title: Modified protection using far proximal portion of self-expandable closed-cell stents for embolization of wide-necked intracranial aneurysms.
abstract: BACKGROUND
  Stent-assisted embolization is sometimes limited in wide-necked aneurysms involving the acute-angled origins of tortuous branching arteries, and occasionally, Y-shaped stenting is required to remedy the sweeping effects of a broad aneurysmal neck on arterial branches. Described herein is a modified stent-assisted coil embolization technique entailing strategic placement of far proximal stent ("distal stenting") as an alternate approach in such scenarios.
  
  
  METHODS
  For this particular technique, stent placement is confined to a branch artery, allowing far proximal stent to cover aneurysmal neck, with no bridge to parent artery. Kinking of stents deployed in tortuous arteries is thereby avoided, and better coverage of aneurysmal neck is achieved, compared with traditional stent protection. Records of 12 consecutive patients with wide-necked aneurysms, all treated by coil embolization with distal stenting between January 2009 and February 2014, were retrieved from a prospective data repository at our institution. Outcomes were analyzed in terms of morphologic features and clinical status.
  
  
  RESULTS
  This modified technique was largely applied to aneurysms of middle cerebral artery, followed by posterior communicating artery and anterior communicating artery sites. With one exception, all aneurysms treated were successfully occluded. There were no complications directly related to distal stenting. At final follow-up (mean interval, 16.8 ± 9.7 months), complete aneurysmal occlusion was sustained in 81.8%. Delayed stent migration was observed in one patient (8.3%).
  
  
  CONCLUSIONS
  Our study suggests that distal stenting in wide-necked aneurysms is a reasonable alternative to traditional stent protection, despite the potential for delayed stent migration.
authors.affiliation: Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Young Dae
authors.initials: YD
authors.lastname: Cho
authors.forename: Hyun-Seung
authors.initials: HS
authors.lastname: Kang
authors.forename: Jeong Eun
authors.initials: JE
authors.lastname: Kim
authors.forename: Won-Sang
authors.initials: WS
authors.lastname: Cho
authors.forename: Hyon-Jo
authors.initials: HJ
authors.lastname: Kwon
authors.forename: Hyeon-Song
authors.initials: HS
authors.lastname: Koh
authors.forename: Moon Hee
authors.initials: MH
authors.lastname: Han
mesh_terms: D000368:Aged; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D015607:Stents; D016896:Treatment Outcome