Combined Treatment with Stenting and Coiling for Complex Cerebral Aneurysms: Preliminary Experience of Twenty Aneurysms Treated by New Generation Intracranial Stents

Abstract

We describe our preliminary experience of a combined treatment with stenting and coiling for ruptured and unruptured complex cerebral aneurysms (AA) using new generation stents (Enterprise®, LeoPlus®, Solitaire®). Eighteen patients, 20 AA, were treated by stenting and coiling. Some had sacciform wide-necked partially thrombosed aneurysms, other had fusiform AA. Six ruptured AA were treated early, while the other 14 were treated electively. In four out of 20 AA coiling was performed by Jailing technique and in three cases a remodelling technique was also performed. Patients with ruptured AA were previously administered a heparin protocol during the procedure and given aspirin (500 mg) after stenting. Patients with unruptured AA were administered plavix and aspirin for seven days before the procedure. Post-intervention medical therapy was plavix and aspirin for six months, then aspirin (100 mg). MRA and DSA at were performed after six to 12 months. Treatment was successfully performed in all cases. The stent could be navigated within the cerebral arteries without any exchange procedure, and thanks to its retractability, it was positioned accurately. No procedure-related complication occurred. Complete occlusion of the aneurysm was observed in 14/20 AA, partial occlusion with residual sac in 2/20. At four months a residual neck was observed in 4/20 with an increase in residual sac at one year in one case treated by coiling. At one year, MRA showed a reduction of the neck in one case and a stable residual neck in the other. Stenting and coiling for sacciform wide-necked or fusiform aneurysms is a safe procedure without complications. Medical-therapy pre and post procedure associated with follow-up are necessary to establish the occlusion rate.