Purpose

We report the long-term results of a modified stent-assisted coil embolization technique using the far proximal part of a self-expanding open-cell stent. The technique was used to cover the neck of the aneurysm while simultaneously preserving the branches of the distal internal carotid artery in patients with aneurysms of the posterior communicating (Pcom) and anterior choroidal arteries (AchA).

Methods

We performed a retrospective review of the prospectively maintained databases at two tertiary neurosurgical centers to identify all patients who underwent embolization of Pcom or AchA aneurysms using this technique between January 2014 and July 2019. Postoperative and follow-up clinical and radiological results for initial (n = 16) or re-do (n = 4) embolizations were analyzed.

Results

We identified 19 patients with 20 (16 Pcom and 4 AchA) unruptured (n = 19) or ruptured (n = 1) aneurysms. Eighteen among 20 stents (90.0%) were deployed successfully, and complete occlusions were initially attained in 18 aneurysms (90.0%). At follow-up examinations 8 to 56 months later, 6 of 14 aneurysms (42.8%) showed neck remnants. All of the branches were saved and no thromboembolic event, rupture, or sequelae were noted during or after the procedures.

Conclusion

These results suggest that this modified stent-assisted technique is a feasible and reasonable alternative to conventional stent deployment for coil embolization of wide-necked sidewall aneurysms in the distal ICA.

中文翻译：

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使用可自我扩张的开放式细胞支架近端同时进行颈部覆盖和分支保存，可治疗远端颈内动脉瘤：多中心，长期效果。

目的

我们报告了使用自扩张开放式细胞支架的近端部分的改良支架辅助线圈栓塞技术的长期结果。该技术被用于覆盖动脉瘤的颈部，同时保留后交通（Pcom）和前脉络膜动脉（AchA）动脉瘤患者的颈内动脉远端分支。

方法

我们在两个三级神经外科中心对前瞻性维护的数据库进行了回顾性研究，以鉴定在2014年1月至2019年7月之间使用该技术进行了Pcom或AchA动脉瘤栓塞治疗的所有患者。初始（n）的术后及后续临床和放射学结果 = 16）或重做（n  = 4）的栓塞进行了分析。

结果

我们确定了19例未破裂（n  = 19）或破裂（n  = 1）动脉瘤的患者（16 Pcom和4 AchA）。成功部署了20个支架中的18个（90.0％），最初在18个动脉瘤（90.0％）中实现了完全闭塞。在8到56个月后的随访检查中，14个动脉瘤中有6个（42.8％）显示出颈部残留。保留所有分支，在手术过程中或手术后均未发现血栓栓塞事件，破裂或后遗症。

结论

这些结果表明，这种改良的支架辅助技术是常规支架部署的可行且合理的替代方案，可用于对远端ICA的宽颈侧壁动脉瘤进行线圈栓塞。