title: Multiple overlapping stent-assisted coiling of complex aneurysms: a single-center experience.
abstract: OBJECTIVE
  Coil embolization of wide-necked and fusiform aneurysms is challenging and is frequently associated with recanalization despite assistance of any additional device. The purpose of this study was to evaluate the feasibility and mid-term outcomes of complex aneurysms after multiple overlapping stent-assisted coiling (OSAC).
  
  
  METHODS
  We retrospectively evaluated 26 wide-necked and fusiform atherosclerotic or dissecting aneurysms that were treated with multiple OSAC. Eight aneurysms (30·8%) presented with subarachnoid hemorrhage and one (3·9%) with intracranial hemorrhage.
  
  
  RESULTS
  Complete embolization was achieved in 15 of the 26 aneurysms (57·7%), while remnant neck was identified in nine (34·6%) and remnant aneurysm was noted in two (7·7%). Immediate procedure-related complications were observed in five patients (19·2%) including two with asymptomatic in-stent thrombosis, one with transient right-sided weakness, one with decreased mentality, and one with aphasia and quadriplegia. A procedure-related permanent neurologic deficit (modified Rankin scale scores of 1 and 5) was noted in two patients (7·7%). Angiographic follow-up (mean duration 23·9 months) after OSAC was carried out in 18 patients (69·2%): 11 (61·1%) were stable, 3 (16·7%) improved, 3 (16·7%) had minor compaction, and 1 had major recanalization (5·5%). One recurred aneurysm after OSAC and two recanalized aneurysms after single stenting were re-treated using additional stent-assisted coiling, and there was no recanalization in these three aneurysms during the 25·7 months after re-treatment.
  
  
  CONCLUSIONS
  Multiple OSAC is feasible and effective for complex aneurysms and recurrent aneurysms after stent-assisted coiling.
authors.forename: Yu Sam
authors.initials: YS
authors.lastname: Won
authors.forename: Yu Sam
authors.initials: YS
authors.lastname: Yon
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Rho
authors.forename: Eun Chul
authors.initials: EC
authors.lastname: Chung
authors.forename: Hyun Pyo
authors.initials: HP
authors.lastname: Hong
authors.forename: Sae Yung
authors.initials: SY
authors.lastname: Kim
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Park
authors.forename: Yoon Jung
authors.initials: YJ
authors.lastname: Choi
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Lee
authors.forename: Chun Sik
authors.initials: CS
authors.lastname: Choi
authors.forename: Yon Kwon
authors.initials: YK
authors.lastname: Ihn
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000473:pathology / Q000628:therapy*; D000792:Angiography; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000628:therapy; D002537:Intracranial Arteriosclerosis / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013345:Subarachnoid Hemorrhage / Q000473:pathology / Q000628:therapy
keywords: Aneurysm,; Coils,; Intracranial stent