Transvenous Aneurysm Sac and Rupture Point Coil Embolization of Direct Carotid Cavernous Fistula after Pipeline Embolization

Oishi, Hidenori; Teranishi, Kosuke; Yatomi, Kenji; Yamamoto, Munetaka; Arai, Hajime

doi:10.2176/nmccrj.cr.2017-0102

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…The first patient among those was reported in the literature. 12) Two patients suffered from remote intraparenchymal hemorrhage, one patient developed a large ipsilateral frontal lobe hematoma on the day after the procedure. One of the causes was thought to be excessive platelet inhibition because of the patient’s four reaction units for clopidogrel and 584 for aspirin (The VerifyNow System, Accumetrics) at the onset.…”

Section: Resultsmentioning

confidence: 99%

Flow Diverter Therapy Using a Pipeline Embolization Device for 100 Unruptured Large and Giant Internal Carotid Artery Aneurysms in a Single Center in a Japanese Population

Oishi

Teranishi

Yatomi

et al. 2018

Neurol. Med. Chir.(Tokyo)

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Flow diverters (FDs) have been developed for intracranial aneurysms difficult to treat with conventional endovascular therapy and surgical clipping. We reviewed 94 patients with 100 large or giant unruptured internal carotid artery (ICA) aneurysms treated with Pipeline embolization device (PED) embolization from December 2012 to June 2017 at Juntendo University Hospital. The patients’ mean age was 63.4 years (range, 19–88), and there were 90 women 89.4%. Aneurysm locations were: C4 (45), C3 (4), and C2 (51) in ICA segments. Mean aneurysm size and neck width were 16.9 ± 6.8 mm and 8.3 ± 4.4 mm, respectively, in 40 symptomatic and 60 asymptomatic aneurysms. Follow-up catheter angiographies of 85 patients with 90 aneurysms showed no filling in 62 aneurysms (68.9%), entry remnant in 16 (17.8%), subtotal filling in 11 (12.2), and total filling in 1 (1.1%) with a mean follow-up of 10.2 ± 5.6 months. In-stent stenosis occurred in 1 patient and parent artery occlusion in 2 during follow-up. Hemorrhagic complications occurred in 4 (4.3%): delayed aneurysm rupture (2) and intraparenchymal hemorrhage (2). Ischemic complications with neurological symptoms occurred in 2 (2.1%): very delayed device occlusion (1) and intraprocedural distal embolism (1). Eighteen patients (45%) showed improvement in pre-existing cranial nerve dysfunction because of the aneurysm’s mass effect, 3 patients (7.5%) worsened. One patient died of systemic organ failure unassociated with the procedure. Morbidity and mortality rates were 4.3% and 1.1%, respectively. PED embolization for unruptured large and giant ICA aneurysms is safe and efficacious. Physicians should be observant of characteristic risks associated with FD therapy.

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Section: Resultsmentioning

confidence: 99%

Flow Diverter Therapy Using a Pipeline Embolization Device for 100 Unruptured Large and Giant Internal Carotid Artery Aneurysms in a Single Center in a Japanese Population

Oishi

Teranishi

Yatomi

et al. 2018

Neurol. Med. Chir.(Tokyo)

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“…Case 2 with carotid cavernous fistula caused by delayed aneurysm rupture was treated by transvenous aneurysmal embolization (Figure 2). 4,34 Only one case (Case 3) of the anticoagulant group with additional coiling did not suffer postoperative delayed aneurysm rupture, and achieved complete obliteration at the final follow up. Flow diverter placement with additional coiling or parent artery occlusion if tolerated will be effective for the prevention of aneurysm rupture and minimize complications.…”

Section: Discussionmentioning

confidence: 96%

Outcome of flow diverter placement for intracranial aneurysm with dual antiplatelet therapy and oral anticoagulant therapy

et al. 2020

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Purpose Antiplatelet therapy initiated before flow diverter placement is effective for the prevention of ischemic complications. However, the effectiveness of oral anticoagulant treatment is unclear. This retrospective study evaluated the complications and obliteration rates after flow diverter placement in patients taking anticoagulants. Methods A total of 155 cases were treated by Pipeline Flex placement for unruptured large and giant cerebral aneurysms in our hospital between October 2015 and June 2019. The groups of 8 patients taking anticoagulants before operation and 147 patients not taking anticoagulants were compared. Results Clopidogrel oral dose ( P = 0.002) was significantly lower in the anticoagulant group. Delayed aneurysm rupture ( P = 0.002) and additional treatment ( P = 0.009) rates were significantly higher and complete obliteration rate ( P = 0.011) was lower in the anticoagulant group. Conclusions Additional oral anticoagulant administration before flow diverter placement does not reduce ischemic complications compared to dual antiplatelet therapy, but does increase hemorrhagic complications, especially delayed aneurysm rupture. Complete obliteration of the cerebral aneurysm is difficult to achieve in patients taking anticoagulants.

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“…Finally, 36 articles reporting on 60 patients were included in the final analysis (Table 1). 8 , 11–45 The flowchart of searching strategy is illustrated in Figure 1. The patients were aged from 29 to 86 (55.31 ± 13.98) ( n = 42) years, with a male to female ratio of 1:3 (11:33).…”

Section: Resultsmentioning

confidence: 99%

“…And embolization of the cavernous sinus via transarterial approach is always impossible. 38 , 39 Hence, transvenous approach is the preferred route. But attention should be paid to the possibility of cranial nerve palsy by mass effect of coils.…”

Section: Discussionmentioning

confidence: 99%

Delayed rupture of intracranial aneurysms after placement of intra-luminal flow diverter

Hou

et al. 2020

Neuroradiol J

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Background Though flow diverter is a safe and efficient modality, some patients can experience delayed aneurysmal rupture. The mechanism of delayed rupture is still obscure to us. Methods We performed a systematic search in the PubMed database for patients with delayed rupture of intracranial aneurysms after flow diverter placement. Results A total of 36 articles reporting on 60 patients were included in the final analysis. Of the 49 patients with description of presenting symptoms, six (12.2%) patients were incidentally diagnosed, 39 (87.8%) patients were admitted for aneurysmal rupture or mass effect. Multiple flow diverters were used in 38.3% (18/47) of the patients. Coil assistance was applied in 13.0% (7/54) of the patients. Delayed aneurysmal rupture led to intracranial hemorrhage or carotid–cavernous sinus fistula (CCF) in 76.8% (43/56) and 23.2% (13/56) of the patients, respectively. Of the 55 patients with description of outcome, 14 (25.5%) patients achieved good recovery, one (1.8%) patient was severely disabled, 40 (72.7%) patients died. All of the patients in the CCF group survived and experienced good recovery. Conclusion Increased intra-aneurysmal pressure, destabilization of the aneurysm wall by intra-aneurysmal thrombus, persistent residual intra-aneurysmal flow, characteristics of the specific aneurysm, and mechanical injury by the flow diverter might conjointly contribute to the final delayed rupture. There has been no established preventive measure to decrease the incidence of delayed rupture yet. The treatment and outcome depend on the presentation of delayed rupture. Patients presenting with aneurysm-related intracranial hemorrhage have a dismal outcome. Those presenting with CCFs usually have a satisfactory recovery.

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Transvenous Aneurysm Sac and Rupture Point Coil Embolization of Direct Carotid Cavernous Fistula after Pipeline Embolization

Cited by 7 publications

References 21 publications

Flow Diverter Therapy Using a Pipeline Embolization Device for 100 Unruptured Large and Giant Internal Carotid Artery Aneurysms in a Single Center in a Japanese Population

Flow Diverter Therapy Using a Pipeline Embolization Device for 100 Unruptured Large and Giant Internal Carotid Artery Aneurysms in a Single Center in a Japanese Population

Outcome of flow diverter placement for intracranial aneurysm with dual antiplatelet therapy and oral anticoagulant therapy

Delayed rupture of intracranial aneurysms after placement of intra-luminal flow diverter

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