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Characteristics and outcomes of varied treatment modalities for partially thrombosed intracranial aneurysms: a review of 35 cases

  • Clinical Article - Vascular
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Abstract

Objective

The purpose of this study was to analyze the characteristics of partially thrombosed intracranial aneurysms (PTIAs) in terms of location, shape, size, and symptoms, and to assess outcome according to the type of treatment.

Methods

We reviewed the radiological and clinical findings of 35 cases of PTIAs followed in our institution between 2006 and 2011. We divided all treatment modalities into two groups. Patients in group A (n = 15) were treated by blood flow blockage from the lesion of the pathogenic segment of the parent where the PTIAs originated, and patients in group B (n = 20) were only treated with obliteration of the remnant perfused aneurysmal sac. Radiological and clinical outcomes of treatment were compared between the two groups.

Results

Group A showed complete occlusion in 15 cases (100 %) compared to six cases (30.0 %) in group B (p < 0.001). No cases required retreatment in group A, while six cases (30.0 %) underwent retreatment in group B (p = 0.027). In terms of clinical outcome, 12 cases (80.0 %) showed symptomatic improvement in group A compared to eight cases (40.0 %) in group B (p = 0.037). Nine cases (60.0 %) showed improvement in postoperative GOS at six months compared to initial preoperative GOS in group A versus four (20.0 %) in group B (p = 0.032).

Conclusion

PTIAs should be treated by preventing blood flow from the lesion of the pathogenic segment of the parent artery where PTIAs originate. This treatment approach is associated with better clinical and radiological outcomes.

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References

  1. Alvarez H (2009) Etiology of giant aneurysms and their treatment. AJNR Am J Neuroradiol 30:E8, author reply E9-10

    Article  CAS  PubMed  Google Scholar 

  2. Atkinson JL, Okazaki H, Sundt TM Jr, Nichols DA, Rufenacht DA (1991) Intracranial cerebrovascular vasa vasorum associated with atherosclerosis and large thick-walled aneurysms. Surg Neurol 36:365–369

    Article  CAS  PubMed  Google Scholar 

  3. Berge J, Tourdias T, Moreau JF, Barreau X, Dousset V (2011) Perianeurysmal brain inflammation after flow-diversion treatment. AJNR Am J Neuroradiol 32:1930–1934

    Article  CAS  PubMed  Google Scholar 

  4. Byrne JV, Beltechi R, Yarnold JA, Birks J, Kamran M (2010) Early experience in the treatment of intra-cranial aneurysms by endovascular flow diversion: a multicentre prospective study. PLoS One 5(9). doi:10.1371/journal.pone.0012492

  5. Campi A, Ramzi N, Molyneux AJ, Summers PE, Kerr RS, Sneade M, Yarnold JA, Rischmiller J, Byrne JV (2007) Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke 38:1538–1544

    Article  PubMed  Google Scholar 

  6. Ferns SP, Sprengers ME, van Rooij WJ, Rinkel GJ, van Rijn JC, Bipat S, Sluzewski M, Majoie CB (2009) Coiling of intracranial aneurysms: a systematic review on initial occlusion and reopening and retreatment rates. Stroke 40:e523–e529

    Article  PubMed  Google Scholar 

  7. Hammoud D, Gailloud P, Olivi A, Murphy KJ (2003) Acute vasogenic edema induced by thrombosis of a giant intracranial aneurysm: a cause of pseudostroke after therapeutic occlusion of the parent vessel. AJNR Am J Neuroradiol 24:1237–1239

    PubMed  Google Scholar 

  8. Iihara K, Murao K, Sakai N, Soeda A, Ishibashi-Ueda H, Yutani C, Yamada N, Nagata I (2003) Continued growth of and increased symptoms from a thrombosed giant aneurysm of the vertebral artery after complete endovascular occlusion and trapping: the role of vasa vasorum. Case report. J Neurosurg 98:407–413

    Article  PubMed  Google Scholar 

  9. Jissendi Tchofo P, Rodesch G, Duret M, Baleriaux D (2002) Natural evolution of an aneurysm of the V4 segment of the vertebral artery into a giant aneurysm. A case report. J Neuroradiol 29:275–280

    CAS  PubMed  Google Scholar 

  10. Kazi M, Thyberg J, Religa P, Roy J, Eriksson P, Hedin U, Swedenborg J (2003) Influence of intraluminal thrombus on structural and cellular composition of abdominal aortic aneurysm wall. J Vasc Surg 38:1283–1292

    Article  PubMed  Google Scholar 

  11. Krings T, Piske RL, Lasjaunias PL (2005) Intracranial arterial aneurysm vasculopathies: targeting the outer vessel wall. Neuroradiology 47:931–937

    Article  PubMed  Google Scholar 

  12. Krings T, Alvarez H, Reinacher P, Ozanne A, Baccin CE, Gandolfo C, Zhao WY, Reinges MH, Lasjaunias P (2007) Growth and rupture mechanism of partially thrombosed aneurysms. Interv Neuroradiol 13:117–126

    CAS  PubMed Central  PubMed  Google Scholar 

  13. Lawton MT, Quinones-Hinojosa A, Chang EF, Yu T (2005) Thrombotic intracranial aneurysms: classification scheme and management strategies in 68 patients. Neurosurgery 56:441–454, discussion 441–454

    Article  PubMed  Google Scholar 

  14. Mericle RA, Wakhloo AK, Lopes DK, Lanzino G, Guterman LR, Hopkins LN (1998) Delayed aneurysm regrowth and recanalization after Guglielmi detachable coil treatment. Case report. J Neurosurg 89:142–145

    Article  CAS  PubMed  Google Scholar 

  15. Mizutani T, Miki Y, Kojima H, Suzuki H (1999) Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery 45:253–259, discussion 259–260

    Article  CAS  PubMed  Google Scholar 

  16. Nagahiro S, Takada A, Goto S, Kai Y, Ushio Y (1995) Thrombosed growing giant aneurysms of the vertebral artery: growth mechanism and management. J Neurosurg 82:796–801

    Article  CAS  PubMed  Google Scholar 

  17. Pierot L (2011) Flow diverter stents in the treatment of intracranial aneurysms: where are we? J Neuroradiol 38:40–46

    Article  PubMed  Google Scholar 

  18. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, Lamoureux J, Chagnon M, Roy D (2003) Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:1398–1403

    Article  PubMed  Google Scholar 

  19. Roccatagliata L, Guedin P, Condette-Auliac S, Gaillard S, Colas F, Boulin A, Wang A, Guieu S, Rodesch G (2010) Partially thrombosed intracranial aneurysms: symptoms, evolution, and therapeutic management. Acta Neurochir (Wien) 152:2133–2142

    Article  Google Scholar 

  20. Schubiger O, Valavanis A, Hayek J (1980) Computed tomography in cerebral aneurysms with special emphasis on giant intracranial aneurysms. J Comput Assist Tomogr 4:24–32

    Article  CAS  PubMed  Google Scholar 

  21. Szikora I, Berentei Z, Kulcsar Z, Marosfoi M, Vajda ZS, Lee W, Berez A, Nelson PK (2010) Treatment of intracranial aneurysms by functional reconstruction of the parent artery: the Budapest experience with the pipeline embolization device. AJNR Am J Neuroradiol 31:1139–1147

    Article  CAS  PubMed  Google Scholar 

  22. Whittle IR, Dorsch NW, Besser M (1982) Spontaneous thrombosis in giant intracranial aneurysms. J Neurol Neurosurg Psychiatry 45:1040–1047

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, Forbes GS, Thielen K, Nichols D, O'Fallon WM, Peacock J, Jaeger L, Kassell NF, Kongable-Beckman GL, Torner JC, International Study of Unruptured Intracranial Aneurysms I (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:103–110

    Article  PubMed  Google Scholar 

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Correspondence to Jung Cheol Park.

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Yang, K., Park, J.C., Ahn, J.S. et al. Characteristics and outcomes of varied treatment modalities for partially thrombosed intracranial aneurysms: a review of 35 cases. Acta Neurochir 156, 1669–1675 (2014). https://doi.org/10.1007/s00701-014-2147-0

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  • DOI: https://doi.org/10.1007/s00701-014-2147-0

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