Y-Stent-Assisted Coil Embolization of Anterior Circulation Aneurysms Using Two Solitaire AB Devices: A Single Center Experience

Wide-neck intracranial aneurysms remain a challenge to endovascular treatment. We describe our experience in repairing wide-neck aneurysms of the anterior circulation located at arterial branch points using coil embolization assisted by Y-stenting using two Solitaire® stents. Six wide-neck intracranial aneurysms located on the middle cerebral artery bifurcation 3, pericallosal artery 1, and anterior communicating artery 2 were repaired by Y-stent-assisted coil embolization using two Solitaire® stents. Four cases were incidental findings of aneurysm and two cases were previously treated ruptured aneurysms that had undergone recanalization. All the cases were successfully treated without complications. Follow-up by digital subtraction angiography and magnetic resonance angiography at six months showed the stents to be patent with no recanalization of the aneurysm sacs. Repairing wide-neck aneurysms of the anterior circulation by Y-stent-assisted coil embolization using two Solitaire® stents is a simple and safe method of treating complex aneurysms. While the results are promising, larger series with longer term follow-ups are needed to corroborate that this treatment method is superior to other techniques.

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Endovascular treatment of wide-neck intracranial bifurcation aneurysms with ‘Y’-configuration, double Neuroform® stents-assisted coiling technique: Experience in a single center

Interventional Neuroradiology ◽

10.1177/1591019917708568 ◽

2017 ◽

Vol 23 (4) ◽

pp. 362-370 ◽

Cited By ~ 7

Author(s):

C Castaño ◽

M Terceño ◽

S Remollo ◽

MR García-Sort ◽

C Domínguez

Keyword(s):

Endovascular Treatment ◽

Medical Records ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Internal Carotid ◽

Anterior Communicating Artery ◽

Single Center ◽

Endovascular Approach ◽

Double Stent ◽

Wide Neck

Background Intracranial wide-neck aneurysms at the arterial bifurcations, especially in the aneurysms where the bifurcating branches emanate directly from the base of the aneurysm, have been particularly difficult on which to perform endovascular treatment. The ‘Y’-configuration, double stent-assisted coil embolization is an option for the treatment of these difficult aneurysms, allowing the closure of the aneurysm, preserving the parent arteries. Material and methods In a nine-year period, 546 intracranial aneurysms in 493 patients were treated at our center by endovascular approach. We have reviewed the medical records and arteriographies from November 2007 to January 2017 of 45 patients who were treated using ‘Y’-configuration double Neuroform® stent-assisted coil embolization. Results All patients were successfully treated. The location of the aneurysms were: middle cerebral artery (MCA) 20 (44.4%), anterior communicating artery (AComA) 17 (37.7%), basilar four (8.9%), internal carotid artery (ICA) bifurcation three (6.6%) and posterior communicating artery (PComA) one (2.2%). The mRS at hospital discharge was: mRS 0: 42 (93.3%), mRS 1: 1 (2.2%), mRS 2: 1 (2.2%) and mRS 5: 1 (2.2%). The Modified Raymond-Roy Occlusion Classification, in the control at six months, was: Class I: 41 (91.1%), Class II: 2 (4.4%), Class IIIa: 1 (2.2%) and Class IIIb: 1 (2.2%). Forty-four (97.8%) patients had a good outcome (mRS < 2) at six months. One (2.2%) patient had a poor outcome (mRS > 2) at six months that was due to sequelae of SAH. There was no mortality at six months. Conclusions This technique is safe and effective for the endovascular treatment of difficult wide-neck bifurcation aneurysms, allowing the stable closure of the aneurysm, preserving the parent arteries.

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Single Center Experience With Pipeline Stent

Neurosurgery ◽

10.1227/neu.0b013e318260fe86 ◽

2012 ◽

Vol 71 (3) ◽

pp. 679-691 ◽

Cited By ~ 79

Author(s):

Rohan Chitale ◽

L. Fernando Gonzalez ◽

Ciro Randazzo ◽

Aaron S. Dumont ◽

Stavropoula Tjoumakaris ◽

...

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Parent Artery ◽

Anterior Circulation ◽

Single Center Experience ◽

Endovascular Coil Embolization ◽

Vertebrobasilar Junction ◽

High Degree ◽

Endovascular Skills ◽

Pipeline Stent

Abstract BACKGROUND: Endovascular coil embolization is an established method of treatment for intracranial aneurysms. The pipeline embolization device (PED) is a low-porosity endovascular stent designed to reconstruct the parent artery and decrease blood flow into the aneurysm. OBJECTIVE: To report a series of 36 patients treated with the PED. METHODS: Thirty-six patients underwent PED placement for aneurysm at the Jefferson Hospital for Neuroscience from October 2010 to November 2011. Clinical charts were reviewed. RESULTS: Thirty-six patients with 42 aneurysms were treated (3 male; 33 female; ages, 34–82; mean age, 60.1 years). Forty-one aneurysms were located in the anterior circulation, whereas one was located at the vertebrobasilar junction. PED placement was successful in all patients and resulted in stasis within all treated aneurysms. Symptomatic postoperative complications were witnessed in 13.9% (n = 5) of patients. These complications included intracerebral hemorrhage (n = 4), dissection (n = 1), symptomatic stroke (n = 2), and death (n = 1). CONCLUSION: Treatment of simple or complex intracranial aneurysms with PEDs alone or in conjunction with coil embolization is technically feasible, and the deployment technique requires a high degree of endovascular skills. Major perioperative adverse events must be studied. Respect for the indications of the procedure is crucial to justify the risk.

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Y-Stent-Assisted Coil Embolization of Wide-Neck Intracranial Aneurysms

Interventional Neuroradiology ◽

10.1177/159101991101700107 ◽

2011 ◽

Vol 17 (1) ◽

pp. 36-48 ◽

Cited By ~ 44

Author(s):

E. Akgul ◽

E. Aksungur ◽

T. Balli ◽

B. Onan ◽

D.M. Yilmaz ◽

...

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Neurological Complications ◽

Anterior Communicating Artery ◽

Hybrid Technique ◽

Treatment Technique ◽

Midterm Results ◽

Procedural Complication ◽

Wide Neck

This report evaluated the short and midterm results of the safety and effectiveness of the treatment technique with hybrid and non-hybrid Y-configured, dual stent-assisted coil embolization of wide-neck intracranial aneurysms, and reviewed the literature concerning this technique. Nine patients, eight with unruptured and one with ruptured aneurysms were included in the study. Of aneurysms embolized with a hybrid (with two different stents) and non-hybrid (with two identical stents) technique, three were located in the anterior communicating artery, three at the tip and one at the distal site of basilar artery, and two in the middle cerebral artery. All aneurysms included the orifices of bifurcation vessels. All aneurysms were stented and embolized during the same session. While Neuroform and Enterprise stents were used in the hybrid technique, two Enterprise stents were used in the non-hybrid technique. Dual Y-stent assisted coil embolization was performed successfully in eight of nine patients (88.9%), including five patients (55.6%) with hybrid and three patients (33.3%) with non-hybrid technique. No procedural complication, no mortality and no minor or major neurological complications were seen during the angiographic or clinical follow-up. When an attempt was made at passing the second stent through the first Enterprise stent, the stent protruded inside the aneurysm in one patient (11.1%). Hybrid or non-hybrid dual Y-stent-assisted coil embolization in the treatment of ruptured or unruptured wide-neck and complex intracranial aneurysms is a safe and effective method from the viewpoint of short and midterm results.

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Single-center experience with balloon-assisted coil embolization of intracranial aneurysms: Safety, efficacy and indications

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2012.07.028 ◽

2013 ◽

Vol 115 (5) ◽

pp. 607-613 ◽

Cited By ~ 14

Author(s):

Nohra Chalouhi ◽

Pascal Jabbour ◽

Stavropoula Tjoumakaris ◽

Aaron S. Dumont ◽

Rohan Chitale ◽

...

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Single Center ◽

Single Center Experience

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LVIS Blue as a low porosity stent and coil adjuvant

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2017-013608 ◽

2018 ◽

Vol 10 (7) ◽

pp. 682-686 ◽

Cited By ~ 7

Author(s):

Matthew J Koch ◽

Christopher J Stapleton ◽

Scott B Raymond ◽

Susan Williams ◽

Thabele M Leslie-Mazwi ◽

...

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Posterior Inferior Cerebellar Artery ◽

Endovascular Embolization ◽

Superior Cerebellar Artery ◽

Anterior Communicating Artery ◽

Aneurysm Neck ◽

Proximal Internal Carotid Artery ◽

Cerebellar Artery

IntroductionThe LVIS Blue is an FDA-approved stent with 28% metallic coverage that is indicated for use in conjunction with coil embolization for the treatment of intracranial aneurysms. Given a porosity similar to approved flow diverters and higher than currently available intracranial stents, we sought to evaluate the effectiveness of this device for the treatment of intracranial aneurysms.MethodsWe performed an observational single-center study to evaluate initial occlusion and occlusion at 6-month follow-up for patients treated with the LVIS Blue in conjunction with coil embolization at our institution using the modified Raymond–Roy classification (mRRC), where mRRC 1 indicates complete embolization, mRRC 2 persistent opacification of the aneurysm neck, mRRC 3a filling of the aneurysm dome within coil interstices, and mRRC 3b filling of the aneurysm dome.ResultsSixteen aneurysms were treated with the LVIS Blue device in conjunction with coil embolization with 6-month angiographic follow-up. Aneurysms were treated throughout the intracranial circulation: five proximal internal carotid artery (ICA) (ophthalmic or communicating segments), two superior cerebellar artery, two ICA terminus, two anterior communicating artery, two distal middle cerebral artery, one posterior inferior cerebellar artery, and two basilar tip aneurysms. Post-procedurally, there was one mRRC 1 closure, five mRRC 2 closures, and 10 mRRC 3a or 3b occlusion. At follow-up, all the mRRC 1 and mRRC 3a closures, 85% of the mRRC 3b closures and 75% of the mRRC 2 closures were stable or improved to an mRRC 1 or 2 at follow-up.ConclusionsThe LVIS Blue represents a safe option as a coil adjunct for endovascular embolization within both the proximal and distal anterior and posterior circulation.

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Treatment of Wide-Neck Intracranial Aneurysms with the Woven EndoBridge Device Associated with Stenting: A Single-Center Experience

American Journal of Neuroradiology ◽

10.3174/ajnr.a6032 ◽

2019 ◽

Vol 40 (5) ◽

pp. 820-826 ◽

Cited By ~ 7

Author(s):

F. Cagnazzo ◽

R. Ahmed ◽

C. Dargazanli ◽

P.-H. Lefevre ◽

G. Gascou ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Single Center ◽

Single Center Experience ◽

Woven Endobridge ◽

Wide Neck

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Stent-assisted coil embolization of aneurysms with small parent vessels: safety and efficacy analysis

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011774 ◽

2015 ◽

Vol 8 (6) ◽

pp. 581-585 ◽

Cited By ~ 9

Author(s):

Anna Luisa Kühn ◽

Samuel Y Hou ◽

Ajit S Puri ◽

Christine F Silva ◽

Matthew J Gounis ◽

...

Keyword(s):

Coil Embolization ◽

Incidental Finding ◽

Vascular Risk ◽

Thromboembolic Complications ◽

Anterior Circulation ◽

Stent Occlusion ◽

Efficacy Analysis ◽

Wide Neck

BackgroundStent-assisted coil embolization (SACE) is a viable therapeutic approach for wide-neck intracranial aneurysms. However, it can be technically challenging in small cerebral vessels (≤2 mm).ObjectiveTo present our experience with stents approved for SACE in aneurysms with small parent arteries.MethodsAll patients who underwent stent-assisted aneurysm treatment with either a Neuroform or an Enterprise stent device at our institution between June 2006 and October 2012 were identified. Additionally, we evaluated each patient's vascular risk factors, aneurysm characteristics (ruptured vs non-ruptured, incidental finding, recanalized) and follow-up angiography data.ResultsA total of 41 patients with 44 aneurysms met our criteria, including 31 women and 10 men. Most of the aneurysms were located in the anterior circulation (75%). Stent placement in vessels 1.2–2 mm in diameter was successful in 93.2%. Thromboembolic complications occurred in 6 cases and vessel straightening was seen in 1 case only. Initial nearly complete to complete aneurysm obliteration was achieved in 88.6%. Six-month follow-up angiography showed coil compaction in three cases, one asymptomatic in-stent stenosis and stent occlusion. Twelve to 20-months’ follow-up showed stable coil compaction in two patients compared with previous follow-up, and aneurysm recanalization in two patients. Twenty-four to 36-months’ follow-up showed further coil compaction in one of these patients and aneurysm recanalization in a previous case of stable coil compaction on mid-term follow-up.ConclusionsOur results suggest that SACE of aneurysms with small parent vessels is feasible in selected cases and shows good long-term patency rates of parent arteries.

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Stent Induced Changes to the Radius of Curvature of the Cerebrovasculature

ASME 2012 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2012-80866 ◽

2012 ◽

Author(s):

Robert M. King ◽

Juyu Chueh ◽

Imramsjah M. J. van der Bom ◽

Christine F. Silva ◽

Ajay K. Wakhloo ◽

...

Keyword(s):

Endovascular Treatment ◽

Stent Implantation ◽

Coil Embolization ◽

Intracranial Aneurysms ◽

Significant Error ◽

Radius Of Curvature ◽

Anterior Communicating Artery ◽

Parent Artery ◽

Hemodynamic Changes ◽

Induced Changes

Stent implantation has expanded the endovascular treatment of intracranial aneurysms to those with widenecks, that were previously unfavorable to coil embolization. Past studies have found that several mechanisms including stent-induced endothelization and hemodynamic changes due to alteration in vessel geometry may contribute to stable clot formation within the aneurysmal sac and aid in aneurismal healing [1,2]. Change in the angle of the parent arteries after stent-assisted coil embolization of anterior communicating artery (Acom) aneurysms has been measured on projection angiograms; however, use of 2D angiographic datasets to describe changes of vessel angle in 3D may result in significant error. The goal of this study was to quantitatively characterize the change in the radius of curvature (RC) of the parent artery induced by the implantation of an intracranial stent in 3D.

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Surgical Clipping May Lead to Better Results than Coil Embolization: Results from a Series of 101 Consecutive Unruptured Intracranial Aneurysms

Neurosurgery ◽

10.1227/01.neu.0000064568.71648.ec ◽

2003 ◽

Vol 52 (6) ◽

pp. 1280-1290 ◽

Cited By ~ 49

Author(s):

Christian Raftopoulos ◽

Pierre Goffette ◽

Geraldo Vaz ◽

Najib Ramzi ◽

Jean-Louis Scholtes ◽

...

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Adverse Outcomes ◽

Surgical Clipping ◽

Anterior Circulation ◽

Significant Discrepancy ◽

Obliteration Rate ◽

Unruptured Intracranial Aneurysms ◽

A Prospective Study ◽

Middle Cerebral Artery Aneurysms

Abstract OBJECTIVE Recent reports in the literature have described a significant discrepancy in adverse outcomes between coil embolization (CE; 10%) and surgical clipping (SC; 25%) for the management of unruptured intracranial aneurysms (UIA). This discrepancy led us to analyze our experience. METHODS In 1996, we designed a prospective study of patients with UIA in which CE was considered the treatment of choice and was performed if the interventional neuroradiologists deemed the aneurysm's fundus-to-neck ratio accessible for CE. SC was performed only if complete CE was unlikely to be achieved or in patients in whom CE already had failed. RESULTS CE was performed in 38 patients with at least one UIA (41 UIAs, 83% in the anterior circulation). SC was performed in 39 patients with at least one UIA unsuitable for CE (59 UIAs, including 6 after failed CE, 96.5% in the anterior circulation). For CE, the total obliteration rate was 56.1%, the subtotal was 14.6%, and CE failed in 29.3%. There were transient complications in 10% of the cases and permanent complications in 7.5%. Of the 12 failed CE procedures, 7 (58%) were performed for middle cerebral artery aneurysms. For SC, the total obliteration rate was 93.2%, the subtotal was 1.7%, and SC failed (wrapping) in 5.1%. There were transient complications in 16.3% of the patients and permanent complications in 1.7%. The success rate for CE was similar to that for SC only when CE was used for aneurysms with a fundus-to-neck ratio of at least 2.5. CONCLUSION SC can produce better results than CE in patients with UIA of the anterior circulation. CE as a first-line treatment should be reserved for patients with UIAs with a fundus-to-neck ratio of 2.5 or greater.

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