with 2008 show large increases in the percentage of coiling procedures performed across the US, with major increases along the coastlines and throughout the Northeast corridor ( Fig. 3 ). Although there are clear differences in reporting between the 2002 and 2008 hospital cohorts, geographic disparity in adoption of endovascular therapy and regional variation in choice of endovascular treatment over open surgical ligation are evident. There was a significant range in the percentage of patients treated with endovascular techniques in 2008, the most recent year with
Gabriel A. Smith, Phillip Dagostino, Mitchell G. Maltenfort, Aaron S. Dumont, and John K. Ratliff
Waro Taki, Shogo Nishi, Kohsuke Yamashita, Akiyo Sadatoh, Ichiro Nakahara, Haruhiko Kikuchi, and Hiroo Iwata
communicating artery; MCA = middle cerebral artery; ICA = internal carotid artery; A 1 = A 1 segment of the anterior cerebral artery; PCA = posterior cerebral artery; V A = vertebral artery; PICA = posterior inferior cerebellar artery; BA = basilar artery; SCA = superior cerebellar artery. Roman numerals denote cranial nerves. Endovascular Techniques Balloon Alone or Combination of Balloon and Coils In 15 patients the aneurysm was treated by balloon occlusion alone, and in one a balloon and coils were introduced. In all but one case, the transfemoral
Report of three cases
Mazen H. Khayata, Armand Aymard, Alfredo Casasco, Denis Herbreteau, France Woimant, and Jean Jacques Merland
. Whether originating from extension of suppurative facial lesions or from septic emboli in the systemic circulation, mycotic aneurysms can enlarge, hemorrhage, and cause neurological sequelae. 4 Because of the distal and sometimes deep location of these aneurysms, selective surgical treatment is not always possible, and treatment has usually consisted of cauterizing the aneurysm and occluding the parent vessel. 1, 3, 6 Some surgeons recommend occluding the parent vessel after a vascular bypass. 5 In the past, endovascular techniques have not been considered in the
Alfredo E. Casasco, Armand Aymard, Y. Pierre Gobin, Emmanuel Houdart, André Rogopoulos, Bernard George, Jonathan E. Hodes, Jean Cophignon, and Jean Jacques Merland
should be evaluated. Endovascular techniques represent such a treatment and deserve consideration. Since the first publication on the approach to aneurysms via the endovascular route, 59 various series have been published. 2, 4, 9, 19, 21, 27, 28, 31 The earlier studies considered high-risk or inoperable aneurysms as well as bilateral lesions, 20 and detachable balloons were used, with high rates of treatment failure or secondary deflation. 21, 28, 46 Nevertheless, when the types of aneurysms and clinical status of the patients are taken into account, the results
Dae Seob Choi, Mun Chul Kim, Seon Kyu Lee, Robert A. Willinsky, and Karel G. Terbrugge
recanalization occurred in 25% of the recanalized aneurysms with a mean follow-up of 29.8 months. In our series, the–mean follow-up period was 26.4 months, and the mean number of follow-up studies was 2.0. Only 1 follow-up imaging study was obtained in 36 patients (41.4%). Thus, further study with longer follow-up imaging studies would be necessary to clarify the risk of recanalization after complete coiling of an aneurysm. Conclusions Complete obliteration of the aneurysm sac with endovascular techniques can be performed with low procedure-related risks. Completely
Brian L. Hoh, Christopher M. Putman, Ronald F. Budzik, Bob S. Carter, and Christopher S. Ogilvy
followed later by GDC occlusion of the lesion and the parent A 2 segment in a patient with a fusiform distal A 2 segment ACA aneurysm. Twelve patients were treated using open surgery, 28 patients endovascularly, five patients with a combination of surgery and endovascular techniques, and three with conservative management. Results Clinical Outcomes Table 4 shows the GOS scores for each method of treatment. Overall there were 29 patients (60.4%) with a GOS score of 5, eight (16.7%) with a GOS score of 4, four (8.3%) with a GOS score of 3, and seven
Peter Kim Nelson, Stephen M. Russell, Henry H. Woo, Anthony J. G. Alastra, and Danko V. Vidovich
, and by directly analyzing all diagnostic and procedural angiograms. During this time period 32 patients with intracranial DAVFs were treated using endovascular techniques: 21 with transarterial injection of NBCA and 11 with transvenous sinus occlusion. The patients who had undergone transvenous sinus occlusion were excluded from further analysis. The mean patient age was 52.4 years (range 3–78 years) and 33% of the patients were female ( Table 1 ). Eight patients presented with tinnitus/bruit, five with intracranial hemorrhage, four with cavernous sinus syndrome
Part I: Results of thrombosis in experimental aneurysms
Shinya Mandai, Kazushi Kinugasa, and Takashi Ohmoto
C erebral aneurysms that are difficult to reach surgically are now treated with a variety of endovascular techniques using detachable balloons or coils. However, these balloons or coils may not completely occlude the aneurysmal neck, and fatal ruptures sometimes occur after the balloons are placed in the lumen of the aneurysm. 11, 15, 21 We have developed a liquid material that, when injected directly into the lumen of an aneurysm, obliterates the aneurysm without the use of a balloon. This article describes the new material and the technique used to
Johan Lundberg, Carina B. Johansson, Stefan Jonsson, and Staffan Holmin
Several older studies report a low risk for parenchymal access to the CNS by surgical techniques. In more recent studies, including those with post-puncture CT scans, there are indications that the risk of bleeding might approach 8%. New therapies, such as those that use viral vectors, modified mRNA, or cell transplantation, will probably warrant more parenchymal access to the CNS. Other minimally invasive routes might then be tempting to explore. This study was designed in 2 parts to address the possibility of using the endovascular route. The first aim was to test the ability to create a parenchymal micro-working channel to the CNS in macaque monkeys through the vessel wall. Second, the biocompatibility of a device-associated, detached, distal securing plug that was made of nitinol was investigated in swine for 1 year.
Trans-vessel wall intervention in the middle cerebral artery and associated cerebral parenchyma was performed in 4 rhesus macaque monkeys using a full clinical angiography suite. A contrast agent and methylene blue were injected to test the working channel and then detached at the distal end to act as a securing plug through the vessel wall. One-year follow-ups were also performed using angiography and histological analysis in 10 swine with 24 implants that were distributed in the external carotid artery tree.
The cerebral interventions were performed without acute bleeding. Both the contrast agent and methylene blue were infused into the brain parenchyma and subarachnoidal space via the endovascular micro-working channel (7 injections in 4 animals). In the 1-year follow-up period, the implant that was left in the external carotid vessel wall in the swine was covered by the endothelium, which was followed by dislodgement just outside the blood vessel with thin capsule formation. No stenosis in the artery was detected on 1-year angiography. The animals showed normal behavior and blood sample results during the follow-up period. This is the first histological demonstration of nitinol biocompatibility when the implant is positioned through an arterial wall and indicates that the trans-vessel wall technique is not comparable with stent placement and its ability to induce intimal hyperplasia and restenosis.
This study demonstrates that the trans-vessel wall technique is applicable to brain intervention in macaque monkeys, providing a micro-working channel for delivery or sampling. The long-term follow-up study of the detached device in swine showed no clinical or biochemical complications and a normal angiography appearance.
Kenji Sugiu, Kazushi Kinugasa, Shinya Mandai, Koji Tokunaga, and Takashi Ohmoto
paraophthalmic aneurysm rupture following endovascular treatment. Case report. J Neurosurg 71 : 777 – 780 , 1989 Strother CM, Lunde S, Graves V, et al: Late paraophthalmic aneurysm rupture following endovascular treatment. Case report. J Neurosurg 71: 777–780, 1989 28. Taki W , Nishi S , Yamashita K , et al : Selection and combination of various endovascular techniques in the treatment of giant aneurysms. J Neurosurg 77 : 37 – 42 , 1992 Taki W, Nishi S, Yamashita K, et al: Selection and combination of various