Single-stage endovascular treatment of multiple intracranial aneurysms with combined endovascular techniques: is it safe to treat all at once?

Andıç, Çağatay; Aydemir, Fatih; Kardeş, Özgür; Gedikoglu, Murat; Akın, Şule

doi:10.1136/neurintsurg-2016-012745

Cited by 22 publications

(13 citation statements)

References 33 publications

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“…3 Patients with multiple aneurysms have higher mortality and significantly poorer outcomes than those with a single aneurysm. 4 The treatment methods for IA include microsurgical clipping and endovascular embolization. The latter has gained major acceptance over time due to progress in endovascular techniques and the expertise of operators, as well as technological advances that have allowed improvement in long-term outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Mid-term follow-up of staged bilateral internal carotid artery aneurysm treatment with Pipeline embolization

et al. 2019

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Background Endovascular treatment of large complex morphology aneurysms is challenging. High recanalization rates have been reported with techniques such as stent-assisted coiling and balloon-assisted coiling. Flow diverter devices have been introduced to improve efficacy outcomes and recanalization rates. Thromboembolic complications and in-device stenosis are certainly more worrisome when treatment of bilateral internal carotid arteries has been performed. This study aimed to report our experience with mid-term imaging follow-up of staged bilateral Pipeline embolization device placement for the treatment of bilateral internal carotid artery aneurysms. Methods We reviewed the clinical, angiographic, and follow-up imaging data in all consecutive patients treated with bilateral internal carotid artery aneurysms who underwent elective Pipeline embolization. Results Six female patients were treated, harboring a total of 13 aneurysms. Of these, 60% were asymptomatic. Diplopia and headache were the most common symptoms. The most common location was the paraclinoid segment (6/13), including by cavernous segment (4/13) and ophthalmic segment (2/13). Successful delivery of the device was achieved in 12 cases. Difficult distal access precluded the deployment of the device in one case. The treatment was always staged with at least eight weeks' difference between the two procedures. All aneurysm necks were covered completely. There were no periprocedural complications. Angiographic follow-up ranged between 3 and 12 months, and computed tomography angiogram follow-up ranged between 2 and 24 months. Complete aneurysm occlusion was achieved in all cases. Conclusion In our series, Pipeline deployment for the treatment of bilateral internal carotid artery aneurysms in a staged fashion is safe and feasible. Mid-term imaging follow-up showed permanent occlusion of all the treated aneurysms.

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Section: Introductionmentioning

confidence: 99%

“…3 Patients with multiple aneurysms have higher mortality and significantly poorer outcomes than those with a single aneurysm. 4…”

Section: Introductionmentioning

confidence: 99%

Mid-term follow-up of staged bilateral internal carotid artery aneurysm treatment with Pipeline embolization

et al. 2019

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“…In patients with unruptured mirror aneurysms, single-stage treatment of multiple aneurysms (if technically feasible) is advantageous to avoid second-round of general anesthesia, to eliminate the risk of rupture without delay, and to reduce hospitalization costs ( 35 ). Other reports have indicated that single-stage treatment is safe and effective in this setting ( 28 36 37 38 39 ). Cho et al ( 36 ) reported single-stage coil embolizations of 371 multiple aneurysms, performed in acceptable time intervals with few complications.…”

Section: Discussionmentioning

confidence: 91%

Intracranial Mirror Aneurysms: Anatomic Characteristics and Treatment Options

et al. 2018

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ObjectiveMirror aneurysms are generally considered as a subset of multiple aneurysms, defined as aneurysms occurring bilaterally and symmetrically on the same-named vessels. Although not infrequent, the characteristics of mirror aneurysms are not well studied. This investigation was conducted to elucidate the anatomic features of such lesions and examine treatment options.Materials and MethodsA retrospective review was conducted, aimed at 172 patients treated for 344 mirror aneurysms between January 2007 and December 2015. Aneurysms of similar nature but in asymmetric locations on the same-named vessels were excluded. All available records were examined and lesion characteristics, as well as treatment outcomes were assessed.ResultsIn study subjects (n = 172), mirror aneurysms most often involved middle cerebral artery bifurcation (n = 83), followed by a paraclinoid internal carotid artery (n = 50) and posterior communicating artery (n = 21). Most of the lesions (95.3%) measured ≤ 10 mm, and in 126 patients (74.6%), the size ratios were > 50%. Of the 344 aneurysms studied, coil embolization was undertaken in 217, surgical clipping in 62, and observation alone (no treatment) in 65. Coil embolization and surgical clipping were done bilaterally in 83 and 12 patients, respectively. In 12 patients, combined coiling and clipping were implemented on each side. Single-stage coil embolization of both the aneurysms was performed in 73 patients, with excellent post-procedural (85.6%) and follow-up (86.8%) occlusive results. There was no procedure-related morbidity or mortality.ConclusionBy adopting different treatment strategies to different configurations and vascular sources, mirror aneurysms can be safely and effectively treated. If feasible, single-stage coil embolization should be considered as a reasonable treatment option for mirror aneurysms.

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“…In cases of MIA, the risk of rupture is relatively high, all aneurysms in need of treatment should be treated as soon as possible; however, as mentioned above, there are no speci c guidelines for this process [7,16,25]. If possible, all of the aneurysms should be treated endovascularly [3,21]. However, there is no reason to avoid one stage operation if multiple lesions can be operated simultaneously [25].…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Craniotomies for Multiple Intracranial Aneurysm Clippings – One-stage Surgery with Multiple Craniotomies

Seo

Jeong

et al. 2021

Preprint

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The treatment of multiple intracranial aneurysms (MIAs) involves various modalities and sometimes requires staged operations. This study aimed to prove the efficacy and safety of one-stage multiple craniotomies (OSMC) for multiple cerebral aneurysms. We retrospectively reviewed the medical records of the patients who underwent surgical clipping of an intracranial aneurysm at Seoul National University Bundang Hospital between 2003 and April 2020. The surgical results, complications, and lengths of hospital stay were compared between the patients who underwent OSMC and those who underwent multi-stage multiple craniotomies (MSMC). The demographic characteristics of the OSMC and MSMC groups (n = 82 and 43, respectively) were similar. There were no statistically significant differences between the two groups when the amount of blood transfused, complications, and surgical results were compared (p = 0.925, p = 0.528, and p = 0.898, respectively); however, the operation time and hospitalization period (353.9 min vs. 490.3 min and 12.3 days vs. 21.8 days, respectively; p < 0.0001 for both) were shorter in the OSMC group. The treatment cost (17,000 USD vs. 22,000 USD, p < 0.0001) was lower in the OSMC group. OSMC for aneurysm clipping in patients with MIAs is a relatively safe and economical method. Furthermore, it has good clinical outcomes. This new surgical method is well worthwhile in that it can be applied to patients who are afraid to undergo multiple surgeries, and it is considered an option that can be tried for neurosurgeon who are contemplating how to treat mUIA patients.

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Single-stage endovascular treatment of multiple intracranial aneurysms with combined endovascular techniques: is it safe to treat all at once?

Cited by 22 publications

References 33 publications

Mid-term follow-up of staged bilateral internal carotid artery aneurysm treatment with Pipeline embolization

Mid-term follow-up of staged bilateral internal carotid artery aneurysm treatment with Pipeline embolization

Intracranial Mirror Aneurysms: Anatomic Characteristics and Treatment Options

Simultaneous Craniotomies for Multiple Intracranial Aneurysm Clippings – One-stage Surgery with Multiple Craniotomies

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