Journal of Cerebrovascular and Endovascular Neurosurgery

  • 제13권3호
  • /
  • Pages.170-176
  • /
  • 2011
  • /
  • 2234-8565(pISSN)
  • /
  • 2287-3139(eISSN)
대한뇌혈관외과학회 (Korean Society of Cerebravascular Surgeons)
권호 표지

Preliminary Results of Y-Stent-Assisted Coil Embolization of Wide-Necked Intracranial Aneurysms : 8 Consecutive Patients

  • Lee, Jun Seok (Department of Neurosurgery, School of Medicine, Pusan National University Hospital) ;
  • Choi, Chang Hwa (Department of Neurosurgery, School of Medicine, Pusan National University Hospital) ;
  • Lee, Jae Il (Department of Neurosurgery, School of Medicine, Pusan National University Hospital) ;
  • Ko, Jun Kyeung (Department of Neurosurgery, School of Medicine, Pusan National University Hospital) ;
  • Cha, Seung Heon (Department of Neurosurgery, School of Medicine, Pusan National University Hospital) ;
  • Lee, Tae Hong (Department of Diagnostic Radiology, School of Medicine, Pusan National University Hospital)
  • 발행 : 2011.09.30
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : The endovascular treatment of wide-necked intracranial aneurysms is challenging. The stent-assisted coil embolization has facilitated treatment of such complex aneurysms. However, the single stent-assisted technique has a limitation for the wide-necked intracranial aneurysm at the arterial bifurcation. The Y-stent-assisted technique could be an alternative solution for these aneurysms. We present a case series where stent-assisted coil embolization where the Y-configuration stent was used. Methods : Between January 2007 to December 2010, 8 wide-necked bifurcation aneurysms in 8 patients were treated with the Y-stent technique. Among the eight patients, there were six unruptured aneurysms and the remaining two patients presented with subarachnoid hemorrhage (SAH). Three out of eight aneurysms were located at the anterior communicating artery (ACOM), three at the top of the basilar artery (BA), one at the middle cerebral artery (MCA) bifurcation and one at the pericallosal artery. The size of aneurysm ranged from 3.6 mm to 28.2 mm (mean 8.7 mm, neck size from 3 to 7 mm). Four patients were female and aged ranged from 52 to 73 years. Results : The Y-stent-assisted coil embolization was successfully performed in all 8 cases. The immediate angiographic results were complete occlusion in 7 cases with a remnant neck the remaining case. Angiographic follow-up was done in six patients and stable occlusion was confirmed in all aneurysms. Acute thromboembolism (TE) during the procedure occurred in 4 patients. There were one acute cerebral infarction due to distal coil migration and one delayed cerebral infarction due to in-stent thrombosis after 2 months. Conclusion : Traditionally microsurgery has been the treatment of choice for wide-necked intracranial aneurysms at the arterial bifurcation. However, with the advancement of new techniques and instruments for endovascular treatment, the Y-stent-assisted coil embolization seems to be a feasible treatment option for reconstruction of these complex aneurysms.

키워드

참고문헌

  1. Akiba Y, Murayama Y, Vinuela F, Lefkowitz MA, Duckwiler GR, Gobin YP. Balloon-assisted Guglielmi detachable coiling of wide-necked aneurysms: Part I-experimental evaluation. Neurosurgery 45:519-30, 1999 https://doi.org/10.1097/00006123-199909000-00022
  2. Benndorf G, Campi A, Schneider GH, Wellnhofer E, Unterberg A. Overlapping stents for treatment of a dissecting carotid artery aneurysm. J Endovasc Ther 8:566-70, 2001 https://doi.org/10.1583/1545-1550(2001)008<0566:OSFTOA>2.0.CO;2
  3. Broadbent LP, Moran CJ, Cross DT 3rd, Derdeyn CP. Management of neuroform stent dislodgement and misplacement. AJNR Am J Neuroradiol 24:1819-22, 2003
  4. Canton G, Levy DI, Lasheras JC. Hemodynamic changes due to stent placement in bifurcating intracranial aneurysms. J Neurosurg 103:146-55, 2005 https://doi.org/10.3171/jns.2005.103.1.0146
  5. 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 26:2578-81, 2005
  6. Fiorella D, Albuquerque FC, Han P, McDougall CG. Preliminary experience using the Neuroform stent for the treatment of cerebral aneurysms. Neurosurgery 54:6-17, 2004 https://doi.org/10.1227/01.NEU.0000097194.35781.EA
  7. Horowitz M, Levy E, Sauvageau E, Genevro J, Guterman LR, Hanel R et al. Intra/extra-aneurysmal stent placement for management of complex and wide-necked-bifurcation aneurysms: eight cases using the waffle cone technique. Neurosurgery 58:ONS-258-62, 2006
  8. Kelly ME, Turner R, Gonugunta V, Woo HH, Rasmussen PA, Masaryk TJ et al. Stent reconstruction of wide-necked aneurysms across the circle of Willis. Neurosurgery 61:249-54, 2007 https://doi.org/10.1227/01.neu.0000303977.04128.3e
  9. Kim M, Levy EI, Meng H, Hopkins LN. Quantification of hemodynamic changes induced by virtual placement of multiple stents across a wide-necked basilar trunk aneurysm. Neurosurgery 61:1305-12, 2007 https://doi.org/10.1227/01.neu.0000306110.55174.30
  10. Lanzino G, Wakhloo AK, Fessler RD, Hartney ML, Guterman LR, Hopkins LN. Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms. J Neurosurg 91:538-46, 1999 https://doi.org/10.3171/jns.1999.91.4.0538
  11. Lee YJ, Kim DJ, Suh SH, Lee SK, Kim J, Kim DI. Stent-assisted coil embolization of intracranial wide-necked aneurysms. Neuroradiology 47:680-9, 2005 https://doi.org/10.1007/s00234-005-1402-8
  12. Lownie SP, Pelz DM, Fox AJ. Endovascular therapy of a large vertebral artery aneurysm using stent and coils. Can J Neurol Sci 27:162-5, 2000
  13. Lozen A, Manjila S, Rhiew R, Fessler R. Y-stent-assisted coil embolization for the management of unruptured cerebral aneurysms: report of six cases. Acta Neurochir (Wien) 151:1663-72, 2009 https://doi.org/10.1007/s00701-009-0436-9
  14. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 360:1267-74, 2002 https://doi.org/10.1016/S0140-6736(02)11314-6
  15. Moret J, Cognard C, Weill A, Castaings L, Rey A. The "Remodelling Technique" in the Treatment of Wide Neck Intracranial Aneurysms. Angiographic Results and Clinical Follow-up in 56 Cases. Interv Neuroradiol 3:21-35, 1997 https://doi.org/10.1177/159101999700300103
  16. Perez-Arjona E, Fessler RD. Basilar artery to bilateral posterior cerebral artery 'Y stenting' for endovascular reconstruction of wide-necked basilar apex aneurysms: report of three cases. Neurol Res 26:276-81, 2004 https://doi.org/10.1179/016164104225013969
  17. Sani S, Lopes DK. Treatment of a middle cerebral artery bifurcation aneurysm using a double neuroform stent "Y" configuration and coil embolization: technical case report. Neurosurgery 57:E209, 2005 https://doi.org/10.1227/01.NEU.0000163684.75204.CD
  18. Shapiro M, Babb J, Becske T, Nelson PK. Safety and efficacy of adjunctive balloon remodeling during endovascular treatment of intracranial aneurysms: a literature review. AJNR Am J Neuroradiol 29:1777-81, 2008 https://doi.org/10.3174/ajnr.A1216
  19. Sluzewski M, van Rooij WJ, Beute GN, Nijssen PC. Balloon-assisted coil embolization of intracranial aneurysms: incidence, complications, and angiography results. J Neurosurg 105:396-9, 2006 https://doi.org/10.3171/jns.2006.105.3.396
  20. Vanninen R, Manninen H, Ronkainen A. Broad-based intracranial aneurysms: thrombosis induced by stent placement. AJNR Am J Neuroradiol 24:263-6, 2003
  21. 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 48:817-20, 2006 https://doi.org/10.1007/s00234-006-0128-6
  22. Yahia AM, Gordon V, Whapham J, Malek A, Steel J, Fessler RD. Complications of Neuroform stent in endovascular treatment of intracranial aneurysms. Neurocrit Care 8:19-30, 2008 https://doi.org/10.1007/s12028-007-9001-7
  23. Youn SO, Lee JI, Ko JK, Lee TH, Choi CH. Endovascular Treatment of Wide-Necked Intracranial Aneurysms Using Balloon-Assisted Technique with HyperForm Balloon. J Korean Neurosurg Soc 48:207-12, 2010 https://doi.org/10.3340/jkns.2010.48.3.207
  24. Zenteno M, Modenesi Freitas JM, Aburto-Murrieta Y, Koppe G, Machado E, Lee A. Balloon-expandable stenting with and without coiling for wide-neck and complex aneurysms. Surg Neurol 66:603-10, 2006 https://doi.org/10.1016/j.surneu.2006.05.058