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Neuroradiology |
1 From the Department of Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75940 Paris 19, France (C.C., A.W., L.S., M.P., L.C., J.M.) and Department of Neurosurgery, Hopital Beaujon, Clichy, France (A.R.). Received November 12, 1997; revision requested February 16, 1998; revision received July 10; accepted February 12, 1999. Address reprint requests to J.M. (e-mail: moretnri@ fo-rothschild.fr).
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Abstract |
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 TOP Abstract IntroductionMATERIALS AND METHODSRESULTSDISCUSSIONReferences |
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MATERIALS AND METHODS: A total of 203 berry aneurysms (<1.5 cm) were treated with EVT. Follow-up angiography at least 3 months later was performed in 169 cases.
RESULTS: Complete occlusion of the aneurysm sac and neck was achieved in 148 aneurysms, subtotal occlusion in 18, and incomplete occlusion in three. Recurrence occurred between 3 and 40 months in 20 (14%) of the 148 totally occluded aneurysms. A second treatment was performed in five cases, was scheduled in one, and failed in one. The small neck remnant increased in size but did not require any retreatment in three cases, and the size of the neck remnant remained stable in 10 cases. Remnant regrowth occurred in six of the 18 subtotally occluded aneurysms. A second treatment was performed in three. Of the 169 cases, last follow-up angiography showed total occlusion in 133 cases, subtotal in 30, and incomplete in six. No rebleeding occurred.
CONCLUSION: A very small recurrence may be observed at the level of the neck of the aneurysm at long-term follow-up angiography despite achieving total occlusion initially with detachable coils.
Index terms: Aneurysm, intracranial, 1728.73 • Angiography, 1722.1247 • Arteries, therapeutic blockade 1723.1264, 1731.1264, 1733.1264, 174.1264, 175.1264 • Brain, hemorrhage, 10.367
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Introduction |
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TOPAbstractIntroductionMATERIALS AND METHODSRESULTSDISCUSSIONReferences |
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The aim of this study was to document the preliminary results of evaluating the long-term angiographic stability of the occlusion of intracranial aneurysms with detachable coils.
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MATERIALS AND METHODS |
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TOPAbstractIntroductionMATERIALS AND METHODSRESULTSDISCUSSIONReferences |
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From November 1992 to November 1996, 236 berry aneurysms (<1.5 cm) in 208 patients were intended to be treated with detachable coils. Treatment was achieved in 203 aneurysms in 182 patients (9). Sixteen patients died—nine of subarachnoid hemorrhage, four of complications of the treatment, one of rebleeding of an incompletely occluded aneurysm, one of aneurysm rupture during surgery of an associated aneurysm, and one of a nonrelated disease. Thus, 166 patients with 187 aneurysms were treated and could be followed up. Each patient was scheduled for follow-up angiography at 3 months, 18 months, and 3–4-year intervals after treatment. Angiography was planned for all patients with subtotal or incomplete occlusions. Eighteen patients, mostly those who lived outside France, were lost to follow up. Of the 187 aneurysms treated, 169 (90%) had at least one follow-up angiography at 3 months.
Clinical symptoms, location of the aneurysm, size of the first coil, and aneurysm sac size–to–neck diameter ratio were all taken into consideration. In this series, we evaluated the evolution of the occlusion on follow-up angiograms in these 169 treated aneurysms; all were reevaluated at 3 months. Of the 169 aneurysms, 107 aneurysms were ruptured and 62 were not ruptured. The locations of all the aneurysms are detailed in Table 1. The size of the first coil was taken in 161 aneurysms as an indirect measurement of the aneurysm sac size. Aneurysms were classified as small berry (2- or 3-mm-diameter coils; 52 cases [32%]), medium berry (4- or 5-mm-diameter coils; 57 cases [35%]), or large berry (6-, 7-, or 8-mm-diameter coils; 52 cases [32%]). The ratio between aneurysm sac size and neck diameter was classified as 1, between 1 and 2, and 2, for the small, medium, and large berry classifications, respectively. We were able to accurately estimate the size of the neck and obtain the ratio in 136 (84%) of the 161 aneurysms. The ratio was 1 in 37 cases (27%), between 1 and 2 in 66 cases (49%), and 2 in 33 cases (24%).
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The results were subjected to statistical analysis by using a standard 
2 test. Recurrence rate was correlated to clinical presentation, ratio between aneurysm sac size and neck diameter, aneurysm location, and aneurysm size. The significant P value was less than .05.
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RESULTS |
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TOPAbstractIntroductionMATERIALS AND METHODSRESULTSDISCUSSIONReferences |
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Evolution of the 148 Aneurysms with Total Occlusion
At the first follow-up angiographic examination (mean, 3 months), a recurrence was observed in eight of the 148 aneurysms (5%) (Table 2). Ninety-nine aneurysms totally occluded at first follow-up angiography underwent second follow-up angiography (mean, 18 months), and a recurrence was observed in nine (9%). Thirty-nine aneurysms totally occluded at second follow-up angiography underwent third angiography (mean, 38 months), and a recurrence was observed in three (8%) (Fig 3).
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Clinical presentation (ruptured or nonruptured aneurysms).—The frequency of recurrence was 17% in ruptured aneurysms and 7% in nonruptured aneurysms (Table 3). At first follow-up angiography (eight recurrences in 148 aneurysms), seven occurred in the 94 ruptured aneurysms (7%) and one in the 54 nonruptured aneurysms (2%). At second follow-up angiography (nine recurrences in 99 cases), there were eight recurrences in 66 ruptured aneurysms (12%) and one recurrence in the 33 nonruptured ones (3%). At the third follow-up angiography (three recurrences in 39 cases), there was only one recurrence in 26 ruptured aneurysms (4%), and there were two recurrences in 13 nonruptured ones (15%).
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Evolution of the Three Aneurysms with Incomplete Occlusion
In one case, the occlusion was stable at 18 months. In the second case, despite a second treatment, the occlusion was still incomplete. In the third case, the aneurysm remnant decreased, resulting in a subtotal occlusion (stable 39 months later).
Final Results
Finally, the last follow-up angiogram showed a total occlusion in 133 cases (79%), subtotal in 30 cases (18%), and incomplete in six cases (4%). All the cases with subtotal occlusion will be reevaluated, depending on the size of the remnant, 1–3 years later. For the six incompletely occluded aneurysms, a surgical clipping was never proposed because of the location of the aneurysm or because the remnant size was too small.
Clinical Evolution
No rupture occurred in this series of 169 treated and reevaluated aneurysms during a follow-up from 3 to 50 months later (mean, 20.2 months), for a cumulative follow-up of 3,419 months.
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DISCUSSION |
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TOPAbstractIntroductionMATERIALS AND METHODSRESULTSDISCUSSIONReferences |
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In a recent study (8), we reported the evolution of the occlusion rate in 55 aneurysms treated with mechanical detachable spirals. The results in the short-term period were disappointing, with a recurrence in 15% of the cases (two of 13) despite initial total occlusion and with 69% regrowth of the remnant in cases that were subtotally occluded. These spirals are no longer used in berry aneurysms.
To our knowledge, little is reported about long-term angiographic follow-up after treatment with detachable coils. Graves et al (15) reported that all of the completely occluded aneurysms in their series remained 100% occluded during follow-up (eight aneurysms with a mean follow-up of 7.7 months). In the series of Gurian et al (20), surgical clipping was required after partial occlusion or recanalization in 5.7% (eight of 141) of aneurysms treated with detachable coils. The frequency of recanalization was not addressed. In their recent study, Raymond et al (6) reported results of 31 aneurysms of the basilar bifurcation. Twenty-seven of the 29 surviving patients underwent 6-month follow-up angiography, and 12 patients underwent another follow-up angiographic examination 1 year later. Recurrence or regrowth of the remnant was shown in seven patients (24%).
Evaluation of the Occlusion
It is very difficult to assess the occlusion rate of the aneurysms after EVT. Evaluation is very subjective and must include both the density of the coil packing and amount of possible neck remnant. It is impossible to compare from one institution to another and then from one article to another what the authors define as complete occlusion with dense packing. In fact, when an aneurysm is already filled with a few large coils, the deposition of several small coils inside the coil mesh does not substantially change the appearance of the coil mesh on radiographs. At our institution, we try to pack the aneurysms as much as possible and stop the procedure only when the last coil cannot be introduced inside the sac. The last coil is always wasted for each procedure. The ability to introduce the last coil is completely dependant on the operator's skill level and experience. In addition, assessment of the neck remnant is made more difficult at the end of the procedure due to the mass of coils that frequently hides the aneurysm neck.
Evaluation of long-term angiographic follow-up is more reliable because aneurysm occlusion is evaluated by the same observers and with the same angiographic machine under exactly the same projections. However, the evaluation remains subjective, and it is sometimes difficult to assess slight modifications of the coil mesh and a very tiny neck remnant. In the current study, occlusion rates could not be determined in 39 aneurysms at the end of the first treatment because vasospasm due either to subarachnoid hemorrhage or to the catheterization made it impossible to assess the occlusion at the level of the neck. Total occlusion was confirmed at the first follow-up angiography when arteries had returned to their normal appearance.
Recurrences
Despite total occlusion obtained in 148 cases, recurrences were observed in 20 aneurysms (14%). It appears that even densely packed, totally occluded aneurysms may recanalize. It is difficult to understand the mechanism of the origin of the coil mesh changes and recanalization of the neck, but probably recurrences may be due to two causes: (a) coil compaction due to arterial blood flow and (b) true persistent growth of the aneurysm due to the initial disease of the arterial wall. These two phenomena are probably interrelated since as soon as a coil compaction occurs it may produce neck remnant growth by the arterial blood flow. However, a regrowth of the neck may produce a change in the coil mesh.
These recurrences are probably much less frequently encountered after surgical clipping and are at least partially related to the principle of the EVT. With intrasaccular occlusion of the aneurysm as in EVT, contact between the arterial walls does not occur as it does in surgical clipping. Nevertheless, true recurrences after complete surgical clipping have been described (21–24). Sasaki et al (23) reported seven cases of rebleeding of previously clipped aneurysms, 4–7 years after treatment. Five of them had initial complete clipping confirmed at angiography. Ebina et al (22) reported two cases of recurrence after complete clipping.
Histologic findings in animal aneurysm models treated with detachable coils are unclear (2,25–28). Mawad et al (25) demonstrated, in a canine lateral venous pouch model, regrowth of a new intimal layer over the neck of all aneurysms filled with coils. Both completely occluded and recanalized aneurysms were isolated from the circulation by this neointima composed of three well-identifiable layers. Reul et al (26) showed different results in a rabbit carotid bifurcation model. No intraluminal thrombi were found adhering to the coils, and in only the most densely packed cases were the coils covered by granulation tissue, with endothelial cells seen on the intraluminal surface of this tissue. Byrne et al (27) reported increased cellularity in the thrombus in a swine aneurysm model, but the importance of this finding is unclear because all the aneurysms in their model thrombosed, indicating that in pigs a vigorous cellular response is not necessary for aneurysms to thrombose and heal. The durability of an aneurysm healing with detachable coils probably cannot be inferred directly from these animal studies, given the very complex phenomena they involve. Coagulation in these animals is not identical to that in humans. Furthermore, in these animal aneurysm models the authors did not study the mechanism at the origin of aneurysm formation and its role in regrowth after treatment (29).
Molyneux et al (28) reported pathologic and histologic findings in two patients with giant partially thrombosed aneurysms. Histologic findings (2 and 6 months after treatment) showed coils embedded in a largely unorganized thrombus with no evidence of endothelialization at the neck. Nevertheless, EVT of large or giant aneurysms is known to be ineffective in the long term, and histologic findings would probably be completely different after treatment of berry aneurysms.
Delay between Treatment and Recurrence
In the current study, recurrence occurred at the third follow-up angiographic examination when postprocedural first and second follow-up angiography showed a total occlusion. In the surgical literature, the mean time between surgical clipping and clinical symptoms of recurrence is approximately 10 years (22,23,30).
Factors Influencing the Rate of Recurrence
Recurrences were more frequent after treatment of ruptured aneurysms (17%) than in nonruptured aneurysms (7%). The more important rate of recurrence in ruptured aneurysms may be due to alterations in anatomic conditions. It is probable that, in ruptured aneurysms, coils are frequently packed due to the spontaneous lysis of the clot at the rupture site and in a false, partially thrombosed aneurysm sac (8). Clinically important changes in the aneurysm sac appearance may be observed when angiography is performed at two separate times within a few days after the rupture (Fig 5). This is probably due to the spontaneous lysis of the clot at the rupture site and in the false aneurysm sac. When lysis of the clot occluding the rupture site occurs in the days after the rupture, this may induce the coils to compact to the back of the aneurysm and in the false aneurysm sac.
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Size of the sac.—It is well known that EVT of large and giant aneurysms frequently fails to obtain a total and durable occlusion of the aneurysm sac (6,13,31). EVT for large berry aneurysms obtains less favorable initial results than for small or medium berry aneurysms (9). In our study, the rate of recurrence was higher in large berry aneurysms (22% vs 8% for small and 9% for medium aneurysms). A dense packing was less frequently obtained, and depositing the last small coils inside the basket of larger coils was very difficult.
Ratio between aneurysm sac size and neck diameter.—The size of the neck was not measured in this series. Previous studies assessed the role of the aneurysm neck size on the occlusion rate (5,6,13). The remodeling technique allowed the same results to be obtained whatever the size of the neck (32). The influence of this ratio on final results was disappointing. In aneurysms with a ratio of 2 (the best morphology for EVT), results were less favorable (rate of recurrence = 22%). This morphology was more frequently encountered in large berry aneurysms in which EVT did not perform optimally.
Evolution of the Recurrences
The indication for retreatment is primarily dependent on the aneurysm remnant size, shape, and angiographic evolution. At our institution, as soon as the remnant seems accessible to an endovascular retreatment, a second procedure is attempted. Nevertheless, a very small remnant (1 or 2 mm) carries a very low risk of rebleeding, and treatment may be very tricky to perform either surgically or with EVT. In cases with very small neck remnants in which retreatment seems impossible or very difficult, legitimate concern regarding rebleeding exists in the very long term period. These aneurysms are reevaluated 1 year later for any remnant growth indicating retreatment. Retreatment after recanalization may be very difficult to perform because the aneurysm remnant frequently has a square shape with a large neck and a small residual sac. The remodeling technique is frequently required to allow for dense coil packing (32). Clipping after incomplete embolization has been described (as has coil placement after incomplete clipping) (20,33–35). Surgical clipping was never required in our cases. In 10 cases, the small remnant at the level of the aneurysm neck was followed for 12–46 months (mean, 25 months) and remained stable. The very tiny neck recurrence did not require (or allow for) any retreatment. A very long term follow-up will be necessary to assess whether a residual deformation of the parent artery does not change over the years.
Evolution of Aneurysms with Subtotal or Incomplete Occlusion
Subtotal initial treatment may lead more frequently to remnant regrowth than total occlusion may lead to true recurrence. Nevertheless, to our knowledge the evolution of such remnants over the years remains unknown.
Comparison with the Surgical Literature
The frequency and long-term consequences of incomplete surgical clipping has been debated for a long time. In 1967, Drake and Vanderlinden (36) reported results of routine postoperative angiography after surgery in 70 cases. They confirmed that no episodes of recurrent hemorrhage occurred from the 45 aneurysms completely obliterated (64%). In 12 (17%) of the 70 aneurysms, a "small" remnant was shown at angiography. Aneurysms rebled in two of these patients; one of the patients died soon after discharge and the other 11 years later. In 13 of the 70 aneurysms (18%), a "large" remnant was revealed. In six cases, the aneurysms rebled and the patients died, three soon after discharge and three in the long-term period. In 1973, Drake and Allcock (37) reported on 329 patients with postoperative angiograms that demonstrated contrast material filling of a substantial part of the sac in 43 patients, and at least 12 aneurysms rebled. Katakura et al (38) reported 41 remnants in 578 cases (7%).
Our search of the recent microneurosurgery literature revealed only a few studies that deal with the rate of inadequate clipping (39–43). Surgical clipping has been the reference standard for intracranial aneurysms, and in the absence of alternative therapy, very little is known concerning routine postoperative angiography. Although it is commonly believed that postoperative angiography may only accurately document the results of clipping, standard practice is to perform angiography only in cases in which the surgery was difficult. Furthermore, up to 50% of the neurosurgeons believe that a second surgical approach should not be required, as shown by Feuerberg et al (41). In 1987, they reported on 715 patients who were operated on with microsurgical technique and in whom postoperative angiography was performed. Residual filling was observed in 28 patients (4%). MacDonald and co-workers (42) reported on a series of patients with 78 aneurysms in whom routine postoperative angiography was performed. They reported unclipped aneurysms in three cases (4%), incomplete clipping in eight (10%), and unexpected major vessel occlusion in nine (12%). In the series by Martin et al (40), inadequate clipping was disclosed during intraoperative angiography in five (9%) of 57 cases and during postoperative angiography in two other cases.
The evolution of these aneurysm rests, the frequency of remnant growth, and the risk of bleeding, as well as indications for reoperation, have been discussed (23,24,30,36,37,41,44–46). In the series of Feuerberg et al (41), 27 aneurysm remnants disclosed at angiography were followed over an 8-year period, with 62% unchanged, 24% resolved, 10% decreased, and only 5% (one case) enlarged and with rebleeding. They found that the incidence of rebleeding from an aneurysm remnant is 3.7% and that the risk of rupture is 0.8% per year. Lin et al (46) reported on 19 patients in which a neck remnant regrew to become symptomatic (14 aneurysms with rebleeding). They stated that even a 1- or 2-mm residual neck seen on postoperative angiograms, previously thought to be a small risk, may dilate over a long period to form another dangerous aneurysm. However, they did not address the number of treated and angiographically reevaluated aneurysms that showed remnants and consequently the rate of remnant regrowth. In 1995, Giannotta and Litofsky (30) discussed reoperative management in 20 recurrent or residual aneurysms. The lag time between initial treatment and clinical recurrence (bleeding or mass effect) was around 10 years. Here again, the rate of recurrence was not discussed. The results of these series suggest that reoperation should be performed on residual aneurysms to avoid further growth and rupture. However, these data must be related to the risk of reoperation given by Drake et al (45), with a 7% operative morbidity rate and a 5% mortality rate. Residual aneurysms were shown despite reoperation in 15 (13%) of the 115 cases (45).
Conclusion
A true recurrence was observed in 20 (14%) of the 148 totally occluded aneurysms. Recurrences may be observed in the very late follow-up, although previous follow-up angiography may have shown persistent total occlusion. Treatment of ruptured aneurysms and of large berry aneurysms is more likely to induce recurrences. In this series, the ratio between the size of the sac and size of the neck and the location of the aneurysm did not correlate with the frequency of recurrences. Recurrences are probably much more frequently encountered after EVT than after surgical clipping, probably due to coil compaction by arterial blood flow. Furthermore, the arterial walls are kept apart with coiling, while after clipping they are closely appositioned. Seven of the 20 recurrences required a second treatment, which was performed without any clinical complications and resulted in total occlusion in five aneurysms. Retreatment may be performed in the course of follow-up angiography. Remnant regrowth after subtotal occlusion was more frequent than true recurrences (30% vs 14%, respectively) and may indicate retreatment. Evolution of aneurysm remnants remains unclear in the very long term follow-up. In some cases, after tiny coil compaction, late follow-up did not show any changes and occlusion remained stable (residual deformation of the parent artery). In others, the small remnant increased in size over the years and required retreatment.
At our institution, patients with total occlusion at the second follow-up angiography (at least 15 months after the procedure) are scheduled for final angiography 3 years later. Patients with subtotal occlusion are followed up angiographically (depending on the remnant) for 1 or 2 years after the second follow-up angiography to assess whether the occlusion remains stable in the long term or if the remnant regrowth requires another procedure to complete the occlusion. It is too early to speculate when repeat angiography will no longer be needed. Magnetic resonance angiography will certainly replace conventional angiography in the future (47). Our results indicate that if thorough angiographic follow-up is performed to look for any recurrence or remnant growth, long-term clinical follow-up remains excellent with no late rebleeding.
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Footnotes |
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Author contributions: Guarantors of integrity of entire study, A.R., J.M.; study concepts and design, C.C., J.M.; definition of intellectual content, C.C., J.M.; literature research, C.C., L.S.; clinical studies, C.C., A.W., L.S., M.P., L.C.; data acquisition, C.C., A.W.; data analysis, C.C.; statistical analysis, C.C.; manuscript preparation and review, C.C., J.M.; manuscript editing, C.C.
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TOPAbstractIntroductionMATERIALS AND METHODSRESULTSDISCUSSIONReferences |
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L. Pierot, A. Bonafe, S. Bracard, X. Leclerc, and for the French Matrix Registry Investigators Endovascular treatment of intracranial aneurysms with matrix detachable coils: immediate posttreatment results from a prospective multicenter registry. AJNR Am. J. Neuroradiol., September 1, 2006; 27(8): 1693 - 1699. [Abstract] [Full Text] [PDF]
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J. Raymond, C. Mounayer, I. Salazkin, A. Metcalfe, G. Gevry, C. Janicki, S. Roorda, and P. Leblanc Safety and Effectiveness of Radioactive Coil Embolization of Aneurysms: Effects of Radiation on Recanalization, Clot Organization, Neointima Formation, and Surrounding Nerves in Experimental Models Stroke, August 1, 2006; 37(8): 2147 - 2152. [Abstract] [Full Text] [PDF]
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R. C. Gaba, S. A. Ansari, S. S. Roy, F. A. Marden, M. A.G. Viana, and T. W. Malisch Embolization of Intracranial Aneurysms With Hydrogel-Coated Coils Versus Inert Platinum Coils: Effects on Packing Density, Coil Length and Quantity, Procedure Performance, Cost, Length of Hospital Stay, and Durability of Therapy Stroke, June 1, 2006; 37(6): 1443 - 1450. [Abstract] [Full Text] [PDF]
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M.-H. Li, B.-L. Gao, C. Fang, B.-X. Gu, Y.-S. Cheng, W. Wang, and G. Scotti Angiographic Follow-Up of Cerebral Aneurysms Treated with Guglielmi Detachable Coils: An Analysis of 162 Cases with 173 Aneurysms. AJNR Am. J. Neuroradiol., May 1, 2006; 27(5): 1107 - 1112. [Abstract] [Full Text] [PDF]
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L. Pierot, C. Delcourt, F. Bouquigny, D. Breidt, B. Feuillet, O. Lanoix, and S. Gallas Follow-up of intracranial aneurysms selectively treated with coils: Prospective evaluation of contrast-enhanced MR angiography. AJNR Am. J. Neuroradiol., April 1, 2006; 27(4): 744 - 749. [Abstract] [Full Text] [PDF]
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H.J. Cloft and for the HEAL Investigators HydroCoil for Endovascular Aneurysm Occlusion (HEAL) Study: Periprocedural Results. AJNR Am. J. Neuroradiol., February 1, 2006; 27(2): 289 - 292. [Abstract] [Full Text] [PDF]
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V. Costalat, E. Lebars, L. Sarry, A. Defasque, E. Barbotte, H. Brunel, G. Bourbotte, and A. Bonafe In Vitro Evaluation of 2D-Digital Subtraction Angiography versus 3D-Time-of-Flight in Assessment of Intracranial Cerebral Aneurysm Filling after Endovascular Therapy AJNR Am. J. Neuroradiol., January 1, 2006; 27(1): 177 - 184. [Abstract] [Full Text] [PDF]
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C. L. Turner, J. N. P. Higgins, A. Gholkar, A. D. Mendelow, A. J. Molyneux, R. S.C. Kerr, S. Chawda, and P. J. Kirkpatrick Intracranial Aneurysms Treated With Endovascular Coils: Detection of Recurrences Using Unenhanced and Contrast-Enhanced Transcranial Color-Coded Duplex Sonography Stroke, December 1, 2005; 36(12): 2654 - 2659. [Abstract] [Full Text] [PDF]
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 A. Iijima, M. Piotin, C. Mounayer, L. Spelle, A. Weill, and J. Moret Endovascular Treatment with Coils of 149 Middle Cerebral Artery Berry Aneurysms Radiology, November 1, 2005; 237(2): 611 - 619. [Abstract] [Full Text] [PDF]
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J. K. Goddard, C. J. Moran, D. T. Cross III, and C. P. Derdeyn Absent Relationship between the Coil-Embolization Ratio in Small Aneurysms Treated with a Single Detachable Coil and Outcomes AJNR Am. J. Neuroradiol., September 1, 2005; 26(8): 1916 - 1920. [Abstract] [Full Text] [PDF]
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I. Linfante, N. M. Akkawi, A. Perlow, V. Andreone, and A. K. Wakhloo Polyglycolide/Polylactide-Coated Platinum Coils for Patients With Ruptured and Unruptured Cerebral Aneurysms: A Single-Center Experience Stroke, September 1, 2005; 36(9): 1948 - 1953. [Abstract] [Full Text] [PDF]
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S. Gallas, A. Pasco, J.-P. Cottier, J. Gabrillargues, J. Drouineau, C. Cognard, and D. Herbreteau A Multicenter Study of 705 Ruptured Intracranial Aneurysms Treated with Guglielmi Detachable Coils AJNR Am. J. Neuroradiol., August 1, 2005; 26(7): 1723 - 1731. [Abstract] [Full Text] [PDF]
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B. Lubicz, X. Leclerc, J.-Y. Gauvrit, J.-P. Lejeune, and J.-P. Pruvo Three-Dimensional Packing with Complex Orbit Coils for the Endovascular Treatment of Intracranial Aneurysms AJNR Am. J. Neuroradiol., June 1, 2005; 26(6): 1342 - 1348. [Abstract] [Full Text] [PDF]
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C. B. L. M. Majoie, M. E. Sprengers, W. J. J. van Rooij, C. Lavini, M. Sluzewski, J. C. van Rijn, and G. J. den Heeten MR Angiography at 3T versus Digital Subtraction Angiography in the Follow-up of Intracranial Aneurysms Treated with Detachable Coils AJNR Am. J. Neuroradiol., June 1, 2005; 26(6): 1349 - 1356. [Abstract] [Full Text] [PDF]
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M. T. Walker, J. Tsai, T. Parish, B. Tzung, A. Shaibani, E. Krupinski, and E. J. Russell MR Angiographic Evaluation of Platinum Coil Packs at 1.5T and 3T: An In Vitro Assessment of Artifact Production: Technical Note AJNR Am. J. Neuroradiol., April 1, 2005; 26(4): 848 - 853. [Abstract] [Full Text] [PDF]
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J.-Y. Gauvrit, X. Leclerc, M. Pernodet, B. Lubicz, J.-P. Lejeune, D. Leys, and J.-P. Pruvo Intracranial Aneurysms Treated with Guglielmi Detachable Coils: Usefulness of 6-Month Imaging Follow-Up with Contrast-Enhanced MR Angiography AJNR Am. J. Neuroradiol., March 1, 2005; 26(3): 515 - 521. [Abstract] [Full Text] [PDF]
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M. J. Slob, M. Sluzewski, W. J. van Rooij, G. Roks, and G. J. E. Rinkel Additional Coiling of Previously Coiled Cerebral Aneurysms: Clinical and Angiographic Results AJNR Am. J. Neuroradiol., September 1, 2004; 25(8): 1373 - 1376. [Abstract] [Full Text] [PDF]
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L. Levesque, F. Gauthier, J. Raymond, and G. Leclerc 32P-Oligodeoxynucleotide-Coated Coils to Prevent Arterial Recanalization after Embolization AJNR Am. J. Neuroradiol., June 1, 2004; 25(6): 1062 - 1066. [Abstract] [Full Text] [PDF]
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 R. D. Brown Jr. and D. G. Piepgras Screening for intracranial aneurysms after subarachnoid hemorrhage: Do our patients benefit? Neurology, February 10, 2004; 62(3): 354 - 356. [Full Text] [PDF]
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M. J.H. Wermer, E. Buskens, I. C. van der Schaaf, P. M.M. Bossuyt, and G. J.E. Rinkel Yield of screening for new aneurysms after treatment for subarachnoid hemorrhage Neurology, February 10, 2004; 62(3): 369 - 375. [Abstract] [Full Text] [PDF]
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J.-N. Vallee, L. Pierot, A. Bonafe, F. Turjman, P. Flandroy, J. Berge, G. Rodesch, and S. Bracard Endovascular Treatment of Intracranial Wide-Necked Aneurysms Using Three-Dimensional Coils: Predictors of Immediate Anatomic and Clinical Results AJNR Am. J. Neuroradiol., February 1, 2004; 25(2): 298 - 306. [Abstract] [Full Text] [PDF]
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H. J. Cloft and D. F. Kallmes Aneurysm Packing with HydroCoil Embolic System versus Platinum Coils: Initial Clinical Experience AJNR Am. J. Neuroradiol., January 1, 2004; 25(1): 60 - 62. [Abstract] [Full Text] [PDF]
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J. Raymond, D. Roy, P. Leblanc, S. Roorda, C. Janicki, L. Normandeau, F. Morel, G. Gevry, J.-P. Bahary, M. Chagnon, et al. Endovascular Treatment of Intracranial Aneurysms With Radioactive Coils: Initial Clinical Experience Stroke, December 1, 2003; 34(12): 2801 - 2806. [Abstract] [Full Text] [PDF]
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J. Raymond, I. Salazkin, A. Metcalfe, F. Guilbert, A. Weill, and D. Roy High-Concentration Ethylene-Vinyl Alcohol Copolymer and Endovascular Treatment of Experimental Aneurysms: Feasibility of Embolization without Protection Devices at the Neck AJNR Am. J. Neuroradiol., October 1, 2003; 24(9): 1778 - 1784. [Abstract] [Full Text] [PDF]
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J.-P. Cottier, A. Bleuzen-Couthon, S. Gallas, C. B. Vinikoff-Sonier, P. Bertrand, F. Domengie, L. Barantin, and D. Herbreteau Intracranial Aneurysms Treated with Guglielmi Detachable Coils: Is Contrast Material Necessary in the Follow-up with 3D Time-of-Flight MR Angiography? AJNR Am. J. Neuroradiol., October 1, 2003; 24(9): 1797 - 1803. [Abstract] [Full Text] [PDF]
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L. P. Broadbent, C. J. Moran, D. T. Cross III, and C. P. Derdeyn Management of Neuroform Stent Dislodgement and Misplacement AJNR Am. J. Neuroradiol., October 1, 2003; 24(9): 1819 - 1822. [Abstract] [Full Text] [PDF]
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I. Wanke, A. Doerfler, B. Schoch, D. Stolke, and M. Forsting Treatment of Wide-Necked Intracranial Aneurysms with a Self-Expanding Stent System: Initial Clinical Experience AJNR Am. J. Neuroradiol., June 1, 2003; 24(6): 1192 - 1199. [Abstract] [Full Text] [PDF]
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M. Sluzewski, W. J. van Rooij, G. J. E. Rinkel, and D. Wijnalda Endovascular Treatment of Ruptured Intracranial Aneurysms with Detachable Coils: Long-term Clinical and Serial Angiographic Results Radiology, June 1, 2003; 227(3): 720 - 724. [Abstract] [Full Text] [PDF]
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J. Raymond, F. Guilbert, A. Weill, S. A. Georganos, L. Juravsky, A. Lambert, J. Lamoureux, M. Chagnon, and D. Roy Long-Term Angiographic Recurrences After Selective Endovascular Treatment of Aneurysms With Detachable Coils Stroke, June 1, 2003; 34(6): 1398 - 1403. [Abstract] [Full Text] [PDF]
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M. H. Han, O-K. Kwon, C. J. Yoon, B. J. Kwon, S. H. Cha, and K.-H. Chang Gas Generation and Clot Formation during Electrolytic Detachment of Guglielmi Detachable Coils: In Vitro Observations and Animal Experiment AJNR Am. J. Neuroradiol., March 1, 2003; 24(3): 539 - 544. [Abstract] [Full Text] [PDF]
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N. H. Fujiwara and D. F. Kallmes Healing Response in Elastase-Induced Rabbit Aneurysms after Embolization with a New Platinum Coil System AJNR Am. J. Neuroradiol., August 1, 2002; 23(7): 1137 - 1144. [Abstract] [Full Text] [PDF]
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H. Kiyosue, S. Tanoue, M. Okahara, Y. Hori, T. Nakamura, H. Nagatomi, and H. Mori Anatomic Features Predictive of Complete Aneurysm Occlusion Can Be Determined with Three-Dimensional Digital Subtraction Angiography AJNR Am. J. Neuroradiol., August 1, 2002; 23(7): 1206 - 1213. [Abstract] [Full Text] [PDF]
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S. Tamatani, Y. Ito, H. Abe, T. Koike, S. Takeuchi, and R. Tanaka Evaluation of the Stability of Aneurysms after Embolization Using Detachable Coils: Correlation between Stability of Aneurysms and Embolized Volume of Aneurysms AJNR Am. J. Neuroradiol., May 1, 2002; 23(5): 762 - 767. [Abstract] [Full Text] [PDF]
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T. Abruzzo, H. J. Cloft, M. Marek, G. G. Shengelaia, P. B. Snowhill, S. M. Waldrop, and A. Sambanis Interaction of Vascular Smooth Muscle Cells with Collagen-Impregnated Embolization Coils Studied with a Novel Quantitative in Vitro Model AJNR Am. J. Neuroradiol., April 1, 2002; 23(4): 674 - 681. [Abstract] [Full Text] [PDF]
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J. G. Short, N. H. Fujiwara, W. F. Marx, G. A. Helm, H. J. Cloft, and D. F. Kallmes Elastase-Induced Saccular Aneurysms in Rabbits: Comparison of Geometric Features with Those of Human Aneurysms AJNR Am. J. Neuroradiol., November 1, 2001; 22(10): 1833 - 1837. [Abstract] [Full Text] [PDF]
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Aneurysm Endovascular Therapy AJNR Am. J. Neuroradiol., September 1, 2001; 22(2007): 4S - 7S. [Full Text] [PDF]
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D. Roy, G. Milot, and J. Raymond Endovascular Treatment of Unruptured Aneurysms Stroke, September 1, 2001; 32(9): 1998 - 2004. [Abstract] [Full Text] [PDF]
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A. Boulin and L. Pierot Follow-up of Intracranial Aneurysms Treated with Detachable Coils: Comparison of Gadolinium-enhanced 3D Time-of-Flight MR Angiography and Digital Subtraction Angiography Radiology, April 1, 2001; 219(1): 108 - 113. [Abstract] [Full Text]
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W. F. Marx, H. J. Cloft, G. A. Helm, J. G. Short, H. M. Do, M. E. Jensen, and D. F. Kallmes Endovascular Treatment of Experimental Aneurysms by Use of Biologically Modified Embolic Devices: Coil-mediated Intraaneurysmal Delivery of Fibroblast Tissue Allografts AJNR Am. J. Neuroradiol., February 1, 2001; 22(2): 323 - 333. [Abstract] [Full Text] [PDF]
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J.-P. Cottier, A. Pasco, S. Gallas, J. Gabrillargues, C. Cognard, J. Drouineau, L. Brunereau, and D. Herbreteau Utility of Balloon-assisted Guglielmi Detachable Coiling in the Treatment of 49 Cerebral Aneurysms: A Retrospective, Multicenter Study AJNR Am. J. Neuroradiol., February 1, 2001; 22(2): 345 - 351. [Abstract] [Full Text] [PDF]
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T. Koivisto, R. Vanninen, H. Hurskainen, T. Saari, J. Hernesniemi, and M. Vapalahti Outcomes of Early Endovascular Versus Surgical Treatment of Ruptured Cerebral Aneurysms : A Prospective Randomized Study Stroke, October 1, 2000; 31(10): 2369 - 2377. [Abstract] [Full Text] [PDF]
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