Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-28T17:10:22.011Z Has data issue: false hasContentIssue false
  • English
  • Français

Navigation of Stents across Communicating Arteries for Aneurysm Embolization

Published online by Cambridge University Press:  23 September 2014

Muhammad Ejaz Ahmed ,
Cheemun Lum ,
Howard Lesiuk ,
Daniela Iancu  and
Marlise dos Santos
Muhammad Ejaz Ahmed
Affiliation:
Neuroradiology Section - Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
Cheemun Lum*
Affiliation:
Neuroradiology Section - Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
Howard Lesiuk
Affiliation:
Division of Neurosurgery - Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
Daniela Iancu
Affiliation:
Neuroradiology Section - Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
Marlise dos Santos
Affiliation:
Neuroradiology Section - Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
*
Neuroradiology Section - Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue Ottawa, Ontario, K1Y 4E9, Canada. Email: [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Introduction:

Endovascular coiling of aneurysms crossing the Circle of Willis has been described in small case series. The technical challenges in manipulating a stent across the Circle of Willis lie in negotiating difficult angles and small arteries. We present our experience with treating aneurysms by stent assistance in which the Circle of Willis was crossed to facilitate optimal stent deployment.

Materials and methods:

We retrospectively reviewed the cases in our institution from January 2009 to June 2012 in which the Circle of Willis was traversed to facilitate optimal stent deployment. We measured the diameter of the communicating arteries traversed, caliber of the target arteries in which the stent was deployed and the most acute angle negotiated (“critical angle”). We compare our results with other published series in the literature.

Results:

Eight patients fulfilled the criteria: 5 males (45-66 years). There were three anterior and five posterior circulation aneurysms. Four of the aneurysms were ruptured. The PCOM was traversed in five cases, the ACOM in three cases. The mean diameter of the communicating artery was 1.17mm. The mean diameter of target arteries was 1.27mm. The “critical angle” was 72-147 degrees. In all patients, there was satisfactory obliteration of the aneurysm. There were two cases of minor SAH post procedure.

Conclusion:

Utilizing the Circle of Willis for optimal stent placement in aneurysm remodeling is technically feasible but challenging. This technique can be performed successfully in patients with acute SAH. The procedural risk must be balanced against potential complications such as SAH.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 41 , Issue 2 , March 2014 , pp. 193 - 199
Copyright
Copyright © The Canadian Journal of Neurological 2014

References

1.Siddiqui, MA, J Bhattacharya, J, Lindsay, KW, Jenkins, S.Horizontal stent-assisted coil embolisation of wide-necked intracranial aneurysms with the Enterprise stent–a case series with early angiographic follow-up. Neuroradiology. 2009;51:411–18.CrossRefGoogle ScholarPubMed
2.Yang, TH, Wong, HF, Yang, MS, Ou, CH, Ho, TL. “Waffle coneDC; technique for intra/extra-aneurysmal stent placement for the treatment of complex and wide-necked bifurcation aneurysm. Interv Neuroradiol. 2008;14 Suppl 2:49–52.Google Scholar
3.Lazzaro, MA, Zaidat, OO.X-configuration intersecting Enterprise stents for vascular remodeling and assisted coil embolization of a wide neck anterior communicating artery aneurysm. J Neurointervent Surg. 2011;3:348–51.Google Scholar
4.Akgul, E, Aksungur, E, Balli, T, et al. Y-stent-assisted coil embolization of wide-neck intracranial aneurysms. A single center experience. Interv Neuroradiol. 2011;17:36–48.Google Scholar
5.Huang, Q, Xu, Y, Hong, B, Zhao, R, Zhao, W, Liu, J.Stent-assisted embolization of wide-neck anterior communicating artery aneurysms: review of 21 consecutive cases. AJNR Am J Neuroradiol. 2009;30:1502–6.Google Scholar
6.Albuquerque, FC, Gonzalez, LF, Hu, YC, Newman, CB, McDougall, CG.Transcirculation endovascular treatment of complex cerebral aneurysms: technical considerations and preliminary results. Neurosurgery. 2011;68:820–9; discussion 829–30.Google Scholar
7.Cross, DT, 3rd, Moran, CJ, Derdeyn, CP, Mazumdar, A, Rivet, D, Chicoine, MM.Neuroform stent deployment for treatment of a basilar tip aneurysm via a posterior communicating artery route. AJNR Am J Neuroradiol. 2005;26:2578–81.Google Scholar
8.Fitzpatrick, D, Chen, M, Meyers, PM.Horizontal Neuroform stent deployment for a ruptured basilar terminus aneurysm via the posterior communicating artery. J Vasc Interv Radiol. 2006;17: 1687–91.Google Scholar
9.Benndorf, G, Klucznik, RP, Meyer, D, Strother, CM, Mawad, ME.“Cross-over” technique for horizontal stenting of an internal carotid bifurcation aneurysm using a new self-expandable stent: technical case report. Neurosurgery. 2006;58:ONS-E172; discussion ONS-E172.Google Scholar
10.Kelly, ME, Turner, R, Gonugunta, V, et al. Stent reconstruction of wide-necked aneurysms across the circle of Willis. Neurosurgery. 2007;61:249–54; discussion 254–5.Google Scholar
11.Wanke, I, Gizewski, E, Forsting, M.Horizontal stent placement plus coiling in a broad-based basilar-tip aneurysm: an alternative to the Y-stent technique. Neuroradiology. 2006;48:817–20.Google Scholar
12.Moret, J, Ross, IB, Weill, A, Piotin, M.The retrograde approach: a consideration for the endovascular treatment of aneurysms. AJNR Am J Neuroradiol. 2000;21:262–8.Google Scholar
13.Blackburn, SL, Kadkhodayan, Y, Shekhtman, E, Derdeyn, CP, Cross, DT, 3rd, Moran, CJ.Treatment of basilar tip aneurysms with horizontal PCA to PCA stent-assisted coiling: case series. J Neurointervent Surg. 2013;5:212–16.Google Scholar
14.Puri, AS, Erdem, E.Unusual intracranial stent navigation through the circle of Willis in a patient with recurrent basilar tip aneurysm during stent-assisted coiling. Interv Neuroradiol. 2009;15:81–6.Google Scholar
15.Pride, GL Jr., Welch, B, Novakovic, R, et al. Retrograde crossing stent placement strategies at the basilar apex for the treatment of wide necked aneurysms: reconstructive and deconstructive opportunities. J Neurointervent Surg. 2009;1:132–5.Google Scholar
16.Raymond, J, Guilbert, F, Weill, A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke. 2003;34:1398–403.Google Scholar
17.O’Kelly, CJ, Spears, J, Chow, M, et al. Canadian experience with the pipeline embolization device for repair of unruptured intracranial aneurysms. AJNR Am J Neuroradiol. 2013;34: 381–7.Google Scholar
18.Park, HR, Yoon, SM, Shim, JJ, Kim, SH.Waffle-cone technique using Solitaire AB stent. J Korean Neurosurg Soc. 2012;51:222–6.Google Scholar
19.Baxter, BW, Rosso, D, Lownie, SP.Double microcatheter technique for detachable coil treatment of large, wide-necked intracranial aneurysms. AJNR Am J Neuroradiol. 1998;19:1176–8.Google Scholar
20.Yashar, P, Kan, PT, Levy, EI.Horizontal deployment of an intracranial stent via an antegrade approach for coil embolization of a basilar apex aneurysm: technical note. J Neurointervent Surg. 2011;3: 355–7.Google Scholar