Endovascular Treatment of Intracranial Aneurysms

Christopher J. Moran; De Witte T. Cross III; Colin P. Derdeyn

doi:10.1055/s-2002-36749

Seminars in Interventional Radiology, Inhaltsverzeichnis

Semin intervent Radiol 2002; 19(4): 339-376
DOI: 10.1055/s-2002-36749

Endovascular Treatment of Intracranial Aneurysms

Christopher J. Moran¹ , DeWitte T. Cross, III² , Colin P. Derdeyn³

¹Neuroradiology Section, Mallinckrodt Institute of Radiology at Washington University Medical Center, St. Louis, Missouri
²Department of Interventional Neuroradiology, Mallinckrodt Institute of Radiology at Washington University Medical Center, St. Louis, Missouri
³Department of Endovascular Surgical Neuroradiology, Neuroradiology Section, Mallinckrodt Institute of Radiology at Washington University Medical Center, St. Louis, Missouri

Abstract

ABSTRACT

An intracranial aneurysm is a benign disorder that causes patients to have neurological deficits or to die. The sequelae develop because aneurysms rupture into the subarachnoid space or compress nervous tissue. Intracranial aneurysms occur in up to 8% of the population, more commonly in women, and the only modifiable risk factor for hemorrhage is cigarette smoking. Treatment is directed at the prevention of rupture or rebleeding and relief of mass effect. Surgical clipping has been the primary treatment, but in the past 6 years, endovascular therapy (Guglielmi detachable coil® [GDC]) has become widely available. Initially GDC treatment was directed at the nonsurgical candidate but recently has begun to compare with surgical clipping as a definitive mode of therapy. The primary consideration for successful GDC treatment of an aneurysm is the relationship of the aneurysm to its parent vessel and any branches. The size of the aneurysm dome in relation to the aneurysm neck, presence of thrombus, and the inflow zone are also significant factors. Coil compaction and aneurysm remnants at its neck are significant problems in GDC treatment. The technique and instruments are constantly improving: development of the remodeling technique; the introduction of softer, stretch-resistant coils; and the use of flexible coronary stents have permitted successful treatment of patients who once would have been considered poor candidates for this mode of therapy. Future development of more compliant balloons, coated coils, and liquid embolics will extend and improve endovascular therapy for patients with intracranial aneurysms.

KEYWORD

Intracranial aneurysms - subarachnoid hemorrhage - saccular aneurysm (berry aneurysm) - dissecting aneurysm - endovascular therapy - Guglielmi detachable coil (GDC)

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Referenzen

REFERENCES

1 Sahs A L, Perret, Locksley H B, Nishioka H. Intracranial Aneurysms and Subarachnoid Hemorrhage; First Cooperative Study of SAH. Philadelphia, PA: JB Lippincott. 1969;
2 Schwartz T H, Solomon R A. Perimesencephalic nonaneurysmal subarachnoid hemorrhage: review of the literature. Neurosurgery . 1996; 39 433-440
3 Schievink W I. Intracranial aneurysms. N Engl J Med . 1997; 336 28-40
4 Qureshi A I, Suarez J I, Parekh P D. Risk factors for multiple intracranial aneurysms. Neurosurgery . 1998; 43 22-27
5 Hunt W E, Hess R M. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg . 1968; 28 14-20
6 Fisher C M, Kistler J P, Davis J M. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery . 1980; 6 1-9
7 Khurana V G, Piepgras D G, Whisnant J P. Ruptured giant intracranial aneurysms. Part I. A study of rebleeding. J Neurosurg . 1998; 88 425-429
8 Piepgras D G, Khurana V G, Whisnant J P. Ruptured giant intracranial aneurysms. Part II. A retrospective analysis of timing and outcome of surgical treatment. J Neurosurg . 1998; 88 430-435
9 Gobin Y P, Viñeula F, Gurian J H. Treatment of large and giant fusiform intracranial aneurysms with Guglielmi detachable coils. J Neurosurg . 1996; 84 55-62
10 Cross III T D, Moran C J, Brown A P. Endovascular treatment of epistaxis in a patient with tuberculosis and a giant petrous carotid pseudoaneurysm. AJNR Am J Neuroradiol . 1995; 16 1084-1086
11 Meyer F B, Morita A M, Puumala M R, Nichols D A. Medical and surgical management of intracranial aneurysms. Mayo Clin Proc . 1995; 70 153-172
12 Wiebers, Whisnant J P, Sundt Jr M T, O'Fallon W M. The significance of unruptured intracranial saccular aneurysms. J Neurosurg . 1987; 66 23-29
13 Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture. J Neurosurg . 2000; 93 379-387
14 Obuchowski N A, Modic M T, Magdinec M. Current implications for the efficacy of noninvasive screening for occult intracranial aneurysms in patients with a family history of aneurysms. J Neurosurg . 1995; 83 42-49
15 The International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms-risk of rupture and risks of surgical intervention. N Engl J Med . 1998; 339 1725-1733
16 Jane J A, Kassell N F, Torner J C, Winn H R. The natural history of aneurysms and arteriovenous malformations. J Neurosurg . 1985; 62 321-323
17 Chyatte D, Fode N C, Sundt Jr M T. Early versus late intracranial aneurysm surgery in subarachnoid hemorrhage. J Neurosurg . 1988; 69 326-331
18 Torner J C, Kassell N F, Haley Jr C E. The timing of surgery and vasospasm. Neurosurg Clin North Am . 1990; 1 335-347
19 Nichols D A, Meyer F R, Piepgras D G, Smith P L. Endovascular treatment of intracranial aneurysms. Mayo Clin Proc . 1994; 69 272-285
20 Solander S, Ulhoa A, Viñuela F. Endovascular treatment of multiple intracranial aneurysms by using Guglielmi detachable coils. J Neurosurg . 1999; 90 857-864
21 Zubillaga A F, Guglielmi G, Viñuela F, Duckwiler G R. Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR Am J Neuroradiol . 1994; 15 815-820
22 Hope J K, Byrne J V, Molyneux A J. Factors influencing successful angiographic occlusion of aneurysms treated by coil embolization. AJNR Am J Neuroradiol . 1999; 10 391-399
23 Litofsky N S, Viñuela F, Giannotta S L. Progressive visual loss after electrothrombosis treatment of a giant intracranial aneurysm: case report. Neurosurgery . 1994; 34 548-551
24 Halbach V V, Higashida R T, Dowd C. The efficacy of endosaccular aneurysm occlusion in alleviating neurological deficits produced by mass effect. J Neurosurg . 1994; 80 659-666
25 Vargas M E, Kupersmith M J, Setton A. Endovascular treatment of giant aneurysms which cause visual loss. Ophthalmology . 1994; 101 1091-1098
26 Gurian J H, Martin N A, King W A. Neurosurgical management of cerebral aneurysms following unsuccessful or incomplete endovascular embolization. J Neurosurg . 1995; 83 843-853
27 Civit T, Auque J, Marchal J C. Aneurysm clipping after endovascular treatment with coils: a report of eight patients. Neurosurgery . 1996; 38 955-961
28 Marks M P, Steinberg G K, Lane B. Combined use of endovascular coils and surgical clipping for intracranial aneurysms. AJNR Am J Neuroradiol . 1995; 16 15-18
29 David C A, Vishteh A G, Spetzler R F. Late angiographic follow-up review of surgically treated aneurysms. J Neurosurg . 2001; 94 541-542
30 Macdonald R L, Wallace M C, Kestle J R. Role of angiography following aneurysm surgery. J Neurosurg . 1993; 79 826-832
31 Derdeyn C P, Moran C J, Cross D T. Intraoperative digital subtraction angiography: a review of 112 consecutive examinations. AJNR Am J Neuroradiol . 1995; 16 307-318
32 Feuerberg I, Lindquist C, Lindqvist M, Steiner L. Natural history of postoperative aneurysm rests. J Neurosurg . 1987; 66 30-34
33 Weir B. Aneurysms Affecting the Nervous System. Baltimore, MD: Williams & Wilkins 1987
34 King Jr T J, Berlin J A, Flamm E S. Morbidity and mortality from elective surgery for asymptomatic, unruptured, intracranial aneurysms: a meta-analysis. J Neurosurg . 1994; 81 837-842
35 Brilstra E H, Rinkel G JE, van der Graaf Y. Treatment of intracranial aneurysms by embolization with coils; a systematic review. Stroke . 1999; 30 470-476
36 Vanninen R, Koivisto T, Saari T. Ruptured intracranial aneurysms: acute endovascular treatment with electrolytically detachable coils-a prospective randomized study. Radiology . 1999; 211 325-336
37 Koivisto T, Vanninen R, Hurskainen H. Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms. A prospective randomized study. Stroke . 2000; 31 2369-2377
38 Dovey Z, Misra M, Thornton J. Guglielmi detachable coiling for intracranial aneurysms; the story so far. Arch Neurol . 2001; 58 559-564
39 van Gijn J, van Dongen J K. The time course of aneurysmal haemorrhage on computed tomograms. Neuroradiology . 1982; 23 153-156
40 Villablanca J P, Martin N, Jahan R. Volume-rendered helical computerized tomography angiography in the detection and characterization of intracranial aneurysms. J Neurosurg . 2000; 93 254-264
41 White P M, Teasdale E M, Wardlaw J M, Easton V. Intracranial aneurysms: CT angiography and MR angiography for detection-prospective blinded comparison in a large patient cohort. Radiology . 2001; 219 739-749
42 Newell D W, LeRoux P D, Dacey Jr G R. CT infusion scanning for the detection of cerebral aneurysms. J Neurosurg . 1989; 71 175-179
43 Noguchi K, Ogawa T, Inugami A. Acute subarachnoid hemorrhage: MR imaging with fluid-attenuated inversion recovery pulse sequences. Radiology . 1995; 196 773-777
44 Atlas S W, Sheppard L, Golldberg H I. Intracranial aneurysms: detection and characterization with MR angiography with use of an advanced postprocessing technique in a blinded-reader study. Radiology . 1997; 203 807-814
45 Adams W M, Laitt R D, Jackson A. The role of MR angiography in the pretreatment assessment of intracranial aneurysms: a comparative study. AJNR Am J Neuroradiol . 2000; 21 1618-1628
46 Cloft H J, Kallmes D F, Dion J E. A second look at the second-look angiogram in cases of subarachnoid hemorrhage. Radiology . 1997; 205 323-325
47 Iwanaga H, Wakai S, Ochiai C. Ruptured cerebral aneurysms missed by initial angiographic study. Neurosurgery . 1990; 27 45-51
48 Cloft H J, Joseph G J, Dion J E. Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation. Stroke . 1999; 30 317-320
49 Strother C M. Interventional neuroradiology. AJNR Am J Neuroradiol . 2000; 21 19-24
50 Goto K, Halbach V V, Hardin C W. Permanent inflation of detachable balloons with a low-viscosity, hydrophilic polymerizing system. Radiology . 1988; 169 787-790
51 Guglielmi G, Viñuela F. Intracranial aneurysms; Guglielmi electrothrombotic coils. Neurosurg Clin North Am . 1994; 5 427-435
52 Guglielmi G, Viñuela F, Sepetka I, Macellari V. Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. J Neurosurg . 1991; 75 1-7
53 Guglielmi G, Viñuela F, Dion J, Duckwiler G. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg . 1991; 75 8-14
54 Hilal S K, Solomon R A. Endovascular treatment of aneurysms with coils (Letter). J Neurosurg . 1992; 76 337-338
55 Thielen K R, Nichols D A, Fulgham J R, Piepgras D G. Endovascular treatment of cerebral aneurysms following incomplete clipping. J Neurosurg . 1997; 87 184-189
56 Regli L, Uske A, de Tribolet N. Endovascular coil placement compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms: a consecutive series. J Neurosurg . 1999; 90 1025-1030
57 Eckard D A, O'Boynick P L, McPherson C M. Coil occlusion of the parent artery for treatment of symptomatic peripheral intracranial aneurysms. AJNR Am J Neuroradiol . 2000; 21 137-142
58 Massoud T F, Guglielmi G, Viñuela F, Duckwiler G R. Endovascular treatment of multiple aneurysms involving the posterior intracranial circulation. ANJR Am J Neuroradiol . 1996; 17 549-554
59 Debrun G M, Aletich V A, Kehrli P. Aneurysm geometry: an important criterion in selecting patients for Guglielmi detachable coiling. Neurol Med Chir Suppl . 1998; 38 1-20
60 Gailloud P, Fasel J HD, Muster M. A case in favor of aneurysmographic studies: a perforating artery originating from the come of a basilar tip aneurysm. AJNR Am J Neuroradiol . 1997; 18 1691-1694
61 Shanno G B, Armonda R A, Benitez R P, Rosenwasser R H. Assessment of acutely unsuccessful attempts at detachable coiling in intracranial aneurysms. Neurosurgery . 2001; 48 1066-1072
62 Turjman F, Massoud T F, Sayre J, Viñuela F. Predictors of aneurysmal occlusion in the period immediately after endovascular treatment with detachable coils: a multivariate analysis. AJNR Am J Neuroradiol . 1998; 19 1645-1651
63 Qureshi A I, Suri M FK, Khan J. Endovascular treatment of intracranial aneurysms by using Guglielmi detachable coils in awake patients: safety and feasibility. J Neurosurg . 2001; 94 880-885
64 Satoh K, Satomi J, Matsubara S, Magahiro S. Measurement of volume ratio to predict coil compaction on aneurysmal embolization. Intervent Neuroradiol . 1998; 4(Suppl 1) 179-182
65 Reul J, Weis J, Spetzger U. Long-term angiographic and histopathologic findings in experimental aneurysms of the carotid bifurcation embolized with platinum and tungsten coils. AJNR Am J Neuroradiol . 1997; 18 35-42
66 Bavinzski G, Talozoglu V, Killer M. Gross and microscopic histopathological findings in aneurysms of the human brain treated with Guglielmi detachable coils. J Neurosurg . 1999; 91 284-293
67 Derdeyn C P, Cross D T, Moran C J. Procedural thrombus and postprocedural ischemic events after treatment of intracranial aneurysms with GDC. J Neurosurg . 2002; 96 165A
68 McDougall C G, Halbach V V, Dowd C F. Causes and management of aneurysmal hemorrhage occurring during embolization with Guglielmi detachable coils. J Neurosurg . 1998; 89 87-92
69 Ricolfi F, Le Guerinel C, Blustaijn J. Rupture during treatment of recently ruptured aneurysms with Guglielmi electrodetachable coils. AJNR Am J Neuroradiol . 1998; 19 1653-1658
70 Sluzewski M, Bosch J A, van Rooij J W. Rupture of intracranial aneurysms during treatment with Guglielmi detachable coils: incidence, outcome, and risk factors. J Neurosurg . 2001; 94 238-240
71 Nornes H. The role of intracranial pressure in the arrest of hemorrhage in patients with ruptured aneurysm. J Neurosurg . 1973; 39 226-234
72 Halbach V V, Higashida R T, Dowd C F. Endovascular treatment of vertebral artery dissections and pseudoaneurysms. J Neurosurg . 1993; 79 183-191
73 Stahmer S A, Raps E C, Mines D I. Carotid and vertebral artery dissections. Emerg Med Clin North Am . 1997; 15 677-698
74 Yamaura I, Tani E, Yokota M. Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils. J Neurosurg . 1999; 90 853-856
75 Kurata A, Ohmomo T, Miyasaka Y. Coil embolization for the treatment of ruptured dissecting vertebral aneurysms. AJNR Am J Neuroradiol . 2001; 22 11-18
76 Drake C G. Ligation of the vertebral (unilateral or bilateral) or basilar artery in the treatment of large intracranial aneurysms. J Neurosurg . 1975; 43 255-274
77 Lylyk P, Ceratto R, Hurvitz D, Basso A. Treatment of a vertebral dissecting aneurysm with stents and coils: technical case report. Neurosurgery . 1998; 43 385-388
78 Lylyk P, Cohen J, Ceratto R. Combined endovascular treatment of dissecting vertebral artery aneurysms by using stents and coils. J Neurosurg . 2001; 94 427-432
79 Mawad M E, Klucznik R P. Giant serpentine aneurysms: radiographic features and endovascular treatment. AJNR Am J Neuroradiol . 1995; 15 1053-1060
80 Graves V B, Peri II J, Strother C M. Endovascular occlusion of the carotid or vertebral artery with temporary proximal flow arrest and microcoils: clinical results. AJNR Am J Neuroradiol . 1997; 18 1201-1206
81 Barr J D, Lemley T J. Endovascular arterial occlusion accomplished using microcoils deployed with and without proximal flow arrest: results in 19 patients. AJNR Am J Neuroradiol . 1999; 20 1452-1456
82 Masaryk T J, Perl II J, Wallace R C. Detachable balloon embolization: concomitant use of a second safety balloon. AJNR Am J Neuroradiol . 1999; 20 1103-1106
83 Mathis J M, Barr J D, Jungreis C A. Temporary balloon test occlusion of the internal carotid artery: experience in 500 cases. AJNR Am J Neuroradiol . 1995; 16 749-754
84 Mericle R A, Lanzino G, Wakhloo A KK. Stenting and secondary coiling of intracranial internal carotid artery aneurysm: technical case report. Neurosurgery . 1998; 43 1229-1234
85 Wilms G, van Calenbergh F, Stockx L. Endovascular treatment of a ruptured paraclinoid aneurysm of the carotid siphon achieved using endovascular stent and endosaccular coil placement. AJNR Am J Neuroradiol . 2000; 21 753-756
86 Taki W, Nishi S, Yamashita K. Selection and combination of various endovascular techniques in the treatment of giant aneurysms. J Neurosurg . 1992; 77 37-42
87 Moret J, Cognard C, Weill A. The "remodelling technique" in the treatment of wide neck intracranial aneurysms; angiographic results and clinical follow-up in 56 cases. Intervent Neuroradiol . 1997; 3 21-35
88 Massoud T F, Turjman F, Ji C. Endovascular treatment of fusiform aneurysms with stents and coils; technical feasibility in a swine model. Am J Neuroradiol . 1995; 16 1953-1963
89 Geremia G, Bakon M, Brennecke L, Haklin M. Experimental arteriovenous fistulas: treatment with porous metallic stents. AJNR Am J Neuroradiol . 1995; 16 1965-1973
90 Jungreis C A. The use of stents in endovascular intervention. AJNR Am J Neuroradiol . 1995; 16 1974-1976
91 Wakhloo A K, Lanzino G, Lieber B B, Hopkins L N. Stents for intracranial aneurysms: the beginning of a new endovascular era?. Neurosurgery . 1998; 43 377-384
92 Higashida R T, Smith W, Gress D. Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. Case report and review of the literature. J Neurosurg . 1997; 87 944-949
93 Lanzino G, Waklhoo A K, Fessler R D. Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms. J Neurosurg . 1999; 91 538-546
94 Phatouros C C, Sasaki T Y, Higashida R T. Stent-supported coil embolization: the treatment of fusiform and wide-neck aneurysms and pseudoaneurysms. Neurosurgery . 2000; 47 107-113
95 Murayama Y, Suzuki Y H, Viñuela F. Development of a biologically active Guglielmi detachable coil for the treatment of cerebral aneurysms. Part I: in vitro study. AJNR Am J Neuroradiol . 1999; 20 1986-1991
96 Murayama Y, Viñuela F, Suzuki Y. Development of the biologically active Guglielmi detachable coil for the treatment of cerebral aneurysms. Part II: an experimental study in a swine aneurysm model. AJNR Am J Neuroradiol . 1999; 20 1992-1999
97 Marx W F, Cloft H J, Helm G A. Endovascular treatment of experimental aneurysms by use of biologically modified embolic devices: coil-mediated intraaneurysmal delivery of fibroblast tissue allografts. AJNR Am J Neuroradiol . 2001; 22 323-333
98 Abrahams J M, Forman M S, Grady M S, Diamond S L. Delivery of human vascular endothelial growth factor with platinum coils enhances wall thickening and coil impregpnation in a rat aneurysm model. AJNR Am J Neuroradiol . 2001; 22 1410-1417
99 Raymond J, Desfaits A C, Roy D. Fibrinogen and vascular smooth muscle cell grafts promote healing of experimental aneurysms treated by embolization. Stroke . 1999; 30 1657-1664
100 Cognard C, Pierot L, Boulin A. Intracranial aneurysms: endovascular treatment with mechanical detachable spirals in 60 aneurysms. Radiology . 1997; 202 783-792
101 Weill A, Ducros V, Cognard C. Corrosion of tungsten spirals: a disturbing finding. Intervent Neuroradiol . 1998; 4 337-340
102 Reul J. Corrosion of tungsten spirals (Letter). Intervent Neuroradiol . 1998; 4 341-342
103 Pelz D. Potential hazards in the use of tungsten mechanical detachable coils (Letter). Radiology . 2000; 214 602-603
104 Murphy K J, Mandai S, Gailloud P. Neurovascular embolization: in vitro evaluation of a mechanical detachable platinum coil system. Radiology . 2000; 217 904-906
105 Murphy K J, Houdart E, Szopinski K T. Mechanical detachable platinum coil: report of the European phase II clinical trial in 60 patients. Radiology . 2001; 219 541-544