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Transcirculation approach for stent-assisted coiling of intracranial aneurysms: a multicenter study
  1. Justin R Mascitelli1,
  2. Michael R Levitt2,
  3. Christoph J Griessenauer3,4,
  4. Louis J Kim2,
  5. Bradley Gross5,
  6. Adib Abla6,
  7. Ethan Winkler6,
  8. Brian Jankowitz7,
  9. Ramesh Grandhi8,
  10. Oded Goren3,
  11. Clemens M Schirmer3,4
  1. 1 Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
  2. 2 Department of Neurosurgery, University of Washington School of Medicine, Seattle, WA, USA
  3. 3 Department of Neurosurgery, Geisinger Health System, Danville, PA, USA
  4. 4 Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
  5. 5 Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
  6. 6 Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
  7. 7 Department of Neurosurgery, Cooper University Health Care, Camden, NJ, USA
  8. 8 Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
  1. Correspondence to Dr Justin R Mascitelli, Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA; jmascite{at}gmail.com

Abstract

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 To describe a multicenter experience using the TCA for SAC.

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 The TCA for SAC can be performed for a variety of aneurysms with a low complication rate and good clinical outcomes.

  • aneurysm
  • stent
  • technique
  • coil

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Footnotes

  • Twitter @DrMichaelLevitt, @cgriessenauer

  • Contributors All authors participated in data collection. JRM drafted the manuscript. All authors participated in manuscript review and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • 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.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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