link
Bookmarks
Aneurysm Treatment (Intracranial)
Carlos E. Baccin, MD; James D. Rabinov, MD
To access 4,300 diagnoses written by the world's leading experts in radiology, please log in or subscribe.Log inSubscribe
0
0

KEY FACTS

  • Terminology

    • Pre-Procedure

      • Procedure

        • Post-Procedure

          TERMINOLOGY

          • Definitions

            • Intracranial aneurysm: Arterial outpouching involving focal segment of arterial circumference
              • Deficient internal elastic lamina
                • Tunica media also sometimes deficient
              • Aneurysm locations/incidence
                • Anterior circulation (87%)
                  • Anterior cerebral artery (ACA)
                  • Anterior communicating artery (AComA)
                  • Middle cerebral artery bifurcation (MCA)
                  • Posterior communicating artery (PComA)
                  • Internal carotid artery (ICA) bifurcation
                  • Paraclinoid internal carotid artery
                  • Anterior choroidal artery (AChA)
                  • Ophthalmic artery
                • Posterior circulation (13%)
                  • Basilar artery (BasA)
                  • Posterior cerebral artery (PCA)
                  • Superior cerebellar artery (SCA)
                  • Vertebrobasilar junction
                  • Posterior inferior cerebellar artery (PICA)
              • 3.2% cumulative incidence of recurrent subarachnoid hemorrhage (SAH) after surgical aneurysm clipping for SAH
              • 3.1% incidence of rebleeding from aneurysm treated with coils in 1st year
                • 0.15% rebleeding incidence after 1 year
            • Giant aneurysm: Diameter > 2.5 cm
              • Compression of adjacent structures in 70-75%
              • Represents about 5-8% of all intracranial aneurysms
            • Wide-necked aneurysms:Neck diameter > 4 mm or dome to neck ratio < 2
              • Adjunctive techniques for aneurysm embolization (wide-necked aneurysms)
                • Stent-assisted coil embolization: Stent initially deployed across aneurysm neck
                  • Microcatheter/coils introduced into aneurysm through stent interstices
                • Balloon-assisted coil embolization: Temporary balloon inflation across aneurysm neck while coiling; balloon typically deflated after each coil

          PRE-PROCEDURE

          • Indications

            • Contraindications

              • Pre-Procedure Imaging

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Procedure Steps

                      • Findings and Reporting

                        • Alternative Procedures/Therapies

                          POST-PROCEDURE

                          • Expected Outcome

                            • Things to Do

                              • Things to Avoid

                                OUTCOMES

                                • Complications

                                  Selected References

                                  1. Harrigan MR et al: Handbook of Cerebrovascular Disease and Neurointerventional Technique. Totowa, NJ: Humana Press, 2009
                                  2. Molyneux AJ 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. 8(5):427-33, 2009
                                  3. Schaafsma JD et al: Long-term recurrent subarachnoid hemorrhage after adequate coiling vs clipping of ruptured intracranial aneurysms. Stroke. 40(5):1758-63, 2009
                                  4. Robert WH et al: Interventional Neuroradiology. New York: Informa Healthcare, 2008
                                  5. Krings T et al: Segmental unfused basilar artery with kissing aneurysms: report of three cases and literature review. Acta Neurochir (Wien). 149(6):567-74, Review, 2007
                                  6. Baccin CE et al: Multiple mirror-like intracranial aneurysms. Report of a case and review of the literature. Acta Neurochir (Wien). 148(10):1091-5, Review, 2006
                                  7. Wermer MJ et al: Incidence of recurrent subarachnoid hemorrhage after clipping for ruptured intracranial aneurysms. Stroke. 36(11):2394-9, 2005
                                  8. Berenstein A et al: Surgical Neuroangiography, vol. 2. 2nd ed. Heidelberg, Berlin: Springer Verlag, 2004
                                  9. Osborn A et al: Diagnostic Imaging: Brain. 1st ed. Salt Lake City: Amirsys, 2004
                                  10. Wiebers DO et al: Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 362(9378):103-10, 2003
                                  11. Roy D et al: Endovascular treatment of unruptured aneurysms. Stroke. 32(9):1998-2004, 2001
                                  12. Connors JJ III et al: Interventional Neuroradiology: Strategies and Practical Techniques. Philadelphia: WB Saunders Company, 1999
                                  Related Anatomy
                                  Loading...
                                  Related Differential Diagnoses
                                  Loading...
                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Pre-Procedure

                                      • Procedure

                                        • Post-Procedure

                                          TERMINOLOGY

                                          • Definitions

                                            • Intracranial aneurysm: Arterial outpouching involving focal segment of arterial circumference
                                              • Deficient internal elastic lamina
                                                • Tunica media also sometimes deficient
                                              • Aneurysm locations/incidence
                                                • Anterior circulation (87%)
                                                  • Anterior cerebral artery (ACA)
                                                  • Anterior communicating artery (AComA)
                                                  • Middle cerebral artery bifurcation (MCA)
                                                  • Posterior communicating artery (PComA)
                                                  • Internal carotid artery (ICA) bifurcation
                                                  • Paraclinoid internal carotid artery
                                                  • Anterior choroidal artery (AChA)
                                                  • Ophthalmic artery
                                                • Posterior circulation (13%)
                                                  • Basilar artery (BasA)
                                                  • Posterior cerebral artery (PCA)
                                                  • Superior cerebellar artery (SCA)
                                                  • Vertebrobasilar junction
                                                  • Posterior inferior cerebellar artery (PICA)
                                              • 3.2% cumulative incidence of recurrent subarachnoid hemorrhage (SAH) after surgical aneurysm clipping for SAH
                                              • 3.1% incidence of rebleeding from aneurysm treated with coils in 1st year
                                                • 0.15% rebleeding incidence after 1 year
                                            • Giant aneurysm: Diameter > 2.5 cm
                                              • Compression of adjacent structures in 70-75%
                                              • Represents about 5-8% of all intracranial aneurysms
                                            • Wide-necked aneurysms:Neck diameter > 4 mm or dome to neck ratio < 2
                                              • Adjunctive techniques for aneurysm embolization (wide-necked aneurysms)
                                                • Stent-assisted coil embolization: Stent initially deployed across aneurysm neck
                                                  • Microcatheter/coils introduced into aneurysm through stent interstices
                                                • Balloon-assisted coil embolization: Temporary balloon inflation across aneurysm neck while coiling; balloon typically deflated after each coil

                                          PRE-PROCEDURE

                                          • Indications

                                            • Contraindications

                                              • Pre-Procedure Imaging

                                                • Getting Started

                                                  PROCEDURE

                                                  • Patient Position/Location

                                                    • Procedure Steps

                                                      • Findings and Reporting

                                                        • Alternative Procedures/Therapies

                                                          POST-PROCEDURE

                                                          • Expected Outcome

                                                            • Things to Do

                                                              • Things to Avoid

                                                                OUTCOMES

                                                                • Complications

                                                                  Selected References

                                                                  1. Harrigan MR et al: Handbook of Cerebrovascular Disease and Neurointerventional Technique. Totowa, NJ: Humana Press, 2009
                                                                  2. Molyneux AJ 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. 8(5):427-33, 2009
                                                                  3. Schaafsma JD et al: Long-term recurrent subarachnoid hemorrhage after adequate coiling vs clipping of ruptured intracranial aneurysms. Stroke. 40(5):1758-63, 2009
                                                                  4. Robert WH et al: Interventional Neuroradiology. New York: Informa Healthcare, 2008
                                                                  5. Krings T et al: Segmental unfused basilar artery with kissing aneurysms: report of three cases and literature review. Acta Neurochir (Wien). 149(6):567-74, Review, 2007
                                                                  6. Baccin CE et al: Multiple mirror-like intracranial aneurysms. Report of a case and review of the literature. Acta Neurochir (Wien). 148(10):1091-5, Review, 2006
                                                                  7. Wermer MJ et al: Incidence of recurrent subarachnoid hemorrhage after clipping for ruptured intracranial aneurysms. Stroke. 36(11):2394-9, 2005
                                                                  8. Berenstein A et al: Surgical Neuroangiography, vol. 2. 2nd ed. Heidelberg, Berlin: Springer Verlag, 2004
                                                                  9. Osborn A et al: Diagnostic Imaging: Brain. 1st ed. Salt Lake City: Amirsys, 2004
                                                                  10. Wiebers DO et al: Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 362(9378):103-10, 2003
                                                                  11. Roy D et al: Endovascular treatment of unruptured aneurysms. Stroke. 32(9):1998-2004, 2001
                                                                  12. Connors JJ III et al: Interventional Neuroradiology: Strategies and Practical Techniques. Philadelphia: WB Saunders Company, 1999