Initial Experience with the Contour Device in the Treatment of Ruptured Intracranial Wide-necked Bifurcation Aneurysms: A Single-operator, Multicenter Study.

Background: Intrasaccular flow diverters are a new modality in the treatment of intracranial aneurysms. The Contour device has been designed to offer a variety of advantages over existing endovascular treatment options for wide-necked bifurcation aneurysms. There is no available literature describing its use in treating ruptured aneurysms. Objective: To assess the safety, outcome, and efficacy of the Contour device as a primary modality in treating ruptured intracranial aneurysms. Materials And Methods: A retrospective analysis of 14 aneurysms in 13 patients treated with the Contour device was studied. Data pertaining to demographics, clinical presentation on arrival, aneurysmal characteristics, and follow-up outcome was collected. The Hunt-Hess scale and modified Rankin scale were used to grade severity of clinical presentation. Results: Of the 14 aneurysms treated, one was unruptured and 13 were ruptured. Six middle cerebral artery aneurysms, six anterior communicating artery, one basilar top and one distal anterior cerebral artery aneurysm were treated. Coiling was required in two patients due to the large size of their aneurysms. No thromboembolic complications or intraoperative rupture was reported following device placement. Two patients required antiplatelet therapy for 6 weeks. A median follow-up at 3 months revealed stable placement of the device within the aneurysm and no sign of residual aneurysm or rebleed. Conclusion: Initial experience with Contour in treating ruptured aneurysms has shown favorable immediate and short-term follow-up outcome. However, long-term follow-up studies are required to assess its safety and long-term efficacy.

Ruptured Posterior Circulation Aneurysms with Bilateral Internal Carotid Artery Occlusion: Surgical Nuance.

BACKGROUND: Craniotomy and surgical clipping is the standard modality of treatment in patients of cerebral aneurysms. However, the surgical clipping of aneurysm may pose serious difficulties in the case of a bilateral carotid artery occlusion. The endovascular treatment has shown promising results in this disease. METHODS: A retrospective study of all patients of posterior circulation aneurysms in the background of carotid occlusive disease at our department was performed. The aim of this study was to describe the clinical, radiological characteristics, and the treatment of this rare entity. RESULTS: Four patients were treated from January 2009 to October 2015. The mean age of our patients was 34 years with ages that ranged from 17 to 45 without any gender predominance. The mean period between onset of symptoms and diagnosis was 6 weeks. Angiographic localization of the disease was observed in all patients. All patients were treated by endovascular techniques. The postoperative course has been satisfactory with a complete neurological recovery in all patients. CONCLUSIONS: Rupture of posterior circulation aneurysms in the setting of bilateral internal carotid artery occlusion is extremely rare. Treatment is exclusively endovascular intervention. The functional outcome of ruptured posterior circulation aneurysms in setting of bilateral carotid occlusive disease is particularly favorable with good neurological recovery.