J Korean Neurosurg Soc.  2021 Sep;64(5):751-762. 10.3340/jkns.2021.0010.

Comparison of Long-Term Angiographic Results of Wide-Necked Intracranial Aneurysms : Endovascular Treatment with Single-Microcatheter Coiling, Double-Microcatheter Coiling, and Stent-Assisted Coiling

• Kim HS
• Cho BM
• Yoo CJ
• Choi DH
• Hyun DK
• Shim YS
• Song JH
• Oh JK
• Ahn JH
• Kim JH
• Chang IB

• KMID: 2519702
• DOI: http://doi.org/10.3340/jkns.2021.0010

Abstract

Objective
: Endovascular treatment of intracranial aneurysms is challenging in case of wide-necked aneurysms because coils are prone to herniate into the parent artery, causing thromboembolic events or vessel occlusion. This study aims to compare long-term angiographic results of wide-necked aneurysms treated by stent-assisted, double-microcatheter, or single-microcatheter groups.
Methods
: Between January 2003 and October 2016, 108 aneurysms that were treated with endovascular coil embolization with a neck size wider than 4 mm and a follow-up period of more than 3 years were selected. We performed coil embolization with singlemicrocatheter, double-microcatheter, and stent-assisted techniques. Angiographic results were evaluated using the Raymond-Roy occlusion classification (RROC). All medical and angiographic records were reviewed retrospectively.
Results
: Clinical and angiographic analyses were conducted in 108 wide-necked aneurysms. The immediate post-procedural results revealed RROC class I (complete occlusion) in 66 cases (61.1%), class II (residual neck) in 36 cases (33.3%), and class III (residual sac) in six cases (5.6%). The final follow-up results revealed class I in 48 cases (44.4%), class II in 49 cases (45.4%), and class III in 11 cases (10.2%). Of a total of 45 (41.6%) radiologic recurrences, there were 21 cases (19.4%) of major recurrence that required additional treatment, and 24 cases (22.2%) of minor recurrence. The final follow-up angiographic results showed statistically significant differences between the stent-assisted group and the others (p<0.01).
Conclusion
: Long-term follow-up angiography demonstrated that the stent-assisted technique had a better complete occlusion rate than the other two techniques.

Keyword

Intracranial aneurysm; Endovascular procedures; Embolization; Stent-assisted coiling

Figure

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  Fig. 1. Single-microcatheter technique of coil embolization. A : A left paraclinoid segment aneurysm was selected with a microcatheter (arrow). B : A frame coil formed stable bascket in the aneurysmal sac (arrow). C : Coil embolization with single-microcatheter was done successfully (arrow).

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  Fig. 2. Double-microcatheter technique of coil embolization. A : An aneurysm of right posterior communicating artery is shown (arrow). B : The aneurysm is selected with two microcatheters and distal tips of microcatheters are marked with arrows. C : Coil embolization was done and proximal markers of two microcatheters are shown (arrow).

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  Fig. 3. Stent-assisted coil embolization of ophthalmic segment of left internal carotid artery. A : An ophthalmic segment aneurysm of left internal carotid artery is shown (arrow). B : A first frame coil is partially deployed and distal marker (long arrow) and proximal marker (short arrow) of deployed stent is shown. C : Additional coils were deployed in the aneurysm. D : Coil embolization is done and distal marker (long arrow) and proximal marker (short arrow) of deployed stent is shown.

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  Fig. 4. Cerebral angiography of a 65-year-old woman showing minor recurrence. A : An immediate angiogram after coil embolization of left vertebral artery aneurysm (arrow). B : A 10 months follow-up angiography shows mild coil compaction (arrow). C : A 42 months follow-up angiography shows contrast filling of the aneurysmal neck but no more severe compaction (arrow).

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  Fig. 5. Cerebral angiography of a 54-year-old man showing major recurrence. A : An immediate angiogram after coil embolization of anterior communicating artery aneurysm (arrow). B : A 10 months follow-up angiography shows contrast filling of the aneurysmal neck (arrow). C : A 24 months follow-up angiography shows enlarged contrast filling area (arrow) and coil compaction. D : A 10 years follow-up angiography shows severe coil compaction and major recurrence of the aneurysm (arrow).

Reference

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