Stent-Assisted Coiling of Intracranial Bifurcation Aneurysms Leads to Immediate and Delayed Intracranial Vascular Angle Remodeling

Gao, Bu-Lang; Baharoglu, Merih I; Cohen, Alex D.; Malek, Adel M.

doi:10.3174/ajnr.a2841

Cited by 98 publications

(96 citation statements)

References 29 publications

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“…Intracranial stents have a multifactorial favorable role in aneurysm embolization: It may enable dense coil mass packing [16,17], change vascular morphology, induce intraaneurysmal flow modifications [18][19][20][21][22], and provide a structural basis for endothelialization [23,24]. However, the use of stent-assisted coil embolization more commonly has been reserved for unruptured aneurysms in order to determine the difference between thromboembolic events and hemorrhagic events when treating acutely ruptured aneurysms compared with unruptured ones.…”

Section: Discussionmentioning

confidence: 99%

Stent-Assisted Coil Embolization for the Treatment of Ruptured Aneurysms at the Anterior Circulation: Comparison Between HydroSoft Coils and Bare Platinum Coils

Che

Hong

et al. 2013

Cardiovasc Intervent Radiol

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Purpose To evaluate the perioperative safety and midterm prognosis (B12 months) of HydroSoft coils in treating ruptured aneurysms at the anterior circulation compared with bare platinum coils. Materials and Methods Patients with aneurysmal subarachnoid hemorrhages admitted to our hospital between January 2009 and March 2012 were retrospectively analyzed. According to strict inclusion and exclusion criteria, cases were selected and classified into two groups: In group A, HydroSoft coils were used as the primary filling coils (C40 % of total coil length); in group B, only bare platinum coils were used. Cases in both groups were all treated with stent-assistance. A comparison between the two groups was performed for periprocedural complications as well as immediate and mid-term outcomes. The stents used included Enterprise, Neuroform, and Solitaire.Results Fifty-six aneurysms were in group A patients, and 68 aneurysms were in group B patients. Compared with group B, group A did not have increased incidence of complications but had greater packing attenuation (44.5 ± 8.8-29.8 ± 9.1 %, t = 2.577, P = 0.014) and increased initial complete occlusion rates (63-44 %, v 2 = 4.161, P = 0.041). Radiologic follow-up were performed in 46 patients from group A and 51 patients from group B. Complete occlusion rates at follow-up were significantly greater in group A than in group B (89.1-70.6 %, v 2 = 5.08, P = 0.043); the difference in recanalization rates were statistically insignificant between the groups (6.5-5.9 %, P = 1.000). Conclusion HydroSoft coils proved safe during the periprocedural period and provided greater initial complete occlusion rates, greater packing density, and better followup results compared with bare platinum coils.

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Section: Discussionmentioning

confidence: 99%

Stent-Assisted Coil Embolization for the Treatment of Ruptured Aneurysms at the Anterior Circulation: Comparison Between HydroSoft Coils and Bare Platinum Coils

Che

Hong

et al. 2013

Cardiovasc Intervent Radiol

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“…Stent-related changes in vascular geometry have been observed in the treatment of cerebral aneurysms. 3,5) Vascular geometry was changed by stent placement in anterior communicating artery aneurysms, and the angle of change ranged from 7.609to 74.889 , with a mean of 29.959 . 5) Change in vascular geometry also occurred after stent placement for bifurcation aneurysms, and the vascular angles changed by a mean of 189on immediate angiograms and 349on follow-up angiograms.…”

Section: Discussionmentioning

confidence: 99%

Delayed In-Stent Occlusion Due to Stent-Related Changes in Vascular Geometry After Cerebral Aneurysm Treatment

Kono

Shintani

Tanaka

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Stent-assisted coil embolization has been recently accepted as a treatment option for wide-neck or complex cerebral aneurysms. Delayed in-stent occlusion is described due to stent-related changes in vascular geometry. A 66-year-old man underwent stent-assisted coil embolization for an unruptured aneurysm of the vertebral artery. The treatment was successfully performed using the Enterprise stent. Follow-up angiography at 6 months showed asymptomatic in-stent occlusion. Three-dimensional analysis of the vascular geometry revealed that the left vertebral artery was straightened by 409due to the stent placement. Such straightening of the vessel presumably caused kinking and occlusion of the vessel. Stent-related changes in vascular geometry may cause kinking of a vessel and result in occlusion after the treatment of cerebral aneurysms. Pre-treatment strategy may avoid this risk.

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“…They observed increases of the radius of curvature of more than 50 % after stent implantation. Gao et al [2]. as well as Chau et al [7] reported that anatomical deformation is more likely in distal (middle cerebral and anterior communicating artery) than in proximal (e.g., internal carotid artery) locations.…”

Section: Introductionmentioning

confidence: 99%

“…The investigated unruptured aneurysm was located at the middle cerebral artery, where according to Gao et al [2] and Chau et al [7] anatomical deformations are more likely. Placement of a laser-cut stent (Acclino flex, Acandis GmbH & Co. KG, Pforzheim, Germany) for stent-assisted coiling led to a marked anatomical deformation of the parent and nearby arteries (Figure 1).…”

Section: Case Description and Pre-processingmentioning

confidence: 99%

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Variability of intra-aneurysmal hemodynamics caused by stent-induced vessel deformation

Voß¹,

Berg²,

Janiga³

et al. 2017

Current Directions in Biomedical Engineering

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Clinical observation revealed deformations of the local vasculature due to implanted devices related to treatment of intracranial aneurysms. Pre-and postinterventional image data is reviewed and segmented. Based on Computational Fluid Dynamics (CFD) the effect of the vessel deformation on the intra-aneurysmal hemodynamics is investigated. The simulations incorporate the vessel trees with aneurysm excluding the device itself in order to consider the isolated effect of geometric modifications. As a result, the aneurysm inflow jet is redirected, changing the local flow quantities. Finally, a neck inflow rate reduction of 52.5 % is archived. Thus, a targeted vessel straightening as a novel tool for treatment planning appear to be an idea worth to discuss in the community.

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Stent-Assisted Coiling of Intracranial Bifurcation Aneurysms Leads to Immediate and Delayed Intracranial Vascular Angle Remodeling

Cited by 98 publications

References 29 publications

Stent-Assisted Coil Embolization for the Treatment of Ruptured Aneurysms at the Anterior Circulation: Comparison Between HydroSoft Coils and Bare Platinum Coils

Stent-Assisted Coil Embolization for the Treatment of Ruptured Aneurysms at the Anterior Circulation: Comparison Between HydroSoft Coils and Bare Platinum Coils

Delayed In-Stent Occlusion Due to Stent-Related Changes in Vascular Geometry After Cerebral Aneurysm Treatment

Variability of intra-aneurysmal hemodynamics caused by stent-induced vessel deformation

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