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Microstent-Assisted Coiling for Wide-Necked Intracranial Aneurysms

Published online by Cambridge University Press:  02 December 2014

Marlise Peruzzo dos Santos Souza ,
Ronit Agid ,
Robert A. Willinsky ,
Michael Cusimano ,
Walter Montanera ,
M. Christopher Wallace ,
Karel G. terBrugge  and
Thomas R. Marotta
Marlise Peruzzo dos Santos Souza
Affiliation:
Department of Medical Imaging, St. Michael’s Hospital and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
Ronit Agid
Affiliation:
Department of Medical Imaging, St. Michael’s Hospital and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
Robert A. Willinsky
Affiliation:
Department of Medical Imaging, St. Michael’s Hospital and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
Michael Cusimano
Affiliation:
Department of Medical Imaging, St. Michael’s Hospital and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
Walter Montanera
Affiliation:
Department of Medical Imaging, St. Michael’s Hospital and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
M. Christopher Wallace
Affiliation:
Department of Medical Imaging, St. Michael’s Hospital and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
Karel G. terBrugge
Affiliation:
Department of Medical Imaging, St. Michael’s Hospital and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
Thomas R. Marotta
Affiliation:
Department of Medical Imaging, St. Michael’s Hospital and Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Abstract

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Objective:

To describe the results, technical feasibility, efficacy and challenges encountered in our preliminary experience using a self-expandable microstent, optimized for intracranial use, as an adjunct in the endovascular treatment of wide-necked aneurysms.

Methods:

Only broad-necked aneurysms (dome-to-neck ratio £2, or an isolated neck size > 4.5 mm) were treated with Neuroform microstent from July 2003 to May 2004. The techniques used for stent deployment were either parallel or sequential. Angiographic results were recorded immediately for all patients and classified as Class 1 (complete occlusion), Class 2 (neck remnant) or Class 3 (sac remnant) by three interventional neuroradiologists not involved in the procedure. Follow-up angiography at six months was obtained for one case. Modified Rankin Score scale was assessed for all patients.

Results:

Seventeen intracranial aneurysms in a total of 18 patients were treated (mean age, 52.2 yr). Eight patients (44.4%) presented with acute subarachnoid hemorrhage. Eleven aneurysms (61.1%) were in the posterior circulation. Average dome size was 10.2 mm (range, 3.7-19.8 mm) and average neck size was 5.36 mm (range, 3.0-10.0 mm). Six out of seven aneurysms of the anterior circulation were approached with parallel technique. Eight aneurysms of the posterior circulation were approached with sequential technique. Average number of coils deployed was 9.64 (range, 4-23 coils). Eleven aneurysms (64.8%) resulted in Class 1 and/or Class 2. One technical failure was observed. Technical complications were recognized in four patients (23.5%), all of them with unruptured aneurysms in the anterior circulation. Two patients (11.7%) presented transient immediate clinical complications. One patient (5.8%) had minor permanent neurological complication. Neither major clinical complications nor death were encountered. Favorable clinical outcome (Modified Rankin Scale score 0-2) was observed in 88.2% of the patients (average follow-up time, 4.72 months).

Conclusion:

Absence of major permanent complications and satisfactory immediate obliteration degree in our preliminary experience indicates that microstent-assisted coiling technique is useful for the minimally invasive treatment of broad-necked complex aneurysms that are not ideal for conventional endovascular treatment and are at a high risk for conventional surgical treatment.

Résumé:

RÉSUMÉ:Objectif:

Décrireles résultats, la faisabilité technique, l’efficacité et les défis rencontrés au cours de nos premières expériences d’utilisation d’un microstent autodéployant adapté pour utilisation intracrânienne dans le traitement endovasculaire des anévrismes à large collet.

Méthodes:

Le microstent Neuroform a été utilisé de juillet 2003 à mai 2004 pour traiter uniquement les anévrismes à large collet (rapport sommet/collet £2, ou un collet >4,5 mm). La technique utilisée pour le déploiement du sent était soit parallèle ou séquentielle. Les résultats angiographiques étaient enregistrés immédiatement pour tous les patients et classifiés par trois neuroradiologistes interventionnels indépendants de l’étude comme suit: classe 1 quand l’occlusion était complète; classe 2 quand il y avait un collet résiduel et classe 3 quand il y avait un sac résiduel. Une angiographie a été faite chez un cas 6 mois après l’intervention. Tous les patients ont été évalués au moyen de l’échelle modifiée de Rankin.

Résultats:

Dix–sept anévrismes chez 18 patients dont l’âge moyen était de 52,2 ans ont été traités. Huit patients, soit 44,4%, avaient consulté pour une hémorragie sous–arachnoïdienne aiguë. Onze anévrismes, soit 61,1% étaient situés au niveau de la circulation postérieure. La taille moyenne du sommet de l’anévrisme était de 10,2 mm (écart de 3,7 à 19,8 mm) et la taille moyenne du collet était de 5,36 mm (écart de 3,0 à 10,0 mm). La technique parallèle a été utilisée pour traiter six des sept anévrismes situés au niveau de la circulation antérieure et la technique séquentielle pour 8 anévrismes situés au niveau de la circulation postérieure. Le nombre moyen de coils déployés était de 9,64 (écart de 4 à 23 coils). Le résultat du traitement de onze anévrismes (64,8%) a été classifié comme étant de classe 1 et/ou de classe 2. Il y a eu un échec technique et des complications techniques sont survenues chez quatre patients (23,5%), tous des patients qui avaient des anévrismes sans rupture au niveau de la circulation antérieure. Deux patients (11,7%) ont eu des complications cliniques passagères immédiates. Un patient (5,8%) a eu une complication neurologique permanente mineure. Aucune complication clinique majeure ou décès n’ont été observés. 88,2% des patients ont eu une issue favorable (score de 0 à 2, à l’échelle modifiée de Rankin) au cours d’un suivi moyen de 4,72 mois.

Conclusions:

Chez ces patients, nous n’avons pas observé de complications permanentes majeures et nous avons obtenu un degré satisfaisant d’oblitération immédiate. Nos résultats préliminaires indiquent que la technique du coiling avec microstent est utile dans le traitement non effractif des anévrismes complexes à large collet pour lesquels le traitement endovasculaire conventionnel n’est pas idéal et la chirurgie conventionnelle présente un risque élevé.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 1 , February 2005 , pp. 71 - 81
Copyright
Copyright © The Canadian Journal of Neurological 2014

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