Stent-Assisted Coiling of Wide-Neck Intracranial Aneurysms Using Low-Profile LEO Baby Stents: Initial and Midterm Results

Abstract

Background and purpose: Low-profile self-expandable stents were recently introduced for the treatment of wide-neck intracranial aneurysms. This study investigated the initial and midterm clinical and angiographic results of LEO Baby stent-assisted coiling in the treatment of wide-neck intracranial aneurysms.

Materials and methods: A retrospective review was performed to identify patients who were treated with LEO Baby stent-assisted coiling. Eighty patients with 80 wide-neck intracranial aneurysms were included in the study. Eleven patients (13.8%) presented with subarachnoid hemorrhage. All patients were treated with LEO Baby stent-assisted coiling. Technical success and immediate postprocedural clinical and angiographic outcomes were evaluated. Seventy-three patients attended angiographic and clinical follow-up for a mean duration of 7.2 ± 3.8 months. Periprocedural and delayed complications were reviewed. Preprocedural and follow-up clinical statuses were assessed by using the modified Rankin Scale.

Results: The technical success rate of the procedure was 97.5%. The immediate postprocedural angiography revealed a complete occlusion of the aneurysm in 75% of the 80 patients. The last follow-up angiograms showed complete occlusion in 85.7% of the 77 patients with an angiographic follow-up. Of the 77 patients with a follow-up angiography, 6.5% showed an increase in the filling status of the aneurysm and 5.2% required retreatment. The overall procedure-related complication rate, including asymptomatic complications, was 11.3%. The permanent morbidity rate was 3.8%. There was no mortality in this study.

Conclusions: This case series demonstrates the relative safety, efficacy, and midterm durability of the LEO Baby stent-assisted coiling procedure for the treatment of wide-neck intracranial aneurysms.

Fig 1.

An illustration showing the LEO Baby stent-assisted coiling treatment of a PICA aneurysm. A microcatheter is jailed into the sac of aneurysm, while the LEO Baby stent is deployed to the parent artery through a second microcatheter.

Fig 2.

Preprocedural cranial CT and procedural and follow-up angiography images of a 44-year-old female patient with a ruptured PICA aneurysm. A, Cranial CT image obtained 9 days before the endovascular procedure (5 days following the rupture of aneurysm) shows the subarachnoid hemorrhage in the prepontine cistern. B, DSA image in a right anterior oblique projection reveals a 5-mm wide-neck aneurysm located on the medullary segment of the left PICA. C, DSA images obtained during the procedure show the catheterization of the parent artery for stent placement (black arrows) from the contralateral (right) vertebral artery and jailing of the coiling microcatheter (white arrows) through the ipsilateral (left) vertebral artery (the small filling defect in the aneurysm sac is a small air bubble introduced by the delivery of coil and trapped between the coil loops). D, DSA image obtained during the procedure shows the successful deployment of a LEO Baby stent (arrows) into the parent artery (PICA–vertebral artery). E, Immediate postprocedural DSA demonstrates the near-total occlusion of the aneurysm, with minimal filling in the neck. F, Six-month follow-up DSA shows complete occlusion of the aneurysm and a moderate degree of in-stent stenosis.

Fig 3.

Pre- and postprocedural DSA and follow-up MR imaging and conventional angiography images of a 43-year-old female patient with a left MCA aneurysm. A, Preprocedural DSA image obtained at a left anterior oblique projection shows an 8-mm bilobed aneurysm located in the left MCA bifurcation. B, Intraprocedural roadmap DSA image shows the catheterization of the inferior trunk of the MCA (black arrows) and jailing of another microcatheter in the aneurysm sac (white arrows). C and D, Intraprocedural DSA images reveal complete occlusion of the superior lobule of the aneurysm after stent placement of the inferior MCA trunk (black arrows show the extension of the stent) and selective catheterization of the inferior lobule of the aneurysm for coiling. E, Immediate postprocedural DSA image demonstrates complete occlusion of the aneurysm. F, Three-month follow-up MR angiography image in a submentovertical projection demonstrates complete occlusion of the aneurysm and patency of the parent artery (arrows). G, Six-month follow-up conventional angiographic image shows complete stable occlusion of the aneurysm.

Fig 4.

Procedural and follow-up angiographic images of a 42-year-old male patient with an AcomA aneurysm. A, Preprocedural DSA image obtained with bilateral internal carotid artery injections shows the wide-neck 8-mm AcomA aneurysm. B, DSA image obtained during the procedure demonstrates deployment of a LEO Baby stent extending from the left A2 to the right A1 (black arrows) and a jailed microcatheter in the aneurysm sac (white arrows). C, Postprocedural immediate DSA image shows complete occlusion of the aneurysm. D and E, Six-month follow-up DSA images demonstrate complete occlusion of the aneurysm and a mild degree of in-stent stenosis.

Fig 5.

Procedural and follow-up angiographic images of a 53-year-old male patient with an AcomA aneurysm. A and B, Preprocedural DSA images show the recanalized AcomA aneurysm that was previously coiled. C, Postprocedural immediate DSA image reveals a partial filling of the aneurysm sac (Raymond class 3). D and E, Nine-month follow-up DSA images demonstrate complete occlusion (Raymond class 1) of the aneurysm as a result of progressive thrombosis during the follow-up period (arrows show the extension of the stent).