Vascular Geometry Change Because of Endovascular Stent Placement for Anterior Communicating Artery Aneurysms

Huang, Qinghai; Wu, Yunpeng; Xu, Yi; Hong, Bo; Zhang, L.; Liu, J.-M.

doi:10.3174/ajnr.a2597

Cited by 70 publications

(46 citation statements)

References 19 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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“…On the other hand, no cases of in-stent occlusion were mentioned in the previous studies. 3,5) The 3D analysis of the vessel revealed that the change in vascular geometry caused the kinking and occlusion of the vessel. Delayed in-stent occlusion rarely occurs after the treatment of cerebral aneurysm.…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…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. 3) In our case, the vessel angle changed by 409at 6 months after treatment, which is consistent with previous findings.…”

Section: Discussionmentioning

confidence: 99%

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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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“…In addition, although a recent study suggested that placement of intracranial stent changed the parent vascular configuration and indirectly affected the local hemodynamics, our CFD analysis could not take this vascular configuration into consideration. 3) Third, the assumption of the flow conditions, fluid properties, inlet velocity, and outlet flow splits for the CFD simulations were made to reflect typical conditions in the cerebral circulation but may not be applicable to all possible clinical situations. Last, although our data emphasize the role of the hemodynamic effects of intracranial stents, the biological potential of intracranial stents might also accelerate endothelialization, intimal coverage, and subsequent occlusion of incompletely embolized cerebral aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Changes in Hemodynamics After Placing Intracranial Stents

Ishida

Miura

Umeda

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Stent-assisted coil embolization has enabled the endovascular treatment of wide-necked cerebral aneurysms. Moreover, recent reports demonstrated that stent-assisted coil embolization was associated with a significant decrease in angiographic recurrences of coiled cerebral aneurysms. One of the possible explanations for this adjunctive effect of stent-assisted coil embolization is changes in the local hemodynamics caused by placing intracranial stents. This study investigated the hemodynamic effect of intracranial stents using computational fluid dynamics (CFD) analysis. The geometry of the intracranial stent, Enterprise TM VRD, was acquired by using micro computed tomography and virtually placed across the aneurysm orifice of a saccular aneurysm model (saccular model) and a blister-like aneurysm model (blister-like model) constructed from patient-specific three-dimensional (3D) rotational angiography data. Transient CFD analysis was performed with these models with and without stents. Stent placement induced no significant changes in the 3D streamline in the saccular model and slight changes in the blister-like model. Both saccular and blister-like models with stents had lower wall shear stress (WSS) and flow velocity, and higher oscillatory shear index, WSS gradient, and relative residence time than the equivalent models without stents, indicating the possibility that stent placement induced stagnant and disturbed blood flow. Cross-sectional vector velocity around the stent strut revealed complex blood flow patterns with variable direction and velocity. Although this study was a simulation under limited conditions, similar hemodynamic changes might be induced in the neck remnants treated with stent-assisted coil embolization.

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Vascular Geometry Change Because of Endovascular Stent Placement for Anterior Communicating Artery Aneurysms

Cited by 70 publications

References 19 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

Changes in Hemodynamics After Placing Intracranial Stents

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