Transcirculation approach for stent-assisted coiling of intracranial aneurysms: a multicenter study.
Carotid Arteries
/ abnormalities
Cerebral Angiography
/ methods
Cerebral Arteries
/ abnormalities
Embolization, Therapeutic
/ instrumentation
Female
Humans
Intracranial Aneurysm
/ diagnosis
Male
Middle Aged
Postoperative Complications
/ diagnosis
Retrospective Studies
Stents
Treatment Outcome
Vertebral Artery
/ abnormalities
aneurysm
coil
stent
technique
Journal
Journal of neurointerventional surgery
ISSN: 1759-8486
Titre abrégé: J Neurointerv Surg
Pays: England
ID NLM: 101517079
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
received:
20
09
2020
revised:
27
10
2020
accepted:
02
11
2020
pubmed:
19
11
2020
medline:
27
7
2021
entrez:
18
11
2020
Statut:
ppublish
Résumé
The transcirculation approach (TCA) for stent-assisted coiling (SAC) of intracranial aneurysms may be useful for certain wide-neck bifurcation aneurysms as well as those with acute-angle efferent branches. To describe a multicenter experience using the TCA for SAC. A multicenter, retrospective study (2016-2020) of aneurysm treatment using SAC via the TCA. Angiographic outcome was scored using the Raymond Scale (adequate occlusion 1 and 2), and clinical outcome was scored using a modified Rankin Scale (good outcome 0-2) RESULTS: Twenty-nine patients with 29 aneurysms were included (62.1% female; average age 61; 89.7% unruptured; 13.8% previously treated; average dome size 6.4 mm; average neck 4.4 mm). Aneurysm locations included internal carotid artery-fetal posterior cerebral artery (n=4), internal carotid artery terminus (n=4), anterior communicating artery (n=8), vertebral artery-posterior inferior cerebellar artery (n=2), and basilar tip (n=11). The TCA used communicating arteries (93.1%; average 1.6 mm), intermediate catheters (51.7%), jailing technique (62.1%), and staged procedures (10.3%). The most common stent was the Neuroform Atlas (Stryker; 69%). Immediate adequate occlusion was obtained in 75.9%, and five patients with inadequate occlusion progressed to adequate occlusion at follow-up. One (3.4%) procedural complication occurred: a watershed stroke in the setting of baseline four-vessel extracranial disease. Two patients had a poor outcome unrelated to the TCA. The majority of patients (86.4%) had a good clinical outcome. One case of in-stent stenosis due to non-compliance with medication was seen, which resolved with medication resumption. The TCA for SAC can be performed for a variety of aneurysms with a low complication rate and good clinical outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
The transcirculation approach (TCA) for stent-assisted coiling (SAC) of intracranial aneurysms may be useful for certain wide-neck bifurcation aneurysms as well as those with acute-angle efferent branches.
OBJECTIVE
OBJECTIVE
To describe a multicenter experience using the TCA for SAC.
METHODS
METHODS
A multicenter, retrospective study (2016-2020) of aneurysm treatment using SAC via the TCA. Angiographic outcome was scored using the Raymond Scale (adequate occlusion 1 and 2), and clinical outcome was scored using a modified Rankin Scale (good outcome 0-2) RESULTS: Twenty-nine patients with 29 aneurysms were included (62.1% female; average age 61; 89.7% unruptured; 13.8% previously treated; average dome size 6.4 mm; average neck 4.4 mm). Aneurysm locations included internal carotid artery-fetal posterior cerebral artery (n=4), internal carotid artery terminus (n=4), anterior communicating artery (n=8), vertebral artery-posterior inferior cerebellar artery (n=2), and basilar tip (n=11). The TCA used communicating arteries (93.1%; average 1.6 mm), intermediate catheters (51.7%), jailing technique (62.1%), and staged procedures (10.3%). The most common stent was the Neuroform Atlas (Stryker; 69%). Immediate adequate occlusion was obtained in 75.9%, and five patients with inadequate occlusion progressed to adequate occlusion at follow-up. One (3.4%) procedural complication occurred: a watershed stroke in the setting of baseline four-vessel extracranial disease. Two patients had a poor outcome unrelated to the TCA. The majority of patients (86.4%) had a good clinical outcome. One case of in-stent stenosis due to non-compliance with medication was seen, which resolved with medication resumption.
CONCLUSIONS
CONCLUSIONS
The TCA for SAC can be performed for a variety of aneurysms with a low complication rate and good clinical outcomes.
Identifiants
pubmed: 33203763
pii: neurintsurg-2020-016899
doi: 10.1136/neurintsurg-2020-016899
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
711-715Informations de copyright
© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: JRM: Compensated for lectures for Penumbra and PMI. MRL: Educational grants from Stryke, Medtronic, Philips volcano; equity interest in Synchron, Cerebrotech, Eloupes; adviser for Metis Innovative; consultant for Medtronic. CJG: Consultant to Stryker; research funding from Medtronic. LJK: Stock ownership, Spi Surgical, LLC. BG: Consultant for Medtronic and MicroVention. AA: Consultant for Stryker. BJ: Consultant for Stryker, Medtronic. RG: Consultant to BALT Neurovascular, Medtronic, Cerenovus. CMS: Research support: Penumbra; ownership; Neurotechnology investors.