Korean J Radiol.  2014 Dec;15(6):850-857. 10.3348/kjr.2014.15.6.850.

The Stent-Assisted Coil-Jailing Technique Facilitates Efficient Embolization of Tiny Cerebral Aneurysms

• Li CH
• Su XH
• Zhang B
• Han YF
• Zhang EW
• Yang L
• Zhang DL
• Yang ST
• Yan ZQ
• Gao BL

• KMID: 1794659
• DOI: http://doi.org/10.3348/kjr.2014.15.6.850

Abstract

OBJECTIVE
Tiny cerebral aneurysms are difficult to embolize because the aneurysm's sac is too small for a single small coil, and coils within the aneurysm may escape from the confinement of a stent. This study was performed to introduce the stent-assisted coil-jailing technique and to investigate its effect on the coil embolization of tiny intracranial aneurysms.
MATERIALS AND METHODS
Sixteen patients with tiny intracranial aneurysms treated with the stent-assisted coil-jailing technique between January 2011 and December 2013 were retrospectively reviewed and followed-up.
RESULTS
All aneurysms were successfully treated with the coil-jailing technique, and at the end of embolization, complete occlusion of the aneurysm was achieved in 9 cases (56.3%), incomplete occlusion in 6 (37.5%), and partial occlusion in 1 (6.3%). Intraprocedural complications included acute thrombosis in one case (6.3%) and re-rupture in another (6.3%). Both complications were managed appropriately with no sequela. Follow-up was performed in all patients for 3-24 months (mean, 7.7 months) after embolization. Complete occlusion was sustained in the 9 aneurysms with initial complete occlusion, progressive thrombosis to complete occlusion occurred in the 6 aneurysms with initial near-complete occlusion, and one aneurysm resulted in progressive thrombosis to complete occlusion after initial partial occlusion. No migration of stents or coils occurred at follow-up as compared with their positions immediately after embolization. At follow-up, all patients had recovered with no sequela.
CONCLUSION
The stent-assisted coil-jailing technique can be an efficient approach for tiny intracranial aneurysms, even though no definite conclusion regarding its safety can be drawn from the current data.

Keyword

Tiny intracranial aneurysm; Stent-assisted coiling; Redundant coil tails; Coil migration

MeSH Terms

Adult
Aged
Cerebral Angiography
Embolization, Therapeutic/*instrumentation
Female
Follow-Up Studies
Humans
Intracranial Aneurysm/pathology/*therapy
Magnetic Resonance Angiography
Male
Middle Aged
Retrospective Studies
Severity of Illness Index
Stents
Treatment Outcome

Figure

• 

  Fig. 1 58-year-old woman (patient 2) had sudden headache, nausea and vomiting for 18 hours. A. Tiny left posterior communicating artery aneurysm was shown. B. 1.5 mm × 3 cm coil was inserted into the aneurysm's sac and coil tail was constrained between stent and wall of internal carotid artery to increase coil stability. C. Deployed coil and its tail form shape of comma (arrow). D. Follow-up six months later revealed complete occlusion of aneurysm. Arrows indicate markers on distal and proximal ends of stent.

• 

  Fig. 2 46-year-old man (patient 1) who had subarachnoid hemorrhage was referred to our hospital for embolization of ruptured tiny aneurysm. 46-year-old man (patient 1) had tiny ruptured aneurysm at right ophthalmic artery segment of internal carotid artery (A). B. Aneurysm was treated with stent-assisted coiling technique. Small 1.5 mm × 2 cm coil was inserted into aneurysm's sac, and coil tail was compressed against wall of internal carotid artery by stent. Arrow indicates coil and constrained coil tail forming shape of comma. C. After stent was deployed, thrombi formed (small arrows) and 3000 IU heparin was infused together with 20 U urokinase. Bigger arrow indicates that anterior cerebral artery did not display very well because of thrombi. D. Fifteen minutes later, thrombi disappeared and patient was discharged with no sequela. Anterior cerebral artery was well displayed after thrombolysis (big arrow).

• 

  Fig. 3 57-year-old woman had sudden headache and nausea (patient 8). A. 57-year-old woman had tiny ruptured anterior communicating artery aneurysm (patient 8). B. Aneurysm was treated with stent-assisted coiling technique. Small 1.5 mm × 3 cm coil was inserted into aneurysm's sac and coil tail was compressed between stent (arrows) and vessel wall.

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