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Sedat J, Chau Y, Gaudart J, Sachet M, Beuil S, Lonjon M. Stent-assisted coiling of intracranial aneurysms using LEO stents: long-term follow-up in 153 patients. Neuroradiology 2017; 60:211-219. [PMID: 29273960 DOI: 10.1007/s00234-017-1965-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 12/15/2017] [Indexed: 01/31/2023]
Abstract
PURPOSE Coiling associated with placement of a self-expandable intracranial stent has improved the treatment of intracranial wide-necked aneurysms. Little is known, however, about the durability of this treatment. The purpose of this report is to present our experience with the LEO stent and to evaluate the complications, effectiveness, and long-term results of this technique. METHODS We analyzed the records of 155 intracranial unruptured aneurysms that were treated by stent-assisted coiling with a LEO stent between 2008 and 2012. Procedural, early post-procedural, and delayed complications were recorded. Clinical and angiographic follow-up of patients was conducted over a period of at least 36 months. RESULTS No procedural mortality was observed. One-month morbidity was observed in 14 out of 153 patients (9,15%). One hundred thirty-eight patients (with 140 aneurysms) had clinical and angiographic follow-up for more than 36 months. No aneurysm rupture was observed during follow-up. Four patients presented an intra-stent stenosis at 8 months, and 6 patients who had an early recurrence were retreated. Final results showed 85% complete occlusion, 13% neck remnants, and 2% stable incomplete occlusion. CONCLUSION Stent-assisted coiling with the LEO stent is a safe and effective treatment for unruptured intracranial aneurysms. The long-term clinical outcomes with the LEO stent are excellent with a high rate of complete occlusion that is stable over time.
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Affiliation(s)
- Jacques Sedat
- Unité de NeuroInterventionnelle, Hôpital Pasteur 2, 06000, Nice, France.
| | - Yves Chau
- Unité de NeuroInterventionnelle, Hôpital Pasteur 2, 06000, Nice, France
| | - Jean Gaudart
- Aix Marseille University, IRD, INSERM, SESSTIM, Marseille, France
| | - Marina Sachet
- Unité de NeuroInterventionnelle, Hôpital Pasteur 2, 06000, Nice, France
| | | | - Michel Lonjon
- Unité de Neurochirurgie, Hôpital Pasteur 2, Nice, France
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Ge H, Jin H, Li Y, Lv X. Extraction of a migrated coil from the Enterprise stent strut using a Solitaire AB stent. Neuroradiol J 2016; 29:470-472. [PMID: 27558991 PMCID: PMC5131764 DOI: 10.1177/1971400916666556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A 56-year-old woman was admitted to stent-assisted coiling for a 2-mm A1 aneurysm of the left anterior cerebral artery and a left 3-mm internal carotid artery aneurysm. While coiling the A1 aneurysm, the first 2 mm × 20 mm coil migrated through the 4.5 mm × 37 mm Enterprise stent struts, lodging at the distal anterior cerebral artery. A 4 mm × 15 mm Solitaire AB stent was used successfully in this case to remove the displaced coil. The A1 aneurysm was re-treated with a 2 mm × 40 mm coil after placement of the Enterprise stent, and the ophthalmic ICA aneurysm was also coiled through the stent struts. The patient was neurologically intact after treatment.
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Affiliation(s)
- Huijian Ge
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, China
| | - Hengwei Jin
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, China
| | - Youxiang Li
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, China
| | - Xianli Lv
- Interventional Neuroradiology Department, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, China
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Ye HW, Liu YQ, Wang QJ, Zheng T, Cui XB, Gao YY, Lai LF, Zhang X, Li XF, Su SX, He XY, Duan CZ. Comparison between Solitaire™ AB and Enterprise stent-assisted coiling for intracranial aneurysms. Exp Ther Med 2015; 10:145-153. [PMID: 26170926 DOI: 10.3892/etm.2015.2481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 08/06/2014] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to analyze the feasibility, rate of procedure-related complications and midterm angiographic follow-up outcomes using the Enterprise (EP) and Solitaire™ AB (ST) stents in the stent-assisted coiling of intracranial aneurysms. In total, 81 patients with 90 aneurysms were included in the study, with the aim to treat 43 aneurysms with the EP stent (47.8%) and 47 aneurysms with the ST stent (52.2%). The 90 aneurysms were successfully stented and subsequently coiled; however, in four patients undergoing treatment with the EP stent, the stent was not navigable; thus, treatment with the ST stent was employed (EP, n=39, 43.3%; ST, n=51, 56.7%). Of the 90 aneurysms, 44 cases were ruptured aneurysms, with 74 located in the anterior circulation and 16 located in the posterior circulation. The stenting success rate of the ST stent was significantly higher compared with the EP stent. However, no statistically significant differences were observed with regard to the packing density, complete occlusion, progressive occlusion, recurrence rate, procedure-related complications, in-stent stenosis and stent migration rates between the two groups. In conclusion, the two common medical devices used for intracranial aneurysms are relatively safe and effective for the treatment of intracranial aneurysms. However, due to the higher stenting success rate of the ST stent, this medical devise was demonstrated to be more flexible and feasible compared with the EP stent.
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Affiliation(s)
- Hua-Wei Ye
- Department of Neurosurgery, The People's Hospital of Baoan Shenzhen, Shenzhen, Guangdong 518101, P.R. China
| | - Ya-Qi Liu
- Department of Neurosurgery, The People's Hospital of Baoan Shenzhen, Shenzhen, Guangdong 518101, P.R. China ; Department of Neurosurgery, Zhujiang Hospital, Guangzhou, Guangdong 510282, P.R. China
| | - Qiu-Jing Wang
- Department of Neurosurgery, Zhujiang Hospital, Guangzhou, Guangdong 510282, P.R. China
| | - Tao Zheng
- Department of Neurosurgery, Zhujiang Hospital, Guangzhou, Guangdong 510282, P.R. China
| | - Xu-Bo Cui
- Department of Neurosurgery, Zhujiang Hospital, Guangzhou, Guangdong 510282, P.R. China
| | - Yu-Yuan Gao
- Department of Neurosurgery, Zhujiang Hospital, Guangzhou, Guangdong 510282, P.R. China
| | - Ling-Feng Lai
- Department of Neurosurgery, Zhujiang Hospital, Guangzhou, Guangdong 510282, P.R. China
| | - Xin Zhang
- Department of Neurosurgery, Zhujiang Hospital, Guangzhou, Guangdong 510282, P.R. China
| | - Xi-Feng Li
- Department of Neurosurgery, Zhujiang Hospital, Guangzhou, Guangdong 510282, P.R. China
| | - Shi-Xing Su
- Department of Neurosurgery, Zhujiang Hospital, Guangzhou, Guangdong 510282, P.R. China
| | - Xu-Ying He
- Department of Neurosurgery, Zhujiang Hospital, Guangzhou, Guangdong 510282, P.R. China
| | - Chuan-Zhi Duan
- Department of Neurosurgery, Zhujiang Hospital, Guangzhou, Guangdong 510282, P.R. China
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Kühn AL, Hou SY, Puri AS, Silva CF, Gounis MJ, Wakhloo AK. Stent-assisted coil embolization of aneurysms with small parent vessels: safety and efficacy analysis. J Neurointerv Surg 2015; 8:581-5. [PMID: 26041097 DOI: 10.1136/neurintsurg-2015-011774] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/11/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Stent-assisted coil embolization (SACE) is a viable therapeutic approach for wide-neck intracranial aneurysms. However, it can be technically challenging in small cerebral vessels (≤2 mm). OBJECTIVE To present our experience with stents approved for SACE in aneurysms with small parent arteries. METHODS All patients who underwent stent-assisted aneurysm treatment with either a Neuroform or an Enterprise stent device at our institution between June 2006 and October 2012 were identified. Additionally, we evaluated each patient's vascular risk factors, aneurysm characteristics (ruptured vs non-ruptured, incidental finding, recanalized) and follow-up angiography data. RESULTS A total of 41 patients with 44 aneurysms met our criteria, including 31 women and 10 men. Most of the aneurysms were located in the anterior circulation (75%). Stent placement in vessels 1.2-2 mm in diameter was successful in 93.2%. Thromboembolic complications occurred in 6 cases and vessel straightening was seen in 1 case only. Initial nearly complete to complete aneurysm obliteration was achieved in 88.6%. Six-month follow-up angiography showed coil compaction in three cases, one asymptomatic in-stent stenosis and stent occlusion. Twelve to 20-months' follow-up showed stable coil compaction in two patients compared with previous follow-up, and aneurysm recanalization in two patients. Twenty-four to 36-months' follow-up showed further coil compaction in one of these patients and aneurysm recanalization in a previous case of stable coil compaction on mid-term follow-up. CONCLUSIONS Our results suggest that SACE of aneurysms with small parent vessels is feasible in selected cases and shows good long-term patency rates of parent arteries.
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Affiliation(s)
- Anna Luisa Kühn
- Division Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Samuel Y Hou
- Division Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ajit S Puri
- Division Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Christine F Silva
- Division Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Matthew J Gounis
- Division Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ajay K Wakhloo
- Division Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Li TF, Shui SF, Han XW, Yan L, Ma J, Guo D, Zhu HC, Wang SK, He YH, Chen WW, Wei LP, Wang MK, Song TM. The Use of Solitaire AB Stents in Coil Embolization of Wide-Necked Cerebral Aneurysms. PLoS One 2015; 10:e0139714. [PMID: 26426804 PMCID: PMC4591355 DOI: 10.1371/journal.pone.0139714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/15/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Solitaire AB stent is one of many assistant stents used for treating wide-necked cerebral aneurysm, and has been used since 2003. However, large sample studies on its safety and effectiveness are lacking. The objective of this study was to evaluate the effectiveness and safety of the Solitaire AB stent in the coil embolization of wide-necked cerebral aneurysms. METHODS Retrospective review of the clinical and image data of 116 patients with wide-necked cerebral aneurysms who had been enrolled at six interventional neuroradiology centers from February 2010 to February 2014 and had been treated by coil embolization; in total, 120 Solitaire AB stents were used. The degree of aneurysm occlusion was examined using digital subtraction angiography (DSA) immediately after the procedure and during follow-up, and was graded using the modified Raymond classification. We also observed complications to evaluate the safety and effectiveness of this therapy. RESULTS The 120 Solitaire AB stents (4 mm × 15 mm, four stents; 4 mm × 20 mm, 16 stents; 6 mm × 20 mm, 36 stents; 6 mm × 30 mm, 64 stents) were inserted to treat 120 wide-necked cerebral aneurysms. All stents were inserted successfully. DSA immediately post-surgery revealed 55 cases of complete occlusion, 59 cases of neck remnant, and six cases of aneurysm remnant. Perioperatively, there were four cases of hemorrhage and four cases of stent thrombosis. The follow-up spanned 3-37 months; of 92 patients examined by DSA at the 6-month follow up, 12 had disease recurrence. CONCLUSIONS The Solitaire AB stent is effective with a good technical success rate and short-term effect for assisting coil embolization of wide-necked cerebral aneurysms.
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Affiliation(s)
- Teng-Fei Li
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Shao-Feng Shui
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Xin-Wei Han
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
- * E-mail:
| | - Lei Yan
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Ji Ma
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Dong Guo
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Hong-Can Zhu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shu-Kai Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuan-Hong He
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wen-Wu Chen
- Department of Neurology, The Affiliated First Hospital of Henan University, Kaifeng, China
| | - Li-Ping Wei
- Department of Neurology, Luoyang Central Hospital, Luoyang, China
| | - Ming-Ke Wang
- Department of Neurology, Luohe First people’s Hospital, Luohe, China
| | - Tai-Min Song
- Department of Neurology, Luohe First people’s Hospital, Luohe, China
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Buyukkaya R, Kocaeli H, Yildirim N, Cebeci H, Erdogan C, Hakyemez B. Treatment of complex intracranial aneurysms using flow-diverting silk® stents. An analysis of 32 consecutive patients. Interv Neuroradiol 2014; 20:729-35. [PMID: 25496683 DOI: 10.15274/inr-2014-10070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 04/19/2014] [Indexed: 11/12/2022] Open
Abstract
This study describes the peri-procedural and late complications and angiographic follow-up results of 32 patients with 34 complex aneurysms treated with flow diverter Silk stents in a single centre. In this retrospective study, 40 Silk stents (SS) were implanted in 34 complex intracranial aneurysms in 32 patients. In our series, 20 (58.8%) carotid-ophthalmic internal carotid artery (ICA), six (17.6%) cavernous ICA, two (5.9%) supraclinoid ICA, two (5.9%) petrosal ICA (the same patient- bilateral) and four (11.8%) posterior circulation aneurysms were treated. One of the posterior circulation lesions was a fenestrated-type aneurysm. Twenty wide-necked, saccular; eight neck remnant; four fusiform and two blister-like aneurysms were included in our series. SS were successfully implanted in all patients (100%). Misdeployment occurred in 17.6% of patients. In two of these patients adequate stent openness was achieved via Hyperglide balloon dilatation. Coil embolization in addition to SS placement was utilized in four aneurysms. One patient (3%) experienced transient morbidity due to a thromboembolic event and there was one mortality (3%) due to remote intraparenchymal haemorrhage. Complete occlusion of 27/33 (81.8 %) and 29/33 (87.9 %) aneurysms was achieved six and 12 months after the procedure, respectively. In-stent intimal hyperplasia was detected in 6.1 % patients. Flow-diverter Silk stent implantation is an effective method of treating complex aneurysms with acceptable mortality and morbidity rates. Complete occlusion is achieved in most of the complex aneurysms.
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Affiliation(s)
- Ramazan Buyukkaya
- Department of Radiology, Düzce University Medical School; Düzce, Turkey -
| | - Hasan Kocaeli
- Department of Neurosurgery, Uludag University Medical School; Bursa, Turkey
| | - Nalan Yildirim
- Department of Radiology, Uludag University Medical School; Bursa, Turkey
| | - Hakan Cebeci
- Department of Radiology, Uludag University Medical School; Bursa, Turkey
| | - Cüneyt Erdogan
- Department of Radiology, Uludag University Medical School; Bursa, Turkey
| | - Bahattin Hakyemez
- Department of Radiology, Uludag University Medical School; Bursa, Turkey
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Guo XB, Yan BJ, Guan S. Waffle-Cone Technique Using Solitaire AB Stent for Endovascular Treatment of Complex and Wide-Necked Bifurcation Cerebral Aneurysms. J Neuroimaging 2014; 24:599-602. [PMID: 24708043 DOI: 10.1111/jon.12121] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 02/15/2014] [Accepted: 03/02/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Xin-bin Guo
- Department of Interventional Radiology; The First Affiliated Hospital of Zhengzhou University; 1 Jianshe Road Zhengzhou 450052 China
| | - Bao-jun Yan
- Department of Interventional Radiology; The First Affiliated Hospital of Zhengzhou University; 1 Jianshe Road Zhengzhou 450052 China
| | - Sheng Guan
- Department of Interventional Radiology; The First Affiliated Hospital of Zhengzhou University; 1 Jianshe Road Zhengzhou 450052 China
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Chen YA, Hussain M, Zhang JY, Zhang KP, Pang Q. Stent-assisted coiling of cerebral aneurysms using the Enterprise and the Solitaire devices. Neurol Res 2014; 36:461-7. [DOI: 10.1179/1743132814y.0000000356] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Mine B, Aljishi A, D'Harcour JB, Brisbois D, Collignon L, Lubicz B. Stent-assisted coiling of unruptured intracranial aneurysms: long-term follow-up in 164 patients with 183 aneurysms. J Neuroradiol 2014; 41:322-8. [PMID: 24462257 DOI: 10.1016/j.neurad.2014.01.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 12/26/2013] [Accepted: 01/01/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Stent-assisted coiling (SAC) is increasingly used to treat complex unruptured intracranial aneurysms (UIA) including wide-necked and fusiform IA. However, few data are available over the long-term results of this technique. We report our 9-year-experience of SAC of UIA. METHODS A retrospective review of our prospectively maintained database identified all patients treated by SAC for an UIA in 2 institutions. The clinical charts, procedural data and angiographic results were reviewed. RESULTS Between 2004 and 2012, we identified 164 patients with 183 UIA. There were 115 women and 49 men with a mean age of 46 years. Embolization was successful in all patients. Procedural morbidity and mortality rates were 2.2% and 0% respectively. Immediate anatomical outcome included 54 complete occlusion (29.5%), 43 neck remnants (23.5%) and 86 incomplete occlusions (47%). Imaging follow-up was available in 137 patients (mean=26 months, range 3 to 99 months) and it showed 104 complete occlusions (75.9%), 23 neck remnants (16.8%) and 10 incomplete occlusions (7.3%). At follow-up, only 3 patients developed a significant intrastent stenosis, one of which was induced by radiosurgery. One of these patients had a symptomatic thrombo-embolic complication 3 years after stent placement. CONCLUSION SAC of complex UIA is effective and associated with low complication rates. Even if immediate anatomical results are relatively unsatisfying, mid- and long-term follow-up show a major improvement with a high rate of adequate occlusion that is stable over time. Moreover, the long-term clinical and angiographic tolerance of intracranial stents is excellent.
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Affiliation(s)
- Benjamin Mine
- Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, 808, route de Lennik, 1070 Brussels, Belgium.
| | - Ali Aljishi
- Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, 808, route de Lennik, 1070 Brussels, Belgium
| | - Jean-Bernard D'Harcour
- Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, 808, route de Lennik, 1070 Brussels, Belgium
| | - Denis Brisbois
- Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, 808, route de Lennik, 1070 Brussels, Belgium
| | - Laurent Collignon
- Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, 808, route de Lennik, 1070 Brussels, Belgium
| | - Boris Lubicz
- Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, 808, route de Lennik, 1070 Brussels, Belgium
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Bae YJ, Jung C, Kim JH, Choi BS, Kim E, Han MK, Bae HJ, Han MH. Potential for the use of the Solitaire stent for recanalization of middle cerebral artery occlusion without a susceptibility vessel sign. AJNR Am J Neuroradiol 2014; 35:149-55. [PMID: 23744693 PMCID: PMC7966480 DOI: 10.3174/ajnr.a3562] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 02/01/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Absence of the MCA susceptibility vessel sign (negative MCA susceptibility vessel sign) on gradient recalled-echo MR imaging in acute stroke is commonly associated with in situ stenosis and thrombotic occlusion. We evaluated the effectiveness and safety of the Solitaire stent as the first-line device for the recanalization of MCA occlusion with a negative MCA susceptibility vessel sign. MATERIALS AND METHODS Thirty-eight consecutive patients presenting with acute ischemic stroke due to MCA occlusion were treated by using the Solitaire AB stent alone or combined with thrombolytic drugs. Among these patients, 11 (7 men and 4 women; median age, 70 years; range, 49-89 years) who underwent multimodal stroke MR imaging before the endovascular procedure and had no MCA susceptibility vessel sign on the initial gradient recalled-echo MR imaging were included in this study. The primary end point was the recanalization of the occluded artery evaluated by the arterial occlusive lesion score. Clinical outcome was assessed at discharge and 90 days, as was the degree of residual MCA stenosis or reocclusion. RESULTS Successful recanalization (arterial occlusive lesion score ≥ II) without balloon angioplasty was obtained in 9 patients (81.8%). Six patients (54.5%) had an mRS score of ≤2 at 90 days. After a median of 147 days, no patient showed reocclusion on follow-up imaging. There were no symptomatic intracerebral hemorrhages. CONCLUSIONS The Solitaire stent is a feasible tool as the first-line device for multimodal endovascular recanalization therapy in acute ischemic stroke with a negative MCA susceptibility vessel sign. It has a good rate of successful and complete recanalization and is a fast yet safe procedure.
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11
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Solitaire AB stent-assisted coiling of wide-necked intracranial aneurysms: short-term results from a prospective, consecutive, European multicentric study. Neuroradiology 2013; 55:1373-8. [PMID: 24057085 DOI: 10.1007/s00234-013-1277-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 08/23/2013] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Solitaire AB stent-assisted coiling facilitates the endovascular treatment of wide-necked intracranial aneurysms. Solitaire Aneurysm Remodeling is the first prospective, consecutive, European multicentric study whose main objective was to evaluate the safety, short-, and long-term efficacy of the Solitaire AB stent. This first analysis is focused on the short-term results. METHODS After exclusion of one patient, 66 Solitaire AB stents were used to treat via endovascular approach 64 aneurysms (63 patients) in seven European centers. Technical and clinical complications were recorded. A core laboratory evaluated the angiographic efficacy by using the Raymond classification scale. RESULTS The mean width of aneurysm sac was 7.5 mm, and the mean diameter of aneurysm neck was 4.7 mm. Complete occlusion was achieved in 27 aneurysms (42.2 %); neck remnant was seen in 25 aneurysms (39.1 %) and aneurysm remnant in 12 aneurysms (18.7 %). Technical and clinical complications related to the procedure were encountered in eight patients (12.7 %). Postprocedural modification of the clinical status was observed in one patient (1.6 %). No patients died (0 %); one had a permanent deficit (1.6 %), and one had a transient deficit (1.6 %). Treatment-related mortality was 0 %, and permanent morbidity was 1.6 %. CONCLUSION The Solitaire AB stent has an excellent rate of technical success navigation with the absence of dislodgement. The safety and short-term efficacy are comparable to those previously reported with coiling alone. Mid- and long-term follow-up will be required to elucidate the impact of the Solitaire AB stent on recanalization rate.
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Mitsos AP, Giannakopoulou MD, Kaklamanos IG, Kapritsou M, Konstantinou MI, Fotis T, Mamoura KV, Mariolis-Sapsakos T, Ntountas IT, Konstantinou EA. Endovascular treatment of cerebral aneurysms in relation to their parent artery wall: a single center study. Neuroradiol J 2013; 26:71-9. [PMID: 23859171 DOI: 10.1177/197140091302600112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 12/13/2012] [Indexed: 11/17/2022] Open
Abstract
We report our two-year experience in the endovascular treatment of brain aneurysms in relation to their parent artery wall. We prospectively recorded patients with intracranial aneurysms (107 ruptured - 38 unruptured) treated with coiling during a two-year period: 145 patients, 94 females and 51 males - mean age 56 years. The aneurysms were divided into side-wall (A) and bifurcation (B) groups. A total occlusion rate was noted in post-embolization angiograms in 101 aneurysms (70%) with a morbidity of 4%. No angiographic recurrence arose in the six-month follow-up. The two groups had a similar total occlusion rate (68.31% and 71.8% respectively), while the complication rate was 3% in group A and 4.7% in group B. Significant differences between the two groups were noted in the number of assisted coiling cases: 28 out of 60 cases (46.7%) in group A - 14 out of 85 cases (16.5%) in group B. Further statistical analysis showed strong dependencies for the type of endovascular procedure between the ruptured and unruptured aneurysms in both groups (p 0.000<0.05), but no dependencies between the aneurysm occlusion rate and the ruptured or non-ruptured aneurysms, or between the occlusion rate and the type of endovascular procedure (p 0.552>0.05 and 0.071>0.05 respectively). In conclusion, the anatomic relation of the aneurysm sac with the wall of the parent artery is important, as significant differences in endovascular practice, devices and techniques were noted between side-wall and bifurcation aneurysms.
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13
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Stent-assisted coil embolization of intracranial aneurysms using the Solitaire™ AB Neurovascular Remodeling Device: initial and midterm follow-up results. Neuroradiology 2013; 55:629-38. [PMID: 23386222 DOI: 10.1007/s00234-013-1148-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 01/22/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The purpose of this retrospective review was to present our experience in using the Solitaire™ AB Neurovascular Remodeling Device in the stent-assisted treatment of intracranial aneurysms, focusing on midterm results. To date, this is the largest series using the Solitaire™ AB Neurovascular Remodeling Device. METHODS From February 2008 to December 2010, 102 patients harboring 104 wide-necked or complex intracranial aneurysms were consecutively enrolled. Forty-five patients presented with an acute subarachnoid hemorrhage. Stent implantation was combined with a standard coiling procedure in 100 patients; in 13 of them, by bailout stenting. On average, at least one clinical and angiographic follow-up was available in 63 patients after 6.3 months. Forty-nine patients were followed for up to 13.6 months. RESULTS Of the stents, 98.4 % could be deployed successfully. A Raymond class 1 occlusion was obtained in 51 % of the aneurysms, a Raymond class 2 occlusion in 44 %, and in the remaining 5 % a Raymond class 3 occlusion was obtained. Procedure-related morbidity was 3.9 % (n = 4) and procedure-related mortality was 2.9 % (n = 3). During the follow-up period, 39.2 % of the aneurysms showed further thrombosis, 45.1 % remained unchanged, and 15.7 % recanalized. In the follow-up clinical examination according to the modified Rankin Scale, 16.3 % of all patients presented with clinical improvement, 73.5 % were unchanged, and 10.2 % of patients deteriorated. CONCLUSION Considering that stent-assisted coiling is indicated in unfavorable aneurysms, which are not amenable to standard coiling procedures, the Solitaire AB stent proved to be an efficient and safe device in midterm angiographic and clinical follow-up results.
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McCabe JJ, Phillips TJ, Phatouros C, Singh T, Blacker D, Hankey GJ, McAuliffe W. Mechanical thrombectomy with the Solitaire AB device in large intracerebral artery occlusions. J Med Imaging Radiat Oncol 2012; 57:149-55. [DOI: 10.1111/j.1754-9485.2012.02474.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 07/30/2012] [Indexed: 11/28/2022]
Affiliation(s)
- John J McCabe
- Neurological Intervention & Imaging Service of Western Australia (NIISWA); Sir Charles Gairdner Hospital; Perth; Western Australia; Australia
| | | | | | | | - David Blacker
- Department of Neurology; Sir Charles Gairdner Hospital; Perth; Western Australia; Australia
| | - Graeme J Hankey
- Department of Neurology; Royal Perth Hospital; Perth; Western Australia; Australia
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Martínez-Galdámez M, Saura P, Saura J, Martínez A, De Campos JM, Pérez A. Y-stent-assisted coil embolization of anterior circulation aneurysms using two Solitaire AB devices: a single center experience. Interv Neuroradiol 2012; 18:158-63. [PMID: 22681730 DOI: 10.1177/159101991201800206] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 02/05/2012] [Indexed: 11/15/2022] Open
Abstract
Wide-neck intracranial aneurysms remain a challenge to endovascular treatment. We describe our experience in repairing wide-neck aneurysms of the anterior circulation located at arterial branch points using coil embolization assisted by Y-stenting using two Solitaire(®) stents.Six wide-neck intracranial aneurysms located on the middle cerebral artery bifurcation( 3), pericallosal artery( 1), and anterior communicating artery( 2) were repaired by Y-stent-assisted coil embolization using two Solitaire(®) stents. Four cases were incidental findings of aneurysm and two cases were previously treated ruptured aneurysms that had undergone recanalization. All the cases were successfully treated without complications. Follow-up by digital subtraction angiography and magnetic resonance angiography at six months showed the stents to be patent with no recanalization of the aneurysm sacs. Repairing wide-neck aneurysms of the anterior circulation by Y-stent-assisted coil embolization using two Solitaire(®) stents is a simple and safe method of treating complex aneurysms. While the results are promising, larger series with longer term follow-ups are needed to corroborate that this treatment method is superior to other techniques.
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Affiliation(s)
- M Martínez-Galdámez
- Interventional Neuroradiology Unit, Radiology Department, Fundación Jiménez Díaz-CAPIO, Madrid, Spain.
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Gao X, Liang G, Li Z, Wei X, Hong Q. Complications and adverse events associated with Neuroform stent-assisted coiling of wide-neck intracranial aneurysms. Neurol Res 2012; 33:841-52. [PMID: 22004708 DOI: 10.1179/1743132811y.0000000012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Successful experiences of the Neuroform stent-assisted coiling have been reported by many teams in endovascular neurosurgery centers throughout the world. However, most of the reported complications involved a limited number of patients. OBJECTIVE To systematically report the complications of Neuroform stent-assisted coiling of intracranial aneurysms and to tentatively assess the efficacy and safety of this method. METHODS A retrospective study of 232 consecutive patients with 239 wide-neck aneurysms treated with Neuroform stent-assisted coil embolization at our institution over a 6-year period was performed. Angiographic results and clinical outcome were evaluated. Cases with complications were analyzed. RESULTS Stenting was successful in 237 of 239 aneurysms. Favorable clinical outcome (modified Rankin score: 0-2) was observed in 88·3% of the patients. Procedure-related complications included thromboembolism (n = 13), intraprocedural rupture (n=8), coil protrusions (n=5), new mass effect (n=3), vessel injury (n=3), and stent dislodgement (n=2). Procedure-related morbidity and mortality were 4·2 and 1·3%, respectively. Non-procedural complications attributable to subarachnoid hemorrhage in 129 patients with ruptured aneurysms were symptomatic vasospasm (18·6%) and shunt-dependent hydrocephalus (6·9%). Angiography follow-up was obtained in 67·1% of the treated aneurysms. The overall recanalization rate was 14·5%. Delayed complications included in-stent stenosis (n=2) and penetrating artery occlusion (n=2) in follow-up period. CONCLUSION Neuroform sent-assisted coiling of intracranial aneurysm is a safe technique with relatively low recanalization rate. The main cause of morbidity and mortality is thromboembolism. Long-term effect on parent artery should be observed carefully.
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Affiliation(s)
- Xu Gao
- Department of Neurosurgery, the General Hospital of Shenyang Military Command, Shenyang, China
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Kim MJ, Chung J, Kim SL, Roh HG, Kwon BJ, Kim BS, Kim TH, Kim BM, Shin YS. Stenting from the vertebral artery to the posterior inferior cerebellar artery. AJNR Am J Neuroradiol 2011; 33:348-52. [PMID: 22051805 DOI: 10.3174/ajnr.a2741] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There are only a few reports on the feasibility and safety of stents used in the PICA, and clinical and angiographic follow-up results have not been fully addressed. We report our experiences of treating PICA origin or vertebral artery-PICA lesions by using self-expanding stents as adjuvant or rescue therapy with angiographic and clinical follow-up results. MATERIALS AND METHODS Six patients were treated with self-expanding stent placements from the vertebral artery to the PICA. Two patients had a vertebral artery dissecting aneurysm involving the PICA origin, 3 had vertebral artery-PICA aneurysms, and 1 had segmental stenosis of the vertebral artery harboring the origin of the PICA. The safety, feasibility, and follow-up angiographic results were retrospectively evaluated. RESULTS All procedures were successfully performed without any procedure-related complications. None of the patients showed PICA territorial infarction on DWI posttreatment. All patients were neurologically intact during the clinical follow-up of 3-24 months following the procedure. Follow-up angiography was performed at between 6 and 12 months in 5 of the 6 patients and was scheduled for the sixth patient but was not performed. The PICA showed good patency without in-stent stenosis in all 5 patients. CONCLUSIONS In patients with lesions of the PICA origin or vertebral artery-PICA lesions, vertebral artery-to-PICA stent placement may be an option for preserving PICA patency in selected cases.
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Affiliation(s)
- M J Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
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Choi JW, Roh HG, Moon WJ, Chun YI, Kang CH. Optimization of MR Parameters of 3D TOF-MRA for Various Intracranial Stents at 3.0T MRI. Neurointervention 2011; 6:71-7. [PMID: 22125752 PMCID: PMC3214815 DOI: 10.5469/neuroint.2011.6.2.71] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 06/24/2011] [Indexed: 12/22/2022] Open
Abstract
Purpose The in-stent signal reduction of the stented artery caused by susceptibility artifact or radiofrequency shielding artifact limited the use of time-of-flight MR angiography (TOF-MRA) as a follow-up tool after intracranial stenting. We showed the degree of an artifact according to different stent types, and optimized MR parameters for TOF-MRA in patients with intracranial stent on 3.0 T MRI. Materials and Methods Four stents (Neuroform, Wingspan, Solitaire, and Enterprise) were placed in a vascular flow phantom and imaged by changing flip angle (FA; 20°,30°,40°,50° and 60°) and bandwidth (BW; 31, 42 and 62.5 KHz) using TOF-MRA. Source data of each image set with different FA and BW were reconstructed with the maximal intensity projection (MIP) technique, and MIP images were used to evaluate the in-stent signal reduction of each stent according to the change of MR parameters. The in-stent signal reduction was assessed by calculating the relative in-stent signal (RIS) inside the stent as compared with background and signal intensity of the tube outside the stent. The optimal FA and BW of each stent were determined by comparing the RIS in each stent by one-sample t test. Finally, one neuroradiologist chose one image set with the best image quality. Results The mean RIS for Neuroform, Wingspan, Solitaire and Enterprise stent was 66.3 ± 6.0, 44.2 ± 5.8, 22.8 ± 3.3 and 8.2 ± 2.9, respectively. The significantly high RIS of each stent was obtained with FA/BW value of 20°/31 KHz (Neuroform), 20°/31 KHz and 30°/42 KHz (Wingspan), 40°/42 KHz and 50°/31 KHz (Solitaire) and 40°/31 KHz and 50°/31 KHz (Enterprise). Among these MIP images with significantly high RIS, images with FA/BW value of 20°/31 KHz (Neuroform and Wingspan) and 50°/31 KHz (Solitaire and Enterprise) had the best image quality. Conclusion The degree of artifact was variable according to the design of each intracranial stent. The luminal visualization of closed-cell design stents such as Solitaire and Enterprise can be improved by higher FA. Thus, MR parameter should be adjusted according to the type of intracranial stents.
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Affiliation(s)
- Jin Woo Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Stampfl S, Hartmann M, Ringleb PA, Haehnel S, Bendszus M, Rohde S. Stent placement for flow restoration in acute ischemic stroke: a single-center experience with the Solitaire stent system. AJNR Am J Neuroradiol 2011; 32:1245-8. [PMID: 21596812 DOI: 10.3174/ajnr.a2505] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE In acute thromboembolic stroke, mechanical recanalization with stents may result in immediate flow restoration. The Solitaire stent can be used both for flow restoration and thrombectomy. In this single-center experience, we report safety and efficacy data on the application of the Solitaire stent. MATERIALS AND METHODS Between March 2009 and July 2010, 18 patients were treated with the Solitaire stent. To evaluate perfusion of the occluded vessel segment before and after the intervention, the TICI score was used (0-3). Clinical outcome was assessed by using the mRS at discharge. RESULTS Overall, recanalization was successful in 16 of 18 patients (88.8%). There were no procedure-related complications. Mean TICI score after the intervention was 2.3 ± 0.8. In 5 patients, reocclusion of the treated vessel occurred immediately after retrieval of the temporarily opened stent, and permanent stent deployment was performed to maintain stable perfusion. In 3 patients, hemorrhage occurred after successful recanalization. Five patients died (infarction, n = 3; hemorrhage, n = 1; organ failure, n = 1). A good clinical outcome (mRS ≤2) was achieved in 33.3% of the patients, 5.5% had a moderate outcome (mRS, 3/4), and 61.2% had a poor outcome or died (mRS, 5/6). CONCLUSIONS Application of the Solitaire stent in acute stroke results in a high recanalization rate (88.8%) without procedural complications and with a good outcome in one-third of patients. These results encourage further evaluation of the stent in larger patient populations.
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Affiliation(s)
- S Stampfl
- Departments of Neuroradiology, University of Heidelberg, Heidelberg, Germany.
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Flow diverter stents in the treatment of intracranial aneurysms: Where are we? J Neuroradiol 2011; 38:40-6. [PMID: 21257202 DOI: 10.1016/j.neurad.2010.12.002] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 12/17/2010] [Indexed: 10/18/2022]
Abstract
Flow diverter stents are devices designed to treat complex aneurysms. According to preliminary series published in the literature, treatment of aneurysms with flow diverters is highly efficacious with acceptable morbidity and mortality. Delayed aneurysm ruptures have been reported but mechanisms are actually not completely elucidated. In-stent thrombosis or stenosis was also observed. Indications of flow diverters are complex aneurysms (fusiform, large and giant, wide neck, small aneurysms untreatable by conventional coiling) as well as recurrences. Several randomized studies and registries are actually in progress and will contribute to a more precise knowledge of the place of the flow diverters in the treatment of intracranial aneurysms.
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Mustafa W, Kadziolka K, Leautaud A, Pierot L. Double lumen remodelling balloon: a new technique for treatment of bifurcation aneurysms. J Neuroradiol 2011; 38:183-6. [PMID: 21215454 DOI: 10.1016/j.neurad.2010.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 09/15/2010] [Accepted: 10/15/2010] [Indexed: 11/19/2022]
Abstract
Bifurcation aneurysms (carotid bifurcation aneurysms, top of basilar artery aneurysms and middle cerebral artery aneurysms) are frequently treated by endovascular treatment (EVT) but their treatment is sometimes difficult singularly when the neck is wide. The "remodelling technique" is used for the treatment of these difficult aneurysms. However, the use of this technique is more complicated in bifurcation aneurysms compared to side-wall aneurysms. It is effectively necessary to protect in the same time the aneurysm neck, the parent vessel, and also the collateral branches. We present endovascular treatment of two cases of bifurcation aneurysms using a new technique of remodelling for endovascular treatment of bifurcation aneurysms by using a double lumen balloon.
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Affiliation(s)
- W Mustafa
- Department of Radiology, Maison Blanche Hospital, University of Reims, 45, rue Cognacq Jay, 51092 Reims cedex, France.
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Gao X, Liang G, Li Z, Qu H, Wei X. Stent-assisted coil embolization of wide-necked intracranial aneurysms using a semi-deployment technique: angiographic and clinical outcomes in 31 consecutive patients. Interv Neuroradiol 2010; 16:385-93. [PMID: 21162768 DOI: 10.1177/159101991001600404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 09/06/2010] [Indexed: 11/17/2022] Open
Abstract
We describe a modified stent-assisted coiling technique, named the semi-deployment technique, in the endovascular treatment of wide-neck aneurysms. Thirty-one consecutive patients with 31 wide-necked or fusiform intracranial aneurysms were treated with the semi-deployment technique. The technical feasibility of the procedure, procedure-related complications, angiographic results, clinical outcome and follow-up angiography were evaluated. In every case, the semi-deployment technique was successfully deployed. Immediate angiography demonstrated complete occlusion in 24 cases (77.4%), neck remnant in four cases (12.9%), and incomplete occlusion in three cases (9.7%). Procedural-related morbidity occurred in one patient (3.2%) but no procedural-related mortality. A favorable clinical outcome (Modified Ran-kin Scale score 0-2) was observed in 90.3% of the patients (average follow-up time, 23.1 months). No rehemorrhage of treated aneurysms occurred. Angiography follow-up was obtained in 22 cases (71.0 %). Three aneurysms (13.6 % of the follow-up angiograms) demonstrated recanalization. No delayed coil or stent migration was found. One patient had in-stent stenosis as a delayed complication. We found that the semi-deployment technique was helpful in the treatment of wide-neck aneurysms.
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Affiliation(s)
- X Gao
- Department of Neurosurgery, The General Hospital of Shenyang Military Command, Shenyang, China
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Stampfl S, Rohde S. Comment on: Mechanical thrombectomy with the Solitaire AB device in large artery occlusions of the anterior circulation: Castaño C, Dorado L, Guerrero C, et al. Stroke. 2010;41:1836-40. Clin Neuroradiol 2010; 20:267-8. [PMID: 21127825 DOI: 10.1007/s00062-010-0043-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 10/21/2010] [Indexed: 12/01/2022]
Affiliation(s)
- S Stampfl
- Dept. of Neuroradiology, University Heidelberg, Heidelberg, Germany.
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