Clinical Study
Endovascular treatment of acutely ruptured, wide-necked anterior communicating artery aneurysms using the Enterprise stent

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Abstract

The treatment of anterior communicating artery (AcomA) wide-necked aneurysms with the Enterprise stent (Codman, Miami Lakes, FL, USA) has not been commonly described, due to the complexity of the vascular anatomy and the small vessels of the AcomA complex. To evaluate the feasibility, effectiveness and safety of Enterprise stent placement in AcomA aneurysms, we performed this retrospective study. Between November 2008 and December 2010, 27 wide-necked AcomA ruptured aneurysms were treated within 72 hours of ictus with the Enterprise stent. Data collected and analyzed were: demographic data, morphologic features of the aneurysm, treatment results and follow-up results. Twenty-nine Enterprise stents were successfully deployed in all 27 aneurysms, including Y-configuration stent deployment in two patients. The initial embolization degrees were Raymond class I in 20 patients, class II in five and class III in the other two. The angiographic follow-up of 21 patients (mean, 8.4 months) showed that all aneurysms remained stable or improved; there was no in-stent stenosis, recurrence or retreatment. The clinical follow-up of 26 patients (mean, 12.6 months) showed that 23 patients displayed no symptoms and no or mild disability; three patients remained with severe or moderately severe disability. The Enterprise stent is feasible and safe for endovascular embolization of wide-necked AcomA ruptured aneurysms. Further follow up is needed to assess the long-term efficacy of Enterprise stent placement in AcomA.

Introduction

Anterior communicating artery (AcomA) aneurysms are one of the most common intracranial aneurysms.1 As techniques and devices have evolved, endovascular embolization of AcomA aneurysms with detachable coils has been associated with low morbidity and mortality rates.2, 3 Although endovascular management of wide-necked AcomA aneurysms remains technically challenging, various devices and stenting strategies have been reported;4, 5, 6 however, treatment of AcomA wide-necked aneurysms using a self-expandable, closed-cell stent (Enterprise stent; Codman, Miami Lakes, FL, USA) has not been commonly described, due to the complex vascular anatomy and small size of the vessels. In addition, the use of stents for the treatment of acutely ruptured aneurysms remains controversial, because of the risks of anticoagulation and anti-platelet therapy in patients with acute subarachnoid hemorrhage (SAH).7 Herein, we report our experience of stent-assisted coiling for acutely ruptured AcomA aneurysms with a modified jailing technique using the Enterprise stent.

Section snippets

Patient population

During November 2008 and December 2010, there were 983 intracranial aneurysms treated in our institute. Multiple intracranial aneurysms were detected in some patients. Patients treated with a self-expandable, closed-cell Enterprise stent were retrospectively analyzed. A total of 256 (26%) saccular aneurysms (143 ruptured, 113 unruptured) were treated using stent-assisted coiling. Of the 143 ruptured aneurysms, 41 were AcomA aneurysms. In our hospital, patients with intracranial aneurysms are

Results

In all patients, stent deployment was a technical success. In terms of timing of stent deployment, the stents were fully deployed after completion of coil embolization in 12 patients, and after satisfactory coil basketing in the other 15 patients. In total, 29 Enterprise stents were deployed. Bilateral A2 protection was by Y-configuration stent deployment in two patients (Supplementary Fig. 1), and by stenting across AcomA in 15 patients from A1 to the contralateral A2 segment. In 10 patients

Discussion

The use of self-expanding microstents for the treatment of cerebral aneurysms continues to evolve.9 This technical evolution has allowed previously uncoilable aneurysms to be successfully treated. Stent-assisted coiling techniques have been reported for the treatment of complex wide-necked AcomA aneurysms and distal anterior cerebral artery aneurysms with small parent vessels.10, 11 The Neuroform stent (Boston Scientific, Natick, MA, USA) is the most commonly used stent for the treatment of

Conflicts of interest/Disclosures

The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.

Acknowledgements

This research was supported by National Natural Science Foundation of China (Grant No. 30901556 and Grant No. 81171092) and Rising-star Plan of Shanghai Science and Technology Committee (Grant No. 11QA1408400).

References (21)

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Qing-Hai Huang and Yong-Fa Wu are equal first authors.

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