Efficacy of endovascular treatment and feasibility of stent-assisted coiling in the presence of severe and symptomatic vasospasm
| Autor: | Emre Durdag, Ozgur Kardes, Murat Gedikoglu, Cagatay Andic, Sule Akin |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Subarachnoid hemorrhage medicine.medical_treatment Severity of Illness Index 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Aneurysm Modified Rankin Scale Occlusion medicine Humans Vasospasm Intracranial cardiovascular diseases Aged Retrospective Studies medicine.diagnostic_test business.industry Endovascular Procedures Stent Intracranial Aneurysm Vasospasm General Medicine Middle Aged medicine.disease Surgery Catheter Treatment Outcome Angiography cardiovascular system Feasibility Studies Female Stents Neurology (clinical) Radiology business 030217 neurology & neurosurgery |
| Zdroj: | Journal of NeuroInterventional Surgery. 9:1075-1080 |
| ISSN: | 1759-8486 1759-8478 |
| DOI: | 10.1136/neurintsurg-2016-012734 |
| Popis: | Background and purpose In patients with aneurysmal subarachnoid hemorrhage, deciding the optimal treatment strategy is challenging in the presence of severe and symptomatic vasospasm and the existing literature is limited. The purpose of this study was to evaluate the safety and effectiveness of endovascular treatment of intracranial aneurysms and the feasibility of stent-assisted coiling during severe and symptomatic vasospasm. Materials and methods Fifteen consecutive patients with 18 aneurysms who underwent endovascular treatment during severe and symptomatic vasospasm were included in the study. Patient and aneurysm characteristics, treatment technique, and clinical and angiographic outcomes were retrospectively evaluated. Results Aneurysms were treated by the following techniques: single catheter coiling in 9, stent-assisted coiling in 8 (3 aneurysms with Y-configuration double stents), and balloon-assisted coiling in 1. All patients showed angiographic improvement of vasospasm after treatment including a noticeable dilation of the spastic parent arteries following deployment of the stents. According to the immediate post-treatment angiography results, 14 aneurysms (77.8%) had class I occlusion and 4 (22.2%) had class II occlusion. Three patients died during the course of subarachnoid hemorrhage. Mortality was related to the poor grade (Hunt and Hess grade V) and cardiovascular complications in two and refractory vasospasm one patient. The remaining patients had favorable clinical outcomes at follow-up (modified Rankin Scale 0–2). Conclusions Endovascular treatment of intracranial aneurysms during severe and symptomatic vasospasm is safe and effective. Stent-assisted coiling in the presence of severe vasospasm is also feasible in wide-necked aneurysms with the additional benefits of mechanical vasodilation. |
| Databáze: | OpenAIRE |
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