scholarly journals Endovascular Treatment of Ruptured Intracranial Aneurysms: Factors Affecting Midterm Quality Anatomic Results: Analysis in a Prospective, Multicenter Series of Patients (CLARITY)

2012 ◽  
Vol 33 (8) ◽  
pp. 1475-1480 ◽  
Author(s):  
L. Pierot ◽  
C. Cognard ◽  
R. Anxionnat ◽  
F. Ricolfi
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Factors Affecting ◽  
Anatomic Results ◽  
Ruptured Intracranial Aneurysms

125 Staged Endovascular Treatment of Ruptured Intracranial Aneurysms: Acute Coiling Followed By Delayed Flow Diversion

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 228-228
Author(s):  
Erick Michael Westbroek ◽  
Matthew Bender ◽  
Narlin B Beaty ◽  
Bowen Jiang ◽  
Risheng Xu AB ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Complication Rate ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Major Complication ◽  
Flow Diversion ◽  
Neurological Deficits ◽  
Major Complication Rate ◽  
Ruptured Intracranial Aneurysms

Abstract INTRODUCTION ISAT demonstrated that coiling is effective for aneurysm treatment in subarachnoid hemorrhage (SAH); however, complete occlusion of wide-necked aneurysms frequently requires adjuvants relatively contraindicated in SAH. As such, a limited “dome occlusive” strategy is often pursued in the setting of SAH. We report a single institution series of coiling of acutely ruptured aneurysms followed by delayed flow diversion for definitive, curative occlusion. METHODS A prospectively collected IRB-approved database was screened for patients with aneurysmal SAH who were initially treated by coil embolization followed by planned flow diversion at a single academic medical institution. Peri-procedural outcomes, complications, and angiographic follow-up were analyzed. RESULTS >50 patients underwent both acute coiling followed by delayed, planned flow diversion. Average aneurysm size on initial presentation was 9.5 mm. Common aneurysm locations included Pcomm (36%), Acomm (30%), MCA (10%), ACA (10%), and vertebral (5%). Dome occlusion was achieved in all cases following initial coiling. Second-stage implantation of a flow diverting stent was achieved in 49/50 cases (98%). Follow-up angiography was available for 33/50 patients (66%), with mean follow-up of 11 months. 27 patients (82%) had complete angiographic occlusion at last follow up. All patients with residual filling at follow-up still had dome occlusion. There were no mortalities (0%). Major complication rate for stage I coiling was 2% (1 patient with intra-procedural aneurysm re-rupture causing increase in a previous ICH). Major complication rate for stage 2 flow diversion was 2% (1 patient with ischemic stroke following noncompliance with dual antiplatelet regimen). Minor complications occurred in 2 additional patients (4%) with transient neurological deficits. CONCLUSION Staged endovascular treatment of ruptured intracranial aneurysms with acute dome-occlusive coil embolization followed by delayed flow diversion is a safe and effective treatment strategy.

Abstract WP87: Endovascular Treatment of Very Small Ruptured Intracranial Aneurysms: Complications, Occlusion Rates and Prediction of Outcome

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Robert M Starke ◽  
Nohra Chalouhi ◽  
Muhammad S Ali ◽  
David L Penn ◽  
Stavropoula I Tjoumakaris ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Endovascular Treatment ◽  
Endovascular Therapy ◽  
Intracranial Aneurysms ◽  
Aneurysm Rupture ◽  
Post Treatment ◽  
Favorable Outcome ◽  
Predictors Of Outcome ◽  
Aneurysm Size ◽  
Ruptured Intracranial Aneurysms

Purpose: In this study we assess predictors of outcome following endovascular treatment of small ruptured intracranial aneurysms (SRA). Methods: Between 2004 and 2011, 91 patients with SRA (≤ 3 mm) were treated at our institution. Multivariate analysis was carried out to assess predictors of endovascular related complications, aneurysm obliteration (>95%), recanalization, and favorable outcome (Glasgow Outcome Scale 3-5). Results: Endovascular treatment was aborted in 9 of 91 patients (9.9%). Procedure-related complications occurred in 8 of 82 patients (9.8%) of which 5 were transient and 3 were permanent. Three patients (3.7%) undergoing endovascular therapy experienced an intra-procedural aneurysm rupture. Three of 9 patients (33.3%) treated with stent or balloon assisted coiling experienced peri-procedural complications compared to 5 of 73 patients (6.8%) receiving only coils or Onyx (p=0.039). There were no procedural deaths or rehemorrhages. Rates of recanalization and retreatment were 18.2% and 12.7%, respectively. No factors predicted initial occlusion or recanalization. In multivariate analysis pre-treatment factors predictive of favorable outcome included younger age (OR=0.94; 95% CI 0.91-0.99, p=0.017), larger aneurysm size (OR=3.4; 95% CI 1.02-11.11, p=0.045), Hunt and Hess grade (OR=0.38; 95% CI 0.19-0.75, p=0.005), and location (OR=5.12; 95% CI 1.29-20.25, p=0.02). When assessing treatment and post-treatment variables, vasospasm was the only additional covariate predictive of poor outcome (OR=5.90; 95% CI 1.34=25.93, p=0.019). Conclusions: The majority of SRA can be treated with endovascular therapy and limited complications. Overall predictors of outcome for patients undergoing endovascular treatment of SRA include age, aneurysm size, Hunt and Hess grade, location, and post-treatment vasospasm.

Evaluation of Cerebral Vasospasm after Early Surgical and Endovascular Treatment of Ruptured Intracranial Aneurysms

Neurosurgery ◽  
1998 ◽  
Vol 42 (2) ◽  
pp. 258-267 ◽  
Author(s):  
Andreas Gruber ◽  
Karl Ungersböck ◽  
Andrea Reinprecht ◽  
Thomas Czech ◽  
Cordell Gross ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Vasospasm ◽  
Intracranial Aneurysms ◽  
Ruptured Intracranial Aneurysms

scholarly journals Endovascular Treatment of Small Ruptured Intracranial Aneurysms (<5 mm)

2019 ◽  
Vol 30 (4) ◽  
pp. 817-826
Author(s):  
Fei Peng ◽  
Xin Feng ◽  
Xin Tong ◽  
Baorui Zhang ◽  
Luyao Wang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Cox Proportional Hazards ◽  
Parent Artery ◽  
Parent Vessel ◽  
Fisher Grade ◽  
Wide Neck ◽  
Ruptured Intracranial Aneurysms

Abstract Purpose To investigate the long-term clinical and angiographic outcomes and their related predictors in endovascular treatment (EVT) of small (<5 mm) ruptured intracranial aneurysms (SRA). Methods The study retrospectively reviewed patients with SRAs who underwent EVT between September 2011 and December 2016 in two Chinese stroke centers. Medical charts and telephone call follow-up were used to identify the overall unfavorable clinical outcomes (OUCO, modified Rankin score ≤2) and any recanalization or retreatment. The independent predictors of OUCO and recanalization were studied using univariate and multivariate analyses. Multivariate Cox proportional hazards models were used to identify the predictors of retreatment. Results In this study 272 SRAs were included with a median follow-up period of 5.0 years (interquartile range 3.5–6.5 years) and 231 patients with over 1171 aneurysm-years were contacted. Among these, OUCO, recanalization, and retreatment occurred in 20 (7.4%), 24 (12.8%), and 11 (7.1%) patients, respectively. Aneurysms accompanied by parent vessel stenosis (AAPVS), high Hunt-Hess grade, high Fisher grade, and intraoperative thrombogenesis in the parent artery (ITPA) were the independent predictors of OUCO. A wide neck was found to be a predictor of recanalization. The 11 retreatments included 1 case of surgical clipping, 6 cases of coiling, and 4 cases of stent-assisted coiling. A wide neck and AAPVS were the related predictors. Conclusion The present study demonstrated relatively favorable clinical and angiographic outcomes in EVT of SRAs in long-term follow-up of up to 5 years. THE AAPVS, as a morphological indicator of the parent artery for both OUCO and retreatment, needs further validation.

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