Safety and Long-term Efficacy of Stent-assisted Coiling for the Treatment of Complex Posterior Cerebral Artery Aneurysms
- 7 Downloads
To evaluate the safety and long-term efficacy of stent-assisted coiling for the treatment of complex posterior cerebral artery (PCA) aneurysms.
Angiographic and clinical data of 23 patients harboring 23 complex PCA aneurysms treated with stent-assisted coiling from March 2010 to March 2017 were retrospectively reviewed.
In this study 8 (34.8%) aneurysms were located at the P1 segment, 7 (30.4%) at the junction of P1 and P2 segments (P1-2), and 8 (34.8%) at the P2 segment. The aneurysms were ruptured in 7 cases (30.4%). Thirteen were dissecting in nature, while the other 10 were classical saccular aneurysms. Of the patients, 5 (21.7%) had of history of recent head trauma, immediate angiographic results were Raymond class I in 5 (21.7%) cases, Raymond class II in 8 (34.8%), and Raymond class III in 10 (43.5%). Perioperative complications occurred in one case with occlusion of the PA due to acute in-stent thrombosis without any neurologic deficit at discharge. The last angiographic follow-up (mean 18.7 months) results demonstrated complete aneurysmal occlusion in 20 (87.0%) cases, PA occlusion in 1 (4.3%) and recurrence in 2 (8.7%). Of the two patients with aneurysm recurrence, one was treated by PA occlusion, and the other was treated with two overlapping stents. Clinical follow-up (mean 58.3 months) was available for all 23 patients, 22 (95.7%) patients had good neurologic outcomes (mRS score 0–2), and 1 (4.3%) patient died 7 months after the procedure for unknown reasons.
Stent-assisted coiling for the treatment of complex PCA aneurysms is safe and durable with a relatively low rate of complication and a relatively high rate of complete occlusion at long-term follow-up and is a promising alternative strategy for the reconstruction of the PCA.
KeywordsPosterior cerebral artery Intracranial aneurysm Endovascular treatment Stent Vascular disorders
Digital subtraction angiography
P1 segment of the posterior cerebral artery
Junction of P1 and P2 segments of the posterior cerebral artery
P2 segment of the posterior cerebral artery
Posterior cerebral artery
The present study was supported by the National Natural Science Foundation of China (grant 81671137, 81571126).
Compliance with ethical guidelines
Conflict of interest
G. Xue, H. Tang, P. Liu, Q. Zuo, P. Yang, Y. Zhou, Q. Li, Y. Fang, Q. Huang, B. Hong, Y. Xu, R. Zhao and J. Liu declare that they have no competing interests.
This study protocol was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Written informed consent for inclusion in the study was waived by the Institutional Review Board because of the retrospective design of this observational study.
- 4.Ulm AJ, Tanriover N, Kawashima M, Campero A, Bova FJ, Rhoton A Jr. Microsurgical approaches to the perimesencephalic cisterns and related segments of the posterior cerebral artery: comparison using a novel application of image guidance. Neurosurgery. 2004;54:1313–27; discussion 1327–8.CrossRefGoogle Scholar
- 7.Lv X, Yang H, Liu P, Li Y. Flow-diverter devices in the treatment of intracranial aneurysms: A meta-analysis and systematic review. Neuroradiol J. 2016;29:66–71.Google Scholar
- 11.Goehre F, Jahromi BR, Lehecka M, Lehto H, Kivisaari R, Andrade-Barazarte H, Ibrahim TF, Párraga RG, Ludtka C, Meisel HJ, Koivisto T, von und zu Fraunberg M, Niemelä M, Jääskeläinen JE, Hernesniemi JA. Posterior cerebral artery aneurysms: treatment and outcome analysis in 121 patients. World Neurosurg. 2016;92:521–32.CrossRefGoogle Scholar
- 18.Zuo Q, Yang P, Lv N, Huang Q, Zhou Y, Zhang X, Duan G, Wu Y, Xu Y, Hong B, Zhao R, Li Q, Fang Y, Zhao K, Dai D, Liu J. Safety of coiling with stent placement for the treatment of ruptured wide-necked intracranial aneurysms: a contemporary cohort study in a high-volume center after improvement of skills and strategy. J Neurosurg 2019;131:435–41. https://doi.org/10.3171/2018.3.JNS172199.Google Scholar
- 25.Fiorella D, Boulos A, Turk AS, Siddiqui AH, Arthur AS, Diaz O, Lopes DK; LVIS investigators. The safety and effectiveness of the LVIS stent system for the treatment of wide-necked cerebral aneurysms: final results of the pivotal US LVIS trial. J Neurointerv Surg. 2019;11:357–61.CrossRefGoogle Scholar
- 26.Muto M, Giurazza F, Ambrosanio G, Vassallo P, Briganti F, Tecame M, Schena E, De Nicola M, Sgreccia A, Giannoni M, Peschillo S, Diana F, Guidetti G, Guarnieri G. Stent-assisted coiling in ruptured cerebral aneurysms: multi-center experience in acute phase. Radiol Med. 2017;122:43–52.CrossRefGoogle Scholar
- 30.Chalouhi N, Jabbour P, Singhal S, Drueding R, Starke RM, Dalyai RT, Tjoumakaris S, Gonzalez LF, Dumont AS, Rosenwasser R, Randazzo CG. Stent-assisted coiling of intracranial aneurysms predictors of complications, recanalization, and outcome in 508 cases. Stroke. 2013;44:1348–53.CrossRefGoogle Scholar
- 31.Choi HH, Cho YD, Yoo DH, Ahn SJ, Cho W, Kang H, Kim JE, Lee JJ, Moon JH, Han MH. Stent-assisted coil embolization of anterior communicating artery aneurysms: safety, effectiveness, and risk factors for procedural complications or recanalization. J Neurointerv Surg. 2018;11:49–56.CrossRefGoogle Scholar
- 35.Zhao K, Zhao R, Huang Q, Xu Y, Hong B, Fang Y, Li Q, Yang P, Liu J, Zhao W. The interaction between stent(s) implantation, PICA involvement, and immediate occlusion degree affect symptomatic intracranial spontaneous vertebral artery dissection aneurysm (sis-VADA) recurrence after reconstructive treatment with stent(s)-assisted coiling. Eur Radiol. 2014;24:2088–96.CrossRefGoogle Scholar
- 39.Wallace AN, Grossberg JA, Almandoz J, Kamran M, Roy AK, Kayan Y, Austin MJ, Howard BM, Moran CJ, Cawley CM, Cross DT, Dion JE, Kansagra AP, Osbun JW. Endovascular treatment of posterior cerebral artery aneurysms with flow diversion: case series and systematic review. Neurosurgery. 2018;83:790–9.CrossRefGoogle Scholar