Experiences and complications in endovascular treatment of paraclinoid aneurysms.

Endovascular treatment is a promising therapeutic alternative for paraclinoid aneurysms. The purpose of this study was to assess the feasibility and results of endovascular treatment for these lesions. We retrospectively reviewed the clinical data, results and complications of endovascular treatment of a series of 47 consecutive patients with paraclinoid aneurysms. Nineteen of these patients presented with acute subarachnoid hemorrhage, and 28 patients were treated for unruptured aneurysms. Endovascular treatment was performed for 50 aneurysms in 47 patients including stent-assisted coiling (19), balloon-assisted coiling (five), coiling without adjunctive techniques (25) and stent alone (one). Technical failures occurred in two patients (one stent deployment failure due to unsuccessful distal access across the aneurysm neck and one coiling failure due to unsuccessful microcatheter navigation through the stent). Periprocedural complications were observed in six patients (12.8%), with permanent morbidity in one patient resulting from a thromboembolic event. Immediate complete occlusion was achieved in 36 aneurysms (72%). During follow up, enlargement of a partially occluded giant aneurysm was observed in one patient, which was treated with parent artery occlusion. No delayed hemorrhagic complications were seen in the remaining patients. Endovascular treatment is technically feasible and safe in most patients with paraclinoid aneurysm, with a low rate of procedural complications.

Endovascular treatment for large and giant fusiform aneurysms of the vertebrobasilar arteries.

Fusiform aneurysms of vertebrobasilar arteries pose great challenge to surgical and endovascular treatment, especially large and giant aneurysms. We retrospectively reviewed our experiences and results of endovascular treatments for a series of 10 consecutive patients with large and giant fusiform aneurysms. Eight patients underwent stents placement (5 patients) or stent-assisted coiling (3 patients), and 2 patients underwent proximal occlusion of the parent arteries. Retreatment was needed in 2 patients. With the exception of 1 patient who died of rebleeding after sole stenting, the remaining 9 patients had good outcome. Reconstructive strategies using stents is a useful alternative for large and giant fusiform aneurysms of the vertebrobasilar arteries.

Angiographic findings in 2 children with cerebral paragonimiasis with hemorrhage.

Hemorrhagic events associated with cerebral paragonimiasis are not rare, especially in children and adolescents; however, angiographic evidence of cerebrovascular involvement has not been reported. The authors describe angiographic abnormalities of the cerebral arteries seen in 2 children in whom cerebral paragonimiasis was associated with hemorrhagic stroke. The patients presented with acute intracerebral and subarachnoid hemorrhage. Angiography revealed a beaded appearance and long segmental narrowing of arteries, consistent with arteritis. In both patients, involved vessels were seen in the area of the hemorrhage. The vascular changes and the hemorrhage, together with new lesions that developed close to the hemorrhage and improved after praziquantel treatment, were attributed to paragonimiasis. Further study of the frequency and mechanism of hemorrhagic cerebrovascular complications associated with cerebral paragonimiasis is needed.

Endovascular treatment of ruptured peripheral intracranial aneurysms.

OBJECTIVE: To assess the feasibility and result of endovascular treatments for ruptured peripheral intracranial aneurysms. METHODS: We retrospectively reviewed our experience and results of endovascular treatments for a series of 18 consecutive patients with ruptured distal intracranial aneurysms at the Department of Neurosurgery, Southwest Hospital, Chongqing, China between January 2005 and June 2010. Depending on the location and shape of the aneurysms, we used various therapeutic strategies including selective aneurysmal coiling, parent artery (and aneurysm) occlusion, stent-assisted coiling, and microcatheter-assisted coiling. RESULTS: Endovascular embolization was technically successful in all patients. Five patients were treated by selective aneurysm coiling; 5 patients were embolized with the stent-assisted technique or microcatheter-assisted technique. In the remaining 8 patients, the parent arteries, or together with the aneurysms were occluded using coils or glue. No procedure complication such as thrombosis or aneurysmal rupture was encountered during treatment. Two patients treated with parent artery occlusion developed acute or delayed transient ischemic symptoms, but they eventually made a good recovery. No patient has experienced postprocedural hemorrhage during the follow-up period (5-66 months; mean, 22.2 months). CONCLUSION: Endovascular treatment is a feasible and effective therapeutic alternative for peripheral intracranial aneurysms.

Rupture of an infectious intracranial aneurysm involving two parent arteries after surgical treatment of infective endocarditis.

Management of patients with infectious intracranial aneurysms (IIAs) who require valve replacement remains a challenge. Although there is potential risk of aneurysmal rupture associated with cardiac surgery, there have been few reported ruptures of IIAs during the perioperative period of valve replacement. We present a unique patient who suffered intracerebral hemorrhage due to rupture of an IIA 2 weeks after mitral valve replacement. This unique aneurysm is fed by 2 adjacent branches of the left middle cerebral arteries. Direct clipping of the aneurysm was successfully performed using 2 clips with preservation of the parent arteries. This case demonstrates that although it is rare, rupture of an untreated IIA might occur during the perioperative period of cardiac surgery. For patient safety, definitive treatment of unruptured IIAs is recommended before cardiac surgery, especially when long-term anticoagulation is needed after surgery.

Endovascular treatment of very small intracranial aneurysms.

BACKGROUND: The treatment of very small cerebral aneurysms with maximal diameter less than 3 mm remains a challenge for endovascular and surgical treatment. Endovascular treatment of these lesions may be difficult and associated with high risk of complications because of their small size. Our purpose was to assess the feasibility and results of endovascular treatment of these lesions. METHODS: We conducted a retrospective review of our experience and results of endovascular treatments for a series of 11 consecutive patients with 11 very small aneurysms. Of 11 aneurysms, 10 were acutely ruptured, and 1 was unruptured with a previous subarachnoid hemorrhage from another aneurysm. Aneurysms were located at the internal carotid artery (n = 4), the anterior communicating artery (n = 6), and the vertebral artery (n = 1). Seven patients were treated with coil embolization, and remodeling technique was used in 1 case. Three cases underwent intravascular stent implantation. Coil packing was done after in 2 of 3 aneurysms, and stent implantation alone was used in the remaining aneurysm. RESULTS: Coil embolization and stent deployment were carried out without difficulty in all cases. Coil packing was not available after stent implantation in 1 case for unsuccessful navigation of microcatheter into the aneurysm sac. Immediate angiography demonstrated complete occlusion in 10 cases and nearly complete occlusion in 1 case with stent implantation alone. No stent thrombosis and aneurysmal rupture was encountered during treatment. With the exception of 1 patient (Hunt and Hess grade 4) who died of pneumonia 4 weeks after treatment, no clinical evidence of neurologic deterioration and hemorrhagic complication was seen during the follow-up period in the remaining 10 patients. Follow-up angiography for 3 to 12 months (mean, 5.3 months) was available in 6 (60%) of 10 surviving patients, and no aneurysm recanalization was found. CONCLUSIONS: Endovascular treatment may be a feasible and effective therapeutic alternative for very small aneurysms. The long-term efficacy and durability of endovascular treatment for these lesions remains to be determined in a large series.