Safety and Efficacy of Stent-Assisted Coiling of Unruptured Intracranial Aneurysms Using Low-Profile Stents in Small Parent Arteries

Abstract

BACKGROUND AND PURPOSE: Stent-assisted coiling of intracranial aneurysms arising from small vessels (# 2.0 mm) is a common procedure. However, data regarding its treatment outcomes are scarce. This study evaluated the clinical and radiologic outcomes of stent-assisted coiling using low-profile stents for aneurysms of small parent arteries. MATERIALS AND METHODS:From November 2015 to October 2020, sixty-four patients with 66 aneurysms arising from parent arteries of #2.0 mm were treated with stent-assisted coiling using a Low-Profile Visualized Intraluminal Support Junior (LVIS Jr) or the Neuroform Atlas stent in a single institution. The clinical and radiologic data were retrospectively reviewed, and the risk factors for procedure-related complications were evaluated. RESULTS:The LVIS Jr and Neuroform Atlas stents were used in 22 (33.3%) and 44 (66.7%) cases, respectively. Technical success was achieved in 66 cases (100%). Immediate postprocedural aneurysm occlusion grades assessed by the Raymond-Roy occlusion classification were I (57.6%), II (19.7%), and III (22.7%), respectively. Procedure-related complications occurred in 10 cases (15.2%), with 8 thromboembolic complications (12.1%) and 2 hemorrhagic complications (3.0%). Procedure-related morbidity was 4.5% without mortality. On multivariate analysis, current smoking (odds ratio ¼ 7.1, P ¼ .021) had a statistically significant effect on procedure-related complications.CONCLUSIONS: Stent-assisted coiling of intracranial aneurysms with low-profile stents in small vessels (# 2.0 mm) had a 100% success rate and a 15.2% overall complication rate with 4.5% morbidity. Current smoking was a significant risk factor associated with procedure-related complications.

Initial and mid-term results of LEO Baby stent-assisted coiling of intracranial aneurysms located in small arteries: A single-center experience with 131 consecutive patients

“…In our study, a total of 130 aneurysms (96.3%) had a similar obliteration results, and the complete embolization rate (Raymond class I) reached 82.2%, which is within the range reported in the relevant literature ( 6 – 8 , 21 ). Immediate postoperative angiography in the study by Kim et al ( 13 ) showed 57.6% of aneurysms rated as Raymond class I, 19.7% as Raymond class II, and 22.7% as Raymond class III. At the 6-month interim follow-up results, they found a complete embolization rate of 87.9%.…”

“…Thus, low-profile stents have a greater advantage in terms of microcatheter diameter, especially for aneurysms located at small size vessels. Kim et al ( 13 ) achieved a 100% technical success rate with the placement of low-profile stents (LVIS Jr or Neuroform Atlas) in 66 aneurysm-carrying arteries (<2.0 mm). Earlier, Santillan et al ( 19 ) successfully delivered all LVIS Jr. stents in 35 aneurysms with an I.D.…”

“…In a study of aneurysms with a parent vessel diameter of 1.2–2 mm, Kuhn et al ( 5 ) found 13.6% of thromboembolic events and 2.3% of hemorrhagic events. In a recent study on the use of low-profile stents in small vessels, Kim et al ( 13 ) showed 12.1% thrombotic events and 3.0% hemorrhagic events in 66 small vessels (<2 mm) using the LVIS Jr or Neuroform Atlas stent. In another study, Santillan et al ( 19 ) had 11.4% thrombotic events and 2.8% hemorrhagic events in a case series of 35 small vessels (<2.5 mm) using LVIS Jr. We reported a total of 14 (10.3%) complications, which included 13 (9.6%) ischemic events and 1 (0.7%) hemorrhagic event.…”

“…In addition, they are also considered to have a moderate flow-redirecting property due to their high metal coverage ( 9 ). The use of this stent has been reported in the literature by several institutions, but little has been reported for its treatment of aneurysms originating from small vessels (<2.5 mm) ( 10 – 13 ). Therefore, we present the largest patient cohort with intracranial aneurysms located in parent arteries <2.5 mm treated with the Leo Baby stent, and examine the feasibility, safety, and therapeutic efficacy.…”

Procedural Outcome Following Stent-Assisted Coiling for Wide-Necked Aneurysms Using Three Different Stent Models: A Single-Center Experience

“…Stent-assisted coiling (SAC) is a popular treatment option for both small and complex intracranial aneurysms, as it facilitates coil packing of wide-necked aneurysms that are at risk of coil dislocation and herniation into the parent target vessel, causing potentially periprocedural or delayed ischemic complications [ 1 , 2 ]. Furthermore, SAC allows higher densities of endo-saccular coil embolization and, as a result, higher occlusion and lower recurrence rates due to improved aneurysm thrombosis in comparison to coiling alone, which is not suitable in the majority of wide-necked aneurysm [ 3 ].…”