OBJECTIVETo explore the causes, prevention, and management of the complications during intracranial aneurysm embolization with controllable coils (mechanical detachable spiral, MDS; and Guglielmi detachable coil, GDC).

METHODSRetrospective review of 120 cases with 125 intracranial aneurysms embolized with controllable coils from March 1995 to July 1999 was conducted. The 20 accidents (in 18 cases) including aneurysm rupture, over-embolization, protrusion of coil end into the parent artery, and thrombosis of the parent artery were analyzed.

RESULTSAmong the 20 accidents, there were 6 aneurysm ruptures, 6 over-embolizations (in 5 cases), 6 coil protrusions, and 2 thromboses (one was secondary to coil protrusion). The embolization-related mortality was 3.33% (4/120), the permanent neurological deficit was 1.67% (2/120), and the transitory neurological deficit was 3.33% (4/120). The occurrence and outcome of the complications were related to the embolizing technique, the pattern of aneurysm and its parent artery, the imperfection of embolic materials, and the observation and management during embolization.

CONCLUSIONSkilled embolizing technique, better understanding of the angio-anatomy of an aneurysm and its parent artery, correct judgement and management during embolization, and improvement of embolic materials are beneficial to the reduction of complications and to the melioration of the outcome of complications.

Aneurysm, Ruptured ; etiology ; Embolization, Therapeutic ; adverse effects ; instrumentation ; Humans ; Intracranial Aneurysm ; therapy ; Retrospective Studies ; Thrombosis ; etiology

OBJECTIVETo explore the diagnosis and treatment strategy of multiple intracranial aneurysms (MIA).

METHODSWe retrospectively analyzed 96 patients with MIA (234 aneurysms). The rupture site was determined on the basis of computed tomographic and angiographic findings, and the supposed ruptured aneurysm was treated with coiling OR clipping. All the patients' records were reviewed including all computed tomographic scans and angiograms.

RESULTSTwelve patients received conservative treatment, 56 patients were treated by endovascular embolization, and 28 patients received clipping; 44 patients received one-stage treatment, and 4 patients needed a second therapy. In 36 patients, only the ruptured aneurysm was eliminated. The clinical outcomes of these 84 patients evaluated by Glasgow Outcome Scale grades were: absence of deficits in 62 patients, minor deficits in 12 patients, major deficit in 8 patients; death occurred in 2 cases. Thirty patients were available for a 6-month follow-up with DSA, which revealed stable occlusion of the aneurysms in 29 patients and the need of a retreatment due to recanalization in only one patient.

CONCLUSIONCorrect localization of the rupture aneurysm based on a comprehensive diagnosis is key to MIA treatment. All the aneurysms should be treated in one session whenever possible to protect the patient from rebleeding.

Aneurysm, Ruptured ; diagnosis ; therapy ; Embolization, Therapeutic ; Humans ; Intracranial Aneurysm ; diagnosis ; therapy ; Retrospective Studies ; Tomography, X-Ray Computed

Aged ; Aneurysm, Ruptured ; diagnostic imaging ; therapy ; Embolization, Therapeutic ; Humans ; Iliac Aneurysm ; therapy ; Male ; Radiography ; Stents ; Stomach ; blood supply

Splenic artery aneurysms are the most common visceral artery aneurysms, which are usually found incidentally. The most common complication of splenic artery aneurysms is spontaneous rupture into the peritoneal cavity, which leads to acute peritonitis and shock. Less commonly, it may rupture directly into the stomach, small bowel or pancreatic duct and may present with acute gastrointestinal hemorrhage. We report a rare case of the ruptured splenic artery aneurysm, presenting as acute massive hematochezia which was treated with transcatheter embolization.
Aneurysm, Ruptured/diagnosis/*therapy ; *Embolization, Therapeutic ; English Abstract ; Female ; Humans ; Middle Aged ; *Splenic Artery

OBJECTIVE: To report effects of the pre-procedural rehydration for reduce thromboembolic complications in acute phase aneurysmal subarachnoid hemorrhage coil embolization. MATERIALS AND METHODS: From January 2009 to December 2013, 190 patients with ruptured aneurysmal subarachnoid hemorrhage (aSAH) treated by coil embolization at our institution were consecutively enrolled in this study. In period 1 (from January 2009 to June 2012, n = 122), pre-procedural fluid was not supplied. In period 2 (from July 2012 to December 2013, n = 68), depending on the state of the patient's body weight and degree of dehydration, intravenous fluid was started with infusion of approximately 7 mL/kg of 0.9 percent saline (minimum 300 to maximum 500 mL) over 30 minutes. RESULTS: A total of 190 patients were hospitalized due to aSAH and underwent coil embolization for five years between January 2009 and December 2013. Of these, 122 patients underwent coil embolization based on the old protocol before June 2012 (period 1) and 68 underwent the procedure based on the new protocol after the period 2. Neck size, width, maximum diameter of the aneurysm and procedure time were associated with procedure related thromboembolic complications in entire periods (multivariate analysis, p < 0.05, in respectively). The frequency of thromboembolism showed a drastic decrease in period 2 (re-hydration period), from 18.0% (22/123) to 4.4% (3/67), which was also statistically significant (p = 0.007, Chi-square test). CONCLUSION: Pre-procedural administration of a sufficient dose of fluid considering the patient's dehydration reduced the frequency of thromboembolism in cases of emergency coil embolization for ruptured aneurysm, without increasing additional specific complications.
Aneurysm ; Aneurysm, Ruptured* ; Body Weight ; Dehydration ; Embolization, Therapeutic ; Emergencies ; Fluid Therapy* ; Humans ; Neck ; Rehydration Solutions ; Subarachnoid Hemorrhage ; Thromboembolism

OBJECTIVE: For patients with giant or dissecting aneurysm, multimodal treatment consisting extracranial-intracranial bypass surgery plus clip or coil for parent artery occlusion may be necessary. In this study, the safety and efficacy of multimodal treatment in 15 patients with complex aneurysms were evaluated retrospectively. METHODS: From January 1995 to June 2007, the authors treated 15 complex aneurysms that were unable to be clipped or coiled. Among them, nine patitents had unruptured aneurysms and 6 had ruptured aneurysms. Aneurysms were located in the internal cerebral artery (ICA) in 11 patients (4 in the dorsal wall, 4 in the terminal ICA, 1 in the paraclinoid, and 2 in the cavernous ICA), in the middle cerebral artery (MCA) in 2, and in the posterior circulation in two patients RESULTS: Fifteen patients with complex aneurysms were treated with bypass surgery previously. Thirteen patients were treated with external carotid middle cerebral artery (ECA-MCA) anastomosis, and one patient with superficial temporal to posterior cerebral artery (STA-PCA) and another patient with occipital artery to posterior inferior cerebellar artery (OA-PICA) anastomosis. Parent artery occlusion was then performed with a clip in 9 patients, with a coil in 4, with balloon plus coil in one patient. All 15 aneurysms were successfully treated with clip or coil combined with bypass surgery. Follow-up angiograms showed good patency of anastomotic site in 10 out of 11 patients, and perfusion study showed sufficient perfusion in 6 out of 9 patients. CONCLUSION: These findings indicate that for patients with complex aneurysms, clip or coil for parent vessel occlusion with additive bypass surgery can successfully exclude the aneurysm from the neurovascular circulatory system.
Aneurysm ; Aneurysm, Dissecting ; Aneurysm, Ruptured ; Arteries ; Caves ; Cerebral Arteries ; Combined Modality Therapy ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Middle Cerebral Artery ; Parents ; Perfusion ; Posterior Cerebral Artery ; Retrospective Studies

OBJECTIVE: A small branch-incorporated aneurysm is an aneurysm with a small branch incorporated into the sac or the neck. It is one of the most difficult aneurysms to treat with coil embolization. The aim of this study was to evaluate the safety and effectiveness of the coil-protected embolization technique for small-branch incorporated aneurysm. MATERIALS AND METHODS: Fourteen aneurysms (2 ruptured and 12 unruptured) in 12 patients (mean age, 56 years, range, 40-73 years; 6 men and 6 women) were treated with the coil-protected embolization technique during the period between February 2007 and October 2011. Clinical and angiographic outcomes were retrospectively evaluated. RESULTS: All aneurysms were successfully treated without any complications during the procedure. Immediate post-treatment angiographies demonstrated complete or near complete occlusion in 12 and incomplete occlusion in 2 patients. Two patients had a delayed small embolic infarction in the relevant posterior circulation territory and middle cerebral artery territory 10 days and 14 days later, respectively, but both recovered completely or almost completely (modified Rankin scale score [mRS score], 0 and 1, respectively). During the clinical follow-up period (mean, 21 months; range: 2-58 months), all patients reported an mRS score of 0 (n = 10) or 1 (n = 2). Vascular imaging follow-up (catheter angiography: n = 3 and MR angiography: n = 8) was available in 11 aneurysms at 6-12 months. All 11 aneurysms showed complete occlusion except for 1 minor neck recurrence that did not require further treatment. CONCLUSION: In this series of cases, the coil-protected embolization technique seems to be feasible and effective in the treatment of small-branch incorporated aneurysms.
Adult ; Aged ; Aneurysm, Ruptured/diagnosis/*therapy ; Embolization, Therapeutic/instrumentation/*methods ; Female ; Humans ; Intracranial Aneurysm/diagnosis/*therapy ; Magnetic Resonance Angiography ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: We aimed to evaluate the results of endovascular coil embolization for very small aneurysms (< or = 3 mm). MATERIALS AND METHODS: Between March 2005 and December 2008, a total of 31 very small aneurysms in 30 patients were treated by coil embolization. Of the 31 aneurysms, five (16%) were ruptured, as opposed to 26 (84%) that were not. We assessed the procedural complications, immediate angiographic outcome after coiling, clinical outcome, and follow-up MR angiography (MRA). RESULTS: Two thromboembolic complications occurred during the procedure, but did not lead to any persistent neurologic deficit. No procedural aneurysmal rupture was observed and procedure-related morbidity and mortality were both 0%. Occlusion was adequate in 25 aneurysms (81%) and incomplete in six aneurysms (19%). The clinical outcomes of five patients with ruptured aneurysms were good (Glasgow outcome scale > or = 4), with no bleeding of the treated aneurysms during a mean follow-up period of 13.3 months. On 27 follow-up MRA, there was no recurrence, and the five incompletely occluded aneurysms showed a spontaneous amelioration resulting in an adequate occlusion. CONCLUSION: Coil embolization of very small aneurysms is technically feasible with good results. The long-term efficacy and the potential as a standard treatment strategy remain to be determined by randomized large trials.
Adult ; Aged ; Aged, 80 and over ; Aneurysm, Ruptured/*therapy ; Cerebral Angiography ; Embolization, Therapeutic/*methods ; Female ; Humans ; Intracranial Aneurysm/*therapy ; Magnetic Resonance Angiography ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVEThe present study was conducted to investigate the feasibility and efficacy of transcatheter closure of ruptured sinus of Valsalva aneurysm (RSVA).

METHODSFour patients (3 females) aged 7-57 years with RSVA (3 congenital RSVA and 1 post-surgery RSVA) were involved in the present study. Two-dimensional and color Doppler echocardiography revealed the ruptures of right coronary sinus into right ventricle in all cases. The echo estimated size of the defect was 2-10 mm. After the establishment of the arterio-venous wire loop, Amplatzer Duct Occluder (ADO) was successfully deployed by antegrade venous approach in all patients. The diameter of the occluder was chosen to be at least 1 to 2 mm larger than defect.

RESULTSThe defects were successfully occluded without any complications. On the follow-up 3 months after operation, there was no device embolization, infective endocarditis and aortic regurgitation.

CONCLUSIONTranscatheter closure is a feasible and effective modality for RSVA without other anomalies.

Adolescent ; Adult ; Aneurysm, Ruptured ; therapy ; Aortic Aneurysm ; therapy ; Cardiac Catheterization ; methods ; Child ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Sinus of Valsalva ; Young Adult

OBJECTIVETo investigate the endovascular treatments for the ruptured aneurysms located at anterior communicating artery complex (ACoAC).

METHODSThe data of patients with ruptured ACoAC aneurysms treated in Department of Neurosurgery, First Affiliated Hospital to Fourth Military Medical University from May 2013 to December 2014 was retrospectively analyzed. Sixty-six cases were recruited including 50 male and 16 female patients. The patients aged from 31 to 69 years old, averaging (51±8) years. The Hunt-Hess grade at admission were 13 cases with grade Ⅰ, 36 cases with grade Ⅱ, 11 cases with grade Ⅲ, and 6 cases with grade Ⅳ. The most diameter of aneurysms sac: 14 cases less than or equal to 3 mm, 36 cases more than 3 mm but less than or equal to 7 mm, and 16 cases more than 7 mm. The height diameter/neck width ratio: 8 cases with absolute wide neck, 50 cases with relatively wide neck, and 8 cases with narrow neck. There were 28 cases underwent single micro-catheter embolization, 18 cases underwent double micro-catheters embolization, 14 cases underwent stent-assisted embolization and 6 cases underwent balloon-assisted embolization. The patients were followed up for 6 to 12 months and evaluated by modified Rankin score (mRS) and digital subtraction angiography (DSA). The ratio of total embolization, recurrence rate, and time from operation to reexamination of four groups managed by different endovascular treatment were compared by χ(2) test or F test.

RESULTSSixty cases were totally embolized, 3 cases subtotally embolized, 3 cases incompletely embolized. Mild hemiparalysis and aphasia occurred in 2 cases, and 1 case died of infarction induced by subarachnoid haemorrhage. The mRS at six months after operation were 0 in 31 cases, 1 in 22 cases, 2 in 8 cases, 3 in 2 cases, 4 in 2 cases, 6 in 1 case. All the included cases reexamined the DSA at averaging (7.5±1.0) month post-operatively and 4 cases recurred. There were not significant differences of the ratio of total embolization, recurrence rate, time from operation to reexamination among four groups (all P>0.05).

CONCLUSIONThe endovascular treatment maybe an ideal management for ruptured ACoAC aneurysms.

Adult ; Aged ; Aneurysm, Ruptured ; therapy ; Catheters ; Embolization, Therapeutic ; Female ; Humans ; Intracranial Aneurysm ; therapy ; Male ; Middle Aged ; Postoperative Period ; Recurrence ; Retrospective Studies ; Stents ; Treatment Outcome