title: Endovascular treatment of ruptured tiny, wide-necked posterior communicating artery aneurysms using a modified stent-assisted coiling technique.
abstract: The endovascular treatment of patients with tiny, wide-necked aneurysms is technically challenging, due to the small volume for microcatheterization and coil stabilization inside the aneurysm sac. We performed a retrospective study to evaluate the feasibility, effectiveness, and safety of stent-assisted embolization for patients with ruptured, tiny, wide-necked posterior communicating artery (PcomA) aneurysms. Between January 2007 and August 2011, 17 tiny, wide-necked PcomA aneurysms that had ruptured were treated at our institution using a modified stent-assisted technique, with delivery of the first coil inside the aneurysm followed by placement of a self-expanding stent via a second microcatheter. All patients were treated successfully using this modified stent-assisted coiling technique. Initial results showed aneurysm occlusion of Raymond Class 1 in 10 patients, Class 2 in four patients, and Class 3 in three patients. The angiographic follow-up results for 13 patients (mean, 12.5 months) showed that all aneurysms remained stable or improved, without any in-stent stenosis or recurrence. Of the other four patients, three refused angiography for economic or personal reasons, and one was lost in follow-up. Clinical follow-up of 16 patients for a mean of 23.8 months showed no death or rebleeding. These results imply that endovascular treatment of ruptured tiny, wide-necked PcomA aneurysms using our modified stent-assisted coiling technique is safe and feasible. This technique improves the long-term outcomes of these aneurysms by increasing the packing density and diverting the intra-aneurysmal blood flow.
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Zhao
authors.forename: Jie
authors.initials: J
authors.lastname: Shen
authors.forename: Qing-Hai
authors.initials: QH
authors.lastname: Huang
authors.forename: Jing-Hao
authors.initials: JH
authors.lastname: Nie
authors.forename: Yi
authors.initials: Y
authors.lastname: Xu
authors.forename: Bo
authors.initials: B
authors.lastname: Hong
authors.forename: Peng-Fei
authors.initials: PF
authors.lastname: Yang
authors.forename: Wen-Yuan
authors.initials: WY
authors.lastname: Zhao
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications / Q000628:therapy*; D057510:Endovascular Procedures / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000150:complications / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D015607:Stents
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Cerebral aneurysm; Embolization; Posterior communicating artery; Stent