Aneurysms endovascular treatment

Cronqvist M, Pierot L, Boulin A, Cognard C, Castaings L, Moret J. Local intraarterial fibrinolysis of thromboemboli occurring during endovascular treatment of intracerebral aneurysm a comparison of anatomic results and clinical outcome. AJNR Am J Neuroradiol 1998 19(l) 157-65. 

Wiebers DO, Whisnant JP, Huston J III et al. (2003). Unruptured intracranial aneurysms natural history, clinical outcome and risks of surgical and endovascular treatment. Lancet 362 103-110... 

Lubicz B, Leclerc X, Levivier M et al. Retractable self-expandable stent for endovascular treatment of widenecked intracranial aneurysms prehminary experience. Neurosurgery. 2006 58 451-457 discussion 451-457... 

Taschner, C. A., Leclerc, X., Rachdi, H., Barros, A. M. Pruvo, J.-P. (2005) Matrix detachable coils for the endovascular treatment of intracranial aneurysms analysis of early angiographic and clinical outcomes. Stroke, 36, 2176-2180. 

Lot G, Houdart E, Cophignon J, Casasco A and George B (1999), Combined management of intracranial aneurysms by surgical endovascular treatment. Modalities and results from a series of 395 cases , Acta Neurochir (Wien), 141, 557-562. 

Park H, Horowitz M, Jungreis C, Kassam A, Koebbe C, Genevro J, Dutton K and Purdy P (2003), Endovascular treatment of paracbnoid aneurysms experience with 73 patients . Neurosurgery, 18, 43 14. 

The advance of endovascular therapy for aorto-iliac aneurysmal disease has also brought about yet another flourishing application of embolotherapy. Embolization of the internal iliac artery plays an important adjunct initial modality to allow endovascular treatment of aortic aneurysms with extension into the common iliac arteries [78-80], It also plays an crucial role in the secondary management of complications related to endoleaks [81-84],... 

Raymond J, Roy D, Leblanc P, et al. (2003) Endovascular treatment of intracranial aneurysms with radioactive coils initial clinical experience. Stroke 34 2801-2806... 

Ultrasound is useful for many aspects of pancreatitis but has a sensitivity of less than 73% for visceral pseudoaneurysm in the condition, vdiereas contrast enhanced computer tomography (CECT) has a sensitivity of almost 100% [22]. CECT is also very useful in terms of endovascular treatment as it can indicate what type of aneurysm has formed, which artery it has formed from and whether there is more than one. 

Haulon S, Lions C, McFadden EP, Koussa M, et al (1998) Prospective evaluation of magnetic resonance imaging after endovascular treatment of infrarenal aortic aneurysms. Eur J Endovasc Surg 22 62-69... 

Table 15.1. Summary of studies reporting embolization of internal iliac arteries in association with endovascular treatment of aortoiliac aneurysms...

Tefera G, turnipseed WD, Carr SC et al. (2004) Is coil embolization of hypogastric artery necessary during endovascular treatment of aortoiliac aneurysms Ann Vase Surg 18 143-146... 

Lee CW, Kaufman JA, Fan CM et al. (2000) Clinical outcome of internal iliac artery occlusions during endovascular treatment of aortoiliac aneurysmal diseases. J Vase Interv Radiol 11 543-545... 

Mialhe, C., Amicabile, C. and Becquemin, J. P, for the Stentor Retrospective Study Group. (1997). Endovascular treatment of infrarenal abdominal aneurysms by the Stentor system Preliminary results of 79 cases. J Vase Surg, 26,199-209. 

In 1995, the Guglielmi detachable coil technique was approved by the FDA for endovascular treatment of aneurysms. This method involves the use of deploying metallic coils into the aneurysm to induce a clotting response and seal off the aneurysm from the artery. Since its inception, over 200,000 patients worldwide have been treated with this technique [52]. However, difficulties in multicoil placement, thromboembolic events during placement, coil-induced rupture, and incomplete filling of fhe aneurysm are some of the challenges associated with the procedure [52]. 

Marks MP, Lane B, Steinberg GK et al. (1992) Intranidal aneurysms in cerebral arteriovenous malformations evaluation and endovascular treatment. Radiology 183 355-360... 

The course of infectious aneurysms is unpredictable. Under antibiotic or antimycotic therapy they may shrink, or completely disappear. However, enlargement during treatment has also been reported (Brust et al. 1990). Septic aneurysms can be obliterated surgically or by endovascular treatment (Chapot et al. 2002 Phuong et al. 2002 Steinberg et al. 1992). The theoretical assumption that implantation of foreign material - like platinum coils - into an infectious lesion might worsen the problem is not true for infectious intracranial aneurysms. Mortality due to rupture of bacterial cerebral aneurysms is reported to be up to 60% (Barrow and Prats 1990 Bohmfalk et al. 1978 Clare and Barrow 1992). 

Fig. 5. 8a-c. Basilar trunk aneurysm in a newborn after bleeding (a) (FLAIR) resulting in acute hydrocephalus, before (b) and after (c) endovascular treatment with selective occlusion of the aneurysm. The baby s outcome was excellent with no neurologic deficits... 

Fig. 5.20. Acutely ruptured fusiform posterior cerebral artery aneurysm before and after endovascular treatment. Overlay of 3D vessel anatomy on cross-sectional CT-like images showing extensive SAH...

Fig. 5.34a-c. Patient after SAH with a basilar tip aneurysm seen on CTA in an outside hospital. a Initial DSA did show vasospasm of the PI segment and the superior cerebellar artery on both sides. In addition, some irregularity at the tip of the basilar artery was noted but no real aneurysm, b Repeated DSA 2 months later showed a small basilar tip aneurysm suitable for endovascular treatment, c The patient was scheduled for embolization 10 days later but the aneurysm again was not visible. The patient was referred to surgery... 

The primary treatment goal of cerebral aneurysms is prevention of rupture. Surgical clipping has been the treatment modality of choice for both ruptured and unruptured cerebral aneurysms for decades. Just over 20 years ago endovascular treatment was mainly restricted to those patients with aneurysms unsuitable for clipping due to the size or location, or in whom surgical clipping was contraindicated... 

ISAT was a randomised, prospective, international, controlled trial of endovascular coiling vs surgical clipping for a selected group of patients with ruptured intracranial aneurysms deemed suitable for both types of therapy. Most patients were treated at high-volume centres in the United Kingdom, with the remainders from other European countries, Australia, Canada, and the United States. The primary endpoint was patient outcome, defined as a modified Rankin scale of 3-6 (dependent or deceased) at 1 year. The primary hypothesis was that endovascular treatment would reduce the proportion of patients dependent or deceased by 25% at 1 year. A total of 9559 patients with SAH were screened... 

Fig. 5.41. a Broad based basilar tip aneurysm. b,c Endovascular treatment was performed with a stent and platinum coils. The stent was deployed with the distal end in the PI segment left and the proximal end in the mid basilar artery (markers). Coiling was done through the mesh of the stent, d 10 month follow-up still showed complete aneurysm occlusion with remodelling of the basilar tip... 

Fig. 5. 56a,b. Medium sized Acorn aneurysm before (a) and after (b) endovascular treatment the parent artery is still open... 

---