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Erschienen in: Neuroradiology 9/2019

15.06.2019 | Interventional Neuroradiology

Safety and efficacy of intracranial aneurysm embolization using the “combined remodeling technique”: low-profile stents delivered through double lumen balloons: a multicenter experience

verfasst von: Mario Martínez-Galdámez, Kirill Orlov, Krzysztof Kadziolka, Mani Puthuran, Vladimir Kalousek, Boris Pabón, Jorge Escartín, Claudio Rodríguez, Arun Chandran, Dmitry Kislitsin, Vadim Berestov, Pedro Vega, Carlos Diaz, Guilherme Dabus

Erschienen in: Neuroradiology | Ausgabe 9/2019

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Abstract

Purpose

Since appearance of the balloon-remodeling technique and stent-assisted coiling, complex aneurysms have been treated successfully by endovascular means worldwide. Although these two techniques have been widely proven, the combination of both traditionally made the procedures more complicated technically. The aim of our study was to determine the technical success, safety, and efficacy of the low-profile stents delivered through double lumen balloons.

Methods

Clinical, procedural, and angiographic data were analyzed.

Results

Eighty-four patients (55 women; age range 20–81 years) harboring 86 aneurysms were included in this study. Aneurysm maximal diameter ranged from 2 to 26 mm, with mean 7.5 mm. There were 62 unruptured, 15 recanalized, and 9 acutely ruptured aneurysms. Aneurysm locations were ACoA (31), MCA (36), supraclinoid ICA (4), carotid bifurcation (2), basilar (7), PCA (3), PICA (2), and VA (1). Ninety-three devices were implanted (63 LVIS jr, 15 LEO Baby, 14 ACCLINO Flex and 1 Neuroform Atlas) through the double lumen balloons (Scepter C or XC and Eclipse 2 L). We found 2 minor clinical events (2.4%) and 1 major event (1.2%). Total intra-procedural technical complication rate was 11.6%. Follow-up was available for 71 patients with an average follow-up of 7 months. Complete and near complete occlusion was 90.1%. Residual aneurysms were seen in 9.9%.

Conclusion

The “combined remodeling technique” with low-profile stents delivered through double-lumen balloons is technically feasible, safe, and effective for the treatment of intracranial aneurysms. This technique allows the operator to avoid extra maneuvers.
Literatur
1.
Zurück zum Zitat Tan IY, Agid RF, Willinsky RA (2011) Recanalization rates after endovascular coil embolization in a cohort of matched ruptured and unruptured cerebral aneurysms. Interv Neuroradiol 17(1):27–35CrossRefPubMedPubMedCentral Tan IY, Agid RF, Willinsky RA (2011) Recanalization rates after endovascular coil embolization in a cohort of matched ruptured and unruptured cerebral aneurysms. Interv Neuroradiol 17(1):27–35CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat Moret J, Cognard C, Weill A, Castaings L, Rey A (1997) The “remodelling technique” in the treatment of wide neck intracranial aneurysms. Angiographic results and clinical follow-up in 56 cases. Interv Neuroradiol 3:21–35CrossRefPubMed Moret J, Cognard C, Weill A, Castaings L, Rey A (1997) The “remodelling technique” in the treatment of wide neck intracranial aneurysms. Angiographic results and clinical follow-up in 56 cases. Interv Neuroradiol 3:21–35CrossRefPubMed
3.
Zurück zum Zitat Shapiro M, Babb J, Becske T, Nelson PK (2008) Safety and efficacy of adjunctive balloon remodeling during endovascular treatment of intracranial aneurysms: a literature review. AJNR Am J Neuroradiol 29:1777–1781CrossRefPubMed Shapiro M, Babb J, Becske T, Nelson PK (2008) Safety and efficacy of adjunctive balloon remodeling during endovascular treatment of intracranial aneurysms: a literature review. AJNR Am J Neuroradiol 29:1777–1781CrossRefPubMed
4.
5.
Zurück zum Zitat Wang F, Chen X, Wang Y, Bai P, Wang HZ, Sun T, Yu HL (2016) Stent-assisted coiling and balloon-assisted coiling in the management of intracranial aneurysms: a systematic review & meta-analysis. J Neurol Sci 364:160–166CrossRefPubMed Wang F, Chen X, Wang Y, Bai P, Wang HZ, Sun T, Yu HL (2016) Stent-assisted coiling and balloon-assisted coiling in the management of intracranial aneurysms: a systematic review & meta-analysis. J Neurol Sci 364:160–166CrossRefPubMed
6.
Zurück zum Zitat Consoli A, Vignoli C, Renieri L et al (2016) Assisted coiling of saccular wide-necked unruptured intracranial aneurysms: stent versus balloon. NeuroIntervent Surg 8:52–57CrossRef Consoli A, Vignoli C, Renieri L et al (2016) Assisted coiling of saccular wide-necked unruptured intracranial aneurysms: stent versus balloon. NeuroIntervent Surg 8:52–57CrossRef
7.
Zurück zum Zitat Chalouhi N, Starke RM, Koltz MT, Jabbour PM, Tjoumakaris SI, Dumont AS, Rosenwasser RH, Singhal S, Gonzalez LF (2013) Stent-assisted coiling versus balloon remodeling of wide-neck aneurysms: comparison of angiographic outcomes. AJNR Am J Neuroradiol 34:1987–1992CrossRefPubMed Chalouhi N, Starke RM, Koltz MT, Jabbour PM, Tjoumakaris SI, Dumont AS, Rosenwasser RH, Singhal S, Gonzalez LF (2013) Stent-assisted coiling versus balloon remodeling of wide-neck aneurysms: comparison of angiographic outcomes. AJNR Am J Neuroradiol 34:1987–1992CrossRefPubMed
8.
Zurück zum Zitat Spiotta AM, Miranpuri A, Chaudry M, Turner RD IV, Turk AS (2013) Combined balloon stent technique with the scepter C balloon and low-profile visualized intraluminal stent for the treatment of intracranial aneurysms. J Neuro-Oncol 5(Suppl 3):iii79–iii82 Spiotta AM, Miranpuri A, Chaudry M, Turner RD IV, Turk AS (2013) Combined balloon stent technique with the scepter C balloon and low-profile visualized intraluminal stent for the treatment of intracranial aneurysms. J Neuro-Oncol 5(Suppl 3):iii79–iii82
9.
Zurück zum Zitat Kadziolka K, Tomas C, Robin G et al (2013) Combined use of a double-lumen remodeling balloon and a low-profile stent in the treatment of intracranial aneurysms (‘remostent’ technique): a technical note. J Neuroradiol 40:50–53CrossRefPubMed Kadziolka K, Tomas C, Robin G et al (2013) Combined use of a double-lumen remodeling balloon and a low-profile stent in the treatment of intracranial aneurysms (‘remostent’ technique): a technical note. J Neuroradiol 40:50–53CrossRefPubMed
10.
Zurück zum Zitat Park SY, Oh JS, Oh HJ, Yoon SM, Bae HG (2017) Safety and efficacy of low-profile, self-expandable stents for treatment of intracranial aneurysms: initial and midterm results - a systematic review and meta-analysis. Interv Neurol 6(3–4):170–182CrossRefPubMedPubMedCentral Park SY, Oh JS, Oh HJ, Yoon SM, Bae HG (2017) Safety and efficacy of low-profile, self-expandable stents for treatment of intracranial aneurysms: initial and midterm results - a systematic review and meta-analysis. Interv Neurol 6(3–4):170–182CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Ferns SP, Sprengers ME, van Rooij WJ et al (2009) Coiling of intracranial aneurysms: a systematic review on initial occlusion and reopening and retreatment rates. Stroke 40(8):e523–e529CrossRefPubMed Ferns SP, Sprengers ME, van Rooij WJ et al (2009) Coiling of intracranial aneurysms: a systematic review on initial occlusion and reopening and retreatment rates. Stroke 40(8):e523–e529CrossRefPubMed
12.
Zurück zum Zitat Dabus G, Brinjikji W, Amar AP, Delgado Almandoz JE, Diaz OM, Jabbour P et al (2018) Angiographic and clinical outcomes of balloon remodeling versus unassisted coil embolization in the ruptured aneurysm cohort of the gel the Nec study. J Neurointervent Surg 10(5):446–450CrossRef Dabus G, Brinjikji W, Amar AP, Delgado Almandoz JE, Diaz OM, Jabbour P et al (2018) Angiographic and clinical outcomes of balloon remodeling versus unassisted coil embolization in the ruptured aneurysm cohort of the gel the Nec study. J Neurointervent Surg 10(5):446–450CrossRef
13.
Zurück zum Zitat Piotin M, Blanc R, Spelle L et al (2010) Stent-assisted coiling of intracranial aneurysms. Clinical and angiographic results in 216 consecutive aneurysms. Stroke. 41:110–115CrossRefPubMed Piotin M, Blanc R, Spelle L et al (2010) Stent-assisted coiling of intracranial aneurysms. Clinical and angiographic results in 216 consecutive aneurysms. Stroke. 41:110–115CrossRefPubMed
14.
Zurück zum Zitat Pierot CC, Anxionnat R et al (2011) Remodeling technique for endovascular treatment of ruptured intracranial aneurysms had a higher rate of adequate postoperative occlusion than did conventional coil embolization with comparable safety. Radiology. 258(2):546–553CrossRefPubMed Pierot CC, Anxionnat R et al (2011) Remodeling technique for endovascular treatment of ruptured intracranial aneurysms had a higher rate of adequate postoperative occlusion than did conventional coil embolization with comparable safety. Radiology. 258(2):546–553CrossRefPubMed
15.
Zurück zum Zitat Gentric JC, Biondi A, Piotin M, Mounayer C, Lobotesis K, Bonafé A, Costalat V (2015) Balloon remodeling may improve angiographic results of stent-assisted coiling of unruptured intracranial aneurysms. Neurosurgery 76:441–445CrossRefPubMed Gentric JC, Biondi A, Piotin M, Mounayer C, Lobotesis K, Bonafé A, Costalat V (2015) Balloon remodeling may improve angiographic results of stent-assisted coiling of unruptured intracranial aneurysms. Neurosurgery 76:441–445CrossRefPubMed
16.
Zurück zum Zitat Mocco SKV, Albuquerque FC et al (2009) Treatment of intracranial aneurysms with the Enterprise stent: a multicenter registry. J Neurosurg 110(1):35–39CrossRefPubMed Mocco SKV, Albuquerque FC et al (2009) Treatment of intracranial aneurysms with the Enterprise stent: a multicenter registry. J Neurosurg 110(1):35–39CrossRefPubMed
17.
Zurück zum Zitat Biondi JV, Katz JM et al (2007) Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and midterm follow-up. Neurosurgery. 61(3):460–468CrossRefPubMed Biondi JV, Katz JM et al (2007) Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and midterm follow-up. Neurosurgery. 61(3):460–468CrossRefPubMed
18.
Zurück zum Zitat Shankar JJS, Quateen A, al WA (2016) Canadian registry of LVIS Jr for treatment of intracranial aneurysms (CaRLA). J NeuroIntervent Surg 0:1–5 Shankar JJS, Quateen A, al WA (2016) Canadian registry of LVIS Jr for treatment of intracranial aneurysms (CaRLA). J NeuroIntervent Surg 0:1–5
19.
Zurück zum Zitat Aydin K, Arat A, Sencer S, Barburoglu M, Men S (2015) Stent-assisted coiling of wide-neck intracranial aneurysms using low-profile LEO baby stents: initial and midterm results. AJNR Am J Neuroradiol 36(10):1934–1941CrossRefPubMed Aydin K, Arat A, Sencer S, Barburoglu M, Men S (2015) Stent-assisted coiling of wide-neck intracranial aneurysms using low-profile LEO baby stents: initial and midterm results. AJNR Am J Neuroradiol 36(10):1934–1941CrossRefPubMed
20.
21.
Zurück zum Zitat Tureli D, Sabet S, Senol S, Andac N, Donmez H, Geyik S, Baltacioglu F, Cekirge S (2016) Stent-assisted coil embolization of challenging intracranial aneurysms: initial and mid-term results with low-profile ACCLINO devices. Acta Neurochir 158:1545–1553CrossRefPubMed Tureli D, Sabet S, Senol S, Andac N, Donmez H, Geyik S, Baltacioglu F, Cekirge S (2016) Stent-assisted coil embolization of challenging intracranial aneurysms: initial and mid-term results with low-profile ACCLINO devices. Acta Neurochir 158:1545–1553CrossRefPubMed
22.
Zurück zum Zitat Yoo E, Kim DJ, Kim DI, Lee JW, Suh SH (2009) Bailout stent deployment during coil embolization of intracranial aneurysms. AJNR Am J Neuroradiol 30:1028–1034CrossRefPubMed Yoo E, Kim DJ, Kim DI, Lee JW, Suh SH (2009) Bailout stent deployment during coil embolization of intracranial aneurysms. AJNR Am J Neuroradiol 30:1028–1034CrossRefPubMed
Metadaten
Titel
Safety and efficacy of intracranial aneurysm embolization using the “combined remodeling technique”: low-profile stents delivered through double lumen balloons: a multicenter experience
verfasst von
Mario Martínez-Galdámez
Kirill Orlov
Krzysztof Kadziolka
Mani Puthuran
Vladimir Kalousek
Boris Pabón
Jorge Escartín
Claudio Rodríguez
Arun Chandran
Dmitry Kislitsin
Vadim Berestov
Pedro Vega
Carlos Diaz
Guilherme Dabus
Publikationsdatum
15.06.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
Neuroradiology / Ausgabe 9/2019
Print ISSN: 0028-3940
Elektronische ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-019-02240-x

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