The place for remodeling technique and stenting in the endovascular management of intracranial aneurysms: a single-center analysis from 2008 to 2010

Piérot, Laurent; Rajpal, Girish; Kądziołka, Krzysztof; Barbe, Coralie

doi:10.1007/s00234-011-0975-7

Cited by 8 publications

(13 citation statements)

References 21 publications

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“…. 40 This study also showed that BAC was used in both ruptured and unruptured aneurysms of all locations as frequently and in aneurysms with small neck and large neck. However, it was more frequently used in aneurysms with unfavorable dome-to-neck ratio (≤1.5).…”

Section: Balloon-assisted Coilingmentioning

confidence: 58%

Endovascular Treatment of Intracranial Aneurysms

Piérot

Wakhloo

2013

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2046I n a recent systematic review and meta-analysis, the overall prevalence of unruptured intracranial aneurysms (IAs) is estimated as 3.2%. 1 The prevalence of IAs is higher in patients with autosomal dominant polycystic kidney disease or a positive family history of IAs of subarachnoid hemorrhage (SAH).1 From the same review, the size of unruptured IAs is <5 mm in 66%, 5 to 9 mm in 27%, and ≥10 mm in 7%; the site of IAs is internal carotid artery, including posterior communicating artery in 42%, middle cerebral artery in 35%, and anterior cerebral artery and anterior communicating artery in 18%.Most IAs are clinically silent until rupture, which is unpredictable and sometimes associated with SAH, intraparenchymal hematoma, and an intraventricular hemorrhage. The case fatality of IA rupture is high (from 27% to 44%), but has decreased during the past 3 decades because of the introduction of improved management strategies, including neurocritical care.2 The International Study of Unruptured Intracranial Aneurysms (ISUIA) showed an increased risk of IA rupture with aneurysm size and for posterior circulation aneurysms. Although treatment of a ruptured aneurysm is accepted as an emergency, indication for treatment of unruptured IAs is still being discussed. Decision for treatment is based on clinical and anatomic factors; among them, the most important being patient's age, family history of IA(s), associated conditions (autosomal dominant polycystic kidney disease), symptomatic aneurysms, aneurysm size, and location. The randomized International Subarachnoid Aneurysm Trial (ISAT) study has clearly demonstrated the superiority of endovascular treatment (EVT) of ruptured aneurysms using coil technology over surgery. 4 Since the publication of these results, EVT has rapidly evolved. Although for unruptured aneurysms a direct comparison between EVT and surgery is not available, EVT has been widely used in this subgroup as well. 5In fact the population presenting with IAs is quite heterogeneous, regarding their status at presentation (ruptured versus unruptured), aneurysm shape (fusiform versus saccular) and location (aneurysm geometry in relationship to parent artery), their size (small/large/giant), the size of their neck (small/ large), and other factors. The heterogeneity illustrates that various approaches have to be considered to treat all types of IAs by EVT. During the past >2 decades, different therapeutic modalities were developed for EVT of IAs, and the goal of the present review is to describe them and to analyze their role in the management of IAs. CoilingEVT of IAs was introduced by use of detachable latex balloons and pushable coils. Because their use was cumbersome and associated with high incidence of periprocedural complications, they were applied in a relatively limited number of patients who were difficult to treat with standard surgery. The development of coils with controlled detachable system was clearly the first important step for widespread use of EVT. 6,7 Initial large series showed accepta...

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Section: Balloon-assisted Coilingmentioning

confidence: 58%

Endovascular Treatment of Intracranial Aneurysms

Piérot

Wakhloo

2013

Stroke

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233

153

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“…The introduction of intracranial stents allows interventionists to treat aneurysms formerly unsuitable for endovascular treatment. However, the use of intracranial stents necessitates the administration of antiplatelet agents after stent placement 2,4,17,22,27 . In acutely ruptured aneurysms a higher rate of thromboembolic events is assumed as after aneurysm occlusion in stent assisted procedures 2 .…”

Section: Introductionmentioning

confidence: 99%

“…During endovascular coiling, the administration of heparin may be necessary to prevent thromboembolic complications and sometimes additional anticoagulation is indicated even after the procedure 1,22,23,29 . The introduction of intracranial stents allows interventionists to treat aneurysms formerly unsuitable for endovascular treatment.…”

Section: Introductionmentioning

confidence: 99%

“…Endovascular techniques have gained importance in the treatment of acutely ruptured aneurysms over the last years as technical advances have improved their safety and effectiveness 1,4,7,12,15,19,22,23 . During endovascular coiling, the administration of heparin may be necessary to prevent thromboembolic complications and sometimes additional anticoagulation is indicated even after the procedure 1,22,23,29 .…”

Section: Introductionmentioning

confidence: 99%

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Ventriculostomy-Related Hemorrhage After Treatment of Acutely Ruptured Aneurysms: The Influence of Anticoagulation and Antiplatelet Treatment

et al. 2015

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“…This has made the use of BACE a more prevalent and preferable approach by clinicians in the last several years to treat wide-necked intracranial aneurysms [3,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21]. Balloons have also been shown to help in the tamponade of the vessel in case of intraoperative perforation [22,23] and are also used for occlusion testing before sacrifice of the vessel.…”

Section: Introductionmentioning

confidence: 99%

Early Experience with the TransForm™ Occlusion Balloon Catheter: A Single-Center Study

et al. 2014

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Background and Objective: Balloon-assisted coil embolization has become an important adjunct in the endovascular treatment of intracranial aneurysms. The management of broad-necked cerebral aneurysms is technically perplexed due to a variety of factors, which include the difficulty in defining the aneurysm-parent vessel interface angiographically and problems in achieving complete aneurysmal occlusion. This could later predispose to regrowth or recanalization. We sought to determine the safety and efficacy of the TransForm™ occlusion balloon catheter (TOBC) for the coiling of intracranial aneurysms at our institute. Methods: A retrospective review was performed to identify TOBC cases between May 1, 2013, and April 30, 2014. Results: A total of 24 TOBC cases were identified. In 23 cases, the TOBC was used for balloon-remodeled coil embolization, and in 1 case, it was used for vasospasm treatment alone. Out of the total 24 cases in which the TOBC was used, 16 (66.6%) were ruptured aneurysms. Stents were used in 6/23 (26%) cases. In all cases, the balloon could be placed as intended. The inflation and deflation times ranged from 3 to 4 s. No serious complications were noted. In the experience of the authors, the balloon performed the intended role in most cases. Conclusions: This series shows that the TOBC is feasible, safe and useful in the treatment of cerebral aneurysms. The balloon was traceable to the intended site and the preparation, inflation and deflation times were short. We believe that the TOBC has effective utility in treating broad-necked and small aneurysms.

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The place for remodeling technique and stenting in the endovascular management of intracranial aneurysms: a single-center analysis from 2008 to 2010

Abstract: In the endovascular management of intracranial aneurysms, the large use of the remodeling technique combined with stenting in selected cases enables a low rate of treatment failures without increasing the rate of complications.

Cited by 8 publications

References 21 publications

Endovascular Treatment of Intracranial Aneurysms

Endovascular Treatment of Intracranial Aneurysms

Ventriculostomy-Related Hemorrhage After Treatment of Acutely Ruptured Aneurysms: The Influence of Anticoagulation and Antiplatelet Treatment

Early Experience with the TransForm™ Occlusion Balloon Catheter: A Single-Center Study

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