Endovascular Treatment of Unruptured Aneurysms

Roy, Daniel; Milot, Geneviève; Raymond, Jean

doi:10.1161/hs0901.095600

Cited by 834 publications

(596 citation statements)

References 45 publications

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“…However, iterative invasive angiography may have adverse effects, and the required duration of close surveillance remains to be determined. 36) Noninvasive MR angiography is currently limited due to metallic artifacts, 46) but advances in MR techniques, the study of large series, and long follow-up periods may increase the usefulness of this modality for the monitoring of such aneurysms.…”

Section: Relationships Of Aneurysm Size and Location To Outcomementioning

confidence: 99%

“…16,26,48) The endovascular approach using Guglielmi detachable coils (GDCs) has improved the overall treatment of patients with incidental aneurysms. 29,36) Recanalization or progressive thrombosis may occur in the short or medium term after the endovascular treatment of ruptured aneurysms. 4,9,14,29,35,36) The anatomic outcomes may or may not be the same for ruptured and unruptured aneurysms treated by coil embolization.…”

Section: Introductionmentioning

confidence: 99%

“…29,36) Recanalization or progressive thrombosis may occur in the short or medium term after the endovascular treatment of ruptured aneurysms. 4,9,14,29,35,36) The anatomic outcomes may or may not be the same for ruptured and unruptured aneurysms treated by coil embolization. 4,9,14,30,42,45) A pathological study revealed that the walls of ruptured and unruptured aneurysms differ with respect to endothelial damage, fragility, and macrophage invasion.…”

Section: Introductionmentioning

confidence: 99%

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Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Soeda

Sakai

et al. 2004

Neurol. Med. Chir.(Tokyo)

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The present study assessed the safety and efficacy of embolization using Guglielmi detachable coils (GDCs) in 100 asymptomatic cerebral aneurysms classified as sidewall (70) or terminal (30) aneurysms according to the parent artery (68 small aneurysms with a small neck, 21 small aneurysms with a wide neck, and 11 large aneurysms). A balloon-assisted technique was used in 49 aneurysms. Immediate angiography revealed that 71 aneurysms were completely obliterated. Transient deficits occurred in 19 patients, permanent deficits in four patients, and one patient died. Most complications occurred during or immediately after treatment and resolved within a few minutes to a few weeks. None of the surviving patients manifested significant morbidity at 1-year follow up. Follow-up angiographic study was performed in 79 aneurysms. Rates of recanalization and progressive thrombosis (total occlusion of the residual aneurysm at follow up) were 11% and 38%, respectively, in sidewall aneurysms, and 26% and 0%, respectively, in terminal aneurysms. Treatment with GDCs was effective for patients with small aneurysms with small necks, the morbidity was acceptable, and progressive thrombosis occurred during the follow-up period. GDC treatment achieved unsatisfactory results in patients with small terminal aneurysms with wide necks and in large aneurysms, because the obliteration rate was low, and the recanalization and complication rates were high. Multivariate analysis showed that complete occlusion was associated with small-necked aneurysms, and ischemic events tended to occur in terminal aneurysms and in aneurysms treated by the balloon-assisted technique.

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Section: Relationships Of Aneurysm Size and Location To Outcomementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Soeda

Sakai

et al. 2004

Neurol. Med. Chir.(Tokyo)

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“…Evaluations of anatomical outcomes were previously described. 17,19,25) In brief, if the neck and sac of the aneurysm were completely occluded, this was defined as complete occlusion. If the contrast medium slightly entered the neck, but did not fill the body of the aneurysm, it was defined as residual neck.…”

mentioning

confidence: 99%

Endovascular Treatment With Bare Platinum Coils for Middle Cerebral Artery Aneurysms

Oishi

Yoshida

Shimizu

et al. 2009

Neurol. Med. Chir.(Tokyo)

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Middle cerebral artery (MCA) aneurysms often have unfavorable anatomical characteristics preventing successful endovascular occlusion. We reviewed the outcomes of our series of endosaccular embolization of MCA aneurysms using bare platinum coils, angiographic images, and medical records. Immediate and follow-up angiographic results were categorized as complete occlusion, residual neck, and residual flow. Follow-up angiographic changes were categorized as unchanged, minor or major recurrence, and progressive thrombosis. Between December 2001 and August 2007, 112 patients with 113 MCA aneurysms underwent endovascular treatment, of whom 60 presented with subarachnoid hemorrhage (SAH) due to MCA aneurysm rupture. Immediate angiographic outcomes for 103 aneurysms revealed complete occlusion in 64, residual neck in 21, residual flow in 18, and failed embolization in 10. Follow-up angiography of 70 aneurysms demonstrated 41 unchanged, 10 minor recurrences, 12 major recurrences, 7 progressive thromboses, and no bleeding of coil embolized aneurysms. Outcomes of 58 SAH patients treated endovascularly revealed 45 good recovery and moderate disability, 10 severe disability or persistent vegetative state, and 3 deaths. Forty-four of the 45 patients with unruptured aneurysms treated endovascularly had no changes in their neurological status. One of 5 patients with complications had permanent morbidity. For patients with MCA aneurysms suitable for endovascular surgery, bare platinum coil embolization can be performed with acceptable low morbidity and mortality rates, with a lower risk of postprocedural aneurysmal bleeding.

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“…Immediate aneurysmal occlusion was defined by the modified Raymond-Roy classification as complete, residual neck, or residual sac [10].…”

Section: Anticoagulation and Antiplatelet Regimensmentioning

confidence: 99%

Stent-Assisted Coil Embolization for the Treatment of Ruptured Aneurysms at the Anterior Circulation: Comparison Between HydroSoft Coils and Bare Platinum Coils

Che

Hong

et al. 2013

Cardiovasc Intervent Radiol

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Purpose To evaluate the perioperative safety and midterm prognosis (B12 months) of HydroSoft coils in treating ruptured aneurysms at the anterior circulation compared with bare platinum coils. Materials and Methods Patients with aneurysmal subarachnoid hemorrhages admitted to our hospital between January 2009 and March 2012 were retrospectively analyzed. According to strict inclusion and exclusion criteria, cases were selected and classified into two groups: In group A, HydroSoft coils were used as the primary filling coils (C40 % of total coil length); in group B, only bare platinum coils were used. Cases in both groups were all treated with stent-assistance. A comparison between the two groups was performed for periprocedural complications as well as immediate and mid-term outcomes. The stents used included Enterprise, Neuroform, and Solitaire.Results Fifty-six aneurysms were in group A patients, and 68 aneurysms were in group B patients. Compared with group B, group A did not have increased incidence of complications but had greater packing attenuation (44.5 ± 8.8-29.8 ± 9.1 %, t = 2.577, P = 0.014) and increased initial complete occlusion rates (63-44 %, v 2 = 4.161, P = 0.041). Radiologic follow-up were performed in 46 patients from group A and 51 patients from group B. Complete occlusion rates at follow-up were significantly greater in group A than in group B (89.1-70.6 %, v 2 = 5.08, P = 0.043); the difference in recanalization rates were statistically insignificant between the groups (6.5-5.9 %, P = 1.000). Conclusion HydroSoft coils proved safe during the periprocedural period and provided greater initial complete occlusion rates, greater packing density, and better followup results compared with bare platinum coils.

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Endovascular Treatment of Unruptured Aneurysms

Cited by 834 publications

References 45 publications

Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Endovascular Treatment With Bare Platinum Coils for Middle Cerebral Artery Aneurysms

Stent-Assisted Coil Embolization for the Treatment of Ruptured Aneurysms at the Anterior Circulation: Comparison Between HydroSoft Coils and Bare Platinum Coils

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