Stent-assisted coiling of paraclinoid aneurysms: risks and effectiveness

Christopher S Ogilvy; Sabareesh K Natarajan; Shady Jahshan; Yuval Karmon; Xinyu Yang; Kenneth V Snyder; L Nelson Hopkins; Adnan H Siddiqui; Elad I Levy

doi:10.1136/jnis.2010.002303

Stent-assisted coiling of paraclinoid aneurysms: risks and effectiveness

¹Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA
²Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
³Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York, USA
⁴Neurovascular Service, Massachusetts General Hospital, Boston, Massachusetts, USA
⁵Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjian, China

Correspondence to Elad I Levy, University at Buffalo Neurosurgery, 3 Gates Circle, Buffalo, NY 14209, USA; elevy{at}ubns.com

Contributors Conceived and designed the research: Ogilvy, Levy. Acquired the data: all authors. Analyzed and interpreted the data: Ogilvy, Yang, Snyder, Jahan, Karmon, Natarajan. Performed statistical analysis: Yang, Jahan, Karmon, Natarajan. Drafted the manuscript: Ogilvy, Yang, Jahan, Karmon, Natarajan. Made critical revision of the manuscript for important intellectual content: all authors.

Received 18 January 2010
Revised 1 July 2010
Accepted 6 July 2010
Published Online First 23 August 2010

Abstract

Background Stent assistance for treatment of wide-based aneurysms is becoming rapidly accepted.

Methods Cases of aneurysms arising in the paraclinoid location of the internal carotid artery treated with intracranial stents and/or bare platinum coils were analyzed retrospectively from our prospectively collected database. We identified 70 aneurysms treated with stent assistance (including one stenting-alone case) and 24 aneurysms treated with coiling alone. Stenting-assisted coiling was achieved either as a one-time treatment or as a two-step maneuver with the stent placed several weeks before coiling, or stent-assisted coiling was used as a second maneuver in aneurysms that recanalized after previous coiling.

Results In aneurysms treated with stent assistance, 60% had ≥95% occlusion at treatment completion, a result comparing favorably with the 54.2% rate of ≥95% occlusion associated with coiling alone. At last follow-up, 60 aneurysms treated with stent assistance had a 66.7% incidence of ≥95% occlusion, with no in-stent stenosis; 75% of patients treated with coiling alone had ≥95% aneurysm occlusion. Thrombus occurred during stent deployment in two patients, one with and one without neurologic sequelae; stent displacement occurred in one patient without neurologic sequelae. At last follow-up, 57 of 62 patients (91.9%) treated with stent-assisted coiling experienced excellent/good outcomes (modified Rankin scale score ≤2). These results compared favorably with those for the coiling-alone group in which 23 of 24 (95.8%) had good outcomes.

Conclusion Stent-assisted coiling of paraclinoid aneurysms did not add significantly to morbidity; overall effectiveness was comparable to that of bare coiling of paraclinoid aneurysms. These results require confirmation by a prospective controlled trial.

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Footnotes

Work conducted at Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York, USA
Competing interests Dr Hopkins receives research study grants from Abbott (ACT 1 Choice), Boston Scientific (CABANA), Cordis (SAPPHIRE WW) and ev3/Covidien Vascular Therapies (CREATE), and a research grant from Toshiba (for the Toshiba Stroke Research Center); has an ownership/financial interest in AccessClosure, Boston Scientific, Cordis, Micrus and Valor Medical; serves on the Abbott Vascular Speakers' Bureau; receives honoraria from Bard, Boston Scientific, Cordis, and from the following for speaking at conferences: Complete Conference Management, Cleveland Clinic, and SCAI; receives royalties from Cordis (for the AngioGuard device), serves as a consultant to or on the advisory board for Abbott, AccessClosure, Bard, Boston Scientific, Cordis, Gore, Lumen Biomedical, Micrus and Toshiba; and serves as the conference director for Nurcon Conferences/Strategic Medical Seminars LLC. Dr Karmon has received a grant from the American Physicians Fellowship for Medicine in Israel. Dr Levy receives research grant support (principal investigator: Stent-Assisted Recanalization in acute Ischemic Stroke, SARIS), other research support (devices), and honoraria from Boston Scientific and research support from Micrus Endovascular and ev3/Covidien Vascular Therapies; has ownership interests in Intratech Medical Ltd and Mynx/Access Closure; serves as a consultant on the board of Scientific Advisors to Codman & Shurtleff, Inc.; serves as a consultant per project and/or per hour for Micrus Endovascular, ev3/Covidien Vascular Therapies and TheraSyn Sensors, Inc.; and receives fees for carotid stent training from Abbott Vascular and ev3/Covidien Vascular Therapies. Dr Levy receives no consulting salary arrangements. All consulting is per project and/or per hour. Dr Natarajan is the recipient of the 2010–2011 Cushing Award of the Congress of Neurological Surgeons (eligible to receive research support after 1 July 2010). Dr Ogilvy serves as a consultant to Mizuho America. Dr Siddiqui has received research grants from the University at Buffalo and from the National Institutes of Health (NINDS 1R01NS064592-01A1, Hemodynamic induction of pathologic remodeling leading to intracranial aneurysms); is a consultant to Codman & Shurtleff, Inc. Concentric Medical, ev3/Covidien Vascular Therapies and Micrus Endovascular; serves on speakers' bureaus for Codman & Shurtleff, Inc. and Genentech; and has received honoraria from Genentech, Neocure Group LLC, American Association of Neurological Surgeons' courses, and an Emergency Medicine Conference and from Codman & Shurtleff, Inc. for training other neurointerventionists. Dr Siddiqui receives no consulting salary arrangements. All consulting is per project and/or per hour. Dr Jahshan, Dr Snyder and Dr Yang have nothing to disclose.
Ethics approval This study was conducted with the approval of the Institutional Review Board at the University at Buffalo.
Provenance and peer review Not commissioned; externally peer reviewed.