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L. Fernando Gonzalez, Cameron G. McDougall, Felipe C. Albuquerque, Louis J. Kim, and Robert F. Spetzler

T o the E ditor: We read with interest the article by Sluzewski et al. (Sluzewski M, van Rooij WJ, Beute GN, et al: Balloon-assisted coil embolization of intracranial aneurysms: incidence, complications, and angiography results. J Neurosurg 105: 396–399, September, 2006). Sluzewski et al. presented their endovascular experience treating 757 patients with 827 intracranial aneurysms during a 10-year period. Balloon-assisted coil embolization was used to treat 71 patients; the rest received conventional CE with bare platinum coils. The parameter that led

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Hyun-Seung Kang, Bae Ju Kwon, O-Ki Kwon, Cheolkyu Jung, Jeong Eun Kim, Chang Wan Oh, and Moon Hee Han

and follow-up results of the use of endovascular coil embolization in patients with AChA aneurysms, including the treatment outcome of AChA-related oculomotor palsy. This study was approved by the Seoul National University Hospital Institutional Review Board (No. H-0806-075-248). Methods Patient Population Between July 1999 and March 2008, 2010 intracranial aneurysms in 1730 patients were occluded using coil embolization at our institutions. During the same period, 88 patients with 90 AChA aneurysms were treated with endovascular coil embolization in 91

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Hiroshi Manabe, Seiichiro Fujita, Toru Hatayama, Shigeharu Suzuki, and Soroku Yagihashi

A lthough endovascular coil embolization therapy for cerebral aneurysms has been developed and can be performed safely, 1, 3–5, 13 the long-term outcome has not been evaluated, and its efficacy in preventing rerupture is still unknown. Although there have been some reports of rerupture of coil-embolized aneurysms, 3, 9 histopathological findings of a reruptured aneurysm after coil embolization have rarely been reported. We report a case with rerupture of recanalized aneurysm 8 months after embolization with interlocking detachable coils (IDCs). Case

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Menno Sluzewski, Willem Jan Van Rooij, Guus N. Beute, and Peter C. Nijssen

patient. Coil Insertion Procedure Coil embolization of aneurysms was performed while the patient was in a state of general anesthesia and receiving systemic heparinization. Heparin was continued intravenously or subcutaneously for 48 hours after the procedure and was followed by low-dose oral aspirin for 3 months thereafter. Coil insertion was performed using Guglielmi detachable coils (Boston Scientific, Fremont, CA) or Tru-Fill DCS coils (Cordis, Miami, FL). Some large aneurysms were embolized with very long mechanically detachable coils (Detach 18; Cook, Inc

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Arnab K. Rana, Panos Koumellis, Timothy Jaspan, Maria Cartmill, and Norman S. Mcconachie

I ntracranial artery aneurysms are rare in pediatric patients, representing approximately 1.4% of the total cases. 6 Traditionally, these lesions have been treated with surgical clip application or excision or managed conservatively. 3 More recently, coil embolization treatment has been used in the pediatric age group, but this strategy is less commonly reported. 1 , 2 , 4 , 8 In children younger than 1 year of age, MCA aneurysms have been treated surgically, 3 , 6 , 7 , 12 , 14 but we have found no reports of embolization in such cases. Embolization

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Christopher J. Stapleton, Brian P. Walcott, William E. Butler, and Christopher S. Ogilvy

E ndovascular coil embolization of ruptured intracranial aneurysms is an accepted treatment alternative to microsurgical clip obliteration. Since publication of the International Subarachnoid Aneurysm Trial (ISAT) and the Barrow Ruptured Aneurysm Trial (BRAT), coil embolization has become the dominant treatment modality for aneurysmal subarachnoid hemorrhage (aSAH) in many modern neurosurgical and neurointerventional practices. 1 , 15 , 16 In fact, a recent analysis of the Nationwide Inpatient Sample reported that 54% to 69% of all ruptured intracranial

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Hyun Ho Choi, Young Dae Cho, Dong Hyun Yoo, Su Hwan Lee, Eung Koo Yeon, Hyun-Seung Kang, Won-Sang Cho, Jeong Eun Kim, and Moon Hee Han

E ndovascular coil embolization of anterior communicating artery (ACoA) aneurysms is technically challenging due to anatomical variations in bilateral A 1 /A 2 flow dynamics and critical perforators. In complex ACoA aneurysms with wide necks, a variety of techniques have been applied, including multicatheter utilization and use of stents or balloons. However, successful occlusion may still be difficult to achieve with only the usual techniques. Infringement on parent arteries during coil embolization is usually contraindicated, given the risk of severe ischemic

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Noriaki Matsubara, Shigeru Miyachi, Yoshitaka Nagano, Tomotaka Ohshima, Osamu Hososhima, Takashi Izumi, Arihito Tsurumi, Toshihiko Wakabayashi, Masamichi Sakaguchi, Akihito Sano, and Hideo Fujimoto

I n recent years, neuroendovascular treatments have been widely used with a variety of improved devices such as microcatheters and microguidewires as well as an enhanced angiographic system. Coil embolization for intracranial aneurysms is one such treatment. Craniotomy with clipping of the aneurysm neck has been the most conventional therapeutic option for intracranial aneurysms. 16 However, with the reports of improved outcomes after coil embolization for ruptured aneurysms—such as those documented in the International Subarachnoid Aneurysm Trial (ISAT

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Uwe Spetzger, Jürgen Reul, Joachim Weis, Helmut Bertalanffy, Armin Thron, and Joachim M. Gilsbach

E ndovascular coil embolization in the treatment of cerebral aneurysms is an evolving method. However, little is known about the permanent occlusion rate and long-term outcome. At present, the treatment of choice for aneurysmal subarachnoid hemorrhage is microsurgical clipping of the aneurysm without alteration of the distal blood flow. 10, 27 Intraaneurysmal balloon occlusion was abandoned because of major disadvantages, 20 but the failures of this therapeutic concept appear to have been forgotten. Although essential problems have not yet been resolved with

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Patrick Mitchell, Richard Kerr, A. David Mendelow, and Andy Molyneux

T he purpose of this paper was to define the sensitivity of the superiority of coil embolization observed in the ISAT cohort according to the rate of late rebleeding over a reasonable range, and to find the range of rebleeding rates for which the superiority of coil embolization may be overturned. Treatment of aneurysmal SAH involves protecting the aneurysm responsible from further hemorrhage. Currently there are 2 methods available to do this: intravascular coil embolization and surgical clip ligation. The relative merits of these treatments depend on 2