Rebleeding of a neck remnant in a case of ruptured aneurysm initially treated with coils

Benaissa, A.; Piérot, Laurent

doi:10.1136/bcr-2014-011601

Cited by 3 publications

(3 citation statements)

References 10 publications

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“…Late aneurysm re-rupture is a well-known phenomenon, and Tsurumi et al 14 reported that re-rupture occurs after coiling when there is an aneurysm remnant but is also possible if a neck remnant remains. This has also been reported by other groups 15. The effect of the addition of a flow-modulating device placed within the aneurysm on this process is unknown at present, although it is not inconceivable that significant changes in flow and haemodynamic stress could occur in a neck remnant.…”

Section: Discussionsupporting

confidence: 75%

The Medina Embolic Device: early clinical experience from a single center

Pérez

Bhogal

Moreno

et al. 2016

J NeuroIntervent Surg

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ObjectiveTo report our initial experience with the Medina Embolic Device (MED) in unruptured intracranial aneurysms either as sole treatment or in conjunction with additional devices.Methods15 consecutive patients (6 women, 9 men) with unruptured aneurysms were treated between September 2015 and April 2016. The aneurysm fundus measured at least 5 mm. We evaluated the angiographic appearances of treated aneurysms at the end of the procedure and at follow-up, the clinical status, complications, and requirement for adjunctive devices.ResultsThe MED was successfully deployed in all but one case and adjunctive devices were required in 10 cases. Aneurysm locations were middle cerebral artery bifurcation (n=3), internal carotid artery (ICA) bifurcation (n=1), supraclinoid ICA (n=5), posterior communicating artery (n=1), anterior communicating artery (n=2), cavernous ICA (n=2), distal basilar sidewall (n=1), basilar tip (n=1). Three patients had complications although none could be attributed to the MED. Immediate angiographic results were modified Raymond-Roy classification (mRRC) I=1, mRRC II=5, mRRC IIIa=3, mRRC IIIb=5, and one patient showed contrast stasis within the fundus of the aneurysm. Follow-up angiography was available in 11 patients, with four showing complete aneurysm exclusion, six with stable remnants and one patient with an enlarging neck remnant.ConclusionsThe MED represents a major step forward in the treatment of intracranial aneurysms. It can result in rapid exclusion of an aneurysm from the circulation and has a good safety profile. We believe that the true value of the MED will be in combining its use with adjunctive devices such as endoluminal flow diverters that will result in rapid aneurysmal exclusion.

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Section: Discussionsupporting

confidence: 75%

The Medina Embolic Device: early clinical experience from a single center

Pérez

Bhogal

Moreno

et al. 2016

J NeuroIntervent Surg

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“…8,[17][18][19] However, the analysis of aneurysm occlusion after WEB treatment of ruptured aneurysms in larger studies is essential because recurrence and rebleeding are feared complications. [20][21][22][23] Morphological aneurysm wall characteristics differ from unruptured aneurysms, and tissue remodeling in the course of rupture might influence WEB positioning and WSM over time. 24,25 In a spherically shaped WEB cage, the curved shoulders of the device create a more harmonious closure toward the parent vessel, compared with the square edges of the barrelshaped WEB SL device.…”

Section: Discussionmentioning

confidence: 99%

Impact of Woven EndoBridge Shape Modification on Aneurysm Recanalization at Short-Term Follow-up Digital Subtraction Angiography

et al. 2022

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BACKGROUND:Woven EndoBridge (WEB) shape modification (WSM) is a frequently observed phenomenon after aneurysm embolization.OBJECTIVE:To test our hypothesis that WSM is associated with worse aneurysm occlusion on short-term angiographic follow-up images.METHODS:Patients with short-term follow-up digital subtraction angiography (DSA) available were included. Baseline patient characteristics, aneurysm morphometrics, and WEB dimensions (“conventional” parameters) and height and width WSM (“WSM” parameters) in the initial and the follow-up examination were analyzed. For ordinal regression analyses, aneurysm occlusion was graded according to the Bicêtre Occlusion Scale Score (BOSS; grades 0, 0′, 1, 2, 3, and 1 + 3). Receiver operating characteristic curve analysis was used to distinguish adequately (BOSS 0, 0′, and 1) from incompletely (BOSS 2, 3, and 1 + 3) occluded aneurysms.RESULTS:We included 93 patients with 96 aneurysms. Adequate occlusion was observed in 72 cases (75.0%). In univariate ordinal regression analysis, width WSM in anteroposterior DSA (odds ratio = 0.96, 95% CI: 0.94-0.99, P = .010) and in lateral DSA (odds ratio = 0.98, 95% CI: 0.97-0.99, P = .049) were significantly associated with the BOSS after 6 months. In multivariate regression analysis, WSM was not independently associated with aneurysm occlusion. Based on receiver operating characteristic curve analysis, the area under the curve (AUC) of the “conventional” model (AUC = 0.83, 95% CI 0.74-0.90) was higher than the AUC of the “WSM” model (WSM; AUC = 0.70, 95% CI 0.60-0.79).CONCLUSION:WSM was not independently associated with angiographic aneurysm occlusion status after 6 months. However, the “conventional” parameters including sex, rupture state, WEB type, WEB width, aneurysm width, height, and volume were associated with partial aneurysm recanalization in WEB-treated patients at the short-term follow-up.

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“…Although 72.4% of the 58 incompletely treated ruptured aneurysms at initial follow-up were due to a neck remnant (n = 42) rather than an aneurysm remnant (n = 16), one must consider that neck remnants still pose a risk to the patient, as they are prone to progress and are susceptible to rerupture. 1,17 These results are at odds with the primary goal of ruptured aneurysm treatment, which is to prevent rerupture. Indeed, 3 patients in the Mortimer et al 14 series experienced rerupture after treatment, and all 3 patients died as a result.…”

Section: Discussionmentioning

confidence: 99%

Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial

Mooney¹,

Simon²,

Brigeman³

et al. 2019

Journal of Neurosurgery

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OBJECTIVE A direct comparison of endovascular versus microsurgical treatment of ruptured middle cerebral artery (MCA) aneurysms in randomized trials is lacking. As endovascular treatment strategies continue to evolve, the number of reports of endovascular treatment of these lesions is increasing. Herein, the authors report a detailed post hoc analysis of ruptured MCA aneurysms treated by microsurgical clipping from the Barrow Ruptured Aneurysm Trial (BRAT). METHODS The cases of patients enrolled in the BRAT who underwent microsurgical clipping for a ruptured MCA aneurysm were reviewed. Characteristics of patients and their clinical outcomes and long-term angiographic results were analyzed. RESULTS Fifty patients underwent microsurgical clipping of a ruptured MCA aneurysm in the BRAT, including 21 who crossed over from the endovascular treatment arm. Four patients with nonsaccular (e.g., dissecting, fusiform, or blister) aneurysms were excluded, leaving 46 patients for analysis. Most (n = 32; 70%) patients presented with a Hunt and Hess grade II or III subarachnoid hemorrhage, with a high prevalence of intraparenchymal blood (n = 23; 50%), intraventricular blood (n = 21; 46%), or both. At the last follow-up (up to 6 years after treatment), clinical outcomes were good (modified Rankin Scale score 0-2) in 70% (n = 19) of 27 Hunt and Hess grades I-III patients and in 36% (n = 4) of 11 Hunt and Hess grade IV or V patients. There were no instances of rebleeding after the surgical clipping of aneurysms in this series at the time of last clinical follow-up. CONCLUSIONS Microsurgical clipping of ruptured MCA aneurysms has several advantages over endovascular treatment, including durability over time. The authors report detailed outcome data of patients with ruptured MCA aneurysms who underwent microsurgical clipping as part of a prospective, randomized trial. These results should be used for comparison with future endovascular and surgical series to ensure that the best results are being achieved for patients with ruptured MCA aneurysms.

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Rebleeding of a neck remnant in a case of ruptured aneurysm initially treated with coils

Cited by 3 publications

References 10 publications

The Medina Embolic Device: early clinical experience from a single center

The Medina Embolic Device: early clinical experience from a single center

Impact of Woven EndoBridge Shape Modification on Aneurysm Recanalization at Short-Term Follow-up Digital Subtraction Angiography

Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial

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