Clinical and Angiographic Results of Endosaccular Coiling Treatment of Giant and Very Large Intracranial Aneurysms: A 7-year, Single-center Experience

Gruber, Andreas; Killer, Monika; Bavinzski, Gerhard; Richling, B.

doi:10.1097/00006123-199910000-00013

Cited by 226 publications

(142 citation statements)

References 60 publications

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“…As a result of a review of the literature, 69 large or giant cerebral aneurysms reported in four papers (Gruber et al, 9) Sluzewski et al, 13) Li et al, 14) and Hauck et al, 15) ) could be evaluated. The patient characteristics and therapeutic outcomes in the four papers and the present study are to expansion of the aneurysmal wall after treatment was less likely to occur in aneurysms in Bouthillier C4 and C5 segments, which are included in lesions with indications for Pipeline, as they are surrounded by the dura mater and bones.…”

Section: Results Of a Literature Reviewmentioning

confidence: 99%

“…It has been reported that the symptomatic improvement was observed after coil embolization of large or giant aneurysms in 38%-46% of the patients with CNP. 9,31) However, Goldenberg-Choen et al 32) reported that symptoms were alleviated in none and exacerbated in 7 of the 10 patients who underwent coil embolization for symptomatic large aneurysms of the cavernous segment. On the other hand, there has been a report that the symptomatic improvement rate in of subacute rupture of aneurysms after treatment with Pipeline alone have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] However, in large or giant cerebral aneurysms, the initial complete occlusion rate has been reported to be 10%-68%, the postoperative recanalization rate to be 56%-90%, and retreatment rate to be 40%-50%. [7][8][9][10][11] In 2013, flow diversion was reported to be effective for large or giant aneurysms of the ICA, 12) and it also began to be used in Japan in 2015. While it is expected to be effective, problems such as stenosis or occlusion of the device, rupture of aneurysms, and difficulty of device placement have been raised.…”

Section: Introductionmentioning

confidence: 99%

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Endovascular Embolization of Large Internal Carotid Artery Aneurysms: Single-center Experience with 10 Cases and Literature Review

Aoyama

Shigeta

Sato

et al. 2017

JNET

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Objective:We reviewed the treatment results of internal carotid artery (ICA) aneurysms with a maximum diameter of 10 mm or greater for the future selection of patients with indications for Pipeline Flex (Medtronic, Irvine, CA, USA). Methods:The treatment methods, treatment effects, complication rate, and retreatment rate were studied in lesions that were treated by coil embolization but are presently considered indications for treatment using Pipeline Flex among the 516 cerebral aneurysms treated at our hospital between July 2009 and May 2016. We also reviewed the literature concerning coil embolization for large and giant aneurysms and examined the results of coil embolization for aneurysms with indications for Pipeline. Results:The subjects were 10 patients consisting of 5 with asymptomatic unruptured aneurysm, 2 with symptomatic unruptured aneurysm, and 3 patients with recurrence after treatment for ruptured aneurysm. The mean size of the aneurysms was 12.8 mm (10.5-17.8 mm), and the mean follow-up period was 49.1 ± 13.4 months. The treatments were balloon-assisted coil embolization in eight patients and stent-assisted coil embolization in two patients. None showed postoperative symptomatic ischemic lesions, and the permanent morbidity was 0%. Of the two patients with symptomatic aneurysms, the symptoms were alleviated after treatment in one patient, and retreatment was necessary in one patient.In the review of the literature, comparisons were made in 69 large or giant aneurysms treated by coil embolization between those with and without indications for Pipeline. The additional treatment rate was significantly lower in the lesions with indications for Pipeline (33.3% vs. 61.9%, P = 0.02). The retreatment rate was significantly lower at 15.4%, particularly in extradural aneurysms (Bouthillier C4, 5). Conclusion:The results of this study suggest that the retreatment rate after conventional coil embolization for extradural unruptured large cerebral aneurysms was not high and that coil embolization is worth considering for asymptomatic aneurysms at these sites 10-15 mm in diameter.

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Section: Results Of a Literature Reviewmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endovascular Embolization of Large Internal Carotid Artery Aneurysms: Single-center Experience with 10 Cases and Literature Review

Aoyama

Shigeta

Sato

et al. 2017

JNET

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“…The main challenge lies in the fact that the definition of "recurrence" varies greatly in the literature. This variability generates a wide range of recurrence rates and results with considerable range in its association with multiple potential risk factors 5,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] . We applied a strict definition of recurrence and major recurrence and analyzed the relationship between several clinical, anatomical and technical data as a surrogate of major recurrence using survival analysis.…”

Section: Discussionmentioning

confidence: 99%

“…The coiling retreatment happened after 2-52 months of the first coiling treatment (Median[IQR]: 9.5 [6][7][8][9][10][11][12][13][14]). Twenty-two retreated major recurrences (56% of 39) had a major recurrence after a second coiling.…”

Section: Methodsmentioning

confidence: 99%

Survival Analysis of Risk Factors for Major Recurrence of Intracranial Aneurysms after Coiling

Santos

Sabri

Dowlatshahi

et al. 2015

Can. J. Neurol. Sci.

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Background: Recurrence after intracranial aneurysm coiling is a highly prevalent outcome, yet to be understood. We investigated clinical, radiological and procedural factors associated with major recurrence of coiled intracranial aneurysms. Methods: We retrospectively analyzed prospectively collected coiling data . We recorded characteristics of aneurysms, patients and interventional techniques, pre-discharge and angiographic follow-up occlusion. The Raymond-Roy classification was used; major recurrence was a change from class I or II to class III, increase in class III remnant, and any recurrence requiring any type of retreatment. Identification of risk factors associated with major recurrence used univariate Cox Proportional Hazards Model followed by multivariate regression analysis of covariates with P < 0.1. Results: A total of 467 aneurysms were treated in 435 patients: 283(65%) harboring acutely ruptured aneurysms, 44(10.1%) patients died before discharge and 33(7.6%) were lost to follow-up. A total of 1367 angiographic follow-up studies (range: 1-108 months, Median [interquartile ranges (IQR)]: 37[14-62]) was performed in 384(82.2%) aneurysms. The major recurrence rate was 98(21%) after 6(3.5-22.5) months. Multivariate analysis (358 patients with 384 aneurysms) revealed the risk factors for major recurrence: age > 65 y (hazard ratio (HR): 1.61; P = 0.04), male sex (HR: 2.13; P < 0.01), hypercholesterolemia (HR: 1.65; P = 0.03), neck size ≥4 mm (HR: 1.79; P = 0.01), dome size ≥7 mm (HR: 2.44; P < 0.01), non-stent-assisted coiling (HR: 2.87; P = 0.01), and baseline class III (HR: 2.18; P < 0.01). Conclusion: Approximately one fifth of the intracranial aneurysms resulted in major recurrence. Modifiable factors for major recurrence were choice of stent-assisted technique and confirmation of adequate baseline occlusion (Class I/II) in the first coiling procedure. La classification Raymond-Roy a été utilisée: une récidive majeure était définie comme un changement de la classe I ou II à la classe III, une augmentation résiduelle de classe III et une récidive nécessitant tout type de réintervention. Les facteurs de risque associés à une récidive majeure ont été identifiés au moyen du modèle des risques proportionnels de Cox suivi d'une analyse de régression multivariée des covariables, p < 0,01. Résultats: Au total, 467 anévrismes ont été traités chez 435 patients: 283 patients (65%) présentaient une rupture aiguë de l'anévrisme, 44 patients (10,1%) sont décédés avant le congé hospitalier et 33 (7,6%) ont été perdus au suivi. En tout, 1367 études angiographiques de suivi (écart de 1 à 108 mois ; médiane 37 ; écarts interquartiles de 14 à 62 mois) ont été effectuées pour 384 anévrismes (82,2%). Le taux de récidive majeure a été de 21% (98) après 6 mois (3,5 à 22,5 mois). L'analyse multivariée (358 patients porteurs de 384 anévrismes) a montré que les facteurs de risque d'une récidive majeure étaient: l'âge > 65 ans (risque relatif (RR): 1,61 ; p = 0,04), le sexe masculin (RR: 2,13 ; p < 0,01), l'hypercho...

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Giant Aneurysm of the Internal Carotid Artery

Choi

Koh²,

Park

et al. 2012

Arch Neurol

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Clinical and Angiographic Results of Endosaccular Coiling Treatment of Giant and Very Large Intracranial Aneurysms: A 7-year, Single-center Experience

Cited by 226 publications

References 60 publications

Endovascular Embolization of Large Internal Carotid Artery Aneurysms: Single-center Experience with 10 Cases and Literature Review

Endovascular Embolization of Large Internal Carotid Artery Aneurysms: Single-center Experience with 10 Cases and Literature Review

Survival Analysis of Risk Factors for Major Recurrence of Intracranial Aneurysms after Coiling

Giant Aneurysm of the Internal Carotid Artery

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