Treatment of Intracranial Broad-Neck Aneurysms with a New Self-Expanding Stent and Coil Embolization
Karsten Alfkea,
Torsten Straubea,
Lutz Dörnerb,
H. Maximilian Mehdornb and
Olav Jansena
a Section of Neuroradiology, University of Schleswig-Holstein, Campus Kiel, Germany
b Department of Neurosurgery, University of Schleswig-Holstein, Campus Kiel, Germany
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FIG 1. Close-up views of the stent show its segmented, open-cell design and itspositioning over the neck of an aneurysm with catheter access to the aneurysm.
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FIG 2. Case 1. Far left, Broad-neck aneurysm of the right ICA, paraophthalmic segment. Middle left, Exchange microguidewire is passed by the aneurysm into a peripheral branch of the MCA. Middle right and far right, The stent is deployed (not visible) in the ICA and proximal MCA. The aneurysm is occluded totally with coils, as shown on the fluoroscopic angiogram (middle right) and digital subtraction angiogram (DSA) (far right).
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FIG 3. Case 1. Lateral fluoroscopic view of the middle cranial fossa shows a stent in the right ICA and proximal MCA. Stent markers (asterisks) placed proximally and distally enable visualization of the deployed stent. Coils in the supraophthalmic aneurysm are seen between the stent markers in projection on the anterior clinoid process.
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FIG 4. Case 1. Left and middle, Maximum intensity projection (MIP) TOF 3D angiograms show that the stent in the right ICA and MCA does not disturb flow signal intensity. Right, Sagittal multiplanar reconstruction (MPR) of the right ICA demonstrates the visibility of the stent as a thin black line at the vessel wall. The coils in the aneurysm of the ophthalmic segment cause susceptibility artifacts.
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FIG 5. Case 2. Left, Broad-neck right ICA aneurysm at the origin of a fetal PCA after incomplete coiling 5 weeks earlier. Middle, After deployment of the stent in ICA and MCA. Right, After complete coiling, a dislocated single loop of the last Ultrasoft-coil is present in the parent vessel.
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FIG 6. Case 2. Broad-neck right ICA aneurysm at the origin of a fetal PCA after stent placement and complete embolization. Left, MIP TOF 3D angiogram. Middle, Primary section of the TOF shows the origin of the right PCA. Right, Sagittal MPR of the right ICA shows the origin of the PCA and the neck of the embolized aneurysm. The stent is visible as a thin black line at the vessel wall distal to the aneurysm.
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FIG 7. Case 3. Angiograms show recurrence of a basilar tip aneurysm. Top row, Images before deployment of a stent in the distal BA and proximal right PCA and coil embolization. Bottom row, Images after treatment.
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FIG 8. Case 3. MIP TOF 3D angiograms show the BA and both the PCA and superior cerebellar artery after treatment. The basilar-tip aneurysm is occluded with coils. Susceptibility artifacts of the coils and the distal stent markers mimic stenosis (which is not visible on DSA).
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FIG 9. Case 3. Sagittal MPR images show the BA and occluded tip aneurysm with the stent in the distal BA (a), the origin of the right PCA and SUCA (b and c), the P1 segment with the stent and SUCA (d), and the P1 segment with the distal end of the stent and the stent markers causing susceptibility artifacts (e).
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FIG 10. Case 6. Left, DSA of a broad-neck aneurysm of the left ICA, paraophthalmic segment. Right, The stent is deployed (not visible) in the distal ICA, the aneurysm is subtotally occluded with coils.
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FIG 11. Case 6. Left, MIP TOF 3D angiogram of the broad-neck aneurysm of the left ICA, paraophthalmic segment after endovascular therapy. A small remainder is noted at the neck (asterisk). Middle, Sagittal MPR. Right, Coronal MPR.
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