Omoto Koji, Takayama Katsutoshi, Okamoto Ai, Myochin Kaoru, Wada Takeshi, Nakagawa Ichiro, Kurokawa Shinichiro, Nakase Hiroyuki, Kichikawa Kimihiko
Departments of Neurosurgery, Ishinkai Yao General Hospital, Yao, Osaka, Japan.
Departments of Radiology and Interventional Radiology, Ishinkai Yao General Hospital, Yao, Osaka, Japan.
J Neuroendovasc Ther. 2021;15(3):135-141. doi: 10.5797/jnet.oa.2020-0061. Epub 2020 Sep 29.
Intraprocedural rupture (IPR) is a rare complication that can occur during endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs). However, it leads to high morbidity and mortality rates. Others have showed that coil flexibility is a risk factor for IPR. Neuroform Atlas (NA) stents can be deployed with 0.0165-inch microcatheters to enable stent assisted coiling (SAC) with a high likelihood. Undersized flexible coils can be inserted initially during SAC. This study aimed to determine whether SAC using NA and highly flexible coils for UIAs can be conducted without IPR.
We retrospectively analyzed nine consecutive patients (mean age, 73.2 years; female, n = 6) who underwent SAC for UIAs combined with NA stents and undersized flexible coils between January 2017 and December 2019. Two aneurysms were located at the internal carotid artery (ICA), and one each was located at the ICA-posterior communicating, anterior communicating, middle cerebral, vertebral, vertebra-posterior inferior cerebral and basilar arteries. The mean size of the aneurysms was 4.6 (range, 3.1-8.6) mm. SAC proceeded using the jailing technique. All coils were selected from among the most flexible coils available. We retrospectively assessed technical success rates, aneurysm occlusion at final digital subtraction angiography (DSA), volume embolization ratios (VERs), rates of IPR and symptomatic stroke within 30 days, angiographic findings of aneurysm occlusion at 3 months post-procedure and late adverse events (frequency of aneurysmal rupture, ipsilateral ischemic stroke, and retreated targeted aneurysms).
The technical success rate was 100%. Complete occlusion (CO) was immediate in 8 (89%) patients and a neck remnant persisted in 1 (11%). No IPR or symptomatic stroke developed within 30 days. During a mean follow-up period of 11.8 months, CO persisted in 8 (89%) patients. No late adverse events occurred.
The early clinical and angiographic findings of SAC for UIAs combined with an NA stent and undersized flexible coils were favorable for this series.
术中破裂（IPR）是未破裂颅内动脉瘤（UIA）血管内治疗（EVT）过程中可能发生的一种罕见并发症。然而，它会导致高发病率和死亡率。其他人已经表明，弹簧圈柔韧性是IPR的一个危险因素。Neuroform Atlas（NA）支架可通过0.0165英寸的微导管进行部署，从而很有可能实现支架辅助弹簧圈栓塞（SAC）。在SAC过程中，最初可插入尺寸偏小的柔软弹簧圈。本研究旨在确定使用NA和高柔韧性弹簧圈对UIA进行SAC是否可以在不发生IPR的情况下进行。
我们回顾性分析了2017年1月至2019年12月期间连续9例接受UIA的SAC治疗的患者（平均年龄73.2岁；女性6例），这些患者使用了NA支架和尺寸偏小的柔软弹簧圈。2个动脉瘤位于颈内动脉（ICA），1个分别位于ICA-后交通动脉、前交通动脉、大脑中动脉、椎动脉、椎动脉-小脑后下动脉和基底动脉。动脉瘤的平均大小为4.6（范围3.1-8.6）mm。SAC采用套入技术进行。所有弹簧圈均从现有最柔软的弹簧圈中选择。我们回顾性评估了技术成功率、最终数字减影血管造影（DSA）时的动脉瘤闭塞情况、体积栓塞率（VER）、30天内的IPR和症状性卒中发生率、术后3个月时动脉瘤闭塞的血管造影结果以及晚期不良事件（动脉瘤破裂频率、同侧缺血性卒中和再次治疗的目标动脉瘤）。
技术成功率为100%。8例（89%）患者立即实现完全闭塞（CO），1例（11%）患者存在颈部残留。30天内未发生IPR或症状性卒中。在平均11.8个月的随访期内，8例（89%）患者持续保持CO。未发生晚期不良事件。
对于本系列病例，UIA的SAC联合NA支架和尺寸偏小的柔软弹簧圈的早期临床和血管造影结果良好。
