One-year Angiographic Results After pCONus Stent-Assisted Coiling of 40 Wide-Neck Middle Cerebral Artery Aneurysms. Issue 6 (23rd March 2017)

• Record Type: Journal Article
• Authors: Gory, Benjamin; Aguilar-Pérez, Marta; Pomero, Elisa; Turjman, Francis; Weber, Werner; Fischer, Sebastian; Henkes, Hans; Biondi, Alessandra
• Is Part Of: Neurosurgery. Volume 80:Issue 6(2017)
• Page Start: 925
• Page End: 933
• Publication Date: 2017-03-23
• Subjects: Intracranial aneurysm -- Coiling -- Stenting -- Stent-assisted coiling -- Outcome -- Middle cerebral artery -- Clipping; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyw131
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: Bifurcation middle cerebral artery (MCA) aneurysms with wide neck are amenable to endovascular coiling with pCONus stent, a recent device dedicated to wide-neck bifurcation intracranial aneurysms. OBJECTIVE: To evaluate the 1-year angiographic follow-up of wide-neck MCA aneurysms treated with pCONus. METHODS: Forty MCA aneurysms (mean dome size, 7.7 mm; mean neck size, 5.6 mm) coiled with pCONus were retrospectively evaluated. "Recanalization" was defined as worsening, and "progressive thrombosis" was defined as improvement on the Raymond scale. RESULTS: Angiographic midterm (mean, 11.9 months; range, 3-20) follow-up was obtained in all aneurysms. Retreatment was performed in 9 aneurysms (22.5%) without clinical complications, and postoperative angiographic outcome included 2 complete occlusions and 7 neck remnants. Six aneurysms were followed after retreatment (mean, 8.8 months), and presented complete occlusion in 1 case, neck remnant in 4 cases, and aneurysm remnant in 1 case. Among the 31 aneurysms, follow-up showed complete occlusion in 67.7% (21/31), neck remnants in 29% (9/31), and aneurysm remnants in 3.3% (1/31). Adequate aneurysm occlusion (total occlusion and neck remnant) was obtained in 96.7% (30/31). Among these 31 aneurysms, improvement of the rate of occlusion was observed in 15 aneurysms (48.4%), and recurrence in 2 aneurysms (6.5%). There was no 1-year angiographic recurrence of 3- or 6-month totally occluded aneurysms. CONCLUSION: pCONus stent allows a safe coiling of wide-neck MCA aneurysms usually considered as surgical with a low recanalization rate for those adequately occluded at 3 to 6 months. Angiographic results improve over time due to progressive aneurysm thrombosis in around 50% of cases.