Semi-jailing technique for coil embolization of complex, wide-necked intracranial aneurysms
Department of Radiology
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
Neurology | Radiology
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.
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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
Hong, Bo; Patel, Neil V.; Gounis, Matthew J.; DeLeo, Michael J. 3rd; Linfante, Italo; Wojak, Joan C.; and Wakhloo, Ajay K., "Semi-jailing technique for coil embolization of complex, wide-necked intracranial aneurysms" (2009). University of Massachusetts Medical School. Senior Scholars Program. Paper 195.