Abstract
BackgroundStent-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.Methods31 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.ResultsStent 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).ConclusionStent 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.
Highlights
Stent-assisted coil embolization (SACE) is a well-established endovascular therapy of cerebral aneurysms with wide necks or low dome-to-neck ratios [1,2,3]
Angular change of δ1 in anterior communicating artery (AcomA) aneurysms was significant greater compared to sidewall aneurysms (26°±4.9° versus 8°± 2.3°, P .05)
Angle δ1 was significantly higher in unruptured compared to ruptured aneurysms (135°±7.1° versus 103°±10.8°, P .05)
Summary
Stent-assisted coil embolization (SACE) is a well-established endovascular therapy of cerebral aneurysms with wide necks or low dome-to-neck ratios [1,2,3]. Stents with closed-cell design show this capability of angular remodeling. The closed-cell design makes the stent work as a whole body, immediately transmitting a force used at one end to the other end [9,10]. This leads to effective straightening of a curved vessel in which the stent is implemented [9,10,11]. Stents with open-cell design show significantly less angular remodeling [11], conform better to curved vascular segments by having several independent segments instead [9,10]
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