Bae Ju Kwon

The Difficulties and Risks of Y-Stent–Assisted Coiling: A Comparison of First and Second Stenting Procedures

OBJECTIVEnY-stent-assisted coiling (YSAC) requires multiple device accesses for double stenting. The purpose of this study was to test the hypothesis that second stenting procedures are riskier than first stenting procedures.nnnMETHODSnWe retrospectively reviewed the medical records of 19 patients with 20 aneurysms undergoing YSAC. Difficulty was determined for each device when the difficulty number was >1. Procedure-based and device-based difficulties were compared between 2 stenting procedures. For second stenting procedures, stent-delivery-catheter difficulties (SDs) in passing through the struts of the first stent were assessed for 3 catheter types, 2 delivery methods, and 3 first-stent types.nnnRESULTSnAll YSACs were successful. Difficulties occurred more frequently with second stenting procedures than with first stenting procedures (procedure-based difficulties, 4 [20%] vs. 7 [35%], Pxa0= 0.29; device-based difficulties, 4 [9%] vs. 8 [18%], Pxa0= 0.19). In second stenting procedures, SDs occurred in 4 (20%) procedures and caused the midportion of the first stent to be bent into aneurysms in 2 of the procedures. Failures following difficulties were observed in only 2 (10%) second stenting procedures, necessitating other methods to complete procedures: 1 of the procedures had SD-related thrombosis leading to morbidity at discharge (modified Rankin Scale score 2). SDs were found only with 1 catheter type (4 of 15; PROWLER SELECT Plus) and 1 delivery method (4 of 15; direct over-the-wire) and not with the other catheter typesxa0(Rebar-18 or Excelsior 1018) and the other method (catheter-exchange). SDs were found most frequently with the use of the CODMAN ENTERPRISE stent in first stenting procedures (50%).nnnCONCLUSIONSnIn YSAC, second stenting procedures seem riskier than first stenting procedures, particularly when SDs occur. A proper device or delivery method may reduce the risks.

Will Fluoroscopic Follow-up after Stent-Assisted Coiling of Cerebral Aneurysms Provide Information on Recanalization?

Fluoroscopic images for comparison (FICs) can be easily obtained for follow-up on an outpatient basis. This study retrospectively assessed the diagnostic performance of a set of FICs for evaluation of recanalization after stent-assisted coiling, with digital subtraction angiography (DSA) as the reference standard. A total of 124 patients harboring 144 stent-assisted coiled aneurysms were included. At least one month postembolization they underwent follow-up angiograms comprising a routine frontal and lateral DSA and a working-angle DSA. For analysis, FICs should be compared with the mask images of postprocedural DSAs to find recanalization. Instead of FIC acquisition, the mask images of follow-up DSAs were taken as a substitute because of the same view-making processes as FICs, full availability, and perfect coincidence with follow-up DSAs. Two independent readers evaluated a set of 169 FICs and DSA images for the presence of recanalization one month apart. Sensitivity, specificity, and interreader agreement were determined. Recanalization occurred in 24 (14.2%) cases. Of these, nine (5.3%) cases were found to have significant recanalization in need of retreatment. Sensitivity and specificity rates were 79.2% (19 of 24) and 95.9% (139 of 145) respectively for reader 1, and 66.7% (16 of 24) and 97.9% (142 of 145) for reader 2. Minimal recanalization was identified in seven out of all eight false negative cases. Excluding minimally recanalized cases in no need for retreatment from the recanalization group, calculation resulted in high sensitivity and specificity of over 94% for both readers. Interreader agreement between the two readers was excellent (96.4%; κ = 0.84). FICs may be a good imaging modality to detect significant recanalization of stent-assisted coiled aneurysms.

A Comparison between Mechanical Thrombectomy and Intra-arterial Fibrinolysis in Acute Basilar Artery Occlusion: Single Center Experiences

Background and Purpose Recent advances in intra-arterial techniques and thrombectomy devices lead to high rate of recanalization. However, little is known regarding the effect of the evolvement of endovascular revascularization therapy (ERT) in acute basilar artery occlusion (BAO). We compared the outcome of endovascular mechanical thrombectomy (EMT) versus intra-arterial fibrinolysis (IAF)-based ERT in patients with acute BAO. Methods After retrospectively reviewed a registry of consecutive patients with acute ischemic stroke who underwent ERT from September 2003 to February 2015, 57 patients with acute BAO within 12 hours from stroke onset were enrolled. They were categorized as an IAF group (n=24) and EMT group (n=33) according to the primary technical option. We compared the procedural and clinical outcomes between the groups. Results The time from groin puncture to recanalization was significantly shorter in the EMT group than in the IAF group (48.5 [25.3 to 87.8] vs. 92 [44 to 179] minutes; P=0.02) The rate of complete recanalization was significantly higher in the EMT group than in the IAF group (87.9% vs 41.7%; P<0.01). The good outcome of the modified Rankin Scale score≤2 at 3 months was more frequent in the EMT group than in the IAF group, but it was not statistically significant (39.4% vs 16.7%; P=0.06). Conclusions EMT-based ERT in patients with acute BAO is superior to IAF-based ERT in terms of the reduction of time from groin puncture to recanalization and the improvement of the rate of complete recanalization.