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.
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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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