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Lu Y, Ding C, Tan S, Zhou X, Wang Y. Predisposing factors for the deformation of parent artery of anterior circulation saccular aneurysm after stent-assisted embolization: A retrospective cohort study. Interv Neuroradiol 2023; 29:243-250. [PMID: 35238673 PMCID: PMC10369118 DOI: 10.1177/15910199221084797] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/24/2022] [Accepted: 02/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It has been previously reported in several studies that deformation of parent artery (DPA) occurs after stent-assisted coil embolization (SACE) for intracranial aneurysms (IAs). OBJECTIVE To investigate the predisposing factors of stent-induced DPA, as well as its effect on the follow-up of aneurysm embolization. METHODS Clinical and imaging data were collected from 198 patients (201 aneurysms). Angles of the stent-covered parental artery were measured before treatment and during follow-up. Cases in which the angle had changed more than 5 degrees, were defined as DPA. The related factors of DPA were analyzed. The relation between DPA and follow-up results was also studied. RESULTS Univariate analysis revealed that sex (p = 0.014), age (p = 0.017), aneurysm location (p < 0.001), stent type (p < 0.001), aneurysm size (p = 0.019), and pretreatment angle (p = 0.002) correlated with DPA. On the other hand, multivariate analysis revealed that aneurysms located in the anterior communicating artery (ACOA) (OR = 4.559, p = 0.013) and middle cerebral artery (MCA) (OR = 9.474, p < 0.001) were independent predisposing factors for DPA after stent implantation, whereas a braided stent (OR = 0.221, p = 0.030), flow diverter (FD) device (OR = 0.100, p = 0.028) were negative factors to develop DPA. The complete occlusion rate in the DPA group was higher (p = 0.035) than in the non-DPA group. CONCLUSIONS Aneurysms located in ACOA and MCA are more prone to DPA after SACE than aneurysms at other locations in the anterior circulation, braided stents and FD devices do not predispose to induce vascular deformation. DPA may be beneficial for the long-term cure of IAs after SACE.
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Affiliation(s)
- Yuzhao Lu
- Department of Neurosurgery, First affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | - Cong Ding
- Department of Neurosurgery, First affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | - Song Tan
- Department of Neurosurgery, First affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | - Xiaobing Zhou
- Department of Neurosurgery, First affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | - Yang Wang
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Altay CM, Binboga AB, Onay M. Modified balloon-assisted coiling instead of acute stenting in the treatment of ruptured wide necked intracranial aneurysms. Interv Neuroradiol 2022; 28:338-346. [PMID: 35275029 DOI: 10.1177/15910199221087010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the safety and efficiency of the modified balloon assisted coiling (mBAC) technique in endovascular treatment (EVT) of ruptured wide-necked aneurysms (WNAs) to avoid stent placement in the acute phase of subarachnoid hemorrhage (SAH). METHODS The local neurointerventional radiology database was retrospectively reviewed to identify patients who underwent EVT due to ruptured WNAs by the authors. According to the EVT technique performed, the study sample was divided into 3 groups: conventional BAC, stent assisted coiling (SAC), and mBAC. The patient demographics, aneurysm features, technical and clinical complications, aneurysm occlusion grades, morbidity, and mortality rates were comparatively analyzed. RESULTS This study involved a total of 113 patients who had ruptured WNAs. The mBAC technique was performed on 26 aneurysms (23 saccular and 3 fusiform) in 26 patients to avoid acute phase stenting. The mean continuous balloon inflation time was 7.1 ± 2.12 min. The initial and follow-up angiographic and clinical outcomes were better in the mBAC group than in the SAC group (p < 0.05). CONCLUSIONS The mBAC technique offers a prolonged, continuous balloon inflation time during the whole coiling process in the treatment of ruptured WNAs. The mBAC technique has the potential to obviate the need for SAC in patients who are candidates for stenting during the acute phase of SAH, and it might be considered a safe and effective endovascular approach with low complication rates and good angiographic and clinical outcomes.
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Affiliation(s)
- Cetin Murat Altay
- Department of Radiology, 506083Dr Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Ali Burak Binboga
- Department of Radiology, 506083Dr Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Mehmet Onay
- Department of Radiology, 506083Dr Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
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Binboga AB, Onay M, Altay CM. Strut remodeling with hypercompliant balloon: A new approach to Y stent-assisted coil embolization in the treatment of complex wide-neck bifurcation aneurysms. Interv Neuroradiol 2020; 27:329-338. [PMID: 33356714 DOI: 10.1177/1591019920984332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The objective of this study was to present the long-term safety and effectiveness of strand remodelling with a hypercompliant balloon. METHODS Patients with complex wide-neck bifurcation aneurysms (WNBAs) who underwent strand remodelling with a hypercompliant balloon via Y-stent-assisted coil embolization (Y-SACE) between September 2016 and January 2020 were included in the study. The feasibility, safety, effectiveness, and complication rates of the strand remodelling technique were investigated. RESULTS A total of 12 patients (6 females, 6 males) were included in this study. Significant expansion was obtained in the intersection zone after remodelling. No regression was observed in the expansion rates during follow-up. There was no additional morbidity or mortality. No delayed thromboembolic complications occurred in our patients during long-term follow-up. CONCLUSIONS Performing strand remodelling to reduce thromboembolic complications triggered by structural faults caused by the Y-stent configuration is feasible, safe, and effective. This new approach can aid in the prevention of thromboembolic complications in Y-SACE.
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Affiliation(s)
- Ali Burak Binboga
- Department of Radiology, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Mehmet Onay
- Department of Radiology, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Cetin Murat Altay
- Department of Radiology, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
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Saied A, Elsaid N, Joshi K, Gomaa M, Amer T, Saad M, Lopes D. Factors Affecting the Degree of Angular Remodeling in Stent-Assisted Coiling of Bifurcation Aneurysms. INTERVENTIONAL NEUROLOGY 2020; 8:220-230. [PMID: 32508904 DOI: 10.1159/000502058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/11/2019] [Indexed: 11/19/2022]
Abstract
Background Stent-assisted coiling (SAC) leads to significant changes in the vascular angle altering the bifurcation geometry and the hemodynamics at the bifurcation apex. It is believed that the stent alone exerts this effect, but other possible factors have not been studied. Purpose To study the factors contributing to angular remodeling following SAC of bifurcation aneurysms including the anatomical, stent-related, and coil-related factors. Materials and Methods We reviewed 43 basilar and carotid bifurcation aneurysms treated by SAC using Neuroform EZ (n = 28), Enterprise (n = 8), and Lvis Jr. (n = 7) stents. The bifurcation angle between the mother and stented daughter vessel was measured in 4 settings: pretreatment, poststenting, postcoiling, and at delayed follow-up (6-12 months). The degree of stent-induced angular remodeling was calculated by subtracting the poststenting bifurcation angle from the pretreatment one, while the coil-induced angular remodeling was calculated as the difference between the postcoiling and poststenting bifurcation angle. The immediate postprocedural degree of angular remodeling is the sum of the stent- and coil-induced angular remodeling. We studied the effect of several factors including the pretreatment bifurcation angle, aneurysm site, diameter of parent vessel, stent type, stent length in the daughter vessel, postoperative actual in situ coil size, and packing density. Results The mean degree of stent-induced and coil-induced angular remodeling was 10.2 (0-47) and 4.53 (-7 to 30), respectively. The immediate postprocedural and delayed angular remodeling was 14.8 (-4 to 47) and 4.75 (-12 to 40), respectively. The degree of immediate remodeling was significantly affected by the actual in situ coil size (p = 0.017), and the pretreatment bifurcation angle (p = 0.024). Linear regression was carried out and the pretreatment bifurcation angle was defined as a predictor. The degree of delayed remodeling is significantly affected only by the pretreatment bifurcation angle (p = 0.011). Conclusion Immediate angular remodeling following SAC of bifurcation aneurysms can happen after stenting or coiling or both. This is the first study reporting the role of the coils as an additional factor beside the stent in inducing immediate angular changes; this effect is correlated to the size of the coils. The pretreatment bifurcation angle is the most consistent factor affecting the degree of both immediate and delayed angular remodeling.
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Affiliation(s)
- Ahmed Saied
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurology, Mansoura University, Mansoura, Egypt
| | - Nada Elsaid
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurology, Mansoura University, Mansoura, Egypt
| | - Krishna Joshi
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Mohamed Gomaa
- Department of Neurology, Mansoura University, Mansoura, Egypt
| | - Talal Amer
- Department of Radiology, Mansoura University, Mansoura, Egypt
| | - Mohamed Saad
- Department of Neurology, Mansoura University, Mansoura, Egypt
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Voß S, Beuing O, Janiga G, Berg P. Stent-induced vessel deformation after intracranial aneurysm treatment – A hemodynamic pilot study. Comput Biol Med 2019; 111:103338. [DOI: 10.1016/j.compbiomed.2019.103338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 12/13/2022]
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Rai AT, Tarabishy AR, Boo S, Carpenter JS, Bhattia S. The 'bendy' basilar: progressive aneurysm tilting and arterial deformation can be a delayed outcome after coiling of large basilar apex aneurysms. J Neurointerv Surg 2018; 11:37-42. [PMID: 29773714 PMCID: PMC6327868 DOI: 10.1136/neurintsurg-2018-013940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/11/2018] [Accepted: 04/15/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Morphological changes in the basilar artery and the artery-aneurysm relationship following coiling of large basilar apex aneurysms may induce morbidity. METHODS The basilar artery radius-of-curvature was measured along its center line on volumetrically reconstructed images formatted along the plane of curvature. The aneurysm-tilt-angle was measured between the distal basilar and the vertical long axis of the aneurysm. The measurements were compared between small (<10 mm) and large (≥10 mm) aneurysms on baseline and follow-up studies. The volume (mm3) and mass (g) of the deployed coils was also compared. RESULTS Among 94 consecutive aneurysms, 62 (66%) were <10 mm and 32 (34%) were ≥10 mm. The mean aneurysm size and volume was 9 mm (±4) and 507 mm3(±1366) respectively. The median aneurysm follow-up was 24 months (IQR 6-59). There was no difference between the groups based on age, gender, or associated comorbidities. The coil mass was 0.4 g (±0.2) for aneurysms <10 mm and 1.9 g (±1.6) for aneurysms ≥10 mm (P<0.0001). The total coil volume was 32 (±20) mm3 for aneurysms <10 mm and 187 (±172) mm3 for aneurysms ≥10 mm (P<0.0001). Aneurysms ≥10 mm tilted 13.5o (±14.4) compared with 1.1o (±2.8) for aneurysms <10 mm (P<0.0001). The basilar artery became more curved by 1.3 (±9.4) mm for aneurysms ≥10 mm and 0.25 (±2.1) mm for aneurysms <10 mm (P=0.0002). Other than size of the coiled aneurysms no other factors correlated with the geometrical changes. CONCLUSION Large coiled basilar apex aneurysms may be more prone to aneurysm tilting and bending of the basilar artery. Speculative causes include the weight of the coil mass and the biomechanical forces exerted on the coiled aneurysm.
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Affiliation(s)
- Ansaar T Rai
- Department of Interventional Neuroradiology, West Virginia University Hospital, Morgantown, West Virginia, USA
| | - Abdul R Tarabishy
- Department of Neuroradiology, West Virginia University, Morgantown, West Virginia, USA
| | - SoHyun Boo
- Department of Interventional Neuroradiology, West Virginia University Hospital, Morgantown, West Virginia, USA.,Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
| | - Jeffrey S Carpenter
- Department of Interventional Neuroradiology, West Virginia University Hospital, Morgantown, West Virginia, USA
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Adeeb N, Griessenauer CJ, Patel AS, Foreman PM, Baccin CE, Moore JM, Gupta R, Alturki A, Harrigan MR, Ogilvy CS, Thomas AJ. The Use of Single Stent-Assisted Coiling in Treatment of Bifurcation Aneurysms: A Multicenter Cohort Study With Proposal of a Scoring System to Predict Complete Occlusion. Neurosurgery 2017; 82:710-718. [DOI: 10.1093/neuros/nyx310] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 05/11/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The development of stent-assisted coiling has allowed for the endovascular treatment of wide-necked bifurcation aneurysms. A variety of options exist, and little is known about the optimal stent configuration in this setting. We report a large multicenter experience of stent-assisted coiling of bifurcations aneurysms using a single stent, with attention to factors predisposing to aneurysm recanalization.
OBJECTIVE
To assess the safety and efficacy of single stent-assisted coiling, in addition to analyzing the factors associated with recanalization, and proposal of a predictive scoring scale.
METHODS
A multicenter retrospective analysis of bifurcation aneurysms treated with a single stent-assisted coiling technique between 2007 and 2015 was performed. Clinical and radiographic data were collected and used to develop a scoring system to predict aneurysm occlusion.
RESULTS
A total of 74 bifurcation aneurysms were treated with single stent-assisted coiling. At a median follow-up of 15.2 mo, complete occlusion or remnant neck was achieved in 90.6% of aneurysms. Aneurysm location, maximal diameter, neck size, and alpha angle were predictive of aneurysm occlusion at last follow-up. A scoring system to predict complete occlusion based on these factors was developed. An increasing score correlated with a higher rate of complete occlusion.
CONCLUSION
The treatment of bifurcation aneurysm using single stent technique for stent-assisted coiling is safe and effective. Complete occlusion or remnant neck occlusion was achieved in 90.6% of cases. Class III aneurysms can be effectively treated using a single stent, while class I may require Y-stent technique.
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Affiliation(s)
- Nimer Adeeb
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christoph J Griessenauer
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Apar S Patel
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Paul M Foreman
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Carlos E Baccin
- Department of Neurosurgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Raghav Gupta
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Abdulrahman Alturki
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mark R Harrigan
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Vascular angular remodeling by kissing-Y stenting in wide necked intracranial bifurcation aneurysms. J Neurointerv Surg 2016; 9:1233-1237. [DOI: 10.1136/neurintsurg-2016-012858] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 11/16/2016] [Accepted: 11/17/2016] [Indexed: 11/03/2022]
Abstract
IntroductionSingle stent deployment leads to a change in vascular geometry in wide necked bifurcation aneurysms. In some complex cases, the use of the single stent technique might not be sufficient or may not be feasible. The kissing-Y stenting technique appears to be an alternative endovascular treatment option. The aim of this study was to evaluate the effects of the kissing-Y stenting technique on vascular angular remodeling.Methods21 patients with wide necked intracranial bifurcation aneurysms at different sites (10 anterior communicating artery, 6 middle cerebral artery, 3 basilar artery, 1 vertebral artery/posterior inferior cerebellar artery, 1 internal carotid artery/posterior communicating artery) were treated with 44 closed cell stents (follow-up 2012–2016) using the kissing-Y stenting technique. We analyzed vascular angle geometry between the mother and both affected daughter vessels by digital subtraction angiography, before and after stent deployment, using standard working projections.ResultsEndovascular treatment of wide necked intracranial aneurysms using the kissing-Y stenting technique significantly decreased the angle between the bifurcation branches from 130.4±9.5° to 91.5±9.1° (p<0.0001).ConclusionsKissing-Y stenting in wide necked bifurcation aneurysms leads to vascular angular remodeling of both affected branches. The resulting straightening of the bifurcation angle may prevent aneurysmal recurrence.
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Beller E, Klopp D, Göttler J, Kaesmacher J, Zimmer C, Kirschke JS, Prothmann S. Closed-Cell Stent-Assisted Coiling of Intracranial Aneurysms: Evaluation of Changes in Vascular Geometry Using Digital Subtraction Angiography. PLoS One 2016; 11:e0153403. [PMID: 27073908 PMCID: PMC4830582 DOI: 10.1371/journal.pone.0153403] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/29/2016] [Indexed: 11/18/2022] Open
Abstract
Background Stent-assisted coil embolization (SACE) plays an important role in the treatment of intracranial aneurysms. The purpose of this study was to investigate geometrical changes caused by closed-cell design stents in bifurcation and sidewall aneurysms. Methods 31 patients with 34 aneurysms underwent SACE with closed-cell design stents. Inflow angle α, determined by aneurysm neck and afferent vessel, and angle between afferent and efferent vessel close to (δ1), respectively, more remote from the aneurysm neck (δ2) were graphically determined in 2D angiography projections. Results Stent assisted coiling resulted in a significant increase of all three angles from a mean value (±SEM) of α = 119° (±6.5°) pretreatment to 130° (±6.6°) posttreatment (P ≤ .001), δ1 = 129° (±6.4°) to 139° (±6.1°), (P ≤ .001) and δ2 = 115° (±8.4°) to 126° (±7.5°), (P ≤ .01). Angular change of δ1 in AcomA aneurysms was significant greater compared to sidewall aneurysms (26°±4.9° versus 8°± 2.3°, P ≤ .05). The initial angle of δ1 and δ2 revealed a significantly inverse relationship to the angle increase (δ1: r = -0.41, P ≤ .05 and δ2: r = -0.47, P ≤ .01). Moreover, angle δ1 was significantly higher in unruptured compared to ruptured aneurysms (135°±7.1° versus 103°±10.8°, P ≤ .05). Conclusion Stent deployment modulates the geometry of the aneurysm-vessel complex, which may lead to favorable hemodynamic changes more similar to unruptured than to ruptured aneurysms. Our findings also suggest that the more acute-angled aneurysm-vessel anatomy, the larger the angular change. Further studies are needed to investigate whether these changes improve the clinical outcome.
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Affiliation(s)
- Ebba Beller
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Jens Göttler
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Johannes Kaesmacher
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claus Zimmer
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jan S Kirschke
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Sascha Prothmann
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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