Progressive occlusion of enterprise stent-assisted coiling of ruptured wide-necked intracranial aneurysms and related factors on angiographic follow-up: a single-center experience with 468 patients

PLoS One. 2014 Mar 21;9(3):e92407. doi: 10.1371/journal.pone.0092407. eCollection 2014.

Abstract

This study was designed to assess the effect of the Enterprise stent on progressive occlusion of wide-necked aneurysms and to evaluate the association between dubious factors and progressive occlusion, which is a consecutive, retrospective, single-center study. Data from 468 patients with 495 wide-necked aneurysms, who had undergone Enterprise stent-assisted coiling (SAC) were reviewed, and the clinical outcomes and the angiographic results were analyzed. A 14-month clinical follow-up was achieved in 421 of the 468 patients (90.0%), showing modified Rankin Scale (mRS) 0-1 in 364 (86.4%), mRS 2 in 17 (4.1%), mRS 3 in 17 (4.1%), mRS 4-5 in 9 (2.1%), and mRS 6 in 14 (3.3%) patients. Overall, the morbidity and mortality were 10.2% and 3.3%, respectively. Initial angiographic results showed Raymond scale (RS)1 in 273 (55.2%), RS2 in 194 (39.2%), and RS3 in 28 (5.6%) patients. Eight-month angiographic follow-up was available in 394 of 495 patients (79.6%), and RS1 was seen in 315 (79.9%), RS2 in 65 (16.5%) and RS3 in 14 (3.6%) cases. At the end of the follow-up, 115 of the 165 (69.7%) patients with initial RS2 and RS3 showed progressive occlusion. Statistical analysis showed no significant difference between progressive occlusion and age (p = 0.654), sex (p = 0.016), aneurysm diameter (p = 0.010), neck size (p = 0.124), dome-to neck ratio (DNR) (p = 0.018) and location (p = 0.001) at the time of follow-up. SAC using Enterprise stent is not only feasible for wide-necked aneurysms, but can achieve a high rate of progressive occlusion with good clinical outcomes at medium-term follow-up. Patient age and aneurysm neck size showed no associated with progressive occlusion at follow-up, while sex, aneurysm diameter, DNR and location were significantly associated with progressive occlusion.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aneurysm, Ruptured / diagnostic imaging*
  • Aneurysm, Ruptured / pathology
  • Aneurysm, Ruptured / therapy
  • Cerebral Angiography
  • Embolization, Therapeutic* / instrumentation
  • Embolization, Therapeutic* / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Intracranial Aneurysm / diagnostic imaging*
  • Intracranial Aneurysm / pathology
  • Intracranial Aneurysm / therapy
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stents
  • Treatment Outcome

Grant support

This article was supported by the National Natural Science Foundation of China (No. 30901557), The High Level Health Technique Talent Training Plan of Beijing Health System (No. 2011-3-036), and the Nova Plan of Beijing Municipal Science and Technology (2007A043), Disciplines Backbone of Beijing Tiantan Hospital (No. DLB2011-09). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.