Abstract
Purpose
Before we enter the era of flow diverter stents (FDS), the standard stent-assisted coiling technique is a well-established treatment option for routine paraclinoid aneurysms. We assess the clinical safety and efficacy of stent-assisted coiling with open-cell stent in the treatment of paraclinoid aneurysms and evaluate the association between clinical factors and follow-up aneurysm occlusion.
Methods
The clinical and radiographic data of 110 consecutive patients with 122 paraclinoid aneurysms treated with open-cell stent between April 2015 and April 2019 were analyzed retrospectively at our center. We assessed the immediate and progressive occlusion rates, complications, and clinical outcome. Multivariate analysis was performed to investigate the risk factors of angiographic incomplete occlusion.
Results
Among 110 patients, stent-assisted coiling was successfully performed in all cases. Four (3.6%) thromboembolic events were reported during the procedure, which resulted in transient morbidity. Immediate angiography demonstrated complete occlusion in 64 (52.5%) aneurysms and no occlusion of ophthalmic artery. Angiographic follow-up at 6 months demonstrated an increase in the complete occlusion rate to 92.9%. No delayed in-stent stenosis was observed, and three aneurysms recurred. Clinical follow-up was completed in 102 patients (92.7%), and favorable outcomes were achieved in 101 (99%) patients at 6 months. Multivariate analysis showed that aneurysm size (p < 0.001) was associated with incomplete aneurysm occlusion at follow-up.
Conclusion
Stent-assisted coil embolization with open-cell stents is safe and effective for the treatment of paraclinoid aneurysms and provides progressive occlusion without significant in-stent stenosis events.
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References
Hoh BL, Carter BS, Budzik RF, Putman CM, Ogilvy CS (2001) Results after surgical and endovascular treatment of paraclinoid aneurysms by a combined neurovascular team. Neurosurgery 48(1):78–89; discussion 89-90. https://doi.org/10.1097/00006123-200101000-00014
Colli BO, Carlotti CG Jr, Assirati JA Jr, Abud DG, Amato MC, Dezena RA (2013) Results of microsurgical treatment of paraclinoid carotid aneurysms. Neurosurg Rev 36(1):99–114; discussion 114-115. https://doi.org/10.1007/s10143-012-0415-0
Fulkerson DH, Horner TG, Payner TD, Leipzig TJ, Scott JA, Denardo AJ, Redelman K, Goodman JM (2009) Endovascular retrograde suction decompression as an adjunct to surgical treatment of ophthalmic aneurysms: analysis of risks and clinical outcomes. Neurosurgery 64(3 Suppl):ons107–ons111; discussion ons111-102. https://doi.org/10.1227/01.NEU.0000330391.20750.71
Touze R, Gravellier B, Rolla-Bigliani C, Touitou V, Shotar E, Lenck S, Boch AL, Degos V, Sourour NA, Clarencon F (2019) Occlusion rate and visual complications with flow-diverter stent placed across the ophthalmic artery’s origin for carotid-ophthalmic aneurysms: a meta-analysis. Neurosurgery. https://doi.org/10.1093/neuros/nyz202
Silva MA, See AP, Khandelwal P, Mahapatra A, Frerichs KU, Du R, Patel NJ, Aziz-Sultan MA (2018) Comparison of flow diversion with clipping and coiling for the treatment of paraclinoid aneurysms in 115 patients. J Neurosurg 130:1–8. https://doi.org/10.3171/2018.1.JNS171774
Griessenauer CJ, Piske RL, Baccin CE, Pereira BJA, Reddy AS, Thomas AJ, Abud TG, Ogilvy CS (2017) Flow diverters for treatment of 160 ophthalmic segment aneurysms: evaluation of safety and efficacy in a multicenter cohort. Neurosurgery 80(5):726–732. https://doi.org/10.1093/neuros/nyw110
Walcott BP, Stapleton CJ, Torok CM, Patel AB (2017) Flow diversion for the treatment of an unruptured paraclinoid carotid artery aneurysm. Oper Neurosurg (Hagerstown) 13(4):537. https://doi.org/10.1093/ons/opw039
Adeeb N, Griessenauer CJ, Foreman PM, Moore JM, Motiei-Langroudi R, Chua MH, Gupta R, Patel AS, Harrigan MR, Alturki AY, Ogilvy CS, Thomas AJ (2017) Comparison of stent-assisted coil embolization and the pipeline embolization device for endovascular treatment of ophthalmic segment aneurysms: a multicenter cohort study. World Neurosurg 105:206–212. https://doi.org/10.1016/j.wneu.2017.05.104
Burrows AM, Brinjikji W, Puffer RC, Cloft H, Kallmes DF, Lanzino G (2016) Flow diversion for ophthalmic artery aneurysms. AJNR Am J Neuroradiol 37(10):1866–1869. https://doi.org/10.3174/ajnr.A4835
Zhou G, Zhu YQ, Su M, Gao KD, Li MH (2016) Flow-diverting devices versus coil embolization for intracranial aneurysms: a systematic literature review and meta-analysis. World Neurosurg 88:640–645. https://doi.org/10.1016/j.wneu.2015.11.007
Durst CR, Starke RM, Clopton D, Hixson HR, Schmitt PJ, Gingras JM, Ding D, Liu KC, Crowley RW, Jensen ME, Evans AJ, Gaughen J (2016) Endovascular treatment of ophthalmic artery aneurysms: ophthalmic artery patency following flow diversion versus coil embolization. J Neurointerv Surg 8(9):919–922. https://doi.org/10.1136/neurintsurg-2015-011887
Di Maria F, Pistocchi S, Clarencon F, Bartolini B, Blanc R, Biondi A, Redjem H, Chiras J, Sourour N, Piotin M (2015) Flow diversion versus standard endovascular techniques for the treatment of unruptured carotid-ophthalmic aneurysms. AJNR Am J Neuroradiol 36(12):2325–2330. https://doi.org/10.3174/ajnr.A4437
Moon K, Albuquerque FC, Ducruet AF, Webster Crowley R, McDougall CG (2014) Treatment of ophthalmic segment carotid aneurysms using the pipeline embolization device: clinical and angiographic follow-up. Neurol Res 36(4):344–350. https://doi.org/10.1179/1743132814Y.0000000322
Lanzino G, Crobeddu E, Cloft HJ, Hanel R, Kallmes DF (2012) Efficacy and safety of flow diversion for paraclinoid aneurysms: a matched-pair analysis compared with standard endovascular approaches. AJNR Am J Neuroradiol 33(11):2158–2161. https://doi.org/10.3174/ajnr.A3207
Shimizu K, Imamura H, Mineharu Y, Adachi H, Sakai C, Sakai N (2016) Endovascular treatment of unruptured paraclinoid aneurysms: single-center experience with 400 cases and literature review. AJNR Am J Neuroradiol 37(4):679–685. https://doi.org/10.3174/ajnr.A4577
Oh SY, Lee KS, Kim BS, Shin YS (2015) Management strategy of surgical and endovascular treatment of unruptured paraclinoid aneurysms based on the location of aneurysms. Clin Neurol Neurosurg 128:72–77. https://doi.org/10.1016/j.clineuro.2014.11.008
Wang Y, Li Y, Jiang C, Jiang F, Meng H, Siddiqui AH, Yang X (2013) Endovascular treatment of paraclinoid aneurysms: 142 aneurysms in one centre. J Neurointerv Surg 5(6):552–556. https://doi.org/10.1136/neurintsurg-2012-010494
D'Urso PI, Karadeli HH, Kallmes DF, Cloft HJ, Lanzino G (2012) Coiling for paraclinoid aneurysms: time to make way for flow diverters? AJNR Am J Neuroradiol 33(8):1470–1474. https://doi.org/10.3174/ajnr.A3009
Gu DQ, Zhang X, Luo B, Long XA, Duan CZ (2013) The effect of Neuroform stent-assisted coil embolization of wide-necked intracranial aneurysms and clinical factors on progressive aneurysm occlusion on angiographic follow-up. J Clin Neurosci 20(2):244–247. https://doi.org/10.1016/j.jocn.2012.01.053
Kulcsar Z, Goricke SL, Gizewski ER, Schlamann M, Sure U, Sandalcioglu IE, Ladd S, Mummel P, Kastrup O, Forsting M, Wanke I (2013) Neuroform stent-assisted treatment of intracranial aneurysms: long-term follow-up study of aneurysm recurrence and in-stent stenosis rates. Neuroradiology 55(4):459–465. https://doi.org/10.1007/s00234-013-1143-z
Santillan A, Greenberg E, Patsalides A, Salvaggio K, Riina HA, Gobin YP (2012) Long-term clinical and angiographic results of Neuroform stent-assisted coil embolization in wide-necked intracranial aneurysms. Neurosurgery 70(5):1232–1237; discussion 1237. https://doi.org/10.1227/NEU.0b013e3182422a68
International Study of Unruptured Intracranial Aneurysms I (1998) Unruptured intracranial aneurysms--risk of rupture and risks of surgical intervention. N Engl J Med 339(24):1725–1733. https://doi.org/10.1056/NEJM199812103392401
Grunwald IQ, Balami JS, Weber D, Mutter J, Kuhn AL, Krick C, Reith W, Papanagiotou P, Shariat K (2013) Different factors influence recanalisation rate after coiling in ruptured and unruptured intracranial aneurysms. CNS Neurol Disord Drug Targets 12(2):228–232. https://doi.org/10.2174/18715273112119990055
Park KY, Kim BM, Kim DJ (2016) Comparison between balloon-assisted and stent-assisted technique for treatment of unruptured internal carotid artery aneurysms. Neurointervention 11(2):99–104. https://doi.org/10.5469/neuroint.2016.11.2.99
Wang F, Chen X, Wang Y, Bai P, Wang HZ, Sun T, Yu HL (2016) Stent-assisted coiling and balloon-assisted coiling in the management of intracranial aneurysms: a systematic review & meta-analysis. J Neurol Sci 364:160–166. https://doi.org/10.1016/j.jns.2016.03.041
Zaidat OO, Hanel RA, Sauvageau EA, Aghaebrahim A, Lin E, Jadhav AP, Jovin TG, Khaldi A, Gupta RG, Johnson A, Frei D, Loy D, Malek A, Toth G, Siddiqui A, Reavey-Cantwell J, Thomas A, Hetts SW, Jankowitz BT, Investigators A (2020) Pivotal trial of the Neuroform atlas stent for treatment of anterior circulation aneurysms: one-year outcomes. Stroke 51(7):2087–2094. https://doi.org/10.1161/STROKEAHA.119.028418
Ogilvy CS, Natarajan SK, Jahshan S, Karmon Y, Yang X, Snyder KV, Hopkins LN, Siddiqui AH, Levy EI (2011) Stent-assisted coiling of paraclinoid aneurysms: risks and effectiveness. J Neurointerv Surg 3(1):14–20. https://doi.org/10.1136/jnis.2010.002303
Xu J, Chen XY, Jiang DY, Li W, Zhang JM (2013) The feasibility and efficacy of endovascular treatment for very small or tiny ruptured paraclinoid aneurysms. Neuroradiology 55(1):77–83. https://doi.org/10.1007/s00234-012-1080-2
Lv N, Zhao R, Yang P, Fang Y, Li Q, Xu Y, Hong B, Zhao W, Liu J, Huang Q (2016) Predictors of recurrence after stent-assisted coil embolization of paraclinoid aneurysms. J Clin Neurosci 33:173–176. https://doi.org/10.1016/j.jocn.2016.03.039
Yeon JY, Hong SC, Kim JS, Kim KH, Jeon P (2012) Unruptured non-branching site aneurysms located on the anterior (dorsal) wall of the supraclinoid internal carotid artery: aneurysmal characteristics and outcomes following endovascular treatment. Acta Neurochir (Wien) 154(12):2163–2171. https://doi.org/10.1007/s00701-012-1509-8
Lessne ML, Shah P, Alexander MJ, Barnhart HX, Powers CJ, Golshani K, Ferrell A, Enterline D, Zomorodi A, Smith T, Britz GW (2011) Thromboembolic complications after Neuroform stent-assisted treatment of cerebral aneurysms: the Duke Cerebrovascular Center experience in 235 patients with 274 stents. Neurosurgery 69(2):369–375. https://doi.org/10.1227/NEU.0b013e31821bc49c
Gentric JC, Biondi A, Piotin M, Mounayer C, Lobotesis K, Bonafe A, Costalat V, French SI (2013) Safety and efficacy of Neuroform for treatment of intracranial aneurysms: a prospective, consecutive, French multicentric study. AJNR Am J Neuroradiol 34(6):1203–1208. https://doi.org/10.3174/ajnr.A3379
Yoon KW, Kim YJ (2010) In-stent stenosis of stent assisted endovascular treatment on intracranial complex aneurysms. J Korean Neurosurg Soc 48(6):485–489. https://doi.org/10.3340/jkns.2010.48.6.485
Nikol S, Huehns TY, Hofling B (1996) Molecular biology and post-angioplasty restenosis. Atherosclerosis 123(1-2):17–31. https://doi.org/10.1016/0021-9150(96)05807-8
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Heng Ni and Lin-Bo Zhao analyzed the data and drafted the manuscript;
Sheng Liu, Zhen-Yu Jia, and Yue-Zhou Cao helped perform the analysis with constructive discussions; Hai-Bin Shi generated the conception, and final approval the version to be submitted.
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Ni, H., Zhao, LB., Liu, S. et al. Open-cell stent-assisted coiling for the treatment of paraclinoid aneurysms: traditional endovascular treatment is still not out of date. Neuroradiology 63, 1521–1530 (2021). https://doi.org/10.1007/s00234-021-02679-x
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DOI: https://doi.org/10.1007/s00234-021-02679-x