Aneurysm
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This document summarizes techniques for treating aneurysms, including: - Endovascular techniques like coiling, remodeling, stent-assisted coiling, Onyx, and graft stents have become prevalent since FDA approval of GDC coils in 1995. - The ISAT trial from 2002-2005 compared coiling to clipping for ruptured aneurysms and found coiling had a 7.4% lower risk of death or dependency. - Newer techniques like flow diverters which have dense stent structures are used to prevent blood flow into the aneurysm sac but cost around 10,000 Euros. Detection and treatment of vasospasm beyond traditional measures is also discussed.
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Aneurysm
- 2. • • • • • •
- 3. Indication • • • •
- 4. • 2005 • 2005-2008 TAE for 10 cases • 2008/8 till now TAE for 50 cases
- 5. • 2005-2006 • Diagnosis with C-arm • TAE with C-arm
- 8. • 2006-2009 • Diagnosis with CTA and OsiriX • TAE with C-arm
- 10. • 2005-2006 • Diagnosis with CTA and OsiriX • TAE with Biplane Angio-suit Siemens Zee
- 11. Methods to Treat Aneurysm • Surgical • clipping • wrapping • aneurysmorrhaphy • Hunterian ligation • EC-IC bypass
- 12. Endovascular • Coiling • Remodeling • Stent-assisted • Onyx • Graft stent • Flow diverter
- 13. Coiling • 1995 FDA approved GDC coil • Guido Guglielmi • 2005 Europe ISAT trial
- 15. ISAT trial • 2002 International Subarachnoid Aneurysm Trial • 2143 patients • 1070 for aneurysm clipping • 1073 for coiling • Coiling have a 7.4% absolute risk reduction. (23.5% vs 30.9% dead and dependent)
- 16. 30.0 22.5 15.0 7.5 0
- 17. 30.0 22.5 15.0 7.5 0 76.3% 23.7% % 69.4% 30.6%
- 18. COIL
- 33. Graft Stent
- 35. AP Lateral
- 40. Double stent
- 41. Onyx • 71 patient • complete occlusion 56 patients (79%) • Subtotal 9(13%) • Incomplete 6(8%)
- 45. Vasospasm • How to detect? • TCD, CT perfusion, DSA • Measures beyond “3H” • Angioplasty • Intra-arterial Nimodipine, Papaverine
- 51. Flow diverter •A stent with very dense strut structure • Silk from Balt • Pipeline from Chestnut • To prevent blood flow into aneurysm sac • Price 10000 EURO
- 56. • Aneurysm ICH & mass effect • • AVM •
Editor's Notes
- A case of NPC s/p radiotherapy, one month ago, he had naso-oral bleeding from branch of right ECA. NBCA embolization of the branch stopped bleeding. This time, he had massive naso-oral bleeding again. Angio showed right ICA cervical segment pseudoaneurysm. Massive bleeding from aneurysm occurred during study. Use Abbot Jostent *2 to cover the location of pseudoaneurysm.
- A case of NPC s/p radiotherapy, one month ago, he had naso-oral bleeding from branch of right ECA. NBCA embolization of the branch stopped bleeding. This time, he had massive naso-oral bleeding again. Angio showed right ICA cervical segment pseudoaneurysm. Massive bleeding from aneurysm occurred during study. Use Abbot Jostent *2 to cover the location of pseudoaneurysm.
- A case of traumatic CCF s/p balloon embolization but failed. Use Jostent to cover the fistula successfully.
- A case of traumatic CCF s/p balloon embolization but failed. Use Jostent to cover the fistula successfully.
- MCA aneurysm with M1 vasospasm. Coiling was done but vasospasm more severe.
- After coiling, use BS Sentry balloon to angioplasty the M1 segment. Distal artery treated with Papaverine and Nimodipine.
- A case of severe SAH