J Korean Neurosurg Soc.  2019 Jan;62(1):27-34. 10.3340/jkns.2018.0064.

Selective Temporary Stent-Assisted Coil Embolization for Intracranial Wide-Necked Small Aneurysms Using Solitaire AB Retrievable Stent

• Heo HY
• Ahn JG
• Ji C
• Yoon WK

• KMID: 2434343
• DOI: http://doi.org/10.3340/jkns.2018.0064

Abstract

OBJECTIVE
Stent-assisted coil embolization of intracranial wide-necked aneurysm requires long-term postoperative antiplatelet therapy to prevent in-stent thrombosis. This study aimed to demonstrate results of temporary stent placement for coiling wide necked small intracranial aneurysms, which eliminated need for antiplatelet agents, and to discuss its feasibility and safety.
METHODS
Data of 156 patients who underwent stent-assisted coil embolization between 2011 and 2014 were retrospectively analyzed. Thirteen cases of temporary stent-assisted coil embolization were included, and their clinical and radiological results were evaluated.
RESULTS
The aneurysms treated were all unruptured except one case. All of them had wide neck with mean dome-to-neck ratio of 0.96 and were small-sized aneurysms with mean maximal diameter of 4.2 mm. There was no technical failure in retrieval of stent after completion of embolization of the target aneurysm. Immediate angiography revealed 11 complete and two partial embolization (one residual neck and one residual aneurysm). Two cases encountered thrombosis complication, and they were managed without neurological sequelae. The mean follow-up period was 43 months, angiographic follow-up revealed two cases with minor recurrence, and clinical outcome was good with modified Rankin scale score of 0.
CONCLUSION
Temporary stent-assisted coil embolization of small wide-necked intracranial aneurysm using fully retrievable stent appears safe and effective. Further application and evaluation of this technique in more cases with larger size aneurysm is warranted.

Keyword

Coil; Intracranial aneurysm; Stents

MeSH Terms

Aneurysm*
Angiography
Embolization, Therapeutic*
Follow-Up Studies
Humans
Intracranial Aneurysm
Neck
Platelet Aggregation Inhibitors
Recurrence
Retrospective Studies
Stents*
Thrombosis
Platelet Aggregation Inhibitors

Figure

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  Fig. 1. Examples of immediate complete embolization with temporary stent-assisted coil embolization. A and B : A case of posterior communicating artery unruptured aneurysm. A : Stent-assisted coil embolization is performed with jail technique on a posterior communicating artery unruptured aneurysm with wide neck. B : Immediate post-procedure angiography shows completely embolized aneurysm with removed stent without any complicated features. C and D : A case of vertebral artery unruptured aneurysm. C : An unruptured left vertebral artery wide-necked aneurysm is treated with jailed stent-assisted technique. The stent is fully deployed. D : After removal of the stent, the aneurysm is completely embolized and the parent artery is patent.

• 

  Fig. 2. Illustrated case of a paraclinoid aneurysm. A : To stabilize the catheter, a Solitaire AB 5×20 mm stent is deployed covering the neck of the aneurysm. Subsequent coil deployment is performed easily. B : After completion of coil packing in the aneurysm, the stent is recaptured and removed. C : First angiographic follow-up at 2 years shows complete and stable packing of the aneurysm. D : Second angiographic follow-up at 4 years demonstrates complete exclusion of the aneurysm out of the blood circulation.

• 

  Fig. 3. Cases of thromboembolic complication. A-D : A case of anterior communicating artery aneurysm. A : The anterior communicating artery aneurysm has a wide neck. B : Change in vascular geometry and wrinkling of proximal A1 segment with distal flow stagnation by stent deployment is observed. The angle between A1 and A2 is changed compared to that in Fig. 3A. C : Note the restored vascular geometry and patent arteries after stent removal. D : Follow-up angiography at 3 years shows stable and complete embolization and patent parent arteries. E-H : A case of middle cerebral artery aneurysm. E : A wide-necked middle cerebral artery bifurcation aneurysm incorporating inferior trunk. F : At the final stage of stent-assisted coil embolization of the aneurysm, thrombosis occurrs in the origin of inferior trunk. G : The stent is removed safely and chemical thrombolysis is performed to achieve full recanalization. H : Follow-up angiogram at 5 years shows completely embolized aneurysm with patent inferior trunk.

Reference

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