Abstract
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. 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). 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. 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.
Highlights
AND PURPOSE: Wide-neck bifurcating aneurysms are increasingly treated with intracranial stent-assisted coiling by using shape-memory alloy microstents
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
Since the introduction of stent-placement techniques for aneurysm treatment, significant progress has led to their use in a variety of methods, including sole stent placement for side wall or fusiform aneurysms,4,9-11 “kissing” stents for wide fusiform aneurysms,[12] overlapping stents with or without coiling for ruptured dissecting aneurysms or small wide-neck aneurysms,[13,14] stents deployed in “Y”15,16 or “waffle-cone”[17]
Summary
Thirty patients underwent stent-mediated coiling for 31 bifurcation aneurysms by using 31 self-expanding Neuroform (n ϭ 14) and Enterprise (n ϭ 17) stents (17 women; mean age, 56 years). Patient Population and Treatment Method Between March 2004 and January 2011, 30 patients (17 females and 13 males) with age range of 13– 82 years (mean, 56 years) underwent adjunctive coiling to treat 31 wide-neck bifurcation aneurysms by using intracranial nitinol self-expanding stent assistance with the open-cell design, Neuroform in 14 and the closed-cell design Enterprise in 17. Patients presented with headache in 5, acute subarachnoid hemorrhage in 7, recurrence of previously treated aneurysms in 2, vertigo in 1, and ischemic stroke in 1 case. One patient with a high-grade subarachnoid hemorrhage had a large hematoma in the right Sylvian fissure, for which he underwent evacuation followed by stent-mediated coil embolization of the aneurysm. Aneurysm size ranged from 2 to 19 mm (mean 8.6 mm), and neck, from 3 to 10 mm (mean, 6 mm)
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