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Abstract
Introduction Small sized aneurysms with <3 mm in maximum diameter and having a wide aneurysm neck remain a challenge for endovascular coil embolisation. We report our experience with stent-assisted coil embolisation (SACE) of such aneurysms, long-term angiography results and patient clinical follow-up.
Material and Methods All patients who underwent SACE or stent placement for small aneurysms at our institution between 2009 and 2012 were identified and included in our retrospective analysis. In addition, we collected information on patient vascular risk factors, mRS on admission, aneurysm characteristics, Hunt and Hess and Fisher grade, angiography follow-up and patient clinical outcome at discharge, 90 days, 6 and 12 months.
Results We included a total of 14 patients (9 females and 5 males) in our study. Mean age of the patients was 57.9 years. Median mRS on admission was 0. Patients’ vascular risk factors included smoking (85.7%) and hypertension (64.3%). The majority of the aneurysms were located in the anterior circulation (78.6%). Mean maximum diameter of the aneurysms was 2.0 mm (range 1.0 to 2.8 mm). Median Hunt and Hess and Fisher grade was 0.5. Twelve patients were treated with SACE and 2 with stent placement only. Periprocedural development of vasospasm was seen in 2 ruptured aneurysm cases (14.3%). One of these patients died eventually from complications of vasospasm. Aneurysm perforation during coil placement occurred in the third ruptured aneurysm case but was managed with SACE. Two patients had thrombus formation during the procedure which was successfully treated with Abciximab. Near complete and complete aneurysm occlusion after treatment was seen in 12 patients. No patient required retreatment. Median mRS at discharge was 1.5 with 13 patients (92.6%) having an mRS ≤2 at the time of discharge. Six-month angiography follow-up was available for the remaining 13 patients (100%). One patient showed stable mild residual filling of the aneurysm and another patient presented with mild focal in-stent stenosis (Y-stenting case). No significant recanalisation could be detected at this time point. No aneurysm re-growth was seen. Median mRS at 90 days, 6 and 12 months was 1. Further angiography follow-up examinations were available for 2 patients (15.4%) at 12 and 36 months, respectively. Control angiography revealed stable aneurysm occlusion in both cases.
Conclusion SACE and stent placement is a safe and efficient treatment option for patients with wide necked small sized aneurysms with stable long-term angiography results and good clinical outcome.
Disclosures A. Puri: None. A. Kuhn: None. S. Hou: None. M. Khan: None. M. Gounis: None. A. Wakhloo: 1; C; Philips Healthcare. 2; C; Stryker Neurovascular, Boston Biomedical Assoc. 3; C; Harvard Postgraduate Course. 4; C; Boston Scientific. 6; C; NIH.