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BACKGROUND AND PURPOSE: Stent-assisted coiling of wide neck bifurcation aneurysms in the anterior communicating segment and basilar tip region can be performed with varying stent configurations, including single stenting or Y-stenting. Y-stenting requires two stents and thus incurs greater cost and procedural complexity than single-stent constructs. The influence of first stent type on the need for Y-stenting remains unknown. MATERIALS AND METHODS: Clinical and angiographic data were retrospectively obtained for patients that underwent stent-assisted coiling for basilar tip or anterior communicating aneurysms at a high-volume center. Patients were included in this study if stent-assisted coiling was performed using Neuroform Atlas or LVIS Jr stents. A multivariate binary logistic regression was performed to measure the influence of first stent type on the need for Y-stenting. RESULTS: Stent-assisted coiling was used to treat 82 aneurysms in 81 patients during the study period, and Y-stenting was performed in 18.3% (15/82) of cases. In multivariate logistic regression analysis, use of LVIS Jr. as the first stent did not significantly influence the need for subsequent Y-stenting after controlling for aneurysm morphology (OR 0.65, 95% CI 0.18-2.43). CONCLUSION: Controlling for aneurysm morphology and location, the use of Y-stenting for stent-assisted coiling was not independently influenced by the choice of LVIS Jr or Neuroform Atlas as the first stent. A larger cohort may reveal differences between these two stents, particularly for aneurysms with large neck sizes.

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OBJECTIVE: The safety of the stent-assisted coil embolization (SAC) technique for acutely ruptured aneurysms has not been established yet. SAC is believed to be associated with a high risk of thromboembolic and hemorrhagic complications in acute subarachnoid hemorrhage (SAH). The aim of this study was to evaluate the safety and efficacy of the SAC technique in the setting of acutely ruptured aneurysm. METHODS: A total of 102 patients who received endovascular treatment for acute SAH between January 2011 and December 2017 were enrolled. The SAC technique was performed in 38 of these patients, whereas the no-stent coil embolization (NSC) technique was performed in 64. The safety and efficacy of the SAC technique in acute SAH was evaluated as compared with the NSC technique by retrospective analysis of radiological and clinical outcomes. RESULTS: There were no significant differences in clinical or angiographic outcomes between the SAC and NSC techniques in patients with acute SAH. The rate of ventriculostomy-related hemorrhagic complications was higher in the SAC group than that in the NSC group (63.6% vs 12.5%; OR 12.25, 95% CI 1.78-83.94, p = 0.01). However, all these complications were asymptomatic and so small that they were only able to be diagnosed with imaging. CONCLUSIONS: Ruptured wide-necked aneurysms could be effectively and safely treated with the SAC technique, which showed clinical and angiographic outcomes similar to those of the NSC technique. Hence, the SAC technique with dual-antiplatelet drugs may be a viable option even in acute SAH.

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Management of anticoagulation and antiplatelet medications after neurosurgery can be complex, especially given that these patients have multiple medical comorbidities. In turn, neurosurgical patients are at high risk for the development of venous thromboembolism after surgery, so neurosurgeons must consider the use of pharmacologic prophylaxis. Developments in endovascular neurosurgery have produced therapies that require close management of antiplatelet medications to prevent postoperative complications. Any of these patient populations may need intrathecal access. This article highlights current strategies for managing these issues in the neurosurgical patient population.

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Although there have been reports of carotid artery pseudoaneurysm formation after adenoidectomy and/or tonsillectomy secondary to iatrogenic injury, there are no case reports of successful endovascular reconstruction of the injured artery in the pediatric population. In most pediatric cases, the internal carotid artery (ICA) is sacrificed. The authors report on a 6-year-old girl who presented with odynophagia, left-sided Horner's syndrome, hematemesis, and severe anemia 6 months after a tonsillectomy. On examination she was found to have a pulsatile mass along the left posterior lateral oropharynx, and imaging demonstrated a dissection of the extracranial left ICA and an associated pseudoaneurysm. The lesion was managed endovascularly with stent-assisted coil embolization and ICA reconstruction. The child had a somewhat complicated postoperative course, requiring additional coil embolization for treatment of a minor recurrence of the pseudoaneurysm at 5 months after the initial treatment and then presenting with extrusion of a portion of the coil mass into the oropharyngeal cavity a year later. She underwent surgical removal of the extruded coils and repair of the defect and has since been free of symptoms or signs of recurrence. The authors conclude that this strategy definitively protected the patient against an oral exsanguination or aspiration event secondary to aneurysm rupture and reduced her risk of stroke by preserving vessel patency and caliber. Moreover, they note that covered stent reconstruction surrenders endovascular access and cannot immediately provide these benefits.

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@#Objective To summarize the technique of stent combined with coils to treat middle cerebral artery bifurcation wide-necked aneurysms. Methods 15 patients were reported. Results 11 of 15 aneurysms were completely occluded and 4 were incompletely (>95%) occluded. Transient ischemia of cerebral occurred in a case. 8 aneurysms were followed up for 6～12 months, 1 presented neck remnant growth. Conclusion It is satisfied to use the stent combined with coils to treat middle cerebral artery bifurcation wide-necked aneurysm, which may protect the parent artery.

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@#ObjectiveTo investigate the effect of endovascular stent with or without coil graft on intracranial wide-necked aneurysms. Methods12 cases with intracranial wide-necked aneurysms, among whom, 10 cases were treated with stents and coils, 2 C4 aneurysms were treated with graft stent, were analyzed retrospectively. ResultsOf the 10 cases who were treated with stents and coils, 8 patients were completely occluded and other 2 patients were incompletely (>95%) occluded. 2 cases accepted graft stent were obliterated. Follow-up with angiography in 10 patients for 3～12 months revealed that all the aneurysms were completely occluded. 1 patient among them died. ConclusionEndovascular stent with or without coil graft is effective on intracranial wide-necked aneurysms.

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@# ObjectiveTo summarize the technique and preliminary outcome of Neuroform stent combined with Guglielmi detachable coil (GDC) to treat wide-necked intracranial aneurysms. Methods32 cases with aneurysms which underwent 32 endovascular procedures performed by using stent were retrospectively analyzed.The ratio of aneurysm neck/body is 1/2～1/1. Results24 aneurysms were completely occluded and other 8 were incompletely (>95%) occluded. Transient ischemia of cerebral occured in 2 cases. 14 aneurysms were followed up 0.5～1 year after. 2 aneurysms of them appeared neck remnant growth.ConclusionUsing Neuroform stent combined with GDC to treat wide-necked intracranial aneurysm may prevent the herniation of GDC into the artery and increase the outcome of wide-necked intacranial aneurysm.