Stent Assistance

Wide-necked and fusiform aneurysms present distinct challenges for interventional neuroradiologists and neurosurgeons, because the aneurysms can involve entire vessels or be irregular in shape. Coils might migrate after deployment, with a potential to occlude the vessel or to embolize. In these circumstances, stent-assisted coiling has proven its utility. In a study of stent-assisted endovascular coil occlusion of wide-necked saccular intracranial aneurysms, it was found that 100% of patients achieved 95% occlusion or better with the aid of a self-expanding microstent (24). The long-term durability of endovascular occlusion of wide-necked cerebral aneurysms has been improved with stent-assisted coiling, resulting in improved aneurysmal occlusion and fewer cases of parent-vessel occlusion (25,26).

Stent-assisted coiling has also been documented in the treatment of wide-necked bifurcation aneurysms, a finding that might have implications for the management of basilar apex and other bifurcation aneurysms (27,28). Successful coiling of a wide-necked basilar bifurcation aneurysm with the use of self-expanding stents in a Y-configuration, double-stent-assisted technique has been reported (27). Furthermore, intracranial vertebral artery dissection has been successfully treated by intravascular stent and endosaccular GDC coils, skirting the hemody-namic complications of the usual technique of balloon occlusion of the vertebral artery (VA). The stenting-coiling association option appears to preserve arterial flow and maintain selective occlusion of the aneurysmal pouch (29). A combination of endovascular stenting and coil packing holds promise as a favorable alternative for the treatment of intracranial aneurysms that are otherwise unsuitable for surgical clipping or coil embolization.

However, despite the promise of stent-assisted coiling, several potential complications must be addressed. Cases of stent malposition within large aneurysms, including dislodgement during microcatheterization, stent movement after deployment, stent movement during coiling, and vasospasm during stenting, have been reported in the literature (26,30,31). In particular, early versions of the Neuroform stent were difficult to pass through tortuous vessels and presented the risk of migration because of their softness (31). Additionally, stent deployment has been documented to result in immediate rupture of the artery (32 ).

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