Balloon-expandable stenting with and without coiling for wide-neck and complex aneurysms

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• Wide-necked, saccular, dissecting, and fusiform intracranial aneurysms present challenges for coil retention.
• Parent-artery stenting across the aneurysm can improve coil retention.

Purpose of the Study:

• To evaluate the efficacy and safety of using a balloon-expandable stent for treating intracranial aneurysms.
• To compare outcomes of stenting alone versus stenting with coiling for aneurysm treatment.

Main Methods:

• A balloon-expandable stent delivery system was used in 36 patients to treat 38 aneurysms.
• Stenting alone was performed in 15 aneurysms, including 7 in vertebral artery V4 segments.
• Stenting with immediate or delayed coiling was performed in 21 aneurysms.

Main Results:

• Stenting alone achieved complete obliteration in 7% and subtotal obliteration in 86% of aneurysms, with one failure.
• Stenting and coiling resulted in 57% complete obliteration and 43% subtotal obliteration, with no failures.
• Follow-up imaging (1-12 months) showed complete obliteration in 83% of patients (13 stent-only, 17 stent-plus-coiling).

Conclusions:

• Stenting and coiling achieved 88% complete obliteration at 1-12 month follow-up.
• Stenting alone was effective for V4-segment wide-necked aneurysms but inferior to combined therapy in less mobile vessels.
• The combined stenting and coiling approach demonstrated superior outcomes for intracranial aneurysm treatment.