Safety and cost of stent-assisted coiling of unruptured intracranial aneurysms compared with coiling or clipping

Frontera, Jennifer A.; Moatti, Joseph; Reyes, Kenneth M. De Los; McCullough, Stephen; Moyle, Henry; Bederson, Joshua B.

doi:10.1136/neurintsurg-2012-010544

Cited by 23 publications

(13 citation statements)

References 17 publications

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“…The shorter waiting time has to be considered in the clinical use of the novel LEA PHIL. 18 There were some limitations to our study. First, the number of trials was small.…”

Section: Discussionmentioning

confidence: 93%

Liquid Embolic Agents for Endovascular Embolization: Evaluation of an Established (Onyx) and a Novel (PHIL) Embolic Agent in an In Vitro AVM Model

Vollherbst¹,

Sommer

Ulfert³

et al. 2017

AJNR Am J Neuroradiol

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“…The shorter waiting time has to be considered in the clinical use of the novel LEA PHIL. 18 There were some limitations to our study. First, the number of trials was small.…”

Section: Discussionmentioning

confidence: 93%

Liquid Embolic Agents for Endovascular Embolization: Evaluation of an Established (Onyx) and a Novel (PHIL) Embolic Agent in an In Vitro AVM Model

Vollherbst¹,

Sommer

Ulfert³

et al. 2017

AJNR Am J Neuroradiol

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“…The use of stents and stent-like devices for the treatment of acutely ruptured aneurysms is still controversial even though several studies have demonstrated that the complication risk of stent-assisted coiling is comparable to both simple coiling and clipping 12 13. Recently, Roh et al compared their experience with stent-assisted and no-stent-assisted coil embolization in the treatment of ruptured aneurysms and found similar clinical and angiographic outcomes between both techniques 14.…”

Section: Discussionmentioning

confidence: 99%

Use of the pCONus HPC as an adjunct to coil occlusion of acutely ruptured aneurysms: early clinical experience using single antiplatelet therapy

Aguilar-Pérez

AlMatter

Hellstern

et al. 2020

J NeuroIntervent Surg

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BackgroundCoil occlusion has become the standard treatment for many ruptured aneurysms. However, specific aneurysm structures pose technical difficulties and may require the use of adjunctive neck-bridging devices, which necessitate the use of dual antiplatelet therapy. The hydrophilic polymer coating (pHPC, phenox) is a surface modification that inhibits platelet adhesion.ObjectiveTo present initial experience with the pCONUS HPC device as an adjunct to coil embolization for ruptured aneurysms using single antiplatelet therapy (SAPT).MethodsAll patients who were treated with the pCONUS HPC for ruptured aneurysms using SAPT were retrospectively identified. The occurrence of thromboembolic and hemorrhagic complications was recorded together with the angiographic and clinical follow-up details.ResultsFifteen patients were identified (nine female) with a median age of 54 years (range 27–81). Six aneurysms were located at the anterior communicating artery, five at the middle cerebral artery bifurcation, two at the basilar artery bifurcation, one at the posterior communicating artery, and one involving the intradural internal carotid artery. Ten patients (66.6%) achieved modified Raymond–Roy classification I or II at post-treatment angiography, with 45.5% of patients having adequate occlusion (defined as complete occlusion or neck remnant) at follow-up. All patients received acetylsalicylic acid (ASA) as SAPT before and after the procedure. Intraprocedural thrombus formation was seen in three patients (20%), resolving in two patients after a bolus dose of eptifibatide, and one treated with mechanical aspiration. No clinical or radiological consequences were seen. There were no recurrent aneurysm ruptures. One patient died owing to cerebral vasospasm.ConclusionThis initial clinical experience highlights the possibility and limitations of using the pCONUS HPC device in the treatment of complex ruptured aneurysm with ASA as SAPT. Randomized trials with longer follow-up in larger cohorts are underway.

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“…The cost of an intracranial stent is approximately USD 5,200 for the Enterprise (Codman Neurovascular) and USD 5,315 for the Neuroform (Stryker, Kalamazoo, Mich., USA) [21]. In comparison, the list price of the Ascent balloon (Codman Neurovascular) as obtained from their regional sales office is USD 1,607, which is a fraction of the cost of an intracranial stent.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to these elevated risks, there is a significant additional cost associated with the use of SAC [21]. The cost of an intracranial stent is approximately USD 5,200 for the Enterprise (Codman Neurovascular) and USD 5,315 for the Neuroform (Stryker, Kalamazoo, Mich., USA) [21].…”

Section: Discussionmentioning

confidence: 99%

Coil Embolization of Wide-Neck Bifurcation Aneurysms Using a Single-Balloon Microcatheter

2014

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Background: Coil embolization of wide-neck cerebral aneurysms frequently requires stent or balloon assistance. Such approaches to coil embolization increase the procedural complexity, adding risk and cost. Objective: To describe a series of coil embolization procedures performed using a single-balloon microcatheter to treat wide-neck aneurysms and establish the safety, feasibility and efficacy of this technique. Methods: A retrospective review was performed to identify cases in which the Ascent balloon (Codman Neurovascular, Raynham, Mass., USA) was used as a single-balloon microcatheter for aneurysm coil embolization at two institutions. Clinical, demographic and angiographic data were obtained, and aneurysm volumes as well as packing densities (PD) were calculated. Results: Eight cerebral aneurysms were treated using this technique. Six of these were unruptured. The aneurysms had an average neck diameter of 3.7 mm, and the maximum dimension ranged from 5 to 11 mm, with a mean of 7.5 mm. The mean aspect ratio was 2.07. The mean volume of the aneurysms was 180.38 mm³. The average PD achieved in these 8 aneurysms was 41.79%. Complete occlusion with coil embolization [Raymond-Roy Occlusion Classification (RROC) 1] was achieved in all cases except one, where a small residual was left deliberately and the occlusion grade was RROC 2. There were no intraprocedural complications. Conclusion: This initial experience demonstrates the feasibility and immediate outcomes of a single-balloon microcatheter technique in coil embolization of wide-neck cerebral aneurysms. This technique may be used to achieve a high PD, comparable to that obtained with stent-assisted coiling or coiling alone, while avoiding permanent stent placement and potentially reducing thromboembolic complications.

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Safety and cost of stent-assisted coiling of unruptured intracranial aneurysms compared with coiling or clipping

Abstract: SAC is a safe alternative to coiling or clipping of unruptured aneurysms but it is currently more expensive.

Cited by 23 publications

References 17 publications

Liquid Embolic Agents for Endovascular Embolization: Evaluation of an Established (Onyx) and a Novel (PHIL) Embolic Agent in an In Vitro AVM Model

Liquid Embolic Agents for Endovascular Embolization: Evaluation of an Established (Onyx) and a Novel (PHIL) Embolic Agent in an In Vitro AVM Model

Use of the pCONus HPC as an adjunct to coil occlusion of acutely ruptured aneurysms: early clinical experience using single antiplatelet therapy

Coil Embolization of Wide-Neck Bifurcation Aneurysms Using a Single-Balloon Microcatheter

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