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DOI: 10.1055/s-0044-1788803
Endovascular Treatment of Ruptured Broad-Necked Intracranial Aneurysms with Double Microcatheter Technique: Case Series with Brief Review of Literature
Funding None.Abstract
Objective Treatment of ruptured broad-necked intracranial aneurysms by endovascular therapy is technically burdensome. It is commonly treated with stent- and balloon-assisted coils embolization. The aim of this study was to evaluate clinical and radiological outcomes following double micro-catheter (MC) technique.
Materials and Methods A retrospective study was done on 16 broad-necked (neck diameter ≥ 4 mm and dome-to-neck ratio < 2) ruptured intracranial aneurysms in 16 patients treated with double MC technique at our center between December 2021 and December 2023. Clinical outcome was evaluated by modified Rankin Score, postcoiling radiological outcome was evaluated by Raymond–Roy occlusion grade, and treatment-related complications were assessed.
Results There were 16 patients, 9 females and 7 males; with a mean age of 51.3 years (35–70 years). All the patients underwent dual MC coils embolization for all aneurysms. Raymond–Roy occlusion class I was achieved in 81.3% (13) cases and Raymond–Roy class II was achieved in 18.7% (3) cases immediately after the procedure. There were no serious postprocedure-related complications or recanalization of the aneurysm at the mean follow-up of 4.8 months (range 2–10 months).
Conclusion Our study presents the safety and effectiveness of double MC system for treating ruptured broad-necked intracranial aneurysm. Large numbers of studies with longer follow-up period are required to secure validity of double MC technique.
Authors' Contributions
M.K. conceived and designed the study, and responsible for data collection and manuscript writing and drafting. G.R. was responsible for editing and providing technical feedback with design and analyses.
Patients' Consent
This is a retrospective study, so informed consent was taken from the institute, and all involved participants were included in this study.
Publikationsverlauf
Artikel online veröffentlicht:
02. August 2024
© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Molyneux A, Kerr R, Stratton I. et al; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial. J Stroke Cerebrovasc Dis 2002; 11 (06) 304-314
- 2 Viñuela F, Duckwiler G, Mawad M. Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 1997; 86 (03) 475-482
- 3 Fernandez Zubillaga A, Guglielmi G, Viñuela F, Duckwiler GR. Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR Am J Neuroradiol 1994; 15 (05) 815-820
- 4 Turjman F, Massoud TF, Sayre J, Viñuela F. Predictors of aneurysmal occlusion in the period immediately after endovascular treatment with detachable coils: a multivariate analysis. AJNR Am J Neuroradiol 1998; 19 (09) 1645-1651
- 5 Hendricks BK, Yoon JS, Yaeger K. et al. Wide-neck aneurysms: systematic review of the neurosurgical literature with a focus on definition and clinical implications. J Neurosurg 2019; 133 (01) 159-165
- 6 Vallée JN, Pierot L, Bonafé A. et al. Endovascular treatment of intracranial wide-necked aneurysms using three-dimensional coils: predictors of immediate anatomic and clinical results. AJNR Am J Neuroradiol 2004; 25 (02) 298-306
- 7 Moret J, Cognard C, Weill A, Castaings L, Rey A. The “Remodelling Technique” in the treatment of wide neck intracranial aneurysms. Angiographic results and clinical follow-up in 56 cases. Interv Neuroradiol 1997; 3 (01) 21-35
- 8 De Paula Lucas C, Piotin M, Spelle L, Moret J. Stent-jack technique in stent-assisted coiling of wide-neck aneurysms. Neurosurgery 2008; 62 (5, suppl 2): ONS414-ONS416 , discussion ONS416–ONS417
- 9 Ryu CW, Park S, Shin HS, Koh JS. Complications in stent-assisted endovascular therapy of ruptured intracranial aneurysms and relevance to antiplatelet administration: a systematic review. AJNR Am J Neuroradiol 2015; 36 (09) 1682-1688
- 10 Chung J, Lim YC, Suh SH. et al. Stent-assisted coil embolization of ruptured wide-necked aneurysms in the acute period: incidence of and risk factors for periprocedural complications. J Neurosurg 2014; 121 (01) 4-11
- 11 Raymond J, Guilbert F, Weill A. et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003; 34 (06) 1398-1403
- 12 Molyneux A, Kerr R, Stratton I. et al; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002; 360 (9342): 1267-1274
- 13 Guglielmi G, Viñuela F, Duckwiler G. et al. Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 1992; 77 (04) 515-524
- 14 Tateshima S, Jones JG, Mayor Basto F, Vinuela F, Duckwiler GR. Aneurysm pressure measurement before and after placement of a Pipeline stent: feasibility study using a 0.014 inch pressure wire for coronary intervention. J Neurointerv Surg 2016; 8 (06) 603-607
- 15 Kwon OK, Kim SH, Oh CW. et al. Embolization of wide-necked aneurysms with using three or more microcatheters. Acta Neurochir (Wien) 2006; 148 (11) 1139-1145 , discussion 1145
- 16 Phatouros CC, Halbach VV, Malek AM, Dowd CF, Higashida RT. Simultaneous subarachnoid hemorrhage and carotid cavernous fistula after rupture of a paraclinoid aneurysm during balloon-assisted coil embolization. AJNR Am J Neuroradiol 1999; 20 (06) 1100-1102
- 17 Soeda A, Sakai N, Sakai H. et al. Thromboembolic events associated with Guglielmi detachable coil embolization of asymptomatic cerebral aneurysms: evaluation of 66 consecutive cases with use of diffusion-weighted MR imaging. AJNR Am J Neuroradiol 2003; 24 (01) 127-132
- 18 Raymond J, Roy D, Leblanc P. et al. Endovascular treatment of intracranial aneurysms with radioactive coils: initial clinical experience. Stroke 2003; 34 (12) 2801-2806
- 19 Layton KF, Cloft HJ, Gray LA, Lewis DA, Kallmes DF. Balloon-assisted coiling of intracranial aneurysms: evaluation of local thrombus formation and symptomatic thromboembolic complications. AJNR Am J Neuroradiol 2007; 28 (06) 1172-1175
- 20 Benitez RP, Silva MT, Klem J, Veznedaroglu E, Rosenwasser RH. Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils. Neurosurgery 2004; 54 (06) 1359-1367 , discussion 1368
- 21 Fiorella D, Albuquerque FC, Han P, McDougall CG. Preliminary experience using the Neuroform stent for the treatment of cerebral aneurysms. Neurosurgery 2004; 54 (01) 6-16 , discussion 16–17
- 22 Lubicz B, François O, Levivier M, Brotchi J, Balériaux D. Preliminary experience with the enterprise stent for endovascular treatment of complex intracranial aneurysms: potential advantages and limiting characteristics. Neurosurgery 2008; 62 (05) 1063-1069 , discussion 1069–1070
- 23 Yahia AM, Gordon V, Whapham J, Malek A, Steel J, Fessler RD. Complications of Neuroform stent in endovascular treatment of intracranial aneurysms. Neurocrit Care 2008; 8 (01) 19-30
- 24 Dos Santos Souza MP, Agid R, Willinsky RA. et al. Microstent-assisted coiling for wide-necked intracranial aneurysms. Can J Neurol Sci 2005; 32 (01) 71-81
- 25 Yoon PH, Lee JW, Lee YH, Kwon YS, Yang KH. Dual microcatheter coil embolization of acutely ruptured wide-necked intracranial aneurysms. Interv Neuroradiol 2017; 23 (05) 477-484
- 26 Lee JY, Seo JH, Cho YD, Kang HS, Han MH. Endovascular treatment of wide-neck intracranial aneurysms using a microcatheter protective technique: results and outcomes in 75 aneurysms. AJNR Am J Neuroradiol 2011; 32 (05) 917-922
- 27 Durst CR, Starke RM, Gaughen Jr JR. et al. Single-center experience with a dual microcatheter technique for the endovascular treatment of wide-necked aneurysms. J Neurosurg 2014; 121 (05) 1093-1101
- 28 Xu X, Zheng Y, Wang D, Cui J, Shang X. Improved endovascular coiling of wide-neck intracranial aneurysms in elderly patients by double-microcatheter technique. Cell Biochem Biophys 2015; 71 (03) 1281-1286