The Merits of Endovascular Coil Surgery for Patients with Unruptured Intracranial Aneurysms

Park, Seong-Ho; Lee, Chang-Young; Yim, Man-Bin

doi:10.3340/jkns.2008.43.6.270

Cited by 17 publications

(14 citation statements)

References 18 publications

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“…Coils alter intra-aneurysmal hemodynamics by reducing flow velocities and increasing blood residence times, which may trigger thrombus formation [2]. Nonetheless, around 15%-25% of aneurysms treated with coils recanalize [3], [4], which means the reestablishment of blood flow in the aneurysm lumen. Recanalization can be caused by either coil compaction or aneurysm regrowth [3], [5], [6], both associated to the hemodynamic forces acting on coils and the aneurysm wall over time [7], [8].…”

Section: Introductionmentioning

confidence: 97%

“…Nonetheless, around 15%-25% of aneurysms treated with coils recanalize [3], [4], which means the reestablishment of blood flow in the aneurysm lumen. Recanalization can be caused by either coil compaction or aneurysm regrowth [3], [5], [6], both associated to the hemodynamic forces acting on coils and the aneurysm wall over time [7], [8]. Moreover, little is known about reliable predictors that identify which aneurysms are prone to recanalize due to hemodynamics and what coiling strategy carries a lower risk for the patient.…”

Section: Introductionmentioning

confidence: 98%

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A Virtual Coiling Technique for Image-Based Aneurysm Models by Dynamic Path Planning

Morales

Larrabide

Geers

et al. 2013

IEEE Trans. Med. Imaging

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Computational algorithms modeling the insertion of endovascular devices, such as coil or stents, have gained an increasing interest in recent years. This scientific enthusiasm is due to the potential impact that these techniques have to support clinicians by understanding the intravascular hemodynamics and predicting treatment outcomes. In this work, a virtual coiling technique for treating image-based aneurysm models is proposed. A dynamic path planning was used to mimic the structure and distribution of coils inside aneurysm cavities, and to reach high packing densities, which is desirable by clinicians when treating with coils. Several tests were done to evaluate the performance on idealized and image-based aneurysm models. The proposed technique was validated using clinical information of real coiled aneurysms. The virtual coiling technique reproduces the macroscopic behavior of inserted coils and properly captures the densities, shapes and coil distributions inside aneurysm cavities. A practical application was performed by assessing the local hemodynamic after coiling using computational fluid dynamics (CFD). Wall shear stress and intra-aneurysmal velocities were reduced after coiling. Additionally, CFD simulations show that coils decrease the amount of contrast entering the aneurysm and increase its residence time.

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Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 98%

A Virtual Coiling Technique for Image-Based Aneurysm Models by Dynamic Path Planning

Morales

Larrabide

Geers

et al. 2013

IEEE Trans. Med. Imaging

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“…There has been a growing interest in endovascular technology as several studies have suggested a lower procedural mortality rate, higher 1-year survival, lower incidence of vasospasm, and a cost benefit with this technology. 3,7,11,23,24,31 The International Subarachnoid Aneurysm Trial (ISAT) evaluated these treatment modalities for ruptured aneurysms in adults. 21 Although ISAT demonstrated superiority of aneurysm coiling over clipping therapy with lower mortality and epilepsy rates at 1 year, results remain controversial in children.…”

Section: ©Aans 2014mentioning

confidence: 99%

Treatment of cerebral aneurysms in children: analysis of the Kids' Inpatient Database

Alawi¹,

Edgell

Elbabaa

et al. 2014

PED

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Object Endovascular coiling and surgical clipping are viable treatment options of cerebral aneurysms. Outcome data of these treatments in children are limited. The objective of this study was to determine hospital mortality and complication rates associated with surgical clipping and coil embolization of cerebral aneurysms in children, and to evaluate the trend of hospitals' use of these treatments. Methods The authors identified a cohort of children admitted with the diagnoses of cerebral aneurysms and aneurysmal subarachnoid hemorrhage from the Kids' Inpatient Database for the years 1998 through 2009. Hospital-associated complications and in-hospital mortality were compared between the treatment groups and stratified by aneurysmal rupture status. A multivariate regression analysis was used to identify independent variables associated with in-hospital mortality. The Cochrane-Armitage test was used to assess the trend of hospital use of these operations. Results A total of 1120 children were included in this analysis; 200 (18%) underwent aneurysmal clipping and 920 (82%) underwent endovascular coiling. Overall in-hospital mortality was higher in the surgical clipping group compared with the coil embolization group (6.09% vs 1.65%, respectively; adjusted odds ratio [OR] 2.52, 95% CI 0.97–6.53, p = 0.05). The risk of postoperative stroke or hemorrhage was similar between the two treatment groups (p = 0.86). Pulmonary complications and systemic infection were higher in the surgical clipping population (p < 0.05). The rate of US hospitals' use of endovascular coiling has significantly increased over the years included in this study (p < 0.0001). Teaching hospitals were associated with a lower risk of death (OR 0.13, 95% CI 0.03–0.46; p = 0.001). Conclusions Although both treatments are valid, endovascular coiling was associated with fewer deaths and shorter hospital stays than clip placement. The trend of hospitals' use of coiling operations has increased in recent years.

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“…Although coiling is associated to lower mortality and morbidity rates compared with surgical clipping, 2 its outcome is not always predictable. [1][2][3][4][5] Packing density is thought to have a strong influence in postcoiling outcome, and usually the aneurysms are packed as dense as possible. [6][7][8] Packing density is defined as the ratio between the inserted coils and aneurysm volume.…”

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confidence: 99%

How Do Coil Configuration and Packing Density Influence Intra-Aneurysmal Hemodynamics?

Morales¹,

Kim²,

Vivas³

et al. 2011

AJNR Am J Neuroradiol

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The Merits of Endovascular Coil Surgery for Patients with Unruptured Intracranial Aneurysms

Cited by 17 publications

References 18 publications

A Virtual Coiling Technique for Image-Based Aneurysm Models by Dynamic Path Planning

A Virtual Coiling Technique for Image-Based Aneurysm Models by Dynamic Path Planning

Treatment of cerebral aneurysms in children: analysis of the Kids' Inpatient Database

How Do Coil Configuration and Packing Density Influence Intra-Aneurysmal Hemodynamics?

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