Horizontal stent deployment via extracranial-intracranial bypass in coil embolization of basilar apex aneurysms: technical report

Purpose Among all stents available for neuroendovascular therapy, the low-profile visible intraluminal support stent bears the highest metal coverage ratio. We deployed a low-profile visible intraluminal support stent with a delivery wire or/and microcatheter system push action to shorten the low-profile visible intraluminal support stent and thus achieve a flow diversion effect. We report our single-institution experience with the use of low-profile visible intraluminal support stents for intentionally shortened deployment (shortening group) and non-shortened deployment (non-shortening group) for unruptured intracranial aneurysms. Methods We retrospectively reviewed the medical records of 130 patients with 131 intracranial aneurysms who were treated with low-profile visible intraluminal support stent-assisted coil embolization from February 2016–January 2019. All perioperative complications were noted. Every 6 months, we re-examined the patients with cerebral angiography or magnetic resonance angiography. The outcomes of aneurysm occlusion were evaluated by the modified Raymond–Roy occlusion classification. We used the finite element method and computational fluid dynamics to investigate the hemodynamics after shortened low-profile visible intraluminal support stent deployment. Results Immediately after treatment, the modified Raymond-Roy occlusion classification was significantly better in the shortening group than in the non-shortening group ( p<0.05). The latest angiographic outcomes showed the same tendency. Hemodynamic analysis by computational fluid dynamics suggested an adequate flow diversion effect with the use of our intentional shortening method. Conclusions Stent-assisted coil embolization using this technique showed good results of a high complete occlusion rate and low complication rate. These findings suggest that shortened low-profile visible intraluminal support stent deployment yields a flow diversion effect and may lead to early intra-aneurysmal thrombus formation.

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Elective Treatment of Saccular and Broad-necked Intracranial Aneurysms using a Closed-cell Nitinol Stent (Leo)

Neurosurgery ◽

10.1227/01.neu.0000197103.10364.0c ◽

2006 ◽

Vol 58 (3) ◽

pp. 443-450 ◽

Cited By ~ 64

Author(s):

Bernhard Kis ◽

Werner Weber ◽

Peter Berlit ◽

Dietmar Kühne

Keyword(s):

Carotid Artery ◽

Cerebral Artery ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Neurological Deficits ◽

Long Term Results ◽

Parent Artery ◽

Stent Deployment ◽

Parent Artery Occlusion

Abstract OBJECTIVE: Endovascular coil embolization of saccular intracranial aneurysms is safe and effective, but long-term results are dissatisfying. Reconstructive treatments using stents improve occlusion rate and protect parent vessels. We present data on our experience with a new self-expanding stent manufactured with braided nitinol wires. METHODS: Twenty-five saccular, complex, and broad-necked intracranial aneurysms in 21 patients were treated electively. They were located at the internal carotid artery (10), basilar trunk (5), cavernous carotid artery (4), basilar tip (2), anterior cerebral artery (2), anterior communicating artery (1), and middle cerebral artery (1). Eleven aneurysms exhibited recanalization after primary endovascular treatment without stent. RESULTS: Stent deployment was successful in 24 lesions, and additional coil embolization was performed in 23. No permanent neurological deficits were encountered consequent to endovascular procedure. Complete or partial occlusion immediately after stent deployment was achieved in 19 aneurysms, whereas no immediate coil embolization was chosen in 6 cases. There were two thromboembolic events related to the deployment of the Leo stent, one failure of stent deployment, difficulties in stent positioning in three cases, and one asymptomatic parent artery occlusion after 7 months. Follow-up (available in 18 patients and 21 aneurysms and obtained at 3–12 mo; average, 5 mo) revealed patent stents in the remaining cases. Angiographic recurrences arose in three lesions, which were retreated without complications. CONCLUSION: Primary and recurrence treatment of saccular and broad-necked intracranial aneurysms using the Leo stent is feasible and effective. No permanent neurological deficits were associated with stent placement. Short-term follow-up identified intact parent arteries and stable occlusion rates in the majority of cases.

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A CASE OF ISOLATED DISSECTING ANEURYSM OF SUPERIOR MESENTERIC ARTERY SUCCESSFULLY TREATED BY ENDOVASCULAR STENT DEPLOYMENT AND COIL EMBOLIZATION

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.72.2460 ◽

2011 ◽

Vol 72 (9) ◽

pp. 2460-2465

Author(s):

Kaori SHIGEMITSU ◽

Ichiro MORITA ◽

Shinichiro KINOSHITA ◽

Takuya FUKAZAWA ◽

Tomoki YAMATSUJI ◽

...

Keyword(s):

Superior Mesenteric Artery ◽

Coil Embolization ◽

Mesenteric Artery ◽

Dissecting Aneurysm ◽

Endovascular Stent ◽

Stent Deployment

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Dose reduction in cone-beam CT scanning for intracranial stent deployment before coil embolization of intracranial wide-neck aneurysms

Interventional Neuroradiology ◽

10.1177/1591019916632489 ◽

2016 ◽

Vol 22 (4) ◽

pp. 420-425 ◽

Cited By ~ 3

Author(s):

Takumi Kuriyama ◽

Nobuyuki Sakai ◽

Norimitsu Niida ◽

Masaki Sueoka ◽

Mikiya Beppu ◽

...

Keyword(s):

Coil Embolization ◽

Cone Beam Ct ◽

Ct Scanning ◽

Cone Beam ◽

Stent Deployment ◽

Intracranial Stent ◽

Aneurysm Embolization ◽

Coil Occlusion ◽

Treatment Procedures ◽

Wide Neck

Purpose Flat panel detector (FD)-equipped angiography machines are increasingly used for neuro-angiographic imaging. During intracranial stent-assisted coil embolization procedures, it is very important to clearly and quickly visualize stent shape after deployment in the vessel. It is necessary to quickly visualize stents by cone-beam computed tomography (CBCT). The aim of this study was to compare CBCTs at 10 and 20 s, and to confirm that this method is useful for neuro-endovascular treatment procedures. Materials and methods We treated 30 patients with wide-necked intracranial aneurysms with a flexible, self-expanding neurovascular stent and subsequent aneurysm embolization with platinum micro-coils. We performed the CBCT after stent deployment. We compared the 10 s and 20 s CBCTs, using the full width one-half maximum (FWHM) visualization. Results Accurate stent placement with subsequent coil occlusion of the aneurysms was feasible in all patients. Stent struts were clearly visualized on both 10 s and 20 s CBCTs. Importantly, 10 s CBCT can reduce the radiation dose by about 42%, compared with 20 s CBCT. Performing 10 s CBCT with a 14% dilution of the contrast medium may significantly improve image acquisition during stent-assisted coil embolization. Conclusions Reduced-dose, 10 s CBCT can visualize stents in clinical cases, while significantly reducing radiation exposure.

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Leo Stent for Endovascular Treatment of Broad-Necked and Fusiform Intracranial Aneurysms

Interventional Neuroradiology ◽

10.1177/159101990701300305 ◽

2007 ◽

Vol 13 (3) ◽

pp. 255-269 ◽

Cited By ~ 23

Author(s):

R. Juszkat ◽

S. Nowak ◽

S. Smóal ◽

W. Kociemba ◽

T. Blok ◽

...

Keyword(s):

Endovascular Treatment ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Internal Carotid ◽

Aneurysm Rupture ◽

Parent Vessel ◽

Stent Deployment ◽

Acute Setting ◽

Aneurysm Occlusion ◽

Braided Stent

The advent of intracranial stents has widened the indications for endovascular treatment of broad-necked and fusiform aneurysms. Leo stent is a self-expandable, nitinol, braided stent dedicated to intracranial vessels. The aim of this study is to present our experience in endovascular treatment of broad-necked and fusiform intracranial aneurysms using self-expanding, nitinol Leo stents. Between February 2004 and November 2006, 25 broad-necked and three fusiform aneurysms in 28 patients were treated using Leo stents in our centre. There were 18 patients who experienced acute subarachnoid haemorrhage due to aneurysm rupture, two patients who experienced SAH at least 12 months ago and in eight patients aneurysms were found incidentally. Aneurysms were located as follows: internal carotid artery, basilar artery, basilar tip, posterior inferior cerebral artery, M1/M2 segment, A2 segment and vertebral artery. There were no difficulties with stent deployment and delivery. All patients after acute SAH (n=18) underwent stent implantation and coil embolization in one procedure. The remaining patients underwent coil embolization in a staged procedure. Immediate aneurysm occlusion of more than 95% was achieved in all patients who underwent stent placement and coil embolization in one procedure. There were three thromboembolic complications encountered in patients in an acute setting of SAH, preloaded only on acetylsalicylic acid. Use of abciximab led to patency within the stent and parent vessel. However, one of these patients presented rebleeding from the aneurysm during administration of abciximab and died. Application of Leo stents in cases of broad-necked and fusiform intracranial aneurysms is safe and effective with a low complication rate.

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Peri-stent aneurysm formation following a stent implant for stenotic intracranial vertebral artery dissection: a technical report of two cases successfully treated with coil embolization

Neuroradiology ◽

10.1007/s00234-012-1109-6 ◽

2012 ◽

Vol 55 (2) ◽

pp. 207-211 ◽

Cited By ~ 1

Author(s):

Hideki Ishimaru ◽

Kazuaki Nakashima ◽

Hideaki Takahata ◽

Yohjiro Matsuoka

Keyword(s):

Vertebral Artery ◽

Coil Embolization ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Aneurysm Formation ◽

Technical Report

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NEUROFORM STENT-ASSISTED COIL EMBOLIZATION OF WIDE-NECK INTRACRANIAL ANEURYSMS

Neurosurgery ◽

10.1227/01.neu.0000290890.62201.a9 ◽

2007 ◽

Vol 61 (3) ◽

pp. 460-469 ◽

Cited By ~ 268

Author(s):

Alessandra Biondi ◽

Vallabh Janardhan ◽

Jeffrey M. Katz ◽

Kimberly Salvaggio ◽

Howard A. Riina ◽

...

Keyword(s):

Coil Embolization ◽

Cerebral Aneurysms ◽

Effective Technique ◽

Stent Deployment ◽

Unruptured Aneurysms ◽

Aneurysm Occlusion ◽

Neuroform Stent ◽

Wide Neck

Abstract OBJECTIVE To evaluate the midterm results of intracranial stent-assisted coil embolization in the treatment of wide-necked cerebral aneurysms and to assess the efficacy of various strategies used in stent deployment. METHODS A retrospective study of 42 patients with 46 wide-necked cerebral aneurysms enrolled in a prospective single-center registry of patients treated with a Neuroform stent (Boston Scientific/Target, Fremont, CA), a flexible self-expanding nitinol stent, was performed. Twenty-seven of 46 aneurysms were unruptured aneurysms, 14 were recanalized aneurysms, and five were acutely ruptured. Thirty-nine aneurysms were located in the anterior and seven in the posterior circulation. Mean aneurysm size was 9.8 mm. Stenting before coiling was performed in 13 of 45 aneurysms (29%), coiling before stenting in 27 of 45 aneurysms (60%), and stenting alone in five of 45 aneurysms (11%). The balloon remodeling technique for coiling before stenting was performed in 77% of patients. Angiographic and clinical follow up was available in 31 patients with 33 aneurysms and ranged from 3 to 24 months. RESULTS Neuroform stenting was attempted in 46 wide-necked aneurysms (42 patients). Forty-nine stent sessions were performed, including three poststent retreatments. In 46 of 49 sessions (94%), successful deployment of 47 stents for 45 aneurysms was obtained. In 40 aneurysms treated with stent-assisted coiling, angiographic results showed 14 (35%) aneurysm occlusions, 18 (45%) neck remnants, and eight (20%) residual aneurysms. In five recanalized aneurysms treated with stenting alone, no changes were observed in four (80%) aneurysms and one (20%) neck remnant reduced in size. At angiographic follow-up in 30 aneurysms treated with stent-assisted coiling, there were 17 (57%) aneurysm occlusions, seven (23%) neck remnants, and six (20%) residual aneurysms. In three recanalized aneurysms treated with stent alone, two (67%) neck remnants remained unchanged and one (33%) neck remnant decreased in size. Procedural morbidity was observed in two of 42 patients (4.8%) and one patient died. On clinical follow-up, the modified Rankin Scale score was 0 in 27 patients (87%), 1 in three patients (10%), and 2 (3%) in one patient. No aneurysm bled during the follow-up period. CONCLUSION These results indicate that Neuroform stent-assisted coil embolization is a safe and effective technique in the treatment of wide-necked cerebral aneurysms. Further studies are needed to evaluate the long-term durability of stent-assisted aneurysm occlusion and tolerance to the stent.

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Jailed double-microcatheter technique following horizontal stenting for coil embolization of intracranial wide-necked bifurcation aneurysms: A technical report of two cases

Interventional Neuroradiology ◽

10.1177/1591019916685080 ◽

2017 ◽

Vol 23 (2) ◽

pp. 117-122 ◽

Cited By ~ 4

Author(s):

Takahiro Kitahara ◽

Taketo Hatano ◽

Makoto Hayase ◽

Etsuko Hattori ◽

Akinori Miyakoshi ◽

...

Keyword(s):

Endovascular Treatment ◽

Coil Embolization ◽

Internal Carotid ◽

Treatment Results ◽

Technical Report ◽

Complete Obliteration ◽

One Year ◽

The One ◽

Additional Coil

The horizontal stenting technique facilitates endovascular treatment of wide-necked bifurcation intracranial aneurysms. Previous literature shows, however, that subsequent coil embolization at initial treatment results in incomplete obliteration in many cases. The authors present two consecutive cases of wide-necked large bifurcation aneurysms to describe an additional coil embolization technique following horizontal stenting. The patients were a 53-year-old female with an unruptured internal carotid artery terminus aneurysm and a 57-year-old female with a recurrent basilar artery tip aneurysm. Both patients underwent endovascular treatment with horizontal stenting followed by coil embolization with jailed double-microcatheters. Immediate complete obliteration was achieved with no complications, and no recanalization was observed at the one-year follow-up in both cases. Coil embolization with jailed double-microcatheter technique following horizontal stenting is a safe and effective strategy for wide-necked bifurcation aneurysms.

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