Evaluation of a neck-bridge device to assist endovascular treatment of wide-neck aneurysms of the anterior circulation

Abstract

Background and purpose: Intracranial aneurysms with a wide-neck or an unfavorable dome-to-neck ratio may be difficult to treat properly and safely. Our aim was to evaluate the TriSpan neck-bridge device to assist coiling of wide-neck bifurcation aneurysms in the anterior circulation.

Materials and methods: In 14 patients, we performed 16 TriSpan-assisted coil embolizations with wide-neck bifurcation aneurysms of the anterior circulation. Eleven procedures were indicated for acutely ruptured aneurysms. Five were performed electively for the following: recurrent aneurysm after coil only (n = 1) or after TriSpan-assisted embolization (n = 2), aneurysm remnant after clipping (n = 1), and aneurysm incidentally found (n = 1). Procedural and clinical complications were recorded. Follow-up angiography was performed, and clinical outcomes were assessed by using the modified Rankin Scale score.

Results: TriSpan-assisted embolization was successful in 15/16 (93.8%) procedures, with complete occlusion in 2/16 (12.5%), near-complete occlusion in 10/16 (62.5%), and incomplete occlusion in 3/16 (18.75%). There were 6 (37.5%) intraprocedural complications: thrombus formation (n = 3), protrusion of a TriSpan loop in the parent artery (n = 1), TriSpan displacement in the aneurysm (n = 1), and tangling of a coil loop in the device (n = 1). Three patients died in the hospital (21.4%). Follow-up angiography or MR angiography was available in 8 (57.1%) patients and showed complete (n = 2), near-complete (n = 2), and incomplete occlusion (n = 4). Long-term clinical outcome was no (n = 4) or minor symptoms (n = 1) and moderate (n = 2), moderately severe (n = 2), or severe handicap (n = 2).

Conclusion: The use of the TriSpan device is feasible in the anterior circulation and can assist treatment of difficult wide-neck bifurcation aneurysms.

Fig 1.

A, Patient 8: right carotid DSA shows a carotid bifurcation aneurysm, partially recanalized due to coil compaction after coil-only embolization 6 months before. B, Plain digital image shows the compacted coils and, partially, the 3 nitinol petals of the TriSpan-10 device (arrows). C, Right carotid DSA shows thrombus (arrows) at the bifurcation in front of the neck. D, Right carotid DSA 1 day after treatment with intra-arterial urokinase and intravenous glycoprotein IIb/ IIIa receptor inhibitor demonstrates resolution of the thrombus and a “dog ear” at the medial site of the neck (arrow).

Fig 2.

A, Patient 1: left carotid DSA shows a wide-neck MCA aneurysm with temporal and parietal branches (arrows) originating from the base. The TriSpan-12 is already in position. B, Plain digital image of a TriSpan configuration. The 3 nitinol “petals” are partially marked with platinum (arrowheads) and fixed by a coiled platinum “stem” wire (arrow). Markers of the coiling microcatheter (with the first coil inside) are indicated by asterisks. The proximal marker of the TriSpan-carrying microcatheter is indicated by a white arrow. C, Control left carotid DSA after embolization shows a “dog ear” (arrow) at the neck-parent vessel junction. D, Left carotid DSA at 8 months shows recurrence at the neck (asterisk) by coil compaction. E, Left carotid DSA after recoiling again shows a “dog ear” (arrow) at the neck-parent vessel junction.

Fig 3.

A, Patient 14: left carotid DSA shows the asymmetric placement of the 3 TriSpan nitinol loops (arrows) at the neck of the aneurysm. B, Left carotid DSA shows complete occlusion of the aneurysm.