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Colin P. Derdeyn - One of the best experts on this subject based on the ideXlab platform.

  • endovascular management of internal carotid artery injuries secondary to endonasal surgery case series and review of the literature
    Journal of Neurosurgery, 2016
    Co-Authors: Peter T Sylvester, Christopher J. Moran, Dewitte T. Cross, Colin P. Derdeyn, Ralph G Dacey, Gregory J Zipfel, Albert H Kim, Ravi Uppaluri, Bruce H Haughey, Rene Tempelhoff
    Abstract:

    OBJECTIVE Internal carotid artery (ICA) injury is a rare but severe complication of endonasal surgery. The authors describe their endovascular experience managing ICA injuries after transsphenoidal surgery; they review and summarize the current literature regarding endovascular techniques; and they propose a treatment algorithm based on the available evidence. METHODS A retrospective review of 576 transsphenoidal pituitary adenoma resections was performed. Cases of ICA injury occurring at our institution and transfers from other hospitals were evaluated. Endovascular treatments for ICA injury reported in the literature were also reviewed and summarized. RESULTS Seven cases were identified from the institutional cohort (mean age 46.3 years, mean follow-up 43.4 months [1-107 months]) that received endovascular treatment for ICA injury. Five injuries occurred at our institution (5 [0.9%] of 576), and 2 injuries occurred at outside hospitals. Three patients underwent ICA sacrifice by Coil placement, 2 underwent lesion Embolization (Coil or stent-assisted Coil placement), and 2 underwent endoluminal reconstruction (both with flow diversion devices). Review of the literature identified 98 cases of ICA injury treated with endovascular methods. Of the 105 total cases, 46 patients underwent ICA sacrifice, 28 underwent lesion Embolization, and 31 underwent endoluminal reconstruction. Sacrifice of the ICA proved a durable solution in all cases; however, the rate of persistent neurological complications was relatively high (10 [21.7%] of 46). Lesion Embolization was primarily performed by Coil Embolization without stenting (16 cases) and stent-assisted Coiling (9 cases). Both techniques had a relatively high rate of at least some technical complication (6 [37.5%] of 16 and 5 [55.6%] of 9, respectively) and major technical complications (i.e., injury, new neurological deficit, or ICA sacrifice) (5 [31.3%] of 16 and 2 [22.2%] of 9, respectively). Endoluminal reconstruction was performed by covered stent (24 cases) and flow diverter (5 cases) placement. Covered stents showed a reasonably high rate of technical complications (10 [41.7%] of 24); however, 8 of these problems were resolved, leaving a small percentage with major technical complications (2 [8.3%] of 24). Flow diverter placement was also well tolerated, with only 1 minor technical complication. CONCLUSIONS Endovascular treatments including vessel sacrifice, Coil Embolization (with or without stent assistance), and endoluminal reconstruction offer a tailored approach to ICA injury management after endonasal surgery. Vessel sacrifice remains the definitive treatment for acute, uncontrolled bleeding; however, vessel preservation techniques should be considered carefully in select patients. Multiple factors including vascular anatomy, injury characteristics, and risk of dual antiplatelet therapy should guide best treatment, but more study is needed (particularly with flow diverters) to refine this decision-making process. Ideally, all endovascular treatment options should be available at institutions performing endonasal surgery.

  • Absent Relationship between the Coil- Embolization Ratio in Small Aneurysms Treated with a Single Detachable Coil and Outcomes
    2015
    Co-Authors: James K. Goddard, Christopher J. Moran, Dewitte T. Cross, Colin P. Derdeyn
    Abstract:

    is an important goal of endovascular Embolization, because of their small size, some aneurysms can only be treated with a single Embolization Coil. We retrospectively analyzed small aneu-rysms treated with a single Guglielmi detachable Coil (GDC) to determine whether the Coil-Embolization ratio (CER) is predictive of Embolization stability. METHODS: The CER was determined for 25 small (<7-mm diameter) intracranial aneu-rysms, each treated with a single Embolization Coil. The largest aneurysm dimension, estimated by comparison to anatomic landmarks, was used for volume calculation based on a spherical model. Coil volumes were according to manufacturer specifications. CER was calculated by the formula (Coil volume/aneurysm volume) 100%. Embolization stability was assessed by angiographic follow-up. RESULTS: The average CER for all aneurysms was 8.2 % (SD, 6.5%; range, 0.6%–21.1%). Twelve percent of the aneurysms had a CER>20%. Follow-up angiographic assessment was conducted at an average of 30.8 months after initial treatment. Eighty-four percent of the aneurysms were obliterated. One large (6 10 mm) and 3 small (<1 mm) recurrences were identified. The average CER for unchanged aneurysms was 8.0 % (SD, 5.9%) and for th

  • absent relationship between the Coil Embolization ratio in small aneurysms treated with a single detachable Coil and outcomes
    American Journal of Neuroradiology, 2005
    Co-Authors: James K. Goddard, Christopher J. Moran, Dewitte T. Cross, Colin P. Derdeyn
    Abstract:

    BACKGROUND AND PURPOSE: Although attenuated Coil packing of intracranial aneurysms is an important goal of endovascular Embolization, because of their small size, some aneurysms can only be treated with a single Embolization Coil. We retrospectively analyzed small aneurysms treated with a single Guglielmi detachable Coil (GDC) to determine whether the Coil-Embolization ratio (CER) is predictive of Embolization stability. METHODS: The CER was determined for 25 small ( RESULTS: The average CER for all aneurysms was 8.2% (SD, 6.5%; range, 0.6%–21.1%). Twelve percent of the aneurysms had a CER >20%. Follow-up angiographic assessment was conducted at an average of 30.8 months after initial treatment. Eighty-four percent of the aneurysms were obliterated. One large (6 × 10 mm) and 3 small ( CONCLUSION: Small aneurysms treated with a single Coil achieved satisfactory stability despite having a low average packing attenuation. CER was not predictive of recurrence in small intracranial aneurysms treated with a single detachable Coil.

Ahmet Memis - One of the best experts on this subject based on the ideXlab platform.

  • Retrieval of intravascular foreign bodies with goose neck snare
    European journal of radiology, 2004
    Co-Authors: Kutsi Koseoglu, Mustafa Parildar, Ismail Oran, Ahmet Memis
    Abstract:

    Purpose: to evaluate the efficacy and advantages of the snare systems in the retrieval of foreign bodies from vascular system. Materials and methods: the snare technique has been used for intravascular foreign body retrieval. We performed percutaneous extraction of intravascular foreign bodies using combination multipurpose catheters and a nitinol snare loop. In this report, we evaluated the patients who had performed endovascular device reposition or foreign body retrieval from 1998 to 2001. Results: foreign body retrieval was performed in 15 patients. The foreign bodies consisted of seven fractured port catheters, one sheath fragment, one Embolization Coil, four wire fragments, one pace-maker transducer and one dislocated endovascular stent. In no case were surgical procedures required, and no complications were encountered. Conclusion: the snare technique is a useful and a safe method as an alternative procedure to surgery. This technique is highly effective with low rate complications.

Christopher J. Moran - One of the best experts on this subject based on the ideXlab platform.

  • endovascular management of internal carotid artery injuries secondary to endonasal surgery case series and review of the literature
    Journal of Neurosurgery, 2016
    Co-Authors: Peter T Sylvester, Christopher J. Moran, Dewitte T. Cross, Colin P. Derdeyn, Ralph G Dacey, Gregory J Zipfel, Albert H Kim, Ravi Uppaluri, Bruce H Haughey, Rene Tempelhoff
    Abstract:

    OBJECTIVE Internal carotid artery (ICA) injury is a rare but severe complication of endonasal surgery. The authors describe their endovascular experience managing ICA injuries after transsphenoidal surgery; they review and summarize the current literature regarding endovascular techniques; and they propose a treatment algorithm based on the available evidence. METHODS A retrospective review of 576 transsphenoidal pituitary adenoma resections was performed. Cases of ICA injury occurring at our institution and transfers from other hospitals were evaluated. Endovascular treatments for ICA injury reported in the literature were also reviewed and summarized. RESULTS Seven cases were identified from the institutional cohort (mean age 46.3 years, mean follow-up 43.4 months [1-107 months]) that received endovascular treatment for ICA injury. Five injuries occurred at our institution (5 [0.9%] of 576), and 2 injuries occurred at outside hospitals. Three patients underwent ICA sacrifice by Coil placement, 2 underwent lesion Embolization (Coil or stent-assisted Coil placement), and 2 underwent endoluminal reconstruction (both with flow diversion devices). Review of the literature identified 98 cases of ICA injury treated with endovascular methods. Of the 105 total cases, 46 patients underwent ICA sacrifice, 28 underwent lesion Embolization, and 31 underwent endoluminal reconstruction. Sacrifice of the ICA proved a durable solution in all cases; however, the rate of persistent neurological complications was relatively high (10 [21.7%] of 46). Lesion Embolization was primarily performed by Coil Embolization without stenting (16 cases) and stent-assisted Coiling (9 cases). Both techniques had a relatively high rate of at least some technical complication (6 [37.5%] of 16 and 5 [55.6%] of 9, respectively) and major technical complications (i.e., injury, new neurological deficit, or ICA sacrifice) (5 [31.3%] of 16 and 2 [22.2%] of 9, respectively). Endoluminal reconstruction was performed by covered stent (24 cases) and flow diverter (5 cases) placement. Covered stents showed a reasonably high rate of technical complications (10 [41.7%] of 24); however, 8 of these problems were resolved, leaving a small percentage with major technical complications (2 [8.3%] of 24). Flow diverter placement was also well tolerated, with only 1 minor technical complication. CONCLUSIONS Endovascular treatments including vessel sacrifice, Coil Embolization (with or without stent assistance), and endoluminal reconstruction offer a tailored approach to ICA injury management after endonasal surgery. Vessel sacrifice remains the definitive treatment for acute, uncontrolled bleeding; however, vessel preservation techniques should be considered carefully in select patients. Multiple factors including vascular anatomy, injury characteristics, and risk of dual antiplatelet therapy should guide best treatment, but more study is needed (particularly with flow diverters) to refine this decision-making process. Ideally, all endovascular treatment options should be available at institutions performing endonasal surgery.

  • Absent Relationship between the Coil- Embolization Ratio in Small Aneurysms Treated with a Single Detachable Coil and Outcomes
    2015
    Co-Authors: James K. Goddard, Christopher J. Moran, Dewitte T. Cross, Colin P. Derdeyn
    Abstract:

    is an important goal of endovascular Embolization, because of their small size, some aneurysms can only be treated with a single Embolization Coil. We retrospectively analyzed small aneu-rysms treated with a single Guglielmi detachable Coil (GDC) to determine whether the Coil-Embolization ratio (CER) is predictive of Embolization stability. METHODS: The CER was determined for 25 small (<7-mm diameter) intracranial aneu-rysms, each treated with a single Embolization Coil. The largest aneurysm dimension, estimated by comparison to anatomic landmarks, was used for volume calculation based on a spherical model. Coil volumes were according to manufacturer specifications. CER was calculated by the formula (Coil volume/aneurysm volume) 100%. Embolization stability was assessed by angiographic follow-up. RESULTS: The average CER for all aneurysms was 8.2 % (SD, 6.5%; range, 0.6%–21.1%). Twelve percent of the aneurysms had a CER>20%. Follow-up angiographic assessment was conducted at an average of 30.8 months after initial treatment. Eighty-four percent of the aneurysms were obliterated. One large (6 10 mm) and 3 small (<1 mm) recurrences were identified. The average CER for unchanged aneurysms was 8.0 % (SD, 5.9%) and for th

  • absent relationship between the Coil Embolization ratio in small aneurysms treated with a single detachable Coil and outcomes
    American Journal of Neuroradiology, 2005
    Co-Authors: James K. Goddard, Christopher J. Moran, Dewitte T. Cross, Colin P. Derdeyn
    Abstract:

    BACKGROUND AND PURPOSE: Although attenuated Coil packing of intracranial aneurysms is an important goal of endovascular Embolization, because of their small size, some aneurysms can only be treated with a single Embolization Coil. We retrospectively analyzed small aneurysms treated with a single Guglielmi detachable Coil (GDC) to determine whether the Coil-Embolization ratio (CER) is predictive of Embolization stability. METHODS: The CER was determined for 25 small ( RESULTS: The average CER for all aneurysms was 8.2% (SD, 6.5%; range, 0.6%–21.1%). Twelve percent of the aneurysms had a CER >20%. Follow-up angiographic assessment was conducted at an average of 30.8 months after initial treatment. Eighty-four percent of the aneurysms were obliterated. One large (6 × 10 mm) and 3 small ( CONCLUSION: Small aneurysms treated with a single Coil achieved satisfactory stability despite having a low average packing attenuation. CER was not predictive of recurrence in small intracranial aneurysms treated with a single detachable Coil.

Dewitte T. Cross - One of the best experts on this subject based on the ideXlab platform.

  • endovascular management of internal carotid artery injuries secondary to endonasal surgery case series and review of the literature
    Journal of Neurosurgery, 2016
    Co-Authors: Peter T Sylvester, Christopher J. Moran, Dewitte T. Cross, Colin P. Derdeyn, Ralph G Dacey, Gregory J Zipfel, Albert H Kim, Ravi Uppaluri, Bruce H Haughey, Rene Tempelhoff
    Abstract:

    OBJECTIVE Internal carotid artery (ICA) injury is a rare but severe complication of endonasal surgery. The authors describe their endovascular experience managing ICA injuries after transsphenoidal surgery; they review and summarize the current literature regarding endovascular techniques; and they propose a treatment algorithm based on the available evidence. METHODS A retrospective review of 576 transsphenoidal pituitary adenoma resections was performed. Cases of ICA injury occurring at our institution and transfers from other hospitals were evaluated. Endovascular treatments for ICA injury reported in the literature were also reviewed and summarized. RESULTS Seven cases were identified from the institutional cohort (mean age 46.3 years, mean follow-up 43.4 months [1-107 months]) that received endovascular treatment for ICA injury. Five injuries occurred at our institution (5 [0.9%] of 576), and 2 injuries occurred at outside hospitals. Three patients underwent ICA sacrifice by Coil placement, 2 underwent lesion Embolization (Coil or stent-assisted Coil placement), and 2 underwent endoluminal reconstruction (both with flow diversion devices). Review of the literature identified 98 cases of ICA injury treated with endovascular methods. Of the 105 total cases, 46 patients underwent ICA sacrifice, 28 underwent lesion Embolization, and 31 underwent endoluminal reconstruction. Sacrifice of the ICA proved a durable solution in all cases; however, the rate of persistent neurological complications was relatively high (10 [21.7%] of 46). Lesion Embolization was primarily performed by Coil Embolization without stenting (16 cases) and stent-assisted Coiling (9 cases). Both techniques had a relatively high rate of at least some technical complication (6 [37.5%] of 16 and 5 [55.6%] of 9, respectively) and major technical complications (i.e., injury, new neurological deficit, or ICA sacrifice) (5 [31.3%] of 16 and 2 [22.2%] of 9, respectively). Endoluminal reconstruction was performed by covered stent (24 cases) and flow diverter (5 cases) placement. Covered stents showed a reasonably high rate of technical complications (10 [41.7%] of 24); however, 8 of these problems were resolved, leaving a small percentage with major technical complications (2 [8.3%] of 24). Flow diverter placement was also well tolerated, with only 1 minor technical complication. CONCLUSIONS Endovascular treatments including vessel sacrifice, Coil Embolization (with or without stent assistance), and endoluminal reconstruction offer a tailored approach to ICA injury management after endonasal surgery. Vessel sacrifice remains the definitive treatment for acute, uncontrolled bleeding; however, vessel preservation techniques should be considered carefully in select patients. Multiple factors including vascular anatomy, injury characteristics, and risk of dual antiplatelet therapy should guide best treatment, but more study is needed (particularly with flow diverters) to refine this decision-making process. Ideally, all endovascular treatment options should be available at institutions performing endonasal surgery.

  • Absent Relationship between the Coil- Embolization Ratio in Small Aneurysms Treated with a Single Detachable Coil and Outcomes
    2015
    Co-Authors: James K. Goddard, Christopher J. Moran, Dewitte T. Cross, Colin P. Derdeyn
    Abstract:

    is an important goal of endovascular Embolization, because of their small size, some aneurysms can only be treated with a single Embolization Coil. We retrospectively analyzed small aneu-rysms treated with a single Guglielmi detachable Coil (GDC) to determine whether the Coil-Embolization ratio (CER) is predictive of Embolization stability. METHODS: The CER was determined for 25 small (<7-mm diameter) intracranial aneu-rysms, each treated with a single Embolization Coil. The largest aneurysm dimension, estimated by comparison to anatomic landmarks, was used for volume calculation based on a spherical model. Coil volumes were according to manufacturer specifications. CER was calculated by the formula (Coil volume/aneurysm volume) 100%. Embolization stability was assessed by angiographic follow-up. RESULTS: The average CER for all aneurysms was 8.2 % (SD, 6.5%; range, 0.6%–21.1%). Twelve percent of the aneurysms had a CER>20%. Follow-up angiographic assessment was conducted at an average of 30.8 months after initial treatment. Eighty-four percent of the aneurysms were obliterated. One large (6 10 mm) and 3 small (<1 mm) recurrences were identified. The average CER for unchanged aneurysms was 8.0 % (SD, 5.9%) and for th

  • absent relationship between the Coil Embolization ratio in small aneurysms treated with a single detachable Coil and outcomes
    American Journal of Neuroradiology, 2005
    Co-Authors: James K. Goddard, Christopher J. Moran, Dewitte T. Cross, Colin P. Derdeyn
    Abstract:

    BACKGROUND AND PURPOSE: Although attenuated Coil packing of intracranial aneurysms is an important goal of endovascular Embolization, because of their small size, some aneurysms can only be treated with a single Embolization Coil. We retrospectively analyzed small aneurysms treated with a single Guglielmi detachable Coil (GDC) to determine whether the Coil-Embolization ratio (CER) is predictive of Embolization stability. METHODS: The CER was determined for 25 small ( RESULTS: The average CER for all aneurysms was 8.2% (SD, 6.5%; range, 0.6%–21.1%). Twelve percent of the aneurysms had a CER >20%. Follow-up angiographic assessment was conducted at an average of 30.8 months after initial treatment. Eighty-four percent of the aneurysms were obliterated. One large (6 × 10 mm) and 3 small ( CONCLUSION: Small aneurysms treated with a single Coil achieved satisfactory stability despite having a low average packing attenuation. CER was not predictive of recurrence in small intracranial aneurysms treated with a single detachable Coil.

James K. Goddard - One of the best experts on this subject based on the ideXlab platform.

  • Absent Relationship between the Coil- Embolization Ratio in Small Aneurysms Treated with a Single Detachable Coil and Outcomes
    2015
    Co-Authors: James K. Goddard, Christopher J. Moran, Dewitte T. Cross, Colin P. Derdeyn
    Abstract:

    is an important goal of endovascular Embolization, because of their small size, some aneurysms can only be treated with a single Embolization Coil. We retrospectively analyzed small aneu-rysms treated with a single Guglielmi detachable Coil (GDC) to determine whether the Coil-Embolization ratio (CER) is predictive of Embolization stability. METHODS: The CER was determined for 25 small (<7-mm diameter) intracranial aneu-rysms, each treated with a single Embolization Coil. The largest aneurysm dimension, estimated by comparison to anatomic landmarks, was used for volume calculation based on a spherical model. Coil volumes were according to manufacturer specifications. CER was calculated by the formula (Coil volume/aneurysm volume) 100%. Embolization stability was assessed by angiographic follow-up. RESULTS: The average CER for all aneurysms was 8.2 % (SD, 6.5%; range, 0.6%–21.1%). Twelve percent of the aneurysms had a CER>20%. Follow-up angiographic assessment was conducted at an average of 30.8 months after initial treatment. Eighty-four percent of the aneurysms were obliterated. One large (6 10 mm) and 3 small (<1 mm) recurrences were identified. The average CER for unchanged aneurysms was 8.0 % (SD, 5.9%) and for th

  • absent relationship between the Coil Embolization ratio in small aneurysms treated with a single detachable Coil and outcomes
    American Journal of Neuroradiology, 2005
    Co-Authors: James K. Goddard, Christopher J. Moran, Dewitte T. Cross, Colin P. Derdeyn
    Abstract:

    BACKGROUND AND PURPOSE: Although attenuated Coil packing of intracranial aneurysms is an important goal of endovascular Embolization, because of their small size, some aneurysms can only be treated with a single Embolization Coil. We retrospectively analyzed small aneurysms treated with a single Guglielmi detachable Coil (GDC) to determine whether the Coil-Embolization ratio (CER) is predictive of Embolization stability. METHODS: The CER was determined for 25 small ( RESULTS: The average CER for all aneurysms was 8.2% (SD, 6.5%; range, 0.6%–21.1%). Twelve percent of the aneurysms had a CER >20%. Follow-up angiographic assessment was conducted at an average of 30.8 months after initial treatment. Eighty-four percent of the aneurysms were obliterated. One large (6 × 10 mm) and 3 small ( CONCLUSION: Small aneurysms treated with a single Coil achieved satisfactory stability despite having a low average packing attenuation. CER was not predictive of recurrence in small intracranial aneurysms treated with a single detachable Coil.