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Endovascular Management of Cerebral Aneurysm

Review of the Literature

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Abstract

Management of intracranial aneurysms remains controversial. For unruptured aneurysms, many factors should be taken into account before deciding the type of treatment and whether to treat or not. Ruptured aneurysms on the other hand are almost always treated. Still, the question remains what are the indicators that one must rely on to decide what treatment suits the patient best. We present a review on the management of intracranial aneurysm while focusing on endovascular aspects.

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References

  1. Loewenstein JE, Gayle SC, Duffis EJ, et al. The natural history and treatment options for unruptured intracranial aneurysms. Int J Vasc Med. 2012;2012:898052.

    PubMed Central  PubMed  Google Scholar 

  2. 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(4):1404–10.

    Article  PubMed  Google Scholar 

  3. Chalouhi N, Dumont AS, Randazzo C, et al. Management of incidentally discovered intracranial vascular abnormalities. Neurosurg Focus. 2011;31:E1.

    Article  PubMed  Google Scholar 

  4. Lall RR, Eddleman CS, Bendok BR, Batjer HH. Unruptured intracranial aneurysms and the assessment of rupture risk based on anatomical and morphological factors: sifting through the sands of data. Neurosurg Focus. 2009;26(5):E2.

    Article  PubMed  Google Scholar 

  5. Ryu CW, Kwon OK, Koh JS, Kim EJ. Analysis of aneurysm rupture in relation to the geometric indices: aspect ratio, volume, and volume-to-neck ratio. Neuroradiology. 2011;53:883–9.

    Article  PubMed  Google Scholar 

  6. Matsukawa H, Uemura A, Fujii M, et al. Morphological and clinical risk factors for the rupture of anterior communicating artery aneurysms. J Neurosurg. 2013;118:978–83.

    Article  PubMed  Google Scholar 

  7. Morita A, Kirino T, Hashi K, et al. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med. 2012;336:2474–82.

    Google Scholar 

  8. Bederson JB, Awad IA, Weibers DO, et al. Recommendations for the management of patients with unruptured intracranial aneurysms: a statement for healthcare professionals from the Stroke Council of the American Heart Association. Circulation. 2000;102(18):2300–8.

    Article  CAS  PubMed  Google Scholar 

  9. Amenta PS, Yadla S, Campbell PG, et al. Analysis of nonmodifiable risk factors for intracranial aneurysm rupture in a large, retrospective cohort. Neurosurgery. 2012;70:693–9. discussion 9–701.

    Article  PubMed  Google Scholar 

  10. Dhar S, Tremmel M, Mocco J, et al. Morphology parameters for intracranial aneurysm rupture risk assessment. Neurosurgery. 2008;63:185–96. discussion 96–7.

    Article  PubMed Central  PubMed  Google Scholar 

  11. You SH, Kong DS, Kim JS, et al. Characteristic features of unruptured intracranial aneurysms: predictive risk factors for aneurysm rupture. J Neurol Neurosurg Psychiatry. 2010;81:479–84.

    Article  PubMed  Google Scholar 

  12. Brown RD. Unruptured intracranial aneurysms. Semin Neurol. 2010;30(5):537–44.

    Article  PubMed  Google Scholar 

  13. McNeill L, English SW, Borg N, et al. Effects of institutional caseload of subarachnoid hemorrhage on mortality: a secondary analysis of administrative data. Stroke. 2013;44(3):647–52.

    Article  PubMed  Google Scholar 

  14. Seibert B, Tummala RP, Chow R, et al. Intracranial aneurysms: review of current treatment options and outcomes. Front Neurol. 2011;2:45.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Wiebers DO, Whisnant JP, Huston J, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362:103–10.

    Article  PubMed  Google Scholar 

  16. Chyatte D, Porterfield R. Functional outcome after repair of unruptured intracranial aneurysms. J Neurosurg. 2001;94(3):417–21.

    Article  CAS  PubMed  Google Scholar 

  17. Krisht AF, Gomez J, Partington S. Outcome of surgical clipping of unruptured aneurysms as it compares with a 10-year nonclipping survival period. Neurosurgery. 2006;58(2):207–16.

    Article  PubMed  Google Scholar 

  18. Jabbour PM, Tjoumakaris SI, Rosenwasser RH. Endovascular management of intracranial aneurysms. Neurosurg Clin N Am. 2009;20:383–98.

    Article  PubMed  Google Scholar 

  19. Naggara ON, White PM, Guilbert F, et al. Endovascular treatment of intracranial unruptured aneurysms: systematic review and meta-analysis of the literature on safety and efficacy. Radiology. 2010;256(3):887–97.

    Article  PubMed  Google Scholar 

  20. Koebbe CJ, Veznedaroglu E, Jabbour P, Rosenwasser RH. Endovascular management of intracranial aneurysms: current experience and future advances. Neurosurgery. 2006;59(5 Suppl 3):S93-102; discussion S3–13.

    Google Scholar 

  21. Higashida RT, Lahue BJ, Torbey MT, et al. Treatment of unruptured intracranial aneurysms: a nationwide assessment of effectiveness. AJNR Am J Neuroradiol. 2007;28(1):146–51.

    CAS  PubMed  Google Scholar 

  22. Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005;366(9488):809–17.

    Google Scholar 

  23. Hwang JS, Hyun MK, Lee HJ, Choi JE, Kim JH, Lee NR, et al. Endovascular coiling versus neurosurgical clipping in patients with unruptured intracranial aneurysm: a systematic review. BMC Neurol 2012;12:99.

    Google Scholar 

  24. Shapiro M, Babb J, Becske T, Nelson PK. Safety and efficacy of adjunctive balloon remodeling during endovascular treatment of intracranial aneurysms: a literature review. AJNR Am J Neuroradiol. 2008;29(9):1777–81.

    Article  CAS  PubMed  Google Scholar 

  25. Pierot L, Spelle L, Leclerc X, et al. Endovascular treatment of unruptured intracranial aneurysms: comparison of safety of remodeling technique and standard treatment with coils. Radiology. 2009;251(3):846–55.

    Article  PubMed  Google Scholar 

  26. Moret J, Cognard C, Weill A, et al. Reconstruction technic in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases. J Neuroradiol. 1997;24(1):30–44.

    CAS  PubMed  Google Scholar 

  27. Ross IB, Dhillon GS. Balloon assistance as a routine adjunct to the endovascular treatment of cerebral aneurysms. Surg Neurol. 2006;66(6):593–601.

    Article  PubMed  Google Scholar 

  28. Aletich VA, Debrun GM, Misra M, et al. The remodeling technique of balloon-assisted Guglielmi detachable coil placement in wide-necked aneurysms: experience at the University of Illinois at Chicago. J Neurosurg. 2000;93(3):388–96.

    Article  CAS  PubMed  Google Scholar 

  29. Spiotta AM, Wheeler AM, Smithason S, et al. Comparison of techniques for stent assisted coil embolization of aneurysms. J Neurointerv Surg. 2012;4(5):339–44.

    Article  PubMed  Google Scholar 

  30. Mocco J, Fargen KM, Albuquerque FC, et al. Delayed thrombosis or stenosis following enterprise-assisted stent-coiling: is it safe? Midterm results of the interstate collaboration of enterprise stent coiling. Neurosurgery. 2011;69(4):908–13.

    Article  CAS  PubMed  Google Scholar 

  31. Sedat J, Chau Y, Mondot L, et al. Endovascular occlusion of intracranial wide-necked aneurysms with stenting (Neuroform) and coiling: mid-term and long-term results. Neuroradiology. 2009;51(6):410–9.

    Article  Google Scholar 

  32. Pierot L, Spelle L, Vitry F. Immediate anatomic results after the endovascular treatment of unruptured intracranial aneurysms: analysis of the ATENA series. AJNR Am J Neuroradiol. 2010;31:140–4.

    Article  CAS  PubMed  Google Scholar 

  33. Piotin M, Blanc R, Spelle L, et al. Stent-assisted coiling of intracranial aneurysms: clinical and angio-graphic results in 216 consecutive aneurysms. Stroke. 2010;41(1):110–5.

    Article  PubMed  Google Scholar 

  34. Amenta PS, Dalyai RT, Kung D, et al. Stent-assisted coiling of wide-necked aneurysms in the setting of acute subarachnoid hemorrhage: experience in 65 patients. Neurosurgery. 2012;70(6):1415–29.

    Article  PubMed  Google Scholar 

  35. Chalouhi N, Dumont AS, Hasan D, et al. Is packing density important in stent-assisted coiling? Neurosurgery. 2012;71(2):381–6.

    Article  PubMed  Google Scholar 

  36. Chalouhi N, Jabbour P, Singhal S, et al. Stent-assisted coiling of intracranial aneurysms: predictors of complications, recanalization, and outcome in 508 cases. Stroke. 2013;44(5):1348–53.

    Article  PubMed  Google Scholar 

  37. Piske RL, Kanashiro LH, Paschoal E, et al. Evaluation of Onyx HD-500 embolic system in the treatment of 84 wide-neck intracranial aneurysms. Neurosurgery. 2009;64(5):E865–75.

    Article  PubMed  Google Scholar 

  38. Simon SD, Kioglu E, Reig A, Mericle RA. Endovascular treatment of side wall aneurysms using a liquid embolic agent: a US single-center prospective trial. Neurosurgery. 2010;67(3):855–60.

    Article  PubMed  Google Scholar 

  39. Simon SD, Lopes DK, Mericle RA. Use of intracranial stenting to secure unstable liquid embolic casts in wide-neck sidewall intracranial aneurysms. Neurosurgery. 2010;66(3 Suppl Operative):92–7; discussion 7–8.

    Google Scholar 

  40. Dalyai RT, Randazzo C, Ghobrial G, et al. Redefining Onyx HD 500 in the flow diversion era. Int J Vasc Med. 2012;2012:435490.

    PubMed Central  PubMed  Google Scholar 

  41. Saatci I, Yavuz K, Ozer C, et al. Treatment of intracranial aneurysms using the pipeline flow-diverter embolization device: a single-center experience with long-term follow-up results. AJNR Am J Neuroradiol. 2012;33(8):1436–46.

    Article  CAS  PubMed  Google Scholar 

  42. Leung GK, Tsang AC, Lui WM. Pipeline embolization device for intracranial aneurysm: a systematic review. Clin Neuroradiol. 2012;22:295–303.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  43. Lylyk P, Miranda C, Ceratto R, et al. Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience. Neurosurgery. 2009;64(4):632–42.

    Article  PubMed  Google Scholar 

  44. Lanzino G, Crobeddu E, Cloft HJ, et al. Efficacy and safety of flow diversion for paraclinoid aneurysms: a matched-pair analysis compared with standard endovascular approaches. AJNR Am J Neuroradiol. 2012;33(11):2158–61.

    Article  CAS  PubMed  Google Scholar 

  45. Chalouhi N, McMahon JF, Moukarzel LA, Starke RM, Jabbour P, Dumont AS, et al. Flow diversion versus traditional aneurysm embolization strategies: analysis of fluoroscopy and procedure times. J Neurointerv Surg. 2013. doi:10.1136/neurintsurg-2013-010777

  46. O'Kelly CJ, Spears J, Chow M, et al. Canadian experience with the pipeline embolization device for repair of unruptured intracranial aneurysms. AJNR Am J Neuroradiol. 2013;34(2):381–7.

    Article  PubMed  Google Scholar 

  47. Chalouhi N, Tjoumakaris S, Starke RM, et al. Comparison of flow diversion and coiling in large unruptured intracranial saccular aneurysms. Stroke. 2013;44(8):2150–4.

    Article  PubMed  Google Scholar 

  48. Jabbour P, Chalouhi N, Tjoumakaris S, et al. The pipeline embolization device: learning curve and predictors of complications and aneurysm obliteration. Neurosurgery. 2013;73(1):113–20.

    Article  PubMed  Google Scholar 

  49. Chitale R, Gonzalez LF, Randazzo C, et al. Single center experience with pipeline stent: feasibility, technique, and complications. Neurosurgery. 2012;71(3):679–91.

    Article  PubMed  Google Scholar 

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Compliance with Ethics Requirements

This article does not contain any studies with human or animal subjects.

Conflict of Interest

Mario Zanaty, Nohra Chalouhi, Stavropoula I. Tjoumakaris, Robert H. Rosenwasser, and Pascal M. Jabbour declare that they have no conflict of interests.

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Authors and Affiliations

  1. Department of Neurological Surgery, Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jefferson University, 909 Walnut St., 2nd Floor, Pennsylvania, PA, 19107, USA

    Mario Zanaty, Nohra Chalouhi, Stavropoula I. Tjoumakaris, Robert H. Rosenwasser & Pascal M. Jabbour

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  1. Mario Zanaty
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  2. Nohra Chalouhi
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  3. Stavropoula I. Tjoumakaris
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Correspondence to Pascal M. Jabbour.

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Zanaty, M., Chalouhi, N., Tjoumakaris, S.I. et al. Endovascular Management of Cerebral Aneurysm. Transl. Stroke Res. 5, 199–206 (2014). https://doi.org/10.1007/s12975-013-0311-0

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  • DOI: https://doi.org/10.1007/s12975-013-0311-0

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