Article Figures & Data
Figures
- 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.
- 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.
- 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.
- 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
Characteristics of the patients, aneurysms, and clinical and angiographic outcomes
No. Age (yr)/ Sex Presentation Initial mRS Loc Size (mm) No. of Stents Occlusion Gradea FU Angio (mo) mRS (mo) 1 M/67 Headache 0 VBJ 15 2 Grade 4 Grade 4 (18) 0 (24) 2 M/40 Headache 0 VA 11 2 Grade 4 Grade 4 (12) 0 (22) 3 M/71 Mass symptom 2 ACA A2 65 2 Grade 4 Grade 3 (6) 1 (20) 4 M/56 Postclip recurrence (ruptured) 4 MCA 11 3 Grade 4 Grade 4 (12) 1 (20) 5 M/63 Incidental 0 BA tip 13 2 Grade 3 Grade 3 (18) 0 (22) 6 M/56 Headache 0 VA 15 2 Grade 3 Grade 4 (12) 0 (18) 7 M/45 Incidental 0 BA tip 15 2 Grade 2 Grade 4 (12) 0 (15) 8 F/30 Postclip recurrence (unruptured) 0 ICA 12 2 Grade 3 Grade 3 (20) 0 (20) 9 M/52 Incidental 0 MCA 11 2 Grade 4 Grade 4 (12) 0 (12) 10 M/56 Incidental 0 MCA 13 2 Grade 4 Grade 4 (12) 0 (12) 11 F/61 Incidental 0 ICA 10.5 2 Grade 3 N/A 0 (8) 12 F/71 Headache 1 ICA 20 2 Grade 2 N/A 0 (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).
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↵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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