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Influences of stents on the outcome of coil embolized intracranial aneurysms: comparison between a stent-remodeled and non-remodeled treatment

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Abstract

Purpose

The influences of a stent on the outcome of embolized aneurysms are not well known. The purpose of this study is to assess and compare the angiographic follow-up (FU) results of stent-remodeled (StR) and non-remodeled (nonR) coil embolization of intracranial aneurysms.

Methods

Thirty-seven StR patients with FU digital subtraction angiography (DSA) were matched with 37 nonR patients according to presentation (ruptured or unruptured), location of the aneurysm (sidewall or bifurcation), initial sac occlusion (complete/near complete or incomplete/failure), and the sac size (largest diameter/less than 2 mm difference). The baseline clinical and aneurysm characteristics, initial/FU treatment success rates, and FU DSA findings between the StR and nonR groups with regard to the morphologic features (size and location) of the aneurysms were assessed and compared.

Results

The StR group showed more frequent progressive thrombosis compared to the nonR group (56.8 vs. 27.0%; p < 0.05). These differences were more prominent for small aneurysms (70 vs. 25%; p < 0.05). Small aneurysms showed a lower rate of FU recanalization in the StR group compared to the nonR group (0 vs. 25%; p < 0.05). Sidewall aneurysms also showed a higher rate of progressive thrombosis in the StR group (61.1 vs. 27.8%; p < 0.05).

Conclusions

Coil embolization is an effective treatment method for intracranial aneurysms, however, changes on follow-up may affect the long-term outcome. Stent remodeling may aid in preserving and enhancing the treatment durability especially in small aneurysms.

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Acknowledgements

This work was supported by the Korea Research Foundation Grant funded by the Korean Government (KRF-2008-331-E00246).

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Authors and Affiliations

  1. Department of Radiology, Research Institute of Radiological Sciences, Yonsei University College of Medicine, Seoul, Korea

    Dong Joon Kim, Sang Hyun Suh, Jae Whan Lee, Byung Moon Kim & Dong Ik Kim

  2. Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea

    Jae Wook Lee & Seung Kon Huh

  3. Department of Radiology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemoon-gu, Seoul, Korea

    Dong Ik Kim

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  1. Dong Joon Kim
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Correspondence to Dong Ik Kim.

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Comment

In the beginning, there is always enthusiasm towards new devices that may or may not be forgotten after relatively short periods of time. New and different kinds of seemingly very promising stents and coils appear on the market frequently without any possibility for us to make a comparison between them as next week there is already a new device on the market to be used. We do not know the long-term consequences of putting hardware like stents inside brain arteries, yet. Will they later migrate partially out of the parent artery and does it even matter? Will they occlude or obstruct arteries from the inside?

In the present study with some selection bias, stent-assisted coiling seems to be more effective than coiling alone in small aneurysms. The follow-up was relatively short to exclude potential parent artery occlusion caused by fibrosis not to talk about late re-canalization of the aneurysms. The adverse effects and costs of long-term anticoagulation can not be understated. The procedural complications of clipping and coiling are about the same in experienced hands (1, 2). Coiling is not without morbidity and mortality, and naturally adding stenting to the procedure must add to the rate of complications. Has anyone analyzed this? In ISAT, only coils were used and compared to clipping. Now those still clipping aneurysms are considered almost as criminals. Is there then a randomized study showing stent-assisted coiling to be superior to clipping in terms of efficacy and safety?

However, if modern stents and flow-diversion work, then some of the problems we are facing with complex and giant aneurysms may be solved. Clipping of small aneurysms, excluding blister-likes (3), is still relatively safe and quick with excellent long-term results regarding durability with no need for anticoagulation.

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3. Meling TR, Sorteberg A, Bakke SJ, Slettebø H, Hernesniemi J, Sorteberg W. Blood blister-like aneurysms of the internal carotid artery trunk casuing subarchnoid hemorrhage: treatment and outcome. J Neurosurg 108(4), 662–671, 2008

Mika Niemelä

Riku Kivisaari

Juha Hernesniemi

Helsinki, Finland

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Kim, D.J., Suh, S.H., Lee, J.W. et al. Influences of stents on the outcome of coil embolized intracranial aneurysms: comparison between a stent-remodeled and non-remodeled treatment. Acta Neurochir 152, 423–429 (2010). https://doi.org/10.1007/s00701-009-0522-z

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