Senior Scholars Program

Title

Semi-jailing technique for coil embolization of complex, wide-necked intracranial aneurysms

UMMS Affiliation

Department of Radiology

Faculty Advisor

Alexei Bogdanov

Date

12-2009

Document Type

Article

Medical Subject Headings

Adult; Aged; Aspirin; *Blood Vessel Prosthesis; Cerebral Angiography; Embolization, Therapeutic; Female; Humans; Intracranial Aneurysm; Male; Microsurgery; Middle Aged; Platelet Aggregation Inhibitors; Prosthesis Design; *Stents; Ticlopidine; Treatment Outcome

Disciplines

Neurology | Radiology

Abstract

OBJECTIVE: Stent-assisted coiling of intracranial aneurysms is performed by placing a microcatheter through a stent's interstices or jailing the microcatheter between the stent and the artery. Both approaches impede manipulation of the microcatheter during coiling. We describe a modified jailing technique that improves catheter maneuverability and report the safety and efficacy of the method for the treatment of complex, wide-necked aneurysms.

METHODS: The semi-jailing technique involves the partial deployment of a retrievable stent, bridging part of the aneurysm neck while leaving space to maneuver the microcatheter. Twenty-two complex, wide-necked aneurysms, including 3 ruptured and 5 dissecting, were treated using the semi-jailing technique (15 women; mean age, 55.2 years).

RESULTS: The semi-jailing technique was successfully applied in all cases. Immediate posttreatment angiograms showed total occlusion of the aneurysm in 17 cases (77%), neck remnant in 3 cases (14%), and aneurysm dome filling in 2 cases (9%). Follow-up angiography available in 10 patients at an average of 8.5 months showed progressive occlusion in 1 aneurysm and 7 remained occluded. In 2 cases of dissecting aneurysms, retreatment was required. No permanent periprocedural morbidity was encountered. One patient died of complications secondary to intracranial hemorrhage 6 days after treatment. In 2 cases (9%), thromboembolic events after final stent placement were successfully treated with intraarterial thrombolysis. No delayed stent migration was seen.

CONCLUSION: Semi-jailing is a safe and effective stent-assisted coiling technique that facilitates treatment of complex, wide-necked aneurysms.

Rights and Permissions

Citation: Neurosurgery. 2009 Dec;65(6):1131-8; discussion 1138-9. doi: 10.1227/01.NEU.0000356983.23189.16. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Comments

Medical student Michael DeLeo participated in this study as part of the Senior Scholars research program at the University of Massachusetts Medical School.

PubMed ID

19934972