Endovascular Treatment of Brain Aneurysms

Abstract

Topic: Chapter discussing the indications for treatment of brain aneurysms, endovascular techniques, tips and tricks. 1. Pathophysiology of aneurysms: Discuss the formation of aneurysms, current thinking of aneurysm development 2. Prevalence/Incidence of aneurysms: Discussion of current state of aneurysm prevalence and how it differs in different populations 3. Unruptured Aneurysms: Diagnosis, Management and Treatment: Imaging paradigms of brain aneurysms, current thoughts on how to follow aneurysms which are being observed, different treatment options for unruptured aneurysms, including clipping, coiling, stent assisted coiling, flow diverter stent, flow disruptors, including the medical management of stent placement 4. Ruptured Aneurysms: Diagnosis, Management and Treatment: Imaging paradigms of ruptured aneurysms, management options for co-morbidities associated with aneurysm rupture, treatment options including coiling, clipping, flow diverter stents, flow disruptors 5. Complication Avoidance: Tips and tricks to avoid complications in the treatment of brain aneurysms.

Flow diverter stent as a definitive endovascular strategy to obliterate acute spontaneous rupture of brain aneurysmal subarachnoid hemorrhage in elderly: a case report in Indonesia

“…5 Hunt and Hess described the survival rate of 70% for the mildest grade of aSAH (grade I), which was asymptomatic or mild headache with slight nuchal rigidity, and 100% for the worst grade of aSAH (grade V). 2 In addition, half of the aSAH cases involve productive-age individuals of less than 55 years old.…”

“…Her Hunt and Hess scale was 3, with potential survival rate of 50%. 2 Aneurysm rebleeding, brain edema, hydrocephalus, and vasospasm have been widely recognized as the complications of aSAH. Therefore, it is recommended to initiate definitive management of brain aneurysm obliteration as early as possible, particularly within 24 hours of onset (2023 American heart association/ American stroke association guideline, class of recommendation I, level of recommendation B).…”

“…Endovascular treatment was suggested for older patients (>70 years old) especially with significant medical comorbidities, poor surgical candidate, posterior circulation aneurysm, or favorable anatomy by endovascular approach. 1,2 Both surgical and endovascular approach provide favorable outcome for aSAH, hence multidisciplinary approach involving neurosurgeon, neuro-interventionist, and interventional neuroradiologist are recommended for determining the risk and benefit of each treatment options. 1 The evolution of endovascular techniques from coiling to stent-assisted coiling, flow diversion, or WEB device has significantly expanded the treatment possibilities, particularly for wide-neck aSAH cases.…”

“…1 The evolution of endovascular techniques from coiling to stent-assisted coiling, flow diversion, or WEB device has significantly expanded the treatment possibilities, particularly for wide-neck aSAH cases. 2,3 Flow diverting stent has broadened the application of endovascular method for addressing giant brain aneurysm or wide-neck aneurysm with a notably high reported success rate. 3,4 This case report described an elderly with spontaneous subarachnoid hemorrhage due to wide-neck saccular aneurysm at internal carotid artery (ICA) which was successfully treated with flow diverter stent.…”

Clinical impact of Sim & Size® simulation software in the treatment of patients with cerebral aneurysms with flow-diverter Pipeline stents

“…1 Among these treatments, parent artery reconstruction with flow-diverter stents appears effective and safe. 2,3…”