Journal of Korean Neurosurgical Society

  • 제53권5호
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  • Pages.274-280
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  • 2013
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Various Techniques of Stent-Assisted Coil Embolization of Wide-Necked or Fusiform Middle Cerebral Artery Aneurysms : Initial and Mid-Term Results

  • Won, Yu Sam (Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Rho, Myung Ho (Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Byung Moon (Department of Radiology, Severance Hospital, Yonsei University College of Medicine) ;
  • Park, Hee Jin (Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Kwag, Hyon Ju (Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Chung, Eun Chul (Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 투고 : 2012.08.27
  • 심사 : 2013.05.13
  • 발행 : 2013.05.28
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초록

Objective : To evaluate the feasibility and clinical and angiographic outcomes of stent-assisted embolization for complex middle cerebral artery (MCA) aneurysms. Methods : The records of 23 consecutive patients with 24 MCA aneurysms, who underwent stent-assisted embolization of the aneurysm, were retrospectively evaluated. Results : Fifteen aneurysms were treated with one stent and 8 were treated using more than two stents (5 a stent-within-a-stent, 1 triple stents, and two Y-stent). Angiographically, complete or near complete occlusion was achieved in 15 aneurysms (65.2%), residual neck in five (21.7%), and residual aneurysm in three (13.1%). Five aneurysms demonstrated thrombosis within the stent during the procedure and hospitalization, and were resolved by intraarterial and intravenous Tirofiban injection. Symptomatic thromboembolic complications were developed in five patients and permanent deficits demonstrated in two patients with modified Rankin Scale 1 and 2, respectively. Treatment-related permanent morbidity and mortality rates were 8.3% and 0% with relatively high complication rate. Angiographic follow-up was available in 17 aneurysms at 6-31 months (mean, 13.2 months) and showed stable or improved in 15 (88.2%) and major and minor recurrence in one, respectively. Conclusion : Complex MCA aneurysms could be treated by stent-assisted coiling and showed lower recanalization rate during mid-term follow-up by effective flow diversion due to various stent-assisted techniques. Our results warrant further study with a longer follow-up period in a larger sample.

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참고문헌

  1. Akpek S, Arat A, Morsi H, Klucznick RP, Strother CM, Mawad ME : Self-expandable stent-assisted coiling of wide-necked intracranial aneurysms : a single-center experience. AJNR Am J Neuroradiol 26 : 1223-1231, 2005
  2. Baxter BW, Rosso D, Lownie SP : Double microcatheter technique for detachable coil treatment of large, wide-necked intracranial aneurysms. AJNR Am J Neuroradiol 19 : 1176-1178, 1998
  3. Benitez RP, Silva MT, Klem J, Veznedaroglu E, Rosenwasser RH : Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils. Neurosurgery 54 : 1359-1367; discussion 1368, 2004 https://doi.org/10.1227/01.NEU.0000124484.87635.CD
  4. Bracard S, Abdel-Kerim A, Thuillier L, Klein O, Anxionnat R, Finitsis S, et al. : Endovascular coil occlusion of 152 middle cerebral artery aneurysms : initial and midterm angiographic and clinical results. J Neurosurg 112 : 703-708, 2010 https://doi.org/10.3171/2009.6.JNS09483
  5. Darsaut T, Salazkin I, Ogoudikpe C, Gevry G, Bouzeghrane F, Raymond J : Effects of stenting the parent artery on aneurysm filling and gene expression of various potential factors involved in healing of experimental aneurysms. Interv Neuroradiol 12 : 289-302, 2006
  6. Fields JD, Brambrink L, Dogan A, Helseth EK, Liu KC, Lee DS, et al. : Stent assisted coil embolization of unruptured middle cerebral artery aneurysms. J Neurointerv Surg 5 : 15-19, 2013 https://doi.org/10.1136/neurintsurg-2011-010162
  7. Fiorella D, Albuquerque FC, Masaryk TJ, Rasmussen PA, McDougall CG : Balloon-in-stent technique for the constructive endovascular treatment of "ultra-wide necked" circumferential aneurysms. Neurosurgery 57 : 1218-1227; discussion 1218-1227, 2005 https://doi.org/10.1227/01.NEU.0000186036.35823.10
  8. Heros RC, Fritsch MJ : Surgical management of middle cerebral artery aneurysms. Neurosurgery 48 : 780-785; discussion 785-786, 2001
  9. Hwang G, Park H, Bang JS, Jin SC, Kim BC, Oh CW, et al. : Comparison of 2-year angiographic outcomes of stent- and nonstent-assisted coil embolization in unruptured aneurysms with an unfavorable configuration for coiling. AJNR Am J Neuroradiol 32 : 1707-1710, 2011 https://doi.org/10.3174/ajnr.A2592
  10. Izar B, Rai A, Raghuram K, Rotruck J, Carpenter J : Comparison of devices used for stent-assisted coiling of intracranial aneurysms. PLoS One 6 : e24875, 2011 https://doi.org/10.1371/journal.pone.0024875
  11. Kim BM, Kim DI, Park SI, Kim DJ, Suh SH, Won YS : Coil embolization of unruptured middle cerebral artery aneurysms. Neurosurgery 68 : 346-353; discussion 353-354, 2011 https://doi.org/10.1227/NEU.0b013e3182035fdc
  12. Kwon OK, Kim SH, Oh CW, Han MH, Kang HS, Kwon BJ, et al. : Embolization of wide-necked aneurysms with using three or more microcatheters. Acta Neurochir (Wien) 148 : 1139-1145; discussion 1145, 2006 https://doi.org/10.1007/s00701-006-0876-4
  13. Lawson MF, Newman WC, Chi YY, Mocco JD, Hoh BL : Stent-associatand ed flow remodeling causes further occlusion of incompletely coiled aneurysms. Neurosurgery 69 : 598-603; discussion 603-604, 2011 https://doi.org/10.1227/NEU.0b013e3182181c2b
  14. Lee BH, Kim BM, Park MS, Park SI, Chung EC, Suh SH, et al. : Reconstructive endovascular treatment of ruptured blood blister-like aneurysms of the internal carotid artery. J Neurosurg 110 : 431-436, 2009 https://doi.org/10.3171/2008.7.JNS08257
  15. Lee JY, Seo JH, Cho YD, Kang HS, Han MH : Endovascular treatment of wide-neck intracranial aneurysms using a microcatheter protective technique : results and outcomes in 75 aneurysms. AJNR Am J Neuroradiol 32 : 917-922, 2011 https://doi.org/10.3174/ajnr.A2411
  16. Lopes D, Sani S : Histological postmortem study of an internal carotid artery aneurysm treated with the Neuroform stent. Neurosurgery 56 : E416; discussion E416, 2005 https://doi.org/10.1227/01.NEU.0000147977.07736.66
  17. Lubicz B, Francois O, Levivier M, Brotchi J, Baleriaux D : Preliminary experience with the enterprise stent for endovascular treatment of complex intracranial aneurysms: potential advantages and limiting characteristics. Neurosurgery 62 : 1063-1069; discussion 1069-1070, 2008 https://doi.org/10.1227/01.neu.0000325868.06764.de
  18. Maldonado IL, Machi P, Costalat V, Mura T, Bonafe A : Neuroform stent-assisted coiling of unruptured intracranial aneurysms : short- and midterm results from a single-center experience with 68 patients. AJNR Am J Neuroradiol 32 : 131-136, 2011
  19. 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 : 1267-1274, 2002 https://doi.org/10.1016/S0140-6736(02)11314-6
  20. 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
  21. Piotin M, Blanc R, Spelle L, Mounayer C, Piantino R, Schmidt PJ, et al. : Stent-assisted coiling of intracranial aneurysms : clinical and angiographic results in 216 consecutive aneurysms. Stroke 41 : 110-115, 2010 https://doi.org/10.1161/STROKEAHA.109.558114
  22. Roy D, Milot G, Raymond J : Endovascular treatment of unruptured aneurysms. Stroke 32 : 1998-2004, 2001 https://doi.org/10.1161/hs0901.095600
  23. Sedat J, Chau Y, Mondot L, Vargas J, Szapiro J, Lonjon M : Endovascular occlusion of intracranial wide-necked aneurysms with stenting (Neuroform) and coiling : mid-term and long-term results. Neuroradiology 51 : 401-409, 2009 https://doi.org/10.1007/s00234-009-0502-2
  24. Stoodley MA, Macdonald RL, Weir BK : Surgical treatment of middle cerebral artery aneurysms. Neurosurg Clin N Am 9 : 823-834, 1998
  25. Suh SH, Kim BM, Park SI, Kim DI, Shin YS, Kim EJ, et al. : Stent-assisted coil embolization followed by a stent-within-a-stent technique for ruptured dissecting aneurysms of the intracranial vertebrobasilar artery. Clinical article. J Neurosurg 111 : 48-52, 2009 https://doi.org/10.3171/2009.2.JNS081418
  26. Vendrell JF, Costalat V, Brunel H, Riquelme C, Bonafe A : Stent-assisted coiling of complex middle cerebral artery aneurysms: initial and midterm results. AJNR Am J Neuroradiol 32 : 259-263, 2011 https://doi.org/10.3174/ajnr.A2272
  27. Vendrell JF, Menjot N, Costalat V, Hoa D, Moritz J, Brunel H, et al. : Endovascular treatment of 174 middle cerebral artery aneurysms : clinical outcome and radiologic results at long-term follow-up. Radiology 253 : 191-198, 2009 https://doi.org/10.1148/radiol.2531082092
  28. Wanke I, Forsting M : Stents for intracranial wide-necked aneurysms : more than mechanical protection. Neuroradiology 50 : 991-998, 2008 https://doi.org/10.1007/s00234-008-0460-0
  29. Yang P, Liu J, Huang Q, Zhao W, Hong B, Xu Y, et al. : Endovascular treatment of wide-neck middle cerebral artery aneurysms with stents : a review of 16 cases. AJNR Am J Neuroradiol 31 : 940-946, 2010 https://doi.org/10.3174/ajnr.A1931
  30. 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 : 207-212, 2010 https://doi.org/10.3340/jkns.2010.48.3.207

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  1. Endovascular treatment of complex intracranial aneurysms by pipeline flow-diverter embolization device: a single-center experience vol.37, pp.4, 2013, https://doi.org/10.1179/1743132814y.0000000450
  2. Tirofiban combined with urokinase selective intra-arterial thrombolysis for the treatment of middle cerebral artery occlusion vol.11, pp.3, 2013, https://doi.org/10.3892/etm.2016.2995