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
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.
KeywordsWide-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.
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.
For this type of retrospective study formal consent is not required.
- 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 75:145–151CrossRefPubMedGoogle Scholar