J Cerebrovasc Endovasc Neurosurg.  2013 Dec;15(4):293-298. 10.7461/jcen.2013.15.4.293.

Jailing Technique Using a Catheter-based Open-cell Stent System in Internal Carotid Artery Sidewall Aneurysms Unfeasible to Simple Coiling

• Yoon SG
• Jin SC
• Kim SH
• Jeon KD
• Kim DY
• Lee SI
• Jeong HW

• KMID: 1810787
• DOI: http://doi.org/10.7461/jcen.2013.15.4.293

Abstract

OBJECTIVE
An open cell stent system may offer better apposition of cell struts to vessel wall than a closed cell stent system in acute vasculature. The purpose of this study was to evaluate the feasibility of coiling using the jailing technique with the Neuroform EZ stent system.
METHODS
The jailing technique using the open-cell stent system of the Neuroform EZ stent was planned in 22 consecutive patients with 22 cerebral aneurysms. We retrospectively evaluated the technical success of the jailing technique and the occurrence of interference between two microcatheters as well as the factors influencing this interference.
RESULTS
The jailing technique was successful in 19/22 patients (86.4%), and interference between two microcatheters occurred in 6/21 (28.6%). The jailing technique failed in 3/22 patients, with problems that included failure of the stent delivery system to advance into the positioned microcatheter in one, interference between the microcatheters during the advancement of the stent delivery system in one, and failure of microcatheter insertion into the aneurysm sac in the remaining patient. Interference between the two microcatheters developed during the advance of the stent delivery system into the positioned microcatheter in all cases. One factor that influences interference between two microcatheters more than expected by chance is the carotid siphon angle (p = 0.019).
CONCLUSION
The acuteness of the carotid siphon angle influences the interference between two microcatheters. Therefore, the jailing technique using the Neuroform EZ stent should be performed carefully in cerebral aneurysms with an acute carotid siphon angle because the procedure may possibly fail.

Keyword

Carotid siphon; Microcatheter; Neuroform; Jailing

MeSH Terms

Aneurysm*
Carotid Artery, Internal*
Humans
Intracranial Aneurysm
Retrospective Studies
Stents*

Figure

• 

  Fig. 1 A case in which the Neuroform stent delivery system failed to advance into the Renegade microcatheter. (A) A working roadmap image shows two well-positioned microcatheters. (B) A working roadmap image shows the dislodging of the microcatheter that was inserted into the aneurysm during the advance of the Neuroform stent delivery system into the Renegade microcatheter. (C) A switch from Neuroform stent-assisted to Enterprise stent-assisted (black arrow) coiling was performed due to the failure of the Neuroform delivery system to advance into the Renegade microcatheter. (D) A final working angiogram shows partial coiling of the aneurysm.

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