Endovascular Treatment of Wide Neck Aneurysms

Authors

  • Menka Lazareska University Institute of Radiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
  • Vjolca Aliji University Institute of Radiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
  • Elizabeta Stojovska-Jovanovska University Institute of Radiology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
  • Jasna Businovska University Clinic of Anesthesiology, Resuscitation and Intensive Care, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
  • Vladimir Mircevski University Clinic of Neurosurgery, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
  • Milenko Kostov University Clinic of Neurosurgery, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
  • Marija Papazova Institute of Anatomy, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia

DOI:

https://doi.org/10.3889/oamjms.2018.443

Keywords:

Intracranial aneurysm, Endovascular treatment, Wide neck, Intracranial stent, Flow diverter, Occlusion classification

Abstract

BACKGROUND: An aneurysm is an abnormal focal dilatation of an artery. Most of the unruptured aneurysms are asymptomatic and discovered incidentally or some of them symptomatic with mass effect or nerve palsy, but rupture of aneurysm results in a potentially life-threatening subarachnoid haemorrhage. Aneurysms with wide necks are defined by neck diameters greater than 4 mm or dome-to-neck ratios less than 2 and are the most difficult to treat with the endovascular method.

AIM: This study aimed to analyse the endovascular treatment of intracranial aneurysms with a wide neck.

METHODS: The study population included 37 patients with 46 aneurysms referred to the University Clinic of Radiology in Skopje, the Republic of Macedonia for endovascular treatment during the period January 2013 to May 2018. This study included 24 females and 13 males, ranging in age from 25 to 74 years.

RESULTS: From total 46 treated aneurysms 13 were ruptured and 33 unruptured. Six patients were with multiple aneurysms. In these study complex aneurysms were treated with combined technique, 5 with balloon-assisted coiling, 25 with stent-assisted coiling, 6 stents, 2 with flow diverter assisted coiling, 6 FD and 2 with partial coil filling without assistance device.

CONCLUSION: Aneurysms with wide neck remain a challenge for endovascular treatment. But the development of new techniques and materials in the treatment of aneurysms makes endovascular treatment of intracranial aneurysms safe and feasible.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Davim ALS, Neto JFS, Albuquerque DF. Anatomical variation of the superior cerebellar artery: a case study. J Morphol Sci. 2010; 27(3-4):155-6.

Kocur D, Slusarczyk W, Przybyłko N, Bazowski P, Właszczuk A, Kwiek S. Stent-assisted endovascular treatment of anterior communicating artery aneurysms – literature review. Pol J Radiol. 2016; 81:374-9. https://doi.org/10.12659/PJR.896818 PMid:27559426 PMCid:PMC4981124

Johnston SC, Adams DR, Gress DR, Ono L. Surgical and endovascular treatment of unruptured cerebral aneurysms at University Hospitals. Neurology. 1999; 52(9):1799. https://doi.org/10.1212/WNL.52.9.1799 PMid:10371526

Horowitz M, Levy EI. Endovascular management of wide-necked aneurysms. Contemporary Neurosurgery. 2001; 23(7):1-8. https://doi.org/10.1097/00029679-200104150-00001

Kim JW, Park YS. Endovascular treatment of wide-necked intracranial aneurysms: techniques and outcomes in 15 patients. J Korean Neurosurg Soc. 2011; 49(2):97-101. https://doi.org/10.3340/jkns.2011.49.2.97 PMid:21519497 PMCid:PMC3079106

Wiebers DO. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003; 362(9378):103–10. https://doi.org/10.1016/S0140-6736(03)13860-3

Molyneux AJ, Kerr RS, Birks J, et al; ISAT Collaborators. Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol. 2009; 8:427–33. https://doi.org/10.1016/S1474-4422(09)70080-8

Mordasini P, Walser A, Gralla J, Wiest R, Ozdoba C, Reinert M, Schroth G. Stent placement in the endovascular treatment of intracranial aneurysms. Swiss Med Wkly. 2008; 138(43-44):646-54. PMid:19005870

Joseph S, Kamble R. Curent trends in endovascular management of intracranial aneurysm (including posterior fossa aneurysma and multiple aneurysms. Indian J Radiol Imaging. 2008; 18(3):256-63. https://doi.org/10.4103/0971-3026.41841 PMid:19774171 PMCid:PMC2747444

Singh R, Vani K, Goel G, Mahajan A. Endovascular treatment of a complex broad neck bifurcation aneurysm at peripheral center by pCONus stent: a new neck bridging device. Indian J Vasc Endovasc Surg. 2018; 5:53-5. https://doi.org/10.4103/ijves.ijves_64_17

Pierot L, Wakhloo AK. Endovascular treatment of intracranial aneurysms: current status. Stroke. 2013; 44(7):2046-54. https://doi.org/10.1161/STROKEAHA.113.000733 PMid:23798560

Kwon BJ, Seo DH, Ha YS, Lee KC. Endovascular treatment of wide-necked cerebral aneurysms with an acute angle branch incorporated into the sac: novel methods of branch access in 8 aneurysms. Neurointervention. 2012; 7(2):93-101. https://doi.org/10.5469/neuroint.2012.7.2.93 PMid:22970418 PMCid:PMC3429850

Brinjikji W, Cloft HJ, Kallmes DF. Difficult aneurysms for endovascular treatment: overwide or undertall? Am J Neuroradiol. 2009; 30(8):1513-7. https://doi.org/10.3174/ajnr.A1633 PMid:19461057

Moret J, Cognard C, Weill A, Castaings L, Rey A. The "remodelling technique" in the treatment of wide neck intracranial aneurysms. Angiographis results and clinical follow-up in 56 cases. Intervention Neuroradiol. 1997; 3:21-35. https://doi.org/10.1177/159101999700300103 PMid:20678369

Youn SO, Lee JI, Ko JK, Lee TH, Choi CH. Endovascular treatment of wide-necked intracranial aneurysms using balloon-assisted technique with Hyper Form balloon. J Korean Neurosurg Soc. 2010; 48(3):207-12. https://doi.org/10.3340/jkns.2010.48.3.207 PMid:21082046 PMCid:PMC2966720

Zhao B, Yin R, Lanzino G, Kallmes DF, Cloft HJ, Brinjikji W. Endovascular coiling of wide-neck and wide-neck bifurcation aneurysms: a systematic review and meta-analysis. Am J Neuroradiol. 2016; 37(9):1700-5. https://doi.org/10.3174/ajnr.A4834 PMid:27256850

Fiorella D, Lylyk P, Szikora I, et al. Curative cerebrovascular reconstruction with the Pipeline embolization device: the emergence of definitive endovascular therapy for intracranial aneurysms. J Neurointerv Surg. 2009; 1:56–65. https://doi.org/10.1136/jnis.2009.000083 PMid:21994109

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. 2007; 61:460-68. https://doi.org/10.1227/01.NEU.0000290890.62201.A9 PMid:17881956

Johnston SC, Dowd CF, Higashida RT, et al; CARAT Investigators. Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: The cerebral aneurysm rerupture after treatment (CARAT) study. Stroke. 2008; 39:120 –25. https://doi.org/10.1161/STROKEAHA.107.495747 PMid:18048860

Crobeddu E, Lanzino G, Kallmes DF, et al. Review of 2 decades of aneurysm-recurrence literature, part 2: managing recurrence after endovascular coiling. Am J Neuroradiol. 2013; 34:481-5. https://doi.org/10.3174/ajnr.A2958 PMid:22422182

Ding YH, Lewis DA, Kadirvel R, et al. The Woven EndoBridge: a new aneurysm occlusion device. Am J Neuroradiol. 2011; 32:607–11. https://doi.org/10.3174/ajnr.A2399 PMid:21330397

Roy D, Milot G, Raymond J. Endovascular treatment of unruptured aneurysms. Stroke. 2001; 32:1998–2004. https://doi.org/10.1161/hs0901.095600 PMid:11546888

Raymond J, Guilbert F, Weill A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke. 2003; 34:1398–403. https://doi.org/10.1161/01.STR.0000073841.88563.E9 PMid:12775880

Mascitelli JR, Moyle H, Oermann EK et-al. An update to the Raymond-Roy occlusion classification of intracranial aneurysms treated with coil embolization. J Neurointerv Surg. 2015; 7(7):496-502. https://doi.org/10.1136/neurintsurg-2014-011258 PMid:24898735

Stapleton CJ, Torok CM, Rabinov JD, et al Validation of the modified Raymond–Roy classification for intracranial aneurysms treated with coil embolization. J Neurointerv Surg. 2016; 8(9):927-33. https://doi.org/10.1136/neurintsurg-2015-012035 PMid:26438554

O'Kelly CJ, Krings T, Fiorella D, et al. A novel grading scale for the angiographic assessment of intracranial aneurysms treated using flow diverting stents. Interv Neuroradiol. 2010; 16:133–37. https://doi.org/10.1177/159101991001600204 PMid:20642887 PMCid:PMC3277972

Kamran M, Yarnold J, Grunwald IQ, et al. Assessment of angiographic outcomes after flow diversion treatment of intracranial aneurysms: a new grading schema. Neuroradiology. 2011; 53:501-8. https://doi.org/10.1007/s00234-010-0767-5 PMid:20838782

Cekirge HS, Saatci I. A new aneurysm occlusion classification after the impact of flow modification. Am J Neuroradiol. 2016; 37(1):19-24. https://doi.org/10.3174/ajnr.A4489 PMid:26316566

Published

2018-12-10

How to Cite

1.
Lazareska M, Aliji V, Stojovska-Jovanovska E, Businovska J, Mircevski V, Kostov M, Papazova M. Endovascular Treatment of Wide Neck Aneurysms. Open Access Maced J Med Sci [Internet]. 2018 Dec. 10 [cited 2024 Mar. 28];6(12):2316-22. Available from: https://oamjms.eu/index.php/mjms/article/view/oamjms.2018.443

Issue

Section

B - Clinical Sciences