The Enterprise Stent for the Treatment of Intracranial Aneurysms Stenting Strategies

Background: Self-expanding microstents are typically placed before a wide-necked aneurysm is filled with coils. Alternatively, the stent may be placed at the end of the procedure, when the coil mass blocks or slows down the flow in the parent artery or a branching vessel. Patients and Methods: Between March 2007 and 2009, 20 aneurysms in 20 patients were treated with a total of 21 Enterprise stents. Nine aneurysms had reopened after coiling, eleven aneurysms were primarily treated, seven after acute subarachnoid hemorrhage. Eight aneurysms were primarily filled with coils and the stent was placed when the flow in the parent or a branching artery was blocked or slowed down. In four of these cases in which secondary stenting was considered an option in advance, the "artery at risk" was initially catheterized with a microcatheter. Results: Stent placement was successful in 19 aneurysms. In a reopened basilar tip aneurysm, Y-like stent placement through a Neuroform stent failed. With secondary stent placement (n = 8), all affected vessels could be safety reopened. None of these patients suffered from transient or permanent neurologic deficits. Using the jailing technique, it was possible to place two parallel stents in the internal carotid artery and posterior cerebral artery (PCA) in a reopened wide-necked PCA aneurysm. Conclusion: Apart from the primary use of the Enterprise stent in wide-necked aneurysm secondary stenting after coiling is a feasible technique to reopen occluded parent or branching arteries. Initial microcatheter placement in the artery which is at risk to get occluded when fitting the aneurysm is a valuable option.