Comparison of the Effects of Embolic Coils and a Low Porosity Stent on Cerebral Aneurysm Fluid Dynamics

2012 ◽  
Author(s):  
Haithem Babiker ◽  
Breigh Roszelle ◽  
L. Fernando Gonzalez ◽  
Felipe Albuquerque ◽  
Daniel Collins ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Cerebral Aneurysm ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
High Porosity ◽  
Period 2 ◽  
Incomplete Filling ◽  
The Stability ◽  
Embolic Coils ◽  
Wide Neck

Wide-neck cerebral aneurysms are difficult to treat with embolic coils. Concerns over the stability of coils within the aneurysmal sac often lead to incomplete filling of the sac, which may cause recurrence [1]. To overcome this challenge, clinicians may deploy a high porosity stent in a staged process to act as a supporting bridge for coils. The stent is commonly deployed 6–8 week prior to coil embolization, which lengthens the treatment period [2].

The Effects of High Porosity Stent Configurations on Cerebral Aneurysm Hemodynamics

2011 ◽  
Author(s):  
Haithem Babiker ◽  
Justin Ryan ◽  
L. Fernando Gonzalez ◽  
Felipe Albuquerque ◽  
Daniel Collins ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Aneurysm ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
High Porosity ◽  
Incomplete Filling ◽  
Aneurysmal Neck ◽  
Treatment For Cerebral Aneurysms ◽  
Wide Neck

Coil embolization is the most common endovascular treatment for cerebral aneurysms at many centers [1]. Nevertheless, the coiling of wide-neck aneurysms is a challenge. Incomplete filling of the aneurysmal sac due to coil configuration challenges and aneurysmal growth can often lead to recurrence. To assist treatment with coils, clinicians may deploy a high porosity stent in a staged process to act as a supporting bridge for coils. The stent is first deployed across the aneurysmal neck, and multiple coils are then deployed into the aneurysmal sac 6–8 weeks later [2]. Under certain circumstances, coil deployment is not possible and high porosity stents alone are used for treatment [2–3].

scholarly journals Lyophilizing thrombin powder-based treatment for hemostasis during coil embolization of ruptured cerebral aneurysm: Two case reports

2019 ◽  
Vol 25 (4) ◽  
pp. 454-459
Author(s):  
Changchun Jiang ◽  
Wei Wang ◽  
Baojun Wang ◽  
Yuechun Li ◽  
Guorong Liu ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Coil Embolization ◽  
Case Reports ◽  
Balloon Catheter ◽  
Treatment Strategies ◽  
Cerebral Aneurysms ◽  
Interventional Therapy ◽  
Parent Artery ◽  
Clinical Practices ◽  
Detachable Coils

Background Rupture of cerebral aneurysm is an inevitable complication during embolization, followed by subsequent acute subarachnoid hemorrhage or intracranial hematoma, and results in the aggravation of a patient’s condition. In particular, for patients who have had a ruptured aneurysm, urgent treatment strategies are required during operation. The most common hemostatic methods seen in clinical practices are as follows: after lowering the blood pressure, we continue to embolize the aneurysms with detachable coils as soon as possible or inject with Glubran/Onyx embolization liquids, as well as use a balloon catheter to temporarily block the blood supply. If the conditions are permissible, a balloon guiding catheter may even be used to restrict the proximal blood flow. At times, due to limitations of these methods, neurosurgeons are requested to perform craniotomy to treat the hemostasis. However, the delayed transition often leads to rapid deterioration of the patient’s condition and even death due to cerebral hernia. Case description We herein presented two cases of ruptured cerebral aneurysms to provide an alternative method for hemostasis and to save the lives of patients as much as possible. In an extremely urgent situation (conventional treatment is ineffective), we successfully saved the patient’s life by injecting lyophilizing thrombin powder (LTP) solution into the aneurysmal sac and the parent artery through a microcatheter. Conclusions To our knowledge, this is the first report of successful hemostasis during coil embolization of ruptured cerebral aneurysm with LTP. Further prospective studies are needed to confirm the safety and efficacy of LTP in cerebrovascular interventional therapy.

Comparison Among Different High Porosity Stent Configurations: Hemodynamic Effects of Treatment in a Large Cerebral Aneurysm

2014 ◽  
Vol 136 (2) ◽  
Author(s):  
Breigh N. Roszelle ◽  
Priya Nair ◽  
L. Fernando Gonzalez ◽  
M. Haithem Babiker ◽  
Justin Ryan ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computational Simulation ◽  
Cerebral Aneurysms ◽  
Post Treatment ◽  
Patient Specific ◽  
High Porosity ◽  
Velocity Magnitude ◽  
Large Patient ◽  
Aneurysm Model

Whether treated surgically or with endovascular techniques, large and giant cerebral aneurysms are particularly difficult to treat. Nevertheless, high porosity stents can be used to accomplish stent-assisted coiling and even standalone stent-based treatments that have been shown to improve the occlusion of such aneurysms. Further, stent assisted coiling can reduce the incidence of complications that sometimes result from embolic coiling (e.g., neck remnants and thromboembolism). However, in treating cerebral aneurysms at bifurcation termini, it remains unclear which configuration of high porosity stents will result in the most advantageous hemodynamic environment. The goal of this study was to compare how three different stent configurations affected fluid dynamics in a large patient-specific aneurysm model. Three common stent configurations were deployed into the model: a half-Y, a full-Y, and a crossbar configuration. Particle image velocimetry was used to examine post-treatment flow patterns and quantify root-mean-squared velocity magnitude (VRMS) within the aneurysmal sac. While each configuration did reduce VRMS within the aneurysm, the full-Y configuration resulted in the greatest reduction across all flow conditions (an average of 56% with respect to the untreated case). The experimental results agreed well with clinical follow up after treatment with the full-Y configuration; there was evidence of thrombosis within the sac from the stents alone before coil embolization was performed. A computational simulation of the full-Y configuration aligned well with the experimental and in vivo findings, indicating potential for clinically useful prediction of post-treatment hemodynamics. This study found that applying different stent configurations resulted in considerably different fluid dynamics in an anatomically accurate aneurysm model and that the full-Y configuration performed best. The study indicates that knowledge of how stent configurations will affect post-treatment hemodynamics could be important in interventional planning and demonstrates the capability for such planning based on novel computational tools.

Influence of Stent Configuration on Cerebral Aneurysm Fluid Dynamics

2010 ◽  
Author(s):  
Haithem Babiker ◽  
L. Fernando Gonzalez ◽  
Felipe Albuquerque ◽  
Daniel Collins ◽  
Arius Elvikis ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Treatment Option ◽  
Treatment Options ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Invasive Technique ◽  
Surgical Clipping ◽  
The Past ◽  
Alternative Treatment Option ◽  
Wide Neck

Treatment options for cerebral aneurysms have drastically evolved in the last decade. In the past, surgical clipping through craniotomy was the predominant treatment option for cerebral aneurysms. Presently, endovascular coiling, a minimally invasive technique, has superseded clipping in many centers [1]. However, the coiling of wide-neck aneurysms is still a challenge [2]. Complete aneurysmal occlusion is often impossible [3]. Recently, stand-alone stents have been explored as an alternative treatment option for wide-neck aneurysms [4].

Abstract 1122‐000063: Postoperative Recanalization Factors of Coil Embolization for Cerebral Aneurysms with Comparable Volume Embolization Ratio

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Hayato Uchikawa ◽  
Hiroyuki Takao ◽  
Soichiro Fujimura ◽  
Yuya Uchiyama ◽  
Yuma Yamanaka ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Aneurysm ◽  
High Velocity ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Mean Value ◽  
Morphological Parameters ◽  
Hemodynamic Parameters ◽  
Concentrated Flow ◽  
Coil Shape

Introduction : Volume embolization ratio (VER) has been reported to be involved in postoperative recanalization of coil embolization. However, despite comparable VER, some cases remained stable, and the others showed recanalization. Hemodynamic and morphological factors, as described in previous studies, may also influence recanalization in addition to VER. In this study, we focused on cerebral aneurysms treated by coil embolization with comparable VER. Blood flow analysis using computational fluid dynamics (CFD) and geometrical measurements were performed to investigate the recanalization factors. Methods : We focused on the aneurysms that underwent coil embolization with 15–20% VER. The criteria for the case selection were that the size of the aneurysms was 5–10 mm and that the aneurysm was treated by only coil (i.e., the stent‐assisted cases were excluded). Aneurysms that recanalized after coil embolization and underwent additional coil deployment were defined as “recanalized”, and aneurysms that remained stable after coil embolization without coil compaction were defined as “stable”. Finally, we selected 7 recanalized cases (ICA: 1, MCA: 3, ACA: 3) and 18 stable cases (ICA: 6, MCA: 3, ACA: 9). CFD analysis and morphometry were performed on the vessel geometry after coil embolization. The coil shape was modeled by the virtual coil technique. We calculated three morphological parameters and 34 hemodynamic parameters, then we compared them between the recanalized and stable cases using the Mann‐Whitney U test to identify recanalization factors. In addition, we reconstructed the coil shape from medical images and compared its structure and flow characters for stable and recanalized cases. Results : The average VER for the cases analyzed in this study were 16.7% for recanalized cases and 17.7% for stable cases. As hemodynamic parameters, the spatially averaged velocity normal to the neck plane into the cerebral aneurysm ( NV neck ), and the ratio of the area where blood flows into the cerebral aneurysm after the coil embolization to the area of the neck surface (inflow area ratio: IAR) showed significant difference. Although the hemodynamic parameters were significantly different, morphological parameters did not show statistically significance. In the recanalized case, NV neck tended to be higher (mean value, recanalized: 0.931, stable: 0.822, P < 0.05), and IAR tended to be lower (mean value, recanalized: 0.319, stable: 0.408, P < 0.01). The high NV neck and low IAR indicate that the aneurysm had concentrated flow with a high velocity at the neck surface. There was the concentrated blood flow with the high velocity that collided with the modeled coil in a CFD result for the recanalized case. The area where the blood flow impinged on the modeled coil coincided with the compacted coil region reconstructed from medical images. Therefore, a large force on the coil indicated by these hemodynamic parameters may cause the postoperative recanalization. Conclusions : Even with the same level of VER, there was a possibility of recanalization in aneurysms with a high velocity and concentrated flow into the aneurysm. It is necessary to consider not only VER but also hemodynamic factors to investigate recanalization factors after the coil embolization.

scholarly journals A new combined parameter predicts re-treatment for coil-embolized aneurysms: a computational fluid dynamics multivariable analysis study

2017 ◽  
Vol 10 (8) ◽  
pp. 791-796 ◽  
Author(s):  
Soichiro Fujimura ◽  
Hiroyuki Takao ◽  
Takashi Suzuki ◽  
Chihebeddine Dahmani ◽  
Toshihiro Ishibashi ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Blood Flow ◽  
Coil Embolization ◽  
Multivariable Analysis ◽  
Cerebral Aneurysms ◽  
Clinical Information ◽  
Patient Specific ◽  
Slight Reduction ◽  
Clinical Parameters ◽  
Basic Fluid

PurposeCoil embolization is a minimally invasive method used to treat cerebral aneurysms. Although this endovascular treatment has a high success rate, aneurysmal re-treatment due to recanalization remains a major problem of this method. The purpose of this study was to determine a combined parameter that can be useful for predicting aneurysmal re-treatment due to recanalization.MethodsPatient-specific geometries were used to retrospectively analyze the blood flow for 26 re-treated and 74 non-retreated aneurysms. Post-operatively aneurysms were evaluated at 12-month follow-up. The hemodynamic differences between the re-treatment and non-retreatment aneurysms were analyzed before and after coil embolization using computation fluid dynamics. Basic fluid characteristics, rates of change, morphological factors of aneurysms and patient-specific clinical information were examined. Multivariable analysis and logistic regression analysis were performed to determine a combined parameter—re-treatment predictor (RP).ResultsAmong examined hemodynamic, morphological, and clinical parameters, slight reduction of blood flow velocity rate in the aneurysm, slight increase of pressure rate at the aneurysmal neck and neck area, and hypertension were the main factors contributing to re-treatment. Notably, hemodynamic parameters between re-treatment and non-retreatment groups before embolization were similar: however, we observed significant differences between the groups in the post-embolization average velocity and the rate of reduction in this velocity in the aneurysmal dome.ConclusionsThe combined parameter, RP, which takes into consideration hemodynamic, morphological, and clinical parameters, accurately predicts aneurysm re-treatment. Calculation of RP before embolization may be able to predict the aneurysms that will require re-treatment.

scholarly journals Risk factors for coil protrusion into the parent artery and associated thrombo-embolic events following unruptured cerebral aneurysm embolization

2015 ◽  
Vol 21 (2) ◽  
pp. 178-183 ◽  
Author(s):  
Hideaki Ishihara ◽  
Shoichiro Ishihara ◽  
Jun Niimi ◽  
Hiroaki Neki ◽  
Yoshiaki Kakehi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Flow ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Operation Time ◽  
Vascular Reconstruction ◽  
Parent Artery ◽  
Unruptured Cerebral Aneurysm ◽  
Aneurysm Embolization ◽  
Wide Neck

Objective Advances in vascular reconstruction devices and coil technologies have made coil embolization a popular and effective strategy for treatment of relatively wide-neck cerebral aneurysms. However, coil protrusion occurs occasionally, and little is known about the frequency, the risk factors and the risk of thrombo-embolic complications. Method We assessed the frequency and the risk factors for coil protrusion in 330 unruptured aneurysm embolization cases, and examined the occurrence of cerebral infarction by diffusion-weighted magnetic resonance imaging (DW-MRI). Result Forty-four instances of coil protrusion were encountered during coil embolization (13.3% of cases), but incidence was reduced to 33 (10% of cases) by balloon press or insertion of the next coil. Coil protrusion occurred more frequently during the last phase of the procedure, and both a wide neck (large fundus to neck ratio) (OR = 1.84, P = 0.03) and an inadequately stable neck frame (OR = 5.49, P = 0.0007) increased protrusion risk. Coil protrusions did not increase the incidence of high-intensity lesions (infarcts) on DW-MRI (33.3% vs 29% of cases with no coil protrusion). However, longer operation time did increase infarct risk ( P = 0.0003). Thus, tail or loop type coil protrusion did not increase the risk of thrombo-embolic complications, if adequate blood flow was maintained. Conclusion Coil protrusion tended to occur more frequently in cases of wide-neck aneurysms with loose neck framing. Moderate and less coil protrusion carries no additional thrombo-embolic risk, if blood flow is maintained, which can be aided by additional post-operative antiplatelet therapy.

NEUROFORM STENT-ASSISTED COIL EMBOLIZATION OF WIDE-NECK INTRACRANIAL ANEURYSMS

Neurosurgery ◽  
2007 ◽  
Vol 61 (3) ◽  
pp. 460-469 ◽  
Author(s):  
Alessandra Biondi ◽  
Vallabh Janardhan ◽  
Jeffrey M. Katz ◽  
Kimberly Salvaggio ◽  
Howard A. Riina ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Effective Technique ◽  
Stent Deployment ◽  
Unruptured Aneurysms ◽  
Aneurysm Occlusion ◽  
Neuroform Stent ◽  
Wide Neck

Abstract OBJECTIVE To evaluate the midterm results of intracranial stent-assisted coil embolization in the treatment of wide-necked cerebral aneurysms and to assess the efficacy of various strategies used in stent deployment. METHODS A retrospective study of 42 patients with 46 wide-necked cerebral aneurysms enrolled in a prospective single-center registry of patients treated with a Neuroform stent (Boston Scientific/Target, Fremont, CA), a flexible self-expanding nitinol stent, was performed. Twenty-seven of 46 aneurysms were unruptured aneurysms, 14 were recanalized aneurysms, and five were acutely ruptured. Thirty-nine aneurysms were located in the anterior and seven in the posterior circulation. Mean aneurysm size was 9.8 mm. Stenting before coiling was performed in 13 of 45 aneurysms (29%), coiling before stenting in 27 of 45 aneurysms (60%), and stenting alone in five of 45 aneurysms (11%). The balloon remodeling technique for coiling before stenting was performed in 77% of patients. Angiographic and clinical follow up was available in 31 patients with 33 aneurysms and ranged from 3 to 24 months. RESULTS Neuroform stenting was attempted in 46 wide-necked aneurysms (42 patients). Forty-nine stent sessions were performed, including three poststent retreatments. In 46 of 49 sessions (94%), successful deployment of 47 stents for 45 aneurysms was obtained. In 40 aneurysms treated with stent-assisted coiling, angiographic results showed 14 (35%) aneurysm occlusions, 18 (45%) neck remnants, and eight (20%) residual aneurysms. In five recanalized aneurysms treated with stenting alone, no changes were observed in four (80%) aneurysms and one (20%) neck remnant reduced in size. At angiographic follow-up in 30 aneurysms treated with stent-assisted coiling, there were 17 (57%) aneurysm occlusions, seven (23%) neck remnants, and six (20%) residual aneurysms. In three recanalized aneurysms treated with stent alone, two (67%) neck remnants remained unchanged and one (33%) neck remnant decreased in size. Procedural morbidity was observed in two of 42 patients (4.8%) and one patient died. On clinical follow-up, the modified Rankin Scale score was 0 in 27 patients (87%), 1 in three patients (10%), and 2 (3%) in one patient. No aneurysm bled during the follow-up period. CONCLUSION These results indicate that Neuroform stent-assisted coil embolization is a safe and effective technique in the treatment of wide-necked cerebral aneurysms. Further studies are needed to evaluate the long-term durability of stent-assisted aneurysm occlusion and tolerance to the stent.

scholarly journals Applications and Roles of Coil Embolization and/or Clipping in the Treatment of Cerebral Aneurysm

2006 ◽  
Vol 12 (1_suppl) ◽  
pp. 77-85 ◽  
Author(s):  
E. Sato ◽  
Y. Konishi ◽  
A. Shimada ◽  
K. Komatsubara ◽  
H. Yazaki ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Coil Embolization ◽  
Treatment Modality ◽  
Cerebral Aneurysms ◽  
Selection Of

We retrospectively analysed to demonstrate the selection of the treatment modality and its efficacy in our department. Subjects of the present study comprised patients in whom coil embolization was abandoned due to such reasons as broad neck, whom coil embolization was performed for residual aneurysm following incomplete clipping or recurrent cerebral aneurysm, whom coil embolization was performed after coil compaction, whom coil embolization and clipping were performed for the treatment of multiple cerebral aneurysms. In the treatment of cerebral aneurysm, selecting proper techniques by considering the characteristics of clipping and coil embolization is desirable. In other words, strategizing therapy by taking advantages of the merits of clipping and coil embolization is important.

scholarly journals Radiation-Induced Cerebral Aneurysm Treated with Endovascular Coil Embolization

2014 ◽  
Vol 20 (4) ◽  
pp. 448-453 ◽  
Author(s):  
Hiroaki Matsumoto ◽  
Hiroaki Minami ◽  
Ikuya Yamaura ◽  
Yasuhisa Yoshida
Keyword(s):  
Cerebral Aneurysm ◽  
Coil Embolization ◽  
Endovascular Procedures ◽  
Cerebral Aneurysms ◽  
Left Internal Carotid Artery ◽  
Risk Of Rupture ◽  
Radiation Induced ◽  
Endovascular Coil Embolization ◽  
Pineal Germinoma ◽  
Small Aneurysms

Radiation-induced cerebral aneurysms are rare. We describe a case of radiation-induced cerebral aneurysm successfully treated with endovascular coil embolization. A 39-year-old man received 60 Gy of radiation to a pineal germinoma at eight years old. The left internal carotid artery (ICA) aneurysm which developed within the irradiated field and stenotic change in the left ICA due to radiation-induced vasculopathy were detected incidentally. Because these aneurysms show a high risk of rupture and mortality, and even small aneurysms are prone to rupture, any such suspected aneurysm should be treated with surgical or endovascular procedures. Endovascular treatment is probably useful if the aneurysm is inaccessible to direct surgery. Special attention must be paid to treatment because of stenotic changes in cerebral vessels within the irradiated field.

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