Crescent sign on magnetic resonance angiography revealing incomplete stent apposition: correlation with diffusion-weighted changes in stent-mediated coil embolization of aneurysms

Abstract

Incomplete stent apposition is detectable on 3-T MR angiography as a crescent sign, and was found to be highly prevalent in Enterprise closed-cell design stents used to assist coil embolization of aneurysms. Incomplete stent apposition was also associated with periprocedural ipsilateral hyperintense lesions on diffusion-weighted imaging. These results identify an association between incomplete stent apposition and thromboembolic complications in stent-mediated coil embolization of intracranial aneurysms.

Analysis of Closed-Cell Intracranial Stent Characteristics Using Cone-Beam Computed Tomography With Contrast Material

“…For example, ISA was associated with periprocedural ipsilateral hyperintense lesions on diffusion-weighted imaging. 8) In the present series, there were three cases of thromboembolic complication in the perioperative and follow-up periods; ISA was not detected by XperCT in any of these cases. As our case series was limited to patients with continuing dual antiplatelet therapy, it is not clear whether ISA is associated with thromboembolic complications.…”

“…Stent kinking and incomplete expansion might create a risk of thromboembolic events. 8) However, the condition of the Enterprise VRD stent is difficult to evaluate with multidetectorrow computed tomography, magnetic resonance angiography, three-dimensional (3D) digital subtraction angiography, or 3D rotational angiography due to poor radiographic visibility. 3,11) A new protocol for intracranial stent visualization has been investigated in our laboratory.…”

Stent-Assisted Coiling versus Coiling Alone in Unruptured Intracranial Aneurysms in the Matrix and Platinum Science Trial: Safety, Efficacy, and Mid-Term Outcomes

“…Fifth, because the core angiographic laboratory evaluated primarily DSA images, although stent proximal and distal markers could usually be visualized, stent struts could not be directly visualized. Given recent reports of increased delayed thromboembolic complications arising in cases in which stents do not fully appose the wall of the parent artery, 22,23 this also limits our ability to evaluate delayed ischemic risk in stent-coiled patients.…”

“Y” and “X” Stent-Assisted Coiling of Complex and Wide-Neck Intracranial Bifurcation Aneurysms

“…This stent, compared with closed-cell-design stents, presented 2 advantages, a better vessel conformability in acute curvature and an outward prolapse of the struts at the convexity. 30 A better conformability reduces the risk of thromboembolic events 31 ; the outward prolapse improves neck coverage and should reduce friction during the deployment of the second stent. scribed an overlapping Y stent placement technique by using 2 closed-cell-design stents without endosaccular coiling; they preferred this combination of stents because it is easier to deliver and deploy but also seems more likely to provide superior modification on aneurysm hemodynamic parameters.…”