Clinical StudyEndovascular treatment of acutely ruptured, wide-necked anterior communicating artery aneurysms using the Enterprise stent
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)
- et al.
International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial
Lancet
(2002) - et al.
Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up
Lancet Neurol
(2009) - et al.
Endovascular treatment of cerebral aneurysms with the use of stents in small cerebral vessels
Neurol Res
(2010) - et al.
Intracranial stents for aneurysms: mere scaffold or hemodynamic therapy?
World Neurosurg
(2010) - et al.
Impact of anatomic features in the endovascular embolization of 181 anterior communicating artery aneurysms
Stroke
(2008) - et al.
Neuroform stent-assisted embolization of incidental anterior communicating artery aneurysms: long-term clinical and angiographic follow-up
Neurosurgery
(2011) - et al.
A novel “Y” stent flow diversion technique for the endovascular treatment of bifurcation aneurysms without endosaccular coiling
AJNR Am J Neuroradiol
(2011) - et al.
Endovascular treatment of wide-neck middle cerebral artery aneurysms with stents: a review of 16 cases
AJNR Am J Neuroradiol
(2010) Should stents be used in the treatment of ruptured intracranial aneurysms?
J Neurosurg Sci
(2011)- et al.
Vascular geometry change because of endovascular stent placement for anterior communicating artery aneurysms
AJNR Am J Neuroradiol
(2011)
Cited by (22)
Endovascular treatment of wide-neck anterior communicating artery aneurysms using the LVIS Junior stent
2015, Journal of Clinical NeuroscienceCitation Excerpt :In this group of 11 patients, the LVIS Jr. stents were well deployed and opened. Vascular morphological changes after Neuroform and Enterprise stent placements for ACA aneurysms were reported in our previous studies [4,11]. However, unlike the open-cell or half open-cell intracranial stents, the LVIS Jr. stent is of closed-cell design with flared ends and there are no associated reports on whether LVIS Jr. has the same effect as these previously reported stents.
Enterprise stent-assisted coiling for wide-necked intracranial aneurysms during ultra-early (48hours) subarachnoid hemorrhage: A single-center experience in 59 consecutive patients
2015, Journal of NeuroradiologyCitation Excerpt :However, their high regrowth rate was mainly due to using traditional detachable coils without the assistance of an aneurysm neck bridge device. Regarding wide-necked ruptured aneurysms, reported regrowth rates are 0.0–13.8% with intracranial SAC versus 0.0–8.8% with the Enterprise stent [15,19–21]. Most aneurysms in our series were located in the tortuous internal carotid artery system, which has greater parent vessel size and is regarded as having a higher risk of regrowth due to incomplete stent apposition in Enterprise SAC.
Endovascular management of anterior communicating artery aneurysms
2014, Neurosurgery Clinics of North AmericaCitation Excerpt :With the results of the International Subarachnoid Aneurysm Trial (ISAT) published in 2002, the treatment of intracranial aneurysms has preferentially shifted toward endovascular treatment at most institutions.3,9,10 Although there remains a large role for open surgical clipping, the endovascular trend has further been facilitated by physician experience and novel technical developments, which have broadened indications of endovascular treatment.11–14 Given the increasing options in endovascular treatments, coupled with open vascular clipping, patient care can often be individualized to minimize risk to the patient.
Stent placement for complex middle cerebral artery aneurysms
2014, Journal of Stroke and Cerebrovascular Diseases
- †
Qing-Hai Huang and Yong-Fa Wu are equal first authors.