title: Stent-assisted coil embolization of posterior communicating artery aneurysms.
abstract: OBJECTIVE
  Use of protective stents may not be effective in coil embolization of wide-neck aneurysms involving the posterior communicating artery. Successful implementation depends on the caliber of the vessel, its angle of origin, and the manner in which its orifice is incorporated into the aneurysm. Presented here are the results (clinical and radiographic) of coil embolization in aneurysms of the ICA-posterior communicating artery junction, variably aided by stents. The primary focus is angiographic configurations that impact stent placement.
  
  
  METHODS
  From a prospective data repository, we retrieved records of 32 consecutive patients with 33 posterior communicating artery aneurysms, all of which were treated by stent-assisted coil embolization between June 2008 and August 2012. Outcomes were analyzed in terms of aneurysm configuration and clinical status.
  
  
  RESULTS
  Stents were positioned entirely in the ICA (n = 26), from the ICA to the posterior communicating artery (n = 2), in the posterior communicating artery only (n = 3), and retrograde from the posterior communicating artery to the ICA terminus (n = 2). Procedure-related complications occurred in 3 patients (9.1%), but only 1 (3.0%) had mild neurologic sequelae (Glasgow Outcome Score 4). Using coil embolization, we achieved successful occlusion in 24 aneurysms (72.7%), and in 9 others, subtotal occlusion was conferred. During a mean follow-up of 15.7 ± 10.7 months, imaging of 27 aneurysms documented stable occlusion in 19 (70.4%), whereas angiography of 15 aneurysms (39.5%) disclosed 2 instances of in-stent stenosis (13.3%) and a solitary occurrence of stent migration (6.7%).
  
  
  CONCLUSIONS
  In posterior communicating artery aneurysms, stent protection during coil embolization is feasible by adjusting the procedural strategy to accommodate differing configurations of the aneurysm and its vascular source.
authors: Departments of Radiology.
authors: Y D
authors: YD
authors: Cho
authors: W J
authors: WJ
authors: Lee
authors: K M
authors: KM
authors: Kim
authors: H-S
authors: HS
authors: Kang
authors: J E
authors: JE
authors: Kim
authors: M H
authors: MH
authors: Han
mesh_terms: D001807:Blood Vessel Prosthesis; D002548:Cerebral Revascularization / Q000295:instrumentation*; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D019544:Equipment Failure Analysis; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
references: World Neurosurg. 2011 Jan;75(1):64-72; discussion 49
references: 21492665
references: Stroke. 2007 May;38(5):1538-44
references: 17395870
references: Neuroradiology. 2007 Jul;49(7):555-61
references: 17476494
references: AJNR Am J Neuroradiol. 2012 Feb;33(2):348-52
references: 22051805
references: Stroke. 2003 Jun;34(6):1398-403
references: 12775880
references: Surg Neurol Int. 2010 Dec 22;1:88
references: 21206898
references: Acta Neurochir (Wien). 2005 Mar;147(3):259-63; discussion 263
references: 15662565
references: Acta Neurochir (Wien). 2010 Sep;152(9):1489-92
references: 20593207
references: Neurosurgery. 2004 Jun;54(6):1359-67; discussion 1368
references: 15157292
references: Stroke. 2010 Jan;41(1):110-5
references: 19959540
references: Acta Neurochir (Wien). 2009 Dec;151(12):1663-72
references: 19618104
references: AJNR Am J Neuroradiol. 2005 Aug;26(7):1751-6
references: 16091525
references: Clin Radiol. 2013 Mar;68(3):256-63
references: 23017739
references: Korean J Radiol. 2012 Jul-Aug;13(4):510-4
references: 22778576
references: AJNR Am J Neuroradiol. 2008 Aug;29(7):1405-8
references: 18436611
references: Lancet. 2003 Jul 12;362(9378):103-10
references: 12867109
references: AJNR Am J Neuroradiol. 2010 Aug;31(7):1206-10
references: 20223886
references: Neurosurgery. 2007 Sep;61(3):460-8; discussion 468-9
references: 17881956
references: AJNR Am J Neuroradiol. 2012 Mar;33(3):500-6
references: 22194388