Modern management of paraclinoid aneurysms: Rise of flow diversion and fall of microsurgery

Ding, Dale

doi:10.1016/j.clineuro.2015.01.017

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…4) Consequently, endovascular techniques have been widely applied for the treatment of these cases with better results than those with microsurgical treatment. 5,6) In April 2011, the pipeline embolization device (PED) (Covidien, Irvine, CA, USA), which is a flow diversion (FD) device, was approved by the Food and Drug Administration for the treatment of large or giant wide-necked intracranial aneurysms of the proximal intracranial ICA, but not for those of the posterior communicating artery; the Japanese government approved the use of PED for the same indications in March 2015 in limited facilities. The efficacy of FD in the treatment of cerebral aneurysms has been established.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Pipeline Embolization and Coil Embolization for the Treatment of Large Unruptured Paraclinoid Aneurysms

Suzuki

Takigawa

Nariai

et al. 2022

Neurol. Med. Chir.(Tokyo)

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The efficacy of flow diversion (FD) in the treatment of paraclinoid aneurysms has been established. The pipeline embolization device (PED) is one of the most commonly used FD devices. Coil embolization is also useful for treating paraclinoid aneurysms. This study aimed to compare the efficacy and safety of PED treatment and coil embolization for large unruptured paraclinoid aneurysms. This was a single-center, retrospective study of large unruptured paraclinoid aneurysms treated endovascularly between 2009 and 2019 (coil embolization between 2009 and 2015, and PED between 2015 and 2019). Cases with a follow-up period of less than 1 year and recurrence after coil embolization were excluded. The treatment outcomes between coil embolization and PED were compared. We investigated 45 patients with 45 large unruptured paraclinoid aneurysms treated by endovascular surgery in our institution. Twenty-four patients were treated with coil embolization and 21 with PED. In the PED group, the device cost was significantly lower (2,770.4 ± 699.5 vs. 1941.2 ± 552.8 [1000 yen], P = 0.03), procedure duration was significantly shorter (155.4 ± 66.7 vs. 95.1 ± 35.4 min, P <0.01), and the numbers of re-treatments were lower than those in the coil embolization group (41.7 vs. 14.3%, P = 0.05). Both PED and coil embolization were effective and safe for large unruptured paraclinoid aneurysms, and their treatment results were similar. The PED is more beneficial because of its lower cost, shorter procedure duration, and fewer retreatments, and is therefore more useful for the treatment of large unruptured paraclinoid aneurysms.

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Section: Introductionmentioning

confidence: 99%

Comparison of Pipeline Embolization and Coil Embolization for the Treatment of Large Unruptured Paraclinoid Aneurysms

Suzuki

Takigawa

Nariai

et al. 2022

Neurol. Med. Chir.(Tokyo)

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“…8,14 Since the publication of the International Subarachnoid Aneurysm Trial results, 15,16 the use of endovascular treatment for unruptured paraclinoid aneurysms has increased substantially, because of its low morbidity and mortality rates. 9,17,18 However, one issue that is encountered after endovascular treatment is aneurysm recanalization (AR). 9,17,19,20 To reduce the rate of AR and prevent aneurysm rupture, innovative endovascular treatments have been developed during recent decades, such as surface-modified coils, stent-assisted coiling, and flow diverters (FDs).…”

Section: Introductionmentioning

confidence: 99%

Larger inflow angle and incomplete occlusion predict recanalization of unruptured paraclinoid aneurysms after endovascular treatment

Liu

et al. 2016

Interv Neuroradiol

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Background Unruptured paraclinoid aneurysms have a high incidence of aneurysm recanalization (AR) after endovascular treatment. We aimed to identify the incidence and predictors of AR in these lesions. Methods We retrospectively analyzed consecutive patients with unruptured paraclinoid aneurysms who underwent endovascular treatment between January 2013 and December 2014. Patients with fusiform aneurysms, dissection aneurysms, traumatic aneurysms, or without digital subtraction angiography (DSA) at follow-up, were excluded. AR was defined as any aneurysm remnant that had increased in size or contrast filling that was observed via DSA at the follow-up. Univariate and multivariate logistic regression analyses were performed to assess the predictors of AR. Results We included 145 patients with 150 unruptured paraclinoid aneurysms in the analysis. The incidence of AR was 8.7% (95% confidence interval (CI): 4.7–13.3%) at a mean follow-up of 7.4 months. In the univariate analysis, AR was associated with aneurysm size (odd ratio (OR): 6.098; 95% CI: 1.870–19.886; p = 0.003), location (OR: 3.88; 95% CI: 1.196–12.583; p = 0.024), inflow angle (OR: 6.852; 95% CI: 1.463–32.087; p = 0.015), and Raymond scale (OR: 12.473; 95% CI: 2.7496–56.59; p < 0.001). In the adjusted multivariate analysis, AR was independently predicted by Raymond scale (OR: 9.136; 95% CI: 1.683–49.587; p = 0.001) and inflow angle (OR: 16.159; 95% CI: 3.211–81.308; p = 0.01). Conclusions Unruptured paraclinoid aneurysms had a high incidence of AR after endovascular treatment. An inflow angle of ≥90 degrees and incomplete occlusion were significant predictors of AR.

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Risk Factors to Predict Neurologic Complications After Endovascular Treatment of Unruptured Paraclinoid Aneurysms

Xu²,

Wang

et al. 2017

World Neurosurgery

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Modern management of paraclinoid aneurysms: Rise of flow diversion and fall of microsurgery

Cited by 3 publications

References 14 publications

Comparison of Pipeline Embolization and Coil Embolization for the Treatment of Large Unruptured Paraclinoid Aneurysms

Comparison of Pipeline Embolization and Coil Embolization for the Treatment of Large Unruptured Paraclinoid Aneurysms

Larger inflow angle and incomplete occlusion predict recanalization of unruptured paraclinoid aneurysms after endovascular treatment

Risk Factors to Predict Neurologic Complications After Endovascular Treatment of Unruptured Paraclinoid Aneurysms

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