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Sample records for coiled intracranial aneurysms

  1. MR angiography after coiling of intracranial aneurysms

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    Schaafsma, J.D.

    2012-01-01

    Introduction Endovascular occlusion with detachable coils has become an alternative treatment to neurosurgical clipping of intracranial aneurysms over the last two decades. Its minimal invasiveness is the most important advantage of this treatment compared to clipping. The disadvantage of occlusion

  2. Abciximab for thrombolysis during intracranial aneurysm coiling

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    Gralla, Jan [West Wing, John Radcliffe Hospital, Department of Neuroradiology, Oxford (United Kingdom); Inselspital-University of Bern, Department of Neuroradiology, Bern (Switzerland); Rennie, Adam T.M.; Corkill, Rufus A.; Lalloo, Shivendra T.; Molyneux, Andrew; Byrne, James V.; Kuker, Wilhem [West Wing, John Radcliffe Hospital, Department of Neuroradiology, Oxford (United Kingdom)

    2008-12-15

    Thrombotic events are a common and severe complication of endovascular aneurysm treatment with significant impact on patients' outcome. This study evaluates risk factors for thrombus formation and assesses the efficacy and safety of abciximab for clot dissolution. All patients treated with abciximab during (41 patients) or shortly after (22 patients) intracranial aneurysm coil embolisation were retrieved from the institutional database (2000 to 2007, 1,250 patients). Sixty-three patients (mean age, 55.3 years, {+-}12.8) had received either intra-arterial or intravenous abciximab. Risk factors for clot formation were assessed and the angiographic and clinical outcome evaluated. No aneurysm rupture occurred during or after abciximab application. The intra-procedural rate of total recanalisation was 68.3%. Thromboembolic complications were frequently found in aneurysms of the Acom complex and of the basilar artery, whilst internal carotid artery aneurysms were underrepresented. Two patients died of treatment-related intracranial haemorrhages into preexisting cerebral infarcts. Two patients developed a symptomatic groin haematoma. Abciximab is efficacious and safe for thrombolysis during and after endovascular intracranial aneurysm treatment in the absence of preexisting ischaemic stroke. (orig.)

  3. Double microcatheter technique for coiling intracranial aneurysms with unfavorable configurations

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    WANG Shu-yuan

    2013-03-01

    Full Text Available Background Although stent-assisted technique has been widely used clinically, it is still hard to perform coiling treatment for complicated intracranial aneurysms, including relatively wide-necked tiny aneurysms and lobulated wide-necked aneurys ms with important branch vessels arising from the neck. This study aims to investigate the feasibility and clinical results of endovascular treatment for intracranial aneurysms with unfavorable configurations by using double microcatheter technique. Methods Thirty-three cases with complicated aneurysms were treated by using double microcatheter technique from April 2008 to November 2012. The locations of these aneurysms were anterior communicating artery (7 cases, posterior communicating artery (14 cases, ophthalmic artery (3 cases, anterior choroidal artery (3 cases, origin of posterior inferior cerebellar artery (3 cases, bifurcation of middle cerebral artery (2 cases and top of basilar artery (1 case. The mean neck- to-body (width ratio was 0.80 ± 0.21 (0.53-1.33. The mean body (width-to-dome (height ratio was 1.12 ± 0.37 (0.55-2.12. The mean dome (height-to-neck ratio was 1.26 ± 0.41 (0.65-2.96. The diameter of neck ≥4 mm was seen in 7 aneurysms, neck≥height in 9 and neck ≥width in 8. Besides, there were 9 very small aneurysms (the maximum diameter≤3 mm and 13 aneurysms with important branch vessels arising from the neck. All of these aneurysms were treated with coiling by using double microcatheter technique. Results All aneurysms were successfully embolized. Immediate postembolization angiography showed no residual contrast filling in 19 aneurysms, and residual filling in 14. There were some small loops protruding from the neck without influencing the blood flow in 12 cases. At discharge, according to modified Rankin Scale (mRS, 30 patients with 0-1 scores presented excellent clinical outcomes and 3 patients with 2 scores had cognitive dysfunction and moderate disability due to vasospasm

  4. Late Reopening of Adequately Coiled Intracranial Aneurysms Frequency and Risk Factors in 400 Patients With 440 Aneurysms

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    Ferns, Sandra P.; Sprengers, Marieke E. S.; van Rooij, Willem Jan; van Zwam, Wim H.; de Kort, Gerard A. P.; Velthuis, Birgitta K.; Schaafsma, Joanna D.; van den Berg, Rene; Sluzewski, Menno; Brouwer, Patrick A.; Rinkel, Gabriel J. E.; Majoie, Charles B. L. M.

    Background and Purpose-In aneurysms that are adequately occluded 6 months after coiling, the risk of late reopening is largely unknown. We assessed the occurrence of late aneurysm reopening and possible risk factors. Methods-From January 1995 to June 2005, 1808 intracranial aneurysms were coiled in

  5. Clinical Application of Insertion Force Sensor System for Coil Embolization of Intracranial Aneurysms.

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    Matsubara, Noriaki; Miyachi, Shigeru; Izumi, Takashi; Yamada, Hiroyuki; Marui, Naoki; Ota, Keisuke; Tajima, Hayato; Shintai, Kazunori; Ito, Masashi; Imai, Tasuku; Nishihori, Masahiro; Wakabayashi, Toshihiko

    2017-09-01

    In endovascular embolization for intracranial aneurysms, it is important to properly control the coil insertion force. However, the force can only be subjectively detected by the subtle feedback experienced by neurointerventionists at their fingertips. The authors envisioned a system that would objectively sense and quantify that force. In this article, coil insertion force was measured in cases of intracranial aneurysm using this sensor, and its actual clinical application was investigated. The sensor consists of a hemostatic valve (Y-connector). A little flexure was intentionally added in the device, and it creates a bend in the delivery wire. The sensor measures the change in the position of the bent wire depending on the insertion force and translates it into a force value. Using this, embolization was performed for 10 unruptured intracranial aneurysms. The sensor adequately recorded the force, and it reflected the operators' usual clinical experience. The presence of the sensor did not affect the procedures. The sensor enabled the operators to objectively note and evaluate the insertion force and better cooperative handling was possible. Additionally, other members of the intervention team shared the information. Force records demonstrated the characteristic patterns according to every stage of coiling (framing, filling, and finishing). The force sensor system adequately measured coil insertion force in intracranial aneurysm coil embolization procedures. The safety of this sensor was demonstrated in clinical application for the limited number of patients. This system is useful adjunct for assisting during coil embolization for an intracranial aneurysm. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. International Subarachnoid Aneurysm Trial 2009 : Endovascular Coiling of Ruptured Intracranial Aneurysms Has No Significant Advantage Over Neurosurgical Clipping

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    Bakker, Nicolaas A.; Metzemaekers, Jan D. M.; Groen, Rob J. M.; Mooij, Jan Jakob A.; Van Dijk, J. Marc C.

    In the May 2009 issue of The Lancet Neurology, the 5-year follow-up results of the International Subarachnoid Aneurysm Trial (ISAT) were published. The authors concluded that, although the significant difference between coiling and neurosurgical clipping of ruptured intracranial aneurysms in terms

  7. MR susceptibility artefact associated with the use of Barricade coils for treatment of intracranial aneurysms.

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    Gontu, Vamsi; McConachie, Norman

    2015-04-01

    Magnetic resonance angiography (MRA) is commonly used to follow up patients after endovascular treatment for intracranial aneurysms. Magnetic resonance artefacts from coil constructs may impair image quality and jeopardise the evaluation of the effectiveness of treatment and review of adjacent vasculature. We present here a technical note on the usage of Barricade coils recently introduced at our institution. The MRA artefacts associated with these coils may make it impossible to ascertain aneurysm closure and anatomy. Hence these patients would need to be recalled for digital subtraction angiograms for a complete neuroradiological follow-up. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  8. Endovascular treatment of intracranial aneurysms with bioactive Cerecyte coils: effects on treatment stability

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    Geyik, Serdar; Yavuz, Kivilcim; Ergun, Onur; Koc, Osman; Cekirge, Saruhan [Hacettepe University Hospitals, Department of Radiology, Ankara (Turkey); Saatci, Isil [Hacettepe University Hospitals, Department of Radiology, Ankara (Turkey); Hacettepe University Hospital, Interventional Neuroradiology Unit, Department of Radiology, Ankara (Turkey)

    2008-09-15

    The Cerecyte coils were developed to improve long-term stability of embolized cerebral aneurysms by producing an increased fibrous reaction over the neck of the aneurysms. We report our preliminary clinical experience with mid-term follow-up. Seventy-eight consecutive patients with 84 intracranial aneurysms treated exclusively with Cerecyte coils were included in this study. Forty-eight aneurysms were ruptured and 36 were incidental. Twenty-two aneurysms were small with (<10 mm) small neck (<4 mm) (SASN); 55 were small with wide neck ({>=}4 mm) (SAWN); six were large (10-25 mm) (L); and one was giant (G) (>25 mm). The embolization technique was the same with that in standard bare coiling. Immediate post-procedure angiography demonstrated complete aneurysm occlusion in 69%, neck remnant in 29.8% and incomplete occlusion in 1.2%. Follow-up angiography was obtained in 80 aneurysms in a period of time ranging from 6 months to 2 years. The overall recanalization rate was 11.3%, and the re-treatment rate was 6.3%; in the subgroup analysis, recanalization rates were 4.5% in S/S; 9.8% in S/W; and 33.3% in large aneurysms. The only giant aneurysm also showed recanalization. Procedure-related morbidity and mortality rates were 2.6% and 1.3%, respectively. Our midterm results showed a relatively low rate of recurrence compared to those reported for platinum coils with morbidity and mortality rates comparable to those with standard bare platinum coils. The efficacy of Cerecyte coils in the long term will be specifically addressed by the ongoing randomized Cerecyte coil trial. (orig.)

  9. Safety of endovascular treatment of intracranial aneurysms with a new, complex shaped Guglielmi detachable coil

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    Taschner, Christian A. [University Hospital Lille, Department of Neuroradiology, Hopital Roger Salengro, Lille (France); Hopital Roger Salengro, C.H.R.U., Lille, Service de Neuroradiologie, Lille Cedex (France); Leclerc, Xavier; Gauvrit, Jean-Yves; Kerkeni, Anis; El-Mahdy, Mohamed; Pruvo, Jean-Pierre [University Hospital Lille, Department of Neuroradiology, Hopital Roger Salengro, Lille (France); Lejeune, Jean-Paul [University Hospital Lille, Department of Neurosurgery, Hopital Roger Salengro, Lille (France)

    2007-09-15

    The Guglielmi detachable coil (GDC) 360 , a new complex shaped bare platinum coil, became available in Europe for aneurysm treatment in September 2005. The purpose of this study was to assess the feasibility and safety of selective embolization of intracranial aneurysms with the GDC 360 in 52 consecutive patients. All patients included in this study were registered in a prospectively maintained database. We assessed the patient clinical history, aneurysm shape and dimensions, technical details and complications of the procedures, degree of aneurysm occlusion, and clinical findings upon discharge. In all patients, the first coil deployed was a GDC 360 . Over a 6-month period, we intended to treat 52 aneurysms with the GDC 360 in 52 patients. Of these 52 patients, 42 (81%) were treated in the context of subarachnoid haemorrhage. In 51 of 52 patients, the underlying aneurysm was successfully treated by coil embolization. Six procedures (11.5%) were complicated by the formation of thrombus in the parent artery during the intervention. One patient suffered a stroke related to the procedure. Angiograms obtained immediately after the procedure showed complete occlusion of the aneurysmal sac in 38 of 51 procedures (74.5%), a neck remnant in 11 (21.6%), and a residual aneurysm in 2 (3.9%). In 43 of 51 patients (84.3%), clinical assessment demonstrated independent clinical status, whereas 7 patients (13.7%) required assistance in the activities of daily living upon hospital discharge. One patient (2.0%) died after development of a severe vasospasm 10 days after the endovascular procedure. The GDC 360 can be safely used for the endovascular occlusion of intracranial aneurysms. (orig.)

  10. Balloon-assisted coiling of intracranial aneurysms is not associated with a higher complication rate

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    Lubicz, Boris [Erasme University Hospital, Department of Neuroradiology, Brussels (Belgium); Hopital Erasme, Service de Radiologie, Brussels (Belgium); Lefranc, Florence [Erasme University Hospital, Department of Neuroradiology, Brussels (Belgium); Erasme University Hospital, Department of Neurosurgery, Brussels (Belgium); Bruneau, Michael; Witte, Olivier de [Erasme University Hospital, Department of Neurosurgery, Brussels (Belgium); Baleriaux, Danielle [Erasme University Hospital, Department of Neuroradiology, Brussels (Belgium)

    2008-09-15

    Within the neurosurgical literature on intracranial aneurysms, balloon-assisted coiling (BAC) remains controversial when compared to conventional coiling (CC). The aim of this study was to compare our results with BAC and CC over a 4-year period. Daily interventional neuroradiology has been available since March 2004 in our institution. Between March 2004 and February 2008, 275 patients with 357 aneurysms were treated by an endovascular approach, including 174 patients/204 aneurysms treated by CC (group I) and 80 patients/92 aneurysms treated by BAC (group II). The remaining patients were treated with other endovascular techniques. Indications of BAC were as follow: aneurysms with an unfavourable neck/sac ratio and/or a branch arising from the neck (90.2%), unstable coiling catheter (6.5%), and anticipated aneurysm rupture (3.3%). The clinical charts, procedural data, and angiographic results of groups I and II were compared. BAC was used in 25.8% (92/357) of all embolized aneurysms and it was successful in 83/92 aneurysms (90%). There was no significant difference in the procedure-related morbidity and mortality rates between group I (2.3% and 1.15%, respectively) and group II (2.5% and 1.25%, respectively). Although retreatment was more frequent in group II (13%) than in group I (11%), the difference was not statistically significant (P=0.8125). When BAC is used frequently, it is a safe and effective technique that is associated with complication rates comparable to those of CC. Although BAC is not associated with more stable anatomical results, it should be considered as an alternative therapeutic option for the treatment of broad-based intracranial aneurysms. (orig.)

  11. Intra-arterial tirofiban infusion for thromboembolic complication during coil embolization of ruptured intracranial aneurysms

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    Cho, Young Dae, E-mail: aronnn@naver.com [Department of Radiology, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 425 Sindaebang-dong, Dongjak-gu, Seoul 156-707 (Korea, Republic of); Lee, Jong Young, E-mail: gen78@naver.com [Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Seo, Jung Hwa, E-mail: jhseo34@gmail.com [Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Kang, Hyun-Seung, E-mail: hsk4428@yahoo.com [Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Kim, Jeong Eun, E-mail: eunkim@snu.ac.kr [Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Jung, Keun Hwa, E-mail: jungkh@gmail.com [Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Han, Moon Hee, E-mail: hanmh@snuh.org [Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of)

    2012-10-15

    Introduction: Intra-arterial (IA) thrombolytic intervention for acute thrombosis has been challenged due to the risk of bleeding during the endovascular treatment of ruptured aneurysms. We present the results of IA tirofiban infusion for thromboembolic complications during coil embolization in patients with ruptured intracranial aneurysms. Methods: Thromboembolic events requiring thrombolytic intervention occurred in 39 (10.5%) cases during coil embolization of 372 consecutive ruptured intracranial aneurysms. Maximal aneurysm diameters of 39 patients (mean age, 54.7 ± 13.2 years; 23 female, 16 male) ranged from 2.1 to 13.1 mm (mean, 6.6 ± 3.0 mm). The anterior communicating artery was the most common site (n = 13), followed by the middle cerebral artery (n = 9) and the posterior communicating artery (n = 7). In this series, we used intracranial stents in 10 patients during the procedure. Superselective IA tirofiban infusion through a microcatheter was performed to resolve thrombi and emboli. We assessed the efficacy and safety of IA tirofiban infusion in patients with ruptured aneurysms. Results: Intraarterially administered tirofiban doses ranged from 0.25 to 1.25 mg (mean, 0.71 ± 0.26 mg). Effective thrombolysis or recanalization was achieved in 34 patients (87.2%), and three patients (7.7%) suffered distal migration of clots with partial recanalization. The rest (5.1%) had no recanalization. Nonconsequent intracerebral hemorrhage occurred in two patients (5.1%) after the procedure. Thromboemboli-related cerebral infarction developed in eight patients, and only two patients remained infarction related disabilities. Conclusion: IA tirofiban infusion seems to be efficacious and safe for thrombolysis during coil embolization in patients with ruptured intracranial aneurysms.

  12. Prasugrel versus clopidogrel in stent-assisted coil embolization of unruptured intracranial aneurysms.

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    Sedat, Jacques; Chau, Yves; Gaudart, Jean; Sachet, Marina; Beuil, Stephanie; Lonjon, Michel

    2017-02-01

    Background Thromboembolic complications are the main problem in stent-assisted coil embolization of unruptured intracranial aneurysms. The combination of aspirin and clopidogrel is generally used to decrease these complications, but some patients do not respond to clopidogrel and have a higher risk of stent thrombosis. In cardiology, clinical trials have shown that prasugrel reduced the incidence of ischaemic events in patients with acute coronary syndrome compared with clopidogrel but, according to several authors, prasugrel would produce an increased risk of cerebral haemorrhagic complications. Objective The purpose of this study was to determine whether prasugrel would be more effective than clopidogrel in reducing procedural events in patients with an unruptured aneurysm treated endovascularly with coils and stent. Materials and methods Two hundred consecutive patients with intracranial aneurysms were treated using coiling and stenting procedures. The first 100 patients were administered a dual antiplatelet of aspirin and clopidogrel, while the remaining 100 patients were administered a dual antiplatelet of aspirin and prasugrel. In each group data were collected on procedural and periprocedural haemorrhagic and ischaemic complications. Results Aneurysmal occlusion and haemorrhagic complications rates were identical in both groups. The number of thromboembolic events observed in the two groups of our study did not differ significantly, but the prasugrel group included more wide-neck aneurysms and more flow-diverted stents. Moreover, complications in the prasugrel group were more benign, explaining the significant difference in clinical outcomes between the two groups on Day 30. Conclusions Prasugrel reduces the clinical consequences of thromboembolic complications of endovascular treatment with stenting and coiling of unruptured intracranial aneurysms.

  13. Coil embolization of intracranial saccular aneurysms using the Low-profile Visualized Intraluminal Support (LVIS™) device.

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    Cho, Young Dae; Sohn, Chul-Ho; Kang, Hyun-Seung; Kim, Jeong Eun; Cho, Won-Sang; Hwang, Gyojun; Kwon, O-Ki; Ko, Mi-Sun; Park, Nam-Mi; Han, Moon Hee

    2014-07-01

    The novel Low-profile Visualized Intraluminal Support (LVIS™, LVIS and LVIS Jr.) device was recently introduced for stent-supported coil embolization of intracranial aneurysms. Periprocedural and midterm follow-up results for its use in stent-supported coil embolization of unruptured aneurysms are presented herein. In this prospective multicenter study, clinical and radiologic outcomes were analyzed for 55 patients with saccular aneurysms undergoing LVIS-assisted coil embolization between October 2012 and February 2013. Magnetic resonance angiography or digital subtraction angiography was performed to evaluate midterm follow-up results. The standard LVIS device, deployed in 27 patients, was more often used in internal carotid artery (ICA) aneurysms (n=19), whereas the LVIS Jr. (a lower profile stent, n=28) was generally reserved for anterior communicating artery (n=14) and middle cerebral artery (n=8) aneurysms. With LVIS-assisted coil embolization, successful occlusion was achieved in 45 aneurysms (81.8 %). Although no instances of navigation failure or stent malposition occurred, segmentally incomplete stent expansion was seen in five patients where the higher profile LVIS was applied to ICA including carotid siphon. Procedural morbidity was low (2/55, 3.6 %), limited to symptomatic thromboembolism. In the imaging of lesions (54/55, 98.2 %) at 6-month follow-up, only a single instances of major recanalization (1.9 %) occurred. Follow-up angiography of 30 aneurysms (54.5 %) demonstrated in-stent stenosis in 26 (86.7 %), with no instances of stent migration. Only one patient suffered late delayed infarction (modified Rankin Scale 1). The LVIS device performed acceptably in stent-assisted coil embolization of non-ruptured aneurysms due to easy navigation and precise placement, although segmentally incomplete stent expansion and delayed in-stent stenosis were issues.

  14. Procedure-related haemorrhage in embolisation of intracranial aneurysms with Guglielmi detachable coils

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    Kwon, B.J.; Kim, K.H. [Department of Radiology, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Han, M.H.; Chang, K.H. [Department of Radiology, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Clinical Research Institute, Seoul National University Hospital, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Institute of Radiation Medicine, Seoul National University Medical Research Centre, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea); Seoul National University College of Medicine (Korea); Oh, C.W. [Department of Neurosurgery, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Ku, 110-744, Seoul (Korea)

    2003-08-01

    We reviewed the haemorrhagic complications of the endovascular treatment of intracranial aneurysms, in terms of frequency, pre-embolisation clinical status, clinical and radiological manifestations, management and prognosis. In 275 patients treated for 303 aneurysms over 7 years we had seven (one man and six women - 2.3%) with haemorrhage during or immediately after endovascular treatment. All procedures were performed with a standardised protocol of heparinisation and anaesthesia. Four had ruptured aneurysms, two at the tip of the basilar artery, and one ach on the internal carotid and posterior cerebral artery, treated after 12, 5, 14, and 2 days, respectively, three were in Hunt and Hess grade 2 and one in grade 1. Bleeding occurred during coiling in three, after placement of at least four coils, and during manipulation of the guidewire to enter the aneurysm in the fourth. Haemorrhage was manifest as extravasation of contrast medium, with a sudden rise in systolic blood pressure in three patients. The other three patients had unruptured aneurysms; they had stable blood pressure and angiographic findings during the procedure, but one, under sedation, had seizures immediately after insertion of four coils, and the other two had seizures, headache and vomiting on the day following the procedure. Heparin reversal with protamine sulphate was started promptly started when bleeding was detected in four patients, and the embolisation was completed with additional coils in three. Emergency ventricular drainage was performed in the two patients with ruptured aneurysm and one with an unruptured aneurysm who had abnormal neurological responses or hydrocephalus. The bleeding caused a third nerve palsy in one patient, which might have been due to ischaemia and progressively improved. (orig.)

  15. Bare platinum coils vs. HydroCoil in the treatment of unruptured intracranial aneurysms-A single center randomized controlled study.

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    Poncyljusz, Wojciech; Zarzycki, Artur; Zwarzany, Łukasz; Burke, Thomas H

    2015-02-01

    The HydroCoil Embolic System (HES) was developed to improve aneurysm filling to provide superior occlusion efficacy, reduce retreatment rates and enhance long-term durability. We performed a randomized clinical trial to compare the effectiveness of bare platinum coils (BPC) vs. HES for unruptured intracranial aneurysms. Ninety-six patients underwent endovascular coiling of unruptured intracranial aneurysms. The aneurysms were randomized equally to receive BPC or HES. Immediate angiographic results, number of coils used and complications were evaluated and all cases had 12-month follow-up angiography. Immediate angiographic results demonstrated that 84.0% of aneurysms treated with HES were completely occluded compared to 76.1% of aneurysms treated with BPC (p=0.3310). The mean number of coils utilized to fill the aneurysm was significantly lower in the HES arm (5.04 vs. 6.93). Additional adjunctive techniques were performed in 51.1% of all cases. There were seven patients (7.3%) with postoperative complications during the study period. The coil type used during the treatment did not demonstrate any significant differences on the overall recurrence rate (HES - 18.0%, BPC - 17.4%, p=0.9712). There was a statistically significant difference in the aneurysm size and the neck width between completely occluded aneurysms and aneurysms with residual flow in both immediate angiographic and mid-term follow-up. Overall, aneurysm size and neck width are the main risk factors associated with aneurysm recurrence. HES compared to BPC required less total number of coils to provide a denser aneurysm filling. However, there were equivocal results with both devices, at the mid-term angiographic follow-up. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  16. Comparison of Intracranial Aneurysms Treated by 2-D Versus 3-D Coils: A Matched-Pairs Analysis.

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    Lang, S; Rösch, J; Gölitz, P; Kloska, S; Struffert, T; Doerfler, A

    2017-03-01

    Knowledge on the influence of 2D and 3D coils to occlude intracranial aneurysms is poor. Therefore, aim of our analysis was to evaluate whether the use of 3-D versus 2-D coils alone may improve the efficacy of endovascular aneurysm treatment. We performed a matched pair analysis comparing aneurysms treated by 3-D coils as initial "framing" coils to aneurysms treated exclusively by 2-D coils. Number of coils, implanted coil length/volume, and associated packing density were calculated. Aneurysmal occlusion was assessed and monitored 6 months (DSA; magnetic resonance angiography (MRA)) and 18 months (MRA) after embolization. Periprocedural complications and retreatment rate of each group were analyzed. Our retrospective analysis revealed 50 pairs. Concerning the 3-D group, number of coils (353 in total, median 7; p = 0.002), implanted coil length (55.69  ± 48.4 cm), implanted coil length per volume (5.92 mm/mm3), and packing density (30 %; p = 0.017) was higher than in the 2-D group (259 in total, median 5 coils; 38.52 ± 43.13 cm; 4.54 mm/mm3; 23 %). Occlusion was not significantly different immediately after treatment but at 6 and 18 months follow-up in favor of 3-D coils. Retreatment was performed in 2 cases of the 3-D group and in 3 cases of the 2-D group and therefore in a similar range (p = 0.564). Initial use of 3-D coils revealed a higher packing density and a higher long-term occlusion. Therefore, we recommend initial use of 3-D coils.

  17. Feasibility of magnetic resonance angiography (MRA) follow-up as the primary imaging modality after coiling of intracranial aneurysms

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    Bakker, Nicolaas A.; Metzemaekers, Jan D. M.; Dijk, J. Marc C. van; Mooij, Jan Jakob A.; Groen, Rob J. M. (Dept. of Neurosurgery, Univ. Medical Center Groningen, Univ. of Groningen, Groningen (Netherlands)), e-mail: r.j.m.groen@nchir.umcg.nl; Westerlaan, Henriette E.; Eshghi, Omid S. (Dept. of Radiology, Univ. Medical Center Groningen, Univ. of Groningen, Groningen (Netherlands))

    2010-03-15

    Background: Digital subtraction angiography (DSA) is still regarded as the gold standard for detecting residual flow in treated aneurysms. Recent reports have also shown excellent results from magnetic resonance angiography (MRA) imaging. This is an important observation, since DSA is associated with a risk of medical complications, is time consuming, and is more expensive. Purpose: To determine whether MRA could replace conventional DSA and serve as the primary postinterventional imaging modality in patients with coiled intracranial aneurysms. Material and Methods: We studied a prospectively enrolled cohort of 190 patients treated endovascularly for a first-ruptured and/or unruptured intracranial aneurysm between January 2004 and December 2008. The imaging protocol included a 1.5T time-of-flight (TOF) MRA and a DSA at 3 months (on the same day) and, depending on comparability, a 1.5T TOF-MRA or DSA 1 year after treatment. All images were evaluated by a multidisciplinary panel. Results: In 141/190 patients, both an MRA and DSA were performed after 3-month follow-up. In 2/141 patients (1.4%), (small) neck remnants gave false-negative MRA results. In one patient (0.7%), this led to additional neurosurgical clipping of the aneurysm. In 25/141 patients, future follow-up (>3 months) consisted of DSA because of various reasons. In 24/25 of these patients, primary MRA images alone would invariably have led to additional DSA imaging. Conclusion: The present study shows that 1.5T TOF-MRA is a feasible primary follow-up modality after coiling of intracranial aneurysms. Given our data, we now suggest that, in every patient with a coiled intracranial aneurysm, the first follow-up, 3 months after coiling, should be an MRA study. Only when this MRA is inconclusive (e.g., because of coil artifacts), or in the case of suspicion of recanalization, should DSA be performed additionally

  18. An in vitro study of pulsatile fluid dynamics in intracranial aneurysm models treated with embolic coils and flow diverters.

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    Babiker, M Haithem; Gonzalez, L Fernando; Albuquerque, Felipe; Collins, Daniel; Elvikis, Arius; Zwart, Christine; Roszelle, Breigh; Frakes, David H

    2013-04-01

    Although coil embolization is one of the most effective treatments for intracranial aneurysms (ICAs), the procedure is often unsuccessful. For example, an ICA may persist after coil embolization if deployed coils fail to block the flow of blood into the aneurysm. Unfortunately, the specific flow changes that are effected by embolic coiling (and other endovascular therapies) are poorly understood, which creates a barrier to the design and execution of optimal treatments in the clinic. We present an in vitro pulsatile flow study of treated basilar tip aneurysm models that elucidates relationships between controllable treatment parameters and clinically important post-treatment fluid dynamics. We also compare fluid dynamic performance across embolic coils and more recently proposed devices (e.g., the Pipeline Embolization Device) that focus on treating ICAs by diverting rather than blocking blood flow. In agreement with previous steady flow studies, coil embolization-reduced velocity magnitude at the aneurysmal neck by greater percentages for a narrow-neck aneurysm, and reduced flow into aneurysms by greater percentages at lower parent vessel flow rates. However, flow diversion reduced flow into a wide-neck aneurysm more so than coil embolization, regardless of flow conditions. Finally, results also showed that for the endovascular devices we examined, treatment effects were generally less dramatic under physiologic pulsatile flow conditions as compared to steady flow conditions. The fluid dynamic performance data presented in this study represent the first direct in vitro comparison of coils and flow diverters in aneurysm models, and provide a novel, quantitative basis to aid in designing endovascular treatments toward specific fluid dynamic outcomes.

  19. Preoperative coiling of coexisting intracranial aneurysm and subsequent brain tumor surgery

    Energy Technology Data Exchange (ETDEWEB)

    Park, Keun Young; Kim, Byung Moon; Kim, Dong Joon [Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2016-11-15

    Few studies have investigated treatment strategies for brain tumor with a coexisting unruptured intracranial aneurysm (cUIA). The purpose of this study was to evaluate the safety and efficacy of preoperative coiling for cUIA, and subsequent brain tumor surgery. A total of 19 patients (mean age, 55.2 years; M:F = 4:15) underwent preoperative coiling for 23 cUIAs and subsequent brain tumor surgery. Primary brain tumors were meningiomas (n = 7, 36.8%), pituitary adenomas (n = 7, 36.8%), gliomas (n = 3, 15.8%), vestibular schwannoma (n = 1, 5.3%), and Rathke's cleft cyst (n = 1, 5.3%). cUIAs were located at the distal internal carotid artery (n = 9, 39.1%), anterior cerebral artery (n = 8, 34.8%), middle cerebral artery (n = 4, 17.4%), basilar artery top (n = 1, 4.3%), and posterior cerebral artery, P1 segment (n = 1, 4.3%). The outcomes of preoperative coiling of cUIA and subsequent brain tumor surgery were retrospectively evaluated. Single-microcatheter technique was used in 13 cases (56.5%), balloon-assisted in 4 cases (17.4%), double-microcatheter in 4 cases (17.4%), and stent-assisted in 2 cases (8.7%). Complete cUIA occlusion was achieved in 18 cases (78.3%), while residual neck occurred in 5 cases (21.7%). The only coiling-related complication was 1 transient ischemic attack (5.3%). Neurological deterioration did not occur in any patient during the period between coiling and tumor surgery. At the latest clinical follow-up (mean, 29 months; range, 2-120 months), 15 patients (78.9%) had favorable outcomes (modified Rankin Scale, 0-2), while 4 patients (21.1%) had unfavorable outcomes due to consequences of brain tumor surgery. Preoperative coiling and subsequent tumor surgery was safe and effective, making it a reasonable treatment option for patients with brain tumor and cUIA.

  20. Long-term MRA follow-up after coiling of intracranial aneurysms: impact on mood and anxiety

    Energy Technology Data Exchange (ETDEWEB)

    Ferns, Sandra P.; Nieuwkerk, Pythia T.; Majoie, Charles B.L.M. [Academic Medical Center, Department of Radiology, Amsterdam (Netherlands); Rooij, Willem Jan J. van [St. Elisabeth Ziekenhuis, Department of Radiology, Tilburg (Netherlands); Rinkel, Gabriel J.E. [University Medical Center, Department of Neurology, Rudolf Magnus Institute of Neuroscience, Utrecht (Netherlands)

    2011-05-15

    Magnetic resonance angiography (MRA) screening for recurrence of a coiled intracranial aneurysm and formation of new aneurysms long-term after coiling may induce anxiety and depression. In coiled patients, we evaluated effects on mood and level of anxiety from long-term follow-up MRA in comparison to general population norms. Of 162 patients participating in a long-term (>4.5 years) MRA follow-up after coiling, 120 completed the EQ-5D questionnaire, a visual analog health scale and a self-developed screening related questionnaire at the time of MRA. Three months later, the same questionnaires were completed by 100 of these 120 patients. Results were compared to general population norms adjusted for gender and age. Any problem with anxiety or depression was reported in 56 of 120 patients (47%; 95%CI38<->56%) at baseline and 42 of 100 patients (42%; 95%CI32<->52%) at 3 months, equally for screen-positives and -negatives. Compared to the reference population, participants scored 38% (95%CI9<->67%) and 27% (95%CI4<->50%) more often any problem with anxiety or depression. Three months after screening, 21% (20 of 92) of screen-negatives and 13% (one of eight) of screen-positives reported to be less afraid of subarachnoid hemorrhage (SAH) compared to before screening. One of eight screen-positives reported increased fear of SAH. Patients with coiled intracranial aneurysms participating in long-term MRA screening reported significantly more often to be anxious or depressed than a reference group. Screening did not significantly increase anxiety or depression temporarily. However, subjectively, patients did report an increase in anxiety caused by screening, which decreased after 3 months. (orig.)

  1. Cost-effectiveness of magnetic resonance angiography versus intra-arterial digital subtraction angiography to follow-up patients with coiled intracranial aneurysms

    NARCIS (Netherlands)

    Schaafsma, Joanna D.; Koffijberg, Hendrik; Buskens, Erik; Velthuis, Birgitta K.; van der Graaf, Yolanda; Rinkel, Gabriël J.E.

    Background and Purpose-: To follow up patients with coiled intracranial aneurysms, magnetic resonance angiography (MRA) is a promising noninvasive alternative to current standard intra-arterial digital subtraction angiography (IA-DSA). MRA test results do not always concord with those of IA-DSA, and

  2. Cost-Effectiveness of Magnetic Resonance Angiography Versus Intra-arterial Digital Subtraction Angiography to Follow-Up Patients With Coiled Intracranial Aneurysms

    NARCIS (Netherlands)

    Schaafsma, Joanna D.; Koffijberg, Hendrik; Buskens, Erik; Velthuis, Birgitta K.; van der Graaf, Yolanda; Rinkel, Gabriel J. E.

    Background and Purpose-To follow up patients with coiled intracranial aneurysms, magnetic resonance angiography (MRA) is a promising noninvasive alternative to current standard intra-arterial digital subtraction angiography (IA-DSA). MRA test results do not always concord with those of IA-DSA, and

  3. Bioactive versus bare platinum coils for the endovascular treatment of intracranial aneurysms: systematic review and meta-analysis of randomized clinical trials.

    Science.gov (United States)

    Broeders, Joris A; Ahmed Ali, Usama; Molyneux, Andrew J; Poncyljusz, Wojciech; Raymond, Jean; White, Phillip M; Steinfort, Brendan

    2016-09-01

    Bioactive coils were introduced in 2002 in an attempt to improve aneurysm healing and durability of angiographic results. Evidence demonstrating superior efficacy to justify the routine use of bioactive coils over bare coils is limited. We compared the periprocedural and clinical outcome after bioactive and bare platinum coiling for intracranial aneurysms. MEDLINE, EMBASE, Cochrane Library, and ISI Web of Knowledge Conference Proceedings Citation Index-Science were searched for randomized clinical trials (RCTs) comparing bioactive and bare coils. The methodological quality was evaluated to assess bias risk. Periprocedural outcomes and mid-term outcomes were compared. Five independent RCTs comparing bioactive (n=1084) and bare coils (n=1084) were identified. Periprocedural outcome was similar for both groups. Bioactive coiling increased the rate of complete aneurysm occlusion (47% vs 40%; RR 1.17 (95% CI 1.05 to 1.31); p=0.006) and reduced the rate of residual aneurysm neck at 10 months compared with bare coiling in the mid-term (26% vs 31%; RR 0.82 (95% CI 0.70 to 0.96); p=0.01). There were no differences in aneurysm recurrence, aneurysm rupture, stroke, neurological death, modified Rankin Scale score and reinterventions. Subgroup analysis for the three RCTs on hydrogel coils demonstrated reduction of residual aneurysms compared with bare coiling (25% vs 34%; RR 0.76 (95% CI 0.58 to 0.99); p=0.04). Bioactive coils ensure a higher rate of medium-term complete aneurysm occlusion while reducing the rate of residual neck aneurysms compared with bare coiling in the mid-term. Hydrogel coils reduce residual aneurysms compared with bare coils. While there is level 1a evidence to show more complete aneurysm occlusion, longer term follow-up is needed to determine if this translates into clinical significance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  4. Management of giant middle cerebral artery aneurysms with incorporated branches: partial endovascular coiling or combined extracranial-intracranial bypass--a team approach.

    Science.gov (United States)

    Shi, Zhong-Song; Ziegler, Jordan; Duckwiler, Gary R; Jahan, Reza; Frazee, John; Ausman, James I; Martin, Neil A; Viñuela, Fernando

    2009-12-01

    Our goal was to assess the long-term anatomic and clinical outcomes in patients with giant middle cerebral artery (MCA) aneurysms treated by endovascular coil embolization alone or in combination with cerebral revascularization. One hundred twenty-six patients with giant intracranial aneurysms were endovascularly treated at the University of California, Los Angeles, between 1990 and 2007. Of these, 9 patients had partially thrombosed MCA aneurysms with incorporated branches. Five patients presented with symptoms of mass effect, 3 had seizures, 2 had episodes of brain ischemia, and 1 presented with acute subarachnoid hemorrhage. Three wide-neck saccular aneurysms were almost completely coil occluded, leaving only small neck remnants that were intended to preserve the patency of incorporated MCA branches. The other 6 fusiform aneurysms were effectively treated by superficial temporal artery-MCA or occipital artery-MCA bypass, followed by complete coil occlusion of these aneurysms. Immediate angiograms and mid- or long-term neuroradiological imaging follow-up examinations revealed complete obliteration or near-complete occlusion (90%-99%) of the aneurysms in all 9 patients. Seven patients had a favorable long-term clinical outcome, and 1 patient died as a result of unrelated congestive heart failure. One patient required emergent surgical aneurysm thrombectomy because of inadvertent coil occlusion of the frontal opercular artery, which was not protected by the bypass, and the patient subsequently sustained a moderate neurological disability. Giant MCA aneurysms with branch incorporations and other unfavorable features such as intraluminal thrombus, mural calcification, and fusiform configuration can be effectively treated with a team approach, using coil embolization after protective surgical bypass. When aneurysms with MCA branches incorporated into the neck rather than the dome are treated by endovascular techniques alone, long-term angiographic follow-up is

  5. Time-of-flight MR angiography at 3 T versus digital subtraction angiography in the imaging follow-up of 51 intracranial aneurysms treated with coils

    Energy Technology Data Exchange (ETDEWEB)

    Ferre, Jean-Christophe [Department of Neuroradiology, Hopital Pontchaillou, University Hospital Rennes, 2 rue Henri Le Guilloux, 35000 Rennes (France)], E-mail: jean-christophe.ferre@chu-rennes.fr; Carsin-Nicol, Beatrice [Department of Neuroradiology, Hopital Pontchaillou, University Hospital Rennes, 2 rue Henri Le Guilloux, 35000 Rennes (France); Morandi, Xavier [Department of Neurosurgery, Hopital Pontchaillou, University Hospital Rennes, 2 rue Henri Le Guilloux, 35000 Rennes (France); Carsin, Michel [Department of Neuroradiology, Hopital Pontchaillou, University Hospital Rennes, 2 rue Henri Le Guilloux, 35000 Rennes (France); Kersaint-Gilly, Axel de [Department of Neuroradiology, Hopital Laennec, University Hospital Nantes, Boulevard Jacques Monod, 44800 Saint-Herblain (France); Gauvrit, Jean-Yves [Department of Neuroradiology, Hopital Pontchaillou, University Hospital Rennes, 2 rue Henri Le Guilloux, 35000 Rennes (France); Desal, Hubert-Armand [Department of Neuroradiology, Hopital Laennec, University Hospital Nantes, Boulevard Jacques Monod, 44800 Saint-Herblain (France)

    2009-12-15

    Objective: To compare 3D time-of-flight MR angiography (TOF-MRA) at 3 Tesla (3 T) with digital subtraction angiography (DSA) for the evaluation of intracranial aneurysm occlusion after endovascular coiling. Methods: In a prospective study, 51 consecutive patients (25 females, 26 males; median age, 51 years) with 51 saccular aneurysms treated with endovascular coiling underwent simultaneous DSA and 3 T TOF-MRA at follow-up. DSA and TOF-MRA images were analyzed independently by two senior neuroradiologists. Findings were assigned to 1 of 3 categories in the Raymond classification: complete obliteration, residual neck or residual aneurysm. Agreement between observers and techniques was evaluated using {kappa} statistics. Results: DSA images were not interpretable for one patient. Interobserver agreement was determined as excellent for DSA ({kappa} = 0.86) and TOF-MRA ({kappa} = 0.80). After reaching a consensus, DSA follow-up showed 26 (51%) complete obliterations, 20 (39%) residual necks and 4 (8%) residual aneurysms. TOF-MRA showed 23 (45%) complete obliterations, 22 (43%) residual necks and 6 (12%) residual aneurysms. Comparison between TOF-MRA and DSA showed excellent agreement between the techniques ({kappa} = 0.86). In the four cases that were misclassified, TOF-MRA findings were assigned to a higher class than for DSA. Conclusion: TOF-MRA at 3 T is at least as efficient as DSA for the evaluation of intracranial aneurysm occlusion after endovascular treatment with detachable coils. We suggest that TOF-MRA at 3 T might be used as the primary method for imaging follow-up of coiled intracranial aneurysms.

  6. Intracranial saccular aneurysm

    Directory of Open Access Journals (Sweden)

    J. R. Pinto

    1992-12-01

    Full Text Available The authors report the cases of three patients from the same family, all with intracranial saccular aneurysm (left carotid artery, anterior communicating artery, and middle cerebral artery. All three patients were operated on with good recovery and no complications. The authors call attention for some etipathogenic aspects of familial saccular aneurysms.

  7. The safety and efficacy of low profile visualized intraluminal support (LVIS) stents in assisting coil embolization of intracranial saccular aneurysms: a single center experience.

    Science.gov (United States)

    Feng, Zhengzhe; Fang, Yibin; Xu, Yi; Hong, Bo; Zhao, Wenyuan; Liu, Jianmin; Huang, Qinghai

    2016-11-01

    The low profile visualized intraluminal support (LVIS) device is a new generation of self-expanding braided stents recently introduced into China for stent assisted coiling of intracranial aneurysms. This study assessed the clinical safety and efficacy of the LVIS stent for embolization of intracranial saccular aneurysms. Patients with intracranial saccular aneurysms treated using the LVIS device in our center between April 2014 and December 2014 were reviewed. The primary outcomes were procedural safety, target aneurysm recurrence, and mid-term follow-up of clinical and angiographic outcomes. 97 patients with intracranial saccular aneurysms were treated using the LVIS stent, with 100% technical success rate. No mortality was observed. One patient had transient deficit (1/97, 1.0%). Immediate angiographic outcome evaluation showed complete occlusion in 28 (28.8%) and neck remnant in 39 (40.2%) of the 97 patients, respectively. Of the 76 (78.35%) patients who underwent angiographic follow-up at a mean of 8.1 months, complete occlusion was achieved in 64 (84.2%) patients. In the remaining patients, neck remnant in nine (11.8%) and residual sac in three (4%) patients were observed. None of the patients had any target aneurysm recurrence, and the mortality rate was 0%. The LVIS stent is safe and effective in the treatment of intracranial saccular aneurysms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  8. Endovascular treatment of intracranial aneurysms with matrix coils: immediate posttreatment results, clinical outcome and follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Kimchi, T.J.; Spears, J.; Lee, S.K.; Ter Brugge, K. [University Health Network, University of Toronto, Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, ON (Canada); Willinsky, R.A. [University Health Network, University of Toronto, Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, ON (Canada); Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, ON (Canada)

    2007-03-15

    Endovascular aneurysm repair with coils has become a safe and effective alternative to surgical clipping. Efforts have been made to create coils that will facilitate aneurysm healing and reduce recurrence. The purpose of this study was to review the safety and durability of our aneurysm treatment using Matrix coils. A total of 39 aneurysms in 38 patients, aged 30 to 77 years, were treated using Matrix coils in 42 procedures. Two procedures were unsuccessful, and 12 were done using only Matrix coils. Aneurysm volume, packing density and percentage length of Matrix coils were calculated. The treatment results, procedural complication rate and clinical outcome were analyzed. Follow-up examinations were available for 34 procedures with a mean follow-up of 4.9 months (maximum 13.5 months). Angiographic results were similar to those following the use of platinum coils, with complete occlusion or a residual neck in 82.5% of procedures. Six procedures (14%) were complicated with platelet aggregation. Recanalization occurred in 32% of the patients. Nine patients (26%) had major recanalization and were retreated. One patient had a re-bleed 5 months after the treatment resulting in severe disability. The mean packing density of 39.2% in the recanalized aneurysms was similar to that in the nonrecanalized group. In our series, treatment with Matrix coils had a complication rate similar to that reported with platinum coils. However, we had a higher percentage of major recanalizations requiring retreatment. We believe that the absorption of the polymer contributes to the failure of formation of a stable scar within the aneurysm. (orig.)

  9. Endovascular treatment for pediatric intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Lv, Xianli; Jiang, Chuhan; Li, Youxiang; Yang, Xinjian; Wu, Zhongxue [Capital Medical University, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, Hebei (China)

    2009-11-15

    The purpose of this study is to report the characteristics and outcomes of pediatric patients with intracranial aneurysms. From 1998 to 2005, 25 pediatric patients (aged {<=}17 years) with intracranial aneurysm were treated at our institute. Eleven of 25 patients had subarachnoid hemorrhage. In ten patients, the aneurysm was an incidental finding. One patient presented with cranial nerves dysfunction and three with neurological deficits. The locations of the aneurysms were as follows: vertebral artery (VA; n = 9), middle cerebral artery (MCA; n = 5), posterior cerebral artery (PCA; n = 4), basilar artery (BA; n = 2), anterior communicating artery (n = 2), anterior cerebral artery (n = 2), and internal carotid artery (n = 1). Five patients were treated with selective embolization with coils. Sixteen patients were treated with parent vessel occlusion (PVO). Eight PVOs were performed with balloons and eight were performed with coils. One patient with a VA aneurysm was spontaneously thrombosed 4 days after the initial diagnostic angiogram. In three patients treated with stent alone or stent-assisted coiling, one with BA trunk aneurysm died. One aneurismal recurrence occurred and was retreated. At a mean follow-up duration of 23.5 months, 96% of patients had a Glasgow Outcome Scale score of 4 or 5. Pediatric intracranial aneurysms occur more commonly in male patients and have a predilection for the VA, PCA, and MCA. PVO is an effective and safe treatment for fusiform aneurysms. Basilar trunk fusiform aneurysms were difficult to treat and were associated with a high mortality rate. (orig.)

  10. Time-of-flight magnetic resonance angiography for follow-up of coil embolization with enterprise stent intracranial aneurysm: Usefulness of source images

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Young Dae; Kim, Kang Min; Lee, Woong Jae; Sohn, Chul Ho; Kang, Hyun Seung; Kim, Jeong Eun; Han, Moon Hee [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2014-02-15

    The aim of this study was to determine the interobserver and intermodality agreement in the interpretation of time-of-flight (TOF) MR angiography (MRA) for the follow-up of coiled intracranial aneurysms with the Enterprise stent. Two experienced neurointerventionists independently reviewed the follow-up MRA studies of 40 consecutive patients with 44 coiled aneurysms. All aneurysms were treated with assistance from the Enterprise stent and the radiologic follow-up intervals were greater than 6 months after the endovascular therapy. Digital subtraction angiography (DSA) served as the reference standard. The degree of aneurysm occlusion was determined by an evaluation of the maximal intensity projection (MIP) and source images (SI) of the TOF MRA. The capability of the TOF MRA to depict the residual flow within the coiled aneurysms and the stented parent arteries was compared with that of the DSA. DSA showed stable occlusions in 25 aneurysms, minor recanalization in 8, and major recanalization in 11. Comparisons between the TOF MRA and conventional angiography showed that the MIP plus SI had almost perfect agreement (κ = 0.892, range 0.767 to 1.000) and had better agreement than with the MIP images only ((κ = 0.598, range 0.370 to 0.826). In-stent stenosis of more than 33% was observed in 5 cases. Both MIP and SI of the MRA showed poor depiction of in-stent stenosis compared with the DSA. TOF MRA seemed to be reliable in screening for aneurysm recurrence after coil embolization with Enterprise stent assistance, especially in the evaluation of the SI, in addition to MIP images in the TOF MRA.

  11. Rationale for treating unruptured intracranial aneurysms: actuarial analysis of natural history risk versus treatment risk for coiling or clipping based on 14,050 patients in the Nationwide Inpatient Sample database.

    Science.gov (United States)

    Lawson, Matthew F; Neal, Daniel W; Mocco, J; Hoh, Brian L

    2013-01-01

    The treatment of small unruptured intracranial aneurysms has been questioned based on the results of the International Study of Unruptured Intracranial Aneurysms. Our objective was to compare natural history rupture risk versus treatment risk for coiling and clipping small unruptured aneurysms using data in the Nationwide Inpatient Sample database. Data for clipping and coiling of unruptured aneurysms was collected from the Nationwide Inpatient Sample from 2002-2008. Treatment risks were adjusted for age, gender, and medical comorbidities. Logistic regression models were used to create curves depicting the estimated probability of poor outcome as a function of patient age for clipping and coiling. These treatment risk curves were compared against natural history actuarial risk curves calculated from four prominent studies. There were 14,050 hospitalizations: 7439(53%) coiling; 6611(47%) clipping. For patients who underwent coiling or clipping, the mortality rate was 2.17% and 2.66%, and the morbidity rate was 2.16% and 4.75%, respectively. The adjusted risk of poor outcome from clipping and coiling, when modeled against most natural history studies, demonstrates a treatment benefit for clipping for patients <70 years and for coiling patients <81 years. Models using the International Study of Unruptured Intracranial Aneurysms data demonstrate a treatment benefit for clipping for patients <61 years and for coiling for patients <70 years. Both clipping and coiling of unruptured intracranial aneurysms are safe. This analysis demonstrates rationale for clipping small unruptured aneurysms in patients <61-70 years and coiling small unruptured aneurysms in patients <70-80 years. Treatment beyond these age ranges is associated with increased risk of poor outcome. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Stenting After Coiling Using a Single Microcatheter for Treatment of Ruptured Intracranial Fusiform Aneurysms with Parent Arteries Less Than 1.5 mm in Diameter.

    Science.gov (United States)

    Liu, Jian; Zhang, Yisen; Wang, Yang; Mu, Shiqing; Yang, Xinjian

    2017-03-01

    Ruptured intracranial fusiform aneurysms involving small-diameter parent arteries are difficult to treat. Parent artery occlusion is a relatively simple and reliable treatment. However, occasionally, the parent arteries have to be retained. The arrival of the low-profile stent (LVIS Jr.) has made reconstructive endovascular treatment for fusiform aneurysms involving small-diameter parent arteries possible. This report describes an innovative method for stent-assisted coiling (stenting after coiling technique using only 1 microcatheter) and describes our initial experience and feasibility of this technique. However, this report carries all limitations of a technical case report of a single patient, including reproducibility, unknown potential of complications, absence of long-term follow-up, and comparative effectiveness or safety with current known techniques. Stenting after a coiling technique using the LVIS Jr. stent provides a possible method for reconstructive endovascular treatment of intracranial fusiform aneurysms with parent arteries <1.5 mm in diameter. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. The Barrel vascular reconstruction device for endovascular coiling of wide-necked intracranial aneurysms: a multicenter, prospective, post-marketing study.

    Science.gov (United States)

    Gory, Benjamin; Blanc, Raphaël; Turjman, Francis; Berge, Jérôme; Piotin, Michel

    2018-02-02

    The Barrel vascular reconstruction device (Barrel VRD) is a novel stent with design features that allow endovascular coiling of wide-necked bifurcation aneurysms while preserving adjacent branches, without necessitating dual stent implantation. This study aimed to assess the safety and effectiveness of the Barrel VRD at 12-month follow-up. The Barrel VRD trial is a prospective, multicenter, observational post-marketing registry evaluating the use of the Barrel VRD for treatment of wide-necked bifurcation aneurysms. The primary effectiveness endpoint was successful aneurysm treatment measured by digital subtraction angiography with a Raymond-Roy occlusion grade of 1 or 2 in the absence of retreatment, parent artery stenosis (>50%), or target aneurysm rupture at 12 months. The primary safety endpoint was the absence of neurological death or major stroke at 12 months. Twenty patients were enrolled from December 2013 to December 2014. The device was implanted in 19 patients with 19 aneurysms (8 middle cerebral artery, 4 anterior communicating artery, 1 internal carotid artery terminus, 4 basilar artery aneurysms; mean dome height 5.7±1.91 mm; mean neck length 4.8±1.35 mm, mean dome-to-neck ratio 1.6±2.0). Coiling was performed in all cases. The primary effectiveness endpoint was achieved in 78.9% of subjects (15/19; 12 complete occlusions, 3 neck remnants), and the primary safety endpoint was 5.3% (1/19). This prospective study demonstrates that the Barrel VRD device resulted in ~80% occlusion rates and ~5% rates of neurological complications at 1 year after endovascular treatment of wide-necked bifurcation intracranial aneurysms. REGISTERED CLINICAL TRIAL: NCT02125097;Results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. Stent-assisted coiling of intracranial aneurysms located on small vessels: midterm results with the LVIS Junior stent in 40 patients with 43 aneurysms.

    Science.gov (United States)

    Alghamdi, Faisal; Mine, Benjamin; Morais, Ricardo; Scillia, Pietro; Lubicz, Boris

    2016-07-01

    The Low-profile Visualized Intraluminal Support (LVIS) Junior stent is dedicated for endovascular treatment of wide-neck intracranial aneurysms located on small-diameter vessels (2-3.5 mm). This study reports midterm clinical and anatomical results of this device. This study was approved by authors' ethical committees. A retrospective review of our prospectively maintained database identified all patients treated by this stent in three institutions. Technical issues and immediate and mid-term anatomical and clinical outcomes were evaluated. Forty patients (30 women/10 men, mean age of 55 years) with 43 aneurysms were identified. Mean aneurysm diameter was 5.6 mm (range, 2-13 mm). In all patients, treatment was successful and the stent could be precisely placed. There were three procedure-related complications, one stent thrombosis and two aneurysm ruptures, leading to immediate morbidity in one patient. Delayed ischemic events occurred in three patients including two transient attacks and one permanent deficit. The overall permanent morbidity rate was thus 5 %. No mortality occurred. Immediate aneurysm occlusion consisted of 36 complete occlusions (83.7 %), five neck remnants (11.6 %), and two incomplete occlusions (4.7 %). Twenty-seven patients (29 aneurysms) and 11 patients (11 aneurysms) had a 12- and 6-month angiographic follow-up, respectively. Final anatomical results included 36 complete occlusions (90 %) and four neck remnants (10 %). Two minor recanalizations were seen but did not require retreatment. Non-significant intrastent stenosis occurred in 7/40 followed-up cases (17.5 %). The LVIS Junior stent appears safe and effective for endovascular treatment of wide-neck intracranial aneurysms located on small vessels. Midterm results show high rates of adequate and stable occlusion.

  15. Surgical decision-making for managing complex intracranial aneurysms

    OpenAIRE

    Esposito, Giuseppe; Regli, Luca

    2014-01-01

    The treatment of complex intracranial aneurysms remains a therapeutic challenge. These lesions are frequently not amenable to selective clipping or coiling or other endovascular procedures and surgery still has a predominant role. We illustrate our “surgical decision making” for managing complex intracranial aneurysmal lesions. The best strategy is decided on the basis of pre-operative neuroradiological and intra-operative main determinants such as anatomical location, peri-aneurysmal ang...

  16. The LVIS Jr. microstent to assist coil embolization of wide-neck intracranial aneurysms: clinical study to assess safety and efficacy.

    Science.gov (United States)

    Möhlenbruch, M; Herweh, C; Behrens, L; Jestaedt, L; Amiri, H; Ringleb, P A; Bendszus, M; Pham, M

    2014-05-01

    This study was aimed to assess clinical safety and efficacy of the LVIS Jr. microstent in stent-assisted coil embolization of wide-neck intracranial aneurysms. IRB approved single-center interventional clinical study in 22 patients (10 females, 12 males, mean age 55, age range 33-74 years) for the endovascular treatment of wide-neck aneurysms. After obtaining informed consent, patients were included according to the following criteria: aneurysm fundus-to-neck ratio  4 mm, and a parent vessel diameter of ≤3.5 mm. Primary end point for clinical safety was absence of death, absence of major or minor stroke, and absence of transient ischemic attack. Primary end point for treatment efficacy was complete angiographic occlusion according to the Raymond-Roy Occlusion Classification (RROC) immediately after the procedure and at follow-up after 3 and 6 months on magnetic resonance imaging (MRI). In 20/22 (91 %) of patients, the primary end point of safety was reached; in the two remaining patients, transient ischemic attack, but no permanent deficit was observed; in 16/22 (73 %), efficient occlusion (RROC1) was reached, and in 6/22 (27 %), a residual neck remained (RROC2). Single [seven with antegrade, two in crossover configuration, and four with "first-balloon-then-stent" (FBTS) technique] or double-stent (eight patients with Y configuration and one patient with X configuration) deployment was technically successful in all cases. Deployment of the LVIS Jr. microstent in various single- or double-stent configurations is safe and effective to assist the treatment of intracranial wide-neck aneurysms.

  17. The LVIS Jr. microstent to assist coil embolization of wide-neck intracranial aneurysms: clinical study to assess safety and efficacy

    Energy Technology Data Exchange (ETDEWEB)

    Moehlenbruch, M.; Herweh, C.; Behrens, L.; Jestaedt, L.; Bendszus, M.; Pham, M. [University of Heidelberg Medical Center, Department of Neuroradiology, Heidelberg (Germany); Amiri, H.; Ringleb, P.A. [University of Heidelberg Medical Center, Department of Neurology, Heidelberg (Germany)

    2014-05-15

    This study was aimed to assess clinical safety and efficacy of the LVIS Jr. microstent in stent-assisted coil embolization of wide-neck intracranial aneurysms. IRB approved single-center interventional clinical study in 22 patients (10 females, 12 males, mean age 55, age range 33-74 years) for the endovascular treatment of wide-neck aneurysms. After obtaining informed consent, patients were included according to the following criteria: aneurysm fundus-to-neck ratio < 2 or neck diameter > 4 mm, and a parent vessel diameter of ≤3.5 mm. Primary end point for clinical safety was absence of death, absence of major or minor stroke, and absence of transient ischemic attack. Primary end point for treatment efficacy was complete angiographic occlusion according to the Raymond-Roy Occlusion Classification (RROC) immediately after the procedure and at follow-up after 3 and 6 months on magnetic resonance imaging (MRI). In 20/22 (91 %) of patients, the primary end point of safety was reached; in the two remaining patients, transient ischemic attack, but no permanent deficit was observed; in 16/22 (73 %), efficient occlusion (RROC1) was reached, and in 6/22 (27 %), a residual neck remained (RROC2). Single [seven with antegrade, two in crossover configuration, and four with ''first-balloon-then-stent'' (FBTS) technique] or double-stent (eight patients with Y configuration and one patient with X configuration) deployment was technically successful in all cases. Deployment of the LVIS Jr. microstent in various single- or double-stent configurations is safe and effective to assist the treatment of intracranial wide-neck aneurysms. (orig.)

  18. Follow-up CT and CT angiography after intracranial aneurysm clipping and coiling - improved image quality by iterative metal artifact reduction

    Energy Technology Data Exchange (ETDEWEB)

    Bier, Georg; Hempel, Johann-Martin; Oergel, Anja; Hauser, Till-Karsten; Ernemann, Ulrike; Hennersdorf, Florian [Eberhard Karls University Tuebingen, Department of Diagnostic and Interventional Neuroradiology, Tuebingen (Germany); Bongers, Malte Niklas [Eberhard Karls University Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany)

    2017-07-15

    This paper aims to evaluate a new iterative metal artifact reduction algorithm for post-interventional evaluation of brain tissue and intracranial arteries. The data of 20 patients that underwent follow-up cranial CT and cranial CT angiography after clipping or coiling of an intracranial aneurysm was retrospectively analyzed. After the images were processed using a novel iterative metal artifact reduction algorithm, images with and without metal artifact reduction were qualitatively evaluated by two readers, using a five-point Likert scale. Moreover, artifact strength was quantitatively assessed in terms of CT attenuation and standard deviation alterations. The qualitative analysis yielded a significant increase in image quality (p = 0.0057) in iteratively processed images with substantial inter-observer agreement (k = 0.72), while the CTA image quality did not differ (p = 0.864) and even showed vessel contrast reduction in six cases (30%). The mean relative attenuation difference was 27% without metal artifact reduction vs. 11% for iterative metal artifact reduction images (p = 0.0003). The new iterative metal artifact reduction algorithm enhances non-enhanced CT image quality after clipping or coiling, but in CT-angiography images, the contrast of adjacent vessels can be compromised. (orig.)

  19. Artefacts induced by coiled intracranial aneurysms on 3.0-Tesla versus 1.5-Tesla MR angiography--An in vivo and in vitro study.

    Science.gov (United States)

    Schaafsma, Joanna D; Velthuis, Birgitta K; Vincken, Koen L; de Kort, Gerard A P; Rinkel, Gabriel J E; Bartels, Lambertus W

    2014-05-01

    To compare metal-induced artefacts from coiled intracranial aneurysms on 3.0-Tesla and 1.5-Tesla magnetic resonance angiography (MRA), since concerns persist on artefact enlargement at 3.0Tesla. We scanned 19 patients (mean age 53; 16 women) with 20 saccular aneurysms treated with coils only, at 1.5 and 3.0Tesla according to standard clinical 3D TOF-MRA protocols containing a shorter echo-time but weaker read-out gradient at 3.0Tesla in addition to intra-arterial digital subtraction angiography (IA-DSA). Per modality two neuro-radiologists assessed the occlusion status, measured residual flow, and indicated whether coil artefacts disturbed this assessment on MRA. We assessed relative risks for disturbance by coil artefacts, weighted kappa's for agreement on occlusion levels, and we compared remnant sizes. For artefact measurements, a coil model was created and scanned with the same protocols followed by 2D MR scans with variation of echo-time and read-out gradient strength. Coil artefacts disturbed assessments less frequently at 3.0Tesla than at 1.5Tesla (RR: 0.3; 95%CI: 0.1-0.8). On 3.0-Tesla MRA, remnants were larger than on 1.5-Tesla MRA (difference: 0.7mm; 95%CI: 0.3-1.1) and larger than on IA-DSA (difference: 1.0mm; 95%CI: 0.6-1.5) with similar agreement on occlusion levels with IA-DSA for both field strengths (κ 0.53; 95%CI: 0.23-0.84 for 1.5-Tesla MRA and IA-DSA; κ 0.47; 95%CI: 0.19-0.76 for 3.0-Tesla MRA and IA-DSA). Coil model artefacts were smaller at 3.0Tesla than at 1.5Tesla. The echo-time influenced artefact size more than the read-out gradient. Artefacts were not larger, but smaller at 3.0Tesla because a shorter echo-time at 3.0Tesla negated artefact enlargement. Despite smaller artefacts and larger remnants at 3.0Tesla, occlusion levels were similar for both field strengths. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  20. Persistent neurological deficit from iodinated contrast encephalopathy following intracranial aneurysm coiling. A case report and review of the literature.

    LENUS (Irish Health Repository)

    Leong, S

    2012-03-01

    Neurotoxicity from iodinated contrast agents is a known but rare complication of angiography and neurovascular intervention. Neurotoxicity results from contrast penetrating the blood-brain barrier with resultant cerebral oedema and altered neuronal excitability. Clinical effects include encephalopathy, seizures, cortical blindness and focal neurological deficits. Contrast induced encephalopathy is extensively reported as a transient and reversible phenomenon. We describe a patient with a persistent motor deficit due to an encephalopathy from iodinated contrast media administered during cerebral aneurysm coiling. This observation and a review of the literature highlights that contrast-induced encephalopathy may not always have a benign outcome and can cause permanent deficits. This potential harmful effect should be recognised by the angiographer and the interventionalist.

  1. Efficacy of Endovascular Therapy for Direct Occlusion of Intracranial Aneurysms

    Directory of Open Access Journals (Sweden)

    K Tamrakar

    2011-09-01

    Full Text Available Introduction: Our purpose was to evaluate the effectiveness of endovascular therapy using detachable coils and balloons for the direct occlusion of intracranial aneurysms. Methods: We retrospectively reviewed 563 patients undergoing digital subtraction angiography from January 2007 to July 2009. Two hundred and fi fty patients with 323 embolized intracranial aneurysms were studied. Results: Among 250 patients, 66 % were female and 34 % male, the age ranging from 19 - 83 years (mean 50.66 ± 12.92. One hundred and seventy-seven had a single aneurysm while 73 showed multiple aneurysms. Seventeen (9.6 % had giant aneurysms. Three hundred and eleven aneurysms were treated using detachable coils, and 12 giant aneurysms were embolized by detachable balloons for the parent vessel occlusion. Of 323 aneurysms treated via the endovascular approach, total occlusion was seen in 93 % of the aneurysms, near total occlusion in 5.2 % and incomplete embolization in 1.5 %. Among patients presenting with sub-arachnoid hemorrhage, 62 improved to the Glasgow outcome score (GOS of 5, 93 improved to GOS 4, 14 improved to GOS 3, 10 improved to GOS 2 at the time of discharge and 5 patients died. Angiographic follow-up was scheduled between 6 - 12 months post-embolization. The aneurysm recurred in 1.2 % and were re-embolized using additional coils. Statistically, Hunt and Hess Grade and GOS indicated clinical signifi cance (P 0.05. Conclusions: Hunt and Hess VI and V are considered as poor clinical gradings in aneurysmal SAH. However, endovascular treatment has been established as an effective method to obliterate intracranial aneurysms allowing subsequent decrease in mortality and morbidity. Keywords: detachable coils, detachable balloons, endovascular therapy, intracranial aneurysms.

  2. [Intracranial carotid artery bifurcation aneurysms].

    Science.gov (United States)

    Vega-Basulto, S D; Montejo-Montejo, J

    Intracranial carotid artery bifurcation aneurysms are infrequent but its clinical behavior, high risk of bleeding and complex anatomic relationships of the sac permit to consider these lesions as a challenge cases. 497 patients harboring intracranial aneurysms were operated on at Manuel Ascunce Domenech Hospital, Camagüey, Cuba between January 1982 to august 2001. We utilized microsurgical procedures, optical magnification, specialized neuroanesthesia and Intensive Care Unit postoperatory following. All patients were evaluated clinically with World Federation Neurological Surgeon Scale and Glasgow Outcome Scale. There were 16 patients with intracranial carotid artery bifurcation aneurysms (3.2 %). 12 patients were under 40 years and 50% were between 16 and 30 years old. All patients present intracranial bleeding. There was 87.5% of total or partial recuperation. There was one death only. Postoperative deficit were observed at 44% but 31% disappeared three month later. Intracranial carotid artery bifurcation aneurysms are complex anatomoclinical lesions. Clinically, we observed high tendency to bleed and multiplicity. Anatomically, these sacs have complex arterial relationship that difficult dissection and clipping. They have frequent postoperative morbidity. Multiple or bilateral aneurysmal sacs will be clipped by one surgical procedure.

  3. Individualized management for intracranial vertebral artery dissecting aneurysms

    Directory of Open Access Journals (Sweden)

    SHANG Yan-guo

    2012-02-01

    Full Text Available Objective To discuss the individualized management strategy for intracranial vertebral artery dissecting aneurysms. Methods Eighteen patients with intracranial vertebral artery dissecting aneurysms were treated with different surgical methods. Results Eighteen patients underwent different surgical treatment. Five patients underwent complete occlusion of the aneurysm and parent artery by coiling, 5 were treated by stent -assisted coiling (3 densely packed coiling and 2 non-densely packed coiling, 4 underwent stent-only therapy and 3 of them presented hemodynamic improvement after surgery, 3 were treated by direct surgical clipping, and 1 underwent occipital artery-posterior inferior cerebellar artery bypass. Two aneurysms ruptured immaturely, in which one patient died on the third day after operation and one patient occurred moderate disablity. Only 1 patient who underwent complete occlusion of aneurysm and parent artery presented temporarily ischemic symptoms. No adverse effects were seen in other patients. Seventeen patients were followed up for 1 month to 3 years, and all the aneurysms were stable. Conclusion There are many kinds of therapeutic methods for intracranial vertebral artery dissecting aneurysms. The patients should be treated according to several factors such as the clinical manifestations, aneurysm configuration, and relationship with the posterior inferior cerebellar artery. The treatment should be individualized.

  4. Comparison of Recanalization and In-stent Stenosis between LVIS stent and Enterprise stent-assisted coiling for 254 intracranial aneurysms.

    Science.gov (United States)

    Feng, Xin; Qian, Zenghui; Liu, Peng; Zhang, Baorui; Wang, Luyao; Guo, Erkang; Wen, Xiaolong; Xu, Wenjuan; Jiang, Chuhan; Wu, Zhongxue; Li, Youxiang; Liu, Aihua

    2017-09-25

    We compared the rates of recanalization and in-stent stenosis between the Enterprise and Low-profile Visualized Intraluminal Support(LVIS) stent deployments for intracranial aneurysms(IAs), and the factors associated therein. In total, 142 patients with 161 IAs were treated by LVIS stent-assisted coiling and 111 patients with 142 IAs were treated by Enterprise stent-assisted coiling, respectively, from June 2014 to July 2016 at our institute. Procedure-related complications, angiographic follow-up results, and clinical outcomes were statistically analyzed. The rates of initially complete and near-complete occlusion of the IAs immediately after the procedure between the LVIS and Enterprise groups were similar(94.3% vs 89.9%, P=0.275). Follow-up data identified that the complete and near-complete occlusion rates and recanalization rates were similar for the two groups(96.6% vs 92.1%, P =0.330; 8.0%vs 13.5%; P=0.245). On logistic regression analysis,a higher size ratio(SR) was significantly associated with the recanalization of aneurysms in the Enterprise group,but not in the LVIS group. The rate of moderate and severe in-stent stenosis was lower in the LVIS group (10.2%) than in the Enterprise group (16.8%), with no statistically significant difference (P=0.198). Our study demonstrated acceptable rates of complete and near-complete occlusion with both LVIS and Enterprise stents. LVIS stents may achieve lower rate of recanalization and in-stent stenosis than Enterprise, although this difference was not significant. Higher SR (≥2) was a significant predictor of recanalization in IAs treated with Enterprise stents, but not those treated with LVIS stents. Copyright © 2017. Published by Elsevier Inc.

  5. Endovascular coiling of small intracranial aneurysms using a very soft bare platinum coil: A comparison of the packing performance of new and old HyperSoft® helical coils.

    Science.gov (United States)

    Ren, Hecheng; Wei, Ming; Yin, Long; Ma, Lin; Peng, Longfeng

    2016-02-01

    Soft and small coils are known to be appropriate for the treatment of small aneurysms. The purpose of this study was to determine whether the new HyperSoft® helical coil, which is softer and smaller than its predecessors, has any effect on the packing performance in a matched-pair study with an old HyperSoft® helical coil. Thirty-six consecutive patients harboring 43 cerebral aneurysms treated with new HyperSofts were included in this study. Forty-one aneurysms treated with old HyperSofts were identified from our database as matched controls based on similar volumes and locations. Packing attenuation, adverse events during the procedures, and angiographic occlusions were observed and compared between the two groups. The mean packing density was significantly higher in the new HyperSoft® group compared to the control group (35.5% vs. 26.9%), and a larger proportion of the aneurysms embolized with the 1.5 mm size coil, which has higher packing density. There was no difference in immediate and midterm angiographic outcomes. There was no difference in the rate of intraprocedural perforation, but there was no intraprocedural rupture related to the 1.5 mm coil. The use of new HyperSoft® helical coils allows higher packing density comparable with the old technology. New HyperSoft® coils, especially those with 1.5 mm loop diameter, can be expected to fill smaller residual spaces in small aneurysms and may be helpful in preventing recanalization. © The Author(s) 2015.

  6. Infectious intracranial aneurysms in the pediatric population: endovascular treatment with Onyx.

    Science.gov (United States)

    Eddleman, Christopher S; Surdell, Daniel; DiPatri, Arthur; Tomita, Tadanori; Shaibani, Ali

    2008-08-01

    Infectious intracranial aneurysms present a treatment challenge in the pediatric population. Current endovascular strategies and tools have been developed, which make treatment of infectious intracranial aneurysms with liquid embolics safe and effective. This study reviews the use of the liquid embolic Onyx in the treatment of infectious intracranial aneurysms in the pediatric population. We used an endovascular approach to treat ruptured infectious intracranial aneurysms. We embolized the aneurysms with either Onyx alone or in combination with platinum coils. Endovascular therapy with liquid embolics (Onyx) has been shown to be a safe and effectual treatment option in the case of pediatric infectious intracranial aneurysms. The combination of endovascular modalities can also be used to tailor the therapeutic goal of exclusion of infectious aneurysms with good results. Further studies are needed to assess the long-term effectiveness of this approach to pediatric infectious intracranial aneurysms.

  7. Short term outcomes following clipping and coiling of ruptured intracranial aneurysms: does some of the benefit of coiling stem from less procedural impact on deranged physiology at presentation?

    Science.gov (United States)

    Mortimer, Alex M; Bradford, Celia; Steinfort, Brendan; Faulder, Ken; Assaad, Nazih; Harrington, Timothy

    2016-02-01

    Endovascular coiling (EVC) has been shown to yield superior clinical outcomes to surgical clipping (SC) in the treatment of ruptured cerebral aneurysms. The reasons for these differences remain obscure. We aimed to assess outcomes of EVC and SC relative to baseline physiological derangement. This was an exploratory analysis of prospectively collected trial data. Physiological derangement was assessed using the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system. Other contributory variables such as age, World Federation of Neurosurgical Societies (WFNS) grade, and development of complications, including hydrocephalus and vasospasm, were included in the analysis. Clinical outcome was independently assessed at 90 days using the modified Rankin Scale (mRS). Hospital stay, ventilated days, and total norepinephrine dose were also used as secondary outcomes. Multivariate analysis was performed using binary logistic regression. EVC was performed in 69 patients and SC in 66 patients. More profound physiological derangement (APACHE II score >15) was the strongest predictor of poor outcome in the overall cohort (OR 17.80, 95% CI 4.78 to 66.21, p15; 59 patients), WFNS grade ≥4 (OR 6.74, 1.43 to 31.75) and SC (OR 6.33, 1.27 to 31.38) were significant predictors of poor outcome (pEVC patients in this subgroup. SC patients had significantly increased total norepinephrine dose, ventilated days, and hospital stay (p<0.05). More profound physiological derangement at baseline is a strong predictor of eventual poor outcome, and outcomes for patients with more profound baseline physiological derangement may be improved if undergoing a coiling procedure. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  8. Intracranial Aneurysms in Adult Moyamoya Disease.

    Science.gov (United States)

    Kim, Jang Hun; Kwon, Taek-Hyun; Kim, Jong Hyun; Chong, Kyuha; Yoon, Wonki

    2018-01-01

    The prevalence of aneurysm formation in adults with moyamoya disease (MMD) is approximately 14%, and it represents a major potential hemorrhagic risk. We aimed to study the characteristics of intracranial aneurysms occurring in patients with MMD. We retrospectively reviewed our 10-year experience of patients with intracranial aneurysms and a diagnosis of MMD at our hospital. Imaging studies and clinical records of 211 patients who were admitted to our hospital between January 2007 and December 2016 and were diagnosed with MMD were retrospectively reviewed. Patients were divided into 2 groups: 1) MMD without intracranial aneurysms and 2) MMD with intracranial aneurysms. The 2 groups were compared using statistical analysis. Angiographic findings and clinical features of MMD-associated aneurysms were reviewed. There were significant differences between the 2 groups, including age and clinical presentation. Among all enrolled patients (N = 132), 11 aneurysms were discovered in 11 patients. Prevalence of intracranial aneurysms in patients with MMD was 8.3%, and the rupture rate of these aneurysms was 63.6%. We classified the 10 MMD-associated aneurysms (excluding 1 incidentally found paraclinoid aneurysm) as follows: 4 dissecting aneurysms or pseudoaneurysms and 6 hemodynamic true aneurysms. MMD-associated intracranial aneurysms frequently occur in patients presenting with hemorrhagic MMD and are associated with an extremely high rate of rupture. Long-standing hemodynamic stress as well as pathologic and anatomic factors might contribute to the formation of an aneurysm. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Phase contrast MRI in intracranial aneurysms

    NARCIS (Netherlands)

    van Ooij, P.

    2012-01-01

    Intracranial aneurysms are outpouchings of intracranial arteries that cause brain hemorrhage after rupture. Unruptured aneurysms can be treated but the risk of treatment may outweigh the risk of rupture. Local intra-aneurysmal hemodynamics can contribute substantially to the rupture risk estimation

  10. The safety of anticoagulation in patients with intracranial aneurysms.

    Science.gov (United States)

    Tarlov, Nicholas; Norbash, Alexander M; Nguyen, Thanh N

    2013-09-01

    Little is known about the safety of long-term anticoagulation in patients with unruptured saccular intracranial aneurysms, although case reports of anticoagulation in patients with fusiform and saccular aneurysms have been published. The goal of this study was to estimate the rate of subarachnoid hemorrhage (SAH) due to aneurysm rupture in patients with intracranial saccular aneurysms receiving therapeutic doses of anticoagulation. This was a retrospective case series of patients with intradural aneurysms receiving therapeutic doses of anticoagulation (defined as a dose that achieves a target INR >2.0 or the equivalent dose of another anticoagulant). The primary outcome was SAH due to aneurysm rupture while receiving anticoagulation treatment. The rate of SAH due to aneurysm rupture was calculated among patients with aneurysms documented on imaging. 42 patients with 48 intradural aneurysms on anticoagulation were identified. Their mean age was 67 years (range 40-83) and 28 (67%) were women. The mean aneurysm size was 5.1±3.6 mm and 40 (83%) aneurysms were in the anterior circulation. The mean±SD follow-up was 495±749 days per patient. Twelve patients had their aneurysms coiled, clipped or surgically wrapped before the period of anticoagulation. Three patients had clipping or coiling of their aneurysms during the period of anticoagulation. Six patients had a history of aneurysm rupture prior to anticoagulation, of which two were treated by coiling and four by clipping. Among the 48 aneurysms, 32 were never coiled or clipped prior to anticoagulation. No anticoagulated patients with known aneurysms developed SAH during 57 patient-years of follow-up. The patients with untreated aneurysms had 31 patient-years of follow-up and those who underwent clipping, coiling or surgical wrapping of their aneurysms had 26 patient-years of follow-up while receiving anticoagulation (for a combined total of 57 years of follow up). The risk of aneurysm rupture is not increased in

  11. Characterization of pressure reduction in coil-filled aneurysm under flow of human blood with and without anti-coagulant.

    Science.gov (United States)

    Lam, Alexander K N; Ko, Match W L; Leung, Leo K K; Kwok, John C K; Yuen, Mathew M F; Lam, David C C

    2013-01-01

    Filling aneurysms with embolization coils is a widely used part of the treatment to stop intracranial aneurysm from rupturing. However, the effect of coiling on aneurysmal pressure has not been established. In this study, the effect of intra-aneurysmal coiling on pressure reduction was characterized. Coil deployment in the aneurysm will disturb flow and may induce aneurysmal coagulation. These effects were experimentally examined in this study using silicone rubber saccular aneurysm models. Changes in aneurysmal blood pressure under pulsatile flow were characterized. With coils in the aneurysm, results showed that flow reduction of anti-coagulated blood in the aneurysm did not reduce aneurysmal pressure. Significant pressure reduction was observed only when the blood's coagulation ability is restored to normal. These results suggest that blood coagulation is pivotal to pressure reduction and concomitant with rupture risk reduction in treatments of aneurysm with coils.

  12. Intracranial aneurysm associated with relapsing polychondritis

    Energy Technology Data Exchange (ETDEWEB)

    Coumbaras, M.; Boulin, A.; Pierot, L. [Dept. of Neuroradiology, Hopital Foch, Suresnes (France); Piette, A.M.; Bletry, O. [Dept. of Medicine, Hopital Foch, Suresnes (France); Graveleau, P. [Dept. of Neurology, Hopital Foch, Suresnes (France)

    2001-07-01

    We describe a 50-year-old man with relapsing polychondritis (RP) involving auricular cartilage, uveitis and hearing loss, who had an aneurysm of the anterior cerebral artery. Intracranial aneurysm is a rare manifestation of RP. (orig.)

  13. Clinical evaluation of therapeutic measures for intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    LI Juan

    2012-02-01

    Full Text Available Objective To evaluate the therapeutic efficacy and side effect of various treatment for intracranial aneurysms in order to formulate the best therapeutic regimen for the evidence-based treatment of intracranial aneurysms. Methods Intracranial aneurysms, treatment, endovascular coiling treatment or neurosurgical clipping treatment were used as retrieval words. MEDLINE, PubMed, Cochrane library were used for retrieval, and manual searching was also used. Related clinical guidelines, systematic reviews, randomised controlled clinical trials, controlled clinical trials, retrospective case analysis and case -observation studies were collected and evaluated by Jadad Scale. Results Twenty-six related articles were selected as follow: 4 clinical guidelines, 4 randomised controlled clinical trials, 7 systematic reviews, 9 retrospective case analysis, 1 controlled clinical trials, and 1 case-observation study. Among the above articles 20 were of high quality (2 articles with 7 points, 2 articles 6 points, 4 articles 5 points, 12 articles 4 points, while 6 were of low quality by score. According to therapeutic principle and the evaluation of therapeutic efficacy and side effects of various therapies, it is suggested that: 1 Endovascular coiling treatment and surgical clipping treatment are the two main methods of intracranial aneurysms, but it is still controversial which method is more advantage. 2 For unruptured intracranial aneurysms, there is still having controversy in whether they should be treated or not. Symptomatic unruptured intracranial aneurysms are suggested to be treated actively, but for asymptomatic small unruptured aneurysms, there is still having controversy, various factors should be comprehensively accounted, such as age, previous history, family history, the size of the aneurysm, location, morphology and life expectancy, etc. 3 For rupture intracranial aneurysms, it should be treated as soon as possible, only when the patients with

  14. Migraine before rupture of intracranial aneurysms

    DEFF Research Database (Denmark)

    Lebedeva, Elena R; Gurary, Natalia M; Sakovich, Vladimir P

    2013-01-01

    Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA.......Rupture of a saccular intracranial aneurysm (SIA) causes thunderclap headache but it remains unclear whether headache in general and migraine in particular are more prevalent in patients with unruptured SIA....

  15. Endovascular treatment of pediatric intracranial aneurysms: a retrospective study of 35 aneurysms.

    Science.gov (United States)

    Takemoto, Koichiro; Tateshima, Satoshi; Golshan, Ali; Gonzalez, Nestor; Jahan, Reza; Duckwiler, Gary; Vinuela, Fernando

    2014-07-01

    Pediatric intracranial aneurysms are rare and not well characterized in comparison with those in adults. To analyze our institution's longitudinal experience of endovascular treatment for pediatric aneurysms to better understand this rare condition. A retrospective record review was performed of patients aged aneurysms between 1995 and 2012. There were 31 patients (average 14.4±4.2 years; 20 male, 11 female) with 35 intracranial aneurysms. The rate of subarachnoid hemorrhage as the initial presentation was 48% and the rates of multiple and giant aneurysms were 13% and 31%, respectively; 28.5% of the cases were posterior circulation aneurysms. Fifteen saccular aneurysms occurred in 14 patients and 17 fusiform aneurysms were noted in 14 patients. Two infectious aneurysms were diagnosed in two patients and one traumatic aneurysm occurred in another patient. Thirty-four aneurysms were treated endovascularly and one had thrombosed spontaneously on a follow-up angiogram. Of the 15 saccular aneurysms, 11 were treated with conventional coiling, one was treated with stent-assisted coiling, one was treated with a flow-diverting stent and two were treated with parent vessel occlusion (PVO). Of the 17 fusiform aneurysms, 15 were treated with PVO with or without prior bypass surgery and one was treated with a flow-diverting stent. The rate of permanent complications and a favorable outcome were 2.9% and 87%, respectively. Endovascular treatment of pediatric aneurysms is technically feasible with an acceptable complication rate despite the high incidence of fusiform aneurysms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  16. Preliminary clinical experience of one-stage endovascular embolization for multiple intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    Hai-dong HUANG

    2011-03-01

    Full Text Available Objective To preliminarily investigate and summarize the technique and efficacy of one-stage endovascular embolization for treatment of multiple intracranial aneurysms.Methods Eighteen patients with multiple intracranial aneurysms,in whom 44 aneurysms were found,were treated by endovascular embolization in one-stage from Sep.2005 to Jun.2009.Thirty-two aneurysms were embolized with hydro-detachable coils,and twelve wide-necked aneurysms were embolized with intracranial stents(LEO stent or Enterprise stent combined with hydro-detachable coils.The clinical and radiological follow-up period was 3-12 months after surgery.Results Embolization was successful in all patients,and the stent placement was optimal in 12.The total occlusion of aneurysmal cavities was achieved in 38 aneurysm,more than 95% of the aneurysmal cavities were occluded in 5 aneurysms and less than 95% in 1 aneurysm.No operative complication was found and all the patients recovered well.No rebleeding or cerebral thrombosis occurred during the period of 3-12 months clinical follow-up,and no aneurysmal recurrence or in-stent stenosis was found in 9 patients followed-up by digital substraction angiography(DSA.Conclusion Endovascular embolization in one-stage is a safe and effective technique for the treatment of multiple intracranial aneurysms,and the long-term efficacy still needs further observation.

  17. Bare platinum coils vs. HydroCoil in the treatment of unruptured intracranial aneurysms—A single center randomized controlled study

    Energy Technology Data Exchange (ETDEWEB)

    Poncyljusz, Wojciech, E-mail: wponcyl@poczta.onet.pl [Departament of Interventional Radiology, Pomeranian Medical University, Neurointerventional Cath Lab MSW Hospital, Al. Powst. Wielkopolskich 72, 70-111 Szczecin (Poland); Zarzycki, Artur, E-mail: arturzarzycki@o2.pl [Department of Neurosurgery and Pediatric Neurosurgery, Pomeranian Medical University, Unii Lubelskiej 1, 71-242 Szczecin Poland (Poland); Zwarzany, Łukasz, E-mail: zwarzany@gmail.com [Departament of Interventional Radiology, Pomeranian Medical University, Neurointerventional Cath Lab MSW Hospital, Al. Powst. Wielkopolskich 72, 70-111 Szczecin (Poland); Burke, Thomas H., E-mail: tom.burke@microvention.com [Microvention–Terumo, Tustin, CA (United States)

    2015-02-15

    Highlights: • The use of HydroCoil tends to improve immediate angiographic outcome. • Less total number of coils is needed when using HydroCoil. • HydroCoil is equivocal to bare platinum coil. - Abstract: Purpose: The HydroCoil Embolic System (HES) was developed to improve aneurysm filling to provide superior occlusion efficacy, reduce retreatment rates and enhance long-term durability. We performed a randomized clinical trial to compare the effectiveness of bare platinum coils (BPC) vs. HES for unruptured intracranial aneurysms. Methods: Ninety-six patients underwent endovascular coiling of unruptured intracranial aneurysms. The aneurysms were randomized equally to receive BPC or HES. Immediate angiographic results, number of coils used and complications were evaluated and all cases had 12-month follow-up angiography. Results: Immediate angiographic results demonstrated that 84.0% of aneurysms treated with HES were completely occluded compared to 76.1% of aneurysms treated with BPC (p = 0.3310). The mean number of coils utilized to fill the aneurysm was significantly lower in the HES arm (5.04 vs. 6.93). Additional adjunctive techniques were performed in 51.1% of all cases. There were seven patients (7.3%) with postoperative complications during the study period. The coil type used during the treatment did not demonstrate any significant differences on the overall recurrence rate (HES – 18.0%, BPC – 17.4%, p = 0.9712). There was a statistically significant difference in the aneurysm size and the neck width between completely occluded aneurysms and aneurysms with residual flow in both immediate angiographic and mid-term follow-up. Conclusions: Overall, aneurysm size and neck width are the main risk factors associated with aneurysm recurrence. HES compared to BPC required less total number of coils to provide a denser aneurysm filling. However, there were equivocal results with both devices, at the mid-term angiographic follow-up.

  18. Rupture of intracranial aneurysm and full moon

    OpenAIRE

    Ottomann, Christian

    2010-01-01

    ABSTRACT OBJECTIVE: To test the hypothesis that the incidence of intracranial aneurysm rupture increases at the time of a full moon period. DESIGN: Retrospective analysis SETTING: Time of rupture and neurosurgical treatment at a university hospital in the capital city of Germany. SETTING: 486 consecutive patients, irrespective of age and sex. MAIN OUTCOME MEASURES: Number of patients who attended an rupture of an intracranial aneurysm and surgical treatment during 1990 to 1998. Th...

  19. Endovascular treatment of posterior cerebral artery aneurysms using detachable coils

    Energy Technology Data Exchange (ETDEWEB)

    Roh, Hong Gee [Kangwon National University Hospital, Department of Radiology, Chuncheon, Kangwon-do (Korea); Konkuk University Hospital, Department of Radiology, Seoul (Korea); Kim, Sam Soo; Han, Heon [Kangwon National University Hospital, Department of Radiology, Chuncheon, Kangwon-do (Korea); Kang, Hyun-Seung [Konkuk University Hospital, Department of Neurosurgery, Seoul (Korea); Moon, Won-Jin [Konkuk University Hospital, Department of Radiology, Seoul (Korea); Byun, Hong Sik [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea)

    2008-03-15

    Aneurysms of the posterior cerebral artery (PCA) are rare, and most of the studies reported in the literature in which the endovascular approach was applied were carried out on a limited number of patients with PCA aneurysms. We retrospectively reviewed our cases of PCA aneurysms - at various locations and of differing shapes - that received endovascular treatment and evaluated the treatment outcome. From January 1996 to December 2006, 13 patients (eight females and five males) with 17 PCA aneurysms (nine fusiform and eight saccular) were treated using the endovascular approach. The age of the patients ranged from 20 to 67 years, with a mean age of 44 years. Of the 13 patients, ten presented with intracranial hemorrhage, and one patient, with a large P2 aneurysm, presented with trigeminal neuralgia; the aneurysms were asymptomatic in the remaining two patients. All 13 patients were successfully treated, with only one procedure-related symptomatic complication. Seven patients were treated by occlusion of the aneurysm and parent artery together; five patients, by selective embolization of the aneurysm; one patient, by partial coiling. Although infarctions were found in two patients treated with selective embolization and in three patients treated with parent artery occlusion, only one patient with a ruptured P2 aneurysm treated with parent artery occlusion developed transient amnesia as an ischemic symptom. Posterior cerebral artery aneurysms can be treated safely with either occlusion of the aneurysm together with the PCA or with a selective coil embolization. Infarctions may occur after endovascular treatment, but they are rarely the cause of a disabling symptom. (orig.)

  20. A Ruptured Basilar Tip Aneurysm Showing Repeated Perianeurysmal Edema after Endovascular Coil Embolization: Case Report

    Science.gov (United States)

    TAKESHITA, Tomonori; HORIE, Nobutaka; FUKUDA, Yutaka; SO, Gohei; HAYASHI, Kentaro; MORIKAWA, Minoru; SUYAMA, Kazuhiko; NAGATA, Izumi

    The authors present an extremely rare case of a 48-year-old female who developed repeated perianeurysmal edema at 2, 9, and 16 weeks after endovascular coil embolization for the ruptured intracranial aneurysm. Interestingly, the mechanism for this edema could be different at each time point in this case; acute thrombosis formation, chemical inflammation, and aneurysm recanalization. We have to be aware of this potential complication in the long term after endovascular coil embolization for the intracranial aneurysm, especially with large size or buried into the brain parenchyma. The clinical implications of this case are discussed with a review of the literature. PMID:24390180

  1. Growth rates of intracranial aneurysms : exploring constancy

    NARCIS (Netherlands)

    Koffijberg, Hendrik; Buskens, Erik; Algra, Ale; Wermer, Marieke J. H.; Rinkel, Gabriel J. E.

    Object. The annual rate of rupture of intracranial aneurysms is often assumed to be constant, but it is unknown whether this assumption is true. Recent case reports have suggested that aneurysms grow fast in a short period of time. The authors of the present report investigated the plausibility of a

  2. Surgery of intracranial aneurysms previously treated endovascularly.

    Science.gov (United States)

    Tirakotai, Wuttipong; Sure, Ulrich; Yin, Yuhua; Benes, Ludwig; Schulte, Dirk Michael; Bien, Siegfried; Bertalanffy, Helmut

    2007-11-01

    To perform a retrospective study on the patients who underwent aneurysmal surgery following endovascular treatment. We performed a retrospective study on eight patients who underwent aneurysmal surgery following endovascular treatment (-attempts) with gugliemi detachable coils (GDCs). The indications for surgery, surgical techniques and clinical outcomes were analyzed. The indications for surgical treatment after GDC coiling of aneurysm were classified into three groups. First group: surgery of incompletely coiled aneurysms (n=4). Second group: surgery of mass effect on the neural structures due to coil compaction or rebleeding (n=2). Third group: surgery of vascular complications after endovascular procedure due to parent artery occlusion or thrombus propagation from aneurysm (n=2). Aneurysm obliterations could be performed in all cases confirmed by postoperative angiography. Six patients had an excellent outcome and returned to their profession. Patient's visual acuity was improved. One individual experienced right hemiparesis (grade IV/V) and hemihypesthesia. Microsurgical clipping is rarely necessary for previously coiled aneurysms. Surgical treatment is uncommonly required when an acute complication arises during endovascular treatment, or when there is a dynamic change of a residual aneurysm configuration over time that is considered to be insecure.

  3. Intracranial pediatric aneurysms: endovascular treatment and its outcome.

    Science.gov (United States)

    Saraf, Rashmi; Shrivastava, Manish; Siddhartha, Wuppalapati; Limaye, Uday

    2012-09-01

    The aim of this study was to analyze the location, clinical presentation, and morphological characteristics of pediatric aneurysms and the safety, feasibility, and durability of endovascular treatment. The authors conducted a retrospective study of all cases involving patients 18 years old or younger who underwent endovascular treatment for pediatric aneurysms at their institution between July 1998 and July 2010. The clinical presentation, aneurysm location, endovascular management, and treatment outcome were studied. During the study period, 23 pediatric patients (mean age 13 years, range 2 months-18 years) were referred to the authors' department and underwent endovascular treatment for aneurysms. The aneurysms were saccular in 6 cases, dissecting in 4, infectious in 5, and giant partially thrombosed lesions in 8. Fourteen of the aneurysms were ruptured, and 9 were unruptured. Thirteen were in the anterior circulation and 10 in the posterior circulation. The most common location in the anterior circulation was the anterior communicating artery; in the posterior circulation, the most common location was the basilar artery. Saccular aneurysms were the most common type in the anterior circulation; and giant partially thrombosed and dissecting aneurysms were the most common types in the posterior circulation. Coil embolization was performed in 7 cases, parent vessel sacrifice in 10, flow reversal in 3, glue embolization in 2, and stent placement in 1. Immediate angiographic cure was seen in 21 (91%) of 23 patients. Complications occurred in 4 patients, 3 of whom eventually had a good outcome. No patient died. Overall, a favorable outcome was seen in 22 (96%) of 23 patients. Follow-up showed stable occlusion of aneurysms in 96% of the patients. Pediatric aneurysms are rare. Their clinical presentation varies from intracranial hemorrhage to mass effect. They may also be found incidentally. Among pediatric patients with aneurysms, giant aneurysms are relatively common

  4. Recanalization and rupture after intracranial aneurysm treatment.

    Science.gov (United States)

    Costa, Emmanuel; Vaz, Geraldo R; Finet, Patrice; Goffette, Pierre; Docquier, Marie A; Raftopoulos, Christian

    2016-11-25

    Treatment of intra cranial aneurysm (ICA) can sometimes required several procedures. The aim of this study is to analyze the risk of recanalization and rupture recurrence after ICA treatment by endovascular coiling (EVC) or surgical clipping (SC) on a very long follow-up. Clinical data of 373 consecutive patients treated in our group between January 1996 and December 2006 as well by EVC as by SC for ruptured (RIA) or unruptured intracranial aneurysm (UIA), were reviewed. Patients were followed up at least to August 2009. First radiologic follow-up done six months after EVC and between three and five years after SC (median time: 5 years)). All patients underwent a clinical follow-up after treatment, at least by telephonic communication (median time: 6 years). Out of 197 patients with 198 RIAs, 82 (42 %) patients underwent an endovascular treatment and 115 (58%) were allocated to surgical treatment. From a total of 176 patients with 229 UIAs, 66 (37.5%) patients were treated by 74 EVC; and 110 (62.5%) patients were treated with 124 surgical procedures. Fifteen recanalizations of coiled RIAs were detected and only one in the surgical group (27% vs. 2%; p= 0.0008). Of the 15 recanalizations in the EVC group, 6 (40%) were initially completely occluded. We observed two rebleedings, one in each group (1.4% for EVC; 1% for SC; p=0.8). Our findings during the longest reported follow-up confirm a greater risk of recanalization for RIA treated by EVC without so far a significant difference in the rerupture risk.

  5. Elastase-induced intracranial aneurysms in hypertensive mice

    Science.gov (United States)

    Nuki, Yoshitsugu; Tsou, Tsung-Ling; Kurihara, Chie; Kanematsu, Miyuki; Kanematsu, Yasuhisa; Hashimoto, Tomoki

    2009-01-01

    Mechanisms of formation and growth of intracranial aneurysms are poorly understood. To investigate the pathophysiology of intracranial aneurysms, an animal model of intracranial aneurysm yielding high incidence of large aneurysm formation within a short incubation period is needed. We combined two well-known clinical factors associated with human intracranial aneurysms—hypertension and the degeneration of elastic lamina— to induce intracranial aneurysm formation in mice. Roles of matrix metalloproteinases (MMPs) in this model were investigated utilizing doxycycline, a broad-spectrum MMP inhibitor, and MMP knockout mice. Hypertension was induced by continuous infusion of angiotensin-II for two weeks. The disruption of elastic lamina was achieved by a single stereotaxic injection of elastase into the cerebrospinal fluid at the right basal cistern. 77% of the mice that received 35 milli-units of elastase and 1000 ng/kg/min angiotensin-II developed intracranial aneurysms in two weeks. There were dose-dependent effects of elastase and angiotensin-II on the incidence of aneurysms. Histologically, intracranial aneurysms observed in this model closely resembled human intracranial aneurysms. Doxycycline, a broad-spectrum MMP inhibitor, reduced the incidence of aneurysm to 10%. MMP-9 knockout mice, but not MMP-2 knockout mice, had reduced the incidence of intracranial aneurysms. In summary, a stereotaxic injection of elastase into the basal cistern in hypertensive mice resulted in intracranial aneurysms that closely resembled human intracranial aneurysms. The intracranial aneurysm formation in this model appeared to be dependent on MMP activation. PMID:19884566

  6. Giant vertebral artery aneurysm in a child treated with endovascular parent artery occlusion and coil embolization.

    Science.gov (United States)

    Park, Hun-Soo; Nakagawa, Ichiro; Wada, Takeshi; Nakagawa, Hiroyuki; Hironaka, Yasuo; Kichikawa, Kimihiko; Nakase, Hiroyuki

    2014-01-01

    Intracranial giant vertebral artery aneurysms are extremely rare in the pediatric population and are associated with significant morbidity and mortality. The present report describes a case of a pediatric patient with giant vertebral artery aneurysm who presented with intracranial mass effect. This patient was successfully treated with endovascular parent artery occlusion and coil embolization. A 7-year-old girl presented with tetraparesis, ataxia, dysphagia, and dysphonia. Cerebral angiography revealed intracranial giant aneurysm arising from the right vertebral artery. The patient underwent endovascular parent artery occlusion alone to facilitate aneurysmal thrombosis as an initial treatment. This was done to avoid a coil mass effect to the brainstem. However, incomplete thrombosis occurred in the vicinity of the vertebral artery union. Therefore, additional coil embolization for residual aneurysm was performed. Two additional coil embolization procedures were performed in response to recurrence. Mass effect and clinical symptoms gradually improved, and the patient had no associated morbidity or recurrence at 2 years after the last fourth coil embolization. Intracranial giant vertebral artery aneurysms are rare and challenging in pediatric patients. Staged endovascular strategy can be a safe and effective treatment option.

  7. The radiological appearance of intracranial aneurysms in adults ...

    African Journals Online (AJOL)

    %. Limited literature is available on intracranial aneurysms in HIV-infected patients. Objectives: To describe the radiological appearance of intracranial aneurysms in HIV positive adults. Method: In this retrospective analysis of data, ...

  8. Microsurgical management of a complicated aneurysmal endovascular embolisation with GDC coil: a case report.

    Science.gov (United States)

    Pogády, P; Mustafa, H; Wies, W; Lungenschmid, K; Wurm, G; Tomancok, B; Holl, K; Fischer, J

    1998-01-01

    We present a case involving a microsurgical approach to solving the problem of a medial cerebral artery (MCA) occlusion occurring after GDC coiling of an internal cerebral artery (ICA) bifurcation aneurysm in a 40 year old woman. We describe the clinical course of the case and discuss technical possibilities and risks of clipping a coiled aneurysm. One key to success is awareness of changes in the aneurysm's properties after coiling. With loss of elasticity the aneurysm had the effect of a tumor fixed on the vessel. The apposition of the aneurysm to the wall of the vessel, as well as the aneurysm's rigidity and increase of intracranial pressure after subarachnoideal hemorrhage (SAH), may lead to occlusion of the vessel. In cases of an mandatory operation due to the occlusion of a main arterial stem after coiling, it is primarily crucial to perforate the aneurysm's fundus, remove the coils, and, finally, to clip the slack neck of the aneurysm. An attempt to precisely prepare and clip the aneurysmal neck without removing the coils could result in the rupture of the aneurysm's neck.

  9. Effect of electromagnetic radiation on the coils used in aneurysm embolization.

    Science.gov (United States)

    Lv, Xianli; Wu, Zhongxue; Li, Youxiang

    2014-06-01

    This study evaluated the effects of electromagnetic radiation in our daily lives on the coils used in aneurysm embolization. Faraday's electromagnetic induction principle was applied to analyze the effects of electromagnetic radiation on the coils used in aneurysm embolization. To induce a current of 0.5mA in less than 5 mm platinum coils required to stimulate peripheral nerves, the minimum magnetic field will be 0.86 μT. To induce a current of 0.5 mA in platinum coils by a hair dryer, the minimum aneurysm radius is 2.5 mm (5 mm aneurysm). To induce a current of 0.5 mA in platinum coils by a computer or TV, the minimum aneurysm radius is 8.6 mm (approximate 17 mm aneurysm). The minimum magnetic field is much larger than the flux densities produced by computer and TV, while the minimum aneurysm radius is much larger than most aneurysm sizes to levels produced by computer and TV. At present, the effects of electromagnetic radiation in our daily lives on intracranial coils do not produce a harmful reaction. Patients with coiled aneurysm are advised to avoid using hair dryers. This theory needs to be proved by further detailed complex investigations. Doctors should give patients additional instructions before the procedure, depending on this study.

  10. Intracranial aneurysms in patients with CREST syndrome.

    Science.gov (United States)

    Nakae, Ryuta; Idei, Masaru; Kumano, Kiyoshi; Okita, Shinji; Yamane, Kanji

    2009-09-01

    CREST syndrome is a variant of scleroderma characterized by calcinosis, Raynaud's phenomenon, esophageal hypomotility, sclerodactyly, and telangiectasia, and is a collagen vascular disease characterized by inflammation and fibrosis of multiple organs/tissues. Neurological and cerebrovascular abnormalities are uncommon in CREST syndrome. Here, we report two patients with CREST syndrome harboring intracranial aneurysms. A 53-year-old woman with a 6-month history of CREST syndrome had multiple intracranial aneurysms that arose from the right middle cerebral artery, the left middle cerebral artery, the choroidal segment of the left internal carotid artery, and the left anterior cerebral artery. A 64-year-old woman with a 2-year history of CREST syndrome had a fusiform aneurysm located on the insular segment of the left middle cerebral artery. These patients were treated surgically and good outcome was achieved in both cases. The pathogenesis of cerebral aneurysms associated with collagen diseases, including CREST syndrome, remains unclear. Early treatment of CREST syndrome and other collagen diseases may prevent arteritis from progressing to affect the intracranial arteries and thus reduce the occurrence of aneurysms. The prognosis for patients with collagen diseases after rupture of cerebral aneurysm seems to be poor because the multiplicity, atypical morphology, and atypical location of their aneurysms make treatment difficult. Thus, early detection and treatment are important to improve the prognosis.

  11. Epidemiology and genetics of intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Caranci, F., E-mail: ferdinandocaranci@libero.it [Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples (Italy); Briganti, F., E-mail: frabriga@unina.it [Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples (Italy); Cirillo, L.; Leonardi, M. [Neuroradiology service, Bellaria Hospital, Bologna (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Service Cardarelli Hospital Naples (Italy)

    2013-10-01

    Intracranial aneurysms are acquired lesions (5–10% of the population), a fraction of which rupture leading to subarachnoid hemorrhage with devastating consequences. Until now, the exact etiology of intracranial aneurysms formation remains unclear. The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured IAs suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management. The most important factors predicting rupture are aneurysm size and site. In addition to ambiental factors (smoking, excessive alcohol consumption and hypertension), epidemiological studies have demonstrated a familiar influence contributing to the pathogenesis of intracranial aneurysms, with increased frequency in first- and second-degree relatives of people with subarachnoid hemorrhage. In comparison to sporadic aneurysms, familial aneurysms tend to be larger, more often located at the middle cerebral artery, and more likely to be multiple. Other than familiar occurrence, there are several heritable conditions associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II and IV. The familial occurrence and the association with heritable conditions indicate that genetic factors may play a role in the development of intracranial aneurysms. Genome-wide linkage studies in families and sib pairs with intracranial aneurysms have identified several loci on chromosomes showing suggestive evidence of linkage, particularly on chromosomes 1p34.3–p36.13, 7q11, 19q13.3, and Xp22. For the loci on 1p34.3–p36.13 and 7q11, a moderate positive association with positional candidate genes has been demonstrated (perlecan gene, elastin gene, collagen type 1 A2

  12. The Influence of Dome Size, Parent Vessel Angle, and Coil Packing Density on Coil Embolization Treatment in Cerebral Aneurysms

    Science.gov (United States)

    Frakes, David H.; Indahlastari, Aprinda; Ryan, Justin; Babiker, M. Haithem; Nair, Priya; Parthas, Varsha

    2013-11-01

    Intracranial aneurysms (ICAs) are dilated cerebral blood vessels. Treating ICAs effectively prior rupture is crucial since their association with 45% mortality rate. Embolic coiling is the most effective ICA treatment. Series of embolic coils are deployed into the aneurysm with the intent of reaching a sufficient packing density (PD) to help seal off the ICA from circulation. While coiling is effective, treatment failures have been associated with basilar tip aneurysms (BTAs), perhaps because of their geometry. The aim of this study was to examine the effect of dome size, parent vessel (PV) angle, and PD on intraaneurysmal (IA) velocity, crossneck (CN) flow and low wall shear stress (WSS) area using simulations and experiments in idealized BTA models. IA velocity and CN flow decreased after coiling, while low WSS area increased. With increasing PD, IA velocity and CN flow were further reduced, but low WSS area had a minimal change. Coil PD had the greatest impact on post-treatment flow while dome size had a greater impact than PV angle. Overall, the role of aneurysmal geometries may vary depending on treatment goal and timing e.g., high coil PD may reduce IA velocity more effectively during early aneurysmal growth when the dome size is small. Funded by the American Heart Association.

  13. Pediatric intracranial aneurysms: new and enlarging aneurysms after index aneurysm treatment or observation.

    Science.gov (United States)

    Hetts, S W; English, J D; Dowd, C F; Higashida, R T; Scanlon, J T; Halbach, V V

    2011-12-01

    Children with brain aneurysms may be at higher risk than adults to develop new or enlarging aneurysms in a relatively short time. We sought to identify comorbidities and angiographic features in children that predict new aneurysm formation or enlargement of untreated aneurysms. Retrospective analysis of the University of California-San Francisco Pediatric Aneurysm Cohort data base including medical records and imaging studies was performed. Of 83 patients harboring 114 intracranial aneurysms not associated with brain arteriovenous malformations or intracranial arteriovenous fistulas, 9 (8.4%) developed new or enlarging brain aneurysms an average of 4.2 years after initial presentation. Comorbidities that may be related to aneurysm formation were significantly higher in patients who developed new aneurysms (89%) as opposed to patients who did not develop new or enlarging aneurysms (41%; RR, 9.5; 95% CI, 1.9%-48%; P = .0099). Patients with multiple aneurysms at initial presentation were more likely than patients with a single aneurysm at presentation to develop a new or enlarging aneurysm (RR, 6.2; 95% CI, 2.1%-185; P = .0058). Patients who initially presented with at least 1 fusiform aneurysm were more likely to develop a new or enlarging aneurysm than patients who did not present with a fusiform aneurysm (RR, 22; 95% CI, 3.6%-68%; P = .00050). Index aneurysm treatment with parent artery occlusion also was associated with higher risk of new aneurysm formation (RR, 4.2; 95% CI, 1.3%-13%; P = .024). New aneurysms did not necessarily arise near index aneurysms. The only fatality in the series was due to subarachnoid hemorrhage from a new posterior circulation aneurysm arising 20 months after index anterior circulation aneurysm treatment in an immunosuppressed patient. Patients who presented with a fusiform aneurysm had a significantly greater incidence of developing a new aneurysm or enlargement of an index aneurysm than did those who presented with a saccular aneurysm

  14. Haemodynamic simulation of aneurysm coiling in an anatomically accurate computational fluid dynamics model: technical note

    Energy Technology Data Exchange (ETDEWEB)

    Mitsos, Aristotelis P. [University of Oxford, Department of Neuroradiology, John Radcliffe Hospital, Oxford (United Kingdom); University of Oxford, Wolfson College, Oxford (United Kingdom); Kakalis, Nikolaos M.P.; Ventikos, Yiannis P. [University of Oxford, Department of Engineering Science, Oxford (United Kingdom); Byrne, James V. [University of Oxford, Department of Neuroradiology, John Radcliffe Hospital, Oxford (United Kingdom)

    2008-04-15

    Computational fluid dynamics (CFD) is a numerical technique that is used for studying haemodynamic parameters in cerebral aneurysms. As it is now possible to represent an anatomically accurate intracranial aneurysm in a computational model, we have attempted to simulate its endosaccular occlusion with coils and demonstrate the haemodynamic changes induced. This is the first attempt to use this particular porous medium-based method for coiling simulation in a CFD model, to our knowledge. Datasets from a rotational 3-D digital subtraction angiogram of a recently ruptured anterior communicating aneurysm were converted into a 3-D geometric model and the discretized data were processed using the computational technique developed. Coiling embolisation simulation was achieved by impediment of flow through a porous medium with characteristics following a series of embolisation coils. Haemodynamic parameters studied were: pressure distribution on the vessel wall, blood velocity and blood flow patterns. Significant haemodynamic changes were detected after deployment of the first coil. Similar, but less dramatic changes occurred during subsequent stages of coiling. The blood flow patterns became less vortical in the aneurysm sac as velocity decreased to stagnation and the wall pressure at the fundus was gradually reduced. Furthermore, the haemodynamic characteristics developed at the area of the neck remnant could form the basis for assessing the likelihood of delayed coil compaction and aneurysm regrowth. Appropriate computational techniques show great promise in simulating the haemodynamic behaviour of the various stages in coil embolisation and may be a potentially valuable tool in interventional planning and procedural decision-making. (orig.)

  15. Balloon-expandable stenting with and without coiling for wide-neck and complex aneurysms.

    Science.gov (United States)

    Zenteno, Marco; Modenesi Freitas, José Maria; Aburto-Murrieta, Yolanda; Koppe, Gelson; Machado, Elcio; Lee, Angel

    2006-12-01

    Wide-necked, saccular, dissecting, and fusiform intracranial aneurysms are poor coil retainers. Retention can be improved by parent-artery stenting across the aneurysm. We used a balloon-expandable stent and delivery system, intending to treat 38 aneurysms in 36 patients. Stents could not be advanced across the neck of 2 aneurysms near the ophthalmic artery origin. These cases were managed by temporary balloon remodeling and coiling. Stenting alone was done for 15 aneurysms, including 7 in vertebral artery V4 segments. Stenting with immediate or delayed coiling was done in 21 aneurysms. Stenting alone caused immediate and complete obliteration of 1 treated aneurysm (7%), subtotal obliteration in 13 treated (86%) aneurysms, and was associated with 1 failure. Stenting and coiling yielded a significantly better 57% complete obliteration rate, 43% subtotal obliteration, and no failures. There were 5 complications: 1 wire perforation, 2 cavernous-carotid-sinus fistulae, and 2 partial in-stent thromboses. All were controlled or cleared with no long-term sequelae or deaths. Contrast imaging at 1 to 12 months was available for 30 patients (13 stent-only, 17 stent-plus-coiling), demonstrating complete obliteration in 25 (83%) and subtotal obliteration in 5. A total of 7 stent-only aneurysms (4 V4s) were completely obliterated, and 3 (all V4s) were > or = 90% obliterated. Stenting and coiling through the wall of the stent resulted in 88% (15/17) complete obliteration when imaged 1 to 12 months after treatment. Stenting alone effectively closed off V4-segment wide-necked aneurysms but was inferior to stenting and coiling in less mobile vessels.

  16. Stent-assisted coil embolization of a symptomatic middle cerebral artery aneurysm in an infant.

    Science.gov (United States)

    Savastano, Luis E; Chaudhary, Neeraj; Gemmete, Joseph J; Garton, Hugh J L; Maher, Cormac O; Pandey, Aditya S

    2014-11-01

    Pediatric intracranial aneurysms are rare and challenging to treat. Achieving efficacy and durability of aneurysmal occlusion while maintaining parent vessel patency requires innovative treatment strategies, especially in cases in which aneurysmal location or morphology pose substantial morbidity associated with microsurgical treatment. In the last 3 decades, endovascular treatments have had a remarkable evolution and are currently considered safe and effective therapeutic options for cerebral aneurysms. While endovascular techniques are well described in the English literature, the endovascular management of pediatric aneurysms continues to pose a challenge. In this report, the authors describe the case of a 9-month-old infant who presented with a 1-day history of acute-onset left-sided hemiparesis and left facial droop. Imaging revealed a large symptomatic saccular middle cerebral artery aneurysm. Treatment included successful stent-assisted aneurysm coiling. At follow-up, the patient continued to fare well and MR angiography confirmed complete occlusion of the aneurysm dome. This case features the youngest patient in the English literature to harbor an intracranial aneurysm successfully treated with stent-assisted coiling. Based on this experience, endovascular intervention with vascular reconstruction can be safe and effective for the treatment of infants and could further improve prognosis; however, further studies are necessary to confirm these findings.

  17. Flow diversion versus traditional endovascular coiling therapy: design of the prospective LARGE aneurysm randomized trial.

    Science.gov (United States)

    Turk, A S; Martin, R H; Fiorella, D; Mocco, J; Siddiqui, A; Bonafe, A

    2014-07-01

    The goal of aneurysm treatment is occlusion of an aneurysm without morbidity or mortality. Using well-established, traditional endovascular techniques, this is generally achievable with a high level of safety and efficacy. These techniques involve either constructive treatment of the aneurysm (coils with or without an intravascular stent) or deconstruction (coil occlusion) of the aneurysm and the parent artery. While established as safe and efficacious, the constructive treatment of large and giant aneurysms with coils has typically been associated with relatively lower rates of complete occlusion and higher rates of recurrence. Parent artery deconstruction, though immediately efficacious in achieving complete and durable occlusion, does require occlusion of a major intracranial blood vessel and is associated with risk of stroke. Flow diversion represents a new technology that can be used to constructively treat large and giant aneurysms. Once excluded successfully, the vessel reconstruction and aneurysm occlusion appears durable. The ability to definitively reconstruct cerebral blood vessels is an attractive approach to these large and giant complex aneurysms and allows the treatment of some aneurysms which were previously not amenable to other therapies. By comparison, conventional coiling techniques have traditionally been used for endovascular treatment of large aneurysms. Large and giant aneurysms that are amenable to either flow diversion or traditional endovascular treatment will be randomized to either therapy with FDA (or appropriate regulatory body) approved devices. The trial is currently enrolling and results of the data are pending the completion of enrollment and follow-up. This paper details the trial design of the LARGE trial, a blinded, prospective randomized trial of large anterior circulation aneurysms amenable to either traditional endovascular treatments using coils or reconstruction with flow diverters. © 2014 by American Journal of

  18. Treatment of pediatric patient with ruptured intracranial aneurysm--case report.

    Science.gov (United States)

    Meljnikov, Igor; Vuleković, Petar; Cigić, Tomislav; Borisev, Vladimir; Milojević, Aleksandar; Iduski, Stevan

    2012-01-01

    Despite the contemporary diagnostics of intracranial aneurysms their treatment is still a great challenge. The decision when and if to apply a surgical or endovascular treatment of intracranial aneurysms should be made by a team of medical specialists which consists of a cerebrovascular neurosurgeon, neuro-radiologist and neuro-anesthesiologist. We report a case of a patient aged 16 who was admitted because of a sudden intensive headache followed by sickness, vomiting, and loss of consciousness. On admission the patient was conscious but sleepy. Glasgow Coma Scale score was 14 and the World Federation of Neurological Surgeons Scale grade was I. The computed tomography scan showed a massive subarachnoid haemorrhage. The computed tomography angiography and digital subtraction angiography revealed a ruptured saccular aneurysm in the left vertebral artery. An early treatment with the coiling of the lumen of the aneurysm was performed under general anaesthesia. On the tenth day the boy was discharged in good condition and without any neurological deficits. Six months after the intervention the patient was without symptoms and the control digital subtraction angiography showed the complete occlusion of the aneurysm. Intracranial aneurysms in children are more common in males and are predominantly localized in the posterior circulation. In addition, they are frequently of greater size and more complex architecture and they are associated with a lower incidence of clinically manifest vasospasm. According to previous experience, endovascular treatment of intracranial aneurysms in paediatric patients has proven to be a safe and efficient method with a small number of complications.

  19. Rapid development of a mycotic aneurysm of the intracranial artery secondary to Scedosporium apiospermum sinusitis

    Directory of Open Access Journals (Sweden)

    Yoshihiko Ogawa

    2016-12-01

    Full Text Available An 85-year-old man complained of a 2-month history of pain on the left side of his face. Brain computed tomography (CT and magnetic resonance imaging/magnetic resonance angiography did not clearly show any intracranial abnormality and only showed fluid effusion in his left sphenoid sinus. Filamentous fungi were detected from the left sphenoid sinus specimen. The isolate was Scedosporium apiospermum. He was empirically treated with voriconazole, to which the isolate was susceptible. His consciousness decreased rapidly. Urgent 3D-CT angiography revealed an intracranial aneurysm near the left sphenoid sinus. Despite urgent coil embolization, the aneurysm ruptured, and he died.

  20. Computational fluid dynamics of cerebral aneurysm coiling using high-resolution and high-energy synchrotron X-ray microtomography: comparison with the homogeneous porous medium approach.

    Science.gov (United States)

    Levitt, Michael R; Barbour, Michael C; Rolland du Roscoat, Sabine; Geindreau, Christian; Chivukula, Venkat K; McGah, Patrick M; Nerva, John D; Morton, Ryan P; Kim, Louis J; Aliseda, Alberto

    2017-08-01

    Computational modeling of intracranial aneurysms provides insights into the influence of hemodynamics on aneurysm growth, rupture, and treatment outcome. Standard modeling of coiled aneurysms simplifies the complex geometry of the coil mass into a homogeneous porous medium that fills the aneurysmal sac. We compare hemodynamics of coiled aneurysms modeled from high-resolution imaging with those from the same aneurysms modeled following the standard technique, in an effort to characterize sources of error from the simplified model. Physical models of two unruptured aneurysms were created using three-dimensional printing. The models were treated with coil embolization using the same coils as those used in actual patient treatment and then scanned by synchrotron X-ray microtomography to obtain high-resolution imaging of the coil mass. Computational modeling of each aneurysm was performed using patient-specific boundary conditions. The coils were modeled using the simplified porous medium or by incorporating the X-ray imaged coil surface, and the differences in hemodynamic variables were assessed. X-ray microtomographic imaging of coils and incorporation into computational models were successful for both aneurysms. Porous medium calculations of coiled aneurysm hemodynamics overestimated intra-aneurysmal flow, underestimated oscillatory shear index and viscous dissipation, and over- or underpredicted wall shear stress (WSS) and WSS gradient compared with X-ray-based coiled computational fluid dynamics models. Computational modeling of coiled intracranial aneurysms using the porous medium approach may inaccurately estimate key hemodynamic variables compared with models incorporating high-resolution synchrotron X-ray microtomographic imaging of complex aneurysm coil geometry. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  1. A Thrombus Generation Model Applied to Aneurysms Treated with Shape Memory Polymer Foam and Metal Coils

    Science.gov (United States)

    Horn, John; Ortega, Jason; Hartman, Jonathan; Maitland, Duncan

    2015-11-01

    To prevent their rupture, intracranial aneurysms are often treated with endovascular metal coils which fill the aneurysm sac and isolate it from the arterial flow. Despite its widespread use, this method can result in suboptimal outcomes leading to aneurysm recurrence. Recently, shape memory polymer foam has been proposed as an alternative aneurysm filler. In this work, a computational model has been developed to predict thrombus formation in blood in response to such cardiovascular implantable devices. The model couples biofluid and biochemical phenomena present as the blood interacts with a device and stimulates thrombus formation. This model is applied to simulations of both metal coil and shape memory polymer foam treatments within an idealized 2D aneurysm geometry. Using the predicted thrombus responses, the performance of these treatments is evaluated and compared. The results suggest that foam-treated aneurysms may fill more quickly and more completely with thrombus than coil-filled aneurysms, potentially leading to improved long-term aneurysm healing. This work was performed in part under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344.

  2. Endovascular treatment of fusiform intracranial aneurysms.

    Science.gov (United States)

    Devulapalli, Kavi K; Chowdhry, Shakeel A; Bambakidis, Nicholas C; Selman, Warren; Hsu, Daniel Pierce

    2013-03-01

    Endovascular treatment (EVT) has emerged as an alternative therapeutic strategy for the treatment of intracranial fusiform aneurysms (IFAs), but little is known about the safety and efficacy of deconstructive and reconstructive methods, especially in patients presenting with subarachnoid hemorrhage (SAH). The purpose of this study is to describe the radiological and clinical outcomes in patients with IFAs undergoing EVT. A retrospective analysis was conducted of 18 patients undergoing EVT of IFAs, 13 of whom (72.2%) presented with SAH. Radiological outcomes were characterized by the presence of parent vessel opacification and aneurysmal remnants for patients undergoing deconstructive and reconstructive EVT, respectively. Clinical outcomes were characterized by the Glasgow Outcome Scale. Contingency analysis of factors associated with clinical outcomes in patients with ruptured aneurysms was conducted. Technical success was achieved in 17 of the 18 patients (94.4%), with 10 (55.6%) undergoing reconstructive EVT and eight (44.4%) undergoing deconstructive EVT. For patients with SAH, favorable clinical outcomes were achieved in 9/13 (69.2%), with 3/6 (50.0%) undergoing reconstructive EVT and 6/7 (85.7%) undergoing deconstructive EVT. Among patients with ruptured aneurysms, only Hunt-Hess grade ≥3 was associated with an unfavorable clinical outcome (p=0.007). Favorable clinical outcomes were seen in all five patients with unruptured aneurysms. Both deconstructive and reconstructive EVT were found to be safe and effective in patients with unruptured aneurysms. Reconstructive EVT may be associated with a higher incidence of poor clinical outcomes in patients presenting with high-grade SAH.

  3. LVIS Jr 'shelf' technique: an alternative to Y stent-assisted aneurysm coiling.

    Science.gov (United States)

    Du, Elizabeth Hai Yen; Shankar, Jai Jai Shiva

    2016-02-04

    Wide-necked bifurcation intracranial aneurysms have traditionally not been amenable to coil embolization with the use of a single stent due to the high risk of coil prolapse. Y-configuration double stent-assisted coil embolization ('Y-stenting') of this aneurysm type has been shown to have generally good clinical outcomes, although the technique is complex with various challenges described in the literature. The compliant and flexible closed-cell design of braided stents such as the LVIS Jr allows for the creation of a 'shelf' across the aneurysm neck sufficient to prevent coil prolapse. We describe this novel 'shelf' technique and present a small case series of LVIS Jr stent-assisted wide-necked bifurcation intracranial aneurysm coiling in eight patients. Our small, albeit important, case series demonstrates that the 'shelf' technique is feasible and safe with very good short-term clinical and angiographic outcomes, and may obviate the need for Y-stenting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  4. Vorticity dynamics in an intracranial aneurysm

    Science.gov (United States)

    Le, Trung; Borazjani, Iman; Sotiropoulos, Fotis

    2008-11-01

    Direct Numerical Simulation is carried out to investigate the vortex dynamics of physiologic pulsatile flow in an intracranial aneurysm. The numerical solver is based on the CURVIB (curvilinear grid/immersed boundary method) approach developed by Ge and Sotiropoulos, J. Comp. Physics, 225 (2007) and is applied to simulate the blood flow in a grid with 8 million grid nodes. The aneurysm geometry is extracted from MRI images from common carotid artery (CCA) of a rabbit (courtesy Dr.Kallmes, Mayo Clinic). The simulation reveals the formation of a strong vortex ring at the proximal end during accelerated flow phase. The vortical structure advances toward the aneurysm dome forming a distinct inclined circular ring that connects with the proximal wall via two long streamwise vortical structures. During the reverse flow phase, the back flow results to the formation of another ring at the distal end that advances in the opposite direction toward the proximal end and interacts with the vortical structures that were created during the accelerated phase. The basic vortex formation mechanism is similar to that observed by Webster and Longmire (1998) for pulsed flow through inclined nozzles. The similarities between the two flows will be discussed and the vorticity dynamics of an aneurysm and inclined nozzle flows will be analyzed.This work was supported in part by the University of Minnesota Supercomputing Institute.

  5. PHASES Score for Prediction of Intracranial Aneurysm Growth

    NARCIS (Netherlands)

    Backes, Daan; Vergouwen, Mervyn D I; Tiel Groenestege, Andreas T.; Bor, A. Stijntje E; Velthuis, BK; Greving, Jacoba P.; Algra, Ale; Wermer, Marieke J H; van Walderveen, Marianne A A; terBrugge, Karel G.; Agid, Ronit; Rinkel, Gabriel

    BACKGROUND AND PURPOSE: Growth of an intracranial aneurysm occurs in around 10% of patients at 2-year follow-up imaging and may be associated with aneurysm rupture. We investigated whether PHASES, a score providing absolute risks of aneurysm rupture based on 6 easily retrievable risk factors, also

  6. Comparison of shape memory polymer foam versus bare metal coil treatments in an in vivo porcine sidewall aneurysm model.

    Science.gov (United States)

    Horn, John; Hwang, Wonjun; Jessen, Staci L; Keller, Brandis K; Miller, Matthew W; Tuzun, Egemen; Hartman, Jonathan; Clubb, Fred J; Maitland, Duncan J

    2017-10-01

    The endovascular delivery of platinum alloy bare metal coils has been widely adapted to treat intracranial aneurysms. Despite the widespread clinical use of this technique, numerous suboptimal outcomes are possible. These may include chronic inflammation, low volume filling, coil compaction, and recanalization, all of which can lead to aneurysm recurrence, need for retreatment, and/or potential rupture. This study evaluates a treatment alternative in which polyurethane shape memory polymer (SMP) foam is used as an embolic aneurysm filler. The performance of this treatment method was compared to that of bare metal coils in a head-to-head in vivo study utilizing a porcine vein pouch aneurysm model. After 90 and 180 days post-treatment, gross and histological observations were used to assess aneurysm healing. At 90 days, the foam-treated aneurysms were at an advanced stage of healing compared to the coil-treated aneurysms and showed no signs of chronic inflammation. At 180 days, the foam-treated aneurysms exhibited an 89-93% reduction in cross-sectional area; whereas coiled aneurysms displayed an 18-34% area reduction. The superior healing in the foam-treated aneurysms at earlier stages suggests that SMP foam may be a viable alternative to current treatment methods. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1892-1905, 2017. © 2016 Wiley Periodicals, Inc.

  7. Computational hemodynamic study of intracranial aneurysms coexistent with proximal artery stenosis

    Science.gov (United States)

    Castro, Marcelo A.; Peloc, Nora L.; Putman, Christopher M.; Cebral, Juan R.

    2012-03-01

    Intracranial aneurysms and artery stenosis are vascular diseases with different pathophysiological characteristics. However, although unusual, aneurysms may coexist in up to 5% of patients with stenotic plaque, according to a previous study. Another study showed that incidental detection of cerebral aneurysm in the same cerebral circulation as the stenotic plaque was less than 2%. Patients with concomitant carotid artery stenosis and unruptured intracranial aneurysms pose a difficult management decision for the physician. Case reports showed patients who died due to aneurysm rupture months after endarterectomy but before aneurysm clipping, while others did not show any change in the aneurysm after plaque removal, having optimum outcome after aneurysm coiling. The purpose of this study is to investigate the intraaneurysmal hemodynamic changes before and after treatment of stenotic plaque. Idealized models were constructed with different stenotic grade, distance and relative position to the aneurysm. Digital removal of the stenotic plaque was performed in the reconstructed model of a patient with both pathologies. Computational fluid dynamic simulations were performed using a finite element method approach. Blood velocity field and hemodynamic forces were recorded and analyzed. Changes in the flow patterns and wall shear stress values and distributions were observed in both ideal and image-based models. Detailed investigation of wall shear stress distributions in patients with both pathologies is required to make the best management decision.

  8. Endothelial cell proliferation in swine experimental aneurysm after coil embolization.

    Directory of Open Access Journals (Sweden)

    Yumiko Mitome-Mishima

    Full Text Available After coil embolization, recanalization in cerebral aneurysms adversely influences long-term prognosis. Proliferation of endothelial cells on the coil surface may reduce the incidence of recanalization and further improve outcomes after coil embolization. We aimed to map the expression of proliferating tissue over the aneurysmal orifice and define the temporal profile of tissue growth in a swine experimental aneurysm model. We compared the outcomes after spontaneous thrombosis with those of coil embolization using histological and morphological techniques. In aneurysms that we not coiled, spontaneous thrombosis was observed, and weak, easily detachable proliferating tissue was evident in the aneurysmal neck. In contrast, in the coil embolization group, histological analysis showed endothelial-like cells lining the aneurysmal opening. Moreover, immunohistochemical and morphological analysis suggested that these cells were immature endothelial cells. Our results indicated the existence of endothelial cell proliferation 1 week after coil embolization and showed immature endothelial cells in septal tissue between the systemic circulation and the aneurysm. These findings suggest that endothelial cells are lead to and proliferate in the former aneurysmal orifice. This is the first examination to evaluate the temporal change of proliferating tissue in a swine experimental aneurysm model.

  9. MR-angiography as a method for evaluating endovascular coiled cerebral aneurysms.

    Science.gov (United States)

    Poncyljusz, Wojciech; Czechowski, Janusz; Corr, Peter; Falkowski, Aleksander; Rać, Monika E

    2007-05-01

    The aim was to compare digital subtraction angiography (DSA) with magnetic resonance angiography (MRA) in evaluating intracranial aneurysms embolized with Guglielmi Detachable Coils (GDCs) and to assess 3D TOF MRA source data, maximum intensity projection (MIP), and 3D iso-surface reconstruction in the follow-up of patients with cerebral aneurysms treated with GDC. 3D TOF MRA source data, MIPs, and 3D iso-surface reconstructions of 32 GDC coiled aneurysms were compared with DSA images in the follow-up of 28 patients. Images were assessed for parent and branch artery flow, the presence of neck recurrence, and aneurysm regrowth. In the DSA follow-ups of the 32 aneurysms there was no flow in the embolized aneurysm in 20 (62.5%), flow between the coil loops was found in 11 (34%), and the neck flow was observed in 8 (25%). There was good correlation for all these features when the 3D iso-surface MRA and source data were compared with DSA. The correlation between MIP MRA and DSA was less robust. The correlation was very good in 21 of the 32 aneurysms (65.62%), good in 6 (18.75%), acceptable in 3 (9.37%), and weak and non-diagnostic in 2 (6.25%). Additional information can be obtained by performing plain film x-rays of the skull to demonstrate a change in the coil ball configuration. MRA did not detect any residual aneurysm neck in 2 cases. MRA is a promising technique to evaluate GDC coiled cerebral aneurysms; however, it cannot substitute DSA.

  10. Changing paradigm in the management of elderly patients with intracranial aneurysms: An institutional review.

    Science.gov (United States)

    Chernyshev, Oleg Y; Bir, Shyamal C; Maiti, Tanmoy K; Patra, Devi Prasad; Liendo, Cesar; Cuellar, Hugo; Minagar, Alireza; Nanda, Anil

    2017-09-01

    Optimal treatment of intracranial aneurysms (IAs) in elderly patients has not yet been well established. We have investigated the clinical and radiological outcomes and predictors of unfavorable outcome of IAs in elderly patients. Radiological and clinical data of 85 elderly patients from 2010 through 2015 were retrospectively reviewed. Significant differences between the groups were determined by a chi-square test. Regression analysis was performed to identify the predictors of unfavorable outcome. Among the 85 patients with IAs, the number of patients with >7mm size aneurysm (p=0.01), diabetes mellitus (DM) (p=0.02), smoking (0.009) and Hunt and Hess grade 4-5 (p=0.003) was significantly higher in the ruptured group compared to the unruptured group. Similarly, the number of patients who underwent clipping was higher in the ruptured aneurysm group (p=0.01). The overall clinical outcome was comparatively better in the unruptured group (p=0.03); however, microsurgical clipping of aneurysms provides a significantly higher rate of complete aneurysmal occlusion (p=0.008). Overall, there was no significant difference in outcome in respect to treatment approach. In regression analysis, hypertension (HTN), obstructive sleep apnea (OSA), prior stroke, ruptured aneurysms and partial occlusion of aneurysms were identified as predictors of unfavorable outcome of IAs. Intracranial aneurysms in elderly patients reveals that endovascular treatment provides better clinical outcome; however, microsurgical clipping yields higher complete occlusion. Retreatment of residual aneurysms was comparatively more in the coiling group. Practice pattern has shifted from clipping to coiling for aneurysms in posterior circulation but not for aneurysms in anterior circulation. Copyright © 2017. Published by Elsevier Ltd.

  11. Intracranial Non-traumatic Aneurysms in Children and Adolescents

    Science.gov (United States)

    Sorteberg, Angelika; Dahlberg, Daniel

    2013-01-01

    An intracranial aneurysm in a child or adolescent is a rare, but potentially devastating condition. As little as approximately 1200 cases are reported between 1939 and 2011, with many of the reports presenting diverting results. There is consensus, though, in that pediatric aneurysms represent a pathophysiological entity different from their adult counterparts. In children, there is a male predominance. About two-thirds of pediatric intracranial aneurysms become symptomatic with hemorrhage and the rate of re-hemorrhage is higher than in adults. The rate of hemorrhage from an intracranial aneurysm peaks in girls around menarche. The most common aneurysm site in children is the internal carotid artery, in particular at its terminal ending. Aneurysms in the posterior circulation are more common in children than adults. Children more often develop giant aneurysms, and may become symptomatic from the mass effect of the aneurysm (tumorlike symptoms). The more complex nature of pediatric aneurysms poses a larger challenge to treatment alongside with higher demands to the durability of treatment. Outcome and mortality are similar in children and adults, but long-term outcome in the pediatric population is influenced by the high rate of aneurysm recurrences and de novo formation of intracranial aneurysms. This urges the need for life-long follow-up and screening protocols. PMID:24696670

  12. Genome screen in familial intracranial aneurysm

    Directory of Open Access Journals (Sweden)

    Langefeld Carl

    2009-01-01

    Full Text Available Abstract Background Individuals with 1st degree relatives harboring an intracranial aneurysm (IA are at an increased risk of IA, suggesting genetic variation is an important risk factor. Methods Families with multiple members having ruptured or unruptured IA were recruited and all available medical records and imaging data were reviewed to classify possible IA subjects as definite, probable or possible IA or not a case. A 6 K SNP genome screen was performed in 333 families, representing the largest linkage study of IA reported to date. A 'narrow' (n = 705 definite IA cases and 'broad' (n = 866 definite or probable IA disease definition were used in multipoint model-free linkage analysis and parametric linkage analysis, maximizing disease parameters. Ordered subset analysis (OSA was used to detect gene × smoking interaction. Results Model-free linkage analyses detected modest evidence of possible linkage (all LOD Conclusion These data suggest it is unlikely that there is a single common variant with a strong effect in the majority of the IA families. Rather, it is likely that multiple genetic and environmental risk factors contribute to the susceptibility for intracranial aneurysms.

  13. The 100 most cited articles in the endovascular management of intracranial aneurysms.

    Science.gov (United States)

    Maingard, Julian; Phan, Kevin; Ren, Yifan; Kok, Hong Kuan; Thijs, Vincent; Hirsch, Joshua A; Lee, Michael J; Chandra, Ronil V; Brooks, Duncan Mark; Asadi, Hamed

    2018-01-19

    Endovascular interventions for intracranial aneurysms have evolved substantially over the past several decades. A citation rank list is used to measure the scientific and/or clinical impact of an article. Our objective was to identify and analyze the characteristics of the 100 most cited articles in the field of endovascular therapy for intracranial aneurysms. We performed a retrospective bibliometric analysis between July and August 2017. Articles were searched on the Science Citation Index Expanded database using Web of Science in order to identify the most cited articles in the endovascular therapy of intracranial aneurysms since 1945. Using selected key terms ('intracranial aneurysm', 'aneurysm', 'aneurysmal subarachnoid', 'endovascular', 'coiling', 'stent-assisted', 'balloon-assisted', 'flow-diversion') yielded a total of 16 314 articles. The top 100 articles were identified and analyzed to extract relevant information, including citation count, authorship, article type, subject matter, institution, country of origin, and year of publication. Citations for the top 100 articles ranged from 133 to 1832. All articles were cited an average of 27 times per year. There were 45 prospective studies, including 7 level-II randomized controlled trials. Most articles were published in the 2000s (n=53), and the majority constituted level III or level IV evidence. Half of the top 100 articles arose from the USA. This study provides a comprehensive overview of the most cited articles in the endovascular management of intracranial aneurysms. It recognizes the contributions made by key authors and institutions, providing an important framework to an enhanced understanding of the evidence behind the endovascular treatment of aneurysms. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. Pediatric intracranial aneurysms--our experience and review of literature.

    Science.gov (United States)

    Garg, Kanwaljeet; Singh, Pankaj Kumar; Sharma, Bhawani Shankar; Chandra, Poodipedi Sarat; Suri, Ashish; Singh, Manmohanjit; Kumar, Rajinder; Kale, Shashank Sarad; Mishra, Nalin Kumar; Gaikwad, Shailesh K; Mahapatra, Ashok Kumar

    2014-05-01

    Intracranial aneurysms in children are not as common as in adults and there are many differences in the etiology, demographic variables, aneurysm location, aneurysm morphological characteristics, clinical presentation, and outcome in pediatric and adult intracranial aneurysms. All children (≤18 years) suffering from intracranial aneurysm managed at our center from July 2001 through June 2013 were included in the study, and the details of these patients were retrieved from the computerized database of our hospital. A total of 62 pediatric patients were treated for 74 aneurysms during the study period and constituted 2.3% of all intracranial aneurysms treated during the same period. The mean age at presentation was 13.5 years. Headache (82%) was the commonest presenting feature; other symptoms included seizures (21%), ictal loss of consciousness (27%), and motor/cranial nerve deficits (22.6%). Computed tomogram revealed subarachnoid hemorrhage in 58% of patients. Eighty-two percent of aneurysms were in anterior circulation. Sixty-seven percent of aneurysms were complex aneurysms. Fifty-eight percent of patients underwent surgical intervention while 30% underwent endovascular procedures. Twenty-one percent of the patients developed vasospasm. There was no postoperative mortality. Favorable outcome was seen in 72% of the patients. Pediatric intracranial aneurysms are uncommon as compared to in adult patients. Seizures and cranial nerve involvement are seen more often as the presenting features in children. Posterior circulation aneurysms are more common in children, as are the internal carotid artery bifurcation aneurysms. There is high incidence of giant, posttraumatic, and mycotic aneurysms in children.

  15. HydroCoil embolization of a ruptured infectious aneurysm in a pediatric patient: case report and review of the literature.

    Science.gov (United States)

    Eddleman, Christopher; Nikas, Dimitrios; Shaibani, Ali; Khan, Pervez; Dipatri, Arthur J; Tomita, Tadanori

    2007-06-01

    Intracranial infectious aneurysms in the pediatric population are rare. Although surgery has been the traditional treatment of ruptured pediatric infectious aneurysms, endovascular coil embolization has become an attractive alternative due to its low rate of morbidity and mortality. A 9-year-old boy with a significant medical history of aortic valve replacement, antibiotic-treated infective endocarditis, and multiple embolic cerebral infarcts presented with a high-grade intraventricular hemorrhage due to the rupture of a large infectious proximal posterior circulation aneurysm. Computed tomography and cerebral angiogram demonstrated a right crural/ambient cistern hematoma and an associated infectious aneurysm of the right proximal posterior cerebral artery. The ruptured infectious aneurysm was coil-embolized with hydrogel-coated platinum coils without sacrifice of the distal parent artery. The aneurysm was completely occluded, and the patient regained all neurological function. Ruptured infectious aneurysms in the pediatric population occur despite aggressive medical therapy. Patients with infective endocarditis and embolic infarcts should be followed closely due to the risk of major hemorrhagic events, including aneurysm rupture. Hybrid coil embolization of ruptured infectious aneurysms with preservation of the distal parent artery is exceedingly rare and effective in the management of ruptured infectious aneurysms in the pediatric population.

  16. The clinical features and treatment of pediatric intracranial aneurysm.

    Science.gov (United States)

    Liang, Jiantao; Bao, Yuhai; Zhang, Hongqi; Wrede, Karsten Henning; Zhi, Xinglong; Li, Meng; Ling, Feng

    2009-03-01

    Intracranial aneurysms are relatively rare in the pediatric population. The objective of this study was to highlight the clinical and radiological features and the therapeutic outcome and clarify the choice of therapeutic strategies for pediatric intracranial aneurysms. Twenty-four consecutive children (age aneurysms in our institute in the last 23 years were included in this study. There were nine (36%) patients with posterior circulation aneurysms and eight (32%) with giant aneurysms. Eleven (46%) patients presented with subarachnoid hemorrhage. Fifteen patients underwent endovascular treatment, and four received microsurgical therapy. Five patients were treated conservatively. Ninety-two percent (n=22) of the patients showed favorable outcomes. Pediatric intracranial aneurysms differ in many ways from those in adults: male predominance; high incidence of giant, dissecting, and fusiform aneurysms; high incidence of aneurysms in the posterior circulation; high incidence of spontaneous thrombosis; better Hunt-Hess grades at presentation; and better therapeutic outcome. For children with intracranial aneurysms, both microsurgical approaches and endovascular treatment were effective. For many complex aneurysms, endovascular therapy was the best choice.

  17. Roles of hypertension in the rupture of intracranial aneurysms.

    Science.gov (United States)

    Tada, Yoshiteru; Wada, Kosuke; Shimada, Kenji; Makino, Hiroshi; Liang, Elena I; Murakami, Shoko; Kudo, Mari; Kitazato, Keiko T; Nagahiro, Shinji; Hashimoto, Tomoki

    2014-02-01

    Systemic hypertension has long been considered a risk factor of aneurysmal rupture. However, a causal link between systemic hypertension and the development of aneurysmal rupture has not been established. In this study, using a mouse model of intracranial aneurysm rupture, we examined the roles of systemic hypertension in the development of aneurysmal rupture. Aneurysms were induced by a combination of deoxycorticosterone acetate (DOCA)-salt and a single injection of elastase into the cerebrospinal fluid in mice. Antihypertensive treatment was started 6 days after aneurysm induction. Aneurysmal rupture was detected by neurological symptoms and confirmed by the presence of intracranial aneurysm with subarachnoid hemorrhage. Hydralazine (direct vasodilator) or discontinuation of DOCA-salt treatment was used to assess the roles of systemic hypertension. Captopril (angiotensin-converting enzyme inhibitor) or losartan (angiotensin II type 1 receptor antagonist) was used to assess the roles of the local renin-angiotensin system in the vascular wall. Normalization of blood pressure by hydralazine significantly reduced the incidence of ruptured aneurysms and the rupture rate. There was a dose-dependent relationship between reduction of blood pressure and prevention of aneurysmal rupture. Captopril and losartan were able to reduce rupture rate without affecting systemic hypertension induced by DOCA-salt treatment. Normalization of blood pressure after aneurysm formation prevented aneurysmal rupture in mice. In addition, we found that the inhibition of the local renin-angiotensin system independent from the reduction of blood pressure can prevent aneurysmal rupture.

  18. Assessment of Matrix coils in a canine model of a large bifurcation aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Song, Joon K.; Niimi, Yasunari; Yoshino, Yoshikazu; Khoyama, Shinya; Berenstein, Alejandro [Roosevelt Hospital, Center for Endovascular Surgery, Beth Israel Hyman-Newman Institute for Neurology and Neurosurgery, New York, NY (United States)

    2007-03-15

    Controversy exists as to whether Matrix coils are an improvement over bare platinum coils in preventing aneurysm recanalization in endosaccularly coiled large aneurysms. We investigated Matrix coils in a dog model of a wide-necked large bifurcation aneurysm. Six experimental aneurysms were created in dogs and these aneurysms were endosaccularly coiled with 100% Matrix coils. Angiographic and histopathological data were analyzed at 2 weeks and at 3 months. Average aneurysm dimensions were length 17.8 mm, width 8.3 mm, and neck 6.2 mm. Aneurysm coil filling ranged 24.1-41.8% by volume. At 14 days, three of six Matrix-treated aneurysms showed coil compaction and aneurysm recanalization. At 3 months, one additional Matrix-treated aneurysm showed delayed coil compaction and aneurysm recanalization. At 3 months, in three harvested aneurysms, the average measured neck neointima was 0.150 {+-} 0.14 mm. However, in two of the three aneurysms harvested at 3 months, aneurysm recanalization had occurred with neointimal tissue not completely covering the aneurysm orifice. Thick connective fibrous intercoil tissue was observed. No immediate or delayed thrombus formation had occurred. Based on limited data in an experimental bifurcation aneurysm in dogs, Matrix coils appear to induce a thicker aneurysm neck neointima tissue and intercoil granulation response but appear prone to coil compaction and aneurysm recanalization. Modifications to the Matrix coil are likely needed to improve angiographic results in large aneurysms. (orig.)

  19. Intracranial Infectious Aneurysm in Orbital Cellulitis.

    Science.gov (United States)

    Lee, Brian; Kim, Charles; Carrasco, Jacqueline

    2015-01-01

    Infectious intracranial aneurysm and cavernous sinus thrombosis are rare complications of orbital cellulitis. We report the case of a 46-year-old male presenting with sinusitis and orbital cellulitis complicated by the development of an orbital mass. Following orbitotomy with debulking, the patient underwent bony orbital decompression for increasing proptosis postoperatively. While his exam stabilized, the patient developed complete ptosis and extraocular motor palsy in the contralateral eye after undergoing bilateral sinus debridement. Imaging was notable for the presence of a pseudoaneurysm of the internal carotid artery, which was treated with a stent. This report demonstrates rare complications of orbital cellulitis. These patients should be monitored carefully with noninvasive imaging studies, such as cerebral angiography, for early detection of vascular abnormalities that can progress rapidly.

  20. Effects of circle of Willis anatomic variations on angiographic and clinical outcomes of coiled anterior communicating artery aneurysms.

    Science.gov (United States)

    Tarulli, E; Sneade, M; Clarke, A; Molyneux, A J; Fox, A J

    2014-08-01

    Anterior communicating artery aneurysms account for one-fourth of all intracranial aneurysms and frequently occur in the context of A1 vessel asymmetry. The purpose of this study was to correlate circle of Willis anatomic variation association to angiographic and clinical outcomes of anterior communicating aneurysm coiling. The Cerecyte Coil Trial provides a subgroup of 124 cases with anterior communicating artery aneurysms after endovascular coiling. One hundred seventeen of 124 anterior communicating artery aneurysms had complete imaging and follow-up for clinical outcome analysis, stability of aneurysm coil packing, and follow-up imaging between 5 and 7 months after treatment. Clinical outcomes were assessed by the mRS at 6 months. Anterior cerebral artery trunk-dominance was seen in 91 of 124 (73%) anterior communicating artery aneurysms and codominance in 33 of 124 (27%) anterior communicating artery aneurysms. There was no significant difference (P > .5) in treatment success at 5-7 months for anterior communicating artery aneurysms between the anterior cerebral artery trunk-dominant (49 of 86, 57%) and anterior cerebral artery trunk-codominant (19 of 31) groups. Angiographic follow-up demonstrates a statistically significant increase in neck remnants and progressive aneurysm sac filling with the A1 dominant configuration (n = 21, 24% at follow-up versus n = 11, 12% at immediate posttreatment, P = .035). There was no statistically significant difference in clinical outcomes between types of anterior cerebral artery trunk configuration (P > .5). Anterior communicating artery aneurysms with anterior cerebral artery trunk-dominant circle of Willis configurations show less angiographic stability at follow-up than those with anterior cerebral artery trunk-codominance similar to other "termination" type aneurysms. This supports the hypothesis that anterior cerebral artery trunk-dominant flow contributes to aneurysm formation, growth, and instability after coiling

  1. Transcatheter Coil Embolization of an Arc of Buhler Aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Su Jin; Lim, Nam Yeul; Choi, Soo Jin Nah; Kim, Jae Kyu; Jeong, Yong Yeon; Kang, Heoung Keun [Chonnam National University Hospital, Gwangju (Korea, Republic of); Jang, Nam Kyu [Hwasun Chonnam National University Hospital, Hwasun (Korea, Republic of)

    2008-07-15

    We report the findings of a patient with an asymptomatic Arc of Buhler (AOB) aneurysm, which was successfully treated by transcatheter coil embolization. An abdominal CT and angiography revealed an intact pancreaticoduodenal artery arcade (PDAA) and an anomalous communication between the SMA and celiac axis, termed an AOB. An aneurysm was observed at the origin of the AOB and treated with a transcatheter embolization using coils. A follow-up CT imaging confirmed the total occlusion of the aneurysm with a patent PDAA. The successful results of this treatment suggest that the endovascular therapy of an AOB aneurysm with a celiac axis occlusion and an intact PDAA is feasible and safe.

  2. THE ACOUSTIC DETECTION OF INTRACRANIAL ANEURYSMS - A CLINICAL-STUDY

    NARCIS (Netherlands)

    VANBRUGGEN, AC; MOOIJ, JJA; JOURNEE, HL

    1991-01-01

    A new recording method for the acoustical detection of intracranial aneurysms is presented. A study examining the capability of the method to discriminate between patients with an aneurysm and control patients by a simple, objective parameter is reported. Sound signals were recorded over the eyes,

  3. [Elective cerebral arteriovenous malformation treatment with onyx after coil embolization of ruptured, flow-realeted aneurysm of the posterior circulation].

    Science.gov (United States)

    Poncyljusz, Wojciech; Falkowski, Aleksander; Rać, Monika; Sagan, Leszek; Kojder, Ireneusz

    2012-01-01

    Intracranial arteriovenous posterior circulation malformation was planned to embolize by onyx injection after acute coil embolization of ruptured flow-realeted aneurysm of posterior cerebral artery. Control angiography revealed completely embolized malformation with normal vessel patency at the end of procedure. There were no adverse events related to this procedure and no neurologic deficit at the discharge.

  4. Retrieval of prolapsed coils during endovascular treatment of cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Dinc, Hasan [Karadeniz Technical University, Department of Radiology, Faculty of Medicine, Trabzon (Turkey); KTU Farabi Hospital, Department of Radiology, Trabzon (Turkey); Kuzeyli, Kayhan [Karadeniz Technical University, Department of Neurosurgery, Faculty of Medicine, Trabzon (Turkey); Kosucu, Polat; Sari, Ahmet [Karadeniz Technical University, Department of Radiology, Faculty of Medicine, Trabzon (Turkey); Cekirge, Saruhan [Hacettepe University, Department of Radiology, Faculty of Medicine, Ankara (Turkey)

    2006-04-15

    One of the feared complications during detachable coil embolization of cerebral aneurysms is herniation of a coil loop into the parent artery. Although coil protrusion of one or two loops into the parent vessel may not cause adverse events and in some instances can be ignored, the authors believe that coil retrieval is indicated if a free end is seen pulsating along the blood flow stream to prevent migration of the entire coil mass. In one patient, a microballoon was inflated across the neck of the aneurysm during retrieval of a herniated coil to prevent further coil herniation from the aneurysm sac. We present two cases in which prolapsed coils were successfully retrieved either using a microsnare and balloon combination or a microsnare alone. This report focuses on the efficacy of the Amplatz microsnare for such retrievals and the circumstances in which a herniated coil needs to be retrieved. We report two cases in which embolization coils partially migrated into the parent artery during endovascular treatment of cerebral aneurysm and were retrieved using the Amplatz Nitinol microsnare. (orig.)

  5. Mannitol-induced rebleeding from intracranial aneurysm. Case report

    DEFF Research Database (Denmark)

    Rosenørn, J; Westergaard, L; Hansen, P H

    1983-01-01

    A case is presented in which rebleeding from an intracranial saccular aneurysm occurred a few minutes after intravenous administration of mannitol during surgery. The relationship between the reducing effect of mannitol on elevated intracranial pressure and the increased pressure gradient across...

  6. Comparison of bare metal and statin-coated coils on rates of intra-aneurysmal tissue organization in a rat model of aneurysm.

    Science.gov (United States)

    Kodama, Tomonobu; Iwata, Hiroo

    2013-05-01

    Endovascular treatment of intracranial aneurysms with detachable coils has been accepted widely. Problems of coil compaction, recanalization and rare endothelialization at the aneurysm orifice are not yet solved. We investigated the efficacy of a simvastatin coating applied without any additional matrix to coils to accelerate thrombus organization in the cavity in a rat model of aneurysm. Twelve metal coils coated with simvastatin and 12 bare coils were inserted into the ligated external carotid arterial (ECA) sacs of rats. The ECA sacs were removed 2 or 4 weeks after the coils were implanted and examined by histology and immunohistochemical assay. The organized areas in the ECA sacs in the simvastatin group (73.6 ± 19.4%, 2 wk; 83.4 ± 11.1%, 4 wk) was significantly higher p = 0.003, 2 wk; p = 0.0004, 4 wk than the bare metal group at 2 and 4 weeks (20.5 ± 10.7%, 2 wk, p ECA sac. We suggest that coating coils with simvastatin effectively accelerated organization within the aneurysms and endothelialization over the coil. Copyright © 2013 Wiley Periodicals, Inc.

  7. Emergency endovascular coiling of a ruptured giant splenic artery aneurysm

    DEFF Research Database (Denmark)

    Wernheden, Erika; Brenøe, Anne Sofie; Shahidi, Saeid

    2017-01-01

    Splenic artery aneurysms (SAAs) are the third most common abdominal aneurysm. Endovascular treatment of SAAs is preferred, and coiling is the most commonly used technique. Ruptured giant (>5 cm) SAAs are usually treated with open surgery including splenectomy. We present a rare case of a ruptured...

  8. Unruptured aneurysms with cranial nerve symptoms: efficacy of endosaccular guglielmi detachable coil treatment

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Joon; Kim, Dong Ik; Lee, Seung Koo; Kim, Si Yeon [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2003-09-01

    To evaluate the efficacy of endosaccular Guglielmi detachable coil (GDC) treatment of unruptured aneurysms causing cranial nerve (CN) symptoms. Among a database of 218 patients whose aneurysms were treated using GDC, seven patients met the criteria for unruptured aneurysms presenting with symptoms and signs of CN palsy. Changes in CN symptoms before and after GDC treatment were reviewed. Aneurysms were located in the internal carotid-posterior communicating artery (n=3), the basilar bifurcation (n=1) and the cavernous internal carotid artery (n=3). CN symptoms included ptosis (n=6), mydriasis (n=2), and extraocular muscle (EOM) disorder (CN III: n=4; CN VI: n=3). Overall, improvement or resolution of CN symptoms after treatment was noted in five patients. CN symptoms in cases involving small (10 mm) and intradural aneurysms tended to respond better to GDC treatment. Ptosis was the initial symptom to show improvement, while EOM dysfunction responded least favourably. GDC coil packing appears to be an appropriate treatment method for the relief of CN symptoms associated with intracranial aneurysms.

  9. Canadian Registry of LVIS Jr for Treatment of Intracranial Aneurysms (CaRLA).

    Science.gov (United States)

    Shankar, Jai Jai Shiva; Quateen, Aiman; Weill, Alain; Tampieri, Donatella; Del Pilar Cortes, Maria; Fahed, Robert; Patro, Satya; Kaderali, Zul; Lum, Cheemun; Lesiuk, Howard; Ahmed, Uzair; Peeling, Lissa; Kelly, Michael E; Iancu, Daniela

    2017-09-01

    Stents reduce the rate of angiographic recurrence of intracranial aneurysms. The newest stent for intracranial use is the Low-profile Visible Intraluminal Support device (LVIS Jr). To assess the efficacy of the new stent in a multicenter retrospective registry. Centers across Canada using LVIS Jr were contacted and asked to participate in a retrospective registry of consecutive patients treated with LVIS Jr for intracranial aneurysms between January 2013 and July 2015. A total of 102 patients, with saccular aneurysms in 100 patients (72 women; age range 21-78 years; mean 56.0 years; median 57.5 years) were treated with a LVIS Jr stent. The mean maximum diameter of the dome and neck of the aneurysm and dome to neck ratios were 8.3 mm±7.7 mm, 4.4 mm±1.9 mm, and 1.86±1.22, respectively. Angiographic complications arose in 23 patients, clinical complications in 9 patients, and only 3% of permanent neurological deficits occurred. Death occurred in 1 patient, unrelated to the stent. The ruptured status of the aneurysms (OR=3.29; p=0.046) and use of LVIS Jr for bailout (OR=2.54; p=0.053) showed a trend towards significant association with higher angiographic complications. At the last available follow-up, 68 class I, 20 class II, and 12 class III results were seen. The LVIS Jr stent is a safe and effective device for stent-assisted coiling, with 3% permanent neurological complications. Stent-assisted coiling continues to be technically challenging in cases of ruptured aneurysms and bailout situations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  10. History, Evolution, and Continuing Innovations of Intracranial Aneurysm Surgery.

    Science.gov (United States)

    Lai, Leon T; O'Neill, Anthea H

    2017-06-01

    Evolution in the surgical treatment of intracranial aneurysms is driven by the need to refine and innovate. From an early application of the Hunterian carotid ligation to modern-day sophisticated aneurysm clip designs, progress has been made through dedication and technical maturation of cerebrovascular neurosurgeons to overcome challenges in their practices. The global expansion of endovascular services has challenged the existence of aneurysm surgery, changing the complexity of the aneurysm case mix and volume that are referred for surgical repair. Concepts of how to best treat intracranial aneurysms have evolved over generations and will continue to do so with further technological innovations. As with the evolution of any type of surgery, innovations frequently arise from the criticism of current techniques. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Thrombosis modeling in intracranial aneurysms: a lattice Boltzmann numerical algorithm

    Science.gov (United States)

    Ouared, R.; Chopard, B.; Stahl, B.; Rüfenacht, D. A.; Yilmaz, H.; Courbebaisse, G.

    2008-07-01

    The lattice Boltzmann numerical method is applied to model blood flow (plasma and platelets) and clotting in intracranial aneurysms at a mesoscopic level. The dynamics of blood clotting (thrombosis) is governed by mechanical variations of shear stress near wall that influence platelets-wall interactions. Thrombosis starts and grows below a shear rate threshold, and stops above it. Within this assumption, it is possible to account qualitatively well for partial, full or no occlusion of the aneurysm, and to explain why spontaneous thrombosis is more likely to occur in giant aneurysms than in small or medium sized aneurysms.

  12. Infantile intracranial aneurysm of the superior cerebellar artery.

    Science.gov (United States)

    Del Santo, Molly Ann; Cordina, Steve Mario

    2016-02-29

    Intracranial aneurysms in the pediatric population are rare. We report a case of a 3-month-old infant who presented with inconsolable crying, vomiting, and sunset eye sign. CT revealed a subarachnoid hemorrhage, with CT angiogram revealing a superior cerebellar artery aneurysm. An external ventricular drain was placed for acute management of hydrocephalus, with definitive treatment by endovascular technique with a total of six microcoils to embolize the aneurysm. Serial transcranial Dopplers revealed no subsequent vasospasm. Although aneurysms in the pediatric population are rare, once the diagnosis is established, early treatment results in better outcomes. 2016 BMJ Publishing Group Ltd.

  13. Mesenteric ischaemia after endovascular coiling of ruptured cerebral aneurysms.

    LENUS (Irish Health Repository)

    Kamel, M H

    2012-02-03

    Three patients were referred to a national neurosurgical centre following CT evidence of subarachnoid haemorrhage. The three patients, who were referred from different institutions within a seven week period, were Fisher grade 3 and WFNS Grade I at all times. Angiography showed a PCOM aneurysm in one case, a ruptured Basilar tip aneurysm and an unruptured ACOM aneurysm in another case, and an ACOM aneurysm in the third case. It was decided that the aneurysms were suitable for endovascular coiling. These patients had unremarkable intraoperative catheterizations and coiling but subsequently deteriorated post-operatively due to mesenteric ischaemia. Two patients required colectomy for mesenteric ischaemia, and the third arrested secondary to sepsis from bowel perforation. We discuss the various causes that may explain this association, and we alert the neurosurgical community for this complication which has not been reported before.

  14. Visualization of novel microstents in patients with unruptured intracranial aneurysms with contrast-enhanced flat panel detector CT

    Energy Technology Data Exchange (ETDEWEB)

    Poncyljusz, Wojciech, E-mail: wponcyl@poczta.onet.pl [Departament of Interventional Radiology, Pomeranian Medical University, Neurointerventional Cath Lab MSW Hospital, Al. Powst. Wielkopolskich 72, 70-111 Szczecin (Poland); Zwarzany, Łukasz, E-mail: zwarzany@gmail.com [Departament of Interventional Radiology, Pomeranian Medical University, Neurointerventional Cath Lab MSW Hospital, Al. Powst. Wielkopolskich 72, 70-111 Szczecin (Poland); Safranow, Krzysztof, E-mail: chrissaf@mp.pl [Department of Biochemistry and Chemistry, Pomeranian Medical University, Al. Powst. Wielkopolskich 72, 70-111 Szczecin (Poland)

    2015-07-15

    Highlights: • We examine the feasibility of FPDCT for visualizing intracranial microstents. • Stent deployment and its apposition to the vessel wall are easily assessable. • Coil streaking artifacts hamper the assessment of stent visibility. - Abstract: Objectives: The aim of our study was to evaluate the feasibility of contrast-enhanced flat panel detector CT (FPDCT) for visualizing the novel microstents implanted in patients with unruptured wide-necked intracranial aneurysms. Methods: Forty-four cases of patients who underwent stent assisted coiling at our department were retrospectively analyzed. In each case, FPDCT images were performed after stent and coils deployment and then assessed in the terms of stent struts and all radiopaque markers and tantalum strands visibility separately using a 3-grade scale (1 – inadequate, 2 – good, 3 – excellent). Results: Stent struts visibility was assessed to be inadequate for evaluation in all cases. All radiopaque markers and tantalum strands visibility was excellent in 61.4% and good in 38.6% of cases. We observed 4 (9.09%) cases of incomplete stent opening. Treated aneurysm size <10 mm was an independent predictor of excellent stent all radiopaque markers and tantalum strands visibility (ρ = 0.014). Conclusions: Contrast-enhanced FPDCT is feasible for visualizing stents implanted in patients with intracranial aneurysms as it gives precise visualization of the relationships between the stent tantalum strands and the vessel wall. Stents used in the treatment of aneurysms ≥10 mm in size are worse visualized because of the coil streaking artifacts.

  15. Analysis of hemodynamics of intracranial saccular aneurysms.

    Science.gov (United States)

    Szafrański, Krzysztof

    2007-01-01

    The aim of this paper is to present the impact of artery curvature and neck size of aneurysms on growth rate and effectiveness of treatment of aneurysms. The dynamics of three-dimensional (3D) lateral aneurysms on arteries of different curvature were analysed using Comsol Femlab software. The simulations were performed for both steady as pulsatile flows. The effect of artery curvature and neck size of aneurysms on parameters such as flow velocity, aneurysm wall shear stress, size of the area of blood reaction (impact area) during the cardiac cycle were evaluated as well as relations between the size of impact area and artery curvature or neck size of aneurysms were provided.

  16. Clinical, radiological, and flow-related risk factors for growth of untreated, unruptured intracranial aneurysms

    NARCIS (Netherlands)

    Bor, A. Stijntje E|info:eu-repo/dai/nl/314109080; Tiel Groenestege, Andreas T.; terBrugge, Karel G.; Agid, Ronit; Velthuis, Birgitta K.|info:eu-repo/dai/nl/176956301; Rinkel, Gabriel J E|info:eu-repo/dai/nl/085712000; Wermer, Marieke J H

    2015-01-01

    BACKGROUND AND PURPOSE: Unruptured intracranial aneurysms are frequently followed to monitor aneurysm growth. We studied the yield of follow-up imaging and analyzed risk factors for aneurysm growth. METHODS: We included patients with untreated, unruptured intracranial aneurysms and ≥6 months of

  17. Investigation of intracranial aneurysm hemodynamics following flow diverter stent treatment.

    Science.gov (United States)

    Zhang, Y; Chong, W; Qian, Y

    2013-05-01

    Flow diverters (FDs) are high density meshed stents designed to reduce blood flow into intra-cranial aneurysms. Though the FD is one of many intracranial aneurysm (IA) treatments, FD implantation may also result in the growth and rupture of residual aneurysms. The purpose of this research is to investigate the effect of FD implantation on IA hemodynamics. Computational fluid dynamics (CFD) was conducted to analyze dynamic and resistance forces after FD deployment. Simulation results for the successful case (patient A) showed that FD flow resistance force was higher than dynamic force. This indicated that the FD provided sufficient resistance to reduce flow into the aneurysm. As a result, flow velocity magnitude at the aneurysm neck was reduced by 95%. On the other hand, the flow velocity magnitude at the aneurysm neck was reduced by about 50% for the unsuccessful case (patient B). The reason was that the flow resistance force at the aneurysm neck section was calculated to be lower than the flow driving force. In order to completely occlude the aneurysm, a higher resistance FD stent is to be required to suppress the dynamic forces. Patient-specific hemodynamic simulations offer means of quantitative estimation FD treatment outcomes. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

  18. Intracranial saccular aneurysm in a child with only persistent headache.

    Science.gov (United States)

    Güngör, Olcay; Özkaya, Ahmet Kağan; Dilber, Cengiz; Çinar, Celal

    2015-06-01

    Headache is one of the common symptoms of intracranial aneursym. A 5-year-old child lately presented to our pediatric emergency department with persistent headache. Brain magnetic resonance imaging revealed a 7×8 mm rounded lesion with slowly heterogeneous low signal in T2 sequence consistent with a partial occluded aneurysm, in the right medial frontal lobe that close to anterior cerebral artery. Intracranial aneurysms are rare in children and they are noncommon without complications as our case. © The Author(s) 2014.

  19. The LVIS/LVIS Jr. stents in the treatment of wide-neck intracranial aneurysms: multicentre registry.

    Science.gov (United States)

    Poncyljusz, Wojciech; Biliński, Piotr; Safranow, Krzysztof; Baron, Jan; Zbroszczyk, Miłosz; Jaworski, Maciej; Bereza, Sławomir; Burke, Thomas H

    2015-07-01

    Wide-necked intracranial aneurysms have been a challenge for endovascular techniques. With the advent of adjunctive devices such as balloons or stents, recanalisation rates have decreased secondary to better packing. The purpose of this registry was to evaluate the safety and effectiveness of the new Low-profiled Visualized Intraluminal Support LVIS and LVIS Jr. stents in the treatment of unruptured wide-neck intracranial aneurysms. The LVIS or LVIS Jr. stent-assisted coil embolisation was performed in 78 patients harbouring 78 intracranial aneurysms. There were 59 aneurysms located in the anterior circulation and 19 in the posterior circulation. Clinical data and 6-month follow-up angiograms are presented. The LVIS and LVIS Jr. stents were successfully delivered to the target aneurysm; however, there were seven cases in which the LVIS/LVIS Jr. stents had suboptimal opening and apposition to the parent vessel wall. The overall technical success for all groups was 91% (71 of 78 stents). There was complete angiographic occlusion in 66 (85%) of 78 cases and residual neck remnants in 12 (15%) cases. All patients had 6-month angiographic follow-up, which demonstrated complete occlusion of the target aneurysm in 64 (82%) cases, residual neck remnants in 5 (6%) cases and there was aneurysm filling in 9 (12%) cases. The LVIS/LVIS Jr. stent system is safe and effective for the treatment of wide-neck intracranial aneurysms, providing suitable support of the coil mass, which allows for a high level of occlusion with low rates of recanalisation and subsequent treatments. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. In vivo hemodynamic analysis of intracranial aneurysms obtained by magnetic resonance fluid dynamics (MRFD) based on time-resolved three-dimensional phase-contrast MRI

    Energy Technology Data Exchange (ETDEWEB)

    Isoda, Haruo; Takeda, Hiroyasu; Yamashita, Shuhei; Takehara, Yasuo; Sakahara, Harumi [Hamamatsu University School of Medicine, Department of Radiology, Hamamatsu, Shizuoka (Japan); Ohkura, Yasuhide; Kosugi, Takashi [Renaissance of Technology Corporation, Hamamatsu, Shizuoka (Japan); Hirano, Masaya [GE Healthcare Japan, Tokyo (Japan); Hiramatsu, Hisaya; Namba, Hiroki [Hamamatsu University School of Medicine, Department of Neurosurgery, Hamamatsu, Shizuoka (Japan); Alley, Marcus T.; Bammer, Roland; Pelc, Norbert J. [Stanford University School of Medicine, Department of Radiology, Radiological Sciences Laboratory, Stanford, CA (United States)

    2010-10-15

    Hemodynamics is thought to play a very important role in the initiation, growth, and rupture of intracranial aneurysms. The purpose of our study was to perform in vivo hemodynamic analysis of unruptured intracranial aneurysms of magnetic resonance fluid dynamics using time-resolved three-dimensional phase-contrast MRI (4D-Flow) at 1.5 T and to analyze relationships between hemodynamics and wall shear stress (WSS) and oscillatory shear index (OSI). This study included nine subjects with 14 unruptured aneurysms. 4D-Flow was performed by a 1.5-T magnetic resonance scanner with a head coil. We calculated in vivo streamlines, WSS, and OSI of intracranial aneurysms based on 4D-Flow with our software. We evaluated the number of spiral flows in the aneurysms and compared the differences in WSS or OSI between the vessel and aneurysm and between whole aneurysm and the apex of the spiral flow. 3D streamlines, WSS, and OSI distribution maps in arbitrary direction during the cardiac phase were obtained for all intracranial aneurysms. Twelve aneurysms had one spiral flow each, and two aneurysms had two spiral flows each. The WSS was lower and the OSI was higher in the aneurysm compared to the vessel. The apex of the spiral flow had a lower WSS and higher OSI relative to the whole aneurysm. Each intracranial aneurysm in this study had at least one spiral flow. The WSS was lower and OSI was higher at the apex of the spiral flow than the whole aneurysmal wall. (orig.)

  1. Emergency endovascular coiling of a ruptured giant splenic artery aneurysm

    Directory of Open Access Journals (Sweden)

    Erika Wernheden, MD

    2017-12-01

    Full Text Available Splenic artery aneurysms (SAAs are the third most common abdominal aneurysm. Endovascular treatment of SAAs is preferred, and coiling is the most commonly used technique. Ruptured giant (>5 cm SAAs are usually treated with open surgery including splenectomy. We present a rare case of a ruptured 15-cm giant SAA in an 84-year-old woman treated successfully with emergency endovascular coiling. To our knowledge, this is one of the few reports of emergency endovascular treatment for ruptured giant SAA.

  2. Low-profile Visualized Intraluminal Support Junior Device for the Treatment of Intracranial Aneurysms.

    Science.gov (United States)

    Gupta, Mihir; Cheung, Vincent J; Abraham, Peter; Wali, Arvin R; Santiago-Dieppa, David R; Gabel, Brandon C; Almansouri, Abdulrahman; Pannell, J Scott; Khalessi, Alexander A

    2017-02-17

    Early case series suggest that the recently introduced Low-profile Visualized Intraluminal Support Junior (LVIS Jr.) device (MicroVention-Terumo, Inc., Tustin, CA) may be used to treat wide-necked aneurysms that would otherwise require treatment with intrasaccular devices or open surgery. We report our single-center experience utilizing LVIS Jr. to treat intracranial aneurysms involving 1.8-2.5 mm parent arteries. We retrospectively reviewed records of patients treated with the LVIS Jr. device for intracranial aneurysms at a single center. A total of 21 aneurysms were treated in 18 patients. Aneurysms were 2-25 mm in diameter; one was ruptured, while three had recurred after previous rupture and treatment. Lesions were distributed across the anterior (n=12) and posterior (n=9) circulations. Three were fusiform morphology. Stent deployment was successful in 100% of cases with no immediate complications. Seventeen aneurysms were treated with stent-assisted coil embolization resulting in immediate complete occlusion in 94% of cases. Two fusiform aneurysms arising from the posterior circulation were further treated with elective clip ligation after delayed expansion and recurrence; no lesions required further endovascular treatment. Four aneurysms were treated by flow diversion with stand-alone LVIS Jr. stent, and complete occlusion was achieved in three cases. Small foci of delayed ischemic injury were noted in two patients in the setting of antiplatelet medication noncompliance. No in-stent stenosis, migration, hemorrhage, or permanent deficits were observed. Good functional outcome based on the modified Rankin Scale score (mRS ≤ 2) was achieved in 100% of cases. Our midterm results suggest that the LVIS Jr. stent may be used for a variety of intracranial aneurysms involving small parent arteries (1.8-2.5 mm) with complete angiographic occlusion, parent vessel preservation, and functional clinical outcomes. This off-label expansion would increase the number of

  3. Magnetic resonance angiography or digital subtraction catheter angiography for follow-up of coiled aneurysms: do we need both?

    Science.gov (United States)

    Lane, Annah; Vivian, Philip; Coulthard, Alan

    2015-04-01

    Endovascular treatment of intracranial aneurysms is now common. Digital subtraction catheter angiography (DSA) is the gold standard for imaging follow-up of coiled intracranial aneurysms; however, it is an invasive procedure with a risk of complications. Time-of-flight magnetic resonance angiography (MRA) is an alternative non-invasive imaging method. In a previous study, we found that MRA at 1.5T was comparable to DSA for detection of aneurysm recurrence in this patient group and subsequently added MRA to the routine follow-up protocol. In the current study, we further compare MRA with DSA to determine whether MRA could safely replace DSA. Patients who had endovascular coiling procedure for intracranial aneurysm from 10/2004 to 6/2010 were identified from our database. A radiologist and a radiology registrar compared MRA and DSA for all patients who received both modalities. DSA was considered as the reference technique. 'Agreement' or 'disagreement' between modalities was noted regarding absence or presence of aneurysm recurrence. The study group comprised 86 treatments of 80 aneurysms in 73 patients. There were 83/86 agreements between modalities and 3 disagreements. In one case, MRA identified a recurrence that was not seen on the corresponding DSA. In two cases, DSA showed a minor recurrence that was not seen on MRA. Of the two MRA 'misses', neither would have resulted in different management. MRA is a safe and accurate modality for follow-up of coiled aneurysms and can replace DSA. © 2015 The Royal Australian and New Zealand College of Radiologists.

  4. Coil embolization of ruptured frontopolar artery aneurysm: case report.

    Science.gov (United States)

    Castaño-Leon, Ana M; Cicuendez, Marta; Paredes, Igor; Alen, Jose F; Navia, Pedro; Lagares, Alfonso

    2014-01-01

    Distal anterior cerebral artery aneurysms are infrequent. The most common location is at the bifurcation of the pericallosal and callosomarginal arteries. Cerebral artery anomalies can sometimes, at least partially, explain aneurysm formation in less common locations in relation to hemodynamic stress caused on the vascular wall. We report a very rare case of subarachnoid hemorrhage due to a ruptured frontopolar artery aneurysm as a part of an anomalous anterior cerebral artery complex that was, for the first time, treated with endovascular coiling. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  5. Intracranial aneurysmal bone cyst: A rare CT appearance

    Energy Technology Data Exchange (ETDEWEB)

    Clavier, E.; Thiebot, J.; Benozio, M.; Godlewski, J.; Creissard, P.

    1988-06-01

    Aneurysmal bone cyst occurring within the calvarium is uncommon. We report a case presenting as an intracranial space-occupying lesion. Fluid levels within a lesion on CT is very suggestive but inconstant. The theory of a pre-existing lesion is noted.

  6. The unruptured intracranial aneurysm treatment score A multidisciplinary consensus

    NARCIS (Netherlands)

    Etminan, Nima; Brown, Robert D.; Beseoglu, Kerim; Juvela, Seppo; Raymond, Jean; Morita, Akio; Torner, James C.; Derdeyn, Colin P.; Raabe, Andreas; Mocco, J.; Korja, Miikka; Abdulazim, Amr; Amin-Hanjani, Sepideh; Al-Shahi Salman, Rustam; Barrow, Daniel L.; Bederson, Joshua; Bonafe, Alain; Dumont, Aaron S.; Fiorella, David J.; Gruber, Andreas; Hankey, Graeme J.; Hasan, David M.; Hoh, Brian L.; Jabbour, Pascal; Kasuya, Hidetoshi; Kelly, Michael E.; Kirkpatrick, Peter J.; Knuckey, Neville; Koivisto, Timo; Krings, Timo; Lawton, Michael T.; Marotta, Thomas R.; Mayer, Stephan A.; Mee, Edward; Pereira, Vitor Mendes; Molyneux, Andrew; Morgan, Michael K.; Mori, Kentaro; Murayama, Yuichi; Nagahiro, Shinji; Nakayama, Naoki; Niemelä, Mika; Ogilvy, Christopher S.; Pierot, Laurent; Rabinstein, Alejandro A.; Roos, Yvo B. W. E. M.; Rinne, Jaakko; Rosenwasser, Robert H.; Ronkainen, Antti; Schaller, Karl; Seifert, Volker; Solomon, Robert A.; Spears, Julian; Steiger, Hans-Jakob; Vergouwen, Mervyn D. I.; Wanke, Isabel; Wermer, Marieke J. H.; Wong, George K. C.; Wong, John H.; Zipfel, Gregory J.; Connolly, E. Sander; Steinmetz, Helmuth; Lanzino, Giuseppe; Pasqualin, Alberto; Rüfenacht, Daniel; Vajkoczy, Peter; McDougall, Cameron; Hänggi, Daniel; LeRoux, Peter; Rinkel, Gabriel J. E.; Macdonald, R. Loch

    2015-01-01

    Objective: We endeavored to develop an unruptured intracranial aneurysm (UIA) treatment score (UIATS) model that includes and quantifies key factors involved in clinical decision-making in the management of UIAs and to assess agreement for this model among specialists in UIA management and research.

  7. The unruptured intracranial aneurysm treatment score : A multidis ciplinary consensus

    NARCIS (Netherlands)

    Etminan, Nima; Brown, Robert D.; Beseoglu, Kerim; Juvela, Seppo; Raymond, Jean; Morita, Akio; Torner, James C.; Derdeyn, Colin P.; Raabe, Andreas; Mocco, J.; Korja, Miikka; Abdulazim, Amr; Amin-Hanjani, Sepideh; Salman, Rustam Al Shahi; Barrow, Daniel L.; Bederson, Joshua; Bonafe, Alain; Dumont, Aaron S.; Fiorella, David J.; Gruber, Andreas; Hankey, Graeme J.; Hasan, David M.; Hoh, Brian L.; Jabbour, Pascal; Kasuya, Hidetoshi; Kelly, Michael E.; Kirkpatrick, Peter J.; Knuckey, Neville; Koivisto, Timo; Krings, Timo; Lawton, Michael T.; Marotta, Thomas R.; Mayer, Stephan A.; Mee, Edward; Pereira, Vitor Mendes; Molyneux, Andrew; Morgan, Michael K.; Mori, Kentaro; Murayama, Yuichi; Nagahiro, Shinji; Nakayama, Naoki; Niemelä, Mika; Ogilvy, Christopher S.; Pierot, Laurent; Rabinstein, Alejandro A.; Roos, Yvo B W E M; Rinne, Jaakko; Rosenwasser, Robert H.; Ronkainen, Antti; Schaller, Karl; Seifert, Volker; Solomon, Robert A.; Spears, Julian; Steiger, Hans Jakob; Vergouwen, Mervyn D I; Wanke, Isabel; Wermer, Marieke J H; Wong, George K C; Wong, John H.; Zipfel, Gregory J.; Sander Connolly, E.; Steinmetz, Helmuth; Lanzino, Giuseppe; Pasqualin, Alberto; Rüfenacht, Daniel; Vajkoczy, Peter; McDougall, Cameron; Hänggi, Daniel; Leroux, Peter; Rinkel, Gabriel J E; Loch Macdonald, R.

    2015-01-01

    Objective: We endeavored to develop an unruptured intracranial aneurysm (UIA) treatment score (UIATS) model that includes and quantifies key factors involved in clinical decision-making in the management of UIAs and to assess agreement for this model among specialists in UIA management and research.

  8. The radiological appearance of intracranial aneurysms in adults ...

    African Journals Online (AJOL)

    2014-04-04

    Apr 4, 2014 ... http://sajr.org.za. The radiological appearance of intracranial aneurysms in adults infected with the human immunodeficiency virus (HIV). Authors: ... Method: In this retrospective analysis of data, 23 HIV-positive patients, of which 15 (65.2%) ..... muscularis layer.14 HIV viral proteins have been associated.

  9. Computational study for the effects of coil configuration on blood flow characteristics in coil-embolized cerebral aneurysm.

    Science.gov (United States)

    Otani, Tomohiro; Ii, Satoshi; Shigematsu, Tomoyoshi; Fujinaka, Toshiyuki; Hirata, Masayuki; Ozaki, Tomohiko; Wada, Shigeo

    2017-05-01

    Coil embolization of cerebral aneurysms with inhomogeneous coil distribution leads to an incomplete occlusion of the aneurysm. However, the effects of this factor on the blood flow characteristics are still not fully understood. This study investigates the effects of coil configuration on the blood flow characteristics in a coil-embolized aneurysm using computational fluid dynamics (CFD) simulation. The blood flow analysis in the aneurysm with coil embolization was performed using a coil deployment (CD) model, in which the coil configuration was constructed using a physics-based simulation of the CD. In the CFD results, total flow momentum and kinetic energy in the aneurysm gradually decayed with increasing coil packing density (PD), regardless of the coil configuration attributed to deployment conditions. However, the total shear rate in the aneurysm was relatively high and the strength of the local shear flow varied based on the differences in coil configuration, even at adequate PDs used in clinical practice (20-25 %). Because the sufficient shear rate reduction is a well-known factor in the blood clot formation occluding the aneurysm inside, the present study gives useful insight into the effects of coil configuration on the treatment efficiency of coil embolization.

  10. Intracranial aneurysm growth quantification in CTA

    Science.gov (United States)

    Firouzian, Azadeh; Manniesing, Rashindra; Metz, Coert T.; Klein, Stefan; Velthuis, Birgitta K.; Rinkel, Gabriel J. E.; van der Lugt, Aad; Niessen, Wiro J.

    2012-02-01

    Next to aneurysm size, aneurysm growth over time is an important indicator for aneurysm rupture risk. Manual assessment of aneurysm growth is a cumbersome procedure, prone to inter-observer and intra-observer variability. In clinical practice, mainly qualitative assessment and/or diameter measurement are routinely performed. In this paper a semi-automated method for quantifying aneurysm volume growth over time in CTA data is presented. The method treats a series of longitudinal images as a 4D dataset. Using a 4D groupwise non-rigid registration method, deformations with respect to the baseline scan are determined. Combined with 3D aneurysm segmentation in the baseline scan, volume change is assessed using the deformation field at the aneurysm wall. For ten patients, the results of the method are compared with reports from expert clinicians, showing that the quantitative results of the method are in line with the assessment in the radiology reports. The method is also compared to an alternative method in which the volume is segmented in each 3D scan individually, showing that the 4D groupwise registration method agrees better with manual assessment.

  11. Validation of Blood Flow Simulations in Intracranial Aneurysms

    Science.gov (United States)

    Yu, Yue; Anor, Tomer; Baek, Hyoungsu; Jayaraman, Mahesh; Madsen, Joseph; Karniadakis, George

    2010-11-01

    Catheter-based digital subtraction angiography (DSA) is the most accurate diagnostic procedure for investigating vascular anomalies and cerebral blood flow. Here we describe utilization of DSA in a patient with an intracranial aneursysm to validate corresponding spectral element simulations. Subsequently, we examine via visualization the structure of flow in internal carotid arteries laden with three different types of aneurysms: (1) a wide-necked saccular aneurysm, (2) a narrower-necked saccular aneurysm, and (3) a case with two adjacent saccular aneurysms. We have found through high resolution simulations that in cases (1) and (3) in physiological conditions a hydrodynamic instability occurs during the decelerating systolic phase resulting in a high frequency oscillation (20-50 Hz). We use the in-silico dye visualization to discriminate among different physical mechanisms causing the instability and contrast their effect with case (2) for which an instability arises only at much higher flowrates.

  12. Arterial tortuosity syndrome with multiple intracranial aneurysms: a case report.

    Science.gov (United States)

    Naunheim, Matthew R; Walcott, Brian P; Nahed, Brian V; MacRae, Calum A; Levinson, John R; Ogilvy, Christopher S

    2011-03-01

    To report a new manifestation of the rare connective tissue disorder arterial tortuosity syndrome in the absence of skin and soft-tissue abnormalities and with bilateral, giant fusiform intracranial aneurysms. Case report. University teaching hospital. A 67-year-old man with a history of hypertension presented to medical attention after a syncopal episode. Imaging revealed incidental, bilateral, giant fusiform intracranial aneurysms of the internal carotid artery at their junction of the circle of Willis. There was also aneurysmal dilatation of the left main coronary artery ectasia and aneurysmal dilation of the aorta and bilateral iliac arteries, suggestive of arterial tortuosity syndrome. The patient's syncope was attributed to transient complete heart block for which a permanent pacemaker was placed. The patient started taking aspirin for stroke prevention and losartan potassium for blood pressure control. To our knowledge, we present the first case of arterial tortuosity syndrome with marked bilateral intracranial artery dilation in the absence of concurrent skin and soft tissue abnormalities. Workup may include systemic vascular imaging to characterize the extent of disease. Antiplatelet therapy can be used for stroke prevention by reducing the risk of clot formation in ectatic vessels with altered hemodynamics and subsequent embolism. Losartan is known to inhibit transforming growth factor β signaling and may be a specific modulator of disease expression in this syndrome.

  13. Management of infectious intracranial aneurysms in the pediatric population.

    Science.gov (United States)

    Flores, Bruno C; Patel, Ankur R; Braga, Bruno P; Weprin, Bradley E; Batjer, H Hunt

    2016-07-01

    Infectious intracranial aneurysms (IIAs) account for approximately 15 % of all pediatric intracranial aneurysms. Histologically, they are pseudoaneurysms that develop in response to an inflammatory reaction within the adventitia and muscularis layers, ultimately resulting in disruption of both the internal elastic membrane and the intima. The majority of pediatric IIAs are located within the anterior circulation, and they can be multiple in 15-25 % of cases. The most common presentation for an IIA is intracerebral and/or subarachnoid hemorrhage. In children with a known diagnosis of infective endocarditis who develop new neurological manifestations, it is imperative to exclude the existence of an IIA. The natural history of untreated infectious aneurysms is ominous; they demonstrate a high incidence of spontaneous rupture. High clinical suspicion, prompt diagnosis, and adequate treatment are of paramount importance to prevent devastating neurological consequences. The prompt initiation of intravenous broad-spectrum antibiotics represents the mainstay of treatment. Three questions should guide the management of pediatric patients with IIAs: (a) aneurysm rupture status, (b) the presence of intraparenchymal hemorrhage or elevated intracranial pressure, and (c) relationship of the parent vessel to eloquent brain tissue. Those three questions should orient the treating physician into either antibiotic therapy alone or in combination with microsurgical or endovascular interventions. This review discusses important aspects of the epidemiology, the diagnosis, and the management of IIAs in the pediatric population.

  14. Rebleeding of a Splenic Artery Aneurysm after Coil Embolisation

    Directory of Open Access Journals (Sweden)

    Kyra D. Kingma

    2016-01-01

    Full Text Available Background. Splenic artery aneurysm (SAA is an uncommon and difficult diagnosis. SAA is more common in females. Only 20% of SAA is symptomatic and may present as a rupture. A ruptured SAA is associated with a 25% mortality rate. Case Presentation. We present a case of a male patient with a bleeding SAA that rapidly increased in size. Distal coiling was technically impossible and despite proximal coil embolisation the SAA continued to bleed. A laparotomy including splenectomy and partial pancreatectomy was performed with an uneventful patient recovery. Discussion. Endovascular management is currently considered the optimal treatment of SAA. However, careful monitoring and follow-up is needed after embolisation as rapid recanalization of the SAA may possibly occur, especially when distal coiling of the aneurysm is unsuccessful. Conclusion. Endovascular treatment of an SAA is not necessarily effective. Surgeons must be prepared to perform open procedures to further reduce mortality rates.

  15. Endovascular treatment of intracranial aneurysms with the LVIS device: a systematic review.

    Science.gov (United States)

    Zhang, Xiaoguang; Zhong, Junjie; Gao, Heng; Xu, Feng; Bambakidis, Nicholas C

    2017-06-01

    Despite promising initial results, current knowledge regarding the use of the Low-profile Visualized Intraluminal Support (LVIS) device to treat wide-necked intracranial aneurysms is still limited. Our aim is to evaluate the feasibility, efficacy, and safety of the LVIS device in stent-assisted coiling of intracranial aneurysms. We conducted a systematic review by searching PubMed, EMBASE, and Cochrane Library for all published studies on the treatment of intracranial aneurysms with the LVIS device up to March 2016. Feasibility was evaluated by the technical success rate during the procedure, efficacy was evaluated by the rate of complete aneurysm occlusion at follow-up angiography, and safety was assessed by procedure-related morbidity and mortality. A total of nine studies were included in the analysis, including 384 patients with 390 aneurysms. The overall technical success rate was 96.8% (95% CI 94.4% to 99.1%). The aneurysmal complete occlusion rate was 54.6% (95% CI 31.8% to 77.4%) on immediate control and 84.3% (95% CI 78.9% to 89.7%) at follow-up angiography. Procedural-related morbidity and mortality were 1.4% (95% CI 0.2% to 2.6%) and 0% (95% CI 0%), respectively. The thromboembolic event rate was 4.9% (95% CI 1.9% to 7.9%) and the hemorrhagic event rate was 2.1% (95% CI 0.7% to 3.5%), with 0.9% (95% CI 0% to 1.8%) experiencing neurologic hemorrhagic complications and 1.9% (95% CI 0.5% to 3.2%) experiencing non-neurologic hemorrhagic complications. Our systematic review suggests that endovascular treatment of intracranial aneurysms with the LVIS device is feasible, safe, and effective in the short term. However, the rate of thromboembolic complications is not negligible. Further prospective studies are needed to evaluate the long-term efficacy and safety of the LVIS device. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  16. Surgery of intracranial aneurysms at Yonsei University: 780 cases.

    Science.gov (United States)

    Lee, K C

    1991-03-01

    Seven hundred and eighty patients with intracranial aneurysm, which were surgically treated by the author since 1976, were analyzed. Strategies important for intracranial aneurysm surgery were the timing of surgery, preoperative preparation and intraoperative management. The best management outcome could be achieved by early operation, removal of subarachnoid blood clot, maintenance of circulating blood volume, administration of nimodipine, and meticulous surgical tactics to avoid pitfalls. Indications for aneurysm surgery in the acute phase were determined by intracerebral hematoma, angiographic findings, clinical grade, general physical status and readiness of the surgical team. Important goals to be considered during the operation were obtaining a slack brain, preparation of proximal control, protection of the brain, awareness of microsurgical anatomy, and complete dissection of the sac. The morbidity and mortality were 2.7% and 4.0%, respectively. The mortality was attributed to intracranial causes in 20 cases (poor grade, delayed ischemic deficits, rebleeding, postoperative infarction, and postoperative epidural hematoma), extracranial causes in 7 cases (pulmonary embolism, heparin induced intracerebral hemorrhage, hepatic failure, myocardial infarction, and gastrointestinal bleeding), and unknown problems in 5 cases. The postoperative intracerebral hemorrhage occurred in 16 cases and seemed to be caused by one or more of the following events: cerebral infarction developed during the preoperative period, occlusion of the cerebral veins during the Sylvian dissection, cerebral retraction and/or sudden change of intracranial hemodynamics. Hydrocephalus, almost always a communicating type as confirmed by isotope cisternography, was managed by lumboperitoneal shunt.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Reconfigurable Polymer Networks for Improved Treatment of Intracranial Aneurysms

    Science.gov (United States)

    Ninh, Chi Suze Q.

    Endovascular embolization of intracranial aneurysms is a minimally invasive treatment in which an implanted material forms a clot to isolate the weakened vessel. Current strategy suffers from long-term potential failure modes. These potential failure modes include (1) enzymatic degradation of the fibrin clot that leads to compaction of the embolic agent, (2) incomplete filling of the aneurysm sac by embolic agent, and (3) challenging geometry of wide neck aneurysms. In the case of wide neck aneurysms, usually an assisting metal stent is used to help open the artery. However, metal stents with much higher modulus in comparison to the soft blood vessel can cause biocompatibilities issues in the long term such as infection and scarring. Motivated to solve these challenges associated with endovascular embolization, strategies to synthesize and engineer reconfigurable and biodegradable polymers as alternative therapies are evaluated in this thesis. (1) Reconfiguration of fibrin gel's modulus was achieved through crosslinking with genipin released from a biodegradable polymer matrix. (2) Reconfigurability can also be achieved by transforming triblock co-polymer hydrogel into photoresponsive material through incorporation of melanin nanoparticles as efficient photosensitizers. (3) Finally, reconfigurability can be conferred on biodegradable polyester networks via Diels-Alder coupling of furan pendant groups and dimaleimide crosslinking agent. Taken all together, this thesis describes strategies to transform a broad class of polymer networks into reconfigurable materials for improved treatment of intracranial aneurysms as well as for other biomedical applications.

  18. Flow Conditions in the Intracranial Aneurysm Lumen Are Associated with Inflammation and Degenerative Changes of the Aneurysm Wall.

    Science.gov (United States)

    Cebral, J; Ollikainen, E; Chung, B J; Mut, F; Sippola, V; Jahromi, B R; Tulamo, R; Hernesniemi, J; Niemelä, M; Robertson, A; Frösen, J

    2017-01-01

    Saccular intracranial aneurysm is a common disease that may cause devastating intracranial hemorrhage. Hemodynamics, wall remodeling, and wall inflammation have been associated with saccular intracranial aneurysm rupture. We investigated how saccular intracranial aneurysm hemodynamics is associated with wall remodeling and inflammation of the saccular intracranial aneurysm wall. Tissue samples resected during a saccular intracranial aneurysm operation (11 unruptured, 9 ruptured) were studied with histology and immunohistochemistry. Patient-specific computational models of hemodynamics were created from preoperative CT angiographies. More stable and less complex flows were associated with thick, hyperplastic saccular intracranial aneurysm walls, while slower flows with more diffuse inflow were associated with degenerated and decellularized saccular intracranial aneurysm walls. Wall degeneration (P = .041) and rupture were associated with increased inflammation (CD45+, P = .031). High wall shear stress (P = .018), higher vorticity (P = .046), higher viscous dissipation (P = .046), and high shear rate (P = .046) were associated with increased inflammation. Inflammation was also associated with lack of an intact endothelium (P = .034) and the presence of organized luminal thrombosis (P = .018), though overall organized thrombosis was associated with low minimum wall shear stress (P = .034) and not with the flow conditions associated with inflammation. Flow conditions in the saccular intracranial aneurysm are associated with wall remodeling. Inflammation, which is associated with degenerative wall remodeling and rupture, is related to high flow activity, including elevated wall shear stress. Endothelial injury may be a mechanism by which flow induces inflammation in the saccular intracranial aneurysm wall. Hemodynamic simulations might prove useful in identifying saccular intracranial aneurysms at risk of developing inflammation, a potential biomarker for rupture.

  19. Surgical treatment of multiple intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    Nelson Martelli

    1988-06-01

    Full Text Available A retrospective study was conducted on 42 patients with multiple aneurysms surgically treated from 1975 to 1986. Thirty one of them had 2 aneurysms 6 had 3, 3 had 4 and 2 had 5 (62 in the internal carotid, 27 in the middle cerebral artery, 11 in the anterior cerebral and 3 in the basilar artery. All patients had subarachnoid hemorrhage and were classified as follows upon admission: 11, grade I; 12, grade II; 15, grade III, and 4, grade IV, and most of them improved before surgery (29, grade I, 7, grade II, and 6, grade III. In most cases, surgery was delayed and the 42 patients needed 57 craniotomies for clipping the aneurysms. Of the 24 patients with bilateral aneurysms, 15 were operated on both sides (11 are asymptomatic, 1 has hemiparesis, and 3 died later. Of the 9 patients submitted to unilateral craniotomy, 4 died and 5 are alive and well. Of the 18 patients with unilateral aneurysms, 11 are asymptomatic, 2 have hemiparesis, 1 has diplegia and behavioral disorders, and 4 died. Overall mortality was 26.1%, intraoperative mortality was 11.9%, and no mortality occurred among the patients operated over the last 5 years. The management of the these patients is discussed.

  20. Visualization of novel microstents in patients with unruptured intracranial aneurysms with contrast-enhanced flat panel detector CT.

    Science.gov (United States)

    Poncyljusz, Wojciech; Zwarzany, Łukasz; Safranow, Krzysztof

    2015-07-01

    The aim of our study was to evaluate the feasibility of contrast-enhanced flat panel detector CT (FPDCT) for visualizing the novel microstents implanted in patients with unruptured wide-necked intracranial aneurysms. Forty-four cases of patients who underwent stent assisted coiling at our department were retrospectively analyzed. In each case, FPDCT images were performed after stent and coils deployment and then assessed in the terms of stent struts and all radiopaque markers and tantalum strands visibility separately using a 3-grade scale (1 - inadequate, 2 - good, 3 - excellent). Stent struts visibility was assessed to be inadequate for evaluation in all cases. All radiopaque markers and tantalum strands visibility was excellent in 61.4% and good in 38.6% of cases. We observed 4 (9.09%) cases of incomplete stent opening. Treated aneurysm size <10mm was an independent predictor of excellent stent all radiopaque markers and tantalum strands visibility (ρ=0.014). Contrast-enhanced FPDCT is feasible for visualizing stents implanted in patients with intracranial aneurysms as it gives precise visualization of the relationships between the stent tantalum strands and the vessel wall. Stents used in the treatment of aneurysms ≥10 mm in size are worse visualized because of the coil streaking artifacts. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Endovascular treatment of unruptured posterior circulation intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    Xianli Lv

    2016-01-01

    Full Text Available Background and Purpose: Endovascular treatment of unruptured posterior circulation intracranial aneurysms (UPCIAs is limited in the International Study of Unruptured Intracranial Aneurysms (ISUIA. The aim of this study is to evaluate the periprocedural morbidity, mortality, and midterm clinical and angiographic follow-ups of endovascular treatment of UPCIAs. Materials and Methods: Retrospective analysis of all patients treated in a 2-year period (89 patients: 10-78 years of age, mean: 45.5 ± 14.3/92 UPCIAs. Fifty-eight aneurysms were found incidentally, 12 in association with mass effect symptoms and 22 with stroke. Results: A clinical improvement or stable outcome was achieved in 84 patients (94.4%. The two cases of permanent morbidity included a patient with paralysis and another patient with hemianopia. One patient died after treatment of a giant fusiform vertebrobasilar aneurysm. In one patient, the aneurysm ruptured during treatment, resulting in death. Another patient suffered a fatal aneurysm rupture 4 days after treatment. Giant size (P = 0.005 and mass effect presentation (P = 0.029 were independent predictors of unfavorable outcomes in UPCIAs. Angiographic follow-up was available in 76 of the 86 surviving patients (88.4% with a mean of 6.8 months (range: 1-36 months. Recanalization in six patients (7.9% at 3 months, 4 months, 4 months, 24 months, and 36 months required retreatment in three patients. In-stent stenosis of >50% was found in three patients. Conclusion: Endovascular therapy is an attractive option for UPCIAs with stable midterm outcome. However, the current endovascular option seems to have a limitation for the treatment of the aneurysm with giant size or mass effect presentation.

  2. High WSS or low WSS? Complex interactions of hemodynamics with intracranial aneurysm initiation, growth, and rupture: toward a unifying hypothesis

    National Research Council Canada - National Science Library

    Meng, H; Tutino, V M; Xiang, J; Siddiqui, A

    2014-01-01

    ... of aneurysm rupture risk. Image-based computational fluid dynamics models have suggested associations between hemodynamics and intracranial aneurysm rupture, albeit with conflicting findings regarding wall shear stress...

  3. Vortex dynamics in ruptured and unruptured intracranial aneurysms

    Science.gov (United States)

    Trylesinski, Gabriel

    Intracranial aneurysms (IAs) are a potentially devastating pathological dilation of brain arteries that affect 1.5-5 % of the population. Causing around 500 000 deaths per year worldwide, their detection and treatment to prevent rupture is critical. Multiple recent studies have tried to find a hemodynamics predictor of aneurysm rupture, but concluded with distinct opposite trends using Wall Shear Stress (WSS) based parameters in different clinical datasets. Nevertheless, several research groups tend to converge for now on the fact that the flow patterns and flow dynamics of the ruptured aneurysms are complex and unstable. Following this idea, we investigated the vortex properties of both unruptured and ruptured cerebral aneurysms. A brief comparison of two Eulerian vortex visualization methods (Q-criterion and lambda 2 method) showed that these approaches gave similar results in our complex aneurysm geometries. We were then able to apply either one of them to a large dataset of 74 patient specific cases of intracranial aneurysms. Those real cases were obtained by 3D angiography, numerical reconstruction of the geometry, and then pulsatile CFD simulation before post-processing with the mentioned vortex visualization tools. First we tested the two Eulerian methods on a few cases to verify their implementation we made as well as compare them with each other. After that, the Q-criterion was selected as method of choice for its more obvious physical meaning (it shows the balance between two characteristics of the flow, its swirling and deformation). Using iso-surfaces of Q, we started by categorizing the patient-specific aneurysms based on the gross topology of the aneurysmal vortices. This approach being unfruitful, we found a new vortex-based characteristic property of ruptured aneurysms to stratify the rupture risk of IAs that we called the Wall-Kissing Vortices, or WKV. We observed that most ruptured aneurysms had a large amount of WKV, which appears to agree with

  4. Treatment of intracranial aneurysms by flow diverter devices: Long-term results from a single center

    Energy Technology Data Exchange (ETDEWEB)

    Briganti, Francesco, E-mail: frabriga@unina.it [Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Napoli, Manuela, E-mail: napoli.manuela@gmail.com [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Leone, Giuseppe, E-mail: g.leonemd@gmail.com [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Marseglia, Mariano, E-mail: mariano-marseglia@libero.it [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Mariniello, Giuseppe, E-mail: giuseppe.mariniello@unina.it [Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Caranci, Ferdinando, E-mail: ferdinando.caranci@unina.it [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Tortora, Fabio, E-mail: fabiotor@libero.it [Chair of Neuroradiology, “Magrassi Lanzara” Clinical-Surgical Department, Second University of Naples, Viale Colli Aminei 21, 80131 Naples (Italy); Maiuri, Francesco, E-mail: frmaiuri@unina.it [Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy)

    2014-09-15

    Highlights: • We report the long-term results (2–4 years) with Flow Diverter Devices (FDD) from a single-center. • We recommend the use of FDD for large-neck aneurysms of the ICA syphon. • We think that more sophisticate FDD will reduce the incidence of technical adverse events. - Abstract: Objectives: Flow-Diverter Devices (FDD) are a new generation stents designed for the treatment of the intracranial aneurysms. This article reports the long-term results (2–4 years) of this treatment from a single-center. Methods: From November 2008 to January 2012, 35 patients (29 females and 6 males; mean age 53.9 y) with 39 intracranial aneurysms were treated by FDD. Five patients (14.3%) had ruptured aneurysms and 30 (85.7%) had no previous hemorrhage. The procedures were performed in 5 patients (14.3%) with SILK and in 30 (85.7%) with PED. In 3 patients FDDs were used as a second treatment after failure of previous coiling (2 cases) or stenting (one case). The 39 aneurysms were in supraclinoid ICA in 26 (66.7%), cavernous ICA in 2 (5.1%), PCoA in 4 (10.2%), MCA in 5 (12.9%), SCA in 1 (2.6%) and PICA in 1 (2.6%). The aneurysms were small (<10 mm) in 32 cases (82%), large (11–25 mm) in 6 (15.3%) and giant in 1 (2.6%). The occlusion rate according to the aneurysm location, size and neck and the complications were evaluated. Results: Peri-procedural complications included transient dysarthria (2 patients), vasospasm with acute intra-stent aggregation (one), microwire rupture (one) and failure of the stent opening (one). The follow-up was made between 24 and 62 months (mean 41 months); clinical examination and CTA were performed at 1, 3, 6 and 12 months after the procedure. The complete occlusion was confirmed by CTA and DSA. MRI with angiographic-studies was taken every year. Complete occlusion was obtained in 35 aneurysms (92.1%) and subtotal in 3 (7.9%). Complete occlusion occurred at 3 months in 24 cases (68.6%), within 3 and 6 months in 9 (25.7%). The rate and

  5. Successful coil embolization of a ruptured basilar artery aneurysm in a child with leukemia: a case report.

    Science.gov (United States)

    Hayashi, Shihori; Maehara, Taketoshi; Mukawa, Maki; Aoyagi, Masaru; Yoshino, Yoshikazu; Nemoto, Shigeru; Ono, Toshiaki; Ohno, Kikuo

    2014-01-01

    Ruptured intracranial aneurysms are rare in the pediatric population compared to adults. This has incited considerable discussion on how to treat children with this condition. Here, we report a child with a ruptured saccular basilar artery aneurysm that was successfully treated with coil embolization. A 12-year-old boy with acute lymphoblastic leukemia and accompanying abdominal candidiasis after chemotherapy suddenly complained of a severe headache and suffered consciousness disturbance moments later. Computed tomography scans and cerebral angiography demonstrated acute hydrocephalus and subarachnoid hemorrhage caused by saccular basilar artery aneurysm rupture. External ventricular drainage was performed immediately. Because the patient was in severe condition and did not show remarkable signs of central nervous system infection in cerebrospinal fluid studies, we applied endovascular treatment for the ruptured saccular basilar artery aneurysm, which was successfully occluded with coils. The patient recovered without new neurological deficits after ventriculoperitoneal shunting. Recent reports indicate that both endovascular and microsurgical techniques can be used to effectively treat ruptured cerebral aneurysms in pediatric patients. A minimally invasive endovascular treatment was effective in the present case, but long-term follow-up will be necessary to confirm the efficiency of endovascular treatment for children with ruptured saccular basilar artery aneurysms.

  6. The radiological appearance of intracranial aneurysms in adults infected with the human immunodeficiency virus (HIV

    Directory of Open Access Journals (Sweden)

    Gerrit Blignaut

    2014-04-01

    Full Text Available Background: The global prevalence of intracranial aneurysms is estimated at 2.3%. Limited literature is available on intracranial aneurysms in HIV-infected patients.Objectives: To describe the radiological appearance of intracranial aneurysms in HIV-positive adults.Method: In this retrospective analysis of data, 23 HIV-positive patients, of which 15 (65.2%were female, with a total of 41 aneurysms were included. The mean age was 38 years, and their median CD4 count was 305 x 106/L. Inclusion criteria comprised subarachnoid haemorrhage and confirmed intracranial aneurysms on four-vessel angiography.Results: Fifteen (65.2% patients had a single aneurysm, of which 12 (80.0% had a saccular appearance. Seven (46.7% of the single aneurysms had a neck width larger than 50% of the transverse aneurysm sac size. The mean longitudinal diameter of the aneurysm sac was 4.9 mm and the transverse diameter 4.4 mm. More than half of these aneurysms occurred at the anterior communicating artery. The median CD4 count of single-aneurysm patients was 319 x 106 /L. Eight patients (34.8% had multiple aneurysms, with a total of 26 aneurysms (range 2–6 aneurysms per patient, of which 13 (50.0% had a complex appearance. Twenty-four (92.3% of the multiple aneurysms had a neck width larger than 50% of the transverse aneurysm sac size. The mean longitudinal diameter of the aneurysm sac was 4.0 mm and the transverse diameter 3.9 mm. The multiple aneurysms occurred more commonly in the internal carotid artery. These patients had a median CD4 count of 294 x 106/L.Conclusion: HIV-associated intracranial aneurysms occur at a younger age, appear to be saccular and complex in shape, with a wide neck, and might rupture at small sizes.

  7. Intracranial aneurysms in autosomal dominant polycystic kidney disease detected by MR angiography. Screening and treatment

    Energy Technology Data Exchange (ETDEWEB)

    Iida, Hiroyuki; Naito, Takero; Hondo, Hiroaki; Demachi, Hiroshi; Aoki, Shuichi [Toyama Prefectural Central Hospital (Japan)

    1998-02-01

    The association of intracranial aneurysm with autosomal dominant polycystic kidney disease (ADPKD) is well-known, and patients with ADPKD are at increased risk of subarachnoid hemorrhage from rupture of intracranial aneurysms. We prospectively performed three-dimensional time-of-flight magnetic resonance angiography (MRA) in 30 nonselective adult patients with ADPKD. Sixteen were women and 14 were men with a mean age of 51 yr (range 24 to 79 yr). The diagnosis of ADPKD was made on the basis of abdominal ultrasound or computed tomographic studies. Three patients were on maintenance hemodialysis, 8 patients were non-dialysed patients with chronic renal failure (serum creatinine {>=}2 mg/dl) and 25 patients had hypertension (BP {>=}140/90 mmHg). None of these patients have a previous diagnosis of intracranial aneurysm. Unruptured intracranial aneurysms were suspected in 5 patients by MRA, and 8 aneurysms were confirmed in 4 (13.3%) of 30 patients by conventional arteriography. These aneurysms were 3-10 mm in diameter and 3 aneurysms (3-4 mm in diameter) were newly detected by cerebral arteriography. After informed consent was obtained, neck clipping of the intracranial aneurysms were performed successfully in all the patients. These results suggest that the prevalence of intracranial aneurysm is about 13% in ADPKD, and that MRA is useful in screening for occult intracranial aneurysms in patients with ADPKD. (author)

  8. LVIS Stent Versus Enterprise Stent for the Treatment of Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Ge, Huijian; Lv, Xianli; Yang, Xinjian; He, Hongwei; Jin, Hengwei; Li, Youxiang

    2016-07-01

    This retrospective study compared clinical and angiographic outcomes between LVIS and Enterprise stents. From November 2014 to December 2015, total 190 patients with 208 unruptured intracranial aneurysms were coiled assisted by LVIS and Enterprise stents. Procedure-related complications, clinical outcomes, and angiographic results were analyzed retrospectively. A total of 92 patients with 96 aneurysms received LVIS stents and 98 patients with 112 aneurysms were treated with Enterprise stents. Procedure-related complications occurred in 10.9% of patients (2 hemorrhagic events and 8 thromboembolic events) in the LVIS stents group whereas 16.3% (1 hemorrhage, 1 mass effect, and 14 thromboembolic events) in the Enterprise stents group. No statistical significant differences in thromboembolic (P = 0.263), hemorrhagic complications (P = 0.611), and favorable clinical outcomes (modified Rankin Scores of 0-2) (P = 0.379) were found between 2 groups. A greater initial complete or near-complete obliteration was found in the LVIS stents group compared with the Enterprise stents group (96.9% vs. 88.4%, P = 0.034). Larger aneurysm size (P = 0.048) was an independent predictor of procedure-related complications in univariate analysis. Compared with Enterprise stents, LVIS stents may achieve greater complete or near-complete occlusion rate. There was no significant difference in procedural-related complications and clinical outcomes between LVIS and Enterprise stents. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. [Application of LVIS stents in very small 
intracranial aneurysms].

    Science.gov (United States)

    Zhang, Mingming; Ouyang, Yian; Huang, Hao; Jiang, Yugang; Yu, Mengqiang

    2016-08-01

    To investigate the safety and short-term efficacy of stent on 17 patients with very small intracranial aneurysms.
 A total of 17 patients with very small intracranial aneurysms were treated by LVIS stent from October 2014 to November 2015. The location, size of the aneurysms and the branch around aneurysms were evaluated by digital subtraction angiography (DSA). The metal coverage for aneurysms was enhanced by using deployment technology ("compression" mode). The safety and efficacy were assessed after operation.
 LVIS stents-assisted treatments for very small aneurysms were carried out in 17 cases, including 7 cases of paraclinoid aneurysms, 4 cases of posterior communicating artery aneurysms, 3 cases of anterior communicating artery aneurysms, 2 cases of carotid bifurcation aneurysms, 1 case of the superior cerebellar artery aneurysm. The stents for 17 patients with very small intracranial aneurysms were released completely (100%); Raymond grade I embolization was seen in 13 cases (76.5%); Raymond grade II embolization was seen in 4 cases (23.5%); during the follow up from a month to a year, 16 patients showed good curative effect (with the mRS score at 0-2), 1 showed poor effect (with the mRS score at 3-6), and the efficacy rate was 94.1%; no perioperative hemorrhagic and ischemic complications happened.
 LVIS stent-assisted therapy for very small intracranial aneurysms by using deployment technology was safe and feasible, which can significantly improve the embolization rate for very small aneurysms.

  10. Comparison of the association of sac growth and coil compaction with recurrence in coil embolized cerebral aneurysms.

    Directory of Open Access Journals (Sweden)

    Anna L Hoppe

    Full Text Available In recurrent cerebral aneurysms treated by coil embolization, coil compaction is regarded as the presumptive mechanism. We test the hypothesis that aneurysm growth is the primary recurrence mechanism. We also test the hypothesis that the coil mass will translate a measurable extent when recurrence occurs.An objective, quantitative image analysis protocol was developed to determine the volumes of aneurysms and coil masses during initial and follow-up visits from 3D rotational angiograms. The population consisted of 15 recurrence and 12 non-recurrence control aneurysms initially completely coiled at a single center. An investigator sensitivity study was performed to assess the objectivity of the methods. Paired Wilcoxon tests (p<0.05, one-tailed were performed to assess for aneurysm and coil growth. The translation of the coil mass center at follow-up was computed. A Mann Whitney U-Test (p<0.05, one-tailed was used to compare translation of coil mass centers between recurrence and control subjects.Image analysis protocol was found to be insensitive to the investigator. Aneurysm growth was evident in the recurrence cohort (p=0.003 but not the control (p=0.136. There was no evidence of coil compaction in either the recurrence or control cohorts (recurrence: p=0.339; control: p=0.429. The translation of the coil mass centers was found to be significantly larger in the recurrence cohort than the control cohort (p=0.047.Aneurysm sac growth, not coil compaction, was the primary mechanism of recurrence following successful coil embolization. The coil mass likely translates to a measurable extent when recurrence occurs and has the potential to serve as a non-angiographic recurrence marker.

  11. National treatment practices in the management of infectious intracranial aneurysms and infective endocarditis.

    Science.gov (United States)

    Singla, Amit; Fargen, Kyle; Blackburn, Spiros; Neal, Dan; Martin, Tomas D; Hess, Phillip J; Beaver, Thomas M; Klodell, Charles T; Hoh, Brian

    2016-07-01

    There is an absence of widely accepted guidelines for the management of infectious intracranial aneurysms (IIAs) owing to a dearth of high-quality evidence in the literature. To better define the incidence of IIAs, treatment practices, and patient outcomes by performing a Nationwide Inpatient Sample (NIS) database query. We queried the NIS database from 2002 to 2011 for all patients with the primary diagnosis of infectious endocarditis (IE), subarachnoid hemorrhage (SAH), or unruptured cerebral aneurysm by ICD-9-CM codes. ICD-9 procedure codes were used to identify patients undergoing neurosurgical or cardiothoracic procedures. The query identified 393 patients with primary diagnosis of IE, SAH or unruptured cerebral aneurysm treated during 2002-2011. The mean age of the patients was 53.5 years; 244 (62%) were male. The majority of patients presented with SAH (361; 91.9%). Only 73 (18.6%) patients underwent neurosurgical coiling or clipping for IIA. Of patients undergoing a neurosurgical procedure, 65 had SAH (constituting only 18% of patients with SAH) and 8 had unruptured aneurysms (constituting only 25% patients with unruptured aneurysms). Cardiac procedures were performed in only 72/393 patients (18.3%) patients. Only 67 (18.6%) of the patients with SAH and 5 (15.6%) with unruptured aneurysms underwent a cardiac corrective surgical procedure. Mortality was significantly higher in those patients managed conservatively (26.7%) than in those who underwent clipping or embolization (15.1%; p<0.001). In this NIS database study, the majority of patients with IIAs were managed non-operatively, regardless of rupture status. Further investigation is warranted to standardize the management of these lesions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  12. Risk factors for and outcomes of intraprocedural rupture during endovascular treatment of unruptured intracranial aneurysms.

    Science.gov (United States)

    Kawabata, Shuhei; Imamura, Hirotoshi; Adachi, Hidemitsu; Tani, Shoichi; Tokunaga, So; Funatsu, Takayuki; Suzuki, Keita; Sakai, Nobuyuki

    2017-07-14

    The risk factors for intraprocedural rupture (IPR) of unruptured intracranial aneurysms (UIAs) and the outcomes of IPR itself are unclear. This study was performed to identify the independent risk factors for and outcomes of IPR. We retrospectively evaluated the medical records and radiologic data of 1375 patients (1406 UIAs) who underwent coil embolization from January 2001 to October 2016. IPR occurred in 20 aneurysms of 20 patients (1.4%). Univariate analyses showed that the rate of IPR was significantly higher in the treatment of aneurysms with a small dome size, aneurysms in the anterior communicating artery (AcomA) (6.6%), and patients with a medical history of dyslipidemia. Multivariate analyses showed that a small dome size and aneurysms in the AcomA were independently associated with IPR (p=0.0096 and p=0.0001, respectively). IPR induced by a microcatheter was associated with a higher risk of severe subarachnoid hemorrhage than other causes of IPR (57% vs 0%, respectively). Thromboembolic complications occurred in seven (35%) patients with IPR. Six (30%) patients required external ventricular drainage placement after developing symptoms of acute hydrocephalus. The overall morbidity and mortality rates from IPR were 0.22% and 0.15%, respectively. Aneurysms in the AcomA and with a small dome size are likely to be risk factors for IPR. IPR induced by microcatheters can result in poor outcomes. The rate of IPR-associated thromboembolic complications is high, and IPR itself is associated with acute hydrocephalus. If managed appropriately, however, most patients with IPR can survive without neurological deterioration. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. Age-related differences in unruptured intracranial aneurysms : 1-year outcomes

    NARCIS (Netherlands)

    Mahaney, Kelly B; Brown, Robert D; Meissner, Irene; Piepgras, David G; Huston, John; Zhang, Jie; Torner, James C; Groen, Rob

    2014-01-01

    OBJECT: The aim of this study was to determine age-related differences in short-term (1-year) outcomes in patients with unruptured intracranial aneurysms (UIAs). METHODS: Four thousand fifty-nine patients prospectively enrolled in the International Study of Unruptured Intracranial Aneurysms were

  14. Systematic review of reviews of risk factors for intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Clarke, Mike [National Institute for Health Research, UK Cochrane Centre, Oxford (United Kingdom)

    2008-08-15

    Systematic reviews of systematic reviews identify good quality reviews of earlier studies of medical conditions. This article describes a systematic review of systematic reviews performed to investigate factors that might influence the risk of rupture of an intracranial aneurysm. It exemplifies the technique of this type of research and reports the finding of a specific study. The annual incidence of subarachnoid haemorrhage resulting from the rupture of intracranial aneurysms is estimated to be nine per 100,000. A large proportion of people who have this bleed, will die or remain dependent on the care of others for some time. Reliable knowledge about the risks of subarachnoid haemorrhage in different populations will help in planning, screening and prevention strategies and in predicting the prognosis of individual patients. If the necessary data were available in the identified reviews, an estimate for the numerical relationship between a particular characteristic and the risk of subarachnoid haemorrhage was included in this report. The identification of eligible systematic reviews relied mainly on the two major bibliographic databases of the biomedical literature: PubMed and EMBASE. These were searched in 2006, using specially designed search strategies. Approximately 2,000 records were retrieved and each of these was checked carefully against the eligibility criteria for this systematic review. These criteria required that the report be a systematic review of studies assessing the risk of subarachnoid haemorrhage in patients known to have an unruptured intracranial aneurysm or of studies that had investigated the characteristics of people who experienced a subarachnoid haemorrhage without previously being known to have an unruptured aneurysm. Reports which included more than one systematic review were eligible and each of these reviews was potentially eligible. The quality of each systematic review was assessed. In this review, 16 separate reports were

  15. "Microbleeding" from intracranial aneurysms: Local hemosiderin deposition identified during microsurgical treatment of unruptured intracranial aneurysms.

    Science.gov (United States)

    Nussbaum, Eric S; Defillo, Archie; Zelensky, Andrea; Pulivarthi, Swaroopa; Nussbaum, Leslie

    2014-01-01

    During elective surgery for unruptured aneurysms, we have identified a group of patients with hemosiderin staining of the pial surface immediately adjacent to the aneurysm dome suggesting a remote and unrecognized history of microbleeding from the aneurysm. These cases form the basis for this report. Medical records of 421 unruptured cerebral aneurysm patients treated surgically between January 2003 and September 2010 were retrospectively reviewed. Patients with a history of prior subarachnoid hemorrhage, craniotomy, or significant closed head injury were excluded from review. Records were reviewed for intraoperative descriptions of hemosiderin deposition in the vicinity of the aneurysm as well as history of headaches, time to presentation, comorbidities, aneurysm characteristics, procedures, and radiologic imaging. Local hemosiderin staining immediately adjacent to the aneurysm was identified intraoperatively in 13 cases. Each of these patients had a history of remote atypical headache prior to presentation. Eight of these patients (62%) had aneurysms described as particularly "thin-walled" at the time of surgery. Aneurysm locations included the internal carotid artery (ICA) (54%), middle cerebral artery (MCA) (23%), anterior communicating artery (ACOMMA) (15%), and the anterior cerebral artery (ACA) (8%). More than half (54%) of these patients had a history of smoking, while 31% had hypertension, and 23% had a history of alcohol abuse. Dyslipidemia and family history of aneurysms were present in 15% and hypercholesterolemia was noted in one patient (8%). We suggest this group of patients had suffered a "microbleed" resulting in local hemosiderin deposition next to the aneurysm. The origins and clinical implications of such microbleeds are unknown and warrant further investigation.

  16. Anatomical considerations in the treatment of intracranial aneurysms.

    Science.gov (United States)

    Almeida, Joao P; Reghin Neto, Matheus; Chaddad Neto, Feres; DE Oliveira, Evandro

    2016-03-01

    Comprehensive understanding of the vascular anatomy, including anatomic variations, anatomy of the perforators, and areas of irrigation for each specific vascular trunk is relevant for the treatment of intracranial aneurysms. Understanding the microanatomy of the cerebral vessels helps surgeons to select the most appropriate microsurgical approach for each case. Anterior circulation aneurysms may be originated from the internal carotid artery and its branches, anterior cerebral artery, middle cerebral artery and anterior communicating artery. Although presenting different surgical nuances, we favor the use of the pterional approach for most anterior circulation aneurysms. In some instances, extensions of the pterional approach improve the surgical exposure and may be selected. In its turn, posterior fossa aneurysms remain a challenge to the neurosurgeon. The exquisite eloquence and complexity of posterior fossa contents require a through knowledge of microsurgical anatomy of this region. Such anatomic background guides the surgeon to the most appropriate approach, which may vary dependind on the size, position of the aneuryms and its relatonship to the surrounding structures.

  17. [Endovascular approach in the management of intracranial aneurysms. Part 2: indications and therapeutic strategy].

    Science.gov (United States)

    Zenteno, Marco; Santos Franco, Jorge Arturo; Lee, Angel; Viñuela, Fernando; Modenesi Freitas, José María; Vega Montesinos, Susana

    2012-01-01

    The success and stability of the occlusion of intracranial aneurysms can be achieved after an adequate conceptualization and implementation of current endovascular techniques, which in turn should be based on knowledge of available devices and the analysis of the specific characteristics the aneurysm and its parent artery to what we called aneurysmal complex.

  18. [Neurologic complications of subarachnoid hemorrhage due to intracranial aneurysm rupture].

    Science.gov (United States)

    Rama-Maceiras, P; Fàbregas Julià, N; Ingelmo Ingelmo, I; Hernández-Palazón, J

    2010-12-01

    The high rates of morbidity and mortality after subarachnoid hemorrhage due to spontaneous rupture of an intracranial aneurysm are mainly the result of neurologic complications. Sixty years after cerebral vasospasm was first described, this problem remains unsolved in spite of its highly adverse effect on prognosis after aneurysmatic rupture. Treatment is somewhat empirical, given that uncertainties remain in our understanding of the pathophysiology of this vascular complication, which involves structural and biochemical changes in the endothelium and smooth muscle of vessels. Vasospasm that is refractory to treatment leads to cerebral infarction. Prophylaxis, early diagnosis, and adequate treatment of neurologic complications are key elements in the management of vasospasm if neurologic damage, lengthy hospital stays, and increased use of health care resources are to be avoided. New approaches to early treatment of cerebral lesions and cortical ischemia in cases of subarachnoid hemorrhage due to aneurysm rupture should lead to more effective, specific management.

  19. [Hemorrhagic Adult Unilateral Moyamoya Disease with Multiple Unruptured Intracranial Aneurysms: A Case Report].

    Science.gov (United States)

    Ozaki, Saya; Inoue, Akihiro; Miyazaki, Hajime; Onoue, Shinji; Ichikawa, Haruhisa; Fukumoto, Shinya; Iwata, Shinji; Kohno, Kanehisa

    2016-02-01

    Adult unilateral moyamoya disease with intracranial aneurysm is frequently reported in the literature, but there is much variation in its treatment. In this case report, we describe the time course and treatment regimen of a patient with moyamoya disease and review the literature regarding moyamoya disease with intracranial aneurysm. A 64-year-old man had untreated intracranial aneurysm and unilateral moyamoya disease for 10 years. He presented with sudden-onset right hemiparesis and aphasia due to a subcortical hemorrhage. He was admitted to the local neurosurgical unit, and upon resolution of symptoms, he was admitted to our hospital. A cerebral angiogram revealed the champagne bottleneck sign of the left carotid artery and obliteration of the top of the left intracranial carotid artery with a moyamoya phenomenon. Two unruptured intracranial aneurysms were identified in the anterior communicating artery(Acom A) and the right intracranial carotid artery(C3). We performed superficial temporal artery-middle cerebral artery anastomosis followed by aneurysmal neck clipping of the Acom A aneurysm. Postoperative imaging showed no new ischemic damage and improved cerebral blood flow. Although the patient experienced temporal worsening of aphasia, his function recovered a few months later and he was able to resume his normal daily life activities. The combination of direct bypass surgery and aneurysmal neck clipping might be a therapeutic option for hemorrhagic unilateral moyamoya disease with unruptured intracranial aneurysm.

  20. Neonatal Intracranial Aneurysm Rupture Treated by Endovascular Management: A Case Report

    Directory of Open Access Journals (Sweden)

    Yi-Pei Tai

    2010-08-01

    Full Text Available Pediatric intracranial aneurysm rupture is rare, and is traditionally managed by surgical clipping. To the best of our knowledge, endovascular embolization of aneurysms in neonates has not previously been reported in Taiwan. We report a 9-day-old boy with intracranial aneurysms who underwent endovascular embolization, representing the youngest reported case in Taiwan. The 9-day-old boy presented with non-specific symptoms of irritable crying, seizure and respiratory distress. Computed tomography disclosed intraventricular hemorrhage, subarachnoid hemorrhage and focal intracranial hemorrhage around the right cerebellum. Subsequent computed tomographic angiography showed two sequential fusiform aneurysms, measuring 3 mm, located in the right side posterior inferior cerebellar artery (PICA. The patient underwent endovascular embolization because of the high risk of aneurysm re-rupture and the impossibility of surgical clipping due to the fusiform nature of the aneurysms. A postembolization angiogram revealed complete obliteration of the right distal PICA and proximal aneurysm. The distal PICA aneurysm was revascularized from the collateral circulation, but demonstrated a slow and delayed filling pattern. The patient's condition remained stable over the following week, and he was discharged without anticonvulsant therapy. No significant developmental delay was noted at follow-up at when he was 3 months old. This case emphasizes the need for clinical practitioners to consider a diagnosis of intracranial hemorrhage in neonates with seizure and increased intracranial pressure. Neonatal intracranial aneurysms can be treated safely by endovascular treatment.

  1. Hemodynamic performance of coil embolization and stentassisted coil embolization treatments: a numerical comparative study based on subject-specific models of cerebral aneurysms

    Science.gov (United States)

    Wang, Shengzhang; Zhang, Yisen; Lu, Gang; Yang, Xinjian; Zhang, Xiaolong; Ding, Guanghong

    2011-11-01

    Hemodynamic characteristics such as blood velocity, blood pressure, flow impingement, wall shear stress and oscillatory shear index are considered to play important roles in the initiation, growth, rupture and recurrence of the cerebral aneurysms. Endovascular therapy is widely implemented to treat the cerebral aneurysms by releasing coils into the aneurysm sac for limiting the blood flow to the sac and stent-assisted coil embolization is adopted to occlude the wide-necked or complex aneurysms. Some researchers believe that stents are not only a mechanical device but may act as a biological system and contribute to vessel wall healing. Hemodynamics simulation helps people understand the effect of hemodynamic characteristics on the recurrence of the coiled aneurysm and it also benefits the interventional planning of neurosurgeons. This study constructed the numerical model for a subject-specific ICA aneurysm treated with stent-assisted coil embolization, which combined the coiled model of the aneurysm with a porous stent placement, and simulated the pulsatile blood flow in these aneurysm models. When a stent was placed across the aneurysm orifice in the coiled aneurysm, the high wall shear stress around the distal aneurysm root was reduced more than that of the coiled aneurysm without a stent. The simulated results point to the conclusion that the stent not only protects the parent artery from occlusion due to extension of coils or thrombosis, but may also reduce the recurrence risk of the stent-assisted coiled aneurysm.

  2. Y stenting assisted coiling using a new low profile visible intraluminal support device for wide necked basilar tip aneurysms: a technical report.

    Science.gov (United States)

    Conrad, Marcelo D; Brasiliense, Leonardo B C; Richie, Alexa N; Hanel, Ricardo A

    2014-05-01

    Many endovascular techniques have been described in recent years for the management of wide necked aneurysms. The Y stent assisted technique has been generally used for coil embolization of wide necked bifurcation aneurysms. This technique was first described for the treatment of basilar tip aneurysms in combination with several different devices, demonstrating encouraging results. We report the results of the first two cases of wide necked basilar tip aneurysms treated with Y stent assisted coil embolization using a new low profile visible intraluminal stent (LVIS Jr; MicroVention, Tustin, California, USA) delivered through a 0.017 inch microcatheter. We also reviewed the literature comparing other endovascular techniques (coiling alone, stent assisted coiling, and Y stent assisted coiling) for wide necked aneurysms. The LVIS Jr device offers a new option for the treatment of these challenging lesions, with clear advantages over currently available intracranial stents. Larger series and long term results are needed to confirm the applicability and durability of this technique/technology.

  3. Wall enhancement on high-resolution magnetic resonance imaging may predict an unsteady state of an intracranial saccular aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Hu, Peng; Zhang, Hong-Qi [Capital Medical University, Department of Neurosurgery, Xuanwu Hospital, Beijing (China); Yang, Qi [Capital Medical University, Department of Radiology, Xuanwu Hospital, Beijing (China); Wang, Dan-Dan [Capital Medical University, Department of Clinical Pathology, Xuanwu Hospital, Beijing (China); Guan, Shao-Chen [Capital Medical University, Department of Evidence-Based Medicine, Xuanwu Hospital, Beijing (China)

    2016-10-15

    The aneurysm wall has been reported to play a critical role in the formation, development, and even rupture of an aneurysm. We used high-resolution magnetic resonance imaging (HRMRI) to investigate the aneurysm wall in an effort to identify evidence of inflammation invasion and define its relationship with aneurysm behavior. Patients with intracranial aneurysms who were prospectively evaluated using HRMRI between July 2013 and June 2014 were enrolled in this study. The aneurysm's wall enhancement and evidence of inflammation invasion were determined. In addition, the relationship between aneurysm wall enhancement and aneurysm size and symptoms, including ruptured aneurysms, giant unruptured intracranial aneurysms (UIAs) presenting as mass effect, progressively growing aneurysms, and aneurysms associated with neurological symptoms, was statistically analyzed. Twenty-five patients with 30 aneurysms were available for the current study. Fourteen aneurysms showed wall enhancement, including 6 ruptured and 8 unruptured aneurysms. Evidence of inflammation was identified directly through histological studies and indirectly through intraoperative investigations and clinical courses. The statistical analysis indicated no significant correlation between aneurysm wall enhancement and aneurysm size. However, there was a strong correlation between wall enhancement and aneurysm symptoms, with a kappa value of 0.86 (95 % CI 0.68-1). Aneurysm wall enhancement on HRMRI might be a sign of inflammatory change. Symptomatic aneurysms exhibited wall enhancement on HRMRI. Wall enhancement had a high consistent correlation of symptomatic aneurysms. Therefore, wall enhancement on HRMRI might predict an unsteady state of an intracranial saccular aneurysm. (orig.)

  4. Computational fluid dynamics (CFD) using porous media modeling predicts recurrence after coiling of cerebral aneurysms.

    Science.gov (United States)

    Umeda, Yasuyuki; Ishida, Fujimaro; Tsuji, Masanori; Furukawa, Kazuhiro; Shiba, Masato; Yasuda, Ryuta; Toma, Naoki; Sakaida, Hiroshi; Suzuki, Hidenori

    2017-01-01

    This study aimed to predict recurrence after coil embolization of unruptured cerebral aneurysms with computational fluid dynamics (CFD) using porous media modeling (porous media CFD). A total of 37 unruptured cerebral aneurysms treated with coiling were analyzed using follow-up angiograms, simulated CFD prior to coiling (control CFD), and porous media CFD. Coiled aneurysms were classified into stable or recurrence groups according to follow-up angiogram findings. Morphological parameters, coil packing density, and hemodynamic variables were evaluated for their correlations with aneurysmal recurrence. We also calculated residual flow volumes (RFVs), a novel hemodynamic parameter used to quantify the residual aneurysm volume after simulated coiling, which has a mean fluid domain > 1.0 cm/s. Follow-up angiograms showed 24 aneurysms in the stable group and 13 in the recurrence group. Mann-Whitney U test demonstrated that maximum size, dome volume, neck width, neck area, and coil packing density were significantly different between the two groups (P CFD and larger RFVs in the porous media CFD. Multivariate logistic regression analyses demonstrated that RFV was the only independently significant factor (odds ratio, 1.06; 95% confidence interval, 1.01-1.11; P = 0.016). The study findings suggest that RFV collected under porous media modeling predicts the recurrence of coiled aneurysms.

  5. Successful Coil Embolization of Pediatric Carotid Cavernous Fistula Due to Ruptured Posttraumatic Giant Internal Carotid Artery Aneurysm.

    Science.gov (United States)

    Wajima, Daisuke; Nakagawa, Ichiro; Park, Hun Soo; Yokoyama, Shohei; Wada, Takeshi; Kichikawa, Kimihiko; Nakase, Hiroyuki

    2017-02-01

    The goal of the treatment of direct carotid cavernous fistula (CCF) is to occlude the arteriovenous shunt and to preserve the patency of the concerned internal carotid artery. However, for the ipsilateral posttraumatic fragile cerebrum, coil embolization plus parent artery occlusion for the high-flow direct CCF is better for the prevention of hyperperfusion syndrome and intracranial hemorrhage. We experienced such a case and managed it successfully. A 6-year-old boy had severe head trauma caused by being hit by a car. He was transferred to our department and diagnosed as having left acute subdural hematoma and acute brain swelling. Emergent evacuation of hematoma and external decompression were performed. He was treated for severe brain swelling in the intensive care unit for 2 months. Cranioplasty was performed 3 months after the injury. His right hemiparesis and aphasia persisted, so he was transferred to a rehabilitation hospital. However, 2 years after the head injury, he was referred to our department because of abducens nerve palsy. He was diagnosed as having a symptomatic posttraumatic direct CCF, which was caused by a ruptured left cavernous giant internal carotid artery aneurysm. The direct CCF was treated with coil embolization of the giant aneurysm and parent artery occlusion. Coil embolization of the aneurysm and parent artery occlusion for the posttraumatic direct CCF was a good option to manage the abducens nerve palsy and to prevent postoperative hyperperfusion. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Hemodynamic analysis of intracranial aneurysms using phase-contrast magnetic resonance imaging and computational fluid dynamics

    Science.gov (United States)

    Zhao, Xuemei; Li, Rui; Chen, Yu; Sia, Sheau Fung; Li, Donghai; Zhang, Yu; Liu, Aihua

    2017-04-01

    Additional hemodynamic parameters are highly desirable in the clinical management of intracranial aneurysm rupture as static medical images cannot demonstrate the blood flow within aneurysms. There are two ways of obtaining the hemodynamic information—by phase-contrast magnetic resonance imaging (PCMRI) and computational fluid dynamics (CFD). In this paper, we compared PCMRI and CFD in the analysis of a stable patient's specific aneurysm. The results showed that PCMRI and CFD are in good agreement with each other. An additional CFD study of two stable and two ruptured aneurysms revealed that ruptured aneurysms have a higher statistical average blood velocity, wall shear stress, and oscillatory shear index (OSI) within the aneurysm sac compared to those of stable aneurysms. Furthermore, for ruptured aneurysms, the OSI divides the positive and negative wall shear stress divergence at the aneurysm sac.

  7. Angiographic and histological comparison of canine bifurcation aneurysms treated with first generation matrix and standard GDC coils

    Energy Technology Data Exchange (ETDEWEB)

    Turk, Aquilla S. [University of Wisconsin Hospital and Clinics, Department of Radiology, Madison, WI (United States); University of Wisconsin Hospital and Clinics, Department of Neurosurgery, Madison, WI (United States); Luty, Christopher M. [University of Wisconsin School of Medicine and Public Health, Madison, WI (United States); Carr-Brendel, Victoria; Polyakov, Igor [Boston Scientific Corporation, Neurovascular Division, Fremont, CA (United States); Consigny, Dan; Grinde, Julie; Strother, Charles M. [University of Wisconsin Hospital and Clinics, Department of Radiology, Madison, WI (United States); Mukherjee, Rajat [University of Wisconsin Hospital and Clinics, Department of Statistics, Madison, WI (United States)

    2008-01-15

    It is claimed that bioactive coils induce accelerated and more durable aneurysm healing. Data supporting this claim are quite limited. Our purpose was to compare the angiographic and histological results obtained following treatment with different coil types. Bifurcation type aneurysms were surgically created in 24 dogs and treated using standard clinical techniques. Eight were treated with Guglielmi detachable coils (GDC), eight with first-generation Matrix coils, and eight with a combination of GDC and Matrix coils. The aneurysms were explanted and final angiographic evaluations performed 12 weeks after treatment. Angiographic and histological outcomes were documented. Increased coil compaction with aneurysm recurrence was found in aneurysms treated with first-generation Matrix coils as compared to standard GDC (P = 0.0001). In aneurysms treated with first-generation Matrix coils thrombus organization was better than in those treated with either standard GDC coils (P = 0.008) or with a combination of GDC and Matrix coils (P = 0.04). In aneurysms treated with first-generation Matrix coils there were no endothelialized vascular clefts within the coil mass, but they were seen in the majority of aneurysms treated with GDC or a combination of GDC and Matrix coils (P = 0.003). Aneurysms treated with first-generation Matrix coils showed the greatest degree of coil compaction and aneurysm recurrence on the final angiographic evaluation. Aneurysms treated with first-generation Matrix coils showed enhanced thrombus organization and absence of vascular clefts at the aneurysm neck that were markedly different from those treated with bare platinum coils or a combination of GDC and Matrix coils. (orig.)

  8. MR angiography as a screening tool for intracranial aneurysms: feasibility, test characteristics, and interobserver agreement

    NARCIS (Netherlands)

    Raaymakers, T. W.; Buys, P. C.; Verbeeten, B.; Ramos, L. M.; Witkamp, T. D.; Hulsmans, F. J.; Mali, W. P.; Algra, A.; Bonsel, G. J.; Bossuyt, P. M.; Vonk, C. M.; Buskens, E.; Limburg, M.; van Gijn, J.; Gorissen, A.; Greebe, P.; Albrecht, K. W.; Tulleken, C. A.; Rinkel, G. J.

    1999-01-01

    OBJECTIVE: MR angiography may be an appropriate tool to screen for unruptured intracranial aneurysms. Feasibility, test characteristics, and interobserver agreement in evaluation of MR angiograms were assessed by members of the MARS (Magnetic resonance Angiography in Relatives of patients with

  9. Toward understanding non-coding RNA roles in intracranial aneurysms and subarachnoid hemorrhage

    Directory of Open Access Journals (Sweden)

    Huang Fengzhen

    2017-05-01

    Full Text Available Subarachnoid hemorrhage (SAH is a common and frequently life-threatening cerebrovascular disease, which is mostly related with a ruptured intracranial aneurysm. Its complications include rebleeding, early brain injury, cerebral vasospasm, delayed cerebral ischemia, chronic hydrocephalus, and also non neurological problems. Non-coding RNAs (ncRNAs, comprising of microRNAs (miRNAs, small interfering RNAs (siRNAs and long non-coding RNAs (lncRNAs, play an important role in intracranial aneurysms and SAH. Here, we review the non-coding RNAs expression profile and their related mechanisms in intracranial aneurysms and SAH. Moreover, we suggest that these non-coding RNAs function as novel molecular biomarkers to predict intracranial aneurysms and SAH, and may yield new therapies after SAH in the future.

  10. Expanding Endovascular Therapy of Very Small Ruptured Aneurysms with the 1.5-mm Coil

    Science.gov (United States)

    Nguyen, Thanh N.; Masoud, Hesham; Tarlov, Nicholas; Holsapple, James; Chin, Lawrence S.; Norbash, Alexander M.

    2015-01-01

    Background Very small ruptured aneurysms (≤3 mm) demonstrate a significant risk for procedural rupture with endovascular therapy. Since 2007, 1.5-mm-diameter coils have been available (Micrus, Microvention, and ev3), allowing neurointerventionalists the opportunity to offer patients with very small aneurysms endovascular treatment. In this study, we review the clinical and angiographic outcome of patients with very small ruptured aneurysms treated with the 1.5-mm coil. Methods This is a retrospective cohort study in which we examined consecutive ruptured very small aneurysms treated with coil embolization at a single institution. The longest linear aneurysm was recorded, even if the first coil was sized to a smaller transverse diameter. Very small aneurysms were defined as ≤3 mm. Descriptive results are presented. Results From July 2007 to March 2015, 81 aneurysms were treated acutely with coils in 78 patients presenting with subarachnoid hemorrhage. There were 5 patients with 3-mm aneurysms, of which the transverse diameter was ≤2 mm in 3 patients. In all 5 patients, a balloon was placed for hemostatic prophylaxis in case of rupture, and a single 1.5-mm coil was inserted for aneurysm treatment without complication. Complete aneurysm occlusion was achieved in 1 patient, residual neck in 2, and residual aneurysm in 2 patients. Aneurysm recanalization was present in 2 patients with an anterior communicating artery aneurysm; a recoiling attempt was unsuccessful in 1 of these 2 patients due to inadvertent displacement and distal coil embolization, but subsequent surgical clipping was successful. Another patient was retreated by surgical clipping for a residual wide-neck carotid terminus aneurysm. One patient died of ventriculitis 3 weeks after presentation; all 4 other patients had an excellent outcome with no rebleed at follow-up (mean 21 months, range 1-62). Conclusion The advent of the 1.5-mm coil may be used in the endovascular treatment of patients with very

  11. Treatment of Moyamoya Disease and Unruptured Intracranial Aneurysm in Floating-Harbor Syndrome.

    Science.gov (United States)

    Coughlin, Daniel J; Miller, Charles A; Schuette, A Jesse

    2017-08-01

    This is the first report of the successful treatment of moyamoya disease and an unruptured intracranial aneurysm in a patient with Floating-Harbor syndrome. A 35-year-old, phenotypically syndromic woman presented with signs and symptoms consistent with ischemic stroke. Magnetic resonance imaging and catheter angiography confirmed diagnosis of moyamoya and a 6-mm basilar apex artery aneurysm (BAA). She underwent right-sided craniotomy for direct and indirect revascularization by means of superficial temporal artery-middle cerebral artery bypass and encephalo-duro-arterio-synangiosis. Three months later, she underwent stent-assisted coiling of the BAA. At 9 months, the patient remains without her preoperative neurological deficits. Interval catheter angiography confirms revascularization of her right hemisphere and obliteration of her BAA. We present the first case of diagnosis and treatment of moyamoya disease and BAA in a patient with Floating-Harbor syndrome. Due to a paucity of literature on this rare disorder, there has not been an associated link between Floating-Harbor syndrome and cerebrovascular disease. Our report and literature review suggest that these patients may be prone to cerebrovascular disorders and should be followed closely with neurovascular imaging. Published by Elsevier Inc.

  12. Intracranial aneurysms in children under 1 year of age: a systematic review of the literature

    NARCIS (Netherlands)

    Buis, D. R.; van Ouwerkerk, W. J. R.; Takahata, H.; Vandertop, W. P.

    2006-01-01

    OBJECTIVE: Intracranial aneurysms are very rare in early childhood. Because the location, morphology as well as the clinical and radiological presentation of these aneurysms seem to be different from those in adults, we performed a systematic review of the literature to discuss the clinical,

  13. Introduction of endovascular embolization for intracranial aneurysms in a low-volume institution

    DEFF Research Database (Denmark)

    Lindekleiv, H M; Jacobsen, E A; Kloster, R

    2009-01-01

    university hospital. MATERIAL AND METHODS: Retrospective study of 243 consecutive patients treated for 284 intracranial aneurysms with endovascular embolization or surgical clipping from 2000 to 2006 at the University Hospital of North Norway. Postoperative complications were registered. The Glasgow Outcome...... with subarachnoid hemorrhage were more likely to experience postoperative complications than patients treated for unruptured aneurysms (42% versus 8% of the patients, P

  14. Aspirin and Clopidogrel Inhibit Aneurysm Healing after HydroCoil Implantation in External Carotid Artery Aneurysm Model.

    Science.gov (United States)

    Zhang, Chao; Li, Peiliang; Xi, Guohua; Gemmete, Joseph J; Chaudhary, Neeraj; Thompson, B Gregory; Pandey, Aditya S

    2016-11-01

    To understand whether the use of antiplatelet agents leads to less intra-aneurismal tissue formation following coil implantation in a rat end-pouch external carotid artery (ECA) aneurysm model. End-pouch ECA aneurysms were created in adult rats and were then embedded with either platinum or HydroCoils. Rats were treated either with aspirin, clopidogrel, aspirin + clopidogrel, or saline for 2 weeks after coil implantation. At 2 weeks after coil implantation, rats were sacrificed and the aneurysm pouch was removed for histological and immunohistochemical analysis. A blinded single observer calculated the percentage of the organized area and the residual length of elastic lamina within the aneurysm. Student's t-test was used to compare data from image analysis between the different groups. Within the platinum group, the organized tissue area was not affected by antiplatelet administration (aspirin versus saline, P = .83; clopidogrel versus saline, P = .46; aspirin + clopidogrel versus saline, P = .54). For the HydroCoil group, the organized tissue area was significantly reduced (aspirin versus saline, P = .02; clopidogrel versus saline, P = .04; aspirin + clopidogrel versus saline, P = .02) in rats treated with antiplatelet agents; however, no difference (aspirin versus clopidogrel, P = .8; aspirin versus aspirin + clopidogrel, P = .3; clopidogrel versus aspirin + clopidogrel, P = .5) was found among type or combination of antiplatelets administered. HydroCoil-treated aneurysms had a similar number of macrophages compared to the platinum group (P = .3819); however, the HydroCoil group had significant suppression of macrophages in the groups treated with combined antiplatelets (P = .02). Following HydroCoil implantation, the area of organized tissue is diminished significantly in a rat end-pouch ECA aneurysm model treated with antiplatelets. Copyright © 2016 National Stroke Association. Published by

  15. Genome-wide association study of intracranial aneurysm identifies three new risk loci

    NARCIS (Netherlands)

    Yasuno, Katsuhito; Bilguvar, Kaya; Bijlenga, Philippe; Low, Siew-Kee; Krischek, Boris; Auburger, Georg; Simon, Matthias; Krex, Dietmar; Arlier, Zulfikar; Nayak, Nikhil; Ruigrok, Ynte M.; Niemela, Mika; Tajima, Atsushi; Fraunberg, Mikael von Und Zu; Doczi, Tamas; Wirjatijasa, Florentina; Hata, Akira; Blasco, Jordi; Oszvald, Agi; Kasuya, Hidetoshi; Zilani, Gulam; Schoch, Beate; Singh, Pankaj; Stueer, Carsten; Risselada, Roelof; Beck, Juergen; Sola, Teresa; Ricciardi, Filomena; Aromaa, Arpo; Illig, Thomas; Schreiber, Stefan; van Duijn, Cornelia M.; van den Berg, Leonard H.; Perret, Claire; Proust, Carole; Roder, Constantin; Ozturk, Ali K.; Gaal, Emilia; Berg, Daniela; Geisen, Christof; Friedrich, Christoph M.; Summers, Paul; Frangi, Alejandro F.; State, Matthew W.; Wichmann, H. Erich; Breteler, Monique M. B.; Wijmenga, Cisca; Mane, Shrikant; Peltonen, Leena; Elio, Vivas; Sturkenboom, Miriam C. J. M.; Lawford, Patricia; Byrne, James; Macho, Juan; Sandalcioglu, Erol I.; Meyer, Bernhard; Raabe, Andreas; Steinmetz, Helmuth; Ruefenacht, Daniel; Jaaskelainen, Juha E.; Hernesniemi, Juha; Rinkel, Gabriel J. E.; Zembutsu, Hitoshi; Inoue, Ituro; Palotie, Aarno; Cambien, Francois; Nakamura, Yusuke; Lifton, Richard P.; Guenel, Murat

    Saccular intracranial aneurysms are balloon-like dilations of the intracranial arterial wall; their hemorrhage commonly results in severe neurologic impairment and death. We report a second genome-wide association study with discovery and replication cohorts from Europe and Japan comprising 5,891

  16. [Infectious endocarditis complicated with preoperative infectious intracranial aneurysm;report of a case].

    Science.gov (United States)

    Ezure, Masahiko; Kaneko, Tatsuo; Hasegawa, Yutaka; Kimura, Chieri; Okada, Shuichi; Okonogi, Shuichi; Takihara, Hitomi; Naito, Noritsugu

    2015-02-01

    A 44-year-old man was admitted with the diagnosis of active infective endocarditis( IE) due to Streptococcus mitis, complicated with infectious intracranial aneurysm. Preoperative echocardiography showed mobile vegetation on the mitral leaflet, size of which was 20 mm. The magnetic resonance imaging( MRI) demonstrated that the size of aneurysm was increasing, and infectious intracranial aneurysm was treated surgically. Twenty one days after the operation, the mitral valve plasty was performed. He was discharged on foot without any neurological findings. The duration between the brain surgery and the cardiac surgery was thought to be important to prevent the new neurological complication.

  17. Embolic stroke secondary to spontaneous thrombosis of unruptured intracranial aneurysm: Report of three cases.

    Science.gov (United States)

    Arauz, Antonio; Patiño-Rodríguez, Hernán M; Chavarría-Medina, Mónica; Becerril, Mayra; Merino, José G; Zenteno, Marco

    2016-04-01

    Intracranial aneurysms uncommonly present with ischemic stroke. Parent artery occlusion due to local extension of the luminal thrombus, aneurysms ejecting emboli to distal arteries, or increased mass effect have been described as possible pathogenic mechanisms. Guidelines for the management of these patients are absent. We present the clinical outcome and radiological characteristics of three patients with spontaneous thrombosis of intracranial aneurysms as a cause of ischemic stroke. This information is relevant given the possible benign history in terms of stroke recurrence and risk of bleeding. © The Author(s) 2015.

  18. Safety and Feasibility of Simultaneous Ipsilateral Proximal Carotid Artery Stenting and Cerebral Aneurysm Coiling

    Directory of Open Access Journals (Sweden)

    Aamir Badruddin

    2010-10-01

    Full Text Available Background: Coexistence of cerebral aneurysm and carotid artery disease may be encountered in clinical practice. Theoretical increase in aneurysmal blood flow may increase risk of rupture if carotid artery disease is treated first. If aneurysm coiling is performed first, stroke risk may increase while repeatedly crossing the diseased artery. It is controversial which disease to treat first, and whether it is safe to treat both simultaneously via endovascular procedures. We document the safety and feasibility of such an approach. Methods: Review of collected neurointerventional database at our institution was performed for patients who underwent both Carotid artery stenting (CAS and aneurysm coil embolization (ACE simultaneously. All patients underwent carotid stenting followed by aneurysm coiling in the same setting. Demographic, clinical data and outcome measures including success rate and periprocedural complications were collected. Results: 590 aneurysms coiling were screened for patients who underwent combined CAS and ACE. Ten patients were identified. Mean age was 67.7 years (range 51 to 89. The success rate for stenting and coiling was 100% with no immediate complications. No stroke, TIAs, or aneurysmal rebleeding was found on their most recent follow up. Conclusions: Our case series demonstrates that it is safe and feasible to perform CAS and ACE simultaneously as one procedure which may avoid unwanted risk of treating either disease at two separate time sessions.

  19. A failure of matrix metalloproteinase inhibition in the prevention of rat intracranial aneurysm formation

    Energy Technology Data Exchange (ETDEWEB)

    Kaufmann, T.J.; Kallmes, D.F. [Mayo Clinic and Foundation, Department of Radiology, Rochester, MN (United States); Marx, W.F. [Asheville Radiology Associates, Asheville, NC (United States)

    2006-03-15

    We tested the hypothesis that nonspecific matrix metalloproteinase (MMP) inhibition with doxycycline would decrease the incidence of intracranial aneurysm formation in a rat aneurysm model. We performed common carotid artery ligation on 96 Long-Evans rats. A treatment group of 48 animals was chosen at random to receive oral doxycycline (3 mg/kg) in addition to standard rat chow, and the control group of 48 animals received standard rat chow only. The major circle of Willis arteries was dissected at 1 year following carotid ligation, and the proportions of animals with aneurysms were compared between groups using Fisher's exact test. Four animals given oral doxycycline and ten control animals expired before 1 year. Of the examined animals, eight saccular intracranial aneurysms were found in 8 of 45 animals which had received doxycycline (17.8%) and seven saccular intracranial aneurysms were found in 7 of 37 control animals (18.9%). There was no significant difference in aneurysm formation between the doxycycline-treated and control groups (P=0.894). Nonspecific MMP inhibition with doxycycline is not effective in preventing intracranial aneurysm formation in a rat model. (orig.)

  20. Impact of hypertension and smoking on the rupture of intracranial aneurysms and their joint effect.

    Science.gov (United States)

    Kang, Huibin; Peng, Tangming; Qian, Zenghui; Li, Youxiang; Jiang, Chuhan; Ji, Wenjun; Wu, Jing; Xu, Wenjuan; Wen, Xiaolong; Liu, Aihua

    2015-01-01

    In general population, the prevalence of intracranial aneurysm reaches as high as three percent. The goal of the study was to analyze retrospectively the independent risk factors for the rupture of intracranial aneurysms and their joint effect. The records and angiographies of continuous 519 intracranial aneurysm patients treated at our center between February 2013 and July 2014 were retrospectively analyzed. Ruptured group and unruptured group were included in the study according to their clinical and imaging information. Univariate analysis and multivariate logistic regression analysis was used to identified independent risk factors for the rupture of intracranial aneurysms. We assessed the joint effect of independent risk factors for the rupture of intracranial aneurysms with an additional logistic regression analysis. The results of multivariate analysis show that hypertension (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.05-2.18) and smoking (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.06-2.33) were independent risk factors for rupture of intracranial aneurysms. The joint risk of hypertension and smoking was higher (OR, 2.28; 95% CI, 1.29-4.02) than the risks of hypertension (OR, 1.74; 95% CI, 1.11-2.72) and smoking (OR, 1.86; 95% CI, 1.05-3.29) independently. Hypertension and smoking increase of the rupture risk of intracranial aneurysms. And the joint risk of hypertension and smoking was higher than the risks of hypertension and smoking independently. Copyright © 2015 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  1. Endovascular Coil Occlusion of Traumatic Intradural Aneurysm with Presentation as Carotid Cavernous Fistula

    Directory of Open Access Journals (Sweden)

    Lakshmi S P Karanam

    2014-01-01

    Full Text Available Carotid cavernous fistulae (CCF are abnormal communication between cavernous segment of the internal carotid artery and cavernous sinus. These entities are usually encountered in 0.2-0.8% of patients with traumatic skull base fractures. Traumatic cerebral aneurysms are rare and account for less than 1% of intracranial aneurysms. CCF due to ruptured intradural traumatic aneurysm is very rare and difficult to treat by surgical methods. We present one such case of a 40-year-old man with post-traumatic CCF due to a ruptured intradural aneurysm successfully treated with endovascular embolization.

  2. Extracranial to intracranial bypass for the treatment of cerebral aneurysms in the pediatric population.

    Science.gov (United States)

    Strickland, Ben A; Attenello, Frank; Russin, Jonathan J

    2016-12-01

    Cerebral aneurysms are rare in the pediatric population, making a definitive treatment algorithm difficult. Microsurgical clipping is the first choice for treatment but is not always feasible, while high recurrence rates and radiation exposure make endovascular options less favorable. Extracranial-intracranial (EC-IC) bypass, though not commonly performed in the pediatric aneurysm population, has been reported in a small number of studies to be both safe and effective for the management of cerebral aneurysms. The authors present the case of a child with a distal middle cerebral artery (MCA) aneurysm in eloquent territory, successfully treated with a superficial temporal artery (STA) to MCA bypass and trapping. A review of the current literature on pediatric EC-IC bypass in the treatment of intracranial aneurysms is presented. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Treatment of intracranial aneurysms using flow-diverting silk stents (BALT): a single centre experience.

    Science.gov (United States)

    Leonardi, M; Cirillo, L; Toni, F; Dall'olio, M; Princiotta, C; Stafa, A; Simonetti, L; Agati, R

    2011-09-01

    The Silk stent (Balt, Montmorency, France) is a retractable device designed to achieve curative reconstruction of the parent artery associated with an intracranial aneurysm. We present our initial experience with the Silk flow-diverting stent in the management and follow-up of 25 patients presenting with intracranial aneurysms.Twenty-five patients (age range, 34-81 years; 24 female) were treated with the Silk flow-diverting device. Aneurysms ranged in size from small (5), large (10) and giant (10) and included wide-necked aneurysms, multiple, nonsaccular, and recurrent intracranial aneurysms. Nine aneurysms were treated for headache, 14 for mass effect. None presented with haemorrhage. All patients were pretreated with dual antiplatelet medications for at least 72 hours before surgery and continued taking both agents for at least three months after treatment. A total of 25 Silk stents were used. Control MR angiography and/or CT angiography was typically performed prior to discharge and at one, three, six and 12 months post treatment. A follow-up digital subtraction angiogram was performed between six and 19 months post treatment.Complete angiographic occlusion or subtotal occlusion was achieved in 15 patients in a time frame from three days to 12 months. Three deaths and one major complication were encountered during the study period. Two patients, all with cavernous giant aneurysms, experienced transient exacerbations of preexisting cranial neuropathies and headache after the Silk treatment. Both were treated with corticosteroids, and symptoms resolved completely within a month.In our experience the Silk stent has proven to be a valuable tool in the endovascular treatment of intracranial giant partially thrombosed aneurysms and aneurysms of the internal carotid artery cavernous segment presenting with mass effect. The time of complete occlusion of the aneurysms and the risk of the bleeding is currently not predictable.

  4. Intracranial aneurysm formation in type-one diabetes rats.

    Directory of Open Access Journals (Sweden)

    Tao Yan

    Full Text Available Diabetes mellitus (DM plays an important role in the pathogenesis of vascular complications including arteriosclerosis and ischemic stroke. Whether DM impacts intracranial aneurysm (IA formation has not been extensively investigated. In this study, we tested the underlying mechanism of type one DM (T1DM induced IA formation in rats.T1DM was induced by streptozotocin injection. Rats were euthanized at 0, 4 and 10 weeks after T1DM induction. To evaluate cerebral vascular perfusion, Fluorescein isothiocyanate - dye was injected at 5 min prior to euthanasia. Vascular perfusion was measured by laser scanning confocal microscopy. Trichrome, Elastica van Gieson, alpha-smooth muscle actin (a-SMA and receptor of advanced glycation end-products (RAGE, toll-like receptor 4 (TLR4 and matrix metalloproteinase 9 (MMP9 immunostaining were performed. The IA formation was classified by 0-3 stages: 0: Normal; 1: Endothelial damage; 2: Moderate protrusion; and 3: Saccular aneurysm formation.T1DM significantly increased IA formation identified by the classification of aneurysmal changes compared with non-DM rats (p<0.05. However, T1DM induced IA formations were classified as stage 1 and stage 2, but not stage 3. Cerebral vascular perfusion was significantly decreased in T1DM rats compared to non-DM rats (p<0.01. DM10W rats exhibited a significant decrease of cerebral vascular perfusion compared to DM4W rats (p<0.05. T1DM rats also significantly increased the internal carotid artery (ICA intimae and media thickness, and decreased the internal carotid artery diameter compared to non-DM rats. RAGE, MMP9 and TLR4 expression were significantly increased in T1DM rats compared to non-DM rats. The increased RAGE, TLR4 and MMP9 significantly correlated with IA formation (p<0.05.T1DM increases IA formation. The increased RAGE, MMP9 and TLR4 expressions might contribute to IA formation in T1DM rats.

  5. Sex-related clustering of intracranial aneurysms within families.

    Science.gov (United States)

    Sijtsma, Laura C; Rinkel, Gabriel J E; Ruigrok, Ynte M

    2015-04-01

    Family history is important risk factor for intracranial aneurysms (ICA), but the pattern of inheritance is unsettled. If ICA within families would cluster according to sex, this may have implications for risk prediction and screening advice within families. We assessed the relationship between the sex of probands and their affected first-degree relatives (FDRs) within families with ICA. We used data from our prospectively collected database of families with known familial ICA. We calculated relative risks for a female affected proband having a female affected FDR as compared with a male affected proband having female affected FDR with corresponding 95% confidence intervals. We included 148 families with 376 affected FDR. For a female proband the relative risk for having a female affected FDR compared with a male proband having an affected female FDR was 1.2 (95% confidence interval, 1.0-1.6). The clustering of ICA within families is greater in women than in men, with an excess of affected female FDR in female probands. However, because this excess is modest, our findings indicate that sex is not a relevant factor in risk prediction or screening advice in families with ICA. © 2015 American Heart Association, Inc.

  6. Intracranial Bypass of Posterior Inferior Cerebellar Artery Aneurysms: Indications, Technical Aspects, and Clinical Outcomes.

    Science.gov (United States)

    Bonda, David J; Labib, Mohamad; Katz, Jeffrey M; Ortiz, Rafael A; Chalif, David; Setton, Avi; Langer, David J; Dehdashti, Amir R

    2017-10-01

    For some posterior inferior cerebellar artery (PICA) aneurysms, there is no constructive endovascular or direct surgical clipping option. Intracranial bypass is an alternative to a deconstructive technique. To evaluate the clinical features, surgical techniques, and outcome of PICA aneurysms treated with bypass and obliteration of the diseased segment. Retrospective review of PICA aneurysms treated via intracranial bypass was performed. Outcome measurements included postoperative stroke, cranial nerve deficits, gastrostomy/tracheostomy requirement, bypass patency, modified Rankin scale (mRS) at discharge, and mRS at 6 mo. Seven patients with PICA aneurysms treated with intracranial bypass were identified. Five had fusiform aneurysms (4 ruptured, 1 unruptured), 1 had a giant partially thrombosed saccular aneurysm (unruptured), and 1 had a dissecting traumatic aneurysm (ruptured). Two aneurysms were at the anteromedullary segment, 4 at the lateral medullary segment, and 1 at the tonsillomedullary segment. Three patients underwent PICA-to-PICA side to side anastomoses, 2 PICA-to-PICA reanastomosis, 1 vertebral artery-to-PICA bypass, and 1 occipital artery-PICA bypass. Six out of 7 aneurysms were obliterated surgically and 1 with additional endovascular occlusion after the bypass. All bypasses were patent intraoperatively; 2 were later demonstrated occluded without radiological signs or symptoms of stroke. No patients had new cranial nerve deficit postoperatively. With the exception of 1 death due to pulmonary emboli 3 mo postoperatively, all others remain at a mRS ≤ 2. Constructive bypass and aneurysm obliteration remains a viable alternative for treatment of PICA aneurysms not amenable to direct surgical clipping or to a vessel-preserving endovascular option.

  7. Body Pigmentation as a Risk Factor for the Formation of Intracranial Aneurysms

    Directory of Open Access Journals (Sweden)

    Günter Schulter

    2014-01-01

    Full Text Available Recent studies demonstrated pigmented cells both in the murine heart, in pulmonary veins, and in brain arteries. Moreover, a role for melanocytes in the downregulation of inflammatory processes was suggested. As there is increasing evidence that inflammation is contributing significantly to the pathogenesis of intracranial aneurysms, melanocyte-like cells may be relevant in preventing age-related impairment of vessels. As pigmentation of the heart reflects that of coat color, aspects of body pigmentation might be associated with the incidence of intracranial aneurysms. We performed a case-control study to evaluate associations between the pigmentation of hair and eyes and the formation of aneurysms. In addition to hair and eye color, constitutive and facultative skin pigmentation were assessed in a replication study as well as individual handedness which can be seen as a neurophysiological correlate of developmental pigmentation processes. Hair pigmentation was highly associated with intracranial aneurysms in both samples, whereas eye pigmentation was not. In the replication cohort, facultative but not constitutive skin pigmentation proved significant. The strongest association was observed for individual handedness. Results indicate a significant association of intracranial aneurysms with particular aspects of body pigmentation as well as handedness, and imply clinical usefulness for screening of aneurysms and possible interventions.

  8. Microsurgical one-stage treatment of intracranial mirror aneurysms via bilateral frontolateral approaches

    Directory of Open Access Journals (Sweden)

    Hong-guang WANG

    2016-08-01

    Full Text Available Objective To investigate surgical strategies, clinical effects and complications of microsurgical one-stage treatment of intracranial mirror aneurysms via bilateral frontolateral approaches.  Methods Review clinical data of 18 cases with anterior circulation mirror aneurysms who underwent one-stage clipping via bilateral frontolateral approaches from July 2010 to July 2015 admitted to Department of Neurosurgery in Tianjin Huanhu Hospital. The operative efficacy was evaluated according to postoperative Glasgow Outcome Scale (GOS.  Results The 36 aneurysms in 18 patients were successfully clipped via bilateral frontolateral approaches at one-stage, including 18 posterior communicating artery (PCoA mirror aneurysms in 9 cases and 18 middle cerebral artery (MCA mirror aneurysms in 9 cases. GOS score of 5 was discovered in 16 cases, and 4 was discovered in 2 cases after operation. One case underwent ventriculoperitoneal shunting (VPS due to communicating hydrocephalus, one case got postoperative pulmonary infection and no death occurred. Intracranial CTA at 6 months postoperatively showed aneurysms of 18 patients were clipped completely, the parent artery blood flow was smooth, and no recurrence was found.  Conclusions Microsurgical one-stage clipping via bilateral frontolateral approaches for treating intracranial mirror aneurysms is a sugrical method with small incision, fitting surgical field, high safety, satisfactory effect and good prognosis, which is a new minimally invasive neurosurgical technique. DOI: 10.3969/j.issn.1672-6731.2016.08.012

  9. The adverse effects of flow-diverter stent-like devices on the flow pattern of saccular intracranial aneurysm models: computational fluid dynamics study.

    Science.gov (United States)

    Hassan, Tamer; Ahmed, Yasser Mohamed; Hassan, Amr Ali

    2011-08-01

    Stent deployment across the aneurysmal neck has been established as one of the endovascular methods to treat intracranial aneurysms with or without coils. The purpose is to study the possible adverse effects of deployment of the new flow-diverter stent-like devices (FD) on the flow characteristics of saccular aneurysm models. Numerical simulations of the blood flow patterns in the artificial models of three aneurysms were studied. One model was designed without an FD stent, the second model with one FD stent, and the third model with two stents. Numerical simulation for incompressible laminar blood flow was conducted in the three artificial cerebral aneurysm models by means of computational fluid dynamics. There was a noticeable increase in the values of the circumferential pressure distributed on the walls of the aneurysm after stent deployment; this led to an increase the tension of the aneurysm surface and was considered to be an adverse effect. This pressure increase was further aggravated by the deployment of another stent. However, there is a beneficial effect of using FD stents, translating into the reduction of the flow velocity inside the aneurysm and wall shear stress at the inflow zone. This reduction decreases further with the deployment of another stent. Aneurysms become tenser after the deployment of one flow-diverter stent and (more tense still) after after the deployment of another stent. This principle should be kept in mind when choosing which group of aneurysms is the best candidate for such a treatment strategy. This study recommends deploying several FD stents during endovascular procedures until complete arrest of the blood flow occurs during the procedure; otherwise, the aneurysm may become tenser and dangerous if a slow blood flow jet still exists inside it at the end of the procedure.

  10. CFD Modelling of Local Hemodynamics in Intracranial Aneurysms Harboring Arterial Branches.

    Science.gov (United States)

    Krylov, Vladimir; Grigoryeva, Elena; Dolotova, Daria; Blagosklonova, Evgenia; Gavrilov, Andrey

    2017-01-01

    The main cause of non-traumatic subarachnoid haemorrhage is an intracranial aneurysm's rupture. The choice of treatment approach is exceptionally difficult in cases of aneurysms with additional branches on the aneurysm's dome or neck. The impact of the arterial branches on local hemodynamics is still unclear and controversial question. At the same time, up-to-date methods of image processing and mathematical modeling provide a way to investigate the hemodynamic environment of aneurysms. The paper discusses hemodynamic aspects of aneurysms harboring arterial branch through the use of patient-specific 3D models and computational fluid dynamics (CFD) methods. The analysis showed that the presence of the arterial branches has a great influence on flow streamlines and wall shear stress, particularly for side wall aneurysm.

  11. Terson syndrome in conjunction with ruptured intracranial aneurysm and penetrating intracranial injury: a review of two cases.

    Science.gov (United States)

    Rheinboldt, Matt; Francis, Kirenza; Parrish, David; Harper, Derrick; Blase, John

    2014-04-01

    Terson syndrome, the presence of intraocular hemorrhage in the setting of acutely elevated intracranial pressure, was historically described in conjunction with acute subarachnoid hemorrhage; however, more recently, it has been associated with a gamut of intracranial pathophysiology ranging from blunt or penetrating injury to neurosurgical procedures. We describe two cases of profound intracranial injury, secondary to ballistic injury, and a ruptured intracranial aneurysm, in which posterior chamber ocular hemorrhage was noted on CT imaging. Though the outcome in such cases, as with ours, is often poor, the findings are germane to clinical care as the presence of Terson syndrome has been noted to be a negative prognostic factor in multiple clinical reviews. Additionally, clinical recovery can be impacted adversely by lasting visual deficits or retinal degradation in the absence of timely ophthalmologic intervention.

  12. Off-Label Uses for Flow Diversion in Intracranial Aneurysm Management.

    Science.gov (United States)

    Al-Mufti, Fawaz; Amuluru, Krishna; Francisco, Gomez; Dodson, Vincent; El-Ghanem, Mohammad; Prestigiacomo, Charles J; Gandhi, Chirag D

    2017-07-01

    Treatment of complex aneurysms using microsurgical and other conventional neuroendovascular techniques remains challenging. As a result, stent- and balloon-assisted coiling are instead performed to treat morphologically complex aneurysms, which include giant, wide-necked, and fusiform aneurysms. While these techniques have had success in treating these complex aneurysms, recanalization rates associated with these techniques are still problematic. In the constant effort to improve the outcome of complex aneurysm treatment, flow-diverting stents (FDSs) have emerged in recent years as the preferred treatment. Instead of directly obstructing the flow of blood into the aneurysmal sac, as is the case for stent- and balloon-assisted coiling, FDSs are placed in the parent blood vessel to divert blood flow away from the aneurysm itself. Subsequent to the diverting away of blood from the aneurysm, a thrombotic cascade ensues that ultimately results in the closure of the aneurysm while the parent vessel's perforators are preserved. Current known risks for this procedure include vessel rupture or perforation, in-stent thrombosis, perforator occlusion, procedural or delayed hemorrhages, and perianeurysmal edema. In this review, we will evaluate the mechanisms of actions, clinical applications, complications, and ongoing studies for FDSs. Copyright © 2016 by the American Society of Neuroimaging.

  13. Morphologic and Hemodynamic Analysis in the Patients with Multiple Intracranial Aneurysms: Ruptured versus Unruptured.

    Science.gov (United States)

    Jing, Linkai; Fan, Jixing; Wang, Yang; Li, Haiyun; Wang, Shengzhang; Yang, Xinjian; Zhang, Ying

    2015-01-01

    The authors evaluated the impact of morphologic and hemodynamic factors on multiple intracranial aneurysms and aimed to identify which parameters can be reliable indexes as one aneurysm ruptured, and the others did not. Between June 2011 and May 2014, 69 patients harboring multiple intracranial aneurysms (69 ruptured and 86 unruptured) were analyzed from 3D-digital subtraction angiography (DSA) images and computational fluid dynamics (CFD). Morphologic and hemodynamic parameters were evaluated for significance with respect to rupture. Receiver operating characteristic (ROC) analysis identified area under the curve (AUC) and optimal thresholds separating ruptured from unruptured intracranial aneurysms for each parameter. Significant parameters were examined by binary logistic regression analysis to identify independent discriminators. Nine morphologic (size, neck width, surface area, volume, diameter of parent arteries, aspect ratio, size ratio, lateral/bifurcation type and regular/irregular type) and 6 hemodynamic (WSSmean, WSSmin, OSI, LSA, flow stability and flow complexity) parameters achieved statistical significance (pflow stability and flow complexity) parameters had high AUC values (AUC>0.7). By binary logistic regression analysis, large aspect ratio and low WSSmean were the independently significant rupture factors (AUC, 0.924; 95% CI, 0.883-0.965). Large aspect ratio and low WSSmean were independently associated with the rupture status of multiple intracranial aneurysms.

  14. Morphologic and Hemodynamic Analysis in the Patients with Multiple Intracranial Aneurysms: Ruptured versus Unruptured.

    Directory of Open Access Journals (Sweden)

    Linkai Jing

    Full Text Available The authors evaluated the impact of morphologic and hemodynamic factors on multiple intracranial aneurysms and aimed to identify which parameters can be reliable indexes as one aneurysm ruptured, and the others did not.Between June 2011 and May 2014, 69 patients harboring multiple intracranial aneurysms (69 ruptured and 86 unruptured were analyzed from 3D-digital subtraction angiography (DSA images and computational fluid dynamics (CFD. Morphologic and hemodynamic parameters were evaluated for significance with respect to rupture. Receiver operating characteristic (ROC analysis identified area under the curve (AUC and optimal thresholds separating ruptured from unruptured intracranial aneurysms for each parameter. Significant parameters were examined by binary logistic regression analysis to identify independent discriminators.Nine morphologic (size, neck width, surface area, volume, diameter of parent arteries, aspect ratio, size ratio, lateral/bifurcation type and regular/irregular type and 6 hemodynamic (WSSmean, WSSmin, OSI, LSA, flow stability and flow complexity parameters achieved statistical significance (p0.7. By binary logistic regression analysis, large aspect ratio and low WSSmean were the independently significant rupture factors (AUC, 0.924; 95% CI, 0.883-0.965.Large aspect ratio and low WSSmean were independently associated with the rupture status of multiple intracranial aneurysms.

  15. Early experience in the treatment of intra-cranial aneurysms by endovascular flow diversion: a multicentre prospective study.

    Directory of Open Access Journals (Sweden)

    James V Byrne

    Full Text Available INTRODUCTION: Flow diversion is a new approach to the endovascular treatment of intracranial aneurysms which uses a high density mesh stent to induce sac thrombosis. These devices have been designed for the treatment of complex shaped and large size aneurysms. So far published safety and efficacy data on this approach is sparse. MATERIAL AND METHODS: Over 8 months, standardized clinical and angiographic data were collected on 70 patients treated with a flow diverter device (SILK flow diverter (SFD in 18 centres worldwide. Treatment and early follow up details were audited centrally. SFDs were deployed alone in 57 (81% or with endosaccular coils in 10 (14% aneurysms, which included: 44 (63% saccular, 26 (37% fusiform shapes and 18 (26% small, 37 (53% large, 15 (21% giant sizes. Treatment outcome data up to 30 days were reported for all patients, with clinical (50 patients and imaging (49 patients follow up (median 119 days data available. RESULTS: Difficulties in SFD deployment were reported in 15 (21% and parent artery thrombosis in 8 (11% procedures. Procedural complications caused stroke in 1 and serious extracranial bleeding in 3 patients; 2 of whom developed fatal pneumonias. Delayed worsening of symptoms occurred in 5 patients (3 transient, 1 permanent neurological deficit, and 1 death and fatal aneurysm bleeding in 1 patient. Overall permanent morbidity rates were 2 (4% and mortality 4 (8%. Statistical analysis revealed no significant association between complications and variables related to treated aneurysm morphology or rupture status. CONCLUSION: This series is the largest reporting outcome of the new treatment approach and provides data for future study design. Procedural difficulties in SFD deployment were frequent and anti-thrombosis prophylaxis appears to reduce the resulting clinical sequelae, but at the cost of morbidity due to extracranial bleeding. Delayed morbidity appears to be a consequence of the new approach and warrants

  16. Uncommon presentation of pediatric ruptured intracranial aneurysm after radiotherapy for retinoblastoma. Case report.

    Science.gov (United States)

    Gonzales-Portillo, Gabriel A; Valdivia, Juan Martin Valdivia

    2006-04-01

    Radiation-induced intracranial aneurysms are a rare entity with high mortality. Their pathogenesis is still in debate. Their unique anatomy and behavior should be considered when deciding the proper management. A background of radiation, uncommon anatomic aspects, age of presentation, and location guide us to suspect a radiation-induced etiology. We report the case of a pediatric patient with a ruptured intracranial aneurysm, who previously received radiation therapy to the orbits. We aim to contribute to the literature of this uncommon condition and stress the importance of its prompt diagnosis and treatment. A 12-year-old boy, who received radiation therapy for recurrent bilateral retinoblastomas at age 4 months, suddenly developed severe headache associated with nausea and vomiting. A computed tomography scan revealed subarachnoid hemorrhage. A 4-vessel cerebral angiogram revealed a 2-mm aneurysm in the right A1 segment. The aneurysm was clipped successfully with excellent outcome. After 3 years of follow-up, the patient remains neurologically intact and asymptomatic. A new computed tomography angiogram revealed no new aneurysms. Vascular abnormalities develop after radiation injury to the brain. Aneurysm formation after radiation therapy has been previously reported, probably secondary to endothelial injury. In this case, early presentation, unusual anatomy, location, and small size at rupture, in contrast with saccular aneurysms, suggest a radiation-induced etiology.

  17. Daughter Sac Formation Related to Blood Inflow Jet in an Intracranial Aneurysm.

    Science.gov (United States)

    Sugiyama, Sin-Ichiro; Endo, Hidenori; Omodaka, Shunsuke; Endo, Toshiki; Niizuma, Kuniyasu; Rashad, Sherif; Nakayama, Toshio; Funamoto, Kenichi; Ohta, Makoto; Tominaga, Teiji

    2016-12-01

    We performed a hemodynamic study of an intracranial aneurysm with a newly developed daughter sac during observation to investigate the role of hemodynamics on the formation of a daughter sac. A 75-year-old man underwent magnetic resonance angiography that revealed a large internal carotid artery aneurysm with inflow jet inside the aneurysm. The aneurysm was stable for 18 months, but a new daughter sac developed at the tip of the aneurysm during the next 6 months. The daughter sac seemed to be related to the inflow jet on magnetic resonance angiography. Aneurysm geometries before and after daughter sac formation were reconstructed using the longitudinal data of magnetic resonance angiography. Computational fluid dynamic simulations were conducted under the patient-specific pulsatile inlet conditions measured by magnetic resonance velocimetry. The hemodynamic simulation revealed that the inflow jet impinged on 2 sites of the aneurysm: the right side of the aneurysmal dome and the tip of the aneurysm. The flow impingement caused elevation of pressure at both sites. However, the daughter sac formed at the latter site surrounded by the basal cistern but did not form at the former site that was in contact with the right temporal lobe. Blood inflow jet caused local elevation of pressure, and the formation of the daughter sac occurred at the site with high pressure but without the surrounding structure, which may cancel the perpendicular wall tension. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Volume changes of extremely large and giant intracranial aneurysms after treatment with flow diverter stents

    Energy Technology Data Exchange (ETDEWEB)

    Carneiro, Angelo; Byrne, James V. [ohn Radcliffe Hospital, Oxford Neurovascular and Neuroradiology Research Unit, Nuffield Department of Surgical Sciences, Oxford (United Kingdom); Rane, Neil; Kueker, Wilhelm; Cellerini, Martino; Corkill, Rufus [John Radcliffe Hospital, Department of Neuroradiology, Oxford (United Kingdom)

    2014-01-15

    This study assessed volume changes of unruptured large and giant aneurysms (greatest diameter >20 mm) after treatment with flow diverter (FD) stents. Clinical audit of the cases treated in a single institution, over a 5-year period. Demographic and clinical data were retrospectively collected from the hospital records. Aneurysm volumes were measured by manual outlining at sequential slices using computerised tomography (CT) or magnetic resonance (MR) angiography data. The audit included eight patients (seven females) with eight aneurysms. Four aneurysms involved the cavernous segment of the internal carotid artery (ICA), three the supraclinoid ICA and one the basilar artery. Seven patients presented with signs and symptoms of mass effect and one with seizures. All but one aneurysm was treated with a single FD stent; six aneurysms were also coiled (either before or simultaneously with FD placement). Minimum follow-up time was 6 months (mean 20 months). At follow-up, three aneurysms decreased in size, three were unchanged and two increased. Both aneurysms that increased in size showed persistent endosaccular flow at follow-up MR; in one case, failure was attributed to suboptimal position of the stent; in the other case, it was attributed to persistence of a side branch originating from the aneurysm (similar to the endoleak phenomenon of aortic aneurysms). At follow-up, five aneurysms were completely occluded; none of these increased in volume. Complete occlusion of the aneurysms leads, in most cases, to its shrinkage. In cases of late aneurysm growth or regrowth, consideration should be given to possible endoleak as the cause. (orig.)

  19. Effect of metal artifact reduction software on image quality of C-arm cone-beam computed tomography during intracranial aneurysm treatment.

    Science.gov (United States)

    Enomoto, Yukiko; Yamauchi, Keita; Asano, Takahiko; Otani, Katharina; Iwama, Toru

    2018-01-01

    Background and purpose C-arm cone-beam computed tomography (CBCT) has the drawback that image quality is degraded by artifacts caused by implanted metal objects. We evaluated whether metal artifact reduction (MAR) prototype software can improve the subjective image quality of CBCT images of patients with intracranial aneurysms treated with coils or clips. Materials and methods Forty-four patients with intracranial aneurysms implanted with coils (40 patients) or clips (four patients) underwent one CBCT scan from which uncorrected and MAR-corrected CBCT image datasets were reconstructed. Three blinded readers evaluated the image quality of the image sets using a four-point scale (1: Excellent, 2: Good, 3: Poor, 4: Bad). The median scores of the three readers of uncorrected and MAR-corrected images were compared with the paired Wilcoxon signed-rank and inter-reader agreement of change scores was assessed by weighted kappa statistics. The readers also recorded new clinical findings, such as intracranial hemorrhage, air, or surrounding anatomical structures on MAR-corrected images. Results The image quality of MAR-corrected CBCT images was significantly improved compared with the uncorrected CBCT image ( p software improved image quality of CBCT images degraded by metal artifacts.

  20. Magnetic resonance angiography in the selection of patients suitable for neurosurgical intervention of ruptured intracranial aneurysms

    NARCIS (Netherlands)

    Westerlaan, Henriette E.; Vliet , van der AM; Hew, JM; Metzemaekers, JDM; Mooij, JJA; Oudkerk, M

    2004-01-01

    This study was aimed at establishing whether magnetic resonance angiography (MRA) can be applied to planning and performing surgery on ruptured intracranial aneurysms, especially in the early phase, without recourse to intra-arterial digital subtraction angiography (IA-DSA). From February 1998 to

  1. Relationship between blood viscosity and cerebral ischemia after surgical treatment of ruptured intracranial aneurysms

    NARCIS (Netherlands)

    Schievink, W. I.; Hageman, L. M.; Velis, D. N.; van der Werf, D. J.; Hardeman, M. R.; Goedhart, P. T.

    1987-01-01

    To determine the role of blood viscosity after surgical treatment of ruptured intracranial aneurysms, the relationship between blood viscosity and clinical condition was examined in 17 patients. A total of 213 blood samples were analyzed. An inverse correlation was found between blood viscosity and

  2. Novel ELN mutation in a family with supravalvular aortic stenosis and intracranial aneurysm

    DEFF Research Database (Denmark)

    Jelsig, Anne Marie; Urban, Zsolt; Hucthagowder, Vishwanathan

    2017-01-01

    stenosis, various other arterial stenoses, sudden death, and intracranial aneurysms. A frameshift mutation in exon 12, not described before, was detected in the affected family members. This report emphasises the importance of family history, genetic counselling, and demonstrates the great variability...

  3. Computer-aided diagnosis improves detection of small intracranial aneurysms on MRA in a clinical setting.

    Science.gov (United States)

    Štepán-Buksakowska, I L; Accurso, J M; Diehn, F E; Huston, J; Kaufmann, T J; Luetmer, P H; Wood, C P; Yang, X; Blezek, D J; Carter, R; Hagen, C; Hořínek, D; Hejčl, A; Roček, M; Erickson, B J

    2014-10-01

    MRA is widely accepted as a noninvasive diagnostic tool for the detection of intracranial aneurysms, but detection is still a challenging task with rather low detection rates. Our aim was to examine the performance of a computer-aided diagnosis algorithm for detecting intracranial aneurysms on MRA in a clinical setting. Aneurysm detectability was evaluated retrospectively in 48 subjects with and without computer-aided diagnosis by 6 readers using a clinical 3D viewing system. Aneurysms ranged from 1.1 to 6.0 mm (mean = 3.12 mm, median = 2.50 mm). We conducted a multireader, multicase, double-crossover design, free-response, observer-performance study on sets of images from different MRA scanners by using DSA as the reference standard. Jackknife alternative free-response operating characteristic curve analysis with the figure of merit was used. For all readers combined, the mean figure of merit improved from 0.655 to 0.759, indicating a change in the figure of merit attributable to computer-aided diagnosis of 0.10 (95% CI, 0.03-0.18), which was statistically significant (F(1,47) = 7.00, P = .011). Five of the 6 radiologists had improved performance with computer-aided diagnosis, primarily due to increased sensitivity. In conditions similar to clinical practice, using computer-aided diagnosis significantly improved radiologists' detection of intracranial DSA-confirmed aneurysms of ≤6 mm. © 2014 by American Journal of Neuroradiology.

  4. Clinical and radiological profiles and outcomes in pediatric patients with intracranial aneurysms.

    Science.gov (United States)

    Mehrotra, Anant; Nair, Anup P; Das, Kuntal Kanti; Srivastava, Arun; Sahu, Rabi Narayan; Kumar, Raj

    2012-10-01

    Intracranial aneurysms are extremely uncommon in the pediatric population, their characteristics are not well studied, and certain features make them unique. The authors analyzed pediatric patients with aneurysms to try to understand their clinical, radiological, and outcome profile. Sixty-three pediatric patients (≤ 18 years of age) with ages ranging from 4 to 18 years and features (clinical and radiological) suggestive of aneurysm presented to, and were treated at, the authors' center in the past 20 years (1991-2011). Included in the present study were only those patients who underwent surgical intervention, and thus data for 57 patients were analyzed. Seventy-three aneurysms in 57 patients were surgically treated. There was a slight female predominance (M/F 1:1.2), and the mean age among all patients was 12.69 ± 3.75 years. Fifty patients (87.72%) presented with subarachnoid hemorrhage, 4 (7.02%) with mass effect, and 3 (5.26%) with seizure. On presentation the majority of patients (45 [78.95%]) had a good clinical grade. Eleven patients had multiple aneurysms. The internal carotid artery (ICA) bifurcation was the most common aneurysm site (18 cases [24.66%]), followed by the middle cerebral artery (MCA) bifurcation (11 cases [15.07%]). At a mean follow-up of 18.58 ± 10.71 months (range 1.5-44 months), 44 patients (77.19%) had a favorable outcome, and 5 patients had died. Pediatric patients with intracranial aneurysms most commonly presented with subarachnoid hemorrhage, and there was a slight female predominance. The ICA bifurcation followed by the MCA bifurcation was the most common aneurysm site. The incidence of posterior circulation and giant aneurysms is higher in pediatric patients than in the adult population. Children tend to present with better clinical grades and have better overall survival results and good functional outcomes.

  5. Usefulness of MR angiography for detection of intracranial aneurysms in patients with adult polycystic kidney disease

    Energy Technology Data Exchange (ETDEWEB)

    Murakami, Koji; Tsuchida, Hiroki; Kamura, Kouichi (National Sakura Hospital, Chiba (Japan)); Shibahashi, Hiroyuki; Ouchi, Toshihiro; Arimizu, Noboru

    1993-11-01

    Patients with adult polycystic kidney disease (APKD) sometimes accompany cerebral aneurysms which may result in fatal intracranial hemorrhage. Our aim is to evaluate the usefulness of MR angiography (MRA) as a screening method for detecting cerebral aneurysms in patients with APKD. Thirty-one neurologically asymptomatic APKD patients were examined with 3D time-of-flight MRA on a 0.5T system. Five patients who suspected of having aneurysms by MRA were also inspected by conventional angiography. As a result, multiple unruptured cerebral aneurysms were found around circle of Willis in 2 patients (6.5%). We also reviewed 46 APKD patients including those who did not undergo MRA. Consequently, 5 patients had coexistent cerebral aneurysms (10.9%). All 5 patients also had mild hypertension as a complication of APKD. Our results indicate that MRA is a noninvasive and useful method which can be performed irrespective of renal function. MRA should be planned as an efficient imaging modality for screening cerebral aneurysms in patients with APKD, especially they have hypertension or family history of intracranial hemorrhage. (author).

  6. Remote ischemic preconditioning in the prevention of ischemic brain damage during intracranial aneurysm treatment (RIPAT): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Tülü, Selma; Mulino, Miriam; Pinggera, Daniel; Luger, Markus; Würtinger, Philipp; Grams, Astrid; Bodner, Thomas; Beer, Ronny; Helbok, Raimund; Matteucci-Gothe, Raffaella; Unterhofer, Claudia; Gizewski, Elke; Schmutzhard, Erich; Thomé, Claudius; Ortler, Martin

    2015-12-29

    The treatment of intracranial aneurysms may be associated with cerebral ischemia. We hypothesize that pre-interventional remote ischemic preconditioning (RIPC) reduces ischemic cerebral tissue damage in patients undergoing elective intracranial aneurysm treatment. This study is a single-center, prospective, randomized, double-blind explorative trial. Patients with an unruptured intracranial aneurysm admitted to Innsbruck Medical University Hospital for coiling or clipping will be consecutively randomized to either the intervention group (= RIPC by inflating an upper extremity blood-pressure cuff for 3 x 5 min to 200 mmHg) or the control group after induction of anesthesia. Participants will be randomized 1:1 to either the preconditioning group or the sham group using a random allocation sequence and block randomization. The precalculated sample size is n = 24 per group. The primary endpoint is the area-under-the-curve concentration of serum biomarkers (S100B, NSE, GFAP, MMP9, MBP, and cellular microparticles) in the first five days after treatment. Secondary endpoints are the number and volume of new ischemic lesions in magnetic resonance imaging and clinical outcome evaluated with the National Institutes of Health Stroke Scale, the modified Rankin Scale, and neuropsychological tests at six and twelve months. All outcome variables will be determined by observers blinded to group allocation. This study was approved by the local institutional Ethics Committee (UN5164), version 3.0 of the study protocol, dated 20 October 2013. This study uses the elective treatment of intracranial aneurysms as a paradigmatic situation to explore the neuroprotective effects of RIPC. If effects are demonstrable in this pilot trial, a larger, prospective phase III trial will be considered.

  7. Bypass Surgery for Complex Intracranial Aneurysms: 15 Years of Experience at a Single Institution and Review of Pertinent Literature.

    Science.gov (United States)

    Ban, Seung Pil; Cho, Won-Sang; Kim, Jeong Eun; Kim, Chang Hyeun; Bang, Jae Seung; Son, Young-Je; Kang, Hyun-Seung; Kwon, O-Ki; Oh, Chang Wan; Han, Moon Hee

    2017-12-01

    Bypass surgery is a treatment option for complex intracranial aneurysms. To determine the utility of bypass surgery for the treatment of complex intracranial aneurysms and to review the literature on this topic. Sixty-two patients were included in this retrospective study. Unruptured aneurysms were dominant (80.6%), and the internal carotid artery was the most common location of the aneurysm (56.4%), followed by the middle cerebral artery (21.0%). The mean maximal diameter of the aneurysms was 20.5 ± 11.4 mm. The clinical and angiographic states were evaluated preoperatively, immediately after surgery (within 3 days) and at the last follow-up. The mean angiographic and clinical follow-up duration was 34.2 ± 38.9 and 46.5 ± 42.5 months, respectively. Sixty-one patients (98.3%) underwent extracranial-intracranial bypass, and 1 underwent intracranial-intracranial bypass. At the last follow-up angiography, 58 aneurysms (93.5%) were completely obliterated and 4 were incompletely obliterated, with a graft patency of 90.3%. Surgical mortality was 0 and permanent morbidity was 8.1%. A good clinical outcome (Karnofsky Performance Scale ≥ 70 and modified Rankin Scale score ≤ 2) was achieved in 91.9% of patients (n = 57). With a proper selection of bypass type, bypass-associated treatment can be a good alternative for patients with complex intracranial aneurysms when conventional microsurgical clipping or endovascular intervention is not feasible.

  8. Finite element model of size, shape and blood pressure on rupture of intracranial saccular aneurysms

    Science.gov (United States)

    Rica Nabong, Jennica; David, Guido

    2017-10-01

    Rupture of intracranial saccular aneurysms is a primary concern for neurologists and patients because it leads to stroke and permanent disability. This paper examines the role of blood pressure, in connection with size of and wall thickness, in the rupture of saccular aneurysms. A bulb-shaped geometry of a saccular aneurysm is obtained from angiographic images of a patient and modeled using Finite Elements based on the principle of virtual work under the Fung stress-strain relationship. The numerical model is subjected to varying levels of systolic blood pressure. Rupture is assumed to occur when the wall stress exceeded its mechanical strength. The results show which sizes of this class of aneurysms are at high risk of rupture for varying levels of blood pressure.

  9. Blood flow in intracranial aneurysms treated with Pipeline embolization devices: computational simulation and verification with Doppler ultrasonography on phantom models

    National Research Council Canada - National Science Library

    Tsang, Anderson Chun On; Lai, Simon Sui Man; Chung, Wai Choi; Tang, Abraham Yik Sau; Leung, Gilberto Ka Kit; Poon, Alexander Kai Kei; Yu, Alfred Cheuk Hang; Chow, Kwok Wing

    2015-01-01

    The aim of this study was to validate a computational fluid dynamics (CFD) simulation of flow-diverter treatment through Doppler ultrasonography measurements in patient-specific models of intracranial bifurcation and side-wall aneurysms...

  10. Inflammation and intracranial aneurysms: mechanisms of initiation, growth, and rupture

    Directory of Open Access Journals (Sweden)

    Peter S Amenta

    2015-06-01

    Full Text Available Outcomes following aneurysmal subarachnoid hemorrhage remain poor in many patients, despite advances in microsurgical and endovascular management. Consequently, considerable effort has been placed in determining the mechanisms of aneurysm formation, growth, and rupture. Various environmental and genetic factors are implicated as key components in the aneurysm pathogenesis. Currently, sufficient evidence exists to incriminate the inflammatory response as the common pathway leading to aneurysm generation and rupture. Central to this model is the interaction between the vessel wall and inflammatory cells. Dysfunction of the endothelium and vascular smooth muscle cells (VSMCs promotes a chronic pathological inflammatory response that progressively weakens the vessel wall. We review the literature pertaining to the cellular and chemical mechanisms of inflammation that contribute to aneurysm development. Hemodynamic stress and alterations in blood flow are discussed regarding their role in promoting chronic inflammation. Endothelial cell and VSMC dysfunction are examined concerning vascular remodeling. The contribution of inflammatory cytokines, especially tumor necrosis factor-α is illustrated. Inflammatory cell infiltration, particularly macrophage-mediated deterioration of vascular integrity, is reviewed. We discuss the inflammation as a means to determine aneurysms at greatest risk of rupture. Finally, future therapeutic implications of pharmacologic modulation of the inflammation are discussed.

  11. Low-profile Visualized Intraluminal Support device (LVIS Jr) as a novel tool in the treatment of wide-necked intracranial aneurysms: initial experience in 32 cases.

    Science.gov (United States)

    Behme, Daniel; Weber, Anushe; Kowoll, Annika; Berlis, Ansgar; Burke, Thomas H; Weber, Werner

    2015-04-01

    The focus of this study was to determine ease of deployment, safety and effectiveness of the LVIS Jr device. A retrospective analysis was performed of 32 cases comprising 34 aneurysms in which the LVIS Jr device was used for stent-assisted coil embolization of intracranial aneurysms from February to October 2012, including all clinical and angiographic data as well as mid-term follow-up (1-12 months of treatment). The median age of the patients was 54 years (range 21-76) and 19 (59%) were women. The aneurysms were ruptured in 12/34 cases (35.3%); 26 (76.4%) were located within the anterior circulation and the remaining 8 (23.5%) were located in the posterior circulation. Eleven of the 34 aneurysms (32.3%) were treated with a Y-stent configuration. Immediate total occlusion was observed in 16/34 (47%), near total occlusion (90-95%) in 5/34 (14.7%) and a 'dog ear' or subtotal occlusion in 12/34 (35.2%). A single aneurysm was treated without coil embolization. Complications occurred in 5/34 cases (15%), including two cases of in-stent thrombosis. Implantation of the LVIS Jr device as a support device for stent-assisted coil embolization seems to be safe and effective. The LVIS Jr device can also be implanted in a Y-stent configuration, offering a novel technique with a potentially lower risk of thromboembolic complications compared with other devices. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. The Use of Solitaire AB Stents in Coil Embolization of Wide-Necked Cerebral Aneurysms.

    Directory of Open Access Journals (Sweden)

    Teng-Fei Li

    Full Text Available The Solitaire AB stent is one of many assistant stents used for treating wide-necked cerebral aneurysm, and has been used since 2003. However, large sample studies on its safety and effectiveness are lacking. The objective of this study was to evaluate the effectiveness and safety of the Solitaire AB stent in the coil embolization of wide-necked cerebral aneurysms.Retrospective review of the clinical and image data of 116 patients with wide-necked cerebral aneurysms who had been enrolled at six interventional neuroradiology centers from February 2010 to February 2014 and had been treated by coil embolization; in total, 120 Solitaire AB stents were used. The degree of aneurysm occlusion was examined using digital subtraction angiography (DSA immediately after the procedure and during follow-up, and was graded using the modified Raymond classification. We also observed complications to evaluate the safety and effectiveness of this therapy.The 120 Solitaire AB stents (4 mm × 15 mm, four stents; 4 mm × 20 mm, 16 stents; 6 mm × 20 mm, 36 stents; 6 mm × 30 mm, 64 stents were inserted to treat 120 wide-necked cerebral aneurysms. All stents were inserted successfully. DSA immediately post-surgery revealed 55 cases of complete occlusion, 59 cases of neck remnant, and six cases of aneurysm remnant. Perioperatively, there were four cases of hemorrhage and four cases of stent thrombosis. The follow-up spanned 3-37 months; of 92 patients examined by DSA at the 6-month follow up, 12 had disease recurrence.The Solitaire AB stent is effective with a good technical success rate and short-term effect for assisting coil embolization of wide-necked cerebral aneurysms.

  13. Hospital volume and 1-year mortality after treatment of intracranial aneurysms: a study based on patient registries in Scandinavia.

    Science.gov (United States)

    Lindekleiv, Haakon; Mathiesen, Ellisiv B; Førde, Olav H; Wilsgaard, Tom; Ingebrigtsen, Tor

    2015-09-01

    The object of this study was to examine the relationship between hospital volume and long-term mortality after treatment of intracranial aneurysms. The authors identified patients treated for intracranial aneurysms between 2002 and 2010 from patient registries of Denmark, Norway, and Sweden, and linked to data on 1-year mortality from the population registry of each country. Cox regression models were used to relate hospital volume to the risk of death and adjusted for potential confounders (age, sex, year of treatment, Charlson comorbidity index, country, and surgical treatment). The authors identified 5773 patients with ruptured and 1756 patients with unruptured intracranial aneurysms, treated at 15 hospitals. One-year mortality rates were 15.6% for patients with ruptured aneurysms and 2.7% for patients with unruptured aneurysms. No consistent relationship was found between hospital volume and 1-year mortality for ruptured aneurysms in the unadjusted analyses, but higher hospital volume was associated with increased mortality in the analyses adjusted for potential confounders (hazard ratio [HR] per 10-patient increase 1.04, 95% CI 1.00-1.07). There was a trend toward a lower mortality rate in higher-volume hospitals after treatment for unruptured intracranial aneurysms, but this was not statistically significant after adjustment for potential confounders (HR per 10-patient increase 0.69, 95% CI 0.42-1.10). There were large variations in mortality after treatment for both ruptured and unruptured intracranial aneurysms across hospitals and between the Scandinavian countries (p < 0.01). The findings in this study did not confirm a relationship between higher hospital volume and reduced long-term mortality after treatment of ruptured intracranial aneurysms. Prospective registries for evaluating outcomes after aneurysm treatment are highly warranted.

  14. Paradoxical Increase in Mortality and Rupture of Intracranial Aneurysms in mPGES-1 Deficient Mice: Attenuation by Aspirin

    Science.gov (United States)

    Peña Silva, Ricardo A.; Mitchell, Ian J; Kung, David K; Pewe, Lecia L.; Granja, Manuel F; Harty, John T; Faraci, Frank M.; Heistad, Donald D; Hasan, David M

    2016-01-01

    Background Inflammation plays an important role in formation and rupture of intracranial aneurysms. Expression of microsomal prostaglandin E2 (PGE2) synthase type 1 (mPGES-1) is increased in the wall of intracranial aneurysms in humans. PGE2, a by-product of mPGES-1, is associated with inflammation and cerebrovascular dysfunction. Objective To test the hypothesis that deletion of mPGES-1 decreases the formation and rupture of intracranial aneurysms in a murine model. Methods Intracranial aneurysms were induced in wild type (WT) and mPGES-1 deficient (mPGES-1 KO) mice using a combination of deoxycorticosterone acetate (DOCA)-salt-induced hypertension and intracranial injection of elastase in the basal cistern. Prevalence of aneurysms, subarachnoid hemorrhage (SAH), and mortality were assessed. We also tested effects of administration of aspirin (6mg/kg/d) by gavage and PGE2 (1mg/kg/d) by subcutaneous infusion. Results Systolic blood pressure (SBP) and prevalence of aneurysm were similar in WT and mPGES-1 KO mice. However, mortality and prevalence of SAH were markedly increased in mPGES-1 KO mice (p <0.05). Bone marrow reconstitution studies suggest that mPGES-1 derived from leukocytes does not appear to increase rupture of intracranial aneurysms. Aspirin, but not PGE2, attenuated the increased mortality in mPGES-1 KO mice (p <0.05). Conclusion Vascular mPGES-1 plays a protective role in blood vessels and attenuates rupture of cerebral aneurysms. In contrast to effects on abdominal aneurysms, mPGES-1 deficiency is associated with an increase in rupture of cerebral aneurysms and mortality, which are attenuated by low-dose aspirin. PMID:26134597

  15. An automatic CFD-based flow diverter optimization principle for patient-specific intracranial aneurysms.

    Science.gov (United States)

    Janiga, Gábor; Daróczy, László; Berg, Philipp; Thévenin, Dominique; Skalej, Martin; Beuing, Oliver

    2015-11-05

    The optimal treatment of intracranial aneurysms using flow diverting devices is a fundamental issue for neuroradiologists as well as neurosurgeons. Due to highly irregular manifold aneurysm shapes and locations, the choice of the stent and the patient-specific deployment strategy can be a very difficult decision. To support the therapy planning, a new method is introduced that combines a three-dimensional CFD-based optimization with a realistic deployment of a virtual flow diverting stent for a given aneurysm. To demonstrate the feasibility of this method, it was applied to a patient-specific intracranial giant aneurysm that was successfully treated using a commercial flow diverter. Eight treatment scenarios with different local compressions were considered in a fully automated simulation loop. The impact on the corresponding blood flow behavior was evaluated qualitatively as well as quantitatively, and the optimal configuration for this specific case was identified. The virtual deployment of an uncompressed flow diverter reduced the inflow into the aneurysm by 24.4% compared to the untreated case. Depending on the positioning of the local stent compression below the ostium, blood flow reduction could vary between 27.3% and 33.4%. Therefore, a broad range of potential treatment outcomes was identified, illustrating the variability of a given flow diverter deployment in general. This method represents a proof of concept to automatically identify the optimal treatment for a patient in a virtual study under certain assumptions. Hence, it contributes to the improvement of virtual stenting for intracranial aneurysms and can support physicians during therapy planning in the future. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Passive Smoking Is Not Associated with Risk of Intracranial Aneurysm Rupture in Nonsmoking Women.

    Science.gov (United States)

    Feng, Xin; Wang, Luyao; Guo, Erkang; Zhang, Baorui; Qian, Zenghui; Wen, Xiaolong; Xu, Wenjuan; Li, Youxiang; Jiang, Chuhan; Wu, Zhongxue; Liu, Aihua

    2017-11-01

    Active smoking is a major risk factor for intracranial aneurysm rupture (IAR); however, little is known about the effects of passive smoking on IAR. In China, female passive smoking is widespread and severe. This study aimed to assess whether passive smoking is associated with increased risk of IAR among nonsmoking women. We enrolled and retrospectively analyzed 385 consecutive female patients with intracranial aneurysms (IAs; 87 ruptured, 298 unruptured) who were admitted to our center between June 2015 and January 2017. Data on female active smoking, passive smoking, and other factors potentially influencing IAR were precisely compared between ruptured and unruptured IAs. For all aneurysms, when adjusting for potential confounders, current smoking was significantly associated with IAR (odds ratio [OR], 3.31; 95% confidence interval [CI], 1.08-10.20; P = 0.037). Furthermore, bifurcation location (OR, 5.73; 95% CI, 3.27-10.03; P passive smoking; however, passive smoking was not significantly associated with IAR. The results also showed that bifurcation location (OR, 6.21; 95% CI, 3.46-11.15; P smoking was strongly associated with aneurysm rupture in female patients, passive smoking was not an independent risk factor for aneurysm rupture in nonsmoking women. Copyright © 2017. Published by Elsevier Inc.

  17. Flat detector CT and its applications in the endovascular treatment of wide-necked intracranial aneurysms-A literature review.

    Science.gov (United States)

    Zwarzany, Łukasz; Poncyljusz, Wojciech; Burke, Thomas H

    2017-03-01

    Flat detector CT (FDCT) provides cross sectional imaging within an angiographic suite and is increasingly gaining popularity in various areas of interventional radiology, as an alternative imaging modality. Its relatively high spatial resolution improves visualization of intraluminal devices such as intracranial stents or flow-diverters. Device deployment and positioning, in relation to the parent vessel and surrounding structures, are easily assessible with FDCT. Furthermore, with contrast agent administration, it expands the diagnostic capabilities of this new imaging tool. However, beam-hardening artifacts is a major limitation in some cases. The examination can be performed both during the endovascular procedure and for pre- and post-treatment imaging. Intravenous contrast agent injection reduces the risk of complications, making it possible to perform this examination in the outpatient settings. The aim of this paper is to present an overview of published studies reporting experience with FDCT in the field of endovascular neurosurgery and in particular, FDCT's contribution in treatment of wide-necked intracranial aneurysms. The authors have focused specifically on stent-assisted coiling and flow-diverter implantation, since obtaining proper parent vessel wall apposition of these devices is essential for short- and long-term procedural outcomes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Genetic variants associated with type 2 diabetes and adiposity and risk of intracranial and abdominal aortic aneurysms

    NARCIS (Netherlands)

    Hof, F.N. van 't; Vaucher, J.; Holmes, M.V.; Wilde, A. de; Baas, A.F.; Blankensteijn, J.D.; Hofman, A.; Kiemeney, L.A.L.M.; Rivadeneira, F.; Uitterlinden, A.G.; Vermeulen, S.H.; Rinkel, G.J.; Bakker, P.I. de; Ruigrok, Y.M.

    2017-01-01

    Epidemiological studies show that type 2 diabetes (T2D) is inversely associated with intracranial aneurysms (IA) and abdominal aortic aneurysms (AAA). Although adiposity has not been considered a risk factor for IA, there have been inconsistent reports relating adiposity to AAA risk. We assessed

  19. Perioperative Variables Contributing to the Rupture of Intracranial Aneurysm: An Update

    Directory of Open Access Journals (Sweden)

    Tumul Chowdhury

    2013-01-01

    Full Text Available Background. Perioperative aneurysm rupture (PAR is one of the most dreaded complications of intracranial aneurysms, and approximately 80% of nontraumatic SAHs are related to such PAR aneurysms. The literature is currently scant and even controversial regarding the issues of various contributory factors on different phases of perioperative period. Thus this paper highlights the current understanding of various risk factors, variables, and outcomes in relation to PAR and try to summarize the current knowledge. Method. We have performed a PubMed search (1 January 1991–31 December 2012 using search terms including “cerebral aneurysm,” “intracranial aneurysm,” and “intraoperative/perioperative rupture.” Results. Various risk factors are summarized in relation to different phases of perioperative period and their relationship with outcome is also highlighted. There exist many well-known preoperative variables which are responsible for the highest percentage of PAR. The role of other variables in the intraoperative/postoperative period is not well known; however, these factors may have important contributory roles in aneurysm rupture. Preoperative variables mainly include natural course (age, gender, and familial history as well as the pathophysiological factors (size, type, location, comorbidities, and procedure. Previously ruptured aneurysm is associated with rupture in all the phases of perioperative period. On the other hand intraoperative/postoperative variables usually depend upon anesthesia and surgery related factors. Intraoperative rupture during predissection phase is associated with poor outcome while intraoperative rupture at any step during embolization procedure imposes poor outcome. Conclusion. We have tried to create such an initial categorization but know that we cannot scale according to its clinical importance. Thorough understanding of various risk factors and other variables associated with PAR will assist in better

  20. Keyhole Approach for Clipping Intracranial Aneurysm: Comparison of Supraorbital and Pterional Keyhole Approach.

    Science.gov (United States)

    Lan, Qing; Zhang, Hengzhu; Zhu, Qing; Chen, Ailin; Chen, Yanming; Xu, Liang; Wang, Zhongyong; Yuan, Liqun; Liu, Shihai

    2017-06-01

    The aim of this research was to compare the functional outcome and safety between supraorbital keyhole approach (SKA) and pterional keyhole approach (PKA) for clipping intracranial aneurysms. This is a retrospective study involving 318 patients with a total of 365 aneurysms who underwent keyhole surgery, comprising 195 cases in SKA group and 123 cases in PKA group. The outcome measures include Glasgow Outcome Scale, complete clipping rate, adverse events incidence, operation view angle, working distance, and surgical incision condition. Of a total of 356 aneurysms that were clipped and 9 trapped, no significant difference was observed in Glasgow Outcome Scale score, adverse events incidence, or complete clipping rate between the SKA and PKA groups. The distance from skin incision to anterior clinoid process was 5.87 ± 0.24 cm in SKA and 5.12 ± 0.27 cm in PKA. The operation view angle (from midline to the operating channel in sagittal plane) was 30°-40° in the SKA group and 60°-68° in the PKA group. Our research demonstrates that both SKA and PKA are safe and effective for most anterior circulation aneurysms and parts of posterior circulation aneurysms. The SKA exposures aneurysm better on deep and sagittal directions and is more suitable for clipping aneurysms by the contralateral approach due to the short distance. The PKA has a good exposure on the neck of aneurysm with dorsal direction of parent artery and can be used to evacuate hematoma in the temporal lobe when clipping the aneurysm. Integrating multimodal 3-dimensional images could help neurosurgeon in selecting an appropriate and effective approach. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. In vivo tissue response following implantation of shape memory polyurethane foam in a porcine aneurysm model

    OpenAIRE

    Rodriguez, Jennifer N.; Clubb, Fred J.; Wilson, Thomas S.; Miller, Matthew W.; Fossum, Theresa W.; Hartman, Jonathan; Tuzun, Egemen; Singhal, Pooja; Maitland, Duncan J.

    2013-01-01

    Cerebral aneurysms treated by traditional endovascular methods using platinum coils have a tendency to be unstable, either due to chronic inflammation, compaction of coils, or growth of the aneurysm. We propose to use alternate filling methods for the treatment of intracranial aneurysms using polyurethane based shape memory polymer (SMP) foams. SMP polyurethane foams were surgically implanted in a porcine aneurysm model to determine biocompatibility, localized thrombogenicity, and their abili...

  2. Stent-assited coil embolization of vertebrobasilar dissecting aneurysms: Procedual outcomes and factors for recanalization

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Jin Pyeong [Dept. of Neurosurgery, Hallym University College of Medicine, Chuncheon (Korea, Republic of); Cho, Young Dae; Cho, Won Sang; Kang, Huin Seung; Hwang, Gyo Hun; Kwon, O Ki; Han, Moon Hee [Seoul National University College of Medicine, Seoul National University Hospital, Seoul (Korea, Republic of); Rhim, Jong Kook [Dept. of Neurosurgery, Jeju National University College of Medicine, Jeju National University Hospital, Jeju (Korea, Republic of); Park, Jeong Jin [Dept. of Neurology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul (Korea, Republic of)

    2016-09-15

    Outcomes of stent-assisted coil embolization (SACE) have not been well established in the setting of vertebrobasilar dissecting aneurysms (VBDAs) due to the low percentage of cases that need treatment and the array of available therapeutic options. Herein, we presented clinical and radiographic results of SACE in patients with VBDAs. A total of 47 patients (M:F, 30:17; mean age ± SD, 53.7 ± 12.6 years), with a VBDA who underwent SACE between 2008 and 2014 at two institutions were evaluated retrospectively. Medical records and radiologic data were analyzed to assess the outcome of SACE procedures. Cox proportional hazards regression analysis was conducted to determine the factors that were associated with aneurysmal recanalization after SACE.Stent-assisted coil embolization technically succeeded in all patients. Three cerebellar infarctions occurred on postembolization day 1, week 2, and month 2, but no other procedure-related complications developed. Immediately following SACE, 25 aneurysms (53.2%) showed no contrast filling into the aneurysmal sac. During a mean follow-up of 20.2 months, 37 lesions (78.7%) appeared completely occluded, whereas 10 lesions showed recanalization, 5 of which required additional embolization. Overall recanalization rate was 12.64% per lesion-year, and mean postoperative time to recanalization was 18 months (range, 3–36 months). In multivariable analysis, major branch involvement (hazard ratio [HR]: 7.28; p = 0.013) and the presence of residual sac filling (HR: 8.49, p = 0.044) were identified as statistically significant independent predictors of recanalization. No bleeding was encountered in follow-up monitoring. Stent-assisted coil embolization appears feasible and safe for treatment of VBDAs. Long-term results were acceptable in a majority of patients studied, despite a relatively high rate of incomplete occlusion immediately after SACE. Major branch involvement and coiled aneurysms with residual sac filling may predispose to

  3. Nonlinear Dynamics and Analysis of Intracranial Saccular Aneurysms with Growth and Remodeling

    Directory of Open Access Journals (Sweden)

    Manal Badgaish

    2016-01-01

    Full Text Available A new mathematical model for the interaction of blood flow with the arterial wall surrounded by cerebral spinal fluid is developed with applications to intracranial saccular aneurysms. The blood pressure acting on the inner arterial wall is modeled via a Fourier series, the arterial wall is modeled as a spring-mass system incorporating growth and remodeling, and the surrounding cerebral spinal fluid is modeled via a simplified one-dimensional compressible Euler equation with inviscid flow and negligible nonlinear effects. The resulting nonlinear coupled fluid-structure interaction problem is analyzed and a perturbation technique is employed to derive the first-order approximation solution to the system. An analytical solution is also derived for the linearized version of the problem using Laplace transforms. The solutions are validated against related work from the literature and the results suggest the biological significance of the inclusion of the growth and remodeling effects on the rupture of intracranial aneurysms.

  4. Salvage of distal non-target coil embolization with stent placement and intravenous eptifibatide in a ruptured, unsecured, atypical aneurysm

    Science.gov (United States)

    Janjua, Nazli; Bulic, Sebina; Tan, Benedict C; Panichpisal, Kessarin; Miller, John

    2013-01-01

    Introduction Small aneurysms may be challenging to embolize. In cases of subarachnoid hemorrhage (SAH) where treatment is delayed, physicians may have to balance the risks of certain required therapies (antiplatelet agents) with the risk of rerupture. We describe a case of a technically challenging anterior cerebral artery aneurysm requiring eptifibatide infusion prior to definitive aneurysm treatment. Case report A 57-year-old woman with SAH, underwent coil embolization of a small fenestrated A1–A2 junction aneurysm. The procedure was complicated by downstream coil migration which was then treated with Enterprise stent placement in the pericallosal artery. This required subsequent infusion of a glycoprotein IIb/IIIa inhibitor until the aneurysm could be repaired surgically. Conclusions Revascularization with a stent in a distal cerebral vessel may salvage inadvertent coil migration. Although it is undesirable to administer antiplatelet agents to patients with SAH, in these circumstances short acting agents may be used. PMID:23536645

  5. Identification of vortex structures in a cohort of 204 intracranial aneurysms.

    Science.gov (United States)

    Varble, Nicole; Trylesinski, Gabriel; Xiang, Jianping; Snyder, Kenneth; Meng, Hui

    2017-05-01

    An intracranial aneurysm (IA) is a cerebrovascular pathology that can lead to death or disability if ruptured. Abnormal wall shear stress (WSS) has been associated with IA growth and rupture, but little is known about the underlying flow physics related to rupture-prone IAs. Previous studies, based on analysis of a few aneurysms or partial views of three-dimensional vortex structures, suggest that rupture is associated with complex vortical flow inside IAs. To further elucidate the relevance of vortical flow in aneurysm pathophysiology, we studied 204 patient IAs (56 ruptured and 148 unruptured). Using objective quantities to identify three-dimensional vortex structures, we investigated the characteristics associated with aneurysm rupture and if these features correlate with previously proposed WSS and morphological characteristics indicative of IA rupture. Based on the Q-criterion definition of a vortex, we quantified the degree of the aneurysmal region occupied by vortex structures using the volume vortex fraction (vVF) and the surface vortex fraction (sVF). Computational fluid dynamics simulations showed that the sVF, but not the vVF, discriminated ruptured from unruptured aneurysms. Furthermore, we found that the near-wall vortex structures co-localized with regions of inflow jet breakdown, and significantly correlated to previously proposed haemodynamic and morphologic characteristics of ruptured IAs. © 2017 The Author(s).

  6. Pediatric intracranial aneurysms: current national trends in patient management and treatment.

    Science.gov (United States)

    Vasan, Rohit; Patel, Jaymin; Sweeney, J M; Carpenter, Anne Marie; Downes, Katheryne; Youssef, A Samy; van Loveren, Harry; Agazzi, Siviero

    2013-03-01

    Pediatric intracranial aneurysms constitute a medical disease process with many unique features that present unique challenges in orchestrating their treatment. Conflicts exist in pediatric aneurysm literature as to whether endovascular therapy is equivalent to surgical therapy in assuring durable aneurysm obliteration in this population. The national Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Dataset was queried using the HCUPnet system. Overall trends in length of stay (LOS), associated charges, and in-hospital deaths were analyzed for both subarachnoid hemorrhage (SAH) and nonruptured aneurysms from 2000 to 2009. Trends in the type of procedure, associated LOS, and charges were analyzed for SAH from 2003 to 2009. A p value aneurysms. Costs of surgery showed a slight increase, while endovascular procedures also rose 50 % from 2006 to 2009. Interestingly, mean length of stay increased for endovascular procedures from 16.5 to 17.2 days and decreased for surgical procedures from 20.4 to 14.7 days (p pediatric subarachnoid hemorrhage have not significantly declined since 1997. Second, in-hospital charges for the management of both ruptured and nonruptured aneurysms rose by over 200 % from 2000 to 2009. Surgical procedures saw a 6 % increase in price, while endovascular procedures sharply rose in costs by 50 %. Finally, endovascular therapy has increased in utilization, while the frequency of surgical therapy has not changed significantly since 2003.

  7. Risks associated with preoperative anemia and perioperative blood transfusion in open surgery for intracranial aneurysms.

    Science.gov (United States)

    Seicean, Andreea; Alan, Nima; Seicean, Sinziana; Neuhauser, Duncan; Selman, Warren R; Bambakidis, Nicholas C

    2015-07-01

    Preoperative anemia may be treated with a blood transfusion. Both are associated with adverse outcomes in various surgical procedures, but this has not been clearly elucidated in surgery for cerebral aneurysms. In this study the authors assessed the association of preoperative anemia and perioperative blood transfusion, separately, on 30-day morbidity and mortality in patients undergoing open surgery for ruptured and unruptured intracranial aneurysms. The authors identified 668 cases (including 400 unruptured and 268 unruptured intracranial aneurysms) of open surgery for treatment of intracranial aneurysms in the 2006-2012 National Surgical Quality Improvement Program, a validated and reproducible prospective clinical database. Anemia was defined as a hematocrit level less than 39% in males and less than 36% in females. Perioperative transfusion was defined as at least 1 unit of packed or whole red blood cells given at any point between the start of surgery to 72 hours postoperatively. The authors separately compared surgical outcome between patients with (n = 198) versus without (n = 470) anemia, and those who underwent (n = 78) versus those who did not receive (n = 521) a transfusion, using a 1:1 match on propensity score. In the matched cohorts, all observed covariates were comparable between anemic (n = 147) versus nonanemic (n = 147) and between transfused (n = 67) versus nontransfused patients (n = 67). Anemia was independently associated with prolonged hospital length of stay (LOS; odds ratio [OR] 2.5, 95% confidence interval [CI] 1.4-4.5), perioperative complications (OR 1.9, 95% CI 1.1-3.1), and return to the operating room (OR 2.1, 95% CI 1.1-4.5). Transfusion was also independently associated with perioperative complications (OR 2.4, 95% CI 1.1-5.3). Preoperative anemia and transfusion are each independent risk factors for perioperative complications in patients undergoing surgery for cerebral aneurysms. Perioperative anemia is also associated with

  8. ORIGINAL ARTICLES Endovascular cerebral aneurysm treatment ...

    African Journals Online (AJOL)

    Corresponding author: D E Le Feuvre (davidlefeuvre@hotmail.com). Introduction. The International Subarachnoid Aneurysm Trial confirmed endovascular treatment as the treatment of choice for intracranial 'berry' aneurysms. The durability of coiling and the relevance of stable neck remnants needed to be addressed next.

  9. Ultra Low Density Shape Memory Polymer Foams With Tunable Physicochemical Properties for Treatment of intracranial Aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Singhal, Pooja [Texas A & M Univ., College Station, TX (United States)

    2013-12-01

    Shape memory polymers (SMPs) are a rapidly emerging class of smart materials that can be stored in a deformed temporary shape, and can actively return to their original shape upon application of an external stimulus such as heat, pH or light. This behavior is particularly advantageous for minimally invasive biomedical applications comprising embolic/regenerative scaffolds, as it enables a transcatheter delivery of the device to the target site. The focus of this work was to exploit this shape memory behavior of polyurethanes, and develop an efficient embolic SMP foam device for the treatment of intracranial aneurysms.In summary, this work reports a novel family of ultra low density polymer foams which can be delivered via a minimally invasive surgery to the aneurysm site, actuated in a controlled manner to efficiently embolize the aneurysm while promoting physiological fluid/blood flow through the reticulated/open porous structure, and eventually biodegrade leading to complete healing of the vasculature.

  10. MRI-validation of SEP monitoring for ischemic events during microsurgical clipping of intracranial aneurysms.

    Science.gov (United States)

    Krayenbühl, Niklaus; Sarnthein, Johannes; Oinas, Minna; Erdem, Eren; Krisht, Ali F

    2011-09-01

    During surgical clipping of intracranial aneurysms, reduction in SEP amplitude is thought to indicate cortical ischemia and subsequent neurological deficits. Since the sensitivity of SEP is questioned, we investigated SEP with respect to post-operative ischemia. In 36 patients with 51 intracranial aneurysms, clinical evaluation and diffusion-weighted MRI (DWI) was performed before and within 24h after surgery. During surgery, time of temporary occlusion was recorded. MRI images were reviewed for signs of ischemia. For 43 clip applications (84%), we observed neither pathologic SEP events nor ischemia in MRI. In two cases where reduction lasted >10 min after clip release, SEP events correlated with ischemia in the MRI. Only one of the ischemic patients was symptomatic and developed a transient hemiparesis. While pathologic SEP events correlated with visible ischemia in MRI only in two cases with late SEP recovery, ischemia in MRI may have been transient or may not have reached detection threshold in the other cases, in agreement with the absence of permanent neurological deficits. In complex aneurysm cases, where prolonged temporary occlusion is expected, SEP should be used to detect ischemia at a reversible stage to improve the safety of aneurysm clipping. Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  11. Onyx HD-500 embolization of intracranial aneurysms: modified technique using continuous balloon inflation under conscious sedation.

    Science.gov (United States)

    Rahme, Ralph; Grande, Andrew; Jimenez, Lincoln; Abruzzo, Todd A; Ringer, Andrew J

    2014-08-01

    The conventional technique of intracranial aneurysm embolization using Onyx HD-500 (ev3 Neurovascular, Irvine, CA, USA) involves repetitive balloon inflation-deflation cycles under general anesthesia. By limiting parent artery occlusion to 5 minutes, this cyclic technique is thought to minimize cerebral ischemia. However, intermittent balloon deflation may lengthen procedure time and allow balloon migration, resulting in intimal injury or Onyx leakage. We report our experience using a modified technique of uninterrupted Onyx injection with continuous balloon occlusion under conscious sedation. All Onyx embolization procedures for unruptured aneurysms performed by the senior author (A.J.R.) between September 2008 and April 2010 were retrospectively reviewed. Demographic, clinical, angiographic, and procedural data were recorded. Twenty-four embolization procedures were performed in 21 patients with 23 aneurysms, including four recurrences. Twenty aneurysms (87%) involved the paraclinoid or proximal supraclinoid internal carotid artery. Size ranged from 2.5 to 24mm and neck diameter from 2 to 8mm. The modified technique was employed in 19 cases. All but one patient (94.4%) tolerated continuous balloon inflation. Complete occlusion was achieved in 20 aneurysms (83.3%) and subtotal occlusion in three (12.5%). Stable angiographic results were seen in 85%, 94%, 94%, and 100% of patients at 6, 12, 24, and 36months, respectively. There were no deaths. Permanent non-disabling neurological morbidity occurred in one patient (4.2%). Minor, transient, and/or angiographic complications were seen in three patients (12.5%), none related to the technique itself. Onyx embolization of unruptured intracranial aneurysms can be safely and effectively performed using continuous balloon inflation under conscious sedation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Outcome of intracranial aneurysm surgery: single center experience

    Directory of Open Access Journals (Sweden)

    Murat Ulutas

    2016-12-01

    Conclusion: Multiple aneurysms, poor grade and intracerebral hematomas are poor prognostic factors. The patients who have subarachnoid hemorrhage should be monitored by an experienced team of neurosurgery and intensive care and should be operated on as soon as possible because of rehemorrhage risk. The surgical clipping as a gold standard is still an affective and successful method. [Cukurova Med J 2016; 41(4.000: 732-743

  13. [Coil embolization for incidental aneurysms in patients with chronic renal failure: midterm clinical results of two cases].

    Science.gov (United States)

    Nakashima, T; Katou, T; Murakawa, T; Yamakawa, H; Yoshimura, S; Kaku, Y; Sakai, N

    2000-06-01

    In spite of recent advances in perioperative management, the risk of neurosurgical intervention for patients with chronic renal failure is still considered too high. In this study, coil embolization for incidental aneurysms in such patients is demonstrated in reference to midterm results. A 42-year-old woman with a history of hemodialisis for 7 years presented with subcortical hemorrhage in her right frontal lobe. The magnetic resonance angiography (MRA) demonstrated a distal anterior cerebral artery aneurysm, but it was considered to be unrelated to the hemorrhage. Two and a half months after the hemorrhage the aneurysm was embolized with interlocking detachable coils. Thirty months after embolization, the angiogram revealed the coil compaction and the recanalization of the aneurysm neck. However, 54 months after embolization, the figure of the embolized aneurysm and neck remnant was the same as the previous findings. A 69-year-old woman with a history of hemodialisis for 5 years suddenly experienced left hemiparesis. Computed tomography revealed cerebral infarction in the right frontoparietal white matter. In addition, a left middle cerebral artery aneurysm was unexpectedly found on the MRA. Five months after the onset of the attack, the aneurysm was embolized with a Guglielmi detachable coli. An angiogram obtained 24 months after the embolization showed the aneurysm to be almost completely obliterated. In considering the therapeutic risks and benefits for incidental aneurysms of patients with chronic renal failure, intra-vascular surgery could be recommended as a less invasive treatment.

  14. [Endovascular coiling of a «true» posterior communicating artery aneurysm].

    Science.gov (United States)

    Almeida-Pérez, Rafael; Espinosa-García, Héctor; Alcalá-Cerra, Gabriel; de la Rosa-Manjarréz, Ginna; Orozco-Gómez, Fernando

    2014-01-01

    True posterior communicating artery aneurysms originate exclusively from the wall of this artery and should be differentiated from aneurysms of the posterior communicating segment of the distal carotid artery. As these lesions are rare, their anatomical relationships have been poorly described; likewise, reports concerning their endovascular treatment are extremely rare and the technical aspects poorly detailed. A case of a patient with a true aneurysm of the left posterior communicating artery treated by endovascular coiling is presented. A literature review was also conducted to illustrate the anatomical and technical details relevant to achieving its successful treatment. Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  15. Reactive tissue proliferation and damage of elastic lamina caused by hydrogel coated coils in experimental rat aneurysms.

    Science.gov (United States)

    Zhang, Chao; Chaudhary, Neeraj; Gemmete, Joseph J; Thompson, B Gregory; Xi, Guohua; Pandey, Aditya S

    2014-07-01

    The HydroCoil Endovascular Aneurysm Occlusion and Packing Study clinical trial, comparing HydroCoil with platinum coils, reported an 8.6% reduction in significant recurrence following cerebral aneurysm coil embolization. We sought to better understand the mechanism of aneurysmal healing following HydroCoil implantation using the rat external carotid artery (ECA) sidewall aneurysm model. We ligated the proximal ECA, creating a blind pouch in our rat model. HydroCoil or bare platinum coil segments (5 mm) were inserted into aneurysms. Sham operated rats underwent identical procedures without coil insertion. 14 days after coil embolization, animals were sacrificed and the common carotid artery/internal carotid artery/ECA complex removed. Sac and surrounding vasculature underwent microscopic and histopathologic evaluation. Cellular and fibrotic components within the sac were defined as the organized area. Percentage of organized area and residual length of internal elastic lamina were calculated. Organized tissue area in ECA sac 2 weeks following coil embolization was significantly greater in the HydroCoil group than the bare coil (60.42±22.58% vs 15.62±19.24%; p=0.01) and sham (60.42±22.58% vs 4.61±3.86%; p=0.002) groups. Elastic lamina was significantly reduced in the HydroCoil group compared with the sham and bare coil groups (21.67±16.50% vs 100% and 96.06±8.78%; both pgroups for organized tissue formation or reduction in elastic lamina. Greater numbers of B cells, T cells, and neutrophils were present within HydroCoil induced organized tissue compared with the platinum group; this difference was not statistically significant. In the rat ECA sidewall aneurysm model, hydrogel coated coils cause more tissue reaction and organization compared with bare platinum coils, possibly attributed to observed elastic lamina damage and vascular smooth muscle cell proliferation. Published by the BMJ Publishing Group Limited. For permission to use (where not already

  16. The Use of Flow Diverter in Ruptured, Dissecting Intracranial Aneurysms of the Posterior Circulation.

    Science.gov (United States)

    Maus, Volker; Mpotsaris, Anastasios; Dorn, Franziska; Möhlenbruch, Markus; Borggrefe, Jan; Stavrinou, Pantelis; Abdullayev, Nuran; Barnikol, Utako Birgit; Liebig, Thomas; Kabbasch, Christoph

    2017-12-23

    Acute dissecting aneurysms of the posterior circulation are a rare cause of subarachnoid hemorrhage. Established endovascular treatment options include parent artery occlusion and stent-assisted coiling, but appear to be associated with an increased risk of ischemic stroke. Vessel reconstruction with flow diverters is an alternative treatment option; however, its safety and efficacy in the acute stage remains unclear. This is a multicentric retrospective analysis of 15 consecutive acutely ruptured dissecting posterior circulation aneurysms treated with flow diverters. The primary end point was favorable aneurysm occlusion, defined as OKM C1-3 and D (O'Kelly Marotta scale). Secondary end points were procedure-related complications and clinical outcome. Nine of 15 aneurysms (60%) arose from the intradural portion of the vertebral artery, 3 were located on the posterior inferior cerebellar artery and 1 each on the anterior inferior cerebellar artery, posterior cerebral artery, and basilar artery. Flow diverter placement was technically successful in 14 of 15 cases (93%). After endovascular treatment, none of the ruptured aneurysms rebled. Median clinical follow-up was 217 days and median angiographic follow-up was 203 days. Favorable occlusion was observed in 7 of 14 aneurysms (50%) directly after flow diverter placement; of those, 5 were completely occluded (36%). Seven patients (47%) with poor-grade subarachnoid hemorrhage died in the acute phase. Favorable clinical outcome (modified Rankin scale ≤2) was observed in 4 of 15 patients (27%) and a moderate outcome (modified Rankin scale 3/4) was observed in 5 of 15 patients (33%). All aneurysms showed complete occlusion at follow-up. Flow diverters might be a feasible, alternative treatment option for acutely ruptured dissecting posterior circulation aneurysms and may effectively prevent rebleeding. Larger cohort studies are required to validate these results. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. CFD and PIV analysis of hemodynamics in a growing intracranial aneurysm.

    Science.gov (United States)

    Raschi, Marcelo; Mut, Fernando; Byrne, Greg; Putman, Christopher M; Tateshima, Satoshi; Viñuela, Fernando; Tanoue, Tetsuya; Tanishita, Kazuo; Cebral, Juan R

    2012-02-01

    Hemodynamics is thought to be a fundamental factor in the formation, progression, and rupture of cerebral aneurysms. Understanding these mechanisms is important to improve their rupture risk assessment and treatment. In this study, we analyze the blood flow field in a growing cerebral aneurysm using experimental particle image velocimetry (PIV) and computational fluid dynamics (CFD) techniques. Patient-specific models were constructed from longitudinal 3D computed tomography angiography images acquired at 1-y intervals. Physical silicone models were constructed from the computed tomography angiography images using rapid prototyping techniques, and pulsatile flow fields were measured with PIV. Corresponding CFD models were created and run under matching flow conditions. Both flow fields were aligned, interpolated, and compared qualitatively by inspection and quantitatively by defining similarity measures between the PIV and CFD vector fields. Results showed that both flow fields were in good agreement. Specifically, both techniques provided consistent representations of the main intra-aneurysmal flow structures and their change during the geometric evolution of the aneurysm. Despite differences observed mainly in the near wall region, and the inherent limitations of each technique, the information derived is consistent and can be used to study the role of hemodynamics in the natural history of intracranial aneurysms.

  18. Delayed aneurysm rupture due to residual blood flow at the inflow zone of the intracranial paraclinoid internal carotid aneurysm treated with the Pipeline embolization device: Histopathological investigation.

    Science.gov (United States)

    Ikeda, Hiroyuki; Ishii, Akira; Kikuchi, Takayuki; Ando, Mitsushige; Chihara, Hideo; Arai, Daisuke; Hattori, Etsuko; Miyamoto, Susumu

    2015-12-01

    Cerebral aneurysm rupture is a serious complication that can occur after flow diverter (FD) placement, but the underlying mechanisms remain unclear. We encountered a case in which direct stress on the aneurysm wall caused by residual blood flow at the inflow zone near the neck during the process of thrombosis after FD placement appeared associated with aneurysm rupture. The patient was a 67-year-old woman with progressive optic nerve compression symptoms caused by a large intracranial paraclinoid internal carotid aneurysm. The patient had undergone treatment with a Pipeline embolization device (PED) with satisfactory adherence between the PED and vessel wall. Surgery was completed without complications, and optic nerve compression symptoms improved immediately after treatment. Postoperative clinical course was satisfactory, but the patient suddenly died 34 days postoperatively. Autopsy confirmed the presence of subarachnoid hemorrhage caused by rupture of the internal carotid aneurysm that had been treated with PED. Although the majority of the aneurysm lumen including the outflow zone was thrombosed, a non-thrombosed area was observed at the inflow zone. Perforation was evident in the aneurysm wall at the inflow zone near the neck, and this particular area of aneurysm wall was not covered in thrombus. Macrophage infiltration was not seen on immunohistochemical studies of the aneurysm wall near the perforation. A hemodynamically unstable period during the process of complete thrombosis of the aneurysm lumen after FD placement may be suggested, and blood pressure management and appropriate management with antiplatelet therapy may be important. © The Author(s) 2015.

  19. CFD: computational fluid dynamics or confounding factor dissemination? The role of hemodynamics in intracranial aneurysm rupture risk assessment.

    Science.gov (United States)

    Xiang, J; Tutino, V M; Snyder, K V; Meng, H

    2014-10-01

    Image-based computational fluid dynamics holds a prominent position in the evaluation of intracranial aneurysms, especially as a promising tool to stratify rupture risk. Current computational fluid dynamics findings correlating both high and low wall shear stress with intracranial aneurysm growth and rupture puzzle researchers and clinicians alike. These conflicting findings may stem from inconsistent parameter definitions, small datasets, and intrinsic complexities in intracranial aneurysm growth and rupture. In Part 1 of this 2-part review, we proposed a unifying hypothesis: both high and low wall shear stress drive intracranial aneurysm growth and rupture through mural cell-mediated and inflammatory cell-mediated destructive remodeling pathways, respectively. In the present report, Part 2, we delineate different wall shear stress parameter definitions and survey recent computational fluid dynamics studies, in light of this mechanistic heterogeneity. In the future, we expect that larger datasets, better analyses, and increased understanding of hemodynamic-biologic mechanisms will lead to more accurate predictive models for intracranial aneurysm risk assessment from computational fluid dynamics. © 2014 by American Journal of Neuroradiology.

  20. Comparison of eye-lens doses imparted during interventional and non-interventional neuroimaging techniques for assessment of intracranial aneurysms.

    Science.gov (United States)

    Guberina, N; Dietrich, U; Forsting, M; Ringelstein, A

    2017-02-27

    A neurointerventional examination of intracranial aneurysms often involves the eye lens in the primary beam of radiation. To assess and compare eye-lens doses imparted during interventional and non-interventional imaging techniques for the examination of intracranial aneurysms. We performed a phantom study on an anthropomorphic phantom (ATOM dosimetry phantom 702-D; CIRS, Norfolk, Virginia, USA) and assessed eye-lens doses with thermoluminescent dosimeters (TLDs) type 100 (LiF:Mg, Ti) during (1) interventional (depiction of all cerebral arteries with triple 3D-rotational angiography and twice 2-plane DSA anteroposterior and lateral projections) and (2) non-interventional (CT angiography (CTA)) diagnosis of intracranial aneurysms. Eye-lens doses were calculated following recommendations of the ICRP 103. Image quality was analysed in retrospective by two experienced radiologists on the basis of non-interventional and interventional pan-angiography examinations of patients with incidental aneurysms (n=50) on a five-point Likert scale. The following eye-lens doses were assessed: (1) interventional setting (triple 3D-rotational angiography and twice 2-plane DSA anteroposterior and lateral projections) 12 mGy; (2) non-interventional setting (CTA) 4.1 mGy. Image quality for depiction of intracranial aneurysms (>3 mm) was evaluated as good by both readers for both imaging techniques. Eye-lens doses are markedly higher during the interventional than during the non-interventional diagnosis of intracranial aneurysms. For the eye-lens dose, CTA offers considerable radiation dose savings in the diagnosis of intracranial aneurysms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  1. Is eptifibatide a safe and effective rescue therapy in thromboembolic events complicating cerebral aneurysm coil embolization? Single-center experience in 42 cases and review of the literature.

    Science.gov (United States)

    Sedat, Jacques; Chau, Yves; Mondot, Lydiane; Chemla, Richard; Lonjon, Michel; Padovani, Bernard

    2014-02-01

    Thromboembolic complications are the most frequent perioperative complications of endovascular treatment of intracranial aneurysms. Even if the effectiveness of glycoprotein IIb/IIIa inhibitors has been reported, the outcomes in published clinic data are contradictory. This study aims to assess the effectiveness and the safety of eptifibatide in thromboembolic complications during intracranial aneurysm embolization procedure. Between 2006 and 2012, 650 patients with intracranial aneurysm were treated using endovascular coil embolization, and in 62 cases (9.5 %), an intra-arterial thrombus developed. Glycoprotein IIb/IIIa inhibitor was administrated in 45 of them who required a rescue treatment. These 45 patients were treated with an intra-arterial bolus (0.2 mg/kg) of eptifibatide. We respectively reviewed the angiographic and clinical outcomes, and the periprocedural complications of the rescue treatment. No intra- or early postoperative (48 h) bleeding was observed after treatment. A total recovery of the entire arterial tree (TICI 3) was established in 28 cases (62.2 %), a partial revascularization in 13 cases (28.8 %) (5 TICI 2A and 8 TICI 2B), and no revascularization or reperfusion (TICI 0 or TICI 1) in 4 cases (9 %). Eptifibatide was more effective on proximal obstructions and in-stent occlusions than on peripheral distal thrombus, which were completely disintegrated one time out of three. Intra-operative intra-arterial use of eptifibatide does not imply an increase of hemorrhagic events. Even if eptifibatide allows for a high rate of arterial recanalization, its effectiveness seems to be less important in cases of distal occlusions.

  2. Presence of inflammatory proteins S100A8 and S100A9 in a giant intracranial aneurysm after flow diverter treatment.

    Science.gov (United States)

    de Korte, Antonius M; Aquarius, René; Meijer, Frederick J A; van Lent, Peter; Boogaarts, Hieronymus D; de Vries, Joost

    2017-05-12

    We demonstrate the presence of S100A8 and S100A9 proteins in the wall and thrombosed lumen of an enlarged intracranial aneurysm after flow diverter treatment. These proteins have shown to play an important role in vascular inflammation and may serve as a biomarker and potential therapeutic target for intracranial aneurysms.

  3. Porous media properties of reticulated shape memory polymer foams and mock embolic coils for aneurysm treatment.

    Science.gov (United States)

    Muschenborn, Andrea D; Ortega, Jason M; Szafron, Jason M; Szafron, David J; Maitland, Duncan J

    2013-10-12

    Shape memory polymer (SMP) foams are being investigated as an alternative aneurysm treatment method to embolic coils. The goal of both techniques is the reduction of blood flow into the aneurysm and the subsequent formation of a stable thrombus, which prevents future aneurysm rupture. The purpose of this study is to experimentally determine the parameters, permeability and form factor, which are related to the flow resistance imposed by both media when subjected to a pressure gradient. The porous media properties-permeability and form factor-of SMP foams and mock embolic coils (MECs) were measured with a pressure gradient method by means of an in vitro closed flow loop. We implemented the Forchheimer-Hazen-Dupuit-Darcy equation to calculate these properties. Mechanically-reticulated SMP foams were fabricated with average cell sizes of 0.7E-3 and 1.1E-3 m, while the MECs were arranged with volumetric packing densities of 11-28%. The permeability of the SMP foams was an order of magnitude lower than that of the MECs. The form factor differed by up to two orders of magnitude and was higher for the SMP foams in all cases. The maximum flow rate of all samples tested was within the inertial laminar flow regime, with Reynolds numbers ranging between 1 and 35. The SMP foams impose a greater resistance to fluid flow compared to MECs, which is a result of increased viscous and inertial losses. These results suggest that aneurysms treated with SMP foam will have flow conditions more favorable for blood stasis than those treated with embolic coils having packing densities ≤ 28%.

  4. Flow Diversion for Treatment of Growing A2 Aneurysm in a Child: Case Report and Review of Flow Diversion for Intracranial Aneurysms in Pediatric Patients.

    Science.gov (United States)

    Vachhani, Jay Ashok; Nickele, Christopher Michael; Elijovich, Lucas; Klimo, Paul; Arthur, Adam Stephen

    2016-12-01

    Intracranial flow diversion has gained increasing popularity since the approval of the Pipeline Embolization Device (PED). Although it is only approved for use in adult patients, the PED has been used to treat aneurysms in pediatric patients. We present the first reported case of the use of a PED in a pediatric patient to treat an unusual fusiform distal anterior cerebral artery aneurysm. A 12-year-old girl presented with new onset seizures and was found to have a distal left anterior cerebral artery aneurysm. Initially, this was managed conservatively, but follow-up imaging performed 4 months after presentation demonstrated enlargement of the aneurysm. The patient underwent endovascular embolization of her aneurysm with PED. This was successfully performed and the patient recovered from the procedure with no neurologic deficits. Follow-up digital subtraction angiography and magnetic resonance angiography at 6 and 12 months, respectively, showed complete occlusion of the aneurysm. We also reviewed the literature on flow diversion for treatment of pediatric intracranial aneurysms. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Intracranial Aneurysms Involving Circle of Willis in a Child with Human Immunodeficiency Virus Associated Vasculitis- A Rare Case Report.

    Science.gov (United States)

    Lahoti, Amol Madanlal; Taori, Abhijit Kishor; Dhok, Avinash Parashuram; Rawat, Jitesh Subhash; Chandak, Nihar Umakant

    2017-07-01

    Intracranial Arterial Aneurysms (IAAs) are relatively rare in paediatric population and they account for at least 10%-15% of haemorrhagic strokes which occur during the first two decades of life. Here we present a unique and unusual case of Human Immunodeficiency Virus (HIV) infected child who presented with intracranial aneurysms with formation of collaterals and vasculopathy, demonstrating low viral count despite receiving adequate antiretroviral treatment. Intracranial vascular involvement, their complications and its incidence in these patients may become increasingly common as the management of human immunodeficiency virus infection continues to improve and afflicted patients survive for longer periods because of advancement in the antiretroviral treatment. Diagnosing aneurysm of cerebral circulation needs high degree of suspicion and correlation between clinical and radiological findings.

  6. Application of virtual reality techniques in preoperative surgical planning for intracranial anterior circulation aneurysms

    Directory of Open Access Journals (Sweden)

    Shou-sen WANG

    2012-05-01

    Full Text Available Objective  To investigate the value of virtual reality (VR technique in the surgical planning for anterior circulation aneurysms of Willis circle. Methods  A total of 50 patients with 57 aneurysms confirmed by CT angiography in the anterior circle of Willis were enrolled in this study. In preoperative Hunt-Hess scale, grade Ⅰ was designated in 7 patients, grade Ⅱ in 22, grade Ⅲ in 17, grade Ⅳ in 3, grade Ⅴ in 1 patient. Among the aneurysms, 16 were small (≤5mm in diameter, 28 medium (5-15mm, 10 large (15-25mm and 3 giant (≥25mm in size. The thin-slice head scanning data were achieved by 64-slice spiral CT machine. These data was then transferred into Dextroscope image workstation. The virtual imaging system generated clear and vivid virtual images. We compared the findings between simulation surgical operation and actual operation. Results  VR system make the operator felt "personally on the scene" and was able to communicate with the imaging. It could not only visually display the anatomical structures in three dimensions, but also could simulate some surgical procedures, which basically simulated the same outcome of actual operation. All the 50 patients were successfully treated by microsurgical clipping of main aneurysmal or contributory aneurysmal necks. Conclusions  The surgeons is able to be more confident, and the identification for the complex vascular abnormality is improved by planning operative procedure in virtual-reality environment. The virtual-reality system makes the actual operative procedure more concise, thus it is of positive value in surgery for intracranial aneurysm.

  7. Blood flow in intracranial aneurysms treated with Pipeline embolization devices: computational simulation and verification with Doppler ultrasonography on phantom models

    Directory of Open Access Journals (Sweden)

    Anderson Chun On Tsang

    2015-04-01

    Full Text Available Purpose: The aim of this study was to validate a computational fluid dynamics (CFD simulation of flow-diverter treatment through Doppler ultrasonography measurements in patient-specific models of intracranial bifurcation and side-wall aneurysms. Methods: Computational and physical models of patient-specific bifurcation and sidewall aneurysms were constructed from computed tomography angiography with use of stereolithography, a three-dimensional printing technology. Flow dynamics parameters before and after flow-diverter treatment were measured with pulse-wave and color Doppler ultrasonography, and then compared with CFD simulations. Results: CFD simulations showed drastic flow reduction after flow-diverter treatment in both aneurysms. The mean volume flow rate decreased by 90% and 85% for the bifurcation aneurysm and the side-wall aneurysm, respectively. Velocity contour plots from computer simulations before and after flow diversion closely resembled the patterns obtained by color Doppler ultrasonography. Conclusion: The CFD estimation of flow reduction in aneurysms treated with a flow-diverting stent was verified by Doppler ultrasonography in patient-specific phantom models of bifurcation and side-wall aneurysms. The combination of CFD and ultrasonography may constitute a feasible and reliable technique in studying the treatment of intracranial aneurysms with flow-diverting stents.

  8. Blood flow in intracranial aneurysms treated with Pipeline embolization devices: computational simulation and verification with Doppler ultrasonography on phantom models.

    Science.gov (United States)

    Tsang, Anderson Chun On; Lai, Simon Sui Man; Chung, Wai Choi; Tang, Abraham Yik Sau; Leung, Gilberto Ka Kit; Poon, Alexander Kai Kei; Yu, Alfred Cheuk Hang; Chow, Kwok Wing

    2015-04-01

    The aim of this study was to validate a computational fluid dynamics (CFD) simulation of flow-diverter treatment through Doppler ultrasonography measurements in patient-specific models of intracranial bifurcation and side-wall aneurysms. Computational and physical models of patient-specific bifurcation and sidewall aneurysms were constructed from computed tomography angiography with use of stereolithography, a three-dimensional printing technology. Flow dynamics parameters before and after flow-diverter treatment were measured with pulse-wave and color Doppler ultrasonography, and then compared with CFD simulations. CFD simulations showed drastic flow reduction after flow-diverter treatment in both aneurysms. The mean volume flow rate decreased by 90% and 85% for the bifurcation aneurysm and the side-wall aneurysm, respectively. Velocity contour plots from computer simulations before and after flow diversion closely resembled the patterns obtained by color Doppler ultrasonography. The CFD estimation of flow reduction in aneurysms treated with a flow-diverting stent was verified by Doppler ultrasonography in patient-specific phantom models of bifurcation and side-wall aneurysms. The combination of CFD and ultrasonography may constitute a feasible and reliable technique in studying the treatment of intracranial aneurysms with flow-diverting stents.

  9. Hemodynamics, inflammation, vascular remodeling, and the development and rupture of intracranial aneurysms: a review

    Directory of Open Access Journals (Sweden)

    Francesco Signorelli

    2015-06-01

    Full Text Available The central nervous system is an immunologically active environment where several components of the immune and inflammatory response interact among them and with the constituents of nervous tissue and vasculature in a critically orchestrated manner, influencing physiologic and pathologic processes. In particular, inflammation takes a central role in the pathogenesis of intracranial aneurysms (IAs. The common pathway for aneurysm formation involves endothelial dysfunction and injury, a mounting inflammatory response, vascular smooth muscle cells (VSMCs phenotypic modulation, extracellular matrix remodeling, and subsequent cell death and vessel wall degeneration. We conducted a literature review (1980-2014 by Medline and EMBASE databases using the searching terms "IA" and "cerebral aneurysm" and further search was performed to link the search terms with the following key words: inflammation, hemodynamic(s, remodeling, macrophages, neutrophils, lymphocytes, complement, VSMCs, mast cells, cytokines, and inflammatory biomarkers. The aim of this review was to summarize the most recent and pertinent evidences regarding the articulated processes of aneurysms formation, growth, and rupture. Knowledge of these processes may guide the diagnosis and treatment of these vascular malformations, the most common cause of subarachnoid hemorrhage, which prognosis remains dismal.

  10. Modeling of the acute effects of primary hypertension and hypotension on the hemodynamics of intracranial aneurysms.

    Science.gov (United States)

    Sarrami-Foroushani, Ali; Villa-Uriol, Maria-Cruz; Nasr Esfahany, Mohsen; Coley, Stuart C; Di Marco, Luigi Yuri; Frangi, Alejandro F; Marzo, Alberto

    2015-01-01

    Hemodynamics is a risk factor in intracranial aneurysms (IA). Hypertension and pharmacologically induced hypotension are common in IA patients. This study investigates how hypertension and hypotension may influence aneurysmal hemodynamics. Images of 23 IAs at typical locations were used to build patient-specific Computational Fluid Dynamics models. The effects of hypotension and hypertension were simulated through boundary conditions by modulating the normotensive flow and pressure waveforms, in turn produced by a 1D systemic vascular model. Aneurysm location and flow pattern types were used to categorize the influence of hypotension and hypertension on relevant flow variables (velocity, pressure and wall shear stress). Results indicate that, compared to other locations, vertebrobasilar aneurysms (VBA) are more sensitive to flow changes. In VBAs, space-averaged velocity at peak systole increased by 30% in hypertension (16-21% in other locations). Flow in VBAs in hypotension decreased by 20% (10-13% in other locations). Momentum-driven hemodynamic types were also more affected by hypotension and hypertension, than shear-driven types. This study shows how patient-specific modeling can be effectively used to identify location-specific flow patterns in a clinically-relevant study, thus reinforcing the role played by modeling technologies in furthering our understanding of cardiovascular disease, and their potential in future healthcare.

  11. Fluid-Structure Simulations of a Ruptured Intracranial Aneurysm: Constant versus Patient-Specific Wall Thickness

    Directory of Open Access Journals (Sweden)

    S. Voß

    2016-01-01

    Full Text Available Computational Fluid Dynamics is intensively used to deepen the understanding of aneurysm growth and rupture in order to support physicians during therapy planning. However, numerous studies considering only the hemodynamics within the vessel lumen found no satisfactory criteria for rupture risk assessment. To improve available simulation models, the rigid vessel wall assumption has been discarded in this work and patient-specific wall thickness is considered within the simulation. For this purpose, a ruptured intracranial aneurysm was prepared ex vivo, followed by the acquisition of local wall thickness using μCT. The segmented inner and outer vessel surfaces served as solid domain for the fluid-structure interaction (FSI simulation. To compare wall stress distributions within the aneurysm wall and at the rupture site, FSI computations are repeated in a virtual model using a constant wall thickness approach. Although the wall stresses obtained by the two approaches—when averaged over the complete aneurysm sac—are in very good agreement, strong differences occur in their distribution. Accounting for the real wall thickness distribution, the rupture site exhibits much higher stress values compared to the configuration with constant wall thickness. The study reveals the importance of geometry reconstruction and accurate description of wall thickness in FSI simulations.

  12. [Results of deconstructive endovascular surgery in treatment of large and giant intracranial aneurysms].

    Science.gov (United States)

    Arustamyan, S R; Yakovlev, S B; Shakhnovich, A R; Krasnoperov, I V; Sazonova, O B; Bocharov, A V; Bukharin, E Yu; Belousova, O B; Kaftanov, A N

    To clarify the indications for deconstructive endovascular surgery in patients with large and giant intracranial aneurysms and to evaluate short-term and long-term postoperative outcomes. The study was based on a retrospective analysis of the treatment results in 50 patients with large (15-25 mm) and giant (more than 25 mm) intracranial aneurysms, aged from 18 to 75 years, who were treated at the Burdenko Neurosurgical Institute in 2002-2014. The patients underwent a balloon occlusion test (BOT) in various modifications before stationary occlusion of the carrier artery. For vascular occlusion, we used detachable latex balloon catheters (33 cases) and microcoils (17 cases). The condition of patients in the pre- and postoperative period was assessed by using the modified Rankin Scale. There were no deaths due to occlusion of the internal carotid artery (37 patients). Postoperative complications occurred in 5 patients. On the basis of BOT, revascularization surgery involving placement of an extra-intracranial microanastomosis (EICMA) was performed in 6 cases. In more 4 cases, EICMA was placed in the early postoperative period due to developing signs of ischemia. Two of 7 patients underwent occlusion of both vertebral arteries (VAs) in the vertebrobasilar basin, which led to fatal outcomes. One more patient died of aggravation of brainstem compression after VA occlusion. There was no worsening of neurological symptoms among survivors. There were no deaths and persistent neurological disorders upon occlusion of branches of the main cerebral arteries, starting with the first order arteries (6 patients). Thirty one patients (66%) were followed-up in the period from 1 to 104 months. There were no deaths associated with artery occlusion. Two patients experienced delayed ischemic disorders. Occlusion of the carrier artery should be performed in a carefully selected group of BOT-negative patients. This surgery can be indicated for aneurysms with a complicated configuration

  13. Postsurgical examination of functional outcome of patients having undergone surgical treatment of intracranial aneurysm.

    Science.gov (United States)

    Slusarz, Robert; Beuth, Wojciech; Ksiazkiewicz, Barbara

    2009-03-01

    Research into outcomes from surgical intervention for intracranial aneurysms have focused on the clinical picture of the disease entity and death rate, comparison of different surgical methods, as well as the most common postoperative and postbleeding complications. From the nursing standpoint, the crucial element in assessing postoperative patients is the broadly understood functional outcome defining patients' ability to function in life, while at the same time recognising the impairments, in which patients will be dependent on the nursing staff. The aim of the study was to assess the functional outcomes of patients in the days following the surgical treatment. The research was carried out in Neurosurgical Department and Clinic, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland. A longitudinal study was carried out with 128 patients having undergone removal of an intracranial aneurysm. In the research both the observation and measuring scores were used. Also Hunt and Hess Grades, the Glasgow Coma Score and the Glasgow Outcome Score were used. To assess functional outcomes of patients, the Functional Capacity Scale was used. The research shows that the functional outcome improves with time, see Statistical analysis (p < 0.001). In the majority of patients some functional outcome deficit was observed mainly in the areas such as relieving oneself and maintaining personal hygiene. The conclusions from the research are as follows: (1) following the surgical treatment of the intracranial aneurysm (day 1, 3, 6 and 9) the majority of patients displayed considerable lack of functional outcome, and were therefore dependent on the nursing staff and relatives (family and friends); (2) on discharge (final measurement) patients were largely self-dependent and displayed negligible impairments of functional outcome.

  14. Type A interrupted aortic arch accompanied by intracranial aneurysms causing subarachnoid hemorrhage in an adult man.

    Science.gov (United States)

    Eren, Suat; Kantarci, Mecit; Pirimoglu, Berhan; Cakir, Murteza; Ogul, Hayri

    2014-01-01

    Interrupted aortic arch anomaly (IAA) characterized by complete luminal dissociation between the ascending and descending aorta and accounting for less than 1% of all cases of congenital heart disease. IAA is a rare condition in infants that occurs approximately three times per million births. It is usually diagnosed and repaired during the neonatal period and is extremely rare in adults. We present the case of an adult man who was diagnosed with IAA accompanied by intracranial aneurysms causing subarachnoid hemorrhage and demonstrate the imaging findings with 256-slice computed tomography angiography and digital subtraction angiography. Copyright © 2014. Published by Elsevier Inc.

  15. Combined Surgical and Endovascular Management of a Giant Fusiform PCA Aneurysm in a Pediatric Patient: A Case Report

    OpenAIRE

    Shin, S H; Choi, I. S.; Thomas, K; David, C.A.

    2013-01-01

    Treatment of intracranial giant aneurysms presents is challenging. In the case of pediatric giant aneurysm, more challenges arise. We describe our experience with a 17-year-old pediatric patient who presented with severe headache. She was diagnosed as having a giant fusiform aneurysm at the right P1-P2-Pcom junction. The aneurysm was treated with superficial temporal artery-posterior cerebral artery bypass and subsequent coil embolization of the aneurysm with parent artery occlusion. The pati...

  16. Advances in open microsurgery for cerebral aneurysms.

    Science.gov (United States)

    Davies, Jason M; Lawton, Michael T

    2014-02-01

    Endovascular techniques introduced strong extrinsic forces that provoked reactive changes in aneurysm surgery. Microsurgery has become less invasive, more appealing to patients, lower risk, and efficacious for complex aneurysms, particularly those unfavorable for or failing endovascular therapy. To review specific advances in open microsurgery for aneurysms. A university-based, single-surgeon practice was examined for the use of minimally invasive craniotomies, surgical management of recurrence after coiling, the use of intracranial-intracranial bypass techniques, and cerebrovascular volume-outcome relationships. The mini-pterional, lateral supraorbital, and orbital-pterional craniotomies are minimally invasive alternatives to standard craniotomies. Mini-pterional and lateral supraorbital craniotomies were used in one-fourth of unruptured patients, increasing from 22% to 28%, whereas 15% of patients underwent orbital-pterional craniotomies and trended upward from 11% to 20%. Seventy-four patients were treated for coil recurrences (2.3% of all aneurysms) with direct clip occlusion (77%), clip occlusion after coil extraction (7%), or parent artery occlusion with bypass (16%). Intracranial-intracranial bypass (in situ bypass, reimplantation, reanastomosis, and intracranial grafts) transformed the management of giant aneurysms and made the surgical treatment of posterior inferior cerebellar artery aneurysms competitive with endovascular therapy. Centralization maximized the volume-outcome relationships observed with clipping. Aneurysm microsurgery has embraced minimalism, tailoring the exposure to the patient's anatomy with the smallest possible craniotomy that provides adequate exposure. The development of intracranial-intracranial bypasses is an important advancement that makes microsurgery a competitive option for complex and recurrent aneurysms. Trends toward centralizing aneurysm surgery in tertiary centers optimize results achievable with open microsurgery.

  17. The safety of vasopressor-induced hypertension in subarachnoid hemorrhage patients with coexisting unruptured, unprotected intracranial aneurysms.

    Science.gov (United States)

    Reynolds, Matthew R; Buckley, Robert T; Indrakanti, Santoshi S; Turkmani, Ali H; Oh, Gerald; Crobeddu, Emanuela; Fargen, Kyle M; El Ahmadieh, Tarek Y; Naidech, Andrew M; Amin-Hanjani, Sepideh; Lanzino, Giuseppe; Hoh, Brian L; Bendok, Bernard R; Zipfel, Gregory J

    2015-10-01

    Vasopressor-induced hypertension (VIH) is an established treatment for patients with aneurysmal subarachnoid hemorrhage (SAH) who develop vasospasm and delayed cerebral ischemia (DCI). However, the safety of VIH in patients with coincident, unruptured, unprotected intracranial aneurysms is uncertain. This retrospective multiinstitutional study identified 1) patients with aneurysmal SAH and 1 or more unruptured, unprotected aneurysms who required VIH therapy (VIH group), and 2) patients with aneurysmal SAH and 1 or more unruptured, unprotected aneurysms who did not require VIH therapy (non-VIH group). All patients had previously undergone surgical or endovascular treatment for the presumed ruptured aneurysm. Comparisons between the VIH and non-VIH patients were made in terms of the patient characteristics, clinical and radiographic severity of SAH, total number of aneurysms, number of ruptured/unruptured aneurysms, aneurysm location/size, number of unruptured and unprotected aneurysms during VIH, severity of vasospasm, degree of hypervolemia, and degree and duration of VIH therapy. For the VIH group (n = 176), 484 aneurysms were diagnosed, 231 aneurysms were treated, and 253 unruptured aneurysms were left unprotected during 1293 total days of VIH therapy (5.12 total years of VIH therapy for unruptured, unprotected aneurysms). For the non-VIH group (n = 73), 207 aneurysms were diagnosed, 93 aneurysms were treated, and 114 unruptured aneurysms were left unprotected. For the VIH and non-VIH groups, the mean sizes of the ruptured (7.2 ± 0.3 vs 7.8 ± 0.6 mm, respectively; p = 0.27) and unruptured (3.4 ± 0.2 vs 3.2 ± 0.2 mm, respectively; p = 0.40) aneurysms did not differ. The authors observed 1 new SAH from a previously unruptured, unprotected aneurysm in each group (1 of 176 vs 1 of 73 patients; p = 0.50). Baseline patient characteristics and comorbidities were similar between groups. While the degree of hypervolemia was similar between the VIH and non-VIH patients

  18. Reconstructive endovascular treatment of vertebral artery dissecting aneurysms with the Low-profile Visualized Intraluminal Support (LVIS) device

    National Research Council Canada - National Science Library

    Chuan-Chuan Wang; Yi-Bin Fang; Ping Zhang; Xuan Zhu; Bo Hong; Yi Xu; Jian-Min Liu; Qing-Hai Huang

    2017-01-01

    Introduction The Low-profile Visualized Intraluminal Support (LVIS) device is a new generation of self-expanding braided stent recently introduced in China for stent assisted coiling of intracranial aneurysms...

  19. Balloon-assisted coil embolization of the celiac trunk before endovascular aortic repair of thoracoabdominal aortic aneurysm.

    Science.gov (United States)

    Endo, Masayuki; Kaminou, Toshio; Ohuchi, Yasufumi; Sugiura, Kimihiko; Yata, Shinsaku; Adachi, Akira; Kawai, Tsuyoshi; Takasugi, Syohei; Yamamoto, Shuichi; Matsumoto, Kensuke; Hashimoto, Masayuki; Ihaya, Takashi; Ogawa, Toshihide

    2013-03-01

    Celiac trunk coil embolization before thoracic endovascular aneurysm repair (TEVAR) of a thoracoabdominal aortic aneurysm involving the celiac trunk can prevent type II endoleaks. One disadvantage of conventional coil embolization is the risk of coil displacement. We performed coil embolization under balloon occlusion of the celiac trunk to address this issue. Between December 2008 and January 2011, 5 patients (3 men and 2 women, mean age 76 years) were included in this study. For all patients, after confirming the collateral blood flow from the superior mesenteric artery via the pancreaticoduodenal arcades by using the balloon occlusion test, celiac trunk coil embolization proceeded under balloon occlusion of the proximal part of the celiac trunk. Balloon-assisted coil embolization of the celiac trunk was completed for all patients without any complications. All coils were deployed as planned in the short segment of the celiac trunk without displacement. Coil migration, ischemic complications, and endoleaks via the celiac trunk did not arise in any of the patients over a follow-up period of 77-637 (mean 258) days. Balloon-assisted coil embolization of the celiac trunk before TEVAR could be a feasible treatment option for suitable patients.

  20. Two Distally Located Right SCA Aneurysms: Endovascular Treatment by Parent Artery Occlusion with GDC Coils and N-BCA Injection

    Science.gov (United States)

    Szajner, M.; Obszaska, K.; Nestorowicz, A.; Szczerbo-Trojanowska, M.

    2003-01-01

    Summary Peripheral aneurysms of the superior cerebellar artery are considered difficult to treat surgically and endovascularly because of their inaccessibility. Parent artery occlusion is therefore frequently the preferred method. Embolic materials previously reported in this situation are either GDC coils or a polymerizing agent (n-BCA). We report a patient with two distally located, wide-neck aneurysms of the right superior cerebellar artery who presented with hemorrhage and was treated by endovascular embolization of the parent artery using a combination of GDC coils and n-BCA. PMID:20591270

  1. Endovascular treatment for intracranial infectious aneurysms Tratamento endovascular de aneurismas infecciosos intracranianos

    Directory of Open Access Journals (Sweden)

    Eduardo Wajnberg

    2008-12-01

    Full Text Available OBJETIVE: To re-enforce an alternative, less aggressive treatment modality in the management of intracranial infectious aneurysms. METHOD: We present a series of five patients with infectious endocarditis and intracranial infectious aneurysms (mycotic aneurysms managed by means of endovascular treatment. RESULTS: Endovascular treatment was executed technically uneventfully in all patients. Three patients had favorable clinical outcome: two were classified as Glasgow Outcome Scale 4/5, and one had total neurological recovery (GOS 5/5. Two patients died (GOS 1/5, one in consequence of the initial intracranial bleeding and the other after cardiac complications from endocarditis and open-heart surgery. CONCLUSION: Endovascular techniques are an expanding option for the treatment of IIAs. It has been especially useful for infectious endocarditis patients with IIA, who will be submitted to cardiac surgery with cardiopulmonary bypass and anticoagulation, with the risk of intracranial bleeding.OBJETIVO: Enfatizar o método endovascular como uma opção de tratamento alternativa e menos agressiva no tratamento de aneurismas infecciosos intracranianos. MÉTODO: Apresentamos uma série de cinco pacientes com endocardite infecciosa e aneurismas infecciosos intra-cranianos (aneurismas micóticos tratados através da via endovascular. RESULTADOS: O tratamento endovascular teve sucesso técnico e sem intercorrências relacionadas ao cateterismo em todos os casos. Três pacientes tiveram desfecho clínico favorável: dois com escala de regeneração de Glasgow 4/5 e um com recuperação neurológica completa (GOS 5/5. Dois pacientes tiveram desfecho desfavorável (GOS 1/5, um devido às conseqüências do sangramento intracraniano inicial e outro devido a complicações cardíacas da endocardite e cirurgia de troca valvar. CONCLUSÃO: As técnicas endovasculares são uma nova opção de tratamento dos aneurismas infecciosos intracranianos. Ela é especialmente

  2. The Siesta Habit is Associated with a Decreased Risk of Rupture of Intracranial Aneurysms

    Directory of Open Access Journals (Sweden)

    Huibin Kang

    2017-09-01

    Full Text Available BackgroundPrevious studies have examined an association between the siesta habit and hypertension, as well as coronary heart disease. However, the relationship between a siesta and the risk of rupture of an intracranial aneurysm (IA has not yet been established. We aimed to investigate the effects of a siesta on the risk of rupture of IAs.MethodsWe prospectively enrolled consecutive patients diagnosed with IAs at our hospital between January 2016 and December 2016. Univariate and multivariate logistic regression analysis were performed to identify independent risk factors associated with IA rupture.ResultsWe studied 581 consecutive patients with 514 unruptured and 120 ruptured aneurysms. Univariate analysis demonstrated that hypertension, hyperlipidemia, diabetes mellitus, cigarette smoking, location, size, as well as shape and aspect ratio were associated with the risk of rupture of IAs. Multivariate analysis identified hypertension [odds ratio (OR 1.68, 95% confidence interval (CI 1.03–2.73], hyperlipidemia (OR 0.25, 95% CI 0.08–0.72, current cigarette smoking ≥20 cigarettes/day (d (OR 3.48, 95% CI 1.63–7.47, siesta (siesta time <1 h, OR 0.49, 95% CI 0.24–0.98 and siesta time ≥1 h, OR 0.32, 95% CI 0.19–0.57, location of largest aneurysm on the anterior communicating and internal carotid-posterior communicating artery (PCOM (anterior communicating artery OR 16.27, 95% CI 7.40–35.79 and PCOM OR 11.21, 95% CI 5.15–24.43, and size of aneurysm ≥7 mm (OR 2.19, 95% CI 1.21–3.97 as independent strong risk factors associated with risk of aneurysm rupture.ConclusionIn the present study, we found that a habitual siesta is a new predictive factor to assess the risk of rupture of an IA. We found the siesta habit may reduce the risk of aneurysm rupture. We also found that hypertension, hyperlipidemia, cigarette smoking, location, and size of aneurysm were associated with the risk of rupture of IAs.

  3. Clinical and imaging features of intracranial arterial aneurysms in the pediatric population.

    Science.gov (United States)

    Aeron, Gunjan; Abruzzo, Todd A; Jones, Blaise V

    2012-01-01

    Intracranial arterial aneurysms (IAAs) are rare in children. Nevertheless, IAAs account for at least 10%-15% of hemorrhagic strokes during the first 2 decades of life. Traditional vascular risk factors, which are common in the adult population, are generally absent in the pediatric population, engendering distinct modes of IAA pathogenesis. Classification of pediatric IAAs according to the pathogenetic mechanism shows eight distinct categories: idiopathic, traumatic, those due to excessive hemodynamic stress, vasculopathic, infectious, noninfectious inflammatory, oncotic, and familial. Pathogenetic mechanism is the best predictor of the clinical course of the disease, response to treatment, and long-term prognosis. The pathogenetic subtypes of pediatric IAA show characteristic and variably overlapping features. In most cases, IAAs manifesting during the first 2 decades of life are idiopathic. IAAs that are idiopathic, traumatic (second most common type), or due to excessive hemodynamic stresses (third most common type) account for more than 80% of IAAs in the pediatric age group. Most of the remaining pediatric IAAs are the result of congenital cerebral aneurysmal arteriopathies or infection. Multiple IAAs are unusual in young children except in those with acquired (secondary to immune deficiency states) or congenital cerebral aneurysmal arteriopathies or infectious IAAs. RSNA, 2012

  4. Acute postoperative neurological deterioration associated with surgery for ruptured intracranial aneurysm: incidence, predictors, and outcomes.

    Science.gov (United States)

    Mahaney, Kelly B; Todd, Michael M; Bayman, Emine O; Torner, James C

    2012-06-01

    Subarachnoid hemorrhage (SAH) results in significant morbidity and mortality, even among patients who reach medical attention in good neurological condition. Many patients have neurological decline in the perioperative period, which contributes to long-term outcomes. The focus of this study is to characterize the incidence of, characteristics predictive of, and outcomes associated with acute postoperative neurological deterioration in patients undergoing surgery for ruptured intracranial aneurysm. The Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST) was a multicenter randomized clinical trial that enrolled 1001 patients and assesssed the efficacy of hypothermia as neuroprotection during surgery to secure a ruptured intracranial aneurysm. All patients had a radiographically confirmed SAH, were classified as World Federation of Neurosurgical Societies (WFNS) Grade I-III immediately prior to surgery, and underwent surgery to secure the ruptured aneurysm within 14 days of SAH. Neurological assessment with the National Institutes of Health Stroke Scale (NIHSS) was performed preoperatively, at 24 and 72 hours postoperatively, and at time of discharge. The primary outcome variable was a dichotomized scoring based on an IHAST version of the Glasgow Outcome Scale (GOS) in which a score of 1 represents a good outcome and a score > 1 a poor outcome, as assessed at 90-days' follow-up. Data from IHAST were analyzed for occurrence of a postoperative neurological deterioration. Preoperative and intraoperative variables were assessed for associations with occurrence of postoperative neurological deterioration. Differences in baseline, intraoperative, and postoperative variables and in outcomes between patients with and without postoperative neurological deterioration were compared with Fisher exact tests. The Wilcoxon rank-sum test was used to compare variables reported as means. Multiple logistic regression was used to adjust for covariates associated with occurrence

  5. Use of antihypertension agents for the suppression of arterial pulse pressure waveforms in patients with intracranial aneurysms.

    Science.gov (United States)

    Turner, Carole L; Wilkinson, Ian B; Kirkpatrick, Peter J

    2006-04-01

    Patients with intracranial aneurysms tend toward raised blood pressure and abnormal pulse pressure profiles. The authors have investigated the influence of three antihypertension agents on blood pressure and pulse pressure waveforms in patients with known intracranial aneurysms, with a view to assessing the potential benefits of longterm antihypertension therapy on the progression of unruptured intracranial aneurysms. Nineteen patients with a mean age of 56 years (range 38-76 years) were recruited for this study. All patients had confirmed intracranial aneurysms. A double-blind, randomized, crossover study was performed using perindopril, irbesartan, isosorbide mononitrate, and a placebo. Blood pressure and pulse pressure waveforms were assessed at the end of each 4-week treatment period. Perindopril and irbesartan were well tolerated. For all measured parameters except heart rate (p = 0.03), no significant difference between baseline and placebo was identified. Each drug when compared with placebo reduced peripheral arterial blood pressure. Perindopril significantly decreased mean blood pressure by 10 mm Hg (p = 0.004), irbesartan by 9 mm Hg (p = 0.004), and isosorbide mononitrate by 13 mm Hg (p = 0.005). The administration of each drug effected a significant reduction in the carotid artery augmentation index (AIX) compared with baseline values (perindopril p = 0.01, irbesartan p = 0.0002, and isosorbide mononitrate p = 0.03). There was also a significant difference in the AIX between irbesartan and the placebo (p = 0.05). Compared with the placebo, there was a significant difference in AIX (adjusted for heart rate) following the administration of irbesartan (p = 0.003) and isosorbide mononitrate (p = 0.01), but not with perindopril (p = 0.17). Irbesartan appears to be the most effective treatment for the combined suppression of blood pressure and AIX in patients with intracranial aneurysms and has a high degree of patient tolerance.

  6. Prognosis of patients in coma after acute subdural hematoma due to ruptured intracranial aneurysm.

    Science.gov (United States)

    Torné, Ramon; Rodríguez-Hernández, Ana; Romero-Chala, Fabián; Arikan, Fuat; Vilalta, Jordi; Sahuquillo, Juan

    2016-04-01

    Acute subdural hematomas (aSDH) secondary to intracranial aneurysm rupture are rare. Most patients present with coma and their functional prognosis has been classically considered to be very poor. Previous studies mixed good-grade and poor-grade patients and reported variable outcomes. We reviewed our experience by focusing on patients in coma only and hypothesized that aSDH might worsen initial mortality but not long-term functional outcome. Between 2005 and 2013, 440 subarachnoid hemorrhage (SAH) patients were admitted to our center. Nineteen (4.3%) were found to have an associated aSDH and 13 (2.9%) of these presented with coma. Their prospectively collected clinical and outcome data were reviewed and compared with that of 104 SAH patients without aSDH who presented with coma during the same period. Median aSDH thickness was 10mm. Four patients presented with an associated aneurysmal cortical laceration and only one had good recovery. Overall, we observed good long-term outcomes in both SAH patients in coma with aSDH and those without aSDH (38.5% versus 26.4%). Associated aSDH does not appear to indicate a poorer long-term functional prognosis in SAH patients presenting with coma. Anisocoria and brain herniation are observed in patients with aSDH thicknesses that are smaller than those observed in trauma patients. Despite a high initial mortality, early surgery to remove the aSDH results in a good outcome in over 60% of survivors. Aneurysmal cortical laceration appears to be an independent entity which shows a poorer prognosis than other types of aneurysmal aSDH. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Comparative proteome analysis of saccular intracranial aneurysms with iTRAQ quantitative proteomics.

    Science.gov (United States)

    Wang, Jia; Yu, Lanbing; Huang, Xiahe; Wang, Yingchun; Zhao, Jizong

    2016-01-01

    To screen differentially expressed proteins of saccular intracranial aneurysms and superficial temporal artery by the proteomics analysis using isobaric tags for relative and absolute quantification (iTRAQ) combined with reverse phase high-performance liquid chromatography. Collecting 17 samples from intracranial aneurysm patients undergoing aneurysmectomy as experiment group and 17 matched STA as control group. After quantification and enzymolysis of the protein, the iTRAQ were used to label the peptides of the 2 groups respectively. Then, the mixture of the peptides was fractioned by RP-HPLC and analyzed by LC-MS/MS to identify the differential expression proteins. A total of 1699 proteins were identified from the ProteinPilot 4.5 software (AB SCIEX) using the Paragon database search algorithm. Comparing with STA, 54 proteins were significantly up-regulated (115:1142.0-fold). Furthermore, Integrin β3, Secreted frizzled-related protein 2 were significantly up-regulated (2.3 fold and 2.1 fold, respectively), whereas MyosinIIb, Alpha-actinin-1, Laminin β2, and Carboxypeptidase A3 were down-regulated (3.01 fold, 2.1 fold, 2.07 fold, and 2.01 fold, respectively) in sIAs. GO Ontology analysis showed that most differential proteins expressed in cytoskeletal; up-regulated proteins in sIAs play an important role in inflammatory reaction, enzymatic hydrolysis, cell adhesion and invasion, and cellular immune reaction; down-regulated proteins in sIAs involved in cytoskeletal protein, enzyme, and structural protein. ITGB3, ACTN1 and MYL2 play a role in aneurysm formation via focal adhesion pathway. The results of Western-blot assay were consistent with the proteomic changes of those 6 proteins. The differentially expressed proteins in sIAs that showed aneurysm formation are related to cytoskeleton abnormal and extracellular matrix changes. The iTRAQ technology provides scientific foundation for the further study to explore the pathogenic mechanism of sIAs. Copyright © 2015

  8. Endovascular coil embolization of segmental arteries prevents paraplegia after subsequent thoracoabdominal aneurysm repair: an experimental model.

    Science.gov (United States)

    Geisbüsch, Sarah; Stefanovic, Angelina; Koruth, Jacob S; Lin, Hung-Mo; Morgello, Susan; Weisz, Donald J; Griepp, Randall B; Di Luozzo, Gabriele

    2014-01-01

    To test a strategy for minimizing ischemic spinal cord injury after extensive thoracoabdominal aneurysm (TAAA) repair, we occluded a small number of segmental arteries (SAs) endovascularly 1 week before simulated aneurysm repair in an experimental model. Thirty juvenile Yorkshire pigs (25.2 ± 1.7 kg) were randomized into 3 groups. All SAs, both intercostal and lumbar, were killed by a combination of surgical ligation of the lumbar SAs and occlusion of intercostal SAs with thoracic endovascular stent grafting. Seven to 10 days before this simulated TAAA replacement, SAs in the lower thoracic/upper lumbar region were occluded using embolization coils: 1.5 ± 0.5 SAs in group 1 (T13/L1), and 4.5 ± 0.5 SAs in group 2 (T11-L3). No SAs were coiled in the controls. Hind limb function was evaluated blindly from daily videotapes using a modified Tarlov score (0 = paraplegia, 9 = full recovery). After death, each segment of spinal cord was graded histologically using the 9-point Kleinman score (0 = normal, 8 = complete necrosis). Hind limb function remained normal after coil embolization. After simulated TAAA repair, paraplegia occurred in 6 of 10 control pigs, but in only 2 of 10 pigs in group 1; no pigs in group 2 had a spinal cord injury. Tarlov scores were significantly better in group 2 (control vs group 1, P = .06; control vs group 2, P = .0002; group 1 vs group 2, P = .05). A dramatic reduction in histologic damage, most prominently in the coiled region, was seen when SAs were embolized before simulated TAAA repair. Endovascular coiling of 2 to 4 SAs prevented paraplegia in an experimental model of extensive hybrid TAAA repair, and helped protect the spinal cord from ischemic histopathologic injury. A clinical trial in a selected patient population at high risk for postoperative spinal cord injury may be appropriate. Copyright © 2014 The American Association for Thoracic Surgery. All rights reserved.

  9. [Traumatic intracranial aneurysm secondary to a bullet wound. Clinical case and a review of the literature].

    Science.gov (United States)

    de la Rosa Morilla, Silvestre Emilio; Melot, Anthony; Boissonneau, Sebastien; Farah, Kaissar; Brunel, Herve; Roche, Pierre-Hugues

    2016-01-01

    Traumatic intracranial aneurysms (AICT) are rare and are associated with high morbidity and mortality. AICT are the result of head injuries caused by accidents, explosions, and gunfire. The case is reported here of a 28 year old man who was admitted to our hospital after suffering a penetrating head injury caused by a bullet. Radiographic studies showed interhemispheric subarachnoid haemorrhage and a likely AICT image that initially went unnoticed. One week later he underwent a cerebral angiography which showed a bilateral vasospasm of the terminal portion of the internal carotid and the appearance of a 2mm fusiform AICT at the orbit-frontal branch of the anterior cerebral artery. This was surgically treated after an aneurismal growth of 3.4mm and failure of the endovascular treatment. The patient showed a favourable outcome after surgery. Copyright © 2015 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  10. Flow modification in canine intracranial aneurysm model by an asymmetric stent: studies using digital subtraction angiography (DSA) and image-based computational fluid dynamics (CFD) analyses

    Science.gov (United States)

    Hoi, Yiemeng; Ionita, Ciprian N.; Tranquebar, Rekha V.; Hoffmann, Kenneth R.; Woodward, Scott, H.; Taulbee, Dale B.; Meng, Hui; Rudin, Stephen

    2011-01-01

    An asymmetric stent with low porosity patch across the intracranial aneurysm neck and high porosity elsewhere is designed to modify the flow to result in thrombogenesis and occlusion of the aneurysm and yet to reduce the possibility of also occluding adjacent perforator vessels. The purposes of this study are to evaluate the flow field induced by an asymmetric stent using both numerical and digital subtraction angiography (DSA) methods and to quantify the flow dynamics of an asymmetric stent in an in vivo aneurysm model. We created a vein-pouch aneurysm model on the canine carotid artery. An asymmetric stent was implanted at the aneurysm, with 25% porosity across the aneurysm neck and 80% porosity elsewhere. The aneurysm geometry, before and after stent implantation, was acquired using cone beam CT and reconstructed for computational fluid dynamics (CFD) analysis. Both steady-state and pulsatile flow conditions using the measured waveforms from the aneurysm model were studied. To reduce computational costs, we modeled the asymmetric stent effect by specifying a pressure drop over the layer across the aneurysm orifice where the low porosity patch was located. From the CFD results, we found the asymmetric stent reduced the inflow into the aneurysm by 51%, and appeared to create a stasis-like environment which favors thrombus formation. The DSA sequences also showed substantial flow reduction into the aneurysm. Asymmetric stents may be a viable image guided intervention for treating intracranial aneurysms with desired flow modification features. PMID:21666881

  11. Flow modification in canine intracranial aneurysm model by an asymmetric stent: studies using digital subtraction angiography (DSA) and image-based computational fluid dynamics (CFD) analyses

    Science.gov (United States)

    Hoi, Yiemeng; Ionita, Ciprian N.; Tranquebar, Rekha V.; Hoffmann, Kenneth R.; Woodward, Scott H.; Taulbee, Dale B.; Meng, Hui; Rudin, Stephen

    2006-03-01

    An asymmetric stent with low porosity patch across the intracranial aneurysm neck and high porosity elsewhere is designed to modify the flow to result in thrombogenesis and occlusion of the aneurysm and yet to reduce the possibility of also occluding adjacent perforator vessels. The purposes of this study are to evaluate the flow field induced by an asymmetric stent using both numerical and digital subtraction angiography (DSA) methods and to quantify the flow dynamics of an asymmetric stent in an in vivo aneurysm model. We created a vein-pouch aneurysm model on the canine carotid artery. An asymmetric stent was implanted at the aneurysm, with 25% porosity across the aneurysm neck and 80% porosity elsewhere. The aneurysm geometry, before and after stent implantation, was acquired using cone beam CT and reconstructed for computational fluid dynamics (CFD) analysis. Both steady-state and pulsatile flow conditions using the measured waveforms from the aneurysm model were studied. To reduce computational costs, we modeled the asymmetric stent effect by specifying a pressure drop over the layer across the aneurysm orifice where the low porosity patch was located. From the CFD results, we found the asymmetric stent reduced the inflow into the aneurysm by 51%, and appeared to create a stasis-like environment which favors thrombus formation. The DSA sequences also showed substantial flow reduction into the aneurysm. Asymmetric stents may be a viable image guided intervention for treating intracranial aneurysms with desired flow modification features.

  12. Role of the structural elements of the arterial wall in the formation and growth of intracranial saccular aneurysms.

    Science.gov (United States)

    Mérei, F T; Gallyas, F

    1980-01-01

    Besides apical medial gaps, lateral and circular medial gaps can be found occasionally at the branching sites of human intracranial arteries, supporting Forbus's idea (1930) of their mechanism of formation and contradicting those put forward by later workers. The large medial gaps situated just distal to the branching sites, considered by Stehbens (1963) to be degenerative in origin, may result from enlargement of congenital multiple apical gaps. Degeneration of the internal elastic layer in the area of medial gaps consists in enlargement and partial fusion of its "physiologic" windows. In contrast to the prevailing opinion, human intracranial arteries do have a well-developed external elastic layer whose density gradually decreases with increasing lengths of the medial gaps. The fundus of a mature aneurysm generally contains no continuous elastic membrane or fiber and relatively little granular elastic material. The equilibrium between partial degeneration and steady reformation of adventitial collagen fibers makes possible the growth of an aneurysm. The thickening of the aneurysmal intima appears to be in causal relationship with the stagnation zones existing in larger aneurysms. In special cases small islets of the arterial media can get into the fundus of an aneurysm, whose spindle-like smooth muscle cells, arranged in a parallel manner, may dissociate themselves from each other and be transformed into spider-like cells.

  13. Opacification of shape memory polymer foam designed for treatment of intracranial aneurysms.

    Science.gov (United States)

    Rodriguez, Jennifer N; Yu, Ya-Jen; Miller, Matthew W; Wilson, Thomas S; Hartman, Jonathan; Clubb, Fred J; Gentry, Brandon; Maitland, Duncan J

    2012-04-01

    Shape memory polymer (SMP) foam possesses structural and mechanical characteristics that make them very promising as an alternative treatment for intracranial aneurysms. Our SMP foams have low densities, with porosities as high as 98.8%; favorable for catheter delivery and aneurysm filling, but unfavorable for attenuating X-rays. This lack of contrast impedes the progression of this material becoming a viable medical device. This paper reports on increasing radio-opacity by incorporating a high-Z element, tungsten particulate filler to attenuate X-rays, while conserving similar physical properties of the original non-opacified SMP foams. The minimal amount of tungsten for visibility was determined and subsequently incorporated into SMP foams, which were then fabricated into samples of increasing thicknesses. These samples were imaged through a pig's skull to demonstrate radio-opacity in situ. Quantification of the increase in image contrast was performed via image processing methods and standard curves were made for varying concentrations of tungsten doped solid and foam SMP. 4% by volume loading of tungsten incorporated into our SMP foams has proven to be an effective method for improving radio-opacity of this material while maintaining the mechanical, physical and chemical properties of the original formulation.

  14. Patient-specific blood flow simulation to improve intracranial aneurysm diagnosis

    Science.gov (United States)

    Fenz, Wolfgang; Dirnberger, Johannes

    2011-03-01

    We present a novel simulation system of blood flow through intracranial aneurysms including the interaction between blood lumen and vessel tissue. It provides the means to estimate rupture risks by calculating the distribution of pressure and shear stresses in the aneurysm, in order to support the planning of clinical interventions. So far, this has only been possible with commercial simulation packages originally targeted at industrial applications, whereas our implementation focuses on the intuitive integration into clinical workflow. Due to the time-critical nature of the application, we exploit most efficient state-of-the-art numerical methods and technologies together with high performance computing infrastructures (Austrian Grid). Our system builds a three-dimensional virtual replica of the patient's cerebrovascular system from X-ray angiography, CT or MR images. The physician can then select a region of interest which is automatically transformed into a tetrahedral mesh. The differential equations for the blood flow and the wall elasticity are discretized via the finite element method (FEM), and the resulting linear equation systems are handled by an algebraic multigrid (AMG) solver. The wall displacement caused by the blood pressure is calculated using an iterative fluid-structure interaction (FSI) algorithm, and the fluid mesh is deformed accordingly. First simulation results on measured patient geometries show good medical relevance for diagnostic decision support.

  15. Effects of Meteorological Variables on the Incidence of Rupture of Intracranial Aneurysms in Central New Jersey.

    Science.gov (United States)

    Kellogg, Marissa; Petrov, Dimitriy; Agarwal, Nitin; Patel, Nitesh V; Hansberry, David Richard; Agarwal, Prateek; Brimacombe, Michael; Gandhi, Chirag D; Prestigiacomo, Charles

    2017-05-01

    Introduction Previous studies have suggested relationships between the rupture of intracranial aneurysms and meteorological variables such as season, barometric pressure, and temperature. Our objective was to examine the relationship between the incidence of hospital admissions secondary to aneurysmal subarachnoid hemorrhage (aSAH) and meteorological variables in central New Jersey. Methods The study population consisted of 312 patients who presented to University Hospital in Newark, New Jersey, between January 1, 2003, and December 31, 2008, with aSAH. Days in the 6-year period were classified as nonbleed days (no aSAH), bleed days (one or more aSAHs within 1 calendar day), cluster days (two or more aSAHs within 2 calendar days), and multiple-bleed days (two or more aSAHs within 1 calendar day). Results The only significant meteorological risk factor for the occurrence of multiple-bleed days was high barometric pressure (1018.5 versus 1016.5 millibars [mbars]; p barometric pressure (+ 2.8 mbars) over the 2 days prior to the multiple-bleed day, although not statistically significant, may be a risk factor (p Barometric pressure was also noted to be increased on bleed days (1017.2 versus 1016.5 mbars) and cluster days (1017.7 versus 1016.5 mbars), but this relationship was not significant (p barometric pressure and low temperature may be risk factors for the onset of aSAH. Georg Thieme Verlag KG Stuttgart · New York.

  16. Association between hemodynamic modifications and clinical outcome of intracranial aneurysms treated using flow diverters

    Science.gov (United States)

    Paliwal, Nikhil; Damiano, Robert J.; Davies, Jason M.; Siddiqui, Adnan H.; Meng, Hui

    2017-03-01

    Treatment of intracranial aneurysms (IAs) has been revolutionized by the advent of endovascular Flow Diverters (FDs), which disrupt blood flow within the aneurysm to induce pro-thrombotic conditions, and serves as a scaffold for endothelial ingrowth and arterial remodeling. Despite good clinical success of FDs, complications like incomplete occlusion and post-treatment rupture leading to subarachnoid hemorrhage have been reported. In silico computational fluid dynamic analysis of the pre- and post-treated geometries of IA patients can shed light on the contrasting blood hemodynamics associated with different clinical outcomes. In this study, we analyzed hemodynamic modifications in 15 IA patients treated using a single FD; 10 IAs were completely occluded (successful) and 5 were partially occluded (unsuccessful) at 12-month follow-up. An in-house virtual stenting workflow was used to recapitulate the clinical intervention on these cases, followed by CFD to obtain pre- and post-treatment hemodynamics. Bulk hemodynamic parameters showed comparable reductions in both groups with average inflow rate and aneurysmal velocity reduction of 40.3% and 52.4% in successful cases, and 34.4% and 49.2% in unsuccessful cases. There was a substantial reduction in localized parameter like vortex coreline length and Energy Loss for successful cases, 38.2% and 42.9% compared to 10.1% and 10.5% for unsuccessful cases. This suggest that for successfully treated IAs, the localized complex blood flow is disrupted more prominently by the FD as compared to unsuccessful cases. These localized hemodynamic parameters can be potentially used in prediction of treatment outcome, thus aiding the clinicians in a priori assessment of different treatment strategies.

  17. Assessment of long-term effects of aneurysms trapping and extracranial-intracranial bypass surgery in patients with complex cerebral aneurysms

    Directory of Open Access Journals (Sweden)

    MAO Zhi-qi

    2012-02-01

    Full Text Available Objective To study the long-term effects of extracranial-intracranial (EC-IC bypass and aneurysms trapping in patients with complex cerebral aneurysms. Methods Seventeen patients with complex aneurysms, who underwent EC-IC bypass and aneurysms trapping from 2008 to 2009, were followed up. Clinical records were reviewed, modified Rankin Scale (mRS was recorded at admission, discharging, and follow-up point, and activities of daily living (ADL scale (Barthel Index at admission and follow-up point. Results Seventeen patients (11 males and 6 females were followed up. At admission mRS scores were 1.06 ± 0.87, Barthel index 91.10 ± 10.30. Superficial temporal artery-middle cerebral artery (STA-MCA was performed in 8 cases, extracarotid artery-great saphenous vein-middle cerebral artery (ECA-GSV-MCA in 5 cases, extracarotid artery-radial artery-middle cerebral artery (ECA-RA-MCA in 3 cases, occipital artery-posterior inferior cerebellar artery (OA-PICA in 1 case. Patients were followed up for 19-39 months (mean 28.67 months. At follow-up point, 2 patients (11.76% died, operation-related mortality was 5.88% (1/17, operation-related morbidity 5.88% (1/17, mRS scores 1.07 ± 1.16, Barthel index 96.40 ± 10.30. Conclusion Patients with complex aneurysms who were impossible to be treated with surgical clipping or endovascular intervention could be cured with extracranial-intracranial bypass and aneurysms trapping, and good follow-up results were acquired.

  18. Intracranial Aneurysms in Sickle-Cell Disease Are Associated With the Hemoglobin SS Genotype But Not With Moyamoya Syndrome

    DEFF Research Database (Denmark)

    Birkeland, Peter; Gardner, Kate; Kesse-Adu, Rachel

    2016-01-01

    BACKGROUND AND PURPOSE: Intracranial aneurysms and aneurysmal subarachnoid hemorrhage may occur more frequently in sickle-cell disease (SCD), and this could be related to the sickle genotype and moyamoya syndrome seen in SCD. METHODS: Records from a total of 1002 patients with SCD attending 2...... had imaging data; the prevalence was significantly higher in patients with HbSS genotype compared with other sickle genotypes with the highest prevalence (15%) observed in women in the age group 30 to 39 years. Fifty-one HbSS patients had a moyamoya vasculopathy, but only 3 of these had concomitant...

  19. Clinical management of unruptured intracranial aneurysm in Germany: a nationwide observational study over a 5-year period (2005-2009).

    Science.gov (United States)

    Walendy, Victor; Stang, Andreas

    2017-01-17

    Our aim was to provide nationwide age-standardised rates (ASR) on the usage of endovascular coiling and neurosurgical clipping for unruptured intracranial aneurysm (UIA) treatment in Germany. Nationwide observational study using the Diagnosis-Related-Groups (DRG) statistics for the years 2005-2009 (overall 83 million hospitalisations). From 2005 to 2009, overall 39 155 hospitalisations with a diagnosis of UIA occurred in Germany. Age-specific and age-standardised hospitalisation rates for UIA with the midyear population of Germany in 2007 as the standard. Of the 10 221 hospitalisations with UIA during the observation period, 6098 (59.7%) and 4123 (40.3%) included coiling and clipping, respectively. Overall hospitalisation rates for UIA increased by 39.5% (95% CI 24.7% to 56.0%) and 50.4% (95% CI 39.6% to 62.1%) among men and women, respectively. In 2005, the ASR per 100 000 person years for coiling was 0.7 (95% CI 0.62 to 0.78) for men and 1.7 (95% CI 1.58 to 1.82) for women. In 2009, the ASR was 1.0 (95% CI 0.90 to 1.10) and 2.4 (95% CI 2.24 to 2.56), respectively. Similarly, the ASR for clipping in 2005 amounted to 0.6 (95% CI 0.52 to 0.68) for men and 1.1 (95% CI 1.00 to 1.20) for women. These rates increased in 2009 to 0.8 (95% CI 0.72 to 0.88) and 1.7 (95% CI 1.58 to 1.82), respectively. We observed a marked geographical variation of ASR for coiling and less pronounced for clipping. For the federal state of Saarland, the ASR for coiling was 5.64 (95% CI 4.76 to 6.52) compared with 0.68 (95% CI 0.48 to 0.88; per 100 000 person years) in Saxony-Anhalt, whereas, ASR for clipping were highest in Rhineland-Palatinate (2.48, 95% CI 2.17 to 4.75) and lowest in Saxony-Anhalt (0.52, 95% CI 0.34 to 0.70). To the best of our knowledge, we presented the first representative, nationwide analysis of the clinical management of UIA in Germany. The ASR increased markedly and showed substantial geographical variation among federal states for all treatment modalities

  20. Temporal bone chondroblastoma with secondary aneurysmal bone cyst presenting as an intracranial mass with clinical seizure activity.

    Science.gov (United States)

    Stapleton, Christopher J; Walcott, Brian P; Linskey, Katy R; Kahle, Kristopher T; Nahed, Brian V; Asaad, Wael F

    2011-06-01

    Chondroblastomas are rare tumors that characteristically arise from the epiphyseal cartilage of long bones of the immature skeleton. Intracranial involvement is uncommon, though the squamous portion of the temporal bone is preferentially affected due to its cartilaginous origin. Patients with temporal bone chondroblastomas classically present with otologic symptoms, while primary neurological complaints are rare. In this report, we describe a 33 year-old man with a chondroblastoma of the temporal bone and an associated aneurysmal bone cyst constituting a large intracranial mass lesion who presented with new-onset seizure activity. We review issues relevant to the pathology and treatment of these lesions. Copyright © 2010 Elsevier Ltd. All rights reserved.

  1. Direct comparison of Neuroform and Enterprise stents in the treatment of wide-necked intracranial aneurysms.

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    Durst, C R; Khan, P; Gaughen, J; Patrie, J; Starke, R M; Conant, P; Liu, K C; Jensen, M E; Evans, A J

    2014-12-01

    To compare the complications and outcomes of Neuroform and Enterprise stents in the treatment of unruptured wide-necked aneurysms. Under the auspices of the institutional review board, a review of a prospectively collected patient log identified 130 patients who underwent elective stent-assisted coil embolization of a wide-necked aneurysm, including 53 patients treated with an Enterprise stent and 77 patients treated with a Neuroform stent. Immediate and long-term clinical and radiographic outcomes were recorded for all patients. All patient data were handled in accordance with Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations. The technical success rate was 94%. Overall morbidity was 15% with Enterprise stents and 3% with Neuroform stents (p = 0.020). However, the type of stent used was not predictive of clinical outcomes as measured by the modified Rankin scale. In a multivariate analysis, the use of a Neuroform stent was one of the predictors of retreatment (p = 0.034). Multivariate analyses identified the use of Neuroform stents as an independent predictor of the need for retreatment and the use of Enterprise stents as an independent predictor of morbidity. However, the type of stent was not predictive of clinical outcome as measured by the modified Rankin scale. Copyright © 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  2. Interest of Flow Diversion Prostheses in the Management of Unruptured Intracranial Aneurysms

    Directory of Open Access Journals (Sweden)

    Xavier Armoiry

    2012-01-01

    Full Text Available Flow diversion prostheses represent a new endovascular approach aimed at treating patients with large wide-neck aneurysms. Our objective is to present this new technology, to review the clinical studies on efficacy, and to emphasize its current limits. Flow diversion prostheses consist of a cylinder made of a large number of braided microfilaments providing a large metallic surface when deployed and inducing a blood flow diversion outside the aneurysm. Two different brands are currently available. Clinical data supporting their efficacy are currently limited to six non comparative cohort studies that included between 18 and 107 patients. Procedural implantation was shown to be feasible in more than 90% and safe with a thirty-day mortality between 2.8 and 5.5%. Complete occlusion rates at twelve months varied between 85.7 and 100%. Even though promising, the current status of flow diversion prostheses needs further evaluation with randomized, prospective, clinical trials with comparison to conventional strategies including endovascular coiling or surgical clipping.

  3. Usefulness of {sup 99m}Tc-HMPAO SPECT in Patients with Subarachnoid Hemorrhage due to Ruptured Intracranial Aneurysm

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    Choi, C. W.; Lee, K. H.; Kim, J. H.; Kwark, C. E.; Lee, D. S.; Chung, J. K.; Lee, M. C.; Han, D. H.; Koh, C. S. [Seoul National University Hospital, Seoul (Korea, Republic of)

    1993-07-15

    We evaluated the usefulness of {sup 99m}Tc-HMPAO SPECT in 21 Patients with subarachnoid hemorrhage due to ruptured intracranial aneurysm and in 3 patients with unruptured intracranial aneurysm. SPECT study could detect the bilaterally hypoperfused cases in 10 patients(48%), but CT/MRI showed the bilateral abnormalities in only 3 patients(14%). The number of abnormal lesions were 56 in SPECT and 25 in CT/MRI. The lesions found in SPECT were well correlated with the neurological signs of the patients such as aphasia or hemiplegia. SPECT study during Matas test was helpful in evaluating the risk for carotid artery occlusion therapy. We thought that {sup 99m}Tc-HMPAO brain SPECT is helpful in evaluating the functional changes in patients with subarachnoid hemorrhage.

  4. [Value of 640-slice 3D CT angiography plus 3D printing for improving surgeries for intracranial aneurysms].

    Science.gov (United States)

    Zhou, Lu-Qiu; Lou, Ming-Wu; Chen, Guo-Chang; Jiu, Zhi-Song; Shen, Yun-Xia; Lu, Lin

    2017-09-20

    To evaluate the value of 640-slice 3D CT angiography (3D-CTA) plus 3D printing for improving the outcomes of surgeries for intracranial aneurysms. Sixty patients with intracranial aneurysm were randomly divided into trial group (n=30) and control group (n=30). The control group received routine surgery, and the simulation models of the intracranial aneurysm in trial group was printed using a 3D printer using the imaging data from 3D-CTA. Using the simulation model, the surgery was designed and planned before operation (including surgical approaches and placement of clips) and simulation surgery was also conducted. The coincidence rates between preoperative and intraoperative findings of the intracranial aneurysms on 3D-CTA were compared. CT scan was performed at 1 and 3 days after the operation to detect potential cerebral infarction or bleeding associated with the operation; CTA was performed both at the same time and at 3-6 months after the operation to detect stenosis, occlusion and aneurysm clipping. The patients were followed up for 3-6 months to assess the outcomes using Glasgow Outcome Scale (GOS). The preoperative 3D-CTA findings were basically consistent with the intraoperative findings in all the 60 patients. Nine patients in the control group and 2 patients in the trial group had short-term adverse operation events; 11 patients in control group and 4 patients in trial group had long-term adverse events; 18 patients in control group and 25 patients in trial group had good neurologic function. The incidences of short-term and long-term adverse events associated with the operation was significantly lower in the trial group than in the control group (χ(2)=5.364, P=0.021; χ(2)=4.841, P=0.028), and the outcomes were significantly better in the trial group than in the control group (χ(2)=4.633, P=0.031). The simulation model of intracranial aneurysm is helpful to improve the quality of surgery and patients outcomes.

  5. Clinical outcomes of surgical clipping for intracranial aneurysms in patients with a Hunt and Hess grade 4 or 5

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    Yang Zhang

    2016-06-01

    Full Text Available ABSTRACT We retrospectively evaluated the records of 49 grade 4 and 5 patients with 42 intracranial aneurysms treated within 72 h of subarachnoid hemorrhage (SAH. In total, 35 patients (71% were grade 4, and 14 (29% were grade 5. A total of 42 (85% patients had one aneurysm, 6 (12% had two aneurysms, and 1 (3% had three aneurysms. Out of 49 patients, one technical (2% and one clinical (2% complication occurred at surgery. Twenty-one (43% patients recovered well, including 7 with postoperative hematoma requiring an immediate evacuation of a clot. Fourteen (29% patients had hydrocephalus and required a ventriculo-peritoneal shunt; 12 patients underwent tracheotomy postoperatively due to coma and pulmonary infection. We found that patients with Hunt and Hess grade 4 and 5 aneurysms can undergo successful neurosurgical clipping of the aneurysms after SAH. However, the morbidity and mortality rates remain high because of their poor clinical condition and a high incidence of vasospasm during treatment.

  6. Effects of preventive surgery for unruptured intracranial aneurysms on attention, executive function, learning and memory: a prospective cohort study.

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    Chung, Joonho; Seok, Jeong-Ho; Kwon, Min A; Kim, Yong Bae; Joo, Jin-Yang; Hong, Chang-Ki

    2016-01-01

    We prospectively evaluated the effects of preventive surgery for unruptured intracranial aneurysms on attention, executive function, learning and memory. Between March 2012 and June 2013, 56 patients were recruited for this study. Fifty-one patients met the inclusion criteria and were enrolled. Inclusion criteria were as follows: (1) age ≤65 years and (2) planned microsurgery or endovascular surgery for unruptured intracranial aneurysm. Exclusion criteria were as follows: (1) preoperative intelligence quotient learning test (VLT) were performed before and after (6 months) preventive surgery. ACCPT (attention), WCT (executive function) and VLT (learning and memory) scores did not change significantly between the pre- and postoperative evaluations. The ACCPT, WCT, total VLT scores (verbal learning) and delayed VLT scores (memory) did not differ significantly between patients undergoing microsurgery and those undergoing endovascular surgery. However, ACCPT, WCT and delayed VLT scores decreased postoperatively in patients with leukoaraiosis on preoperative FLAIR images (OR 9.899, p = 0.041; OR 11.421, p = 0.006; OR 2.952, p = 0.024, respectively). Preventive surgery for unruptured intracranial aneurysms did not affect attention, executive function, learning or memory. However, patients with leukoaraiosis on FLAIR images might be prone to deficits in attention, executive function and memory postoperatively, whereas learning might not be affected.

  7. Unruptured intracranial aneurysm presenting with epiletic seizure Epilepsia secundária a aneurisma cerebral não roto

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    José C. Sena

    2003-09-01

    Full Text Available Intracranial aneurysms are frequently present with subarachnoid hemorrhage.Less often they produce suggestive symptoms of cranial nerve dysfunction or intracranial tumor when very large. Their association with epilepsy has rarely been reported; such concurrence may not be a coincidence. When the patient presents with epileptiforme attacks the presence of an intracranial aneurysm is rarely considered. In this paper we report the case of a 45-years-old patient with an unruptured aneurysm of the middle cerebral artery with a 10 years history of epileptic seizure.Aneurismas intracranianos freqüentemente se apresentam com hemorragia subaracnóidea quando rotos, porém quando gigantes sangram com menor freqüência e se comportam como verdadeiros tumores, comprimindo estruturas cerebrais adjacentes, apresentando sintomatologia peculiar. Relatamos o caso de um paciente de 45 anos que apresentava crises convulsivas generalizadas com evolução de 10 anos. A investigação radiológica revelou presença de aneurisma gigante da artéria cerebral média, não roto. É realizada revisão da literatura correlacionando a presença de aneurismas não rotos e epilepsia, pois esta associação é pouco freqüente na literatura.

  8. Comparison of platinum and first-generation matrix coils in under-packed canine side-wall aneurysms: evaluation of progressive thrombosis

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    Turk, Aquilla S. [University of Wisconsin Hospital and Clinics, Department of Radiology, Madison, WI (United States); University of Wisconsin Hospital and Clinics, Department of Neurosurgery, Madison, WI (United States); Luty, Christopher M.; Grum, Katherine [University of Wisconsin School of Medicine and Public Health, Madison, WI (United States); Grinde, Julie; Consigny, Dan; Pulfer, Kari; Rappe, Al; Strother, Charles M. [University of Wisconsin Hospital and Clinics, Department of Radiology, Madison, WI (United States)

    2007-11-15

    There is much speculation in reference to the occurrence and mechanisms of progressive aneurysm occlusion after treatment with bioactive coils. However, to our knowledge, there are no studies documenting the impact on progressive occlusion in aneurysms that are intentionally under-packed. A total of 24 experimental side-wall aneurysms were created in canine common carotid arteries. Of these 24, 9 were treated with Guglielmi detachable coils (GDC) and 15 with first-generation Matrix (Matrix1) coils to packing densities of 22% or less. Angiograms were obtained immediately after treatment and again at the time of explant at 2 weeks, 8 weeks, or 12 weeks, and were graded utilizing the Raymond scale. At the time of the final angiography and explant all aneurysms were histologically processed and evaluated. At the conclusion of initial coiling, near or complete occlusion was achieved in 7 of the 15 aneurysms (47%) treated with Matrix1 coils and in 2 of the 9 (22%) treated with GDC. Of the aneurysms that were incompletely occluded, six of eight (75%) treated with Matrix1 coils and two of seven (29%) treated with GDC showed progressive thrombosis at explant. Histopathological analysis demonstrated that the aneurysms treated with Matrix1 coils had increased fibrocellular tissue and inflammation, with less histological recanalization or vascular spaces, relative to those treated with GDC. Experimental wide-necked side-wall canine aneurysms suboptimally treated with first-generation Matrix1 coils had a higher incidence of progressive occlusion and on histological analysis showed evidence of more advanced thrombus organization than did those treated with GDC. (orig.)

  9. Treatment strategies for complex internal carotid artery (ICA) aneurysms: direct ICA sacrifice or combined with extracranial-to-intracranial bypass.

    Science.gov (United States)

    Zhu, Wei; Tian, Yan-Long; Zhou, Liang-Fu; Song, Dong-Lei; Xu, Bin; Mao, Ying

    2011-01-01

    Direct surgery for complex internal carotid artery (ICA) aneurysms can be difficult. In certain situations, sacrificing the parent artery is a unique way to obliterate the aneurysm and extracranial-to-intracranial (EC-IC) bypass is indispensable to prevent postoperative cerebral ischemia. This article discusses the indications for direct ICA occlusion, and the strategies, techniques, and outcomes in a series of patients treated for complex ICA aneurysms in a single institution. During a 7-year period, 49 patients with complex ICA aneurysms underwent direct ICA sacrifice, or ICA sacrifice combined with EC-IC bypass. The appropriate type of bypass was determined by the results of balloon occlusion test and computed tomographic perfusion. The technique of ICA sacrifice used was selected based on the evaluation of retrograde filling of the aneurysm during balloon occlusion test. Ten patients underwent direct ICA sacrifice and no ischemia-related complications were evident during the 5-12 months of follow-up. A total of 39 patients were treated by ICA sacrifice combined with EC-IC bypass, including 21 cases of superficial temporal artery-radial artery-middle cerebral artery and 18 cases of external carotid artery-radial artery-middle cerebral artery. ICA sacrifice was achieved in 38 patients by using prolonged occlusion (25 cases) or acute occlusion (13 cases). Five patients presented with minor ischemia after surgery, but four patients recovered completely. Two patients developed brain swelling postoperatively and one developed intracranial hemorrhage, which required evacuation of the hematoma. Balloon occlusion test combined with computed tomographic perfusion can be an efficient way to evaluate the compromised cerebrovascular reserve in patients with complex ICA aneurysms after ICA occlusion. In conjunction with EC-IC bypass, ICA proximal occlusion or trapping can be an effective treatment strategy. Copyright © 2011 Elsevier Inc. All rights reserved.

  10. Extracranial-intracranial bypass and vessel occlusion for the treatment of unclippable giant middle cerebral artery aneurysms.

    Science.gov (United States)

    Kalani, M Yashar S; Zabramski, Joseph M; Hu, Yin C; Spetzler, Robert F

    2013-03-01

    Giant middle cerebral artery (MCA) aneurysms pose management challenges. To review the outcomes of patients with giant MCA aneurysms not amenable to clipping or vessel reconstruction treated with extracranial-intracranial (EC-IC) bypass and vessel sacrifice. We retrospectively reviewed a database of aneurysms treated at our institution between 1983 and 2011. Sixteen patients (11 males, 5 females) were identified. There were 10 saccular, 4 fusiform, and 2 serpentine aneurysms. The aneurysms predominantly involved the M1 segment in 5 cases, M2 in 9 cases, and both M1 and M2 in 2 cases. The EC-IC bypasses performed included 13 superficial temporal artery-MCA, 1 saphenous vein graft-MCA, and 2 radial artery grafts-MCA. The postoperative bypass patency rate was 93.8% (15/16). There were 3 cerebrovascular accidents (18.8%), but no perioperative deaths (0% mortality). The mean follow-up was 58.4 months (range, 1-265; median, 23.5 months). In 75% (12/16) of cases the aneurysms were occluded successfully. A small residual was noted in 3 cases with the use of this treatment strategy, and they were re-treated. In a fourth case treated with partial distal occlusion, reduced flow through the aneurysm was noted postoperatively, but the patient did not undergo further treatment. The mean modified Rankin scale and mean Glasgow Outcome Scale scores at last follow-up were 1.6 (range, 1-4; median, 1) and 4.8 (range, 3-5; median, 5), respectively. Giant MCA aneurysms are challenging lesions. EC-IC bypass with parent vessel occlusion can provide a durable form of treatment with acceptable rates of morbidity and mortality.

  11. A Novel Association between Lysyl Oxidase Gene Polymorphism and Intracranial Aneurysm in Koreans.

    Science.gov (United States)

    Hong, Eun Pyo; Jeon, Jin Pyeong; Kim, Sung Eun; Yang, Jin Seo; Choi, Hyuk Jai; Kang, Suk Hyung; Cho, Yong Jun

    2017-09-01

    Lysyl oxidase (LOX) controls the cross-linking and maturation of elastin and collagen fibers. In this study, we investigated the association between LOX gene polymorphisms and intracranial aneurysm (IA) formation in a homogeneous Korean population. This cross-sectional study involved 80 age-sex matched patients with IA and controls. Fisher's exact test was performed to analyze allelic associations between ten single nucleotide polymorphisms (SNPs) and IA, including 41 ruptured and 39 unruptured cases. Haplotype-specific associations were analyzed using the omnibus test estimating asymptotic chi-square statistics. Of ten SNPs, three SNPs (rs2303656, rs3900446, and rs763497) were significantly associated with IA (p<0.01). The C allele of rs3900446 was significantly related to increased IA risk with a significant threshold [odds ratio (OR)=20.15, p=4.8×10⁻⁵]. Meanwhile, the A allele of rs2303656 showed a preventive effect against IA formation (p=8.2×10⁻⁴). Seventeen of 247 haplotype structures showed a suggestive association with IA (asymptotic p<0.001). Of ten SNP haplotype combinations, the CG combination of rs3900446 and rs763497 reached Bonferroni-adjusted significant threshold in IA patients (minor haplotype frequency=0.113, asymptotic p=1.3×10⁻⁵). However, there was no association between aneurysm rupture and the LOX gene. This preliminary study indicated that LOX gene polymorphisms, such as rs2303656, rs3900446, and rs763497, may play crucial roles in IA formation in the Korean population. Our novel findings need to be validated in a large-scale independent population.

  12. Diagnostic Accuracy of Magnetic Resonance Angiography for Detection of Intracranial Aneurysms in Patients with Acute Subarachnoid Hemorrhage; A Comparison to Digital Subtraction Angiography

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    Farahmand, Mohammad; Farahangiz, Siamak; Yadollahi, Mahnaz

    2013-01-01

    Objectives: To determine the diagnostic accuracy of magnetic resonance angiography (MRA) compared to intra-arterial digital subtraction angiography (DSA) in detection of intracranial aneurysms in those suffering from acute subarachnoid hemorrhage (SAH). Methods: This observational diagnostic study was performed at a tertiary teaching hospital and reference center in Shiraz, Iran. We included 55 patients who presented to our center with the diagnosis of acute SAH. All the patients underwent MRA and DSA during their hospital course in order to detect the intracranial aneurysms. The time-of-flight MRA protocol was used and the results were compared to the results of DSA as the gold standard test. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for MRA. Results: The mean age of the patients was 46.3 ± 7.9 including 26 (47.3%%) men and 29 (52.7%) women. In 46 patients, 51 intracranial aneurysms were diagnosed by DSA (5 patients had two aneurysms). No evidence of intracranial aneurysm was found in 9 patients with subarachnoid hemorrhage. MRA correctly identified 42 of the 51 aneurysms (sensitivity 82%) and missed 9 small aneurysms (less than 10 mm). MRA revealed one false- positive finding, resulting in a specificity of 88.8%. The PPC and NPV for MRA were 97% and 47%, respectively. The diagnostic accuracy per aneurysm was 0.83 for MRA. Conclusion: High sensitivity and specificity of MRA compared to DSA in diagnosis of intracranial aneurysms in those with acute SAH indicate that MRA could be reliably used as a diagnostic tool for this purpose. However we cannot recommend it as a routine substitute for DSA before surgery. PMID:27162847

  13. Intracranial pressure and outcome in critically ill patients with aneurysmal subarachnoid hemorrhage: a systematic review.

    Science.gov (United States)

    Cossu, Giulia; Messerer, Mahmoud; Stocchetti, Nino; Levivier, Marc; Daniel, Roy T; Oddo, Mauro

    2016-06-01

    Evidences supporting the use of intracranial pressure (ICP) monitoring after aneurysmal subarachnoid hemorrhage (aSAH) are limited. The aim of our paper was to examine whether elevated intracranial pressure and ICP-derived variables predict mortality and functional outcomes after aSAH. A systematic review of the literature was performed through PubMed and Cochrane databases up to June 2015. Population was restricted to aSAH patients requiring admission to the intensive care unit. ICP was included in the analysis as absolute value as well as variables derived from ICP monitoring (pressure reactivity index, ICP pulse wave amplitude, ICP-arterial blood pressure wave amplitude correlation and ICP variability). Outcomes included mortality, neurological recovery and delayed cerebral ischemia (DCI). Quality of evidence was rated using the GRADE system. Twenty-six studies were examined. Due to heterogeneity in qualifying studies, a meta-analysis could not be generated. We found a correlation between elevated ICP and mortality. However, ICP absolute values were not independent predictors of long-term functional outcomes (low quality of evidence). A variable relationship between elevated ICP and DCI was found (very low quality of evidence). ICP-derived variables had higher accuracy than ICP absolute values in predicting functional outcomes (moderate quality of evidence). Elevated ICP was associated with higher mortality however absolute ICP values per se were not independent predictors of functional recovery. Variables derived from ICP monitoring are more accurate than ICP absolute values in predicting outcome. Given the absence of good quality data, additional large studies may help to better define the prognostic value of ICP after aSAH.

  14. Effects of nimodipine on cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage treated by endovascular coiling.

    Science.gov (United States)

    Mijailovic, Milian; Lukic, Snezana; Laudanovic, Dragomir; Folic, Marko; Folic, Nevena; Jankovic, Slobodan

    2013-01-01

    An aneurysmal subarachnoid hemorrhage could be complicated with cerebral vasospasm and resultant ischemia, causing neurological deficit. The aim of our study was to compare early and late outcomes in patients with subarachnoidal hemorrhage (SAH) treated by endovascular coiling, who either received or did not receive prophylaxis of cerebral vasospasm with nimodipine. In this retrospective cross-sectional study, the data was collected from the histories of 68 patients (38 females and 30 males, age range 29-71 years) with spontaneous aneurysmal SAH in clinical stage HH I-IV, treated at Kragujevac Clinical Center, Serbia, from January 2008 till June 2009. The study population was divided into two groups: (1) the group of 42 patients who received intravenous prophylaxis with nimodipine for 3 weeks, and (2) the group of 26 patients who did not receive nimodipine prophylaxis. Prophylactic use of nimodipine did not decrease the rate of neurological deficit after one month, but the rates of both cerebral vasospasm (symptomatic and asymptomatic) and the morphological signs of ischemia using nuclear magnetic resonance imaging (MRI) were significantly lower in the nimodipine-protected group. Cerebral vasospasm was detected by Digital Subtraction Angiography (DSA) in the group protected by nimodipine as discrete in 2 patients (5%), and as apparent in 0 patients (0%). On the other hand, in the group unprotected by nimodipine, cerebral vasospasm was detected by DSA as discrete in 9 patients (35%), and as apparent in 6 patients (23%). Up to one month after the endovascular coiling, in the nimodipine-protected group, the T1W hypointense zones were detected by MRI as "small" in 5 patients (12%), as "medium" in 1 patient (2.5%), as "large" in 1 patient (2.5%), and as "multiple" in 2 patients (5%). In the nimodipine-unprotected group, the T1W hypointense zones were detected by MRI as "small" in 4 patients (16%), as "medium" in 2 patients (8%), as "large" in 3 patients (12%), and as

  15. Variability of hemodynamic parameters using the common viscosity assumption in a computational fluid dynamics analysis of intracranial aneurysms.

    Science.gov (United States)

    Suzuki, Takashi; Takao, Hiroyuki; Suzuki, Takamasa; Suzuki, Tomoaki; Masuda, Shunsuke; Dahmani, Chihebeddine; Watanabe, Mitsuyoshi; Mamori, Hiroya; Ishibashi, Toshihiro; Yamamoto, Hideki; Yamamoto, Makoto; Murayama, Yuichi

    2017-01-01

    In most simulations of intracranial aneurysm hemodynamics, blood is assumed to be a Newtonian fluid. However, it is a non-Newtonian fluid, and its viscosity profile differs among individuals. Therefore, the common viscosity assumption may not be valid for all patients. This study aims to test the suitability of the common viscosity assumption. Blood viscosity datasets were obtained from two healthy volunteers. Three simulations were performed for three different-sized aneurysms, two using measured value-based non-Newtonian models and one using a Newtonian model. The parameters proposed to predict an aneurysmal rupture obtained using the non-Newtonian models were compared with those obtained using the Newtonian model. The largest difference (25%) in the normalized wall shear stress (NWSS) was observed in the smallest aneurysm. Comparing the difference ratio to the NWSS with the Newtonian model between the two Non-Newtonian models, the difference of the ratio was 17.3%. Irrespective of the aneurysmal size, computational fluid dynamics simulations with either the common Newtonian or non-Newtonian viscosity assumption could lead to values different from those of the patient-specific viscosity model for hemodynamic parameters such as NWSS.

  16. Brain Aneurysm

    Science.gov (United States)

    ... tiny metal clip on the neck of the aneurysm to stop blood flow to it. Endovascular coiling is a less invasive ... the aneurysm. The wire coils up inside the aneurysm, disrupts the blood flow and causes blood to clot. This clotting essentially ...

  17. Thinner regions of intracranial aneurysm wall correlate with regions of higher wall shear stress: a 7.0 tesla MRI

    Science.gov (United States)

    Blankena, Roos; Kleinloog, Rachel; Verweij, Bon H.; van Ooij, Pim; ten Haken, Bennie; Luijten, Peter R.; Rinkel, Gabriel J.E.; Zwanenburg, Jaco J.M.

    2016-01-01

    Purpose To develop a method for semi-quantitative wall thickness assessment on in vivo 7.0 tesla (7T) MRI images of intracranial aneurysms for studying the relation between apparent aneurysm wall thickness and wall shear stress. Materials and Methods Wall thickness was analyzed in 11 unruptured aneurysms in 9 patients, who underwent 7T MRI with a TSE based vessel wall sequence (0.8 mm isotropic resolution). A custom analysis program determined the in vivo aneurysm wall intensities, which were normalized to signal of nearby brain tissue and were used as measure for apparent wall thickness (AWT). Spatial wall thickness variation was determined as the interquartile range in AWT (the middle 50% of the AWT range). Wall shear stress was determined using phase contrast MRI (0.5 mm isotropic resolution). We performed visual and statistical comparisons (Pearson’s correlation) to study the relation between wall thickness and wall shear stress. Results 3D colored AWT maps of the aneurysms showed spatial AWT variation, which ranged from 0.07 to 0.53, with a mean variation of 0.22 (a variation of 1.0 roughly means a wall thickness variation of one voxel (0.8mm)). In all aneurysms, AWT was inversely related to WSS (mean correlation coefficient −0.35, P<0.05). Conclusions A method was developed to measure the wall thickness semi-quantitatively, using 7T MRI. An inverse correlation between wall shear stress and AWT was determined. In future studies, this non-invasive method can be used to assess spatial wall thickness variation in relation to pathophysiologic processes such as aneurysm growth and –rupture. PMID:26892986

  18. Fluid-Structure Interaction Modeling of Intracranial Aneurysm Hemodynamics: Effects of Different Assumptions

    Science.gov (United States)

    Rajabzadeh Oghaz, Hamidreza; Damiano, Robert; Meng, Hui

    2015-11-01

    Intracranial aneurysms (IAs) are pathological outpouchings of cerebral vessels, the progression of which are mediated by complex interactions between the blood flow and vasculature. Image-based computational fluid dynamics (CFD) has been used for decades to investigate IA hemodynamics. However, the commonly adopted simplifying assumptions in CFD (e.g. rigid wall) compromise the simulation accuracy and mask the complex physics involved in IA progression and eventual rupture. Several groups have considered the wall compliance by using fluid-structure interaction (FSI) modeling. However, FSI simulation is highly sensitive to numerical assumptions (e.g. linear-elastic wall material, Newtonian fluid, initial vessel configuration, and constant pressure outlet), the effects of which are poorly understood. In this study, a comprehensive investigation of the sensitivity of FSI simulations in patient-specific IAs is investigated using a multi-stage approach with a varying level of complexity. We start with simulations incorporating several common simplifications: rigid wall, Newtonian fluid, and constant pressure at the outlets, and then we stepwise remove these simplifications until the most comprehensive FSI simulations. Hemodynamic parameters such as wall shear stress and oscillatory shear index are assessed and compared at each stage to better understand the sensitivity of in FSI simulations for IA to model assumptions. Supported by the National Institutes of Health (1R01 NS 091075-01).

  19. The Role of Computational Fluid Dynamics in the Management of Unruptured Intracranial Aneurysms: A Clinicians' View

    Directory of Open Access Journals (Sweden)

    Pankaj K. Singh

    2009-01-01

    Full Text Available Objective. The importance of hemodynamics in the etiopathogenesis of intracranial aneurysms (IAs is widely accepted. Computational fluid dynamics (CFD is being used increasingly for hemodynamic predictions. However, alogn with the continuing development and validation of these tools, it is imperative to collect the opinion of the clinicians. Methods. A workshop on CFD was conducted during the European Society of Minimally Invasive Neurological Therapy (ESMINT Teaching Course, Lisbon, Portugal. 36 delegates, mostly clinicians, performed supervised CFD analysis for an IA, using the @neuFuse software developed within the European project @neurIST. Feedback on the workshop was collected and analyzed. The performance was assessed on a scale of 1 to 4 and, compared with experts' performance. Results. Current dilemmas in the management of unruptured IAs remained the most important motivating factor to attend the workshop and majority of participants showed interest in participating in a multicentric trial. The participants achieved an average score of 2.52 (range 0–4 which was 63% (range 0–100% of an expert user. Conclusions. Although participants showed a manifest interest in CFD, there was a clear lack of awareness concerning the role of hemodynamics in the etiopathogenesis of IAs and the use of CFD in this context. More efforts therefore are required to enhance understanding of the clinicians in the subject.

  20. Late-onset Pompe disease with complicated intracranial aneurysm: a Chinese case report

    Directory of Open Access Journals (Sweden)

    Zhang B

    2016-03-01

    Full Text Available Bin Zhang,1,2,* Yuying Zhao,1,3,* Junling Liu,1,4 Ling Li,1 Jingli Shan,1 Dandan Zhao,1 Chuanzhu Yan1,3 1Laboratory of Neuromuscular Disorders and Department of Neurology, Qilu Hospital of Shandong University, Jinan, Shandong, 2Department of Neurology, Liaocheng People’s Hospital, Liaocheng, Shandong, 3Department of Neurology, Qilu Hospital of Shandong University, Key Laboratory for Experimental Teratology of the Ministry of Education, Brain Science Research Institute, Shandong University, Jinan, Shandong, 4Department of Neurology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, People’s Republic of China *These authors contributed equally to this work Abstract: Pompe disease is a rare autosomal recessive hereditary disease caused by genetic defects of acid maltase. This disease could be divided into two forms: infantile and late-onset, which mainly affect cardiac, respiratory, and skeletal muscle systems. Late-onset patients mainly show symptoms of skeletal muscle involvement, but recent reports have found that the central nervous system was also affected in some patients. Herein, we report a case of a female, adolescent-onset Pompe patient, who was diagnosed with complicated intracranial aneurysm in adulthood. Keywords: Pompe disease, glycogen storage disease II, acid maltase, acid alpha-glucosidase, cerebrovascular disorders

  1. Progressive Occlusion of Small Saccular Aneurysms Incompletely Occluded After Stent-Assisted Coil Embolization : Analysis of Related Factors and Long-Term Outcomes.

    Science.gov (United States)

    Lim, Jeong Wook; Lee, Jeongjun; Cho, Young Dae

    2017-08-08

    Incompletely occluded aneurysms after coil embolization are subject to recanalization but occasionally progress to a totally occluded state. Deployed stents may actually promote thrombosis of coiled aneurysms. We evaluated outcomes of small aneurysms (LVIS stent is especially susceptible to progressive thrombosis, more so than Neuroform (OR = 0.098; p = 0.008) or Enterprise (OR = 0.317; p = 0.098) stents. In 57 instances of progressive thrombosis, followed for ≥12 months (mean 25.0 ± 10.7 months), 56 (98.2%) were stable, with minor recanalization noted once (1.8%) and no major recanalization. Aneurysms associated with smaller diameter necks, hyperlipidemic states and LVIS stent deployment may be inclined to possible thrombosis, if occlusion immediately after stent-assisted coil embolization is incomplete. In such instances, excellent long-term durability is anticipated.

  2. Morphologic and Clinical Outcome of Intracranial Aneurysms after Treatment Using Flow Diverter Devices: Mid-Term Follow-Up

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    Anna-Katharina Breu

    2016-01-01

    Full Text Available Flow diverters (FDs are designed for the endovascular treatment of complex intracranial aneurysm configurations. From February 2009 to March 2013 28 patients (22 females, 6 males were treated with FD; mean age was 57 years. Data, including aneurysm features, clinical presentation, history of previous bleeding, treatment, and follow-up results, are presented. Early postinterventional neurological deficits (transient: n=3/enduring: n=1 appeared in 4/28 patients (14%, and early improvement of neurological symptoms was observed in 7 patients with previous restriction of cranial nerve function. The overall occlusion rate was 20/26 (77%; 59% after 3 months. 77% achieved best results according to O’Kelly-Marotta score grade D with no contrast material filling (70% of those after 3 months. In 4/6 patients who did not achieve grade D, proximal and/or distal stent overlapping ≥5 mm was not guaranteed sufficiently. During follow-up we did not detect any aneurysm recurrence or haemorrhage. In-stent stenosis emerged as the most frequent complication (4/27; 15% followed by 2 cases of vascular obliteration (AICA/VA. In conclusion endovascular reconstruction using a FD represents a modern and effective treatment in those aneurysms that are not suitable for conventional interventional or surgical treatment. The appearance of severe complications was rare.

  3. Three dimensional CT angiography versus digital subtraction angiography in the detection of intracranial aneurysms in subarachnoid hemorrhage.

    Science.gov (United States)

    Prestigiacomo, Charles J; Sabit, Aria; He, Wenzhuan; Jethwa, Pinakin; Gandhi, Chirag; Russin, Jonathan

    2010-12-01

    Ruptured intracranial aneurysms are responsible for over 90% of cases of spontaneous subarachnoid hemorrhage (SAH). Conventional digital subtraction angiography (DSA) remains the gold standard for diagnosing the source of SAH. A prospective study is presented wherein SAH patients underwent three dimensional CT angiography (CTA) prior to DSA in order to assess the specificity and sensitivity of this non-invasive modality to detect aneurysms. 179 consecutive patients with spontaneous SAH presented over 36 months, as identified by screening CT and CTA. Patients with negative CTA findings underwent DSA within 24 h of presentation. All patients who were determined to have angiographically negative SAH underwent follow-up DSA 2 weeks later. Of the 179 patients screened by CTA, 13 (7%) were negative for aneurysms or other vascular lesions (arteriovenous malformation or dural fistula) on CTA and underwent DSA. No new lesions were identified on six vessel angiography, resulting in a 0% false negative rate (sensitivity 100%, predictive value 100%). MRI to rule out thrombosed aneurysms and repeat angiography at the 2 week follow-up were negative. Sensitivity and specificity were higher than previously reported, suggesting that CTA may be used as an initial screening tool in lieu of DSA. Further studies are necessary to determine if CTA can supplant DSA in ruling out all forms of vascular disease in idiopathic SAH.

  4. Nocardia abscessus-related intracranial aneurysm of the internal carotid artery with associated brain abscess: A case report and review of the literature.

    Science.gov (United States)

    Farran, Yvette; Antony, Suresh

    2016-01-01

    Nocardia infections primarily begin in the lungs and spread hematogenously to other sites in the body. Thus, a Nocardia brain abscess is not a completely uncommon occurrence. However, a Nocardia brain abscess complicated by a middle cerebral artery and infectious intracranial aneurysm is a very rare clinical entity. We present a case of an infectious intracranial aneurysm with an associated Nocardia brain abscess that required surgical intervention and resection. The patient was an immunocompetent 60-year-old male who presented with a chief complaint of headache and was found to have an infected intracranial aneurysm and cerebral abscess. He underwent drainage of the abscess with subsequent resection of the infected aneurysm. Cultures from both the blood vessel and brain tissue grew Nocardia abscessus. He was successfully treated with 6 weeks of ceftriaxone and high-dose trimethoprim-sulfamethoxazole. Infectious intracranial aneurysms of the brain caused by Nocardia are rare occurrences, and only a single previous case has been described in the literature. The outcomes of this condition can be catastrophic if it is not treated with a combination of surgery and intravenous antibiotics. The guidelines for the management of this infection are not well defined at this time. Copyright © 2015 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  5. The "focus on aneurysm" principle: Classification and surgical principles of management of concurrent arterial aneurysm with arteriovenous malformation causing intracranial hemorrhage.

    Science.gov (United States)

    Jha, Vikas; Behari, Sanjay; Jaiswal, Awadhesh K; Bhaisora, Kamlesh Singh; Shende, Yogesh P; Phadke, Rajendra V

    2016-01-01

    Concurrent arterial aneurysms (AAs) occurring in 2.7-16.7% patients harboring an arteriovenous malformation (AVM) aggravate the risk of intracranial hemorrhage. We evaluate the variations of aneurysms simultaneously coexisting with AVMs. A classification-based management strategy and an abbreviated nomenclature that describes their radiological features is also proposed. Tertiary care academic institute. Test of significance applied to determine the factors causing rebleeding in the groups of patients with concurrent AVM and aneurysm and those with only AVMs. Sixteen patients (5 with subarachnoid hemorrhage and 11 with intracerebral/intraventricular hemorrhage; 10 with low flow [LF] and 6 with high flow [HF] AVMs) underwent radiological assessment of Spetzler Martin (SM) grading and flow status of AA + AVM. Their modified Rankin's score (mRS) at admission was compared with their follow-up (F/U) score. Pre-operative mRS was 0 in 5, 2 in 6, 3 in 1, 4 in 3 and 5 in 1; and, SM grade I in 5, II in 3, III in 3, IV in 4 and V in 1 patients, respectively. AA associated AVMs were classified as: (I) Flow-related proximal (n = 2); (II) flow-related distal (n = 3); (III) intranidal (n = 5); (IV) extra-intranidal (n = 2); (V) remote major ipsilateral (n = 1); (VI) remote major contralateral (n = 1); (VII) deep perforator related (n = 1); (VIII) superficial (n = 1); and (IX) distal (n = 0). Their treatment strategy included: Flow related AA, SM I-III LF AVM: aneurysm clipping with AVM excision; nidal-extranidal AA, SM I-III LF AVM: Excision or embolization of both AA + AVM; nidal-extranidal and perforator-related AA, SM IV-V HF AVM: Only endovascular embolization or radiosurgery. Surgical decision-making for remote AA took into account their ipsilateral/contralateral filling status and vessel dominance; and, for AA associated with SM III HF AVM, it varied in each patient based on diffuseness of AVM nidus, flow across arteriovenous fistula and eloquence of cortex. Follow up (F

  6. Screening for Unruptured Intracranial Aneurysms in Autosomal Dominant Polycystic Kidney Disease: A Survey of 420 Nephrologists.

    Directory of Open Access Journals (Sweden)

    Adrien Flahault

    Full Text Available Despite a high prevalence of intracranial aneurysm (ICA in autosomal dominant polycystic kidney disease (ADPKD, rupture events are rare. The current recommendations for ICA screening are based on expert opinions and studies with low levels of evidence.The aim of our study was to describe the attitudes of practicing nephrologists in Europe towards screening for ICA using magnetic resonance angiography (MRA.We conducted a web-based survey among 1315 European French-speaking nephrologists and nephrology residents. An anonymous, electronic questionnaire including 24 independent questions related to ICA screening modalities, indications and participant profiles was sent by email between September and December 2014. Four hundred and twenty nephrologists (mostly from France participated, including 31 nephrology residents; the response rate was 32%.Systematic screening for ICA was advocated by 28% of the nephrologists. A family history of ICA rupture, sudden death, stroke and migraine were consensual indications for screening (> 90% of the panel. In other clinical situations largely not covered by the recommendations (pregnancy, nephrectomy, kidney transplantation, cardiac or hepatic surgery, uncontrolled hypertension, lack of familial ADPKD history, at-risk activity, tobacco use, the attitudes towards screening were highly divergent. ICA screening was influenced by nephrologists experience with ADPKD and by their practice setting. The majority of participants (57% would not repeat a normal ICA screening. Only a few participants (22% knew that non-contrast MRA was the reference diagnostic tool for ICA screening, whereas most participants thought that contrast enhancement was necessary to screen for ICA. The results from the nephrology residents were analyzed separately and yielded similar results.This practice survey revealed that most nephrologists follow the current recommendations for the initial screening of ICAs. However, more than a quarter of the

  7. Characteristics and Outcomes of Patients with Anterior Circulation Intracranial Aneurysm Managed with Clipping in Hospital Sungai Buloh.

    Science.gov (United States)

    Ab Ghani, Ailani; Nayan, Saiful Azli Mat; Kandasamy, Regunath; Rosman, Azmin Kas; Ghani, Abdul Rahman Izani

    2016-11-01

    The annual incidence of intracranial aneurysm in Malaysia is estimated to be 1.1-1.7 per 100,000 population based on a study done conducted in 1988. Since then, little epidemiological research has been conducted in Malaysia, and the real incidence is therefore probably unreported despite advancements in the diagnosis and treatment of this disorder. Intracranial aneurysm may be treated by microsurgical clipping or embolisation depending on its location and the surgeon's preference. This study aims to report the characteristics and outcomes of patients with a clipped anterior circulation aneurysm in Hospital Sungai Buloh. We retrospectively collected the data of patients with anterior circulation aneurysms who underwent clipping from 1 January 2013 until 30 June 2014 in Hospital Sungai Buloh. The mean age of the patients was 48.9 years old, and 56.7% of the study population were male and 63.3% were Malay. There were almost equal numbers of patients with (46.7%) and without (53.3%) co-morbidities such as hypertension and ischaemic heart disease. Half of the study population fell under Fisher grade 3 (50.0%), whereas 46.7% were Fisher grade 4. With respect to the Navarro score, 20% of patients scored 10, 16.7% scored 5 or 7, 13.3% scored 11, 10% scored 9, 6.7% scored 1 and 3.3% scored 2, 3 or 8. Most of the patients fell under grade I (33.3%) of the World Federation of Neurological Societies grading (WFNS), and the fewest number of patients were grade III (3.3%). Most (56.7%) patients had an intracranial aneurysm located at the anterior communicating artery (ACOM), followed by the anterior cerebral artery (ACA) and the middle cerebral artery (MCA) (16.7% each), the posterior communicating artery (PCOM) (6.7%) and, finally, the internal carotid artery (ICA) (3.3%). Neurological outcomes at three and six months were assessed using the Modified Rankin Scale (mRS). At three months follow-up, the majority of the participants (33.3%) scored 0 or 6, whereas at six months

  8. Aneurysm in the brain

    Science.gov (United States)

    ... gov/ency/article/001414.htm Aneurysm in the brain To use the sharing features on this page, ... aneurysm occurs in a blood vessel of the brain, it is called a cerebral, or intracranial, aneurysm. ...

  9. Preliminary Experience with Stent-Assisted Coiling of Aneurysms Arising from Small (<2.5 mm) Cerebral Vessels Using The Low-Profile Visualized Intraluminal Support Device.

    Science.gov (United States)

    Wang, C-C; Li, W; Feng, Z-Z; Hong, B; Xu, Y; Liu, J-M; Huang, Q-H

    2017-06-01

    The Low-Profile Visualized Intraluminal Support (LVIS) stent is a new device recently introduced for the treatment of wide-neck intracranial aneurysms. This single-center study presents the authors' preliminary experience using the LVIS stent to treat saccular aneurysms with parent arteries smaller than 2.5 mm. Aneurysms with a LVIS stent used in a small parent vessel (LVIS stents in small vessels is feasible, safe, and effective in the midterm. Larger studies with long-term follow-up are needed to validate our promising results. © 2017 by American Journal of Neuroradiology.

  10. A method for semi-automatic segmentation and evaluation of intracranial aneurysms in bone-subtraction computed tomography angiography (BSCTA) images

    Science.gov (United States)

    Krämer, Susanne; Ditt, Hendrik; Biermann, Christina; Lell, Michael; Keller, Jörg

    2009-02-01

    The rupture of an intracranial aneurysm has dramatic consequences for the patient. Hence early detection of unruptured aneurysms is of paramount importance. Bone-subtraction computed tomography angiography (BSCTA) has proven to be a powerful tool for detection of aneurysms in particular those located close to the skull base. Most aneurysms though are chance findings in BSCTA scans performed for other reasons. Therefore it is highly desirable to have techniques operating on standard BSCTA scans available which assist radiologists and surgeons in evaluation of intracranial aneurysms. In this paper we present a semi-automatic method for segmentation and assessment of intracranial aneurysms. The only user-interaction required is placement of a marker into the vascular malformation. Termination ensues automatically as soon as the segmentation reaches the vessels which feed the aneurysm. The algorithm is derived from an adaptive region-growing which employs a growth gradient as criterion for termination. Based on this segmentation values of high clinical and prognostic significance, such as volume, minimum and maximum diameter as well as surface of the aneurysm, are calculated automatically. the segmentation itself as well as the calculated diameters are visualised. Further segmentation of the adjoining vessels provides the means for visualisation of the topographical situation of vascular structures associated to the aneurysm. A stereolithographic mesh (STL) can be derived from the surface of the segmented volume. STL together with parameters like the resiliency of vascular wall tissue provide for an accurate wall model of the aneurysm and its associated vascular structures. Consequently the haemodynamic situation in the aneurysm itself and close to it can be assessed by flow modelling. Significant values of haemodynamics such as pressure onto the vascular wall, wall shear stress or pathlines of the blood flow can be computed. Additionally a dynamic flow model can be

  11. Unsecured intracranial aneurysms and induced hypertension in cerebral vasospasm: is induced hypertension safe?

    Science.gov (United States)

    Platz, Johannes; Güresir, Erdem; Vatter, Hartmut; Berkefeld, Joachim; Seifert, Volker; Raabe, Andreas; Beck, Jürgen

    2011-04-01

    Induced hypertension is an established therapy to treat cerebral vasospasm (CVS) following subarachnoid hemorrhage (SAH) to prevent delayed ischemic deficits. Currently, there is minimal evidence available assessing the risk of induced hypertension in the presence of unsecured aneurysms. The aim of this study was to investigate the impact of induced hypertension on the rupturing of unsecured aneurysms in treating CVS. We conducted a retrospective analysis between 1999 and 2009. Patients with unsecured aneurysms treated with induced hypertension were identified and stratified as having (1) additional unruptured unsecured aneurysms or (2) ruptured unsecured aneurysms. Hemodynamic parameters were analyzed and any bleeding recorded. Forty-five patients were included. Of those, 41 had 71 additional unruptured unsecured aneurysms and four patients had four ruptured unsecured aneurysms. The mean size of unsecured aneurysms was: 4.0 ± 1.9 mm (additional unruptured) and 5.3 ± 2.2 mm (ruptured), respectively. No aneurysm ruptured during therapy. Combining our data with previously published studies, there appears to be no increase of risk for aneurysm rupture by induced hypertension when compared to the natural history (0.5% for group 1, 2.9% for group 2). These data corroborate that induced hypertension may be a safe treatment option to prevent cerebral infarction in CVS, even in the presence of unsecured aneurysms. Our findings suggest that induced hypertension does not increase rupture of unsecured aneurysms. Given the high risk for cerebral infarction in severe CVS, we conclude that induced hypertension should not be omitted due to the presence of unsecured aneurysms.

  12. Comparison of remnant size in embolized intracranial aneurysms measured at follow-up with DSA and MRA

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    Serafin, Zbigniew; Strzesniewski, Piotr; Lasek, Wladyslaw [Nicolaus Copernicus University, Department of Radiology and Diagnostic Imaging, Collegium Medicum, Bydgoszcz (Poland); Beuth, Wojciech [University of Humanities and Economics in Wloclawek, Faculty of Health Sciences, Wloclawek (Poland)

    2012-12-15

    The possibility of recanalization and the need for retreatment are the most important limitations of intracranial aneurysm embolization. The purpose of the study was to compare the size of aneurysm remnants measured at follow-up with three-dimensional digital subtracted angiography (3D-DSA) and magnetic resonance angiography (MRA). Twenty-six aneurysms were found incompletely occluded in 72 consecutively examined patients at a follow-up after 3 months. The diameters and volume of aneurysm remnants were compared between 3D-DSA, time-of-flight MRA (TOF-MRA), contrast-enhanced TOF-MRA (CE-TOF-MRA), and contrast-enhanced MRA (CE-MRA) at 1.5 T. There was a significant correlation between remnant volumes calculated based on 3D-DSA and all MRA modalities. The intraobserver variability of the measurements ranged from 3.4 to 4.1 % and the interobserver variability from 5.8 to 7.3 %. There were no significant differences in the variability between the techniques. The mean residual filling volume ranged from 16.3 {+-} 19.0 mm{sup 3} in TOF-MRA to 30.5 {+-} 44.6 mm{sup 3} in 3D-DSA (P < 0.04). Significant differences were found in the volumes measured with 3D-DSA and CE-MRA as compared to TOF-MRA and CE-TOF-MRA (P < 0.01). There was a moderate significant correlation between the residual filling and the relative error of measurement in the case of TOF-MRA and CE-TOF-MRA. TOF-MRA seems to underestimate the size of aneurysm remnants detected at follow-up and should not be used as a sole imaging method to decide on re-embolization. (orig.)

  13. Overlapped Stenting Combined with Coiling for Blood Blister-Like Aneurysms: Comparison of Low-Profile Visualized Intraluminal Support (LVIS) Stent and Non-LVIS Stent.

    Science.gov (United States)

    Zhu, Deyuan; Fang, Yibin; Yang, Pengfei; Zhang, Ping; Chen, Lei; Xu, Yi; Hong, Bo; Huang, Qinghai; Liu, Jian-Min

    2017-08-01

    To evaluate the safety and efficacy of overlapped stenting for blood blister-like aneurysms (BBAs) and to compare the outcomes between Low-profile Visualized Intraluminal Support (LVIS) and non-LVIS stents. A retrospective review of the aneurysm database identified 37 patients with intracranial carotid artery BBAs treated by overlapped stenting in our institution from June 2013 to June 2016. The clinical characteristics and angiographic results were reviewed. Overlapped stenting combined with coiling were applied in 37 BBAs, including LVIS stents in 18 cases and non-LVIS stents in 19. For the LVIS group, angiographic results at 3-24 months were complete occlusion in 15 cases (83.3%), improved in 2 cases (11.1%), and recanalized in 1 case (5.6%). The modified Rankin Scale scores at 3-36 months' follow-up were 0-2 in 15 cases (83.3%) and 3-6 in 3 cases (16.7%). For the non-LVIS group, angiographic results at 3-46 months were complete occlusion in 12 cases (63.2%) and recanalized in 7 cases (36.8%). Clinical outcomes at 6-58 months were modified Rankin Scale scores of 0-2 in 17 cases (89.5%) and 3-6 in 2 cases (10.5%). Use of the LVIS stent was less likely to result in recanalization (odds ratio 0.10, 95% confidence interval 0.01-0.93, P = 0.042) than the non-LVIS stent. The LVIS group had a lower average number of stents than did the non-LVIS group (2.2 vs. 2.6, P = 0.016). In terms of complication rate (11.1% vs. 5.3%, P = 0.604), good outcome rate (83.3% vs. 89.5%, P = 0.660), and immediate angiographic result (P = 0.424), no statistically significant difference between the 2 groups was found. Overlapped LVIS stenting combined with coiling is feasible and safe for BBAs. Overall, the LVIS stent provided less risk of BBA recurrence compared with the non-LVIS stent and did not increase the risk of procedure-related complications. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Effect of short-term ε-aminocaproic acid treatment on patients undergoing endovascular coil embolization following aneurysmal subarachnoid hemorrhage.

    Science.gov (United States)

    Malekpour, Mahdi; Kulwin, Charles; Bohnstedt, Bradley N; Radmand, Golnar; Sethia, Rishabh; Mendenhall, Stephen K; Weyhenmeyer, Jonathan; Hendricks, Benjamin K; Leipzig, Thomas; Payner, Troy D; Shah, Mitesh V; Scott, John; DeNardo, Andrew; Sahlein, Daniel; Cohen-Gadol, Aaron A

    2017-05-01

    OBJECTIVE Aneurysmal rebleeding before definitive obliteration of the aneurysm is a cause of mortality and morbidity. There are limited data on the role of short-term antifibrinolytic therapy among patients undergoing endovascular intervention. METHODS All consecutive patients receiving endovascular therapy for their ruptured saccular aneurysm at the authors' institution between 2000 and 2011 were included in this study. These patients underwent endovascular coiling of their aneurysm within 72 hours of admission. In patients receiving ε-aminocaproic acid (EACA), the EACA administration was continued until the time of the endovascular procedure. Complications and clinical outcomes of endovascular treatment after aneurysmal subarachnoid hemorrhage (aSAH) were compared between EACA-treated and untreated patients. RESULTS During the 12-year study period, 341 patients underwent endovascular coiling. Short-term EACA treatment was administered in 146 patients and was withheld in the other 195 patients. EACA treatment did not change the risk of preinterventional rebleeding in this study (OR 0.782, 95% CI 0.176-3.480; p = 0.747). Moreover, EACA treatment did not increase the rate of thromboembolic events. On the other hand, patients who received EACA treatment had a significantly longer duration of hospital stay compared with their counterparts who were not treated with EACA (median 19 days, interquartile range [IQR] 12.5-30 days vs median 14 days, IQR 10-23 days; p < 0.001). EACA treatment was associated with increased odds of shunt requirement (OR 2.047, 95% CI 1.043-4.018; p = 0.037) and decreased odds of developing cardiac complications (OR 0.138, 95% CI 0.031-0.604; p = 0.009) and respiratory insufficiency (OR 0.471, 95% CI 0.239-0.926; p = 0.029). Short-term EACA treatment did not affect the Glasgow Outcome Scale score at discharge, 6 months, or 1 year following discharge. CONCLUSIONS In this study, short-term EACA treatment in patients who suffered from aSAH and

  15. Complete Obliteration of a Basilar Artery Aneurysm after Insertion of a Self- Expandable Leo Stent into the Basilar Artery without Coil Embolization

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    Juszkat, Robert; Nowak, Stanis Aw; Wieloch, Micha; Zarzecka, Anna [Poznan University of Medical Sciences, Poznan (Poland)

    2008-08-15

    We report a case of a 45-year-old man who underwent endovascular treatment in the acute setting of a subarachnoid hemorrhage due to rupture of a widenecked basilar trunk aneurysm. The patient was treated with stent implantation without coiling. A control angiographic scan obtained immediately after the procedure revealed significantly decreased intraaneurysmal flow. Follow-up angiography performed after one month demonstrated total aneurysm occlusion.

  16. Association between polymorphism of SMAD3 gene and risk of sporadic intracranial arterial aneurysms in the Chinese Han population.

    Science.gov (United States)

    Liao, Mao-Fan; Gong, Qiu-Wen; Liu, Liang; Xiong, Xiao-Yi; Zhang, Qin; Gong, Chang-Xiong; Yang, Qing-Wu

    2018-01-01

    Intracranial arterial aneurysms (IAAs) are locally abnormal dilations of the cerebral arteries and often result in subarachnoid hemorrhages (SAH). Genetic, molecular and cellular mechanisms of sporadic IAAs forms are poorly understood. In this study, we investigate the association between mothers against decapentaplegic homolog 3 (SMAD3) genotypes and the risk of sporadic intracranial arterial aneurysms among the Chinese Han population. A case-control study was conducted examining 330 IAA patients and 313 controls. There were eight single nucleotide polymorphisms of SMAD3 selected and genotyped using the polymerase chain reaction-ligase detection reaction (PCR-LDR) method. Our results indicated that SMAD3 rs1065080 polymorphism was associated with a risk of IAAs in a codominant model (GA vs GG, OR=1.433; 95% CI 1.030-1.994; P=0.032). In summary, we observed that SMAD3 rs1065080 single nucleotide gene polymorphisms were significantly associated with patient susceptibility to IAAs. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Two Distally Located Right SCA Aneurysms: Endovascular Treatment by Parent Artery Occlusion with GDC Coils and N-BCA Injection. Case Report and Review of the Literature.

    Science.gov (United States)

    Szajner, M; Obszaska, K; Nestorowicz, A; Szczerbo-Trojanowska, M

    2003-06-30

    Peripheral aneurysms of the superior cerebellar artery are considered difficult to treat surgically and endovascularly because of their inaccessibility. Parent artery occlusion is therefore frequently the preferred method. Embolic materials previously reported in this situation are either GDC coils or a polymerizing agent (n- BCA). We report a patient with two distally located, wide-neck aneurysms of the right superior cerebellar artery who presented with hemorrhage and was treated by endovascular embolization of the parent artery using a combination of GDC coils and n-BCA.

  18. Non-enhanced magnetic resonance imaging of unruptured intracranial aneurysms at 7 Tesla: Comparison with digital subtraction angiography.

    Science.gov (United States)

    Wrede, Karsten H; Matsushige, Toshinori; Goericke, Sophia L; Chen, Bixia; Umutlu, Lale; Quick, Harald H; Ladd, Mark E; Johst, Sören; Forsting, Michael; Sure, Ulrich; Schlamann, Marc

    2017-01-01

    To prospectively evaluate non-contrast-enhanced 7-Tesla (T) MRA for delineation of unruptured intracranial aneurysms (UIAs) in comparison with DSA. Forty patients with single or multiple UIAs were enrolled in this IRB-approved trial. Sequences acquired at 7 T were TOF MRA and non-contrast-enhanced MPRAGE. All patients additionally underwent 3D rotational DSA. Two neuroradiologists individually analysed the following aneurysm and image features on a five-point scale in 2D and 3D image reconstructions: delineation of parent vessel, dome and neck; overall image quality; presence of artefacts. Interobserver accordance was assessed by the kappa coefficient. A total of 64 UIAs were detected in DSA and in all 2D and 3D MRA image reconstructions. Ratings showed comparable results for DSA and 7-T MRA when considering all image reconstructions. Highest ratings for individual image reconstructions were given for 2D MPRAGE and 3D TOF MRA. Interobserver accordance was almost perfect for the majority of ratings. This study demonstrates excellent delineation of UIAs using 7-T MRA within a clinical setting comparable to the gold standard, DSA. The combination of 7-T non-enhanced MPRAGE and TOF MRA for assessment of untreated UIAs is a promising clinical application of ultra-high-field MRA. • Non-enhanced 7-T MRA allowed excellent delineation of unruptured intracranial aneurysms (UIAs). • Image quality at 7-T was comparable with DSA considering both sequences. • Assessment of UIAs is a promising clinical application of ultra-high-field MRA.

  19. Intracranial arterial aneurysms in childhood: case report Aneurismas arteriais intracranianos na infância: relato de caso

    Directory of Open Access Journals (Sweden)

    Fernando Campos Gomes Pinto

    2006-09-01

    Full Text Available A case of an intracranial arterial aneurysm at internal carotid bifurcation in a 10-year-old girl is described with the special features of cerebral aneurysm which occur in children, comparing with the adults. We alert for the necessity of carefully operative technique in order to avoid damage and intraoperative rupture of the aneurysm due to the very thin vessel wall that this population can develop. Our recommendation is early surgery in these patients.Relatamos o caso de aneurisma arterial intracraniano na bifurcação da carótida interna em menina de 10 anos de idade. As características especiais dos aneurismas intracranianos que acometem a faixa etária pediátrica são descritas, comparando com a faixa etária adulta. Alertamos a necessidade de emprego de técnica operatória microcirúrgica cautelosa para evitar lesão e ruptura intraoperatória do aneurisma, devido a parede do aneurisma geralmente ser muito fina na faixa etária pediátrica. Recomendamos cirurgia precoce nestes pacientes.

  20. High risk population isolate reveals low frequency variants predisposing to intracranial aneurysms.

    Directory of Open Access Journals (Sweden)

    Mitja I Kurki

    2014-01-01

    Full Text Available 3% of the population develops saccular intracranial aneurysms (sIAs, a complex trait, with a sporadic and a familial form. Subarachnoid hemorrhage from sIA (sIA-SAH is a devastating form of stroke. Certain rare genetic variants are enriched in the Finns, a population isolate with a small founder population and bottleneck events. As the sIA-SAH incidence in Finland is >2× increased, such variants may associate with sIA in the Finnish population. We tested 9.4 million variants for association in 760 Finnish sIA patients (enriched for familial sIA, and in 2,513 matched controls with case-control status and with the number of sIAs. The most promising loci (p<5E-6 were replicated in 858 Finnish sIA patients and 4,048 controls. The frequencies and effect sizes of the replicated variants were compared to a continental European population using 717 Dutch cases and 3,004 controls. We discovered four new high-risk loci with low frequency lead variants. Three were associated with the case-control status: 2q23.3 (MAF 2.1%, OR 1.89, p 1.42×10-9; 5q31.3 (MAF 2.7%, OR 1.66, p 3.17×10-8; 6q24.2 (MAF 2.6%, OR 1.87, p 1.87×10-11 and one with the number of sIAs: 7p22.1 (MAF 3.3%, RR 1.59, p 6.08×-9. Two of the associations (5q31.3, 6q24.2 replicated in the Dutch sample. The 7p22.1 locus was strongly differentiated; the lead variant was more frequent in Finland (4.6% than in the Netherlands (0.3%. Additionally, we replicated a previously inconclusive locus on 2q33.1 in all samples tested (OR 1.27, p 1.87×10-12. The five loci explain 2.1% of the sIA heritability in Finland, and may relate to, but not explain, the increased incidence of sIA-SAH in Finland. This study illustrates the utility of population isolates, familial enrichment, dense genotype imputation and alternate phenotyping in search for variants associated with complex diseases.

  1. A New Imaging Tool for Realtime Measurement of Flow Velocity in Intracranial Aneurysms

    Science.gov (United States)

    Petridis, Athanasios K.; Kaschner, Marius; Cornelius, Jan F.; Kamp, Marcel A.; Tortora, Angelo; Steiger, Hans-Jakob; Turowski, Bernd

    2017-01-01

    With modern imaging modalities of the brain a significant number of unruptured aneurysms are detected. However, not every aneurysm is prone to rupture. Because treatment morbidity is about 10% it is crucial to identify unstable aneurysms for which treatment should be discussed. Recently, new imaging tools allow analysis of flow dynamics and wall stability have become available. It seems that they might provide additional data for better risk profiling. In this study we present a new imaging tool for analysis of flow dynamics, which calculates fluid velocity in an aneurysm (Phillips Electronics, N.V.). It may identify regions with high flow and calculate flow reduction after stenting of aneurysms. Contrast is injected with a stable injection speed of 2 mL/sec for 3 sec. Two clinical cases are illustrated. Velocity in aneurysms and areas of instability can be identified and calculated during angiography in real-time. After stenting and flow diverter deployment flow reduction in the internal carotid aneurysm was reduced by 60% and there was a reduction of about 65% in the posterior cerebral artery in the second case we are reporting. The dynamic flow software calculates the flow profile in the aneurysm immediately after contrast injection. It is a real-time, patient specific tool taking into account systole, diastole and flexibility of the vasculature. These factors are an improvement as compared to current models of computational flow dynamics. We think it is a highly efficient, user friendly tool. Further clinical studies are on their way. PMID:28839527

  2. A new imaging tool for realtime measurement of flow velocity in intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    Athanasios K. Petridis

    2017-08-01

    Full Text Available With modern imaging modalities of the brain a significant number of unruptured aneurysms are detected. However, not every aneurysm is prone to rupture. Because treatment morbidity is about 10% it is crucial to identify unstable aneurysms for which treatment should be discussed. Recently, new imaging tools allow analysis of flow dynamics and wall stability have become available. It seems that they might provide additional data for better risk profiling. In this study we present a new imaging tool for analysis of flow dynamics, which calculates fluid velocity in an aneurysm (Phillips Electronics, N.V.. It may identify regions with high flow and calculate flow reduction after stenting of aneurysms. Contrast is injected with a stable injection speed of 2 mL/sec for 3 sec. Two clinical cases are illustrated. Velocity in aneurysms and areas of instability can be identified and calculated during angiography in real-time. After stenting and flow diverter deployment flow reduction in the internal carotid aneurysm was reduced by 60% and there was a reduction of about 65% in the posterior cerebral artery in the second case we are reporting. The dynamic flow software calculates the flow profile in the aneurysm immediately after contrast injection. It is a real-time, patient specific tool taking into account systole, diastole and flexibility of the vasculature. These factors are an improvement as compared to current models of computational flow dynamics. We think it is a highly efficient, user friendly tool. Further clinical studies are on their way.

  3. Symptomatic regrowth of a small intracranial aneurysm that had ruptured and completely thrombosed: a case report

    Directory of Open Access Journals (Sweden)

    Hidetoshi Ooigawa

    2015-06-01

    Full Text Available We report a case of small internal carotid–posterior communication artery (IC–PC aneurysm that was completely thrombosed after initial bleeding, but subsequently became symptomatic, causing a mass effect. A 54-year-old woman initially presented with grade-five subarachnoid hemorrhage from a small right IC–PC aneurysm. The aneurysm was treated conservatively and completely thrombosed within 35 days. The patient slowly recovered and remained well until 4 years later, when she developed right oculomotor nerve palsy. Imaging revealed relapse of the aneurysm, and repair led to symptom resolution. This case offers a reminder that totally thrombosed aneurysms carry a risk of regrowth if left untreated.

  4. Administration of eptifibatide during endovascular treatment of ruptured cerebral aneurysms reduces the rate of thromboembolic events.

    Science.gov (United States)

    Sedat, Jacques; Chau, Yves; Gaudard, Jean; Suissa, Laurent; Lachaud, Sylvain; Lonjon, Michel

    2015-02-01

    Thromboembolic complications are the most frequent complications of endovascular treatment of ruptured intracranial aneurysms. The optimal protocol to prevent thromboembolic complications during coil embolization does not yet exist. The aim of this study was to investigate the effectiveness and safety of eptifibatide for the prevention of thromboembolic complications during elective coil embolization of ruptured cerebral aneurysms. A consecutive series of 100 patients (group 1) with ruptured intracranial aneurysm were treated using endovascular coil embolization. At the beginning of the procedure, all patients received an intra-arterial bolus (0.2 mg/kg) of eptifibatide. The following data were collected: degree of aneurysmal occlusion after treatment, thromboembolic and hemorrhagic complications and other intraoperative adverse events. The results were compared with those from a control group (group 2) which were analyzed retrospectively. Group 2 consisted of 100 previous patients with ruptured aneurysm managed with coil embolization who had received heparin and/or aspirin at the beginning of the procedure. (1) Patient populations in groups 1 and 2 were considered statistically comparable, except that group 1 (eptifibatide) included more wide-necked aneurysms (p = 0.011). (2) There were less thromboembolic complications in group 1 (p = 0.011): seven intraoperative complications in group 1 versus 20 in group 2. (3) Intraoperative hemorrhagic complications were statistically comparable in both groups (p = 1). Eptifibatide was effective in lowering the intraoperative thromboembolic complication rate in ruptured aneurysms treated with coil embolization and did not increase the hemorrhagic risk.

  5. The Computational Fluid Dynamics Rupture Challenge 2013--Phase II: Variability of Hemodynamic Simulations in Two Intracranial Aneurysms.

    Science.gov (United States)

    Berg, Philipp; Roloff, Christoph; Beuing, Oliver; Voss, Samuel; Sugiyama, Shin-Ichiro; Aristokleous, Nicolas; Anayiotos, Andreas S; Ashton, Neil; Revell, Alistair; Bressloff, Neil W; Brown, Alistair G; Chung, Bong Jae; Cebral, Juan R; Copelli, Gabriele; Fu, Wenyu; Qiao, Aike; Geers, Arjan J; Hodis, Simona; Dragomir-Daescu, Dan; Nordahl, Emily; Bora Suzen, Yildirim; Owais Khan, Muhammad; Valen-Sendstad, Kristian; Kono, Kenichi; Menon, Prahlad G; Albal, Priti G; Mierka, Otto; Münster, Raphael; Morales, Hernán G; Bonnefous, Odile; Osman, Jan; Goubergrits, Leonid; Pallares, Jordi; Cito, Salvatore; Passalacqua, Alberto; Piskin, Senol; Pekkan, Kerem; Ramalho, Susana; Marques, Nelson; Sanchi, Stéphane; Schumacher, Kristopher R; Sturgeon, Jess; Švihlová, Helena; Hron, Jaroslav; Usera, Gabriel; Mendina, Mariana; Xiang, Jianping; Meng, Hui; Steinman, David A; Janiga, Gábor

    2015-12-01

    With the increased availability of computational resources, the past decade has seen a rise in the use of computational fluid dynamics (CFD) for medical applications. There has been an increase in the application of CFD to attempt to predict the rupture of intracranial aneurysms, however, while many hemodynamic parameters can be obtained from these computations, to date, no consistent methodology for the prediction of the rupture has been identified. One particular challenge to CFD is that many factors contribute to its accuracy; the mesh resolution and spatial/temporal discretization can alone contribute to a variation in accuracy. This failure to identify the importance of these factors and identify a methodology for the prediction of ruptures has limited the acceptance of CFD among physicians for rupture prediction. The International CFD Rupture Challenge 2013 seeks to comment on the sensitivity of these various CFD assumptions to predict the rupture by undertaking a comparison of the rupture and blood-flow predictions from a wide range of independent participants utilizing a range of CFD approaches. Twenty-six groups from 15 countries took part in the challenge. Participants were provided with surface models of two intracranial aneurysms and asked to carry out the corresponding hemodynamics simulations, free to choose their own mesh, solver, and temporal discretization. They were requested to submit velocity and pressure predictions along the centerline and on specified planes. The first phase of the challenge, described in a separate paper, was aimed at predicting which of the two aneurysms had previously ruptured and where the rupture site was located. The second phase, described in this paper, aims to assess the variability of the solutions and the sensitivity to the modeling assumptions. Participants were free to choose boundary conditions in the first phase, whereas they were prescribed in the second phase but all other CFD modeling parameters were not

  6. Comparison of 3D TOF-MRA and 3D CE-MRA at 3 T for imaging of intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Cirillo, Mario, E-mail: mario.cirillo@unina2.it [Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences – 2nd University of Naples (Italy); Scomazzoni, Francesco [Department of Neuroradiology, Scientific Institute San Raffaele, Milan (Italy); Cirillo, Luigi [IRCCS – Institute of Neurological Sciences, Bologna (Italy); Cadioli, Marcello; Simionato, Franco; Iadanza, Antonella [Department of Neuroradiology, Scientific Institute San Raffaele, Milan (Italy); Kirchin, Miles [Worldwide Medical and Regulatory Affairs, Bracco Imaging SpA, Milan (Italy); Righi, Claudio; Anzalone, Nicoletta [Department of Neuroradiology, Scientific Institute San Raffaele, Milan (Italy)

    2013-12-01

    Purpose: To compare 3 T elliptical-centric CE MRA with 3 T TOF MRA for the detection and characterization of unruptured intracranial aneurysms (UIAs), by using digital subtracted angiography (DSA) as reference. Materials and methods: Twenty-nine patients (12 male, 17 female; mean age: 62 years) with 41 aneurysms (34 saccular, 7 fusiform; mean diameter: 8.85 mm [range 2.0–26.4 mm]) were evaluated with MRA at 3 T each underwent 3D TOF-MRA examination without contrast and then a 3D contrast-enhanced (CE-MRA) examination with 0.1 mmol/kg bodyweight gadobenate dimeglumine and k-space elliptic mapping (Contrast ENhanced Timing Robust Angiography [CENTRA]). Both TOF and CE-MRA images were used to evaluate morphologic features that impact the risk of rupture and the selection of a treatment. Almost half (20/41) of UIAs were located in the internal carotid artery, 7 in the anterior communicating artery, 9 in the middle cerebral artery and 4 in the vertebro-basilar arterial system. All patients also underwent DSA before or after the MR examination. Results: The CE-MRA results were in all cases consistent with the DSA dataset. No differences were noted between 3D TOF-MRA and CE-MRA concerning the detection and location of the 41 aneurysms or visualization of the parental artery. Differences were apparent concerning the visualization of morphologic features, especially for large aneurysms (>13 mm). An irregular sac shape was demonstrated for 21 aneurysms on CE-MRA but only 13/21 aneurysms on 3D TOF-MRA. Likewise, CE-MRA permitted visualization of an aneurismal neck and calculation of the sac/neck ratio for all 34 aneurysms with a neck demonstrated at DSA. Conversely, a neck was visible for only 24/34 aneurysms at 3D TOF-MRA. 3D CE-MRA detected 15 aneurysms with branches originating from the sac and/or neck, whereas branches were recognized in only 12/15 aneurysms at 3D TOF-MRA. Conclusion: For evaluation of intracranial aneurysms at 3 T, 3D CE-MRA is superior to 3D TOF

  7. Low plasma arginine:asymmetric dimethyl arginine ratios predict mortality after intracranial aneurysm rupture

    DEFF Research Database (Denmark)

    Staalsø, Jonatan Myrup; Bergström, Anita; Edsen, Troels

    2013-01-01

    Asymmetrical dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthases, predicts mortality in cardiovascular disease and has been linked to cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). In this prospective study, we assessed whether circulating ADMA, arginine...

  8. CFD and PIV Analysis of Hemodynamics in a Growing Intracranial Aneurysm

    OpenAIRE

    Raschi, Marcelo; Mut, Fernando; Byrne, Greg; Putman, Christopher M.; Tateshima, Satoshi; Viñuela, Fernando; Tanoue, Tetsuya; Tanishita, Kazuo; Cebral, Juan R.

    2011-01-01

    Hemodynamics is thought to be a fundamental factor in the formation, progression and rupture of cerebral aneurysms. Understanding these mechanisms is important to improve their rupture risk assessment and treatment. In this study we analyze the blood flow field in a growing cerebral aneurysm using experimental particle image velocimetry (PIV) and computational fluid dynamics (CFD) techniques. Patient-specific models were constructed from longitudinal 3D computed tomography angiography (CTA) i...

  9. Subarachnoid hemorrhage due to ruptured intracranial aneurysm following posterior reversible encephalopathy syndrome

    OpenAIRE

    Takamasa Nanba; Hiroshi Kashimura; Hiroaki Saura; Masaru Takeda

    2016-01-01

    Although posterior reversible encephalopathy syndrome (PRES) is rarely associated with subarachnoid hemorrhage, to our knowledge, rupture of a concomitant cerebral aneurysm following PRES has not been reported. We describe a patient with atypical PRES involving the brainstem, thalamus, and periventricular white matter without cortical or subcortical edema of the parietooccipital lobe on magnetic resonance imaging, with rupture of a concomitant cerebral aneurysm. Preexisting extremely high blo...

  10. Enterprise Deployment Through PulseRider To Treat Anterior Communicating Artery Aneurysm Recurrence.

    Science.gov (United States)

    Valente, Iacopo; Limbucci, Nicola; Nappini, Sergio; Rosi, Andrea; Laiso, Antonio; Mangiafico, Salvatore

    2018-02-01

    PulseRider (Pulsar Vascular, Los Gatos, California, USA) is a new endovascular device designed to treat wide-neck bifurcation intracranial aneurysms. Deployment of a stent through a PulseRider to treat an aneurysm's recurrence has never been described before. We report the case of a 55-year-old man who underwent coiling of an 8-mm anterior communicating artery aneurysm with assistance of a PulseRider neck reconstruction device. The 6-month digital subtraction angiography control showed aneurysm recurrence, so we deployed an Enterprise 2 closed-cell stent (Codman, Miami Lakes, Florida, USA) in the A1-A2 segment passing across the previously implanted PulseRider. Enterprise correctly expanded and allowed for adequate coiling of the aneurysm. An Enterprise stent can be safely opened through a PulseRider in order to treat aneurysm recurrence. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. [The Therapeutic Dilemma in Treatment of Intracranial Infectious Aneurysm in Patients with Infective Endocarditis: Proposal for a Patient-Centered, Interdisciplinary Treatment Concept].

    Science.gov (United States)

    Leuenhagen, S; Burghaus, L; Kukolja, J; Rosenkranz, S; Kabbasch, C; Fink, G R; Onur, O A

    2016-07-01

    Intracranial infectious aneurysms are rare but hazardous complications of an infective endocarditis. To date, there are no evidence-based recommendations for the treatment of patients with this condition. Therefore, it remains an interdisciplinary challenge to decide which treatment steps are required and in which order they should be carried out. To illustrate the interdisciplinary dilemma in the treatment of these patients, we here present a case of a 23-year-old, drug-addicted woman with infectious endocarditis. While antibiotic treatment of the streptococcus-mitis-induced endocarditis stabilized the overall status of the patient, rupture of a basilar artery aneurysm caused her sudden death. We discuss the decision-making processes of the treatment, potential difficulties and dilemmas when dealing with patients suffering from infectious endocarditis and infectious intracranial aneurysm. Based upon case reports, studies and reviews, we present the options and risks of conservative, neurosurgical, endovascular, and cardiosurgical treatment of intracranial infectious aneurysms, and propose a patient-centered, interdisciplinary treatment concept. © Georg Thieme Verlag KG Stuttgart · New York.

  12. Nonthyroidal illness syndrome in patients with subarachnoid hemorrhage due to intracranial aneurysm

    Directory of Open Access Journals (Sweden)

    Casulari Luiz Augusto

    2004-01-01

    Full Text Available We have previously reported that subarachnoid hemorrhage due to ruptured intracranial aneurysm (SH is associated with changes in the hormonal profile in the first 24 hours after the event. We proposed that the hormonal changes observed are due to the intense stress to which the patients are exposed. However, the thyroidal hormonal profile is indicative of the presence of a nonthyroidal illness syndrome (NTIS. In this paper, we examined whether the change in the thyroid hormone profile is compatible with a NTIS. Two groups of patients were included in the study: A 30 patients with SH (21 females and 9 males; 41.7±11.4 years and B a control group including 25 patients with benign diseases of the spine (BDS (lumbar disc hernia or stable spinal trauma (8 females and 17 males; 41.3±14.2 years. In a subgroup of eight patients of each group serum triiodothyronine (T3 and reverse T3 levels were measured. The blood samples were obtained between 8:00 and 9:00 AM. The following results were obtained: The SH group had smaller serum T3 and free T4 levels than the BDS group (p<0.05: T3 (ng/mL: SH = 58.7±1.1 and BDS = 74.5±13.9; free T4 (ng/dL: SH = 0.9±0.2 and BDS = 1.1±0.3. There was no significant difference in the serum levels of total thyroxine (T4 and thyroid-stimulating hormone (TSH between the two groups: T4 (µg/dL: SH = 6.9±1.1 and BDS = 7.4±2.1; TSH (µUI/mL: SH = 1.5±0.8 and BDS = 1.8±1,0. In the sample of eight patients of each group we had the following results: T3 (ng/mL: SH = 66.8±3.8 and BDS = 77.2±1.1 (p <0.05; reverse T3 (ng/dL: SH = 32.8±8 and BDS = 24.7±2.2 (NS; T3/ reverse T3 ratio: SH = 2.6±0.3 and BDS = 3.3±0.4 (NS. Thyreoglobulin and microsomal antibodies were not detectable, except in one patient in the SH group. In conclusion, the SH patients present serum levels of T3 and free T4 significantly lower than that of BDS patients; the thyroidal hormone profile suggests that SH patients have developed the nonthyroidal

  13. Apolipoprotein E ε4: A Possible Risk Factor of Intracranial Pressure and White Matter Perfusion in Good-Grade Aneurysmal Subarachnoid Hemorrhage Patients at Early Stage.

    Science.gov (United States)

    Peng, Jian-Hua; Qin, Xing-Hu; Pang, Jin-Wei; Wu, Yue; Dong, Jin-Hu; Huang, Chang-Ren; Wan, Wei-Feng; Yang, Xiao-Bo; Sun, Xiao-Chuan; Chen, Li-Gang; Jiang, Yong

    2017-01-01

    Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating and complicated disease with significant morbidity and mortality. Previous studies have shown that genetic susceptibility may play an important role in the outcome of a given individual with aSAH. This study evaluates the potential association in effects of the APOE allele on the early brain injury (EBI) in light of elevated intracranial pressure (ICP) and cerebral perfusion disorders in a consecutive series of non-comatose Chinese patients with aSAH. A total of 122 patients with aSAH (54 males and 68 females) were enrolled in this study. Demographic and clinical data were collected. We measured ICP before microsurgical clipping or endovascular coiling during the first 72 h after aneurysm rupture. Computed tomography perfusion (CTP) examination in patients was performed before treatment. The distributions of APOE genotypes and alleles matched Hardy-Weinberg law (p > 0.05). In this study, 68 patients (55.7%) had a normal ICP, whereas 54 (44.3%) had an elevated ICP. Fourteen of 21 patients with APOE ε4 had an elevated ICP, which was significantly different from those without APOE ε4 (p = 0.03). The patients with the ε4 allele had a higher incidence of elevated ICP [p = 0.009, 95% confidence interval (CI) = 1.481-15.432, odds ratio = 4.780] than those without this allele. For CTP measurements, a lower mean cerebral blood flow (difference, -4.74; 95% CI, 0.53-8.94 s, p = 0.03), longer mean transit time (difference, 0.47; 95% CI, -0.87 to -0.78, p = 0.02), and time-to-peak (difference, 2.29; 95% CI, -3.64 to -0.93 s, p = 0.02) were observed in patients with ε4 allele than in those without in the internal capsule regions. In conclusion, the APOE ε4 allele predisposes patients to elevated ICP and perfusion disorders in white matter regions during the first 72 h after aSAH. The presence of an APOE ε4 allele plays an important role in the EBI response to aSAH.

  14. High resolution three-dimensional cine phase contrast MRI of small intracranial aneurysms using a stack of stars k-space trajectory.

    Science.gov (United States)

    Kecskemeti, Steven; Johnson, Kevin; Wu, Yijing; Mistretta, Charles; Turski, Patrick; Wieben, Oliver

    2012-03-01

    To develop a method for targeted volumetric, three directional cine phase contrast (PC) imaging with high spatial resolution in clinically feasible scan times. A hybrid radial-Cartesian k-space trajectory is used for cardiac gated, volumetric imaging with three directional velocity encoding. Imaging times are reduced by radial undersampling and temporal viewsharing. Phase contrast angiograms are displayed in a new approach that addresses the concern of signal drop out in regions of slow flow. The feasibility of the PC stack of stars (SOS) trajectory was demonstrated with an in vivo study capturing 14 small intracranial aneurysms (2-10 mm). Aneurysm measures from six aneurysms also imaged with digital subtraction angiography (DSA) were compared with linear regression with those from the PC SOS images. All aneurysms were identified on the phase contrast angiograms. The geometric measures from PC SOS and DSA were in good agreement (linear regression: slope = 0.89, intercept = 0.35, R∧2 = 0.88). PC SOS is a promising method for obtaining volumetric angiograms and cine phase contrast velocity measurements in three dimensions. Acquired spatial resolutions of 0.4 × 0.4 × (0.7-1.0) mm make this method especially promising for studying flow in small intracranial aneurysms. Copyright © 2011 Wiley-Liss, Inc.

  15. Ruptured Intrasellar Superior Hypophyseal Artery Aneurysm Presenting with Pure Subdural Haematoma

    Science.gov (United States)

    Hornyak, M.; Hillard, V.; Nwagwu, C.; Zablow, B. C.; Murali, R.

    2004-01-01

    Summary Subdural haemorrhage from a ruptured intracranial aneurysm is a well-known entity when associated with subarachnoid haemorrhage. However, haemorrhage confined only to the subdural space is rare because there are limited anatomical sites where extravasation can be purely subdural. We report the rare case of a patient who suffered pure subdural haematoma after the rupture of a left superior hypophyseal artery aneurysm located within the sella turcica. The patient was treated with endovascular coil embolization of the aneurysm. Angiography immediately after treatment and one month later revealed complete obliteration of the aneurysm. Six months after treatment, the patient remained symptom free. PMID:20587264

  16. Real-time surgery simulation of intracranial aneurysm clipping with patient-specific geometries and haptic feedback

    Science.gov (United States)

    Fenz, Wolfgang; Dirnberger, Johannes

    2015-03-01

    Providing suitable training for aspiring neurosurgeons is becoming more and more problematic. The increasing popularity of the endovascular treatment of intracranial aneurysms leads to a lack of simple surgical situations for clipping operations, leaving mainly the complex cases, which present even experienced surgeons with a challenge. To alleviate this situation, we have developed a training simulator with haptic interaction allowing trainees to practice virtual clipping surgeries on real patient-specific vessel geometries. By using specialized finite element (FEM) algorithms (fast finite element method, matrix condensation) combined with GPU acceleration, we can achieve the necessary frame rate for smooth real-time interaction with the detailed models needed for a realistic simulation of the vessel wall deformation caused by the clamping with surgical clips. Vessel wall geometries for typical training scenarios were obtained from 3D-reconstructed medical image data, while for the instruments (clipping forceps, various types of clips, suction tubes) we use models provided by manufacturer Aesculap AG. Collisions between vessel and instruments have to be continuously detected and transformed into corresponding boundary conditions and feedback forces, calculated using a contact plane method. After a training, the achieved result can be assessed based on various criteria, including a simulation of the residual blood flow into the aneurysm. Rigid models of the surgical access and surrounding brain tissue, plus coupling a real forceps to the haptic input device further increase the realism of the simulation.

  17. Non-enhanced magnetic resonance imaging of unruptured intracranial aneurysms at 7 Tesla: Comparison with digital subtraction angiography

    Energy Technology Data Exchange (ETDEWEB)

    Wrede, Karsten H.; Chen, Bixia [University Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); University Hospital Essen, Department of Neurosurgery, Essen (Germany); Matsushige, Toshinori [University Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); University Hospital Essen, Department of Neurosurgery, Essen (Germany); Hiroshima University, Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima (Japan); Goericke, Sophia L.; Umutlu, Lale; Forsting, Michael [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Quick, Harald H. [University Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); University Hospital Essen, High Field and Hybrid MR Imaging, Essen (Germany); Ladd, Mark E. [University Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); German Cancer Research Center (DKFZ), Division of Medical Physics in Radiology (E020), Heidelberg (Germany); Johst, Soeren [University Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); Sure, Ulrich [University Hospital Essen, Department of Neurosurgery, Essen (Germany); Schlamann, Marc [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); University Hospital Giessen, Department of Neuroradiology, Giessen (Germany)

    2017-01-15

    To prospectively evaluate non-contrast-enhanced 7-Tesla (T) MRA for delineation of unruptured intracranial aneurysms (UIAs) in comparison with DSA. Forty patients with single or multiple UIAs were enrolled in this IRB-approved trial. Sequences acquired at 7 T were TOF MRA and non-contrast-enhanced MPRAGE. All patients additionally underwent 3D rotational DSA. Two neuroradiologists individually analysed the following aneurysm and image features on a five-point scale in 2D and 3D image reconstructions: delineation of parent vessel, dome and neck; overall image quality; presence of artefacts. Interobserver accordance was assessed by the kappa coefficient. A total of 64 UIAs were detected in DSA and in all 2D and 3D MRA image reconstructions. Ratings showed comparable results for DSA and 7-T MRA when considering all image reconstructions. Highest ratings for individual image reconstructions were given for 2D MPRAGE and 3D TOF MRA. Interobserver accordance was almost perfect for the majority of ratings. This study demonstrates excellent delineation of UIAs using 7-T MRA within a clinical setting comparable to the gold standard, DSA. The combination of 7-T non-enhanced MPRAGE and TOF MRA for assessment of untreated UIAs is a promising clinical application of ultra-high-field MRA. (orig.)

  18. Acute Paraplegia After Aneurysmal SAH: A Case Report of a Rare Complication and Review of the Literature.

    Science.gov (United States)

    Chiang, Yi-Chun; Lee, Chung-Hsih; Chen, Wen-Hsien; Tsuei, Yuang-Seng

    2016-04-01

    Paraplegia after intracranial aneurysmal subarachnoid hemorrhage (SAH) is a rare condition, and its pathogenesis is still unclear. We present a case of a ruptured basilar dissecting aneurysm treated with the stent-assisted coiling procedure. Progressive weakness of the lower limbs developed within 5 days postoperatively. Spinal magnetic resonance image showed SAH accumulation in the lumbosacral area. Emergency lumbar drainage was performed, and the patient's symptoms improved dramatically. To the best of our knowledge, this is the first report to describe the successful treatment of paraplegia after intracranial aneurysmal SAH. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Subarachnoid hemorrhage due to ruptured intracranial aneurysm following posterior reversible encephalopathy syndrome

    Directory of Open Access Journals (Sweden)

    Takamasa Nanba

    2016-01-01

    Full Text Available Although posterior reversible encephalopathy syndrome (PRES is rarely associated with subarachnoid hemorrhage, to our knowledge, rupture of a concomitant cerebral aneurysm following PRES has not been reported. We describe a patient with atypical PRES involving the brainstem, thalamus, and periventricular white matter without cortical or subcortical edema of the parietooccipital lobe on magnetic resonance imaging, with rupture of a concomitant cerebral aneurysm. Preexisting extremely high blood pressure may trigger atypical PRES, and failure to lower blood pressure may lead to a concomitant aneurysm rupture. In the future treatment of hypertensive urgency with a recurrence of symptoms and mean arterial blood pressure >150 mmHg, it is advisable to immediately hospitalize the patient for aggressive blood pressure management, especially if PRES is suspected based on clinical and radiological features.

  20. Subarachnoid hemorrhage due to ruptured intracranial aneurysm following posterior reversible encephalopathy syndrome.

    Science.gov (United States)

    Nanba, Takamasa; Kashimura, Hiroshi; Saura, Hiroaki; Takeda, Masaru

    2016-01-01

    Although posterior reversible encephalopathy syndrome (PRES) is rarely associated with subarachnoid hemorrhage, to our knowledge, rupture of a concomitant cerebral aneurysm following PRES has not been reported. We describe a patient with atypical PRES involving the brainstem, thalamus, and periventricular white matter without cortical or subcortical edema of the parietooccipital lobe on magnetic resonance imaging, with rupture of a concomitant cerebral aneurysm. Preexisting extremely high blood pressure may trigger atypical PRES, and failure to lower blood pressure may lead to a concomitant aneurysm rupture. In the future treatment of hypertensive urgency with a recurrence of symptoms and mean arterial blood pressure >150 mmHg, it is advisable to immediately hospitalize the patient for aggressive blood pressure management, especially if PRES is suspected based on clinical and radiological features.

  1. Treatment of intracranial aneurysms. Reconstruction of the parent artery with flow-diverting (Silk) stent

    DEFF Research Database (Denmark)

    Wagner, Aase; Cortsen, Marie; Hauerberg, John

    2011-01-01

    the periprocedural complications, immediate result, late complications, imaging follow-up at 6 and 12 months and clinical follow-up at 2-23 months. METHODS: Twenty-two patients with 26 wide-necked or blister-like aneurysms had 23 treatments with implantation of a Silk stent. Eleven patients had re......-canalizations, and 11 patients were either untreated or had been treated for another aneurysm. RESULTS: Periprocedural complications were seen in four treatments (17%). However, none of these had clinical consequences. Mortality and morbidity rates were 1 of 22 (5%) and 1 of 22 (5%), respectively. Clinical outcome...... (86%) were occluded. CONCLUSION: The effect of the Silk FD in terms of occlusion of the aneurysms seems to occur mainly during the first 6 months after placement but continues during the following time. Most delayed complications occur immediately after discontinuing the anticoagulation medication...

  2. A follow-up study of autosomal dominant polycystic kidney disease with intracranial aneurysms using 3.0 T three-dimensional time-of-flight magnetic resonance angiography

    Energy Technology Data Exchange (ETDEWEB)

    Jiang, Tao; Wang, Peng; Qian, Yi [Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai (China); Zheng, Xuan [Clinical Nutrition Department of Changhai Hospital, Second Military Medical University, Shanghai (China); Xiao, Liaoyuan [Department of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai (China); Yu, Shengqiang, E-mail: yushengqiang_cz@163.com [Department of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai (China); Liu, Shiyuan, E-mail: laijiangtaotao@163.com [Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai (China)

    2013-11-01

    Objective: Autosomal dominant polycystic kidney disease (ADPKD) patients have an increased risk for intracranial aneurysms (IAs). Our aim was to screen and follow up the unruptured intracranial aneurysms (UIAs) detected by 3.0 T three-dimensional time-of-flight magnetic resonance angiography (3D-TOF MRA) in patients with ADPKD in order to evaluate the growth of UIAs and the value of 3D-TOF MRA. Methods: From 2011 to 2012, we followed up UIAs detected in 40 ADPKD patients who had MRA examinations with an interval of at least 36 months. All MRA examinations were performed on a 3 T system (Achieva X-Series, Philips Medical Systems) with a Sense-Head-8 receiver head coil. The acquired data sets were transferred to a workstation (EWS, Philips Medical) to perform maximum intensity projection (MIP) and volume rendering (VR) with a specialized software package (Philips Medical). The size of UIAs was determined as the longest diameter in transverse or vertical measurement. UIAs that grew more than 20% were considered as enlarged. Results: Fifty UIAs were found in 40 previously examined ADPKD patients who underwent 3.0 T 3D-TOF MRA follow-ups. No patients ever had treatment before the second examination. The longest diameter of all follow-up UIAs was less than 10 mm and mean diameter was 3.64 ± 2.25 mm. UIAs in only 4 patients (10%) were considered as enlarged. None of the 50 IAs in the 40 ADPKD patients ruptured during the MRA follow-up period. Conclusion: 3.0 T 3D-TOF MRA was feasible for UIAs follow-up in ADPKD patients. The chance of enlargement and rupture of UIAs in ADPKD patients was not higher than in the general population.

  3. Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Thompson, B Gregory; Brown, Robert D; Amin-Hanjani, Sepideh; Broderick, Joseph P; Cockroft, Kevin M; Connolly, E Sander; Duckwiler, Gary R; Harris, Catherine C; Howard, Virginia J; Johnston, S Claiborne Clay; Meyers, Philip M; Molyneux, Andrew; Ogilvy, Christopher S; Ringer, Andrew J; Torner, James

    2015-08-01

    The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment. © 2015 American Heart Association, Inc.

  4. Emergency Use of Stent and rtPA with Mechanical Cloth Defragmentation for a Thromboembolic Complication during GDC Coil Treatment of an Acutely Ruptured Basilar Tip Aneurysm.

    Science.gov (United States)

    Poncyljusz, W; Falkowski, A; Kojder, I; Sagan, L

    2006-11-30

    Thrombotic occlusion of both posterior cerebral arteries occurred during embolization of an acutely ruptured basilar tip aneurysm. Intracranial stenting and continuous superselective infusion of rtPA was administered combined with mechanical clot fragmentation to reestablish normal vessel flow. DSA disclosed that normal vessel patency was achieved within 30 min. There were no adverse events related to rtPA administration and the patient recovered from the embolization with minor neurologic deficit as present before the procedure.

  5. Quality of life, anxiety, and depression in patients with an untreated intracranial aneurysm or arteriovenous malformation

    NARCIS (Netherlands)

    van der Schaaf, IC; Brilstra, EH; Rinkel, GJE; Bossuyt, PM; van Gijn, J

    Background and Purpose-The objective of this study was to assess the health-related quality of life and symptoms of anxiety and depression in patients who are aware of the presence of a patent aneurysm or arteriovenous malformation. Methods-Participants were retrospectively identified and invited to

  6. Volume depletion and natriuresis in patients with a ruptured intracranial aneurysm

    NARCIS (Netherlands)

    Wijdicks, E. F.; Vermeulen, M.; ten Haaf, J. A.; Hijdra, A.; Bakker, W. H.; van Gijn, J.

    1985-01-01

    We studied the sodium balance and changes in plasma volume by an isotope dilution technique in the first week after an aneurysmal subarachnoid hemorrhage in 21 patients. In 11 of the patients, the plasma volume decreased by more than 10%. This was accompanied by a negative sodium balance and

  7. Characteristics of Intracranial Aneurysms in the Else Kröner-Fresenius Registry of Autosomal Dominant Polycystic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Hartmut P.H. Neumann

    2012-10-01

    Full Text Available Background: Patients who harbor intracranial aneurysms (IAs run a risk for aneurysm rupture and subsequent subarachnoid hemorrhage which frequently results in permanent deficits or death. Prophylactic treatment of unruptured aneurysms is possible and recommended depending on the size and location of the aneurysm as well as patient age and condition. IAs are major manifestations of autosomal dominant polycystic kidney disease (ADPKD. Current guidelines do not suggest surveillance of IAs in ADPKD except in the setting of family history if IA was known in any relative with ADPKD. Management of IAs in ADPKD is problematic because limited data exist from large studies. Methods: We established the Else Kröner-Fresenius Registry for ADPKD in Germany. Clinical data were assessed for age at diagnosis of IAs, stage of renal insufficiency, and number, location and size of IAs as well as family history of cerebral events. Patients with symptomatic or asymptomatic IAs were included. All patients with ADPKD-related IAs were offered mutation scanning of the susceptibility genes for ADPKD, the PKD1 and PKD2 genes. Results: Of 463 eligible ADPKD patients from the population base of Germany, 32 (7% were found to have IAs, diagnosed at the age of 2–71 years, 19 females and 13 males. Twenty (63% of these 32 patients were symptomatic, whereas IAs were detected in an asymptomatic stage in 12 patients. IAs were multifocal in 12 and unifocal in 20 patients. In 26 patients (81%, IAs were diagnosed before end-stage renal failure. Twenty-five out of 27 unrelated index cases (93% had no IAs or cerebral events documented in their relatives with ADPKD. In 16 unrelated index patients and 3 relatives, we detected germline mutations. The mutations were randomly distributed across the PKD1 gene in 14 and the PKD2 gene in 2 index cases. Questionnaires answered for 320/441 ADPKD patients without IAs revealed that only 45/320 (14% had MR angiography. Conclusion: In ADPKD

  8. Changes in blood flow due to stented parent artery expansion in an intracranial aneurysm.

    Science.gov (United States)

    Mori, Futoshi; Ohta, Makoto; Matsuzawa, Teruo

    2015-01-01

    Stent placement is thought to obstruct the inflow of blood to an aneurysm. However, we introduced parent artery expansion and demonstrated that this may reduce the blood flow by the stent. In our previous study using idealized shapes, the results showed that flow reduction was greater than 22.2%, even if the expansion rate was only 6%. Furthermore, the parent artery expansion is predominantly caused by the effect of flow reduction as compared to that of flow reduction due to the obstruction of flow under stent placement. However, a realistic shape is complex and the blood flow also becomes complex flow. It is not understood whether the results of flow in the idealized shape are reflective of flow from a realistic 3D model. Therefore, we examined the effect of parent artery expansion using a realistic model. The aim is to clarify the effects of parent artery expansion on inflow rate, wall shear stress, and oscillatory shear index. We used a patient-specific geometry of a human internal carotid artery with an aneurysm. The geometry of parent artery expansion due to oversized stent constructed based on the voronoi diagram. We performed calculations in the unsteady-state situations using constructed models. The complexity of the flow in the aneurysm decreases in case of expanded parent artery. The inflow rate decreases by 33.6% immediately after parent artery expansion alone without a stent. The effect of the parent artery expansion on flow reduction is larger than that of the obstruction flow by stent placement. In addition, wall shear stress and oscillatory shear index on the aneurysm wall decrease by change in blood flow due to the parent artery expansion. The effects of the parent artery expansion in a realistic aneurysm model with different stent lengths were evaluated on the basis of a numerical simulation. Although the flow was complex, the parent artery expansion with stent reduces the inflow to the aneurysm and wall shear stress and oscillatory shear index on

  9. Fetal-type posterior cerebral artery: the pitfall of parent artery occlusion for ruptured P₂ segment and distal aneurysms.

    Science.gov (United States)

    Xu, Jing; Xu, Liang; Wu, Ziheng; Chen, Xianyi; Yu, Jun; Zhang, Jianmin

    2015-10-01

    P2 segment and distal aneurysms are rare lesions of the cerebrovascular system. The efficacy and safety of endovascular occlusion for these types of aneurysms remain controversial. The aim of this study was to reveal risk factors for endovascular parent artery occlusion of ruptured P2 segment and distal aneurysms. Between March 2010 and November 2012, 812 patients with a ruptured intracranial aneurysm were admitted to the authors' hospital. Among them, 11 patients presented with P2 segment and distal posterior cerebral artery (PCA) aneurysms. These patients were subjected to endovascular treatment. Periprocedural data and clinical and angiographic records were studied retrospectively. Of the patients with a ruptured PCA aneurysm, 2 of them underwent selective aneurismal coiling, and the remaining patients were treated with simultaneous occlusion of the parent artery. Patients with an adult-type PCA (n = 6), treated with either selective coiling or simultaneous parent artery occlusion, had no serious neurological deficits on follow-up. Four patients with a fetal-type PCA that was also occluded intraoperatively exhibited newly developed permanent paralysis and hemianopsia. However, 1 patient with a fetal-type PCA aneurysm that was selectively coiled recovered without complications. No recanalization was observed in any of the treated aneurysms. Endovascular occlusion of an aneurysm and its parent artery is a safe and effective method for managing adult-type P2 segment and distal aneurysms. However, the authors' clinical data suggest that this method is of high risk for patients with fetal-type PCA aneurysms.

  10. Clinical and multidetector CT follow-up results of renal artery aneurysms treated by detachable coil embolization using 3D rotational angiography

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Jung Min; Park, Kwang Bo; Kim, Keon Ha; Jeon, Pyoung; Shin, Sung Wook; Park, Hong Suk; Do, Young Soo (Dept. of Radiology and the Center for Imaging Science, Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of)), email: kbparksmc@skku.edu; Kim, Dong-Ik; Kim, Young-Wook (Div. of Vascular Surgery, Dept. of Surgery, Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of))

    2011-10-15

    Background: There are very few reports regarding the use of 3D rotational angiography (3D RA) in embolization of renal artery aneurysms (RAAs). No valuable data have been reported on the follow-up result of coil embolization for RAAs on computed tomography (CT). Purpose: To evaluate the clinical and multidetector computed tomography (MDCT) follow-up results of renal artery aneurysms treated by detachable coil embolization using 3D RA. Material and Methods: Six patients diagnosed with RAAs were included. Five patients underwent detachable coil embolization. Five patients underwent 3D RA and the parameters used for planning endovascular treatment obtained by 2D CT, reformatted 3D CT angiography (3D CTA), 2D digital subtraction angiography (2D DSA) and 3D RA were compared. The post embolization MDCT follow-up findings were analyzed retrospectively. Results: The technical success rate for detachable coil embolization was 40%. The 3D CTA showed the dome-to-neck ratio (DNR) and tangential view of the renal artery aneurysm in five patients (83.3%) and the 2D CT showed it in four (66.7%). An optimal working angle assessment could not be obtained on the 2D CT and 3D CTA. The 3D RA showed the DNR, tangential view, and optimal working angle in all patients. Renal infarction occurred in three patients and Postprocedural hypertension developed in two patients during the follow-up period. Conclusion: The 3D RA was useful in preoperative determination of adequate working angle for detachable coil embolization of RAAs. Late complications of detachable coil embolization for RAAs were renal infarction and hypertension

  11. Terson syndrome in aneurysmal subarachnoid hemorrhage-its relation to intracranial pressure, admission factors, and clinical outcome.

    Science.gov (United States)

    Joswig, Holger; Epprecht, Lorenz; Valmaggia, Christophe; Leschka, Sebastian; Hildebrandt, Gerhard; Fournier, Jean-Yves; Stienen, Martin Nikolaus

    2016-06-01

    A large number of reports have not been able to clarify the pathophysiology of Terson syndrome (TS) in aneurysmal subarachnoid hemorrhage (aSAH). Prospective single-center study on aSAH patients. Fundoscopic and radiological signs of TS were assessed. The opening intracranial pressure (ICP) in patients who required a ventriculostomy was recorded with a manometer. Six out of 36 included patients had TS (16.7 %), which was associated with unfavorable admission scores. Twenty-nine patients (80.5 %) required ventriculostomy; TS was associated with higher ICP (median, 40 vs. 15 cm cmH2O, p = .003); all patients with TS had pathological ICP values of >20 cmH2O. Patients with a ruptured aneurysm of the anterior cerebral artery complex were ten times as likely to suffer from TS (OR 10.0, 95 % CI 1.03-97.50). Detection of TS on CT had a sensitivity of 50 %, a specificity of 98.4 %, a positive predictive value of 83.3 %, and a negative predictive value of 92.4 %. Mortality was 45 times as high in patients with TS (OR 45.0, 95 % CI 3.86-524.7) and neurologic morbidity up until 3 months post-aSAH was significantly higher in patients with TS (mRS 4-6; 100 vs. 17 %; p = .001). Our findings demonstrate an association between raised ICP and the incidence of TS. TS should be ruled out in aSAH patients presenting comatose or with raised ICP to ensure upfront ophthalmological follow-up. In alert patients without visual complaints and a TS-negative CT scan, the likelihood for the presence of TS is very low.

  12. Cranio-orbito-zygomatic approach for a previously coiled/recurrent giant MCA aneurysm in a hybrid angio/OR suite.

    Science.gov (United States)

    Arko, Leopold; Quach, Eric; Sukul, Vishad; Desai, Anuj; Gassie, Kelly; Erkmen, Kadir

    2015-07-01

    We present surgical clipping of a giant middle cerebral artery aneurysm. The patient is a 64-year-old woman who suffered subarachnoid hemorrhage in 2005. She was treated with coiling of the aneurysm at an outside institution. She presented to our clinic with headaches and was found on angiography to have giant recurrence of the aneurysm. To allow adequate exposure for clipping, we performed the surgery through a cranio-orbito-zygomatic (COZ) skull base approach, which is demonstrated. The surgery was performed in an operating room/angiography hybrid suite allowing for high quality intraoperative angiography. The technique and room flow are also demonstrated. The video can be found here: http://youtu.be/eePcyOMi85M.

  13. In vivo tissue response following implantation of shape memory polyurethane foam in a porcine aneurysm model

    Science.gov (United States)

    Rodriguez, Jennifer N.; Clubb, Fred J.; Wilson, Thomas S.; Miller, Matthew W.; Fossum, Theresa W.; Hartman, Jonathan; Tuzun, Egemen; Singhal, Pooja; Maitland, Duncan J.

    2014-01-01

    Cerebral aneurysms treated by traditional endovascular methods using platinum coils have a tendency to be unstable, either due to chronic inflammation, compaction of coils, or growth of the aneurysm. We propose to use alternate filling methods for the treatment of intracranial aneurysms using polyurethane based shape memory polymer (SMP) foams. SMP polyurethane foams were surgically implanted in a porcine aneurysm model to determine biocompatibility, localized thrombogenicity, and their ability to serve as a stable filler material within an aneurysm. The degree of healing was evaluated via gross observation, histopathology and low vacuum scanning electron microscopy (LV-SEM) imaging after zero, thirty and ninety days. Clotting was initiated within the SMP foam at time zero (less than one hour exposure to blood prior to euthanization), partial healing was observed at thirty days, and almost complete healing had occurred at ninety days in vivo, with minimal inflammatory response. PMID:23650278

  14. In vivo response to an implanted shape memory polyurethane foam in a porcine aneurysm model.

    Science.gov (United States)

    Rodriguez, Jennifer N; Clubb, Fred J; Wilson, Thomas S; Miller, Matthew W; Fossum, Theresa W; Hartman, Jonathan; Tuzun, Egemen; Singhal, Pooja; Maitland, Duncan J

    2014-05-01

    Cerebral aneurysms treated by traditional endovascular methods using platinum coils have a tendency to be unstable, either due to chronic inflammation, compaction of coils, or growth of the aneurysm. We propose to use alternate filling methods for the treatment of intracranial aneurysms using polyurethane-based shape memory polymer (SMP) foams. SMP polyurethane foams were surgically implanted in a porcine aneurysm model to determine biocompatibility, localized thrombogenicity, and their ability to serve as a stable filler material within an aneurysm. The degree of healing was evaluated via gross observation, histopathology, and low vacuum scanning electron microscopy imaging after 0, 30, and 90 days. Clotting was initiated within the SMP foam at time 0 (<1 h exposure to blood before euthanization), partial healing was observed at 30 days, and almost complete healing had occurred at 90 days in vivo, with minimal inflammatory response. Copyright © 2013 Wiley Periodicals, Inc.

  15. Diagnostic value of 3D time-of-flight magnetic resonance angiography for detecting intracranial aneurysm: a meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Liu, HaiFeng; Xu, YongSheng [First Hospital of LanZhou University, Department of Radiology, Lanzhou, Gansu (China); First Clinical Medical College of LanZhou University, Lanzhou, Gansu (China); Xun, YangQin [Lanzhou University, Evidence-based Medicine Center, Lanzhou (China); Dou, Yu; Wang, ShuaiWen; Lu, XingRu; Lei, JunQiang [First Hospital of LanZhou University, Department of Radiology, Lanzhou, Gansu (China)

    2017-11-15

    This meta-analysis is to comprehensively evaluate the diagnostic performance of three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) for detecting intracranial aneurysm (IA). PubMed, Embase, Web of Science, and the Cochrane library were systematically searched for retrieving eligible studies. Study inclusion, data extraction, and risk of bias assessment were performed by two researchers independently. Pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated to assess the diagnostic value. In addition, heterogeneity and subgroup analysis were carried out. In total, 18 studies comprising 3463 patients were selected. The results of 3D-TOF-MRA for diagnosing IA were SEN 0.89 (95% CI 0.82-0.94), SPE 0.94 (0.86-0.97), PLR 13.79 (5.92-32.12), NLR 0.11 (0.07-0.19), DOR 121.90 (38.81-382.94), and AUC 0.96 (0.94-0.98), respectively. In the subgroup analysis, studies without subarachnoid hemorrhage (SAH) tend to perform statistical significantly better (P < 0.05) in detecting IAs than studies with SAH 0.99 (0.98-1.00) vs. 0.89 (0.86-0.91). The diagnostic value of studies with a two-image reconstruction method was higher than studies with only one image reconstruction method: 0.99 (0.98-1.00) vs. 0.91 (0.89-0.94) with P < 0.05. The 3D-TOF-MRA had better SEN in aneurysms > 3 mm than the aneurysms ≤ 3 mm in diameter: 0.89 (0.87-0.92) vs. 0.78 (0.71-0.84) with P < 0.05. This study demonstrated that 3D-TOF-MRA has an excellent diagnostic performance for the overall assessment of IA and may serve as an alternative for further patient management with IA. (orig.)

  16. Hypertension predisposes to the formation of saccular intracranial aneurysms in 467 unruptured and 1053 ruptured patients in Eastern Finland.

    Science.gov (United States)

    Lindgren, Antti E; Kurki, Mitja I; Riihinen, Annamaija; Koivisto, Timo; Ronkainen, Antti; Rinne, Jaakko; Hernesniemi, Juha; Eriksson, Johan G; Jääskeläinen, Juha E; von und zu Fraunberg, Mikael

    2014-05-01

    Hypertension associates with subarachnoid hemorrhage from saccular intracranial aneurysm (sIA-SAH) when compared to matched controls or general population. Few series compare hypertension in unruptured sIA versus sIA-SAH, so its impact on the sIA disease remains uncertain. Kuopio sIA Database ( www.uef.fi/ns ) contains all cases of unruptured and ruptured sIAs admitted to Kuopio University Hospital from its Eastern Finnish catchment population. We compared the age-adjusted incidence of drug-treated hypertension in 467 unruptured and 1053 ruptured sIA patients admitted to Kuopio University Hospital from 1995 to 2007, using the national registry of prescribed medicines. Antihypertensive medication was more frequent in the unruptured (73% versus 62%) with higher age-adjusted incidence. At sIA diagnosis, the sIA-SAH group had more often untreated hypertension (29% versus 23%). The size of unruptured sIAs increased with age at sIA diagnosis, independently of hypertension. Multiple sIAs, familial sIA, and sIA-SAH were not associated with hypertension in multivariate analysis. Results indicate that drug-treated hypertension associates with the formation of sIAs rather than their growth or rupture. Hypertension is highly prevalent in the carriers of unruptured sIAs when compared to those with ruptured sIA. Hypertension may associate with the sIA formation, and may predispose to the rupture of sIA if untreated.

  17. Inaccuracy of the administrative database: comparative analysis of two databases for the diagnosis and treatment of intracranial aneurysms.

    Science.gov (United States)

    Woodworth, Graeme F; Baird, Clinton J; Garces-Ambrossi, Giannina; Tonascia, James; Tamargo, Rafael J

    2009-08-01

    Administrative databases of hospital admissions are increasingly being used, mostly without validation, for epidemiological and clinical outcomes studies. Although it has been difficult to assess the true accuracy of administrative databases, we have identified an opportunity to directly compare the State of Maryland administrative database against a prospectively maintained departmental database at The Johns Hopkins Hospital. Data for patients with the diagnosis of an intracranial aneurysm treated at The Johns Hopkins Hospital over a 17-year period were compared in the State of Maryland administrative database and the neurosurgery departmental database. Discrepancies were clarified by review of the original medical records. The sensitivity, specificity, and positive predictive value of each database were calculated. The administrative database missed 16% of all cases and was significantly inaccurate in 10 of 12 categories. It had particularly low values in the specificity regarding surgical treatment (67%), the sensitivity regarding endovascular treatment (48%), and the positive predictive value regarding endovascular treatment (30%). By contrast, the lowest score of the departmental database in any category was 97%. We show that this representative administrative database is significantly flawed. Given the exponentially increasing number of research studies based on administrative databases, the pitfalls of research based solely on these need to be recognized. Strong criteria requiring accurate data validation are critical to justify the conclusions of these studies, regardless of their large numbers and complex statistics.

  18. Reconstructive endovascular treatment of vertebral artery dissecting aneurysms with the Low-profile Visualized Intraluminal Support (LVIS) device

    OpenAIRE

    Wang, Chuan-Chuan; Fang, Yi-Bin; Zhang, Ping; ZHU, XUAN; Hong, Bo; Xu, Yi; Liu, Jian-Min; Huang, Qing-Hai

    2017-01-01

    Introduction The Low-profile Visualized Intraluminal Support (LVIS) device is a new generation of self-expanding braided stent recently introduced in China for stent assisted coiling of intracranial aneurysms. The aim of our study is to evaluate the feasibility, safety, and efficacy of the LVIS device in reconstructive treatment of vertebral artery dissecting aneurysms (VADAs). Methods We retrospectively reviewed the neurointerventional database of our institution from June 2014 to May 2016. ...

  19. Transitional hemodynamics in intracranial aneurysms - Comparative velocity investigations with high resolution lattice Boltzmann simulations, normal resolution ANSYS simulations, and MR imaging.

    Science.gov (United States)

    Jain, Kartik; Jiang, Jingfeng; Strother, Charles; Mardal, Kent-André

    2016-11-01

    Blood flow in intracranial aneurysms has, until recently, been considered to be disturbed but still laminar. Recent high resolution computational studies have demonstrated, in some situations, however, that the flow may exhibit high frequency fluctuations that resemble weakly turbulent or transitional flow. Due to numerous assumptions required for simplification in computational fluid dynamics (CFD) studies, the occurrence of these events, in vivo, remains unsettled. The detection of these fluctuations in aneurysmal blood flow, i.e., hemodynamics by CFD, poses additional challenges as such phenomena cannot be captured in clinical data acquisition with magnetic resonance (MR) due to inadequate temporal and spatial resolutions. The authors' purpose was to address this issue by comparing results from highly resolved simulations, conventional resolution laminar simulations, and MR measurements, identify the differences, and identify their causes. Two aneurysms in the basilar artery, one with disturbed yet laminar flow and the other with transitional flow, were chosen. One set of highly resolved direct numerical simulations using the lattice Boltzmann method (LBM) and another with adequate resolutions under laminar flow assumption were conducted using a commercially available ANSYS Fluent solver. The velocity fields obtained from simulation results were qualitatively and statistically compared against each other and with MR acquisition. Results from LBM, ANSYS Fluent, and MR agree well qualitatively and quantitatively for one of the aneurysms with laminar flow in which fluctuations were ∼ 600 Hz showed vivid differences between LBM, ANSYS Fluent, and magnetic resonance imaging. After ensemble averaging and down-sampling to coarser space and time scales, these differences became minimal. A combination of MR derived data and CFD can be helpful in estimating the hemodynamic environment of intracranial aneurysms. Adequately resolved CFD would suffice gross assessment of

  20. Reversible Isolated Accessory Nerve Palsy due to a Large Thrombosed Vertebral Aneurysm

    Directory of Open Access Journals (Sweden)

    Hisayasu Saito

    2013-08-01

    Full Text Available Objective: Isolated accessory nerve palsy due to intracranial disorders is uncommon because intracranial accessory nerve injury usually occurs in case of a skull base tumor or trauma, resulting in one of multiple cranial nerve palsies. We report a very rare case of isolated accessory nerve palsy due to a large thrombosed aneurysm of the intracranial vertebral artery. Full recovery was achieved after surgery. Case Report: A patient complaining of transient numbness in the right side was referred to our hospital. An MRI indicated a large thrombosed aneurysm of the right vertebral artery. The aneurysm severely compressed the medulla oblongata. First, the proximal vertebral artery (VA was clipped with an aneurysm clip to reduce the pressure inside the aneurysm. However, cerebral angiography revealed a partial recanalization of the right VA. The patient then underwent coil embolization of the right VA just proximal to the aneurysm clip. Subsequently, the right VA was completely obliterated. The patient was discharged without any neurological deficit. Two weeks later, however, she complained of right shoulder pain. Physical and neurological examinations demonstrated atrophy of the right trapezius and sternocleidomastoid muscle, leading to a deepening of the right supraclavicular fossa. The symptoms were considered to result from the right isolated accessory nerve palsy. Follow-up MRI showed that the VA aneurysm gradually decreased in size over a period of several months. At the same time, her symptoms disappeared completely. Conclusion: We should keep in mind that isolated accessory nerve palsy can be caused by a large or giant vertebral aneurysm.

  1. Combined Surgical and Endovascular Management of a Giant Fusiform PCA Aneurysm in a Pediatric Patient

    Science.gov (United States)

    Shin, S.H.; Choi, I.S.; Thomas, K.; David, C.A.

    2013-01-01

    Summary Treatment of intracranial giant aneurysms presents is challenging. In the case of pediatric giant aneurysm, more challenges arise. We describe our experience with a 17-year-old pediatric patient who presented with severe headache. She was diagnosed as having a giant fusiform aneurysm at the right P1-P2-Pcom junction. The aneurysm was treated with superficial temporal artery-posterior cerebral artery bypass and subsequent coil embolization of the aneurysm with parent artery occlusion. The patient had an excellent outcome at one-year follow-up. Our case suggests a combined approach of surgical and endovascular management may yield a better outcome than surgery or endovascular management alone in the treatment of pediatric giant aneurysm. PMID:23693047

  2. 3D digital subtraction angiography of intracranial aneurysms: comparison of flat panel detector with conventional image intensifier TV system using a vascular phantom.

    Science.gov (United States)

    Kakeda, S; Korogi, Y; Ohnari, N; Hatakeyama, Y; Moriya, J; Oda, N; Nishino, K; Miyamoto, W

    2007-05-01

    Compared with the image intensifier (I.I.)-TV system, the flat panel detector (FPD) system of direct conversion type has several theoretic advantages, such as higher spatial resolution, wide dynamic range, and no image distortion. The purpose of this study was to compare the image quality of 3D digital subtraction angiography (DSA) in the FPD and conventional I.I.-TV systems using a vascular phantom. An anthropomorphic vascular phantom was designed to simulate the various intracranial aneurysms with aneurysmal bleb. The tubes of this vascular phantom were filled with 2 concentrations of contrast material (300 and 150 mg I/mL), and we obtained 3D DSA using the FPD and I.I.-TV systems. First, 2 blinded radiologists compared the volume-rendering images for 3D DSA on the FPD and I.I.-TV systems, looking for pseudostenosis artifacts. Then, 2 other radiologists independently evaluated both systems for the depiction of the simulated aneurysm and aneurysmal bleb using a 5-point scale. For the degree of the pseudostenosis artifacts at the M1 segment of the middle cerebral artery at 300 mg I/mL, 3D DSA with FPD system showed mild stenoses, whereas severe stenoses were observed at 3D DSA with I.I.-TV system. At both concentrations, the FPD system was significantly superior to I.I.-TV system regarding the depiction of aneurysm and aneurysmal bleb. Compared with the I.I.-TV system, the FPD system could create high-resolution 3D DSA combined with a reduction of the pseudostenosis artifacts.

  3. Superficial temporal artery-middle cerebral artery bypass surgery in a pediatric giant intracranial aneurysm presenting as migraine-like episodes.

    Science.gov (United States)

    Goedee, H S; Depauw, P R A M; vd Zwam, B; Temmink, A H

    2009-02-01

    Aneurysms of the intracranial arteries in the pediatric population are reportedly rare. There is a male predominance, association with connective tissue disorders, as well as bacterial, mycotic infections, and trauma. Common sites of presentation are the internal carotid artery bifurcation, posterior circulation, and distal segment of middle cerebral artery. Clinical manifestations can vary from seizures and subarachnoidal hemorrhage to headache, irritability, lethargy, vomiting, or focal motor deficits. Current treatment modalities encompass endovascular or surgical approach. We present a case report on an 11-year-old girl with migraine-like episodes due to an underlying giant fusiform middle cerebral artery aneurysm treated successfully with two superficial temporal artery-middle cerebral artery bypasses.

  4. Impact of metal artifact reduction software on image quality of gemstone spectral imaging dual-energy cerebral CT angiography after intracranial aneurysm clipping

    Energy Technology Data Exchange (ETDEWEB)

    Dunet, Vincent; Bernasconi, Martine; Hajdu, Steven David; Meuli, Reto Antoine; Zerlauth, Jean-Baptiste [Lausanne University Hospital, Department of Diagnostic and Interventional Radiology, Lausanne (Switzerland); Daniel, Roy Thomas [Lausanne University Hospital, Department of Neurosurgery, Lausanne (Switzerland)

    2017-09-15

    We aimed to assess the impact of metal artifact reduction software (MARs) on image quality of gemstone spectral imaging (GSI) dual-energy (DE) cerebral CT angiography (CTA) after intracranial aneurysm clipping. This retrospective study was approved by the institutional review board, which waived patient written consent. From January 2013 to September 2016, single source DE cerebral CTA were performed in 45 patients (mean age: 60 ± 9 years, male 9) after intracranial aneurysm clipping and reconstructed with and without MARs. Signal-to-noise (SNR), contrast-to-noise (CNR), and relative CNR (rCNR) ratios were calculated from attenuation values measured in the internal carotid artery (ICA) and middle cerebral artery (MCA). Volume of clip and artifacts and relative clip blurring reduction (rCBR) ratios were also measured at each energy level with/without MARs. Variables were compared between GSI and GSI-MARs using the paired Wilcoxon signed-rank test. MARs significantly reduced metal artifacts at all energy levels but 130 and 140 keV, regardless of clips' location and number. The optimal rCBR was obtained at 110 and 80 keV, respectively, on GSI and GSI-MARs images, with up to 96% rCNR increase on GSI-MARs images. The best compromise between metal artifact reduction and rCNR was obtained at 70-75 and 65-70 keV for GSI and GSI-MARs images, respectively, with up to 15% rCBR and rCNR increase on GSI-MARs images. MARs significantly reduces metal artifacts on DE cerebral CTA after intracranial aneurysm clipping regardless of clips' location and number. It may be used to reduce radiation dose while increasing CNR. (orig.)

  5. Assisted coiling using LEO Baby or LVIS Jr stents: Report of six cases.

    Science.gov (United States)

    Negrotto, Matías; Crosa, Roberto; Casagrande, Walter

    2015-10-01

    Endovascular treatment of broad-neck, complex cerebral aneurysms is a challenging issue. Placement of a stent over the aneurysm neck and secondary coil embolization prevents coil migration and allows dense packing of the coils. Another challenge is represented by distal aneurysms situated in small vessels. In these cases, the use of little stents, which we are going call ministents, could be a good decision. These low-profile intracranial ministents can be deployed into arteries with diameters between 1.5 and 3.10 mm and delivered through microcatheters with an internal diameter of 0.0165 inches, which allows easier navigation in small-sized, delicate vessels. We present six cases of wide-neck aneurysms, with small parental arteries less than 2.5 mm using a low-profile ministent system (LEO Baby and LVIS Jr) plus coil embolization. We retrospectively reviewed patients in whom LEO Baby or LVIS Jr stent was used for the treatment of intracranial aneurysms. Five aneurysms were treated during 2013-2014 in our service using the LEO Baby stent and one aneurysm using LVIS Jr. Stent-assisted coil embolization was performed using the jailing technique in all cases. Clinical and angiographic findings, procedural data, and follow-up are reported. Six consecutive patients were included in this study. Four patients presented with subarachnoid hemorrhage in the subacute-chronic phase and two patients had unruptured aneurysms. Two of the six aneurysms were located at branches of the sylvian artery, one at the basilar artery, two at the anterior communicating artery, and one at the P1-P2 artery. The procedures were successful. Six-month control digital subtraction angiograms were obtained in all cases; they demonstrated complete occlusion of the aneurysms in all instances. All patients had good clinical outcomes on follow-up, as measured with the Glasgow Outcome Scale and Modified Rankin Scale. The results of this small study show that the LEO Baby and LVIS Jr ministents could

  6. Diagnostic Value of 64-slice CTA in Detection of Intracranial Aneurysm in Patients with SAH and Comparison of the CTA Results with 2D-DSA and Intraoperative Findings

    Directory of Open Access Journals (Sweden)

    Elif Ergun

    2011-03-01

    Full Text Available Objective: To prospectively evaluate the diagnostic value of 64-slice CTA in detecting intracranial aneurysms and to compare it with 2D-DSA and/or intra-operative findings.Material and Methods: 37 cases with SAH according to unenhanced cranial CT were included in the study. A 64-slice CTA was performed to all cases immediately after the nonenhanced cranial CT. DSA was performed in 24-48 hours following CTA. CT images were reviewed by two radiologists experienced in CT vascular imaging. The DSA reader was the angiographer who performed the DSA. The results of the CTA were compared with the DSA results and/or intraoperative findings in order to determine the diagnostic efficacy of CTA in detecting intracranial aneurysms. Results: Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CTA in detecting aneurysms were 92.8%, 83.3%, 96.2%, 71.4% and 91.2% respectively. The diagnostic value of CTA in detecting intracranial aneurysms was found to be equal to DSA by Mcnemar test. Conclusion: CTA is invaluable in detecting intracranial aneurysms. It may be used as a first line modality in SAH, and DSA may be reserved for patients with negative or equivocal CTA results.

  7. Combined use of a double-lumen remodeling balloon and a low-profile stent in the treatment of intracranial aneurysms ('remostent' technique): a technical note.

    Science.gov (United States)

    Kadziolka, Krzysztof; Tomas, Catherine; Robin, Georges; Pierot, Laurent

    2013-03-01

    Remodeling technique and stenting represent important options for intracranial aneurysm treatment, and they sometimes need to be combined. The technology of remodeling balloons and stents has recently evolved with the development of the double-lumen remodeling balloon (Scepter and Ascent) and the low-profile stent (LVIS Jr). This report describes our initial experience with and feasibility of the deployment of the low-profile stent through the balloon's internal guidewire lumen, thereby reducing the number of manoeuvres by combining remodeling and stenting. Copyright © 2013. Published by Elsevier Masson SAS.

  8. Image-based analysis of blood flow modification in stented aneurysms

    Science.gov (United States)

    Cebral, Juan; Mut, Fernando; Appanaboyina, Sunil; Löhner, Rainald; Miranda, Carlos; Escrivano, Esteban; Lylyk, Pedro; Putman, Christopher

    2009-02-01

    Currently there is increased interest in the use of stents as flow diverters for the treatment of intracranial aneurysms, especially wide necked aneurysms that are difficult to treat by coil embolization or surgical clipping. This paper presents image-based patient-specific computational models of the hemodynamics in cerebral aneurysms before and after treatment with a stent alone, with the goal of better understanding the hemodynamic effects of these devices and their relation to the outcome of the procedures. Stenting of cerebral aneurysms is a feasible endovascular treatment option for aneurysms with wide necks that are difficult to treat with coils or by surgical clipping. However, this requires stents that are capable of substantially modifying the intra-aneurysmal flow pattern in order to cause thrombosis of the aneurysm. The results presented in this paper show that the studied stent was able to change significantly the hemodynamic characteristics of the aneurysm. In addition, it was shown that patient-specific computational models constructed from medical images are capable of realistically representing the in vivo hemodynamic characteristics observed during conventional angiography examinations before and after stenting. This indicates that these models can be used to better understand the effects of different stent designs and to predict the alteration in the hemodynamic pattern of a given aneurysm produced by a given flow diverter. This is important for improving current design of flow diverting devices and patient treatment plans.

  9. Phase-Contrast MRI measurements in intra-cranial aneurysms in-vivo of flow patterns, velocity fields and wall shear stress: A comparison with CFD

    Science.gov (United States)

    Boussel, Loic; Rayz, Vitaliy; Martin, Alastair; Acevedo-Bolton, Gabriel; Lawton, Michael T.; Higashida, Randall; Smith, Wade S.; Young, William L.; Saloner, David

    2010-01-01

    Evolution of intracranial aneurysms is known to be related to hemodynamic forces such as Wall Shear Stress (WSS) and Maximum Shear Stress (MSS). Estimation of these parameters can be performed using numerical simulations (computational fluid dynamics - CFD) but can also be directly measured with MRI using a time-dependent 3D phase-contrast sequence with encoding of each of the three components of the velocity vectors (7D-MRV). In order to study the accuracy of 7D-MRV in estimating these parameters in–vivo, in comparison with CFD, 7D-MRV and patient-specific CFD modeling was performed for three patients who had intracranial aneurysms. A visual and a quantitative analysis of the flow pattern and the distribution of velocities, MSS, and WSS were performed between the two techniques. Spearman's coefficients of correlation between the two techniques were 0.56 for the velocity field, 0.48 for MSS and 0.59 for WSS. Visual analysis and Bland-Altman plots showed a good agreement for flow pattern and velocities but large discrepancies for MSS and WSS. In conclusion, these results indicate that in-vivo 7D-MRV can be used to measure velocity flow fields and to estimate MSS and WSS but is not currently able to provide accurate quantification of these two last parameters. PMID:19161132

  10. Combined surgical and endovascular management of a giant fusiform PCA aneurysm in a pediatric patient. A case report.

    Science.gov (United States)

    Shin, S H; Choi, I S; Thomas, K; David, C A

    2013-06-01

    Treatment of intracranial giant aneurysms presents is challenging. In the case of pediatric giant aneurysm, more challenges arise. We describe our experience with a 17-year-old pediatric patient who presented with severe headache. She was diagnosed as having a giant fusiform aneurysm at the right P1-P2-Pcom junction. The aneurysm was treated with superficial temporal artery-posterior cerebral artery bypass and subsequent coil embolization of the aneurysm with parent artery occlusion. The patient had an excellent outcome at one-year follow-up. Our case suggests a combined approach of surgical and endovascular management may yield a better outcome than surgery or endovascular management alone in the treatment of pediatric giant aneurysm.

  11. Endovascular treatment of basilar and ICA termination aneurysms: effects of the use of HydroCoils on treatment stability in a subgroup of patients prone to a higher recurrence rate

    Energy Technology Data Exchange (ETDEWEB)

    Geyik, Serdar; Yavuz, Kivilcim; Cekirge, Saruhan; Saatci, Isil [Hacettepe University Hospital, Interventional Neuroradiology Unit, Radiology Department, Ankara (Turkey)

    2007-12-15

    The aim of this study was to evaluate the stability of occlusion of terminal bifurcation aneurysms after embolization with hydrogel-coated coils. Of 35 bifurcation aneurysms, 34 were treated with hydrogel-coated coils in combination with platinum coils, and 1 was treated with hydrogel-coated coils only. Aneurysms were located at the basilar tip in 17 patients, and the internal carotid artery (ICA) bifurcation in 18 patients. The patient population consisted of 20 women and 15 men with ages ranging from 21 to 65 years. The aneurysm was found in 16 patients on presentation for subarachnoid hemorrhage, and in 19 patients the finding was incidental. Of the 35 aneurysms, 25 were small, 9 were large and 1 was giant. The giant aneurysm was located at the basilar tip and showed partial thrombosis. All except two basilar tip aneurysms were treated with balloon assistance. The remaining two basilar tip aneurysms were embolized with the assistance of an aneurysmal neck bridge device. The mean percentage occluded aneurysm volume for all devices was in the range 34-100%. Follow-up angiograms were obtained at 1 year in 6 patients, 2 years in 11 patients, and 3 years in 18 patients. Angiograms obtained immediately after embolization demonstrated a Raymond class 1 occlusion in 29 patients (82.9%) and a Raymond class 2 occlusion in 6 patients (17.1%). In four of these six patients follow-up angiograms demonstrated regrowth with resultant Raymond class 3 occlusion. In the other two patients, Raymond class 2 occlusion remained stable on follow-up angiograms. In patients who had a Raymond class 1 occlusion on the angiogram obtained immediately after embolization, no regrowth was seen on the follow-up angiograms. The overall recanalization rate was 11.4% (three large, one giant) at 6 months. Retreatment was not considered in three of these patients and they were to be followed; the other patient was retreated. Our initial procedural data demonstrate that higher volumetric occlusion was

  12. The “focus on aneurysm” principle: Classification and surgical principles of management of concurrent arterial aneurysm with arteriovenous malformation causing intracranial hemorrhage

    Science.gov (United States)

    Jha, Vikas; Behari, Sanjay; Jaiswal, Awadhesh K.; Bhaisora, Kamlesh Singh; Shende, Yogesh P.; Phadke, Rajendra V.

    2016-01-01

    Context: Concurrent arterial aneurysms (AAs) occurring in 2.7-16.7% patients harboring an arteriovenous malformation (AVM) aggravate the risk of intracranial hemorrhage. Aim: We evaluate the variations of aneurysms simultaneously coexisting with AVMs. A classification-based management strategy and an abbreviated nomenclature that describes their radiological features is also proposed. Setting: Tertiary care academic institute. Statistics: Test of significance applied to determine the factors causing rebleeding in the groups of patients with concurrent AVM and aneurysm and those with only AVMs. Subjects and Methods: Sixteen patients (5 with subarachnoid hemorrhage and 11 with intracerebral/intraventricular hemorrhage; 10 with low flow [LF] and 6 with high flow [HF] AVMs) underwent radiological assessment of Spetzler Martin (SM) grading and flow status of AA + AVM. Their modified Rankin's score (mRS) at admission was compared with their follow-up (F/U) score. Results: Pre-operative mRS was 0 in 5, 2 in 6, 3 in 1, 4 in 3 and 5 in 1; and, SM grade I in 5, II in 3, III in 3, IV in 4 and V in 1 patients, respectively. AA associated AVMs were classified as: (I) Flow-related proximal (n = 2); (II) flow-related distal (n = 3); (III) intranidal (n = 5); (IV) extra-intranidal (n = 2); (V) remote major ipsilateral (n = 1); (VI) remote major contralateral (n = 1); (VII) deep perforator related (n = 1); (VIII) superficial (n = 1); and (IX) distal (n = 0). Their treatment strategy included: Flow related AA, SM I-III LF AVM: aneurysm clipping with AVM excision; nidal-extranidal AA, SM I-III LF AVM: Excision or embolization of both AA + AVM; nidal-extranidal and perforator-related AA, SM IV-V HF AVM: Only endovascular embolization or radiosurgery. Surgical decision-making for remote AA took into account their ipsilateral/contralateral filling status and vessel dominance; and, for AA associated with SM III HF AVM, it varied in each patient based on diffuseness of AVM nidus, flow

  13. Clinical and imaging features of intracranial arterial aneurysms in the pediatric population; Klinische und radiologische Merkmale des intrakraniellen arteriellen Aneurysmas bei Kindern und Jugendlichen

    Energy Technology Data Exchange (ETDEWEB)

    Abruzzo, Todd A. [Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States). Dept. of Radiology; Aeron, Gunjan; Jones, Blaise V.

    2013-07-15

    Intracranial arterial aneurysms (IAAs) are rare in children. Nevertheless, IAAs account for at least 10 % - 15 % of hemorrhagic strokes during the first two decades of life. Traditional vascular risk factors, which are common in the adult population, are generally absent in the pediatric population, engendering distinct modes of IAA pathogenesis. Classification of pediatric IAAs according to the pathogenetic mechanism shows eight distinct categories: idiopathic, traumatic, those due to excessive hemodynamic stress, vasculopathic, infectious, noninfectious inflammatory, oncotic, and familial. Pathogenetic mechanism is the best predictor of the clinical course of the disease, response to treatment, and long-term prognosis. The pathogenetic subtypes of pediatric IAA show characteristic and variably overlapping features. In most cases, IAAs manifesting during the first two decades of life are idiopathic. IAAs that are idiopathic, traumatic (second most common type), or due to excessive hemodynamic stresses (third most common type) account for more than 80 % of IAAs in the pediatric age group. Most of the remaining pediatric IAAs are the result of congenital cerebral aneurysmal arteriopathies or infection. Multiple IAAs are unusual in young children except in those with acquired (secondary to immune deficiency states) or congenital cerebral aneurysmal arteriopathies or infectious IAAs. (orig.)

  14. In vitro performance of a shape memory polymer foam-coated coil embolization device.

    Science.gov (United States)

    Boyle, Anthony J; Wierzbicki, Mark A; Herting, Scott; Weems, Andrew C; Nathan, Adam; Hwang, Wonjun; Maitland, Duncan J

    2017-11-01

    Intracranial saccular aneurysm treatment using endovascular embolization devices are limited by aneurysm recurrence that can lead to aneurysm rupture. A shape memory polymer (SMP) foam-coated coil (FCC) embolization device was designed to increase packing density and improve tissue healing compared to current commercial devices. FCC devices were fabricated and tested using in vitro models to assess feasibility for clinical treatment of intracranial saccular aneurysms. FCC devices demonstrated smooth delivery through tortuous pathways similar to control devices as well as greater than 10 min working time for clinical repositioning during deployment. Furthermore, the devices passed pilot verification tests for particulates, chemical leachables, and cytocompatibility. Finally, devices were successfully implanted in an in vitro saccular aneurysm model with large packing density. Though improvements and future studies evaluating device stiffness were identified as a necessity, the FCC device demonstrates effective delivery and packing performance that provides great promise for clinical application of the device in treatment of intracranial saccular aneurysms. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

  15. Increased intracranial pressure

    Science.gov (United States)

    ... by pressing on important structures and by restricting blood flow into the brain. Many conditions can increase intracranial pressure. Common causes include: Aneurysm rupture and subarachnoid hemorrhage Brain tumor Encephalitis Head ...

  16. Fluorescein Angiography in Intracranial Aneurysm Surgery: A Helpful Method to Evaluate the Security of Clipping and Observe Blood Flow.

    Science.gov (United States)

    Kakucs, Cristian; Florian, Ioan-Alexandru; Ungureanu, Gheorghe; Florian, Ioan-Stefan

    2017-09-01

    In cerebral aneurysm surgery, various tools are used to evaluate blood flow, including Doppler ultrasonography, conventional cerebral angiography, and electrophysiological monitoring. Fluorescein and indocyanine green are widely used in vascular and central nervous system tumor neurosurgery; however, their routine utilization in aneurysmal surgery is uncommon, despite the fact that they allow direct visualization of blood flow after aneurysmal sac occlusion, enabling the observation of vessel permeability and the effectiveness of aneurysmal obliteration. We report our initial experience using fluorescein video angiography as a control measure for proper clip placement and control of blood flow in aneurysm surgery, and review the relevant literature. This pilot study presents an initial experience, with enrollment of 10 patients harboring a total of 12 cerebral aneurysms who underwent surgery via clipping and subsequent fluorescence videoangiography control. The intravenous injection was performed to demonstrate the patency of the arteries adjacent to the aneurysm. Following intravenous injection, fluorescein sodium remains in the cerebral vasculature for approximately 3 minutes, providing ample time to evaluate vessel patency and determine whether clip repositioning is needed. None of the patients experienced complications during intravenous injection of fluorescein sodium, and the patency of surrounding vessels was demonstrated in all cases. Fluorescein injection in itself does not present a risk of complications, is simple to use, and offers a clear image of the cerebral vasculature. Thus, this technique is useful for determining vessel patency and the degree of aneurysmal occlusion. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Potent risk factor for aneurysm formation: termination aneurysms of the anterior communicating artery and detection of A1 vessel asymmetry by flow dilution.

    Science.gov (United States)

    Tarulli, Emidio; Fox, A J

    2010-08-01

    There is a high incidence of intracranial aneurysms of the AcomA suggesting the possibility of an anatomic risk factor. There also exists an association of termination-type aneurysms with anatomic variations of 1 anterior cerebral artery trunk (A1) as the exclusive or dominant supply to both pericallosal arteries (A2). This yields the hypotheses of aneurysm formation from straight jets of A1 blood. The anatomy and contrast filling of A1 and A2 segments and AcomAs were studied for a subset of cases entered into the Cerecyte Coil Trial for patients with AcomA (n = 105) and other aneurysms (n = 123) that were selected from imaging available at the Cerecyte Core Trial angiographic Core Lab. These cases were analyzed for A1 vessel dominance by measurement of the vessel diameter and dilution of angiographic contrast agent in A2s due to the differential flow source on selective angiography. A control group without aneurysms was assessed anatomically, using a large sequential CTA series (n = 159), acquired during acute stroke assessment. A1 dominance configuration is strongly associated with the presence of AcomA aneurysms for patients with intracranial aneurysms (odds ratio, 17.8). This association is also present compared with the incidence of A1 dominance in the large sequential control series of patients without aneurysms undergoing CTA for other reasons (odds ratio, 7.5). Outflow dilution of selective angiographic images augments anatomic information. A flow-based assessment of contrast flowing from the A1 to the A2 segments after injection pressure is superior to an A1 diameter based categorization when A1 vessel diameters are not strikingly different. The anatomic variant of asymmetric A1 configurations likely facilitates the development of AcomA aneurysms by flow stresses, providing further evidence to support the role of biophysical factors in intracranial aneurysm development.

  18. Embolization of a giant pediatric, posttraumatic, skull base internal carotid artery aneurysm with a liquid embolic agent.

    Science.gov (United States)

    Reig, Adam S; Simon, Scott; Mericle, Robert A

    2009-11-01

    Many treatments for posttraumatic, skull base aneurysms have been described. Eight months after an all-terrain-vehicle accident, this 12-year-old girl presented with right-side Horner syndrome caused by a 33 x 19-mm internal carotid artery aneurysm at the C-1 level. We chose to treat the aneurysm with a new liquid embolic agent for wide-necked, side-wall aneurysms (Onyx HD 500). We felt this treatment would result in less morbidity than surgery and was less likely to occlude the parent artery than placement of a covered stent, especially in a smaller artery in a pediatric patient. Liquid embolic agents also appear to be associated with a lower chance of recanalization and lower cost compared with stent-assisted coil embolization. After the patient was treated with loading doses of aspirin, clopidogrel bisulfate, and heparin, 99% of the aneurysm was embolized with 9 cc of the liquid embolic agent. There were no complications, and the patient remained neurologically stable. Follow-up angiography revealed durable aneurysm occlusion after 1 year. The cost of Onyx was less than the cost of coils required for coil embolization of similarly sized intracranial aneurysms at our institution. Liquid embolic agents can provide a safe, efficacious, and cost-effective approach to treatment of select giant, posttraumatic, skull base aneurysms in pediatric patients.

  19. Endovascular treatment of a large ruptured middle cerebral artery bifurcation aneurysm in a 5-week-old infant: case report.

    Science.gov (United States)

    Lyon, Kristopher A; Arrey, Eliel N; Haider, Ali S; Jeevan, Dhruve S; Benardete, Ethan A

    2017-10-01

    Ruptured intracranial aneurysms are extremely rare in infants. The optimal treatment strategy is not well established. Both microsurgical and endovascular techniques and strategies have been tried, and in the literature there is a significant variability in outcome. The authors report the presentation and successful endovascular treatment of a large, ruptured, middle cerebral artery bifurcation aneurysm in a 5-week-old girl, one of only a few reported in the literature. Clinical and radiological findings at follow-up are also presented. The authors then review the literature on aneurysmal subarachnoid hemorrhage in infants, with particular regard to outcome after either endovascular or open surgical management. They also provide recommendations for follow-up in pediatric patients whose intracranial aneurysms have been treated with coil embolization.

  20. A patient-specific intracranial aneurysm model with endothelial lining: a novel in vitro approach to bridge the gap between biology and flow dynamics.

    Science.gov (United States)

    Kaneko, Naoki; Mashiko, Toshihiro; Namba, Katsunari; Tateshima, Satoshi; Watanabe, Eiju; Kawai, Kensuke

    2017-06-26

    To develop an in vitro model for studying the biological effect of complex-flow stress on endothelial cells in three-dimensional (3D) patient-specific vascular geometry. A vessel replica was fabricated with polydimethylsiloxanes using 3D printing technology from vascular image data acquired by rotational angiography. The vascular model was coated with fibronectin and immersed in a tube filled with a cell suspension of endothelium, and then cultured while being slowly rotated in three dimensions. Culture medium with viscosity was perfused in the circulation with the endothelialized vascular model. A computational fluid dynamics (CFD) study was conducted using perfusion conditions used in the flow experiment. The morphology of endothelial cells was observed under a confocal microscope. The CFD study showed low wall shear stress and circulating flow in the apex of the basilar tip aneurysm, with linear flow in the parent artery. Confocal imaging demonstrated that the inner surface of the vascular model was evenly covered with monolayer endothelial cells. After 24 h of flow circulation, endothelial cells in the parent artery exhibited a spindle shape and aligned with the flow direction. In contrast, endothelial cells in the aneurysmal apex were irregular in shape and size. A geometrically realistic intracranial aneurysm model with live endothelial lining was successfully developed. This in vitro model enables a new research approach combining study of the biological impact of complex flow on endothelial cells with CFD analysis and patient information, including the presence of aneurysmal growth or rupture. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Treatment of aneurysms with wires and electricity: a historical overview.

    Science.gov (United States)

    Siddique, Khawar; Alvernia, Jorge; Fraser, Kenneth; Lanzino, Giuseppe

    2003-12-01

    Endovascular treatment of aneurysms has only recently become an accepted therapeutic modality. Nonetheless, treatment of aneurysms with the aid of various foreign bodies such as needle and wire insertion with or without electrical current has been reported since the first half of the 19th century. In 1832 Phillips induced clot formation in the femoral and carotid arteries of dogs by leaving needles in the arteries for variable lengths of time. Simultaneously, in France, Velpeau had proposed using "l'acupuncture des arteres dans le traitement des anevrismes." Later, Phillips and Pelrequin connected the offending needles to a source of electrical current in an attempt to increase thrombus formation and aneurysm occlusion. Subsequently, Moore introduced the concept of packing the aneurysm with wire inserted through a needle transfixed to the vessel wall. To this method, Corradi added electrical current. Widely known as the Moore-Corradi technique, it was used in ensuing years with variable success. The early phase of endovascular aneurysm treatment culminated when Blakemore and Moore treated a case of symptomatic cavernous sinus aneurysm by passing wire through the patient's orbit. These pioneering cases combined with technological advances in the diagnosis of intracranial aneurysms paved the way for further refinements in coil embolization of aneurysms.

  2. A Novel Method for Super-selective Coil Embolization Using an Extremely Soft Bare Coil through a Liquid Embolic Delivery Microcatheter

    Science.gov (United States)

    HORIE, Nobutaka; HAYASHI, Kentaro; MORIKAWA, Minoru; IZUMO, Tsuyoshi; NAGATA, Izumi

    Endovascular coil embolization for intracranial aneurysms, arteriovenous malformations (AVMs), dural arteriovenous fistulas (AVFs), and hypervascular tumors are recognized as an effective adjunctive or curative treatment. In this setting, it is sometimes difficult to navigate a coil delivery microcatheter to the target point of a tiny, tortuous vessel. We herein present a case series of a novel method that enabled super-selective coil embolization using an extremely soft bare, electrodetachable coil (ED extrasoft® coil) through a liquid embolic delivery microcatheter (Marathon®). The Marathon® catheter was successfully placed at the target point of the tiny, tortuous vessel, and coil embolization was achieved in all 16 patients with 9 AVMs, 2 distal aneurysms, 2 AVFs, and 3 meningiomas. The primary ED extrasoft® coil and delivery wire have a very small radius, and the coil is rapidly detachable with an alarm notice from the generator even under Marathon® with one marker. We believe that this technique can provide safe and efficient embolization for selected patients. PMID:24670315

  3. Thrombosis and spontaneous recanalization of a giant intracranial aneurysm: diagnostic and management pearls in a pediatric patient.

    Science.gov (United States)

    Kooshkabadi, Ali; Jankowitz, Brian; Choi, Phillip A; Weiner, Gregory M; Greene, Stephanie

    2015-01-01

    The authors present the case of a boy who was successfully managed through the spontaneous thrombosis of a cavernous internal carotid artery (ICA) aneurysm, the subsequent occlusion of the ICA, its recanalization, and ultimate endovascular sacrifice, using only two angiograms because of the diagnostic capability of CT angiography. Spontaneous recanalization of the ICA following occlusion in the setting of a giant aneurysm has not been previously reported.

  4. NOISY INTRACRANIAL TUMORS

    NARCIS (Netherlands)

    VANDOOREN, BTH; VANBRUGGEN, AC; MOOIJ, JJA; HEW, JM; JOURNEE, HL

    1994-01-01

    Transorbital sound recordings were obtained from 21 patients with intracranial tumours, 28 patients with intracranial aneurysms and 20 control patients. The group of patients with tumours consisted of 12 patients with gliomas, of whom 6 had low-grade gliomas and 6 had high-grade gliomas, and 9

  5. Cost of Treatment of Cerebral Aneurysm Embolization: Study of Associated Factors.

    Science.gov (United States)

    Cheikh, Amine; Rachid, Razine; Jehanne, Aasfara; Adil, Ababou; Ali, Benomar; Cherrah, Yahya; Amine, El Hassani; Abdeljalil, El Quessar

    2016-12-01

    Surgical clipping or endovascular coiling are the main procedures used in the treatment of cerebral aneurysms, with a preference for endovascular coiling. In Morocco, the number of patients needing endovascular coiling is growing, but many of them do not have access to this technique. The aim of this study was to determine the main parameters associated with variations in the total cost of this procedure in order to establish the amount (lump sum) that may be reimbursed by health insurance funds. One hundred and seventeen patients with 124 aneurysms were admitted for treatment of one or more intracranial aneurysms between January 2010 and December 2015. The overall cost of hospitalization was assessed by using the micro-costing technique. The calculation was based on the tariffs of medical procedures as defined by the Ministry of Health in Morocco. A regression analysis was used to define the correlation between the overall cost and the various parameters. Univariate linear regression showed that the total cost was influenced by overall duration of hospitalization, ICU duration of hospitalization and size of aneurysm. On the other hand, univariate linear regression showed that the total cost was not influenced by sex, localization of aneurysm, and size of the aneurysm's neck. However, multivariate linear regression showed that the total cost was influenced by one type of insurance health, overall duration of hospitalization, ICU duration of hospitalization, size of the aneurysm, and size of the aneurysm's neck. Setting a rate for reimbursement of patients who have had coiling treatment for a cerebral aneurysm should take into account the results of our study in order to limit the costs borne by patients. The parameters that influence the overall cost must be reimbursed in each case while the parameters that do not influence treatment costs could be included in a lump sum.

  6. Infective endocarditis due to Abiotrophia defectiva and Granulicatella spp. complicated by infectious intracranial cerebral aneurysms: a report of three cases and review of the literature.

    Science.gov (United States)

    Rhodes, Heather M; Hirigoyen, Diane; Shabnam, Lubna; Williams, David N; Hansen, Glen T

    2016-06-01

    Nutritionally variant streptococci, now classified as Abiotrophia defectivaor Granulicatella spp., are thought to account for 2 % of all infective endocarditis cases but estimates of their frequency are complicated by changes in nomenclature and difficulties in obtaining positive microbiology cultures. Their growth characteristics and difficulty undertaking antibiotic susceptibility testing may impede optimal antibiotic treatment decisions. We describe three patients with definite infective endocarditis due to these organisms seen at our hospital between 2005 and 2010, all of whom presented with neurological symptoms due to infectious intracranial cerebral aneurysms. We recommend that, for patients with left-sided infective endocarditis due to A. defictiva and Granulicatella spp., clinicians should consider imaging the central nervous system.

  7. In vitro and in vivo evaluation of a shape memory polymer foam-over-wire embolization device delivered in saccular aneurysm models.

    Science.gov (United States)

    Boyle, Anthony J; Landsman, Todd L; Wierzbicki, Mark A; Nash, Landon D; Hwang, Wonjun; Miller, Matthew W; Tuzun, Egemen; Hasan, Sayyeda M; Maitland, Duncan J

    2016-10-01

    Current endovascular therapies for intracranial saccular aneurysms result in high recurrence rates due to poor tissue healing, coil compaction, and aneurysm growth. We propose treatment of saccular aneurysms using shape memory polymer (SMP) foam to improve clinical outcomes. SMP foam-over-wire (FOW) embolization devices were delivered to in vitro and in vivo porcine saccular aneurysm models to evaluate device efficacy, aneurysm occlusion, and acute clotting. FOW devices demonstrated effective delivery and stable implantation in vitro. In vivo porcine aneurysms were successfully occluded using FOW devices with theoretical volume occlusion values greater than 72% and rapid, stable thrombus formation. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1407-1415, 2016. © 2015 Wiley Periodicals, Inc.

  8. Subarachnoid hemorrhage-negative Terson syndrome after balloon-assisted coil embolization in a patient with underlying antiphospholipid antibody syndrome.

    Science.gov (United States)

    Gupta, Vikas; Kolomeyer, Anton M; Bhagat, Neelakshi; Turbin, Roger E; Prestigiacomo, Charles J; Gandhi, Chirag D

    2014-01-01

    To report subarachnoid hemorrhage-negative Terson syndrome after coil embolization of an unruptured intracranial aneurysm in a patient with underlying antiphospholipid syndrome. Retrospective case report. A 48-year-old woman with underlying antiphospholipid syndrome. Our patient underwent balloon-assisted coil embolization of an unruptured right internal carotid artery aneurysm. There was herniation of the second coil requiring coil retrieval with subsequent nonflow limiting herniation of the first coil left in situ on anticoagulation. In the immediate postprocedure period, she developed preretinal, intraretinal, and vitreous hemorrhages requiring temporary withholding of anticoagulation therapy with careful resumption. Visual acuity was counting fingers and there was an afferent pupillary defect. Two week after discharge, the patient underwent a pars plana vitrectomy for dense breakthrough vitreous hemorrhage. Four weeks after pars plana vitrectomy, her visual acuity was 20/400. Terson syndrome should be considered in a patient with visual symptoms after not only aneurysmal subarachnoid hemorrhage but also non-subarachnoid hemorrhage elective aneurysm coiling as demonstrated by our case.

  9. [Neuroimaging follow-up of cerebral aneurysms treated with endovascular techniques].

    Science.gov (United States)

    Delgado, F; Saiz, A; Hilario, A; Murias, E; San Román Manzanera, L; Lagares Gomez-Abascal, A; Gabarrós, A; González García, A

    2014-01-01

    There are no specific recommendations in clinical guidelines about the best time, imaging tests, or intervals for following up patients with intracranial aneurysms treated with endovascular techniques. We reviewed the literature, using the following keywords to search in the main medical databases: cerebral aneurysm, coils, endovascular procedure, and follow-up. Within the Cerebrovascular Disease Group of the Spanish Society of Neuroradiology, we aimed to propose recommendations and an orientative protocol based on the scientific evidence for using neuroimaging to monitor intracranial aneurysms that have been treated with endovascular techniques. We aimed to specify the most appropriate neuroimaging techniques, the interval, the time of follow-up, and the best approach to defining the imaging findings, with the ultimate goal of improving clinical outcomes while optimizing and rationalizing the use of available resources. Copyright © 2013 SERAM. Published by Elsevier Espana. All rights reserved.

  10. Impact of inherited genetic variants associated with lipid profile, hypertension, and coronary artery disease on the risk of intracranial and abdominal aortic aneurysms.

    Science.gov (United States)

    van 't Hof, Femke N G; Ruigrok, Ynte M; Baas, Annette F; Kiemeney, Lambertus A L M; Vermeulen, Sita H; Uitterlinden, André G; Hofman, Albert; Rivadeneira, Fernando; Rinkel, Gabriël J E; de Bakker, Paul I W

    2013-06-01

    Epidemiological studies show that an unfavorable lipid profile and coronary artery disease (CAD) are risk traits for abdominal aortic aneurysms (AAAs) but not for intracranial aneurysms (IAs), and that hypertension is a main risk trait for IAs but not for AAAs. To evaluate these observations, we investigated single-nucleotide polymorphisms associated with serum lipid levels, hypertension, and CAD and tested their contribution to AAA and IA risk. We defined sets of single-nucleotide polymorphisms previously reported to be associated with serum lipid levels, CAD, and blood pressure. From previously collected genome-wide data, we extracted genotypes for these single-nucleotide polymorphism sets in 709 IA cases and 2692 controls and 807 AAA cases and 1905 controls (all of Dutch origin). We computed genetic scores for each individual by summing the observed number of risk alleles weighted by their previously published effect size. Using logistic regression, we tested the genetic scores for association with IAs and AAAs and found significant associations for genetic scores of total cholesterol (P=3.6×10⁻⁶), low-density lipoprotein-cholesterol (P=5.7×10⁻⁷), and CAD (P=0.0014) with AAAs and for the blood pressure score with IAs (P=0.0030). We demonstrate that genetic risk profiles of lipid factors and CAD are associated with AAAs but not with IAs, and the genetic risk profile of blood pressure is associated with IAs but not with AAAs. These findings are consistent with epidemiological observations.

  11. Sex differences in intracranial arterial bifurcations

    DEFF Research Database (Denmark)

    Lindekleiv, Haakon M; Valen-Sendstad, Kristian; Morgan, Michael K

    2010-01-01

    Subarachnoid hemorrhage (SAH) is a serious condition, occurring more frequently in females than in males. SAH is mainly caused by rupture of an intracranial aneurysm, which is formed by localized dilation of the intracranial arterial vessel wall, usually at the apex of the arterial bifurcation. T....... The female preponderance is usually explained by systemic factors (hormonal influences and intrinsic wall weakness); however, the uneven sex distribution of intracranial aneurysms suggests a possible physiologic factor-a local sex difference in the intracranial arteries....

  12. International differences in the management of intracranial aneurysms: implications for the education of the next generation of neurosurgeons.

    Science.gov (United States)

    Alshafai, Nabeel; Falenchuk, Olesya; Cusimano, Michael D

    2015-09-01

    The publication of the International Subarachnoid Aneurysm Trial rapidly changed the management of patients with subarachnoid hemorrhage. The present and perceived future trends of aneurysm management have significant implications for patients and how we educate future cerebrovascular specialists. To determine present perceived competencies of final-year neurosurgical residents who have just finished their residencies and to relate those to what practitioners from a variety of continents expect of these persons. The goal is to provide a basis for further discussion regarding the design of further educational programs in neurosurgery. A 55-item questionnaire with 33 questions related to competencies and expectations of competency from final-year residents who have just finished residency was completed by 229 neurosurgeons and neuro-radiologists (81 % response rate) of mixed seniority from 45 countries. We used bivariate and descriptive analyses to determine future trends and geographic differences in cerebral aneurysm management as well as the educational implications on the future. More North Americans than those from the rest of the world are of the opinion that graduating residents are presently competent to perform basic cerebrovascular procedures like evacuation of a hematoma and clipping a simple 7-mm middle cerebral artery aneurysm. Extremely few graduating neurosurgical residents anywhere are presently capable of performing endovascular techniques for even the most basic of aneurysms. Most of those surveyed also believe that endovascular and open surgical management of aneurysms should be a part of residency training for all residents (70.4 and 88.7 %, respectively). Our findings have implications for the design of neurosurgical curricula for residents as well as for certification examinations and procedures. Specialty and educational organizations and those responsible for the education of future clinicians who will care for patients with cerebrovascular

  13. Endovascular Aneurysm Repair Treatment of Aortoiliac Aneurysms

    DEFF Research Database (Denmark)

    Taudorf, Mikkel; Rasmussen, John Bøje Grønvall; Schroeder, Torben V

    2016-01-01

    PURPOSE: To compare the risk of gluteal claudication after endovascular aneurysm repair (EVAR) of aortoiliac aneurysms by interventional exclusion of the internal iliac artery (IIA) with plugs or coils versus a branch iliac device to maintain pelvic blood supply and to identify risk factors...

  14. Superior cerebellar artery aneurysms treated using the sole stenting approach. Technical note.

    Science.gov (United States)

    Zenteno, Marco; Santos-Franco, Jorge; Aburto-Murrieta, Yolanda; Modenesi-Freitas, Jose-María; Ramírez-Guzmán, Guadalupe; Gómez-Llata, Sergio; Lee, Angel

    2007-10-01

    Endovascular treatment of intracranial aneurysms has evolved since the introduction of detachable coils. Sole stenting is a brand-new technique that has recently emerged as a definitive treatment for saccular or fusiform aneurysms at particular locations. Superior cerebellar artery aneurysms are rare, and few treated cases have been reported. Most of them have been treated surgically, and endovascular cases usually have been managed with occlusion of the parent vessel. The authors report on the first two endovascularly treated cases with complete cure of the aneurysm as well as preservation of the parent vessel and distal circulation via the sole stenting technique. The results together with several aspects of the technique, such as the correction of the angle of the vessel and modification of the shear stress, are discussed.

  15. A contribution to the controversy over dimethyl sulfoxide toxicity: anesthesia monitoring results in patients treated with Onyx embolization for intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Pamuk, A.G.; Aypar, U. [Hacettepe University Hospital, Department of Anesthesia, Sihhiye, Ankara (Turkey); Saatci, I.; Cekirge, H.S. [Hacettepe University Hospital, Department of Radiology, Ankara (Turkey)

    2005-05-01

    Onyx injection is a new technique for embolization of cerebral aneurysms that is involved in a controversy about the 'toxicity' of its solvent, dimethyl sulfoxide (DMSO). We retrospectively studied 38 patients treated for aneurysms with the liquid polymer, Onyx. Induction was with propofol, fentanyl and vecuronium, and anesthesia was maintained with isoflurane in O{sub 2} and N{sub 2}O. The patients were given 500 ml of fluid after induction, and bradycardia was prevented in order to keep patients hyperdynamic. Electrocardiography (ECG), non-invasive blood pressure (NIBP), pulse oximetry, core temperatures, invasive blood pressure (BP), etCO{sub 2}, and urine output were monitored throughout the intervention. Heart rate and BP changes in response to balloon inflation, DMSO injection, Onyx injection and balloon deflation were recorded. The patients were followed with serial neurological examinations, computerized tomography and/or magnetic resonance imaging postoperatively for evidence of any neurological injury. Cumulative DMSO doses were always well under previously implicated doses for systemic toxicity. No changes implicating toxic reactions were observed during DMSO and Onyx injections. Balloon-induced changes returned to baseline within 1 min of balloon deflation. Technique-related permanent morbidity occurred in two patients (worsening of cranial nerve palsies in one and monocular blindness in another) and intracranial hemorrhage with resulting death in one patient. All patients showed a tendency to oxygen desaturation, but this finding did not cause any clinical consequence. Anesthesiologists need to be vigilant in monitoring patients treated with techniques that are new or are being developed. We have seen no evidence of toxicity or any anesthetic complications in our group of patients, our only clinical concern being a tendency to oxygen desaturation, which may be explained by the inhalational elimination of DMSO. (orig.)

  16. Pediatric cerebral aneurysms.

    Science.gov (United States)

    Gemmete, Joseph J; Toma, Ahmed K; Davagnanam, Indran; Robertson, Fergus; Brew, Stefan

    2013-11-01

    Childhood intracranial aneurysms differ from those in the adult population in incidence and gender prevalence, cause, location, and clinical presentation. Endovascular treatment of pediatric aneurysms is the suggested approach because it offers both reconstructive and deconstructive techniques and a better clinical outcome compared with surgery; however, the long-term durability of endovascular treatment is still questionable, therefore long-term clinical and imaging follow-up is necessary. The clinical presentation, diagnosis, and treatment of intracranial aneurysms in children are discussed, and data from endovascular treatments are presented. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Reoperation and readmission after clipping of an unruptured intracranial aneurysm: a National Surgical Quality Improvement Program analysis.

    Science.gov (United States)

    Dasenbrock, Hormuzdiyar H; Smith, Timothy R; Rudy, Robert F; Gormley, William B; Aziz-Sultan, M Ali; Du, Rose

    2017-04-07

    OBJECTIVE Although reoperation and readmission have been used as quality metrics, there are limited data evaluating the rate of, reasons for, and predictors of reoperation and readmission after microsurgical clipping of unruptured aneurysms. METHODS Adult patients who underwent craniotomy for clipping of an unruptured aneurysm electively were extracted from the prospective National Surgical Quality Improvement Program registry (2011-2014). Multivariable logistic regression and recursive partitioning analysis evaluated the independent predictors of nonroutine hospital discharge, unplanned 30-day reoperation, and readmission. Predictors screened included patient age, sex, comorbidities, American Society of Anesthesiologists (ASA) classification, functional status, aneurysm location, preoperative laboratory values, operative time, and postoperative complications. RESULTS Among the 460 patients evaluated, 4.2% underwent any reoperation at a median of 7 days (interquartile range [IQR] 2-17 days) postoperatively, and 1.1% required a cranial reoperation. The most common reoperation was ventricular shunt placement (23.5%); other reoperations were tracheostomy, craniotomy for hematoma evacuation, and decompressive hemicraniectomy. Independent predictors of any unplanned reoperation were age greater than 51 years and longer operative time (p ≤ 0.04). Readmission occurred in 6.3% of patients at a median of 6 days (IQR 5-13 days) after discharge from the surgical hospitalization; 59.1% of patients were readmitted within 1 week and 86.4% within 2 weeks of discharge. The most common reason for readmission was seizure (26.7%); other causes of readmission included hydrocephalus, cerebrovascular accidents, and headache. Unplanned readmission was independently associated with age greater than 65 years, Class II or III obesity (body mass index > 35 kg/m2), preoperative hyponatremia, and preoperative anemia (p ≤ 0.04). Readmission was not associated with operative time

  18. Gelling process differences in reverse emulsion, in situ gelling polymeric materials for intracranial aneurysm embolization, formulated with injectable contrast agents.

    Science.gov (United States)

    Riley, Celeste M; McLemore, Ryan; Preul, Mark C; Vernon, Brent L

    2011-01-01

    The use of liquid-to-solid curing materials for brain aneurysm embolization has become increasingly attractive, as liquid embolics can be delivered noninvasively and can potentially achieve a higher degree of aneurysm volume occlusion. This study was aimed at characterizing differences in the gelling process of a reverse emulsion, crosslinking polymer system formulated with different types of injectable contrast agents. The polymeric system consists of poly(propylene glycol) diacrylate (PPODA) and pentaerythritol tetrakis(3-mercaptopropionate) (QT). These monomers undergo Michael-type addition upon initiation by a basic, aqueous solution. Conray™ and Omnipaque™ 300, commercially available contrast agents, were pH-adjusted to basic conditions and used as initiating solutions with the PPODA-QT system. Material characteristics were identified through rheology and scanning electron microscopy (SEM). Results showed that Conray- and Omnipaque-formulated materials progress through the gelling process uniquely, evidenced by distinctly different viscosity profiles and droplet distributions. These results indicate that Conray is more miscible with the PPODA-QT organic phase. Greater solubility in the organic phase allows Conray-formulated gels to have faster and more widespread reaction initiation kinetics when Conray and Omnipaque have the same pH. Omnipaque-formulated gels require a higher pH for the material to solidify in a time frame comparable to Conray-formulated gels. This discrepancy arises because the majority of reaction initiation sites in Omnipaque-formulated gels occur at phase boundaries via hydroxide ion flux from emulsified droplets rather than from hydroxide ions that are solubilized and integrated within the PPODA-QT organic phase. Copyright © 2010 Wiley Periodicals, Inc.

  19. Large aneurysm in a nonbifurcating cervical carotid artery: an aneurysm associated with a rare anomaly treated with radial artery graft bypass: case report.

    Science.gov (United States)

    Tokugawa, Joji; Yoshida, Kensaku; Yamamoto, Munetaka; Kamiyama, Hiroyasu; Oishi, Hidenori; Arai, Hajime

    2011-03-01

    A nonbifurcating cervical carotid artery is an extremely rare type of carotid artery anomaly. We present a patient with a nonbifurcating cervical carotid artery and a large aneurysm of the cavernous internal carotid artery (ICA). The patient was successfully treated with combined microsurgical and endovascular techniques. We describe this case with reference to the relevant literature. A 66-year-old woman with progressive left external ocular movement dysfunction was found to have a large left cavernous ICA aneurysm. Serial magnetic resonance angiography revealed progressive growth of the lesion. In addition, conventional angiography showed a nonbifurcating cervical carotid artery and a persistent primitive trigeminal artery. The aneurysm was found unsuitable for direct surgery because of its size and location and for endovascular intervention because of extreme tortuosity of both carotid and right vertebral arteries. Surgery was performed in 2 stages. First, we performed an extracranial-intracranial high-flow bypass using radial artery graft, followed by proximal occlusion of the carotid artery. As the second stage, the patient underwent intravascular parent artery occlusion via the radial artery graft bypass to approach the intracranial carotid artery. The carotid artery was successfully coil embolized, and the aneurysm was undetectable on a postprocedure angiogram. Serial follow-up magnetic resonance imaging revealed thrombosis of the aneurysm. We report a rare case that involves the novel use of the radial artery graft bypass as an approach for parent vessel occlusion.

  20. Brain aneurysm patients seen in Harare, Zimbabwe: cases review ...

    African Journals Online (AJOL)

    Objectives: The study aimed to look at the demographic information, size and location of intracranial aneurysms, treatment rendered and the outcomes in Zimbabwe. Design: ... Subjects: Adult intracranial aneurysm patients. ... Ten of the seventeen (58.8%) had hypertension while two had a history of aneurysms in the family.

  1. Endovascular treatment of wide-neck anterior communicating artery aneurysms using the LVIS Junior stent.

    Science.gov (United States)

    Feng, Zhengzhe; Zhang, Lei; Li, Qiang; Zhao, Rui; Xu, Yi; Hong, Bo; Zhao, Wenyuan; Liu, Jianmin; Huang, Qinghai

    2015-08-01

    We performed this retrospective study to assess the clinical safety and efficacy of the low-profile visualized intraluminal support junior (LVIS Jr.; MicroVention, Aliso Viejo, CA, USA) stent placement in anterior communicating artery (ACA) aneurysms. ACA aneurysms are some of the most common intracranial aneurysms. Stent placement is particularly difficult due to the complexity of the vascular anatomy and the small vessels of the ACA complex. From November 2013 and June 2014, LVIS Jr. stent-assisted coiling was performed in 11 patients with 12 wide-neck ACA aneurysms. Patient demographics, morphologic features of the aneurysm, clinical results and follow-up results are presented. Successful deployment of the LVIS Jr. stent in the targeted artery was achieved in all patients. Complete occlusion was achieved in seven patients, neck remnant in three, and partial occlusion in two. The angiographic follow-up of nine patients (mean 4.4 months) showed that all aneurysms remained stable or improved. There was no in-stent stenosis, recurrence or retreatment. The modified Rankin scale score at discharge was 0 in eight patients and 1 in three patients. The LVIS Jr. stent provided excellent trackability and deliverability and is safe and effective for the treatment of wide-necked ACA aneurysms. Further follow-up is needed to assess the long-term efficacy of LVIS Jr. stent placement in ACA. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Endovascular Treatment of Middle Cerebral Artery Aneurysm with the LVIS Junior Stent.

    Science.gov (United States)

    Feng, Zhengzhe; Li, Qiang; Zhao, Rui; Zhang, Ping; Chen, Lei; Xu, Yi; Hong, Bo; Zhao, Wenyuan; Liu, Jianmin; Huang, Qinghai

    2015-06-01

    Middle cerebral artery (MCA) aneurysms often occur in small parent vessels and are incorporated with the orifice of acute-angled efferent branch vessels. Endovascular treatment for these aneurysms remains technically challenging. This study aimed to assess the clinical safety and efficacy of the Low-profile Visualized Intraluminal Support Junior (LVIS Jr) stent for embolization of MCA aneurysms. Eighteen intracranial aneurysms, including 13 unruptured and 5 ruptured aneurysms, were treated with LVIS Jr stent-assisted coil embolization. The clinical data and technical results are presented. A total of 18 stents were successfully delivered to the target aneurysms, and the technical success rate was 100%. There was complete occlusion in 8 (44.4%) of 18 cases, neck remnants in 7 (38.9%) cases, and partial occlusion in 3 (16.7%) cases. In-stent thrombosis occurred in 1 case, and the symptoms disappeared after transvenous tirofiban injection. The modified Rankin Scale score at discharge was 0 in 14 patients, 1 in 3 patients, and 2 in 1 patient. The LVIS Jr stent provided excellent trackability and deliverability and is safe and effective for the treatment of wide-necked MCA aneurysms with tortuous and smaller parent vessels. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  3. [Cerebral infarction and intracranial aneurysm related to the reactivation of varicella zoster virus in a Japanese acquired immunodeficiency syndrome (AIDS) patient].

    Science.gov (United States)

    Yasuda, Chiharu; Okada, Kazumasa; Ohnari, Norihiro; Akamatsu, Naoki; Tsuji, Sadatoshi

    2013-01-01

    A 35-years-old right-handed man admitted to our hospital with a worsening of dysarthria, left facial palsy and left hemiparesis for 2 days. Acquired immunodeficiency syndrome (AIDS) was diagnosed when he was 28 years old. At that time, he also was treated for syphilis. After highly active antiretroviral treatment (HAART) was introduced at the age of 35 years old, serum level of human immunodeficiency virus (HIV) was not detected, but the number of CD4+ T cells was still less than 200/μl. He had no risk factors of atherosclerosis including hypertension, diabetes and hyperlipidemia. He had neither coagulation abnormality nor autoimmune disease. Magnetic resonance imaging (MRI) showed acute ischemic infarction spreading from the right corona radiate to the right internal capsule without contrast enhancement. Stenosis and occlusion of intracranial arteries were not detected by MR angiography. Although argatroban and edaravone were administered, his neurological deficits were worsened to be difficult to walk independently. Cerebrospinal fluid (CSF) examination showed a mild mononuclear pleocytosis (16/μl). Oligoclonal band was positive. The titer of anti-varicella zoster virus (VZV) IgG antibodies was increased, that indicated VZV reactivation in the central nervous system (CNS), although VZV DNA PCR was not detected. Therefore, acyclovir (750 mg/day for 2 weeks) and valaciclovir (3,000 mg/day for 1 month) were administered in addition to stroke therapy. He recovered to be able to walk independently 2 month after the admission.Angiography uncovered a saccular aneurysm of 3 mm at the end of branch artery of right anterior cerebral artery, Heubner artery, 28 days after the admission. We speculated that VZV vasculopathy caused by VZV reactivation in CNS was involved in the pathomechanism of cerebral infarction rather than HIV vasculopathy in the case.

  4. Surgical treatment of intracranial aneurysms: six-year experience in Belo Horizonte, MG, Brazil Tratamento cirúrgico dos aneurismas intracranianos: experiência de seis anos em Belo Horizonte, MG, Brasil

    Directory of Open Access Journals (Sweden)

    Leodante Batista da Costa Jr

    2004-06-01

    Full Text Available Spontaneous subarachnoid hemorrhage accounts for 5 to 10 % of all strokes, with a worldwide incidence of 10.5 / 100000 person/year, varying in individual reports from 1.1 to 96 /100000 person/year. Angiographic and autopsy studies suggest that between 0.5% and 5% of the population have intracranial aneurysms. Approximately 30000 people suffer aneurysmal subarachnoid hemorrhage in the United States each year, and 60% die or are left permanently disabled. We report our experience in the surgical treatment of intracranial aneurysms in a six year period, in Belo Horizonte, Minas Gerais, Brazil. We reviewed the hospital files, surgical and out-patient notes of all patients operated on for the treatment of intracranial aneurysms from January 1997 to January 2003. Four hundred and seventy-seven patients were submitted to 525 craniotomies for treatment of 630 intracranial aneurysms. The majority of patients were female (72.1% in the fourth or fifth decade of life. Anterior circulation aneurysms were more common (94.4%. The most common location for the aneurysm was the middle cerebral artery bifurcation. The patients were followed by a period from 1 month to 5 years. The outcome was measured by the Glasgow Outcome Scale (GOS. At discharge, 62.1% of the patients were classified as GOS 5, 13.9% as GOS 4, 8.7% as GOS 3, 1.7% as GOS 2 and 14.8% as GOS 1.A hemorragia subaracnóidea espontânea é responsável por cerca de 5 a 10% de todos os acidentes vasculares cerebrais, com uma incidência mundial de 10,5 / 100000 pessoas/ano, variando em estudos individuais de 1,1 a 96 / 100000 pessoas / ano, de acordo com diferenças étnicas e geográficas. Estudos angiográficos e de necropsia sugerem que a presença de aneurismas intracranianos ocorre em 0,5-5% da população mundial. De acordo com estatísticas norte-americanas, ocorrem cerca de 30000 rupturas de aneurisma cerebral por ano naquele país, com conseqüências desastrosas para grande parte dos pacientes

  5. Clipping Surgery for Paraclinoid Carotid Aneurysm.

    Science.gov (United States)

    Horiuchi, Tetsuyoshi; Yamamoto, Yasunaga; Suzuki, Yota; Kobayashi, Masayoshi; Ichinose, Shunsuke; Hongo, Kazuhiro

    2016-01-01

    Paraclinoid carotid aneurysm is widely treated with coil embolization. However, all paraclinoid carotid aneurysms cannot be obliterated by the endovascular approach. Our direct surgical procedure was presented. The clinical data of surgically treated paraclinoid carotid aneurysms were retrospectively reviewed. One hundred ninety paraclinoid carotid aneurysms in 181 patients were directly obliterated at the Shinshu University Hospital and its affiliated hospitals between 1991 and 2013. Direct surgical repair of the paraclinoid carotid aneurysm is still useful, even in the era of endovascular treatment.

  6. Late angiographic and clinical follow-up results of 100 consecutive aneurysms treated with Onyx reconstruction: largest single-center experience

    Energy Technology Data Exchange (ETDEWEB)

    Cekirge, H. Saruhan; Saatci, Isil; Cil, Barbaros; Arat, Anil [Hacettepe University Hospital, Department of Radiology, Ankara (Turkey); Ozturk, M. Halil [SSK Diskapi Hospital, Department of Radiology, Ankara (Turkey); Mawad, Michel [Baylor College of Medicine, Department of Radiology, Houston (United States); Ergungor, Fikret; Bavbek, Murat; Beskonakli, Ethem [Numune Hospital, Department of Neurosurgery, Ankara (Turkey); Belen, Deniz; Er, Uygur; Turk, Sami; Sekerci, Zeki [SSK Diskapi Hospital, Department of Neurosurgery, Ankara (Turkey); Ozcan, Osman E.; Ozgen, Tuncalp [Hacettepe University Hospital, Department of Neurosurgery, Ankara (Turkey)

    2006-02-15

    We present the long-term clinical and angiographic follow-up results of 100 consecutive intracranial aneurysms treated with Onyx liquid embolic system (MTI, Irvine, Calif.), either alone or combined with an adjunctive stent, in a single center. A total of 100 aneurysms in 94 patients were treated with endosaccular Onyx packing. Intracranial stenting was used adjunctively in 25 aneurysms including 19 during initial treatment and 6 during retreatment. All aneurysms except two were located in the internal carotid artery. Of the 100 aneurysms, 35 were giant or large/wide-necked, and 65 were small. Follow-up angiography was performed in all 91 surviving patients (96 aneurysms) at 3 and/or 6 months. Follow-up angiography was performed at 1, 2, 3, 4 and 5 years in 90, 41, 26, 6 and 2 patients, respectively. Overall, aneurysm recanalization was observed in 12 of 96 aneurysms with follow-up angiography (12.5%). All 12 were large or giant aneurysms, resulting in a 36% recanalization rate in the large and giant aneurysm group. One aneurysm out of 25 treated with the combination of a stent and Onyx showed recanalization. There was also no recanalization in the follow-up of small internal carotid artery aneurysms treated with balloon assistance only. At final follow-up, procedure- or device-related permanent neurological morbidity was present in eight patients (8.3%). There were two procedure-related and one disease-related (subarachnoid hemorrhage) deaths (mortality 3.2%). Delayed spontaneous asymptomatic occlusion of the parent vessel occurred in two patients, detected on routine follow-up. Onyx provides durable aneurysm occlusion with parent artery reconstruction resulting in perfectly stable 1-year to 5-year follow-up angiography both in small aneurysms treated with balloon assistance only (0% recanalization rate) and large or giant aneurysms treated with stent and Onyx combination (4% recanalization rate). Endosaccular Onyx packing with balloon assistance may not be

  7. Dose comparison of classical 2-plane DSA and 3D rotational angiography for the assessment of intracranial aneurysms.

    Science.gov (United States)

    Guberina, N; Lechel, U; Forsting, M; Mönninghoff, C; Dietrich, U; Ringelstein, A

    2016-07-01

    The purpose of this experimental phantom study was to compare radiation doses imparted to patients undergoing classical two-plane digital subtraction angiography (2-plane DSA) and 3D rotational angiography in interventional neuroradiology. Thermoluminescence dosimeter (TLD) measurements were performed at an anthropomorphic phantom using a digital interventional angiography system. Two-plane DSA included posterior/anterior (PA) and lateral (LAT) projections (frame-rate, 7.6 frames (PA) and 9.8 frames (LAT) for a scan time of approximately 8 s; image intensifier 27 cm (PA) and 25 cm (LAT)). For 3D rotational angiography, 122 images were acquired from one single image run with the imaging system rotating 240° around the phantom's head (image intensifier 37 cm). Effective dose was 0.4 mSv for 2-plane DSA compared to 0.1 mSv for 3D rotational angiography. Organ doses were approximately two to five times higher for classical 2-plane technique compared to the 3D rotational angiography, respectively: brain (11.4 vs. 2.4 mSv), eye lens (4.5 vs.1 mSv), salivary glands (7 vs. 1,7 mSv), oral mucosa (2.7 vs.0.9 mSv), thyroid (0.5 vs. 0.2 mSv), thymus (0.2 vs. 0.05 mSv), bone marrow within imaged region (1 vs. 0.2 mSv), oesophagus (0.07 vs. 0.03 mSv), endotracheal system (2.6 vs. 0.7 mSv) and skeletal components in the imaged region (0.7 vs. 0.2 mSv). Three-dimensional rotational angiography clearly reduces radiation doses compared to the classical 2-plane technique. Replacement of additional 2-plane DSA projections with 3D rotational angiography will lead to a remarkable decrease in patient radiation dose, without loss of image quality. Thus, we recommend routine application of 3D rotational angiography, in particular for diagnostic assessment of aneurysm morphology.

  8. Assessment of Pre- and Post-Operative Cerebral Perfusion in Anterior Circulation Intracranial Aneurysm Clipping Patients at Hospital Sungai Buloh Using CT Perfusion Scan and Correlations to Fisher, Navarro and WFNS Scores.

    Science.gov (United States)

    Ghani, Ailani Ab; Nayan, Saiful Azli Mat; Kandasamy, Regunath; Ghani, Abdul Rahman Izani; Rosman, Azmin Kass

    2017-02-01

    Intracranial aneurysms may rupture and are typically associated with high morbidity and mortality, commonly due to vasospasm after rupture. Once the aneurysm ruptures, the patient's cerebral blood flow may be disturbed during the acute phase, affecting cerebral circulation and thus cerebral perfusion prior to the onset of vasospasm. Fisher and Navarro scores are used to predict vasospasm, while World Federation of Neurosurgical Societies (WFNS) scores are used to predict patient outcomes. Several score modifications are available to obtain higher sensitivity and specificity for the prediction of vasospasm development, but these scores are still unsuccessful. Alternatively, cerebral CT perfusion scan (CTP) is a non-invasive method for measuring cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) in regions of interests (ROI) to obtain the cerebral perfusion status as well as detecting vasospasm. A total of 30 patients' data with clipped anterior circulation intracranial aneurysms admitted to the hospital between 1 January 2013 and 30 June 2014, were collected from the hospital's electronic database. The data collected included patients' admissions demographic profiles, Fisher, Navarro and WFNS scores; and their immediate pre- and post-operative CTP parameters. This study found a significant increase in post-operative MTT (pre- and post-operative MTT) were 9.75 (SD = 1.31) and 10.44 (SD = 1.56) respectively, (P < 0.001)) as well as a significant reduction in post-operative CBF (pre- and post-operative mean CBF were 195.29 (SD = 24.92) and 179.49 (SD = 31.17) respectively (P < 0.001)). There were no significant differences in CBV. There were no significant correlations between the pre- and post-operative CTP parameters and Fisher, Navarro or WFNS scores. Despite the interest in using Fisher, Navarro and WFNS scores to predict vasospasm and patient outcomes for ruptured intracranial aneurysms, this study found no significant correlations

  9. Distal posterior inferior cerebellar artery aneurysm in a child

    Directory of Open Access Journals (Sweden)

    J. Francisco Salomão

    1992-06-01

    Full Text Available The case of a 7-year-old boy presenting with recurrent episodes of subarachnoid hemorrhage due to a distal posterior inferior cerebellar artery aneurysm (PICA, successfully operated, is reported.' The low incidence of intracranial aneurysms in the first decade of life and the rare occurrence of distal PICA aneurysms are unusual features of this case. The theories regarding the origin of intracranial berry aneurysms are discussed.

  10. Evaluation of a New Brain Tissue Probe for Intracranial Pressure, Temperature, and Cerebral Blood Flow Monitoring in Patients with Aneurysmal Subarachnoid Hemorrhage.

    Science.gov (United States)

    Seule, Martin; Sikorski, Christopher; Sakowitz, Oliver; von Campe, Gord; Santos, Edgar; Orakcioglu, Berk; Unterberg, Andreas; Keller, Emanuela

    2016-10-01

    To evaluate an intraparenchymal probe for intracranial pressure (ICP) and temperature (TEMP) monitoring as well as determination of cerebral hemodynamics using a near-infrared spectroscopy (NIRS) and indocyanine green (ICG) dye dilution method (NIRS-ICP probe). The NIRS-ICP probe was applied after aneurysmal subarachnoid hemorrhage if multimodal monitoring was established due to poor neurological condition. ICP and TEMP values were obtained from ventricular catheters and systemic temperature sensors. Repeated NIRS-ICG measurements (2 injections within 30 min) were performed daily for determination of cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time of ICG (mttICG). Secondary neurologic dysfunction was defined as brain tissue oxygen tension 35 obtained from cerebral probing. A total of 128 NIRS-ICG measurements were performed in ten patients. The correlation coefficients between ICP and TEMP values obtained with the NIRS-ICP probe and values from routine monitoring were r = 0.72 and r = 0.96, respectively. The mean values were 30.3 ± 13.6 ml/100 g/min for CBF, 3.3 ± 1.2 ml/100 g for CBV, and 6.8 ± 1.6 s for mttICG. The coefficients of variation from repeated NIRS-ICG measurements were 10.9 % for CBF, 11.7 % for CBV, and 3.8 % for mttICG. The sensitivity for detection of secondary neurologic dysfunction was 85 % and the specificity 83 % using a CBF-threshold of 25 ml/100 g/min. Multimodal monitoring using the NIRS-ICP probe is feasible with high reproducibility of measurement values and the ability to detect secondary neurologic dysfunction. No safety concerns exist for the routine clinical use of the NIRS-ICP probe.

  11. [Comparison of effectiveness of percutaneous embolization and microsurgery in the treatment of 60 patients with MCA berry aneurysms].

    Science.gov (United States)

    Szajner, Maciej; Szczepanek, Dariusz; Trojanowski, Tomasz; Nestorowicz, Andrzej; Szczerbo-Trojanowska, Małgorzata

    2003-01-01

    Surgical clipping has been considered for years a "golden standard" in the treatment of middle cerebral artery (MCA) aneurysms. The recent development of materials and endovascular techniques has permitted the use of embolization for the treatment of intracranial aneurysms regardless of their locations and size. In 30 patients with 32 MCA aneurysms (group I) the endovascular approach with GDC-10 coils was used, while in other 30 patients with 31 aneurysms (group II) surgical clipping was performed. On completion of the diagnostic process the patients were randomly assigned either to the endovascular or microsurgical treatment. Group I: 21 (70%) embolization procedures were carried out, while in 9 (30%) cases with 10 aneurysms embolisation was impossible or regarded as too risky due to various causes. The total occlusion of aneurysm SAC was achieved in 17 (77%) aneurysms, subtotal in 5 (23%). The morbidity rate was 8%, mortality-0%. Group II: Microsurgical clipping was performed in 27 (90%) cases, 3 (10%) patients were disqualified from treatment due to their poor clinical status. An excellent technical result was achieved in 24 (86%) patients, in 4 (14%) cases the neck remnant was observed in control angiography. The morbidity rate was 14%, mortality-0%.

  12. Risk of rupture of small anterior communicating artery aneurysms is similar to posterior circulation aneurysms

    NARCIS (Netherlands)

    P. Bijlenga (Philippe); T. Ebeling (Tapani); M. Jaegersberg (Max); P. Summers (Paul); A. Rogers (Alister); D. Waterworth (Dawn); J. Iavindrasana (Jimison); J. MacHo (Juan); V.M. Pereira (Vitor Mendes); P. Bukovics (Peter); E. Vivas (Elio); M.C.J.M. Sturkenboom (Miriam); J. Wright (Juliet); C.M. Friedrich (Christoph); A.F. Frangi (Alejandro); P.J. Byrne (James); K. Schaller (Karl); D. Rüfenacht (Daniel)

    2013-01-01

    textabstractBackground and Purpose: According to the International Study of Unruptured Intracranial Aneurysms (ISUIA), anterior circulation (AC) aneurysms of <7 mm in diameter have a minimal risk of rupture. It is general experience, however, that anterior communicating artery (AcoA) aneurysms are

  13. Coil Migration through a Neuroform 3 Stent during Endovascular Coiling. A Case Report.

    LENUS (Irish Health Repository)

    O'Hare, A

    2009-07-29

    Summary: A 43-year-old woman attended for stent assisted coiling. A Neuroform 30 x 4.5 mm stent had been successfully placed over the left periophthalmic aneurysm. During the coiling the first coil migrated through the crowns in the stent, lodging at the MCA bifurcation. We believe that the coil herniated through the overlying stent due to the carotid siphon curvature and the open cell design. Furthermore the distal markers of the stent impeded coil extraction with a MERCI device.

  14. A microfabricated microfluidic bioMEMS device to model human brain aneurisms: the aneurysm-on-a-chip

    Science.gov (United States)

    Reece, Lisa M.; Khor, Jian Wei; Thakur, Raviraj; Amin, Ahmed; Wereley, Steven T.; Leary, James F.

    2015-03-01

    Aneurysms are pockets of blood that collect outside blood vessel walls forming dilatations and leaving arterial walls very prone to rupture. There is little information concerning the causes of intracranial aneurysm formation, growth, and rupture. Current treatments include: (1) clipping, and (2) coil embolization, including stent-assisted coiling. Further, the evolution of any aneurysm is assumed to be caused by the remodeling of the affected blood vessel's material constituents (tunica intima, tunica media, or tunica adventitia). Velocity, pressure, and wall shear stresses aid in the disease development of aneurysmal growth, while the shear force mechanisms effecting wound closure are elusive. To study aneurysm pathogenesis, a lab-on-a-chip device is the key to discovering the underlying mechanisms of these lesions. A two-dimensional microfluidic model, the Aneurysm-on-a-Chip™ (AOC), was the logical answer to study particle flow within an aneurysm "sac". The AOC apparatus can track particles/cells when it is coupled to particle image velocimetry software (PIV) package. The AOC fluid flow was visualized using standard microscopy techniques with commercial microparticles and human aortic smooth muscle cells (HASMC). Images were taken during fluid flow experiments and PIV was utilized to monitor the flow of particles within the "sac" region, as well as particles entering and exiting the device. Quiver plots were generated from fluid flow experiments using standard 7 μm latex particles and fixed HASMC in PBS. PIV analysis shows that the particles flowed nicely from input to output. Wall shear stress provided evidence that there was some back flow at the edges of the "sac" - an indicator of aneurysm development in human patients.

  15. Intracranial aneurysms in patients with subarachnoid hemorrhage : CT angiography as a primary examination tool for diagnosis--systematic review and meta-analysis

    NARCIS (Netherlands)

    Westerlaan, Henriette E.; van Dijk, J. M. C.; Jansen -van der Weide, Marijke; de Groot, Jan Cees; Groen, Rob J. M.; Mooij, Jan Jakob A.; Oudkerk, Matthijs

    Purpose: To calculate the sensitivity and specificity of computed tomographic (CT) angiography in the diagnosis of cerebral aneurysms in patients with acute subarachnoid hemorrhage (SAH) at presentation. Materials and Methods: A systematic search for relevant studies was performed of the

  16. A giant internal carotid artery aneurysm: case report

    Directory of Open Access Journals (Sweden)

    Dilcan Kotan

    2013-12-01

    Full Text Available Aneurysms greater than 2.5 cm in diameter are classified as giant aneurysms and represent 5-8% of all intracranial aneurysms. Giant intracranial aneurysms demonstrates the clinical course with symptoms related to subarachnoid haemorrhage, mass effect, thromboembolism and seizures. Not only because of their large sizes, but also because of their usually wide and calcified aneurysm neck, existing thrombus within and its proximity to cranial nerves; giant aneurysms causes serious surgical difficulties. Giant aneurysms of the anterior intracranial circulation are rare, slowly progressive vascular abnormalities, often presenting with neuro-ophthalmological symptoms before they rupture. Herein, a case of 77-year-old woman with a giant aneurysm originated from intracavernous segment of internal carotid artery detected in magnetic resonance angiography who presented symptoms due to affected multiple cranial nerves related to mass effect.

  17. [Aneurysm of the anterior inferior cerebellar artery: case report].

    Science.gov (United States)

    Adorno, Juan Oscar Alarcón; de Andrade, Guilherme Cabral

    2002-12-01

    The intracranial aneurysms of the posterior circulation have been reported between 5 and 10% of all cerebral aneurysms and the aneurysms of the anterior inferior cerebellar artery (AICA) are considered rare, can cause cerebello pontine angle (CPA) syndrome with or without subarachnoid hemorrhage. Since 1948 few cases were described in the literature. We report on a 33 year-old female patient with subarachnoid hemorrhage due to sacular aneurysm of the left AICA. She was submitted to clipage of the aneurysm without complications.

  18. Spinal cord infarction is an unusual complication of intracranial neuroendovascular intervention.

    Science.gov (United States)

    Matsubara, Noriaki; Miyachi, Shigeru; Okamaoto, Takeshi; Izumi, Takashi; Asai, Takumi; Yamanouchi, Takashi; Ota, Keisuke; Oda, Keiko; Wakabayashi, Toshihiko

    2013-12-01

    Spinal cord infarction is an unusual complication of intracranial neuroendovascular intervention. The authors report on two cases involving spinal cord infarction after endovascular coil embolization for large basilar-tip aneurysms. Each aneurysm was sufficiently embolized by the stent/balloon combination-assisted technique or double catheter technique. However, postoperatively, patients presented neurological symptoms without cranial nerve manifestation. MRI revealed multiple infarctions at the cervical spinal cord. In both cases, larger-sized guiding catheters were used for an adjunctive technique. Therefore, guiding catheters had been wedged in the vertebral artery (VA). The wedge of the VA and flow restriction may have caused thromboemboli and/or hemodynamic insufficiency of the spinal branches from the VA (radiculomedullary artery), resulting in spinal cord infarction. Spinal cord infarction should be taken into consideration as a complication of endovascular intervention for lesions of the posterior circulation.

  19. Stromal Cell-Derived Factor-1 Is Associated with Angiogenesis and Inflammatory Cell Infiltration in Aneurysm Walls

    Science.gov (United States)

    Hoh, Brian L.; Hosaka, Koji; Downes, Daniel P.; Nowicki, Kamil W.; Wilmer, Erin N.; Velat, Gregory J.; Scott, Edward W.

    2013-01-01

    Object A small percentage of cerebral aneurysms rupture, but when they do, the effects are devastating. Current management of unruptured aneurysms consist of surgery, endovascular treatment, or watchful waiting. If the biology of how aneurysms grow and rupture were better known, a novel drug could be developed to prevent unruptured aneurysms from rupturing. Ruptured cerebral aneurysms are characterized by inflammation-mediated wall remodeling. We studied the role of stromal cell-derived factor-1 (SDF-1) in inflammation-mediated wall remodeling in cerebral aneurysms. Methods Human aneurysms; murine carotid aneurysms; and murine intracranial aneurysms were studied by immunohistochemistry. Flow cytometry analysis was performed on blood from mice developing carotid aneurysms or intracranial aneurysms. The effect of SDF-1 on endothelial cells and macrophages was studied by chemotaxis cell migration assay and capillary tube formation assay. Anti-SDF-1 blocking antibody was given to mice and compared to control (vehicle)-administered mice for its effects on the walls of carotid aneurysms and the development of intracranial aneurysms. Results Human aneurysms, murine carotid aneurysms, and murine intracranial aneurysms, all express SDF-1; and mice with developing carotid aneurysms or intracranial aneurysms have increased progenitor cells expressing CXCR4, the receptor for SDF-1 (Paneurysms and murine carotid aneurysms have endothelial cells, macrophages, and capillaries in the walls of the aneurysms; and the presence of capillaries in the walls of human aneurysms is associated with presence of macrophages (P=0.01). SDF-1 promotes endothelial cell and macrophage migration (Paneurysm wall. Mice given anti-SDF-1 blocking antibody develop significantly fewer intracranial aneurysms (33% versus 89% in mice given control IgG)(Paneurysms, and may have a role in the development of intracranial aneurysms. PMID:24160472

  20. Novel Metal Artifact Reduction Techniques with Use of Slice-Encoding Metal Artifact Correction and View-Angle Tilting MR Imaging for Improved Visualization of Brain Tissue near Intracranial Aneurysm Clips.

    Science.gov (United States)

    Friedrich, B; Wostrack, M; Ringel, F; Ryang, Y-M; Förschler, A; Waldt, S; Zimmer, C; Nittka, M; Preibisch, C

    2016-03-01

    The MR image quality after intracranial aneurysm clipping is often impaired because of artifacts induced by metal implants. The purpose of the present study was to evaluate the benefit of a new WARP sequence with slice-encoding metal artifact correction (SEMAC) and view-angle tilting (VAT) MR imaging as novel artifact reduction techniques. A new WARP TSE (a work-in-progress software package provided by Siemens Healthcare) sequence was implemented for cranial applications based on a turbo spin echo (TSE) sequence. T1- and T2-weighted images with standard and WARP TSE sequences were acquired from 6 patients with 11 clipping sites, and the images were compared based on artifact size and general image quality. T2- and T1-weighted WARP TSE sequences resulted in a highly significant reduction of metal artifacts compared with standard sequences (T2w- WARP TSE: 89.8 ± 1.4 %; T1w- WARP TSE: 84.9 ± 2.9 %; p < 0.001) without a substantial loss of image quality. The use of a new WARP TSE sequence after aneurysm clipping is highly beneficial for increasing the diagnostic MR image quality due to a striking reduction of metal artifacts.

  1. Histological demonstration of healing in experimental aneurysms.

    Science.gov (United States)

    Killer, M; Plenk, H; Minnich, B; Al-Schameri, R; Lametschwantner, A; Richling, B

    2009-08-01

    Recanalisation of aneurysms after interventional therapy is still an unsolved problem. The aim of this study is to demonstrate the angiographic and histological evidence of healing after endovascular embolisation of experimental aneurysms. We evaluated the healing reaction in experimental aneurysms treated with HydroCoils and platinum coils. After microsurgical construction of aneurysms in 24 rabbits, embolisation was performed. Four animals were sacrificed immediately after embolisation and 5 after 1 month, 3 months and 6 months, respectively, the remaining served as control group. Serial plastic-embedded ground sections of the parent arteries-aneurysm complexes were evaluated by light microscopy. Thrombus organisation in the aneurysms resulted in fibrovascular tissue formation between bare platinum and HydroCoils from the walls of the aneurysms towards the centre of the sac over time. In the clefts between HydroCoils only thin strands of granulation tissue were observed. From one month on, there was a neointimal layer covering the coil mass at the aneurysm orifice. Progressive occlusion by the expanding hydrogel polymers on the coils seemed to result in a durable healing reaction in the aneurismal sac in a short-term follow-up period. Georg Thieme Verlag KG Stuttgart * New York.

  2. Combined Effects of Flow Diverting Strategies and Parent Artery Curvature on Aneurysmal Hemodynamics: A CFD Study.

    Science.gov (United States)

    Xu, Jinyu; Wu, Zhichen; Yu, Ying; Lv, Nan; Wang, Shengzhang; Karmonik, Christof; Liu, Jian-Min; Huang, Qinghai

    2015-01-01

    Flow diverters (FD) are increasingly being considered for treating large or giant wide-neck aneurysms. Clinical outcome is highly variable and depends on the type of aneurysm, the flow diverting device and treatment strategies. The objective of this study was to analyze the effect of different flow diverting strategies together with parent artery curvature variations on altering intra-aneurysmal hemodynamics. Four ideal intracranial aneurysm models with different parent artery curvature were constructed. Computational fluid dynamics (CFD) simulations of the hemodynamics before and after applying five types of flow diverting strategies (single FD, single FD with 5% and 10% packing density of coils, two FDs with 25% and 50% overlapping rate) were performed. Changes in pressure, wall shear stress (WSS), relative residence time (RRT), inflow velocity and inflow volume rate were calculated and compared. Each flow diverting strategy resulted in enhancement of RRT and reduction of normalized mean WSS, inflow volume rate and inflow velocity in various levels. Among them, 50% overlapped FD induced most effective hemodynamic changes in RRT and inflow volume rate. The mean pressure only slightly decreased after treatment. Regardless of the kind of implantation of FD, the mean pressure, inflow volume rate and inflow velocity increased and the RRT decreased as the curvature of the parent artery increased. Of all flow diverting strategies, overlapping FDs induced most favorable hemodynamic changes. Hemodynamics alterations post treatment were substantially influenced by parent artery curvature. Our results indicate the need of an individualized flow diverting strategy that is tailored for a specific aneurysm.

  3. Intracranial pathology of the visual pathway

    Energy Technology Data Exchange (ETDEWEB)

    Mueller-Forell, W. E-mail: mueller-forell@neuroradio.klinik.uni-mainz.de

    2004-02-01

    Intracranial pathologies involving the visual pathway are manifold. Aligning to anatomy, the most frequent and/or most important extrinsic and intrinsic intracranial lesions are presented. Clinical symptoms and imaging characteristics of lesions of the sellar region are demonstrated in different imaging modalities. The extrinsic lesions mainly consist of pituitary adenomas, meningeomas, craniopharyngeomas and chordomas. In (asymptomatic and symptomatic) aneurysms, different neurological symptoms depend on the location of aneurysms of the circle of Willis. Intrinsic tumors as astrocytoma of any grade, ependymoma and primary CNS-lymphoma require the main pathology in the course of the visual pathway. Vascular and demyelinating diseases complete this overview of intracranial lesions.

  4. Non-enhanced MR imaging of cerebral aneurysms: 7 Tesla versus 1.5 Tesla.

    Directory of Open Access Journals (Sweden)

    Karsten H Wrede

    Full Text Available PURPOSE: To prospectively evaluate 7 Tesla time-of-flight (TOF magnetic resonance angiography (MRA in comparison to 1.5 Tesla TOF MRA and 7 Tesla non-contrast enhanced magnetization-prepared rapid acquisition gradient-echo (MPRAGE for delineation of unruptured intracranial aneurysms (UIA. MATERIAL AND METHODS: Sixteen neurosurgical patients (male n = 5, female n = 11 with single or multiple UIA were enrolled in this trial. All patients were accordingly examined at 7 Tesla and 1.5 Tesla MRI utilizing dedicated head coils. The following sequences were obtained: 7 Tesla TOF MRA, 1.5 Tesla TOF MRA and 7 Tesla non-contrast enhanced MPRAGE. Image analysis was performed by two radiologists with regard to delineation of aneurysm features (dome, neck, parent vessel, presence of artifacts, vessel-tissue-contrast and overall image quality. Interobserver accordance and intermethod comparisons were calculated by kappa coefficient and Lin's concordance correlation coefficient. RESULTS: A total of 20 intracranial aneurysms were detected in 16 patients, with two patients showing multiple aneurysms (n = 2, n = 4. Out of 20 intracranial aneurysms, 14 aneurysms were located in the anterior circulation and 6 aneurysms in the posterior circulation. 7 Tesla MPRAGE imaging was superior over 1.5 and 7 Tesla TOF MRA in the assessment of all considered aneurysm and image quality features (e.g. image quality: mean MPRAGE7T: 5.0; mean TOF7T: 4.3; mean TOF1.5T: 4.3. Ratings for 7 Tesla TOF MRA were equal or higher over 1.5 Tesla TOF MRA for all assessed features except for artifact delineation (mean TOF7T: 4.3; mean TOF1.5T 4.4. Interobserver accordance was good to excellent for most ratings. CONCLUSION: 7 Tesla MPRAGE imaging demonstrated its superiority in the detection and assessment of UIA as well as overall imaging features, offering excellent interobserver accordance and highest scores for all ratings. Hence, it may bear the potential to serve as a

  5. Non-enhanced MR imaging of cerebral aneurysms: 7 Tesla versus 1.5 Tesla.

    Science.gov (United States)

    Wrede, Karsten H; Dammann, Philipp; Mönninghoff, Christoph; Johst, Sören; Maderwald, Stefan; Sandalcioglu, I Erol; Müller, Oliver; Özkan, Neriman; Ladd, Mark E; Forsting, Michael; Schlamann, Marc U; Sure, Ulrich; Umutlu, Lale

    2014-01-01

    To prospectively evaluate 7 Tesla time-of-flight (TOF) magnetic resonance angiography (MRA) in comparison to 1.5 Tesla TOF MRA and 7 Tesla non-contrast enhanced magnetization-prepared rapid acquisition gradient-echo (MPRAGE) for delineation of unruptured intracranial aneurysms (UIA). Sixteen neurosurgical patients (male n = 5, female n = 11) with single or multiple UIA were enrolled in this trial. All patients were accordingly examined at 7 Tesla and 1.5 Tesla MRI utilizing dedicated head coils. The following sequences were obtained: 7 Tesla TOF MRA, 1.5 Tesla TOF MRA and 7 Tesla non-contrast enhanced MPRAGE. Image analysis was performed by two radiologists with regard to delineation of aneurysm features (dome, neck, parent vessel), presence of artifacts, vessel-tissue-contrast and overall image quality. Interobserver accordance and intermethod comparisons were calc