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Navigation of Stents across Communicating Arteries for Aneurysm Embolization

Published online by Cambridge University Press:  23 September 2014

Muhammad Ejaz Ahmed ,
Cheemun Lum ,
Howard Lesiuk ,
Daniela Iancu  and
Marlise dos Santos
Muhammad Ejaz Ahmed
Affiliation:
Neuroradiology Section - Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
Cheemun Lum*
Affiliation:
Neuroradiology Section - Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
Howard Lesiuk
Affiliation:
Division of Neurosurgery - Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
Daniela Iancu
Affiliation:
Neuroradiology Section - Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
Marlise dos Santos
Affiliation:
Neuroradiology Section - Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
*
Neuroradiology Section - Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue Ottawa, Ontario, K1Y 4E9, Canada. Email: chlum@ottawahospital.on.ca
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Abstract

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Introduction:

Endovascular coiling of aneurysms crossing the Circle of Willis has been described in small case series. The technical challenges in manipulating a stent across the Circle of Willis lie in negotiating difficult angles and small arteries. We present our experience with treating aneurysms by stent assistance in which the Circle of Willis was crossed to facilitate optimal stent deployment.

Materials and methods:

We retrospectively reviewed the cases in our institution from January 2009 to June 2012 in which the Circle of Willis was traversed to facilitate optimal stent deployment. We measured the diameter of the communicating arteries traversed, caliber of the target arteries in which the stent was deployed and the most acute angle negotiated (“critical angle”). We compare our results with other published series in the literature.

Results:

Eight patients fulfilled the criteria: 5 males (45-66 years). There were three anterior and five posterior circulation aneurysms. Four of the aneurysms were ruptured. The PCOM was traversed in five cases, the ACOM in three cases. The mean diameter of the communicating artery was 1.17mm. The mean diameter of target arteries was 1.27mm. The “critical angle” was 72-147 degrees. In all patients, there was satisfactory obliteration of the aneurysm. There were two cases of minor SAH post procedure.

Conclusion:

Utilizing the Circle of Willis for optimal stent placement in aneurysm remodeling is technically feasible but challenging. This technique can be performed successfully in patients with acute SAH. The procedural risk must be balanced against potential complications such as SAH.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 41 , Issue 2 , March 2014 , pp. 193 - 199
Copyright
Copyright © The Canadian Journal of Neurological 2014

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