To coil or not to coil? How to pick the right treatment of intracranial aneurysms.

Congress:

ECR 2018

Poster Number:

C-2777

Type:

Educational Exhibit

Keywords:

Haemorrhage, Aneurysms, Stents, Embolisation, CT-Angiography, CT, Neuroradiology brain, Interventional vascular, Arteries / Aorta

Authors:

E. Y. A. Palkhi, K. Anand, J. Zhong, H. Nejadhamzeeigilani, T. Patankar, T. Goddard; Leeds/UK

DOI:

10.1594/ecr2018/C-2777

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-2777

Fig. 9: A case of an incidental partially thrombosed basilar tip aneurysm (red arrows)...

Fig. 2: Early and late complications of endovascular coiling

Fig. 3: Summary of types of FDD devices and novel neck reconstructive devices

Fig. 4: Case of a basilar artery aneurysm treated solely with an intra-saccular WEB...

Learning objectives

To gain insight into the factors to consider when deciding to treat intracranial aneurysms (ICA) and how to select the most suitable device. To review all endovascular devices used for treating intracranial aneurysms To discuss the types of complications that may result from each treatment

Background

Endovascular techniques for treating intracranial aneurysms are now making treatment increasingly safer and more effective with multiple new devices and treatment combinations available. This can present a conundrum for the neuro-interventionist for selecting the best treatment option.

Findings and procedure details

Endovascular options should be considered based on anatomic considerations such as aneurysm geometry and morphology, peripheral access, and parent vessel anatomy. Clinical presentation, patient medical history and comorbidities, as well as operator experience are other important factors that must be evaluated. Endovascular treatment with coiling of saccular aneurysm with a favourable neck has been accepted as a safe procedure with better outcomes than surgical clipping as per the international subarachnoid haemorrhage trial (ISAT). However, treatment of complex aneurysms such as large, wide neck and fusiform...

Conclusion

Although coiling remains the workhorse of ICA treatment, many complex ICAs which were previously untreatable can be definitely occluded in combination or independently with newer devices.

Personal information

References

Eboli P, Ryan RW, Alexander MJ. General technical considerations for the endovascular management of cerebral aneurysms. Neurosurg Clin N Am. 2014 Jul;25(3):395–404. Pierot L, Wakhloo AK. Endovascular treatment of intracranial aneurysms: current status. Stroke. 2013 Jul;44(7):2046–54. Anxionnat R, Tonnelet R, Derelle AL, Liao L, Barbier C, Bracard S. Endovascular treatment of ruptured intracranial aneurysms: Indications, techniques and results. Diagn Interv Imaging. 2015 Aug;96(7-8):667–75. (Figure 5) CONTOUR illustration adapted from : Cerus-Endovascular-Contour-300x194.jpg (300×194) [Internet]. [cited 2018 Jan 6]. Available from: https://neuronewsinternational-wpengine.netdna-ssl.com/wp-content/uploads/sites/3/2016/07/Cerus-Endovascular-Contour-300x194.jpg Intracranial aneurysm Archives - NeuroNews...