Endosaccular Packing Research Articles

Endovascular Treatment of Unruptured Pancreatic Arcade Aneurysms.

This study aimed to assess the safety and efficacy of endovascular treatment of unruptured pancreatic arcade aneurysms in a single-center series. The electronic medical records of patients who underwent endovascular treatment for unruptured pancreatic arcade aneurysms between 2011 and 2022 at our tertiary center were retrospectively reviewed. The presence of celiac artery stenosis/occlusion; aneurysm number, location, and size; endovascular technique; procedure-related complication incidence; and clinical outcomes were assessed. Twenty-three patients (12 men and 11 women; mean [range] age, 63.8 [45-84] years) with 33 unruptured pancreatic arcade aneurysms were identified. Celiac artery stenosis/occlusion coexisted in 17 (74%) patients. Five (21%) patients had multiple aneurysms. The median aneurysm size was 9.3mm (range, 4-18mm). Seven, 6, 6, 5, 4, 3, and 2 aneurysms were located in the gastroduodenal, dorsal pancreatic, anterior superior pancreaticoduodenal, inferior pancreaticoduodenal, posterior inferior pancreaticoduodenal, posterior superior pancreaticoduodenal, and anterior inferior pancreaticoduodenal arteries, respectively. Four (15%) and 22 (85%) aneurysms were treated with endosaccular packing alone and coil embolization with endosaccular packing and parent artery occlusion, respectively, with resulting exclusion from arterial circulation. The remaining 7 aneurysms coexisting with larger aneurysms in other peripancreatic arteries were observed without embolization because they were small and for preserving collateral blood flow to the celiac artery. The treated aneurysms did not rupture or recur during the follow-up period (median, 40months). Endovascular treatment is a safe and effective treatment for unruptured pancreatic arcade aneurysms. 3, non-controlled retrospective cohort study.

Recurrent Renal Artery Aneurysm after Endosaccular Packing

Recurrent Renal Artery Aneurysm after Endosaccular Packing

The Pipeline embolization device for treatment of intracranial aneurysms

Flow diversion is a new endovascular technique developed for treatment of intracranial aneurysms. It is based on stent-induced modification of blood flow within and around an aneurysm inflow zone, leading to gradual intra-aneurysmal thrombosis and subsequent atrophy, while preserving flow into the parent vessel and perforating branches. Flow-diversion technique is well-suited for the treatment of large, giant, wide-necked, and fusiform intracranial aneurysms because it does not rely on endosaccular packing with coils but rather on the strategy of placing a stent across the aneurysm “neck” or across the diseased segment of a vessel in case of a fusiform aneurysm. Over time, neointimal endothelium covers the flow diverter such that it becomes incorporated into the parent vessel wall and occludes the aneurysm from the circulation, effectively repairing the diseased parent vessel segment. This report describes in detail the Pipeline embolization device (ev3-Covidien, Irvine, California, USA), its mechanism of action and deployment technique, and reviews the pertinent literature regarding safety, efficacy and potential risks and complications associated with the use of this flow diverter.

Complications, imaging results, and midterm clinical outcomes of pipeline embolisation device in the treatment of cerebral aneurysms

Background: The introduction of pipeline embolisation device (PED) has improved the feasibility of endovascular treatment of intracranial aneurysms. The device allows for endoluminal reconstruction across the aneurysm neck but is permeable enough that flow is preserved across the pressure gradients into sidebranch arteries. In spite of higher rates of aneurysm occlusion, there is lack of data concerning medium to long-term clinical and imaging results. Methods: This study was a prospective single center analysis of complications, imaging results, and medium term clinical outcomes after PED treatment of intracranial aneurysms. We included cases over a 17-month period in a tertiary interventional neuroradiology center. We collected data on demographics, vascular risk factors, clinical presentation, angiographic results post treatment, angiographic follow-up and clinical follow-up. Results: Thirty-three patients were included, 25 females and 8 males, with mean age of 55 years; 3 presented with acute subarachnoid hemorrhage and 30 for elective treatment. Thirty-seven aneurysms were treated: 35 Internal Carotid Artery (ICA), 1 basilar trunk fusiform, and 1 vertebral artery intradural dissecting aneurysms. No deaths have occurred. Five patients suffered transient neurological complications (15%). Overall aneurysm occlusion was demonstrated in 85% of patients at the end of one year. Discussion: Overall, the technique of flow diversion and endoluminal reconstruction differs greatly from the established endosaccular packing techniques of standard coiling, balloon remodeling, or stent assisted coiling. Our midterm follow-up confirms that, the rates of clinically significant complications compare favorably with published data on stent assisted coiling, potentially making these devices a truly revolutionizing technique.

Unenhanced Magnetic Resonance Angiography with Time-Spatial Labeling Inversion Pulse for Evaluating Visceral Artery Aneurysms after Endosaccular Packing with Detachable Coils: Preliminary Results

The aim of this brief report is to compare unenhanced magnetic resonance (MR) angiography with time-spatial labeling inversion pulse (Time-SLIP) with conventional digital subtraction angiography (DSA) in assessing degree of saccular visceral artery aneurysm (VAA) occlusion after endosaccular packing with detachable coils. Eight patients with VAAs (five renal and three splenic artery aneurysms) were enrolled in this study. VAA occlusion rates based on Time-SLIP MR angiography were complete occlusion in four patients, neck remnants in three patients, and body filling in one patient. These findings corresponded with the DSA findings.

A single-centre experience and follow-up of patients with endovascular coiling of large and giant intracranial aneurysms with parent artery preservation

Large and giant aneurysms are some of the most challenging vascular pathologies in the central nervous system. Their peculiarities make the surgical and endovascular approaches difficult and frequently limit them by posing risks and complications. Endovascular coil embolization of these lesions is being used increasingly as an alternative. Here we report the clinical experience and follow-up results of the endosaccular packing of 102 consecutive patients with 106 large or giant aneurysms to assess the efficacy and safety of this method. Embolization was completed by packing the aneurysm sac with a variety of commercially available coils. Primary endosaccular coiling, balloon-assisted coiling and stent-assisted coiling were used. The technical feasibility of the procedure, procedure-related complications, angiographic results, clinical outcome and follow-up angiography were evaluated. During admission, immediate angiography demonstrated complete occlusion in 48.1%, neck remnant in 28.3%, and incomplete occlusion in 23.6%. Procedure-related morbidity and mortality was 7.5% and 2.8%, respectively. A favorable clinical outcome (Modified Rankin Scale score of 0–2) was observed in 88.2% of patients (average follow-up time, 56.5months). No re-hemorrhage of a treated aneurysm occurred. Angiography follow-up was obtained in 77.5% (79/102) patients (average follow-up time, 38.1months). The overall recanalization rate was 29.6%. Comparison of occlusion class immediately after treatment and at last follow-up showed that 80.2% of the 81 aneurysms (in 79 patients) were stable or had improved. Five stent-assisted aneurysms that were not completely occluded initially had converted to complete occlusion on last follow-up. Nineteen recanalized aneurysms underwent successful re-embolization. No procedural complication was seen at retreatment. We conclude that in treating large and giant intracranial aneurysms, endovascular coiling with parent vessel preservation is a safe and effective technique.

A Novel “Y” Stent Flow Diversion Technique for the Endovascular Treatment of Bifurcation Aneurysms without Endosaccular Coiling

Stent-assisted endovascular treatment and flow diversion techniques are increasingly used for the management of wide-neck intracranial aneurysms. We report our initial clinical experience using a new flow diversion technique for the endovascular management of bifurcation aneurysms. Eight bifurcation aneurysms were treated by placing 2 stents in Y-configuration with no accompanying endosaccular packing. This treatment technique aimed at flow diversion was selected in these cases because 1) the aneurysm was giant and causing mass effect, 2) the emanating branches were incorporated within the sac, or 3) the aneurysm was too small. Aneurysms were located at middle cerebral (5 aneurysms) and basilar artery bifurcations (3 aneurysms). Five aneurysms were small, 1 was large, and 2 were partially thrombosed giant. Closed-cell stents were used in all Y-stent placement procedures. In all aneurysms, both stents could be placed at the intended locations without any procedural complication. Follow-up angiograms obtained at 3 months to 2 years demonstrated that all stents were patent except for one with asymptomatic P1 occlusion. Complete occlusion with remodelled bifurcation was observed in all middle cerebral artery bifurcation aneurysms and the large basilar tip aneurysm. Residual filling despite reduction in size was observed in both of the partially thrombosed giant aneurysms at 2-year and 3-month follow-up angiograms, respectively. Flow diversion with double stent placement in Y-configuration provided successful and stable aneurysm occlusion. The technical and clinical results achieved are highly encouraging that this technique may contribute to the endovascular treatment of these complex bifurcation aneurysms.

Idiopathic aneurysms of distal cerebellar arteries: endovascular treatment after rupture

Idiopathic ruptured aneurysms of distal cerebellar arteries (DCAAs) are rare, and their endovascular therapy (EVT) has as yet not been extensively reported. They are usually assumed to result from local arterial wall disruption rather than infection, unlike distal supratentorial artery aneurysms. This study was performed to audit their frequency, potential aetiology and results of EVT. Using strict inclusion criteria and a database of 1715 EVT patients, we identified ten idiopathic ruptured DCAAs (0.6%) over a 13-year period (1993-2006). The series comprised six males and four females with mean age of 64 years and solitary aneurysms located on posterior inferior cerebellar artery (five patients), anterior inferior cerebellar artery (three patients) and superior cerebellar artery (two patients). Nine aneurysms were fusiform and were treated by endovascular parent artery occlusion, and one was saccular and treated by endosaccular packing. Endovascular therapy was performed with coils in seven cases, n-butyl-2-cyanoacrylate (NBCA) in two cases and with both in one case. Primary EVT was successful in eight patients. One patient died following a procedure-related re-bleeding and one patient required re-treatment after failed endosaccular packing. Nine patients made good or excellent clinical recoveries (modified Rankin Scale 2 or less). Focal cerebellar infarctions were seen on computed tomography images after EVT in three patients, only one of whom was symptomatic with transient dysmetria, which resolved completely during follow up. No aneurysm recanalisation was detected on late follow-up imaging up to 24 months. Ruptured DCAAs are rare. The majority are fusiform in shape and their aetiology remains uncertain. Endovascular treatment is feasible and effective. It usually requires parent artery occlusion.

Review article: endovascular treatments for intracranial aneurysms.

During the last 10 years, the development of flexible microcatheters which can navigate cerebral vessels to lesions deep within the brain, has allowed the treatment of an increasing range of intracranial pathologies, including aneurysms. Techniques to embolize aneurysms, either by occlusion of their parent artery or endosaccular packing with its preservation, have evolved largely in order to treat inoperable aneurysms. Endosaccular packing with thrombogenic coils has recently allowed embolization of smaller aneurysms to be performed in patients acutely ill after subarachnoid haemorrhage. The procedural morbidity associated with these endovascular treatments are less dependent on aneurysm site than conventional neurosurgical clipping and initial results are comparable. These developments are challenging current thinking on the surgical management of patients with intracranial aneurysms. This review describes the evolution and practice of current endovascular treatments and their possible implications for the future of neuroradiology.

Endosaccular treatment of inoperable intracranial aneurysms with platinum coils.

Endosaccular packing of inoperable aneurysms with electrolytic platinum coils was performed in 50 patients. Complete embolization of the aneurysms was achieved in 100% of small, 95% of large and 85% of giant aneurysms, with combined procedural and periprocedural morbidity and mortality rates of 6 and 4%, respectively. Follow-up angiography of 42 aneurysms demonstrated some degree of refilling in 17% of small, 19% of large and 50% of giant aneurysms. The risks associated with the procedure were similar in aneurysms of the carotid and vertebrobasilar circulations. This treatment should therefore be considered for all inoperable aneurysms and particularly for aneurysms involving the posterior circulation. Its long-term efficacy remains uncertain.

Endovascular coil occlusion of experimental aneurysms: partial treatment does not prevent subsequent rupture.

Experimental aneurysms with a high propensity to spontaneous rupture were used to assess the efficacy of endosaccular packing with platinum coils. Lateral aneurysms, surgically constructed in pigs from vein allographs, were untreated or treated by partial or total endovascular packing with coils. All untreated aneurysms (4/4) ruptured and most (3/4) partially treated aneurysms also ruptured. None of 6 aneurysms in which the lumen was occluded by 90% or more ruptured or demonstrated regrowth on subsequent angiography. Partial treatment was therefore not effective in preventing delayed haemorrhage. These findings suggest that subtotal endovascular treatment may not be protective after aneurysmal subarachnoid haemorrhage.