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  • Procedural Thromboembolic Risk in Stent-Mediated Coiling Of Sidewall Carotid Aneurysms is Stent-Type and Aneurysm Size Dependent

    Final Number:

    Luke Antonio Silveira BS; Robert Heller MD; Mina G Safain MD; Adel M. Malek MD, PhD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting - Late Breaking Science

    Introduction: Open- and closed-cell stents represent two principal options for stent-assisted coiling of internal carotid artery (ICA) aneurysms. This study seeks to compare clinical outcomes and procedural thromboembolic risk in treating sidewall ICA aneurysms with stent-assisted coiling (SAC) using these stent designs.

    Methods: 122 consecutive patients (mean age, 56.8 years) receiving open-cell (n = 53) or closed-cell stents (n = 69) for SAC of sidewall ICA aneurysms underwent routine post-procedural magnetic resonance diffusion weighted imaging (MR-DWI) within 48 hours. Patient demographics, aneurysm location and size and, intra-procedural clotting function, presence and number of MR-DWI lesions (MR-DWI+), and peri-procedural complications were analyzed.

    Results: Within the <5 mm aneurysm subset, no open-cell (0/31) patients demonstrated MR-DWI lesions, compared to 12/36 or 33.3% of patients in the closed-cell group, (P <0.01). Within the > 5 mm aneurysm subset, 8/22 or 36.4% of patients in the open-cell group demonstrated post-procedural MR-DWI lesions, compared to 13/33 or 39.4% of patients in the closed-cell group, (P=0.82). The rate of MR-DWI+ among patients with new neurologic deficits (7/10) was significantly higher than among those without deficits (26/108), (P<0.01). Among open-cell patients’ post procedural deficits 1 out of 2 (50%) completely resolved by discharge compared to 3 out of 8 (37.5%) for closed-cell patients.

    Conclusions: The previously described lower rate of procedural thromboembolic lesions associated with open-cell stent design owing to superior vessel apposition is aneurysm size-dependent and is voided in larger aneurysms. Although the exact mechanism needs further research, it could be the result of complex hemodynamics and inflow-outflow interactions across stent struts in larger aneurysms. Our findings may help guide stent choice based on lesion size and provide procedural thromboembolic estimates when considering SAC versus flow-diverter therapy in sidewall carotid aneurysms.

    Patient Care: Our findings may help guide stent choice based on lesion size and provide procedural thromboembolic estimates when considering SAC versus flow-diverter therapy in sidewall carotid aneurysms.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1. Be aware of the compared post-procedure MR-DWI findings for open cell and closed cell stent-assisted coiling (SAC) of sidewall ICA aneurysms as a means of evaluating the thromboembolic risk associated with each stent. 2. Be aware of the demonstrated interaction between thromboembolic risk and maximal aneurysm diameter across stent types, open cell and closed cell. 3. Understand the evaluated and compared clinical outcomes associated with stent-assisted coiling of ICA sidewall aneurysms for both open cell and closed cell stents.

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