Treatment and follow-up of 22 unruptured wide-necked intracranial aneurysms of the internal carotid artery with Onyx HD 500.

BACKGROUND AND PURPOSE: The purpose of this study was to demonstrate endovascular treatment of wide-necked aneurysms of the internal carotid artery with the liquid embolic agent Onyx HD 500. METHODS: Twenty-two wide-necked, large or giant aneurysms of the internal carotid artery (ICA) were treated in 22 patients with Onyx HD 500 (15 ophthalmic, 1 clinoid, and 6 cavernous aneurysms). Sixteen patients were asymptomatic, and mass effect of the aneuryms caused cranial nerve palsy in 6. Seven aneurysms showed regrowth after prior endovascular coiling. RESULTS: Postinterventional angiography demonstrated total occlusion in 18 aneurysms, and a small remnant was left in 4. Clinical and angiographic follow-up data are available in 19 patients (average follow-up, 13 months; range, 5-36 months). Total occlusion was demonstrated in 17 aneurysms (91%), and a partial recanalization was seen in 2. There were 2 ICA occlusions and 1 ICA stenosis. Clinical follow-up demonstrated a transient ischemic attack in 1 patient; 2 with cranial nerve palsy were unchanged, and 2 showed improved symptoms compared with the findings before treatment. The remaining 14 patients were clinically asymptomatic. There was no permanent severe morbidity and no mortality at follow-up. CONCLUSION: The endovascular treatment of wide-necked, large or giant ICA aneurysms with Onyx HD 500 is a treatment option in these selected cases. The benefit is a primary high and stable occlusion rate and good clinical outcome. ICA occlusion caused by Onyx migration in the parent artery is a typical problem, with a benign clinical course in this series.

Stent-angioplasty of intracranial vertebral and basilar artery stenoses in symptomatic patients.

BACKGROUND: To present our two-center treatment results with stent angioplasty of intracranial vertebrobasilar stenoses in symptomatic patients. MATERIAL AND METHODS: Between 2001 and 2003, 21 patients with 22 stenoses, refractory to medical therapy, who underwent elective stenting of intracranial vertebrobasilar stenoses were retrospectively analyzed. All patients had ischemic events clinically referable to the stenoses. Only high-grade stenoses of at least 80% were treated. Clinical evaluation was done based on the modified ranking scale (MRS). RESULTS: In all cases, the stent deployment turned out to be technically successful and control angiography demonstrated the elimination of the high-grade stenoses. A minor residual stenoses was still detectable in six cases. According to the MRS, clinical outcome improved in the case of four patients, seemed unchanged in 14 and worsened in three. The clinical morbidity rate amounted to 14%. Clinical follow-up was available for 13 patients after 9 months with no recurrent symptoms and angiographic follow-up was available after 10 months. Re-stenoses occurred in two cases without clinical symptoms. Retreatment was not done. CONCLUSION: According to our data, stent angioplasty for symptomatic intracranial vertebrobasilar stenoses can be a treatment alternative in case of recurrent symptoms despite medical therapy; particularly, for stenoses of type Mori A or B.

Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results.

OBJECTIVE: We sought to evaluate the early angiographic and clinical outcomes of the first session of endovascular coil occlusion of a large number of patients with intracranial aneurysms treated by five neurointerventionalists during a decade at a single center. METHODS: We performed retrospective analyses of pre- and postprocedural angiographic studies and early clinical outcomes. Enrolled patients underwent endovascular treatment of intracranial aneurysms with detachable coils. RESULTS: A total of 1811 aneurysms in 1579 patients were treated with coil occlusion. Of these, 90 to 100% occlusion of 86.5% of the aneurysms was achieved. In 82.3% of the procedures, no complications occurred. The clinical outcome profile at primary discharge according to the Glasgow Outcome Scale was as follows: Grade V, 74.6%; Grade IV, 6.7%; Grade III, 11.1%; Grade II, 3.1%; and Grade I, 4.5%. In patients with large aneurysms with wide necks, a lower occlusion rate and an increased complication rate were encountered. The use of three-dimensional and fibered coils resulted in higher occlusion rates. Balloon remodeling and stent deployment increased the complication rate. Previous aneurysm rupture, procedural complications, and vasospasm correlated with poor outcome. Of the patients in poor grade after aneurysm rupture, 42% recovered to Glasgow Outcome Scale Grade IV or V, as opposed to 90% of patients who were treated for unruptured aneurysms. The ischemic complication rate was 9%, and the hemorrhagic complication rate was 3%. The early procedural morbidity rate was 5.3%, and the procedural mortality rate was 1.5%. The management mortality rate was 4.4%. CONCLUSION: These data confirm the safety and efficacy of endovascular coil occlusion for patients with intracranial aneurysms.