Stent-Assisted Coiling of Ruptured and Incidental Aneurysms of the Intracranial Circulation Using Moderately Flow-Redirecting, Braided Leo Stents—Initial Experience in 39 Patients

Abstract

BackgroundFlow diversion (FD)—a young technique using stents with highly increased surface coverage—was introduced to treat complex aneurysms without intra-aneurysmal material placement and has amended the spectrum of endovascular techniques such as stent-assisted coil occlusion considerably. However, ischemic complications, a common side effect in FD, occur more frequently compared with the conventional endovascular approaches and certainly limit the indication of this technique. Our study aimed to investigate the feasibility and efficacy of stent-assisted coiling using low profile self-expandable stents, which exhibit only moderate flow-redirecting properties and therefore represent a combination of hemodynamic endovascular and occlusive endosaccular therapy.Materials and methods39 Patients were included in our retrospective study. Occlusion rates were assessed 6 months after the procedure in a total of 27 cases using the Raymond scale.ResultsComplete occlusion (Raymond I) was achieved in 24/27 aneurysms. Small neck remnants (Raymond II) were evident in 3/27 aneurysms. There were no cases with sac remnant or complete persistence of aneurysmal filling (Raymond III and IV).ConclusionOur study demonstrates interventional treatment of intracranial aneurysms using flow-redirecting stent-assisted coiling to be technically feasible and highly effective in aneurysmal occlusion. We believe that this approach is outstanding in the prevention of long-term aneurysmal reperfusion and exhibits a more acceptable risk profile than highly efficient FD techniques.

Flow diversion beyond the circle of Willis: endovascular aneurysm treatment in peripheral cerebral arteries employing a novel low-profile flow diverting stent

“…In most peripheral aneurysms, even the approach of an exchange maneuver (first probing the target segment with a better navigable microcatheter and then converting to a stiffer delivery catheter via a microguidewire) or other complementary techniques frequently did not result in a sufficient delivery catheter position or the maneuver carried an unjustifiably increased risk of vessel perforation 19 20. Therefore, stent-assisted coiling employing low-profile braided stents, which offers better deliverability with a reduced hemodynamic effect and increased risk of procedural perforation due to direct manipulation of the most fragile aneurysm sac, had to be performed in such cases 21. Consequentially, great efforts were made to develop FDS for smaller cerebral vessels.…”

Delayed Stroke after Aneurysm Treatment with Flow Diverters in Small Cerebral Vessels: A Potentially Critical Complication Caused by Subacute Vasospasm

“…Consistent guidelines regarding the time point and appropriate modality for follow-ups after FDS implantation are not yet defined [12]. Therefore, as it is generally accepted for endovascular aneurysm treatment, the first time point for follow-up imaging in our neurovascular center was set at six months post intervention [12,13]. Related to the recent limited marketing release of a low-profile FDS, specifically developed for the unprecedented treatment of small cerebral vessels [14], we defined a follow-up regimen, henceforth including imaging at three, nine, and 24 months after the intervention.…”

Endovascular treatment of complex vertebrobasilar junction aneurysms: A report of two cases

“…We initially performed an angioplasty to widen the origin of the VA. We felt that the best therapeutic option would be to place a braided stent from the right VA into the basilar trunk followed by coil embolization of the aneurysm sac. Braided stents have a dense mesh of nitinol with a smaller pore size compared with other conventional self-expandable stents, and also exhibit a moderate flow-diverting effect [ 8 ].…”