Immediate Clinical Outcome of Patients Harboring Unruptured Intracranial Aneurysms Treated by Endovascular Approach

Abstract

MD; for the ATENA InvestigatorsBackground and Purpose-The management of unruptured intracranial aneurysms remains controversial and the results of endovascular treatment are not precisely known because no prospective data exist. The first prospective multicenter study (ATENA) was conducted in Canada and France to determine clinical outcome and risks of this treatment. Methods-Six hundred forty-nine patients harboring a total of 1100 aneurysms from 27 Canadian and French neurointerventional centers were prospectively and consecutively treated by endovascular coil embolization. Of these, 739 unruptured intracranial aneurysms were treated during 700 procedures. Aneurysms were selectively treated in the great majority of cases (98.4%) with coils alone (54.5%), the balloon remodeling technique (37.3%), or stenting (7.8%). Results-Endovascular treatment failed in 32 aneurysms (4.3%). Technical adverse events with or without clinical modification were encountered in 15.4% of patients and included thromboembolic complications (7.1% per procedure), intraoperative rupture (2.6% per procedure), and device-related problems (2.9% per procedure). Adverse events associated with transient or permanent neurological deficit or death were encountered in 5.4% of cases. The 1-month morbidity and mortality rates were 1.7% and 1.4%, respectively. Conclusions-Endovascular treatment of unruptured intracranial aneurysms is feasible in a high percentage of cases with low morbidity and mortality rates.

Silk Flow-Diverter Stent for the Treatment of Intracranial Aneurysms: A Series of 58 Patients with Emphasis on Long-Term Results

“…4,6 In this series, adequate occlusion was obtained in the whole population (narrow and wide-neck aneurysms) and in 80.4% at midterm follow-up after bare platinum coil treatment. In wide-neck aneurysms, the rate of adequate occlusion was 68.2%, which is much lower than the 89% observed in the present series.…”

“…Moreover, no retreatment was performed in the present series, and that is a major advantage compared with what was reported in CLARITY (6.2%) and in the Ferns et al review (10.3%). [4][5][6] These anatomic results are very satisfying because of our selected population that included mostly wide-neck and fusiform intracranial aneurysms. Stent tolerance is another major concern with flow-diverter stents.…”

Difficult Aneurysms for Endovascular Treatment: Overwide or Undertall?

“…Two recent multicenter studies have demonstrated that adjunctive techniques were necessary in approximately 45% of cases. 13,14 Thus, our practice with adjunctive techniques does not seem to be unusual.…”

Flow-Diverter Stents for the Treatment of Saccular Middle Cerebral Artery Bifurcation Aneurysms

“…[1][2][3] However the choice between surgical and endovascular approaches for the treatment of aneurysms in this location is still a matter of debate. 4 Furthermore, wide-neck MCA bifurcation lesions can sometimes prove challenging for traditional EVT approaches, and numerous techniques have been developed to address these cases.…”