Safety and Long-term Efficacy of Stent-assisted Coiling for the Treatment of Complex Posterior Cerebral Artery Aneurysms

Xue, Gaici; Tang, Haishuang; Liu, Peng; Zuo, Qiao; Yang, Pengfei; Zhou, Yu; Li, Qiang; Fang, Yibin; Huang, Qinghai; Hong, Bo; Xu, Yi; Zhao, Rui; Liu, Jianmin

doi:10.1007/s00062-019-00825-w

Cited by 13 publications

(10 citation statements)

References 38 publications

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“…In contrast, PCA aneurysms are relatively rare and direct surgical treatments including neck clipping and trapping with cerebral revascularization are often complicated and associated with high morbidity rates ( 27 , 28 ). Endovascular treatment with stent-assisted coil embolization and flow diverter placement with preservation of the parent artery has been selected as a first choice, but these technique seem to encounter difficulty in achieving cure, particularly in cases of giant, fusiform, or partially thrombosed PCA aneurysm ( 29 , 30 ). Endovascular parent artery occlusion (PAO) represents an alternative treatment strategy for such complicated aneurysms, but preoperative evaluation of ischemic tolerance is required and BOT is usually performed.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Impact of Monitoring Visual Evoked Potentials to Prevent Visual Complications During Endovascular Treatment for Intracranial Aneurysm

et al. 2022

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IntroductionThe present study aimed to determine the incidence of intraprocedural visual-evoked potential (VEP) changes and to identify correlations with intraprocedural ischemic complications during endovascular treatment in patients with intracranial aneurysm related to visual function.MethodsThis study analyzed data from 104 consecutive patients who underwent endovascular coil embolization to treat intracranial aneurysms related to visual function under VEP and transcranial motor evoked potential (MEP) monitoring. We analyzed associations between significant changes in MEP and VEP, defined as a >50% decrease in amplitude, and both intraprocedural complications and postoperative neurological deficits. Factors associated with postoperative neurological deficits were also assessed.ResultsTreated aneurysms were predominantly located in the internal carotid artery (95%). Five (5%) were located in the posterior cerebral artery (PCA). Significant decreases in intraprocedural VEP occurred in four patients (4%), although one of those four patients did not show concomitant MEP decreases during procedures. Immediate salvage procedures avoided postoperative visual disturbances. All VEP decreases were transient and not associated with postoperative visual impairment. One of three cases who underwent intraoperative balloon occlusion test showed tolerance to balloon occlusion of the proximal PCA under VEP assessment; parent artery occlusion was performed without postoperative visual disturbance in that case.ConclusionAlthough significant VEP decreases occurred 4% during neuro-endovascular aneurysm treatment related to visual function, intraprocedural VEP monitoring identifies ischemic changes associated with visual pathways and facilitates prompt initiation of salvage procedures.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Impact of Monitoring Visual Evoked Potentials to Prevent Visual Complications During Endovascular Treatment for Intracranial Aneurysm

et al. 2022

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“…Apart from the above treatments, stent-assisted coiling might be considered for the aneurysm of classic dissecting aneurysm and segmental ectasia, and had a favorable angiographic outcome. [24] This study has several limitations. First, this was a single-center retrospective study, and might include an inherent bias in patient selection.…”

Section: Complicationsmentioning

confidence: 92%

Endovascular Treatment of Vertebral and Basilar Artery Aneurysms with Low-Profile Visualized Intraluminal Support Device

Qiang

et al. 2020

Preprint

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Background: The Low-profile Visualized Intraluminal Support (LVIS) device is a self-expanding, nitinol, single-braid, closed-cell device that was recently developed for endovascular embolization of intracranial aneurysms. However, current knowledge regarding the use of LVIS devices to treat vertebral and basilar artery aneurysms is limited. We aimed to evaluate the feasibility, efficacy, and safety of the LVIS device for treating vertebral and basilar artery aneurysms.Methods: Between January 2015 and December 2017, patients with vertebral and basilar artery aneurysms treated using LVIS stents were enrolled in this study. We analyzed patients’ demographic, clinical and aneurysmal characteristics, procedural details, complications, and angiographic and clinical follow-up results.Results: We identified 63 patients with 64 vertebral and basilar artery aneurysms who underwent treatment with (n=59) or without (n=5) LVIS stenting, including 10 patients with ruptured aneurysms. Forty-one aneurysms were located at the vertebral artery, and 23 at the basilar artery. Intraprocedural-related complications developed in three (4.8%) patients, while none of these patients developed morbidities or died during follow-up. Three patients developed post-procedural complications (4.8%). Two patients experienced ischemic events immediately post-procedure. A minor permanent morbidity developed in one of the two patients (1.6%). The mortality rate was 1.6%, for that the patient died of brainstem hemorrhage after 1 month of follow-up. At a mean follow-up of 12.5 months, 39/43 (90.7%) patients had stable or improved aneurysms, and four (9.3%) had recanalized.Conclusions: Endovascular treatment of vertebral and basilar artery aneurysms with the LVIS device is feasible, safe, and effective in the short-term. Long-term and larger cohort studies are necessary to validate our results.

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“…The clinicians should be cautious in the decision-making process regarding whether or when a flow diverter should be applied in the vertebral and basilar artery. Apart from the above treatments, stent-assisted coiling might be considered for the aneurysm of classic dissecting aneurysm and segmental ectasia, and had a favorable angiographic outcome [28].…”

Section: Complicationsmentioning

confidence: 99%

Endovascular treatment of vertebral and basilar artery aneurysms with low-profile visualized intraluminal support device

Qiang

et al. 2021

BMC Neurol

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Background The Low-profile Visualized Intraluminal Support (LVIS) device is a self-expanding, nitinol, single-braid, closed-cell device that was recently developed for endovascular embolization of intracranial aneurysms. However, current knowledge regarding the use of LVIS devices to treat vertebral and basilar artery aneurysms is limited. We aimed to evaluate the feasibility, efficacy, and safety of the LVIS device for treating vertebral and basilar artery aneurysms. Methods Between January 2015 and December 2017, patients with vertebral and basilar artery aneurysms treated using LVIS stents were enrolled in this study. We analyzed patients’ demographic, clinical and aneurysmal characteristics, procedural details, complications, and angiographic and clinical follow-up results. Results We identified 63 patients with 64 vertebral and basilar artery aneurysms who underwent treatment with (n = 59) or without (n = 5) LVIS stenting, including 10 patients with ruptured aneurysms. Forty-one aneurysms were located at the vertebral artery, and 23 at the basilar artery. Intraprocedural-related complications developed in three (4.8%) patients, while none of these patients developed morbidities or died during follow-up. Three patients developed post-procedural complications (4.8%). Two patients experienced ischemic events immediately post-procedure. A minor permanent morbidity developed in one of the two patients (1.6%). The mortality rate was 1.6%, for that the patient died of brainstem hemorrhage after 1 month of follow-up. At a mean follow-up of 12.5 months, 39/43 (90.7%) patients had stable or improved aneurysms, and four (9.3%) had recanalized. Conclusions LVIS device of vertebral and basilar artery aneurysms may be an acceptable safety profile and may represent a reasonable treatment option in the short-term. Long-term and larger cohort studies are necessary to validate our results.

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Safety and Long-term Efficacy of Stent-assisted Coiling for the Treatment of Complex Posterior Cerebral Artery Aneurysms

Cited by 13 publications

References 38 publications

Diagnostic Impact of Monitoring Visual Evoked Potentials to Prevent Visual Complications During Endovascular Treatment for Intracranial Aneurysm

Diagnostic Impact of Monitoring Visual Evoked Potentials to Prevent Visual Complications During Endovascular Treatment for Intracranial Aneurysm

Endovascular Treatment of Vertebral and Basilar Artery Aneurysms with Low-Profile Visualized Intraluminal Support Device

Endovascular treatment of vertebral and basilar artery aneurysms with low-profile visualized intraluminal support device

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