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      The ’bendy' basilar: progressive aneurysm tilting and arterial deformation can be a delayed outcome after coiling of large basilar apex aneurysms

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          Abstract

          Background

          Morphological changes in the basilar artery and the artery-aneurysm relationship following coiling of large basilar apex aneurysms may induce morbidity.

          Methods

          The basilar artery radius-of-curvature was measured along its center line on volumetrically reconstructed images formatted along the plane of curvature. The aneurysm-tilt-angle was measured between the distal basilar and the vertical long axis of the aneurysm. The measurements were compared between small (<10 mm) and large (≥10 mm) aneurysms on baseline and follow-up studies. The volume (mm 3) and mass (g) of the deployed coils was also compared.

          Results

          Among 94 consecutive aneurysms, 62 (66%) were <10 mm and 32 (34%) were ≥10 mm. The mean aneurysm size and volume was 9 mm (±4) and 507 mm 3(±1366) respectively. The median aneurysm follow-up was 24 months (IQR 6–59). There was no difference between the groups based on age, gender, or associated comorbidities. The coil mass was 0.4 g (±0.2) for aneurysms <10 mm and 1.9 g (±1.6) for aneurysms ≥10 mm (P<0.0001). The total coil volume was 32 (±20) mm 3 for aneurysms <10 mm and 187 (±172) mm 3 for aneurysms ≥10 mm (P<0.0001). Aneurysms ≥10 mm tilted 13.5 o (±14.4) compared with 1.1 o (±2.8) for aneurysms <10 mm (P<0.0001). The basilar artery became more curved by 1.3 (±9.4) mm for aneurysms ≥10 mm and 0.25 (±2.1) mm for aneurysms <10 mm (P=0.0002). Other than size of the coiled aneurysms no other factors correlated with the geometrical changes.

          Conclusion

          Large coiled basilar apex aneurysms may be more prone to aneurysm tilting and bending of the basilar artery. Speculative causes include the weight of the coil mass and the biomechanical forces exerted on the coiled aneurysm.

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          Most cited references 23

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          Comparison of Devices Used for Stent-Assisted Coiling of Intracranial Aneurysms

          Introduction Two self-expandable stents, the Neuroform and the Enterprise stent, are widely used for stent-assisted coiling (SAC) of complex shaped intracranial aneurysms. However, comparative knowledge about technical feasibility, peri- and post-procedural morbidity and mortality, packing densities as well as follow-up data is limited. Material and Methods We conducted a retrospective study to investigate differences in aneurysms stented with the Enterprise or Neuroform stents. Angiographic follow-up (mean 19.42 months) was available in 72.6% (61/84) of aneurysms treated with stent-assisted coiling. We further sought to compare stent-assisted coiling to a matched patient population with aneurysms treated by conventional coil embolization. Results The stenting success rate of the Enterprise was higher compared to the Neuroform stent (46/48 and 42/51, respectively). In 5 of 9 cases in which the Neuroform stent was not navigable to the landing zone, we successfully deployed an Enterprise stent instead. Eventually, 42 aneurysms were coiled after stenting in each group. We observed no significant differences in peri-procedural complication rate, post-procedural hospital stay, packing density, recurrence rate or number of in-stent stenosis. Strikingly, 36.1% of followed aneurysms in the SAC group showed progressive occlusion on angiographic follow-up imaging. The packing density was significantly higher in aneurysms treated by SAC as compared to conventionally coiled aneurysms, while recanalization rate was significantly lower in the SAC group. Conclusion The procedural success rate is higher using the Enterprise, but otherwise both stents exhibited similar characteristics. Lower recurrence frequency and complication rates comparable to conventional coil embolization emphasize the importance of stent-assisted coiling in the treatment of complex aneurysms. Progressive occlusion on angiographic follow-up was a distinct and frequent observation in the SAC group and may in part be due to flow diversion.
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            WEB Treatment of Intracranial Aneurysms: Clinical and Anatomic Results in the French Observatory.

             L Pierot (corresponding) ,  J Moret,  F Turjman (2016)
            Flow disruption with the WEB device is a new technique for the endovascular treatment of wide-neck bifurcation aneurysms. To obtain precise data regarding the safety and efficacy of this treatment with high-quality methodology, the prospective French Observatory study was conducted. Analysis of these data is presented, including 1-year follow-up.
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              Endovascular coiling versus neurosurgical clipping in patients with a ruptured basilar tip aneurysm.

              To compare endovascular coiling with neurosurgical clipping of ruptured basilar bifurcation aneurysms. Patient and aneurysm characteristics, procedural complications, and clinical and anatomical results were compared retrospectively in 44 coiled patients and 44 patients treated by clipping. The odds ratios for poor outcome (Glasgow outcome scale 1, 2, 3) adjusted for age, clinical condition, and aneurysm size were assessed by logistic regression analysis. In the endovascular group, five patients (11%) had a poor outcome v 13 (30%) in the surgical group; the adjusted odds ratio for poor outcome after coiling v clipping was 0.28 (95% confidence interval, 0.08 to 0.99). Procedural complications were more common in the surgical group. Optimal or suboptimal occlusion of the aneurysm immediately after coiling was achieved in 41 patients (93%). Clipping was successful in 40 patients (91%). The results suggest that embolisation with coils is the preferred treatment for patients with ruptured basilar bifurcation aneurysms.
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                Author and article information

                Journal
                J Neurointerv Surg
                J Neurointerv Surg
                neurintsurg
                jnis
                Journal of Neurointerventional Surgery
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                1759-8478
                1759-8486
                January 2019
                17 May 2018
                : 11
                : 1
                : 37-42
                Affiliations
                [1 ] departmentDepartment of Interventional Neuroradiology , West Virginia University Hospital , Morgantown, West Virginia, USA
                [2 ] departmentDepartment of Neuroradiology , West Virginia University , Morgantown, West Virginia, USA
                [3 ] departmentDepartment of Neurosurgery , West Virginia University , Morgantown, West Virginia, USA
                Author notes
                [Correspondence to ] Dr Ansaar T Rai, Department of Interventional Neuroradiology, West Virginia University, Morgantown, WV 26506, USA; ansaar.rai@ 123456gmail.com
                Article
                neurintsurg-2018-013940
                10.1136/neurintsurg-2018-013940
                6327868
                29773714
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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                Hemorrhagic Stroke
                1506
                1543
                Original research
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                Surgery

                complication, aneurysm, coil

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