Closed-Cell Stent-Assisted Coiling of Intracranial Aneurysms: Evaluation of Changes in Vascular Geometry Using Digital Subtraction Angiography

被引:15
作者
Beller, Ebba [1 ]
Klopp, David [2 ]
Goettler, Jens [1 ]
Kaesmacher, Johannes [1 ]
Zimmer, Claus [1 ]
Kirschke, Jan S. [1 ]
Prothmann, Sascha [1 ]
机构
[1] Tech Univ Munich, Klinikum Rechts Isar, Abt Diagnost & Intervent Neuroradiol, D-80290 Munich, Germany
[2] Acandis GmbH & Co KG, Pforzheim, Germany
来源
PLOS ONE | 2016年 / 11卷 / 04期
关键词
WALL SHEAR-STRESS; BIFURCATION ANEURYSMS; UNRUPTURED ANEURYSMS; CEREBRAL ANEURYSM; ARTERY ANEURYSMS; HEMODYNAMICS; FLOW; EMBOLIZATION; DEPLOYMENT; SIZE;
D O I
10.1371/journal.pone.0153403
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
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 alpha, determined by aneurysm neck and afferent vessel, and angle between afferent and efferent vessel close to (delta(1)), respectively, more remote from the aneurysm neck (delta(2)) 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 alpha = 119 degrees (+/- 6.5 degrees) pretreatment to 130 degrees (+/- 6.6 degrees) posttreatment (P <= .001), delta(1) = 129 degrees (+/- 6.4 degrees) to 139 degrees (+/- 6.1 degrees), (P <= .001) and delta(2) = 115 degrees (+/- 8.4 degrees) to 126 degrees (+/- 7.5 degrees), (P <= .01). Angular change of d1 in AcomA aneurysms was significant greater compared to sidewall aneurysms (26 degrees +/- 4.9 degrees versus 8 degrees +/- 2.3 degrees, P <= .05). The initial angle of delta(1) and delta(2) revealed a significantly inverse relationship to the angle increase (delta(1): r = -0.41, P <= .05 and delta(2): r = -0.47, P <= .01). Moreover, angle delta(1) was significantly higher in unruptured compared to ruptured aneurysms (135 degrees +/- 7.1 degrees versus 103 degrees +/- 10.8 degrees, 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.
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页数:11
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共 39 条
  • [31] Magnitude and role of wall shear stress on cerebral aneurysm - Computational fluid dynamic study of 20 middle cerebral artery aneurysms
    Shojima, M
    Oshima, M
    Takagi, K
    Torii, R
    Hayakawa, M
    Katada, K
    Morita, A
    Kirino, T
    [J]. STROKE, 2004, 35 (11) : 2500 - 2505
  • [32] Mid-term Results of Endovascular Coiling of Wide-Necked Aneurysms Using Double Stents in a Y Configuration
    Spiotta, Alejandro M.
    Gupta, Rishi
    Fiorella, David
    Gonugunta, Vivekananda
    Lobo, Bjorn
    Rasmussen, Peter A.
    Moskowitz, Shaye I.
    [J]. NEUROSURGERY, 2011, 69 (02) : 421 - 429
  • [33] INFLUENCE OF INTRACRANIAL ANEURYSM-TO-PARENT VESSEL SIZE RATIO ON HEMODYNAMICS AND IMPLICATION FOR RUPTURE: RESULTS FROM A VIRTUAL EXPERIMENTAL STUDY
    Tremmel, Markus
    Dhar, Sujan
    Levy, Elad I.
    Mocco, J.
    Meng, Hui
    [J]. NEUROSURGERY, 2009, 64 (04) : 622 - 630
  • [34] Hemodynamic-Morphologic Discriminants for Intracranial Aneurysm Rupture
    Xiang, Jianping
    Natarajan, Sabareesh K.
    Tremmel, Markus
    Ma, Ding
    Mocco, J.
    Hopkins, L. Nelson
    Siddiqui, Adnan H.
    Levy, Elad I.
    Meng, Hui
    [J]. STROKE, 2011, 42 (01) : 144 - 152
  • [35] Combined Effects of Flow Diverting Strategies and Parent Artery Curvature on Aneurysmal Hemodynamics: A CFD Study
    Xu, Jinyu
    Wu, Zhichen
    Yu, Ying
    Lv, Nan
    Wang, Shengzhang
    Karmonik, Christof
    Liu, Jian-Min
    Huang, Qinghai
    [J]. PLOS ONE, 2015, 10 (09):
  • [36] Bailout Stent Deployment during Coil Embolization of Intracranial Aneurysms
    Yoo, E.
    Kim, D. J.
    Kim, D. I.
    Lee, J. -W.
    Suh, S. H.
    [J]. AMERICAN JOURNAL OF NEURORADIOLOGY, 2009, 30 (05) : 1028 - 1034
  • [37] Sole stenting bypass for the treatment of vertebral artery aneurysms: Technical case report
    Zenteno, MA
    Murillo-Bonilla, LM
    Guinto, G
    Gomez, CR
    Martinez, SR
    Higuera-Calleja, J
    Lee, A
    Gomez-Llata, S
    [J]. NEUROSURGERY, 2005, 57 (01) : 208 - 208
  • [38] Ten-year follow-up of giant basilar aneurysm treated by sole stenting technique: A case report
    Zenteno M.
    Gómez C.R.
    Santos-Franco J.A.
    Vinuela F.
    Aburto-Murrieta Y.
    Lee A.
    [J]. Journal of Medical Case Reports, 4 (1)
  • [39] Use of the sole stenting technique for the management of aneurysms in the posterior circulation in a prospective series of 20 patients
    Zenteno, Marco Antonio
    Santos-Franco, Jorge Arturo
    Freitas-Modenesi, Jose Maria
    Gomez, Camilo
    Murillo-Bonilla, Luis
    Aburto-Murrieta, Yolanda
    Diaz-Romero, Ricardo
    Nathal, Edgar
    Gomez-Llata, Sergio
    Lee, Angel
    [J]. JOURNAL OF NEUROSURGERY, 2008, 108 (06) : 1104 - 1118