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Embolization of Acutely Ruptured and Unruptured Wide-Necked Cerebral Aneurysms Using the Neuroform2 Stent without Pretreatment with Antiplatelets: A Single Center Experience

V. Katsaridis, C. Papagiannaki and C. Violaris

From the Neurosurgical Department, Papanikolaou General Hospital, Thessaloniki, Greece


Figure 1
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  		Fig 1. A, Digital subtraction angiography (DSA), working projection, in a 69-year-old woman who presented with subarachnoid hemorrhage from a ruptured wide-necked left internal carotid artery (ICA) aneurysm at the origin of the posterior communicating artery (PcomA). A pseudoaneurysm is noted at the fundus of the ruptured aneurysm.

B, DSA, working projection. The aneurysm is shown embolized after the deployment of a 4 x 15-mm Neuroform2 stent in the ICA. No contrast material in the aneurysm is shown, and the PcomA is shown patent.

C, Unsubtracted angiography, working projection, showing the stent in the ICA and the coils in the aneurysm.

D, Unsubtracted view, working projection, showing the markers of the stent and the coils.

E, Follow-up DSA of the left ICA at 17 months, anteroposterior projection. The aneurysm is not visualized and all the branches are patent.

F, Follow-up DSA the left ICA at 17 months, lateral projection. The aneurysm is not visualized and all the branches are patent.


Figure 2
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  		Fig 2. A, Digital subtraction angiography (DSA), anteroposterior projection, of a 32-year-old woman with aplasia of the left internal carotid artery (ICA) harboring an incidental aneurysm of the anterior communicating artery (AcomA). The whole left hemisphere is supplied by the right ICA through the AcomA. Patency of the AcomA after the embolization was of the utmost importance.

B, DSA, working projection for the embolization of the wide-necked AcomA aneurysm.

C, DSA, working projection, showing the aneurysm embolized after the deployment of a 3 x 15-mm Neuroform2 stent in the A1 segment of the right anterior cerebral artery (ACA) extending to the AcomA and to the A2 segment of the left ACA, covering the neck of the aneurysm.

D, Unsubtracted angiography, working projection, showing the stent in the AcomA complex and the coils in the aneurysm.

E, Unsubtracted view, working projection, showing the markers of the stent and the coils.

F, DSA, anteroposterior projection, after the embolization of the aneurysm showing the patency of the AcomA and the adequate supply of the left hemisphere.

G, Follow-up DSA at 6 months, anteroposterior projection, showing the adequate supply of the left hemisphere from the right ICA.

H, Follow-up DSA at 6 months, working projection, showing the persistent occlusion of the aneurysm and the patency of all the branches of the AcomA complex.


Figure 3
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  		Fig 3. A 30-year-old man presented with subarachnoid hemorrhage, and angiography revealed he harbored 3 aneurysms: 1 at the basilar tip and 1 on each internal carotid artery (ICA) at the origin of both posterior communicating arteries. The wide-necked basilar tip aneurysm was considered the ruptured one and was treated first with coil embolization.

A, Digital subtraction angiography (DSA), working projection, showing the wide-necked basilar tip aneurysm incorporating in the neck the proximal left posterior cerebral artery.

B, DSA, working projection. The aneurysm is shown embolized after the deployment of a 3.5 x 15-mm Neuroform2 stent in the basilar artery extending into the left posterior cerebral artery.

C, DSA, working projection showing a wide-necked left ICA aneurysm at the origin of the posterior communicating artery.

D, DSA, working projection. The left ICA aneurysm is shown embolized with the use of a 4 x 15-mm Neuroform2 stent. The posterior communicating artery is shown patent despite the prolapse of a small coil loop in its lumen.

E, DSA, working projection, showing a third small aneurysm on the right ICA by the origin of the posterior communicating artery which was not opacified by the ICA injection.

F, DSA, working projection. The aneurysm is shown embolized after the deployment of another 4 x 15-mm Neuroform2 stent.

G, Unsubtracted view, anteroposterior projection, showing the proximal and distal markers of the 3 stents and the 3 coil masses inside the 3 aneurysms.

H, Unsubtracted view, lateral projection, showing the proximal and distal markers of the 3 stents and the 3 coil masses inside the 3 aneurysms. Follow-up DSA is not available for this patient because he was a resident of a different country and returned home in excellent clinical condition.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X