Abstract
Purpose
Not infrequently, intracranial aneurysms may be multifocal. However, strategies conferring open surgical access to opposite sides of the brain are limited. Given the recent advances in protection devices and coiling technique, a study of single-stage coil embolization in patients with multiple intracranial aneurysms was undertaken, assessing procedural safety and efficacy.
Methods
Data prospectively accrued between January 2010 and September 2013 were systematically reviewed, assessing clinical and morphologic outcomes of single-stage coil embolization in 172 patients with multiple aneurysms (≥ 2 aneurysms each; total, 371 aneurysms).
Results
Internal carotid artery (n = 132) was the most common site, with progressively fewer aneurysms found elsewhere (middle cerebral artery, 103; anterior communicating artery, 41; posterior communicating artery, 38). In 26 patients, one-stage embolization of three or more aneurysms took place (25 patients with three each; 1 patient with four). Stents were applied in 109 aneurysms, and in 33 lesions, balloons were used. Occlusion was achieved in 326 aneurysms (87.9 %) through coil embolization, and attempted coiling rarely failed (3 of 371, 0.8 %). Mean procedural time was 111.5 ± 37.8 min. Although procedure-related adverse events included three instances of treatment failure, asymptomatic thrombi in four patients, and aneurysmal leakage in one patient, procedural morbidity was low (1 of 172, 0.6 %), and no procedure-related deaths occurred. Postembolization follow-up of 303 aneurysms at > 6 months (mean, 15.4 ± 9.8 months) showed complete occlusion in the vast majority (275 of 303, 90.8 %), with comparatively fewer instances of minor (19 of 303, 6.3 %) and major (9 of 303, 3.0 %) recanalization. Four patients experienced delayed cerebral infarction, but only one suffered permanent neurologic deficit (Glasgow outcome scale 4).
Conclusion
Single-stage coil embolization of multiple unruptured intracranial aneurysms is technically feasible. The time required for such procedures and the rate of complications observed seem acceptable.
Similar content being viewed by others
References
Inagawa T. Incidence and risk factors for multiple intracranial saccular aneurysms in patients with subarachnoid hemorrhage in Izumo City, Japan. Acta Neurochir (Wien). 2009;151:1623–30.
Solander S, Ulhoa A, Viñuela F, Duckwiler GR, Gobin YP, Martin NA, Frazee JG, Guglielmi G. Endovascular treatment of multiple intracranial aneurysms by using Guglielmi detachable coils. J Neurosurg. 1999;90:857–64.
Dunn GP, Nahed BV, Walcott BP, Jung H, Tierney TS, Ogilvy CS. Dual ipsilateral craniotomies through a single incision for the surgical management of multiple intracranial aneurysms. World Neurosurg. 2012;77:502–6.
Lynch JC, Andrade R. Unilateral pterional approach to bilateral cerebral aneurysms. Surg Neurol. 1993;39:120–7.
Mizoi K, Suzuki J, Yoshimoto T. Surgical treatment of multiple aneurysms: review of experience with 372 cases. Acta Neurochir (Wien). 1989;96:8–14.
Oshiro EM, Rini DA, Tamargo RJ. Contralateral approaches to bilateral cerebral aneurysms: a microsurgical anatomical study. J Neurosurg. 1997;87:163–9.
Chung J, Shin YS. Multiple intracranial aneurysms treated by multiple treatment modalities. Neurosurgery. 2011;69:E1030–2.
Cho YD, Lee WJ, Kim KM, Kang HS, Kim JE, Han MH. Endovascular coil embolization of middle cerebral artery aneurysms of the proximal (M1) segment. Neuroradiology. 2013;55:1097–102.
Kang HS, Kwon BJ, Kim JE, Han MH. Preinterventional clopidogrel response variability for coil embolization of intracranial aneurysms: clinical implications. AJNR Am J Neuroradiol. 2010;31:1206–10.
Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, Lamoureux J, Chagnon M, Roy D. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke. 2003;34:1398–403.
Kang HS, Han MH, Kwon BJ, Kwon OK, Kim SH, Choi SH, Chang KH. Short-term outcome of intracranial aneurysms treated with polyglycolic acid/lactide copolymer-coated coils compared to historical controls treated with bare platinum coils: a single-center experience. AJNR Am J Neuroradiol. 2005;26:1921–8.
Baccin CE, Krings T, Alvarez H, Ozanne A, Lasjaunias P. Multiple mirror-like intracranial aneurysms. Report of a case and review of the literature. Acta Neurochir (Wien). 2006;148:1091–5.
Takeuchi S, Wada K, Otani N, Nawashiro H. Multiple intracranial aneurysms associated with hyper-IgE syndrome. Intern Med. 2012;51:515–6.
Takayama K, Nakagawa H, Iwasaki S, Taoka T, Myouchin K, Wada T, Sakamoto M, Fukusumi A, Kurokawa S, Kichikawa K. Multiple cerebral aneurysms associated with Takayasu arteritis successfully treated with coil embolization. Radiat Med. 2008;26:33–8.
Hama Y, Kaji T, Iwasaki Y, Kawauchi T, Yamamoto M, Kusano S. Endovascular management of multiple arterial aneurysms in Behcet’s disease. Br J Radiol. 2004;77:615–9.
Waldron JS, Hetts SW, Armstrong-Wells J, Dowd CF, Fullerton HJ, Gupta N, Lawton MT. Multiple intracranial aneurysms and moyamoya disease associated with microcephalic osteodysplastic primordial dwarfism type II: surgical considerations. J Neurosurg Pediatr. 2009;4:439–44.
Mont’alverne F, Tournade A, Riquelme C, Musacchio M. Multiple intracranial aneurysms. Angiographic study and endovascular treatment. Interv Neuroradiol. 2002;8:95–106.
Juvela S. Risk factors for multiple intracranial aneurysms. Stroke. 2000;31:392–7.
Leblanc R. Familial cerebral aneurysms. A bias for women. Stroke. 1996;27:1050–4.
Lu HT, Tan HQ, Gu BX, Wu-Wang, Li MH. Risk factors for multiple intracranial aneurysms rupture: a retrospective study. Clin Neurol Neurosurg. 2013;115:690–4.
Yasui N, Magarisawa S, Suzuki A, Nishimura H, Okudera T, Abe T. Subarachnoid hemorrhage caused by previously diagnosed, previously unruptured intracranial aneurysms: a retrospective analysis of 25 cases. Neurosurgery. 1996;39:1096–101.
Hoh BL, Sistrom CL, Firment CS, Fautheree GL, Velat GJ, Whiting JH, Reavey-Cantwell JF, Lewis SB. Bottleneck factor and height-width ratio: association with ruptured aneurysms in patients with multiple cerebral aneurysms. Neurosurgery. 2007;61:716–22.
Komotar RJ, Mocco J, Solomon RA. Guidelines for the surgical treatment of unruptured intracranial aneurysms: the first annual J. Lawrence pool memorial research symposium-controversies in the management of cerebral aneurysms. Neurosurgery. 2008;62:183–93.
James Ling A D’Urso PS Madan A. Simultaneous microsurgical and endovascular management of multiple cerebral aneurysms in acute subarachnoid haemorrhage. J Clin Neurosci. 2006;13:784–8.
Cervoni L, Delfini R, Santoro A, Cantore G. Multiple intracranial aneurysms: surgical treatment and outcome. Acta Neurochir. 1993;124:66–70.
Mizoi K, Suzuki J, Yoshimoto T. Surgical treatment of multiple aneurysms. Review of experience with 372 cases. Acta Neurochir. 1989;96:8–14.
Orz Y, Osawa M, Tanaka Y, Kyoshima K, Kobayashi S. Surgical outcome for multiple intracranial aneurysms. Acta Neurochir. 1996;138:411–7.
Vajda J. Multiple intracranial aneurysms: a high risk condition. Acta Neurochir. 1992;118:59–75.
Oh K, Lim YC. Single-session coil embolization of multiple intracranial aneurysms. J Cerebrovasc Endovasc Neurosurg. 2013;15:184–90.
Jeon P, Kim BM, Kim DJ, Kim DI, Suh SH. Treatment of multiple intracranial aneurysms with 1-stage coiling. AJNR Am J Neuroradiol. 2014;35:1170–3.
Rinkel GJ. Natural history, epidemiology and screening of unruptured intracranial aneurysms. J Neuroradiol. 2008;35:99–103.
Wermer MJ, van der Schaaf IC, Algra A, Rinkel GJ. Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics: an updated meta-analysis. Stroke. 2007;38:1404–10.
Xavier AR, Rayes M, Pandey P, Tiwari A, Kansara A, Guthikonda M. The safety and efficacy of coiling multiple aneurysms in the same session. J Neurointerv Surg. 2012;4:27–30.
Acknowledgment
This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A111101).
Conflict of Interest
The authors declare that there are no actual or potential conflicts of interest in relation to this article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cho, Y., Ahn, J., Jung, S. et al. Single-Stage Coil Embolization of Multiple Intracranial Aneurysms: Technical Feasibility and Clinical Outcomes. Clin Neuroradiol 26, 285–290 (2016). https://doi.org/10.1007/s00062-014-0367-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00062-014-0367-6