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Research ArticleInterventional

Reconstructive Endovascular Treatment of Fusiform or Ultrawide-Neck Circumferential Aneurysms with Multiple Overlapping Enterprise Stents and Coiling

P. Jeon, B.M. Kim, D.I. Kim, S.I. Park, K.H. Kim, D.J. Kim, S.H. Suh, S.K. Huh and Y.B. Kim
American Journal of Neuroradiology May 2012, 33 (5) 965-971; DOI: https://doi.org/10.3174/ajnr.A2857
P. Jeon
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B.M. Kim
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D.I. Kim
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S.I. Park
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K.H. Kim
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D.J. Kim
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S.H. Suh
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S.K. Huh
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Y.B. Kim
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    Fig 1.

    A 71-year-old man (patient 3) presenting with a giant aneurysm with partial thrombosis in the left anterior cerebral artery second portion. A, Brain MR imaging shows a giant 65-mm aneurysm with partial thrombosis in the left frontal region with marked perianeurysmal edema. B−D, The working projection (B), cross-sectional view (C), and its illustration (D) of 3D reconstruction reveal a large aneurysm sac (approximately 20 mm in diameter) at the left ACA A2. E, Stent-assisted coil embolization was performed after the Prowler Select Plus microcatheter was re-advanced to the initial position over the stent-loading wire of the first Enterprise stent. F, A second Enterprise stent was deployed by using the stent-within-a-stent technique following compact coiling of the aneurysm neck encompassing the parent artery (white arrow). Black arrows indicate the distal markers of 2 overlapping Enterprise stents. G, Final control angiogram reveals complete occlusion of the aneurysm sac and a well-preserved parent artery. H, The 6-month follow-up angiogram reveals a neck recurrence, but the follow-up T2WI MR image (not shown) revealed markedly decreased perianeurysmal edema.

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    Fig 2.

    A 63-year-old man with a progressively enlarging unruptured basilar artery tip aneurysm. A, The aneurysm had increased from 8 to 13 mm in a 1-year follow-up angiogram, and a circumferential encasement of the left PCA had developed. B, Stent-assisted coil embolization was performed after the Prowler Select Plus microcatheter was re-advanced to the initial position over the stent-loading wire. C, A second Enterprise stent was deployed following the coil embolization. D and E, Final control angiogram (D) reveals near-complete embolization of the aneurysm sac and a well-preserved left PCA (E, white arrowheads). F, The 18-month follow-up lateral angiogram reveals a stable state of the aneurysm occlusion.

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    Fig 3.

    A 30-year-old woman with a postclip recurrent aneurysm in the left posterior communicating artery, left anterior choroidal artery, and right anterior choroidal artery. The 3D reconstruction image (A) and its illustration (B) reveal a fusiform aneurysm of the right distal internal carotid artery with incorporation of the right anterior choroidal artery. C, Stent-assisted coil embolization was performed after deployment of the first Enterprise stent and re-advancement of the Prowler Select Plus microcatheter. White and black arrows indicate distal markers of the re-advanced Prowler Select Plus microcatheter and the deployed Enterprise stent, respectively. Asterisks indicate the coil-embolized left posterior communicating artery and anterior choroidal artery aneurysms. D, A second Enterprise stent was deployed after completion of coil embolization. The black arrows indicate distal markers of 2 overlapping Enterprise stents. E, Final control angiogram reveals near-complete occlusion of the aneurysm sac and preservation of the right internal carotid artery and the anterior choroidal artery (arrowheads). F, A 12-month follow-up angiogram in a working projection shows stable aneurysm occlusion.

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    Fig 4.

    A 45-year-old man with an unruptured large aneurysm at the basilar artery tip. A, The posterior view of the 3D reconstruction image reveals a large aneurysm encompassing the basilar artery tip and left posterior communicating artery. B, During the stent-assisted coiling, blood flow compromise through the stented basilar artery to the left PCA is noted (arrow). C, A second Enterprise stent deployment with a stent-within-stent technique immediately restores blood flow completely (arrow). D, The 12-month follow-up lateral angiogram reveals complete occlusion of the aneurysm sac but an asymptomatic severe degree of in-stent stenosis.

Tables

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  • Characteristics of the patients, aneurysms, and clinical and angiographic outcomes

    No.Age (yr)/ SexPresentationInitial mRSLocSize (mm)No. of StentsOcclusion GradeaFU Angio (mo)mRS (mo)
    1M/67Headache0VBJ152Grade 4Grade 4 (18)0 (24)
    2M/40Headache0VA112Grade 4Grade 4 (12)0 (22)
    3M/71Mass symptom2ACA A2652Grade 4Grade 3 (6)1 (20)
    4M/56Postclip recurrence (ruptured)4MCA113Grade 4Grade 4 (12)1 (20)
    5M/63Incidental0BA tip132Grade 3Grade 3 (18)0 (22)
    6M/56Headache0VA152Grade 3Grade 4 (12)0 (18)
    7M/45Incidental0BA tip152Grade 2Grade 4 (12)0 (15)
    8F/30Postclip recurrence (unruptured)0ICA122Grade 3Grade 3 (20)0 (20)
    9M/52Incidental0MCA112Grade 4Grade 4 (12)0 (12)
    10M/56Incidental0MCA132Grade 4Grade 4 (12)0 (12)
    11F/61Incidental0ICA10.52Grade 3 N/A0 (8)
    12F/71Headache1ICA202Grade 2 N/A0 (5)
    • Note:—Loc indicates location of the aneurysm; No. of stents, number of Enterprise stents; FU Angio, results on follow-up angiography; VBJ, vertebrobasilar junction; VA, vertebral artery; BA, basilar artery; N/A, not applicable (follow-up angiography is scheduled but not yet performed).

    • ↵a Occlusion grade: 0, aneurysm dome filling; 1, >50% sac filling from the aneurysm neck; 2, <50% sac filling from the aneurysm base; 3, filling restricted to a region that is smaller than the width of the original neck; 4, complete sac occlusion.5

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American Journal of Neuroradiology: 33 (5)
American Journal of Neuroradiology
Vol. 33, Issue 5
1 May 2012
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P. Jeon, B.M. Kim, D.I. Kim, S.I. Park, K.H. Kim, D.J. Kim, S.H. Suh, S.K. Huh, Y.B. Kim
Reconstructive Endovascular Treatment of Fusiform or Ultrawide-Neck Circumferential Aneurysms with Multiple Overlapping Enterprise Stents and Coiling
American Journal of Neuroradiology May 2012, 33 (5) 965-971; DOI: 10.3174/ajnr.A2857

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Reconstructive Endovascular Treatment of Fusiform or Ultrawide-Neck Circumferential Aneurysms with Multiple Overlapping Enterprise Stents and Coiling
P. Jeon, B.M. Kim, D.I. Kim, S.I. Park, K.H. Kim, D.J. Kim, S.H. Suh, S.K. Huh, Y.B. Kim
American Journal of Neuroradiology May 2012, 33 (5) 965-971; DOI: 10.3174/ajnr.A2857
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  • Stent usage in the treatment of intracranial aneurysms: past, present and future
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