, Volume 60, Issue 11, pp 1223–1230 | Cite as

Low rates of recanalization for wide-necked aneurysms treated with stenting after balloon-assisted coiling: combination of techniques delivers stable and improved results during follow-up

  • Aglaé Velasco González
  • P. Stracke
  • H. Nordmeyer
  • M. Heddier
  • S. Saleme
  • C. Sauerland
  • S. Berkemeyer
  • B. Buerke
  • W. Heindel
  • R. Chapot
Interventional Neuroradiology



In the treatment of wide-necked aneurysms, stenting may be required after balloon-assisted coiling (BAC) for reconstructing the lumen/flow of the parent artery in cases of coil herniation. The potential benefits and complications of both techniques remain unclear when used together. Our aim was to assess the safety and long-term angiographic outcomes of stenting after BAC.


Retrospective review of 87 unruptured wide necked aneurysms (in 80 patients) treated with BAC and requiring stent placement at the final stage of the procedure due to coil prolapse. Aneurysm characteristics, technical issues, clinical records, and MR results were assessed. Post-treatment and follow-up angiograms were evaluated by two independent reviewers and categorized as “stable,” “further thrombosis,” or “recanalization.”


The mean maximum diameter was 9.1 ± 4.7 mm and aspect ratio 1.20 ± 0.47. Complete and near-complete initial occlusion were observed in 53 (60.9%) and 28 (32.2%) of all treated aneurysms, respectively. Angiographic follow-up (80 aneurysms; mean, 34.68 ± 25.26 months) revealed stability and further thrombosis in 92.4% (74/80). Recanalization was observed in six cases (7.5%, 6/83), four of which were retreated. No significantly different outcomes were found in terms of aneurysm size (p = 0.641). Transient and reversible procedure-related complications occurred in eight (9.2%), minor permanent deficits in 2.3%, and major deficits, including death, in four cases (4.6%).


Our results suggest that treatment of wide-necked aneuryms with stent placement after BAC yields low recanalization rates and enhanced angiographic outcomes in long-term follow-up.


Wide-necked aneurysms Intracranial stenting Balloon-assisted coiling Recanalization 



We thank the University of Muenster (WWU) for giving us time to proceed with this project.

Compliance with ethical standards


No funding was received for this study.

Conflict of interest

CPS consults for EV3 and Acandis (Pforzheim, Germany). RC consults for Balt (Montmorency, France), EV3 (Irvine, California) and Microvention (Saint-Germain-en-Laye, France.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

For this type of retrospective study formal consent is not required.


  1. 1.
    Piotin M, Blanc R, Spelle L, Mounayer C, Piantino R, Schmidt PJ, Moret J (2009) Stent-assisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms. Stroke 41:110–115CrossRefGoogle Scholar
  2. 2.
    Peterson E, Hanak B, Morton R, Osbun JW, Levitt MR, Kim LJ (2014) Are aneurysms treated with balloon-assisted coiling and stent-assisted coiling different? Morphological analysis of 113 unruptured wide-necked aneurysms treated with adjunctive devices. Neurosurgery 75:145–151CrossRefGoogle Scholar
  3. 3.
    Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, Lamoureux J, Chagnon M, Roy D (2003) Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 34:1398–1403CrossRefGoogle Scholar
  4. 4.
    Ferns SP, Sprengers ME, van Rooij WJ et al (2009) Coiling of intracranial aneurysms: a systematic review on initial occlusion and reopening and retreatment rates. Stroke 40:e523–e529CrossRefGoogle Scholar
  5. 5.
    Naggara ON, Lecler A, Oppenheim C et al (2012) Endovascular treatment of intracranial unruptured aneurysms: a systematic review of the literature on safety with emphasis on subgroup analyses. Radiology 263:828–835CrossRefGoogle Scholar
  6. 6.
    Shapiro M, Babb J, Becske T, Nelson PK (2008) Safety and efficacy of adjunctive balloon remodeling during endovascular treatment of intracranial aneurysms: a literature review. AJNR Am J Neuroradiol 29:1777–1781CrossRefGoogle Scholar
  7. 7.
    Pierot L, Cognard C, Spelle L, Moret J (2012) Safety and efficacy of balloon remodeling technique during endovascular treatment of intracranial aneurysms: critical review of the literature. AJNR Am J Neuroradiol 33:12–15CrossRefGoogle Scholar
  8. 8.
    Spiotta AM, Bhalla T, Hussain MS, Sivapatham T, Batra A, Hui F, Rasmussen PA, Moskowitz SI (2011) An analysis of inflation times during balloon-assisted aneurysm coil embolization and ischemic complications. Stroke 42:1051–1055CrossRefGoogle Scholar
  9. 9.
    Albayram SSH, Kara B et al (2004) Thromboembolic events associated with balloon-assisted coil embolization: evaluation with diffusion-weighted MR imaging. AJNR Am J Neuroradiol 25:1768–1777PubMedGoogle Scholar
  10. 10.
    Shapiro M, Becske T, Sahlein D, Babb J, Nelson PK (2012) Stent-supported aneurysm coiling: a literature survey of treatment and follow-up. AJNR Am J Neuroradiol 33:159–163CrossRefGoogle Scholar
  11. 11.
    Nishido H, Piotin M, Bartolini B, Pistocchi S, Redjem H, Blanc R (2014) Analysis of complications and recurrences of aneurysm coiling with special emphasis on the stent-assisted technique. AJNR Am J Neuroradiol 35:339–344CrossRefGoogle Scholar
  12. 12.
    Consoli A, Vignoli C, Renieri L, Rosi A, Chiarotti I, Nappini S, Limbucci N, Mangiafico S (2016) Assisted coiling of saccular wide-necked unruptured intracranial aneurysms: stent versus balloon. J Neurointerv Surg 8:52–57CrossRefGoogle Scholar
  13. 13.
    Spiotta AM, Wheeler AM, Smithason S, Hui F, Moskowitz S (2012) Comparison of techniques for stent assisted coil embolization of aneurysms. J Neurointerv Surg 4:339–344CrossRefGoogle Scholar
  14. 14.
    Chalouhi N, Starke RM, Koltz MT, Jabbour PM, Tjoumakaris SI, Dumont AS, Rosenwasser RH, Singhal S, Gonzalez LF (2013) Stent-assisted coiling versus balloon remodeling of wide-neck aneurysms: comparison of angiographic outcomes. AJNR Am J Neuroradiol 34:1987–1992CrossRefGoogle Scholar
  15. 15.
    Gao B, Baharoglu MI, Malek AM (2013) Angular remodeling in single stent-assisted coiling displaces and attenuates the flow impingement zone at the neck of intracranial bifurcation aneurysms. Neurosurgery 72:739–748CrossRefGoogle Scholar
  16. 16.
    Kono K, Shintani A, Terada T (2014) Hemodynamic effects of stent struts versus straightening of vessels in stent-assisted coil embolization for sidewall cerebral aneurysms. PLoS One 9:e108033CrossRefGoogle Scholar
  17. 17.
    Chalouhi N, Dumont AS, Hasan D, Tjoumakaris S, Gonzalez LF, Starke RM, Dalyai R, el Moursi S, Rosenwasser R, Jabbour P (2012) Is packing density important in stent-assisted coiling? Neurosurgery 71:381–386CrossRefGoogle Scholar
  18. 18.
    Luo CB, Chang FC, Teng MM, Guo WY, Chang CY (2008) Stent management of coil herniation in embolization of internal carotid aneurysms. AJNR Am J Neuroradiol 29:1951–1955CrossRefGoogle Scholar
  19. 19.
    Gentric JC, Biondi A, Piotin M, Mounayer C, Lobotesis K, Bonafe A, Costalat V (2015) Balloon remodeling may improve angiographic results of stent-assisted coiling of unruptured intracranial aneurysms. Neurosurgery 76:441–445CrossRefGoogle Scholar
  20. 20.
    Sluzewski M, van Rooij W, Beute GN et al (2006) Balloon-assisted coil embolization of intracranial aneurysms: incidence, complications, and angiography results. J Neurosurg 105:396–399CrossRefGoogle Scholar
  21. 21.
    Naggara ON, White P, Guilbert F et al (2010) Endovascular treatment of intracranial unruptured aneurysms: systematic review and meta-analysis of the literature on safety and efficacy. Radiology 256:887–897CrossRefGoogle Scholar
  22. 22.
    Sluzewski M, van Rooij WJ, Slob MJ, Bescós JO, Slump CH, Wijnalda D (2004) Relation between aneurysm volume, packing, and compaction in 145 cerebral aneurysms treated with coils. Radiology 231:653–658CrossRefGoogle Scholar
  23. 23.
    Abdihalim M, Kim SH, Maud A, Suri MF, Tariq N, Qureshi AI (2011) Short- and intermediate-term angiographic and clinical outcomes of patients with various grades of coil protrusions following embolization of intracranial aneurysms. AJNR Am J Neuroradiol 32:1392–1398CrossRefGoogle Scholar
  24. 24.
    Murayama Y, Nien Y, Duckwiler G et al (2003) Guglielmi detachable coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg 98:959–966CrossRefGoogle Scholar
  25. 25.
    Tosello RT, Batista UC, Pereira BJA, Piske RL (2017) Packing density necessary to reach a high complete occlusion rate in circumferential unruptured intracranial aneurysms treated with stent-assisted coil embolization. AJNR Am J Neuroradiol 38:1973–1977CrossRefGoogle Scholar
  26. 26.
    Gao B, Baharoglu MI, Cohen AD, Malek AM (2012) Stent-assisted coiling of intracranial bifurcation aneurysms leads to immediate and delayed intracranial vascular angle remodeling. AJNR Am J Neuroradiol 33:649–654CrossRefGoogle Scholar
  27. 27.
    Jeon JP, Cho YD, Rhim JK, Yoo DH, Cho WS, Kang HS, Kim JE, Han MH (2016) Fate of coiled aneurysms with minor recanalization at 6 months: rate of progression to further recanalization and related risk factors. AJNR Am J Neuroradiol 37:1490–1495CrossRefGoogle Scholar
  28. 28.
    Piotin M, Blanc R (2014) Balloons and stents in the endovascular treatment of cerebral aneurysms: vascular anatomy remodeled. Front Neurol 5:41CrossRefGoogle Scholar
  29. 29.
    Sedat J, Chau Y, Mondot L, Vargas J, Szapiro J, Lonjon M (2009) Endovascular occlusion of intracranial wide-necked aneurysms with stenting (neuroform) and coiling: mid-term and long-term results. Neuroradiology 51:401–409CrossRefGoogle Scholar
  30. 30.
    Geyik S, Yavuz K, Yurttutan N, Saatci I, Cekirge HS (2013) Stent-assisted coiling in endovascular treatment of 500 consecutive cerebral aneurysms with long-term follow-up. AJNR Am J Neuroradiol 34:2157–2162CrossRefGoogle Scholar
  31. 31.
    Biondi A, Janardhan VKJ et al (2007) Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and midterm follow-up. Neurosurgery 61:460–468CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeuroradiologyAlfried-Krupp Krankenhaus HospitalEssenGermany
  2. 2.Department of Clinical Radiology, NeuroradiologyUniversity of MuensterMuensterGermany
  3. 3.Department of Interventional NeuroradiologyDupuytren University HospitalLimogesFrance
  4. 4.Department of Biostatistics and Clinical InvestigationUniversity of MuensterMuensterGermany
  5. 5.Department of Community HealthHochschule für GesundheitBochumGermany

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