Abstract
BackgroundStent-assisted coiling is well-established for treatment of cerebral aneurysms. The technique enables treatment of wide-neck, bifurcation and recurrent aneurysms with high packing rates. While described in extenso for laser cut stents, the results of patients treated with the Leo+ Baby (Balt, Montmorency, France) braided microstent are presented.Material and MethodsPatients were included if treated with a Leo+ Baby and with digital subtraction angiography (DSA) follow-up available of at least 6 months. Data were evaluated for successful deployment, aneurysm occlusion according to the modified Raymond-Roy classification (MRRC), stent patency and procedure-related morbidity and mortality.ResultsA total of 81 patients were included and Leo+ Baby deployment was successful in all cases. Coils were used in 80 cases. In 1 case 2 stents were used stent-in-stent without additional coiling. Initial aneurysm occlusion rates were MRRCi1 51.9%, MRRCi2 11.1%, MRRCi3a 24.7% and MRRCi3b 12.3%. Occlusion rates after 6 months were MRRC6m1 78.9%, MRRC6m2 3.9%, MRRC6m3a 6.6% and MRRC6m3b 10.5%. Procedure-related morbidity was 1 case of acute stent thrombosis successfully treated with tirofiban and 1 case with transient hemiparesis due to stent thrombosis after 4 months. There was 1 case of coil-associated subarachnoid hemorrhage (SAH) which caused prolonged hospitalization. No procedure-related mortality was observed.ConclusionThe results confirm that stent-assisted coiling with the Leo+ Baby stent is safe and efficient for treatment of wide neck or recurrent cerebral aneurysms. Spontaneous progressive aneurysm occlusion over 6 months supports the theory of considerable flow-modulating effects of Leo+ Baby.
Highlights
This study reports on a single center experience and mid-term results in a series of 81 aneurysms treated by a braided microstents (BMS) (Leo+ Baby) stent-assisted coiling
Of the patients 5 refused to have digital subtraction angiography (DSA) follow-up and underwent follow-up with flat-detector computed tomography (FD-CT) and magnetic resonance imaging (MRI). In these 5 cases the aneurysm was rated as MRRC1 after 6 months
Treatment of wide-neck or recurrent cerebral aneurysms can still be challenging if located at the periphery or if a bifurcation is involved
Summary
In the last decade the possibilities for endovascular treatment of cerebral aneurysms (CA) have been considerably extended and studies have proved lower morbidity and mortality for coiling than for surgical clipping [1, 2]; many aneurysms are still challenging to treat, especially if very small, wide neck, located at a bifurcation or at distant parent vessels [3]. Stent-assisted coiling is well-established for treatment of cerebral aneurysms. While described in extenso for laser cut stents, the results of patients treated with the Leo+ Baby (Balt, Montmorency, France) braided microstent are presented. Material and Methods Patients were included if treated with a Leo+ Baby and with digital subtraction angiography (DSA) follow-up available of at least 6 months. Data were evaluated for successful deployment, aneurysm occlusion according to the modified Raymond-Roy classification (MRRC), stent patency and procedure-related morbidity and mortality. Results A total of 81 patients were included and Leo+ Baby deployment was successful in all cases.
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