Sole Stenting Technique for the Treatment of Uncoilable Very Small Aneurysms in the Intracranial Internal Carotid Artery

Abstract

The treatment of very small aneurysms with diameter of less than 3 mm remains a challenge for both endovascular and surgical treatment. Endovascular treatment of these lesions may be difficult and is associated with a high risk of complications because of their small size. The present study evaluated the safety, feasibility, and efficacy of the endovascular treatment using sole stenting technique for uncoilable very small aneurysms of the intracranial internal carotid artery (ICA). From August 2004 through January 2010, eight very small aneurysms of intracranial ICA in eight patients were treated with endovascular sole stenting technique. All very small aneurysms were ruptured (n = 3) or aneurysms associated with another ruptured (n = 2) and unruptured aneurysms (n = 3) in the same artery. Stents were Neuroform and balloon expandable coronary stents. Stent deployment was carried out without difficulty in all patients. Single stent deployment was done for six aneurysms, and double stents in two aneurysms. The immediate angiographic results were partial occlusion in one case and no occlusion in seven cases. One direct carotid-cavernous fistula occurred during coronary stenting without permanent neurological deficit. No neurological deterioration or hemorrhagic complication was seen during the follow-up period in seven patients. Follow-up angiography (mean 9 months) was available in six patients and revealed complete occlusion in four and no occlusion in two cases. Sole stenting technique may be a feasible and effective therapeutic alternative for uncoilable very small aneurysms. The long-term efficacy and durability of stenting for these lesions remains to be determined in a large series.

Outcomes of Stent-assisted Coil Embolization of Wide-necked Intracranial Aneurysms Using the Solitaire™ AB Neurovascular Remodeling Device

“…These strategies have evolved from the early "microcatether transposition stent technique" and "stent stable microcatheter technique (Jailing)" to newly developed variable techniques, including semi-jailing, simple or multiple stenting for flow diversion, stent-jack, post-releasing, Y-stenting, waffle-cone stenting, and bailout or coil-jailing stenting techniques. 1) 2) 10) 12) 18) 19) 20) 24) 26) 34) 43) 44) 45) In our study, we mostly used the jailing technique, along with the stent-jack technique as a variation of the jailing technique. A major advantage of the jailing technique is an improvement in the stability against the kick-back and unstable movement of the microcatheter during coiling in intracranial aneurysms.…”

Does a Low-wall Coverage Stent Have a Flow Diverting Effect in Small Aneurysms?

“…The flow diverting effect of a low-wall coverage stent remains controversial. Although stenting can lead to improvements in the hemodynamic parameters of aneurysms [ 1 ], there are few clinical reports regarding long-term outcomes after stenting [ 2 3 ].…”