Article Figures & Data
Figures
- Fig 1.
Schematic illustration of Neuroform-assisted embolization of a wide-necked superior hypophyseal aneurysm.
A, Microcatheter containing the stent was positioned over the wire distal to aneurysm location.
B, The stent was deployed by holding the stabilizing catheter in a fixed position while the 3F catheter was pulled back.
C and D, Interstices of fully expanded stent can easily accommodate microcatheter for coiling. Protrusion of coil loops in to internal carotid artery is prevented by the stent.
- Fig 2.
Case 8.
A, Pretreatment lateral carotid angiography shows a broad-necked superior hypophyseal aneurysm of the right internal carotid artery.
B, Stent delivery system is advanced distal to the aneurysm over microguidewire. Distal marker of the stent delivery catheter, proximal and distal markers of the stent itself within the catheter are visible.
C, Lateral fluoroscopic view shows the stent in the cavernous internal carotid artery, covering the orifice of the aneurysm.
D, Late arterial phase of lateral carotid angiography obtained after the stent deployment shows contrast extravasation, which is confirmed by CT (E) also. F and G, The second session of embolization performed 3 weeks later failed because of the persistent protrusion of the coils into the internal carotid artery.
- Fig 3.
Case 10.
A, Left vertebral angiography obtained 6 months after previous surgery shows residual filling of the basilar tip aneurysm and additional right vertebral artery aneurysm close to the origin of the posterior inferior cerebellar artery. Right posteriocerebral artery is supplied by the right carotid circulation via right posterior communicating artery (not shown).
B, Fluoroscopic road map image during embolization with balloon remodeling technique and postembolization right vertebral angiogram (C) shows satisfactory occlusion of the aneurysm with small neck remnant, especially on the right side.
D, Follow-up angiography 22 months after the embolization reveals recanalization and regrowth of the aneurysm.
E, After placement of Neuroform stent extending from the left posterior communicating artery to the distal basilar artery recanalized portion of the aneurysm embolized with multiple coils.
F, Proximal and distal markers of second Neuroform stent, placed across the right vertebral artery aneurysm, are seen. After insertion of the first coil into the aneurysm, lumen flow within the right posterior inferior cerebellar artery is diminished. The coil is retracted and embolization is abandoned.
- Fig 4.
Case 3.
A, Left carotid angiogram obtained after deployment of Neuroform stent shows broad-necked aneurysm originating from the lateral wall of the internal carotid artery at the level of ophthalmic artery.
B, Advancement of the first coil in to the aneurysm through interstices of the stent.
C, Total occlusion of the aneurysm is seen on postembolization anteroposterior left carotid angiography.
D, On lateral view, ill-defined filling defects consistent with significant amount of fresh thrombus is seen within the stented segment of the left internal carotid artery proximal to aneurysm. Partial and complete lysis of the clot is seen on angiograms obtained 15 minutes (E) and 24 hours (F) after starting the intravenous abciximab protocol.
Tables
Patient No. Age Aneurysm location Sizes (Dome/Neck) (mm) Status Stent size Balloon protection Result F/U time (Month) F/U result Adverse events and notes 1 46 Basilar tip 12/7 UR 4.0 × 20 Yes PS 2 59 L Carotid, supraclinoid 7/5 UR 4.5 × 20 No RF 7 RF Prev emb w/o stent failed 3 61 L Carotid, ophthalmic 6/5 UR 4.5 × 20 No C Reopro infusion for thrombus 4 29 L Carotid, pCom 10/8 UR 4.0 × 20 No PS 8 C 5 62 R Carotid, ophthalmic 5/5 UR 4.0 × 20 No RF Reopro infusion for thrombus Right Groin Hematoma Re-treatment Yes PS 14 C Balloon protection 6 52 R Carotid, cavernous 8/6 UR, Rec 4.0 × 20 No C 9 C Previous attempt with balloon expandable stent failed Stenting failed at 1st attempt 7 47 R Carotid, sup. Hypo 5/5 UR 4.0 × 20 Yes RF 7 C Reopro infusion for thrombus 8 39 R Carotid, sup. Hypo 4/4 UR 4.0 × 20 Extravasation due to guide wire injury to a distal branch 2nd attempt No Failed Coil protrusion 9 44 L Carotid, ophthalmic 18/7 UR 4.0 × 20 No PS 2 PS Stenting failed at 1st attempt Loss of vision on left eye 10 67 Basilar tip 12/6 R, Rec 4.0 × 20 No PS 3 PS R. Vertebral, PICA 11/8 UR 4.5 × 20 No Failed Protrusion of coils into PICA Aneurysm ruptured 11 60 L Carotid, ophthalmic 4/5 UR 4.5 × 20 Yes Failed Right hemiplegia & aphasia R Carotid, ophthalmic 4/4 UR 4.5 × 20 N/A 12 67 R Carotid, pCom. 4/3 UR 4.5 × 20 No RF 13 58 R Carotid, cavernous 12/7 UR 4.5 × 20 Yes PS 6 RF 14 72 R Carotid, supraclinoid 11/8 UR 4.5 × 20 Yes PS Putaminal hemorrhage nine days after embolization 15 67 R Carotid, ophthalmic 16/6* UR 4.0 × 20 Yes PS 2 RF 16 53 L Carotid, ophthalmic 12/8 UR 4.5 × 20 Yes RF 4.0 × 15 17 59 L Carotid, supraclinoid 7/6 UR No Failed Severe contrast reaction 18 82 R Carotid, pCom. 6/5 R 4.0 × 20 No PS 19 58 L Carotid, petrous 6/4 UR, Rec 4.5 × 20 No PS 7 RF 20 46 L Carotid, ophthalmic 9/6 UR 4.5 × 20 Yes PS Reopro infusion for thrombus 21 71 R Carotid, supraclinoid 8/7 UR 4.5 × 20 Yes RF Stenting failed at 1st attempt R Carotid, pCom. 8/7 UR Yes RF 22 68 L Carotid, ophthalmic 10/8 UR 4.0 × 20 No PS 23 78 R Carotid, ophthalmic 5/4 UR 4.5 × 20 No PS 6 C 24 59 L Carotid, supraclinoid 10/5 UR 4.5 × 20 No C 3 C 25 46 R Posterior cerebral 19/19 UR 4.0 × 20 No C Parent artery occlusion resulted occipital stroke 26 59 L Carotid, ophthalmic 7/6 UR 4.5 × 20 Yes PS 27 36 L Posterior cerebral 6/6 R 4.0 × 20 No PS 28 70 Basilar tip 10/10 R, Rec 4.0 × 20 No PS Cross-stenting, late mortal posterior circulation stroke 4.0 × 20 No 29 54 L Carotid, cavernous 7/7 UR, Rec 4.0 × 20 No RF Reopro infusion for thrombus 30 66 Basilar tip 20/12 UR 4.0 × 20 No RF 31 62 R Carotid, ophthalmic 6/4 UR 4.5 × 20 No C Reopro infusion for thrombus Occular TIA 2 weeks after 32 73 R Carotid, ophthalmic 12/7 UR 4.5 × 20 No RF Note.—
a L, left; R, right; pCom, posterior communicating artery; sup. Hypo, superior hypophyseal; PICA, Posterior inferior cerebellar artery; UR, unruptured; R, ruptured; Rec, Recurrent; C, Complete occlusion; PS, Partial but satisfactory occlusion (>90%); RF, Residual filling (<90%); F/U, follow-up; w/o, without.
Patient # Event PND 1 28 Late subacute thromboembolic stroke Yes* 2 11 Aneurysm rupture Yes 3 8 SAH due to guide wire perforation No 4 25 Parent vessel occlusion No 5 9 Loss of vision Yes 6 31 Visual TIA No 7 14 Late Intra cranial hemorrhage Yes 8 5 Groin Hematoma No 9 17 Contrast Reaction No Note.—PND, Permanent neurologic deficit; SAH, Subarachnoid hemorrhage; TIA, Transient ischemic attack.
* Patient deceased.
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