Balloon-expandable stenting with and without coiling for wide-neck and complex aneurysms.
BACKGROUND
Wide-necked, saccular, dissecting, and fusiform intracranial aneurysms are poor coil retainers. Retention can be improved by parent-artery stenting across the aneurysm.


METHODS
We used a balloon-expandable stent and delivery system, intending to treat 38 aneurysms in 36 patients. Stents could not be advanced across the neck of 2 aneurysms near the ophthalmic artery origin. These cases were managed by temporary balloon remodeling and coiling. Stenting alone was done for 15 aneurysms, including 7 in vertebral artery V4 segments. Stenting with immediate or delayed coiling was done in 21 aneurysms.


RESULTS
Stenting alone caused immediate and complete obliteration of 1 treated aneurysm (7%), subtotal obliteration in 13 treated (86%) aneurysms, and was associated with 1 failure. Stenting and coiling yielded a significantly better 57% complete obliteration rate, 43% subtotal obliteration, and no failures. There were 5 complications: 1 wire perforation, 2 cavernous-carotid-sinus fistulae, and 2 partial in-stent thromboses. All were controlled or cleared with no long-term sequelae or deaths. Contrast imaging at 1 to 12 months was available for 30 patients (13 stent-only, 17 stent-plus-coiling), demonstrating complete obliteration in 25 (83%) and subtotal obliteration in 5. A total of 7 stent-only aneurysms (4 V4s) were completely obliterated, and 3 (all V4s) were > or = 90% obliterated.


CONCLUSIONS
Stenting and coiling through the wall of the stent resulted in 88% (15/17) complete obliteration when imaged 1 to 12 months after treatment. Stenting alone effectively closed off V4-segment wide-necked aneurysms but was inferior to stenting and coiling in less mobile vessels.
Zenteno
Marco
M
Department of Neurological Endovascular Therapy, Instituto Nacional de Neurologia y Neurocirugía, Mexico City, 14269 Mexico.
Modenesi Freitas
José Maria
JM
Aburto-Murrieta
Yolanda
Y
Koppe
Gelson
G
Machado
Elcio
E
Lee
Angel
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000295:instrumentation* / Q000379:methods*; D001488:Basilar Artery / Q000000981:diagnostic imaging* / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019635:Neurosurgical Procedures / Q000295:instrumentation; D011859:Radiography; D015607:Stents; D014711:Vertebral Artery / Q000000981:diagnostic imaging* / Q000601:surgery*