ORCID Profile
0000-0002-1739-6115
Current Organisations
University of Oxford
,
University Hospital Southampton
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Publisher: Elsevier BV
Date: 09-2017
Publisher: Springer Science and Business Media LLC
Date: 20-09-2008
DOI: 10.1007/S00234-008-0457-8
Abstract: Thrombotic events are a common and severe complication of endovascular aneurysm treatment with significant impact on patients' outcome. This study evaluates risk factors for thrombus formation and assesses the efficacy and safety of abciximab for clot dissolution. All patients treated with abciximab during (41 patients) or shortly after (22 patients) intracranial aneurysm coil embolisation were retrieved from the institutional database (2000 to 2007, 1,250 patients). Sixty-three patients (mean age, 55.3 years, +/- 12.8) had received either intra-arterial or intravenous abciximab. Risk factors for clot formation were assessed and the angiographic and clinical outcome evaluated. No aneurysm rupture occurred during or after abciximab application. The intra-procedural rate of total recanalisation was 68.3%. Thromboembolic complications were frequently found in aneurysms of the Acom complex and of the basilar artery, whilst internal carotid artery aneurysms were underrepresented. Two patients died of treatment-related intracranial haemorrhages into preexisting cerebral infarcts. Two patients developed a symptomatic groin haematoma. Abciximab is efficacious and safe for thrombolysis during and after endovascular intracranial aneurysm treatment in the absence of preexisting ischaemic stroke.
Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
Date: 03-2010
DOI: 10.3171/2008.8.17657
Abstract: Endovascular treatment of very small aneurysms poses a significant technical challenge for endovascular therapists. The authors review their experience with a series of patients who had intracranial aneurysms smaller than 3 mm in diameter. Between 1995 and 2006, 97 very small aneurysms (defined for purposes of this study as 3 mm in diameter) were diagnosed in 94 patients who were subsequently referred for endovascular treatment. All patients presented after subarachnoid hemorrhage, which was attributed to the very small aneurysms in 85 patients. The authors reviewed the endovascular treatment, the clinical and angiographic results of the embolization, and the complications. Five (5.2%) of the 97 endovascular procedures failed, and these patients underwent craniotomy and clip ligation. Of the 92 aneurysms successfully treated by coil embolization, 64 (69.6%) were completely occluded and 28 (30.4%) showed minor residual filling or neck remnants on the immediate postembolization angiogram. Complications occurred in 7 (7.2%) of 97 procedures during the treatment (3 thromboembolic events [3.1%] and 4 intraprocedural ruptures [4.1%]). Seventy-six patients were followed up angiographically 4 (5.3%) of these 76 showed angiographic evidence of recanalization that required retreatment. The clinical outcomes for the 76 patients were also graded using the Glasgow Outcome Scale. In 61 (80.3%) cases the outcomes were graded 4 or 5, whereas in 15 (19.7%) they were graded 3. Seven patients (7.4%) died (GOS Grade 1), 2 due to procedure-related complications (intraoperative rupture) and 5 due to complications related to the presenting subarachnoid hemorrhage. Endosaccular coil embolization of very small aneurysms is associated with relatively high rates of intraprocedural rupture, especially intraoperative rupture. With the advent of more sophisticated endovascular materials (microcatheters and microguidewires, soft and ultrasoft coils, and stents) endovascular procedures have become feasible and can lead to a good angiographic outcome.
Publisher: Springer Science and Business Media LLC
Date: 07-12-2013
DOI: 10.1007/S00234-013-1304-0
Abstract: This study assessed volume changes of unruptured large and giant aneurysms (greatest diameter >20 mm) after treatment with flow erter (FD) stents. Clinical audit of the cases treated in a single institution, over a 5-year period. Demographic and clinical data were retrospectively collected from the hospital records. Aneurysm volumes were measured by manual outlining at sequential slices using computerised tomography (CT) or magnetic resonance (MR) angiography data. The audit included eight patients (seven females) with eight aneurysms. Four aneurysms involved the cavernous segment of the internal carotid artery (ICA), three the supraclinoid ICA and one the basilar artery. Seven patients presented with signs and symptoms of mass effect and one with seizures. All but one aneurysm was treated with a single FD stent six aneurysms were also coiled (either before or simultaneously with FD placement). Minimum follow-up time was 6 months (mean 20 months). At follow-up, three aneurysms decreased in size, three were unchanged and two increased. Both aneurysms that increased in size showed persistent endosaccular flow at follow-up MR in one case, failure was attributed to suboptimal position of the stent in the other case, it was attributed to persistence of a side branch originating from the aneurysm (similar to the endoleak phenomenon of aortic aneurysms). At follow-up, five aneurysms were completely occluded none of these increased in volume. Complete occlusion of the aneurysms leads, in most cases, to its shrinkage. In cases of late aneurysm growth or regrowth, consideration should be given to possible endoleak as the cause.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-03-2013
Publisher: BMJ
Date: 16-06-2020
DOI: 10.1136/NEURINTSURG-2020-016083
Abstract: While anatomic features associated with the risk of posterior communicating artery (PcoA) occlusion after embolization of aneurysms of the PcoA segment of the internal carotid artery (ICA) are well known, the link between perforator origin and perforator infarction has only been reported following neurosurgical clipping. The aim of this study was to determine the origin of anterior thalamic perforators and correlate it with risk of perforator infarction after embolization of PcoA segment aneurysms. One-hundred-and-ninety consecutive patients treated for PcoA segment aneurysms between 2017 and 2019 were included. PcoA and anterior thalamic perforator origin anatomy was assessed with computed tomography (CT) angiography, digital subtracted angiography, and high-resolution three-dimensional rotational cone-beam CT angiography (CBCT-A) by two independent interventional neuroradiologists. The presence of perforator infarction after embolization was ascertained from the patient’s notes and follow-up imaging. CBCT-A was superior in demonstrating the origin of perforators (P .001). The prevalence of perforator origin was estimated at 86% (95% CI 81%–92%) for PcoA, 8% (95% CI 4%–13%) for aneurysm wall, and 5% (95% CI 2%–9%) for ICA. The aneurysm wall origin was exclusively associated with PcoA agenesis, as well as higher risk of perforator infarction after aneurysm coiling compared with other variants (OR=14, 95% CI 2–88, P=0.006). Our study suggests that anterior thalamic perforators may arise from aneurysm wall when there is no PcoA. Anatomic association between PcoA agenesis and perforator arising from ICA could underlie such findings, and careful consideration is essential before aneurysm repair to anticipate the risk of thalamic infarction in such cases.
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.EJVS.2013.07.020
Abstract: ACST-2 is currently the largest trial ever conducted to compare carotid artery stenting (CAS) with carotid endarterectomy (CEA) in patients with severe asymptomatic carotid stenosis requiring revascularization. Patients are entered into ACST-2 when revascularization is felt to be clearly indicated, when CEA and CAS are both possible, but where there is substantial uncertainty as to which is most appropriate. Trial surgeons and interventionalists are expected to use their usual techniques and CE-approved devices. We report baseline characteristics and blinded combined interim results for 30-day mortality and major morbidity for 986 patients in the ongoing trial up to September 2012. A total of 986 patients (687 men, 299 women), mean age 68.7 years (SD ± 8.1) were randomized equally to CEA or CAS. Most (96%) had ipsilateral stenosis of 70-99% (median 80%) with contralateral stenoses of 50-99% in 30% and contralateral occlusion in 8%. Patients were on appropriate medical treatment. For 691 patients undergoing intervention with at least 1-month follow-up and Rankin scoring at 6 months for any stroke, the overall serious cardiovascular event rate of periprocedural (within 30 days) disabling stroke, fatal myocardial infarction, and death at 30 days was 1.0%. Early ACST-2 results suggest contemporary carotid intervention for asymptomatic stenosis has a low risk of serious morbidity and mortality, on par with other recent trials. The trial continues to recruit, to monitor periprocedural events and all types of stroke, aiming to randomize up to 5,000 patients to determine any differential outcomes between interventions. ISRCTN21144362.
Publisher: Springer Science and Business Media LLC
Date: 03-2005
DOI: 10.1007/S00234-005-1359-7
Abstract: Anatomical variants of the cerebral arteries in general are frequent and due to the complex ontogenesis of these structures. Although encountered in many mammals, a single anterior cerebral artery (ACA) trunk is an infrequent finding in humans with an incidence of 3-5%. This vessel, giving rise to the arteries of both frontal lobes, is subjected to high flow volumes and distal arterial aneurysms have repetitively been encountered, mostly however before the introduction of endovascular treatment strategies. We report on five patients with acute SAH and arterial aneurysms of an unpaired ACA, who underwent coil embolisation. In all cases endovascular treatment using detachable platinum coils resulted in an at least satisfactory degree of aneurysm obliteration without parent artery occlusion or embolic infarcts. All patients had clinical and angiographic follow-up with median follow-up time of 29 months during which no aneurysm regrowth was encountered. In spite of a small patient group our results suggest, that altered flow dynamics due to enlarged single intracranial vessels may predispose to aneurysm formation and that endovascular embolisation is an appropriate treatment option in distal aneurysms of an unpaired ACA.
Publisher: BMJ
Date: 23-01-2019
DOI: 10.1136/NEURINTSURG-2018-014488
Abstract: Low profile braided stents have facilitated the endovascular treatment of broad-based intracranial aneurysms. Between 2013 and June 2018, we attempted 104 Leo baby stent placements in 101 patients. Locations were the anterior communicating artery (AcomA) (37 aneurysms, 35.6%), middle cerebral artery (MCA) bifurcation (29 aneurysms, 27.9%) and basilar artery (23aneurysms, 22.1%). Mean neck size was 4.9 mm (2.2–8.2). 60 aneurysms were incidental, 31 of 37 recurrent aneurysms had ruptured before. Stent deployment was successful in 89.4% of cases. Common reasons for failure were inability to access the parent artery (n=5) or to deploy the stent across the aneurysm neck (n=4). Two patients had poor outcomes within 24 hours. One patient developed a brain hemorrhage caused by guide wire perforation (MRS 5), the other an early thrombotic stent occlusion (MRS 4). No patient died. Nine (8.7%) patients experienced transient neurological deficits with ischemic lesions on diffusion weighted imaging (DWI). Initially Raymond-Roy class 1 occlusion was achieved in 23 aneurysms (24.7%), class 2 occlusion in 40 (43%), class 3a occlusion in 14 (15.0%), and 3b occlusion in 16 aneurysms (17.2%). Follow-up imaging in 87 patients showed stable or improved occlusion grades in 76%. Six patients required retreatment while the rest were managed conservatively. Four delayed stent occlusions occurred in three patients, with severe morbidity in one patient (MRS 5). There were no aneurysm ruptures or deaths. Stent assisted treatment of broad-based aneurysms with the Leo baby stent is safe and effective. The frequency of delayed thrombotic complications is low and similar to other stents.
Publisher: Springer Science and Business Media LLC
Date: 23-10-2007
DOI: 10.1007/S00234-007-0315-0
Abstract: Idiopathic ruptured aneurysms of distal cerebellar arteries (DCAAs) are rare, and their endovascular therapy (EVT) has as yet not been extensively reported. They are usually assumed to result from local arterial wall disruption rather than infection, unlike distal supratentorial artery aneurysms. This study was performed to audit their frequency, potential aetiology and results of EVT. Using strict inclusion criteria and a database of 1715 EVT patients, we identified ten idiopathic ruptured DCAAs (0.6%) over a 13-year period (1993-2006). The series comprised six males and four females with mean age of 64 years and solitary aneurysms located on posterior inferior cerebellar artery (five patients), anterior inferior cerebellar artery (three patients) and superior cerebellar artery (two patients). Nine aneurysms were fusiform and were treated by endovascular parent artery occlusion, and one was saccular and treated by endosaccular packing. Endovascular therapy was performed with coils in seven cases, n-butyl-2-cyanoacrylate (NBCA) in two cases and with both in one case. Primary EVT was successful in eight patients. One patient died following a procedure-related re-bleeding and one patient required re-treatment after failed endosaccular packing. Nine patients made good or excellent clinical recoveries (modified Rankin Scale 2 or less). Focal cerebellar infarctions were seen on computed tomography images after EVT in three patients, only one of whom was symptomatic with transient dysmetria, which resolved completely during follow up. No aneurysm recanalisation was detected on late follow-up imaging up to 24 months. Ruptured DCAAs are rare. The majority are fusiform in shape and their aetiology remains uncertain. Endovascular treatment is feasible and effective. It usually requires parent artery occlusion.
Publisher: Springer Science and Business Media LLC
Date: 11-04-2018
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Wilhelm Kuker.