Article Figures & Data
Figures
- Fig 1.
Construction of the wide neck aneurysm model.
A, Artistic representation of the preparation of arterial and venous components.
B, Construction of the Y-type carotid bifurcation model.
C, Wide neck aneurysm model. To obtain a wide neck incorporating the origin of the left branch (left carotid artery), the distance between the proximal and distal contact points of the left and right carotid arteries is reduced to 0 (see text for details).
D, Intraoperative photograph of the resulting wide neck aneurysm model.
E, Angiogram of the carotid artery, obtained immediately after surgery.
- Fig 2.
Neointimal formation and scoring system. Definitions of scores and examples shown by macroscopic photography of neointimal formation and recanalization at the neck of aneurysms treated with coils or cyanoacrylate.
A, Thick neointima completely seals orifice of aneurysmal neck treated with cyanoacrylate.
B, ANBD-assisted coil embolization treated with cyanoacrylate.
C, ANBD-assisted coil embolization.
D, Coil embolization without ANBD.
E, ANBD-assisted coil embolization.
- Fig 3.
Photographs and pathologic sections of neointima at the coil surface.
A, Macroscopic photograph of the tissue found at the surface of a loop of platinum coil protruding through the ANBD (arrow).
B, Tissue is dissected free of coil.
C–E, Histopathologic section shows typical neointima consisting of multiple layers of fusiform cells embedded in collagen covered by a single layer of endothelial cells. Note that neointima is thinner on the surface of the coil facing the parent artery (arrow).
- Fig 4.
Angiographic results of embolization.
A, Obtained before embolization with coils.
B, Obtained immediately after embolization with coils.
C, Obtained 12 weeks after embolization with coils. This aneurysm, treated with coils only, recurred within 12 weeks.
D, Obtained before ANBD-assisted coiling.
E, Obtained immediately after ANBD-assisted coiling.
F, Obtained 12 weeks after ANBD-assisted coiling. This lesion was stable at 12 weeks.
G, Obtained before ANBD-assisted cyanoacrylate injection.
H, Obtained immediately after ANBD-assisted cyanoacrylate injection.
I, Obtained 12 weeks after ANBD-assisted cyanoacrylate injection. This aneurysm was cured at 12 weeks.
Tables
Endovascular treatment of wide neck aneurysms
Treatment Mean Neck Diameter Complications Results Median Angiographic Scores Median Neointimal Scores T0 T3 weeks T12 weeks Coils only 7.50 3 / 10 2.0 2.5 3.0 2.5 ANBD + coils 8.70 2 / 11 2.0 2.0 3.0 2.0 ANBD + cyanoacrylate 8.80 1 / 7 0.0 0.0 1.0 0.0 P 0.33 0.71 0.08 0.06 0.05 0.004 Note.—ANBD indicates aneurysm neck bridge device.
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