H. Saruhan Cekirge

Immediate and midterm follow-up results of using an electrodetachable, fully retrievable SOLO stent system in the endovascular coil occlusion of wide-necked cerebral aneurysms

OBJECT Stent-assisted embolization is an alternative endovascular treatment method for wide-necked intracranial aneurysms. Currently available stents have the limitations of poor radial force, difficult delivery systems, and lack of full retrievability. The authors report on their preliminary experience with the use of a new, fully retrievable, self-expanding neurovascular stent, which has a high radial force and easy delivery system, combined with coil or Onyx embolization for the treatment of wide-necked aneurysms, including 6-month follow-up data. METHODS Fifteen patients with 18 wide-necked intracranial aneurysms were treated using the SOLO stent system and detachable platinum coils. Aneurysms were located at the posterior communicating artery (seven lesions), midbasilar artery (one lesion), internal carotid artery (ICA) bifurcation (one lesion), ICA-ophthalmic artery segment (eight lesions), and posterior cerebral artery (one lesion). Eleven aneurysms were small, six were large, and one was giant. Only one of these aneurysms was in the acute stage of subarachnoid hemorrhage; balloon remodeling alone failed to keep the coils in the aneurysm sac. RESULTS Only one stent required retrieving and repositioning after it had been fully deployed, and retrieval was easy and successful. No thromboembolic complication, dissection/rupture, or vasospasm occured during stent placement. Follow-up angiograms obtained at 6 months posttreatment in the 18 aneurysms demonstrated that all stents were patent with no evidence of intimal hyperplasia or stenosis. In all cases but one, 100% lesion occlusion was observed at the 6-month control angiography examination. Only one aneurysm had recanalized. CONCLUSIONS The fully retrievable self-expandible SOLO stent is a feasible, secure, and effective system with a high radial force and ease of delivery in treating wide-necked intracranial aneurysms in combination with coil embolization.

WingSpan Stent System in the endovascular treatment of intracranial aneurysms: clinical experience with midterm follow-up results

OBJECT The WingSpan stent is a new self-expandable neurovascular stent designed for endovascular treatment of intracranial atheromatous lesions. The authors report their experience with the use of this stent for the endovascular treatment of intracranial aneurysms. METHODS Thirty-seven patients with 40 wide-necked intracranial aneurysms were treated using the WingSpan stent. Twenty-two aneurysms (55%) were small and 18 (45%) were large or giant. In all but 4 aneurysms, embolization was completed by packing the aneurysm sac with platinum coils. In 4 dissecting aneurysms that were fusiform or too small and wide necked to be catheterized, the stent was used alone. In these cases, the stent bridged the aneurysm neck to allow for flow redirection and the potential stent-induced endothelization effect. RESULTS Follow-up angiograms obtained in 3 of 4 aneurysms, treated with only stent placement, demonstrated aneurysmal thrombosis and parent artery remodeling in 2 patients and moderate decrease in size in 1. Follow-up angiography obtained at 6 months to 1 year in 31 aneurysms after stent-supported coil embolization demonstrated complete occlusion in 23 aneurysms (74.2%) with a progressive thrombosis rate of 66.7% (10 of 15 aneurysms), and a recanalization rate of 16.1%. CONCLUSIONS In treating wide-necked intracranial aneurysms, the WingSpan Stent System is very flexible, secure, and effective. Its delivery system is very easy and exact in that it exerts higher outward radial force, thus providing an excellent conformability and a strong scaffold to hold the coils in place. It may offer an effective treatment when used alone in some fusiform or very wide-necked, small dissecting aneurysms in which other surgical or endovascular treatment strategies are not deemed feasible.

Comparison of bioactive coils and bare platinum coils for treatment of intracranial aneurysms: a matched-pair analysis

OBJECT The primary goal of this matched-pair analysis was to evaluate the durability of the treatment results with Cerecyte coils in comparison with that of bare platinum coils in terms of angiographic occlusion rates at follow-up. METHODS Eighty aneurysms treated with Cerecyte coils were included in this study to carry out a matched-pair analysis. Every aneurysm treated with Cerecyte coils was matched with an aneurysm treated with bare platinum coils. Matching of the aneurysms was done according to the aneurysm size, location, neck size, initial occlusion grade, and clinical presentation. RESULTS The initial treatment results were similar in both groups as part of a matching protocol. Subgroup analysis revealed a significant difference in the durability of occlusion in aneurysms that showed Raymond Class I obliteration on follow-up angiograms (69 [86.2%] in the Cerecyte group vs 51 [63.8%] in the control group, p = 0.002). Further thrombosis to Raymond Class I occlusions was higher in the Cerecyte group (17 [77.3%] of 22 vs 8 [36.4%] of 22 aneurysms). CONCLUSIONS Cerecyte coils provide further thrombosis and more durable results than bare platinum coils following coil embolization of cerebral aneurysms.

Endovascular treatment of an ''anterior cerebral artery'' aneurysm in a patient with ''embryonic unfused middle cerebral artery'' anomaly: a case report

We report a unique case of an anterior cerebral artery aneurysm in a patient with embryonic unfused middle cerebral artery anomaly. The arterial twigs of the middle cerebral artery supply the entire middle cerebral artery territory including the lenticulostriate branches. There was a vessel incorporated into the aneurysm, which was referred to as an accessory middle cerebral artery and it gave rise to a lenticulostriate branch. The aneurysm was occluded with detachable coils using a remodeling technique. After successful occlusion of the aneurysm the so-called accessory middle cerebral artery including its lenticulostriate branch started to fill from the anomalous middle cerebral artery network and the patient did not experience any ischemic injury.

Placement of Mechanically Detachable Spiral Coils in the Endovascular Treatment of Intracranial Aneurysms. Work in Progress

PURPOSE To determine the usefulness of mechanically detachable spiral tungsten coils (MDSs) in the endovascular, endosaccular occlusion of intracranial aneurysms. MATERIALS AND METHODS Anterior communicating artery aneurysms shown at angiography in two patients and a basilar tip aneurysm shown in one patient were treated with MDSs. RESULTS In the basilar artery aneurysm, eight coils were delivered. Two additional coils were placed at 3 months because of filling of the residual aneurysm neck. Angiography at 1 year showed no recanalization. The smaller aneurysm in the anterior communicating artery was totally occluded by a single coil. Angiography at 6 months showed no recanalization. The other aneurysm was occluded by two coils, with a small amount of residual filling. A third coil was withdrawn before detachment. The patient had aspiration pneumonia and electrolyte imbalance, but he was in stable condition 3 weeks later and was discharged. CONCLUSION The pliable, soft, retrievable MDS system provides instantaneous release of a spiral coil.

COMPARISON OF MR SEQUENCES IN EARLY CEREBRAL INFARCTION AT 0.5 T

PURPOSE To compare the diagnostic values of fluid-attenuated inversion recovery (FLAIR) and gradient spin-echo (GRASE) with those of conventional spin-echo (SE) and fast SE T2-weighted sequences in the evaluation of acute cerebrovascular lesions at 0.5 T. MATERIAL AND METHODS Twenty-two consecutive patients with the clinical diagnosis of acute cerebrovascular accident were examined by MR imaging within the first 48 h of ictus. MR examination included 5-mm axial conventional SE and turbo SE (TSE) T2-weighted, dual-echo GRASE and FLAIR sequences. The patients also had pre- and postcontrast T1-weighted axial images. Two examiners evaluated the images and scored the conspicuity of the acute lesions. RESULTS Regardless of location, FLAIR provided the best lesion conspicuity in the detection of acute infarcts, followed by the GRASE sequence. In the posterior fossa, TSE and SE demonstrated the lesions better than GRASE and FLAIR techniques. In the detection of hemorrhagic elements within the ischemic region, TSE demonstrated statistically significant superiority over other sequences. CONCLUSION In the detection of acute ischemic lesions in locations other than the posterior fossa, FLAIR provided the best lesion conspicuity among four T2-weighted sequences, including SE, TSE, GRASE and FLAIR. However, for the posterior fossa examination, preference of SE or TSE T2-weighted sequences is suggested.

Delayed thrombosis of a complex fusiform ICA aneurysm treated with flow reversal and partial occlusion: case report and brief review of possible mechanisms

Immediate complete occlusion of complex cerebral aneurysms associated with perforating or major branch arteries may cause serious ischemic complications due to poor collateral supply. Flow reversal with concomitant proximal occlusion is an important therapeutic strategy in clinical practice and induces gradual thrombosis in the aneurysm within weeks or months, providing a time window for collateral progression. Herein, we report a case of delayed thrombosis of a complex fusiform aneurysm of the ICA following flow reversal with EC-IC bypass and concomitant partial coiling with parent artery occlusion. The effects of hemodynamic alterations on collateral circulation and intra-aneurysmal thrombosis are briefly discussed in the light of the literature.