Stent-Assisted Coiling of Intracranial Bifurcation Aneurysms Leads to Immediate and Delayed Intracranial Vascular Angle Remodeling
Open Access
- 22 December 2011
- journal article
- clinical trial
- Published by American Society of Neuroradiology (ASNR) in American Journal of Neuroradiology
- Vol. 33 (4), 649-654
- https://doi.org/10.3174/ajnr.a2841
Abstract
BACKGROUND AND PURPOSE: Wide-neck bifurcating aneurysms are increasingly treated with intracranial stent-assisted coiling by using shape-memory alloy microstents. We sought to investigate the short- and long-term effects of intracranial stent implantation on the geometry and angular conformation of the stent-coiled vascular bifurcation. MATERIALS AND METHODS: Thirty patients underwent stent-mediated coiling for 31 bifurcation aneurysms by using 31 self-expanding Neuroform (n = 14) and Enterprise (n = 17) stents (17 women; mean age, 56 years). The angle (δ) between the stented mother and daughter vessels at the bifurcation was measured by using multiplanar imaging of reconstructed rotational conventional angiography volumes and was compared by using matched-pair statistics. Neuroform and Enterprise longitudinal stent stiffness was measured in vitro at an increasing bending angle θ (θ = 180°− δ). RESULTS: Stent deployment increased the bifurcation angle δ from 101.5° to 119.8° postprocedurally and to 137.3° (P < .0001) at latest follow-up, resulting in effective straightening; the angular remodeling was greater in distal-versus-proximal arteries (anterior cerebral > MCA > BA > ICA), inversely proportional to mother-vessel diameter and proportional to pretreatment bending angle θ. At follow-up, angle δ continued to significantly expand, with remodeling being greater in the early period (1–6 versus >7 months) and more pronounced with the longitudinally stiffer closed-cell Enterprise compared with the open-cell Neuroform stent. CONCLUSIONS: Stent placement across bifurcation aneurysms leads to a significant biphasic angular remodeling related to stent type and vessel caliber, altering morphology to mimic sidewall lesions, a phenomenon needing consideration during procedural planning. Future work is needed to uncover the hemodynamic implications of this structural change and any possible effect on aneurysm-recurrence rates.Keywords
This publication has 29 references indexed in Scilit:
- Use of the sole stenting technique for the management of aneurysms in the posterior circulation in a prospective series of 20 patientsJournal of Neurosurgery, 2008
- THE EFFECT OF VASCULAR RECONSTRUCTION DEVICE-ASSISTED COILING ON PACKING DENSITY, EFFECTIVE NECK COVERAGE, AND ANGIOGRAPHIC OUTCOMENeurosurgery, 2007
- NEUROFORM STENT-ASSISTED COIL EMBOLIZATION OF WIDE-NECK INTRACRANIAL ANEURYSMSNeurosurgery, 2007
- Sole Stenting Bypass for the Treatment of Vertebral Artery Aneurysms: Technical Case ReportOperative Neurosurgery, 2005
- Treatment of a Middle Cerebral Artery Bifurcation Aneurysm Using a Double Neuroform Stent “Y” Configuration and Coil Embolization: Technical Case ReportOperative Neurosurgery, 2005
- Usefulness of the Neuroform Stent for the Treatment of Cerebral Aneurysms: Results at Initial (3–6-mo) Follow-upNeurosurgery, 2005
- ENDOVASCULAR OCCLUSION OF WIDE-NECKED ANEURYSMS WITH A NEW INTRACRANIAL MICROSTENT (NEUROFORM) AND DETACHABLE COILSNeurosurgery, 2004
- Preliminary Experience Using the Neuroform Stent for the Treatment of Cerebral AneurysmsNeurosurgery, 2004
- Endovascular reconstruction of intracranial arteries by stent placement and combined techniquesJournal of Neurosurgery, 2002
- Intravascular stent placement for a fusiform aneurysm of the posterior cerebral artery: case reportEuropean Radiology, 2000