J Korean Neurosurg Soc.  2017 Feb;60(2):146-154. 10.3340/jkns.2016.0607.002.

Semi-Jailing Technique Using a Neuroform3 Stent for Coiling of Wide-Necked Intracranial Aneurysms

• Ko JK
• Cho WH
• Cha SH
• Choi CH
• Lee SW
• Lee TH

• KMID: 2374875
• DOI: http://doi.org/10.3340/jkns.2016.0607.002

Abstract

OBJECTIVE
The semi-jailing technique (SJT) provides stent-assisted remodeling of the aneurysm neck during coil embolization without grasping the coil delivery microcatheter. We retrospectively evaluated the efficacy and safety of SJT using a Neuroform3 stent for coiling of wide-necked intracranial aneurysms.
METHODS
We collected the clinical and radiological data between January 2009 and June 2015 of the wide-necked aneurysms treated with SJT using a Neuroform3 stent.
RESULTS
SJT using a Neuroform3 stent was attempted in 70 wide-necked aneurysms (68 patients). There were 56 unruptured and 14 ruptured aneurysms. The size of aneurysm ranged from 1.7 to 28.1 mm (mean 6.1 mm). The immediate angiographic results were complete occlusion in 55 aneurysms (78.6%), neck remnant in 7 (10.0%), and aneurysm remnant in 8 (11.4%). Overall, periprocedural complications occurred in 13 patients (19.1%), including asymptomatic thromboembolism in 7 (10.3%), symptomatic thromboembolism in 4 (5.9%), and symptomatic hemorrhagic complications in 2 (2.9%). Conventional angiography follow-up was obtained in 55 (78.6%) of 70 aneurysms (mean, 10.9 months). The result showed progressive occlusion in 7 aneurysms (12.7%) and recanalization in 1 aneurysm (1.8%). At the end of the observation period (mean, 17.5 months), all 54 patients without subarachnoid hemorrhage showed excellent clinical outcomes (modified Rankin Scale [mRS] 0), except two (mRS 1 or 2) and seven of 14 patients with subarachnoid hemorrhage remained symptom-free (mRS 0).
CONCLUSION
In this report of 70 aneurysms, SJT using a Neuroform3 stent for coiling of wide-necked intracranial aneurysms showed good technical safety, as well as favorable clinical and angiographic outcomes.

Keyword

Aneurysm; Coil; Stent

MeSH Terms

Aneurysm
Aneurysm, Ruptured
Angiography
Embolization, Therapeutic
Follow-Up Studies
Hand Strength
Humans
Intracranial Aneurysm*
Neck
Retrospective Studies
Stents*
Subarachnoid Hemorrhage
Thromboembolism

Figure

• 

  Fig. 1 Schematic illustration of semi-jailing technique using a Neuroform3 stent. A: After selection of the aneurysm with microcatheter with partially deployed coil, the Neuroform3 stent is then delivered over the aneurysm portion. B: After the stent is partially deployed to cover the part of aneurysm neck, homogeneous coil framing is achieved without coil protrusion by the limitation of the partially-deployed stent. Because the coil delivery catheter is not jailed to the vessel wall, it moves freely within the sac and provides better control over the coil mass. C: The stent is fully deployed after achieving the dense coil packing, or coiling can be continued using the jailed microcatheter.

• 

  Fig. 2 A: A 63-year-old female with an unruptured aneurysm of the left carotid-ophthalmic segment. B: After the first coil is delivered into the aneurysm, a stent is partially deployed across the aneurysm neck. C: Immediate post-operative angiogram shows a definite filling defect along the stent wall representing acute in-stent thrombosis. D: After intra-arterial administration of 10 mg abciximab, acute thrombosis completely disappeared on the angiogram performed 15 minutes later.

• 

  Fig. 3 A 54-year-old female with a wide-necked aneurysm arising from carotid-ophthalmic segment. A and B: Unsubtracted and subtracted images acquired immediately after SJT-assisted coiling show residual aneurysm filling (arrow). C and D: The 12-month follow-up angiograms reveal a completely occluded aneurysm, which may be attributed to coil remodeling and progressive thrombosis, and patent parent artery. SJT: semi-jailing technique.

Reference

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