Stent-assisted embolization of 100 middle cerebral artery aneurysms

Clinical article

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Object

The introduction of intracranial stents to aneurysm treatment allows endovascular repair of nearly all aneurysms, but the safety and durability of stent-assisted embolization of middle cerebral artery (MCA) aneurysms is unclear.

Methods

Ninety-one patients with 100 complex MCA aneurysms not amenable to simple coiling were treated with stent-assisted embolization as a first option. Technical and clinical results, initial follow-up imaging, and long-term annual MR angiography (MRA) were reviewed.

Results

Intracranial stents were successfully deployed in all 100 aneurysms. There was 1 case of significant neurological morbidity (1%) and 1 case of death (1%) related to treatment. Initial posttreatment angiography revealed complete occlusion of 48 aneurysms (48%), a residual neck in 21 (21%), and residual aneurysm filling in 31 (31%). Follow-up imaging performed in 85 (90.4%) of a possible 94 aneurysms showed complete occlusion of 77 aneurysms (90.6%), residual neck in 3 (3.5%), and residual filling in 5 (5.9%). Four aneurysms (4.7%) required retreatment. Long-term MRA follow-up revealed stability or progressive thrombosis in 47 (97.9%) of 48 aneurysms. In 11 patients Y-configuration stenting caused only 1 minor complication and provided durable occlusion in all cases.

Conclusions

Stent-assisted techniques increase the number of aneurysms that may be treated endovascularly and represent an acceptable alternative to craniotomy. Stents provided adequate vessel reconstruction, low complication rates, and good long-term occlusion.

Abbreviations used in this paper:MCA = middle cerebral artery; MRA = MR angiography.

Article Information

Address correspondence to: Demetrius K. Lopes, M.D., Department of Neurological Surgery, Rush University Medical Center, 1725 West Harrison Street, Suite 1115, Chicago, Illinois 60612. email: brainaneurysm@mac.com.

Please include this information when citing this paper: published online February 8, 2013; DOI: 10.3171/2013.1.JNS121298.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    DynaCT (Siemens) oblique axial reconstructed scan showing Y-configuration stenting of an MCA aneurysm using Neuroform stents; the anterior communicating artery aneurysm is covered by a single Neuroform stent.

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    Left: Anteroposterior digital subtraction angiogram showing an M1 segment aneurysm treated with overlapping stents and coil embolization. Right: Magnetic resonance angiogram demonstrating new filling at the site of the aneurysm 3 years after treatment. This unusual case of either recurrence or adjacent de novo aneurysm formation was treated with coil embolization delivered through the struts of the existing stents.

References

1

Akpek SArat AMorsi HKlucznick RPStrother CMMawad ME: Self-expandable stent-assisted coiling of widenecked intracranial aneurysms: a single-center experience. AJNR Am J Neuroradiol 26:122312312005

2

Benitez RPSilva MTKlem JVeznedaroglu ERosenwasser RH: Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils. Neurosurgery 54:135913682004

3

Biondi AJanardhan VKatz JMSalvaggio KRiina HAGobin YP: Neuroform stent-assisted coil embolization of wideneck intracranial aneurysms: strategies in stent deployment and midterm follow-up. Neurosurgery 61:4604692007

4

Brinjikji WLanzino GCloft HJRabinstein AKallmes DF: Endovascular treatment of middle cerebral artery aneurysms: a systematic review and single-center series. Neurosurgery 68:3974022011

5

Cekirge HSYavuz KGeyik SSaatci I: A novel “Y” stent flow diversion technique for the endovascular treatment of bifurcation aneurysms without endosaccular coiling. AJNR Am J Neuroradiol 32:126212682011

6

Ferré JCCarsin-Nicol BMorandi XCarsin Mde Kersaint-Gilly AGauvrit JY: Time-of-flight MR angiography at 3T versus digital subtraction angiography in the imaging follow-up of 51 intracranial aneurysms treated with coils. Eur J Radiol 72:3653692009

7

Fields JDBrambrink LDogan AHelseth EKLiu KCLee DS: Stent assisted coil embolization of unruptured middle cerebral artery aneurysms. J Neurointerv Surg 5:15192013

8

Fiorella DAlbuquerque FCHan PMcDougall CG: Preliminary experience using the Neuroform stent for the treatment of cerebral aneurysms. Neurosurgery 54:6172004

9

Handa AAbdo GYilmaz HLovblad KOLylyk PRüfenacht DA: Efficacy and limitations of the neuroform stent system for intracranial aneurysms. Interv Neuroradiol 10:Suppl 262682004

10

Henkes HBose AFelber SMiloslavski EBerg-Dammer EKühne D: Endovascular coil occlusion of intracranial aneurysms assisted by a novel self-expandable nitinol microstent (neuroform). Interv Neuroradiol 8:1071192002

11

Higashida RTHalbach VVDowd CFJuravsky LMeagher S: Initial clinical experience with a new self-expanding nitinol stent for the treatment of intracranial cerebral aneurysms: the Cordis Enterprise stent. AJNR Am J Neuroradiol 26:175117562005

12

Horowitz MGupta RGologorsky YJovin TGenevro JLevy E: Clinical and anatomic outcomes after endovascular coiling of middle cerebral artery aneurysms: report on 30 treated aneurysms and review of the literature. Surg Neurol 66:1671712006

13

Kim SRVora NJovin TGGupta RThomas AKassam A: Anatomic results and complications of stent-assisted coil embolization of intracranial aneurysms. Interv Neuroradiol 14:2672842008

14

Kis BWeber WBerlit PKühne D: Elective treatment of saccular and broad-necked intracranial aneurysms using a closed-cell nitinol stent (Leo). Neurosurgery 58:4434502006

15

Lanzino GWakhloo AKFessler RDHartney MLGuterman LRHopkins LN: Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms. J Neurosurg 91:5385461999

16

Lee YJKim DJSuh SHLee SKKim JKim DI: Stent-assisted coil embolization of intracranial wide-necked aneurysms. Neuroradiology 47:6806892005

17

Lopes DKWells K: Stent remodeling technique for coiling of ruptured wide-neck cerebral aneurysms: case report. Neurosurgery 65:E1007E10082009

18

Lubicz BFrançois OLevivier MBrotchi JBalériaux D: Preliminary experience with the enterprise stent for endovascular treatment of complex intracranial aneurysms: potential advantages and limiting characteristics. Neurosurgery 62:106310702008

19

Lylyk PCohen JECeratto RFerrario AMiranda C: Endovascular reconstruction of intracranial arteries by stent placement and combined techniques. J Neurosurg 97:130613132002

20

Mocco JSnyder KVAlbuquerque FCBendok BRAlan SBCarpenter JS: Treatment of intracranial aneurysms with the Enterprise stent: a multicenter registry. Clinical article. J Neurosurg 110:35392009

21

Molyneux AJKerr RSYu LMClarke MSneade MYarnold JA: International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:8098172005

22

Regli LDehdashti ARUske Ade Tribolet N: Endovascular coiling compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms: an update. Acta Neurochir Suppl 82:41462002

23

Sani SJobe KWLopes DK: Treatment of wide-necked cerebral aneurysms with the Neuroform2 Treo stent. A prospective 6-month study. Neurosurg Focus 18:2E42005

24

Sedat JChau YMondot LVargas JSzapiro JLonjon M: Endovascular occlusion of intracranial wide-necked aneurysms with stenting (Neuroform) and coiling: mid-term and long-term results. Neuroradiology 51:4014092009

25

Spiotta AMGupta RFiorella DGonugunta VLobo BRasmussen PA: Mid-term results of endovascular coiling of wide-necked aneurysms using double stents in a Y configuration. Neurosurgery 69:4214292011

26

Vendrell JFCostalat VBrunel HRiquelme CBonafe A: Stent-assisted coiling of complex middle cerebral artery aneurysms: initial and midterm results. AJNR Am J Neuroradiol 32:2592632011

27

Wajnberg Ede Souza JMMarchiori EGasparetto EL: Single-center experience with the Neuroform stent for endovascular treatment of wide-necked intracranial aneurysms. Surg Neurol 72:6126192009

28

Weng HHJao SYYang CYTsai YH: Meta-analysis on diagnostic accuracy of MR angiography in the follow-up of residual intracranial aneurysms treated with guglielmi detachable coils. Interv Neuroradiol 14:Suppl 253632008

29

Yang PLiu JHuang QZhao WHong BXu Y: Endovascular treatment of wide-neck middle cerebral artery aneurysms with stents: a review of 16 cases. AJNR Am J Neuroradiol 31:9409462010

30

Yang XWu ZMu SLi YLv M: Endovascular treatment of giant and large intracranial aneurysms using the neuroform stent-assisted coil placement. Neurol Res 30:5986022008

31

Yavuz KGeyik SSaatci ICekirge HS: WingSpan Stent System in the endovascular treatment of intracranial aneurysms: clinical experience with midterm follow-up results. J Neurosurg 109:4454532008

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