DOI QR코드

DOI QR Code

Coil-Protected Embolization Technique for a Branch-Incorporated Aneurysm

  • Ihn, Yon-Kwon (Department of Radiology, The Catholic University of Korea College of Medicine, St. Vincent's Hospital) ;
  • Kim, Byung Moon (Department of Radiology, Yonsei University College of Medicine, Severance Hospital) ;
  • Suh, Sang Hyun (Department of Radiology, Yonsei University College of Medicine, Gangnam Severance Hospital) ;
  • Kim, Dong Joon (Department of Radiology, Yonsei University College of Medicine, Severance Hospital) ;
  • Kim, Dong Ik (Department of Radiology, Yonsei University College of Medicine, Severance Hospital)
  • Published : 2013.04.01

Abstract

Objective: A small branch-incorporated aneurysm is an aneurysm with a small branch incorporated into the sac or the neck. It is one of the most difficult aneurysms to treat with coil embolization. The aim of this study was to evaluate the safety and effectiveness of the coil-protected embolization technique for small-branch incorporated aneurysm. Materials and Methods: Fourteen aneurysms (2 ruptured and 12 unruptured) in 12 patients (mean age, 56 years, range, 40-73 years; 6 men and 6 women) were treated with the coil-protected embolization technique during the period between February 2007 and October 2011. Clinical and angiographic outcomes were retrospectively evaluated. Results: All aneurysms were successfully treated without any complications during the procedure. Immediate posttreatment angiographies demonstrated complete or near complete occlusion in 12 and incomplete occlusion in 2 patients. Two patients had a delayed small embolic infarction in the relevant posterior circulation territory and middle cerebral artery territory 10 days and 14 days later, respectively, but both recovered completely or almost completely (modified Rankin scale score [mRS score], 0 and 1, respectively). During the clinical follow-up period (mean, 21 months; range: 2-58 months), all patients reported an mRS score of 0 (n = 10) or 1 (n = 2). Vascular imaging follow-up (catheter angiography: n = 3 and MR angiography: n = 8) was available in 11 aneurysms at 6-12 months. All 11 aneurysms showed complete occlusion except for 1 minor neck recurrence that did not require further treatment. Conclusion: In this series of cases, the coil-protected embolization technique seems to be feasible and effective in the treatment of small-branch incorporated aneurysms.

Keywords

References

  1. Kim, BM, Park, SI, Kim, DJ, Kim, DI, Suh, SH, Kwon, TH,Endovascular coil embolization of aneurysms with a branch incorporated into the sac, AJNR Am J Neuroradiol, 31, 1, 145-151(2010) https://doi.org/10.3174/ajnr.A1785
  2. Lubicz, B, Lefranc, F, Levivier, M, Dewitte, O, Pirotte, B, Brotchi, J,Endovascular treatment of intracranial aneurysms with a branch arising from the sac, AJNR Am J Neuroradiol, 27, 2, 142-147(2006)
  3. Qureshi, AI, Janardhan, V, Hanel, RA, Lanzino, G,Comparison of endovascular and surgical treatments for intracranial aneurysms: an evidence-based review, Lancet Neurol, 6, 3, 816-825(2007) https://doi.org/10.1016/S1474-4422(07)70217-X
  4. 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, 4, 894-900(2005)
  5. Pierot, L, Cognard, C, Anxionnat, R, Ricolfi, F,Remodeling technique for endovascular treatment of ruptured intracranial aneurysms had a higher rate of adequate postoperative occlusion than did conventional coil embolization with comparable safety, Radiology, 258, 5, 546-553(2011) https://doi.org/10.1148/radiol.10100894
  6. Biondi, A, Janardhan, V, Katz, JM, Salvaggio, K, Riina, HA, Gobin, YP,Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and midterm follow-up, Neurosurgery, 61, 6, 460-468(2007) https://doi.org/10.1227/01.NEU.0000290890.62201.A9
  7. Kelly, ME, Turner, R, Gonugunta, V, Woo, HH, Rasmussen, PA, Masaryk, TJ,Stent reconstruction of wide-necked aneurysms across the circle of Willis, Neurosurgery, 61, 7, 249-254(2007)
  8. Kim, BM, Kim, DI, Chung, EC, Kim, SY, Shin, YS, Park, SI,Endovascular coil embolization for anterior choroidal artery aneurysms, Neuroradiology, 50, 8, 251-257(2008) https://doi.org/10.1007/s00234-007-0331-0
  9. Chae, KS, Jeon, P, Kim, KH, Kim, ST, Kim, HJ, Byun, HS,Endovascular coil embolization of very small intracranial aneurysms, Korean J Radiol, 11, 9, 536-541(2010) https://doi.org/10.3348/kjr.2010.11.5.536
  10. Lubicz, B, François, O, Levivier, M, Brotchi, J, Balériaux, D,Preliminary experience with the enterprise stent for endovascular treatment of complex intracranial aneurysms: potential advantages and limiting characteristics, Neurosurgery, 62, 10, 1063-1069(2008) https://doi.org/10.1227/01.neu.0000325868.06764.de
  11. Ihn, YK, Kim, DI, Kim, BS, Lee, JM,Utility of catheter-assisted Guglielmi detachable coiling in the treatment of wide-necked aneurysms, Acta Neurochir (Wien), 148, 11, 1045-1052(2006) https://doi.org/10.1007/s00701-006-0881-7
  12. Lee, JY, Seo, JH, Cho, YD, Kang, HS, Han, MH,Endovascular treatment of wide-neck intracranial aneurysms using a microcatheter protective technique: results and outcomes in 75 aneurysms, AJNR Am J Neuroradiol, 32, 12, 917-922(2011) https://doi.org/10.3174/ajnr.A2411
  13. Layton, KF, Cloft, HJ, Gray, LA, Lewis, DA, Kallmes, DF,Balloon-assisted coiling of intracranial aneurysms: evaluation of local thrombus formation and symptomatic thromboembolic complications, AJNR Am J Neuroradiol, 28, 13, 1172-1175(2007) https://doi.org/10.3174/ajnr.A0490
  14. Pierot, L, Spelle, L, Leclerc, X, Cognard, C, Bonafe, A, Moret, J,Endovascular treatment of unruptured intracranial aneurysms: comparison of safety of remodeling technique and standard treatment with coils, Radiology, 251, 14, 846-855(2009) https://doi.org/10.1148/radiol.2513081056
  15. Baldi, S, Mounayer, C, Piotin, M, Spelle, L, Moret, J,Balloon-assisted coil placement in wide-neck bifurcation aneurysms by use of a new, compliant balloon microcatheter, AJNR Am J Neuroradiol, 24, 15, 1222-1225(2003)
  16. Benitez, RP, Silva, MT, Klem, J, Veznedaroglu, E, Rosenwasser, RH,Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils, Neurosurgery, 54, 16, 1359-1367(2004) https://doi.org/10.1227/01.NEU.0000124484.87635.CD
  17. Cottier, JP, Pasco, A, Gallas, S, Gabrillargues, J, Cognard, C, Drouineau, J,Utility of balloon-assisted Guglielmi detachable coiling in the treatment of 49 cerebral aneurysms: a retrospective, multicenter study, AJNR Am J Neuroradiol, 22, 17, 345-351(2001)
  18. Fiorella, D, Albuquerque, FC, Han, P, McDougall, CG,Preliminary experience using the Neuroform stent for the treatment of cerebral aneurysms, Neurosurgery, 54, 18, 6-16(2004) https://doi.org/10.1227/01.NEU.0000097194.35781.EA

Cited by

  1. Endovascular and Surgical Treatment of Unruptured MCA Aneurysms: Meta-Analysis and Review of the Literature vol.2014, pp.None, 2013, https://doi.org/10.1155/2014/348147
  2. Combination of Multicatheter Plus Stent or Balloon for Treatment of Complex Aneurysms vol.37, pp.2, 2013, https://doi.org/10.3174/ajnr.a4526
  3. Endovascular Coiling for a Wide-neck Bifurcated Aneurysm with Anterograde Horizontal Stenting via Microcatheter Looping: A Technical Case Report vol.20, pp.3, 2013, https://doi.org/10.7461/jcen.2018.20.3.181
  4. A Newly-Developed Flow Diverter (FloWise) for Internal Carotid Artery Aneurysm: Results of a Pilot Clinical Study vol.20, pp.3, 2019, https://doi.org/10.3348/kjr.2018.0421