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Subarachnoid Hemorrhage
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Dominic A. Harris, Ajith J. Thomas
The next paradigm shift occurred in the 1990s with the introduction of endovascular coiling for cerebral aneurysms. Guido Guglielmi developed the detachable coil using electrolysis and successfully treated his first patient in 1990 [2]. Endovascular treatment is performed under fluoroscopic guidance where a catheter is navigated to the parent artery of the aneurysm. A microcatheter is then advanced into the aneurysm sac where metal coils are deployed into the aneurysm. This causes thrombus formation inside the aneurysm sac, and thus occludes the aneurysm and eliminates risk of rerupture [3].
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.
Neurological deficits
Published in Philip Woodrow, Nursing Acutely Ill Adults, 2015
With haemorrhagic stroke, bleeding needs stopping, necessitating urgent intervention in, and so transfer to, a neurological centre. The preferred treatment is endovascular coiling (inserting a platinum coil into an aneurysm); alternatively, bleeding points are surgically ligated (‘clipping’). With intervention, most survive a first bleed, but a second bleed has very poor prognosis. Other early complications include vasospasm and hydrocephalus. Both procedures entail risks, but ten-year survival is higher with endovascular coiling (Molyneux et al., 2014).
Assessment of balloon remodeling techniques in endovascular treatment of wide-neck intracranial aneurysms (WN-IAs)
Published in Neurological Research, 2023
Nabiel Abd-Elhakeem Metwaly, Khaled Mohammed Sobh, Mahmoud Glal Ahmed, Abd Elaziz Shokry Abd Elaziz, Salah Ibrahim Ahmed
In conclusion, digital subtraction angiography is the gold standard method for diagnosing intracranial aneurysms and should be done when suspected. Balloon-assisted detachable coiling is an important option in the treatment of WN-IAs. We found that this technique allowed safe and efficient treatment of aneurysms when conventional treatment had failed due to WN. Endovascular coiling using the balloon remodeling technique of wide neck showed a high technical success rate and good short-term clinical outcomes. A good selection of patients with WN-IAs treated by endovascular coiling using balloon remodeling technique and a good selection of materials used help in decreasing the complications. Further studies with larger sample sizes and longer duration of follow-up are required to evaluate and differentiate the feasibility of Balloon-assisted detachable coiling from other methods and techniques in the treatment of WN-IAs.
The value of repeated lumbar puncture to test for xanthochromia, in patients with clinical suspicion of subarachnoid haemorrhage, with CT-negative and initial traumatic tap
Published in British Journal of Neurosurgery, 2021
Musa China, Samir A. Matloob, Joan P. Grieve, Ahmed K. Toma
In the context of a normal plain CT scan and an unconvincing clinical history, vascular imaging is more likely to detect an unruptured aneurysm than for a bleed to have occurred.1,4 Approximately 2–3% of the general population harbour an unruptured cerebral aneurysm4 and the incidence of an actual SAH in the population is estimated to be approximately eight per 100,000 person-years.13 Endovascular coiling carries a 5% risk of intra-procedural aneurysm rupture14 and an estimated 2% 30-day mortality or morbidity risk.15 Late re-bleeding from the aneurysm responsible for the first SAH is still a potential complication following successful coiling or clipping, estimated to be around 2–3% in the first decade following treatment of the ruptured aneurysm.16 Overall, this highlights the need for an alternative diagnostic strategy which can exclude SAH, limit unnecessary secondary imaging and reduce potential further risks patients are exposed to. For the further investigation of a traumatic tap following a negative CT scan for SAH, the value of performing a repeat LP has not yet been explored.
Initial multicentre experience using the neuroform atlas stent for the treatment of un-ruptured saccular cerebral aneurysms
Published in British Journal of Neurosurgery, 2020
Jin Wook Baek, Sung-Chul Jin, Jung Hoon Kim, Min Wook Yoo, Hae Woong Jeong, Jung Hwa Seo, Ji Yeon Han, Young Jin Heo, Sung Tae Kim
We retrospectively evaluated all intracranial aneurysms treated by SAC with a single Neuroform Atlas stent in two medical institutions between February and May 2018. During the given period, endovascular coiling was performed on 210 aneurysms. SAC was performed on 115 aneurysms, of which 62 aneurysms which underwent SAC with a single Neuroform Atlas stent were enrolled in this study. Since our study focused on the practical outcomes of stent usage, the angiographic and clinical outcomes of SAC using the Neuroform Atlas stent in unruptured saccular aneurysms were evaluated. Therefore, two ruptured aneurysms, four dissecting aneurysms, and one aneurysm which was treated using multiple stents were excluded. Thus, a total of 51 patients with 55 unruptured saccular aneurysms were included in our study. Details are presented in Figure 1. There were 40 females and 11 males, and the mean age of the patients was 59.29 ± 11.96 years. Clinical data were obtained by reviewing patient medical records. The primary endpoint of this study was the technical success rate and the secondary endpoint was the procedural complication rate.