Y-stent assisted coiling of ruptured wide neck intracranial aneurysm in the acute phase

2021 ◽  
pp. 159101992110053
Author(s):  
İsmail Okan Yıldırım ◽  
Mehmet Kolu ◽  
Mehmet Akif Durak ◽  
Bora Tetik ◽  
Ramazan Paşahan ◽  
...  
Keyword(s):  
Acute Phase ◽  
Clinical Condition ◽  
Demographic Data ◽  
Severe Disabilities ◽  
Technical Failure ◽  
Total Occlusion ◽  
Class 1 ◽  
Good Clinical Condition ◽  
Wide Neck

Background The objective of the present study is to analyze the outcomes of patients with subarachnoid hemorrhage (SAH) in the acute phase after treatment with Y-stent-assisted coiling (YSAC) embolization. Methods This retrospective study assessed of 30 patients with acutely ruptured wide-neck aneurysms following YSAC treatment between April 2013 and October 2019. The demographic data, aneurysm occlusion grade, procedural and periprocedural complications, and clinical outcomes were assessed. Results The procedure was completed in 30 cases (90.1%) and technical failure occurred in 3 cases (9.1%). Immediate control angiography revealed that total occlusion Raymond-Ray Class 1 (RR1) was achieved in 21 (70%), neck filling (RR2) in eight (26.6%) and sac filling (RR1) in one (3.3%) aneurysm. Upon angiographic follow-up, RR1 occlusion was observed in 15 (71.4%) patients, RR2 in three (14.3%) patients and RR3 in three (14.3%) patients. In-stent thrombus developed in five (16.6%) patients; procedural ischemic events were observed in four (13.3%) patients; and two (6.6%) patients were symptomatic. A periprocedural asymptomatic intracranial hemorrhage was detected in two patients. At discharge, 17 (56.6%) patients were in good clinical condition, six (20%) were in a severe disability condition, and seven (23.3%) patients had died. At the final follow-up visit (mean: 18.9 months), 16 (76,2%) of 21 patients were in a good clinical condition and five (23.8%) had severe disabilities. Conclusions Y-stent assisted coiling in might be a feasible and promising option for treatment in acute phase in selected wide-necked ruptured intracranial aneurysms.

One-year Angiographic Results After pCONus Stent-Assisted Coiling of 40 Wide-Neck Middle Cerebral Artery Aneurysms

Neurosurgery ◽  
2017 ◽  
Vol 80 (6) ◽  
pp. 925-933 ◽  
Author(s):  
Benjamin Gory ◽  
Marta Aguilar-Pérez ◽  
Elisa Pomero ◽  
Francis Turjman ◽  
Werner Weber ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Endovascular Coiling ◽  
Total Occlusion ◽  
Complete Occlusion ◽  
Neck Size ◽  
Clinical Complications ◽  
Middle Cerebral Artery Aneurysms ◽  
Wide Neck

Abstract BACKGROUND: Bifurcation middle cerebral artery (MCA) aneurysms with wide neck are amenable to endovascular coiling with pCONus stent, a recent device dedicated to wide-neck bifurcation intracranial aneurysms. OBJECTIVE: To evaluate the 1-year angiographic follow-up of wide-neck MCA aneurysms treated with pCONus. METHODS: Forty MCA aneurysms (mean dome size, 7.7 mm; mean neck size, 5.6 mm) coiled with pCONus were retrospectively evaluated. “Recanalization” was defined as worsening, and “progressive thrombosis” was defined as improvement on the Raymond scale. RESULTS: Angiographic midterm (mean, 11.9 months; range, 3-20) follow-up was obtained in all aneurysms. Retreatment was performed in 9 aneurysms (22.5%) without clinical complications, and postoperative angiographic outcome included 2 complete occlusions and 7 neck remnants. Six aneurysms were followed after retreatment (mean, 8.8 months), and presented complete occlusion in 1 case, neck remnant in 4 cases, and aneurysm remnant in 1 case. Among the 31 aneurysms, follow-up showed complete occlusion in 67.7% (21/31), neck remnants in 29% (9/31), and aneurysm remnants in 3.3% (1/31). Adequate aneurysm occlusion (total occlusion and neck remnant) was obtained in 96.7% (30/31). Among these 31 aneurysms, improvement of the rate of occlusion was observed in 15 aneurysms (48.4%), and recurrence in 2 aneurysms (6.5%). There was no 1-year angiographic recurrence of 3- or 6-month totally occluded aneurysms. CONCLUSION: pCONus stent allows a safe coiling of wide-neck MCA aneurysms usually considered as surgical with a low recanalization rate for those adequately occluded at 3 to 6 months. Angiographic results improve over time due to progressive aneurysm thrombosis in around 50% of cases.

scholarly journals Microstent-Assisted Coiling for Wide-Necked Intracranial Aneurysms

2005 ◽  
Vol 32 (1) ◽  
pp. 71-81 ◽  
Author(s):  
Marlise Peruzzo dos Santos Souza ◽  
Ronit Agid ◽  
Robert A. Willinsky ◽  
Michael Cusimano ◽  
Walter Montanera ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Neurological Complication ◽  
Posterior Circulation ◽  
Technical Failure ◽  
Anterior Circulation ◽  
Neck Size ◽  
Clinical Complications ◽  
Class 1

Objective:To describe the results, technical feasibility, efficacy and challenges encountered in our preliminary experience using a self-expandable microstent, optimized for intracranial use, as an adjunct in the endovascular treatment of wide-necked aneurysms.Methods:Only broad-necked aneurysms (dome-to-neck ratio £2, or an isolated neck size > 4.5 mm) were treated with Neuroform microstent from July 2003 to May 2004. The techniques used for stent deployment were either parallel or sequential. Angiographic results were recorded immediately for all patients and classified as Class 1 (complete occlusion), Class 2 (neck remnant) or Class 3 (sac remnant) by three interventional neuroradiologists not involved in the procedure. Follow-up angiography at six months was obtained for one case. Modified Rankin Score scale was assessed for all patients.Results:Seventeen intracranial aneurysms in a total of 18 patients were treated (mean age, 52.2 yr). Eight patients (44.4%) presented with acute subarachnoid hemorrhage. Eleven aneurysms (61.1%) were in the posterior circulation. Average dome size was 10.2 mm (range, 3.7-19.8 mm) and average neck size was 5.36 mm (range, 3.0-10.0 mm). Six out of seven aneurysms of the anterior circulation were approached with parallel technique. Eight aneurysms of the posterior circulation were approached with sequential technique. Average number of coils deployed was 9.64 (range, 4-23 coils). Eleven aneurysms (64.8%) resulted in Class 1 and/or Class 2. One technical failure was observed. Technical complications were recognized in four patients (23.5%), all of them with unruptured aneurysms in the anterior circulation. Two patients (11.7%) presented transient immediate clinical complications. One patient (5.8%) had minor permanent neurological complication. Neither major clinical complications nor death were encountered. Favorable clinical outcome (Modified Rankin Scale score 0-2) was observed in 88.2% of the patients (average follow-up time, 4.72 months).Conclusion:Absence of major permanent complications and satisfactory immediate obliteration degree in our preliminary experience indicates that microstent-assisted coiling technique is useful for the minimally invasive treatment of broad-necked complex aneurysms that are not ideal for conventional endovascular treatment and are at a high risk for conventional surgical treatment.

scholarly journals Arthroscopic Treatment of Septic Arthritis of the Elbow in a 4-Year-Old Girl

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Masashi Koide ◽  
Yuichi Tojo ◽  
Yoshihiro Hagiwara ◽  
Souichi Nakajima ◽  
Minoru Tanaka ◽  
...  
Keyword(s):  
Septic Arthritis ◽  
Clinical Condition ◽  
Arthroscopic Surgery ◽  
Arthroscopic Treatment ◽  
Joint Aspiration ◽  
Good Clinical Condition ◽  
Open Arthrotomy

Pediatric septic arthritis is uncommon and has been traditionally treated by joint aspiration or open arthrotomy. There are some reports about arthroscopic surgery in pediatric septic arthritis of the knee, hip, and shoulder. However, there is no report for the case of elbow. We report a case of pediatric septic arthritis of elbow treated with arthroscopically with good clinical condition at 3-year follow-up. This paper is based on a report first published in Japanese (Tojo (2012)).

scholarly journals Initial single centre experience with Barrel VRD stent in large neck aneurisms

2019 ◽  
pp. 127-134
Author(s):  
Cristian Mihalea ◽  
Felicia Otilia Humulescu ◽  
Hazem Abdelkhalek ◽  
Sorin Pescariu ◽  
Bogdan Valeriu Popa ◽  
...  
Keyword(s):  
Case Series ◽  
Design Feature ◽  
Flow Diverter ◽  
Technical Success ◽  
Total Occlusion ◽  
New Device ◽  
Single Centre Experience ◽  
Wide Neck ◽  
Large Neck

Introduction. Despite the use of new techniques, such as Y-stenting, the waffle-cone technique and intrasaccular flow disrupters the treatment of wide-neck bifurcation aneurysms is still challenging, especially for those where adjacent branches are arising at the neck level. Moreover, the use of flow diverter stents in bifurcation aneurysms has been proposed by several teams, although the results remain controversial.This study is reflecting initial experience in our department with a relatively new device available on the market: Barrel VRD stent. The unique design feature of the device is the “belly-like” central part of the stent which protects the adjacent branches.Methods. We retrospectively reviewed all patients in whom stenting with braided or laser-cut stents had been performed in our center. Three patients were identified and analyzed. Technical success, complications, immediate angiographic outcomes, procedural data, are reported here.Results. One MCA bifurcation and two basilar tip large neck aneurysms with one branch arising from the neck level have been identified. Technical success was achieved in all procedures. Overall procedure-related morbidity and mortality was 0%. In the immediate post-treatment angiography, adequate occlusion (neck remnant or total occlusion) was observed in all patients. Short- and mild-term follow-up angiography showed adequate occlusion of the aneurysms.Conclusions. In this small case series, retrospective single-center analysis we showed that Barrel VRD - stent assisted coiling is a safe and feasible technique. Moreover, it offers an elegant and effective endovascular solution for large neck basilar tip aneurysms on which the neurosurgical clipping remains challenging.

Endovascular WEB Flow Disruption in Middle Cerebral Artery Aneurysms

Neurosurgery ◽  
2013 ◽  
Vol 73 (1) ◽  
pp. 27-35 ◽  
Author(s):  
Laurent Pierot ◽  
Joachim Klisch ◽  
Christophe Cognard ◽  
Istvan Szikora ◽  
Benjamin Mine ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Preliminary Treatment ◽  
Short Term ◽  
Total Occlusion ◽  
Flow Disruption ◽  
Wide Neck ◽  
The Web

Abstract BACKGROUND: The endovascular treatment of middle cerebral artery (MCA) aneurysms with unfavorable anatomy (wide neck, unfavorable morphology) is frequently challenging. Flow disruption with the WEB is a potentially interesting endovascular treatment for this type of aneurysm. OBJECTIVE: To report in a multicenter series the preliminary treatment experience of MCA aneurysms with flow disruption by the WEB. METHODS: Thirty-three patients with 34 MCA aneurysms were treated with the WEB in 5 European centers. The ability to successfully deploy the WEB, procedure- and device-related adverse events, morbidity and mortality of the treatment, and short-term angiographic follow-up results were analyzed. RESULTS: Most treated aneurysms were unruptured (85.3%) and were between 5 and 10 mm (85.3%) with a neck size ≥ 4 mm (88.2%). The treatment failed in 1 of the 34 aneurysms (2.9%) owing to a lack of appropriate device size. Treatment was performed exclusively with the WEB in 29 of 33 aneurysms (87.9%). Additional treatment (coiling and/or stenting) was used in 4 of 33 aneurysms (12.1%). Mortality of the treatment was 0.0% and morbidity was 3.1% (intraoperative rupture with modified Rankin Scale score of 3 at the 1-month follow-up). In short-term follow-up (range, 2-12 months), adequate occlusion (total occlusion or neck remnant) was observed in 83.3% of aneurysms. CONCLUSION: WEB flow disruption seems to be a promising technique for the treatment of complex MCA aneurysms, particularly those with a wide neck or unfavorable dome-to-neck ratio.

Stenting as Monotherapy for Uncoilable Intracranial Aneurysms

2012 ◽  
Vol 73 (suppl_1) ◽  
pp. ons80-ons85 ◽  
Author(s):  
Ketan R. Bulsara ◽  
Gregory A. Kuzmik ◽  
Ryan Hebert ◽  
Vincent Cheung ◽  
Charles C. Matouk ◽  
...  
Keyword(s):  
Clinical Condition ◽  
Intracranial Aneurysms ◽  
Senior Author ◽  
Radiographic Outcomes ◽  
Effective Option ◽  
Good Clinical Condition ◽  
Aneurysm Occlusion ◽  
Flow Diverters

Abstract BACKGROUND: Small, blister-like aneurysms (BLAs), by virtue of their unique morphology, are difficult to treat with conventional modalities. The use of oversized self-expanding stents as monotherapy for BLAs is a relatively new and promising concept that warrants further investigation. OBJECTIVE: To clarify the role of oversized self-expanding stents as monotherapy for BLAs. METHODS: Five consecutive patients were treated for BLAs with oversized self-expanding stents alone by the senior author (K.R.B.). We report on their clinical and radiographic outcomes. RESULTS: All 5 patients in our series were discharged in good clinical condition. Complete aneurysm occlusion was observed in all patients at the time of most recent radiographic follow-up. Mean follow-up time was 13.6 months (range, 1 month to 4.5 years). CONCLUSION: The use of oversized self-expanding stents to redirect flow away from aneurysms is an effective option for patients with BLAs. This approach represents an alternative to the use of flow diverters.

scholarly journals Endovascular Treatment for Very Small Supraclinoid Aneurysms with Stent-Assisted Coiling

2009 ◽  
Vol 15 (1) ◽  
pp. 37-44 ◽  
Author(s):  
C. Fang ◽  
M-H. Li ◽  
P-L Zhang ◽  
W. Wang ◽  
H-Q. Tan ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Side Wall ◽  
Maximum Diameter ◽  
Endovascular Stent ◽  
Total Occlusion ◽  
Aneurysm Occlusion ◽  
Neuroform Stent ◽  
Wide Neck ◽  
Small Aneurysms

The endovascular treatment of very small aneurysms (lesions less than 3 mm in maximum diameter) with wide necks remains a challenge for saccular embolization. We retrospectively analyzed our data using Neuroform stent-assist-ed coiling for very small supraclinoid aneurysms with wide neck to evaluate the feasibility and efficacy of endovascular treatment of these lesions. We conducted a review of our experience and results of endovascular treatments in six patients with seven very small aneurysms. All aneurysms were located at the side wall of the supraclinoid segment of the ICA. They were ruptured in two patients and unruptured in four. The technique of stent-assisted coiling was used in all cases with coiling before stenting and additional coils after deployment of the stent in the same session. All patients were successfully embolized with stent-assisted coiling. The coils were introduced into the lumen for subtotal occlusion in five aneurysms and for partial occlusion in two. During one to two years follow-up angiography, all aneurysms were completely occluded and no recurrence occurred. No complications were observed. Endovascular stent-assisted coil embolization of supraclinoid very small aneurysms with wide necks is effective and feasible. Subtotal aneurysm occlusion might progress to total occlusion.

scholarly journals Microsurgical clipping and endovascular flow diversion of ruptured anterior circulation blood blister-like aneurysms

2018 ◽  
Vol 24 (6) ◽  
pp. 615-623 ◽  
Author(s):  
V Hellstern ◽  
M Aguilar-Pérez ◽  
M AlMatter ◽  
P Bhogal ◽  
E Henkes ◽  
...  
Keyword(s):  
Acute Phase ◽  
Clinical Symptoms ◽  
Demographic Data ◽  
Flow Diversion ◽  
Parent Vessel ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Microsurgical Clipping ◽  
Safety Margins

Background Detection and treatment of blister-like intracranial aneurysms as a source of subarachnoid hemorrhage (SAH) can be challenging. In the past the results of both microsurgical and endovascular treatment were difficult. We present our experience with the treatment of blister-like aneurysms in the acute phase of SAH using microsurgical clipping, endovascular parent vessel occlusion or flow diversion. Methods A retrospective analysis of the cases of eight consecutive patients presenting in the acute phase after SAH from an intracranial blister aneurysm was performed. The demographic data of the patients, aneurysm characteristics, the clinical results of the treatment and the follow-up examinations were recorded. Procedural safety margins and aneurysm occlusion on follow-up digital subtraction angiography were the main interest of this evaluation. Results Between January 2012 and November 2017 a total of eight ruptured blister aneurysms were treated in our center, six patients endovascularly. Five patients were treated in the acute phase of SAH, four by flow diversion. All endovascular procedures were feasible and no procedure-related complications were observed, especially no recurrent hemorrhage. In the first angiographic follow-up all blood blister-like aneurysms were completely occluded; two of the six patients treated by flow diverter implantation showed mild, transient intimal hyperplasia without clinical symptoms or the need for treatment. Conclusions Endovascular flow diversion is a viable option in the acute phase after SAH due to the rupture of a blister aneurysm. Implants with reduced thrombogenicity, obviating dual-platelet function inhibition, and flow diverters for vessel bifurcations would extend the indications for this treatment modality.

scholarly journals Stent-Assisted Coiling of Unruptured MCA Aneurysms Using the LVIS Jr. Device: A Multicenter Registry

2020 ◽  
Vol 9 (10) ◽  
pp. 3168
Author(s):  
Wojciech Poncyljusz ◽  
Łukasz Zwarzany ◽  
Bartosz Limanówka ◽  
Miłosz Zbroszczyk ◽  
Mariusz Banach ◽  
...  
Keyword(s):  
Study Patient ◽  
Total Occlusion ◽  
Patient Demographics ◽  
Post Procedure ◽  
Low Profile ◽  
Class 1 ◽  
The Mean ◽  
New Generation

Purpose: The low-profile visualized intraluminal support junior (LVIS Jr.) is a new generation low-profile braided stent. Our aim was to evaluate the safety and efficacy of the LVIS Jr. in the stent-assisted coiling of unruptured middle cerebral artery (MCA) aneurysms. This was a multicenter retrospective study. Patient demographics, aneurysm characteristics, procedural details, complications, and the results of clinical and imaging follow-up were analyzed. Four centers participated in the study. A total of 162 consecutive patients with 162 unruptured MCA aneurysms were included for the analysis. The mean aneurysm size was 7.6 mm (range 2 to 37 mm) and 97.5% were wide-necked. Immediate postprocedural angiograms showed Raymond-Roy class 1 in 118 (72.8%), class 2 in 23 (14.2%), and class 3 in 21 patients (13%). Periprocedural complications occurred in 14 patients (8.6%). There were no procedure-related deaths. Follow-up imaging at 12–18 months post-procedure showed Raymond–Roy class 1 in 132 (81.5%), class 2 in 17 (10.5%), and class 3 in 13 patients (8%). There were 3 cases of in-stent stenosis (1.9%). All 162 patients had good clinical outcome (mRS score 0–2) at 90 days post-procedure. Stent-assisted coiling of unruptured MCA aneurysms with the LVIS Jr. stent is safe and effective, with high immediate and long-term total occlusion rates.

Y-stent assisted coiling of bifurcation aneurysms with Enterprise stent: long-term follow-up

2014 ◽  
Vol 8 (2) ◽  
pp. 158-162 ◽  
Author(s):  
Nicola Limbucci ◽  
Leonardo Renieri ◽  
Sergio Nappini ◽  
Arturo Consoli ◽  
Andrea Rosi ◽  
...  
Keyword(s):  
Long Term Results ◽  
Technical Failure ◽  
Complete Occlusion ◽  
Long Term Stability ◽  
Single Center Experience ◽  
Long Term Follow Up ◽  
Occlusion Rate ◽  
Wide Neck

BackgroundY-stent assisted coiling has been proposed for the treatment of wide-neck bifurcation aneurysms, but there are many technical variations. We report our single-center experience of Y-stent assisted coiling of bifurcation aneurysms with the closed cell Enterprise stent in order to evaluate the safety and long-term results of this technique. The literature on Y-stenting and its hemodynamic effects are reviewed.MethodsFifty-two consecutive patients with wide-neck bifurcation aneurysms underwent Y-stent assisted coiling with two Enterprise stents. The procedure was completed in 48 cases (92.3%) and technical failure occurred in 4 cases (7.3%). Cases performed with other stents were excluded. All procedures were performed under double antiplatelet therapy. Periodic clinical and neuroradiological follow-up was performed.ResultsMean neuroradiological follow-up time was 26 months. Complete immediate occlusion was obtained in 87.5% of patients. Two remnants had regrown at follow-up and were recoiled, achieving complete occlusion. The late neuroradiological occlusion rate was: complete occlusion 93.6%, neck remnant 4.3%, sac remnant 2.1%. No in-stent stenosis was detected at follow-up. Among the 48 procedures, two complications occurred (4.2%). Mortality was 2.1%. No delayed ischemic stroke occurred.ConclusionsY-stent assisted coiling has a high immediate occlusion rate and very good long-term stability. The procedure is relatively safe, although the complication and mortality rates are not negligible. Two Enterprise stents can be safely used for Y-stenting and, indeed, offer the advantage of easier catheterization, delivery and deployment into distal and tortuous vessels than open cell stents.

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