scholarly journals Level of headaches after surgical aneurysm clipping decreases significantly faster compared to endovascular coiled patients

2017 ◽  
Vol 7 (2) ◽  
Author(s):  
Athanasios K. Petridis ◽  
Jan F. Cornelius ◽  
Marcel A. Kamp ◽  
Sina Falahati ◽  
Igor Fischer ◽  
...  
Keyword(s):  
Aneurysm Rupture ◽  
Endovascular Coiling ◽  
Analog Scale ◽  
Surgical Clipping ◽  
Time Points ◽  
Ruptured Aneurysms ◽  
Aneurysm Clipping ◽  
Incidental Aneurysms ◽  
The Difference ◽  
Late Recovery

In incidental aneurysms, endovascular treatment can lead to post-procedural headaches. We studied the difference of surgical <em>clipping</em> <em>vs</em>. endovascular <em>coiling</em> in concern to post-procedural headaches in patients with ruptured aneurysms. Sixtyseven patients with aneurysmal subarachnoidal haemorrhage were treated in our department from September 1<sup>st</sup> 2015 - September 1<sup>st</sup> 2016. 43 Patients were included in the study and the rest was excluded because of late recovery or highgrade subarachnoid bleedings. Twenty-two were surgical treated and twenty-one were interventionally treated. We compared the post-procedural headaches at the time points of 24 h, 21 days, and 3 months after treatment using the visual analog scale (VAS) for pain. After surgical clipping the headache score decreased for 8.8 points in the VAS, whereas the endovascular treated population showed a decrease of headaches of 3.3 points. This difference was highly statistical significant and remained significant even after 3 weeks where the pain score for the surgically treated patients was 0.68 and for the endovascular treated 1.8. After 3 months the pain was less than 1 for both groups with surgically treated patients scoring 0.1 and endovascular treated patients 0.9 (not significant). Clipping is relieving the headaches of patients with aneurysm rupture faster and more effective than endovascular coiling. This effect stays significant for at least 3 weeks and plays a crucial role in stress relieve during the acute and subacute ICU care of such patients.

scholarly journals Stent-Assisted Coiling of Cerebral Aneurysms: A Multicenter Analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Maxim Mokin ◽  
Christopher T Primiani ◽  
Keaton Piper ◽  
David Fiorella ◽  
Ansaar Rai ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cerebral Aneurysms ◽  
Final Analysis ◽  
Patient Characteristics ◽  
Aneurysm Rupture ◽  
Endovascular Coiling ◽  
Complete Occlusion ◽  
Low Profile ◽  
Grade Scale ◽  
The Difference

Abstract INTRODUCTION New devices have allowed endovascular stent-assisted coiling for the treatment of cerebral aneurysms. It remains unknown how each type of stent affects the safety, efficacy, and clinical outcomes of the stent-coiling procedure. METHODS This study compared the outcomes of endovascular coiling of cerebral aneurysms using Neuroform (NEU), Enterprise (EP), and Low-profile Vi_sualized Intraluminal Support (LVIS) stents. Cases of aneurysms treated with more than one type of stents (NEU, EP, LVIS) used for coiling of the same lesion (n = 24) or other devices (n = 32) were excluded. Patient characteristics, angiographic results using the Raymond-Roy grade scale (RRGS), clinical outcomes and procedural complications were analyzed in our study. Patients data was retrospectively collected from 6 academic centers. RESULTS A total of 659 patients with 670 cerebral aneurysms treated with stent-assisted coiling (NEU, n = 182; EP, n = 158; LVIS, n = 330) were included in final analysis. Patient characteristics included mean age 56 ? 12 yr old, female prevalence 74% and aneurysm rupture on initial presentation of 19%. The degree of occlusion at baseline angiography was significantly associated with age (P = .002), location by circulation (P = .002), aneurysm size (P = .009), and rupture status (P = .013). We found differences in complete occlusion on baseline imaging, defined as RRGS I, among the three stents: LVIS 64% (210/326); NEU 56% (95/169); EP 48% (68/143); P = .008. The difference of complete occlusion on 10.5 mo (mean) and 8 mo (median) angiographic follow-up was also significant: LVIS 84% (251/299); NEU 78% (117/150); EP 67% (83/123); P = .004. There were 7% (47/670) intraprocedural complications and 11.5% (73/632) postprocedural related complications in our cohort. CONCLUSION There were significant affects based on type of stent used for assisted coiling in the immediate and long-term angiographic outcomes in our cohort. Randomized prospective trials are warranted to compare stent types and clinical outcome.

Treatment of Cerebral Aneurysms: Surgical, Endovascular or Combined Intervention

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 153-158 ◽  
Author(s):  
H. Sano ◽  
Y. Kato ◽  
F.B. Singh ◽  
N. Kanaoka ◽  
K. Shankar ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Treatment Group ◽  
Intervention Group ◽  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Good Recovery ◽  
Surgical Clipping ◽  
Ruptured Aneurysms ◽  
Incidental Aneurysms ◽  
Combined Intervention

A retrospective study of 437 cases of cerebral aneurysms over a 4 year period is reported. Surgical clipping was performed in 322 cases (254 ruptured and 68 incidental aneurysms) and endovascular embolization was done in 50 cases (26 ruptured and 24 incidental aneurysms). No intervention (either surgical or endovascular) was performed in 65 patients. In the direct surgical treatment group, mortality was 1.5% in incidental and 9.8% in ruptured aneurysms and good recovery was seen in 98.5% and 74.8% cases respectively. In the endovascular intervention group, results were poor due to the severity of their neurological grading and older age. Mortality was 42.3% in ruptured and 4.2% in incidental aneurysms. Six out of 26 ruptured and 11 out 24 incidental aneurysm patients had complications in the endovascular treatment group. We have discussed the results and indications for both modes of treatment in our study.

scholarly journals Balloon-Assisted Cannulation for Difficult Anterior Cerebral Artery Access

2017 ◽  
Vol 7 (1-2) ◽  
pp. 48-52
Author(s):  
Varun Naragum ◽  
Mohamad AbdalKader ◽  
Thanh N. Nguyen ◽  
Alexander Norbash
Keyword(s):  
Cerebral Artery ◽  
Paradigm Shift ◽  
Intracranial Aneurysms ◽  
Anterior Cerebral Artery ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
Surgical Clipping ◽  
Ruptured Aneurysms ◽  
Common Location ◽  
Proximal Middle Cerebral Artery

The anterior communicating artery is a common location for intracranial aneurysms. Compared to surgical clipping, endovascular coiling has been shown to improve outcomes for patients with ruptured aneurysms and we have seen a paradigm shift favoring this technique for treating aneurysms. Access to the anterior cerebral artery can be challenging, especially in patients with tortuous anatomy or subarachnoid hemorrhage or in patients presenting with vasospasm. We present a technique for cannulating the anterior cerebral artery using a balloon inflated in the proximal middle cerebral artery as a rebound surface.

Stent-assisted coiling of cerebral aneurysms: multi-center analysis of radiographic and clinical outcomes in 659 patients

2019 ◽  
Vol 12 (3) ◽  
pp. 289-297 ◽  
Author(s):  
Maxim Mokin ◽  
Christopher T Primiani ◽  
Zeguang Ren ◽  
Keaton Piper ◽  
David J Fiorella ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Patient Characteristics ◽  
Aneurysm Rupture ◽  
Endovascular Coiling ◽  
Complete Occlusion ◽  
Stent Type ◽  
Low Profile ◽  
Grade Scale ◽  
Procedural Complications ◽  
The Difference

IntroductionThe endovascular stent-assisted coiling approach for the treatment of cerebral aneurysms is evolving rapidly with the availability of new stent devices. It remains unknown how each type of stent affects the safety and efficacy of the stent-coiling procedure.MethodsThis study compared the outcomes of endovascular coiling of cerebral aneurysms using Neuroform (NEU), Enterprise (EP), and Low-profile Visualized Intraluminal Support (LVIS) stents. Patient characteristics, treatment details and angiographic results using the Raymond–Roy grade scale (RRGS), and procedural complications were analyzed in our study.ResultsOur study included 659 patients with 670 cerebral aneurysms treated with stent-assisted coiling (NEU, n=182; EP, n=158; LVIS, n=330) that were retrospectively collected from six academic centers. Patient characteristics included mean age 56.3±12.1 years old, female prevalence 73.9%, and aneurysm rupture on initial presentation of 18.8%. We found differences in complete occlusion on baseline imaging, defined as RRGS I, among the three stents: LVIS 64.4%, 210/326; NEU 56.2%, 95/169; EP 47.6%, 68/143; P=0.008. The difference of complete occlusion on 10.5 months (mean) and 8 months (median) angiographic follow-up remained significant: LVIS 84%, 251/299; NEU 78%, 117/150; EP 67%, 83/123; P=0.004. There were 7% (47/670) intra-procedural complications and 11.5% (73/632) post-procedural-related complications in our cohort. Furthermore, procedure-related complications were higher in the braided-stents vs laser-cut, P=0.002.ConclusionsThere was a great variability in techniques and choice of stent type for stent-assisted coiling among the participating centers. The type of stent was associated with immediate and long-term angiographic outcomes. Randomized prospective trials comparing the different types of stents are warranted.

Lack of functional patency of the lamina terminalis after fenestration following clipping of anterior circulation aneurysms

2013 ◽  
Vol 119 (3) ◽  
pp. 629-633 ◽  
Author(s):  
Muhammad Omar Chohan ◽  
Andrew P. Carlson ◽  
Blaine L. Hart ◽  
Howard Yonas
Keyword(s):  
Contrast Agent ◽  
Positive Control ◽  
Negative Control ◽  
Lamina Terminalis ◽  
Surgical Clipping ◽  
Anterior Circulation ◽  
Ruptured Aneurysms ◽  
Aneurysm Clipping ◽  
Anterior Circulation Aneurysms ◽  
Basal Cisterns

Object Fenestration of the lamina terminalis (FLT) during aneurysm surgery for subarachnoid hemorrhage can, in theory, improve CSF circulation from the lateral and third ventricles to the cortical subarachnoid space, which may, in turn, decrease the incidence of hydrocephalus and vasospasm. However, the actual effects of FLT on CSF circulation have been difficult to determine, due to confounding factors. In addition, it is unclear whether the lamina terminalis remains functionally patent when the brain resumes its normal position. The goal of this study was to assess the functional patency of the fenestrated lamina terminalis in patients who underwent surgery for ruptured aneurysms. Methods This prospective study included 15 patients who underwent surgical clipping of ruptured anterior circulation aneurysms, with FLT performed during surgery. On postoperative Day 1, the external ventricular drain of each patient was closed, and 1 ml of Omnipaque 300, an iodine based contrast agent, was injected intraventricularly, accompanied by cranial maneuvering designed to position the contrast agent adjacent to the lamina terminalis. Three to 5 minutes after cranial maneuvering, the flow of contrast agent into the basal cisterns was assessed with CT imaging. Flow was verified by an increase in Hounsfield units in a prespecified “region of interest” within the basal cisterns on the CT scan. This procedure was performed using a standardized protocol designed in consultation with the Department of Radiology and approved by the institutional review board. One patient who underwent endoscopic third ventriculostomy was recruited as a positive control to validate the technique, and 1 patient who underwent aneurysm clipping but not FLT was recruited as a negative control. Results Seventeen patients consented to study participation. In the 15 patients who underwent aneurysm clipping and FLT, and the negative control patient who underwent aneurysm clipping but not FLT, the contrast agent followed the normal ventricular pathway from the lateral ventricles into the fourth ventricle, and did not appear in the basal cisterns. In the positive control patient, the contrast agent robustly and immediately filled the basal cisterns. Conclusions Fenestration of the lamina terminalis did not result in functional patency of the lamina terminalis when performed as part of surgical clipping for ruptured aneurysms.

The Impact of Endovascular Coiling Versus Surgical Clipping on Functional Outcome After Intracranial Aneurysm Rupture

2008 ◽  
Vol 18 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Taura L. Barr ◽  
Sheila A. Alexander ◽  
Mary E. Kerr ◽  
Elizabeth Crago ◽  
Michael Horowitz ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Functional Outcome ◽  
Aneurysm Rupture ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
The Impact

Abstract WP80: Efficacy of Coiling Versus Clipping for Posterior Communicating Artery Aneurysms Causing Oculomotor Nerve Palsy: A Systematic Review and Meta-analysis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ou Siqi ◽  
Liang Feng ◽  
Li Fanying ◽  
Yang Yibing ◽  
Qi Tiewei
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Oculomotor Nerve ◽  
Posterior Communicating Artery ◽  
Oculomotor Nerve Palsy ◽  
Cochrane Library ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Nerve Paralysis ◽  
Ruptured Aneurysms

Objective: To compare the advantages in respect of recovery from oculomotor nerve paralysis(ONP) between endovascular coiling and surgical clipping in the treatment of cases with posterior communicating artery (PComA) aneurysms in China. Methods: By retrieving PubMed, Cochrane Library, Embase, Chinese Biomedicine Database(CMB), Chinese National Knowledge Infrastructure(CNKI) and other domestic literature database, we collect relevant studies of cases in China from 2004 to 2015. Using Review Manager (RevMan) version 5.0 software, we perform a systematic review of literature and conduct meta-analysis. Result: The meta-analysis included 12 related studies involving 712 Chinese patients with ONP secondary to PComA aneurysms, of whom 302(42.4%) were treated by endovascular coiling while 410(57.6%) received surgical clipping. Surgical clipping (298 of 410 patients, or 72.7%) resulted in greater complete recovery from ONP compared with endovascular coiling (151 of 302 patients, or 50.0%), in correspond to overall pooled odds ratio (OR) of 0.39 [confidence interval (CI) =0.19-0.83, P = 0.01]. The subgroup analysis reveal a significant benefit of surgical clipping over endovascular coiling in cases with preoperative ruptured aneurysms(P=0.01)or complete initial ONP(P=0.002). Conclusion: Better resolution of ONP with PComA aneurysms is more commonly associated with clipping than coiling, which could be especially true in the patients with preoperative ruptured aneurysms or complete initial ONP. A randomized trial including more cases is expected to elaborate this effect.

Ruptured Intracranial Aneurysms With Small Basal Outpouching

Neurosurgery ◽  
2012 ◽  
Vol 71 (5) ◽  
pp. 994-1002 ◽  
Author(s):  
Jaechan Park ◽  
Hyunjin Woo ◽  
Dong-Hun Kang ◽  
Yongsun Kim ◽  
Seung Kug Baik
Keyword(s):  
High Risk ◽  
Intracranial Aneurysms ◽  
Optimal Treatment ◽  
Ruptured Aneurysm ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
Surgical Clipping ◽  
Aneurysm Clip ◽  
Ruptured Aneurysms ◽  
Ruptured Intracranial Aneurysms

Abstract BACKGROUND: Recognizing an aneurysmal basal rupture using angiographic evaluation is crucial for optimal treatment. OBJECTIVE: To evaluate the incidence of a small basal outpouching (the most common angiographic configuration suggesting a basal rupture), the incidence of a ruptured basal outpouching, and the results of surgical and endovascular treatments. METHODS: The occurrence of small basal outpouchings was determined in the initial angiographic examinations of 471 patients with a ruptured aneurysm. Information was also obtained from patient charts, surgical and interventional reports, operative video records, and reviews of radiological investigations. RESULTS: A small basal outpouching was identified in 41 (8.7%) of the 471 ruptured aneurysms. In the surgical series (n = 286), a basal rupture was identified in 8 (30.8%) of the 26 cases of a basal outpouching and successfully treated by aneurysm clip placement. In the endovascular series (n = 185), intraprocedural aneurysm rebleeding developed in 5 of the 15 patients (33.3%) with a basal outpouching, which was most commonly observed with anterior communicating artery aneurysms. CONCLUSION: The current surgical series included a 9% incidence of ruptured intracranial aneurysms with a small basal outpouching, and a 31% incidence of these basal outpouchings being identified as the rupture point. The results also suggested that endovascular coiling of a basal outpouching carries a high risk of intraprocedural aneurysm rebleeding, whereas surgical clipping is safer and provides more protection against rebleeding of aneurysms with a basal rupture.

Cerebral Aneurysm Clipping

2018 ◽  
Author(s):  
Irene P. Osborn ◽  
Jocelin Jones Molina
Keyword(s):  
Intracranial Aneurysms ◽  
Perioperative Management ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Endovascular Techniques ◽  
Surgical Clipping ◽  
Traditional Treatment ◽  
Aneurysm Clipping ◽  
Skilled Personnel ◽  
Development And Evolution

Subarachnoid hemorrhage (SAH) is usually caused by the rupture of an intracranial aneurysm. Craniotomy and surgical management has been the traditional treatment for decades until the development and evolution of endovascular techniques. Operative clipping of cerebral aneurysms is performed less frequently, but the procedure is still required for aneurysms that are not amenable to endovascular coiling. Some centers do not have the skilled personnel to perform endovascular techniques, and craniotomy is therefore necessary to treat the aneurysm and prevent the problem of rebleeding and avoid vasospasm. This discussion will address specifically the perioperative management of surgical clipping for intracranial aneurysms.

Long-term outcomes of treatment for unruptured intracranial aneurysms in South Korea: clipping versus coiling

2018 ◽  
Vol 10 (12) ◽  
pp. 1218-1222 ◽  
Author(s):  
Young Deok Kim ◽  
Jae Seung Bang ◽  
Si Un Lee ◽  
Won Joo Jeong ◽  
O-Ki Kwon ◽  
...  
Keyword(s):  
Aneurysm Rupture ◽  
Average Treatment Effect ◽  
Rank Test ◽  
Endovascular Coiling ◽  
Long Term Outcomes ◽  
Surgical Clipping ◽  
Log Rank Test ◽  
Unruptured Intracranial Aneurysms ◽  
All Cause Mortality

BackgroundThe long-term outcomes of endovascular coiling and surgical clipping for the treatment of unruptured intracranial aneurysms are unclear.MethodsWe performed a nationwide retrospective cohort study using claims data from the Korean Health Insurance Review and Assessment Service on patients undergoing surgical clipping or endovascular coiling from 2008 to 2014. Inverse probability treatment weighting for average treatment effect on the treated and the multiple imputation method were used to balance covariates and handle missing values. The primary outcome was all-cause mortality at 7 years.ResultsWe identified 26 411 patients of whom 11 777 underwent surgical clipping and 14 634 underwent endovascular coiling. After adjustment with the use of inverse probability treatment weighting for average treatment effect on the treated, all-cause mortality rates at 7 years were 3.8% in the endovascular coiling group and 3.6% in the surgical clipping group (HR 1.05; 95% CI 0.86 to 1.28; P=0.60, log-rank test). The adjusted probabilities of aneurysm rupture at 7 years were 0.9% after endovascular coiling and 0.7% after surgical clipping (HR 0.9; 95% CI 0.61 to 1.34; P=0.63, log-rank test). The probabilities of retreatment at 7 years after adjustment were 4.9% in the endovascular coiling group and 3.2% in the surgical clipping group (HR 1.52; 95% CI 1.28 to 1.81; P<0.001, log-rank test).ConclusionsAll-cause mortality at 7 years was similar between the elective surgical clipping and endovascular coiling groups in patients with unruptured aneurysms who had no history of subarachnoid hemorrhage due to aneurysm rupture.

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