Clinical and Imaging Follow-Up of Patients with Coiled Basilar Tip Aneurysms Up to 20 Years

Eijck, M. van; Bechan, R.S.; Sluzewski, M.; Peluso, J.P.; Roks, Gerwin; Rooij, W.J. van

doi:10.3174/ajnr.a4410

Cited by 19 publications

(7 citation statements)

References 20 publications

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“…41 Although this does not seem to result in mortality for patients, rebleeding rates could be higher and patients may develop symptoms as the result of mass-effect from the aneurysm. 41,45,46 Currently, no prospective and comparative outcomes are known for retreated intracranial aneurysm and little is known on factors that contribute to regrowth.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Retreatment for Intracranial Aneurysms — A Meta-Analysis

et al. 2018

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BACKGROUND Long-term results from the International Subarachnoid Hemorrhage Trial (ISAT) and Barrow Ruptured Aneurysm Trial (BRAT) indicate considerably higher retreatment rates for aneurysms treated with coiling compared to clipping, but do not report the outcome of retreatment. OBJECTIVE To evaluate retreatment related outcomes. METHODS A meta-analysis in accordance with PRISMA guidelines was conducted using Medline search engines PubMed and EMBASE to identify articles describing outcomes after retreatment for intracranial aneurysms. Pooled prevalence rates for complete occlusion rate and mortality were calculated. Outcomes of different treatment and retreatment combinations were not compared because of indication bias. RESULTS Twenty-five articles that met the inclusion criteria were included in the meta-analysis. Surgery after coiling had a pooled complete occlusion rate of 91.2% (95% confidence interval [CI]: 87.0-94.1) and a pooled mortality rate of 5.6% (95% CI: 3.7-8.3). Coiling after coiling had a pooled complete occlusion rate of 51.3% (95% CI: 22.1-78.0) and a pooled mortality rate of 0.8% (95% CI: 0.15-3.7). Surgery after surgery did not provide a pooled estimate for complete occlusion as only one study was identified but had a pooled mortality rate of 5.9% (95% CI: 3.1-11.2). Coiling after surgery had a pooled complete occlusion rate of 56.1% (95% CI: 11.4-92.7) and a pooled mortality rate of 9.3% (95% CI: 4.1-19.9). All pooled incidence rates were produced using random-effect models. CONCLUSION Surgical retreatment was associated with a high complete occlusion rate but considerable mortality. Conversely, endovascular retreatment was associated with low mortality but also a low complete occlusion rate.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Retreatment for Intracranial Aneurysms — A Meta-Analysis

et al. 2018

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“…Basilar tip aneurysms (BTAs) were chosen in part because aneurysms at the tip of the basilar artery bifurcation have higher rates of rupture [1,[21][22][23]. Furthermore, coil embolization is the preferred treatment method for BTAs due to their location in the posterior circulation of the circle of Willis, a dangerous and difficult area to access with open operations [24,25]. Geometric changes were characterized in terms of two factors: DS and PV-CA.…”

Section: Methodsmentioning

confidence: 99%

Hemodynamic Characterization of Geometric Cerebral Aneurysm Templates Treated With Embolic Coils

Nair

Chong

Indahlastari

et al. 2016

Journal of Biomechanical Engineering

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Embolic coiling is one of the most effective treatments for cerebral aneurysms (CAs), largely due to the hemodynamic modifications that the treatment effects in the aneurysmal environment. However, coiling can have very different hemodynamic outcomes in aneurysms with different geometries. Previous work in the field of biofluid mechanics has demonstrated on a general level that geometry is a driving factor behind aneurysmal hemodynamics. The goal of this study was to relate two specific geometric factors that describe CAs (i.e., dome size (DS) and parent-vessel contact-angle (PV-CA)) and one factor that describes treatment (i.e., coil packing density (PD)) to three clinically relevant hemodynamic responses (i.e., aneurysmal root-mean-square velocity (Vrms), aneurysmal wall shear stress (WSS), and cross-neck flow (CNF)). Idealized models of basilar tip aneurysms were created in both virtual and physical forms to satisfy two-level multifactorial experimental designs. Steady and pulsatile flow hemodynamics were then evaluated in the virtual models using computational fluid dynamics (CFD) (before and after virtual treatment with finite element (FE) embolic coil models), and hemodynamics were also evaluated in the physical models using particle image velocimetry (PIV) (before and after treatment with actual embolic coils). Results showed that among the factors considered, PD made the greatest contributions to effects on hemodynamic responses in and around the aneurysmal sac (i.e., Vrms and WSS), while DS made the greatest contributions to effects on hemodynamics at the neck (i.e., CNF). Results also showed that while a geometric factor (e.g., PV-CA) may play a relatively minor role in dictating hemodynamics in the untreated case, the same factor can play a much greater role after coiling. We consider the significance of these findings in the context of aneurysmal recurrence and rupture, and explore potential roles for the proposed methods in endovascular treatment planning.

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“…Up to 50% recanalization and regrowth of a coiled aneurysm has been reported [ 17 , 18 , 19 , 20 ]. The annual risk of bleeding in a partially coiled or recanalized aneurysm is reported to range from 2.1–15% [ 17 , 18 , 21 , 22 , 23 ]. This is relatively high and similar to rates for an unruptured aneurysm [ 5 , 24 , 25 , 26 , 27 , 28 , 29 ].…”

Section: Introductionmentioning

confidence: 99%

Endovascular Temporary Balloon Occlusion for Microsurgical Clipping of Posterior Circulation Aneurysms

et al. 2020

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Based on the relationship between the posterior clinoid process and the basilar artery (BA) apex it may be difficult to obtain proximal control of the BA using temporary clips. Endovascular BA temporary balloon occlusion (TBO) can reduce aneurysm sac pressure, facilitate dissection/clipping, and finally lower the risk of intraoperative rupture. We present our experience with TBO during aneurysm clipping of posterior circulation aneurysms within the setting of a hybrid operating room (hOR). We report one case each of a basilar tip, posterior cerebral artery, and superior cerebellar artery aneurysm that underwent surgical occlusion under TBO within an hOR. Surgical exposure of the BA was achieved with a pterional approach and selective anterior and posterior clinoidectomy. Intraoperative digital subtraction angiography (iDSA) was performed prior, during, and after aneurysm occlusion. Two patients presented with subarachnoid hemorrhage and one patient presented with an unruptured aneurysm. The intraluminal balloon was inserted through the femoral artery and inflated in the BA after craniotomy to allow further dissection of the parent vessel and branches needed for the preparation of the aneurysm neck. No complications during balloon inflation and aneurysm dissection occurred. Intraoperative aneurysm rupture prior to clipping did not occur. The duration of TBO varied between 9 and 11 min. Small neck aneurysm remnants were present in two cases (BA and PCA). Two patients recovered well with a GOS 5 after surgery and one patient died due to complications unrelated to surgery. Intraoperative TBO within the hOR is a feasible and safe procedure with no additional morbidity when using a standardized protocol and setting. No relevant side effects or intraoperative complications were present in this series. In addition, iDSA in an hOR facilitates the evaluation of the surgical result and 3D reconstructions provide documentation of potential aneurysm remnants for future follow-up.

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Clinical and Imaging Follow-Up of Patients with Coiled Basilar Tip Aneurysms Up to 20 Years

Abstract: BACKGROUND AND PURPOSE:Long-term follow-up data of coiled basilar tip aneurysms are scarce, and little is known about the risk of late aneurysm-related adverse events. We followed a cohort of 154 patients with basilar tip aneurysms coiled between 1995 and 2006.

Cited by 19 publications

References 20 publications

Outcomes of Retreatment for Intracranial Aneurysms — A Meta-Analysis

Outcomes of Retreatment for Intracranial Aneurysms — A Meta-Analysis

Hemodynamic Characterization of Geometric Cerebral Aneurysm Templates Treated With Embolic Coils

Endovascular Temporary Balloon Occlusion for Microsurgical Clipping of Posterior Circulation Aneurysms

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