TY - JOUR
T1 - Closed-cell stent-assisted coiling of intracranial aneurysms
T2 - Evaluation of changes in vascular geometry using digital subtraction angiography
AU - Beller, Ebba
AU - Klopp, David
AU - Göttler, Jens
AU - Kaesmacher, Johannes
AU - Zimmer, Claus
AU - Kirschke, Jan S.
AU - Prothmann, Sascha
N1 - Publisher Copyright:
© 2016 Beller et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2016/4
Y1 - 2016/4
N2 - Background: Stent-assisted coil embolization (SACE) plays an important role in the treatment of intracranial aneurysms. The purpose of this study was to investigate geometrical changes caused by closed-cell design stents in bifurcation and sidewall aneurysms. Methods: 31 patients with 34 aneurysms underwent SACE with closed-cell design stents. Inflow angle α, determined by aneurysm neck and afferent vessel, and angle between afferent and efferent vessel close to (δ1), respectively, more remote from the aneurysm neck (δ2) were graphically determined in 2D angiography projections. Results: Stent assisted coiling resulted in a significant increase of all three angles from a mean value (±SEM) of α = 119° (±6.5°) pretreatment to 130° (±6.6°) posttreatment (P ≤.001), δ1 = 129° (±6.4°) to 139° (±6.1°), (P ≤.001) and δ2 = 115° (±8.4°) to 126° (±7.5°), (P ≤.01). Angular change of δ1 in AcomA aneurysms was significant greater compared to sidewall aneurysms (26°±4.9° versus 8°± 2.3°, P ≤.05). The initial angle of δ1 and δ2 revealed a significantly inverse relationship to the angle increase (δ1: r =-0.41, P ≤.05 and δ2: r =-0.47, P ≤.01). Moreover, angle δ1 was significantly higher in unruptured compared to ruptured aneurysms (135°±7.1° versus 103°±10.8°, P ≤.05). Conclusion: Stent deployment modulates the geometry of the aneurysm-vessel complex, which may lead to favorable hemodynamic changes more similar to unruptured than to ruptured aneurysms. Our findings also suggest that the more acute-angled aneurysm-vessel anatomy, the larger the angular change. Further studies are needed to investigate whether these changes improve the clinical outcome.
AB - Background: Stent-assisted coil embolization (SACE) plays an important role in the treatment of intracranial aneurysms. The purpose of this study was to investigate geometrical changes caused by closed-cell design stents in bifurcation and sidewall aneurysms. Methods: 31 patients with 34 aneurysms underwent SACE with closed-cell design stents. Inflow angle α, determined by aneurysm neck and afferent vessel, and angle between afferent and efferent vessel close to (δ1), respectively, more remote from the aneurysm neck (δ2) were graphically determined in 2D angiography projections. Results: Stent assisted coiling resulted in a significant increase of all three angles from a mean value (±SEM) of α = 119° (±6.5°) pretreatment to 130° (±6.6°) posttreatment (P ≤.001), δ1 = 129° (±6.4°) to 139° (±6.1°), (P ≤.001) and δ2 = 115° (±8.4°) to 126° (±7.5°), (P ≤.01). Angular change of δ1 in AcomA aneurysms was significant greater compared to sidewall aneurysms (26°±4.9° versus 8°± 2.3°, P ≤.05). The initial angle of δ1 and δ2 revealed a significantly inverse relationship to the angle increase (δ1: r =-0.41, P ≤.05 and δ2: r =-0.47, P ≤.01). Moreover, angle δ1 was significantly higher in unruptured compared to ruptured aneurysms (135°±7.1° versus 103°±10.8°, P ≤.05). Conclusion: Stent deployment modulates the geometry of the aneurysm-vessel complex, which may lead to favorable hemodynamic changes more similar to unruptured than to ruptured aneurysms. Our findings also suggest that the more acute-angled aneurysm-vessel anatomy, the larger the angular change. Further studies are needed to investigate whether these changes improve the clinical outcome.
UR - http://www.scopus.com/inward/record.url?scp=84963813681&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0153403
DO - 10.1371/journal.pone.0153403
M3 - Article
C2 - 27073908
AN - SCOPUS:84963813681
SN - 1932-6203
VL - 11
JO - PLoS ONE
JF - PLoS ONE
IS - 4
M1 - e0153403
ER -