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The place for remodeling technique and stenting in the endovascular management of intracranial aneurysms: a single-center analysis from 2008 to 2010

  • Interventional Neuroradiology
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Abstract

Introduction

The objective of this study was to analyze the place for the balloon remodeling and stenting in the endovascular treatment of intracranial aneurysms as well as the impact of their use on the failure and complications rates. Analysis was conducted in a recent 3-year period (2008–2010) in a single center.

Methods

A total of 287 aneurysms, harbored by 252 patients (age, 16–87 years; mean, 50.9 ± 13.4 years), were proposed for endovascular treatment. Patient and aneurysms characteristics, modalities of treatment (coiling, remodeling, or stenting), failure rate, and rate of adverse events related to the treatment were analyzed.

Results

Treatment failed in 3/287 aneurysms (1.0%). The use of the remodeling technique and stenting increased over time (23.9% and 4.6% in 2008, 39.5% and 14.9% in 2009, and 43.9% and 20.7% in 2010, respectively). The remodeling technique was used in a similar percentage of cases independent of aneurysm characteristics (aneurysm status, location, and size, and neck size), except dome-to-neck ratio. Stenting was more frequently used in unruptured aneurysms, in internal carotid artery aneurysms, and in wide neck aneurysms. The rate of specific adverse events (thromboembolism and intraoperative rupture) was similar in coiling (2.8%), remodeling (6.9%), and stenting (1.1%). The rate of specific adverse events was similar in 2008, 2009, and 2010 (2.3%, 4.4%, and 6.1%, respectively).

Conclusion

In the endovascular management of intracranial aneurysms, the large use of the remodeling technique combined with stenting in selected cases enables a low rate of treatment failures without increasing the rate of complications.

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References

  1. Molyneux AJ, Kerr RSC, Stratton I, International Subarachnoid Aneurysm Trial (ISAT) Colaborative Group et al (2002) International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1262–1263

    Article  Google Scholar 

  2. Pierot L, Spelle L, Vitry F, for the ATENA investigators (2008) Clinical outcome of patients harbouring unruptured intracranial aneurysms treated by endovascular approach: results of the ATENA trial. Stroke 39:2497–2504

    Article  PubMed  Google Scholar 

  3. Piotin M, Pistocchi S, Bartolini B, Blanc R (2011) Intracranial aneurysm coiling with PGLA-coated coils versus bare platinum coils: long-term anatomic follow-up. Neuroradiology (in press)

  4. Ryu CW, Kwon OK, Koh JS, Kim EJ (2011) Analysis of aneurysm rupture in relation to the geometric indices: aspect ratio, volume, and volume-to-neck ratio. Neuroradiology 53:883–889

    Google Scholar 

  5. Hwang JH, Roh HG, Chun YI, Kang HS, Choi JW, Moon WJ, Cho J, Moon CT, Koh YC (2011) Endovascular coil embolization of very small intracranial aneurysms. Neuroradiology 53:349–357

    Article  PubMed  Google Scholar 

  6. Bandeira A, Raphaeli G, Balériaux D, Bruneau M, De Witte O, Lubicz B (2010) Selective embolization of unruptured intracranial aneurysms is associated with low retreatment rate. Neuroradiology 52:141–146

    Article  PubMed  Google Scholar 

  7. Moret J, Cognard C, Weill A, Castaings L, Rey A (1997) The “remodeling technique” in the treatment of wide neck intracranial aneurysms. Intervent Neuroradiol 3:21–35

    CAS  Google Scholar 

  8. Aletich VA, Debrun GM, Misra M, Charbel F, Ausman JL (2000) The remodeling technique of balloon-assisted Guglielmi detachable coil placement in wide-necked aneurysms: experience at the University of Illinois at Chicago. J Neurosurg 93:388–396

    Article  PubMed  CAS  Google Scholar 

  9. Cottier JP, Pasco A, Gallas S et al (2001) Utility of balloon-assisted Guglielmi detachable coiling in the treatment of 49 cerebral aneurysms: a retrospective, multicenter study. AJNR Am J Neuroradiol 22:345–351

    PubMed  CAS  Google Scholar 

  10. Layton KF, Cloft HJ, Gray LA, Lewis DA, Kallmes DF (2007) Balloon-assisted coiling of intracranial aneurysms: evaluation of local thrombus formation and symptomatic thromboembolic complications. AJNR Am J Neuroradiol 28:1172–1175

    Article  PubMed  CAS  Google Scholar 

  11. Lefkowitz MA, Gobin YP, Akiba Y et al (1999) Balloon-assisted Guglielmi detachable coiling of wide necked aneurysms, II: clinical results. Neurosurgery 45:531–537

    Article  PubMed  CAS  Google Scholar 

  12. Malek AM, Halbach VV, Phatouros CC et al (2000) Balloon-assisted technique for endovascular coil embolization of geometrically difficult intracranial aneurysms. Neurosurgery 22:19–26

    Google Scholar 

  13. Nelson PK, Levy DI (2001) Balloon-assisted coil embolization of wide-necked aneurysms of the internal carotid artery: medium term angiographic and clinical follow-up in 22 patients. AJNR Am J Neuroradiol 22:19–26

    PubMed  CAS  Google Scholar 

  14. Ross IB, Dhillon GS (2006) Balloon assistance as a routine adjunct to the endovascular treatment of cerebral aneurysms. Surg Neurol 66:593–601

    Article  PubMed  Google Scholar 

  15. Sluzewski M, Von Rooij WJ, Beute GN, Nijssen PC (2006) Balloon-assisted coil embolization of intracranial aneurysms: incidence, complications, and angiography results. J Neurosurg 105:396–399

    Article  PubMed  Google Scholar 

  16. Pierot L, Spelle L, Leclerc X, Cognard C, Bonafé A, Moret J (2009) Endovascular treatment of unruptured intracranial aneurysms: comparison of safety of remodeling technique and standard treatment with coils. Radiology 251:846–855

    Article  PubMed  Google Scholar 

  17. Pierot L, Cognard C, Anxionnat R, Ricolfi F, for the CLARITY investigators (2011) Remodeling technique for endovascular treatment of ruptured intracranial aneurysms had a high rate of adequate postoperative occlusion than did conventional coil embolization with comparable safety. Radiology 258:546–553

    Article  PubMed  Google Scholar 

  18. Cekirge HS, Yavuz K, Geyik S, Saatchi I (2011) Hyperform balloon remodeling in the endovascular treatment of anterior cerebral, middle cerebral, and anterior communicating artery aneurysms: clinical and angiographic follow-up results in 800 consecutive patients. J Neurosurg 114:944–953

    Article  PubMed  Google Scholar 

  19. Piotin M, Blanc R, Spelle L et al (2010) Stent-assisted coiling of intracranial aneurysm. Clinical and angiographic results in 216 consecutive aneurysms. Stroke 41:110–115

    Article  PubMed  Google Scholar 

  20. Meckel S, Singh TP, Undren P et al (2011) Endovascular treatment using predominantly stent-assisted coil embolization and antiplatelet and anticoagulation management of ruptured blood blister-like aneurysms. AJNR Am J Neuroradiol 32:764–771

    Article  PubMed  CAS  Google Scholar 

  21. Pierot L (2011) Flow diverter stents in the treatment of intracranial aneurysms: where are we? J Neuroradiol 38:40–46

    Article  PubMed  Google Scholar 

  22. Ferns SP, Sprengers MES, von Rooij WJ et al (2009) Coiling of intracranial aneurysms: a systematic review on initial occlusion and reopening and retreatment rates. Stroke 40:e523–e529

    Article  PubMed  Google Scholar 

  23. Henkes H, Fischer S, Weber W et al (2004) Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results. Neurosurgery 54:268–280

    Article  PubMed  Google Scholar 

  24. Gallas S, Januel AC, Pasco A et al (2003) Long-term follow-up of 1036 cerebral aneurysm treated with bare coils: a multicentric cohort treated between 1998 and 2003. AJNR Am J Neuroradiol 30:1986–1992

    Article  Google Scholar 

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Conflict of interest

LP consults for Codman, EV3, Microvention, and Sequent.

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Authors and Affiliations

  1. Department of Neuroradiology, Reims University, Reims, France

    Laurent Pierot, Girish Rajpal & Krzysztof Kadziolka

  2. Department of Clinical Research, Reims University, Reims, France

    Coralie Barbe

  3. Service de Radiologie—Hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51092, Reims cedex, France

    Laurent Pierot

Authors
  1. Laurent Pierot
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  2. Girish Rajpal
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  3. Krzysztof Kadziolka
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  4. Coralie Barbe
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Correspondence to Laurent Pierot.

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Pierot, L., Rajpal, G., Kadziolka, K. et al. The place for remodeling technique and stenting in the endovascular management of intracranial aneurysms: a single-center analysis from 2008 to 2010. Neuroradiology 54, 973–979 (2012). https://doi.org/10.1007/s00234-011-0975-7

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  • DOI: https://doi.org/10.1007/s00234-011-0975-7

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