Progressive Occlusion of Small Saccular Aneurysms Incompletely Occluded After Stent-Assisted Coil Embolization
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Incompletely occluded aneurysms after coil embolization are subject to recanalization but occasionally progress to a totally occluded state. Deployed stents may actually promote thrombosis of coiled aneurysms. We evaluated outcomes of small aneurysms (<10 mm) wherein saccular filling with contrast medium was evident after stent-assisted coiling, assessing factors implicated in subsequent progressive occlusion.
Between September 2012 and June 2016, a total of 463 intracranial aneurysms were treated by stent-assisted coil embolization. Of these, 132 small saccular aneurysms displayed saccular filling with contrast medium in the immediate aftermath of coiling. Progressive thrombosis was defined as complete aneurysmal occlusion at the 6‑month follow-up point. Rates of progressive occlusion and factors predisposing to this were analyzed via binary logistic regression.
In 101 (76.5%) of the 132 intracranial aneurysms, complete occlusion was observed in follow-up imaging studies at 6 months. Binary logistic regression analysis indicated that progressive occlusion was linked to smaller neck diameter (odds ratio [OR] = 1.533; p = 0.003), hyperlipidemia (OR = 3.329; p = 0.036) and stent type (p = 0.031). The LVIS stent is especially susceptible to progressive thrombosis, more so than Neuroform (OR = 0.098; p = 0.008) or Enterprise (OR = 0.317; p = 0.098) stents. In 57 instances of progressive thrombosis, followed for ≥12 months (mean 25.0 ± 10.7 months), 56 (98.2%) were stable, with minor recanalization noted once (1.8%) and no major recanalization.
Aneurysms associated with smaller diameter necks, hyperlipidemic states and LVIS stent deployment may be inclined to possible thrombosis, if occlusion immediately after stent-assisted coil embolization is incomplete. In such instances, excellent long-term durability is anticipated.
KeywordsAneurysm Coil embolization Stent Recanalization Progressive occlusion
Conflict of interest
J.W. Lim, J. Lee and Y.D. Cho declare that they have no competing interests.
- 20.Griessenauer CJ, Adeeb N, Foreman PM, Gupta R, Patel AS, Moore J, Abud TG, Thomas AJ, Ogilvy CS, Baccin CE. Impact of coil packing density and coiling technique on occlusion rates for aneurysms treated with stent-assisted coil embolization. World Neurosurg. 2016;94:157–66.CrossRefPubMedGoogle Scholar
- 28.Saw J, Steinhubl SR, Berger PB, Kereiakes DJ, Serebruany VL, Brennan D, Topol EJ; Clopidogrel for the Reduction of Events During Observation Investigators. Lack of adverse clopidogrel-atorvastatin clinical interaction from secondary analysis of a randomized, placebo-controlled clopidogrel trial. Circulation. 2003;108:921–4.CrossRefPubMedGoogle Scholar
- 30.Lotfi A, Schweiger MJ, Giugliano GR, Murphy SA, Cannon CP, Investigators T. High-dose atorvastatin does not negatively influence clinical outcomes among clopidogrel treated acute coronary syndrome patients – a pravastatin or atorvastatin evaluation and infection therapy-thrombolysis in myocardial infarction 22 (PROVE IT-TIMI 22) analysis. Am Heart J. 2008;155:954–8.CrossRefPubMedGoogle Scholar
- 32.Yao PF, Yu Y, Yang PF, Xu Y, Hong B, Zhao WY, Liu JM, Huang QH. Safety and long-term efficacy of endovascular treatment of small posterior communicating artery aneurysms by coiling with or without stent: a single center retrospective study. Clin Neurol Neurosurg. 2013;115:2502–7.CrossRefPubMedGoogle Scholar
- 33.Jeon JP, Cho YD, Rhim JK, Park JJ, Cho WS, Kang HS, Kim JE, Han MH. Effect of stenting on progressive occlusion of small unruptured saccular intracranial aneurysms with residual sac immediately after coil embolization: a propensity score analysis. J Neurointerv Surg. 2016;8:1025–9.CrossRefPubMedGoogle Scholar
- 45.Nakiri GS, Santos AC, Abud TG, Aragon DC, Colli BO, Abud DG. A comparison between magnetic resonance angiography at 3 teslas (time-of-flight and contrast-enhanced) and flat-panel digital subtraction angiography in the assessment of embolized brain aneurysms. Clinics (Sao Paulo). 2011;66:641–8.CrossRefGoogle Scholar