Skip to main content

Advertisement

SpringerLink
Log in

Stenting is improving and stabilizing anatomical results of coiled intracranial aneurysms

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

Stent-assisted coiling (SAC) is an alternative to surgical clipping for the treatment of wide-necked intracranial aneurysms (IA). However, little information is available concerning the long-term results of this treatment. The aim of this study was to report the long-term clinical and anatomical findings in 32 patients with 34 wide-necked IA treated by SAC.

Methods

A retrospective review of our prospectively maintained database identified all patients followed up for wide-necked IA treated by SAC. The clinical charts, procedural data, and angiographic results were reviewed.

Results

Thirty-two patients with 34 IA were identified including 25 asymptomatic patients, four with cranial nerve palsies, two with a subarachnoid hemorrhage, and one with transient ischemic attacks. Mean aneurysm size was 10.2 mm (range 3.5 to 26 mm). Embolization was successful in all patients and no procedure-related neurological morbidity or mortality was observed. Immediate anatomical results included nine complete occlusions (26.5%), two neck remnants (6%), and 23 incomplete occlusions (67.5%). Mean imaging follow-up of 20 months showed 18 further thrombosis (53%) and 16 stable results (47%). Finally, 27 aneurysms were completely occluded (79%), three had a neck remnant (9%), and four were incompletely occluded (12%). Asymptomatic and nonsignificant in-stent stenosis occurred in seven patients (22%).

Conclusions

SAC is safe and effective for the treatment of wide-necked IA. Despite unsatisfying immediate aneurysm occlusion, the adjunctive effect of the stent is stabilizing or significantly improving long-term anatomical results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group (2002) ISAT of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial. Lancet 360:1267–1274. doi:10.1016/S0140-6736(02)11314-6

    Article  Google Scholar 

  2. Lubicz B, Balériaux D, Lefranc F, Brotchi J, Bruneau M, Levivier M (2007) Endovascular treatment of intracranial aneurysms as the first therapeutic option: a prospective study over 30 months in a single-centre. J Neuroradiol 34:250–259

    PubMed  CAS  Google Scholar 

  3. Fernandez Zubillaga A, Guglielmi G, Vinuela F, Duckwiler GR (1994) Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR Am J Neuroradiol 15:815–820

    PubMed  CAS  Google Scholar 

  4. Mericle RA, Wakhloo AK, Lopes DK, Lanzino G, Guterman LR, Hopkins LN (1998) Delayed aneurysm regrowth and recanalization after Guglielmi detachable coil treatment. J Neurosurg 89:142–145

    PubMed  CAS  Google Scholar 

  5. Cognard C, Weill A, Spelle L, Piotin M, Castaings L, Rey A, Moret J (1999) Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology 212:348–356

    PubMed  CAS  Google Scholar 

  6. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, Lamoureux J, Chagnon M, Roy D (2003) Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:1398–1403. doi:10.1161/01.STR.0000073841.88563.E9

    Article  PubMed  Google Scholar 

  7. Murayama Y, Nien YL, Duckwiller G, Gobin YP, Jahan R, Frazee J, Martin N, Vinuela F (2003) Guglielmi detachable coils embolization of cerebral aneurysms: 11 years experience. J Neurosurg 98:959–966

    Article  PubMed  Google Scholar 

  8. Taschner CA, Leclerc C, Rachdi H, Barros AM, Pruvo JP (2005) Matrix detachable coils for the endovascular treatment of intracranial aneurysms: analysis of early angiographic and clinical outcomes. Stroke 36:2176–2180. doi:10.1161/01.STR.0000181770.14869.ce

    Article  PubMed  Google Scholar 

  9. Gaba RC, Ansari SA, Roy SS, Marden FA, Viana MA, Malisch TW (2006) Embolization of intracranial aneurysms with hydrogel-coated coils versus inert platinum coils: effects on packing density, coil length and quantity, procedure performance, cost, length of hospital stay, and durability of therapy. Stroke 37:1443–1450. doi:10.1161/01.STR.0000221314.55144.0b

    Article  PubMed  Google Scholar 

  10. Molyneux AJ, Cekirge S, Saatci I, Gal G (2004) Cerebral Aneurysm Multicenter European Onyx (CAMEO) trial: results of a prospective observational study in 20 European centers. AJNR Am J Neuroradiol 25:39–51

    PubMed  Google Scholar 

  11. Biondi A, Janardhan V, Katz JM, Salvaggio K, Riina HA, Gobin YP (2007) Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and midterm follow-up. Neurosurgery 61:460–468

    Article  PubMed  Google Scholar 

  12. Lubicz B, Leclerc X, Levivier M, Brotchi J, Pruvo JP, Lejeune JP, Balériaux D (2006) Retractable self-expandable stent for endovascular treatment of wide-necked intracranial aneurysms: preliminary experience. Neurosurgery 58:451–457

    PubMed  Google Scholar 

  13. Lubicz B, François O, Levivier M, Brotchi J, Balériaux D (2008) Preliminary experience with the Enterprise stent for endovascular treatment of complex intracranial aneurysms: potential advantages and limiting characteristics. Neurosurgery 62:1063–1069

    Article  PubMed  Google Scholar 

  14. Wanke I, Forsting M (2008) Stents for intracranial wide-necked aneurysms: more than mechanical protection. Neuroradiology 50:991–998. doi:10.1007/s00234-008-0460-0

    Article  PubMed  Google Scholar 

  15. Yavuz K, Geyik S, Pamuk AG, Koc O, Saatci I, Cekirge S (2007) Immediate and midterm follow-up results of using an electrodetachable, fully retrievable SOLO stent system in the endovascular coil occlusion of wide-necked cerebral aneurysms. J Neurosurg 107:49–55. doi:10.3171/JNS-07/07/0049

    Article  PubMed  Google Scholar 

  16. Hunt W, Hess R (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20

    Article  PubMed  CAS  Google Scholar 

  17. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484. doi:10.1016/S0140-6736(75)92830-5

    Article  PubMed  CAS  Google Scholar 

  18. Lubicz B, Collignon L, Lefranc F, Bruneau M, Brotchi J, Balériaux D, De Witte O (2008) Circumferential and fusiform intracranial aneurysms: reconstructive endovascular treatment with self-expandable stents. Neuroradiology 50:499–507. doi:10.1007/s00234-008-0366-x

    Article  PubMed  Google Scholar 

  19. Hirabayashi M, Ohta M, Rüfenacht DA, Chopard B (2003) Characterization of flow reduction properties in an aneurysm due to a stent. Phys Rev E Stat Nonlin Soft Matter Phys 68(2 Pt 1):021918. doi:10.1103/PhysRevE.68.021918

    PubMed  Google Scholar 

  20. Lieber BB, Gounis MJ (2002) The physics of endoluminal stenting in the treatment of cerebrovascular aneurysms. Neurol Res 24(Suppl 1):S33–S42. doi:10.1179/016164102101200014

    Article  PubMed  Google Scholar 

  21. Barath K, Cassot F, Fasel JH, Ohta M, Rüfenacht DA (2005) Influence of stent properties on the alteration of cerebral intra-aneurysmal haemodynamics: flow quantification in elastic sidewall aneurysm models. Neurol Res 27:S120–S128. doi:10.1179/016164105X35477

    Article  PubMed  Google Scholar 

  22. Fiorella D, Albuquerque FC, Woo H, Rasmussen PA, Masaryk TJ, Mc Dougall CG (2006) Neuroform in-stent stenosis: incidence, natural history, and treatment strategies. Neurosurgery 59:34–42. doi:10.1227/01.NEU.0000219853.56553.71

    Article  PubMed  Google Scholar 

Download references

Conflict of interest statement

Dr. Lubicz is currently the PI of a multicenter trial concerning the use of the Enterprise stent (Cordis, Miami Lakes, FL, USA) for EVT of wide-necked IA.

Author information

Authors and Affiliations

  1. Department of Neuroradiology, Erasme University Hospital, Brussels, Belgium

    Boris Lubicz, Alexandra Bandeira & Danielle Balériaux

  2. Department of Neurology, Erasme University Hospital, Brussels, Belgium

    Aloys Dewindt

  3. Department of Neurosurgery, Erasme University Hospital, Brussels, Belgium

    Michaël Bruneau & Olivier De Witte

  4. Service de Radiologie, Hôpital Erasme, 808 Route de Lennik, 1070, Brussels, Belgium

    Boris Lubicz

Authors
  1. Boris Lubicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexandra Bandeira
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michaël Bruneau
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aloys Dewindt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Danielle Balériaux
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Olivier De Witte
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Boris Lubicz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lubicz, B., Bandeira, A., Bruneau, M. et al. Stenting is improving and stabilizing anatomical results of coiled intracranial aneurysms. Neuroradiology 51, 419–425 (2009). https://doi.org/10.1007/s00234-009-0519-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-009-0519-6

Keywords

Search

Navigation