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Peng Roc Chen

It is generally considered difficult and risky to treat a small aneurysm (less than 4 mm) by use of coil embolization. The main issues are related to the following factors: frequently broad-based aneurysm with shallow dome, complex in shape, difficult to maintain microcatheter stability in an aneurysm, difficult to achieve complete coil packing, and higher risk of intra-procedure rupture hemorrhage. However, routine use of balloon-assisted coiling technique will enable us to achieve successful aneurysm embolization with safety. This video demonstrates some key nuances in the balloon-assisted coil embolization of small aneurysms via three case examples.

The video can be found here: http://youtu.be/E1il3oPnUD8.

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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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Kentaro Hayashi, Naoki Kitagawa, Minoru Morikawa, Takeshi Hiu, Yoichi Morofuji, Kazuhiko Suyama, and Izumi Nagata

V arious types of coils have been developed for neurointervention. 2 , 7 , 21 Because of rapid advances in embolization materials, the indications for endovascular therapies have expanded widely. 13 , 15 , 16 Among embolization coils, detachable coils are used for delicate lesions such as cerebral aneurysm. 7 Notably, the advantage of the detachable coils is that they can be retrieved if they do not fit the lesion. However, detachable coils are expensive, and detachable-coil embolization is not cost effective. For occluding arteries and veins, fiber

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

CW , Kim KH , Chang KH : Procedurerelated haemorrhage in embolisation of intracranial aneurysms with Guglielmi detachable coils . Neuroradiology 45 : 562 – 569 , 2003 21 Kwon OK , Kim SH , Kwon BJ , Kang HS , Kim JH , Oh CW , : Endovascular treatment of wide-necked aneurysms by using two microcatheters: techniques and outcomes in 25 patients . AJNR Am J Neuroradiol 26 : 894 – 900 , 2005 22 Kwon OK , Kim SH , Oh CW , Han MH , Kang HS , Kwon BJ , : Embolization of wide-necked aneurysms with using three or more

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Masaomi Koyanagi, Akira Ishii, Hirotoshi Imamura, Tetsu Satow, Kazumichi Yoshida, Hitoshi Hasegawa, Takayuki Kikuchi, Yohei Takenobu, Mitsushige Ando, Jun C. Takahashi, Ichiro Nakahara, Nobuyuki Sakai, and Susumu Miyamoto

T he main purpose of the treatment of unruptured intracranial aneurysms (UIAs) is to prevent rupture over the long term with low treatment risk. Although the perioperative risks of endovascular coil embolization have been repeatedly demonstrated to be less than those associated with surgical clipping, 1 , 7 , 9 , 10 the long-term durability of endovascular coiling remains unclear. In the International Subarachnoid Aneurysm Trial (ISAT), the risk of rebleeding from a coiled ruptured aneurysm over 18 years was very small. 11 Long-term follow-up data for

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Progressive perianeurysmal edema induced after endovascular coil embolization

Report of three cases and review of the literature

Nobutaka Horie, Naoki kitagawa, Minoru Morikawa, Keisuke Tsutsumi, Makio Kaminogo, and Izumi Nagata

endovascular embolization is aneurysm regrowth in spite of repeated embolizations. 10 Edema formation in the perianeurysmal region is a very rare complication of endovascular embolization. 18 We present three cases of progressive perianeurysmal edema following coil embolization and discuss the clinical implications and the mechanism of such edema formation. Case Reports Case 1 History and Examination This 72-year-old man was admitted to our hospital for treatment of an incidental aneurysm. Use of DS angiography revealed an aneurysm with a diameter of 15 mm

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Yuichi Murayama, Yih Lin Nien, Gary Duckwiler, Y. Pierre Gobin, Reza Jahan, John Frazee, Neil Martin, and Fernando Viñuela

) and the anterior inferior cerebellar (4), superior cerebellar (5), and basilar trunk (3) arteries. Indication for GDC Embolization In the early phase of our study we had a dominant referral pattern of surgically difficult aneurysms such as those located in the posterior circulation or large lesions. After FDA approval of the GDC technique in 1995, our referral pattern became similar to that experienced in a standard neurosurgical practice, although there was still a higher incidence of posterior circulation aneurysms. Guglielmi Detachable Coil

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Tim W. Malisch, Guido Guglielmi, Fernando Viñuela, Gary Duckwiler, Y. Pierre Gobin, Neil A. Martin, John G. Frazee, and Joan S. Chmiel

E ndovascular treatment of intracranial aneurysms by using the Guglielmi detachable coil (GDC) is proving to be a safe method of preventing aneurysm rupture. 13–15, 24, 25, 39 Patients with unruptured intracranial aneurysms may present with symptoms related to the aneurysm's mass effect on either the brain parenchyma or cranial nerves. Previous reports have suggested that such symptoms can be affected by GDC embolization of the aneurysm. 11, 17, 18, 22, 24, 25, 38 This study was undertaken to evaluate the response of patients with cranial nerve deficits to

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Martin Bendszus and René Chapot

balloon also has a potentially life-saving aspect which, for neurosurgeons, is well known as the “proximal control.” In cases of intraprocedural aneurysm rupture, the balloon can be immediately inflated to stop the bleeding and the aneurysm can rapidly be embolized with coils. References 1 Baldi S , Mounayer C , Piotin M , Moret J : Balloon-assisted coil placement in wide-neck bifurcation aneurysms by use of a new, compliant balloon microcatheter . AJNR Am J Neuroradiol 24 : 1222 – 1225 , 2003 2 Cottier JP , Pasco A , Gallas S