Factors Affecting the Degree of Angular Remodeling in Stent-Assisted Coiling of Bifurcation Aneurysms.

BACKGROUND

Stent-assisted coiling (SAC) leads to significant changes in the vascular angle altering the bifurcation geometry and the hemodynamics at the bifurcation apex. It is believed that the stent alone exerts this effect, but other possible factors have not been studied.

PURPOSE

To study the factors contributing to angular remodeling following SAC of bifurcation aneurysms including the anatomical, stent-related, and coil-related factors.

MATERIALS AND METHODS

We reviewed 43 basilar and carotid bifurcation aneurysms treated by SAC using Neuroform EZ (

RESULTS

The mean degree of stent-induced and coil-induced angular remodeling was 10.2 (0-47) and 4.53 (-7 to 30), respectively. The immediate postprocedural and delayed angular remodeling was 14.8 (-4 to 47) and 4.75 (-12 to 40), respectively. The degree of immediate remodeling was significantly affected by the actual in situ coil size (

CONCLUSION

Immediate angular remodeling following SAC of bifurcation aneurysms can happen after stenting or coiling or both. This is the first study reporting the role of the coils as an additional factor beside the stent in inducing immediate angular changes; this effect is correlated to the size of the coils. The pretreatment bifurcation angle is the most consistent factor affecting the degree of both immediate and delayed angular remodeling.

Informations de copyright

Copyright © 2019 by S. Karger AG, Basel.

Déclaration de conflit d'intérêts

Dr. Demetrius Lopes received research grants from Penumbra, Stryker, and Microvention, is a consultant/on the Advisory Board of Medtronic, Microvention, Asahi, and Siemens, and aprincipal investigator for Dawn, Swift Prime, and Therapy. Honoraria were granted by Stryker, Microvention, Medtronic, and Penumbra. Ownership interest/options were held by Crowdoptic, Three Rivers, Neurvana, MIVI, Blockade, NDI, Nextgen, Elum, and Bendit.