Transcirculation approach for stent-assisted coiling of intracranial aneurysms: A multicenter study

Justin R. Mascitelli, Michael R. Levitt, Christoph J. Griessenauer, Louis J. Kim, Bradley Gross, Adib Abla, Ethan Winkler, Brian Jankowitz, Ramesh Grandhi, Oded Goren, Clemens M. Schirmer

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The transcirculation approach (TCA) for stent-assisted coiling (SAC) of intracranial aneurysms may be useful for certain wide-neck bifurcation aneurysms as well as those with acute-angle efferent branches. Objective: To describe a multicenter experience using the TCA for SAC. Methods: A multicenter, retrospective study (2016-2020) of aneurysm treatment using SAC via the TCA. Angiographic outcome was scored using the Raymond Scale (adequate occlusion 1 and 2), and clinical outcome was scored using a modified Rankin Scale (good outcome 0-2) Results: Twenty-nine patients with 29 aneurysms were included (62.1% female; average age 61; 89.7% unruptured; 13.8% previously treated; average dome size 6.4 mm; average neck 4.4 mm). Aneurysm locations included internal carotid artery-fetal posterior cerebral artery (n=4), internal carotid artery terminus (n=4), anterior communicating artery (n=8), vertebral artery-posterior inferior cerebellar artery (n=2), and basilar tip (n=11). The TCA used communicating arteries (93.1%; average 1.6 mm), intermediate catheters (51.7%), jailing technique (62.1%), and staged procedures (10.3%). The most common stent was the Neuroform Atlas (Stryker; 69%). Immediate adequate occlusion was obtained in 75.9%, and five patients with inadequate occlusion progressed to adequate occlusion at follow-up. One (3.4%) procedural complication occurred: a watershed stroke in the setting of baseline four-vessel extracranial disease. Two patients had a poor outcome unrelated to the TCA. The majority of patients (86.4%) had a good clinical outcome. One case of in-stent stenosis due to non-compliance with medication was seen, which resolved with medication resumption. Conclusions: The TCA for SAC can be performed for a variety of aneurysms with a low complication rate and good clinical outcomes.

Original languageEnglish (US)
Article numberneurintsurg-2020-016899
JournalJournal of neurointerventional surgery
DOIs
StateAccepted/In press - 2020

Keywords

  • aneurysm
  • coil
  • stent
  • technique

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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