We report our two-year experience in the endovascular treatment of brain aneurysms in relation to their parent artery wall. We prospectively recorded patients with intracranial aneurysms (107 ruptured - 38 unruptured) treated with coiling during a two-year period: 145 patients, 94 females and 51 males - mean age 56 years. The aneurysms were divided into side-wall (A) and bifurcation (B) groups. A total occlusion rate was noted in post-embolization angiograms in 101 aneurysms (70%) with a morbidity of 4%. No angiographic recurrence arose in the six-month follow-up. The two groups had a similar total occlusion rate (68.31% and 71.8% respectively), while the complication rate was 3% in group A and 4.7% in group B. Significant differences between the two groups were noted in the number of assisted coiling cases: 28 out of 60 cases (46.7%) in group A - 14 out of 85 cases (16.5%) in group B. Further statistical analysis showed strong dependencies for the type of endovascular procedure between the ruptured and unruptured aneurysms in both groups (p 0.000<0.05), but no dependencies between the aneurysm occlusion rate and the ruptured or non-ruptured aneurysms, or between the occlusion rate and the type of endovascular procedure (p 0.552 >0.05 and 0.071 >0.05 respectively). In conclusion, the anatomic relation of the aneurysm sac with the wall of the parent artery is important, as significant differences in endovascular practice, devices and techniques were noted between side-wall and bifurcation aneurysms.
GuglielmiGViñuelaFSepetkaI. Electrothrombosis of saccular aneurysms via endovascular approach. Part I: Electrochemical basis, technique, and experimental results. J Neurosurg. 1991; 75: 1–7.
2.
GuglielmiGViñuelaFDionJ. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg. 1991; 75: 8–14.
3.
MolyneuxAKerrRStrattonI. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet. 2002; 360: 1267–1274.
4.
MolyneuxAJKerrRSYuLM. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005; 366: 809–817.
5.
HanelRALopesDKWehmanJC. Endovascular treatment of intracranial aneurysms and vasospasm after aneurysmal subarachnoid hemorrhage. Neuroendovascular Surgery. Neurosurgery Clinics of North America. 2005; 16 (2): 317–353.
6.
BrinjikjiWRabinsteinAANasrDM. Better Outcomes with Treatment by Coiling Relative to Clipping of Unruptured Intracranial Aneurysms in the United States, 2001–2008. Am J Neuroradiol. 2011; 32: 1071–1075.
7.
MassoudTFGuglielmiGViñuelaF. Experimental models of bifurcation and terminal aneurysms: constructive techniques in swine. Neuroradiology. 1994; 15: 938–944.
8.
YoshinoYNiimiYSongJK. Endovascular treatment of intracranial aneurysms: comparative evaluation in a terminal bifurcation aneurysm model in dogs. J Neurosurg. 2004; 101 (6): 996–1003.
9.
BouzeghraneFNaggaraOKallmesDF. International Consortium of Neuroendovascular Centres: In vivo experimental intracranial aneurysm models: a systematic review. Am J Neuroradiol. 2010; 31 (3): 418–23.
10.
GravesVStrotherCPartingtonC. Flow dynamics of lateral carotid artery aneurysms and their effects on coils and balloons: an experimental study in dogs. Am J Neuroradiol. 1992; 13: 189–196.
LiouTMLiouSN. A review of haemodynamic characteristics in terminal and lateral aneurysm models. Proc Natl Sci Counc Repub China B.1999; 23 (4): 133–148.
13.
GrodenCLaudanJGatchellS. Three-dimensional flow simulation before and after endovascular coil embolization of a terminal cerebral aneurysm. J Cereb Blood Flow Metab. 2001; 21: 1464–1471.
14.
FergusonGG. Physical factors in initiation, growth and rupture of human intracranial saccular aneurysms. J Neurosurg. 1972; 37: 666–677.
15.
OtaniNTakasatoYMasaokaH. Clinical and radiological findings and surgical management of ruptured aneurysms at the non-branching sites of the internal carotid artery. J Clin Neurosci. 2009; 16 (8): 1018–1023.
16.
JuvelaSPoussaKPorrasM. Factors affecting formation and growth of intracranial aneurysms: a long-term follow-up study. Stroke. 2002; 32: 485–491.
17.
ByrneJSohnMJMolyneuxAJ. Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding. J Neurosurg. 1999; 90: 656–663.
18.
CognardCWeillASpelleL. Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology. 1999; 212: 348–356.
MoretJCognardCWeillA. The “Remodelling Technique” in the treatment of wide-necked intracranial aneurysms. Angiographic results and clinical follow-up in 56 cases. Interv Neuroradiol. 1997; 3 (1): 21–35.
22.
MoretJCognardCWeillA. Reconstruction technique in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases. J Neuroradiol. 1997; 24: 30–44.
23.
LefkowitzMAGobinYPAkibaY. Balloon-assisted Guglielmi detachable coiling of wide-necked aneurysma: Part II - Clinical results. Neurosurgery. 1999; 45 (3): 531–537; discussion 537–538.
24.
LubiczBLefrancFBruneauM: Balloon-assisted coiling of intracranial aneurysms is not associated with a higher complication rate. Neuroradiology. 2008; 50 (9): 769–776.
25.
NelsonPKLevyDI. Balloon-assisted coil embolization of wide-necked aneurysms of the internal carotid artery: medium-term angiographic and clinical follow-up in 22 patients. Am J Neuroradiol. 2001; 22: 19–26.
26.
RossIBDhillonGS. Balloon assistance as a routine adjunct to the endovascular treatment of cerebral aneurysms. Surg Neurol. 2006; 66 (6): 593–601; discussion 601–602.
27.
ShapiroMBabbJBecskeT. Safety and efficacy of adjunctive balloon remodeling during endovascular treatment of intracranial aneurysms: a literature review. Am J Neuroradiol. 2008; 29 (9): 1777–1781.
28.
PiotinMIijimaAWadaH. Increasing the packing of small aneurysms with complex-shaped coils: an in-vitro study. Am J Neuroradiol. 2003; 24: 1446–1448.
29.
TurkASLutyCMGrumK. Comparison of platinum and first-generation Matrix coils in under-packed canine side-wall aneurysms: evaluation of progressive thrombosis. Neuroradiology. 2007; 49 (11): 939–945.
30.
AkpekSAratAMorsiH. Self-expandable stentassisted coiling of wide-necked intracranial aneurysms: a single-center experience. Am J Neuroradiol. 2005; 26: 1223–1231.
31.
FiorellaDAlbuquerqueFCHanP. Preliminary experience using the Neuroform stent for the treatment of cerebral aneurysms. Neurosurgery. 2004; 54: 6–16.
32.
HigashidaRTHalbachVVDowdCF. Initial clinical experience with a new self-expanding nitinol stent for the treatment of intracranial cerebral aneurysms: the Cordis Enterprise. Am J Neuroradiol. 2005; 26: 1751–1756.
33.
KellyMETurnerRGonuguntaV. Stent reconstruction of wide-necked aneurysms across the circle of Willis. Neurosurgery. 2007; 61 (Suppl 2): 249–254; discussion 254–255.
LubiczBCollignonLRaphaeliG. Solitaire stent for endovascular treatment of intracranial aneurysms: Immediate and mid-term results in 15 patients with 17 aneurysms. J Neuroradiol. 2010; 37 (2): 83–88.
36.
NelsonPKSahleinDShapiroM. Recent steps toward a reconstructive endovascular solution for the orphaned, complex-neck aneurysm. Neurosurgery. 2006; 59 5 (Suppl 3): S77–S92; discussion S3-S13.
37.
PiotinMBlancRSpelleL. Stent-assisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms. Stroke. 2010; 41 (1): 110–115.
38.
NelsonPKLylykPSzikoraI. The pipeline embolization device for the intracranial treatment of aneurysms trial. Am J Neuroradiol. 2011; 32 (1): 34–40.
39.
KurreWBerkefeldL. Materials and techniques for coiling of cerebral aneurysms: how much scientific evidence do we have?Neuroradiology. 2008; 50 (11): 909–927.
40.
BurlesonAStrotherCTurittoV. Computer modelling of intracranial saccular and lateral aneurysms and the study of their haemodynamics. Am J Neuroradiol. 1995; 37 (4): 774–784.
41.
CebralJRCastroMABurgessJE. Characterization of cerebral aneurysms for assessing risk of rupture by using patient-specific computational hemodynamics models. Am J Neuroradiol. 2005; 26 (10): 2550–2559.
42.
HoiYMengHWoodwardSH. Effects of arterial geometry one aneurysm growth: three-dimensional computational fluid dynamics. J Neurosurg. 2004; 4:676–681.
43.
MitsosAPKakalisNMVentikosYP. Haemodynamic simulation of aneurysm coiling in an anatomically accurate computational fluid dynamics model: technical note. Neuroradiology. 2008; 50 (4): 341–347.
44.
HopJWRinkelGJAlgraA. Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke. 1997; 28: 660–664.
45.
RinkelGJDjibutiMAlgraA. Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke. 1998; 29: 251–256.
46.
AlbayramSSelcukHKaraB. Thromboembolic events associated with balloon-assisted coil embolisation: evaluation with diffusion-weighted MR imaging. Am J Neuroradiol. 2004; 25 (10): 1768–1777.
47.
BrooksNPTurkASNiemannDB. Frequency of thromboembolic events associated with endovascular aneurysm treatment: retrospective case series. J Neurosurg. 2008; 108 (6): 1095–1100.
48.
CampiARamziNMolyneuxAJ. Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke. 2007; 38 (5): 1538–1544.
