The evolution of non-reconstructive methods of endovascular treatment of cerebral aneurysms

Abstract

The evolution of endovascular treatment of cerebral aneurysms has logically developed in the direction from non-constructive methods (treatment of aneurysms using detachable balloons, using liquid embolizing agents, occlusion of aneurysms with detachable coils, occlusion of aneurysms with balloon-assisted coils, implantation of various types of intradaccular devises) to reconstruction of the artery segment carrying the aneurysm (occlusion of aneurysms with stent-assisted coils and the use of flow-diverters). The effectiveness of these methods, including in the treatment of patients in the acute period of aneurysm rupture, in the immediate postoperative period has been proven by a variety of randomized studies, at the same time, in the long-term period, there are cases of aneurysm recurrence, including those accompanied by its rupture and the need for repeated surgical treatment. It should be noted that the development and modernization of various devices for the treatment of cerebral aneurysms is aimed at reducing the risk of operational complications and achieving greater radicality not only in the near, but also in the long-term postoperative period. The purpose of this review is to describe the stages of development of endovascular treatment of cerebral aneurysms. In this work, we describe the most well-known non-constructive methods of treatment.

Keywords

cerebral aneurysm / endovascular treatment / coiling / subarachnoid hemorrhage

References

[1] Moniz E. L’encephalographie arterielle, son importance dans la localisation des tumeurs cerebrales. Rew Neurol (Paris). 1927;(2):72–90. (In French)

[2] Moniz E. L’encephalographie arterielle, son importance dans la localisation des tumeurs cerebrales // Rew. Neurol. (Paris). 1927. № 2. P. 72–90.

[3] Bobinov VV, Petrov AE, Goroshchenko SA. Historical aspects of cerebral aneurysms surgery. Part 1. Rossiiskii neirokhirurgicheskii zhurnal im. professora A.L. Polenova. 2020;12(1):5–11. (In Russ.)

[4] Бобинов В.В., Петров А.Е., Горощенко С.А. и др. Исторические аспекты хирургического лечения церебральных аневризм. Часть I // Российский нейрохирургический журнал им. профессора А.Л. Поленова. 2020. Т. 12, № 1. С. 5–11.

[5] Velpeau A. Memoire sur la piqure ou l’acupuncture des arteres dans le traitement des anevrismes. Gaz Med Paris. 1831;2:1–4. (In French)

[6] Velpeau A. Memoire sur la piqure ou l’acupuncture des arteres dans le traitement des anevrismes // Gaz. Med. Paris. 1831. Vol. 2. P. 1–4.

[7] Moore CH, Murchinson C. On a new method of procuring the consolidation of fibrin in certain incurable aneurysms: with the report of a case in which an aneurysm of the ascending aorta was treated by the insertion of wire. Med Chir Trans. 1864;47:129–149. DOI: 10.1177/095952876404700115

[8] Moore C.H., Murchinson C. On a new method of procuring the consolidation of fibrin in certain incurable aneurysms: with the report of a case in which an aneurysm of the ascending aorta was treated by the insertion of wire // Med. Chir. Trans. 1864. Vol. 47. P. 129–149. DOI: 10.1177/095952876404700115

[9] Gallagher JP, Baiz T. Pilojection for carotid aneurysm in the cavernous sinus. JAMA. 1964;188:1156–1158. DOI: 10.1001/jama.1964.03060390058018

[10] Gallagher J.P., Baiz T. Pilojection for carotid aneurysm in the cavernous sinus // JAMA. 1964. Vol. 188. P. 1156–1158. DOI: 10.1001/jama.1964.03060390058018

[11] Kessler LA, Wholey M. Internal carotid occlusion for treatment of intracranial aneurysms. A new percutaneous technique. Radiology. 1970;95(3):581–583. DOI: 10.1148/95.3.581

[12] Kessler L.A., Wholey M.H. Internal carotid occlusion for treatment of intracranial aneurysms. A new percutaneous technique // Radiology. 1970. Vol. 95, No. 3. P. 581–583. DOI: 10.1148/95.3.581

[13] Serbinenko FA. Catheterization and occlusion of major cerebral vessels and prospects for the development of vascular neurosurgery. Vopr Neirokhir. 1971;(5):17–27. (In Russ.)

[14] Сербиненко Ф.А. Катетеризация и окклюзия магистральных сосудов головного мозга и перспективы развития сосудистой нейрохирургии // Вопросы нейрохирургии. 1971. № 5. С. 17–27.

[15] Serbinenko FA. Occlusion by ballooning of sacular aneurysms of the cerebral arteries. Vopr Neirokhir. 1974;(4):8–15. (In Russ.)

[16] Сербиненко Ф.А. Окклюзия баллоном мешотчатых аневризм артерий головного мозга // Вопросы нейрохирургии. 1974. № 4. С. 8–15.

[17] Rozhchenko LV, Ivanov AYu, Goroshchenko SA, et al. Development of vascular surgery in the russian research neurosurgery institute n. a. prof. A.L. Polenov (on the occasion of the 50th anniversary of the department of cerebral vascular surgery of the Russian research neurosurgery institute n. a. prof. A.L. Polenov). Rossiiskii neirokhirurgicheskii zhurnal imeni professora A.L. Polenova. 2017;9(1):5–10. (In Russ.)

[18] Рожченко Л.В., ИвановА.Ю., Горощенко С.А. и др. Развитие сосудистой нейрохирургии в РНХИ им. проф. А.Л. Поленова (к 50-летнему юбилею отделения хирургии сосудов головного мозга РНХИ им. проф. А.Л. Поленова) // Российский нейрохирургический журнал им. проф. А.Л. Поленова. 2017. Т. 9, №. 1. С. 5–10.

[19] Zubkov YN, Nikiforov BM, Shustin VA. Balloon catheter technique for dilatation of constricted cerebral arteries after aneurysmal SAH. Acta Neurochir (Wien). 1984;70(1–2):65–79. DOI: 10.1007/BF01406044

[20] Zubkov Y.N., Nikiforov B.M., Shustin V.A. Balloon catheter technique for dilatation of constricted cerebral arteries after aneurysmal SAH // Acta Neurochir. (Wien). 1984. Vol. 70, No. 1–2. P. 65–79. DOI: 10.1007/BF01406044

[21] Shcheglov IV, Savenko AG, Romodanov AP. Okklyuziruyushchee ustroistvo. Opisanie izobreteniya k avtorskomu svidetel’stvu SU 810246 A1. Byull. № 9 ot 07.03.1981. (In Russ.)

[22] Щеглов И.В., Савенко А.Г., Ромоданов А.П. Окклюзирующее устройство. Описание изобретения к авторскому свидетельству SU 810246 A1. Бюлл. № 9 от 07.03.1981.

[23] Romodanov AP, Shcheglov VI. Intravascular occlusion of saccular aneurysms of the cerebral arteries by means of a detachable balloon catheter. In: Advances and Technical Standards in Neurosurgery. 1982;9:25–49. DOI: 10.1007/978-3-7091-7034-2_2

[24] Romodanov A.P., Shcheglov V.I. Intravascular occlusion of saccular aneurysms of the cerebral arteries by means of a detachable balloon catheter // Advances and Technical Standards in Neurosurgery. 1982;9:25–49. DOI: 10.1007/978-3-7091-7034-2_2

[25] Kerber CW, Cromwell LD, Zanetti PH. Experimental carotid aneurysms, II: endovascular treatment with cyanoacrylate. Neurosurgery. 1985;16(1):13–17.

[26] Kerber C.W., Cromwell L.D., Zanetti P.H. Experimental carotid aneurysms, II: endovascular treatment with cyanoacrylate // Neurosurgery. 1985. Vol. 16, No. 1. P. 13–17.

[27] Debrun GM, Varsos V, Liszczak TM, et al. Obliteration of experimentation aneurysms in dogs with isobutyl-cyanoacrylate. J Neurosurg. 1984;61:37–43. DOI: 10.3171/jns.1984.61.1.0037

[28] Debrun G.M., Varsos V., Liszczak T.M. et al. Obliteration of experimentation aneurysms in dogs with isobutyl-cyanoacrylate // J. Neurosurg. 1984. Vol. 61. P. 37–43. DOI: 10.3171/jns.1984.61.1.0037

[29] Taki W, Nishi S, Yamashita K, et al. Selection and combination of various endovascular techniques in the treatment of giant aneurysms. J Neurosurg. 1992;77(1):37–42. DOI: 10.3171/jns.1992.77.1.0037

[30] Taki W., Nishi S., Yamashita K. et al. Selection and combination of various endovascular techniques in the treatment of giant aneurysms // J. Neurosurg. 1992. Vol. 77, No. 1. P. 37–42. DOI: 10.3171/jns.1992.77.1.0037

[31] Mandai S, Kinugasa K, Ohmoto T. Direct thrombosis of aneurysms with cellulose acetate polymer. Part I: Results of thrombosis in experimental aneurysms. J Neurosurg. 1992;77(4):497–500. DOI: 10.3171/jns.1992.77.4.0497

[32] Mandai S., Kinugasa K., Ohmoto T. Direct thrombosis of aneurysms with cellulose acetate polymer. Part I: Results of thrombosis in experimental aneurysms // J. Neurosurg. 1992. Vol. 77, No. 4. P. 497–500. DOI: 10.3171/jns.1992.77.4.0497

[33] Kinugasa K, Mandai S, Terai Y, et al. Direct thrombosis of aneurysms with cellulose acetate polymer. Part II: Preliminary clinical experience. J Neurosurg. 1992;77(4):501–507. DOI: 10.3171/jns.1992.77.4.0501

[34] Kinugasa K., Mandai S., Terai Y. et al. Direct thrombosis of aneurysms with cellulose acetate polymer. Part II: Preliminary clinical experience // J. Neurosurg. 1992. Vol. 77, No. 4. P. 501–507. DOI: 10.3171/jns.1992.77.4.0501

[35] Moret J. One year experience and follow up of 18 intracranial aneurysms treated with ONYX injection: analysis of results. Presented at the 39th annual meeting of the American Society of Neuroradiology. Boston. April 23–27, 2001:291.

[36] Moret J. One year experience and follow up of 18 intracranial aneurysms treated with ONYX injection: analysis of results. Presented at the 39th annual meeting of the American Society of Neuroradiology. Boston. April 23–27, 2001. P. 291.

[37] Molyneux AJ, Cekirge S, Saatci I, Gál G. Cerebral Aneurysm Multicenter European Onyx (CAMEO) trial: results of a prospective observational study in 20 European centers. AJNR Am J Neuroradiol. 2004;25(1):39–51.

[38] Molyneux A.J., Cekirge S., Saatci I., Gál G. Cerebral Aneurysm Multicenter European Onyx (CAMEO) trial: results of a prospective observational study in 20 European centers // AJNR Am. J. Neuroradiol. 2004. Vol. 25, No. 1. P. 39–51.

[39] Ueno J, Tohma N. Endovascular treatment of cerebral aneurysm with coils and Onyx. in-vivo experiment. Interv Neuroradiol. 2004;10 Suppl 1(Suppl 1):51–56. DOI: 10.1177/15910199040100S106

[40] Ueno J., Tohma N. Endovascular treatment of cerebral aneurysm with coils and Onyx. in-vivo experiment // Interv. Neuroradiol. 2004. Vol. 10 Suppl 1, No. Suppl 1. P. 51–56. DOI: 10.1177/15910199040100S106

[41] Agner C, Dujovny M. Historical evolution of neuroendovascular surgery of intracranial aneurysms: from coils to polymers. Neurol Res. 2009;31(6):632–637. DOI: 10.1179/174313209X455790

[42] Agner C., Dujovny M. Historical evolution of neuroendovascular surgery of intracranial aneurysms: from coils to polymers // Neurol. Res. 2009. Vol. 31, No. 6. P. 632–637. DOI: 10.1179/174313209X455790

[43] Braun IF, Hoffman JCJr, Casarella WJ, Davis PC. Use of coils for transcatheter carotid occlusion. AJNR Am J Neuroradiol. 1985;6(6):953–956.

[44] Braun I.F., Hoffman J.C.Jr., Casarella W.J., Davis P.C. Use of coils for transcatheter carotid occlusion // AJNR Am. J. Neuroradiol. 1985. Vol. 6, No. 6. P. 953–956.

[45] Dowd CF, Halbach VV, Higashida RT, et al. Endovascular coil embolization of unusual posterior inferior cerebellar artery aneurysms. Neurosurgery. 1990;27:954–961. DOI: 10.1097/00006123-199012000-00015

[46] Dowd C.F., Halbach V.V., Higashida R.T. et al. Endovascular coil embolization of unusual posterior inferior cerebellar artery aneurysms // Neurosurgery. 1990. Vol. 27. P. 954–961. DOI: 10.1097/00006123-199012000-00015

[47] Guglielmi G., Viñuela F, Sepetka I, et al. Electrothrombosis of saccular aneurysms via endovascular approach. Part I: Electrochemical basis, technique, and experimental results. J Neurosurg. 1991;75:1–7. DOI: 10.3171/jns.1991.75.1.0001

[48] Guglielmi G., Viñuela F., Sepetka I. et al. Electrothrombosis of saccular aneurysms via endovascular approach. Part I: Electrochemical basis, technique, and experimental results // J. Neurosurg. 1991. Vol. 75. P. 1–7. DOI: 10.3171/jns.1991.75.1.0001

[49] Guglielmi G., Viñuela F, Dion J, Duckwiler G. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg. 1991;75(1):8–14. DOI: 10.3171/jns.1991.75.1.0008

[50] Guglielmi G., Viñuela F., Dion J., Duckwiler G. Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience // J. Neurosurg. 1991. Vol. 75, No. 1. P. 8–14. DOI: 10.3171/jns.1991.75.1.0008

[51] Murayama Y, Tateshima S, Gonzalez NR, Vinuela F. Matrix and bioabsorbable polymeric coils accelerate healing of intracranial aneurysms: long-term experimental study. Stroke. 2003;34:2031–2037. DOI: 10.1161/01.STR.0000083394.33633.C2

[52] Murayama Y., Tateshima S., Gonzalez N.R., Vinuela F. Matrix and bioabsorbable polymeric coils accelerate healing of intracranial aneurysms: long-term experimental study // Stroke. 2003. Vol. 34. P. 2031–2037. DOI: 10.1161/01.STR.0000083394.33633.C2

[53] Taschner CA, Leclerc X, Rachdi H, et al. Matrix detachable coils for the endovascular treatment of intracranial aneurysms: analysis of early angiographic and clinical outcomes. Stroke. 2005;36(10):2176–2180. DOI: 10.1161/01.STR.0000181770.14869.ce

[54] Taschner C.A., Leclerc X., Rachdi H. et al. Matrix detachable coils for the endovascular treatment of intracranial aneurysms: analysis of early angiographic and clinical outcomes // Stroke. 2005. Vol. 36, No. 10. P. 2176–2180. DOI: 10.1161/01.STR.0000181770.14869.ce

[55] Mitra D, Herwadkar A, Soh C, Gholkar A. Follow-up of intracranial aneurysms treated with matrix detachable coils: a single-center experience. AJNR Am J Neuroradiol. 2007;28(2):362–367.

[56] Mitra D., Herwadkar A., Soh C., Gholkar A. Follow-up of intracranial aneurysms treated with matrix detachable coils: a single-center experience // AJNR Am. J. Neuroradiol. 2007. Vol. 28, No. 2. P. 362–367.

[57] Pierot L, Leclerc X, Bonafé A, et al. Endovascular treatment of intracranial aneurysms with matrix detachable coils: midterm anatomic follow-up from a prospective multicenter registry. AJNR Am J Neuroradiol. 2008;29(1):57–61. DOI: 10.3174/ajnr.A0738

[58] Pierot L., Leclerc X., Bonafé A. et al. Endovascular treatment of intracranial aneurysms with matrix detachable coils: midterm anatomic follow-up from a prospective multicenter registry // AJNR Am. J. Neuroradiol. 2008. Vol. 29, No. 1. P. 57–61. DOI: 10.3174/ajnr.A0738

[59] O’Hare AM, Fanning NF, Ti JP, et al. HydroCoils, occlusion rates, and outcomes: a large single-center study. AJNR Am J Neuroradiol. 2010;31(10):1917–1922. DOI: 10.3174/ajnr.A2210

[60] O’Hare A.M., Fanning N.F., Ti J.P. et al. HydroCoils, occlusion rates, and outcomes: a large single-center study // AJNR Am. J. Neuroradiol. 2010. Vol. 31, No. 10. P. 1917–1922. DOI: 10.3174/ajnr.A2210

[61] Brinjikji W, White PM, Nahser H, et al. HydroCoils reduce recurrence rates in recently ruptured medium-sized intracranial aneurysms: a subgroup analysis of the HELPS trial. AJNR Am J Neuroradiol. 2015;36(6):1136–1141. DOI: 10.3174/ajnr.A4266

[62] Brinjikji W., White P.M., Nahser H. et al. HydroCoils reduce recurrence rates in recently ruptured medium-sized intracranial aneurysms: a subgroup analysis of the HELPS trial // AJNR Am. J. Neuroradiol. 2015. Vol. 36, No. 6. P. 1136–1141. DOI: 10.3174/ajnr.A4266

[63] Bobinov VV, Petrov AE, Rozhchenko LV, et al. Microsurgical clipping anterior communicating artery aneurysm after endovascular coiling. case report. Modern problems of science and education. 2021;(3):192. (In Russ.) DOI: 10.17513/spno.30693

[64] Бобинов В.В., Петров А.Е., Рожченко Л.В. и др. Микрохирургическое лечение пациента с рецидивом аневризмы передней соединительной артерии после внутрисосудистой окклюзии спиралями. Случай из практики // Современные проблемы науки и образования. 2021. № 3. С. 192. DOI: 10.17513/spno.30693

[65] Bobinov VV, Petrov AE, Goroshchenko SA, et al. Endovascular reconstruction with flow diverting stent as a treatment for recurrent internal carotid artery aneurysm. A case report. Rossiiskii neirokhirurgicheskii zhurnal imeni professora A.L. Polenova. 2021;13(3):41–45. (In Russ.)

[66] Бобинов В.В., Петров А.Е., Горощенко С.А. и др. Реконструкция артерии с помощью потокотклоняющего стента как метод лечения рецидива аневризмы внутренней сонной артерии. Случай из практики // Российский нейрохирургический журнал им. профессора А.Л. Поленова. 2021. Т. 13, № 3. С. 41–45.

[67] Moret J, Cognard C, Weill A, et al. Reconstruction technic in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases. J Neuroradiol. 1997;24(1):30–44. (In French)

[68] Moret J., Cognard C., Weill A. et al. Reconstruction technic in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases // J. Neuroradiol. 1997. Vol. 24, No. 1. P. 30–44. (In French)

[69] Chalouhi N, Jabbour P, Tjoumakaris S, et al. Single-center experience with balloon-assisted coil embolization of intracranial aneurysms: safety, efficacy and indications. Clin Neurol Neurosurg. 2013;115(5):607–613. DOI: 10.1016/j.clineuro.2012.07.028

[70] Chalouhi N., Jabbour P., Tjoumakaris S. et al. Single-center experience with balloon-assisted coil embolization of intracranial aneurysms: safety, efficacy and indications // Clin. Neurol. Neurosurg. 2013. Vol. 115, No. 5. P. 607–613. DOI: 10.1016/j.clineuro.2012.07.028

[71] Ding YH, Lewis DA, Kadirvel R, et al. The Woven EndoBridge: a new aneurysm occlusion device. AJNR Am J Neuroradiol. 2011;32(3):607–611. DOI: 10.3174/ajnr.A2399

[72] Ding Y.H., Lewis D.A., Kadirvel R. et al. The Woven EndoBridge: a new aneurysm occlusion device // AJNR Am. J. Neuroradiol. 2011. Vol. 32, No. 3. P. 607–611. DOI: 10.3174/ajnr.A2399

[73] Asnafi S, Rouchaud A, Pierot L, et al. Efficacy and safety of the woven endobridge (WEB) device for the treatment of intracranial aneurysms: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2016;37(12):2287–2292. DOI: 10.3174/ajnr.A4900

[74] Asnafi S., Rouchaud A., Pierot L. et al. Efficacy and safety of the woven endobridge (WEB) device for the treatment of intracranial aneurysms: a systematic review and meta-analysis // AJNR Am. J. Neuroradiol. 2016. Vol. 37, No. 12. P. 2287–2292. DOI: 10.3174/ajnr.A4900

[75] Piotin M, Biondi A, Sourour N, et al. The LUNA aneurysm embolization system for intracranial aneurysm treatment: short-term, mid-term and long-term clinical and angiographic results. J Neurointerv Surg. 2018;10(12):e34. DOI: 10.1136/neurintsurg-2018-013767

[76] Piotin M., Biondi A., Sourour N. et al. The LUNA aneurysm embolization system for intracranial aneurysm treatment: short-term, mid-term and long-term clinical and angiographic results // J. Neurointerv. Surg. 2018. Vol. 10, No. 12. P. e34. DOI: 10.1136/neurintsurg-2018-013767

[77] Haffaf I, Clarençon F, Shotar E, et al. Medina embolization device for the treatment of intracranial aneurysms: 18 months’ angiographic results. J Neurointerv Surg. 2019;11(5):516–522. DOI: 10.1136/neurintsurg-2018-014110

[78] Haffaf I., Clarençon F., Shotar E. et al. Medina embolization device for the treatment of intracranial aneurysms: 18 months’ angiographic results // J. Neurointerv. Surg. 2019. Vol. 11, No. 5. P. 516–522. DOI: 10.1136/neurintsurg-2018-014110

[79] Bhogal P, Udani S, Cognard C, et al. Endosaccular flow disruption: where are we now? J Neurointerv Surg. 2019;11(10):1024–1025. DOI: 10.1136/neurintsurg-2018-014623

[80] Bhogal P., Udani S., Cognard C. et al. Endosaccular flow disruption: where are we now? // J. Neurointerv. Surg. 2019. Vol. 11, No. 10. P. 1024–1025. DOI: 10.1136/neurintsurg-2018-014623

[81] Peach T, Cornhill JF, Nguyen A, et al. The ‘Sphere’: A dedicated bifurcation aneurysm flow-diverter device. Cardiovasc Eng Technol. 2014;5(4):334–347. DOI: 10.1007/s13239-014-0188-4

[82] Peach T., Cornhill J.F., Nguyen A. et al. The ‘Sphere’: A dedicated bifurcation aneurysm flow-diverter device // Cardiovasc. Eng. Technol. 2014. Vol. 5, No. 4. P. 334–347. DOI: 10.1007/s13239-014-0188-4

[83] Spiotta AM, Sattur MG, Kan P, Crowley RW. Bifurcation aneurysm treatment with pulserider: technical nuances, device selection, positioning strategies, and overcoming geometric challenges. World Neurosurg. 2020;142:339–351. DOI: 10.1016/j.wneu.2020.04.126

[84] Spiotta A.M., Sattur M.G., Kan P., Crowley R.W. Bifurcation aneurysm treatment with pulserider: technical nuances, device selection, positioning strategies, and overcoming geometric challenges // World Neurosurg. 2020. Vol. 142. P. 339–351. DOI: 10.1016/j.wneu.2020.04.126

[85] Pranata R, Yonas E, Vania R, et al. Efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm – A systematic review and meta-analysis. Interv Neuroradiol. 2021;27(1):60–67. DOI: 10.1177/1591019920940521

[86] Pranata R., Yonas E., Vania R. et al. Efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm – A systematic review and meta-analysis // Interv. Neuroradiol. 2021. Vol. 27, No. 1. P. 60–67. DOI: 10.1177/1591019920940521

[87] Lylyk P, Chudyk J, Bleise C, et al.Treatment of wide-necked bifurcation aneurysms: initial results with the pCANvas neck bridging device. Clin Neuroradiol. 2019;29(3):467–477. DOI: 10.1007/s00062-018-0680-6

[88] Lylyk P., Chudyk J., Bleise C. et al.Treatment of wide-necked bifurcation aneurysms: initial results with the pCANvas neck bridging device // Clin. Neuroradiol. 2019. Vol. 29, No. 3. P. 467–477. DOI: 10.1007/s00062-018-0680-6

[89] De Vries J, Boogaarts HD, Sørensen L, et al. eCLIPs bifurcation remodeling system for treatment of wide neck bifurcation aneurysms with extremely low dome-to-neck and aspect ratios: a multicenter experience. J Neurointerv Surg. 2021;13(5):438–442. DOI: 10.1136/neurintsurg-2020-016354

[90] De Vries J., Boogaarts H.D., Sørensen L. et al. eCLIPs bifurcation remodeling system for treatment of wide neck bifurcation aneurysms with extremely low dome-to-neck and aspect ratios: a multicenter experience // J. Neurointerv. Surg. 2021. Vol. 13, No. 5. P. 438–442. DOI: 10.1136/neurintsurg-2020-016354

RIGHTS & PERMISSIONS

Eco-Vector