Endovascular management of adjacent tandem intracranial aneurysms: Utilization of stent-assisted coiling and flow diversion
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Tandem intracranial aneurysms are aneurysms located along a single intracranial vessel. Adjacent tandem aneurysms arise within the same vascular segment and their presence often suggests diffuse parent vessel anomaly. Endovascular management of these rare lesions has not been well studied. In this retrospective observational study, we describe our experience treating adjacent tandem intracranial aneurysms with endovascular embolization.
We retrospectively reviewed records of patients with these lesions who underwent endovascular treatment between 2008 and 2013.
Thirteen patients (mean age 60.8 years; 12 women) with 28 adjacent tandem aneurysms were treated during the study timeframe. Aneurysms were located along the clinoidal, ophthalmic, and communicating segments of the internal carotid artery in 12 patients and at the basilar apex in one patient. Average size was 8.4 mm. Six patients (12 aneurysms) were treated by flow diversion via the Pipeline embolization device (PED) and seven (16 aneurysms) by stent-assisted coiling, with coils successfully placed in 11 aneurysms. Clinical follow-up was available for an average of 26.1 months; postprocedural angiography was performed for 12 patients. Complete occlusion was achieved in nine of ten (90 %) PED-treated aneurysms and eight of 11 (72.7 %) treated by stent-assisted coiling (p = 0.44). Two patients treated by stent-assisted coiling required re-coiling for aneurysm recanalization. Overall, modified Rankin scale scores were 0–1 for 12 patients and 3 for one patient.
Adjacent tandem intracranial aneurysms can be safely and effectively treated by either stent-assisted coiling or flow diversion. We prefer PED flow diversion due to better parent vessel reconstruction and lower recanalization risk.
KeywordsPipeline embolization device Tandem adjacent intracranial aneurysms
The authors thank Paul H. Dressel BFA for preparation of the illustrations and Debra J. Zimmer for editorial assistance.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflicts of interest
Hopkins: grant/research support-Toshiba; consultant-Abbott, Boston Scientific, Cordis, Covidien; financial interests- AccessClosure, Augmenix, Boston Scientific, Claret Medical Inc., Endomation, Ostial Corporation, Silk Road, Valor Medical; board/trustee/officer position-Claret Medical, Inc.; speakers’ bureau-Abbott Vascular; honoraria-Complete Conference Management, Cordis, Covidien, Memorial Healthcare System. Levy: shareholder/ownership interests–Intratech Medical Ltd., Blockade Medical LLC. Principal investigator: Covidien US SWIFT PRIME Trials. Other financial support–Abbott for carotid training for physicians. Mokin: research grant-Toshiba; Siddiqui: research grants (not related to present study)–National Institutes of Health (co-investigator: NINDS 1R01NS064592-01A1 and NIBIB 5 RO1EB002873-07), University at Buffalo (Research Development Award); financial interests–Hotspur, Intratech Medical, StimSox, Valor Medical, Blockade Medical, Lazarus Effect; consultant–Codman & Shurtleff, Inc., Concentric Medical, Covidien Vascular Therapies, GuidePoint Global Consulting, Penumbra, Stryker Neurovascular, Pulsar Vascular; speakers’ bureaus–Codman & Shurtleff, Genentech; National Steering Committees for Penumbra 3D Separator Trial, Covidien SWIFT PRIME Trial, MicroVention FRED Trial; advisory board–Codman & Shurtleff, Covidien Vascular Therapies; honoraria–Abbott Vascular and Codman & Shurtleff, Inc. for training other neurointerventionists in carotid stenting and for training physicians in endovascular stenting for aneurysms. Snyder: research and consultant support-Boston Scientific, Cordis, EndoTex, EPI, Guidant, Medtronic, Micrus, Kerberos, Zimmer, Abbott Vascular, ev3, Toshiba. financial/shareholder interests-EndoTex, Micrus, BSC EPI, Access Closure Inc, Primus, Cordis, Boston Scientific, Niagara Gorge Medical. Xiang: American Society for Quality Biomedical Division Dr. Richard J. Schlesinger grant. No disclosures: Brouillard, Krishna, Lin, Natarajan, Sonig.
Lin and Levy are responsible for concepts and design. All authors contributed intellectually. All authors acquired, analyzed, and interpreted the data. Statistical analysis was performed by Lin. Manuscript was prepared by Lin and Brouillard. All authors reviewed and made critical revisions to the manuscript.
Data sharing statement
Additional data from this study (case series) may be made available upon request directed to the corresponding author.
This study was approved by the University at Buffalo Institutional Review Board (Project 578913-2).
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