Long-term results of wide-necked intracranial bifurcation aneurysms treated with stent-assisted coiling using low-profile acandis acclino stents

Abstract

Purpose: Little data exists on endovascular treatment of complex intracranial aneurysms with the Acandis Acclino low-profile self-expanding closed-cell stent systems and is mainly limited to short- or midterm results. We report our long-term, single-centre experience with three generations of Acclino stents treating complex intracranial aneurysms.

Methods: 62 wide-necked intracranial aneurysms were treated electively using 88 Acclino stent systems. Single stent-assisted coiling was the preferred treatment in 38 cases and the kissing-Y stenting technique in 24 cases. We analysed demographic data and long-term follow-up results.

Results: All stents were successfully deployed with immediate complete (Raymond Roy occlusion classification, RROC I) or near-complete occlusion (RROC II) achieved in 93,5%. Follow-up was available in 55 cases with a mean follow-up of 36 months (range 9-80 months). Long-term RROC I or II was achieved in 49 cases (89,1%). Three cases of stable residual aneurysmal filling were observed (5,5%). Seven aneurysms (12,7%) demonstrated a worsening on follow-up leading either to a neck remnant (4 cases, 7,3%) or to an aneurysm recurrence (3 cases, 5,5%). One recurrent aneurysm was retreated with coilembolization (1,8%). The directly procedural-related complication rate was 4,8%. Seven cases of clinically silent in-stent stenosis (12,7%; morbidity n = 0) were detected on long-term follow-up, six of them using the kissing-Y stenting technique.

Conclusion: Endovascular treatment of various intracranial aneurysms using the Acandis Acclino stent systems is safe and efficient with high aneurysm occlusion rates combined with low complication rates on long-term follow-up. Overall, rates of in-stent stenosis are low but may depend on the treatment technique (single stent-assisted coiling versus kissing-Y stenting with coiling).

Keywords: Aneurysm; coil; stenosis; stent.

Figure 1.

3D TOF MRA (A, D) and DSA in frontal projection, right internal carotid artery (ICA) injection (B, C), showing a wide-necked right MCA bifurcation aneurysm before treatment (A, B) and at 16-month follow up after stent-assisted coil embolization with complete aneurysmal occlusion (C, D). Contrast-enhanced MRA at 16 months (E) and 80 months (F) demonstrate a stable complete occlusion of the aneurysm, and a patent preserved M2-branch (inferior trunk) without in-stent stenosis. Note the in-stent signal reduction of the stented inferior trunk on 3D TOF MRA at 16 months follow-up erroneously simulating in-stent stenosis (arrow in D).

Figure 2.

3D TOF MRA (A) and DSA in frontal projection, right internal carotid artery (ICA) injection (B-E), showing a wide-necked right MCA bifurcation aneurysm before treatment (A, B), immediately after stent-assisted coil embolization with kissing-Y stenting (C), DSA at 33-month follow up (D) and 57-month follow-up (E). Long-term follow-up demonstrates a stable complete occlusion of the aneurysm and in-stent stenosis of an M2-branch (superior trunk, white arrows), compared to the initial diameter after stenting (black arrow in C).