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1.
Artigo em Japonês | MEDLINE | ID: mdl-34148899

RESUMO

Magnetic resonance angiography (MRA) using ultra-short TE (uTE) is known to be used for the evaluation of cerebral aneurysm after treatment such as clipping and coiling. However, conventional uTE sequences are not appropriate as an additional imaging sequence for 3D time-of-flight (TOF)-MRA because it is not possible to shorten scan time and acquire selective-volume imaging. To solve the problem, we focused on the combination of uTE sampling and 3D radial scan sequences. In this study, we examined the optimal imaging parameters of the proposed uTE-MRA. A simulated blood flow phantom with stents (Enterprise) and titanium clips (YASARGIL) was used for optimizing the TR, flip angle (FA), and radial percentage. The signal intensity in the simulated vessel was measured in each imaging condition, and the ratio of the presence or absence of a stent was evaluated as a relative in-stent signal (RIS). In addition, the diameter of the signal loss of the simulated artery was measured for each imaging condition, and signal loss length (SLL) of a clip was calculated from the average value. The RIS improved with increasing the FA and shortening the TR, but it did not change by changing the radial percentage. The SLL became smaller at the coil as the FA increased, but there was no significant difference between the intersection and the blade. There was also no significant difference between TR and radial percentage. The effective imaging conditions for uTE-MRA to improve the vascular description of the evaluation after treatment of cerebral aneurysms with metallic devices were those with large FA and short TR.


Assuntos
Embolização Terapêutica , Aneurisma Intracraniano , Angiografia Cerebral , Humanos , Imageamento Tridimensional , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Angiografia por Ressonância Magnética , Imagens de Fantasmas , Stents
2.
Niger J Clin Pract ; 24(6): 833-840, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34121730

RESUMO

Aims: To investigate the distribution, characteristics, and association with subarachnoid hemorrhage (SAH) of aneurysms identified in Turkish adult patients with computed tomography angiography (CTA) performed with suspicion of intracranial aneurysms and/or SAH. Subjects and Methods: A total of 356 patients (164 male, and 192 female) with a mean age of 55.6 ± 4.0 (range, 18-90) years were analyzed retrospectively. The dimension in millimeters, localization, type, and multiplicity of aneurysms were noted. The differences in these parameters between females and males were investigated. The correlations of sex, aneurysm size, multiplicity, and size with SAH were researched. Results: On 356 CTA, 140 cases were identified to have aneurysm (39.3%) (56 males [40.0%], 84 females [60.0%]). The incidence of aneurysms and SAH in females was high relative to males. In 140 patients, a total of 187 aneurysms were present (mean size, 7.25 ± 2.56 mm). The highest number of aneurysms was found in the middle cerebral artery 64 (34.2%) while the least was in posterior circulation 20 (10.7%). There was no significant difference between genders in terms of aneurysm size, type, and multiplicity. Individuals with aneurysm site on the internal carotid artery had lower SAH incidence. Receiver Operating Characteristic curve analysis results determined that individuals with aneurysm size >13.5 mm had increased incidence of SAH. Conclusions: The general properties of intracranial aneurysms investigated with CTA in Turkish adults had similarities to information defined in the literature. These results will likely be beneficial to direct approaches to aneurysm diagnosis and treatment in routine practice.


Assuntos
Aneurisma Intracraniano , Hemorragia Subaracnóidea , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/epidemiologia , Adulto Jovem
3.
Medicine (Baltimore) ; 100(19): e25783, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106612

RESUMO

RATIONALE: Among the possible complications during endovascular embolization of intracranial aneurysms, coil protrusion into the parent artery is associated with parent artery occlusion or thromboembolic of the distal arteries. There is no clearly established management strategy for coil protrusion. This report demonstrates our experience with balloon-assisted remodeling to reposition a protruded coil loop. PATIENT CONCERNS: A 53-year-old man was admitted to our hospital with severe bursting headache, nausea, and vomiting. Computed tomography showed subarachnoid hemorrhage and digital subtraction angiography revealed an anterior communicating artery aneurysm. We decided to obliterate the aneurysm with endovascular embolization using detachable coils. DIAGNOSIS: A small loop protruded into the parent artery during the removal of the microcatheter. INTERVENTIONS: We performed successful repositioning of the protruded coil loop using balloon inflation. CONCLUSION: The rescue balloon-assisted remodeling technique was useful in the management of protrusion of a small coil loop into the parent artery during endovascular coil embolization of an intracranial aneurysm. The procedure was associated with minimal complications.


Assuntos
Artéria Cerebral Anterior/lesões , Oclusão com Balão/métodos , Embolização Terapêutica/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Aneurisma Intracraniano/terapia , Complicações Intraoperatórias/terapia , Lesões do Sistema Vascular/terapia , Angiografia Digital , Artéria Cerebral Anterior/diagnóstico por imagem , Embolização Terapêutica/instrumentação , Embolização Terapêutica/métodos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Terapia de Salvação/métodos , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia
4.
Artigo em Russo | MEDLINE | ID: mdl-34156206

RESUMO

BACKGROUND: Aneurysms of vertebral artery confluence and proximal parts of basilar artery are extremely rare. They are usually combined with proximal fenestration of basilar artery. No timely surgical treatment of these aneurysms is associated with high risk of adverse outcomes, and their treatment is a challenge for neurosurgeons. MATERIAL AND METHODS: We analyzed postoperative outcomes in 17 patients with 21 aneurysms of vertebral artery confluence and proximal parts of basilar artery. RESULTS: Six patients with 10 aneurysms underwent microsurgical resection, 11 patients with 11 aneurysms - endovascular procedure. Persistent postoperative deterioration was observed in 5 (29.4%) patients: severe neurological symptoms (GOS grade 3) in 1 case (5.9%), minor bulbar disorders in 4 cases (23.53%). There were no lethal outcomes. CONCLUSION: According to our own and literature data, aneurysms of vertebral artery confluence are extremely rare. The risk of rupture of these aneurysms is extremely high. Endovascular approach is preferred in these patients. Microsurgical procedure is an acceptable alternative if endovascular surgery is impossible.


Assuntos
Procedimentos Endovasculares , Aneurisma Intracraniano , Artéria Basilar , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Resultado do Tratamento , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia
5.
Neurol India ; 69(3): 748-750, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34169882

RESUMO

The incidence of cerebral aneurysms is rare in children, and it has to be definitively ruled out in all cases of intracranial bleed even if there is associated history of trauma. We report a case of 11-month-old girl who presented with intracranial bleed after a history of minor trauma whose diagnosis of an intracranial aneurysm was initially missed which later led to a rebleed. It was managed emergently with endovascular coiling and the patient showed incredible recovery in the post-operative period.


Assuntos
Aneurisma Roto , Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Aneurisma Roto/terapia , Angiografia Cerebral , Criança , Feminino , Humanos , Lactente , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/terapia , Resultado do Tratamento
6.
J Pak Med Assoc ; 71(2(B)): 656-662, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33941954

RESUMO

OBJECTIVE: To assess the outcome of endovascular treatment of intracranial aneurysm over 15 years. METHODS: The retrospective study was conducted at the at Radiology Department of Aga Khan University Hospital, Karachi, and comprised medical records from April 2003 to April 2018 of patients who received endovascular treatment for intracranial aneurysm. Multiple variables reviewed included demographics, clinical presentation, aneurysm morphology, technique used, technique outcome and clinical outcome. Data was analysed using SPSS 22. RESULTS: Of the 242 patients, 111(45.8%) were males and 131(54.1%) were female. The overall mean age was 46.3+/-13.543 years (range: 9-78years). Aneurysm size was <5mm in 95(40.4%) patients, 5-10mm in 98(41.7%) and >10mm in 42(17.9%) patients. Aneurysms were located in the anterior communicating artery in 93(38.4%) patients, internal carotid artery 48(19.8%) patients and posterior communicating artery 26(10.7%) patients. Patients with higher initial Hess and Hunt grade were more likely to have higher modified Rankin scale score after treatment (p=0.001). Overall, 222(91.7%) patients were treated successfully. Complications were noted in 37(15.2%) patients and 10(4.0%) patients died. CONCLUSIONS: No correlation was found between Hess and Hunt grades and aneurysm severity based on aneurysm size, neck and ruptured/unruptured cases.


Assuntos
Aneurisma Roto , Procedimentos Endovasculares , Aneurisma Intracraniano , Adulto , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/epidemiologia , Aneurisma Roto/terapia , Angiografia Cerebral , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
7.
Comput Methods Programs Biomed ; 206: 106148, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33992899

RESUMO

BACKGROUND AND OBJECTIVE: The attainment of a methodology to simulate the hemodynamic in patient-specific cerebral vessels with aneurysms is still a challenge. The novelty of this work is focused on the effect of coil embolization in a realistic cerebral aneurysm, according to the vessel wall thickness and aneurysm thickness, through transient FSI simulations. METHODS: The quality of the mesh for simulations was checked with a specific mesh convergence study; and the numerical methodology was validated using numerical research data of the literature. The model was implemented in ANSYS® software. The total deformation and equivalent stress evolution in the studied cases, before and after coil embolization, were compared. More than 20 different models were employed due to different arterial wall thickness and aneurysm wall thickness combinations. RESULTS: The obtained results have showed that deformation and stress values are highly influenced with the sac thickness. The thinner sac aneurysm thickness is, the greater deformation and stress are. The results after coil embolization process have highlighted that considering typical values of arterial wall thickness and aneurysm thickness 0.3 mm and 0.15 mm respectively, a deformation reduction around 50% and a stress reduction around 70% can be achieved. CONCLUSIONS: The proposed methodology is a step forward in the personalized medicine, quantifying the aneurysm rupture risk reduction, and helping the medical team in the preoperative planning, or to deciding the optimal treatment.


Assuntos
Aneurisma Intracraniano , Modelos Cardiovasculares , Artérias , Hemodinâmica , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia
8.
J Coll Physicians Surg Pak ; 30(5): 585-587, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34027874

RESUMO

The coexistence of intracerebral aneurysm and meningioma is a rare occurrence. There is no consensus about the treatment options. We aim to present a case of a 61-year female admitted to this clinic with persistent headache and loss of vision in both eyes, especially on the left. Radiological images demonstrated a para-ophthalmic saccular aneurysm coexisting with an extra-axial homogenously enhancing mass in the right cavernous sinus, which was possibly a meningioma. A flow diverting stent, following the coil embolisation of the aneurysm, was placed. Then the patient underwent stereotactic radiosurgery for the cavernous sinus meningioma. Diagnosis and treatment of such pathologies are easily achieved with the technological advancements of imaging techniques. The hypothesis of increased hemodynamic pressures, due to meningioma causing intracranial aneurysms, may explain this coexistence. Endovascular surgery, followed by stereotactic radiosurgery, may be a reliable approach for a patient with coexistent meningioma and aneurysm. Key Words: Meningioma, Aneurysm, Cavernous sinus.


Assuntos
Seio Cavernoso , Aneurisma Intracraniano , Neoplasias Meníngeas , Meningioma , Radiocirurgia , Seio Cavernoso/diagnóstico por imagem , Seio Cavernoso/cirurgia , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/cirurgia , Meningioma/complicações , Meningioma/cirurgia
9.
BMJ Case Rep ; 14(5)2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34016624

RESUMO

We present two cases of 17-year-old man and 10-year-old boy presenting with subarachnoid haemorrhage and a history of road traffic accident. One patient had dissecting aneurysm of the posterior cerebral artery (PCA), and the other patient had partially thrombosed aneurysm on CT angiography. On digital subtraction angiography of the second patient, there was formation of PCA pontomesencephalic vein pial arteriovenous fistula (PAVF). Both the patients underwent endovascular treatment: stent-assisted coiling for aneurysm and coiling with parent vessel occlusion for PAVF. There were no procedural complications. Follow-up angiography showed no residual aneurysm or fistula. Trauma is one of the recognised causes of dissection, and intracranial dissections can present as stenotic lesions, aneurysms or fistulas, depending on the pathology. Traumatic dissecting PCA aneurysm has been reported in only two case reports previously, and post-traumatic PAVF in PCA has not been reported.


Assuntos
Fístula Arteriovenosa , Embolização Terapêutica , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Angiografia Digital , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/diagnóstico por imagem , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Masculino , Artéria Cerebral Posterior/diagnóstico por imagem , Resultado do Tratamento
10.
BMJ Case Rep ; 14(4)2021 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-33906881

RESUMO

Delayed rupture of an aneurysm following WEB embolization has not yet been reported. We present a case of a multiply ruptured anterior communicating artery aneurysm treated via WEB embolization. A post-treatment CT scan confirmed no evidence of rebleeding during treatment. Four hours after treatment, the patient developed an acute, significant increase in intracranial pressure with bloody ventriculostomy output, with CT scan demonstrating new parenchymal and intraventricular hemorrhage. The aneurysm was subsequently treated via microsurgical clipping that did not identify an "uncovered" bleb or rupture source.


Assuntos
Aneurisma Roto , Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/terapia , Embolização Terapêutica/efeitos adversos , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/terapia , Resultado do Tratamento
11.
Oper Neurosurg (Hagerstown) ; 21(1): E39-E40, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-33861345

RESUMO

Coaxial support is a fundamental technique utilized by neurointerventionalists to optimize distal catheter control within the intracranial circulation. Here we present a 41-yr-old woman with a previously coiled ruptured anterior communicating artery aneurysm with progressive recurrence harboring tortuous internal carotid anatomy to demonstrate the utility of coaxial support. Raymond-Roy classification of initial aneurysm coiling of class 1 resulted as class 3b over the 21 mo from initial treatment.1 The patient consented to stent-assisted coiling for retreatment of this aneurysm. Coaxial support was advanced as distally as possible in the proximal vasculature to improve catheter control, reducing dead space within which the microcatheter could move, decreasing angulations within proximal vasculature, limiting the movement of the native vessels, and providing a surface of lower friction than the endothelium. As the risk of recurrent subarachnoid hemorrhage in previously treated coiled aneurysms approaches 3%, retreatment occurs in 16.4% within 6 yr2 and in 17.4% of patients within 10 yr.3 Rerupture is slightly higher in patients who underwent coiling vs clipping, with the rerupture risk inversely proportional to the degree of aneurysm occlusion,4 further substantiating that coaxial support provides technical advantage in selected patients where additional microcatheter control is necessary for optimal occlusion. Pitfalls of this technique include vasospasm and vascular injury, which can be ameliorated by pretreatment of the circulation with vasodilators to prevent catheter-induced vasospasm. This case and model demonstration illustrates the technique of coaxial access in the stent-assisted coiling of a recurrent anterior communicating artery aneurysm and identification and management of catheter-induced vasospasm.


Assuntos
Embolização Terapêutica , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Adulto , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Retratamento , Stents , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/cirurgia
13.
J Neuroimaging ; 31(3): 532-540, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33848017

RESUMO

BACKGROUND AND PURPOSE: We aimed to assess the accuracy of magnetic resonance angiography (MRA) in the differentiation of small aneurysms versus infundibular dilations (IDs) at the internal carotid artery-posterior communicating artery (ICA-PComA) junction, emphasizing the role of MRA axial source images. METHODS: This retrospective study consisted of 83 focal arterial protrusions at ICA-PComA junction in 76 patients who underwent both MRA and digital subtraction angiography (DSA)/3-dimensional rotational angiography (3DRA). The diagnostic performance of MRA for differential diagnosis of aneurysm from ID was calculated using DSA/3DRA interpretation as the standard of reference. In addition, long-axis diameter, short-axis diameter, long-axis diameter/short-axis diameter (L/S) ratio, and angle of lesion (angle of the long-axis of lesion with respect to the x-axis) measured on MRA source images were compared between aneurysms and IDs. RESULTS: Sensitivity, specificity, and accuracy of MRA for distinguishing aneurysms from IDs were 74.4% (57.9-87.0%) to 76.9% (60.7-88.9%), 93.2% (81.3-98.6%) to 95.5% (84.5-99.4%), and 85.5% (76.1-92.3%), respectively. Significant differences were found for the long-axis diameter (P < .001), short-axis diameter (P < .001), L/S ratio (P < .05), and angle of the lesion (P < .001) on MRA axial source images between aneurysms and IDs. The angle of the lesion had the highest discriminatory ability (area under the curve = .966 [.902-.994]) to differentiate aneurysms from IDs. An angle of lesion >60° was 89.7% (75.8-97.1%) sensitive and 100% (92.0-100.0%) specific for diagnosis of aneurysm. CONCLUSIONS: MRA is a useful imaging modality for distinguishing between aneurysm and ID at the ICA-PComA junction. Furthermore, geometric parameters on MRA axial source images can provide added value in their differentiation.


Assuntos
Angiografia Digital/métodos , Artéria Carótida Interna/diagnóstico por imagem , Dilatação Patológica/diagnóstico , Aneurisma Intracraniano/diagnóstico , Angiografia por Ressonância Magnética/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Dilatação , Dilatação Patológica/diagnóstico por imagem , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
BMJ Case Rep ; 14(4): 1-2, 2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33875517

RESUMO

Delayed rupture of an aneurysm following WEB embolization has not yet been reported. We present a case of a multiply ruptured anterior communicating artery aneurysm treated via WEB embolization. A post-treatment CT scan confirmed no evidence of rebleeding during treatment. Four hours after treatment, the patient developed an acute, significant increase in intracranial pressure with bloody ventriculostomy output, with CT scan demonstrating new parenchymal and intraventricular hemorrhage. The aneurysm was subsequently treated via microsurgical clipping that did not identify an "uncovered" bleb or rupture source.


Assuntos
Aneurisma Roto , Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/terapia , Embolização Terapêutica/efeitos adversos , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/terapia , Resultado do Tratamento
15.
J Stroke Cerebrovasc Dis ; 30(7): 105773, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33865230

RESUMO

BACKGROUND: Duplication of the middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery (ICA). Aneurysms at the origin of a DMCA have been reported; however, most have been treated with clipping surgery. Here, we describe two cases of aneurysms at the origin of a DMCA treated with coil embolization. CASE PRESENTATION: Case 1: A seventy-three year-old man presented with severe headache and was diagnosed with subarachnoid hemorrhage (SAH). Digital subtraction angiography (DSA) and 3-dimensional (3-D) DSA showed an aneurysm arising from a DMCA. Coil embolization was performed with DMCA patency. The patient had an uneventful postoperative course. CASE 1: A 44-year-old woman presented with a history of clipping for an IC-anterior choroidal artery (AchA) aneurysm 8 years prior. Magnetic resonance imaging (MRI) showed regrowth of the aneurysm. 3-D DSA showed an IC-DMCA aneurysm located laterally and distal to the AchA. The DMCA arose from the bottom of the aneurysm. Coil embolization was performed without DMCA occlusion and showed no postoperative ischemic changes. CONCLUSION: An IC-DMCA aneurysm is rare and may be misdiagnosed as an AchA aneurysm. Clinicians should perform a 3D-DSA evaluation if the aneurysm arises from the lateral wall of the IC to obtain a precise diagnosis and to preserve the DMCA during coil embolization.


Assuntos
Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/terapia , Artéria Cerebral Média/anormalidades , Adulto , Idoso , Angiografia Digital , Angiografia Cerebral , Diagnóstico Diferencial , Feminino , Humanos , Imageamento Tridimensional , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Valor Preditivo dos Testes , Resultado do Tratamento
16.
J Stroke Cerebrovasc Dis ; 30(7): 105794, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33887663

RESUMO

INTRODUCTION: Flow diversion of the distal anterior circulation cerebral vasculature may be used for management of wide necked aneurysms not amenable to other endovascular approaches. Follow-up angiography sometimes demonstrates neo-intimal hyperplasia within or adjacent to the stent, however there is limited evidence in the literature examining the incidence in MCA and ACA aneurysms. We present our experience with flow diversion of the distal vasculature and evaluate the incidence of neo-intimal hyperplasia. MATERIALS AND METHODS: Retrospective review of patients who underwent Pipeline embolization device (PED) treatment for ruptured and unruptured anterior circulation aneurysms. RESULTS: A total of 251 anterior circulation aneurysms were treated by pipeline flow diversion, of which 175 were ICA aneurysms, 14 were ACA aneurysms and 18 were MCA aneurysms. 6-month follow-up angiography was available in 207 patients. The incidence of neo-intimal hyperplasia was 15.9%, 21.4%, and 61.1% in ICA, ACA, and MCA aneurysms, respectively. MCA-territory aneurysms developed neo-intimal hyperplasia at a significantly higher rate than aneurysms in other vessel territories. Rates of aneurysmal occlusion did not significantly differ from those patients who did not exhibit intimal hyperplasia on follow-up angiography. CONCLUSION: In our experience, flow diversion of distal wide-necked MCA and ACA aneurysms is a safe and effective treatment strategy. The presence of neo-intimal hyperplasia at 6-month angiography is typically clinically asymptomatic. Given the statistically higher rate of neo-intimal hyperplasia in MCA aneurysms at 6-month angiography, we propose delaying initial follow-up angiography to 12-months and maintaining dual antiplatelet therapy during that time.


Assuntos
Artéria Cerebral Anterior/patologia , Artéria Carótida Interna/patologia , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/terapia , Artéria Cerebral Média/patologia , Neointima , Stents , Artéria Cerebral Anterior/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo , Artéria Carótida Interna/diagnóstico por imagem , Angiografia Cerebral , Circulação Cerebrovascular , Feminino , Humanos , Hiperplasia , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/fisiopatologia , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
18.
J Stroke Cerebrovasc Dis ; 30(7): 105821, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33915389

RESUMO

OBJECTIVES: The purpose of this study was to investigate the risk factors associated with recurrence of posterior communicating artery aneurysms after treatment and to evaluate the significance of fetal-type posterior cerebral artery as an independent risk factor for recurrence of posterior communicating artery aneurysms. MATERIALS AND METHODS: The clinical and radiological findings of 220 posterior communicating artery aneurysms treated between January 2009 and December 2016 in a single tertiary institute were retrospectively reviewed. Univariate and multivariate analyses were performed to evaluate the association between clinical and radiological variables and recurrence. RESULTS: Of 220 posterior communicating artery aneurysms, 148 aneurysms were unruptured and 82 aneurysms were treated with surgery. Forty-six out of 220 aneurysms (20.9%) were associated with fetal-type posterior cerebral artery. Overall recurrence rate was 19% (42 out of 220 aneurysms) during mean 54.6 ± 29.8 months follow-up. Multivariate logistic regression analysis showed that size (OR=1.238; 95% CI, 1.087-1.409, p = 0.001), ruptured status (OR=2.699; 95% CI, 1.179-6.117, p = 0.019), endovascular treatment (OR=3.803; 95% CI, 1.330-10.875, p = 0.013), incomplete occlusion (OR=4.699; 95% CI, 1.999-11.048, p = <0.001) and fetal-type posterior cerebral artery (OR=3.533; 95% CI, 1.373-9.089, p = 0.009) were significantly associated with recurrence after treatment. CONCLUSIONS: The results demonstrated that fetal-type posterior cerebral artery may be an independent risk factor for the recurrence of posterior communicating artery aneurysms. Therefore, fetal-type posterior cerebral artery can be considered as an important risk factor for the recurrence of posterior communicating artery aneurysms, along with other known risk factors such as size, ruptured status, endovascular treatment, and incomplete occlusion.


Assuntos
Procedimentos Endovasculares/efeitos adversos , Aneurisma Intracraniano/cirurgia , Microcirurgia/efeitos adversos , Artéria Cerebral Posterior/anormalidades , Artéria Cerebral Posterior/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Posterior/diagnóstico por imagem , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
19.
Oper Neurosurg (Hagerstown) ; 20(6): E424-E425, 2021 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-33928385

RESUMO

Giant paraclinoid aneurysm remains a treatment challenge because of their complex anatomy and surgical difficulties stems frequently from a calcified or atherosclerotic aneurysmal neck and compression of the optic pathways.1-9 To improve exposure, facilitate the dissection of the aneurysm, assure vascular control, reduce brain retraction and temporary occlusion time, and enable simultaneous treatment of possible associated aneurysms, we combined the cranio-orbital zygomatic (COZ) approach9 with endovascular balloon occlusion of the internal carotid artery (ICA) and suction decompression of the aneurysm.4 The patient is a 50-yr-old female who presented with headache and hemianopsia. MRI, CT, and 4-vessel angiography revealed a giant right ophthalmic paraclinoid partially thrombosed aneurysm. Surgery was performed via right COZ approach with removal of the anterior clinoid. Unroofing the optic canal and opening the falciform ligament and the optic sheath, allowing the dissection and mobilization of the optic nerve from the aneurysm and the origin of ophthalmic artery. The endovascular team placed a deflated, double lumen balloon catheter in the ICA 2 cm above the common carotid bifurcation. Proximal control is achieved by inflating the balloon. Distal control is then gained by temporary clipping just proximal of the origin of PcomA.4 Retrograde suction decompression through the catheter partially collapses and softens the aneurysm.1,4,6-8 Carotid occlusion was applied twice, 2:47 and 2:57 min. Intraoperative angiogram revealed the obliteration of the aneurysm and the patency of the carotid and ophthalmic artery. The patient recovered well, and visual deficit resolved and was neurologically intact. Patient consented for surgery. Illustrations in video reprinted with minimal modification from Surgical Neurology, vol 50, issue 6, Arnautovic KI, Al-Mefty O, Angtuaco E, A combined microsurgical skull-base and endovascular approach to giant and large paraclinoid aneuroysms, 504-518,4 Copyright 1998, with permission from Elsevier Science Inc.


Assuntos
Doenças das Artérias Carótidas , Aneurisma Intracraniano , Doenças das Artérias Carótidas/cirurgia , Descompressão Cirúrgica , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Artéria Oftálmica/diagnóstico por imagem , Artéria Oftálmica/cirurgia , Sucção
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