Parent Vessel Size and Curvature Strongly Influence Risk of Incomplete Stent Apposition in Enterprise Intracranial Aneurysm Stent Coiling

Heller, Robert S.; Malek, Ali

doi:10.3174/ajnr.a2584

Cited by 70 publications

(67 citation statements)

References 22 publications

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“…Evaluation of the relationship between geometric features of the parent vessel at the stent deployment site and the prevalence of ISA detected a unique crescent flow pattern on 3 T magnetic resonance angiography, which was confirmed by flat panel computed tomography as indicating ISA. 7) Further multivariate analysis revealed that the crescent flow pattern correlated with small vessel-curvature radius, large stent-subtended angle, and large parent vessel diameter. 7) Two patterns of ISA of the Enterprise VRD were also reported in an in vitro stent deployment study.…”

Section: Discussionmentioning

confidence: 99%

“…7) Further multivariate analysis revealed that the crescent flow pattern correlated with small vessel-curvature radius, large stent-subtended angle, and large parent vessel diameter. 7) Two patterns of ISA of the Enterprise VRD were also reported in an in vitro stent deployment study. 6) Using a microcatheter pull-back technique, the stents tended to follow the contour of the inner vessel curve, with poor contact on the outer curve (outer curve ISA).…”

Section: Discussionmentioning

confidence: 99%

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

Tsuruta

Matsumaru

Hamada

et al. 2013

Neurol. Med. Chir.(Tokyo)

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The intracranial nitinol stent named the Enterprise Vascular Reconstruction Device has poor radiographic visibility. The characteristics of closed-cell intracranial stents were investigated and the efficacy of intraoperative stent visualization examined with the 80 kV high-resolution XperCT protocol, which is a flat detector C-arm volume acquisition functionality system integrated with the angiography equipment. We treated 39 aneurysms with stent-assisted coil embolization. The aneurysms were located on the internal carotid artery in 24 cases, the anterior communicating artery (AcomA) in three, the basilar artery (BA) in 10, and the vertebral artery in two. Intraoperative 80 kV XperCT was performed in all cases after deposition of the stent. We evaluated the coverage of the aneurysm neck, incomplete stent apposition (ISA), and shift of vessels. Accurate stent visualization was achieved in 29 of the 39 cases without coil and delivery wire artifact. Coverage of the aneurysm neck succeeded in 28 cases; there was one case of BA top Y-configuration stenting in which the stent was dislocated into the aneurysm. ISA was detected in nine cases, including seven kinks and one flattening in the carotid siphon and one kink in the BA top. We detected linearization of vessels due to stent deployment in three AcomA cases and three BA top cases. We conclude that intraoperative 80 kV XperCT is an efficient modality for the evaluation of ISA. Stent kinking in the carotid siphon and linearization in distal vessels can be detected with this protocol.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Tsuruta

Matsumaru

Hamada

et al. 2013

Neurol. Med. Chir.(Tokyo)

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“…Another commonly used method involves the initial placement of the microcatheter for coil delivery into the aneurysm and jailing of the catheter against the vessel wall by stenting. Despite increasing clinical experience and technological improvements, stent-assisted coiling still has inherent risks of morbidity and mortality [4][5][6][7] . The pirin daily for three to five days before treatment.…”

Section: %-99%) and 31% (95%ci 0%-73%) Combined Procedure-relatmentioning

confidence: 99%

Peri-Procedural Morbidity and Mortality Associated with Stent-Assisted Coiling for Intracranial Aneurysms

Wang

Yong-quan

2013

Interv Neuroradiol

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Despite experience and technological improvements, stent-assisted coiling for intracranial aneurysms still has inherent risks. We evaluated peri-procedural morbidity and mortality associated with stent-assisted coiling for intracranial aneurysms. Patients with cerebral aneurysms that were broad-based (>4 mm) or had unfavorable dome/neck ratios (<1.5) were enrolled in this study between February and November 2011 at our center. Aneurysms were treated with the self-expanding neurovascular stents with adjunctive coil embolization. Seventy-two consecutive patients (27 men and 45 women; 22–78 years of age; mean age, 52.8 years) underwent 13 procedures for 13 ruptured aneurysms and 64 procedures for 73 unruptured aneurysms. Nine [11.7%, 95% CI(4.5%–18.9%)] procedure-related complications occurred: one and eight with initial embolization of ruptured and unruptured aneurysms, respectively. Complications included six acute in-stent thromboses, one spontaneous stent migration, one post-procedural aneurysm rupture, and one perforator occlusion. Three complications had no neurologic consequences. Two caused transient neurologic morbidity, two persistent neurologic morbidity, and two death. Procedure-related neurologic morbidity and mortality rates, respectively, were as follows: overall, 5.2% (95%CI, 0.2%–10.2%) and 2.6% (95%CI, 0%–6.2%); ruptured aneurysms, 7.7% (95%CI, 0%–36%) and 0% (95%CI, 0%–25%); unruptured aneurysms, 4.7% (95%CI, 0%–9.9%) and 3.1% (95%CI, 0%–7.3%). Combined procedure-related morbidity and mortality rates for ruptured and unruptured aneurysms were 7.7% (95%CI, 1.7%–13.7%) and 7.8% (95%CI, 1.8%–13.8%), respectively. Stent-assisted coiling is an attractive option for intracranial aneurysms. However, stent-assisted coiling for unruptured aneurysms is controversial for its comparable risk to natural history.

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“…Heller et al 16) reported that incomplete stent apposition of ES was associated with stent-subtended arc angle or parent vessel diameter. In our study, patients with a high risk of incomplete stent apposition located in an acute angle structure (e.g., carotid siphon) or within a small diameter parent artery were excluded, because incomplete stent apposition and delayed arterial healing was associated with delayed ischemic events and late stent thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…Heller et al 16) evaluated for incomplete stent apposition using high-resolution flat-panel computed tomography (CT).…”

Section: Discussionmentioning

confidence: 99%

Enterprise Stent-assisted Cerebral Aneurysm Coiling: Can Antiplatelet Therapy be Terminated after Neointima Formation with the Enterprise Stent?

Takayama

Taoka

Myouchin

et al. 2016

JNET

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Objective: Patients who undergo Enterprise stent (ES)-assisted cerebral aneurysm coiling require long-term antiplatelet therapy (AT). Some studies have reported that cessation or modification of AT increases the risk of cerebral infarction.The aim of this study was to evaluate whether AT can terminated without increasing the risk of ischemic events among patients who have undergone ES-assisted cerebral aneurysm coiling. Methods:This study evaluated 9 with 11 unruptured aneurysms were confirmed to have neointima formation with the ES on follow-up angiography. Dual AT was given for ≥3 months postoperatively, then one antiplatelet agent was administered until ≥6 months postoperatively before termination of all AT. Incidences of ipsilateral ischemic events and stent occlusion after AT termination were assessed prospectively.Results: During follow-up (mean, 32.8 months; range, 21.5-51.3 months) ipsilateral ischemic events and stent occlusion did not occur in any cases. Conclusion:Termination of AT ≥6 months postoperatively did not result in ischemic events among patients with neointima formation after ES-assisted cerebral aneurysm coiling.

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Parent Vessel Size and Curvature Strongly Influence Risk of Incomplete Stent Apposition in Enterprise Intracranial Aneurysm Stent Coiling

Cited by 70 publications

References 22 publications

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

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

Peri-Procedural Morbidity and Mortality Associated with Stent-Assisted Coiling for Intracranial Aneurysms

Enterprise Stent-assisted Cerebral Aneurysm Coiling: Can Antiplatelet Therapy be Terminated after Neointima Formation with the Enterprise Stent?

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