techniques. A 40-year-old female patient was admitted due to headache. Angiography showed eight aneurysms in the posterior circulation and, bilaterally, in the anterior circulation. All aneurysms were treated endovascularly in two sessions. In the treatment of the aneurysms, different endovascular techniques were used including flow diverters stents, stent-assisted coiling, Y-stent-assisted coiling, and coiling alone.

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Comparative results of operative and endovascular treatment of intracranial aneurysms

Acta chirurgica iugoslavica ◽

10.2298/aci1103049n ◽

2011 ◽

Vol 58 (3) ◽

pp. 49-57

Author(s):

Igor Nikolic ◽

Branislav Nestorovic ◽

Goran Tasic ◽

Miodrag Rakic ◽

Vaso Antunovic ◽

...

Keyword(s):

Intracranial Aneurysm ◽

Subarachnoid Haemorrhage ◽

Endovascular Treatment ◽

Intracranial Aneurysms ◽

International Experience ◽

Aneurysm Treatment ◽

Patient Status ◽

Treatment Analysis ◽

Comparative Results

Terapeutic protoclol for intracranial aneurysm treatment is very complex. In depand of patient status and anviografic founding we determinate modality and time of treatment. Analysis included 137 patients who were treated in Neurosurgical clinic CCS because sponatenus subarachnoid haemorrhage rigine from aneurysm belading. We performed direct surgery (microsurgery) in 109 patients. In early termine we operated 28 patients (25.69%), in first 24 hours 5 of them. In interemdiare period we performed surgery in 9, and other 72 patient we operated in postpone period. Embolisation was performed in 22 patinet. GOS form embolised patient was 4.636+0.581 and in operated 4.113+1.106 (p<0.05). Cumulative experient of Neurisurgical Clinic CCS and sumation of international experience impose as the best treatment is the treatment which is best known for the physitan.

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Concomitant Endovascular Treatment of Concomitant Extracranial Carotid Stenosis and Intracranial Aneurysm

Interventional Neuroradiology ◽

10.1177/159101990901500108 ◽

2009 ◽

Vol 15 (1) ◽

pp. 53-59 ◽

Cited By ~ 12

Author(s):

J.I. Gallego León ◽

L. Concepción Aramendía ◽

F. Ballenilla Marco ◽

J.C. Vázquez Suárez

Keyword(s):

Intracranial Aneurysm ◽

Endovascular Treatment ◽

Carotid Stenosis ◽

Intracranial Aneurysms ◽

Carotid Stenting ◽

Alternative Treatments ◽

Single Procedure ◽

Diagnosis Rate ◽

Angioplasty And Stenting ◽

Aneurysm Coiling

Angioplasty and stenting are emerging alternative treatments to endarterectomy for carotid stenosis. The increasing number of procedures performed carries an increased diagnosis rate of associated asymptomatic intracranial aneurysms, resulting in a clinical and therapeutic dilemma, not fully solved in the literature. When an incidental lesion is found, the first question is whether it is necessary to treat it or not? If treatment is decided, the next question is which should be treated first, the intra or the extracranial lesion? We review our experience and the literature and discuss our preferred approach of single-procedure carotid stenting and aneurysm coiling, which we believe is feasible, safe and effective constituting an option when confronted with this difficult therapeutic dilemma.

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Evaluation of ischemic lesion prevalence after endovascular treatment of intracranial aneurysms, as documented by 3-T diffusion-weighted imaging: a 2-year, single-center cohort study

Journal of Neurosurgery ◽

10.3171/2016.11.jns161020 ◽

2018 ◽

Vol 128 (4) ◽

pp. 982-991 ◽

Cited By ~ 8

Author(s):

Christina Iosif ◽

Jean-Christophe Lecomte ◽

Eduardo Pedrolo-Silveira ◽

George Mendes ◽

Marie-Paule Boncoeur Martel ◽

...

Keyword(s):

Cohort Study ◽

Endovascular Treatment ◽

Diffusion Weighted Imaging ◽

Intracranial Aneurysms ◽

Published Data ◽

Single Center ◽

Endovascular Techniques ◽

Ischemic Lesion ◽

Diffusion Weighted

OBJECTIVEEven though published data exist concerning the prevalence of ischemic lesions detected by diffusion-weighted imaging (DWI) following endovascular treatment of intracranial aneurysms, a single-center cross-evaluation of the different endovascular techniques has been lacking. The authors sought to prospectively evaluate the prevalence and clinical significance of ischemic lesions occurring after endovascular treatment of intracranial aneurysms and to compare the safety and effectiveness of a broad spectrum of currently accepted endovascular techniques in a single-center setting.METHODSThis was a prospective cohort study involving consecutive patients treated for intracranial aneurysms exclusively by endovascular means, excluding treatments in the acute rupture phase, in a center featuring an endovascular-only treatment policy for intracranial aneurysms. All patients underwent MRI, including a 3-directional DWI sequence, before treatment, 24 hours postprocedure, and 6 months following endovascular embolization. Selective angiography was performed at 6 months’ follow-up.RESULTSFrom January 2012 through December 2013, 164 aneurysms were treated in 128 consecutive patients. Endovascular techniques included coiling (14.6%), balloon-assisted coiling (20.1%), stent-assisted coiling (3.7%), low-profile stent-assisted coiling, flow diversion (38.4%), and very complex treatments (6.1%) involving 2 stents in Y or T configurations. On postprocedure MRI, the rates of occurrence of new DWI-positive lesions were 64.3% for coiling, 54.5% for remodeling, 61.1% for stent-assisted coiling, 53.7% for flow-diverting stents, and 75% for very complex treatments (p = 0.4962). The 6-month procedure-related morbidity and mortality rates were 6.25% and 0%, respectively. At 6 months’ follow-up, 93% of the patients had modified Rankin Scale (mRS) scores of 0–2. Very complex treatments offered a higher complete occlusion rate (100%) than all other techniques (66.7%–88.9%). Age and length of procedure were independent factors for DWI lesion occurrence. The diameter of DWI lesions on 24-hour postprocedure MRI was positively correlated with mRS score at discharge. Among the DWI-positive lesions measuring less than 2 mm in diameter on the 24-hour MRI, 44.12% had regressed at 6 months.CONCLUSIONSProcedure-related DWI lesions are far more often encountered in silent forms than they are clinically evident. They do not seem to be significantly correlated with procedure-related complications, nor do they seem to impair clinical outcome, regardless of the endovascular technique. Small lesions (< 2 mm in diameter) may regress within 6 months. The use of the most adapted technique, in terms of aneurysm configuration, results in significant total occlusion rates, with acceptable safety.

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