Coiling Of Cerebral Aneurysms Research Articles

Effects of Remimazolam versus Sevoflurane on Hemodynamics in Patients Undergoing Coil Embolization of Cerebral Aneurysm: A Prospective Randomized Controlled Trial.

Background: Cerebral aneurysm coil embolization is often performed under general anesthesia to prevent patient movement and sudden high blood pressure. However, the optimal anesthetic agent remains uncertain. This study aimed to determine whether maintaining anesthesia with remimazolam in patients undergoing coil embolization could avoid hypotension or hypertension compared to sevoflurane. Methods: Thirty-three adult patients participated in this single-blinded, randomized controlled trial. Patients in Group R were induced and maintained with remimazolam, whereas those in Group S received propofol and sevoflurane. Results: The use of remimazolam significantly reduced the incidence of intraoperative hypotension events (33.3% vs. 80.0%; p = 0.010) but did not change the incidence of hypertension events (66.7% vs. 73.3%; p = 0.690). Patients in Group R maintained a significantly higher range of maximal (100.2 ± 16.6 vs. 88.1 ± 13.5 mmHg; p = 0.037) and minimal (69.4 ± 6.6 vs. 63.4 ± 4.8 mmHg; p = 0.008) mean arterial blood pressure than those in Group S during the intervention. Conclusions: This is the first study to demonstrate the feasibility of maintaining general anesthesia with remimazolam in patients undergoing cerebral aneurysm coil embolization. The findings suggest that remimazolam may maintains better hemodynamic stability, reducing the incidence of hypotensive events without compromising patient safety.

Utility of catheter-shaping using mixed-reality devices in cerebral aneurysm coil embolization

BackgroundCatheter shaping is vital in cerebral aneurysm coil embolization; however, understanding three-dimensional (3D) vascular structures on two-dimensional screens is challenging. Although 3D-printed vascular models are helpful, they demand time, effort, and sterility. This study explores whether mixed-reality (MR) devices displaying 3D computer graphics (3D-CG) can address these issues. MethodsThis study focused on magnetic resonance imaging (MRI) of seven cases of cerebral aneurysms. Head-mounted display (HMD) and spatial reality display (SRD) MR devices were used, and applications for 3D-CG display at a 1:1 scale and a 3D-CG control panel were developed. Catheters shaped using a 3D printer, HMD, and SRD were inserted into hollow models to assess their accessibility and positioning. ResultsThe concordance rate of the 3D printer and HMD groups in terms of accessibility to the aneurysm was 71.4 %, while that of the 3D printer and SRD group was 85.7 %, and that of the HMD and SRD group was 85.7 %. The concordance rates of positioning in the 3D printer and HMD groups, 3D printer and SRD groups, and HMD and SRD groups were 85.7 %, 85.7 %, and 100 %, respectively. ConclusionsMR devices facilitate catheter shaping in cerebral aneurysm coil embolization and offer a time-efficient, precise, and sterile alternative to traditional 3D printing methods.

Three-Dimensional (3D) Microcatheter Shaping Using Touch Screen Devices for Cerebral Aneurysm Coil Embolization

In cerebral aneurysm coil embolization, proper microcatheter shaping is crucial to reduce complications and achieve sufficient embolization. Shaping a microcatheter in 3 dimensions (3D) is often required but can be challenging. We assessed the usefulness of a novel shaping on screen (SOS) method that displays real-size 3D rotational angiography (RA) images on a touch screen device during cerebral aneurysm embolization to facilitate 3D microcatheter shaping. In this study, 18 patients with cerebral aneurysm treated with this technique were included. Real-size 3D-RA images obtained during the embolization procedure were displayed on the touch screen device, which allowed for real-time manipulation. The shape of the microcatheter was adjusted to conform to the curvature of the vessel by swiping the touch screen device and bending the mandrel accordingly. We assessed the clinical and angiographic results, along with the accuracy and stability of the microcatheter. No procedure-related complications were observed. The mean packing density was 41%±12%. In all but 1 case, microcatheters were inserted into the aneurysms without guidewire assistance. After coiling, all microcatheter forms were stable. Three-dimensional (3D) microcatheter shaping using touch screen devices during cerebral aneurysm coil embolization may be simple and safe and can achieve high packing density of aneurysms.

Hemodynamic nature of black-blood enhancement in long-term coiled cerebral aneurysms.

Vessel wall imaging (VWI) with black-blood (BB) technique can demonstrate aneurysmal enhancement preluding to growth/rupture in treatment-naive cerebral aneurysms. Interestingly, recent works showed that BB enhancement may also occur in endovascularly treated aneurysms, though its meaning is controversial. Hypothesizing a flow-related mechanism of BB enhancement, we explored its relationship with incomplete occlusion status and coil packing density at DSA. We analyzed the subjects undergoing 3T MRI between January 2017 and October 2020 for a previous aneurysmal coiling. All the MRI studies included pre- and post-contrast 3D BB sequences. The presence of intra-aneurysmal pre-contrast BB signal was assessed. BB enhancement (when present) was classified as follows: (1) enhancement at the neck, (2) intrasaccular/intra-coil enhancement, and (3) peripheral enhancement. Coil packing density and aneurysmal occlusion status (according to the modified Raymond-Roy classification, MRRC) were determined on post-treatment DSA and compared with BB findings using generalized linear mixed-effect model and ANOVA. Significant p values were <0.05. Forty-eight aneurysms from 44 patients were eligible for analysis. Pre-contrast BB signal was observed in 50% of the aneurysms and showed a relationship with baseline aneurysmal size. BB enhancement was detectable in 31 aneurysms (65%), being significantly associated with incomplete aneurysmal occlusion and reduced coil packing density at DSA. BB enhancement of coiled aneurysms is related with increasing degrees of post-coiling aneurysmal remnants and with loose coil packing density at DSA. This supports a hemodynamic interpretation of BB enhancement in long-term coiled aneurysms.

Improving the accuracy of computational fluid dynamics simulations of coiled cerebral aneurysms using finite element modeling

Cerebral aneurysms are a serious clinical challenge, with ∼half resulting in death or disability. Treatment via endovascular coiling significantly reduces the chances of rupture, but the techniquehas failure rates of ∼20 %. This presents a pressing need to develop a method fordetermining optimal coildeploymentstrategies. Quantification of the hemodynamics of coiled aneurysms using computational fluid dynamics (CFD) has the potential to predict post-treatment outcomes, but representing the coil mass in CFD simulations remains a challenge. We use the Finite Element Method (FEM) for simulating patient-specific coil deployment for n = 4 ICA aneurysms for which 3D printed in vitro models were also generated, coiled, and scanned using ultra-high resolution synchrotron micro-CT. The physical and virtual coil geometries were voxelized onto a binary structured grid and porosity maps were generated for geometric comparison. The average binary accuracy score is 0.8623 and the average error in porosity map is 4.94 %. We then conduct patient-specific CFD simulations of the aneurysm hemodynamics using virtual coils geometries, micro-CT generated oil geometries, and using the porous medium method to represent the coil mass. Hemodynamic parameters including Neck Inflow Rate (Qneck) and Wall Shear Stress (WSS) were calculated for each of the CFD simulations. The average relative error in Qneck and WSS from CFD using FEM geometry were 6.6 % and 21.8 % respectively, while the error from CFD using a porous media approximation resulted in errors of 55.1 % and 36.3 % respectively; demonstrating a marked improvement in the accuracy of CFD simulations using FEM generated coil geometries.

Accuracy of uncalibrated 2D digital subtraction angiography measurements on a novel biplane system compared to computed tomography angiography.

2D digital subtraction angiography (DSA) images are the gold standard for neuroradiological vascular assessment and the basis of interventional procedures such as mechanical thrombectomy and cerebral aneurysm coiling. However, length measurements in projected DSA images are affected by the distance between the x-ray source, the object, and the detector. Precise coordination between all integrated parts of a novel biplane system makes it possible to accurately measure DSA distances without manual calibration. The aim of this study was to compare vascular diameter measurements in uncalibrated DSA images with computed tomography angiography (CTA). Consecutive patients undergoing interventional neuroradiological procedures were retrospectively included. Vascular diameter measurements in the image isocenter and periphery were performed. These measurements were repeated in picture archiving and communication system (PACS) on DSA images and maximum intensity pixel (MIP) CTA images. Forty-two (42) consecutive patients with adequate DSA and CTA images were included in the final analysis. The correlation between vessel diameter measurements in the image isocenter (R2 = 0.81/0.85, p < 0.0001/p < 0.0001 [Reader1/Reader2]), periphery (R2 = 0.85/0.82, p < 0.0001/p < 0.0001 [Reader1/Reader2]), and all measurements combined (R2 = 0.87/0.87, p < 0.0001/p < 0.0001 [Reader1/Reader2]) on DSA and CTA were strong and statistically significant. The interclass correlation coefficient for measurements performed by two independent reviewers was strong (ICC = 0.96, 95% CI 0.92-0.98). The correlations between uncalibrated DSA measurements and CTA for vessel diameter were strong. In addition, there were strong correlations between these image types for repeated measurements in the image isocenter as well as image periphery for vessel diameter. Consequently, endovascular devices can be sized correctly without the need for pre-operative non-invasive imaging.

Development of technical skills in simulated cerebral aneurysm coiling.

Endovascular surgical procedures require visual-spatial coordination in workspaces with restricted motions and temporally limited imaging. The development of the skills needed for these procedures can be facilitated by 3D simulator-based training. Cerebral angiography (CA) has lagged behind in this training approach due to the lack of validated, realistic training models, relying strictly on clinical case exposure frequency ("number of hours logged") as a means of assessing proficiency. The ANGIO Mentor visual-haptic simulator is regarded as an effective training tool, however, this simulator has not been tested thoroughly in its ability to train interventional skills. In particular, the details of the aneurysm coiling process during simulation-based training have not been assessed. In this study, 12 novice medical students were given simulation-based diagnostic CA training until a procedural plateau in performance, established in our previous work. Subsequently, they were trained using video tutorials and written instructions to identify, measure and intervene with cerebral aneurysms using endovascular coils. Over the span of 6 sessions, participants were assessed on their procedural task time, coiling quantity and quality, and perforation rates. Prior to commencing the study, participant spatial ability was assessed using a mental rotation test (MRT) and used as a comparative baseline for the performance analysis. We found that all individuals were able to perform the procedure faster after 6 sessions, reducing their average time from 42 to 24 minutes. Coil success rate improved over from 82% to 88% and coil packing rate remained consistent at 30% throughout testing. High perforation rate seen at the start of the study showed a trend of decreasing over the latter sessions, however, over half of aneurysms were still being perforated by the novice participants. No change in aneurysm coiling quality was found, with a slight decrease in number of parent artery coil protrusions. High MRT individuals were better able to establish necessary tools prior to coiling, however, no other MRT-specific changes were seen. This work identifies the utility of simulation-based CA training in identifying the particular difficulties trainees experience in learning procedural skills, including prevention of perforations, proper positioning and success of coils within the aneurysm.

Volume embolization ratio of coiled cerebral aneurysms, does awake technique affect the results?

BackgroundDespite the great innovations in the neuroendovascular techniques and related materials, there are still notable percentages of recurrent cerebral aneurysms after aneurysm coiling. Aneurysm packing density is well known to affect the initial angiographic result of aneurysm embolization and has a crucial role in the stability of aneurysm obliteration. Although aneurysm coiling is commonly performed under general anesthesia, it could be performed under local anesthesia in certain circumstances.ObjectiveThe purpose of this study is to compare the volume embolization ratio (VER) and angiographic results of cerebral aneurysm embolization performed under local and general anesthesia.Materials and methodsThis is a retrospective cohort analysis of 20 consecutive cases of coiled cerebral aneurysms that were coiled under LA. Further, 15 cerebral aneurysm coil embolization cases have been collected from our data as matched control group.ResultsEmbolization was performed under local anesthesia (Group A) in 20 patients (57.1%) and under general anesthesia (Group B) in 15 patients (42.9%). At the end of the procedure, control angiogram revealed complete obliteration in 13 patients (37.1%), while incomplete obliteration was detected in 22 patients (62.9%). The mean VER 27.9 ± 11.8 without a significant difference between both groups of the study as the VER of Group (A) was 26.05 ± 8.4 and that of Group B was 30.44 ± 15.2. Follow-up angiography at 1 year revealed complete obliteration in 17 (48.6%) of the coiled aneurysms, while incomplete obliteration was detected in 18 patients (51.4%).ConclusionsEndovascular coiling of cerebral aneurysms under local anesthesia is a safe and feasible procedure without significant effects on the VER.

Abstract 122: The P2x4 Inhibitor, Paroxetine Dramatically Prevents Not Only Growth Of Unruptured Cerebral Aneurysms But Also Recanalization After Aneurysm Coil Embolization; A Retrospective Clinical Study, Drug For Aneurysm Study

Introduction: We have suggested that inhibition of P2X4 purinoceptor, which is involved in the endothelial flow sensing mechanism, prevents cerebral aneurysm development and growth in an animal model. Therefore, we retrospectively investigated whether a P2X4 inhibitor, paroxetine used as an antidepressant, has an inhibitory effect on the growth of unruptured cerebral aneurysms and the rate of recanalization after coil embolization. Methods: Among the cases registered in the J-ASPECT Study, the Japanese stroke inpatient reimbursement database, from 2010 to 2019, we searched for cases who were taking paroxetine and with registered unruptured cerebral aneurysm or had undergone cerebral aneurysm coil embolization. We then invited medical centers with these cases to participate in the study and enrolled cases that met the selection criteria by referring to the imaging data and patient background of the cases. The inhibitory effect in the paroxetine-treated group was compared with that of the control group in a multivariate analysis after adjustment for age, gender, and known risk factors. Results: There were 708 cases at 226 facilities nationwide that were potentially matched in the criteria. Seventy-four facilities participated, of which 74 cases at 45 facilities met the selection criteria. A total of 700 control cases were enrolled from 14 core participating centers. The rate of growth incidence of aneurysms was 0.0318 for paroxetine-treated cases (n=36) and 0.0960 for control cases (397). The significant factors (regression coefficients) were paroxetine (-2.26), specific sites of occurrence (-1.28), shape irregularity (1.63), age (0.11), female (1.54), hypertension (-0.55), statin (0.87), and family history of stroke (0.71). The significant factors (odds ratios) in recanalization after 1 year of coil embolization were paroxetine (0.21), complete embolization (0.26), ruptured aneurysm (3.95), and size (1.14). Conclusions: This retrospective study suggests that P2X4 inhibitors including paroxetine may be clinically applicable as agents to inhibit the growth of unruptured cerebral aneurysms and recanalization after 1 year of aneurysm coil embolization. The use of reimbursement information may be useful when collecting very rare cases.

Modeling the Mechanical Microenvironment of Coiled Cerebral Aneurysms.

Successful occlusion of cerebral aneurysms using coil embolization is contingent upon stable thrombus formation, and the quality of the thrombus depends upon the biomechanical environment. The goal of this study was to investigate how coil embolization alters the mechanical micro-environment within the aneurysm dome. Inertialess particles were injected in three-dimensional, computational simulations of flow inside patient aneurysms using patient-specific boundary conditions. Coil embolization was simulated as a homogenous porous medium of known permeability and inertial constant. Lagrangian particle tracking was used to calculate the residence time and shear stress history for particles in the flow before and after treatment. The percentage of particles entering the aneurysm dome correlated with the neck surface area before and after treatment (pretreatment: R2 = 0.831, P < 0.001; post-treatment: R2 = 0.638, P < 0.001). There was an inverse relationship between the change in particles entering the dome and coil packing density (R2 = 0.600, P < 0.001). Following treatment, the particles with the longest residence times tended to remain within the dome even longer while accumulating lower shear stress. A significant correlation was observed between the treatment effect on residence time and the ratio of the neck surface area to porosity (R2 = 0.390, P = 0.007). The results of this study suggest that coil embolization triggers clot formation within the aneurysm dome via a low shear stress-mediated pathway. This hypothesis links independently observed findings from several benchtop and clinical studies, furthering our understanding of this treatment strategy.

Evaluation of Radiation Dose according to Aneurysm Size and Location during Cerebral Aneurysm Coil Embolization

Evaluation of Radiation Dose according to Aneurysm Size and Location during Cerebral Aneurysm Coil Embolization

Modeling Flow in Cerebral Aneurysm After Coils Embolization Treatment: A Realistic Patient-Specific Porous Model Approach.

Computational fluid dynamics (CFD) has been used to evaluate the efficiency of endovascular treatment in coiled cerebral aneurysms. The explicit geometry of the coil mass cannot typically be incorporated into CFD simulations since the coil mass cannot be reconstructed from clinical images due to its small size and beam hardening artifacts. The existing methods use imprecise porous medium representations. We propose a new porous model taking into account the porosity heterogeneity of the coils deployed in the aneurysm. The porosity heterogeneity of the coil mass deployed inside two patients' cerebral aneurysm phantoms is first quantified based on 3D X-ray synchrotron images. These images are also used to compute the permeability and the inertial factor arising in porous models. A new homogeneous porous model (porous crowns model), considering the coil's heterogeneity, is proposed to recreate the flow within the coiled aneurysm. Finally, the validity of the model is assessed through comparisons with coil-resolved simulations. The strong porosity gradient of the coil measured close to the aneurysmal wall is well captured by the porous crowns model. The permeability and the inertial factor values involved in this model are closed to the ideal homogeneous porous model leading to a mean velocity in the aneurysmal sac similar as in the coil-resolved model. The porous crowns model allows for an accurate description of the mean flow within the coiled cerebral aneurysm.

Intrasaccular neck-bridging: A technical note on Nautilus-assisted coiling of wide-necked cerebral aneurysms. Feasibility study, immediate and early angiographic results.

Various adjunctive devices have been reported to be helpful during the endovascular coiling of complex, wide-necked cerebral aneurysms. This study aimed to describe the utilization of a recently introduced intrasaccular neck-bridging implant specifically designed to facilitate coil embolization. We retrospectively reviewed eight consecutive patients who underwent treatment for intracranial aneurysms with the Nautilus intrasaccular bridging system between February 2022 to May 2022. We evaluated the angiographic appearances of treated aneurysms at the end of the procedure and early follow-up, the clinical status and complications. Eight patients with eight cerebral aneurysms (3 men and 5 women, mean age 52.8 years (range 39-66) were analyzed. Five of the treated aneurysms were managed in an acute case scenario. There were no technical difficulties while executing the technique. No other procedural adverse events were documented. Immediate complete occlusion of the aneurysm was seen in 6 patients, neck remnant in 1 and stable aneurysm reperfusion in one case. Early radiological follow-up was available in five patients, and the observed occlusion rates were - RR class I in all radiologically screened aneurysms. Nautilus-assisted coil embolization represents a rapid and safe solution for complex cerebral aneurysms. In our opinion this device symbolizes a significant step forward in treating intracranial aneurysms. We believe that the technique's actual value consists of the fact that the device is fully compatible with the modern low-profile microcatheter technology and does not involve the need for antiplatelet medications.

Effect of nursing interventions protocol on patients' clinical outcomes undergoing peri cerebral aneurysm coiling

Introduction: Cerebral aneurysm coiling considers ideal treatment for intracranial aneurysms. Objective: to evaluate the effect of nursing interventions protocol on patients' clinical outcomes undergoing peri cerebral aneurysm coiling. Materials and methods: Quasi-experimental study conducted at the Neuro-psychiatry Center affiliated to Tanta University. A Convenience sample of 60 adult patients undergoing peri cerebral aneurysm coiling for the first time. Four tools used Tool I Patients Structured interview schedule. Tool II Glasgow Coma Scale. Tool III Numerical rating scale. Tool IV: Post aneurysmal patient assessment tools. Results: The present study shows that less than half of both study and control group age ranged from 41-60 years, also it shows that more than half of study group and approximately two third of control group were female. In addition, it reveals that there was improvement of post aneurysmal coiling nursing interventions protocol mean results which include that majority of study group post nursing interventions protocol and minority of control group post routine hospital care haven’t localized pain and neck stiffness, furthermore all patients of study group and less than two third of control group haven’t localized hematoma, Moreover majority of study group and less than one quarter of control group haven’t aneurysmal nausea.

P.120 Contrast induced encephalopathy following endovascular therapy for the treatment of cerebrovascular disease

Background: Contrast induced encephalopathy (CIE) is an underrecognized, adverse effect of contrast administration during endovascular procedures. A paucity of literature exists regarding CIE following treatment of cerebrovascular disease. As such, we sought to describe our institutional experience with this entity. Methods: We searched our neurovascular database for instances of CIE following endovascular therapy for cerebrovascular disease. We extracted patient data, including demographics, comorbidities, procedural data, symptoms, radiological findings, and treatment. Informed consent was obtained in all cases. Data was analyzed using descriptive statistics. Results: Two patients underwent coiling of cerebral aneurysms; four were treated for ischemic stroke (thromboembolism or large artery atherosclerosis). Mean age was 67.2 years. Risk factors for microvascular dysfunction were identified for most patients: hypertension (100%), obesity (83%), dyslipidemia (83%), prior stroke (83%), renal disease (80%), and connective tissue disorders (33%). Mean operative duration: 284.5 minutes. Mean contrast volume: 285.7 mL. Decreased level of consciousness and lateralizing neurological deficits were the most common CIE-related symptoms. Treatments included intravenous fluids, corticosteroids, and anti-hypertensives. Radiographic findings included effaced cortical sulci, parenchymal edema, and cortical/subarachnoid contrast enhancement. Conclusions: Here, we describe our institutional experience with CIE following endovascular therapy for cerebrovascular disease. We hypothesize that CIE may be facilitated by pre-existing microvascular pathology.

Letter to the Editor: Could a Patient's Bedridden State of 6 Years Have Been Prevented and Changed His Fate? Should We Emphasize the Role of Endovascular Coiling of Cerebral Aneurysms in Nepal?

Letter to the Editor: Could a Patient's Bedridden State of 6 Years Have Been Prevented and Changed His Fate? Should We Emphasize the Role of Endovascular Coiling of Cerebral Aneurysms in Nepal?

Trends in interventional stroke device utilization during the COVID-19 pandemic

ObjectivesThe collateral effect of the COVID-19 pandemic on interventional stroke care is not well described. We studied this effect by utilizing stroke device sales data as markers of interventional stroke case volume in the United States. MethodsUsing a real-time healthcare device sales registry, this observational study examined trends in the sales of thrombectomy devices and cerebral aneurysm coiling from the same 945 reporting hospitals in the U.S. between January 22 and June 31, 2020, and for the same months in 2018 and 2019 to allow for comparison. We simultaneously reviewed daily reports of new COVID-19 cases. The strength of association between the cumulative incidence of COVID-19 and procedural device sales was measured using Spearman rank correlation coefficient (CC). ResultsDevice sales decreased for thrombectomy (− 3.7%) and cerebral aneurysm coiling (− 8.5%) when comparing 2019–2020. In 2020, thrombectomy device sales were negatively associated with the cumulative incidence of COVID-19 (CC − 0.56, p < 0.0001), with stronger negative correlation during April (CC − 0.97, p < 0.0001). The same negative correlation was observed with aneurysm treatment devices (CC − 0.60, p < 0.001), with stronger correlation in April (CC − 0.97, p < 0.0001). ConclusionsThe decline in sales of stroke interventional equipment underscores a decline in associated case volumes. Future pandemic responses should consider strategies to mitigate such negative collateral effects.

Left Transradial Neurointerventions Using the 6-French Simmons Guiding Sheath: Initial Experiences with the Interchange Technique

The transradial approach using a Simmons-shaped catheter has been increasingly used for diagnostic cerebral angiography and neurointervention. In the transradial approach for neurointervention, the right radial artery is mainly used. However, in interventional cardiology, there are apparent clinical benefits with the left transradial approach for right-handed patients. To our knowledge, no studies have reported on neurointervention with the routine use of the left transradial approach. We therefore devised a novel technique for cases with an unachievable form of the Simmons shape using the standard technique, which we named the "interchange technique." The purpose of this study was to evaluate the technical feasibility of the left transradial neurointervention. This study is a retrospective review of our prospective database of consecutive patients who underwent a left transradial neurointervention, using a 6-French Simmons guiding sheath, performed from January through April 2021. The outcome variables studied were successful catheterization and procedure-related complications. Twenty-one patients underwent a left transradial neurointervention including cerebral aneurysm coiling, carotid artery stenting, and meningioma embolization. The Simmons shape could not be formed with the standard technique for 3 patients, for whom we successfully formed the Simmons shape with our new interchange technique. The procedure was completely achieved in all 21 patients. No patients required crossover to the right radial or femoral arteries, and there were no radial artery spasms or occlusions or any procedural complications. The left transradial approach for neurointervention is a technically feasible, safe, and effective alternative while providing more comfort to right-handed patients.

Clinical and Angiographic Outcomes After Stent-Assisted Coiling of Cerebral Aneurysms With Laser-Cut and Braided Stents: A Comparative Analysis of the Literatures.

Introduction: Stent-assisted coiling (SAC) plays an important role in endovascular treatment of intracranial aneurysms (IAs). This comparative analysis examines the safety and efficacy of SAC in general and compares clinical and angiographic outcomes between laser-cut stents and braided stents.Methods: Relevant English-language studies were identified via a PubMed search for published articles regarding outcomes of SAC using laser-cut stents and braided stents published from 2015 to 2020. Data from 56 studies that met our inclusion criteria were pooled and statistically compared.Results: A total of 4,373 patients harboring with 4,540 IAs were included. Patients were divided into two groups on the basis of stent type: laser-cut stents (2,076 aneurysms in 1991 patients; mean follow-up, 12.99 months) and braided stents (2,464 aneurysms in 2382 patients; mean follow-up, 18.41 months). Overall, the rates of successful stent deployment, thromboembolic events, stent stenosis, periprocedural intracranial hemorrhage, permanent morbidity, mortality, and recanalization were 97.72, 4.72, 2.87, 1.51, 2.14, 1.16, and 6.06%, respectively. Laser-cut stents were associated with a significantly higher rate of successful deployment (p = 0.003) and significantly lower rate of periprocedural intracranial hemorrhage (p = 0.048). Braided stents were associated with a significantly lower rate of permanent morbidity (p = 0.015).Conclusion: SAC of IAs using laser-cut stents or braided stents was effective and safe. Rates of thromboembolic events, stent stenosis, mortality, and recanalization were comparable between the stent types. Braided stents were associated with lower permanent morbidity while laser-cut stents were associated with more favorable rates of successful deployment and periprocedural intracranial hemorrhage.

Contrast-enhanced encephalopathy and massive cerebral edema after endovascular coiling of cerebral aneurysm. A case report

Contrast-induced encephalopathy (CIEP) is a rare complication after endovascular therapy. The etiology of CIEP is still a matter of debate. We present a rare occurrence of CIEP in a known hypertensive and type 2 diabetic patient after endovascular coiling of cerebral aneurysm with oculomotor nerve palsy. A 68-year old female presented with seven days history of headache and left ptosis or blepharoptosis with mild mydriasis. The headaches were localized mainly at the left side of the nose, orbit, and upper forehead while the left ptosis was associated with blurred vision. Computed tomography angiography revealed an aneurysm in between the C4 segment of the left internal carotid artery (ICA) and the bifurcation of the left posterior communicating artery. Digital subtraction angiography further confirmed the aneurysm. We used the transarterial approach to assess the aneurysm and subsequent coiling. Iohexol (Omnipaque) contrast agent was used during the endovascular procedure. The patient’s condition deteriorated into acute confusion state with cardinal symptomology of CIEP immediately after the operation. Computed tomography scan revealed cortical contrast enhancement in the vascular territory of the ICA as well as edema. Her symptomatology resolved 48 hours after treated with anticonvulsants, intracranial pressure reduction and hydration. Chronic hypertension as well as type 2 diabetics may be critical predisposing factors to CIEP. CIEP should be suspected in patients presenting with acute confusion state after endovascular therapy. Massive edema with ischemic brain changes in white matter of the brain before endovascular procedure should rise suspicion of CIEP.