title: Stent-assisted coiling of wide-neck bifurcation aneurysms with a branch incorporated in the aneurysm base: long-term follow-up in 49 patients with 53 aneurysms.
abstract: OBJECTIVE
  Wide-neck bifurcation intracranial aneurysms (WNBA) with a branch incorporated in the aneurysm base remain difficult to treat by embolization. We aim to report our long-term follow-up of stent-assisted coiling (SAC) in this subgroup of patients.
  
  
  METHODS
  This study was approved by our local ethical committee. A retrospective review of our prospectively maintained database identified all patients treated in our institution by SAC for a WNBA with a branch incorporated in the aneurysm base. Technical issues, immediate, long-term outcomes were evaluated.
  
  
  RESULTS
  Between 2007 and 2015, 49 patients with 53 intracranial aneurysms (IAs) (52 unruptured, 1 ruptured) were identified and successfully treated. No morbidity/mortality occurred. The incorporated branch was preserved in all patients but one who was treated during a vasospasm phase. At the first 6-month imaging control, the branch was patent. Immediate occlusion was near-complete in 11/53 aneurysms (20.8%), neck remnant in 20/53 aneurysms (37.7%), and incomplete in 22/53 aneurysms (41.5%). Available imaging follow-up of 47 IAs, ranging from 3 to 84 months (mean 26 months ± 19.6 months), showed 27 progressive thrombosis (57.4%), 17 stable occlusions (36.2%), 1 minor recanalization (2.1%), and 2 significant recanalizations that were retreated (4.3%). The latest imaging control showed 30 near-complete occlusions (63.8%), 13 neck remnants (27.7%), and 4 incomplete occlusions (8.5%).
  
  
  CONCLUSIONS
  Stent-assisted coiling is safe and effective for the treatment of WNBA with a branch incorporated in the aneurysm base. Despite poor immediate anatomical results, long-term follow-up shows a high rate of progressive thrombosis achieving adequate and stable occlusion in most patients.
authors.affiliation: Department of Interventional Neuroradiology, Hôpital Erasme, 808 route de Lennik, 1070, Bruxelles, Belgium. blubicz@ulb.ac.be.
authors.forename: Boris
authors.initials: B
authors.lastname: Lubicz
authors.affiliation: Department of Interventional Neuroradiology, Hôpital Erasme, 808 route de Lennik, 1070, Bruxelles, Belgium.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Morais
authors.affiliation: Department of Interventional Neuroradiology, Hôpital Erasme, 808 route de Lennik, 1070, Bruxelles, Belgium.
authors.forename: Pierre-Julien
authors.initials: PJ
authors.lastname: Bruyère
authors.affiliation: Department of Neurology, Erasme University Hospital, Brussels, Belgium.
authors.forename: Noémie
authors.initials: N
authors.lastname: Ligot
authors.affiliation: Department of Interventional Neuroradiology, Hôpital Erasme, 808 route de Lennik, 1070, Bruxelles, Belgium.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Mine
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Coiling; Intracranial aneurysms; Stent