Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Acta Neurochirurgica
Published in: Acta Neurochirurgica 8/2016

01-08-2016 | Experimental Research - Vascular

Stent-assisted coil embolization of challenging intracranial aneurysms: initial and mid-term results with low-profile ACCLINO devices

Authors: Derya Tureli, Soheil Sabet, Serkan Senol, Nurten Andac, Halil Donmez, Serdar Geyik, Feyyaz Baltacioglu, Saruhan Cekirge

Published in: Acta Neurochirurgica | Issue 8/2016

Login to get access

Abstract

Background

Stent-assisted coiling using low-profile, self-expandable and retrievable stents is a valid option in endovascular treatment of challenging intracranial aneurysms. This study aims to evaluate the feasibility and efficacy of ACCLINO 1.9 F and ACCLINO Flex stent systems, designed for use as adjunctive products in coil embolization of intracranial aneurysms.

Methods

Case files of 47 patients, and 52 aneurysms in total, treated with at least one ACCLINO 1.9 F or ACCLINO Flex stent were retrospectively evaluated. Technical success, complications, and angiographic outcomes were assessed based on immediate post-procedural controls along with 6th and 12th month angiograms.

Results

Mechanical untoward event rate, including asymptomatic complications, is 9.6 % (five out of 52 aneurysms). Failed dual-stenting attempt rate is 15.4 % (two out of 13). Overall procedure-related morbidity is 4.2 % with no neurologic sequelae. Initial occlusion rate is 90.4 % (47 aneurysms). One patient had residual filling in the aneurysm neck, which was stable throughout follow-up. The remaining four cases had spontaneous follow-up occlusion. Recanalization rate at 6th month is 2.1 % with one aneurysm requiring retreatment. One patient was lost to follow-up. There is no mortality associated with treatment.

Conclusions

Stent–assisted coil embolization with ACCLINO stents in single or dual configurations is a feasible treatment option for challenging intracranial aneurysms. Follow-up results are encouraging; techniques were effective in complex cases and there were no clinically significant adverse outcomes.
Literature
1.
2.
3.
Akmangit I, Aydin K, Sencer S, Topcuoglu OM, Topcuoglu ED, Daglioglu E, Barburoglu M, Arat A (2015) Dual stenting using low-profile LEO baby stents for the endovascular management of challenging intracranial aneurysms. AJNR Am J Neuroradiol 36:323–329CrossRefPubMed
4.
Akpek S, Arat A, Morsi H, Klucznick RP, Strother CM, Mawad ME (2005) Self-expandable stent-assisted coiling of wide-necked intracranial aneurysms: a single-center experience. AJNR Am J Neuroradiol 26:1223–1231PubMed
5.
Aydin K, Arat A, Sencer S, Barburoglu M, Men S (2015) Stent-assisted coiling of wide-neck intracranial aneurysms using low-profile Leo baby stents: initial and midterm results. AJNR Am J Neuroradiol 36:1934–1941CrossRefPubMed
6.
Behme D, Weber A, Kowoll A, Berlis A, Burke TH, Weber W (2015) Low-profile Visualized Intraluminal Support device (LVIS Jr) as a novel tool in the treatment of wide-necked intracranial aneurysms: initial experience in 32 cases. J Neurointerv Surg 7:281–285CrossRefPubMed
7.
Benndorf G, Claus B, Strother CM, Chang L, Klucznik RP (2006) Increased cell opening and prolapse of struts of a neuroform stent in curved vasculature: value of angiographic computed tomography: technical case report. Neurosurgery 58:ONS-E380; discussion ONS-E380
8.
Bodily KD, Cloft HJ, Lanzino G, Fiorella DJ, White PM, Kallmes DF (2011) Stent-assisted coiling in acutely ruptured intracranial aneurysms: a qualitative, systematic review of the literature. Am J Neuroradiol 32:1232–1236CrossRefPubMed
9.
Brassel F, Melber K, Schlunz-Hendann M, Meila D (2015) Kissing-Y stenting for endovascular treatment of complex wide necked bifurcation aneurysms using Acandis ACCLINO stents: results and literature review. J NeuroIntervent Surg 1–10
10.
Cohen JE, Melamed I, Itshayek E (2014) X-microstenting and transmesh coiling in the management of wide-necked tent-like anterior communicating artery aneurysms. J Clin Neurosci 21:664–667CrossRefPubMed
11.
Daluolio M, Calbucci F, Fioravanti A, Bortolotti C, Cirillo L, Princiotta C, Leonardi M (2013) Revascularized giant aneurysm of the anterior communicating artery after surgery and embolization, occluded by placement of a Leo + Baby intracranial stent. Neuroradiol J 26:320–326CrossRef
12.
Ebrahimi N, Claus B, Lee CY, Biondi A, Benndorf G (2007) Stent conformity in curved vascular models with simulated aneurysm weeks using flat-panel CT: an in vitro study. Am J Neuroradiol 28:823–829PubMed
13.
Gao B, Baharoglu MI, Cohen AD, Malek AM (2013) Y-stent coiling of basilar bifurcation aneurysms induces a dynamic angular vascular remodeling with alteration of the apical wall shear stress pattern. Neurosurgery 72:617–628CrossRefPubMed
14.
Gao B, Baharoglu MI, Malek AM (2013) Angular remodeling in single stent-assisted coiling displaces and attenuates the flow impingement zone at the neck of intracranial bifurcation aneurysms. Neurosurgery 72:739–748CrossRefPubMed
15.
Heller RS, Malek AM (2015) Delivery technique plays an important role in determining vessel wall apposition of the Enterprise self-expanding intracranial stent. J NeuroIntervent Surg 3:340–343CrossRef
16.
Heller RS, Miele WR, Do-Dai DD, Malek AM (2011) Crescent sign on magnetic resonance angiography revealing incomplete stent apposition: correlation with diffusion-weighted changes in stent-mediated coil embolization of aneurysms. J Neurosurg 115:624–632CrossRefPubMed
17.
Innovations (2012) Acandis ACCLINO 1.9-F stent system. Endovasc Today 11:100
18.
Kabbasch CLT, Faymonville C, Dorn F, Mpotsaris A (2014) Initial clinical experience with a new self-expanding nitinol microstent for the treatment of wide-neck intracranial cerebral aneurysms: the Acandis ACCLINO stent. J Vasc Interv Neurol 8:1–6
19.
Krajewski S, Neumann B, Kurz J, Perle N, Avci-Adali M, Cattaneo G, Wendel HP (2015) Preclinical evaluation of the thrombogenicity and endothelialization of bare metal and surface-coated neurovascular stents. AJNR Am J Neuroradiol 36:133–139CrossRefPubMed
20.
Lawson MF, Newman WC, Chi YY, Mocco JD, Hoh BL (2011) Stent-associated flow remodeling causes further occlusion of incompletely coiled aneurysms. Neurosurgery 69:598–603CrossRefPubMed
21.
Mascitelli JR, Moyle H, Oermann EK, Polykarpou MF, Patel AA, Doshi AH, Gologorsky Y, Bederson JB, Patel AB (2015) An update to the Raymond–Roy occlusion classification of intracranial aneurysms treated with coil embolization. J Neurointerv Surg 7:496–502CrossRefPubMed
22.
McLaughlin N, McArthur DL, Na M (2013) Use of stent-assisted coil embolization for the treatment of wide-necked aneurysms: a systematic review. Surg Neurol Int 4:43CrossRefPubMedPubMedCentral
23.
Molyneux AJ (2006) Ruptured intracranial aneurysms-clinical aspects of subarachnoid hemorrhage management and the international subarachnoid aneurysm trial. Neuroimaging Clin N Am 16:391–396CrossRefPubMed
24.
Möhlenbruch M, Herweh C, Behrens L, Jestaedt L, Amiri H, Pa R, Bendszus M, Pham M (2014) The LVIS Jr. microstent to assist coil embolization of wide-neck intracranial aneurysms: Clinical study to assess safety and efficacy. Neuroradiology 56:389–395CrossRefPubMed
25.
Naggara ON, Lecler A, Oppenheim C, Meder JF, Raymond J (2012) Endovascular treatment of intracranial unruptured aneurysms: a systematic review of the literature on safety with emphasis on subgroup analyses. Radiology 263:828–835CrossRefPubMed
26.
27.
Piotin M, Blanc R, Spelle L, Mounayer C, Piantino R, Schmidt PJ, Moret J (2010) Stent-assisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms. Stroke 41:110–115CrossRefPubMed
28.
Poncyljusz W, Biliński P, Safranow K, Baron J, Zbroszczyk M, Jaworski M, Bereza S, Burke TH (2014) The LVIS/LVIS Jr. stents in the treatment of wide-neck intracranial aneurysms: multicentre registry. J NeuroIntervent Surg 7:524–529CrossRef
29.
Shapiro M, Becske T, Sahlein D, Babb J, Nelson PK (2012) Stent-supported aneurysm coiling: a literature survey of treatment and follow-up. Am J Neuroradiol 33:159–163CrossRefPubMed
30.
Spiotta AM, Miranpuri A, Chaudry MI, Turner RD, Turk AS (2013) Combined balloon stent technique with the scepter C balloon and low-profile visualized intraluminal stent for the treatment of intracranial aneurysms. J Neurointerv Surg 5(Suppl 3):iii79–iii82CrossRefPubMed
31.
Tahtinen OI, Vanninen RL, Manninen HI, Rautio R, Haapanen A, Niskakangas T, Rinne J, Keski-nisula L (2009) Wide-necked intracranial aneurysms: treatment with stent-assisted coil embolization during acute subarachnoid hemorrhage-experience in 61consecutive patients. Radiology 253:199–208CrossRefPubMed
32.
Valdivia y Alvarado M, Ebrahimi N, Benndorf G (2009) Study of conformability of the new LEO PLUS stent to a curved vascular model using flat-panel detector computed tomography (DynaCT). Neurosurgery 64:130–134
33.
Wanke I, Doerfler A, Schoch B, Stolke D, Forsting M (2003) Treatment of wide-necked intracranial aneurysms with a self-expanding stent system: initial clinical experience. AJNR Am J Neuroradiol 24:1192–1199PubMed
34.
Wanke I, Forsting M (2008) Stents for intracranial wide-necked aneurysms: more than mechanical protection. Neuroradiology 50:991–998CrossRefPubMed
35.
Zanaty M, Chalouhi N, Tjoumakaris SI, Rosenwasser RH, Gonzalez LF, Jabbour P (2014) Flow-diversion panacea or poison? Front Neurol 5:1–8CrossRef
Metadata
Title
Stent-assisted coil embolization of challenging intracranial aneurysms: initial and mid-term results with low-profile ACCLINO devices
Authors
Derya Tureli
Soheil Sabet
Serkan Senol
Nurten Andac
Halil Donmez
Serdar Geyik
Feyyaz Baltacioglu
Saruhan Cekirge
Publication date
01-08-2016
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 8/2016
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-016-2839-8

Other articles of this Issue 8/2016

Acta Neurochirurgica 8/2016 Go to the issue

Case Report - Brain Tumors

Temporal aneurysmal bone cyst: cost-effective method to achieve gross total resection

Clinical Article - Neurosurgical Techniques

Fewer complications with bolt-connected than tunneled external ventricular drainage

Technical Note - Neurosurgical Techniques

Transposition of the paraclival carotid artery: a novel concept of self-retaining vascular retraction during endoscopic endonasal skull base surgery technical report

Case Report - Spine

Intradural synovial cyst of the atlantoaxial joint: a case report

Letter to the editor - Neurosurgical Anatomy

Ventriculoperitoneal shunt malfunction secondary to distal catheter entrapment at the right paracolic gutter

Clinical Article - Brain Injury

Military neurosurgery in operation: experience in the French role-3 medical treatment facility of Kabul