Short- and midterm outcome of ruptured and unruptured intracerebral wide-necked aneurysms with microsurgical treatment

Won, Sae‐Yeon; Seifert, Volker; Dubinski, Daniel; Kashefiolasl, Sepide; Dinc, Nazife; Bruder, Markus; Konczalla, Juergen

doi:10.1038/s41598-021-84339-x

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…Aneurysm occlusion degrees were evaluated using the Raymond–Roy grading system, with grade I for complete occlusion, grade II for neck remnant, and grade III for aneurysm sac remnant. [ 10 ] The clinical outcome was assess with the modified Rankin Scale (mRS) score, with good clinical outcomes as mRS 0 to 2 and poor as mRS 3 to 6.…”

Section: Methodsmentioning

confidence: 99%

Safety and effects of endovascular treatment of basilar tip aneurysms in patients with moyamoya diseases

Chen¹,

Gao²,

Yang³

et al. 2023

Medicine

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The effect and safety of endovascular treatment of basilar tip aneurysms associated with moyamoya disease are unknown. This study was to investigate the safety and effect of endovascular treatment of basilar tip aneurysms associated with moyamoya disease. Patients with moyamoya disease concurrent with basilar tip aneurysms were retrospectively enrolled and treated with endovascular embolization. The clinical and angiographic data were analyzed. Thirty patients with a basilar tip aneurysm were enrolled, including 8 (26.67%) male and 22 (73.33%) female patients aged 38 to 72 years (mean 54.4 ± 8.15). Endovascular treatment was successfully performed in 29 (96.67%) patients but failed in 1 (3.33%). Immediately after embolization, aneurysm occlusion degree was Raymond-Roy grade I in 26 (89.66%), grade II in 2 (6.90%), and grade III in 1 (3.45%). Intraprocedural complications occurred in 2 (10%) patients, including aneurysm rupture in 1 (3.33%), leading to death of the patient, and stent thrombosis in 2 (6.67%) which was successfully treated with thrombolysis. At discharge, good clinical outcome (modified Rankin Scale 0–2) was achieved in 29 (96.67%) and death in 1 (3.03%). Follow-up was performed 6 to 26 months (median 15) in 27 (93.1%) patients. Aneurysm occlusion degree was Raymond-Roy grade I in 21 (77.78%) patients, grade II in 4 (14.81%), and grade III in 2 (7.41%), not significantly (P = .67) different from those immediately after embolization. Aneurysm recurrence was found in 4 patients (14.81%). The clinical outcome was modified Rankin Scale 0 to 2 in all 27 patients, not significantly different from that at discharge. Endovascular embolization can be performed safely and effectively for basilar tip aneurysms associated with moyamoya disease even though more advanced embolization techniques are necessary.

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Section: Methodsmentioning

confidence: 99%

Safety and effects of endovascular treatment of basilar tip aneurysms in patients with moyamoya diseases

Chen¹,

Gao²,

Yang³

et al. 2023

Medicine

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“…Clinical and angiographic follow-up was scheduled in all patients, and the treatment effect of the flow-diverting device was evaluated 6 months after the procedure using the Raymond grading system ( 26 ), with the Raymond grade I as complete obliteration of aneurysm, grade II as a residual neck, and grade III as any opacification of the aneurysm sac or residual aneurysm. The clinical prognosis was assessed with the modified Rankin scale (mRS) scores.…”

Section: Methodsmentioning

confidence: 99%

Small Unruptured Intracranial Aneurysms Can Be Effectively Treated With Flow-Diverting Devices

Gao

Shao

et al. 2022

Front. Neurol.

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PurposeTo investigate the effect and safety of flow diverters in the management of small (<10 mm in diameter) unruptured intracranial aneurysms.Materials and MethodsOne hundred and ten patients with 145 small intracranial aneurysms treated with flow diverters were retrospectively enrolled. The clinical, endovascular, and follow-up data were analyzed.ResultsOne hundred twenty-one flow diverters were deployed for the treatment of 145 small intracranial aneurysms in 110 patients, and the stenting success rate was 99.1%. In 133 (91.7%) aneurysms, only flow-diverting devices were deployed, and in the rest 12 (8.3%) of aneurysms, coils were used to loosely pack the aneurysm after deployment of a flow-diverting device. Five patients (4.5%) experienced ischemic complications, but no hemorrhagic complications were occurred. All patients had clinical follow-up 6–18 (median 12) after the procedure, with the modified Rankin scale score (mRS) 0 in 101 patients, 1 in four patients, 2 in three patients, 4 in one patient, and 5 in one patient. Digital subtraction angiography was performed at follow-up in 90 (81.8%) patients with 118 (81.4%) aneurysms 6–18 months (median 12) after the procedure, with the Raymond grade I in 90 (76.2%) aneurysms and Raymond grade III in 28 (23.7%). Eighteen patients with 22 partially occluded aneurysms at the first angiographic follow-up experienced the second digital subtraction angiography 12–36 months (median 26) after the procedure, and 21 (95.5%) aneurysms were completely occluded. Two patients had asymptomatic in-stent stenosis.ConclusionTreatment of small unruptured intracranial aneurysms with flow diverters can be performed safely and effectively with satisfactory outcomes.

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“…The most widely utilized definition is based on a neck diameter ≥ 4 mm and/or a dome-to-neck ratio of < 2 [ 6 , 12 ]. The particular anatomy of WNA makes their treatment either through surgical or endovascular modalities challenging [ 20 ]. On the one hand, surgical dissection of the neck and proper visualization of the parent and distal vessels can be obstructed [ 4 ]; on the other hand, coil migration and parent vessel occlusion can often ensue if these aneurysms are treated endovascularly [ 3 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Microsurgical clipping vs Woven EndoBridge (WEB) device for the management of unruptured wide-neck bifurcation aneurysms

2022

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The Woven EndoBridge device (WEB) was introduced in 2010 to treat wide-neck bifurcation aneurysms (WNBAs). Three landmark studies have been conducted to assess its safety and efficacy: WEBCAST, WEBCAST 2, and French Observatory Study. However, these studies have not compared its safety and efficacy to other treatment modalities. In this study, we compare WEB versus microsurgical clipping in the management of unruptured WNBA. We conducted a retrospective study of unruptured WNBA meeting the morphological criteria to be amenable for WEB treatment operated on at our institution. Surgical morbidity, mortality, and occlusion rates were assessed. We compared our results to those reported in the cumulative population of the three WEB landmark studies at 1 year. A total of 84 patients with 89 WNBA were included. The most common aneurysm location was the middle cerebral artery bifurcation (n = 67/89, 75%). No operative mortality was observed. Morbidity comprised small-vessel vasospasm (n = 1/89, 1%) resulting in hemiparesis vs. 3% morbidity for WEB (p = .324). All but one (n = 1/89, 1%) WNBA were completely occluded vs WEB occlusion rate of 53% at 1 year, statistically significantly worse (p < .001). In our analysis, we were not able to show superiority of WEB in terms of procedural morbidity in comparison to microsurgical clipping, defined as worsening in mRS. Microsurgical clipping achieves statistically significantly higher rates of complete aneurysm occlusion, thus posing the question of whether the WEB should be presented as a viable, comparable alternative to patients amenable to surgical treatment.

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Short- and midterm outcome of ruptured and unruptured intracerebral wide-necked aneurysms with microsurgical treatment

Cited by 5 publications

References 22 publications

Safety and effects of endovascular treatment of basilar tip aneurysms in patients with moyamoya diseases

Safety and effects of endovascular treatment of basilar tip aneurysms in patients with moyamoya diseases

Small Unruptured Intracranial Aneurysms Can Be Effectively Treated With Flow-Diverting Devices

Microsurgical clipping vs Woven EndoBridge (WEB) device for the management of unruptured wide-neck bifurcation aneurysms

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