RESUMO
Intracranial dissecting aneurysms constitute rare lesions with complex management and elevated morbidity and mortality. Results of 23 patients harboring such lesions treated with the PED are reported. Standard dual antiplatelet therapy was instituted. Neurologic and angiographic assessments were obtained at 3, 6, and 12 months. Clinical presentation included SAH (52%), symptoms of mass effect (22%), ischemia (4%), and incidental finding (22%). The posterior circulation was affected in 91% of cases. Total occlusion was demonstrated in 69.5% of patients, with an increment to 87.5% considering only patients with at least 3 months of follow-up. Small aneurysms demonstrated higher rates of total occlusion (6/7) compared with large (5/7) and giant (5/9) ones. Good clinical outcome was achieved in 74% of patients. Reconstructive endovascular treatment of intracranial dissecting aneurysms with the PED provided good clinical and angiographic results with acceptable risks, representing an attractive therapeutic option for this complex disease, especially when parent vessel preservation is mandatory.
Assuntos
Dissecção Aórtica/cirurgia , Oclusão com Balão/instrumentação , Prótese Vascular , Cateteres de Demora , Aneurisma Intracraniano/cirurgia , Stents , Adulto , Idoso , Dissecção Aórtica/diagnóstico por imagem , Criança , Pré-Escolar , Análise de Falha de Equipamento , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Radiografia , Resultado do TratamentoRESUMO
Partial clipping may occur in about 4% of surgical procedures. The risk of hemorrhage persists if the aneurysm is not completely excluded. Reoperations are often difficult, technically demanding and may carry an increased risk of complications. We report our experience with the use of Guglielmi detachable coils in the treatment of 9 aneurysm remnants. Five patients (55.6%) presented with a second subarachnoid hemorrhage. Eight of the aneurysms (88.9%) were located on the anterior circulation. Postoperative angiography showed complete occlusion in 8 cases (88.9%). Certain partial clipping types may assist and favor a stable coiling procedure allowing a more compact cast. On the other hand, the clip may interfere with the correct visualization of the neck. In this series, there was no neurological morbidity associated with the procedure. There were no hemorrhagic events during or after the embolization. Endovascular treatment of aneurysm remnants can be performed safely and may constitute a valuable option to microsurgery.
Assuntos
Aneurisma Intracraniano/terapia , Complicações Pós-Operatórias/terapia , Stents , Hemorragia Subaracnóidea/terapia , Instrumentos Cirúrgicos , Adulto , Artérias Carótidas/diagnóstico por imagem , Angiografia Cerebral/métodos , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Recidiva , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Artéria Vertebral/diagnóstico por imagemRESUMO
OBJECT: With the recent development and refinement of endovascular stents, the significant potential for these devices in the treatment of wide-necked dissecting and fusiform aneurysms has become apparent. In this article the authors report on the use of stents and coils to treat dissecting and fusiform vertebral artery (VA) aneurysms. METHODS: Eight consecutive patients harboring eight dissecting aneurysms and one fusiform aneurysm of the VA were succesfully treated using a procedure in which the authors inserted an intravascular stent and secondary endosaccular coils when needed. In all but one patient complete aneurysm occlusion was achieved, and in all cases there was no neurological complication. Follow-up angiography examinations were performed in all patients (mean duration of follow-up angiography review 13.1 months, range 3-42 months). The patients remained stable throughout the clinical follow-up period (mean 14.1 months, range 4-42 months). No rebleeding was recorded. CONCLUSIONS: At present this combined approach represents a reliable and safe alternative for the treatment of VA dissecting aneurysms, especially in patients who cannot tolerate occlusion tests.
Assuntos
Embolização Terapêutica , Stents , Dissecação da Artéria Vertebral/terapia , Adulto , Angiografia Digital , Angiografia Cerebral , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Complicações Pós-Operatórias/mortalidade , Resultado do Tratamento , Dissecação da Artéria Vertebral/diagnóstico , Dissecação da Artéria Vertebral/mortalidadeRESUMO
Partial clipping may occur in about 4
of surgical procedures. The risk of hemorrhage persists if the aneurysm is not completely excluded. Reoperations are often difficult, technically demanding and may carry an increased risk of complications. We report our experience with the use of Guglielmi detachable coils in the treatment of 9 aneurysm remnants. Five patients (55.6
) presented with a second subarachnoid hemorrhage. Eight of the aneurysms (88.9
) were located on the anterior circulation. Postoperative angiography showed complete occlusion in 8 cases (88.9
). Certain partial clipping types may assist and favor a stable coiling procedure allowing a more compact cast. On the other hand, the clip may interfere with the correct visualization of the neck. In this series, there was no neurological morbidity associated with the procedure. There were no hemorrhagic events during or after the embolization. Endovascular treatment of aneurysm remnants can be performed safely and may constitute a valuable option to microsurgery.
RESUMO
En los últimos años las técnicas percutáneas han evolucionado de forma tal, que a la fecha estos procedimiento se efectúan rutinaria y extensivamente en muchos centros, para el diagnóstico y el tratamiento del dolor originada en la columna vertebral por diferentes procesos. Estas técnicas permiten una reducción de los costos de hospitalización y una rápida reincorporación del paciente a sus tareas habituales. En este artículo analizamos las indicaciones, resultados y complicaciones de los procedimientos, así como tambien el desarrollo de nuevas técnicas que son y serán de utilidad en la práctica. (AU)
Assuntos
Humanos , Masculino , Feminino , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/terapia , Doenças da Coluna Vertebral/cirurgia , Dor/diagnóstico , Dor/diagnóstico por imagem , Dor/radioterapia , Dor/terapia , MétodosRESUMO
En los últimos años las técnicas percutáneas han evolucionado de forma tal, que a la fecha estos procedimiento se efectúan rutinaria y extensivamente en muchos centros, para el diagnóstico y el tratamiento del dolor originada en la columna vertebral por diferentes procesos. Estas técnicas permiten una reducción de los costos de hospitalización y una rápida reincorporación del paciente a sus tareas habituales. En este artículo analizamos las indicaciones, resultados y complicaciones de los procedimientos, así como tambien el desarrollo de nuevas técnicas que son y serán de utilidad en la práctica.