Transcript 14. Cerebral aneurysm - single center experience

1.
2.
3.
4.
5.
6.
7.
1974 Serbrenenko first reported cases of latex balloon embolization.?
1984 Ramadanov et al. present Russian experience in endovascular
procedures?
1992 Gugliamini detachable coil * (GDC) registered with the FDA-Food and
drug administration in 1995?
1997 Team G. Sea presents the experience in balloon-remodeling
technique for endovascular treatment of with-neck aneurysm?
Higashida et al. in 1997 presented stent remodeling technique with
coronary stents?
Dr. P. Nelson presents self expandable nitinol stents developed by Boston
Saentifik 2003 - Neuroform stent supported techniques?
2006 EV3 to develop Self expandable stent for treatment of aneurysms
with a flow-divert feature.









Posterior circulation aneurysms
Multiple aneurysms
Paraclinoid aneurysms
Aneurysms with severe vasospasm
Patient I extremes of age
Giant/serpentine, fusiform, dissecting, mycotic and pseudoaneurysms
Blood-blister like aneurysms (Ogawa aneurysms)
Aneurysms with brain AVM
ISAT supports offering coiling when there is high likelihood of success.





Tortuosity of neck vessels (Stability of arterial access is the primary
step for endovascular treatment)
Renal failure *
Non-availabilitiy of modern DSA facility
High cost of material
Aneurysms with large parenchymal clot may require surgical
evacuation end clipping done in the same sitting.
1.
2.
Coil embolization
- platinum embolization coils
- bio active coils
Balloon-remodeling technique
3. Stent remodeling technique
4. Self stent technique / Flow diverter


For the period from March 2010 to November 2012 were at
the clinic 47 embolized aneurysms of which :
-16 in SVD and 31 respectively in the VSA
-10 Com. Ant.
- 7 Com.post
-8 A. Cerebri med.
-6 ICA in the cavernous and optico-carotid region.
When performing endovascular procedures were used 8 Flow
divert device, one stent Soliter and stakes of the Helix Axium
and EV3.
Coiling
After then Stenting
MRT
control
after 6
months









Results: The average age of the patients was 52.2 years(24-70).
The average hospital staying was 5.9 days (3-15).?
Complications: One patient on the third day after the procedure was a
symptoms of ischemic stroke in RMCA. Aneurysm was treated as a a.com.ant.
Through thrombolytic and vasoprotecticve therapy the patient was discharged with
improvement.
All patients were discharged without additional neurological symptoms.
Track: Patients were followed up with a CT angio and MRI with contrast 3,6,9
months after the procedure and control angiography after 1year
If a patient to establish a new growth of the aneurysm a. cerebri med.
CONCLUSION
Metod relatively safe with low morbidity and mortality rate .
Short-term hospitalization
Endovascular treatment should be first choice for the treatment of aneurysms in the SVD
and optico-carotid segment ICA.