OBJECTIVE: Recently the treatment of endovascular coil embolization is gradually increasing compared to the traditional method of microsurgical clipping. However, both methods carry certain risks. The aim of this study was to compare each method's morbidity and complications in patients with ruptured cerebral aneurysms. METHODS: We investigated patients who underwent surgery for subarachnoid hemorrhage (SAH) due to cerebral aneurysm rupture between January 2007 to December 2009 in our hospital. Patients' medical records and radiologic images were referenced and initial grade, location and size of aneurysm, treatment method, complications, prognosis, hospital stay and the cost were retrospectively investigated. We divided the patients into two groups according to surgical METHODS: clipping group and coiling group. Treatment results were evaluated using Modified Rankin Scale (MRS). RESULTS: Total 187 aneurysms were treated in 149 patients. Sixty-five and 84 patients were classified as clipping group and coiling group, respectively. The ratio of patients with good outcome in clipping vs. coiling was 83.6% vs. 80.8%. The incidence of vasospasm was significantly lower in the coiling group compared to the clipping group. The length of hospitalization was shorter in the coiling group. The cost and operation time was also less in the coiling group. However, higher numbers of remnant sac and coil compaction were observed in the coiling group. CONCLUSION: Endovascular coil embolization for ruptured cerebral aneurysms had fewer vasospasms and complications. Also, it reduced the hospital stay, operation time, and cost compared with the clipping group. So, in addition to traditional microsurgical neck clipping, we think that endovascular coiling is a good alternative method to treat ruptured aneurysms.
Aneurysm ; Aneurysm, Ruptured ; Hospitalization ; Humans ; Incidence ; Intracranial Aneurysm ; Length of Stay ; Medical Records ; Neck ; Prognosis ; Retrospective Studies ; Rupture ; Subarachnoid Hemorrhage

OBJECTIVE: This study investigated the proportion of small cerebral aneurysm (<5 mm) to help in the decision making concerning unruptured small aneurysms using the proportion of ruptured small aneurysms as a guide. METHODS: The records of aneurysm patients treated in our hospital from January 2004 to December 2006 were retrospectively reviewed. Patients with ruptured aneurysms were divided into five groups according to their sizes (Group1 defined as tiny :< 3, Group2 defined as very small: 3~5, Group3 defined as small: 5~7, Group4 defined as medium: 7~10 and Group5 defined as large: > 10mm). The clinical and radiological findings of the ruptured aneurysms were also evaluated. RESULTS: The mean age of the 244 enrolled patients was 54.6 years. The mean size of the rupture and the unruptured aneurysms was 6.8 mm. The proportions of aneurysm sizes were 7.8% (<3 mm), 30.7% (3~5 mm), 25.4% (5~7 mm), 19.3% (7~10 mm) and 16.8% (<10 mm). CONCLUSION: The proportion of small ruptured aneurysms (<5 mm) was appreciable; the proportion was not small just to observe. The proportion of very small ruptured aneurysms (3~5 mm) was significant in patients who required surgery or endovascular coiling. Although tiny aneurysms (<3 mm) may have a very low risk of rupture, they should be closely followed-up to preclude such a catastrophe.
Aneurysm ; Aneurysm, Ruptured ; Decision Making ; Humans ; Intracranial Aneurysm ; Retrospective Studies ; Rupture

Although the incidence of intracranial multiple aneurysms are not low, the occurrence of multiple aneurysms more than three developing on the ipsilateral carotid artery is quite rare. We present a patient with five aneurysms on the left internal carotid artery. Four aneurysms arising from the left internal carotid artery underwent microsurgical clipping and wrapping, and remnant superior hypophyseal artery aneurysm was treated by using coil embolization. Incidence and risk factors for management of multiple aneurysms were investigated with the literature review.
Aneurysm ; Arteries ; Carotid Arteries ; Carotid Artery, Internal ; Humans ; Incidence ; Risk Factors

Ruptured vertebral artery- dissecting aneurysms (VADAs) must be treated as early as possible due to frequent rebleeding in the early stage. We have reported herein two patients with VADAs who were treated using internal trapping using detachable coils. Both patients were young females in their 40's. They had been admitted to the emergency clinic due to severe headaches and mental deterioration. Brain computed tomography (CT) scans revealed a subarachnoid hemorrhages in the posterior fossa, and transfemoral catheter cerebral angiography revealed dissecting aneurysms at the dominant vertebral arteries. Under general anesthesia, embolization of the parent artery, including the aneurysmal portion, using Guglielmi detachable coils was performed without any procedural complications. Before the induction of general anesthesia, a balloon test occlusion was done on both patients. Both patients improved well after surgery. One patient underwent cerebral angiography at six months after surgery and showed no recurrence of the aneurysm or recanalization of the parent artery. Both patients were free of neurologic findings on follow-up at the 6- and 12- month. Based on these results, patients with ruptured VADAs, located in the dominant vertebral arteries, may be successfully treated with urgent internal trapping using an endovascular technique in selected cases.
Anesthesia, General ; Aneurysm ; Aneurysm, Dissecting ; Arteries ; Balloon Occlusion ; Brain ; Catheters ; Cerebral Angiography ; Embolization, Therapeutic ; Emergencies ; Endovascular Procedures ; Female ; Follow-Up Studies ; Headache ; Humans ; Neurologic Manifestations ; Parents ; Recurrence ; Subarachnoid Hemorrhage ; Vertebral Artery

An infraoptic course of the anterior cerebral artery (ACA) is a rare anomaly of the anterior part of the circle of Willis. About 56 cases have been reported, often in association with cerebral aneurysm. We describe a case involving an infraoptic ACA in which a ruptured middle cerebral artery aneurysm was also present. A 52-year-old man experienced a sudden onset of severe headache without focal neurological deficits. Computed tomography demonstrated diffuse subarachnoid hemorrhage. Three-dimensional computed tomographic angiography and conventional angiography revealed a saccular aneurysm in the left middle cerebral artery. An anomalous arterial branch, originating from the right internal carotid artery at the level of the ophthalmic artery was also visible. This vessel followed an infraoptic course. The aneurysm was successfully embolized with coils. We review the literature for the possible genesis of this anomaly and consider treatment of the associated aneurysm.
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Carotid Artery, Internal ; Circle of Willis ; Glycosaminoglycans ; Headache ; Humans ; Intracranial Aneurysm ; Middle Aged ; Middle Cerebral Artery ; Ophthalmic Artery ; Optic Nerve ; Subarachnoid Hemorrhage

With the development of devices and techniques, including complex shape coils, balloons, multiple catheter techniques, and intracranial stents, endosaccular treatment of ruptured or unruptured wide-necked cerebral aneurysms has advanced rapidly with respect to indications and outcomes. In contrast to other options, stent-assisted aneurysm embolization has a distinct feature in which the stent is permanently implanted in the cerebral vessels. Therefore, we must consider the short-term effect of stent-assisted aneurysm embolization in the prevention of coil migration and adverse thrombogenicity, but also the permanent mechanical, hemodynamic, and biological influence on the parent vessels and the aneurysm. We have reviewed the current experimental and clinical data on stent-assisted coil embolization of cerebral aneurysms.
Aneurysm ; Catheters ; Hemodynamics ; Humans ; Intracranial Aneurysm ; Parents ; Stents

OBJECTIVE: Multidetector-Row computed tomographic angiography (MDCTA) is a promising method for detection and surgical planning of intracranial vascular abnormalities. However, there are several problems, such as image degradation due to inevitable patients movement, venous contamination, kissing vessel artifact, demonstration of venous structures mimicking aneurysm and bone artifacts. The purpose of our study is to review our recent experience with false negative or positive cases on MDCTA. METHODS: Between May 2007 and May 2010, 259 consecutive patients, who were diagnosed with intracranial aneurysms or other vascular abnormalities by MDCTA, were retrospectively reviewed. Among the 259 patients, 172 patients who underwent digital subtraction angiography (DSA), which was considered as the standard of reference, were included in the study. Two neuroradiologists and two neurosurgeons evaluated independently and separately all of the MDCTA images. RESULTS: A total 26 cases (15.3%) were revealed abnormal vascular findings on MDCTA. There were 11 false negatives on MDCTA including incomplete scanning range of lesion site (n=3), a blood blister aneurysm (n=1), severe vasospasm (n=4) and bone artifacts (n=3). Also there were 15 false positives on MDCTA; venous contamination over the lesion site (n=6), focal dilation of the bifurcation or branching site of major vessels (n=6) and poor quality of the images due to inevitable patients movement (n=3). CONCLUSIONS: MDCTA is clearly not the total answer for aneurysm diagnosis. We recommend that MDCTA scanning range is planned to encompass the whole intracerebral vasculature. Close attention to image acquisition and interpretation are required to reduce errors in MDCTA of intracranial aneurysms.
Aneurysm ; Angiography ; Angiography, Digital Subtraction ; Artifacts ; Blister ; Glycosaminoglycans ; Humans ; Intracranial Aneurysm ; Retrospective Studies

OBJECTIVE: Direct surgical clipping of paraclinoid aneurysms is challenging due to nearby anatomic structures. However, as endovascular techniques advance, endovascular coil embolizations for paraclinoid aneurysms are more frequently performed. We reviewed our experience with endovascular coil embolization of paraclinoid aneurysms to evaluate its safety and efficacy. METHODS: From 2005 to 2011, 78 patients underwent endovascular procedures with detachable coils for 86 paraclinoid aneurysms at our institute. A retrospective review of the medical records was performed. RESULTS: Seventy-eight patients with 86 paraclinoid aneurysms were evaluated. Thirteen patients (16.7%) were men and 65 (83.3%) were women. Patient age ranged from 23 to 78 years (mean age, 48 years). Five patients (6.4%) presented with subarachnoid hemorrhage (SAH) with decreased consciousness and visual field defects. In the 86 treated aneurysms, the immediate post procedural angiogram demonstrated complete occlusion in 73 aneurysms (84.9%), near-complete occlusion in eight aneurysms (9.3%) and partial occlusion in five aneurysms (5.8%). We obtained angiographic follow-up in 46 cases. Minor recanalization occurred in two cases and major recanalization occurred in one case. One thromboembolic complication and one blurred vision occurred among the 78 patients. CONCLUSION: Despite difficulties with surgical approaches for paraclinoid aneurysms, these lesions can be successfully managed by endovascular treatment. Favorable outcomes with a low morbidity suggest endovascular techniques as alternatives to microsurgical therapy for treating paraclinoid aneurysms.
Aneurysm ; Consciousness ; Endovascular Procedures ; Female ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Retrospective Studies ; Subarachnoid Hemorrhage ; Surgical Instruments ; Vision, Ocular ; Visual Fields

OBJECTIVE: Endovascular treatment of cerebral aneurysms with detachable coils has proved to be a safe and effective. However, long term result was not satisfactory in less than 30% for regrowth or coil compaction. This paper highlighted the safety and technique of microsurgical clipping and coil removal in previously coiled aneurysms showing recurrence or remnant growth. METHODS: Sixty two patients from 2007 to 2010 were treated by endovascular coiling. Among them, six patients (9.6%) showed recurrence, who had near complete obliteration initially. We retrospectively analyzed the clinical data and radiographic images of these patients (male 2, female 4, mean age 46.6) who underwent microsurgical clipping with partial (4 cases) or complete (2 cases) coil removal. Computerized tomographic angiogram (CTA) was performed soon after microsurgical clipping for the evaluation. RESULTS: Four aneurysms were located at anterior circulation and two were at the posterior circulation. Four patients were detected by routine followed CTA or angiography and one had recurrent subarachnoid hemorrhage and another one had severe eyeball pain. Microsurgical treatment were performed about 12.9 months (range: 2~26) after coiling. Complete coil removal was done in two patients. Complete obliteration was performed in all, which were confirmed by postoperative CTA with less coil artifact. All patients attained the same neurological state presented prior to surgery (the Glasgow Outcome Scale (GOS) 4~5). CONCLUSION: Microsurgical clipping and coil removal following a previous endovascular coil embolization are not so common. However, these would be permanent treatment options without any morbidity in properly selected patients. These are challenging and risky procedure, but necessary to avoid postoperative coil artifact on the follow-up radiologic evaluation.
Aneurysm ; Angiography ; Artifacts ; Female ; Follow-Up Studies ; Glasgow Outcome Scale ; Humans ; Intracranial Aneurysm ; Recurrence ; Retrospective Studies ; Subarachnoid Hemorrhage

Acute vertebrobasilar artery occlusion is a fatal event, even after intra-arterial thrombectomy and thrombolysis. We are reporting a case of acute vertebral artery (VA) occlusion. A 37-year-old man was admitted with mild dizziness, but cardiopulmonary arrest suddenly developed after eleven hours. We performed cardiopulmonary resuscitation immediately and his mental and vital state was recovered. Thus we performed intra-arterial thrombectomy, thrombolysis and balloon angioplasty for left vertebral artery occlusion. But pre-existing stenosis of VA was revealed during intervention so we inserted a stent to the stenotic area. Conclusively, we obtained the good angiographical and clinical outcomes.
Adult ; Angioplasty ; Angioplasty, Balloon ; Arteries ; Cardiopulmonary Resuscitation ; Constriction, Pathologic ; Dizziness ; Emergencies ; Heart Arrest ; Humans ; Stents ; Thrombectomy ; Vertebral Artery