Intraoperative Complications of Endovascular Treatment of                    Intracranial Aneurysms with Coiling or Balloon-assisted Coiling in a Prospective                    Multicenter Cohort of 1088 Participants: Analysis of Recanalization after                    Endovascular Treatment of Intracranial Aneurysm (ARETA) Study

Piérot, Laurent; Barbe, Coralie; Nguyen, Huu An; Herbreteau, Denis; Gauvrit, Jean‐Yves; Januel, Anne-Christine; Bala, Fouzi; Comby, Pierre-Olivier; Desal, Hubert; Velasco, Stéphane; Aggour, Mohamed; Chabert, Emmanuel; Sédat, Jacques; Trystram, Denis; Marnat, Gaultier; Gallas, Sophie; Rodesch, Georges; Clarençon, Frédéric; Soize, Sébastien; Gawlitza, Matthias; Spelle, Laurent; White, Philip

doi:10.1148/radiol.2020191842

Cited by 56 publications

(37 citation statements)

References 18 publications

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“…In reality, when aneurysms are treated by specialized teams, the risk of treatment is currently significantly lower than even a decade earlier. The prospective multicenter Analysis of Treatment by Endovascular Approach of Nonruptured Aneurysms (ATENA) 34 and Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm (ARETA) 35 studies have reported rates of major complications of respectively 2.2% and 1.1%.…”

Section: Discussionmentioning

confidence: 99%

Increased rupture risk in small intracranial aneurysms associated with methamphetamine use

et al. 2020

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Background Aneurysmal subarachnoid hemorrhage (SAH) is the most common cause of nontraumatic SAH. Current guidelines generally recommend observation for unruptured intracranial aneurysms smaller than 7 mm, for those are considered at low risk for spontaneous rupture according to available scoring systems. Objective We observed a tendency for SAH in small intracranial aneurysms in patients who are methamphetamine users. A retrospective, single center study to characterize the size and location of ruptured and unruptured intracranial aneurysms in methamphetamine users was performed. Materials and methods Clinical characteristics and patient data were collected via retrospective chart review of patients with intracranial aneurysms and a history of methamphetamine use with a specific focus on aneurysm size and location. Results A total of 62 patients were identified with at least one intracranial aneurysm and a history of methamphetamine use, yielding 73 intracranial aneurysms (n = 73). The mean largest diameter of unruptured aneurysms (n = 44) was 5.1 mm (median 4.5, SD 2.5 mm), smaller than for ruptured aneurysms (n = 29) with a mean diameter of 6.3 mm (median 5.5, SD 2.5 mm). Aneurysms measuring less than 7 mm presented with SAH in 36.5%. With regard to location, 28% (n = 42) of anterior circulation aneurysms less than 7 mm presented with rupture, in contrast to 70% (n = 10) of posterior circulation aneurysms which were found to be ruptured. Conclusions Methamphetamine use may be considered a significant risk factor for aneurysmal SAH at a smaller aneurysm size than for other patients. These patients may benefit from a lower threshold for intervention and/or aggressive imaging and clinical follow-up.

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Section: Discussionmentioning

confidence: 99%

Increased rupture risk in small intracranial aneurysms associated with methamphetamine use

et al. 2020

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“…Findings from analyses of intraoperative complications in the ARETA study occurring during aneurysm treatment have already been published. 10 However, several complications occur after endovascular treatment of intracranial aneurysms, including: delayed aneurysm rupture inducing rebleeding in ruptured aneurysms, bleeding in unruptured aneurysms, thromboembolic events, and delayed remote hematomas. 4 While delayed bleeding of UIA is rare during the year following aneurysm treatment, rebleeding of RIA can occur within 3 days (acute bleeding), 30 days (early rebleeding), or later (late rebleeding) following aneurysm treatment.…”

Section: Hemorrhagic Strokementioning

confidence: 99%

Rebleeding and bleeding in the year following intracranial aneurysm coiling: analysis of a large prospective multicenter cohort of 1140 patients—Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm (ARETA) Study

Piérot

Barbe

Herbreteau

et al. 2020

J NeuroIntervent Surg

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BackgroundEndovascular treatment is the first line therapy for the management of ruptured and unruptured intracranial aneurysms, but delayed aneurysm rupture leading to bleeding/rebleeding can occur subsequently. ARETA (Analysis of Recanalization after Endovascular Treatment of intracranial Aneurysm) is a prospective, multicenter study conducted to analyze aneurysm recanalization. We analyzed delayed bleeding and rebleeding in this large cohort.Methods16 neurointerventional departments prospectively enrolled patients treated for ruptured and unruptured aneurysms between December 2013 and May 2015 (ClinicalTrials.gov: NCT01942512). Participant demographics, aneurysm characteristics and endovascular techniques were recorded. Data were analyzed from participants with ruptured or unruptured aneurysms treated by coiling or balloon-assisted coiling. Rates of bleeding and rebleeding were analyzed and associated factors were studied using univariable and multivariable analyses.ResultsThe bleeding rate was 0.0% in patients with unruptured aneurysms and 1.0% (95% CI 0.3% to 1.7%) in patients with ruptured aneurysms. In multivariate analysis, two factors were associated with rebleeding occurrence: incomplete aneurysm occlusion after initial treatment (2.0% in incomplete aneurysm occlusion vs 0.2% in complete aneurysm occlusion, OR 10.2, 95% CI 1.2 to 83.3; p=0.03) and dome-to-neck ratio (1.5±0.5 with rebleeding vs 2.2±0.9 without rebleeding, OR 0.2, 95% CI 0.04 to 0.8; p=0.03). Modalities of management of aneurysm rebleeding as well as clinical outcomes are described.ConclusionsAneurysm coiling affords good protection against bleeding (for unruptured aneurysms) and rebleeding (for ruptured aneurysms) at 1 year with rates of 0.0% and 1.0%, respectively. Aneurysm occlusion and dome-to-neck ratio are the two factors that appear to play a role in the occurrence of rebleeding.

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“…For the treatment of cerebral aneurysms, craniotomy clipping presents greater surgical trauma and risk, while endovascular interventional therapy achieves occlusion of intracranial aneurysms by implanting stents into the aneurysm and releasing a coil. Due to its minimally invasive nature, safety, and effectiveness, it has been widely used in clinical practice in recent years [4,[15][16][17][18][19]. Cerebral aneurysm embolization is an intravascular operation associated with mild stimulation.…”

Section: Discussionmentioning

confidence: 99%

“…With the popularization of endovascular techniques, interventional embolization of unruptured cerebral aneurysms with general anesthesia under digital subtraction angiography (DSA) has become the primary treatment [1][2][3][4][5][6]. In order to avoid aneurysm rupture and bleeding, the maintenance of hemodynamic stability during the perioperative period is important factor that should be taken into account [7,8].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Jcerity Endoscoper Airway with the LMA Supreme for Airway Management in Patients Undergoing Cerebral Aneurysm Embolization

Zhou

Wang

et al. 2021

Preprint

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Background Interventional embolization of cerebral aneurysms often requires anticoagulation and antiplatelet therapy during perioperative period. A new type of laryngeal mask airway (Jcerity Endoscoper Airway)with a unique design may cause less oropharyngeal injury and bleeding for patients receiving perioperative anticoagulation. This study sought to compare the efficacy, safety and complications of Jcerity Endoscoper airwayvs LMA((Laryngeal Mask Airway) Supreme in the procedure of cerebral aneurysm embolization. Methods In this prospective, randomised clinical trial, 182 adult patients with American Society of Anesthesiologists class Ι-II scheduled for interventional embolization of cerebral aneurysms were randomly allocated into the Jcerity Endoscoper airway group and the LMA Supreme group. We compared success rate of LMA implantation, ventilation quality, airway sealing pressure, peak airway pressure, degree of blood staining, postoperative oral hemorrhage, sore throat and other complications between the groups. Results There were no significant differences between the groups in terms of success rate of LMA implantation, ventilation quality, airway sealing pressure or airway peak pressure. The LMA Supreme group showed a significantly higher degree of blood staining than the Jcerity Endoscoper airway group when the laryngeal mask airway was removed (P = 0.04), and there were also more oral hemorrhages and pharyngeal pain than in the the Jcerity Endoscoper airway group (P = 0.03,P = 0.02). No differences were observed between groups in terms of other complications related to the LMA. Conclusions The Jcerity Endoscoper airway can be safely and effectively used for airway management in patients undergoing cerebral aneurysm embolization, which can significantly reduce airway complications related to perioperative anticoagulation.

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Intraoperative Complications of Endovascular Treatment of Intracranial Aneurysms with Coiling or Balloon-assisted Coiling in a Prospective Multicenter Cohort of 1088 Participants: Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm (ARETA) Study

Cited by 56 publications

References 18 publications

Increased rupture risk in small intracranial aneurysms associated with methamphetamine use

Increased rupture risk in small intracranial aneurysms associated with methamphetamine use

Rebleeding and bleeding in the year following intracranial aneurysm coiling: analysis of a large prospective multicenter cohort of 1140 patients—Analysis of Recanalization after Endovascular Treatment of Intracranial Aneurysm (ARETA) Study

Comparison of the Jcerity Endoscoper Airway with the LMA Supreme for Airway Management in Patients Undergoing Cerebral Aneurysm Embolization

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