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Abstract

Background

It has been previously reported in several studies that deformation of parent artery (DPA) occurs after stent-assisted coil embolization (SACE) for intracranial aneurysms (IAs).

Objective

To investigate the predisposing factors of stent-induced DPA, as well as its effect on the follow-up of aneurysm embolization.

Methods

Clinical and imaging data were collected from 198 patients (201 aneurysms). Angles of the stent-covered parental artery were measured before treatment and during follow-up. Cases in which the angle had changed more than 5 degrees, were defined as DPA. The related factors of DPA were analyzed. The relation between DPA and follow-up results was also studied.

Results

Univariate analysis revealed that sex (p = 0.014), age (p = 0.017), aneurysm location (p < 0.001), stent type (p < 0.001), aneurysm size (p = 0.019), and pretreatment angle (p = 0.002) correlated with DPA. On the other hand, multivariate analysis revealed that aneurysms located in the anterior communicating artery (ACOA) (OR = 4.559, p = 0.013) and middle cerebral artery (MCA) (OR = 9.474, p < 0.001) were independent predisposing factors for DPA after stent implantation, whereas a braided stent (OR = 0.221, p = 0.030), flow diverter (FD) device (OR = 0.100, p = 0.028) were negative factors to develop DPA. The complete occlusion rate in the DPA group was higher (p = 0.035) than in the non-DPA group.

Conclusions

Aneurysms located in ACOA and MCA are more prone to DPA after SACE than aneurysms at other locations in the anterior circulation, braided stents and FD devices do not predispose to induce vascular deformation. DPA may be beneficial for the long-term cure of IAs after SACE.

Keywords

Anterior circulation saccular aneurysm stent deformation of the parent artery follow up

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References

Lubicz

Bandeira

Bruneau

, et al. Stenting is improving and stabilizing anatomical results of coiled intracranial aneurysms. Neuroradiology 2009; 51: 419.

Phan

Huo

Jia

, et al. Meta-analysis of stent-assisted coiling versus coiling-only for the treatment of intracranial aneurysms. J Clin Neuroence 2016; 31: 15–22.

Shobayashi

Tateshima

Kakizaki

, et al. Intra-aneurysmal hemodynamic alterations by a self-expandable intracranial stent and flow diversion stent: high intra-aneurysmal pressure remains regardless of flow velocity reduction. J Neurointerv Surg 2013; 5: i38–i42.

Tremmel

Xiang

Natarajan

, et al. Alteration of intra-aneurysmal hemodynamics for flow diversion using enterprise and vision stents. World Neurosurg 2010; 74: 306–315.

Wang

Tian

Jian

, et al. Flow diverter effect of LVIS stent on cerebral aneurysm hemodynamics: a comparison with enterprise stents and the pipeline device. J Transl Med 2016; 14: 199.

Wang

Zhang

, et al. Efficacy of LVIS vs. Enterprise stent for endovascular treatment of Medium-sized intracranial aneurysms: a hemodynamic comparison study. Front Neurol 2019; 10: 522.

Zenteno

Santos-Franco

Freitas-Modenesi

, et al. Use of the sole stenting technique for the management of aneurysms in the posterior circulation in a prospective series of 20 patients. J Neurosurg 2008; 108: 1104–1118.

Appanaboyina

Mut

Loehner

, et al. Simulation of intracranial aneurysm stenting: techniques and challenges. Comp Methods Appl Mech Eng 2009; 198: 3567–3582.

Larrabide

Kim

Augsburger

, et al. Fast virtual deployment of self-expandable stents: method and in vitro evaluation for intracranial aneurysmal stenting. Med Image Anal 2012; 16: 721–730.

10.

King

Chueh

Van

, et al. The effect of intracranial stent implantation on the curvature of the cerebrovasculature. AJNR Am J Neuroradiol 2012; 33: 1657.

11.

Gao

Baharoglu

Cohen

, et al. Stent-assisted coiling of intracranial bifurcation aneurysms leads to immediate and delayed intracranial vascular angle remodeling. Am. J Neuroradiol 2012; 33: 649–654.

12.

Beller E, Klopp D, Gottler J, et al. Closed-Cell stent-assisted coiling of intracranial aneurysms: evaluation of changes in vascular geometry using digital subtraction angiography. Plos One 2016; 11: e153403.

13.

Chau

Mondot

Sachet

, et al. Modification of cerebral vascular anatomy induced by Leo stent placement depending on the site of stenting: a series of 102 cases. Interv Neuroradiol 2016; 22: 666–673.

14.

Voß

Beuing

Janiga

, et al. Stent-induced vessel deformation after intracranial aneurysm treatment – A hemodynamic pilot study. Comput Biol Med 2019; 111: 103338.

15.

Melber

Meila

Draheim

, et al. Vascular angular remodeling by kissing-Y stenting in wide necked intracranial bifurcation aneurysms. J Neurointerv Surg 2016; 9: 1233–1237.

16.

, et al. Combined effects of flow diverting strategies and parent artery curvature on aneurysmal hemodynamics: a CFD study. Plos One 2015; 10: e138648.

17.

Raymond

Guilbert

Weill

, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003; 34: 1398–1403.

18.

Mitra

Herwadkar

Soh

, et al. Follow-Up of intracranial aneurysms treated with matrix detachable coils: a single-center experience. AJNR Am J Neuroradiol 2007; 28: 362.

19.

Yamaguchi

Ito

Osaki

, et al. Narrowing of the angle of the parent artery after coil embolization increases the risk for aneurysm recurrence. Clin Neurol Neurosurg 2021; 203: 106568.

20.

Huang

, et al. Vascular geometry change because of endovascular stent placement for anterior communicating artery aneurysms. Ajnr Am J Neuroradiol 2011; 32: 1721–1725.

21.

Saglam

Kizilkilic

Anagnostakou

, et al. Geometrical characteristics after Y-stenting of the basilar bifurcation. Diagn Interv Radiol 2015; 21: 483–487.

22.

Piotin M, Blanc R, Spelle L, et al. Stent-assisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms. Stroke 2010; 41: 110–115.

23.

Jeong

Han

Rhee

. The hemodynamic alterations induced by the vascular angular deformation in stent-assisted coiling of bifurcation aneurysms. Comput Biol Med 2014; 53: 1–8.

24.

Xia

. Interaction between flow diverter and parent artery of intracranial aneurysm: a computational study. Appl Bionics Biomech 2017; 2017: 3751202.

25.

Tenjin

and, et al.

. Morphologic and hemodynamic changes after stent placement for experimental carotid aneurysm. Interv Neuroradiol 2002; 8: 143–149.

26.

Krischek O, Miloslavski E, Fischer S, et al. A comparison of functional and physical properties of self-expanding intracranial stents [Neuroform3, wingspan, solitaire, Leo(+), enterprise]. Minim Invasive Neurosurg Min 2011; 54: 21–28.

27.

Cho SH, Jo WI, Jo YE, et al. Bench-top comparison of physical properties of 4 commercially-available self-expanding intracranial stents. Neurointervention 2017; 12: 31–39.

28.

Gabrielsen

Greitz

. Normal size of the internal carotid, middle cerebral and anterior cerebral arteries. Acta Radiol Diagn 1970; 10: 1–10.

29.

Arutiunov

Baron

Majorova

. The role of mechanical factors in the pathogenesis of short-term and prolonged spasm of the cerebral arteries. J Neurosurg 1974; 40: 459–472.

30.

Tian

Liu

Zhang

, et al. Risk factors of angiographic recurrence after endovascular coil embolization of intracranial saccular aneurysms: a retrospective study using a multicenter database. Front Neurol 2020; 11: 1026.

31.

Schneiders

Marquering

van den Berg

, et al. Rupture-associated changes of cerebral aneurysm geometry: high-resolution 3D imaging before and after rupture. AJNR Am J Neuroradiol 2014; 35: 1358–1362.

32.

Sano

Ishida

Tsuji

, et al. Hemodynamic differences between ruptured and unruptured cerebral aneurysms simultaneously existing in the same location: 2 case reports and proposal of a novel parameter oscillatory velocity Index. World Neurosurg 2017; 98: 865–868.

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