Clinical application of Neuroform Atlas stent-assisted coiling in the treatment of unruptured wide-neck intracranial aneurysms / 北京大学学报(医学版)

OBJECTIVE@#To assess the safety and efficacy of Neuroform Atlas stent used in treatment of unruptured wide-neck intracranial aneurysms.@*METHODS@#Clinical data of 62 patients with unruptured wide-neck intracranial aneurysms undergoing Neuroform Atlas stent-assisted coiling from August 2020 to September 2021 were retrospectively analyzed. There were 64 aneurysms in those 62 patients. Among them, 25 aneurysms were located at the bifurcation of M1 segment on middle cerebral artery, 16 at the anterior communicating artery, 10 at the C7 segment of internal carotid artery, 5 at the C6 segment of internal carotid artery, 4 at the apex of basilar artery, 3 at the A3 segment of anterior cerebral artery, and 1 at the M2 segment of middle cerebral artery. All the patients underwent Neuroform Atlas stent-assisted coiling, including 49 patients with single stent assisted coiling and 15 patients with dual stents assisted coiling (14"Y"style and 1"X"style). After the procedure, the immediate DSA was performed to evaluate the status of aneurysm occlusion and the parent artery patency. The clinical follow-up was performed 3 months after the operation and evaluated based on the modified Rankin Scale(mRS).DSA image was reviewed at 6 months after operation and Raymond grading scale was used to assess the status of aneurysm occlusion and the parent artery patency.@*RESULTS@#A total of 62 patients with 64 aneurysms were all achieved technical success(100%).The immediate post-procedural Raymond scale was assessed, including Raymond Ⅰ in 57 aneurysms(89.1%, 57/64), Raymond Ⅱ in 6 aneurysms(9.3%, 6/64) and Raymond Ⅲ in 1 aneurysm(1.6%, 1/64). The peri-procedural complications rate was 4.8%(3/62), 2 patients developed intraoperative thrombosis and 1 patient suffered from local subarachnoid hemorrhage. Among them, 55 patients obtained 3 months clinical follow-up after operation and all the patients had good outcomes (mRS≤2), 50 patients with 52 aneurysms were followed up with DSA 6 months after operation, including Raymond Ⅰ in 45 aneurysms(86.5%, 45/52), Raymond Ⅱ in 4 aneurysms(7.7%, 4/52) and Raymond Ⅲ in 3 aneurysms(5.8%, 3/52).@*CONCLUSION@#Neuroform Atlas stent for the treatment of unruptured wide-neck intracranial aneurysms has high safety and good efficacy, and has its advantages over other traditional stents.

Braided stent-assisted coil embolization versus laser engraved stent-assisted coil embolization in patients with unruptured complex intracranial aneurysms

Abstract Purposes: Braided and laser-cut stents both are efficacious and safe for coiling intracranial aneurysms. The study aimed to compare outcomes following braided stent-assisted coil embolization versus laser engraved stent-assisted coil embolization in 266 patients who were diagnosed with unruptured intracranial aneurysms of different types and locations. Methods: Patients with unruptured complex intracranial aneurysms underwent braided (BSE cohort, n = 125) or laser engraved (LSE cohort, n = 141) stent-assisted embolization. Results: The deployment success rate was higher for patients of the LSE cohort than those of the BSE cohort (140 [99%] vs. 117 [94%], p = 0.0142). Seventy-one (fifty-seven percentages) and 73 (52%) were coil embolization procedure success rates of the BSE and the LSE cohorts. Periprocedural intracranial hemorrhage was higher in patients of the BSE cohort than those of the LSE cohort (8 [6%] vs. 1 [1%], p = 0.0142). Four (three percentages) patients from the LSE cohort and 3 (2%) patients from the BSE cohort had in-stent thrombosis during embolization. Permanent morbidities were higher in patients of the LSE cohort than those of the BSE cohort (8 [6%] vs. 1 [1%], p = 0.0389). Higher successful procedures (76% vs. 68%) and fewer postprocedural intracranial hemorrhage (0% vs. 5%) and mortality (0% vs. 5%) were reported for patients of the BSE cohort in posterior circulation aneurysmal location than those of the LSE cohort. Laser engraved stent has fewer problems with deployment and may have better periprocedural and follow-up outcomes after embolization. Conclusions: Braided stent-assisted embolization should be preferred when the aneurysm is present in the posterior circulation.

Efficacy of dual stent-assisted coil embolization in ruptured vertebral artery dissecting aneurysms / 中华神经医学杂志

Objective:To evaluate the safety and efficacy of dual stent-assisted coil embolization in intracranial ruptured vertebral artery dissecting aneurysms (VADAs).Methods:Seventeen patients with intracranial ruptured VADAs (17 aneurysms), treated with dual stent-assisted coil embolization in our hospital from September 2015 to March 2020, were recruited. DSA was performed immediately after surgery to evaluate the embolization degrees of VADAs. At the end of follow-up, modified Rankin scale (mRS) was used to evaluate the prognoses of these patients, and DSA was used to determine the healing status of aneurysms.Results:The postoperative immediate DSA showed that total occlusion was achieved in 6 patients (35.3%), subtotal occlusion in 8 (47.1%) and partial occlusion in 3 (17.6%). Two patients died during the perioperative period and 2 patients presented symptoms of cranial nerve palsy after surgery. Fifteen patients were followed up for 5-24 months, 14 were with good prognosis, and one was with poor prognosis. Eleven patients underwent DSA follow-up, which showed that 8 aneurysms healed completely, 2 aneurysms were stable, and 1 aneurysm recurred.Conclusion:Dual stent-assisted coil embolization may be an effective and safe treatment method for intracranial ruptured VADAs.

Predictive value of cerebral aneurysm neck diameter on the occurrence of progressive cerebrovascular occlusion after stent-assisted coil embolization / 中国脑血管病杂志

Objective: To investigate the predictive factors of developing progressive cerebrovascular occlusion in incomplete occlusion after cerebral aneurysms treated with stent-assisted coil embolization. Methods: Ninety-two consecutive patients with cerebral aneurysm received stent-assisted coil embolization and immediate intraoperative angiography revealed incomplete occlusion at the Department of Neurosurgery, Yulin First Hospital from January 2012 to December 2015 were enrolled retrospectively. According to the follow-up results of angiography 6 months after operation, the patients were divided into progressive occlusion group (n = 59) and non-occlusion group (ra=33). Multi-dimensional angiographic images of patients immediately and 6 months after surgery were collected using a biplane angiography system and a threedimensional rotational angiography system, and the angiographic results of all patients were graded by the Raymond grading criteria. Predictors of progressive cerebrovascular occlusion were assessed using multivariate logistic regression analysis and receiver operating characteristic (ROC) curves. Results: The mean maximum diameter of cerebral aneurysms (6.6 ±2.9 mm) and mean neck diameter (4.9 ± 1.0mm) in the progressive occlusion group were less than those in the non-occlusion group (8.5 ±2.4 mm and 6. 2 ± 1. 2 mm respectively). The differences were statistically significant, (l = -3. 196 and -5.661 respectively,all P < 0.01). Multivariate logistic regression analysis showed that the neck diameter of cerebral aneurysms was an independent influencing factor for progressive cerebrovascular occlusion (OR,0. 44,95% CI 0. 18-0. 79, P =0.030). The cut-off value of neck diameter for predicting cerebrovascular occlusion was 5. 8 mm (specificity 82. 1%,sensitivity 75.8%,and the area under curve 0. 847,P <0. 01). Conclusions: The neck diameter of cerebral aneurysms was an independent predictor for progressive cerebrovascular occlusion after stent-assisted coil embolization. Patients with cerebral aneurysms < 5. 8 mm in neck diameter were more likely to spontaneously develop cerebrovascular occlusion within 6 months after stent-assisted coil embolization.

Efficacy of stent-assisted and non-stent-assisted coil embolization in the treatment of posterior communicating ruptured wide-necked aneurysms in acute stage / 中国医师进修杂志

compare the safety and efficacy of stent-assisted and non-stent-assisted coil embolization in the treatment of posterior communicating ruptured wide-necked aneurysms. Methods Data were collected from January 2014 to December 2018 in Dezhou People′s Hospital where patients with ruptured posterior communicating artery wide- necked aneurysm were treated by interventional embolization. All patients were admitted to hospital for subarachnoid hemorrhage, and the diagnosis of posterior communicating artery aneurysm of internal carotid artery was confirmed within 7 d of admission, and the patients were treated with interventional embolization. To compare the perioperative complications, mortality and clinical prognosis between stent-assisted embolization group (stent group , 45 patients) and non-stent-assisted embolization group(non-stent group , 38 patients) was analyzed. Results The incidence of ischemic complications in stent group was 20.0% (9/45), in non-stent group was 5.3% (2/38), and there was significant difference (χ2＝3.892, P < 0.05). The overall complication rate in stent group was 28.9%(13/45), in non-stent group was 10.5%(4/38), and there was significant difference (χ2＝4.265, P < 0.05). There was no significant difference in bleeding complications, symptomatic vasospasm, mortality and clinical prognosis between the two groups (P >0.05). Conclusions In the acute stage of posterior communicating artery aneurysm rupture, stent-assisted embolization has a high rate of thrombotic complication, and the clinical application needs to be cautious. Both the stent-assisted and non-stent-assisted embolization have a good clinical outcome in the treatment of wide-necked posterior communicating aneurysms in the acute phase.

Efficacy of stent-assisted and non-stent-assisted coil embolization in the treatment of posterior communicating ruptured wide-necked aneurysms in acute stage / 中国医师进修杂志

Objective@#To compare the safety and efficacy of stent-assisted and non-stent-assisted coil embolization in the treatment of posterior communicating ruptured wide-necked aneurysms.@*Methods@#Data were collected from January 2014 to December 2018 in Dezhou People′s Hospital where patients with ruptured posterior communicating artery wide-necked aneurysm were treated by interventional embolization. All patients were admitted to hospital for subarachnoid hemorrhage, and the diagnosis of posterior communicating artery aneurysm of internal carotid artery was confirmed within 7 d of admission, and the patients were treated with interventional embolization. To compare the perioperative complications, mortality and clinical prognosis between stent-assisted embolization group (stent group, 45 patients) and non-stent-assisted embolization group(non-stent group, 38 patients) was analyzed.@*Results@#The incidence of ischemic complications in stent group was 20.0% (9/45), in nonstent group was 5.3% (2/38), and there was significant difference (χ2=3.892, P < 0.05). The overall complication rate in stent group was 28.9%(13/45), in non-stent group was 10.5%(4/38), and there was significant difference (χ2=4.265, P < 0.05). There was no significant difference in bleeding complications, symptomatic vasospasm, mortality and clinical prognosis between the two groups (P > 0.05).@*Conclusions@#In the acute stage of posterior communicating artery aneurysm rupture, stent-assisted embolization has a high rate of thrombotic complication, and the clinical application needs to be cautious. Both the stent-assisted and non-stent-assisted embolization have a good clinical outcome in the treatment of wide-necked posterior communicating aneurysms in the acute phase.

The therapeutic effect of balloon-assisted coiling and stent-assisted coiling of ruptured intracranial aneurysms in the acute phase / 中华急诊医学杂志

Objective To investigate the perioperative complications and therapeutic effects of balloon-assisted coiling (BAC) and stent-assisted coiling (SAC) in patients with ruptured intracranial aneurysms in the acute phase. Methods Totally 91 patients with 91 intracranial ruptured aneurysms were treated with BAC or SAC in our hospital between January 2014 and December 2016. Among them, 37 patients were treated with BAC and 54 patients with SAC respectively. Of the two groups, the position distribution and shape of aneurysms, and the complications after procedures and the therapeutic effects were summarized and evaluated retrospectively using chi-square test. Results The width of the aneurysm neck was narrower in the BAC-treated group compared to the SAC-treated group (3.31±1.63 mm vs. 4.35±2.10 mm, P=0.01). The aneurysm body/neck ratio (B/N) was lower in the BAC-treated group than in the SAC-treated group (1.64 ± 0.46 vs. 1.35±0.66, P=0.025). The recurrence rate was higher in the BAC-treated group than that in the SAC-treated group (18.9％ vs. 0.9％, P=0.005). There was no statistical difference in perioperative complication in both the BAC-treated group and SAC-treated group. However, 2 patients died due to the relative postoperative intracranial bleeding in the SAC-treated group. Better outcomes (Modified Rankin Score, mRS, 0-2) were achieved in the BAC-treated group compared to the SAC-treated group (94.6％ vs. 88.9％, P=0.028) at the follow-up visit. Conclusions These findings suggested that there is no difference between the BAC-treated group and the SAC-treated group in the risk of complication. BAC can achieve a better prognosis,but it is more prone to relapse. The SAC method was more appropriate for wider neck aneurysms. It was also an option to coiling the aneurysm in BAC in acute phase firstly, followed by additional treatment in SAC during the follow-up period.

Frontiers and prospects in stent-assisted coiling in acutely ruptured intracranial aneurysms / 医学研究生学报

Stent-assisted coiling has been widely used in endovascular treatment of wide-necked,giant and fusiform intracra-nial aneurysm,and has become an important technique for endovascular treatment of intracranial aneurysms. However,for acutely rup-tured intracranial aneurysms,stent implantation will cause platelet aggregation and increase the incidence of ischemic events. There-fore,dual antiplatelet therapy should be used during perioperative period of endovascular treatment. However,the use of antiplatelet drugs may increase the risk of rebleeding and increase the difficulty and risk of subsequent external ventricular drainage and evacuation of intracranial hematoma. Therefore,the feasibility and safety of stent-assisted coiling in acutely ruptured intracranial aneurysms are still in dispute. In this article,we briefly introduce the progress in stent-assisted coiling in acutely ruptured intracranial aneurysms.

Safety of external ventricular drainage after stent-assisted embolization for poor-grade ruptured aneurysm / 医学研究生学报

Objective The management of poor-grade ruptured aneurysm is important and challenging in intravascular inter-vention. This study aimed to investigate the safety of external ventricular drainage(EVD)after stent-assisted embolization for patients with poor-grade ruptured aneurysm in the acute stage. Methods From January 2015 to July 2017,27 patients with poor-grade rup-tured aneurysm underwent EVD after endovascular embolization by stent-assisted coiling(n=14)or simple coiling(n=13). We com-pared the clinical data about and the postoperative complications between the two groups of patients. Results There were no statisti-cally significant differences in the patients'age,gender,Glasgow Coma Scale(GCS)scores before embolization and discharge,the in-terval between EVD and the end of embolization,preoperative intraventricular hemorrhage and hydrocephalus,puncture-related bleed-ing after EVD,catheter-indwelling time,perioperative bleeding in other parts,or poor prognosis between the stent-assisted coiling and simple coiling groups(all P>0.05). Conclusion EVD after stent-assisted embolization is a relatively safe strategy for the treatment of poor-grade ruptured aneurysm in the acute stage.

The effect of ultra-early stent-assisted coil embolization in the treatment of ruptured wide-necked intracranial aneurysms / 天津医药

Objective To explore the efficacy of ultra-early stent-assisted coil (SAC) in the treatment of intracranial rupture of wide- necked aneurysms. Methods The angiographic and clinical data of 24 patients (including 8 male, 16 female, age ranged from 29 to 86 years, with a median age 59) with acutely ruptured wide-necked intracranial aneurysms treated with SAC were retrospectively analyzed. The postoperative complications and clinical results were observed. The postoperative embolization was assessed according to the Raymond grading standard. The assessment of the follow-up results from 6 to 12 months after procedure was observed according to the modified Rankin Scale (mRS) score. Results Procedure-related complications occurred in 3 patients (12.5%). All of them were hemorrhagic events, of which 2 cases died. Perioperative death was found in 3 cases. Of the 19 surviving patients, 17 showed good recovery (mRS 0-2). After 6 to 12 months of DSA, no recurrence of aneurysm was found in 10 follow-up patients. Conclusion Ultra-early stent-assisted coil treatment for intracranial wide-neck rupture aneurysm can improve the success rate of embolization and reduce the recurrence.

Kissing Aneurysms at Fenestrated Proximal Basilar Artery: Double-barrel Stent-assisted Coiling Using Dual Closed-cell Stents

Kissing aneurysms associated with a proximal basilar artery fenestration are an exceedingly rare and unique therapeutic challenge due to anatomical complexity. This report describes double-barrel stent-assisted technique with dual closed-cell stents for the successful endovascular coiling of kissing aneurysms from a proximal basilar artery fenestration.

Efficacy comparison of Solitaire AB and Enterprise stent-assisted embolization of intracranial wide-necked aneurysms / 中国脑血管病杂志

Objective To compare the effect of Solitaire AB and Enterprise stent-assisted endovascular embolization of intracranial wide-necked aneurysms. Methods The clinical data 218 patients with intracranial aneurysm treated with Solitaire AB stent or Enterprise stent in Guangdong General Hospital from January 2012 to December 2014 were analyzed retrospectively. Seventy patients were treated with Solitaire AB stents and 148 were treated with Enterprise stents. They were followed up after procedure (2 months to 2 years). The Raymond grade and the modified Rankin scale (mRS)scores were used to compare the efficacy of the 2 kinds of stents. Results There were no significant differences in patients before procedure in the Hunt-Hess grade (Z = 1. 550,P = 0. 121),Fisher grade (Z =1. 537,P =0. 124),aneurysm size (Z =0. 192,P =0. 848),and position (χ2 = 0. 337,P = 0. 736)between the 2 stent groups,while there were no significant differences in patients after procedure in the instant Raymond grade (Z = 0. 682,P = 0. 495), follow-up Raymond grade (Z = 0. 206,P =0. 837),and mRS score (P =0. 662)between the 2 stent groups. Further multivariate Logistic regression analysis showed that the stent type (Solitaire AB stent or Enterprise stent),Raymond grade follow-up grade (OR,0. 029 ,95% CI 0. 126 - 0. 199,P = 0. 661 ),and postoperative mRS score (OR,2. 000,95% CI 0. 204 - 19. 603,P = 0. 552)had no influence on the prognosis. Conclusions In the assisted embolization of intracranial wide-necked aneurysms using the Solitaire AB and Enterprise stents,the effects of both stents are good in the assisted embolization of intracranial wide-necked aneurysms.

Easy Advancement of a Large-Profile Microcatheter (Excelsior XT27(TM)) by Parallel Use of Two Microguidewires For Stent Delivery / 신경중재치료의학

PURPOSE: In the endovascular treatment of cerebral aneurysms, navigating a large-bore microcatheter for delivery of an open-cell stent can be challenging, especially in wide-necked bifurcation aneurysms. We were able to overcome this difficulty by parallel use of two microguidewires through the stent-delivery microcatheter. MATERIALS AND METHODS: From December 2014 to April 2015, we treated 15 patients with wide-necked bifurcation aneurysms. For stent delivery, we used a 300-cm 0.014-in microguidewire (Transend), which was placed into the target branch using an exchange technique. A 0.027-in microcatheter (Excelsior XT-27), which was designed for the stent, was advanced over the exchange microguidewire. If we had trouble in advancing the microcatheter over the exchange microguidewire, we inserted a regular microguidewire (Traxcess), into the microcatheter lumen in a parallel fashion. We also analyzed the mechanism underlying microcatheter positioning failure and the success rate of the 'parallel-wire technique'. RESULTS: Among the 15 cases, we faced with navigation difficulty in five patients. In those five cases, we could advance the microcatheter successfully by applying the parallel-wire technique. There were no procedure-related complications. CONCLUSION: Simply by using another microguidewire together with pre-existing microguidewire in a parallel fashion, the stent-delivery microcatheter can be easily navigated into the target location in case of any advancement difficulty.

Y-configuration Stent-assisted Coil Embolization for Wide-necked Intracranial Bifurcation Aneurysms

OBJECTIVE: The objective of this study was to determine the efficiency and safety of Y configuration stent-assisted coiling with double-closed stents for wide-necked intracranial aneurysms located at arterial bifurcations thorough analysis of a multicenter case series. MATERIALS AND METHODS: A retrospective chart review was done on 10 patients who underwent endovascular treatment of wide-necked intracranial aneurysms with Y-configuration stent-assisted coil embolization in three centers from August 2011 to March 2014. The degree of aneurysmal occlusion was assessed using the Raymond scale. Clinical outcomes were assessed before operation, at discharge, and at the last follow-up visit using the Glasgow outcome scale. RESULTS: The 10 patients included 6 females and 4 males with a mean age of 58.6 years. Indications for treatment included 6 unruptured intracranial aneurysms and 4 ruptured intracranial aneurysms. Five aneurysms were located at the basilar artery bifurcation, four aneurysms were located in an anterior communicating artery, and one aneurysm was in the pericallosal artery. The mean size of the 10 aneurysms was 9.7 mm. All aneurysms had a dome-to-neck ratio of < 1.5 (mean, 0.89). Immediate complications included one thromboembolic event out of the 10 cases. Immediate posttreatment angiograms showed complete occlusion in 1 aneurysm and residual necks in 9 aneurysms. Follow-up results showed 8 complete occlusions and 2 residual necks. No delayed complications were observed during the follow-up period (mean: 20 months). CONCLUSION: Y configuration using double-closed cell stents is feasible and safe in selected patients. This method is an acceptable option for managing complex wide-necked bifurcations.

Effect of ultra-early stent-assisted coil embolization on ruptured intracranial aneurysms / 中国脑血管病杂志

Objective To investigate the therapeutic effect of the ultra-early stent-assisted coil embolization of the ruptured intracranial aneurysms. Methods The clinical data of 13 patients with ruptured intracranial aneurysm treated by ultra-early stent-assisted coil embolization were analyzed retrospectively. The preoperative Hunt-Hess gradeⅠ-Ⅱ was in 7 cases,gradeⅢ was in 4 cases,and grade Ⅳ was in 2 cases. The patients were treated with stent-assisted coil embolization under the general anesthesia with endotracheal intubation within 24 h of aneurysm rupture. The postoperative embolization was assessed according to the Raymond grading standard. The postoperative complications and the assessment of the follow-up results from 1 to 6 months after procedure according to the modified Rankin scale (mRS ) scores were observed. Results All 11 patients recovered well,1 case had postoperative hemiplegia,1 case had postoperative bleeding,and none of them died. During the follow-up period,no patients had rebleeding, 1 had recurrence,and DSA revealed that the patient was embolized completely at 2 months after reembolization. Conclusion The method of ultra-early stent-assisted coil embolization of ruptured intracranial aneurysms is feasible. It may improve the cure rate of the ruptured aneurysms and improve the prognosis of patients.

Severe perioperative neurological complications underwent stent assisted coil embolization of intracranial aneurysm / 中国脑血管病杂志

Objective To analyze the perioperative clinical character of the severe neurological complications in intracranial aneurism treated with stent-assisted coiling(SAC). Methods 203 cases of intracranial aneurysms patients treated by SAC were enrolled retrospectively(ruptured aneurysm group 45 cases and un-ruptured,aneurysm group 158 cases)and the perioperative clinical character of the serious neurological complications(11 cases)was further analyzed. Results The total rate of serious neurological complication was 5. 4%,11 cases of patients with 13 aneurysms got 13 stents. In the ruptured aneurysm group, 5 cases(11. 1%)suffered severe neurological complications,including intraoperative bleeding in one case, postoperative stent-related ischemia in one case,both 2. 2% . Postoperative bleeding 2 cases(4. 4%),and one case of bleeding during anesthesia induced stage(2. 2%). In the unruptured aneurysm group,intraoperative bleeding in three cases,and postoperative stent-related ischemia in three cases,both 1. 9% . No bleeding case during anesthesia induced stage or postoperative period. Although active rescue treatments were performed, 8 patients eventually died,and the total mortality rate was 3. 9% . Conclusion Intracranial aneurysms patients following SAC treatment may suffer from bleeding,ischemia,severe neurological complications, severe disability,and even die. So,we have to strengthen perioperative management.

Efficacy analysis of endovascular treatment of vertebral basilar artery dissecting aneurysms / 中国脑血管病杂志

Objective To investigate the effect of endovascular treatment of vertebral basilar artery dissecting aneurysms. Methods The clinical data of 40 patients with vertebral basilar artery dissecting aneurysm admitted to Beijing Xuanwu Hospital and Haidian hospital,Capital Medical University from August 2013 to September 2014 were analyzed retrospectively. Their clinical symptoms and imaging were followed up. According to the treatment methods,they were divided into either a stent-assisted coil emboliza-tion group (group A;n = 34)or a parent artery occlusion (group B;n = 6),and according to the clinical symptoms and imaging followed-up,the efficacy was assessed at 1 year after procedure. Results The patients were followed up for 1 year after procedure,29 patients (85. 3%)were improved in group A, 1 (2.9%)was stable,and 4 (11. 8%)deteriorated. All the 4 deteriorated patients died of cerebral infarction complications (at 1 week to 6 months after procedure). The 6 patients in group B were improved compared with before procedure. No intracranial hemorrhage and ischemic events occurred. Conclusion Using the stent-assisted coil embolization technique and the parent artery occlusion technique for the treatment of the vertebral basilar artery dissecting aneurysms are relatively safe and effective.

Endovascular Treatment in Ruptured Middle Cerebral Artery Dissection Preservation of Arterial Continuity

Rupture of spontaneous dissecting aneurysms of the middle cerebral artery (MCA) is rare and its etiology remains obscure, although the risk of rebleeding is greater than with saccular aneurysms. Most reports concerning the treatment of a ruptured dissecting aneurysm of the anterior circulation involve surgical trapping or wrapping. Here, we report on a case of an MCA dissecting rupture treated with endovascular procedures. A 22-year-old female presented with sudden stuporous mental change following severe headache and left side hemiparesis. A computed tomography scan showed a diffuse subarachnoid hemorrhage and diffusion MR showed diffusion restriction at the right putamen and internal capsule. A 3-hour follow-up digital subtraction angiography (DSA) showed a dissecting aneurysm, which was not seen on an initial DSA. A stent assisted coil embolization was performed and double stents were applied to achieve flow diversion effects. A small remnant area of the dissecting aneurysm had disappeared at 60-day and was not observed on 12-month follow-up DSA.

Iatrogenic Carotid-Cavernous Fistula after Stent Assisted Coil Embolization of Posterior Communicating Artery Aneurysm

Stent assisted coiling (SAC) is a useful technique for the treatment of wide necked complex aneurysm. As the frequency of SAC increases, stent-related complications such as thromboembolism, aneurysm rupture, and vessel rupture have been reported. However, to the best of our knowledge, carotid-cavernous fistula (CCF) after SAC has never been reported. The authors experienced a case of direct CCF after a SAC procedure for treatment of a complex posterior communicating artery (PCoA) aneurysm regrowth, which was treated by clip ligation 12 years before. The patient was managed conservatively and angiograms performed three months after the procedure showed the complete obliteration of the left PcoA aneurysm and the spontaneous disappearance of CCF. Navigation of Solitaire stent lumen with microcatheter can cause unexpected arterial injury, especially when the proximal tip is placed in the curved portion. It seems to be desirable to place the proximal tip of Solitaire stent in the straight portion whenever possible to reduce the risk of inadvertent arterial injury which might be caused by future navigation of stent lumen.

Stent-assisted coiling for unruptured vertebral dissecting aneurysm / 实用医学杂志

Objective To evaluate the efficacy of stent-assisted coiling in the treatment of unruptured vertebral dissecting aneurysm. Methods We retrospectively reviewed 59 consecutive patients with unruptured vertebral dissecting aneurysms that underwent endovascular treatment. 31 patients received single stent-assisted coiling, 28 patients received multiple stent-assisted coiling. Results Clinical outcome was favorable in 56 of the 59 patients, the modified Rankin Scale score had no difference in both groups (P = 0.24). The immediate obliteration grade in multiple-stent group was higher than that in single-stent group (75.0% vs. 41.9%, P=0.010). What′s more, the recurrence rate was lower in multiple-stent group (0% vs. 19.4%, P = 0.043). Conclusions Stent-assisted coiling in the treatment of unruptured vertebral dissecting aneurysm is safe and effective , multilayer disposition of stents with coils will decrease the complications and facilitate the aneurysmal occlusion. Larger , prospective studies are necessary to explore the long-term outcomes of reconstruction therapy.