General Technical Considerations for the Endovascular Management of Cerebral Aneurysms

Eboli, Paula; Ryan, Robert W.; Alexander, Michael J.

doi:10.1016/j.nec.2014.04.016

Cited by 3 publications

(3 citation statements)

References 30 publications

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“…5 Among these complications, postprocedural aneurysmal reruptures are often fatal or disabling. 6 Reruptures can be divided into early and late types based on the timing of the postprocedural aneurysmal rerupture. 7 Early rerupture is defined as a bleeding event within 30 days after coiling accompanied by worsening of the patient's condition; it can be further divided into acute (within three days), subacute (4-14 days), and delayed (15-30 days) depending on the timing of the rerupture after coil embolization.…”

Section: Introductionmentioning

confidence: 99%

Acute rerupture after coil embolization of ruptured intracranial saccular aneurysms: A literature review

Guo

Zhao

et al. 2017

Interv Neuroradiol

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Acute rerupture after coil embolization is defined as rerupture within three days after treatment; its prognosis is worse than that of rebleeding at other time periods. However, to date, little is known about complications during the acute phase. Therefore, we used the PubMed database to perform a review of acute rerupture after coil embolization of ruptured intracranial saccular aneurysms and increase our understanding. After reviewing the complications, we found that the cause of acute rerupture is unclear, but the following risk factors are involved: incomplete occlusion of the initial aneurysm, the presence of a hematoma adjacent to a ruptured aneurysm, an aneurysmal outpouching, poor Hunt-Hess grade at the time of treatment, and the location of the aneurysm in an anterior communicating artery. In addition, intraoperative rupture is a non-negligible cause. Acute rerupture after coil embolization mainly occurs within the first 24 hours after the procedure. Brain computed tomography is the gold standard for diagnosing acute rebleeding of a coiled aneurysm. For acute rerupture after coil embolization, prevention is critical, and complete occlusion of the aneurysm in the first session is the best protection against acute rebleeding. In addition, a restricted postembolization anticoagulation strategy is recommended for patients with high-risk aneurysms. For patients with an adjacent hematoma, surgical clipping is recommended. Most patients present no changes immediately after acute rebleeding because of their poor condition. However, surgical or endovascular treatments can be attempted if the patient is in an acceptable condition. Even so, the outcomes are typically unsatisfactory.

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Section: Introductionmentioning

confidence: 99%

Acute rerupture after coil embolization of ruptured intracranial saccular aneurysms: A literature review

Guo

Zhao

et al. 2017

Interv Neuroradiol

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“…Intracranial aneurysm embolization is an effective approach to the treatment of aneurysms, and features reduced trauma and fast recovery. 1,2 Currently, more physicians are opting to use this approach as a first-line treatment strategy. The results of the Barrow Ruptured Aneurysm Trial (BRAT), the International Subarachnoid Aneurysm Trial (ISAT), and another randomized trial of endovascular versus surgical treatment of ruptured cerebral aneurysms from Finland suggest little difference in outcome between the endovascular coiling and neurosurgical clipping treatments for anterior circulation aneurysms; for posterior circulation aneurysms, coil embolization appears to provide a sustained advantage over clipping.…”

Section: Introductionmentioning

confidence: 99%

Intracranial post-embolization residual or recurrent aneurysms: Current management using surgical clipping

et al. 2016

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Post-embolization residual or recurrent aneurysms (PERRAs) are not rare in patients with intracranial aneurysms treated by embolization. Their occurrence is mainly associated with an increased amount of interventional therapy. Repeated interventional embolization can be applied in some patients with PERRAs, whereas surgical clipping is preferred in other cases that are not suitable for repeated interventional embolization due to the difficulties inherent to this operation. The surgical clipping of PERRAs is very complicated and difficult to perform, and relevant reports are rare. This study offers a review of PERRA treatment using surgical clipping. Retrospective studies have shown that PERRAs are common aneurysms of the anterior and posterior communicating arteries. According to the recurrent characteristics of PERRAs, it is reasonable to categorize PERRAs into three types: type I—coils are compressed, and no embolic material fills the neck of the aneurysm; type II—coils are migrated, and very few coils fill the neck of the aneurysm or the parent artery; and type III—coils are migrated, and multiple coils fill the neck of the aneurysm or the parent artery. Direct clipping can be applied to types I and II PERRAs, whereas trapping, wrapping, or auxiliary revascularization is required in type III PERRAs. Most coils do not require removal unless they interfere with clipping. However, it is necessary to avoid damaging the surrounding adhesive tissue during coil removal. Satisfactory therapeutic outcomes can be achieved by selecting appropriate PERRA cases in which to perform surgical clipping.

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“…The appropriate coil is selected based on aneurysm morphology leading to create a stable flame like a basket-like structure, for delivering subsequent coils inside to achieve the aneurysm occlusion (Eboli et al, 2014). However, the aneurysm morphology includes individual difference (normally described by the existence of blebs and several shape indices) (Raghavan et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Computational model of coil placement in cerebral aneurysm with using realistic coil properties

Otani

Satoshi

Shigematsu

et al. 2015

JBSE

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This study presents a computational mechanical model of coil placement in cerebral aneurysms with using realistic coil properties. The mechanical behavior of the coil is expressed by solving a variational problem including the kinetic and elastic energies of the coil and geometric constraints due to the multiple contacts. The coil is discretized as a set of beam elements obeying Timoshenko beam theory, in which these elastic properties are determined based on the actual shape and material property of the coil. Numerical examples of the coil placement are presented for four cases with different coil properties in terms of the elastic property (hard and soft) and reference configurations (helical loop and complex loop) within the realistic range. These results exhibit the effects of the coil properties on not only the transition of the coil configuration during the placement process but also the contact force of the coil against the aneurysm wall which has a fatal risk of bleeding in the operation. The proposed computational model will assist surgeons to select the appropriate coil and coil deployment protocol to achieve the sufficient treatment effectiveness with minimizing the risk of bleeding in the view of the mechanical sense.

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General Technical Considerations for the Endovascular Management of Cerebral Aneurysms

Cited by 3 publications

References 30 publications

Acute rerupture after coil embolization of ruptured intracranial saccular aneurysms: A literature review

Acute rerupture after coil embolization of ruptured intracranial saccular aneurysms: A literature review

Intracranial post-embolization residual or recurrent aneurysms: Current management using surgical clipping

Computational model of coil placement in cerebral aneurysm with using realistic coil properties

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