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Central nervous system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
If the aneurysm ruptures, subarachnoid haemorrhage occurs as blood leaks into the space around the brain. Aneurysms may be treated by surgical clipping or by endovascular coiling, which involves an interventional neuroradiologist approaching the aneurysm using a microcatheter and filling the aneurysm with coils. In some cases a balloon may be inflated in the artery to assist in packing the aneurysm, especially if it is complex with a wide neck, and in some cases to protect the brain if rupture and bleeding occurs. New coils, stents and flow divertors are fast emerging into this area, as well as intrasaccular devices such as Web/Lunar devices, made of extremely fine-shaped mesh that expand to fill the aneurysm and eliminate the need for multiple coils to be deployed.
Neurovascular devices for the treatment of intracranial aneurysms: emerging and future technologies
Published in Expert Review of Medical Devices, 2020
In a recent meta-analysis of endovascular coiling of wide-neck and wide-neck bifurcation aneurysms with 38 studies including 2446 patients with 2556 aneurysms, the authors reported that endovascular coiling with or without stent-assisted coiling is safe, with low rates of per-procedural morbidity and mortality [69]. For all wide-neck aneurysms, immediate and follow-up complete or near-complete occlusion rates were 57.4% and 74.5%, respectively. Recanalization and retreatment rates were 9.4% and 5.8%, respectively. For wide-neck bifurcation aneurysms, initial complete or near-complete occlusion rate was 60.0%, long-term complete or near-complete occlusion rate was 71.9%, and the recanalization and retreatment rates were 9.8% and 5.2%, respectively. Initial and long-term angiographic outcomes were generally satisfactory, but not ideal.
Recent advances in stent-assisted coiling of cerebral aneurysms
Published in Expert Review of Medical Devices, 2020
Soliman Oushy, Lorenzo Rinaldo, Waleed Brinjikji, Harry Cloft, Giuseppe Lanzino
Endovascular treatment of intracranial aneurysms is an efficacious alternative to open surgical clipping. Recent development in treatment techniques and introduction of stent-assisted endovascular coiling has expanded the horizon of endovascular therapy to include treatment of wide-necked and bifurcation aneurysms. Although randomized control trials comparing stent-assisted coiling and flow diversion are not available yet, intravascular and intrasaccular flow diversion are likely to play a bigger role in the future of endovascular treatment of aneurysms.