Article Figures & Data
Figures
- Fig 1.
(Patient #15) This 46-year-old woman has a history of SAH 6 months ago, with multiple aneurysms (a ruptured anterior communicating artery aneurysm [previously coiled] and bilateral unruptured MCA aneurysms). A, Left ICA DSA showed a tiny saccular aneurysm at left MCA M2 bifurcation (black arrow). B, 3D DSA demonstrated the branch artery arising from the proximal aspect of the aneurysm sac. C, An LVIS stent was deployed in the MCA M2 trunk initially. D, A coil delivery microcatheter was navigated close to the stent interstices, but not through the interstice. Only 1 coil was introduced into the aneurysm sac. E, Initial angiogram after treatment showed the sac residual with patency of the parent vessels. F, The final fluoroscopy demonstrated that the stent was completely opened and totally covered the aneurysm neck. G and H, Follow-up angiography at 10 months demonstrated complete obliteration of the aneurysm with preserved patency of the parent and branch arteries.
- Fig 2.
(Patient #16) A, Angiogram showed a ruptured anterior communicating artery aneurysm. B, The aneurysm underwent conventional coiling initially. C and D, Follow-up at 1 month revealed the residual sac filling, and an LVIS stent was then deployed in the ipsilateral anterior cerebral artery. E and F, Total aneurysm occlusion was achieved at 8-month follow-up. In-stent stenosis occurred at the distal stent marker for approximately 55%.
- Fig 3.
(Patient #21) A, Oblique left ICA angiogram showed an MCA M1 bifurcation aneurysm. B, Roadmap image revealed the coiling microcatheter and stent placement microcatheter in place (black arrows). C, Native image after stent-assisted coil embolization. D, Seven-month follow-up demonstrated complete occlusion of the aneurysm with the patency of the parent vessel. Insignificant stenosis was found in the inferior branch covered by stent. E and F, The fluoroscopy demonstrated that the stent was fully deployed, with the midsegment expanded across the aneurysm neck and good stent apposition to parent vessel wall.
Tables
Patient No. Age (yr), Sex Risk Factors Presentation HHG Aneurysm Location Aneurysm PA Size Initial Angiogram Results Complications FU Angiogram Results FU Time Size Neck 1 42, F NS Chronic headaches 0 BT 8.5 8.2 1.9 RA N/A NR 13 2 57, M HP Lt hemiparesis, unconsciousness 3 MCA 8.8 5.1 1.8 NR N/A CO 8 3 65, M HP Acute onset of headaches 2 ACA 5.6 4.6 1.7 NR N/A NR 14 4 63, M HP, DM Lt UE weakness, slurred speech 0 AComA 2.1 1.4 2.1 CO Rupture CO 11 5 44, F NS Incidental 0 AComA 10.8 5.2 2.1 CO N/A CO 8 6 61, M HP Acute onset of headaches 2 MCA 4.4 3.2 2.0 CO N/A CO 10 7 53, M NS Incidental 0 AComA 3.6 3.1 2.1 NR N/A CO 6 8 40, M HP, S Recanalized 0 MCA 3.0 2.9 2.3 NR N/A CO 8 9 49, M NS Headaches, seizure 1 MCA 5.0 4.7 2.4 NR N/A NR 6 10 52, M NS Incidental 0 BT 4.4 3.6 1.8 CO N/A CO 6 11 61, M HP, DM Incidental 0 MCA 6.5 6.0 2.3 RA N/A CO 9 12 35, M NS Chronic headaches 0 AComA 6.7 3.3 2.3 CO N/A CO 6 13 51, F HP Chronic headaches and dizziness 0 MCA 4.8 2.7 1.8 RA N/A CO 11 14 55, F HP, DL Incidental 0 MCA 3.5 1.8 2.2 NR N/A CO 6 15 46, F HP Incidental 0 MCA 1.8 1.5 2.1 RA N/A CO 10 16 33, M S Recanalized 0 AComA 3.0 2.3 2.1 NR N/A CO and PA stenosis 8 17 54, M HP Acute onset of headaches 2 MCA 3.6 2.5 2.0 CO N/A CO 8 18 54, F NS Incidental 0 MCA 3.2 2.0 2.3 CO N/A CO 8 19 59, M S, DL Incidental 0 MCA 1.7 1.5 1.9 RA N/A RA 6 20 60, F HP Dizziness, nausea, vomiting 0 MCA 7.9 5.0 1.9 NR N/A CO 7 21 49, F NS Chronic headaches 0 MCA 3.6 2.6 2.3 CO N/A CO 8 22 53, F HP Chronic headaches 0 MCA 3.7 3.2 2.2 RA N/A CO 6 Note:—ACA indicates anterior cerebral artery; AComA, anterior communicating artery; BT, basilar tip; CO, complete occlusion; DL, dyslipidemia; DM, diabetes mellitus; FU, follow-up; HP, hypertension; Lt, left; N/A, not available; NR, neck residual; NS, not significant; PA, parent artery; RA, residual aneurysm; S, smoking; UE, upper extremity; HHG, Hunt and Hess grade.
- Table 2:
Clinical and anatomic results of the stent deployment in small intracranial vessels in previous studies
Series, yr Sample Size (no.) Vessel Diameter (mm) Stent Technical Success Rate (%) Complication (%) Near or Complete Occlution Rate (%) Follow-Up (%) Thromboembolic Hemorrhagic Recurrence Rate In-Stent Stenosis Turk et al, 20079 8 1.5 NF 100 25 0 100 0 N/A Siddiqui et al, 20098 8 1.58 EP 100 12.5 0 100 25 12.5 Yun and Cho, 20107 11 1.6 NF 100 0 0 100 0 9.1 Zhang et al, 20106 12 1.8 NF, LEO, WP 100 8.3 0 91.6 NA N/A Chung et al, 20155 31 1.6 EP 100 9.7 0 96.3 0 11.1 Kühn et al, 20164 44 1.7 NF, EP 93.2 13.6 2.3 88.6 9.1 6.1 Aydin et al, 201511 80 2.35 LEO Baby 97.5 7.5 1.3 96.3 6.5 15.6 Alghamdi et al, 201610 43 2.2 LVIS Jr 100 10 5 95.3 5 17.5 Puri et al, 20163 7 1.9 PED 100 0 0 N/A 0 28 Note:—N/A indicates not available; NF, Neuroform stent; EP, Enterprise stent; WP, Wingspan stent; PED, Pipeline Embolization Device.
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