Cerebral Aneurysms
Diagnosis, Indications, and Strategies for Endovascular Treatment
George D. Dangas MD, MACC, MSCAI, FAHA, FESC
Professor of Medicine (Cardiology) & Surgery (Vascular) Professor of Cardiology Adjunct Professor of Internal Medicine
Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
National Kapodistrian University of Athens, Greece
Medical University of Vienna, Austria
Search for more papers by this authorCarlo Di Mario MD, PhD, FRCP, FACC, FSCAI, FESC
Professor of Cardiology Director of the Structural Interventional Cardiology Division Honorary Consultant
University of Florence
University Hospital Careggi, Florence, Italy
Cardiologist Royal Brompton Hospital, London, UK
Search for more papers by this authorHolger Thiele MD
Professor of Cardiology at University of Leipzig
Heart Center Leipzig at University of Leipzig, Leipzig, Germany
Search for more papers by this authorPeter Barlis MBBS, MPH, PHD, FACC, FESC, FRACP
Professor of Cardiology Interventional Cardiologist
University of Melbourne, Melbourne, Victoria, Australia
St Vincent's & Northern Hospitals Victoria, Australia
Search for more papers by this authorSummary
This chapter deals with intracranial aneurysms, describing their classification according to their location, size, symptomatology and the severity of the disease they may cause. The baselines of their diagnosis, including CT, CTA, and MRA, and the principles of the endovascular treatment will be highlighted, along with the currently available and most widely used tools, like detachable coils, remodeling balloons, intracranial stents, intraluminal and intrasaccular flow diverters and neck-bridging devices. A short summary of the basic principles of the treatment strategies will give an insight in the work of a neurovascular team, consisting of highly specialized interventional neuroradiologists and vascular neurosurgeons.
References
- Molyneux A , Kerr R , Stratton I , Sandercock P et al . International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial . The Lancet. 2002 Oct 26; 360 ( 9342 ): 1267 – 74 .
- Kassell NF , Torner JC , Jane JA , et al . The International Cooperative Study on the Timing of Aneurysm Surgery. Part 2: Surgical results . J Neurosurg. 1990 Jul; 73 ( 1 ): 37 – 47 .
- Wiebers DO , Whisnant JP , Huston J 3rd , et al . Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment . The Lancet. 2003 Jul 12; 362 ( 9378 ): 103 – 10 .
- Serbinenko FA . Balloon catheterization and occlusion of major cerebral vessels . J Neurosurg. 1974 Aug; 41 ( 2 ): 125 – 45 .
- 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 Jul; 75 ( 1 ): 1 – 7 .
- Guglielmi G , Viñuela F , Dion J , Duckwiler G . Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience . J Neurosurg. 1991 Jul; 75 ( 1 ): 8 – 14 .
- Moret J , Cognard C , Weill A , et al . Reconstruction technic in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases J Neuroradiol. 1997 Jun; 24 ( 1 ): 30 – 44 .
- G D Luzardo , I B Ross , G Gal . Balloon-assisted coiling through a single 6F guiding catheter . American Journal of Neuroradiology 02/ 2006 ; 27 ( 1 ): 190 – 1
- Slob MJ , Sluzewski M , van Rooij WJ . The relation between packing and reopening in coiled intracranial aneurysms: a prospective study . Neuroradiology. 2005 Dec; 47 ( 12 ): 942 – 5 .
- Klisch J , Sychra V , Strasilla C , et al . The Woven EndoBridge cerebral aneurysm embolization device (WEB II) initial clinical experience . Neuroradiology 53 : 599 – 607 , 2011
- Pierot L , Liebig T , Sychra V , et al . Intrasaccular flow-disruption treatment of intracranial aneurysms: preliminary results of a multicenter clinical study . AJNR Am J Neuroradiol 33 : 1232 – 1238 , 2012
- Cognard C , Januel AC . Remnants and Recurrences After the Use of the WEB Intrasaccular Device in Large-Neck Bifurcation Aneurysms . Neurosurgery. 2015 May; 76 ( 5 ): 522 – 30 .
- Akhunbay-Fudge CY , Deniz K , Tyagi AK , Tufail Patankar Endovascular treatment of wide-necked intracranial aneurysms using the novel Contour Neurovascular System: a single-center safety and feasibility study . J NeuroIntervent Surg 2020 ; 1 – 6 . doi: 10.1136/neurintsurg-2019-015628
