The neck remodeling owing to changes of vessel-angle after placement of a stent applied to small-sized bifurcating arteries for coiling of cerebral aneurysms

초록

Background : The stent-assisted coiling has been effectively applied to treat the wide-neck and complex cerebral aneurysms. Objective : To assess the changes of vessel angles and neck-diameters of aneurysm after the placement of a stent at small-sized bifurcating arteries. Methods : Imaging data with thirty aneurysms underwent stent-assisted coiling involving small-sized bifurcating arteries by using 13 self-expanding intracranial stents (6 women; mean age, 56.5 years) were retrospectively analyzed. The angle between the afferent vessels and the efferent vessels, and the neck-diameter was calculated to investigate the changes after stent placement. Result : In all 13 deployment of stents, 7 stents were placed between A1 and A2, 5 stents were placed between basilar artery and posterior cerebral artery (PCA), and 1 stent was placed between M1 and M2. Six of 7 (85.7%) A1-A2 stentings, 3 of 5 (60.0%) BA-PCA stentings and one M1-M2 stenting were presented angular change over 5 degree. Two of 7 (28.6%) A1-A2 stentings and 2 of 5 (60.0%) BA-PCA stentings were presented decrease of neck-diameters over 1 mm. In the mean comparison, stent deployment increased the angles from 95.4’ to 115.7’ (p < 0.001) and decreased the neck-diameters from 7.8 mm to 7.3 mm (p < 0.001). The Statistical differences of angle (p = 0.174) and neck-diameter (p=0.401) under the location of stents were not significant. Conclusion : Stent placement at the small-sized bifurcating artery changes the angle between efferent and afferent vessel and effect the neck-diameter of aneurysms. The geometrical changes may play a role in the remodeling effects between parent arteries and aneurysms.