Wingspan stent-assisted coiling of intracranial aneurysms with symptomatic parent artery stenosis: experience in 35 patients with mid-term follow-up results

Background

There is a potential risk of aneurysm rupture after parent artery revascularization because of increased blood flow. The purpose of this study is to assess the efficacy and safety of Wingspan stent-assisted coil embolization in the treatment of intracranial aneurysms with symptomatic parent artery stenosis.

Methods

Thirty-five consecutive patients (19 men, 16 women; age range, 48–79 years; mean age, 60.4 years) harboring 35 unruptured wide-necked or fusiform intracranial aneurysms (mean size 6.8 mm; range 2.5–18 mm.) with symptomatic parent artery stenosis (mean degree 71.1%; range 50–92%) were treated with the Wingspan stent-assisted coiling. Twenty-four lesions were located in the anterior circulation and eleven in the posterior circulation. Patients were premedicated with antiplatelet therapy consisting of aspirin 300 mg and clopidogrel 75 mg for at least 3 days before the procedure. Following pre-dilatation and stent placement, a coiling microcatheter entered the aneurysm through the interstices of the stent, and then coiling was performed. After the procedure, clopidogrel 75 mg daily was recommended for an additional 30 days, and aspirin 100 mg was recommended throughout follow-up. For all patients, clinical follow-up was conducted by clinic visitation, or telephone interview. Angiographic follow-up with DSA was recommended at 6 months and 1 year after the procedure. Angiography follow-up (mean time 10.6 months) was obtained in 31 cases (88.6%). The technical feasibility of the procedure, procedure-related complications, angiographic results, clinical outcome and follow-up angiography were evaluated.

Results

In every case, technical success was achieved. The degree of stenosis was reduced from 71.1% to 17.4% after balloon angioplasty and stenting. Immediate angiography demonstrated complete occlusion in 25 cases (71.4%), neck remnant in 7 cases (20.0%), and incomplete occlusion in 3 cases (8.6%). Procedure-related morbidity occurred in two patients (5.7%), including thromboembolism (n = 1) and occlusion of small penetrating arteries (n = 1). At follow-up (mean time 18.3 months), two additional cases of ischemic stroke occurred. The overall frequency of any stroke, intracranial hemorrhage, or death within 30 days or ipsilateral stroke beyond 30 days was 11.4%. No rehemorrhage of treated aneurysm occurred. At angiographic follow-up, four cases demonstrated ≥50% in-stent restenosis (12.9%), one of which was symptomatic, and two aneurysms (6.4% of the follow-up angiograms) demonstrated recanalization.

Conclusion

We found that the Wingspan stent-assisted coil embolization was helpful in the treatment of intracranial aneurysms with parent artery stenosis.