scholarly journals Shrinkage of a Vertebral Dissecting Aneurysm After Stent-Assisted Coil Embolization Demonstrated by the Three-Dimensional Driven Equilibrium Sequence

2012 ◽  
Vol 52 (4) ◽  
pp. 205-208
Author(s):  
Hideaki TAKAHATA ◽  
Hideki ISHIMARU ◽  
Yoichi MOROFUJI ◽  
Kazuaki NAKASHIMA ◽  
Keisuke TSUTSUMI ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Three Dimensional ◽  
Dissecting Aneurysm ◽  
Equilibrium Sequence

Stent-assisted coil embolization followed by a stent-within-a-stent technique for ruptured dissecting aneurysms of the intracranial vertebrobasilar artery

2009 ◽  
Vol 111 (1) ◽  
pp. 48-52 ◽  
Author(s):  
Sang Hyun Suh ◽  
Byung Moon Kim ◽  
Sung Il Park ◽  
Dong Ik Kim ◽  
Yong Sam Shin ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Therapeutic Option ◽  
Direct Consequence ◽  
Treatment Method ◽  
Dissecting Aneurysm ◽  
High Rate ◽  
Parent Artery ◽  
Vertebrobasilar Artery ◽  
Complete Obliteration

Object A ruptured dissecting aneurysm of the vertebrobasilar artery (VBA-DA) is a well-known cause of acute subarachnoid hemorrhage (SAH) with a high rate of early rebleeding. Internal trapping of the parent artery, including the dissected segment, is one of the most reliable techniques to prevent rebleeding. However, for a ruptured VBA-DA not suitable for internal trapping, the optimal treatment method has not been well established. The authors describe their experience in treating ruptured VBA-DAs not amenable to internal trapping of the parent artery with stent-assisted coil embolization (SAC) followed by a stent-within-a-stent (SWS) technique. Methods Eleven patients—6 men and 5 women with a mean age of 48 years and each with a ruptured VBA-DA not amenable to internal trapping of the parent artery—underwent an SAC-SWS between November 2005 and October 2007. The feasibility and clinical and angiographic outcomes of this combined procedure were retrospectively evaluated. Results The SAC-SWS was successful without any treatment-related complications in all 11 patients. Immediate posttreatment angiograms revealed complete obliteration of the DA sac in 3 patients, near-complete obliteration in 7, and partial obliteration in 1. One patient died as a direct consequence of the initial SAH. All 10 surviving patients had excellent clinical outcomes (Glasgow Outcome Scale Score 5) without posttreatment rebleeding during a follow-up period of 8–24 months (mean follow-up 15 months). Angiographic follow-up at 6–12 months after treatment was possible at least once in all surviving patients. Nine VBA-DAs showed complete obliteration; the other aneurysm, which had appeared partially obliterated immediately after treatment, demonstrated progressive obliteration on 2 consecutive follow-up angiography studies. There was no in-stent stenosis or occlusion of the branch or perforating vessels. Conclusions The SAC-SWS technique seems to be a feasible and effective reconstructive treatment option for a ruptured VBA-DA. The technique may be considered as an alternative therapeutic option in selected patients with ruptured VBA-DAs unsuitable for internal trapping of the parent artery.

Detection of the Residual Lumen of Intracranial Aneurysms Immediately after Coil Embolization by Three-dimensional Digital Subtraction Angiographic Virtual Endoscopic Imaging

Neurosurgery ◽  
2002 ◽  
Vol 50 (3) ◽  
pp. 476-485 ◽  
Author(s):  
Hiro Kiyosue ◽  
Mika Okahara ◽  
Shuichi Tanoue ◽  
Takaharu Nakamura ◽  
Hirofumi Nagatomi ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Cerebral Arteries ◽  
Three Dimensional ◽  
Digital Subtraction ◽  
Aneurysm Volume ◽  
Digital Subtraction Angiographic ◽  
Incomplete Occlusion ◽  
Coil Volume

Abstract OBJECTIVE: Detection of a small residual lumen after coil embolization is often difficult because of the coil mass and the overlap of the cerebral arteries. The purpose of this study was to assess the usefulness of virtual endoscopic (VE) analysis of three-dimensional digital subtraction angiographic (DSA) images for evaluation of aneurysmal occlusion immediately after the procedure. METHODS: Twenty-seven intracranial aneurysms were treated with coil embolization using a three-dimensional DSA system. Biplane and rotational DSA scanning was performed before and immediately after the procedures. VE images were obtained at a separate workstation, after transfer of the rotational images. Two-dimensional (2D) DSA images and VE images obtained after the procedure were assessed with respect to aneurysmal occlusion. Morphological outcomes and other factors, including location, size, volumetric ratio (coil volume/aneurysm volume), and residual sites, were also evaluated. RESULTS: Seven aneurysms were evaluated as complete occlusion (CO) on both 2D DSA images and VE images. Twelve aneurysms exhibited residual lumina on both 2D DSA images and VE images. Five aneurysms were evaluated as CO on 2D DSA images and as incomplete occlusion on VE images. There were no recurrences among the aneurysms that were evaluated as CO on VE images. Two of five aneurysms that were evaluated as CO on 2D DSA images and as incomplete occlusion on VE images demonstrated regrowth in follow-up examinations. Residual sites and volumetric ratios were correlated with aneurysmal regrowth. CONCLUSION: VE imaging can demonstrate a residual lumen more frequently than can 2D DSA imaging and is useful for evaluating aneurysmal occlusion after coil embolization.

Abstract 19240: Operative Indication for Chronic Dissecting Aneurysm in Descending Thoracic and Thoracoabdominal Aorta

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
TATSUYA ODA ◽  
Kenji Minatoya ◽  
Hiroaki Sasaki ◽  
Hiroshi Tanaka ◽  
Yoshimasa Seike ◽  
...  
Keyword(s):  
Ct Scan ◽  
Aortic Surgery ◽  
Three Dimensional ◽  
Connective Tissue Disorder ◽  
Dissecting Aneurysm ◽  
Operative Indication ◽  
Thoracoabdominal Aorta ◽  
Ruptured Aneurysms ◽  
Lack Of Information ◽  
Risk Patients

Background: Because of a lack of information about the rupture size of chronic dissecting descending thoracic and thoracoabdominal aneurysms, we evaluated the natural history of those aneurysms. Patiens and Methods: Data on 422 patients (mean age, 63.3 ± 11.3; 272 male) with chronic dissection in descending thoracic and thoracoabdominal aorta treated at our institution from 2007 to 2014, were analyzed. Patients with connective tissue disorder, impending rupture of aneurysms, infected aneurysms, and an acute dissection without aneurysms were excluded. Chronic dissection was defined as a dissection more than 2 weeks from symptom onset. The aneurysm diameter at the time of the rupture was measured on CT scan in ruptured aneurysms group (n=21), and initial aneurysmal diameter on CT scan in non-ruptured aneurysms group (n=401). The measurements were performed at maximum short axis diameter of the aneurysm on three-dimensional CT. Results: Midian size of all aneurysms was 4.5 cm (range 3.5 to 9.0 cm) and that of in ruptured aneurysms was 5.9 cm (range 4.5-8.0 cm). The location of aneurysms was descending aorta in 303 patients, thoracoabdominal aorta in 119. Aortic surgery was performed in 150 patients (urgent in 20, elective in 130). Hospital mortality rate were 20% (5/20) in patients with ruptured aneurysms and 2.3% (3/130) in patients with non-ruptured aneurysms. Figure shows the incidences of rupture according to the aneurysm size. The incidence of a rupture increases with larger aortic size. At 3.5 to 3.9 cm, 4.0 to 4.4 cm, 4.5 to 4.9 cm, 5.0 to 5.4 cm, 5.5 to 5.9 cm and more than 6.0 cm, the incidence of rupture was 0%, 0%, 1.2%, 10.2%, 14.3% 20.8%, respectively. The aneurysms more than 5.0 cm were ruptured in 15.1% of patients. Conclusions: Because an elective operation is associated with low mortality, operative indication of chronic dissecting aneurysm in descending and thoracic-abdominal aorta should be considered when its size is 5.0 cm or larger in good-risk patients.

scholarly journals Hemodynamic differences by increasing low profile visualized intraluminal support (LVIS) stent local compaction across intracranial aneurysm orifice

2020 ◽  
Vol 26 (5) ◽  
pp. 557-565
Author(s):  
Zhongbin Tian ◽  
Mingqi Zhang ◽  
Gaohui Li ◽  
Rongbo Jin ◽  
Xiaochang Leng ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Three Dimensional ◽  
Patient Specific ◽  
Pore Density ◽  
Similar Reduction ◽  
Flow Reduction ◽  
Flow Parameters ◽  
Low Profile ◽  
Support Device ◽  
Local Compaction

Background The Low-profile Visualized Intraluminal Support device (LVIS) has been successfully used to treat cerebral aneurysm, and the push-pull technique has been used clinically to compact the stent across aneurysm orifice. Our aim was to exhibit the hemodynamic effect of the compacted LVIS stent. Methods Two patient-specific aneurysm models were constructed from three-dimensional angiographic images. The uniform LVIS stent, compacted LVIS and Pipeline Embolization Device (PED) with or without coil embolization were virtually deployed into aneurysm models to perform hemodynamic analysis. Intra-aneurysmal flow parameters were calculated to assess hemodynamic differences among different models. Results The compacted LVIS had the highest metal coverage across the aneurysm orifice (case 1, 46.37%; case 2, 67.01%). However, the PED achieved the highest pore density (case 1, 19.56 pores/mm2; case 2, 18.07 pores/mm2). The compacted LVIS produced a much higher intra-aneurysmal flow reduction than the uniform LVIS. The PED showed a higher intra-aneurysmal flow reduction than the compacted LVIS in case 1, but the results were comparable in case 2. After stent placement, the intra-aneurysmal flow was further reduced as subsequent coil embolization. The compacted LVIS stent with coils produced a similar reduction in intra-aneurysmal flow to that of the PED. Conclusions The combined characteristics of stent metal coverage and pore density should be considered when assessing the flow diversion effects of stents. More intra-aneurysmal flow reductions could be introduced by compacted LVIS stent than the uniform one. Compared with PED, compacted LVIS stent may exhibit a flow-diverting effect comparable to that of the PED.

Three-dimensional CT imaging of an isolated dissecting aneurysm of the superior mesenteric artery

1996 ◽  
Vol 21 (6) ◽  
pp. 515-516 ◽  
Author(s):  
H. Hyodoh ◽  
K. Hyodoh ◽  
K. Takahashi ◽  
M. Yamagata ◽  
K. Kanazawa
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Three Dimensional ◽  
Dissecting Aneurysm ◽  
Ct Imaging

Treatment of a spontaneous intracranial dissecting aneurysm with stent-assisted coil embolization

2003 ◽  
Vol 45 (11) ◽  
pp. 825-829 ◽  
Author(s):  
Keiko Irie ◽  
Makoto Negoro ◽  
Motoharu Hayakawa ◽  
Junichi Hayashi ◽  
Tetsuo Kanno
Keyword(s):  
Coil Embolization ◽  
Dissecting Aneurysm ◽  
Intracranial Dissecting Aneurysm

scholarly journals “Waffle Cone” Technique for Intra/Extra-Aneurysmal Stent Placement for the Treatment of Complex and Wide-Necked Bifurcation Aneurysm

2008 ◽  
Vol 14 (2_suppl) ◽  
pp. 49-52 ◽  
Author(s):  
Tzu-Hsien Yang ◽  
Ho-Fai Wong ◽  
Ming-Shiang Yang ◽  
Chang-Hsien Ou ◽  
Tzu-Lung Ho
Keyword(s):  
Endovascular Treatment ◽  
Stent Placement ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Three Dimensional ◽  
Parent Vessel ◽  
Surgical Clipping ◽  
Selective Embolization ◽  
Bifurcation Aneurysm

Endovascular treatment of intracranial aneurysms by coiling has become an accepted alternative to surgical clipping 1. In cases of wide-necked and sidewall aneurysms, selective embolization is difficult because of the risk of coil protrusion into the parent vessel. The use of three-dimensional coils, stents 2, and balloon remodeling have all aided the attempt to adequately manage such lesions. However, compared with sidewall aneurysms, bifurcation aneurysms are more challenging from an endovascular standpoint. Because of their specific anatomy and hemodynamics, the tendency to recur and rerupture is higher. Several authors have reported successful treatment of these complex and wide-necked bifurcation aneurysms by using Y-configured dual stent-assisted coil embolization 3,4, the double microcatheter technique 5, a more compliant balloon remodeling technique6, the TriSpan neck-bridge device7, or the waffle cone technique8. We describe two cases of wide-necked bifurcation aneurysms in which the waffle cone technique was used for coil embolization. The waffle cone technique was first described in 2006; however, the small number of published cases and the lack of follow-up prevent one from assessing this technique's durability and the probability of recanalization. We report the cases of two patients harboring unruptured wide-necked bifurcation aneurysms that were treated and followed-up for six months.

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