Intra-aneurysmal pressure changes during stent-assisted coiling

Area of Science:

• Endovascular Neurosurgery
• Cerebrovascular Hemodynamics
• Medical Device Engineering

Background:

• Intracranial aneurysms pose significant risks, necessitating effective endovascular treatment strategies.
• Understanding hemodynamics within aneurysms is crucial for evaluating treatment efficacy.
• Current treatments like coiling and stenting have varying impacts on intra-aneurysmal pressure.

Purpose of the Study:

• To measure intra-saccular pressure in intracranial aneurysms.
• To compare the hemodynamic effects of coiling, stenting, and stent-assisted coiling.
• To investigate the relationship between stent characteristics and pressure reduction.

Main Methods:

• Intra-saccular pressure measurements using an arterial pressure transducer in 45 patients.
• Measurements taken in parent artery and aneurysm dome before and after interventions.
• Comparison of pressure changes following coiling, stenting, and stent-assisted coiling with various braided stents.

Main Results:

• Stent presence showed a significant inverse correlation with systolic and diastolic intra-aneurysmal pressure.
• Stent implantation significantly decreased diastolic intra-aneurysmal pressure (p=0.046).
• Coil embolization alone did not significantly alter intra-aneurysmal pressure, irrespective of packing density or stent use.

Conclusions:

• Low-profile braided stents demonstrate potential for blood flow diversion, reducing diastolic pressure.
• Stent porosity correlates with flow-diverting properties.
• Coiling is less effective than stenting in modifying intra-aneurysmal hemodynamics.