Stent-assisted embolization of recurrent or residual intracranial aneurysms

Abstract

Intracranial stents have theoretical advantages in the treatment of wide-necked intracranial aneurysms, but the usability of intracranial stents in the retreatment of recurrent intracranial aneurysms is relatively unknown. In this study, we aim to evaluate the safety and efficacy of stent-assisted embolization in the retreatment of recurrent or residual intracranial aneurysms. Retrospective evaluation was carried out for 55 consecutive patients (17 men and 38 women; mean age 51.5 years), with 56 recurrent or residual intracranial aneurysms electively retreated with stent-assisted embolization. The technical success rate was 91% (50/55 patients). Procedural complications were encountered with six patients (11%). Angiographic and clinical follow-up data were available for 51 patients (93%), with a mean follow-up period of 28.1 months. No rebleedings were encountered during the study period. The clinical outcome was favorable in 50 patients (91%), with a Glasgow Outcome Score of 4 (N = 14) or 5 (N = 36) at the end of the study period. Poor clinical outcome correlated with very large (>2 cm) total aneurysm size (P = 0.002), large (>10 mm) recurrent aneurysm size (P = 0.011), and occurrence of periprocedural complications (P < 0.001). Stent-assisted coil embolization is beneficial for the retreatment of wide-necked recurrent or residual intracranial aneurysms, but stability and permanent occlusion of the recurrent aneurysm is unlikely if the aneurysm exceeds 2 cm in diameter, the recurrent diameter of the aneurysm exceeds 10 mm, or if mass effect is present with the recurrent aneurysm.