Multiple overlapping stent-assisted coiling of complex aneurysms: A single-center experience

Objectives: Coil embolization of wide-necked and fusiform aneurysms is challenging and is frequently associated with recanalization despite assistance of any additional device. The purpose of this study was to evaluate the feasibility and mid-term outcomes of complex aneurysms after multiple overlapping stentassisted coiling (OSAC).

Methods: We retrospectively evaluated 26 wide-necked and fusiform atherosclerotic or dissecting aneurysms that were treated with multiple OSAC. Eight aneurysms (30.8%) presented with subarachnoid hemorrhage and one (3.9%) with intracranial hemorrhage.

Results: Complete embolization was achieved in 15 of the 26 aneurysms (57.7%), while remnant neck was identified in nine (34.6%) and remnant aneurysm was noted in two (7.7%). Immediate procedure-related complications were observed in five patients (19.2%) including two with asymptomatic in-stent thrombosis, one with transient right-sided weakness, one with decreased mentality, and one with aphasia and quadriplegia. A procedure-related permanent neurologic deficit (modified Rankin scale scores of 1 and 5) was noted in two patients (7.7%). Angiographic follow-up (mean duration 23.9 months) after OSAC was carried out in 18 patients (69.2%): 11 (61.1%) were stable, 3 (16.7%) improved, 3 (16.7%) had minor compaction, and 1 had major recanalization (5.5%). One recurred aneurysm after OSAC and two recanalized aneurysms after single stenting were re-treated using additional stent-assisted coiling, and there was no recanalization in these three aneurysms during the 25.7 months after re-treatment.

Conclusions: Multiple OSAC is feasible and effective for complex aneurysms and recurrent aneurysms after stent-assisted coiling.