Endovascular treatment of previously clipped aneurysms: continued evolution of hybrid neurosurgery

Gross, Bradley A.; Albuquerque, Felipe C; Moon, Karam; Ducruet, Andrew F.; McDougall, Cameron G.

doi:10.1136/neurintsurg-2016-012625

Cited by 16 publications

(15 citation statements)

References 20 publications

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“…1,12,15,17,18 One patient developed a fatal distal hemorrhage shortly after the procedure, although no other complications were observed. 15 Similarly, our experience with the use of PEDs in these patients has been overwhelmingly positive, with a 100% rate of complete occlusion and no adverse complications. Given our mean duration of follow-up of 27.7 months for these patients, this treatment appears to be both durable and highly effective.…”

Section: Ped Following Failed Microsurgical Clippingmentioning

confidence: 99%

“…1,5,12,14,15,17,18,20 Among studies that have specifically evaluated outcomes following PED treatment in this recurrent subtype (Table 3), reported rates of complete aneurysm occlusion have ranged from 50% to 100%. 1,12,15,17,18 One patient developed a fatal distal hemorrhage shortly after the procedure, although no other complications were observed. 15 Similarly, our experience with the use of PEDs in these patients has been overwhelmingly positive, with a 100% rate of complete occlusion and no adverse complications.…”

Section: Ped Following Failed Microsurgical Clippingmentioning

confidence: 99%

“…Given that the PED is still in its infancy, little literature exists regarding PED failures and treatment options for recurrent aneurysms following prior PED apart from a few case reports. 3,7,15 In a study evaluating the treatment of 119 unruptured aneurysms with a PED, 7 patients experienced occlusion failure, and in 3 of the 7 cases, this residual was treated with a second PED. 7 Unfortunately, adequate follow-up to assess the durability of this second treatment was not available.…”

Section: Ped Following Failed Flow Diversionmentioning

confidence: 99%

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Pipeline embolization device for recurrence of previously treated aneurysms

Dornbos

Karras

Wenger

et al. 2017

Neurosurgical Focus

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OBJECTIVEThe utilization of the Pipeline embolization device (PED) has increased significantly since its inception and original approval for use in large, broad-necked aneurysms of the internal carotid artery. While microsurgical clipping and advances in endovascular techniques have improved overall efficacy in achieving complete occlusion, recurrences still occur, and the best modality for retreatment remains controversial. Despite its efficacy in this setting, the role of PED utilization in the setting of recurrent aneurysms has not yet been well defined. This study was designed to assess the safety and efficacy of PED in the recurrence of previously treated aneurysms.METHODSThe authors reviewed a total of 13 cases in which patients underwent secondary placement of a PED for aneurysm recurrence following prior treatment with another modality. The PEDs were used to treat aneurysm recurrence or residual following endovascular coiling in 7 cases, flow diversion in 2, and microsurgical clipping in 4. The mean time between initial treatment and retreatment with a PED was 28.1 months, 12 months, and 88.7 months, respectively. Clinical outcomes, including complications and modified Rankin Scale (mRS) scores, and angiographic evidence of complete occlusion were tabulated for each treatment group.RESULTSAll PEDs were successfully placed without periprocedural complications. The rate of complete occlusion was 80% at 6 months after PED placement and 100% at 12 months in these patients who underwent PED placement following failed endovascular coiling; there were no adverse clinical sequelae at a mean follow-up of 26.1 months. In the 2 cases in which PEDs were placed for treatment of residual aneurysms following prior flow diversion, 1 patient demonstrated asymptomatic vessel occlusion at 6 months, and the other exhibited complete aneurysm occlusion at 12 months. In patients with aneurysm recurrence following prior microsurgical clipping, the rate of complete occlusion was 100% at 6 and 12 months, with no adverse sequelae noted at a mean clinical follow-up of 27.7 months.CONCLUSIONSThe treatment of recurrent aneurysms with the PED following previous endovascular coiling, flow diversion, or microsurgical clipping is associated with a high rate of complete occlusion and minimal morbidity.

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Section: Ped Following Failed Microsurgical Clippingmentioning

confidence: 99%

Section: Ped Following Failed Microsurgical Clippingmentioning

confidence: 99%

Section: Ped Following Failed Flow Diversionmentioning

confidence: 99%

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Pipeline embolization device for recurrence of previously treated aneurysms

Dornbos

Karras

Wenger

et al. 2017

Neurosurgical Focus

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“…Such rooms can incorporate more sophisticated image guidance capabilities than do traditional surgical procedure rooms, and they can provide a greater degree of sterility control and anesthesia utilization than do traditional interventional rooms. Most of the studies conclude with an evaluation that states that improvement of the facilities, equipment, technologies, and processes is mandatory (5,(9)(10)(11)(12). However, there are several limitations that apply (12).…”

Section: █ Discussionmentioning

confidence: 99%

Novel hybrid operating table for neuroendovascular treatment

Park¹,

Mun²,

Shin³

et al. 2017

Turkish Neurosurgery

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“…Coil embolisation has frequently been used to treat recurrent or residual aneurysms after surgical clipping with good results42; however, as noted by Owen et al ,43 it is important to consider the morphology of the recurrent aneurysm when deciding treatment options. Insufficient coil compaction may not create enough space on the aneurysm neck for clip placement.…”

Section: Illustrative Case Scenariosmentioning

confidence: 99%

Contemporary endovascular and open aneurysm treatment in the era of flow diversion

Mazur

Taussky

Park

et al. 2017

J Neurol Neurosurg Psychiatry

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Clinical outcomes have improved considerably over the last decade for patients with ruptured and unruptured aneurysms. Modern endovascular techniques, such as flow diversion, are associated with high aneurysm occlusion rates and have become a popular treatment modality for many types of aneurysms. However, the safety and effectiveness of flow diversion has not yet been established in trials comparing it with traditional aneurysm treatments. Moreover, there are some types of aneurysms that may not be appropriate for endovascular coiling, such as wide-necked aneurysms located at branch points of major vessels, large saccular aneurysms with multiple efferent arteries, dolichoectatic aneurysms, large aneurysms with mass effect, when there are technical complications with endovascular treatment, when patients cannot tolerate or have contraindications to antiplatelet therapy or in the setting of a subarachnoid haemorrhage. For these cases, open cerebrovascular surgery remains important. This review provides a discussion on the current trends and evidence for both flow diversion and open cerebrovascular surgery for complex aneurysms that may not be suitable for coiling. We emphasise a continued important role for surgical treatment in certain situations.

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Endovascular treatment of previously clipped aneurysms: continued evolution of hybrid neurosurgery

Abstract: Endovascular treatment of residual or recurrent clipped aneurysms is an excellent treatment approach in well selected patients; 'clip induced' narrow neck aneurysms fare particularly well after treatment both angiographically and clinically.

Cited by 16 publications

References 20 publications

Pipeline embolization device for recurrence of previously treated aneurysms

Pipeline embolization device for recurrence of previously treated aneurysms

Novel hybrid operating table for neuroendovascular treatment

Contemporary endovascular and open aneurysm treatment in the era of flow diversion

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