Neck-Bridge Device for Endovascular Treatment of Wide-Neck Bifurcation Aneurysms: Initial Experience
Abstract
PURPOSE: To report the authors’ initial experience in treating patients with wide-neck aneurysms with assistance from a recently developed neck-bridge device (TriSpan; Target Therapeutics/Boston Scientific, Fremont, Calif).
MATERIALS AND METHODS: Twenty-five patients were examined. Aneurysms were most frequently at the basilar bifurcation (n = 19). Sixteen aneurysms were treated electively: six aneurysms that recurred after coil-only embolization and 10 nontreated aneurysms (including four that had failed coil-only embolization). Nine aneurysms were treated acutely following subarachnoid hemorrhage. All lesions except one had a wide neck. A dual-catheter technique was used in 23 patients. Immediate angiographic results, technical incidents, and complications were recorded. Follow-up angiography was performed in 16 patients. Clinical follow-up ranged from 1 to 12 months.
RESULTS: Neck-bridge device–assisted coil packing was successfully performed in 23 lesions, with complete obliteration in three, residual necks in 13, and a minimal residual sac in seven patients. Parent vessel protection failed, with coil protrusion and arterial occlusion, in one of these patients. Other complications that were not directly related to use of the neck-bridge device included retroperitoneal hematoma, rebleeding, coil perforation, and transient embolic arterial occlusion. One patient died of vasospasm and heart failure. Follow-up angiography revealed complete obliteration in four, a residual neck in one, a persistent residual sac in four, and recurrent aneurysm in seven patients. One patient had a small occipital infarction 5 weeks after treatment.
CONCLUSION: The described neck-bridge device is useful for assisting coil embolization of wide-neck bifurcation aneurysms.
References
- 1 Fernandez Zubillaga A, Guglielmi G, Vinuela F, Duckwiler GR. Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR Am J Neuroradiol 1994; 15:815-820.
- 2 Moret J, Cognard C, Weill A, Castaings L, Rey A. The “remodeling technique” in the treatment of wide neck intracranial aneurysms. Intervent Neuroradiol 1997; 3:21-35.
- 3 DeBrun GM, Aletich VA, Kehrli P, Misra M, Ausman JI, Charbel F. Selection of cerebral aneurysms for treatment using Guglielmi detachable coils: the preliminary University of Illinois at Chicago experience. Neurosurgery 1998; 43:1281-1295.
- 4 Lefkowitz MA, Gobin YP, Akiba Y, et al. Balloon-assisted Guglielmi detachable coiling of wide-necked aneurysms. II. Clinical results. Neurosurgery 1999; 45:531-538.
- 5 Pelz DM, Lownie SP, Fox AJ. Thromboembolic events associated with the treatment of cerebral aneurysms with Guglielmi detachable coils. AJNR Am J Neuroradiol 1998; 19:1541-1547.
- 6 Aquilla ST, Rappe AH, Villar F, Virmani R, Strother CM. Evaluation of the TriSpan neck bridge device for the treatment of wide-necked aneurysm: an experimental study in canines. Stroke 2001; 32:492-497.
- 7 Moret J, Ross IB, Weill A, Piotin M. The retrograde approach: a consideration for the endovascular treatment of aneurysms. AJNR Am J Neuroradiol 2000; 21:262-268.
- 8 Baxter BW, Rosso D, Lownie SP. Double microcatheter technique for detachable coil treatment of large, wide-necked intracranial aneurysms. AJNR Am J Neuroradiol 1998; 19:1176-1178.
- 9 Raymond J, Roy D. Safety and efficacy of endovascular treatment of acutely ruptured aneurysms. Neurosurgery 1997; 41:1235-1244.
- 10 Murayama Y, Vinuela F, Duckwiler GR, Gobin YP, Guglielmi G. Embolization of incidental aneurysms by using the Guglielmi detachable coil system. J Neurosurg 1999; 90:207-214.
- 11 Roy D, Raymond J, Bouthillier A, Bojanowski MW, Moumdjian R, L’Espérance G. Endovascular treatment of ophthalmic segment aneurysms with Guglielmi detachable coils. AJNR Am J Neuroradiol 1997; 18:1207-1215.
- 12 Raymond J, Roy D, Bojanowski M, Moumdjian R, L’Espérance G. Endovascular treatment of acutely ruptured and unruptured aneurysms of the basilar bifurcation. J Neurosurg 1997; 86:211-219.
- 13 Akiba Y, Murayama Y, Vinuela F, Lefkowitz A, Duckwiler GR, Gobin YP. Balloon-assisted Guglielmi detachable coiling of wide-necked aneurysms. I. Experimental evaluation. Neurosurgery 1999; 45:519-530.
- 14 Turjman F, Massoud TF, Ji C, Guglielmi G, Vinuela F, Robert J. Combined stent implantation and endosaccular coil placement for treatment of experimental wide-necked aneurysms: a feasibility study in swine. AJNR Am J Neuroradiol 1995; 15:1087-1090.
- 15 Wakhloo AK, Lanzino G, Lieber BB, Hopkins LN. Stents for intracranial aneurysms: the beginning of a new endovascular era? Neurosurgery 1998; 43:377-379.
- 16 Civit T, Auque J, Marchal JC, Bracard S, Picard L, Hepner H. Aneurysm clipping after endovascular treatment with coils: a report of eight patients. Neurosurgery 1996; 38:955-960.
- 17 Gurian JH, Martin NA, King WA, Duckwiler GR, Guglielmi G, Vinuela F. Neurosurgical management of cerebral aneurysms following unsuccessful or incomplete endovascular embolization. J Neurosurg 1995; 83:843-853.
- 18 Qureshi AI, Luft AR, Sharma M, Guterman LR, Hopkins LN. Prevention and treatment of thromboembolic and ischemic complications associated with endovascular procedures. I. Pathophysiological and pharmacological features. Neurosurgery 2000; 46:1344-1359.
- 19 Raymond J, Venne D, Allas S, et al. Healing mechanisms in experimental aneurysms. I. Vascular smooth muscle cells and neointima formation. J Neuroradiol 1999; 26:7-20.
- 20 Raymond J, Desfaits AC, Roy D. Fibrinogen and vascular smooth muscle cell grafts promote healing of experimental aneurysms treated by embolization. Stroke 1999; 30:1657-1664.
- 21 Reul J, Weis J, Spetzger U, Konert T, Fricke C, Thron A. Long-term angiographic and histopathologic findings in experimental aneurysms of the carotid bifurcation embolized with platinum and tungsten coils. AJNR Am J Neuroradiol 1997; 18:35-42.
- 22 Bavinski G, Talazoglu V, Killer M, et al. Gross and microscopic histopathological findings in aneurysms of the human brain treated with Guglielmi detachable coils. J Neurosurg 1999; 91:284-293.
