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Wide necked aneurysm

see Wide necked unruptured aneurysm.

Anterior communicating artery (AcomA) intracranial aneurysms frequently is a wide necked aneurysm with an irregular shape, incorporate parent vessels, and are associated with significant variations in vascular anatomy.

see Wide necked anterior communicating artery aneurysm.

Endovascular treatment of wide-neck MCA and basilar apex aneurysms resulted in a core lab adjudicated Raymond Roy occlusion classification 1 of 30.6%. Self-reported results at follow-up favour better angiographic outcomes, with OR 1.75 (95% CI 1.08 to 2.83). These data demonstrate the need for novel endovascular devices specifically designed to treat complex intracranial aneurysms, as well as the importance of core lab adjudication in assessing outcomes in such a trial 1).


Many endovascular techniques have been described in recent years for the management of wide necked aneurysms. The Y stent assisted technique has been generally used for coil embolization of wide necked bifurcation aneurysms. This technique was first described for the treatment of basilar tip aneurysms in combination with several different devices, demonstrating encouraging results.

If endovascular treatment is now the first-line treatment for both ruptured and unruptured aneurysms, wide neck aneurysms are sometimes untreatable or difficult to treat with standard coiling. 2) 3).

Endovascular treatment of wide-necked aneurysms with preservation of the parent artery remains a challenge. Ito et al. describe a novel and simple technique to navigate a balloon or stent-delivery catheter across a wide-necked aneurysm in which previously existing methods could have failed to pass the catheter across the neck of the aneurysm, which they have named “temporary caging” technique. The technical results using this method are presented in 6 cases 4).

The two primary indications for the deployment of microstents in intracranial vessels are stentassisted coil embolization of wide-necked or fusiform aneurysms and treatment of atherosclerotic stenosis 5).

Case series

Zhao et al performed a comprehensive literature search for all articles on the endovascular coiling of wide-neck and wide-neck bifurcation aneurysms. Studies meeting the inclusion criteria and abstracted data were selected by 2 independent reviewers. Primary outcomes were >6-month complete or near-complete angiographic occlusion, aneurysm recanalization, and aneurysm retreatment. Secondary outcomes included initial complete or near-complete occlusion, long-term good neurologic outcome, procedure-related morbidity, and procedure-related mortality. Data were analyzed by using random-effects meta-analysis.

In total, 38 studies including 2446 patients with 2556 aneurysms were included. For all wide-neck aneurysms, immediate complete or near-complete occlusion rate was 57.4% (95% CI, 48.1%-66.8%). Follow-up near-complete occlusion rate was 74.5% (95% CI, 68.0%-81.0%). Recanalization and retreatment rates were 9.4% (95% CI, 7.1%-11.7%) and 5.8% (95% CI, 4.1%-7.5%), respectively. Long-term good neurologic outcome was 91.4% (95% CI, 88.5%-94.2%). For wide-neck bifurcation aneurysms, initial complete or near-complete occlusion rate was 60.0% (95% CI, 42.7%-77.3%), long-term complete or near-complete occlusion rate was 71.9% (95% CI, 52.6%-91.1%), and the recanalization and retreatment rates were 9.8% (95% CI, 7.1%-12.5%) and 5.2% (95% CI, 1.9%-8.4%), respectively

The study of angiographic and clinical outcomes for patients with wide-neck aneurysms demonstrates that endovascular coiling with or without stent-assisted coiling is safe, with low rates of perioperative morbidity and mortality. Initial and long-term angiographic outcomes were generally satisfactory, but not ideal. These data provide some baseline comparisons against which emergent technologies can be assessed 6).

De Leacy RA, Fargen KM, Mascitelli JR, Fifi J, Turkheimer L, Zhang X, Patel AB, Koch MJ, Pandey AS, Wilkinson DA, Griauzde J, James RF, Fortuny EM, Cruz A, Boulos A, Nourollah-Zadeh E, Paul A, Sauvageau E, Hanel R, Aguilar-Salinas P, Novakovic RL, Welch BG, Almardawi R, Jindal G, Shownkeen H, Levy EI, Siddiqui AH, Mocco J. Wide-neck bifurcation aneurysms of the middle cerebral artery and basilar apex treated by endovascular techniques: a multicentre, core lab adjudicated study evaluating safety and durability of occlusion (BRANCH). J Neurointerv Surg. 2018 Jun 1. pii: neurintsurg-2018-013771. doi: 10.1136/neurintsurg-2018-013771. [Epub ahead of print] PubMed PMID: 29858397.
Cognard C, Pierot L, Anxionnat R, Ricolfi F; Clarity Study Group. Results of embolization used as the first treatment choice in a consecutive nonselected population of ruptured aneurysms: clinical results of the Clarity GDC study. Neurosurgery. 2011;69(4):837–841.
Pierot L, Spelle L, Vitry F; ATENA Investigators. Clinical outcome of patients harbouring unruptured intracranial aneurysms treated by endovascular approach: results of the ATENA trial. Stroke. 2008;39(9):2497–2504.
Ito H, Onodera H, Wakui D, Uchida M, Sase T, Morishima H, Oshio K, Tanaka Y. The “temporary caging” technique for catheter navigation in patients with intracranial wide-necked aneurysms. Int J Clin Exp Med. 2015 Jul 15;8(7):11214-11219. eCollection 2015. PubMed PMID: 26379926.
Kessler IM, Mounayer C, Piotin M, Spelle L, Vanzin JR, Moret J: The use of balloon-expandable stents in the management of intracranial arterial diseases: A 5-year single-center experience. AJNR Am J Neuroradiol 26: 2342–2348, 2005
Zhao B, Yin R, Lanzino G, Kallmes DF, Cloft HJ, Brinjikji W. Endovascular Coiling of Wide-Neck and Wide-Neck Bifurcation Aneurysms: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol. 2016 Jun 2. [Epub ahead of print] PubMed PMID: 27256850.
wide_necked_aneurysm.txt · Last modified: 2018/06/03 19:43 by administrador