Coil Embolization Of Intracranial Aneurysms Research Articles

Factors predicting recanalization following stent-assisted coil embolization of unruptured intracranial aneurysms with long-term follow-up.

Stents have been widely used for coil embolization for intracranial aneurysms. Few studies have analyzed the risk factors of recanalization through long-term follow-up observation of only stent-assisted coiling. We analyzed the risk factors for recanalization through long-term observations. A total number of 399 unruptured aneurysms treated by stent-assisted coil embolization between 2003 and 2016 in a single institution were analyzed for determining the factors associated with recanalization including the patient characteristics, aneurysms, and procedural variables. All patients underwent angiographic follow-up with digital subtraction angiography or magnetic resonance angiography at 24 months or more following the procedure. Recanalization occurred in 8%. The mean time for the recanalization was 21.1 ± 14.0 months (range, 5-51 months). The receiver operating characteristic curve analysis indicated areas under the curve for a maximum aneurysm size of 0.773 (cut-off, 6.415 mm). Multivariate analysis revealed that the maximum aneurysm size and parent artery curvature at which the aneurysm developed were significantly associated with recanalization. In parent artery curvature, the bifurcation group (OR, 9.02; 95% CI, 2.53-32.13; p = 0.001) and the convex group (OR, 3.68; 95% CI, 1.17-11.50; p = 0.025) were independent predictors of recanalization compared with the straight group. The maximum aneurysm size and parent artery curvature are risk factors associated with recanalization in stent-assisted coil embolization.

Safety and efficacy of the novel Alpha stent for the treatment of intracranial wide-necked aneurysm

The Alpha stent is an intracranial closed-cell stent with a unique mesh design to enhance wall apposition. It recently underwent structural modifications to facilitate easier stent deployment. This study aimed to evaluate the safety and efficacy of stent-assisted coil embolization for unruptured intracranial aneurysms using the Alpha stent. Between January 2021 and November 2021, 35 adult patients with 35 unruptured intracranial aneurysms in the distal internal carotid artery were prospectively enrolled. For efficacy outcomes, magnetic resonance angiography at the 6-month follow-up was evaluated using the Raymond-Roy occlusion classification (RROC). The safety outcome evaluated the occurrence of symptomatic procedure-related neurological complications up to 6 months postoperatively. Technical success was achieved in 34/35 (97.1%). Six months postoperatively, aneurysm occlusion showed RROC I in 32/35 (91.4%) and RROC II in 3/35 (8.6%) patients. Procedure-related neurologic complications occurred in one patient (2.9%) who experienced hemiparesis due to acute lacunar infarction, which resulted in a 6-month mRS score of 1. The Alpha stent demonstrated excellent efficacy and safety outcomes in stent-assisted coil embolization of unruptured distal ICA aneurysms. The recent structural modifications allowed for easier stent delivery and deployment.Clinical trial registration number: KCT0005841; registration date: 28/01/2021.

The white-collar sign after Neuroform Atlas stent-assisted coil embolization of unruptured intracranial aneurysms.

Although stent-assisted technique is expected to help provide a scaffold for neointima formation at the orifice of the aneurysm, not all aneurysms treated with stent-assisted technique develop complete neointima formation. The white-collar sign (WCS) indicates neointimal tissue formation at the aneurysm neck that prevents aneurysm recanalization. The aim of this study was to explore factors related to WCS appearance after stent-assisted coil embolization of unruptured intracranial aneurysms (UIAs). A total of 59 UIAs treated with a Neuroform Atlas stent were retrospectively analyzed. The WCS was identified on digital subtraction angiography (DSA) 1year after coil embolization. The cohort was divided into WCS-positive and WCS-negative groups, and possible predictors of the WCS were explored using logistic regression analysis. The WCS appeared in 20 aneurysms (33.9%). In the WCS-positive group, neck size was significantly smaller (4.2 (interquartile range (IQR): 3.8-4.6) versus 5.4 (IQR: 4.2-6.8) mm, p = .006), the VER was significantly higher (31.8% (IQR: 28.6%-38.4%) versus 27.6% (IQR: 23.6%-33.8%), p = .02), and the rate of RROC class 1 immediately after treatment was significantly higher (70% vs 20.5%, p < .001) than in the WCS-negative group. On multivariate analysis, neck size (odds ratio (OR): 0.542, 95% confidence interval (CI): 0.308-0.954; p = .03) and RROC class 1 immediately after treatment (OR: 6.99, 95% CI: 1.769-27.55; p = .006) were independent predictors of WCS appearance. Smaller neck size and complete occlusion immediately after treatment were significant factors related to WCS appearance in stent-assisted coil embolization for UIAs using the Neuroform Atlas stent.

Clopidogrel versus newer P2Y12 inhibitors in the dual antiplatelet therapy for stent-assisted coil embolization of intracranial aneurysms: A meta-analysis.

Stent-assisted coil embolization (SACE) for cerebral aneurysms requires dual antiplatelet therapy (DAPT), commonly clopidogrel plus aspirin is preferable to ticagrelor or prasugrel plus aspirin. However, there are few studies assessing the safety of the association of ticagrelor or prasugrel plus aspirin. Compare the safety of newer P2Y12 inhibitors with clopidogrel in patients that underwent a SACE for cerebral aneurysms. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we searched PubMed and Embase for studies comparing newer P2Y12 inhibitors with clopidogrel in patients undergoing DAPT for SACE. Outcomes were total number of complications, number of hemorrhagic complications, and number of thromboembolic complications both intraoperative and follow-up. A random effects model was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs). We included 1026 patients from six studies. Newer P2Y12 inhibitors were used in 562 (54,77%) patients. There were no significant differences between groups in total number of complications (OR 0.80; 95% CI 0.32, 1.99; p < 0.01; I2 = 78%), in intraoperative hemorrhagic complications (OR 0.66; 95% CI 0.09, 4.71; p = 0.68; I2 = 0%), follow-up hemorrhagic complications (OR 1.23; 95% CI 0.70, 2.15; p = 0.49; I2 = 0%), intraoperative thromboembolic complications (OR 0.43; 95% CI 0.14, 1.35; p = 0.25; I2 = 24%), and in follow-up thromboembolic complications (OR 0.89; 95% CI 0.33, 2.39; p = 0.03; I2 = 59%). In patients who underwent a SACE, newer P2Y12 inhibitors showed no differences in intraoperative and follow-up complications compared with clopidogrel.

Risk factors and management of intraprocedural rupture during coil embolization of unruptured intracranial aneurysms: role of balloon guiding catheter.

Intraprocedural rupture (IPR) is a serious complication of endovascular coil embolization of unruptured intracranial aneurysms (UIAs). Although outcomes after IPR are poor, methods to prevent subsequent neurological deterioration have not yet been investigated. We evaluated the risk factors and management strategies for IPR, particularly the role of balloon guiding catheters (BGCs) in rapid hemostasis. We retrospectively reviewed all UIA cases treated with coil embolization at three institutions between 2003 and 2021, focusing on preoperative radiological data, operative details, and outcomes. In total, 2,172 aneurysms were treated in 2026 patients. Of these, 19 aneurysms in 19 patients (0.8%) ruptured during the procedure. Multivariate analysis revealed that aneurysms with a bleb (OR: 3.03, 95% CI: 1.21 to 7.57, p = 0.017), small neck size (OR: 0.56, 95% CI: 0.37 to 0.85, p = 0.007), and aneurysms in the posterior communicating artery (PcomA) (OR: 4.92, 95% CI: 1.19 to 20.18, p = 0.027) and anterior communicating artery (AcomA) (OR: 12.08, 95% CI: 2.99 to 48.79, p < 0.001) compared with the internal carotid artery without PcomA were significantly associated with IPR. The incidence of IPR was similar between the non-BGC and BGC groups (0.9% vs. 0.8%, p = 0.822); however, leveraging BGC was significantly associated with lower morbidity and mortality rates after IPR (0% vs. 44%, p = 0.033). The incidence of IPR was relatively low. A bleb, small aneurysm neck, and location on PcomA and AcomA are independent risk factors for IPR. The use of BGC may prevent fatal clinical deterioration and achieve better clinical outcomes in patients with IPR.

Risk factor analyses of contrast leakage and contrast-induced encephalopathy following coil embolization for unruptured intracranial aneurysm

BackgroundContrast-induced encephalopathy (CIE) following endovascular interventions is a rare but serious complication. This study aimed to investigate the risk factors of contrast leakage (CL) and CIE in patients who underwent...

Feasibility and safety values of activated clotting time-guided systemic heparinization in coil embolization for unruptured intracranial aneurysms.

This study aimed to evaluate the feasibility and safety values of activated clotting time (ACT)-guided systemic heparinization in reducing periprocedural thrombosis and bleeding complications during coil embolization of unruptured intracranial aneurysms. A total of 228 procedures performed on 213 patients between 2016 and 2021 were included in the retrospective analysis. The target ACT was set at 250 s. Logistic regression was performed to assess predictors for the occurrence of thrombosis and bleeding. Receiver operating characteristic (ROC) analyses were employed to determine the optimal cut-off values for ACT, heparinization, and procedure time. Most (85.1%) of procedures were stent-assisted embolization. The mean baseline ACT was 128.8 ± 45.7 s. The mean ACT at 20 min after the initial intravenous heparin loading of 78.2 ± 18.8 IU/kg was 185 ± 46.4 s. The mean peak ACT was 255.6 ± 63.8 s with 51.3% (117 cases) achieving the target ACT level. Peak ACT was associated with symptomatic thrombosis (OR per second, 1.008; 95% CI, 1.000-1.016; P = 0.035) (cut-off value, 275 s; area under ROC (AUROC), 0.7624). Total administered heparin dose per body weight was negatively associated with symptomatic thrombosis (OR per IU/kg, 0.972; 95% CI, 0.949-0995; P = 0.018) (cut-off value, 294 IU/kg; AUROC, 0.7426) but positively associated with significant bleeding (OR, 1.008 per IU/kg; 95% CI, 1.005-1.012; P <0 .001) (cut-off value, 242 IU/kg; AUROC, 0.7391). Procedure time was significantly associated with symptomatic thrombosis (OR per minute, 1.05; 95% CI, 1.017-1.084; P value = 0.002) (cut-off value, 158 min; area under ROC, 0.8338). This study demonstrated that ACT-guided systemic heparinization was feasible to achieve the target ACT value and proposes probable safety thresholds to prevent periprocedural complications through reducing procedure time during coil embolization of unruptured intracranial aneurysms in the stent era.

Comparison of treatment outcomes and complications of coil embolization in elderly and very elderly patients with cerebral aneurysms: a propensity score matching analysis.

This single center study aims to compare the treatment outcomes and procedure-related complications of coil embolization in elderly patients (60-79 years) and very elderly patients (aged 80 years or older) with cerebral aneurysms. Data was collected from 504 elderly patients aged 60 years or older who underwent coil embolization for intracranial aneurysms from 2018 to 2021. The study evaluated patient-related and anatomical factors and assessed various outcomes, comparing results between groups using statistical analysis and propensity score matching. A total of 503 cerebral aneurysms were analyzed from individuals aged 60-79 years (n = 472) and those aged 80 years or older (n = 31). The majority of the aneurysms were unruptured with an average size of 3.5 mm in height and 3.4 mm in width. The patients were compared using 1:1 propensity score matching, and no significant differences were found in factors other than age and aortic elongation. Logistic analysis revealed that being over 80 years old and having a severe aortic arch elongation were identified as risk factors for procedure-related events in both total and unruptured cases. The study compared coil embolization treatment for cerebral aneurysms in patients aged 60-79 and over 80, finding no significant difference in treatment outcomes except for procedure-related events. Procedure-related events were associated with severe aortic arch elongation and being over 80 years old. Coil embolization can be considered safe and effective for patients over 80, but further trials are needed for accurate conclusions.

A deep-learning system to help make the surgical planning of coil embolization for unruptured intracranial aneurysms

BackgroundCoil embolization is a common method for treating unruptured intracranial aneurysms (UIAs). To effectively perform coil embolization for UIAs, clinicians must undergo extensive training with the assistance of senior physicians over an extended period. This study aimed to establish a deep-learning system for measuring the morphological features of UIAs and help the surgical planning of coil embolization for UIAs.MethodsPreoperative computational tomography angiography (CTA) data and surgical data from UIA patients receiving coil embolization in our medical institution were retrospectively reviewed. A convolutional neural network (CNN) model was trained on the preoperative CTA data, and the morphological features of UIAs were measured automatically using this CNN model. The intraclass correlation coefficient (ICC) was utilized to examine the similarity between the morphologies measured by the CNN model and those determined by experienced clinicians. A deep neural network model to determine the diameter of first coil was further established based on the CNN model within the derivation set (75% of all patients) using neural factorization machines (NFM) model and was validated using a validation set (25% of all patients). The general match ratio (the difference was within ± 1 mm) between the predicted diameter of first coil by model and that used in practical scenario was calculated.ResultsOne-hundred fifty-three UIA patients were enrolled in this study. The CNN model could diagnose UIAs with an accuracy of 0.97. The performance of this CNN model in measuring the morphological features of UIAs (i.e., size, height, neck diameter, dome diameter, and volume) was comparable to the accuracy of senior clinicians (all ICC > 0.85). The diameter of first coil predicted by the model established based on CNN model and the diameter of first coil used actually exhibited a high general match ratio (0.90) within the derivation set. Moreover, the model performed well in recommending the diameter of first coil within the validation set (general match ratio as 0.91).ConclusionThis study presents a deep-learning system which can help to improve surgical planning of coil embolization for UIAs.

Clinical Outcomes of Coil Embolization for Unruptured Intracranial Aneurysms Categorized by Region and Hospital Size : A Nationwide Cohort Study in Korea.

To analyze the outcomes of coil embolization (CE) for unruptured intracranial aneurysm (UIA) according to region and hospital size based on National Health Insurance Service data in South Korea. The incidence of complications, including intracranial hemorrhage (ICRH) and cerebral infarction (CI), occurring within 3 months and the 1-year mortality rates in UIA patients who underwent CE in 2018 were analyzed. Hospitals were classified as tertiary referral general hospitals (TRGHs), general hospitals (GHs) or semigeneral hospitals (sGHs) according to their size, and the administrative districts of South Korea were divided into 15 regions. In 2018, 8425 (TRGHs, 4438; GHs, 3617; sGHs, 370) CEs were performed for UIAs. Complications occurred in 5.69% of patients seen at TRGHs, 13.48% at GHs, and 20.45% at sGHs. The complication rate in TRGHs was significantly lower than that in GHs (p=0.039) or sGHs (p=0.005), and that in GHs was significantly lower than that in sGHs (p=0.030). The mortality rates in TRGHs, GHs, and sGHs were 0.81%, 2.16%, and 3.92%, respectively, with no significant difference. Despite no significant difference in the mortality rates, the complication rate significantly increased as the number of CE procedures per hospital decreased (p=0.001; rho=-0.635). Among the hospitals where more than 30 CEs were performed for UIAs, the incidence of CIs (p=0.096, rho=-0.205) and the mortality rates (3 months, p=0.048, rho=-0.243; 1 year, p=0.009, rho=-0.315) significantly decreased as the number of CEs that were performed increased and no significant difference in the incidence of post-CE ICRH was observed. The complication rate in patients who underwent CE for UIA increased as the hospital size and physicians' experience in conducting CEs decreased. We recommend nationwide quality control policies CEs for UIAs.

Three-dimensional reconstruction imaging by C-arm computed tomography accurately visualizes in-stent neointimal formation in patients with stent-assisted coil embolization.

Stent apposition to the vessel wall and in-stent neointimal formation after stent-assisted coil embolization for intracranial aneurysm are important factors associated with postoperative thromboembolic complications. No assessment methods have been established to depict 3-dimensional (3D) all-round in-stent neointimal formation. To demonstrate the superiority of Dyna-3D imaging assessment as a modality for all-round ISNF in comparison with conventional two-dimensional digital subtraction angiography (2D-DSA). Consecutive patients who underwent braided stent-assisted coil embolization for unruptured aneurysm between November 2016 and September 2021 were enrolled. Radiological assessments for stent apposition to the parent vessel after stent deployment and in-stent neointimal formation after 3 months were obtained. Dyna-3D was reconstructed by overlapping a plain image showing stent struts with a rotational DSA image showing the vessel lumen. Reconstructed Dyna-3D images can be rotated to any angle on the screen to evaluate to stent apposition around the vessel and in-stent neointimal formation in 3D, for comparison with 2D-DSA evaluations. Among the 73 patients enrolled, 70 patients (96%) showed complete stent wall apposition on Dyna-3D. Higher intra-rater agreement was confirmed on assessment of in-stent neointimal formation with Dyna-3D (Cohen's κ = 0.811) than with conventional 2D-DSA (Cohen's κ = 0.517). in-stent neointimal formation could not be confirmed on conventional imaging in 9 cases (16%) and on Dyna-3D in 2 cases (3%). The number of in-stent neointimal formations rated as stent wire completely outside the endothelial line was significantly higher with Dyna-3D than with 2D-DSA (p = 0.0001). All-round 3D evaluation by Dyna-3D imaging appears useful for confirming in-stent neointimal formation after braided stent deployment in patients after stent-assisted coil embolization.

Risk factors for radial artery occlusion after neurointervention for unruptured intracranial aneurysm via transradial access.

Neurointervention via transradial access (TRA) is less invasive than via transfemoral access. However, radial artery occlusion (RAO) may occur with TRA. The purpose of this study was to explore risk factors for RAO after coil embolization of unruptured intracranial aneurysms (UIAs) via TRA. Forty-two consecutive patients who underwent coil embolization for UIAs via TRA between March 2021 and March 2022 and were available for angiographic evaluation 1 year after treatment were retrospectively reviewed. Multivariate logistic regression analysis was conducted to identify potential risk factors for RAO. Seventeen (40%) of the 42 patients showed RAO. Compared with the non-RAO group, radial artery size was significantly smaller (2.2 mm [interquartile range (IQR): 2.1, 2.4 mm] vs 2.6 mm [IQR: 2.5, 2.7 mm]; p = 0.001) and the incidence of radial artery spasm (RAS) was significantly higher in the RAO group. Multivariate analysis identified radial artery size (odds ratio [OR] 4.9 × 10-3, 95% confidence interval [CI] 6.4 × 10-5-0.38) and incidence of RAS (OR 14.8, 95%CI 2.1-105) as significant independent predictors of subsequent RAO. Based on receiver operating characteristic (ROC) curve analysis, the optimal cutoff for radial artery size was 2.5 mm (sensitivity, 82.4%; specificity, 76.0%; area under the ROC curve, 0.80 [95%CI 0.66-0.95]). Radial artery size and RAS represent reliable parameters for predicting RAO 1 year after coil embolization for UIA via TRA. Prophylaxis against RAS and limiting neurointervention via TRA to patients with radial artery larger than 2.5 mm in diameter may reduce the risk of postoperative RAO.

Balloon assisted Woven endobridge deployment (BAWD): A safety and efficacy study.

Balloon-assisted deployment/remodelling is a proven adjunctive technique for coil embolization of intracranial aneurysms, and it may be a helpful adjunct in delivering the Woven EndoBridge (WEB) device. To evaluate the safety, efficacy and feasibility of balloon-assisted WEB deployment in both ruptured and unruptured intracranial aneurysms in both typical and atypical locations. Patients who underwent treatment of ruptured and unruptured intracranial aneurysms with the BAWD technique were retrospectively identified from a prospectively maintained database at two neurointerventional centres. Patient demographics, aneurysm characteristics, technical procedure details, clinical and imaging outcomes were reviewed. Thirty-three aneurysms (23 women) were identified with a median age of 58 years. There were 15 (45.5%) ruptured aneurysms, 25 (64.3%) in the anterior circulation and 12 (36.4%) aneurysms having an atypical location for WEB treatment. The average aneurysm size was 6.8 mm (greatest dimension), 4.6 mm (height) and 4.5 mm (width), and 25 (75.8%) aneurysms had a wide neck morphology. One patient died (3.0%) secondary to a procedure-related complication, and there was no procedure-related permanent morbidity. Complete and adequate aneurysm occlusion on mid-term follow-up DSA was 85.2% and 92%, respectively. Balloon-assisted WEB deployment appears to be a safe and effective technique that may increase the utility of the WEB device. Further prospective studies on BAWD should be considered.

Retracted: A Meta-analysis: Cost Comparison of Flow Diversion and Coil Embolization for Intracranial Aneurysm.

[This retracts the article DOI: 10.1155/2022/2925366.].

Delayed cerebral ischemia after coil embolization of an unruptured giant intracranial aneurysm: A case report

Delayed Cerebral Ischemia (DCI) is a frequent and serious complication after Subarachnoid Hemorrhage (SAH), the leading cause of disability

Packing density and the angiographic results of coil embolization of intracranial aneurysms: A systematic review and meta-analysis.

Endovascular coil embolization (ECE) for intracranial aneurysms has been proven as an effective minimally invasive treatment. However, the aneurysm recanalization after coiling is a serious complication of this technique. Among all the proposed factors associated with recanalization, the impact of packing density (PD) is still controversial. To clarify the role of PD in the aneurysm recanalization following ECE, via conducting a systematic review and meta-analysis. A systematic literature search was conducted using PubMed, Scopus, Embase, and Web of Science databases, until November 28, 2022, by adhering to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement guidelines. Considering the eligibility criteria, all the studies reporting the outcomes of interest were included. Data elements of interest were extracted and analyzed using R software version 4.2.1. The pooled analysis of the 17 eligible papers revealed a 29% higher PD of the nonrecanalized aneurysms (ROM = 1.29, 95% confidence interval [CI] = 1.18-1.40, p < 0.001), even after removing outlier studies to reduce heterogeneity. However, the pooled estimates from multivariable regression models within nine included studies showed no significant effect of PD on recanalization odds when incorporated into a multivariable model with other predictors (odds ratio [OR] = 0.93, 95% CI = 0.84-1.02, p = 0.126), even after removing outlier studies. The current literature does not support PD as a significant predictor of aneurysm treatment outcomes, especially with adjusting for other variables. This finding necessitates further prospective multicenter studies with a larger sample size to overcome the current methodological shortcomings.

Endovascular Treatment of Intracranial Aneurysms Using aMicrocatheter Protection.

Stent protective or balloon remodeling techniques have enabled coil embolization of complexly configured aneurysms. Still, the utility of such methods may be limited in some small-caliber and/or inherently tortuous lesions. The present study was conducted to examine the efficacy of microcatheter protection (MCP) when applied in these circumstances. This retrospective review included 432patients with 452 intracranial aneurysms subjected to MCP between April 2001 and January 2021. All available medical records and radiologic data were analyzed, focusing on strategic, safety, and efficacy aspects of the procedures. In amajority (255/452, 56.4%) of cases, MCP was applied throughout entire coiling procedures, as opposed to coil framing (137/452, 30.3%) or filling/finishing (60/452, 13.3%) only. Lesions of the middle cerebral artery (54.9%) predominated, followed by anterior (12.4%) and posterior (11.1%) communicating artery aneurysms. Stent protection was also used occasionally (46/452, 10.2%). Procedural morbidity was low (3/432, 0.7%), limited to symptomatic thromboembolism and procedural leakage, and there were no deaths. Occlusion was successfully achieved by MCP in 424aneurysms (93.8%). During the follow-up period (mean, 43.4 ± 30.4months), satisfactory occlusion was documented in 406 of 440 (92.3%) aneurysms. MCP is feasible and safe for coil embolization of intracranial aneurysms, in conjunction with multicatheter, balloon, or stenting techniques. MCP may have merit in small-sized or tortuous lesions not amenable to balloon or stent usage, often eliminating the need for stenting altogether.

Therapeutic efficacy and complications of radial versus femoral access in endovascular treatment of unruptured intracranial aneurysms.

The transradial approach (TRA) in neuroendovascular treatment is known to have a lower risk of complications than the transfemoral approach (TFA). However, little research has focused on assessments of efficacy and risk of complications in the treatment of intracranial aneurysms. This study aimed to compare the efficacy and complications of TRA and TFA in coil embolization of unruptured intracranial aneurysms (UIAs) at our institution. Consecutive patients who underwent endovascular surgery via TRA or TFA at a single institution from 1 April 2019, to 28 February 2022, were retrospectively analyzed. Patients were classified into TRA and TFA groups and assessed using propensity-adjusted analysis for outcomes including fluoroscopy time, volume embolization ratio (VER), and complications. A total of 163 consecutive UIAs were treated with coil embolization during the 35-months study period. The incidence of minor access site complications (ASCs) was significantly higher with TFA (20%, 25/126) than with TRA (2.7%, 1/37; p = 0.01). Propensity-adjusted analysis (matched for age, sex, aneurysm volume, embolization technique, and sheath size) revealed that TRA was associated with a lower risk of minor ASCs (odds ratio, 0.085; 95% confidence interval 0.0094-0.78; p = 0.029). However, TRA did not differ significantly from TFA with respect to fluoroscopy time, VER, major ASCs, and non-ASCs. Coil embolization for UIAs via TRA can reduce risk of minor ASCs without increasing the risk of non-ASCs compared with conventional TFA, and can achieve comparable results in term of efficacy and fluoroscopy time.

Thromboelastography 6s for assessment of platelet function during coil embolization of unruptured intracranial aneurysms

ObjectivesMethods for assessing platelet function in patients with neurovascular disease remain controversial and poorly studied. This study aimed to assess associations between thromboelastography 6s (TEG6s) measurements and postoperative ischemic complications in patients with unruptured intracranial aneurysms (UIAs) treated by coil embolization. MethodsEighty-four patients with UIAs taking a combined aspirin and clopidogrel protocol were retrospectively reviewed from January 2021 to May 2022. Blood samples were obtained for TEG6s to assess platelet function on the day of coil embolization. To identify acute ischemic complications, diffusion-weighted imaging (DWI) was performed within 24 h after coil embolization. Multivariate logistic regression analysis was conducted to identify potential risk factors for postoperative positive DWI (DWI (+)) lesions. ResultsForty-three of the 84 patients (51%) with DWI (+) lesions were identified. Compared with patients without DWI (+) lesions, Adenosine diphosphate (ADP)-induced platelet-fibrin clot strength (MAADP) was significantly higher (53.6 mm [Interquartile range (IQR): 48.3–58.3 mm] vs 46.7 mm [IQR: 36.8–52.2 mm]; p=0.001) and ADP inhibition rate (ADP%) was significantly lower (19% [IQR: 11–31%] vs 31% [IQR: 21–44%]; p=0.001) in DWI (+) patients. Multivariate analysis identified MAADP, ADP%, and procedure time as significant independent predictors of subsequent DWI (+) lesions (odds ratios: 1.07, 0.96, and 1.02, respectively). Based on receiver operating characteristic curve analysis, MAADP >50.9 mm and ADP% <28.8% were associated with postoperative DWI (+) lesions in patients undergoing coil embolization for UIAs. ConclusionsMAADP and ADP% as assessed by TEG6s can offer reliable parameters to predict postoperative ischemic complications after coil embolization of UIAs. Lower MAADP values and higher ADP% may decrease the risk of postoperative ischemic complications.

A Meta-analysis: Cost Comparison of Flow Diversion and Coil Embolization for Intracranial Aneurysm.

Background Intracranial aneurysm serves as a prevalent cerebral disorder leading to the low-quality life and financial burden of the patients. Flow diversion and coil embolization have been confirmed as common therapeutic strategies for intracranial aneurysms. In this work, we identified and compared the cost between the flow diversion and coil embolization in the treatment of intracranial aneurysms in a meta-analysis. Methods We downloaded literatures that are published before Feb 2021 from Cochrane Library, Embase, and Pubmed using terms including “flow diversion”, “pipeline embolization device”, “coil embolization”, “coiling”, “Intracranial aneurysms”, and “Cerebral aneurysms”. The data were analyzed by STATA 15.1. Differences in treatment costs were determined by WMD (95% CI). Results A total of 1332 articles were included in the search of the limited terms, and 8 were selected after eliminating duplicate and unwanted studies. Our data indicated that the total cost of flow diversion for intracranial aneurysms is significantly lower than coil embolization (WMD = −4419.12, 95% CI: -6292.21 to -2546.03, p ≤ 0.001). In addition, we explored the retreatment hospitalization cost of flow diversion and coil embolization for intracranial aneurysms. We found that the retreatment hospitalization cost of flow diversion for intracranial aneurysms is significantly higher than coil embolization (WMD = 3203.85, 95% CI: 1904.60 to 4503.10, p ≤ 0.001). Conclusion We concluded that the total cost was lower, and the retreatment hospitalization costs of flow diversion were higher than coil embolization for the treatment of intracranial aneurysms. Our finding provides valuable insights into the application of flow diversion and coil embolization in intracranial aneurysm therapy. Flow diversion may be applied as a major treatment with the consideration of retreatment.