Elsevier

Clinical Radiology

Volume 68, Issue 3, March 2013, Pages 256-263
Clinical Radiology

Coil embolization using the self-expandable closed-cell stent for intracranial saccular aneurysm: A single-center experience of 289 consecutive aneurysms

https://doi.org/10.1016/j.crad.2012.07.017Get rights and content

Aim

To present the clinical and radiological follow-up results of coil embolization using the Enterprise stent for intracranial saccular aneurysms.

Materials and methods

The clinical and morphological outcomes of 261 consecutive patients with a total of 289 aneurysms that were treated with a stent-protected coiling technique using the Enterprise stent from June 2008 to August 2011 were assessed.

Results

Stents were delivered before first coil insertion in 162 aneurysms (56.1%), during coiling in 68 (23.5%), and after completion of coil insertion in 59 (20.4%). Procedure-related complications occurred in 36 patients (13.8%), and four (1.5%) suffered permanent neurological sequelae. Successful occlusion after coil embolization was achieved in 205 aneurysms (70.9%) and subtotal occlusion was achieved in 84. During the mean follow-up of 12.4 (±5.8) months, follow-up imaging of 229 aneurysms (79.2%) documented stable occlusion in 183 (79.9%) of the lesions, minor recanalization in 17 (7.4%), and major recanalization in 29 (12.7%). Follow-up angiography of 110 aneurysms (38.1%) demonstrated in-stent stenosis in 14 (12.7%) and stent migration in five (4.5%). Eleven patients (4.2%) suffered late delayed infarction during the follow-up period, which was related to cessation or modification of anti-platelet medication.

Conclusion

The stent-protection technique using the Enterprise stent is useful and effective for coil embolization of wide-necked aneurysms due to easy navigation and precise placement. However, the possibility of procedure-related complications, in-stent stenosis, and delayed cerebral infarction should be noted.

Introduction

Since the International Subarachnoid Aneurysm Trial (ISAT), endovascular coil embolization has been widely used for treatment of intracranial aneurysms. Improved devices and advanced coiling techniques have made it possible to treat more aneurysms with difficult configurations. Among them, the stent protection technique has significantly widened the applicability of endovascular therapy of intracranial aneurysms to a greater extent.1 Although development of a self-expandable stent accelerated the popularity of this technique due to easy navigation and delivery, only a few studies of Enterprise Vascular Reconstruction Device (Enterprise stent, Codman, Raynhan, MA, USA) use for the treatment of aneurysms have been reported. Therefore, the present study was undertaken to describe the clinical and radiological results of coil embolization for intracranial saccular aneurysms using the Enterprise stent.

Section snippets

Patient population

From June 2008 to August 2011, endovascular treatment was performed in 1160 patients with 1326 intracranial aneurysms. Over the same period, 261 patients (65 men, 196 women; mean age 60.0 ± 9.8 years) with a total of 289 saccular aneurysms underwent coil embolization using the Enterprise stent. Patients with dissecting, fusiform, blood blister-like, or false aneurysms were excluded from the study. Therapeutic alternatives were discussed between the neurosurgical and neuro-interventional teams

Procedural results

The Enterprise stent was most frequently used in internal carotid artery aneurysms (n = 103, 35.6%; Fig 1), followed by the anterior communicating artery (n = 57, 19.7%) and the middle cerebral artery aneurysms (n = 51, 17.6%).

Among the 289 saccular aneurysms, total occlusion was achieved in 20 aneurysms, near-total occlusion in 185, and subtotal occlusion in 84 through endovascular coiling using the Enterprise stent. Y-configured stenting was applied in six cases, staged double stenting in

Discussion

Since Higashida et al.3 reported their experience with stent-assisted coiling of intracranial aneurysms in five patients, a few clinical studies have been published regarding the Enterprise stent protection technique (Table 3).1, 3, 4, 5, 6, 7, 8, 9 However, the populations were too small to estimate the efficacy and safety of the stent in the previous studies. Mocco et al.5 reported the results of the stent for 142 aneurysms, but they did not include the follow-up results. The present study

Acknowledgements

This study was supported by Ministry of Health and Welfare, Republic of Korea (A110894).

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