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Simulator Training for Endovascular Neurosurgery
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A Single Center Experience with Coil Embolization for Cerebral Aneurysms Greater than 10 mm in the Internal Carotid
Kensuke Suzuki1, Ryotaro Suzuki1, Tomoji Takigawa1
1Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital.
Insights
Endovascular treatment for large internal carotid artery aneurysms shows low complication rates but high retreatment needs, especially for paraclinoid aneurysms. Scheduled follow-up is crucial for managing these complex cases.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Radiology
Background:
- Large aneurysms (≥10 mm) in the internal carotid artery (IC) pose significant treatment challenges.
- Endovascular techniques are increasingly utilized for complex intracranial aneurysms.
Purpose of the Study:
- To retrospectively analyze the outcomes of endovascular treatment for large IC aneurysms.
- To evaluate complications, re-treatment rates, and impact on ophthalmologic symptoms.
Main Methods:
- Retrospective analysis of 35 patients with IC aneurysms (≥10 mm) treated between 2011-2014.
- Data collected on aneurysm characteristics, treatment methods (coil embolization, stent use), complications, and follow-up outcomes.
Main Results:
- No post-treatment rupture occurred. Permanent complications were observed in 11% of cases.
- Re-treatment was necessary in 31% of patients, particularly those with paraclinoid segment aneurysms (50%).
- Ophthalmologic symptoms improved or remained stable in 75% of treated patients.
Conclusions:
- Endovascular treatment for large IC aneurysms is feasible with low complication rates.
- High re-treatment rates necessitate diligent follow-up protocols.
- Flow diverter stents may offer future therapeutic advancements for these challenging aneurysms.
Abstract:
We investigated endovascular treatment for 10 mm or larger aneurysms in the internal carotid artery (IC), including the cavernous portion, the paraclinoid portion, and the posterior communication artery (PC). Between 2011 and 2014 at our hospital, there were 35 cases of aneurysms that were 10 mm or larger in the carotid artery. We analyzed these 35 cases retrospectively based on the size and location of the aneurysms, method of treatment, number of coils implanted, use of a stent, complications, rupture after treatment, ophthalmologic symptoms, and need for re-treatment. There was no bleeding after treatment. Of the 35 cases, four cases (11%) had permanent complications. Re-treatment was indicated in 11 cases (31%), including eight cases localized in the paraclinoid portion, two cases in the IC-PC, and one case in the cavernous portion. Among these re-treatment cases, two cases required a third treatment. Of the 16 cases with paraclinoid aneurysms, half required re-treatment. Of the 12 cases with ophthalmologic symptoms prior to treatment, 9 (75%) improved or had no change and 3 (25%) became worse. There were no complications in the 13 re-treatment procedures. Re-treatment is not uncommon, and a scheduled follow-up is needed. Coil embolization has been one of the main options for aneurysms that are 10 mm or larger in the IC. In the future, these large aneurysms will be treated with a flow diverter stent (FD).
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