Research About Stent-Assisted Coiling Of Intracranial Bifurcation Aneurysms Leads To Intracranial Vascular Geometry Remodeling

BACKGROUND AND PURPOSE:Intracranial aneurysm is a common cerebrovascular disease of neurosurgery. The Subarachnoid hemorrhage (SAH) caused by aneurysm rupture can lead to high mortality about 25-60%.Wide-neck bifurcating aneurysms are increasingly treated with intracranial stent-assisted coiling by using shape-memory alloy microstents.The deployment of an intracranial microstent serves as a metal scaffold to prevent coil herniation through the neck of these wide-neck aneurysms and can also increase the treatment_coil packing attenuation. We sought to investigate the short-and long-term effects of intracranial stent implantation on the geometry and angular conformation of the stent-coiled vascular bifurcation. After noting striking cerebral vascular deformation with stent placement in a preliminary analysis, we sought to investigate the geometric consequences of intracranial stent coiling at bifurcations harboring aneurysms, in order to know whether the geometric change can affect the prognosis.METHODS:During the period of 2011 to 2014, thirty patients underwent stent-mediated coiling for 31 bifurcation aneurysms by using 31 self-expanding Solitaire (n=13) and Enterprise (n=18) stents. The angle between the stented mother and daughter vessels at the bifurcation was measured by using multiplanar imaging of reconstructed rotational conventional angiography volumes and was compared by using matched-pair statistics.RESULTS:Stent deployment increased the bifurcation angle at latest follow-up, resulting in effective straightening; the angular remodeling was greater in distal-versus-proximal arteries (ACA>MCA>BA>ICA). At follow-up, angle continued to significantly expand, with remodeling being greater in the early period (1-6 versus>7 months) and more pronounced with the longitudinally stiffer closed-cell Enterprise compared with the open-cell Solitaire stent.CONCLUSIONS:Stent placement across bifurcation aneurysms leads to a significant biphasic angular remodeling related to stent type and vessel position, a phenomenon needing consideration during procedural planning. The use of intracranial microstent can reduce the recurrence rate of aneurysm.