Stent-assisted embolization of wide-neck anterior communicating artery aneurysms: Review of consecutive 34 cases

Neurol Neurochir Pol. 2016 Nov-Dec;50(6):425-431. doi: 10.1016/j.pjnns.2016.07.008. Epub 2016 Jul 26.

Abstract

Objective: We report our experience with stent-assisted coiling of anterior communicating artery aneurysms with special consideration of angiographic and clinical outcomes, retreatment rate and periprocedural complications.

Materials and methods: The analysis included 34 consecutive ruptured and unruptured wide-neck aneurysms. The aneurysm size ranged from 2 to 18mm (mean 5.47). Clinical examinations with the use of modified Rankin Score and angiographic outcomes were evaluated initially post-embolization and at a minimum follow-up of 6 months.

Results: Initial post-treatment complete and near-complete aneurysm occlusion was achieved in 32 (94%) and 2 (6%) cases, respectively. Imaging follow-up, performed in 28 (82%) patients, showed no change in the degree of occlusion in 25 (89%) cases and coil compaction in 3 (11%) patients. Of these, one (3.6%) patient underwent a second coil embolization. The periprocedural severe complication rate was 2.9% (1/35) and was associated with prolonged attempt of retrieval of migrated coil resulting in anterior cerebral artery infarct with serious clinical consequences. In another 3 patients periprocedural adverse events without delayed clinical consequences were noticed. The clinical follow-up evaluation achieved in 33 (97%) patients showed no change in 30 (91%) cases, one patient (3%) with clinical improvement and two (6%) cases of neurological deterioration.

Conclusions: The use of stent is feasible and effective for coil embolization of wide-necked anterior communicating artery aneurysms. Although periprocedural complications resulting in severe morbidity are rare, they should be noted, since in terms of thromboembolic events some of them presumably have a potential to be avoidable.

Keywords: Anterior communicating artery aneurysm; Stent-assisted embolization; Wide-neck aneurysm.

MeSH terms

  • Adult
  • Aged
  • Aneurysm, Ruptured / diagnostic imaging
  • Aneurysm, Ruptured / therapy*
  • Anterior Cerebral Artery / diagnostic imaging
  • Anterior Cerebral Artery / surgery*
  • Cerebral Angiography
  • Embolization, Therapeutic / methods*
  • Endovascular Procedures / methods*
  • Female
  • Humans
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / therapy*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stents*
  • Treatment Outcome