Background: Stent-assisted coil embolization and flow diversion with the Pipeline embolization device (PED) are both effective endovascular treatment options for ophthalmic segment aneurysms (OSAs) of the internal carotid artery. Here we present a large comparative cohort study.
Methods: A multicenter, retrospective cohort comparison study of consecutively treated OSAs was conducted at 2 academic institutions in the United States comparing stent-coiling (between 2007 and 2015) and PED (between 2011 and 2016).
Results: A total of 62 of OSAs were treated with stent-coiling and 106 were treated with the PED. The stent-coiling-treated aneurysms were larger, although the maximum diameter was not significantly different between the 2 groups (P = 0.05). The median duration of follow-up was 22.5 months for the stent-coiling group and 8.7 months for the PED group (P = 0.0002). Complete occlusion at last follow-up was achieved in 75.9% of aneurysms in the stent-coiling group and in 81.1% of aneurysms in the PED group (P = 0.516). The retreatment rate was higher with stent-coiling, but the difference did not reach statistical significance (P = 0.062). A good functional outcome was achieved in 96.6% of patients in the stent-coiling group and in 94.7% of those in the PED group (P = 0.707). The rate of neurologic complications was 4.8% in the stent-coiling group and 9.4% in the PED group (P = 0.376).
Conclusion: Stent-coiling and the PED were equally effective for treating OSAs. There were no significant differences in terms of procedural complications, angiographic, functional, and visual outcomes. PED may be more favorable for multiple adjacent OSAs.
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http://dx.doi.org/10.1016/j.wneu.2017.05.104 | DOI Listing |
Neuroradiol J
November 2024
Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA.
Introduction: Platelet function testing using serial VerifyNow P2Y12 platelet reactivity units (PRUs) is established for guiding clopidogrel antiplatelet therapy in cerebral aneurysm stenting procedures. However, for ticagrelor, the impact of serial PRU testing and the identification of safe PRU ranges remains unexplored.
Methods: Flow diversion stenting ( = 232) and stent-assisted coiling procedures ( = 83) performed 05/2017-12/2021 were reviewed.
Clin Neurol Neurosurg
March 2022
Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing Jiangsu Province 210029, China. Electronic address:
Purpose: During stent-assisted coiling of ruptured intracranial aneurysms (RIA), appropriate antiplatelet administration is an important element of management. We aimed to evaluate the safety and efficacy of intravenous tirofiban administration versus dual antiplatelet therapy (DAPT) for stent-assisted coiling of RIAs within 24 h after procedure.
Methods: From January 2015 to March 2019, two groups of patients with RIAs treated with stent-coiling were compared: the DAPT group (a loading dose of 300 mg clopidogrel and 300 mg aspirin) and the tirofiban group (intravenous administration of tirofiban 5 µg/kg over 1 min, followed by a maintenance dose of 0.
J Neurointerv Surg
December 2022
Department of Neurosurgery, Yokohama City University, Yokohama, Kanagawa, Japan.
Background: Endovascular embolization using standalone coils is the preferred treatment option for ruptured cerebral aneurysms to avoid the use of dual antiplatelet therapy with stent coiling or endoluminal flow diversion devices. However, it has been reported that patients undergoing the standalone coiling approach are at risk for periprocedural thromboembolism. Therefore, this systematic review and meta-analysis was performed to clarify the risks and benefits of antiplatelet therapy (AT) during coiling procedures performed to treat ruptured aneurysms, including the incidence of early thromboembolic events, hemorrhagic and delayed ischemic events, as well as clinical outcomes.
View Article and Find Full Text PDFOper Neurosurg (Hagerstown)
July 2021
Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Wide-necked bifurcation aneurysms pose technical and anatomical challenges to endovascular treatment, which make the simpler assisted (balloon or single stent) coiling techniques less effective.1 Consequently, unique endovascular solutions to treat such aneurysms have been devised.2,3 One such device is PulseRider (Cerenovus, New Brunswick, New Jersey), which is designed to provide neck support for a coil mass while protecting the bifurcation.
View Article and Find Full Text PDFBMC Neurol
November 2020
Department of Neurosurgery, Chongqing Medical University Affiliated Second Hospital, No.76 Linjiang road, Yuzhong District, Chongqing, 400010, China.
Background: Incomplete aneurysmal occlusion is a common feature of immediate posttreatment angiography. The safety and outcomes of acutely ruptured intracranial aneurysms (RIAs) with incomplete occlusion after stent-assisted coiling (SAC) and no-stent coiling (NSC) have not been well clarified. Progressive occlusion of stents can promote the complete occlusion of intracranial aneurysms (IAs), but it remains to be determined if progressive occlusion in acutely RIAs with incomplete occlusion after coiling may be enhanced by protective stenting.
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