Endovascular Therapy of Intracranial Aneurysms – Methods, Indications, Complications

Česká verze

Authors: A. Krajina ¹; Miroslav Lojík ¹ ; T. Česák ²; D. Krajíčková ³; J. Žižka ¹; K. Zeleňák ⁴; J. Habalová ²; M. Mulačová ³; S. Řehák ²
Authors place of work: Radiologická klinika LF UK a FN Hradec Králové ¹; Neurochirurgická klinika LF UK a FN Hradec Králové ²; Neurologická klinika LF UK a FN Hradec Králové ³; Radiologická klinika JLF UK a UN Martin ⁴
Published in the journal: Cesk Slov Neurol N 2012; 75/108(5): 552-560
Category: Přehledný referát

Summary

Endovascular therapy of intracranial aneurysms has become the first-line treatment option whenever this option is available; it appears to be straightforward and with promising long-term effect. A neurointerventionalist performing the procedure should have appropriate radiographic equipment, training and appropriate number of patients. This can be appropriately accomplished within a specialized neurovascular center in which appropriate neurosurgical care can be instituted promptly. There are two endovascular strategies to treat cerebral aneurysms. The first involves an occlusion of the aneurysmal sac with metallic coils and preserving the parent artery. The second involves occlusion of the parent artery in order to exclude otherwise untreatable aneurysms from blood circulation. Implantation of intracranial stents stabilizes implanted coils in the aneurysmal sac of wide neck aneurysms and expands indication spectrum of endovascular therapy with long-term effect. High density mesh cylinder stents modify the blood flow by disrupting aneurysm inflow, leading to remodeling of the entire diseased arterial segment. Standard imaging protocol of acute SAH includes non-enhanced CT and CT angiography. Catheterization angiography is the imaging modality used for patients with non-conclusive or negative findings. Detection and detailed imaging of small (less then 3 mm in size) aneurysms is more reliable using catheterization angiography with 3D volume rendering technique. MR angiography is a reliable, non-invasive and cost-effective method that is gradually replacing catheterization angiography in a long-term follow-up of patients with coiled aneurysms. In comparison to neurosurgical therapy, endovascular therapy of acutely ruptured aneurysms was proved, in a one-year follow up, to significantly reduce mortality and postsurgical disability. Unruptured aneurysms form a heterogeneous entity with extreme variation in reported risk of rupture. Their prevalence is estimated at 1–2% of the adult population. However, with an increasing availability of non-invasive brain imaging methods, they are now diagnosed more frequently.

Key words:
intracranial aneurysms – subarachnoid hemorrhage – endovascular therapy

Zdroje

1. Agid R, Andersson T, Almqvist H, Willinsky RA, Lee SK, terBrugge KG et al. Negative CT angiography findings in patients with spontaneous subarachnoid hemorrhage: When is digital subtraction angiography still needed? AJNR Am J Neuroradiol 2010; 31(4): 696–705.

2. Papke K, Kuhl CH, Fruth M, Haupt C, Schlunz-Hendann M, Sauner D et al. Intracranial aneurysms: role of multidetector CT angiography in diagnosis and endovascular therapy planning. Radiology 2007; 244(2): 532–540.

3. Teitelbaum GP, Larsen DW, Zelman V, Lysachev AG, Likhterman LB. A tribute to dr. Fedor A. Serbinenko, founder of endovascular neurosurgery. Neurosurgery 2000; 46(2): 462–469.

4. Guglielmi G, Viñuela F, Dion J, Duckwiller G. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: preliminary clinical experience. J Neurosurg 1991; 75(1): 8–14.

5. Moret J, Cognard C, Weill A, Castaings L, Rey A. The “Remodeling Technique” in the treatment of wide neck intracranial aneurysms. Angiographic results and clinical follow-up in 56 cases. Interv Neuroradiol 1997; 3(1): 21–35.

6. Szikora I, Guterman LR, Wells KM, Hopkins LN. Combined use of stents and coils to treat experimental wide-necked carotid aneurysms: preliminary results. AJNR Am J Neuroradiol 1994; 15(6): 1091–1102.

7. White PM, Raymond J. Endovascular coiling of cerebral aneurysms using “bioactive” or coated-coil technologies: a systematic review of the literature. AJNR Am J Neuroradiol 2009; 30(2): 219–226.

8. Wakhloo AK, Gounis MJ, Sandhu JS, Akkawi N, Schenck AE, Linfante I. Complex-shaped platinum coils for brain aneurysms: higher packing density, improved biomechanical stability, and midterm angiographic outcome. AJNR Am J Neuroradiol 2007; 28(7): 1395–1400.

9. Sluzewski M, van Rooij WJ. Packing performance of helical Guglielmi detachable coil (GDC) 18 in intracranial aneurysms: a comparison with helical GDC 10 coils and complex Trufill/Orbit coils. AJNR Am J Neuroradiol 2007; 28(7): 1384–1387.

10. Pierot L, Leclerc X, Bonafé A, Bracard S. French Matrix Registry Investigators. Endovascular treatment of intracranial aneurysms using Matrix coils: short- and mid-term results in ruptured and unruptured aneurysms. Neurosurgery 2008; 63(5): 850–858.

11. Veznedaroglu E, Koebbe CJ, Siddiqui A, Rosenwasser RH. Initial experience with bioactive Cerecyte detachable coils: impact on reducing recurrence rates. Neurosurgery 2008; 62(4): 799–806.

12. Liebig T, Henkes H, Fischer S, Weber W, Miloslavski E, Mariushi W et al. Fibered electrolytically detachable platinum coils used for the endovascular treatment of intracranial aneurysms. Initial experiences and mid-term results in 474 aneurysms. Interv Neuroradiol 2004; 10(1): 5–26.

13. van Rooij WJ, de Gast AN, Sluzewski M. Results of 101 aneurysms treated with polyglycolic/polylactic acid microfilament Nexus coils compared with historical controls treated with standard coils. AJNR Am J Neuroradiol 2008; 29(5): 991–996.

14. Gunnarsson T, Tong FC, Klurfan P, Cawley CM, Dion JE. Angiographic and clinical outcomes in 200 consecutive patients with cerebral aneurysm treated with hydrogel-coated coils. AJNR Am J Neuroradiol 2009; 30(9): 1657–1664.

15. Sorteberg A, Bakke SJ, Boysen M, Sorteberg M. Angiographic balloon test occlusion and therapeutic sacrifice of major arteries to the brain. Neurosurgery 2008; 63(4): 651–661.

16. Fox AJ, Pelz DM, Viñuela F, Barnett HJ, Peerless SJ. Results of the international extracranial/intracranial bypass study. Implications for neuroradiologists. Acta Radiol 1986; 369: 77–78.

17. Fiorella D, Kelly ME, Albuquerque FC, Nelson PK. Curative reconstruction of a giant midbasilar trunk aneurysm with the Pipeline embolization device. Neurosurgery 2009; 64(2): 212–217.

18. Lylyk P, Miranda C, Ceratto R, Ferrario A, Scrivano E, Luna HR et al. Curative endovascular reconstruction of cerebral aneurysms with the Pipeline embolization device: the Buenos Aires experience. Neurosurgery 2009; 64(4): 632–643.

19. Kulcsár Z, Houdart E, Bonafé A, Parker G, Millar J, Goddard AJ et al. Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol 2011; 32(1): 20–25.

20. Kulcsár Z, Yilmaz H, Bonvin C, Lovlblad KO, Rüfenacht DA. Multiple coaxial catheter system for reliable access in interventional stroke therapy. Cardiovasc Intervent Radiol 2010; 33(6): 1205–1209.

21. Prabhakaran S, Wells KR, Lee VH, Flaherty CA, Lopes DK. Prevalence and risk for aspirin and clopidogrel resistance in cerebrovascular stenting. AJNR Am J Neuroradiol 2008; 29(2): 281–285.

22. Zubkov YN, Nikiforov BM, Shustin VA. Balloon catheter technique for dilatation of constricted cerebral arteries after aneurysmal SAH. Acta Neurochir (Wien) 1984; 70(1–2): 65–79.

23. Zwienenberg-Lee M, Hartman J, Rudisill N, Madden LK, Smith K, Eskridge J et al. Effect of prophylactic transluminal balloon angioplasty on cerebral vasospasm and outcome in patients with Fisher grade III subarachnoid hemorrhage: results of a phase II multicenter, randomized, clinical trial. Stroke 2008; 39(6):1759–1765.

24. Cloft HJ, Kallmes DF. Cerebral aneurysm perforations complicating therapy with Guglielmi detachable coils: a meta-analysis. AJNR Am J Neuroradiol 2002; 23(10): 1706–1709.

25. Kwon BJ, Chang HW, Youn SW, Kim JE, Han MH. Intracranial aneurysm perforation during endovascular coiling: impact on clinical outcome, initial occlusion, and recanalization rates. Neurosurgery 2008; 63(4): 676–683.

26. Struffert T, Richter G, Engelhorn T, Doelken M, Goelitz P, Kalender WA et al. Visualisation of intracerebral haemorrhage with flat-detector CT compared to multislice CT: results in 44 cases. Eur Radiol 2009; 19(3): 619–625.

27. Aviv RI, O’Neill R, Patel MC, Colquhoun IR. Abciximab in patients with ruptured intracranial aneurysms. AJNR Am J Neuroradiol 2005; 26(7): 1744–1750.

28. Bederson JB, Connolly ES Jr, Batjer HH, Dacey RG, Dion JE, Diringer MN et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 2009; 40(3): 994–1025.

29. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J et al. International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2,143 patients with ruptured intracranial aneurysms: a randomized trial. Lancet 2002; 360(9342): 1267–1274.

30. Derdeyn CP, Barr JD, Berenstein A, Connors JJ, Dion JE, Duckwiler GR et al. The International Subarachnoid Aneurysmal Trial (ISAT): a position statement from the Executive Committee of the American Society of Interventional and Therapeutic Neuroradiology and the American Society of Neuroradiology. AJNR Am J Neuroradiol 2003; 24(7): 1404–1408.

31. Molyneux AJ, Kerr RSC, Yu LM, Clarke M, Sneade M, Yarnold JA et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005; 366(9488): 809–817.

32. Molyneux AJ, Kerr RS, Birks J, Ramzi N, Yarnold J, Sneade M et al. Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. Lancet Neurol 2009; 8(5): 427–433.

33. CARAT Investigators. Rates of delayed rebleeding from intracranial aneurysms are low after surgical and endovascular treatment. Stroke 2006; 37(6): 1437–1442.

34. Johnston SC, Dowd CF, Higashida RT, Lawton MT, Duckwiler GR, Gress DR et al. CARAT Investigators. Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the Cerebral Aneurysm Rerupture After Treatment (CARAT) Study. Stroke 2008; 39(1): 120–125.

35. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A et al. Long-term angiography recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003; 34(6): 1398–1403.

36. Wiebers DO, Whisnant JP, Huston J jr, Meissner I, Brown RD jr, Piepgras DG et al. International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003; 362(9378): 103–110.

37. Pierot L, Spelle L, Vitry F. ATENA Investigators. Immediate clinical outcome of patients harboring unruptured intracranial aneurysms treated by endovascular approach: results of the ATENA study. Stroke 2008; 39(9): 2497–2504.

38. Raymond J, Molyneux AJ, Fox AJ, Johnston SC, Collet JP, Rouleau I. TEAM Collaborative Group. The TEAM trial: safety and efficacy of endovascular treatment of unruptured intracranial aneurysms in the prevention of aneurysmal hemorrhages: a randomized comparison with indefinite deferral of treatment in 2002 patient followed for 10 years. Trials 2008; 9: 43.

39. Wallace RC, Karis JP, Partovi S, Fiorella D. Noninvasive imaging of treated cerebral aneurysms, part I: MR angiographic follow-up of coiled aneurysms. AJNR Am J Neuroradiol 2007; 28(6): 1001–1008.

40. Gauvrit JY, Caron S, Taschner CA, Lejeune JP, Pruvo JP, Leclerc X. Intracranial aneurysms treated with Guglielmi detachable coils: long-term imaging follow-up with contrast-enhanced magnetic resonance angiography. J Neurosurg 2008; 108(3): 443–449.

41. Campi A, Ramzi N, Molyneux AJ, Summers PE, Kerr RS, Sneade M et al. Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke 2007; 38(5): 1538–1544.

42. Sluzewski M, van Rooij WJ, Rinke GJ, Wijnalda D. Endovascular treatment of ruptured intracranial aneurysms with detachable coils: long-term clinical and serial angiographic results. Radiology 2003; 227(3): 720–724.

43. van Rooij WJ, Sluzewski M. Opinion: imaging follow-up after coiling of intracranial aneurysms. AJNR Am J Neuroradiol 2009; 30(9): 1646–1648.

44. van der Schaaf IC, Velthuis BK, Wermer MJ, Majoie C, Witkamp T, de Kort G et al. ASTRA Study Group. New detected aneurysms on follow-up screening in patients with previously clipped intracranial aneurysms: comparison with DSA or CTA at the time of SAH. Stroke 2005; 36(8): 1753–1758.

45. Wermer MJ, Greebe P, Algra A, Rinkel GJ. Incidence of recurrent subarachnoid hemorrhage after clipping for ruptured intracranial aneurysms. Stroke 2005; 36(11): 2394–2399.

46. Broderick J. Clipping or coiling: the first step for ruptured aneurysms. Lancet Neurol 2009; 8(5): 414–415.

47. Heros RC. International subarachnoid aneurysm trial analysis. J Neurosurg 2008; 108(3): 433–435.

48. Bakker NA, Metzemaekers JD, Groen RJ, Mooij JJ, van Dijk JM. International subarachnoid aneurysm trial 2009: endovascular coiling of ruptured intracranial aneurysms has no significant advantage over neurosurgical clipping. Neurosurgery 2010; 66(5): 961–962.

49. Raper DM, Allan R. International subarachnoid trial in the long run: critical evaluation of the long--term follow-up data from the ISAT trial of clipping vs coiling for ruptured intracranial aneurysms. Neurosurgery 2010; 66(6): 1166–1169.

50. Raja PV, Huang J, Germanwala AV, Gailloud P, Murphy KP, Tamarqo RJ. Microsurgical clipping and endovascular coiling of intracranial aneurysms: a critical review of the literature. Neurosurgery 2008; 62(6): 1187–1203.

51. Mitchell P, Kerr R, Mendelow D, Molynuex A. Could late rebleeding overturn the superiority of cranial aneurysm coil embolization over clip ligation seen in the International Subarachnoid Aneurysm Trial? J Neurosurg 2008; 108(3): 437–442.

52. Bendel P, Koivisto T, Könönen M, Hänninen T, Hurskainen H, Saari T et al. MR Imaging of the brain 1 year after aneurysmal subarachnoid hemorrhage: randomized study comparing surgical with endovascular treatment. Radiology 2008; 246(2): 543–552.

53. Vergouwen MD, Fang J, Casaubon LK, Stamplecoski M, Robertson A, Kapral MK et al. Higher incidence of in-hospital complications in patients with clipped versus coiled ruptured intracranial aneurysms. Stroke 2011; 42(11): 3093–3098.

54. Sato K, Yoshimoto Y. Risk profile of intracranial aneurysms: rupture rate is not constant after formation. Stroke 2011; 42(12): 3376–3381.