A neurysmal subarachnoid hemorrhage (aSAH) occurs in 8–9 people per 100,000, 21 , 23 leading to significant morbidity 1 and mortality. 3 , 13 , 14 , 31 To reduce the risk of rehemorrhage, the ruptured aneurysm is treated either by neurosurgical clipping 29 or endovascular coiling. 16 , 28 , 30 Since publication of the International Subarachnoid Aneurysm Trial (ISAT) 30 in 2002, endovascular coiling has gained wide acceptance and has become the preferred treatment modality at many centers. 20 The most appropriate treatment modality for specific
Oliver G. S. Ayling, George M. Ibrahim, Brian Drake, James C. Torner and R. Loch Macdonald
Nancy J. Edwards, Wesley H. Jones, Aditya Sanzgiri, Juan Corona, Mark Dannenbaum and Peng Roc Chen
F unctional outcomes for patients with aneurysmal subarachnoid hemorrhage (aSAH) have improved in the past 2 decades, likely due in part to the availability and refinement of neurosurgical and endovascular treatment options. 16 Because ruptured aneurysms are increasingly treated via coil embolization, preventing periprocedural complications will become more and more important. To date, the primary complication of coil embolization is a thromboembolic event (TEE). 5 , 8 , 12 , 19 In the multicenter, prospective Clinical and Anatomical Results in the Treatment
Vincenzo Albanese, Antonio Spadaro, Fausto Iannotti, Piero Picozzi, Francesco Tomasello and Fernando Antonio Cioffi
K inking and coiling of the internal carotid artery (ICA) have been described as early as 1898, 8 but have only recently been associated with clinical symptoms of cerebral ischemia. 13, 16 Hemodynamic disturbances associated with neck movements, 2, 5, 14, 18–20 or atherosclerotic lesions located on the affected segment 11, 19 have been considered responsible for the cerebral ischemic episodes. While there have been many reports on the incidence, clinical symptoms, and treatment of kinking and coiling of the ICA, 2–4, 7, 11, 14, 18–20 very little is known
Le-Bao Yu, Xin-Jian Yang, Qian Zhang, Shao-Sen Zhang, Yan Zhang, Rong Wang and Dong Zhang
, indicating an association between endovascular treatment and aneurysm rerupture in the current literature. 2–4 , 7 , 12 Aneurysm recurrence after coil embolization remains both a major shortcoming of endovascular treatment and a daunting challenge for neurosurgeons without optimal management strategies. 1 , 3 , 5 , 21 However, few data are available regarding the morphological changes of recurrent aneurysms and their management strategy. The modified Raymond scale or the original Raymond scale 8 , 15–17 , 19 is a well-known classification system for initial angiographic
Kimon Bekelis, Daniel J. Gottlieb, Yin Su, A. James O'Malley, Nicos Labropoulos, Philip Goodney, Michael T. Lawton and Todd A. MacKenzie
C erebral aneurysms are a common cause of intracranial hemorrhage, stroke, and death. 3 , 8 Two treatment options are used in current practice. 3 , 25 Surgical clipping involves a craniotomy and clip placement on the blood vessel to exclude the weakened area, whereas endovascular coiling is a minimally invasive angiographic technique in which aneurysm obliteration is achieved from within the blood vessel. 3 , 8 Since the publication of the International Subarachnoid Aneurysm Trial (ISAT), 25 which focused on ruptured aneurysms, there has been a
Spencer Twitchell, Hussam Abou-Al-Shaar, Jared Reese, Michael Karsy, Ilyas M. Eli, Jian Guan, Philipp Taussky and William T. Couldwell
diverter devices for complex aneurysm treatment has affected the cost of care for patients treated for aneurysms. Therefore, the aim of this study was to evaluate specific cost drivers for surgical clipping and endovascular management (i.e., coil embolization and flow diversion) of both ruptured and unruptured intracranial aneurysms using the VDO system. Methods The study was approved by the IRB at the University of Utah. The data were collected using the VDO database and the electronic medical record database to isolate elective and emergent patient cases in which
Young Soo Kim, Sang Won Lee, Jeong A Yeom, Chang Hyo Yoon and Seung Kug Baik
E ndovascular treatment of intracranial aneurysms is a useful alternative to open clipping. A recent multicenter randomized trial demonstrated improved safety and clinical outcomes of endovascular treatment compared with neurosurgical clipping. Furthermore, an increasing trend toward endovascular treatment for aneurysm elimination is reported, and results from recent studies have shown that stent-assisted coil embolization (SACE) now accounts for about one-fourth to one-fifth of all endovascular treatments. 1 However, while most SACE studies appear to be
Mandy Binning, Zakaria Hakma and Erol Veznedaroglu
The patient is a 60-year-old woman who presented to her primary care physician with new onset of headache. She was neurologically intact without cranial nerve deficit. An outpatient CT angiogram (CTA) revealed no subarachnoid hemorrhage, but showed a right-sided posterior communicating artery aneurysm measuring 11 mm by 10 mm. Digitally subtracted cerebral angiography confirmed these measurements and showed that the aneurysm was amenable to endovascular coil embolization. The patient underwent aneurysm coiling without complication and was discharged to home on postoperative Day 1.
The video can be found here: http://youtu.be/MjOc3Zpv2K8.
Lee A. Tan, Andrew K. Johnson, Kiffon M. Keigher, Roham Moftakhar and Demetrius K. Lopes
Y-stent–assisted coiling is a technique used by neuroendovascular surgeons to treat complex, wide-necked, bifurcation aneurysms in locations such as basilar tip and middle cerebral artery bifurcation. Several recent studies have demonstrated low complication rate and favorable clinical and angiographic outcomes. The Y-stent technique is illustrated here in detail and the intraoperative nuances are also discussed to minimize potential complications associated with technique.
The video can be found here: http://youtu.be/77pEmqx_fyQ.
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