Closed-Cell Stent-Assisted Coiling of Intracranial Aneurysms: Evaluation of Changes in Vascular Geometry Using Digital Subtraction Angiography

Beller, Ebba; Klopp, David; Göttler, Jens; Kaesmacher, Johannes; Zimmer, Claus; Kirschke, Jan S.; Prothmann, Sascha

doi:10.1371/journal.pone.0153403

Cited by 17 publications

(13 citation statements)

References 37 publications

(57 reference statements)

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“…[27][28][29] Our results further suggest that the smaller side branches show angular change sooner (e.g., the end of the procedure), while the angular change in the larger branches occurs later, during follow-up. Notwithstanding the fact that such modifications are allegedly an indicator of a higher likelihood of aneurysm occlusion during follow-up, 27,30 they may also be associated with stent migrations in approximately 2% of SAC cases, especially with CC stents. 28 Excessive and sustained forces applied on the bifurcations of similarly sized coronary arteries are also known to result in side-branch occlusions.…”

Section: Discussionsupporting

confidence: 64%

“…As in those reports, the remodeling affected smaller arteries and those arising with acute angles more than the larger, proximal arteries. 27–29 Our results further suggest that the smaller side branches show angular change sooner (e.g., the end of the procedure), while the angular change in the larger branches occurs later, during follow-up. Notwithstanding the fact that such modifications are allegedly an indicator of a higher likelihood of aneurysm occlusion during follow-up, 27,30 they may also be associated with stent migrations in approximately 2% of SAC cases, especially with CC stents.…”

Section: Discussionsupporting

confidence: 61%

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Stent-assisted coiling of cerebral aneurysms with the Neuroform Atlas stent

2018

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Objectives The Neuroform Atlas stent (AS) is the smallest intracranial stent with an open-cell design. This study reports the first clinical experience with AS. Methods All intracranial aneurysms treated by stent-assisted coiling using a single AS in a single institution were retrospectively evaluated. Patient demographics, aneurysm characteristics, angles between the parent artery and stented branch, technical success, and clinical and angiographic follow-up were analyzed. Results Fifty-five consecutive aneurysms treated with AS-assisted coiling were included. Of these, 69.1% were located distal to the circle of Willis. Technical success rate was 100%. The mean diameters of proximal and distal parent arteries were 2.62 mm (range 1.5–4.4) and 1.8 mm (range 0.8–3.5), respectively. Except for a minor stroke in a patient who completely discontinued antiplatelet therapy on postoperative day 4, there were no clinical events with permanent sequelae, and 94.1% of patients had Raymond-Roy score of 1 or 2 aneurysmal occlusion at a mean follow-up duration of 7.9 months. Although the angle between the parent artery and the stented branch increased significantly ( p < 0.001) with time, the angular change at follow-up was only 16.45 ± 11.03 degrees and was inversely correlated both with preoperative angle and the diameter of the distal parent artery ( r = −0.465 and r = −0.433, respectively, p = 0.004 for both). Conclusion AS-assisted coiling was associated with a favorable early clinical outcome and angiographic results in this series. This stent can be used for distally located aneurysms and results in minimal alteration of the arterial anatomy.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionsupporting

confidence: 61%

Stent-assisted coiling of cerebral aneurysms with the Neuroform Atlas stent

2018

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“…The approach used in this study supports both. In the past, different approaches were used including radiological tools and digital image reconstruction to understand the three-dimensional anatomy of the head and neck (21,22). However, fine tissue dissection after trypan blue perfusion, and without the use of a tissue fixative, allows for more exact analysis of the tiny structures of the murine head and neck region and retains a near normal tactile sense throughout the procedure.…”

Section: Discussionmentioning

confidence: 99%

Comparing the Organs and Vasculature of the Head and Neck in Five Murine Species

Kim

Chao

et al. 2018

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Abstract. Background The murine species are often used as an in vivo model due to their relatively short developmental period and comparatively cheap price. To evaluate the pathologic mechanism or effect of a new treatment or medication, a large sized mammalian is the optimal. However, there are major limitations for their use in experimental studies. As a result, a murine animal is often chosen instead. But, in these smaller animals, there are challenges, including the relatively small size of the head and neck structures, challenges in identifying the vascular and neural anatomy and the unavailability of a surgical atlas of normal anatomy.Previous studies suffered from two major problems. First, dissection produced trauma to the microvascular system, resulting in staining of the entire dissection field. This problem was aggravated whenever major vessels had to be removed. Second, attempts to avoid this problem, by first using formaldehyde to fix the tissues, made delicate 861

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“…Furthermore, we measured the diameters of all bifurcation branches and the parent artery. Our vascular measurements were based on the method described by Beller et al 8 and are described below.…”

Section: Methodsmentioning

confidence: 99%