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Stent-assisted coiling embolization of tiny, wide-necked intracranial aneurysms

  • Original Article - Vascular
  • Published:
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Abstract

Background

Tiny, wide-necked intracranial aneurysms pose a significant therapeutic challenge for interventional neuroradiologists because of the small volume for microcatheterization and coil stabilization inside the aneurysm sac. We report our preliminary experience of stent-assisted coiling embolization of these aneurysms.

Methods

A total of 50 patients with 52 tiny, wide-necked aneurysms who were treated with stent-assisted coiling from January 2007 to December 2014 were reviewed retrospectively. Baseline characteristics, procedure-related complications, angiographic follow-up results and clinical outcomes were statistically analyzed.

Result

All aneurysms were successfully treated with the stent-assisted coiling technique, and at the end of the procedure, aneurysm occlusion was complete for 45 (86.5 %), near complete for 3 (5.8 %) and incomplete for 4 (7.7 %). Procedural complications (1 intraprocedural rupture, 2 coil migrations and 1 aneurysm re-rupture) occurred in 4 (8 %) of 50 patients, resulting in permanent morbidity in 1 (2 %) patient and death in 1 (2 %) patient. Follow-up imaging was available in 43 (84.3 %) aneurysms for 6–31 months (mean, 13 months). Complete occlusion was achieved in 40 (93 %) of 43 aneurysms on long-term follow-up. One aneurysm with complete occlusion and one with incomplete occlusion after the initial embolization developed a significant recurrence (4.7 %). Clinical follow-up was available for 43 (86 %) of 50 patients at a mean of 36.7 months (range 15–66 months). Of these 43 patients, 42 (97 %) made an excellent recovery achieving a GOS of 5. None of the patients died or experienced re-bleeding or ischemic cerebral vascular events during follow-up.

Conclusion

Stent-assisted coiling embolization is feasible and relatively safe for tiny, wide-necked intracranial aneurysms of carotid arteries. Furthermore, long-term follow-up angiography indicated stent-assisted coiling seems to be effective in preventing early recanalization.

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Author notes

    Authors and Affiliations

    1. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Middle Road, Shanghai, 200040, China

      Yongtao Zheng, Yanbing Song, Yingjun Liu, Yanlong Tian & Bing Leng

    2. Department of Neurosurgery, Second People Hospital, Taizhou, China

      Dajun Liu

    3. Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China

      Qiang Xu

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    1. Yongtao Zheng
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    2. Yanbing Song
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    Correspondence to Bing Leng.

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    No funding was received for this research.

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    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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    Informed consent was obtained from all individual participants included in the study.

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    Comments

    The authors indicated the feasibility and safety of stent-assisted coiling for tiny, wide-necked intracranial aneurysms in this article. Their clinical follow-up at a mean of 36.7 months demonstrated no re-bleeding or ischemic cerebral vascular events in this series. I believe that stent-assisted coiling has less chance of recanalization than standard coiling. This manuscript revealed this fact in a tiny, wide-necked aneurysm group. A limitation of stent-assisted coiling includes prolonged usage of antiplatelet drugs. This may cause bleeding complications. They used 75 mg of clopidogrel and 100 mg of aspirin for 6 months and 100 mg of aspirin forever in this study. Longer follow-up will prove the safety of stent-assisted coiling for tiny, wide-necked intracranial aneurysms.

    Kenji Sugiu

    Okayama, Japan

    Yongtao Zheng, Yanbing Song and Dajun Liu contributed equally to this work.

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    Zheng, Y., Song, Y., Liu, D. et al. Stent-assisted coiling embolization of tiny, wide-necked intracranial aneurysms. Acta Neurochir 159, 93–100 (2017). https://doi.org/10.1007/s00701-016-3022-y

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