Endovascular treatment of cerebral aneurysms: a retrospective study of 163 embolized aneurysms (original) (raw)
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Endovascular Treatment of Cerebral Aneurysms
American Journal of Roentgenology, 2001
The advances of the endovascular techniques observed in the past two decades has made this surgical alternative, previously recommended only for aneurysms with no indication to be treated by conventional surgical technique (clipping), into a first choice approach for a large number of cerebral aneurysms in some services 1-3 . One of the main advances in these techniques was the advent of detachable plat-inum coils termed Guglielmi detachable coils (GDC). The development of coils with a better capacity to conform to aneurysms, quicker and safer detachable mechanisms and the use of bioactive materials in addition to coils are responsible for the higher rate currently obtained in aneurysm occlusion 4 . The development of the remodeling techniques, the use of intracranial stents and of liquid embolic ma-ABSTRACT -Objective: To present the results of cerebral aneurysms treated by endovascular technique. Method: Retrospective analysis of patient files of Hospital Geral de Fortaleza, Brazil. Results: We report the results of 163 cerebral aneurysms treated by endovascular techniques from January 2002 to October 2005. Patients with ruptured aneurysms (87.2%), according to Hunt-Hess scale were: 33.7% HH I, 28.4% HH II, 24.1% HH III, 13.8% HH IV. The Fisher scale grade IV was the most common (39.7%). Remodeling, coil embolization, arterial occlusion and histoacryl embolization were the techniques employed. Effective occlusion was achieved in 87.7%, partial occlusion in 5.3% and non-effective occlusion in 7.0% of the patients. Glasgow outcome scale results were: 76.3% GOS 5, 5.0% GOS 4, 5.8% GOS 3, 1.4% GOS 2 and 11.5% GOS 1. Conclusion: Endovascular treatment seems to be feasible within Brazilian public health system, with results as good as those obtained in larger international centers.
Endovascular Treatment of Cerebral Aneurysms at a Low-Volume Institution: A Viable Alternative?
Journal of Neuroimaging, 2012
The advances of the endovascular techniques observed in the past two decades has made this surgical alternative, previously recommended only for aneurysms with no indication to be treated by conventional surgical technique (clipping), into a first choice approach for a large number of cerebral aneurysms in some services 1-3 . One of the main advances in these techniques was the advent of detachable plat-inum coils termed Guglielmi detachable coils (GDC). The development of coils with a better capacity to conform to aneurysms, quicker and safer detachable mechanisms and the use of bioactive materials in addition to coils are responsible for the higher rate currently obtained in aneurysm occlusion 4 . The development of the remodeling techniques, the use of intracranial stents and of liquid embolic ma-ABSTRACT -Objective: To present the results of cerebral aneurysms treated by endovascular technique. Method: Retrospective analysis of patient files of Hospital Geral de Fortaleza, Brazil. Results: We report the results of 163 cerebral aneurysms treated by endovascular techniques from January 2002 to October 2005. Patients with ruptured aneurysms (87.2%), according to Hunt-Hess scale were: 33.7% HH I, 28.4% HH II, 24.1% HH III, 13.8% HH IV. The Fisher scale grade IV was the most common (39.7%). Remodeling, coil embolization, arterial occlusion and histoacryl embolization were the techniques employed. Effective occlusion was achieved in 87.7%, partial occlusion in 5.3% and non-effective occlusion in 7.0% of the patients. Glasgow outcome scale results were: 76.3% GOS 5, 5.0% GOS 4, 5.8% GOS 3, 1.4% GOS 2 and 11.5% GOS 1. Conclusion: Endovascular treatment seems to be feasible within Brazilian public health system, with results as good as those obtained in larger international centers.
Universiti Kebangsaan Malaysia Medical Center (UKMM C) started neurointerventional service in August 2008. In this study, we aimed to evaluate the immed iate and short term outcome of endovascular treatment (EVT) of cerebral aneurysm during early period of the services. A retrospective study for cerebral aneurysm treated by endovascular technique, fro m the Neurosurgical and Rad iology Depart ment fro m September 2008 till February 2010 was performed. Patient's demographic data, initial clinical presentation and assessment of the aneurysm were performed. The immediate results and short term assessment post EVT were evaluated based on standard criteria. Recurrence and complicat ions during and following EVT procedures, were recorded. Twenty one patients with total of 22 aneurysms were treated. The mean age was 54.52 years with 57% being males and 43% females. The majority (81%) had single aneurysm. The most common site was anterior commun icating artery (28 %). Mean aneurysm sac size was 6.19 mm and 2.55 mm for aneurysm neck. At follow-up, 3 (27.2%) had a small residual neck. Four patients (37.2%) had residual aneurysm filling, but three of them were treated with stent aiming to achieve flow diversion effect instead of complete occlusion during initial treat ment. There was no rebleed or rupture from the immediate to follow-up. Significant co mplications up to 30-days was observed in 4 patients (20%) whereby 2 patients showed improvement and 2 patients died (10 % mortality rate). Endovascular treatment of cerebral aneurysms performed in our centre had early outcome, morbid ity and mortality compared to other higher volume centres. Longer term follow up is needed to evaluate the long term outcome/occlusion rate, morb idity and mortality.
Endovascular treatment of cerebral aneurysm: Early experience in a Malaysian tertiary centre
Universiti Kebangsaan Malaysia Medical Center (UKMM C) started neurointerventional service in August 2008. In this study, we aimed to evaluate the immed iate and short term outcome of endovascular treatment (EVT) of cerebral aneurysm during early period of the services. A retrospective study for cerebral aneurysm treated by endovascular technique, fro m the Neurosurgical and Rad iology Depart ment fro m September 2008 till February 2010 was performed. Patient's demographic data, initial clinical presentation and assessment of the aneurysm were performed. The immediate results and short term assessment post EVT were evaluated based on standard criteria. Recurrence and complicat ions during and following EVT procedures, were recorded. Twenty one patients with total of 22 aneurysms were treated. The mean age was 54.52 years with 57% being males and 43% females. The majority (81%) had single aneurysm. The most common site was anterior commun icating artery (28 %). Mean aneurysm sac size was 6.19 mm and 2.55 mm for aneurysm neck. At follow-up, 3 (27.2%) had a small residual neck. Four patients (37.2%) had residual aneurysm filling, but three of them were treated with stent aiming to achieve flow diversion effect instead of complete occlusion during initial treat ment. There was no rebleed or rupture from the immediate to follow-up. Significant co mplications up to 30-days was observed in 4 patients (20%) whereby 2 patients showed improvement and 2 patients died (10 % mortality rate). Endovascular treatment of cerebral aneurysms performed in our centre had early outcome, morbid ity and mortality compared to other higher volume centres. Longer term follow up is needed to evaluate the long term outcome/occlusion rate, morb idity and mortality.
American Journal of Neuroradiology, 2009
BACKGROUND AND PURPOSE: Endovascular embolization is a well-established treatment of ruptured intracranial aneurysms, but concern about its long-term stability and its ability to prevent rehemorrhage are still present. We evaluated the long-term clinical and angiographic follow-up of patients with ruptured cerebral aneurysms treated with coiling, focusing on rehemorrhage and changes in aneurysm morphologic features. MATERIALS AND METHODS: A total of 377 patients with ruptured aneurysms that were treated with endovascular approaches at our institution between 1994 and 2008 were reviewed. Clinical and angiographic data were analyzed from a prospectively collected data base. RESULTS: There were 377 patients with 391 ruptured aneurysms treated for 14 years. Good outcome (Glasgow Outcome Score [GOS], 5) was achieved in 74% of patients, moderate disability or poor outcome in 18%, and 8.8% died. Permanent morbidity or mortality from procedural complications occurred in 2.9%. Complete follow-up was available for 85% of surviving patients, with mean follow-up of 22.3 months. Re-treatment was required in 11% (31 patients). Eight (2.1%) patients had rebleeding, 6 (1.6%) in the hospital within 30 days of treatment, 5 in the first 48 hours. Follow-up imaging was available in 276 aneurysms in 270 patients. Recanalization occurred in 56 of 276 aneurysms (20.3%) regardless of the initial angiographic result, but the risk was higher if a body remnant was left (2 , 11.791; P ϭ .0006). CONCLUSIONS: Long-term clinical and angiographic follow-up demonstrates the efficacy of endovascular treatment of ruptured intracranial aneurysms. Rebleeding after treatment is rare, with the greatest risk during the first 48 hours after treatment. Initial angiographic results are not a useful predictor of clinical outcome or rehemorrhage.
American Journal of Neuroradiology, 2013
BACKGROUND AND PURPOSE: There is controversy as to the best mode of treating MCA aneurysms. We report the results of a large endovascular series of patients treated at our center. MATERIALS AND METHODS: This study was a retrospective analysis of a prospectively acquired data base. All patients with saccular MCA aneurysms treated between November 1996 and June 2012 were included. World Federation of Neurosurgical Societies grade, aneurysm site, size, and aneurysm neck size were recorded, along with clinical outcome assessed with the Glasgow Outcome Scale and radiographic occlusion assessed with the Raymond classification at 6 months and 2.5 years. RESULTS: A total of 295 patients with 300 MCA aneurysms were treated including 244 ruptured aneurysms (80.7%). The technical failure rate was 4.3% (13 patients). Complete occlusion or neck remnant was achieved in 264 (91.4%). Complications included rupture in 15 patients (5%), thromboembolism in 17 patients (5.7%), and early rebleeding in 3 patients (1%). Overall permanent procedural-related morbidity and mortality were seen in 12 patients (7.8%). Of the ruptured aneurysms, 189 (79.4%) had a favorable clinical outcome (Glasgow Outcome Scale score, 4-5). A total of 33 patients (13.6%) died. On initial angiographic follow-up, aneurysm remnant was seen in 18 aneurysms (8.1%). A total of 13 patients (4.3%) were retreated. CONCLUSIONS: Our experience demonstrates that endovascular treatment of MCA aneurysms has an acceptable safety profile with low rates of technical failure and re-treatment. Therefore, coiling is acceptable as the primary treatment of MCA aneurysms. ABBREVIATIONS: EVC ϭ endovascular coiling; GOS ϭ Glasgow Outcome Scale; ISAT ϭ International Subarachnoid Aneurysm Trial; WFNS ϭ World Federation of Neurosurgical Societies T he International Subarachnoid Aneurysm Trial (ISAT) demonstrated an absolute 6.9% reduction in the rate of death or dependency at 1 year for patients treated with endovascular coiling (EVC). 1 ISAT did not, however, address the specific issue of patients with MCA aneurysms, who represented only 303 (14.1%) of the 2143 enrolled patients. This has resulted in controversy as to the best mode of treatment of aneurysms at this location. Surgical clipping remains the standard treatment in many institutions. The anatomic location aids surgical access, and in some cases, surgery facilitates hematoma evacuation. There is also a perceived increased risk for EVC at this site because these aneurysms are often wide-neck and have branches arising from the neck. 2,3 Recently, several surgical series have been published that demonstrate excellent clinical results with low rates of morbidity and mortality. 4-7 Therefore, we analyzed the strategy at our institution where EVC is the first-line therapy for aneurysm treatment at any location and focused on the more controversial MCA aneurysms. MATERIALS AND METHODS Patient Population This was an observational, prospectively collated study of 295 consecutive patients referred to our institution for endovascular treatment of ruptured and unruptured MCA aneurysms. All patients underwent primary EVC during a 15.5-year period (between November 1996 and June 2012). All patients with SAH were considered for EVC as the primary treatment technique when a consultant interventional neuroradiologist was available. Elective cases were discussed at our institutional neurovascular multidisciplinary meeting. Patients with fusiform or dissecting aneurysms and those treated with primary parent vessel occlusion were excluded from this study. Patient information, aneurysm characteristics, details of treatment,
Endovascular Treatment of Un-Ruptured Cerebral Aneurysms (Experience by Neurologist)
The Egyptian Journal of Hospital Medicine, 2019
Saccular intracranial aneurysms are localized enlargement lesions of the vasculature, most commonly sited at bifurcation points in the circle of Willis. Un-ruptured intracranial aneurysms (UIA) are a common finding, occurring in about 2% of the population, making them very probable to be seen by most practitioners, and present a challenge in the recommendations for optimum management and screening. Most aneurysms do not rupture and patients harboring these lesions often remain asymptomatic. Material and Methods: we recruited 12 patients with un-ruptured intracranial aneurysms that was treated by endovascular intervention and evaluated clinically and angiographically before procedure and 3-6 months after procedure Results: the mean age of the patients was 51.42±11.23 ranging age 23 – 69 years. 6 were females and 6 were males. 5 patients (41.7 %) were hypertensive which was the commonest risk factor in those patients, 6 patients (50%) had ICA (Internal Carotid Artery) aneurysm. Conclu...
Endovascular treatment of intracranial aneurysms as the first thérapeutic option
Journal of Neuroradiology, 2007
Background-Endovascular embolization of ruptured intracranial aneurysms provides an adequate treatment and long-term results with less morbidity and mortality (M&M) compared with surgical treatment. Since the last decade more and more ruptured and unruptured intracranial aneurysms (IA) undergo endovascular embolization in the United States. We present our experience of the initial one year periprocedural M&M at Paul L. Foster School of Medicine (PLFSM), Texas Tech Health Science Center (TTUHSC) in El Paso, Texas.