Endovascular Treatment of Giant Intracranial Aneurysms

Linfante, Italo; Andreone, Vincenzo; Ravelo, Natalia; Starosciak, Amy; Arif, Bilal; Shallwani, Hussain; Kan, Peter; McDermott, Michael W.; Dabus, Guilherme

doi:10.7759/cureus.8290

Cited by 3 publications

(3 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Em virtude do seu grande volume, o risco de ruptura de um AIG pode chegar a 50%, de acordo com o International Study of Unruptured Intracranial Aneurysms (ISUIA), além de evoluir com cerca de 50 a 70% de sintomas decorrentes de efeito de massa (Lawton et al, 1998;Linfante et al, 2020). Os principais sintomas apresentados são a diminuição da acuidade visual, por compressão do nervo óptico, dor facial nos territórios do nervo trigêmeo, por compressão do mesmo, disfunção da motricidade ocular, por compressão dos nervos da motricidade ocular (III e IV nervos cranianos), síndrome de frontalização, pele efeito de massa sobre o lobo frontal, disfunção hipotalâmica, por compressão direta sobre o hipotálamo, e hidrocefalia, por obstrução do fluxo liquórico (Lawton et al, 1998;Agnoletto et al, 2019).…”

Section: Palavrasunclassified

Avaliação da abordagem endovascular em aneurismas intracranianos gigantes tratados com stents de fluxo vs embolização com micromolas

Demeneck Pereira,

Carvalho Parry,

Siqueira Waihrich

et al. 2023

PIC

View full text Add to dashboard Cite

Os aneurismas intracranianos gigantes (AG), acima de 25 mm são raro subgrupo quegeralmente se apresentam com a clínica de efeito de massa. Normalmente observa-sediminuição da acuidade visual, neuralgias, disfunção da motricidade ocular, entre outros. Asopções terapêuticas incluem microcirurgia com trapping da artéria parental e as múltiplasestratégias endovasculares. Em decorrência da baixa frequência da doença, carecemevidências científicas que apontem a melhor estratégia tendo em vista diminuir o risco desangramentos e resolver os efeitos de massa. Dessa maneira, o estudo objetivou avaliar amelhora clínica de Aneurismas Intracranianos Gigantes com uso de técnicas reconstrutivasvasculares - uso de Stents de fluxo e embolização com micromolas, e das técnicas destrutivas- oclusão da artéria parental. Coorte retrospectiva com dados coletados do prontuário eentrevista de 28 pacientes. Os critérios avaliados foram: queixa principal, antecedentespessoais, tabagismo, diabetes, hipertensão arterial e colesterol, características angiográficasdo aneurisma, como tamanho e colo, e técnica cirúrgica. Os pacientes foram avaliados nopós-operatório e em consulta de retorno para análise da resolução do efeito de massa. Osaneurismas gigantes podem levar a déficits neurológicos importantes, em decorrência doefeito de massa, eventos isquêmicos ou hemorragias subaracnóideas. Dentre os sintomas,destacam-se a diminuição da acuidade visual, por compressão do nervo óptico, dor facialnos territórios do nervo trigêmeo, disfunção da motricidade ocular, síndrome defrontalização, pele efeito de massa sobre o lobo frontal, disfunção hipotalâmica, porcompressão direta sobre o hipotálamo, e hidrocefalia, por obstrução do fluxo liquórico. Aestratégia de tratamento é planejada de acordo com diversos fatores, como idade,comorbidades, tamanho, localização, morfologia, projeção do aneurisma, relaçãocolo-domus, características aneurismáticas, circulação colateral e a presença de ramosperfurantes na parede do saco aneurismático. Os Stents intracranianos de fluxo são cilindrosde fios metálicos trançados, com fenestrações diminutas, que ao serem implantadospossibilitam a passagem de sangue para os ramos penetrantes, evitando assim déficitsneurológicos, e bloqueiam a entrada de sangue no saco aneurismático, levando a trombosee redução do seu volume. Já a embolização com micromolas, outra técnica endovascular, érealizada por intermédio de cateteres inseridos à distância, posicionando-se dentro do sacoaneurismático, em que são introduzidos micromolas, preenchendo o seu interior e causandotrombose. Sua finalidade é ocluir total ou subtotal o interior do aneurisma, reduzindo o seurisco de ruptura e consequentemente de hemorragia cerebral. O estudo sugere que otratamento endovascular por Oclusão com Micromolas ou uso de Stent de Fluxo em AIGs navigência de um efeito de massa é viável e pode ser realizado com taxas de complicaçõesrelativamente baixas, com desfechos clínicos e radiográficos de longo prazo moderados

show abstract

Section: Palavrasunclassified

Avaliação da abordagem endovascular em aneurismas intracranianos gigantes tratados com stents de fluxo vs embolização com micromolas

Demeneck Pereira,

Carvalho Parry,

Siqueira Waihrich

et al. 2023

PIC

View full text Add to dashboard Cite

show abstract

“…Giant intracranial aneurysms present a significant risk of rupture, with mortality rates ranging from 65% to 100% within 1 to 5 years following rupture. [ 1 , 2 ] While both neurosurgical clipping and endovascular coiling have demonstrated effectiveness in treatment, [ 3 ] the choice between them is influenced by certain factors. For ruptured cerebral aneurysms, microsurgical clipping is often preferred due to limitations associated with antiplatelet agents.…”

Section: Introductionmentioning

confidence: 99%

Thrombectomy for delayed thromboembolism in a recurrent cerebral aneurysm previously treated with coiling: A case report

Shao,

Yang,

Huang

et al. 2024

Medicine

View full text Add to dashboard Cite

Rationale: Giant intracranial aneurysms pose a significant threat due to high mortality rates upon rupture, prompting interventions such as neurosurgical clipping or endovascular coiling. Patient Concerns: We present a rare case involving a 47-year-old female with a history of successfully treated ruptured giant intracranial aneurysms. Six months post-surgical clipping, she developed symptoms of acute ischemic stroke, prompting the decision for neurosurgical coiling and stent-assisted aneurysm coil embolization due to recurrent intracranial aneurysms. Diagnoses: Subsequently, occlusion occurred at the previously implanted stent site during embolization, necessitating exploration of alternative therapeutic options. Digital subtraction angiography confirmed stent occlusion in the right middle cerebral artery. Interventions: Despite an initial unsuccessful attempt using a direct aspiration first-pass technique, the patient underwent successful mechanical thrombectomy with a retrievable stent, leading to successful reperfusion. This study aims to highlight the challenges and therapeutic strategies in managing delayed cerebral vascular occlusion following stent-assisted coil embolization, emphasizing the significance of exploring alternative interventions to enhance patient outcomes. Outcomes: The patient achieved successful reperfusion, and the study underscores the importance of recognizing and addressing delayed cerebral vascular occlusion after stent-assisted coil embolization for recurrent cerebral aneurysms. Lessons: Our findings suggest that retrievable stent mechanical thrombectomy may serve as a viable therapeutic option in challenging scenarios, emphasizing the need for further exploration of alternative interventions to enhance patient care.

show abstract

“…3 to 4 attempts of stent retrieval can reduce the chances of recanalization and increase the risk of complications based on the previous studies [7], and multiple attempts of stent retrieval can lead to a poor prognosis for AIS patients [8,9]. Single attempt of EVT with stent retrieval seems to be associated with favorable clinical outcomes, but the relationship between single attempt and clinical outcomes or complications have not been investigated.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes and Factors of Single Attempt of Stent Retrieval during Endovascular Thrombectomy for Acute Ischemic Stroke

M¹,

Y²,

Liu³

et al. 2020

Preprint

View full text Add to dashboard Cite

Backgrounds: Single attempt of stent retrieval during endovascular thrombectomy (EVT) seems to be associated with favorable clinical outcomes of patients with acute ischemic stroke (AIS), but the relationship between single attempt and clinical outcomes or complications have not been characterized. In addition, the factors related to single retrieval attempts during EVT are undefined. Here, we investigated the relationship between single attempt of stent retrieval and the clinical outcomes or complications after EVT, and further investigated the factors associated with single attempt of stent retrieval in AIS patients. Methods: This study enrolled consecutive patients with AIS treated by EVT with second-generation stent retriever devices from April 2016 to April 2019. Attempts of EVT were classified as single or multiple attempts of stent retrieval after filtrating all enrolled patients based on inclusion and exclusion criteria. We analyzed the clinical outcomes and complications between single attempt of stent retrieval and multiple attempts of stent retrieval, and the factors independently associated with a single attempt were identified through logistical regression analysis. Results: We enrolled 143 patients, including 69 patients with single attempt of stent retrieval and 74 patients with multiple attempts of stent retrieval. More patients with single attempt of stent retrieval reached favorable clinical outcomes ( p =0.016; adjusted OR [95%CI]: 2.652 [1.204-5.843] ), and patients with single attempts of stent retrieval showed as a lower incidence of symptomatic intracranial hemorrhage (sICH) ( p =0.046; adjusted OR [95%CI]: 0.192 [0.038-0.973] ). Diabetes mellitus ( p =0.026; adjusted OR [95%CI]: 2.871 [1.137-7.249] ) was independently associated with single attempt of EVT with stent retrieval. Conclusions: Single attempt of stent retrieval during EVT can decrease incidence of sICH and improve favorable clinical outcomes of patients with AIS. Those with diabetes mellitus may be more prone to single attempt of stent retrieval during EVT .

show abstract

Endovascular Treatment of Giant Intracranial Aneurysms

Cited by 3 publications

References 21 publications

Avaliação da abordagem endovascular em aneurismas intracranianos gigantes tratados com stents de fluxo vs embolização com micromolas

Avaliação da abordagem endovascular em aneurismas intracranianos gigantes tratados com stents de fluxo vs embolização com micromolas

Thrombectomy for delayed thromboembolism in a recurrent cerebral aneurysm previously treated with coiling: A case report

Clinical Outcomes and Factors of Single Attempt of Stent Retrieval during Endovascular Thrombectomy for Acute Ischemic Stroke

Contact Info

Product

Resources

About