Abstract
Several advanced multiple catheter techniques have been invented for endovascular treatment. Stent-supported coil embolization is one of the most useful methods for wide neck aneurysms. We report 13 vertebral artery aneurysms treated with this method and discuss its efficacy.
Between April 1999 and March 2006, we treated 13 patients with wide neck vertebral aneurysms, comprising 9 males and 4 females aged 38 to 79 (mean 60.0 years old) and treated with stent-supported coil embolization. Stent for coronary intervention was used in all cases. Using our original method, the microcatheter was inserted into the aneurysmal sac in advance, followed by deployment of the stent at the orifice. In this method, the microcatheter is placed out of the stent, which is useful to stabilize the microcatheter and to prevent the kick-back of microcatheter into the parent artery. Further, we repeated the inflation of balloon catheter at the orifice to prevent the coil herniation whenever placing coils.
Complete obliteration of the aneurysm was achieved in 9 patients and subtotal occlusion in 4 patients. Two stents were needed in 1 patient because of stent migration into the aneurysm. A stent slipped down during withdrawal of the balloon catheter in 1 case without coil herniation or vessel injury. In follow-ups of 3 months to 7 years, there was no recurrence except for 1 case whose aneurysm regrew resulting in trapping of VA. The only procedure-related symptomatic complication was 1 case with transient abducens nerve palsy.
Stent supported coil embolization for wide-based vertebral aneurysms is a very useful and valuable technique. It permanenty prevents coil herniation and the rectification of parent artery flow. Although sufficient results were initially obtained, long term follow-up should be carried out.
