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AJNR - American Journal of Neuroradiology

Published ahead of print on October 10, 2007
doi: 10.3174/ajnr.A0767

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American Journal of Neuroradiology 29:73-78, January 2008
© 2008 American Society of Neuroradiology

INTERVENTIONAL

Evaluation of a Neck-Bridge Device to Assist Endovascular Treatment of Wide-Neck Aneurysms of the Anterior Circulation

K. De Keukeleire^a, P. Vanlangenhove^a and L. Defreyne^a

^a From the Department of Vascular and Interventional Radiology, Ghent University Hospital, Ghent, Belgium

Please address correspondence to Katrien De Keukeleire, MD, Department of Vascular and Interventional Radiology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium; e-mail: katrien.dekeukeleire{at}uzgent.be

BACKGROUND AND PURPOSE: Intracranial aneurysms with a wide-neck or an unfavorable dome-to-neck ratio may be difficult to treat properly and safely. Our aim was to evaluate the TriSpan neck-bridge device to assist coiling of wide-neck bifurcation aneurysms in the anterior circulation.

MATERIALS AND METHODS: In 14 patients, we performed 16 TriSpan-assisted coil embolizations with wide-neck bifurcation aneurysms of the anterior circulation. Eleven procedures were indicated for acutely ruptured aneurysms. Five were performed electively for the following: recurrent aneurysm after coil only (n = 1) or after TriSpan-assisted embolization (n = 2), aneurysm remnant after clipping (n = 1), and aneurysm incidentally found (n = 1). Procedural and clinical complications were recorded. Follow-up angiography was performed, and clinical outcomes were assessed by using the modified Rankin Scale score.

RESULTS: TriSpan-assisted embolization was successful in 15/16 (93.8%) procedures, with complete occlusion in 2/16 (12.5%), near-complete occlusion in 10/16 (62.5%), and incomplete occlusion in 3/16 (18.75%). There were 6 (37.5%) intraprocedural complications: thrombus formation (n = 3), protrusion of a TriSpan loop in the parent artery (n = 1), TriSpan displacement in the aneurysm (n = 1), and tangling of a coil loop in the device (n = 1). Three patients died in the hospital (21.4%). Follow-up angiography or MR angiography was available in 8 (57.1%) patients and showed complete (n = 2), near-complete (n = 2), and incomplete occlusion (n = 4). Long-term clinical outcome was no (n = 4) or minor symptoms (n = 1) and moderate (n = 2), moderately severe (n = 2), or severe handicap (n = 2).

CONCLUSION: The use of the TriSpan device is feasible in the anterior circulation and can assist treatment of difficult wide-neck bifurcation aneurysms.

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