Closed-Cell Stent-Assisted Coiling of Intracranial Aneurysms: Evaluation of Changes in Vascular Geometry Using Digital Subtraction Angiography
Open Access
- 13 April 2016
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 11 (4), e0153403
- https://doi.org/10.1371/journal.pone.0153403
Abstract
Stent-assisted coil embolization (SACE) plays an important role in the treatment of intracranial aneurysms. The purpose of this study was to investigate geometrical changes caused by closed-cell design stents in bifurcation and sidewall aneurysms. 31 patients with 34 aneurysms underwent SACE with closed-cell design stents. Inflow angle α, determined by aneurysm neck and afferent vessel, and angle between afferent and efferent vessel close to (δ1), respectively, more remote from the aneurysm neck (δ2) were graphically determined in 2D angiography projections. Stent assisted coiling resulted in a significant increase of all three angles from a mean value (±SEM) of α = 119° (±6.5°) pretreatment to 130° (±6.6°) posttreatment (P ≤ .001), δ1 = 129° (±6.4°) to 139° (±6.1°), (P ≤ .001) and δ2 = 115° (±8.4°) to 126° (±7.5°), (P ≤ .01). Angular change of δ1 in AcomA aneurysms was significant greater compared to sidewall aneurysms (26°±4.9° versus 8°± 2.3°, P ≤ .05). The initial angle of δ1 and δ2 revealed a significantly inverse relationship to the angle increase (δ1: r = -0.41, P ≤ .05 and δ2: r = -0.47, P ≤ .01). Moreover, angle δ1 was significantly higher in unruptured compared to ruptured aneurysms (135°±7.1° versus 103°±10.8°, P ≤ .05). Stent deployment modulates the geometry of the aneurysm-vessel complex, which may lead to favorable hemodynamic changes more similar to unruptured than to ruptured aneurysms. Our findings also suggest that the more acute-angled aneurysm-vessel anatomy, the larger the angular change. Further studies are needed to investigate whether these changes improve the clinical outcome.Keywords
This publication has 39 references indexed in Scilit:
- Analysis of Morphological Parameters to Differentiate Rupture Status in Anterior Communicating Artery AneurysmsPLOS ONE, 2013
- Our capricious vessels: The influence of stent design and vessel geometry on the mechanics of intracranial aneurysm stent deploymentJournal of Biomechanics, 2012
- Vascular Geometry Change Because of Endovascular Stent Placement for Anterior Communicating Artery AneurysmsAmerican Journal of Neuroradiology, 2011
- Impact of Stents and Flow Diverters on Hemodynamics in Idealized Aneurysm ModelsJournal of Biomechanical Engineering, 2011
- Hemodynamic–Morphologic Discriminants for Intracranial Aneurysm RuptureStroke, 2011
- Flow Residence Time and Regions of Intraluminal Thrombus Deposition in Intracranial AneurysmsAnnals of Biomedical Engineering, 2010
- Ten-year follow-up of giant basilar aneurysm treated by sole stenting technique: a case reportJournal of Medical Case Reports, 2010
- INFLUENCE OF INTRACRANIAL ANEURYSM-TO-PARENT VESSEL SIZE RATIO ON HEMODYNAMICS AND IMPLICATION FOR RUPTURENeurosurgery, 2009
- Aneurysm Growth Occurs at Region of Low Wall Shear StressStroke, 2008
- Size and location of ruptured and unruptured intracranial aneurysms measured by 3-dimensional rotational angiographySurgical Neurology, 2005