Stent assisted coiling

Stent-assisted coiling technology has been widely used in the treatment of ++intracranial aneurysm++s.

Stent-assisted coiling achieved better complete occlusion rates of aneurysms at 6 months or later after the procedure compared to balloon assisted coiling, without being associated with a higher risk of intraprocedural complications and retreatment 1).

Stent-assisted coiling (SAC) and balloon-assisted coiling (BAC) were alternative techniques developed to deal with complex aneurysms, but studies have shown their less than expected efficacy given their high rate of recanalization 2) 3) 4) 5).

Stent assisted coiling of unruptured wide necked intracranial aneurysms require antiplatelets to prevent stent thrombosis. The effect of the loading dose of antiplatelets prior to the stent coiling procedure in an unsecured wide necked ruptured intracranial aneurysm is not known.

In the series of Lodi et al carefully selected patients, therapeutic dual antiplatelet loading prior to stent assisted coiling of ruptured wide necked intracranial aneurysm was not associated with increased bleeding complications. However, thromboembolic events remain the main challenge. Further study is required to confirm the safety of antiplatelet loading in stent assisted ruptured intracranial aneurysm coiling 6).

see Middle cerebral artery aneurysm stent assisted coiling.

Stent assisted coiling case series.

There are several complications associated with Stent-assisted Coil Embolization (SACE) in cerebral aneurysm treatments, due to damaging operations by surgeons and undesirable mechanical properties of stents. Therefore, it is necessary to develop an in vitro simulator that provides both training and research for evaluating the mechanical properties of stents.

A new in vitro simulator for three-dimensional digital subtraction angiography was constructed, followed by aneurysm models fabricated with new materials. Next, this platform was used to provide training and to conduct photoelastic stress analysis to evaluate the SACE technique.

The average interaction stress increasingly varied for the two different stents. Improvements for the Maximum-Likelihood Expectation-Maximization method were developed to reconstruct cross-sections with both thickness and stress information.

The technique presented can improve a surgeon's skills and quantify the performance of stents to improve mechanical design and classification. This method can contribute to three-dimensional stress and volume variation evaluation and assess a surgeon's skills 7).

Wang F, Chen X, Wang Y, Bai P, Wang HZ, Sun T, Yu HL. Stent-assisted coiling and balloon-assisted coiling in the management of intracranial aneurysms: A systematic review & meta-analysis. J Neurol Sci. 2016 May 15;364:160-6. doi: 10.1016/j.jns.2016.03.041. Epub 2016 Mar 25. PubMed PMID: 27084238.
Shapiro M, Becske T, Sahlein D, Babb J, Nelson PK. Stent-supported aneurysm coiling: a literature survey of treatment and follow-up. AJNR Am J Neuroradiol (2012) 33(1):159–63.10.3174/ajnr.A2719
Coley S, Sneade M, Clarke A, Mehta Z, Kallmes D, Cekirge S, et al. Cerecyte coil trial: procedural safety and clinical outcomes in patients with ruptured and unruptured intracranial aneurysms. AJNR Am J Neuroradiol (2012) 33(3):474–80.10.3174/ajnr.A2836
White PM, Lewis SC, Gholkar A, Sellar RJ, Nahser H, Cognard C, et al. Hydrogel-coated coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms (HELPS): a randomised controlled trial. Lancet (2011) 377(9778):1655–62.10.1016/S0140-6736(11)60408-X
Piotin M, Pistocchi S, Bartolini B, Blanc R. Intracranial aneurysm coiling with PGLA-coated coils versus bare platinum coils: long-term anatomic follow-up. Neuroradiology (2012) 54(4):345–8.10.1007/s00234-011-0870-2
Lodi YM, Latorre JG, El-Zammar Z, Swarnkar A, Deshaies E, Fessler RD. Stent assisted coiling of the ruptured wide necked intracranial aneurysm. J Neurointerv Surg. 2012 Jul;4(4):281-6. doi: 10.1136/neurintsurg-2011-010035. Epub 2011 Jul 18. PubMed PMID: 21990500.
Shi C, Kojima M, Tercero C, Najdovski Z, Ikeda S, Fukuda T, Arai F, Negoro M. In vitro simulator with numerical stress analysis for evaluation of stent-assisted coiling embolization in cerebral aneurysm treatments. Int J Med Robot. 2014 Dec;10(4):505-15. doi: 10.1002/rcs.1563. Epub 2013 Dec 27. PubMed PMID: 24375971.
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