Long-Term Outcomes of Placement of a Single Transverse Stent through the Anterior Communicating Artery via the Nondominant A1 in Coil Embolization of Wide-Necked Anterior Communicating Artery Aneurysms

Abstract

Objective : Placement of a single transverse stent via the nondominant A1 across the anterior communicating artery (AComA) into the contralateral A2 can provide sufficient neck coverage for wide-necked bifurcation AComA aneurysms. The authors described the feasibility, safety and long-term outcomes of this technique.Methods : Between January 2015 and February 2018, placement of a single transverse stent via the nondominant A1 was attempted in 17 wide-necked bifurcation AComA aneurysms. The authors reviewed the medical records and radiological studies.Results : The technical success rate was 94.1% (16/17). Periprocedural thromboembolic complications occurred in one patient (6.3%) without permanent neurological deficits. The mean clinical follow-up duration was 39.9±9.8 months. No deaths or delayed thromboembolic complications occurred. The mean angiographic follow-up duration was 38.9±9.8 months. The immediate and final follow-up complete occlusion rates were 87.4 and 93.7%, respectively. There was no recanalization during the follow-up period.Conclusion : Placement of a single transverse stent via the nondominant A1 across the AComA into the contralateral A2 is a feasible and relatively safe endovascular technique for the treatment of wide-necked bifurcation AComA aneurysms, with good long-term occlusion rates and a reasonable complication rate, if only the nondominant A1 is applicable.

Physiologic Flow Diversion Coiling Technique for Wide-Necked Aneurysms with an Asymmetric Bidirectional Flow at the Aneurysm Neck

“…Double stenting techniques seem to increase thromboembolism because of insufficient wall apposition and endothelialization. 28 In our results, we did not find any ischemic complications including perforator infarction and territorial infarction. We thought that both partial occlusion of the parent artery and the potential of CoW collateral modification may prevent these ischemic events.…”

“…The rate of recanalization and retreatment were 0.0–7.8% and 0.0–2.4%, respectively. Double stenting techniques seem to increase thromboembolism because of insufficient wall apposition and endothelialization [ 28 ]. In our results, we did not find any ischemic complications including perforator infarction and territorial infarction.…”

Single stent transverse-configuration in assisted coiling treatment of a double anterior communicating aneurysm

“…For such particular anatomical cases an A1-AcomA-contralateral A1 stenting could be performed. This particular transverse stenting configuration may successfully prevent the aforementioned inconveniences with optimal results on long-term aneurysmal occlusion [2,3,4].…”

“…The few reports in the literature on the use of single transverse-configuration stent assisted coiling for AcomA aneurysms have mentioned beside the success of using this technique, the difficulties encountered in its implementation. The technical challenges with possible related complication such as suboptimal stent deployment, dissection and thrombosis may be increased by difficult navigation through even curved and smaller calibre arteries [3,4,5].…”

“…Yasargil reports that 81.3% of ACoAnt aneurysms usually occurred at the junction of the dominant A1 and AcomA and only 18.7% occurred in the middle of the AcomA. This correlate with the fact that only 22% of cases have comparable diameters of A1 segments of the bilateral anterior cerebral arteries, suggesting a relatively low percentage of patients with AcomA aneurysms who may benefit from the application of single stent assisted coiling technique with stent in a transverse A1 to A1 configuration [2,3,6].…”