Surgical Outcome of Very Small Intracranial Aneurysms Utilizing the Double Clip Technique

Rahmanian, Abdolkarim; Ghaffarpasand, Fariborz; Alibai, Ehsanali; Choque-Velasquez, Joham; Jahromi, Behnam Rezai; Hernesniemi, Juha

doi:10.1016/j.wneu.2017.11.060

Cited by 9 publications

(10 citation statements)

References 31 publications

(57 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Treatments for VSIAs are often associated with increased preoperative complications, including IPR, due to the small cavity and frail wall of VSIAs ( 9 ). Rahmanian et al ( 6 ) treated 32 VSIAs with the double-clip technique and the IPR rate was 30.8%. A meta-analysis of 1,295 aneurysms treated with coil embolization showed that the IPR rate in VSIAs was twice as high as that in larger aneurysms (7.7 vs. 3.6%; P = 0.018) ( 1 ).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Endovascular Treatment of Ruptured Very Small Intracranial Aneurysms: Complications, Recurrence Rate, and Clinical Outcomes

et al. 2022

View full text Add to dashboard Cite

Objective: The aim of this study was to evaluate the safety and efficacy of endovascular treatment for ruptured very small (≤3 mm) intracranial aneurysms (VSIAs).Methods: The clinical data and imaging results for 152 patients with VSIAs treated with coil embolization from August 2014 to June 2020 were retrospectively reviewed. The influential factors related to the preoperative complications, aneurysm recurrence, and clinical outcomes for these patients were analyzed.Results: Among 152 patients with ruptured VSIAs, 90 were treated with coil embolization alone, while 62 were treated with stent-assisted coil embolization. Eighteen patients experienced intra and/or postoperative complications (overall incidence = 11.8%). One person died of intraoperative aneurysm re-rupture and postoperative rebleeding (mortality rate = 0.65%). Twenty patients had various degrees of neurological dysfunction (morbidity rate = 13.1%). Statistical analysis showed that there was no independent risk factor associated with perioperative complications. The rate of complete aneurysm occlusion at discharge and follow-up was 76.3 and 86.2%, respectively. A total of 105 patients underwent digital subtraction angiography during follow-up, and 18 of them experienced postoperative recurrence (recurrence rate = 17.1%). Seven patients were retreated (retreatment rate = 6.7%). The use of stents was the only factor that affected the postoperative recurrence of aneurysm. The incidence of favorable clinical outcomes (Glasgow Outcome Scale score ≥ 4) at discharge and follow-up was 86.2 and 97.1%, respectively. Univariate analysis showed that the preoperative Hunt-Hess grade, CT Fisher grade, and perioperative complications were risk factors for poor clinical outcomes. Multiple logistic regression analysis showed that perioperative complication was the most significant risk factor for the clinical prognosis of patients with ruptured VSIAs.Conclusion: Endovascular treatment is a safe and efficient approach for ruptured VSIAs. Stent-assisted coiling reduced the recurrence rate of aneurysm without increasing the incidence of perioperative complications. The Hunt-Hess grade, CT Fisher grade, and perioperative complications were independent factors associated with the clinical outcomes of patients with ruptured VSIAs, and perioperative complication was the most significant risk factor for poor prognosis in patients.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Surgical clipping is a conventional treatment for intracranial aneurysm, but not an ideal approach for VSIAs because these aneurysms are small and often associated with a high incidence of complications, such as clip slippage, intraoperative rupture, intracranial infection, postoperative epilepsy, etc. ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

Endovascular Treatment of Ruptured Very Small Intracranial Aneurysms: Complications, Recurrence Rate, and Clinical Outcomes

et al. 2022

View full text Add to dashboard Cite

show abstract

“…19 Rahmanian et al reported a series of 26 patients with 32 VSIAs treated with the double-clip technique to reduce clip slippage. 20 Mini-clips have the disadvantage of producing lower closing forces than standard clips. 20 Therefore, a double-clip technique of booster clipping has been introduced by the Helsinki team.…”

Section: Discussionmentioning

confidence: 99%

Insufficient Closing Forces of Yasargil Titanium Clips in Two Small Aneurysms Detected with Intraoperative Indocyanine Green Videoangiography

Scheller

Prell

Simmermacher

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

View full text Add to dashboard Cite

Background and Study Aims Aneurysm clips must have adequate closing forces because residual blood flow in clipped aneurysms may result in aneurysm recurrence. Such flow can be intraoperatively detected by visual inspection, microvascular Doppler sonography, indocyanine green videoangiography (ICG-V), angiography, and puncture. Patients We present two patients with ruptured very small middle cerebral artery aneurysms (3 and 2.9 mm). The necks of both aneurysms were microsurgically clipped with Yasargil aneurysm clips without any complications. Results In both aneurysms, visual inspection suggested complete occlusion, but ICG-V showed persistent residual blood flow between the middle parts of the clip blades.The first patient was treated with a 5.4-mm FT744T clip (closing force of 1.47 N). After the ICG-V finding, a second 3.9-mm FT714T clip (closing force of 1.08 N) was placed on the tips of the already implanted clip to increase the closing forces. Subsequent ICG-V did not show any further residual blood flow. In the second patient, the aneurysm was clipped with an 8.0-mm FE764K clip (closing force of 1.77 N). Intraoperative ICG-V showed persistent residual blood flow within the aneurysmal dome despite complete closure of the clip. The clip was repositioned closer to the parent vessel. Consecutive ICG-V did not show any residual blood flow. Conclusion Visually undetected incomplete aneurysm occlusion can be revealed with ICG-V. In very small aneurysms, standard closing forces of clips may not be sufficient and complete closure of the clip branches should be intraoperatively validated with ICG-V.

show abstract

“…Old age is reported to be one of the significant risk factors that affect the severity of aSAH (7,9,10), and the elderly patients with poor cerebrovascular reserve function are more likely to suffer from severe neurological dysfunction after aSAH. Few previous studies have focused on comparing the clinical outcome of patients with small ruptured aneurysms according to age, and most of these previous studies have focused on the treatment outcome of coiling or clipping for patients with small ruptured aneurysms (3,(11)(12)(13)(14). It is unclear whether age itself increases the risk of complications in patients during small cerebral aneurysm treatment.…”

Section: Introductionmentioning

confidence: 99%

Influence of Age-Related Complications on Clinical Outcome in Patients With Small Ruptured Cerebral Aneurysms

2020

View full text Add to dashboard Cite

Background: Small ruptured cerebral aneurysms (≤5 mm) account for the majority of aneurysmal subarachnoid hemorrhages, and its clinical management remains a challenge. The aim of this study was to identify the effect of age-related complications on the outcome of patients with small ruptured aneurysm. Methods: A retrospective review was performed in patients with small ruptured aneurysms who underwent microsurgical clipping or endovascular coiling from September 2012 to December 2018. According to their ages, the patients were divided into the elderly group and the non-elderly group. Baseline characteristics, clinical complications, and outcome of patients were analyzed between the two groups. A multivariate logistic regression analysis was used to determine the risk factors associated with the poor outcome of the elderly patients. Results: In the elderly group, 83 patients were treated with clipping and 50 were treated with coiling. In the non-elderly group, 188 patients were treated with clipping and 117 were treated with coiling. The incidence of neurological complications with neurologic deficit in the elderly group was significantly higher compared with that in the non-elderly group (P = 0.006). The elderly patients had a longer hospital stay (P = 0.032) and a poorer outcome (P = 0.001) compared with the non-elderly patients. A multivariate analysis showed that irregular aneurysms (P = 0.045) and ischemic events (P < 0.001) were independent risk factors associated with poor outcome in the elderly. Conclusions: Neurological complications with neurologic deficit, especially ischemic complications, were clearly more common in the elderly patients. Irregular small aneurysms or postoperative ischemic events should be paid attention as the higher risk of poor outcome in the elderly.

show abstract

Surgical Outcome of Very Small Intracranial Aneurysms Utilizing the Double Clip Technique

Abstract: VSIAs are difficult to treat because of their small sizes; therefore, with a double-clip technique, one can reduce complications related to the treatment of small aneurysms.

Cited by 9 publications

References 31 publications

Endovascular Treatment of Ruptured Very Small Intracranial Aneurysms: Complications, Recurrence Rate, and Clinical Outcomes

Endovascular Treatment of Ruptured Very Small Intracranial Aneurysms: Complications, Recurrence Rate, and Clinical Outcomes

Insufficient Closing Forces of Yasargil Titanium Clips in Two Small Aneurysms Detected with Intraoperative Indocyanine Green Videoangiography

Influence of Age-Related Complications on Clinical Outcome in Patients With Small Ruptured Cerebral Aneurysms

Contact Info

Product

Resources

About