J Cerebrovasc Endovasc Neurosurg.  2015 Dec;17(4):301-312. 10.7461/jcen.2015.17.4.301.

Outcomes of Stent-assisted Coil Embolization of Wide-necked Intracranial Aneurysms Using the Solitaire(TM) AB Neurovascular Remodeling Device

• Jeong HW
• Seung WB

• KMID: 2150968
• DOI: http://doi.org/10.7461/jcen.2015.17.4.301

Abstract

OBJECTIVE
This retrospective study presents our experience with respect to the clinical and angiographic outcomes of patients treated with stent-assisted coil embolization using Solitaire(TM) AB stents.
MATERIALS AND METHODS
From March 2011 to December 2014, 50 patients with 55 wide-necked and/or complex intracranial aneurysms were evaluated. Four patients presented with an acute subarachnoid hemorrhage. Stent deployment was performed with a standard coiling procedure in 49 aneurysms. Three patients underwent bailout stenting, 2 patients were treated by temporary stenting and one patient was treated only by stenting without coiling for dissecting aneurysm.
RESULTS
Successful placement of the Solitaire AB stent was achieved in all the cases. Based on the postprocedural angiographic results, a Raymond 1 was obtained in 32 (59%) of 54 aneurysms, excluded by one case of dissecting aneurysm, and a Raymond 2 in 13 (24%), and a Raymond 3 in 9 (17%). There was one thromboembolic (2%) and three hemorrhagic complications (6%). However, procedure-related morbidity or mortality was not found. Annual follow-up angiographic results from the embolization were obtained in 40 (74.1%) of 54 cases. These results were represented as Raymond 1 in 27 (67.5%), class 2 in 9 (22.5%), and class 3 in 4 (10%) cases. Angiographic improvement associated with progressive thrombosis of the aneurysm was obtained in 10 aneurysms. Four aneurysms were recanalized without requiring additional treatment. In-stent stenosis was found in one aneurysm, but stent migration was not seen on follow-up angiography.
CONCLUSION
Stent-assisted coil embolization using the Solitaire AB stent for treating wide-necked and/or complex intracranial aneurysms was found to be safe and effective immediately post-embolization and after follow-up. Long-term follow-up will be required to identify the effect of the Solitaire AB stent on recanalization rates.

Keyword

Intracranial aneurysm; Outcome; Solitaire(TM) AB neurovascular remodeling device; Stent-assisted coil embolization

MeSH Terms

Aneurysm
Aneurysm, Dissecting
Angiography
Constriction, Pathologic
Embolization, Therapeutic*
Follow-Up Studies
Humans
Intracranial Aneurysm*
Mortality
Retrospective Studies
Stents
Subarachnoid Hemorrhage
Thrombosis

Figure

• 

  Fig. 1 Location of aneurysms. ACA = anterior cerebral artery, AcoA = anterior communicating artery, BA = basilar artery, ICA = internal carotid artery, OPH = ophthalmic artery, PCA = posterior cerebral artery, PcoA = posterior communicating artery, PICA = posterior inferior cerebellar artery.

• 

  Fig. 2 Results of postprocedural occlusions and annual occlusion rates after procedure.

• 

  Fig. 3 A 60-year-old man presenting with headache is found to have dual aneurysms located at the anterior communicating artery (AcoA) and the right callosomarginal artery (CMA). (A) An arteriogram of the left internal carotid artery shows a complete occlusion of the right CMA aneurysm after stent-assisted coil embolization. (B, C) Subsequently, coiling for the AcoA aneurysm is started without stenting. During coiling, the coil loops become a coil protrusion into the AcoA. After the placement of the Solitaire AB stent, the aneurysm is completely occluded. However, in-stent thrombosis does develop at the contralateral proximal A2 (black arrow) and finally, the ipsilateral A1 is totally occluded. (D) The stent is removed as soon as possible and the occluded arteries are completely recanalized.

• 

  Fig. 4 A 35-year-old man presents with semicomatous mentality and computed tomographic scans reveal a thick subarachnoid hemorrhage. (A) An arteriogram of the left internal carotid artery shows an aneurysm originating from the superior and anterior parts (white arrow) of the anterior communicating artery (AcoA). (B) Coiling is performed and the two parts of the AcoA aneurysm are occluded. However, the AcoA is compromised by protruded coil loops and the contralateral A2 flow slows down (black arrow). Also, encroachment of the coil mesh into the ipsilateral A2 is noted (black arrow heads). (C) Due to concerns of ipsilateral A2 compromise, a Solitaire AB stent is deployed at the site of the protruded coil mesh, achieving successful molding of the protruded coil mesh (white arrow heads). (D) Contralateral A2 flow is maintained through the right internal carotid artery.

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