Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

The Stent-Assisted Coil-Jailing Technique Facilitates Efficient Embolization of Tiny Cerebral Aneurysms

  • Li, Cong-Hui (Department of Neurosurgery, Shijiazhuang First Hospital, Hebei Medical University) ;
  • Su, Xian-Hui (Department of Neurosurgery, Shijiazhuang First Hospital, Hebei Medical University) ;
  • Zhang, Bo (Department of Neurosurgery, Shijiazhuang First Hospital, Hebei Medical University) ;
  • Han, Yong-Feng (Department of Neurosurgery, Shijiazhuang First Hospital, Hebei Medical University) ;
  • Zhang, Er-Wei (Department of Neurosurgery, Shijiazhuang First Hospital, Hebei Medical University) ;
  • Yang, Lei (Department of Neurosurgery, Shijiazhuang First Hospital, Hebei Medical University) ;
  • Zhang, Dong-Liang (Department of Neurosurgery, Shijiazhuang First Hospital, Hebei Medical University) ;
  • Yang, Song-Tao (Department of Neurosurgery, Shijiazhuang First Hospital, Hebei Medical University) ;
  • Yan, Zhen-Quan (Department of Neurosurgery, Shijiazhuang First Hospital, Hebei Medical University) ;
  • Gao, Bu-Lang (Department of Neurosurgery, Shijiazhuang First Hospital, Hebei Medical University)
  • Received : 2014.06.14
  • Accepted : 2014.09.15
  • Published : 2014.12.01
⟨ Previous Next ⟩

Abstract

Objective: Tiny cerebral aneurysms are difficult to embolize because the aneurysm's sac is too small for a single small coil, and coils within the aneurysm may escape from the confinement of a stent. This study was performed to introduce the stent-assisted coil-jailing technique and to investigate its effect on the coil embolization of tiny intracranial aneurysms. Materials and Methods: Sixteen patients with tiny intracranial aneurysms treated with the stent-assisted coil-jailing technique between January 2011 and December 2013 were retrospectively reviewed and followed-up. Results: All aneurysms were successfully treated with the coil-jailing technique, and at the end of embolization, complete occlusion of the aneurysm was achieved in 9 cases (56.3%), incomplete occlusion in 6 (37.5%), and partial occlusion in 1 (6.3%). Intraprocedural complications included acute thrombosis in one case (6.3%) and re-rupture in another (6.3%). Both complications were managed appropriately with no sequela. Follow-up was performed in all patients for 3-24 months (mean, 7.7 months) after embolization. Complete occlusion was sustained in the 9 aneurysms with initial complete occlusion, progressive thrombosis to complete occlusion occurred in the 6 aneurysms with initial near-complete occlusion, and one aneurysm resulted in progressive thrombosis to complete occlusion after initial partial occlusion. No migration of stents or coils occurred at follow-up as compared with their positions immediately after embolization. At follow-up, all patients had recovered with no sequela. Conclusion: The stent-assisted coil-jailing technique can be an efficient approach for tiny intracranial aneurysms, even though no definite conclusion regarding its safety can be drawn from the current data.

Keywords

References

  1. Molyneux AJ, Kerr RS, Birks J, Ramzi N, Yarnold J, Sneade M, 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;8:427-433 https://doi.org/10.1016/S1474-4422(09)70080-8
  2. Brinjikji W, Lanzino G, Cloft HJ, Rabinstein A, Kallmes DF. Endovascular treatment of very small (3 mm or smaller) intracranial aneurysms: report of a consecutive series and a meta-analysis. Stroke 2010;41:116-121 https://doi.org/10.1161/STROKEAHA.109.566356
  3. Doerfler A, Wanke I, Egelhof T, Dietrich U, Asgari S, Stolke D, et al. Aneurysmal rupture during embolization with Guglielmi detachable coils: causes, management, and outcome. AJNR Am J Neuroradiol 2001;22:1825-1832
  4. van Rooij WJ, Keeren GJ, Peluso JP, Sluzewski M. Clinical and angiographic results of coiling of 196 very small (< or = 3 mm) intracranial aneurysms. AJNR Am J Neuroradiol 2009;30:835-839 https://doi.org/10.3174/ajnr.A1429
  5. Yang MS, Wong HF, Yang TH, Chen YL, Chan SW, Lee HJ, et al. Alternative option in the treatment of very small ruptured intracranial aneurysms. Surg Neurol 2009;72 Suppl 2:S41-S46 https://doi.org/10.1016/j.wneu.2009.09.003
  6. Nussbaum ES, Erickson DL. The fate of intracranial microaneurysms treated with bipolar electrocoagulation and parent vessel reinforcement. Neurosurgery 1999;45:1172-1174; discussion 1174-1175 https://doi.org/10.1097/00006123-199911000-00031
  7. Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003;362:103-110 https://doi.org/10.1016/S0140-6736(03)13860-3
  8. Gupta V, Chugh M, Jha AN, Walia BS, Vaishya S. Coil embolization of very small (2 mm or smaller) berry aneurysms: feasibility and technical issues. AJNR Am J Neuroradiol 2009;30:308-314
  9. Jeong YG, Jung YT, Kim MS, Eun CK, Jang SH. Size and location of ruptured intracranial aneurysms. J Korean Neurosurg Soc 2009;45:11-15 https://doi.org/10.3340/jkns.2009.45.1.11
  10. Cho CS. Coil Migration under Stent-Assisted Embolization. A Case Report. Interv Neuroradiol 2006;12:65-68 https://doi.org/10.1177/159101990601200113
  11. Gao BL, Li MH, Wang YL, Fang C. Delayed coil migration from a small wide-necked aneurysm after stent-assisted embolization: case report and literature review. Neuroradiology 2006;48:333-337 https://doi.org/10.1007/s00234-005-0044-1
  12. Nguyen TN, Raymond J, Guilbert F, Roy D, Berube MD, Mahmoud M, et al. Association of endovascular therapy of very small ruptured aneurysms with higher rates of procedure-related rupture. J Neurosurg 2008;108:1088-1092 https://doi.org/10.3171/JNS/2008/108/6/1088
  13. Proust F, Debono B, Hannequin D, Gerardin E, Clavier E, Langlois O, et al. Treatment of anterior communicating artery aneurysms: complementary aspects of microsurgical and endovascular procedures. J Neurosurg 2003;99:3-14 https://doi.org/10.3171/jns.2003.99.1.0003
  14. Sluzewski M, Bosch JA, van Rooij WJ, Nijssen PC, Wijnalda D. Rupture of intracranial aneurysms during treatment with Guglielmi detachable coils: incidence, outcome, and risk factors. J Neurosurg 2001;94:238-240 https://doi.org/10.3171/jns.2001.94.2.0238
  15. Lim YC, Kim BM, Shin YS, Kim SY, Chung J. Structural limitations of currently available microcatheters and coils for endovascular coiling of very small aneurysms. Neuroradiology 2008;50:423-427 https://doi.org/10.1007/s00234-008-0365-y
  16. Bruening R, Mueller-Schunk S, Morhard D, Seelos KC, Brueckmann H, Schmid-Elsaesser R, et al. Intraprocedural thrombus formation during coil placement in ruptured intracranial aneurysms: treatment with systemic application of the glycoprotein IIb/IIIa antagonist tirofiban. AJNR Am J Neuroradiol 2006;27:1326-1331
  17. Gralla J, Rennie AT, Corkill RA, Lalloo ST, Molyneux A, Byrne JV, et al. Abciximab for thrombolysis during intracranial aneurysm coiling. Neuroradiology 2008;50:1041-1047 https://doi.org/10.1007/s00234-008-0457-8
  18. Kang HS, Kwon BJ, Roh HG, Yoon SW, Chang HW, Kim JE, et al. Intra-arterial tirofiban infusion for thromboembolism during endovascular treatment of intracranial aneurysms. Neurosurgery 2008;63:230-237; discussion 237-238 https://doi.org/10.1227/01.NEU.0000320440.85178.CC
  19. Park JH, Kim JE, Sheen SH, Jung CK, Kwon BJ, Kwon OK, et al. Intraarterial abciximab for treatment of thromboembolism during coil embolization of intracranial aneurysms: outcome and fatal hemorrhagic complications. J Neurosurg 2008;108:450-457 https://doi.org/10.3171/JNS/2008/108/3/0450
  20. Thornton J, Debrun GM, Aletich VA, Bashir Q, Charbel FT, Ausman J. Follow-up angiography of intracranial aneurysms treated with endovascular placement of Guglielmi detachable coils. Neurosurgery 2002;50:239-249; discussion 249-250
  21. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003;34:1398-1403 https://doi.org/10.1161/01.STR.0000073841.88563.E9

Cited by

  1. Outcomes of Stent-assisted Coil Embolization of Wide-necked Intracranial Aneurysms Using the Solitaire™ AB Neurovascular Remodeling Device vol.17, pp.4, 2015, https://doi.org/10.7461/jcen.2015.17.4.301
  2. Stent-assisted embolization of wide-neck anterior communicating artery aneurysms: Review of consecutive 34 cases vol.50, pp.6, 2014, https://doi.org/10.1016/j.pjnns.2016.07.008
  3. Endovascular Treatment of Very Small Intracranial Aneurysms: Meta-Analysis vol.37, pp.5, 2014, https://doi.org/10.3174/ajnr.a4651
  4. Stent-assisted modified coil protection technique for bilobulated aneurysm: technical note vol.12, pp.1, 2014, https://doi.org/10.1016/j.radcr.2016.10.024