Acta Neurochirurgica

, Volume 159, Issue 1, pp 93–100

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

  • Yongtao Zheng
  • Yanbing Song
  • Dajun Liu
  • Yingjun Liu
  • Qiang Xu
  • Yanlong Tian
  • Bing Leng
Original Article - Vascular
  • 387 Downloads

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.

Keyword

Stent-assisted coiling Tiny intracranial aneurysm Complication Recanalization 

References

  1. 1.
    Bodily KD, Cloft HJ, Lanzino G, Fiorella DJ, White PM, Kallmes DF (2011) Stent assisted coiling in acutely ruptured intracranial aneurysms: a qualitative, systematic review of the literature. AJNR Am J Neuroradiol 32:1232–1236CrossRefPubMedGoogle Scholar
  2. 2.
    Brinjikji W, Lanzino G, Cloft HJ, Rabinstein A, Kallmes DF (2010) Endovascular treatment of very small (3 mm or smaller) intracranial aneurysms: report of a consecutive series and a meta-analysis. Stroke 41:116–121CrossRefPubMedGoogle Scholar
  3. 3.
    Cho YD, Lee JY, Seo JH, Kang HS, Kim JE, Kwon OK, Chung YS, Han MH (2012) Early recurrent hemorrhage after coil embolization in ruptured intracranial aneurysms. Neuroradiology 54:719–726CrossRefPubMedGoogle Scholar
  4. 4.
    Gupta V, Chugh M, Jha AN, Walia BS, Vaishya S (2009) Coil embolization of very small (2 mm or smaller) berry aneurysms: feasibility and technical issues. AJNR Am J Neuroradiol 30:308–314CrossRefPubMedGoogle Scholar
  5. 5.
    Im SH, Han MH, Kwon OK, Kwon BJ, Kim SH, Kim JE, Oh CW (2009) Endovascular coil embolization of 435 small asymptomatic unruptured intracranial aneurysms: procedural morbidity and patient outcome. AJNR Am J Neuroradiol 30:79–84CrossRefPubMedGoogle Scholar
  6. 6.
    Jeong YG, Jung YT, Kim MS, Eun CK, Jang SH (2009) Size and location of ruptured intracranial aneurysms. J Korean Neurosurg Soc 45:11–15CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kim M, Levy EI, Meng H, Hopkins LN (2007) Quantification of hemodynamic changes induced by virtual placement of multiple stents across a wide-necked basilar trunk aneurysm. Neurosurgery 61:1305–1312, discussion 1312–1303CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Kim YJ (2009) Sole stenting technique for treatment of complex aneurysms. J Korean Neurosurg Soc 46:545–551CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Lu J, Liu JC, Wang LJ, Qi P, Wang DM (2012) Tiny intracranial aneurysms: endovascular treatment by coil embolisation or sole stent deployment. Eur J Radiol 81:1276–1281CrossRefPubMedGoogle Scholar
  10. 10.
    Moret J, Cognard C, Weill A, Castaings L, Rey A (1997) The "remodelling technique" in the treatment of wide neck intracranial aneurysms. Angiographic results and clinical follow-up in 56 cases. Interv Neuroradiol 3:21–35PubMedGoogle Scholar
  11. 11.
    Nguyen TN, Raymond J, Guilbert F, Roy D, Berube MD, Mahmoud M, Weill A (2008) Association of endovascular therapy of very small ruptured aneurysms with higher rates of procedure-related rupture. J Neurosurg 108:1088–1092CrossRefPubMedGoogle Scholar
  12. 12.
    Nussbaum ES, Erickson DL (1999) The fate of intracranial microaneurysms treated with bipolar electrocoagulation and parent vessel reinforcement. Neurosurgery 45:1172–1174, discussion 1174–1175CrossRefPubMedGoogle Scholar
  13. 13.
    Raghavan ML, Ma B, Harbaugh RE (2005) Quantified aneurysm shape and rupture risk. J Neurosurg 102:355–362CrossRefPubMedGoogle Scholar
  14. 14.
    Raymond J, Roy D, Bojanowski M, Moumdjian R, L’Esperance G (1997) Endovascular treatment of acutely ruptured and unruptured aneurysms of the basilar bifurcation. J Neurosurg 86:211–219CrossRefPubMedGoogle Scholar
  15. 15.
    Ryu CW, Park S, Shin HS (2015) Complications in stent-assisted endovascular Tterapy of ruptured intracranial aneurysms and relevance to antiplatelet administration. Syst Rev 36:1682–1688Google Scholar
  16. 16.
    Sedat J, Chau Y, Mondot L, Vargas J, Szapiro J, Lonjon M (2009) Endovascular occlusion of intracranial wide-necked aneurysms with stenting (Neuroform) and coiling: mid-term and long-term results. Neuroradiology 51:401–409CrossRefPubMedGoogle Scholar
  17. 17.
    Songsaeng D, Geibprasert S, ter Brugge KG, Willinsky R, Tymianski M, Krings T (2011) Impact of individual intracranial arterial aneurysm morphology on initial obliteration and recurrence rates of endovascular treatments: a multivariate analysis. J Neurosurg 114:994–1002CrossRefPubMedGoogle Scholar
  18. 18.
    Starke RM, Chalouhi N, Ali MS, Penn DL, Tjoumakaris SI, Jabbour PM, Gonzalez LF, Rosenwasser RH, Dumont AS (2013) Endovascular treatment of very small ruptured intracranial aneurysms: complications, occlusion rates and prediction of outcome. J Neurointerv Surg 5(Suppl 3):iii66–71CrossRefPubMedGoogle Scholar
  19. 19.
    Suzuki S, Kurata A, Ohmomo T, Sagiuchi T, Niki J, Yamada M, Oka H, Fujii K, Kan S (2006) Endovascular surgery for very small ruptured intracranial aneurysms Technical note. J Neurosurg 105:777–780CrossRefPubMedGoogle Scholar
  20. 20.
    Tureli D, Sabet S, Senol S, Andac N, Donmez H, Geyik S, Baltacioglu F, Cekirge S (2016) Stent-assisted coil embolization of challenging intracranial aneurysms: initial and mid-term results with low-profile ACCLINO devices. Acta Neurochir 158:1545–1553CrossRefPubMedGoogle Scholar
  21. 21.
    van Rooij WJ, Keeren GJ, Peluso JP, Sluzewski M (2009) Clinical and angiographic results of coiling of 196 very small (< or = 3 mm) intracranial aneurysms. AJNR Am J Neuroradiol 30:835–839CrossRefPubMedGoogle Scholar
  22. 22.
    van Rooij WJ, Sprengers ME, de Gast AN, Peluso JP, Sluzewski M (2009) 3D rotational angiography: the new gold standard in the detection of additional intracranial aneurysms. AJNR Am J Neuroradiol 29:976–979CrossRefGoogle Scholar
  23. 23.
    Weir B, Disney L, Karrison T (2002) Sizes of ruptured and unruptured aneurysms in relation to their sites and the ages of patients. J Neurosurg 96:64–70CrossRefPubMedGoogle Scholar
  24. 24.
    Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, Forbes GS, Thielen K, Nichols D, O’Fallon WM (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:103–110CrossRefPubMedGoogle Scholar
  25. 25.
    Yang P, Zhao K, Zhou Y, Zhao R, Zhang L, Zhao W et al (2015) Stent-assisted coil placement for the treatment of 211 acutely ruptured wide-necked intracranial aneurysms: a single-center 11-year experience. Radiology 276:545–552CrossRefPubMedGoogle Scholar
  26. 26.
    Zhang J, Wang D, Li X (2015) Solitaire AB stent-assisted coiling embolization for the treatment of ruptured very small intracranial aneurysms. Exp Ther Med 10:2239–2244PubMedPubMedCentralGoogle Scholar
  27. 27.
    Zhao R, Shen J, Huang QH, Nie JH, Xu Y, Hong B, Yang PF, Zhao WY, Liu JM (2013) Endovascular treatment of ruptured tiny, wide-necked posterior communicating artery aneurysms using a modified stent-assisted coiling technique. J Clin Neurosci 20:1377–1381CrossRefPubMedGoogle Scholar
  28. 28.
    Zheng Y, Xu F, Ren J, Xu Q, Liu Y, Tian Y, Leng B (2016) Assessment of intracranial aneurysm rupture based on morphology parameters and anatomical locations. J Neurointerven Surg. doi:10.1136/neurintsurg-2015-012112 Google Scholar
  29. 29.
    Zuccarello M (2001) Treatment strategy for patients with unruptured intracranial aneurysms. Neurol Med Chir 41:571–575CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2016

Authors and Affiliations

  • Yongtao Zheng
    • 1
  • Yanbing Song
    • 1
  • Dajun Liu
    • 2
  • Yingjun Liu
    • 1
  • Qiang Xu
    • 3
  • Yanlong Tian
    • 1
  • Bing Leng
    • 1
  1. 1.Department of Neurosurgery, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina
  2. 2.Department of NeurosurgerySecond People HospitalTaizhouChina
  3. 3.Department of Radiology, Huashan Hospital, Shanghai Medical CollegeFudan UniversityShanghaiChina

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