Stent-Assisted Coil Embolization for the Proximal Middle Cerebral Artery Fusiform Aneurysm

Jeong, Seong Man; Kang, Sung Ho; Lee, Nam Joon; Lim, Dong Jun

doi:10.3340/jkns.2010.47.5.406

Cited by 10 publications

(4 citation statements)

References 15 publications

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“…La literatura indica que los aneurismas gigantes, con mala relación saco/cuello, fusiformes y de arteria cerebral media, no son buenos candidatos para tratamiento endovascular; sin embargo, el diseño de nuevos coils y técnicas como embolización asistida por balón o por stent y sole stenting; permiten obtener buenos resultados en los aneurismas mencionados. 5,[10][11][12][13][14][15] En este estudio se observó que todos los aneurismas gigantes, fusiformes, de arteria cerebral media, y 93 % (n=25) de los aneurismas de cuello ancho se embolizaron sin complicación, realizando embolización asistida con stent en dos casos y sole stenting en uno.…”

Section: Discussionunclassified

Embolización versus clipaje microquirúrgico en aneurismas cerebrales de circulación anterior.

2017

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ResumenObjetivo: determinar el mejor procedimiento para el tratamiento de aneurismas cerebrales de circulación anterior, entre embolización y clipaje microquirúrgico, en términos de mortalidad y complicaciones. Materiales y métodos: estudio de cohorte, retroprospectivo de pacientes con hemorragia subaracnoidea por ruptura de aneurismas de circulación anterior; tratados mediante embolización o clipaje microquirúrgico en varios hospitales de Guayaquil, entre el 1 de enero de 2010 y el 31 de noviembre de 2011. Resultados: se incluyó 58 pacientes sometidos a embolización y 43 sometidos a clipaje. Se hallaron 113 aneurismas, localizados principalmente en la arteria comunicante posterior (39 %, n=24). En lo que refiere a mortalidad, fallecieron 10 % (n=6) de los pacientes embolizados y 14 % (n=6) de los clipados; el riesgo relativo (RR) fue 0.71, la reducción de riesgo relativo (RRR) fue 25,86 % y la reducción absoluta del riesgo (RAR) fue 3,96 % (IC95 %: 0.213-2.38, p=0.57). Las complicaciones transoperatorias se presentaron en 3,54 % (n=4) del total de pacientes, siendo éstas la migración del dispositivo de embolización y la ruptura del aneurisma. Las complicaciones posoperatorias fueron infección, convulsiones y resangrado; presentándose en 6% (n=7) de los casos. El RR para complicaciones fue 0.24, RRR= 75,29 % y RAR= 15,76 % (IC95 %: 0.059-0.961, p=0.032), favoreciendo a los pacientes embolizados. Conclusión: la embolización presenta menor riesgo de complicaciones frente al clipaje de aneurismas de circulación anterior en pacientes con hemorragia subaracnoidea por ruptura aneurismática; sin embargo, no existen diferencias significativas en relación a mortalidad entre ambos procedimientos.PALABRAS CLAVE: aneurisma intracraneal, hemorragia subaracnoidea, neurocirugía, embolización terapéutica. Abstract Objective: to determine the best procedure for treatment of cerebral aneurysms on anterior circulation, between embolization and microsurgical clipping, in terms of mortality and complications. Materials and methods: A retrospective cohort study of patients with subarachnoid hemorrhage from a rupture of anterior circulation aneurysms that had been treated by embolization or microsurgical clipping in several hospitals in Guayaquil between january 1, 2010 and november 31, 2011. Result: 58 patients who underwent embolization and 43 who underwent clipping were included. 113 aneurysms, located mainly in the posterior communicating artery (39 %, n = 24) were found. Regarding mortality, 10 % (n = 6) of the embolized patients and 14 % (n = 6) of the clipped died. The relative risk (RR) was 0.71, the relative risk reduction (RRR) was of 25.86 % and the absolute risk reduction (ARR) was of 3.96 % (95 % CI: 0.213-2.38, p = 0.57). Intraoperative complications occurred in 3.54 % (n = 4) of the total number of patients, consisting it in the migration of the embolization device and rupture of the aneurysm. Postoperative complications were infection, seizures, and rebleeding; present in 6 % (n = 7) of the cases. The RR for complicati...

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Section: Discussionunclassified

Embolización versus clipaje microquirúrgico en aneurismas cerebrales de circulación anterior.

2017

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“…41 A associação conjunta entre embolização seguida pela passagem de um stent para ocluir o vaso tem se mostrado como alternativa mais eficaz no tratamento endovascular dos aneurismas fusiformes, entretanto a necessidade de anticoagulação plena e a possibilidade de hemorragia subaracnóidea e/ou ressangramento do aneurisma deixa essa opção ainda pouco segura, 46 embora o tratamento de um aneurisma fusiforme da artéria cerebral média tenha obtido bons resultados com essa associação. 47 A associação conjunta de um stent com um polímero líquido sintético para a oclusão do vaso já foi descrita na literatura, entretanto, o número restrito de pacientes submetidos ao procedimento e a eficácia não comprovada do método não implicam perspectivas para essa forma de manejo. 48…”

Section: Stentsunclassified

As opções terapêuticas para os aneurismas fusiformes

Viegas¹,

Rodrigues²,

Teixeira³

et al. 2014

Arq Bras Neurocir

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ResumoOs aneurismas fusiformes são pouco frequentes e geralmente não estão associados a fatores de risco específicos. Ocorrem principalmente nas artérias cerebrais, por meio de uma dilatação circunferencial na parede da artéria, garantindo seu aspecto morfológico típico: ausência de colo aneurismático. Por essa razão, não podem ser usualmente clipados ou embolizados, necessitando de métodos alternativos de tratamento que representam um desafio para os neurocirurgiões. As alternativas cirúrgicas estão associadas a um melhor prognóstico e incluem as técnicas de revascularização com o uso de bypass, a oclusão da artéria aferente (PAO, sigla em inglês) e “wrapping” ou clip-wrap. Métodos endovasculares, como o uso de stents, representam uma opção para restauração mais fisiológica do fluxo sanguíneo, embora necessitem de mais estudos para confirmar a eficácia.

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“…Newer techniques such as stenting and remodeling may allow expanded treatment of fusi-form aneurysms in the future, although the question of the durability of endovascular treatment in children remains. 13,15,21,29,37,41,56 Surgical strategies include direct clipping and possible reconstruction of the vessel wall, proximal vessel occlusion, wrapping, bypass alone, or trapping with bypass. Direct clipping was performed in Cases 1 and 7.…”

Section: Treatment Of Mca Aneurysmsmentioning

confidence: 99%

Middle cerebral artery aneurysms in children: case series and review

Fulkerson

Voorhies²,

Payner³

et al. 2011

PED

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Object Pediatric intracranial aneurysms are rare lesions that differ from their adult counterparts. Aneurysms involving the middle cerebral artery (MCA) are particularly challenging to treat in children, as they are often fusiform and cannot undergo direct clipping alone. The authors recently treated a patient with a heavily calcified, dysplastic, left-sided MCA aneurysm. The present study was performed to evaluate the authors' previous operative and follow-up experience with these difficult lesions. Methods The authors performed a review of a prospectively maintained database of all aneurysms treated at Methodist Hospital in Indianapolis, Indiana, from January 1990 through November 2010. Relevant operative notes, clinical charts, and radiological reports were reviewed for all patients 18 years of age or younger. Results A total of 2949 patients with aneurysms were treated over the study period, including 28 children (0.95%). Seven children harbored MCA aneurysms. Five of these 7 aneurysms (71.4%) were fusiform. Two patients were treated with direct clipping, 2 underwent parent vessel occlusion without bypass, and 3 underwent aneurysm trapping with extracranial-intracranial vessel bypass. Long-term follow-up data were available in 6 cases. All 6 patients had a 1-year follow-up Glasgow Outcome Scale score of 5. Long-term radiological follow-up was available in 4 patients. One patient required a reoperation for a recurrent aneurysm 4 years after the initial surgery. Conclusions Middle cerebral artery aneurysms in children are often fusiform, giant, and incorporate the origins of proximal artery branches. Direct clipping may not be possible; trapping of the lesion may be required. Children seem to tolerate surgical trapping with or without bypass extremely well. Aggressive therapy of these rare lesions in children is warranted, as even patients presenting with a poor clinical grade may have excellent outcomes. Long-term surveillance imaging is necessary because of the risk of aneurysm recurrence.

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Stent-Assisted Coil Embolization for the Proximal Middle Cerebral Artery Fusiform Aneurysm

Cited by 10 publications

References 15 publications

Embolización versus clipaje microquirúrgico en aneurismas cerebrales de circulación anterior.

Embolización versus clipaje microquirúrgico en aneurismas cerebrales de circulación anterior.

As opções terapêuticas para os aneurismas fusiformes

Middle cerebral artery aneurysms in children: case series and review

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