Anatomic Results and Complications of Stent-Assisted Coil Embolization of Intracranial Aneurysms

Abstract

<jats:p> The purpose of this study was to evaluate and report our anatomic results and complications associated with stent-assisted coil embolization of intracranial aneurysms using the Neuroform stent. From September 2003 to August 2007, 127 consecutive patients (ruptured 50, 39.4%; unruptured 77, 60.6%) underwent 129 stent-assisted coil embolization procedures to treat 136 aneurysms at our institution. Anatomic results at follow-up, procedure-related complications, and morbidity/mortality were retrospectively reviewed. </jats:p><jats:p> Stent deployment was successful in 128 out of 129 procedures (99.2%). Forty-seven patients presented with 53 procedure-related complications (37.0%, 47/127). Thromboembolic events (n = 17, 13.4%) were the most common complications, followed by intraoperative rupture (n = 8, 6.3%), coil herniation (n = 5, 3.9%), and postoperative rupture (n = 4, 3.1%). For thromboembolic events, acute intra-procedural in-stent thromboses were observed in two patients and subacute or delayed in-stent thromboses in three patients. Overall mortality rate was 16.5% (21/127) and procedure-related morbidity and mortality rates were 5.5% (7/127) and 8.7% (11/127) retrospectively. Patients with poor grade subarachnoid hemorrhage (Hunt and Hess grade IV or V; 25/127, 19.7%) exhibited 56% (14/25) overall mortality rate and 24% (6/25) procedure-related mortality rate. Immediate angiographic results showed complete occlusion in 31.7% of aneurysms, near-complete occlusion in 45.5%, and partial occlusion in 22.8%. Sixty nine patients in 70 procedures with 77 aneurysms underwent angiographic follow-up at six months or later. Mean follow-up period was 13.7 months (6 to 45 months). Complete occlusion was observed in 57 aneurysms (74.0%) and significant in-stent stenosis was not found. </jats:p><jats:p> Thromboembolism and intra/postoperative aneurysm ruptures were the most common complications and the main causes of procedure-related morbidity and mortality. Patients with poor grade subarachnoid hemorrhage showed poor clinical outcomes. Since most complications were induced by stent manipulation and deployment, it is mandatory to utilize these devices selectively and cautiously. While the follow-up angiographic results are promising, further studies are essential to evaluate safety, efficacy, and durability of the Neuroform stent. </jats:p>

Surpass Flow Diverter in the Treatment of Intracranial Aneurysms: A Prospective Multicenter Study

“…If we restricted the analysis to unruptured or nonacutely ruptured aneurysms, the rates of morbidity and mortality varied between 3.8%-8.3% and 0%-3.9%, respectively. [28][29][30][31][32][33][34] The data presented in our study show a safety profile comparable with that of stentassisted coil embolization.…”

Stent-Assisted Coiling in Acutely Ruptured Intracranial Aneurysms: A Qualitative, Systematic Review of the Literature

“…6,9,10,12,13,[17][18][19]21,[23][24][25][26][27] Three of 17 articles representing 72 (21%) of 339 patients had a subset of procedures that were staged, but only patients who had uncovered stents placed acutely were included in this analysis. 11,20,22 Eight (2%) of 339 patients had uncovered stent placement alone without coil placement. 6,17,19 A number of different stent manufacturers were included in the series.…”

“…In 326 (96%) of 339 cases, dual antiplatelet therapy, usually aspirin and clopidogrel, was administered after the procedure; clopidogril was continued for approximately 3 months postprocedure and aspirin, from 3 months to indefinitely. 6,[9][10][11][12][13][17][18][19][20][21][22][23][24][25]27 Minor variations in anticoagulation/antiplatelet therapy included the use of heparin without bolus infusion, reversal of heparin at the end of the procedure versus continuation for 24 -48 hours postprocedure, the use of only 1 antiplatelet agent, delaying antiplatelet therapy until the morning after the procedure, variations in the duration of the antiplatelet therapy in general, and the use of glycoproteins IIb/IIIa inhibitors in a few select patients.…”

“…25 Twelve (4%) of 339 patients had intraprocedural rupture of aneurysms. 6,20,22 More than half of these intraprocedural ruptures were reported in a single case series of 50 patients. 20 Four (1%) of 339 patients had confirmed or suspected rerupture of their aneurysm within 1 month after their procedure.…”

“…[9][10][11][12]15,16 Notwithstanding the reluctance of many operators to use stent-assisted coiling in cases of ruptured aneurysms, a number of case series of stent use in ruptured aneurysms have now been published. 6,[9][10][11][12][13][17][18][19][20][21][22][23][24][25][26] Review of these published case series might inform the neurovascular community regarding periprocedural management options as well as rates of hemorrhagic complications associated with stent-assisted coiling in ruptured aneurysm cases. The purpose of the current study was to summarize existing literature data to inform the community regarding the safety and efficacy of stent-assisted coiling in acutely ruptured aneurysms.…”