Evaluation of Balloon Occlusion Test for Giant Brain Aneurysms under Local Anaesthesia

Hassan, Tamer; Sultan, Ali; Elwany, Mostafa

doi:10.1177/197140091102400511

Cited by 4 publications

(3 citation statements)

References 12 publications

(14 reference statements)

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“…Parent artery sacrifice should only be considered if the collateral circulation is good. Nevertheless, patients with a negative BOT are still at risk for ischemia, and sometimes, bypass procedures are needed [ 2 , 19 , 20 ]. Then again, a large meta-analysis reported that aneurysms were more likely to be completely occluded after the deconstructive treatment, with the complete occlusion rate which was 93% and 71% after deconstructive and reconstructive treatments, respectively [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Conservative Therapy vs. Endovascular Approach for Intracranial Vertebrobasilar Artery Trunk Large Aneurysms: A Prospective Multicenter Cohort Study

Jiang

et al. 2022

Oxidative Medicine and Cellular Longevity

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Background. Intracranial vertebrobasilar trunk large (≥10 mm) aneurysms (IVBTLAs) are rare and challenging to manage. In this study, we describe the natural prognosis and evaluate the safety and efficacy of endovascular treatment of IVBTLAs compared with conservative therapy. Methods. This prospective multicenter cohort study included patients with IVBTLAs, who chose either endovascular treatment (endovascular group) or conservative therapy (conservative group) after discussion with their doctors. The primary endpoint was the incidence of serious adverse events (SAEs) related to the target vessel, while secondary endpoints included target vessel-related mortality, major stroke, other serious adverse events, and aneurysm occlusion rate. Results. In total, 258 patients were referred to our two centers for the management of vertebrobasilar aneurysms, and 69 patients had IVBTLAs. Among them, 51 patients underwent endovascular treatment, and 18 patients received conservative therapy. The incidence of target vessel-related SAEs was 15.7% (8/51) in the endovascular group and 44.4% (8/18) in the conservative group ( P = 0.031 ). The target vessel-related mortality was 2.0% (1/51) in the endovascular group and 38.9% (7/18) in the conservative group ( P < 0.001 ). The cumulative survival rates in the endovascular group and conservative group within 1-year, 3-year, and 5-year were 98.0% vs. 83.3%, P = 0.020 ; 98.0% vs. 66.7%, P = 0.001 ; and 98.0% vs. 35.6%, P < 0.001 , respectively. Multivariate analysis revealed conservative therapy, giant aneurysm, and ischemic onset as risks factor for SAEs. Conclusions. Compared with conservative treatment, endovascular treatment of the IVBTLAs may be associated with a lower incidence of SAEs, with higher 1-year, 3-year, and 5-year survival rates. Conservative therapy, giant aneurysm, and ischemic onset were associated with a high risk of SAEs.

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Section: Discussionmentioning

confidence: 99%

Conservative Therapy vs. Endovascular Approach for Intracranial Vertebrobasilar Artery Trunk Large Aneurysms: A Prospective Multicenter Cohort Study

Jiang

et al. 2022

Oxidative Medicine and Cellular Longevity

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“…Suppose there is a calcified aneurysm or a thrombus in the neck or perforating vessels arising from the dome, in that case, other alternative techniques can be used, such as wrapping, trapping, and aneurysmectomy. BOT should precede the procedure in which there are parent vessels sacrificed [ 42 – 45 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment of giant intracranial aneurysms: long-term outcomes in surgical versus endovascular management

et al. 2022

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Aneurysms with a major diameter > 25 mm are defined as giant intracranial aneurysms (GIAs). Different clinical, pathological, and radiological factors were revealed as playing a role in choosing the best strategy between surgical and endovascular approaches. Despite the improvement of both techniques, the efficacy and safety of these different management are still debated. We evaluated the differences in clinical and radiological outcomes of GIAs treated with surgical and endovascular techniques in a large retrospective mono-centric study. We compared aneurysm location, clinical, morphological features, treatment outcome, and complications on the ground of treatment technique. The final cohort consisted of 162 patients. All the patients were assigned on the ground of the type of eligible treatment: surgical (118 patients) and endovascular procedure (44 patients). The different treatment strategies were made through a multidisciplinary selection whereas clinical parameters, location, and morphologic features of the aneurysm were considered. The surgical group manifested a greater reduction in performance levels and neurological status in the post-operative phases than the endovascular group (p < 0.01) with a higher incidence of complications (p = 0.012) in contrast to a lower recurrence rate (p > 0.01). There is no significant difference in post-operative mortality and survival between surgical and endovascular groups. The surgical group manifested a higher incidence of complications after treatment. The endovascular group has a better post-operative outcome, but a higher risk of recurrence and the necessity of further treatment.

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“…PAO can occlude the entire internal carotid artery of the affected side in patients deemed able to undergo internal carotid artery occlusion by preoperative assessment such as the balloon occlusion test (BOT). 8–11 It has been reported that in the PAO procedure, there are risks of enlargement and rupture of pre-existing aneurysms and de novo aneurysm formation due to the haemodynamic load on the contralateral artery. 12,13 Therefore, we wondered if FDDP is performed for intracranial aneurysms whether they could withstand the haemodynamic load, and if they could be adequately occluded, as described in previous reports.…”

Section: Introductionmentioning

confidence: 99%

Flow diverter device placement for cerebral aneurysm is not effective for the patient with parent artery occlusion for contralateral aneurysm

et al. 2020

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Purpose There have been many reports on the risks of enlargement and rupture of residual aneurysms and de novo aneurysm formation in the contralateral internal carotid artery after parent artery occlusion (PAO). In the present study, we investigated the efficacy of flow diverter device placement (FDDP) for the treatment of contralateral internal carotid artery aneurysms after PAO. Methods After 11 patients, who had bilateral large or giant internal carotid aneurysms, were treated for either side with PAO or FDDP, they underwent FDDP for residual lesions in our hospital between October 2015 and June 2018. The patients were divided into two groups, depending on the prior procedure: PAO or FDDP. The embolic state after subsequent FDDP was evaluated by angiography. The embolic state was graded using the O’Kelly Marotta scale. Patients’ characteristics and the embolic state of intracranial aneurysms after FDDP were compared between the two groups. Results Comparing patients’ characteristics between the PAO group and FDDP group, statistically significant differences were observed in laterality of the lesions and the interval between prior treatment and FDDP for residual aneurysms ( p < 0.05). The embolic state at the one-year follow-up revealed that there could be significantly sufficient embolisation in the FDDP group ( p < 0.05). Conclusion When FDDP is performed for the contralateral lesion after PAO treatment, it is difficult to attain sufficient embolisation of intracranial aneurysms because haemodynamic load in this procedure is large compared to that in a regular FDDP.

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Evaluation of Balloon Occlusion Test for Giant Brain Aneurysms under Local Anaesthesia

Cited by 4 publications

References 12 publications

Conservative Therapy vs. Endovascular Approach for Intracranial Vertebrobasilar Artery Trunk Large Aneurysms: A Prospective Multicenter Cohort Study

Conservative Therapy vs. Endovascular Approach for Intracranial Vertebrobasilar Artery Trunk Large Aneurysms: A Prospective Multicenter Cohort Study

Treatment of giant intracranial aneurysms: long-term outcomes in surgical versus endovascular management

Flow diverter device placement for cerebral aneurysm is not effective for the patient with parent artery occlusion for contralateral aneurysm

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