Stent-assisted coiling of complex intracranial aneurysms

Objective: To discuss the indications, technical details, and safety of endovascular treatment of complex intracranial aneurysms using coiling in combination with stent-assisted remodeling of the parent artery. Methods: Forty-one consecutive patients with complex intracranial aneurysms were treated with stent-assisted coiling. Three patients had double aneurysms that were located within 5mm. Nine patients had giant wide-necked aneurysms. Two patients had neck remnants at 2 years after the initial coiling. One patient had recurrent aneurysm at 3 years after the initial coiling. Twenty-six patients had acutely ruptured aneurysms. Neuroform, LEO and SolitaireAB stents, and Matrix, Orbit coils were used. Results: All endovascular procedures were performed uneventfully. There were no complications. Postoperative angiography showed complete dense packing (95% to 100%) in all aneurysms, except 2 giant aneurysms, which had subtotal embolization. In patients with acutely ruptured aneurysms, there was no intrastent thrombosis or stenosis of the stent lumen. Twenty-one patients underwent angiography at 3 to 6 months postoperatively. All of them showed a good outcome, except that one giant aneurysm showed a slight residual filling inside the sac. Discussion: Stent-assisted remodeling of the parent artery in combination with various types of coils can increase the cure rate of intracranial complex aneurysms. In patients with acutely ruptured aneurysms, antiplatelet drugs should be weighed against the risks of possible open surgeries. Although we have not encountered complications in our emergent cases without using antiplatelet drugs, we should still be cautious when deploying stent without anticoagulation treatment.