Complication analysis in nitinol stent-assisted embolization of 486 intracranial aneurysms

Abstract

OBJECT Stent-assisted embolization (SAE) has broadened the scope of endovascular cerebral aneurysm treatment. The risks associated with stent selection and configuration are poorly defined. In this study, the authors aimed to characterize the risk factors that contribute to complications in SAE of intracranial aneurysms. METHODS Over a 10-year period, a single surgeon treated 486 aneurysms with SAE in which open-cell Neuroform or closed-cell Enterprise stents were used. Single stents were used in 386 cases, overlapping stents were deployed in 80 cases, and Y-configuration stents were used in the remaining 20 cases. All neurological complications, which included transient deficits, were analyzed; disabling strokes and death were considered major complications. The chi-square test and multivariate logistic regression were used to evaluate the influence of aneurysm size and morphology, aneurysm location, stent selection, and stent configuration on complication rates. RESULTS There were 7 deaths (1.4%), 9 major strokes (1.9%), and 18 minor neurological complications (3.7%). For all complications, multivariate analysis revealed that large aneurysm size (10–25 mm; p = 0.01), giant aneurysm size (> 25 mm; p = 0.04), fusiform aneurysm morphology (p = 0.03), and using a Y-configuration stent (p = 0.048) were independent risk factors. For the major complications, independent risk factors included an aneurysm in the posterior circulation (p = 0.02), using an overlapping stent configuration (p = 0.03), and using a Y-configuration stent (p < 0.01). CONCLUSIONS In this series, SAE for cerebral aneurysm treatment carried an acceptable complication rate. With continued innovations in techniques and devices and with increased experience, the complication rates associated with SAE may be even lower in the future.

The Enterprise2 Stent for Endovascular Treatment of Intracranial Aneurysms: Short-Term Results From a Single Center Experience

“…Nevertheless, there remain some drawbacks limiting its application. Johnson et al reported that 4.4-6.4% (8) of patients who underwent SAC treatment had thromboembolic complications partially due to the incomplete stent apposition (ISA) in blood vessels with large diameters and curvatures (9).…”

A Patient in Whom Straightening of a Parent Vessel Related to Insertion of a Braided Stent Contributed to Complete Occlusion of an Intracranial Aneurysm

“…Several studies reported their usefulness. [1][2][3][4] The metallic coverage rate of an LVIS stent is 28%, being higher than those of the other two stents. According to some case reports, potent embolization effects were obtained through flow diversion (FD) effects (metallic coverage rate: LVIS Jr, 18%; Neuroform, 11%; and Enterprise, 10%).…”

‘Railroad switch’ technique for stent-assisted coil embolization of a wide-neck bifurcation intracranial aneurysm: technical note

“…6,7 With the advent of intracranial stents, successful treatment of these complex lesions has become more common, but the complication rates remain higher than with simple coiling alone. 3,5,8 A subset of wide-neck bifurcation aneurysms requires even further protection of the efferent arteries than a traditionally placed single stent may provide.…”

“…1 While the technology available for approaching wide-neck bifurcation aneurysms continues to evolve, novel techniques for stent deployment exist to protect branching vessels. [2][3][4][5] We describe a technique to protect two efferent arteries with a single stent during coil embolization of a recurrent wide-neck basilar bifurcation aneurysm that to our knowledge has not been reported in the literature.…”