Contribution of the straightening effect of the parent artery to decreased recanalization in stent-assisted coiling of large aneurysms

Akira Ishii MD, PhD, Hideo Chihara MD, Takayuki Kikuchi MD, PhD, Daisuke Arai MD, Hiroyuki Ikeda MD and Susumu Miyamoto MD, PhD
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  • Department of Neurosurgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
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OBJECTIVE

The durability of embolization of large aneurysms is enhanced by use of the neck-bridging stent. However, it remains unclear what factors contribute to decreased recanalization. The purpose of this study was to demonstrate the contribution of the straightening effect of the parent artery to the durability of stent-assisted coiling for large aneurysms.

METHODS

Of the 182 aneurysms treated by embolization since the introduction of the neurovascular stent, 82 consecutive unruptured aneurysms with a diameter greater than 7 mm were selected. There were 52 aneurysms treated with a stent (Group S) and 30 treated without a stent (Group NS). Occlusion status was evaluated 12 months after embolization with digital subtraction angiography. The vascular angle of the parent artery was measured before, immediately after, and 12 months after embolization. The rates of recanalization were compared between Group S and Group NS. In Group S, the rates of recanalization were further compared between those aneurysms with and without a significant angle change.

RESULTS

The rate of major recanalization was 9.6% in Group S and 26.7% in Group NS. The volume embolization ratio was 32.6% in Group S and 31.6% in Group NS, with no statistically significant difference. However, the angulation change before and after coiling was significantly higher in Group S (10.6°) than in Group NS (0.9°). The difference in the angulation was more evident 12 months after coiling (19.1° in Group S and 1.5° in Group NS). In Group S, recanalization was found in 14.3% of 35 stented aneurysms without a significant angular change when a significant angular change was defined as more than 20°. In contrast, all 17 aneurysms with ≥ 20° of angular change remained occluded.

CONCLUSIONS

Significant angular change of ≥ 20° most likely leads to decreased recanalization following stent-assisted embolization of large aneurysms.

ABBREVIATIONS ACoA = anterior communicating artery; BA = basilar artery; CFD = computational fluid dynamics; CO = complete occlusion; DF = dome filling; DSA = digital subtraction angiography; ICA = internal carotid artery; MRA = MR angiography; NR = neck remnant; PGLA = polyglycolic acid/polylactic acid; SAH = subarachnoid hemorrhage; TOF = time of flight; VER = volume embolization ratio; VRD = vascular reconstruction device.

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Contributor Notes

Correspondence Akira Ishii, Department of Neurosurgery, Kyoto University, Graduate School of Medicine, 54 Kawahara-cho, Syogo-in, Sakyo-ku, Kyoto 606-8507, Japan. email: ishii@kuhp.kyoto-u.ac.jp.

INCLUDE WHEN CITING Published online December 23, 2016; DOI: 10.3171/2016.9.JNS16501.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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