Experiences of neuroform stent applications for ruptured anterior communicating artery aneurysms with small parent vessel

Abstract

Objective: The purpose of this study was to review the safety and durability of aneurysms treated with stent-assisted coiling of ruptured anterior communicating artery aneurysms with small parent vessels (< 2.0 mm).

Methods: Retrospective review of all ruptured aneurysm treated with stent assisted endovascular coiling between March 2005 and March 2009 at our institution was conducted. We report 11 cases of the Neuroform stent placement into cerebral vessels measuring less than 2.0 mm in diameter (range, 1.3-1.9 mm) in anterior cerebral artery. Clinical follow-up ranged from 3 to 12 months and imaging follow-up was performed with cerebral angiography at 6 months and 12 months after discharge.

Results: Complete occlusion was achieved in 10 patients, and a remnant neck was evident in one. No stent displacement or no dislodgement occurred during stent placement. There was no evidence of thromboembolic complication, arterial dissection and spasm during procedure. We performed follow-up angiography in all patients at 6 months and/or 12 months from the first procedure. The follow-up angiographic data showed successfully results except one in-stent stenosis case. All patients improved clinical performances except one patient with severe vasospasm who showed poor clinical condition initially.

Conclusion: We have safely and successfully treated 11 vessels smaller than 2.0 mm in diameter with self-expanding stents with good short and intermediate term results. More clinical data with longer follow-ups are needed to establish the role of stent-assisted coiling in ruptured aneurysms with small parent vessels.

Keywords: Neuroform stent; Small parent vessel.

Fig. 1

3D reconstruction image in left internal carotid artery (ICA) angiography presented with a 3.2×4.0 mm sized anterior communicating aneurysm (ACoA) with a wide neck. A : 3D angiogram shows anterior communicating artery aneurysm on left ICA before the procedure. B : Immediately post-treatment, left ICA angiography demonstrating no contrast dye filling in the aneurysm. C : Follow-up 6 months angiographic image, there are no definite internal change with coil and stent.

Fig. 2

Left ICA angiography and 3D reconstruction image presented with a 6.2×5.2 mm sized ACoA with a wide neck. A : The left ICA angiogram shows a wide-neck aneurysm at ACoA segment before treatment. B : Immediately after the treatment, left ICA angiography no contrast dye filling in the aneurysm. C : At follow-up angiography after 12 months, coil and stent application was good position without stenosis.

Fig. 3

Left ICA angiography and 3D reconstruction image presented with pre and post-embolization view, then follow-up image showed in-stent stenosis. A : The left ICA angiogram 3D reconstruction image showing a 4.6×3.2 mm sized broad neck ACoA with 1.9 mm parent vessel before embolization. B : Immediately post-treatment, oblique view left ICA angiogram demonstrating an optimal stent position and no filling in aneurysm. C : Follow-up cerebral angiography after 6 months, angiogram revealed in-stent stenosis at left anterior cerebral artery (A1) segment.