Coiling Techniques in management of Cerebral Aneurysms Preoperative assessment, Outcome and Complications | ||
| Minia Journal of Medical Research | ||
| Article 36, Volume 30, Issue 3, July 2019, Pages 177-186 PDF (312.7 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/mjmr.2022.221923 | ||
| Authors | ||
| Enas M. Hassan1; Ahmed A. Ibrahim Elbassiony2; Mohamed M. Ismail1; Ahmed Z. Khafagy3 | ||
| 1Department of Neurology- Faculty of Medicine- Minya University1 | ||
| 2Department of Neurology - Faculty of Medicine- Ain Shams university | ||
| 3* Department of Neurology- Faculty of Medicine- Minya University | ||
| Abstract | ||
| Background: according to the International Subarachnoid Trial (ISAT), patients with subarachnoid hemorrhage (SAH) fared better with endovascular coiling than those with surgical clipping (Molyneux et al., 2005). With the emergence of flow diversion as a useful technique in management of cerebral aneurysm, endovascular techniques now have many varieties that enable the interventionalist to achieve best outcome. Objective: This study aimed to compare the outcome and complications between balloon assisted coiling and the use of Flow diverter stent, also studying the theoretical effect of antiplatelet use in flow diverter group and whether there is an added risk for development of bleeding. Patients and Methods: Thirty two patients were included in this study between February/2016 and June/2017. Age range was 25-69 (54± 10.5) for balloon group (Group B =17), 30-68 years old (50.7±10.1) for the Flow diverter group (Group F=15). The females were 10 (58%) in the balloon group and 6 (40%) in the Flow diverter group. No statistically significant difference was found between two groups. Those patient were found to have wide neck aneurysm by either CT cerebral angiography of 4 vessel angiography. Patient undergo preoperative assessment using NIHS stroke scale, modified Rankin scale, Hunt and Hess scale and modified fisher scale. Post-operative assessment included, modified Rankin scale for clinical outcome and Raymond Roy scale for the degree of obliteration of aneurysm. Follow up study was done after 6 month of the procedure including the same sale to detect the clinical improvement as well as recanalization rate. Results: Regarding follow up assessment in clinical outcome, significant improvement occurred in both groups with minimal or no symptoms in 15 out of 17 (88.23%) in the balloon group and 14 out of 15 (93%) in the flow diverter group. Findings show that total obliteration was achieved immediately in most of cases (11 out of 17 in the balloon group, 13 out of 15 in the Flow diverter group). No significant difference between angiographic outcome of immediate and follow up imaging in the case of flow diverter. There is a significant difference between the immediate and follow up score of the balloon group but eventually most of the cases achieve complete obliteration (15 out of 17). Regarding complications, the operation went uneventful for more than 2 thirds of cases in each group. Although thrombotic complication is higher in Flow diverter group (20% for FD Vs 11.8% for B), manifest infarction is paradoxically higher in Balloon group (6.7% for FD Vs 17.6% for B). Hemorrhagic event occurred only once in balloon group (5.9%). For correlation, clinical outcome correlates with radiological outcome (P=0.007 significant level is P<0.001). Conclusion: both techniques are safe and effective in management of wide neck cerebral aneurysm with no significant difference between both techniques. Selection of either method is upon the experience of the interventional neurologist’s experience and preference. | ||
| Keywords | ||
| Neurointerventional management of cerebral aneurysms; wide-neck cerebral aneurysm; Balloon assisted coiling; Flow diverter stent | ||
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