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Updated: Aug 8, 2026
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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Longitudinal Stent Malapposition After Microcatheter Removal Is Associated With Incomplete Occlusion After Pipeline
Kazuaki Okamura1, Yoichi Morofuji1,2, Nobutaka Horie3
1Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Operative Neurosurgery (Hagerstown, Md.)
|August 7, 2026
Summary
Longitudinal malapposition of stents after Pipeline flow diversion is linked to incomplete aneurysm occlusion. Cone-beam computed tomography (CBCT) can identify this issue, aiding procedural adjustments for better outcomes.
Area of Science:
- Interventional neuroradiology
- Vascular neurosurgery
- Medical device technology
Background:
- Flow diversion effectively treats intracranial aneurysms, but incomplete occlusion is a challenge.
- Stent-vessel wall apposition is crucial for aneurysm healing.
- The impact of longitudinal malapposition on long-term outcomes is not well understood.
Purpose of the Study:
- To assess if longitudinal stent malapposition, detected by cone-beam computed tomography (CBCT) post-procedure, correlates with incomplete aneurysm occlusion.
- To evaluate the association between malapposition and Pipeline flow diversion outcomes.
- To investigate the clinical relevance of malapposition in aneurysm treatment.
Main Methods:
- Retrospective analysis of 54 intracranial aneurysms treated with Pipeline embolization device.
- CBCT imaging used to assess stent configuration immediately after microcatheter removal.
- Longitudinal malapposition defined as ≥5 mm incomplete stent-vessel wall apposition.
- Primary endpoint: aneurysm occlusion at 12 months (O'Kelly-Marotta scale).
Main Results:
- Complete occlusion (OKM D) achieved in 67% of aneurysms at 12 months.
- Longitudinal malapposition (≥5 mm) identified in 13% of cases.
- Incomplete occlusion occurred in 71% of aneurysms with malapposition versus 28% without (OR 6.5, P=.03).
- Malapposition in coil-assisted cases (13%) invariably led to incomplete occlusion.
Conclusions:
- Longitudinal malapposition ≥5 mm detected on CBCT is significantly associated with incomplete aneurysm occlusion post-Pipeline flow diversion.
- This association is particularly notable in coil-assisted procedures.
- CBCT assessment of malapposition may guide procedural optimization and risk stratification for improved aneurysm healing.
