Angular Remodeling in Single Stent-Assisted Coiling Displaces and Attenuates the Flow Impingement Zone at the Neck of Intracranial Bifurcation Aneurysms

Gao, Bu-Lang; Baharoglu, Merih I; Malek, Adel M.

doi:10.1227/neu.0b013e318286fab3

Cited by 63 publications

(68 citation statements)

References 17 publications

(21 reference statements)

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“…Straightening the vascular bifurcation angle results in statistically significant migration of the flow impingement zone to the distal vessel as well as narrowing its width which, in effect, fundamentally alters the underlying wall shear stress and decreases the pressure at the bifurcation (4,5). Additionally, it is known that, the flow vortices at the arterial bifurcation tend to be larger if the combined size of the distal vessels is much larger than the parent artery or if the bifurcation angle is large (2).…”

Section: Discussionmentioning

confidence: 99%

Geometrical characteristics after Y-stenting of the basilar bifurcation

Sağlam¹,

Kızılkılıç²,

Anagnostakou³

et al. 2015

Diagn Interv Radiol

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Section: Discussionmentioning

confidence: 99%

Geometrical characteristics after Y-stenting of the basilar bifurcation

Sağlam¹,

Kızılkılıç²,

Anagnostakou³

et al. 2015

Diagn Interv Radiol

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“…Some reports have shown that straightening of vessels may reduce recanalization rates [3,4,12]. Because there was no difference in straightening effects between the Enterprise and Enterprise 2 stents, this strategy would not change between these stents.…”

Section: Discussionmentioning

confidence: 99%

In vitro experiments of vessel wall apposition between the Enterprise and Enterprise 2 stents for treatment of cerebral aneurysms

Kono

Terada

2015

Acta Neurochir

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The Enterprise 2 stent has better wall apposition in curved vessels than the Enterprise stent. The gap between a vessel wall and the Enterprise 2 stent is approximately half that of the Enterprise stent. However, gaps and kinks are still present in curved vessels with a small radius. Caution should be taken for kinks and malposition in acutely curved vessels, such as the siphon of the internal carotid artery.

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“…Several reasons may account for the improved durability of treatment with self-expanding stents: denser aneurysm packing with increased neck coverage, flow diversion, parent vessel straightening, angular remodeling, and fibroelastic tissue formation along the neck of the aneurysm. 3,4,6,8,11,14,18,23 Likewise, the use of the balloon remodeling technique was found to significantly improve the durability of endovascular therapy. 3,7 The strong association between delayed aneurysm recurrence and male sex is interesting and has not been previously reported.…”

Section: Discussionmentioning

confidence: 99%

Long-term catheter angiography after aneurysm coil therapy: results of 209 patients and predictors of delayed recurrence and retreatment

Chalouhi

Bovenzi

Thakkar

et al. 2014

JNS

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Object Aneurysm recurrence after coil therapy remains a major shortcoming in the endovascular management of cerebral aneurysms. The need for long-term imaging follow-up was recently investigated. This study assessed the diagnostic yield of long-term digital subtraction angiography (DSA) follow-up and determined predictors of delayed aneurysm recurrence and retreatment. Methods Inclusion criteria were as follows: 1) available short-term and long-term (> 36 months) follow-up DSA images, and 2) no or only minor aneurysm recurrence (not requiring further intervention, i.e., < 20%) documented on short-term follow-up DSA images. Results Of 209 patients included in the study, 88 (42%) presented with subarachnoid hemorrhage. On shortterm follow-up DSA images, 158 (75%) aneurysms showed no recurrence, and 51 (25%) showed minor recurrence (< 20%, not retreated). On long-term follow-up DSA images, 124 (59%) aneurysms showed no recurrence, and 85 (41%) aneurysms showed recurrence, of which 55 (26%) required retreatment. In multivariate analysis, the predictors of recurrence on long-term follow-up DSA images were as follows: 1) larger aneurysm size (p = 0.001), 2) male sex (p = 0.006), 3) conventional coil therapy (p = 0.05), 4) aneurysm location (p = 0.01), and 5) a minor recurrence on short-term follow-up DSA images (p = 0.007). Ruptured aneurysm status was not a predictive factor. The sensitivity of short-term follow-up DSA studies was only 40.0% for detecting delayed aneurysm recurrence and 45.5% for detecting delayed recurrence requiring further treatment. Conclusions The results of this study highlight the importance of long-term angiographic follow-up after coil therapy for ruptured and unruptured intracranial aneurysms. Predictors of delayed recurrence and retreatment include large aneurysms, recurrence on short-term follow-up DSA images (even minor), male sex, and conventional coil therapy.

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Angular Remodeling in Single Stent-Assisted Coiling Displaces and Attenuates the Flow Impingement Zone at the Neck of Intracranial Bifurcation Aneurysms

Cited by 63 publications

References 17 publications

Geometrical characteristics after Y-stenting of the basilar bifurcation

Geometrical characteristics after Y-stenting of the basilar bifurcation

In vitro experiments of vessel wall apposition between the Enterprise and Enterprise 2 stents for treatment of cerebral aneurysms

Long-term catheter angiography after aneurysm coil therapy: results of 209 patients and predictors of delayed recurrence and retreatment

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