Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Single Center Experience of the Balloon-Stent Technique for the Treatment of Unruptured Distal Internal Carotid Artery Aneurysms: Sharing a Simple and Reliable Tip to Use Scepter-Atlas Combination

원위내경동맥에 위치한 비파열성 동맥류의 치료에 있어 풍선-스텐트 테크닉에 대한 단일기관의 경험: Scepter-Atlas 조합을 사용하기 위한 간단하지만 확실한 방법

  • Yu-jung Park (Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine) ;
  • Jieun Roh (Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine) ;
  • Seung Kug Baik (Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine) ;
  • Jeong A Yeom (Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine) ;
  • Chul-Hoo Kang (Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine) ;
  • Hee Seok Jeong (Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine) ;
  • Sang Won Lee (Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine)
  • 박유정 (부산대학교 의과대학 양산부산대학교병원 영상의학과) ;
  • 노지은 (부산대학교 의과대학 양산부산대학교병원 영상의학과) ;
  • 백승국 (부산대학교 의과대학 양산부산대학교병원 영상의학과) ;
  • 염정아 (부산대학교 의과대학 양산부산대학교병원 영상의학과) ;
  • 강철후 (제주대학교 의과대학 제주대학교병원 신경과) ;
  • 정희석 (부산대학교 의과대학 양산부산대학교병원 영상의학과) ;
  • 이상원 (부산대학교 의과대학 양산부산대학교병원 신경외과)
  • Received : 2020.06.10
  • Accepted : 2020.10.28
  • Published : 2021.09.01
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Abstract

Purpose The balloon-stent technique (BST) has certain strengths as an assisted technique for the treatment of complex aneurysms. After Atlas release, the BST can be executed without an exchange maneuver of the balloon to the stent-delivery catheter. The purpose of this article is to share our experience with the BST using the Scepter-Atlas combination. Materials and Methods Device inspection led us to a simple method to avoid failure in loading Atlas to the Scepter. From March 2018 to December 2019, 57 unruptured distal internal carotid artery (dICA) aneurysms were treated with coil embolization; among which, 25 aneurysms in 23 patients were treated with BST. Clinical and angiographic data were retrospectively collected and reviewed. Results The technical success rate of the Scepter-Atlas combination increased from 50% to 100% after careful inspection. BST angiographic results were comparable to the stent-assisted coil (SAC) group treated during the immediately post-embolization same period (modified Raymond-Roy classification [MRRC] 1 & 2 84% in BST, 96.3% in SAC) and during short-term follow-up (MRRC 1 & 2 95.8% in BST, 88.4% in SAC). A small number of patients showed periprocedural complications, but none had clinical consequences. Conclusion BST using the Scepter-Atlas combination can provide an effective and safe method for the treatment of dICA aneurysms. Scepters can be used as delivery catheters for Atlas.

목적 풍선-스텐트 테크닉(balloon-stent technique; 이하 BST)은 복잡한 동맥류를 치료하는 보조술로서 그 고유한 장점을 가지고 있다. 저자들의 기관에서 Atlas의 출시 이래 Scepter-Atlas 조합의 BST를 치료에 적용해 온 경험을 공유하고자 한다. 대상과 방법 초기에 Atlas를 Scepter 카테터에 진입시키지 못하는 기술적 실패를 겪은 뒤 이를 해결하기 위해 문제가 되었던 기구들을 면밀히 관찰하였다. 2018년 3월부터 2019년 12월까지 총 57개의 비파열성 원위내경동맥 동맥류에 대해 코일 색전술을 시행하였고, 이중 25개(23명)의 증례는 BST로 치료하였다. 포함된 증례들의 영상 및 임상 정보는 후향적으로 수집하고 분석하였다. 결과 이 논문에서 소개하는 간단한 팁을 알게 된 이후 Scepter-Atlas 조합의 기술적 성공률은 50%에서 100%로 상승하였다. BST로 치료한 환자군에서 시술 직후에 84%, 추적검사에서 95.8%가 완전하거나 거의 완전한 폐색을 보였고 stent-assisted coil 그룹에서는 각각 96.3%, 88.4%가 시술 직후와 추적검사에서 같은 결과를 보였다. 소수의 환자에서 합병증을 보였지만 임상적으로 문제가 된 증례는 없었다. 결론 Scepter-Atlas 조합을 이용한 BST는 원위내경동맥에 위치한 비파열성 동맥류를 치료하는 데 효과적이고 안전한 방법이 될 수 있다. Scepter는 Atlas를 매개하는 카테터로 충분히 사용될 수 있다.

Keywords

Acknowledgement

Authors of this article would like to express special thanks to Mijin Jung from MJED Biomedial illustration & Design Company, for creating the illustrations used in figure 3.

References

  1. Gentric JC, Biondi A, Piotin M, Mounayer C, Lobotesis K, Bonafe A, et al. Balloon remodeling may improve angiographic results of stent-assisted coiling of unruptured intracranial aneurysms. Neurosurgery 2015;76:441-445 
  2. Spiotta AM, Wheeler AM, Smithason S, Hui F, Moskowitz S. Comparison of techniques for stent assisted coil embolization of aneurysms. J Neurointerv Surg 2012;4:339-344 
  3. Martinez-Galdamez M, Orlov K, Kadziolka K, Puthuran M, Kalousek V, Pabon B, et al. Safety and efficacy of intracranial aneurysm embolization using the "combined remodeling technique": low-profile stents delivered through double lumen balloons: a multicenter experience. Neuroradiology 2019;61:1067-1072 
  4. Velasco Gonzalez A, Stracke P, Nordmeyer H, Heddier M, Saleme S, Sauerland C, et al. 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. Neuroradiology 2018;60:1223-1230
  5. Spiotta AM, Miranpuri A, Chaudry MI, Turner RD 4th, Turk AS. Combined balloon stent technique with the Scepter C balloon and low-profile visualized intraluminal stent for the treatment of intracranial aneurysms. J Neurointerv Surg 2013;5 Suppl 3:iii79-iii82 
  6. Kadziolka K, Tomas C, Robin G, Pierot L. Combined use of a double-lumen remodeling balloon and a low-profile stent in the treatment of intracranial aneurysms ('remostent' technique): a technical note. J Neuroradiol 2013;40:50-53 
  7. Cay F, Peker A, Arat A. Stent-assisted coiling of cerebral aneurysms with the Neuroform Atlas stent. Interv Neuroradiol 2018;24:263-269 
  8. Ulfert C, Pham M, Sonnberger M, Amaya F, Trenkler J, Bendszus M, et al. The Neuroform Atlas stent to assist coil embolization of intracranial aneurysms: a multicentre experience. J Neurointerv Surg 2018;10:1192-1196 
  9. Ten Brinck MFM, De Vries J, Bartels RHMA, Grotenhuis JA, Boogaarts HD. NeuroForm Atlas stent-assisted coiling: preliminary results. Neurosurgery 2019;84:179-189 
  10. Yoon CH, Lee HW, Kim YS, Lee SW, Yeom JA, Roh J, et al. Preliminary study of tirofiban infusion in coil embolization of ruptured intracranial aneurysms. Neurosurgery 2018;82:76-84 
  11. Baik SK, Oh SJ, Park KP, Lee JH. Intra-arterial tirofiban infusion for partial recanalization with stagnant flow in hyperacute cerebral ischemic stroke. Interv Neuroradiol 2011;17:442-451 
  12. Mascitelli JR, Moyle H, Oermann EK, Polykarpou MF, Patel AA, Doshi AH, et al. An update to the RaymondRoy Occlusion Classification of intracranial aneurysms treated with coil embolization. J Neurointerv Surg 2015;7:496-502