Selective Temporary Stent-Assisted Coil Embolization for Intracranial Wide-Necked Small Aneurysms Using Solitaire AB Retrievable Stent

Abstract

ObjectiveStent-assisted coil embolization of intracranial wide-necked aneurysm requires long-term postoperative antiplatelet therapy to prevent in-stent thrombosis. This study aimed to demonstrate results of temporary stent placement for coiling wide necked small intracranial aneurysms, which eliminated need for antiplatelet agents, and to discuss its feasibility and safety. MethodsData of 156 patients who underwent stent-assisted coil embolization between 2011 and 2014 were retrospectively analyzed. Thirteen cases of temporary stent-assisted coil embolization were included, and their clinical and radiological results were evaluated. ResultsThe aneurysms treated were all unruptured except one case. All of them had wide neck with mean dome-to-neck ratio of 0.96 and were small-sized aneurysms with mean maximal diameter of 4.2 mm. There was no technical failure in retrieval of stent after completion of embolization of the target aneurysm. Immediate angiography revealed 11 complete and two partial embolization (one residual neck and one residual aneurysm). Two cases encountered thrombosis complication, and they were managed without neurological sequelae. The mean follow-up period was 43 months, angiographic follow-up revealed two cases with minor recurrence, and clinical outcome was good with modified Rankin scale score of 0. ConclusionTemporary stent-assisted coil embolization of small wide-necked intracranial aneurysm using fully retrievable stent appears safe and effective. Further application and evaluation of this technique in more cases with larger size aneurysm is warranted.

Results of Temporary Stent-assisted Coil Embolization (CATS) for the Treatment of Wide-neck Aneurysms

“…Temporary stenting has been suggested as an alternative to the well-established remodeling techniques of balloonassisted coil embolization and stent-assisted coil embolization. To the best of our knowledge, however, since the first report on this technique in 2013, only 6 case reports or small case series have been published with a total number of reported cases of 65 [4,[6][7][8][9][10]. This already included 33 cases from our own group.…”

“…The CATS is an established standard technique in our institution for the treatment of wide-neck aneurysms. To date, only case reports and small case series on this technique have been published [4,[6][7][8][9][10]. To assess safety and effectiveness of CATS, we performed a retrospective intention-to-treat analysis of all consecutive patients, who were intended to be treated with CATS over a period of 10 years.…”

Aspiration After Sealing the Entrance by Stenting Is a Promising Method to Treat Subintimal Hematoma

“…However, when performing this technique, it is necessary to exclude the possibility of complete coagulation of hematoma blood by IVUS examination, and to avoid the microcatheter becoming stuck between the vessel wall and stent struts by pulling back the microcatheter slightly proximally to check the degree of resistance while slowly inflating the stent balloon. This procedure is acceptable because stent-traps for microcatheters are commonly used during coiling in neurointerventional radiology ( 3 ). If the aspiration method does not work after sealing the entry site by stenting, cutting balloon dilation at a distal site should be considered to create a re-entry at this point.…”

Y-stent assisted coiling of ruptured wide neck intracranial aneurysm in the acute phase

“…The absence of dual antiplatelet maintenance therapy is the most important advantage of this technique. 18,19 Sirlov et al 20 treated acutely ruptured basilar artery bifurcation aneurysms with simultaneous Cascade and Comaneci temporaryassisted coiling. Their findings suggested that this method may be an alternative treatment to YSAC, especially in patients with acute ruptured aneurysms.…”