A review of technological innovations leading to modern endovascular brain aneurysm treatment

Lauzier, David C.; Huguenard, Anna L.; Srienc, Anja I.; Cler, Samuel J.; Osbun, Joshua W.; Chatterjee, Arindam; Vellimana, Ananth K.; Kansagra, Akash P.; Derdeyn, Colin P.; Cross, DeWitte T.; Moran, Christopher J.

doi:10.3389/fneur.2023.1156887

Cited by 7 publications

(4 citation statements)

References 119 publications

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“…Within the realm of microsurgical interventions, there are several options, including clip reconstruction, trapping, or bypass with proximal occlusion. Notably, the choice of surgically obliterating the aneurysm sac has shown an association with decreased recurrence rates and a subsequent reduction in the development of de novo aneurysms [ 8 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

Ruptured Intracranial Aneurysm in a 60-Day-Old Infant: An Extreme Case

Pinto Silva,

Teles Silva,

Silva

et al. 2024

Cureus

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The prevalence of aneurysms in children is low when compared to adults, being even rarer in the first year of life. They can be secondary to infections, traumatic brain injury, autoimmune diseases, or connective tissue diseases. Dissecting etiology is rare. A 60-day-old female infant, previously healthy, presented to the emergency department (ED) with irritability and loss of appetite since the preceding day, a fever of one-hour duration, and vomiting. Laboratory analysis revealed a hemoglobin level of 6.5 g/dL, without elevation of inflammatory markers. In the ED, she experienced two episodes, with a one-hour interval, of clonic movements of the upper eyelid and right upper limb, along with conjugate gaze deviation to the same side, which resolved after intravenous diazepam. Levetiracetam was initiated after the second episode. The anterior fontanelle became progressively tense. Brain computed tomography (CT) showed a voluminous intraparenchymal and subarachnoid hemorrhage with an aneurysm at the bifurcation of the left middle cerebral artery (MCA). Initially, an endovascular approach was tried but was not successful due to technical problems. Consequently, a Vaso-CT scan was performed that confirmed a dissecting aneurysm/pseudoaneurysm (8 mm × 10 mm × 10 mm) of the left MCA, originating from the upper wall of the M1 segment. Next, she underwent microsurgical exclusion of the aneurysm using microclips. Post-surgery brain CT showed acute ischemia in the entire MCA region. Follow-up angiography showed complete exclusion of the aneurysm. She evolved to grade 3 monoparesis of the upper limb at the six-month interval follow-up, which has been gradually improving with physical rehabilitation. The next-generation sequencing (NGS) panel for aneurysms and arterial dissections did not detect any pathogenic variants. Clinical presentation of cerebral aneurysms in infants can be subtle, and a high index of suspicion is required in cases of irritability, altered consciousness, seizures, bulging fontanelle, and motor deficits. Early detection is of utmost importance as it is associated with moderate mortality. Surgical treatment with the use of clips proved to be effective in this case.

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Section: Discussionmentioning

confidence: 99%

Ruptured Intracranial Aneurysm in a 60-Day-Old Infant: An Extreme Case

Pinto Silva,

Teles Silva,

Silva

et al. 2024

Cureus

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“… Giant or large intracranial aneurysms[ 6 ] Wide-neck intracranial aneurysms[ 6 ] Aneurysms arising from the internal carotid artery (ICA) (petrous to the superior hypophyseal segments). [ 6 ] …”

Section: How Do Fd Devices Work?mentioning

confidence: 99%

“…Aneurysms arising from the internal carotid artery (ICA) (petrous to the superior hypophyseal segments). [ 6 ]…”

Section: How Do Fd Devices Work?mentioning

confidence: 99%

Periprocedural management of patients presenting for neurointerventional procedures using flow diverters for complex intracranial aneurysms: An anesthetist’s perspective - A narrative review

Sree,

Hrishi,

Praveen

et al. 2024

Brain Circulation

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Complex intracranial aneurysms pose significant challenges in the realm of neurointervention, necessitating meticulous planning and execution. This article highlights the crucial roles played by anesthetists in these procedures, including patient assessment, anesthesia planning, and continuous monitoring and maintaining hemodynamic stability, which are pivotal in optimizing patient safety. Understanding these complex procedures and their complications will aid the anesthetist in delivering optimal care and in foreseeing and managing the potential associated complications. The anesthetist’s responsibility extends beyond the procedure itself to postprocedure care, ensuring a smooth transition to the recovery phase. Successful periprocedural anesthetic management in flow diverter interventions for complex intracranial aneurysms hinges on carefully orchestrating these elements. Moreover, effective communication and collaboration with the interventional neuroradiologist and the procedural team are emphasized, as they contribute significantly to procedural success. This article underscores the essential requirement for a multidisciplinary team approach when managing patients undergoing neurointerventions. In this collaborative framework, the expertise of the anesthetist harmoniously complements the skills and knowledge of other team members, contributing to the overall success and safety of these procedures. By providing a high level of care throughout the periprocedural period, anesthetists play a pivotal role in enhancing patient outcomes and minimizing the risks associated with these intricate procedures. In conclusion, the periprocedural anesthetic management of neurointervention using flow diverters for complex intracranial aneurysms is a multifaceted process that requires expertise, communication, and collaboration.

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“…1 -аневризматические факторы, такие как расположение, размер, морфология, наличие тромба внутри аневризмы и наличие дочернего мешка или нескольких долей; 2 -факторы пациента, такие как возраст, анамнез, история субарахноидального кровоизлияния и семейный анамнез субарахноидального кровоизлияния [3]. Лечение ЦА заключается в предотвращении разрыва, тромбоза или симптомов массэффекта [4]. Основные методы лечения внутричерепных аневризм: открытое клипирование, имплантация потокотклоняющих устройств, резецирование и стентирование.…”

Section: актуальностьunclassified

Capabilities of Dynamic Magnetic Resonance Angiography in Patients With Cerebral Aneurysms in the Postoperative Period

Kardailskaya,

Zyablova,

Trofimova

et al. 2024

Innovacionnaâ medicina Kubani

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Introduction: The leading cause of hemorrhagic stroke is a ruptured cerebral aneurysm (CA), accounting for 70%-85% of nontraumatic subarachnoid hemorrhages. The primary goals of CA treatment are to prevent a rupture, thrombosis, or symptoms of mass effect. The main treatment options for intracranial aneurysms are open clipping, flow-diverter device implantation, resection and stenting of aneurysms. Treated aneurysms should be monitored to assess the stability of the occlusion because more than 20% of surgically treated aneurysms are known to recur. Magnetic resonance angiography (MRA) has recently become increasingly attractive for the follow-up of surgically treated CAs because it is noninvasive, does not require hospitalization, and reduces complications associated with the frequent use of cerebral angiography.Objective: To evaluate capabilities of dynamic MRA in postoperative monitoring of patients with CAs.Materials and methods: The study was conducted at the premises of the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation). In a hospital setting, 38 patients with CAs were examined in the late postoperative period. All the patients underwent magnetic resonance imaging, 3-dimensional time-of-flight (3D-TOF) MRA, and dynamic MRA followed by cerebral angiography. Imaging findings (MRA, dynamic MRA, and cerebral angiography) were evaluated by radiologists, x-ray surgeons, and neurosurgeons. They assessed treated aneurysms according to the Raymond-Roy occlusion classification: complete obliteration (class 1), residual neck (class 2), and residual aneurysm (class 3). Untreated aneurysms in patients with multiple CAs and de novo aneurysms were also assessed, and we looked for other vascular malformations.Results: The study was conducted in the late postoperative period from 6 to 18 months. A total of 38 patients participated in the study; of them 27 were women (age, 32-77 years) and 11 were men (age, 32-65 years). Dynamic MRA detected neck remnants of 4 clipped aneurysms and 2 embolized ones, which was confirmed by cerebral angiography. According to the dynamic MRA results, in case of clipped aneurysms neck remnants were found in the anterior communicating artery (n = 2), internal carotid artery (n = 1), and anterior choroidal artery (n = 1). In case of embolized aneurysms, neck remnants were revealed in the internal carotid artery (n = 1) and basilar artery (n = 1). Dynamic MRA also detected 5 additional aneurysms: 2 internal carotid artery aneurysms, 1 basilar artery aneurysm, 1 anterior cerebral artery aneurysm, and 1 anterior communicating artery aneurysm. These findings coincided with those of cerebral angiography. Based on the results of our study, the sensitivity and specificity of dynamic MRA in detecting CA neck remnants and untreated aneurysms were 100%.Discussion: Dynamic MRA findings are fully consistent with those of cerebral angiography in terms of determining an aneurysm occlusion status during postoperative follow-up. As for evaluation of de novo intracranial aneurysms, dynamic MRA is also superior to noncontrast 3D-TOF MRA in assessment of aneurysm shape and neck detection. Therefore, dynamic MRA can clearly visualize the structure of cerebral vessels mainly due to the effect of blood flow and static tissue contrast, and the principle is mainly the effect of multiphase scanning and accumulation of contrast agent.Conclusions: Dynamic MRA has a number of advantages over cerebral angiography, such as noninvasiveness, high-resolution images of the cerebral arteries, absence of radiation exposure, use of iodinated contrast agent, and absence of artifacts from metal clips or embolic material.

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A review of technological innovations leading to modern endovascular brain aneurysm treatment

Cited by 7 publications

References 119 publications

Ruptured Intracranial Aneurysm in a 60-Day-Old Infant: An Extreme Case

Ruptured Intracranial Aneurysm in a 60-Day-Old Infant: An Extreme Case

Periprocedural management of patients presenting for neurointerventional procedures using flow diverters for complex intracranial aneurysms: An anesthetist’s perspective - A narrative review

Capabilities of Dynamic Magnetic Resonance Angiography in Patients With Cerebral Aneurysms in the Postoperative Period

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