Manabu Shirakawa1, Shinichi Yoshimura2, Kazutaka Uchida1, Kiyofumi Yamada1, Daisuke Sakamoto1, Tomoko Iida1, Yoshihiro Takada3, Reiichi Ishikura4. 1. Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. 2. Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. Electronic address: hyogoneuro@yahoo.co.jp. 3. Department of Radiology, Meiwa Hospital, Nishinomiya, Hyogo, Japan. 4. Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
Abstract
BACKGROUND: Numerous reports have described the semi-jailing technique (SJT) using a closed-cell stent for stent-assisted coil embolization, revealing issues including poor expansion and thrombotic complications in curved vessels. This paper reports preliminary experience with SJT using an open-cell stent, a novel type of stent allowing stent placement from a microcatheter. METHODS: First, this research investigated differences between open- and closed-cell types in SJT using silicone vessel models. Next, 43 patients who underwent SJT for the internal carotid artery were divided into 2 groups to investigate treatment outcomes: 24 patients with placement of an open-cell stent (open-cell group) and 19 patients with closed-cell stents (closed-cell group). RESULTS: In the silicone vessel model, coils could be placed with the open-cell stent deployed with a shorter length than the closed-cell stent. No significant differences were found between groups in terms of maximum diameter of the aneurysm or dome-neck ratio. The open-cell group showed a trend toward higher complete embolization immediately after surgery (54.2% vs. 26.3%, P = 0.06), with few cases of stent malapposition (0% vs. 31.6%, P < 0.01). However, 1 case of ischemic complication in the closed-cell group and 1 case of hemorrhagic complication in open-cell group occurred. All cases of modified Rankin Scale scores at discharge were 0-1. CONCLUSIONS: Although the open-cell stent carries the disadvantage of an unresheathable design, coil placement with a shorter stent deployment length may be advantageous during SJT for internal carotid artery aneurysm embolization with favorable consequences for excellent vessel wall apposition.
BACKGROUND: Numerous reports have described the semi-jailing technique (SJT) using a closed-cell stent for stent-assisted coil embolization, revealing issues including poor expansion and thrombotic complications in curved vessels. This paper reports preliminary experience with SJT using an open-cell stent, a novel type of stent allowing stent placement from a microcatheter. METHODS: First, this research investigated differences between open- and closed-cell types in SJT using silicone vessel models. Next, 43 patients who underwent SJT for the internal carotid artery were divided into 2 groups to investigate treatment outcomes: 24 patients with placement of an open-cell stent (open-cell group) and 19 patients with closed-cell stents (closed-cell group). RESULTS: In the silicone vessel model, coils could be placed with the open-cell stent deployed with a shorter length than the closed-cell stent. No significant differences were found between groups in terms of maximum diameter of the aneurysm or dome-neck ratio. The open-cell group showed a trend toward higher complete embolization immediately after surgery (54.2% vs. 26.3%, P = 0.06), with few cases of stent malapposition (0% vs. 31.6%, P < 0.01). However, 1 case of ischemic complication in the closed-cell group and 1 case of hemorrhagic complication in open-cell group occurred. All cases of modified Rankin Scale scores at discharge were 0-1. CONCLUSIONS: Although the open-cell stent carries the disadvantage of an unresheathable design, coil placement with a shorter stent deployment length may be advantageous during SJT for internal carotid artery aneurysm embolization with favorable consequences for excellent vessel wall apposition.