Posts Tagged ‘aneurysm’
Background: Aneurysmal subarachnoid hemorrhage is a disabling disease. Endovascular coiling provides minimally invasive, effective, and safe treatment of both ruptured and unruptured intracranial aneurysms. Intracranial stents have improved the endovascular treatment of complex aneurysms, but the long-term durability of this treatment modality needs clarification.
Objective: To elucidate the long-term success of intracranial stent use in the treatment of aneurysms.
Methods: Four hundred ten patients were treated with stent-assisted endovascular management of 464 aneurysms. Treatment of 363 small aneurysms, 88 large aneurysms, and 13 giant aneurysms was analyzed with respect to both long-term anatomical results using digital subtraction (DSA) and magnetic resonance angiography (MRA) over the follow-up period.
Objective: To assess the effect of stent compression on FDS porosity, evaluate the influence of single and overlapping implantation of FDS on intra-aneurysmal flow profiles, and correlate stent porosity with changes of static mean intra-aneurysmal pressure.
Methods: Intra-aneurysmal time-density curves were recorded in a pulsatile in vitro flow model before and after implantation of FDS (Pipeline Embolization Device; ev3) in seven different types of aneurysm models. Reduction of the maximum contrast inflow and time to maximum intra-aneurysmal contrast were calculated. Micro-CT was performed and compression-related FDS-porosity was measured. Influence of FDS placement on mean static intra-aneurysmal pressure was measured.
Objective: To review our experience with the treatment of these lesions.
Methods: We retrospectively reviewed all aneurysms treated at our institution between 1994 and 2005. Relevant operative notes, radiology reports, and inpatient/outpatient records were reviewed.
Objective: To describe the endoscopic anatomy of common aneurysm sites, and to compare it with the microsurgical anatomy.
Methods: Pterional, anterior interhemispheric, and subtemporal approaches to the most common aneurysm sites were examined in cadaveric heads under the surgical microscope, and with the endoscope.
Background: Computed tomographic angiography (CTA) is the first-line imaging modality used for cerebral aneurysms because of its speed and sensitivity for detection, though digital subtraction angiography is often required for more detailed aneurysm shape delineation.
Objective: To determine if a sharper CTA reconstruction kernel can better characterize an aneurysm and improve decision-making prior to intervention.
Methods: 15 patients presenting with aneurysmal subarachnoid hemorrhage underwent 64-row CTA. CTA data were reconstructed using the default H20f smooth kernel and a H60f sharp kernel and compared to contemporaneous catheter three-dimensional rotational angiography (3DRA). Aneurysm neck, width, and aspect ratio measurements were made using intensity line-plots of identical projections on all imaging datasets and compared by matched-pair statistics.
Background and Importance: Endovascular treatment of geometrically complex bifurcation aneurysms using a standard Y-configured stenting technique might be extremely difficult, particularly in aneurysms with daughter branches that acutely arise from the aneurysm sac itself. In those cases, deployment of the second stent through interstices of the first stent could be troublesome because of untoward angular changes in the vascular bifurcation prompted by angular changes resulting from placement of the first stent. Here, we describe a novel application of the buddy wire technique to facilitate Y-configured stenting in middle cerebral artery (MCA) bifurcation aneurysms with unfavorable anatomical configuration.
Clinical Presentation: A 60-year-old man with a left-sided MCA bifurcation aneurysm was treated using the buddy wire technique. In addition to the standard Y-configured stenting procedure, we also inserted a 0.014-inch exchange microguidewire into the superior daughter branch, which more acutely emanated from the sac, to attain a favorable bifurcation configuration prior to deployment of the stents in the Y-configuration. The new technique was successful, and the post-procedural course of the treatment was uneventful.