Partially Thrombosed Intracranial Aneurysms Presenting with Mass Effect: Long-Term Clinical and Imaging Follow-Up after Endovascular Treatment

Ferns, S.P.; Rooij, W.J. van; Sluzewski, M.; Berg, René van den; Majoie, Charles B. L. M.

doi:10.3174/ajnr.a2057

Cited by 69 publications

(65 citation statements)

References 27 publications

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“…2,14) In this study, there was a tendency of reduction in size with thrombosed aneurysms after surgery, and thrombosed aneurysms were more frequent in patients with symptom relief after surgery. Thrombosed aneurysms may not influence coil mass effects, and a reduction in the aneurysmal size after surgery may have contributed to symptom relief due to the improvement of mass effects.…”

Section: Discussionmentioning

confidence: 82%

“…However, intra-aneurysmal embolization for partially thrombosed aneurysms may lead to recanalization related to a coil mass submerged into the thrombus; recurrence must be considered. 14) Considering the mechanism of symptom appearance related to symptomatic cerebral aneurysms, the placement of flow diverter will disperse the aneurysmal pulsation and promote the thrombosis, and may contribute to symptom relief as a consequence. 15,16) According to a study, 17) there were no changes in the aneurysmal size after the insertion of a flow diverter, and the mass effects remained, whereas symptom relief was achieved; a reduction in aneurysmal pulsation through flow diversion effects may have contributed to symptom relief.…”

Section: Discussionmentioning

confidence: 99%

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Outcome of Coil Embolization for Symptomatic Unruptured Cerebral Aneurysms

Nishihiro

Sugiu

Hishikawa

et al. 2018

JNET

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Purpose:We examined the outcome of coil embolization for symptomatic unruptured cerebral aneurysms, and investigated factors contributing to symptom relief after surgery. Methods:We retrospectively reviewed 19 patients who underwent coil embolization between January 2008 and April 2016.Results: After surgery, symptoms reduced in 13 patients (68%), but not in 6 (32%). In the improved group, the mean duration of disease was significantly shorter than in the unimproved group (1.3 vs. 16.2 months, respectively, p <0.05).There was a significant reduction in the aneurysmal size in the former (mean rate of reduction: 3.51 mm), whereas there was an increase in the latter (mean increase: 1.63 mm) (p <0.05). Conclusion:Early therapeutic intervention and a postoperative reduction in the aneurysmal size may be important to achieve the relief of symptoms of symptomatic unruptured cerebral aneurysms after surgery.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Outcome of Coil Embolization for Symptomatic Unruptured Cerebral Aneurysms

Nishihiro

Sugiu

Hishikawa

et al. 2018

JNET

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“…The main challenge lies in the fact that the definition of "recurrence" varies greatly in the literature. This variability generates a wide range of recurrence rates and results with considerable range in its association with multiple potential risk factors 5,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] . We applied a strict definition of recurrence and major recurrence and analyzed the relationship between several clinical, anatomical and technical data as a surrogate of major recurrence using survival analysis.…”

Section: Discussionmentioning

confidence: 99%

“…The coiling retreatment happened after 2-52 months of the first coiling treatment (Median[IQR]: 9.5 [6][7][8][9][10][11][12][13][14]). Twenty-two retreated major recurrences (56% of 39) had a major recurrence after a second coiling.…”

Section: Methodsmentioning

confidence: 99%

Survival Analysis of Risk Factors for Major Recurrence of Intracranial Aneurysms after Coiling

Santos

Sabri

Dowlatshahi

et al. 2015

Can. J. Neurol. Sci.

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Background: Recurrence after intracranial aneurysm coiling is a highly prevalent outcome, yet to be understood. We investigated clinical, radiological and procedural factors associated with major recurrence of coiled intracranial aneurysms. Methods: We retrospectively analyzed prospectively collected coiling data . We recorded characteristics of aneurysms, patients and interventional techniques, pre-discharge and angiographic follow-up occlusion. The Raymond-Roy classification was used; major recurrence was a change from class I or II to class III, increase in class III remnant, and any recurrence requiring any type of retreatment. Identification of risk factors associated with major recurrence used univariate Cox Proportional Hazards Model followed by multivariate regression analysis of covariates with P < 0.1. Results: A total of 467 aneurysms were treated in 435 patients: 283(65%) harboring acutely ruptured aneurysms, 44(10.1%) patients died before discharge and 33(7.6%) were lost to follow-up. A total of 1367 angiographic follow-up studies (range: 1-108 months, Median [interquartile ranges (IQR)]: 37[14-62]) was performed in 384(82.2%) aneurysms. The major recurrence rate was 98(21%) after 6(3.5-22.5) months. Multivariate analysis (358 patients with 384 aneurysms) revealed the risk factors for major recurrence: age > 65 y (hazard ratio (HR): 1.61; P = 0.04), male sex (HR: 2.13; P < 0.01), hypercholesterolemia (HR: 1.65; P = 0.03), neck size ≥4 mm (HR: 1.79; P = 0.01), dome size ≥7 mm (HR: 2.44; P < 0.01), non-stent-assisted coiling (HR: 2.87; P = 0.01), and baseline class III (HR: 2.18; P < 0.01). Conclusion: Approximately one fifth of the intracranial aneurysms resulted in major recurrence. Modifiable factors for major recurrence were choice of stent-assisted technique and confirmation of adequate baseline occlusion (Class I/II) in the first coiling procedure. La classification Raymond-Roy a été utilisée: une récidive majeure était définie comme un changement de la classe I ou II à la classe III, une augmentation résiduelle de classe III et une récidive nécessitant tout type de réintervention. Les facteurs de risque associés à une récidive majeure ont été identifiés au moyen du modèle des risques proportionnels de Cox suivi d'une analyse de régression multivariée des covariables, p < 0,01. Résultats: Au total, 467 anévrismes ont été traités chez 435 patients: 283 patients (65%) présentaient une rupture aiguë de l'anévrisme, 44 patients (10,1%) sont décédés avant le congé hospitalier et 33 (7,6%) ont été perdus au suivi. En tout, 1367 études angiographiques de suivi (écart de 1 à 108 mois ; médiane 37 ; écarts interquartiles de 14 à 62 mois) ont été effectuées pour 384 anévrismes (82,2%). Le taux de récidive majeure a été de 21% (98) après 6 mois (3,5 à 22,5 mois). L'analyse multivariée (358 patients porteurs de 384 anévrismes) a montré que les facteurs de risque d'une récidive majeure étaient: l'âge > 65 ans (risque relatif (RR): 1,61 ; p = 0,04), le sexe masculin (RR: 2,13 ; p < 0,01), l'hypercho...

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“…The pathogenesis of intraluminal thrombus in these aneurysms is thought to be related to subacute or chronic wall dissections and repeated intramural hematomas, proliferating vasa vasorum and triggering of inflammatory mechanisms [1][2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

The Donut Sign: A New Angiographic Sign for Partially Thrombosed Aneurysms with Flow-Induced Intraluminal Thrombus

et al. 2014

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Three patients are described with unruptured large partially thrombosed aneurysms with a peculiar donut-shaped remaining lumen. Observations suggest that the flow geometry of the aneurysm and parent vessels induces a preferential circular laminar flow inside the aneurysm followed by partial intraluminal thrombosis leaving a donut-shaped lumen to accommodate the circular flow. This flow mechanism of thrombus formation inside aneurysms is different from the more common repeated intramural dissections and hemorrhages that cause growth in most large and giant partially thrombosed aneurysms.

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Partially Thrombosed Intracranial Aneurysms Presenting with Mass Effect: Long-Term Clinical and Imaging Follow-Up after Endovascular Treatment

Cited by 69 publications

References 27 publications

Outcome of Coil Embolization for Symptomatic Unruptured Cerebral Aneurysms

Outcome of Coil Embolization for Symptomatic Unruptured Cerebral Aneurysms

Survival Analysis of Risk Factors for Major Recurrence of Intracranial Aneurysms after Coiling

The Donut Sign: A New Angiographic Sign for Partially Thrombosed Aneurysms with Flow-Induced Intraluminal Thrombus

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