Temporary Semi-Jailing Technique Avoiding Inevitable Antiplatelet Medication for Coil Embolization of Wide-necked Cerebral Aneurysms

Abstract

Stent-assisted neck remodeling for wide-necked aneurysms requires long-term medication with antiplatelet agents. We describe here a temporary semi-jailing technique (SJT) for wide-necked aneurysms that avoids the need for antiplatelet medications. Materials and Methods: Among 101 patients who underwent stent-and/or balloon-assisted embolizations, 3 wide-necked aneurysms, including 1 ruptured aneurysm, underwent the temporary SJT using Enterprise stents. Temporary SJTs were used due to resistance to antiplatelet agents prior to cardiac surgery or to a ruptured aneurysm with a wide neck. The aneurysms were located in the middle cerebral artery, the paraclinoid internal carotid artery segment, and the posterior communicating artery. Results: Enterprise stents were retrieved after coiling without any change in coil mass stability. The final angiogram showed good patency of each parent artery, good stability of the coil mass and total occlusion of the aneurysm. None of the patients experienced any periprocedural or delayed neurological complications. While retrieving the stent from tortuous vessels, we experienced the jumping phenomenon associated with this device. Conclusion: Temporary SJTs have the advantage of stent retrieval, thus avoiding inevitable antiplatelet medication. However, care should be taken in tortuous vessels to avoid the jumping phenomenon associated with the device.

Temporary Solitaire stent neck remodeling in the coiling of ruptured aneurysms

“…The technique of temporary neck remodeling has been described using the Enterprise stent 9 10. However, the use of the Solitaire stent has a number of advantages.…”