Rerupture of coil-embolized aneurysm during long-term observation

Manabe, Hiroshi; Fujita, Shuzo; Hatayama, Toru; Suzuki, Shigeharu; Yagihashi, Soroku

doi:10.3171/jns.1998.88.6.1096

Cited by 60 publications

(29 citation statements)

References 12 publications

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“…2,34) The immediate angiographic results in aneurysms with later recanalization and regrowth are often unsatisfactory. 22,24,43) Aneurysms completely embolized with GDCs were permanently excluded from the circulation. 29) However, in our series, three of 56 completely occluded aneurysms manifested recanalization.…”

Section: Relationships Of Aneurysm Size and Location To Outcomementioning

confidence: 99%

“…9,42) This mismatch results in deformity of the coil mass and/or new shear stress on the aneurysm wall, leading to recanalization and rupture due to coil compaction and/or aneurysm regrowth. 22,33) Coil embolization may induce flow stagnation and promote thrombus formation in sidewall aneurysms. 11,23) A higher rate of progressive thrombosis was reported for sidewall aneurysms with a diameter larger than that of the orifice.…”

Section: Relationships Of Aneurysm Size and Location To Outcomementioning

confidence: 99%

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Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Soeda

Sakai

et al. 2004

Neurol. Med. Chir.(Tokyo)

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The present study assessed the safety and efficacy of embolization using Guglielmi detachable coils (GDCs) in 100 asymptomatic cerebral aneurysms classified as sidewall (70) or terminal (30) aneurysms according to the parent artery (68 small aneurysms with a small neck, 21 small aneurysms with a wide neck, and 11 large aneurysms). A balloon-assisted technique was used in 49 aneurysms. Immediate angiography revealed that 71 aneurysms were completely obliterated. Transient deficits occurred in 19 patients, permanent deficits in four patients, and one patient died. Most complications occurred during or immediately after treatment and resolved within a few minutes to a few weeks. None of the surviving patients manifested significant morbidity at 1-year follow up. Follow-up angiographic study was performed in 79 aneurysms. Rates of recanalization and progressive thrombosis (total occlusion of the residual aneurysm at follow up) were 11% and 38%, respectively, in sidewall aneurysms, and 26% and 0%, respectively, in terminal aneurysms. Treatment with GDCs was effective for patients with small aneurysms with small necks, the morbidity was acceptable, and progressive thrombosis occurred during the follow-up period. GDC treatment achieved unsatisfactory results in patients with small terminal aneurysms with wide necks and in large aneurysms, because the obliteration rate was low, and the recanalization and complication rates were high. Multivariate analysis showed that complete occlusion was associated with small-necked aneurysms, and ischemic events tended to occur in terminal aneurysms and in aneurysms treated by the balloon-assisted technique.

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Section: Relationships Of Aneurysm Size and Location To Outcomementioning

confidence: 99%

Section: Relationships Of Aneurysm Size and Location To Outcomementioning

confidence: 99%

Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Soeda

Sakai

et al. 2004

Neurol. Med. Chir.(Tokyo)

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“…Following thrombus organization, the aneurysm orifice becomes endothelialized. However, failure of these processes and coil compaction may result in aneurysm recanalization and growth, 3,4,6,13) so even immediate post-embolization angiographical evidence of complete aneurysm obliteration does not guarantee a good long-term outcome. Significant predictors of post-treatment recanalization or regrowth include large size, wide neck, rupture, and suboptimal immediate angiographic results.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Aneurysm Stability After Endovascular Embolization With Guglielmi Detachable Coils: Correlation Between Long-Term Stability and Volume Embolization Ratio

Yagi

Satoh

Satomi

et al. 2005

Neurol. Med. Chir.(Tokyo)

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The correlation between volume embolization ratio (VER), the percentage of aneurysm volume occupied by coils, and aneurysm stability after endovascular treatment with platinum coils was studied in 86 patients who underwent embolization of 88 cerebral saccular aneurysms with standard platinum coils between March 1997 and January 2003. Radiographic follow up was possible of 62 aneurysms with greater than 70% obliteration on immediate post-procedure angiograms for more than 6 months. Immediate post-procedure evaluation found that 12 of 14 small (º4 mm), 12 of 38 medium (4-º10 mm), and two of 10 large (AE10 mm) aneurysms had high (AE25%) VER. In addition, the VER was high in 22 of 40 aneurysms with small (º4 mm) and four of 22 with wide necks (AE4 mm). Evaluation of 57 aneurysms at 6 months after coil embolization found recanalization in two of 25 aneurysms with high VER and 21 of 32 with low (º25%) VER, indicating that aneurysms with high VER are significantly more stable than those with low VER (p º 0.01). VER strongly affects aneurysm stability, so high VER is desirable and a useful predictor of aneurysm stability.

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“…The relevance of animal models is uncertain, and mechanisms involved in aneurysmal healing after embolization remain speculative. [22][23][24][25][26][27][28][29][30] Few human pathological studies have been performed on aneurysms treated by endovascular techniques. Deficient thrombosis and poor neointima formation, as seen in our canine model, have been documented in many cases.…”

Section: Discussionmentioning

confidence: 99%

Growth Factors Stimulate Neointimal Cells In Vitro and Increase the Thickness of the Neointima Formed at the Neck of Porcine Aneurysms Treated by Embolization

Desfaits

Raymond

Muizelaar³

2000

Stroke

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Background and Purpose-Growth factors (GFs) may favor the healing of aneurysms treated with endovascular techniques by stimulating neointima formation. Methods-Bilateral carotid aneurysms were constructed with venous pouches in 50 pigs and embolized intraoperatively with collagen sponges with and without GFs (platelet-derived growth factor-BB [PDGF-BB] 0.15 or 1.5 g or transforming growth factor-␤ 1 [TGF-␤ 1 ] 60 or 600 ng) in each animal. DNA synthesis, cell proliferation, and collagen secretion assays were performed to assess the in vitro effects of GFs on neointimal cells harvested from the treated aneurysms. 125 I-PDGF-BB was used to study in vivo GF release from sponges. The thickness of the neointima at the surface of the sponges was measured 2 weeks after surgery. Since porcine aneurysms tend to heal after collagen sponge embolization, this experiment was repeated in dogs, which have shown a propensity for recurrence with the same technique, with 600 ng TGF-␤ 1 or platelet extracts. Results-PDGF-BB stimulated DNA synthesis and cell proliferation, while TGF-␤ 1 strongly increased collagen synthesis of neointimal cells in vitro. Clearance of 125 I-PDGF-BB from the sponges followed a biphasic curve, with 1.5% of exogenous PDGF-BB remaining at 1 week. The local delivery of PDGF-BB (0.15 or 1.5 g) and TGF-␤ 1 (600 ng) significantly increased neointimal thickness at the neck of porcine aneurysms, while 60 ng of TGF-␤ 1 had no demonstrable effect. TGF-␤ 1 (600 ng) or platelet extracts had no influence on canine aneurysms. Conclusions-PDGF-BB

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Rerupture of coil-embolized aneurysm during long-term observation

Cited by 60 publications

References 12 publications

Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Evaluation of Aneurysm Stability After Endovascular Embolization With Guglielmi Detachable Coils: Correlation Between Long-Term Stability and Volume Embolization Ratio

Growth Factors Stimulate Neointimal Cells In Vitro and Increase the Thickness of the Neointima Formed at the Neck of Porcine Aneurysms Treated by Embolization

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