Correlation Between Vascular Geometry Changes and Long-Term Outcomes After Enterprise Stent Deployment for Intracranial Aneurysms Located on Small Arteries

Abstract

Enterprise stents are widely used for intracranial aneurysms located on small arteries (<2.5 mm in diameter) and change the geometry of parent arteries. The purpose of this study was to investigate the correlation between vascular geometry changes and long-term outcomes. Between May 2013 and 2018, 1065 consecutive intracranial aneurysms were treated with Enterprise stents at our institution. After inclusion and exclusion criteria were applied, 377 aneurysms with >6 months of digital subtraction angiography follow-up were evaluated. The cohort comprised 101 aneurysms located on small parent arteries. After stent-assisted coiling, the vascular geometry parameters of small parent arteries were compared to explore their correlation with procedural complications, delayed stent migration, and recanalization. The rate of delayed aneurysm occlusion in patients with initial efferent artery diameter (De) <2.5 mm was significantly higher than in patients with De >2.5 mm (62.2% vs. 40.2%; P= 0.032). At follow-up, vascular geometry parameters significantly increased (P < 0.001). In multivariate analyses, larger aneurysms and initial parent artery angle (α) <90° were independent predictors of procedural complications and discrepancy in vessel size (ΔD) >0.5 mm was an independent predictor of delayed stent migration. Larger aneurysms and follow-up angle change (ΔAngle) <30° were independent predictors for recanalization of aneurysms located on small arteries. Enterprise stent-assisted coiling of intracranial aneurysms located on small arteries is safe and effective. Our study found that Enterprise deployment in small arteries had a low procedural complication rate and high stent tolerance. Vascular geometry changes play an important role in aneurysm recanalization.