• World Neurosurg · Jun 2019

    Effect of Straightening the Parent Vessels in Stent-Assisted Coil Embolization for Anterior Communicating Artery Aneurysms.

    • Yusuke Funakoshi, Hirotoshi Imamura, Shoichi Tani, Hidemitsu Adachi, Ryu Fukumitsu, Tadashi Sunohara, Keita Suzuki, Yoshihiro Omura, Yuichi Matsui, Natsuhi Sasaki, Toshiaki Bando, Tatsumaru Fukuda, Ryo Akiyama, Kazufumi Horiuchi, Shinji Kajiura, Masashi Shigeyasu, and Nobuyuki Sakai.
    • Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe City, Japan. Electronic address: sf1wan0610@gmail.com.
    • World Neurosurg. 2019 Jun 1; 126: e410-e416.

    BackgroundStent-assisted coil embolization (SAC) for treating anterior communicating artery (AcomA) aneurysms is safe and effective. Straightening of parent vessels by stent placement can lead to progressive thrombosis. We describe our experience with SAC for AcomA aneurysms and demonstrate the effect of straightening the parent vessels.MethodsA total of 26 patients with AcomA aneurysms were treated using SAC in our institute between July 2010 and December 2017. Follow-up digital subtraction angiography was performed 6 months after treatment, magnetic resonance angiography was performed every year, and outcomes were analyzed.ResultsFrom all aneurysms (n = 24), 12 (50.0%) were neck remnant, and 12 (50.0%) were dome-filling types immediately after the procedure. At the 6-month digital subtraction angiography follow-up (n = 22), 13 (59.1%) aneurysms were complete obliteration, 8 (36.4%) were neck remnant, and 1 (4.5%) was dome filling. The median parent vessel angle was measured preoperatively at 98.1°, increased to 124.8° immediately after stent deployment, and further increased to 149.6° at the 6-month follow-up. Progressive thrombosis was observed in 13 of 22 (59.1%) aneurysms. The parent vessel angle change immediately after stent deployment in the progressive thrombosis group tended to be larger than that observed in the no thrombosis group; this change was significant at the 6-month follow-up. The median follow-up term was 18 months. No patients required retreatment.ConclusionsGood SAC outcomes were achieved for AcomA aneurysms, and hemodynamic changes related to straightening of the parent vessels is a consideration in SAC.Copyright © 2019 Elsevier Inc. All rights reserved.

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