Assisted coiling of saccular wide-necked unruptured intracranial aneurysms: stent versus balloon

Abstract

Stent-assisted coiling achieved better results in terms of complete occlusion and stability than balloon-assisted coiling with a lower rate of recurrence without being associated with a higher risk of intraprocedural complications. Bifurcational and large to giant aneurysms were associated with higher complication rates and higher recurrence rates, respectively, and still represent a challenge for both techniques.

Anterior Communicating Artery Aneurysms: Anatomical Considerations and Microsurgical Strategies

“…Some studies have even reported that in some AcoA aneurysm embolization procedures, the surgical procedure has been changed to surgical clipping due to finding a small aneurysm diameter or an inappropriate aspect ratio (dome/neck) ( 11 ). With the development of new balloons, stents, and more optimized catheter techniques, small or tiny AcoA aneurysms can also be successfully treated by interventional embolization; however, at present, it is not widely used, and long-term follow-up data are lacking ( 34 – 38 ). Some studies have investigated the relationship between the size of an AcoA aneurysm and the risk of intraoperative rupture, especially during interventional embolization.…”

Combination of Multicatheter Plus Stent or Balloon for Treatment of Complex Aneurysms

“…Although there was a 14% recurrence (3 major and 4 minor recurrences) on follow-up imaging (mean, 21 months), this recurrence rate is favorably comparable with the results reported in the literature. 4,15,20,21,[24][25][26] An intentional dog-ear remnant in coiling of a branch-incorporated aneurysm cannot be helped, though a dog-ear remnant may be a risk factor for recurrence. There was, however, no significant predictor of recurrence in this study.…”

“…5,13,22,23 Notably, in our series, treatment-related morbidity occurred in only 1 patient (1.6%), which is acceptable in comparison with the reported results from the literature focusing only on wide necks and is also remarkable because adding an adjunctive device may lead to an increase in adverse events like thromboembolism and intraprocedural rupture. 24,25 Another concern is a possible increase in the recanalization rate after frequent incomplete coiling due to the complicated characteristics of the aneurysm. However, through the combination technique, only 1 incomplete coiling occurred in our study.…”

“…Furthermore, the combination strategy for complex aneurysms had a safety and effectiveness favorably comparable with the single adjunctive endovascular techniques in previous studies. [1][2][3]8,9,[13][14][15][17][18][19][22][23][24][25][26] Our study had several limitations due to its retrospective design and the relatively small number of cases. Therefore, the se- lection bias was inevitable, but it might be somewhat lowered because our data of endovascular treatment were consecutively and prospectively registered.…”

PulseRider Stent-Assisted Coiling of Wide-Neck Bifurcation Aneurysms: Periprocedural Results in an International Series

“…[4][5][6][7] Endovascular treatment of bifurcation IAs often requires stent placement with double stents in "Y" or "X" configurations, which could increase the risk of clinical complications, 7,8 whereas some authors reported low rates of complications compared with the balloon-remodeling technique. 9,10 Recently, 3 devices have been specifically developed for the endovascular treatment of such aneurysms arising at bifurcations: the WEB (Sequent Medical, Aliso Viejo, California), the pCONus (phenox, Bochum, Germany), and the PulseRider device (Pulsar Vascular, San Jose, California). The WEB is an intrasaccular braided-wire flow disruptor, 11,12 and the pCONus is a new stentlike self-expanding nitinol implant with 4 distal petals allowing coiling of the aneurysmal sac.…”