Usefulness of a Simplified Management Scheme for Paraclinoid Aneurysms Based on a Modified Classification

Chen, Lukui; Kato, Yoshihiro; Karagiozov, Kostadin; Yoneda, Minoru; Imizu, Shuei; Hayakawa, Masayuki; Sadato, Akiyo; Irie, Keiko; Negoro, Makoto; Sano, Hirotoshi

doi:10.1159/000151679

Cited by 14 publications

(2 citation statements)

References 85 publications

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“…Final occlusion rates in this series were in line with the reported range for these aneurysms of 50% to 88%. [5][6][7][8][9][10][11][12][13][14][15] With current coil techniques (with or without adjuncts such as balloons and stents), treatment of most small paraclinoid aneurysms is very safe, as we have observed a very low incidence of permanent morbidity and no mortality in our series. Technical complications (including intraprocedural perforation in 5 patients) are not uncommon but did not affect outcome.…”

Section: Discussionmentioning

confidence: 56%

Coiling for Paraclinoid Aneurysms: Time to Make Way for Flow Diverters?

D’Urso¹,

Karadeli²,

Kallmes

et al. 2012

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Paraclinoid aneurysms represent challenging lesions for which endovascular techniques have gained widespread application in their treatment. A new endovascular strategy, flow diversion, is gaining importance in the treatment of these aneurysms. Before embracing flow diversion in larger numbers of patients with paraclinoid aneurysms, it is important to know the safety and efficacy of "traditional" endovascular methods for these aneurysms. We review complications and outcomes of patients with unruptured paraclinoid aneurysms treated with coils, with or without balloon and stent assistance, over the past 12 years at our institution.

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Section: Discussionmentioning

confidence: 56%

Coiling for Paraclinoid Aneurysms: Time to Make Way for Flow Diverters?

D’Urso¹,

Karadeli²,

Kallmes

et al. 2012

AJNR Am J Neuroradiol

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“…Data on each patient’s age, sex, aneurysm location, aneurysm projection, aneurysm size, aneurysm condition (ruptured or unruptured), packing ratio and thromboembolic complication were reviewed. The location of aneurysm was classified into three titles according to Chen’s modified classification 3) : group I (supra-ophthalmic), group II (ophthalmic), and group III (infra-ophthalmic). Group I consisted of aneurysm with necks arising from the supra-ophthalmic segment of the ICA.…”

Section: Methodsmentioning

confidence: 99%

Simple Coiling versus Stent-Assisted Coiling of Paraclinoid Aneurysms : Radiological Outcome in a Single Center Study

Kim

Park

et al. 2017

J Korean Neurosurg Soc

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ObjectiveParaclinoid aneurysms are a group of aneurysms arising at the distal internal carotid artery. Due to a high incidence of small, wide-necked aneurysms in this zone, it is often challenging to achieve complete occlusion when solely using detachable coils, thus stent placement is often required. In the present study, we aimed to investigate the effect of stent placement in endovascular treatment of paraclinoid aneurysms.MethodsData of 98 paraclinoid aneurysms treated by endovascular approach in our center from August 2005 to June 2016 were retrospectively reviewed. They were divided into two groups: simple coiling and stent-assisted coiling. Differences in the recurrence and progressive occlusion between the two groups were mainly analyzed. The recurrence was defined as more than one grade worsening according to Raymond-Roy Classification or major recanalization that is large enough to permit retreatment in the follow-up study compared to the immediate post-operative results.ResultsComplete occlusion was achieved immediately after endovascular treatment in eight out of 37 patients (21.6%) in the stent-assisted group and 18 out of 61 (29.5%) in the simple coiling group. In the follow-up imaging studies, the recurrence rate was lower in the stent-assisted group (one out of 37, 2.7%) compared to the simple coiling group (13 out of 61, 21.3%) (p=0.011). Multivariate logistic regression model showed lower recurrence rate in the stent-assisted group than the simple coiling group (odds ratio [OR] 0.051, 95% confidence interval [CI] 0.005–0.527). Furthermore there was also a significant difference in the rate of progressive occlusion between the stent-assisted group (16 out of 29 patients, 55.2%) and the simple coiling group (10 out of 43 patients, 23.3%) (p=0.006). The stent-assisted group also exhibited a higher rate of progressive occlusion than the simple coiling group in the multivariate logistic regression model (OR 3.208, 95% CI 1.106–9.302).ConclusionUse of stents results in good prognosis not only by reducing the recurrence rate but also by increasing the rate of progressive occlusion in wide-necked paraclinoid aneurysms. Stent-assisted coil embolization can be an important treatment strategy for paraclinoid aneurysms when considering the superiority of long term outcome.

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