Is the Risk of Balloon Assistance Underinflated?

Sluzewski, M.; Rooij, W.J. van

doi:10.3174/ajnr.a1250

Cited by 10 publications

(6 citation statements)

References 10 publications

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“…Despite the low rate of complications, in all the reports, the authors pointed out that the infusions were not truly superselective, and intracranial vascular territories also received high concentrations of chemotherapy through the cavernous branches of the internal carotid artery. Additionally, there might be concern that inflation of a nondetachable balloon in the parent artery may lead to increased adverse events, such as it is discussed in the literature about aneurysm coiling in adult patients with cerebral aneurysms (Sluzewski et al. 2006, 2008; Shapiro et al.…”

Section: Discussionmentioning

confidence: 99%

Superselective ophthalmic artery infusion of melphalan for intraocular retinoblastoma: preliminary results from 140 treatments

Venturi

Bracco

Cerase

et al. 2012

Acta Ophthalmologica

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ABSTRACT.Purpose: To report our experience in superselective ophthalmic artery infusion of melphalan (SOAIM) for intraocular retinoblastoma. Methods: From June 2008 to October 2010, 38 patients (18 women, 20 men; age range at first treatment, 7 months to 22 years) with 41 eyes with retinoblastoma were scheduled for SOAIM, for 17 newly diagnosed retinoblastomas Tumour, Node and Metastasis (TNM) 7th Edition 1a (n = 1), 1b (n = 1), 2a (n = 7), 2b (n = 4) and 3a (n = 4) and 24 retinoblastomas with partial remission ⁄ relapse TNM 7th Edition 1b (n = 13), 2a (n = 1) and 2b (n = 10). Eight patients (ten eyes) have been treated by SOAIM alone. Follow-up was 6-27 months in 28 patients (30 eyes). Results: Ophthalmic artery cannulation failed in two patients. Thirty-six patients underwent 140 treatments by internal (n = 112) or external (n = 28) carotid arteries. No major procedural complications occurred. Two patients have been lost to follow-up. Remaining 34 patients (37 eyes) had no metastatic disease. Four patients suffered permanent ocular complications: chorioretinal dystrophy (n = 2), ptosis (n = 1) and strabismus ⁄ exotropia (n = 1). Eight (22%) eyes in eight (24%) patients underwent enucleation: 7 ⁄ 16 (43%) newly diagnosed retinoblastomas and 1 ⁄ 22 (4.5%) retinoblastomas undergoing partial remission ⁄ relapse. For all treated eyes, Kaplan-Meier eye enucleation-free rates (K-M) were 85.4% (95% CI, 73.3-97.5%), 74.4% (95% CI, 57-91.8%) and still stable at 6, 12 months and 2 years, respectively. For eyes with partial remission ⁄ relapse, and eyes at presentation, K-M at 2 years were 95.5% (95% CI, 86.9-100%) and 45.6% (95% CI, 16.6-74.6%), respectively. Conclusion: Superselective ophthalmic artery infusion of melphalan was safe and powerful, especially following other therapies. Superselective ophthalmic artery infusion of melphalan should be added to focal therapies spectrum. In selected cases, melphalan should be combined with other chemotherapeutic agents.

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Section: Discussionmentioning

confidence: 99%

Superselective ophthalmic artery infusion of melphalan for intraocular retinoblastoma: preliminary results from 140 treatments

Venturi

Bracco

Cerase

et al. 2012

Acta Ophthalmologica

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“…Limitations of the balloon are the need for additional endovascular manipulation and intermittent flow occlusion of the parent vessel during balloon inflation, which may increase the risk of thromboembolic complications. 13 The balloon-remodeling technique in the case of very small aneurysms can be associated with an increased risk of perforations, as the inflated balloon may increase friction of the advancing coil against the fragile aneurysm wall. However, should a perforation occur under these circumstances, the result is often not catastrophic, as the balloon prevents blood extravasation.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Very Small (3 mm or Smaller) Intracranial Aneurysms

Brinjikji

Lanzino

Cloft

et al. 2010

Stroke

158

143

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Background and Purpose-We performed a meta-analysis of published studies on the endovascular treatment of very small intracranial aneurysms, including 71 patients treated at our institution. Methods-We conducted a computerized MEDLINE search of the literature for reports on the treatment of intracranial aneurysms with a maximum dimension of Յ3 mm by using the search terms "small," "tiny," "intracranial aneurysm," "endovascular," and "coil." A total of 7 studies, including our institution's consecutive case series of 71 intracranial aneurysms, were included in this study. We extracted information regarding intraoperative complications, procedural mortality and morbidity, immediate-and long-term angiographic outcomes, and retreatment rate. The meta-analysis was performed with the statistical package Comprehensive Meta-Analysis. Results-Approximately 61% of the aneurysms in this meta-analysis presented as ruptured, whereas 39% of the aneurysms were unruptured. Procedural rupture rates for very small aneurysms was 8.3% (95% CI, 6.0% to 11.4%). The mortality rate due to procedural rupture was 2.4% (95% CI, 1.2% to 4.7%). The morbidity rate due to thromboembolic complications was 1.9% (95% CI, 0.9% to 3.9%). Subarachnoid hemorrhage within 1 month of treatment occurred in 1.6% (95% CI, 0.6% to 3.7%) of cases. There was no statistically significant difference between unruptured and ruptured aneurysms for any of these outcomes. Conclusion-Our meta-analysis suggests that treatment of very small aneurysms is feasible and effective in Ͼ90% of treated aneurysms. However, the risk of periprocedural rupture is higher than that reported for larger aneurysms. Similarly, the combined rate of periprocedural mortality and morbidity is not negligible (7.3%) and should be considered when considering the best therapeutic option for these aneurysms. (Stroke. 2010;41:116-121.)

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“…The advent of adjunctive techniques, such as balloon or stentassisted coiling, has made possible the endovascular occlusion of an increasing number of very small aneurysms. Limitations of the balloon assisted technique are the need for additional endovascular manipulation and intermittent flow occlusion of the parent vessel during balloon inflation, which may increase the risk of thromboembolic complications (Sluzewski et al 2008). Based on their meta-analysis, Brinjikji et al (2010) reported a retreatment rate of 5.4% for 3 mm or smaller aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Anterior Cerebral Artery (A1 Segment) Aneurysm: a Very Small Incidental A1 Aneurysm Treated with p48 Flow Diverter with Good Clinical and Angiographic Outcome

Valtorta¹,

Lylyk²,

Viso³

et al. 2020

The Aneurysm Casebook

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A very small aneurysm arising from the posterior wall of the A1 segment of the left anterior cerebral artery (ACA) was found incidentally in a 60-year-old female patient who presented with headaches and diplopia due to a large right posterior communicating artery aneurysm (PcomA) with mass effect. The A1 aneurysm was treated using an endovascular flow diversion technique with a p48 Flow Modulation Device (phenox). The patient had a good clinical and angiographic outcome. Angiography confirmed that the aneurysm had been completely excluded while the anterior cerebral artery remained patent. The various treatment criteria and endovascular methods available to treat very small aneurysms and enable flow diversion in small vessels distal to the circle of Willis are the main topics of this chapter.

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Is the Risk of Balloon Assistance Underinflated?

Cited by 10 publications

References 10 publications

Superselective ophthalmic artery infusion of melphalan for intraocular retinoblastoma: preliminary results from 140 treatments

Superselective ophthalmic artery infusion of melphalan for intraocular retinoblastoma: preliminary results from 140 treatments

Endovascular Treatment of Very Small (3 mm or Smaller) Intracranial Aneurysms

Anterior Cerebral Artery (A1 Segment) Aneurysm: a Very Small Incidental A1 Aneurysm Treated with p48 Flow Diverter with Good Clinical and Angiographic Outcome

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