Neurological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Neurointerv Surg. 2012 Sep;4(5):339-44. doi: 10.1136/neurintsurg-2011-010055. Epub 2011 Sep 7.
Stent assisted coiling (SAC) of aneurysms has been adopted with potential mechanical, hemodynamic and biologic properties imparting an advantage over coil embolization alone. The purpose of this investigation is to compare the various techniques of SAC at a single institution with regards to clinical, technical and angiographic complications and success.
Patients who underwent SAC between 2003 and 2010 were identified. Clinical charts, procedures, angiographic and non-invasive radiological images were analyzed to determine the anatomical and procedural details and adverse events. Immediate post-procedural angiograms as well as follow-up imaging were studied to assess the degree of aneurysm occlusion.
260 aneurysms were identified. The 'coil through' technique was employed in 37.3%, 'balloon stent' in 36.2%, 'jailing' in 10.8% and the 'coil stent' technique in 7.7%. Overall rate of adverse events was higher with the 'coil stent' and 'jailing' techniques compared with the 'balloon stent' technique. The 'coil through' technique was associated with a significantly lower packing density (31.4±20%) than all other techniques ('coil stent' 45.4±22%, 'jailing' 42.2±20%, 'balloon stent' 44.3±22%). Among 'coil stent' patients, an initial Raymond class 1 was achieved in 40%, compared with 57% of 'jailing', 28% of 'coil through' and 63% of 'balloon stent' cases.
Balloon assisted coil embolization followed by adjunctive stent deployment across the aneurysm neck appears to be the superior technique among stent assisted coiling methods at our institution. It combines a lower rate of thrombotic and coil related complications with a high rate of complete occlusion on initial and follow-up imaging.
支架辅助弹簧圈栓塞（SAC）已被采用，具有潜在的机械、血液动力学和生物学特性，相对于单纯的弹簧圈栓塞具有优势。本研究旨在比较单一机构中 SAC 的各种技术在临床、技术和血管造影并发症及成功率方面的差异。
确定了 2003 年至 2010 年间接受 SAC 的患者。分析临床病历、手术过程、血管造影和非侵入性影像学图像，以确定解剖和程序细节及不良事件。研究即刻术后血管造影以及随访影像学以评估动脉瘤闭塞程度。
共发现 260 个动脉瘤。“线圈贯穿”技术应用于 37.3%、“球囊支架”技术 36.2%、“线圈囚禁”技术 10.8%和“线圈支架”技术 7.7%。“线圈支架”和“线圈囚禁”技术的不良事件发生率明显高于“球囊支架”技术。“线圈贯穿”技术的填塞密度（31.4±20%）明显低于其他所有技术（“线圈支架”45.4±22%、“线圈囚禁”42.2±20%、“球囊支架”44.3±22%）。在“线圈支架”患者中，初始 Raymond 分级为 1 级的比例为 40%，而“线圈囚禁”为 57%、“线圈贯穿”为 28%、“球囊支架”为 63%。
在我们的机构中，球囊辅助弹簧圈栓塞后在动脉瘤颈部附加支架似乎是支架辅助弹簧圈栓塞方法中较好的技术。它结合了较低的血栓和线圈相关并发症发生率，以及较高的初始和随访影像学完全闭塞率。
