Download Program - Canadian Neurological Sciences Federation

PUBLIé DANS LE JOURNAL CANADIEN DES SCIENCES NEUROLOGIqUES
2013 update on the Canadian Unruptured Endovascular vs
Surgery (CURES) trial
TE Darsaut (Edmonton)* M Findlay (Edmonton) J Raymond
(Montreal)
Background: The best treatment for patients with unruptured
intracranial aneurysms (UIA) remains uncertain. Surgical clipping is
widely considered to provide more consistent and permanent
aneurysm exclusion and better long-term protection from
hemorrhage but may result in greater morbidity than endovascular
treatment. A randomized comparison of the two treatments has not
been done. Purpose: To compare anatomical results, treatment
morbidity & mortality, and long-term clinical outcome of surgical
clipping versus endovascular coiling of intracranial aneurysms in a
randomized controlled trial. Methods: So far, in Canada, 53 patients
with UIAs have been randomized. The available anonymized data
will be presented at the conference. Conclusion: CURES is a CIHRscan
or MRA were requested. We focused on recruiting familial
cases, particularly those with more than two affected relatives.
Result: The present cohort includes 86 probands with ICA including
50 familial probands, 34 of their affected relatives and 338 of their
unaffected relatives. There are 29 probands with sporadic ICAs and
14 unaffected relatives. In total 558 individuals have been enrolled.
CT or MRA has been completed on 437. Of the 117 affected
participants, clipping has been performed on 42, coiling on 22. 53
patients are being followed for unruptured aneurysms. Death from
SAH occurred in 4. There are 8 major families (each with 4 – 11
affected individuals) and these will be the focus of future molecular
genetic studies. Details of some of these families will be discussed.
Conclusion: Identification of patients with familial ICA is important
for early treatment, family screening and eventual prevention of
subarachnoid hemorrhage.
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Excellent long-term outcomes in complex intracranial
aneurysms treated with PED
E Barber (Saskatoon)* SU Ahmed (Saskatoon) Z Tymchak
(Saskatoon) ME Kelly (Saskatoon)
Background: The Pipeline embolization device (PED) is a flowdiverting
stent that has been used to treat complex aneurysms not
amenable to treatment alternatives. We present a single-centre
experience of the long-term efficacy and outcomes of PED
placement. Methods: Case data of aneurysms treated with the PED
were collected prospectively and pooled for retrospective analysis.
Clinical outcomes were converted to modified Rankin scores and
imaging was used to determine post-procedure aneurysm filling.
Results: 32 PEDs were placed in 16 patients. Patients were
followed-up for an average of 20 months. Angiographic cure was
achieved in 12/16 patients, and 14/16 scored ≤ 2 on the modified
Rankin scale at most recent follow-up. One patient presenting with
SAH died, and a second suffered progressive right-sided weakness
leading to hemiplegia. Conclusions: Our experience shows high
rates of angiographic cure and favourable clinical outcomes at longterm
follow-up, and suggests that the PED is a viable treatment
option for complex cerebral aneurysms.
I.09
Flow diversion of giant curved sidewall and bifurcation
aneurysms: very low porosity devices may not produce reliable
occlusion in experimental models
TE Darsaut (Edmonton)* F Bing (Strasbourg) A Makoyeva
(Montréal) I Salazkin (Montréal) G Gevry (Montréal) J Raymond
(Montréal)
Background and Purpose: Flow diverters (FDs) are increasingly
used to treat difficult intracranial aneurysms. Giant curved sidewall
(cSW) and bifurcation aneurysms present special difficulties that
could perhaps be overcome using very low porosity devices.
Materials and Methods: Large and giant endwall bifurcation (EwB;
n=12) and cSW aneurysms (n =5) were constructed in 17 dogs. EwB
aneurysms were treated with 48 (n =4), 64 (n=4) or two telescoping
64 wire low-porosity devices (n=4), while all cSW aneurysms were
treated with 64 wire devices. Angiographic results were recorded
immediately, at 2-4 and at 12 weeks, immediately before euthanasia.
Pathological specimens were photographed and metallic and
neointimal closure of the aneurysm ostium measured and scored.
Results: One of twelve EwB and 1/5 cSW aneurysms were occluded
at 12 weeks. All other aneurysms were patent. Device-related
stenoses occurred in 13/17 animals, hemodynamically significant in
two. All branches jailed by the FDs remained patent. For all animals,
there was a significant correlation (P=0.04) between the
angiographic scores and the degree of neointima formation (Rho =
0.527). Failures of aneurysm occlusion could be explained by leaks
or holes, sometimes barely visible, in the neointima over the device,
which tended to occur at the level of specific, transition zones within
the stent. Conclusion: Low porosity FDs can fail to occlude
experimental giant EwB and cSW aneurysms.
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STAT: stenting in the treatment of large, wide necked or
recurring intracranial aneurysms trial
TE Darsaut (Edmonton)* D Roy (Montréal) A Weill (Montréal) J
Raymond (Montréal)
In patients with intracranial aneurysms treated with endovascular
coiling, angiographic recurrences are often observed. This problem
becomes significant in patients with large, recurring, or wide necked
aneurysms. Stenting combined with coil occlusion presumably
modifies intra-aneurysmal hemodynamics and leads to a decrease in
recurrence rate. The STAT (Stenting in the Treatment of large, wide
necked or recurring intracranial Aneurysms Trial) RCT thus aims at
comparing coiling versus coiling plus stenting in patients with
aneurysms prone to recurrence, i.e. large aneurysms (≥10mm; STAT-
1), recurring aneurysms after previous coiling (major recurrence;
STAT-2), or wide-necked aneurysms (aspect ratio50%).
A pilot phase is underway in Canada and has already enrolled 9
STAT subjects.
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Canadian Neurological Sciences Federation • 48th Annual Congress • Montreal, Quebec • June 12-14, 2013 • Pre-Congress June 11
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