Article Figures & Data
Figures
- Fig 1.
A 39-year-old woman with an MCA bifurcation aneurysm treated with the mesh technique. A, Angiogram shows a small wide-neck MCA bifurcation aneurysm mainly involving the superior branch. B, The microcatheter is inserted into the aneurysm sac through the interstices of a LEO stent to facilitate further coiling. C and D, Postembolization angiogram shows complete occlusion of the aneurysm with patency of the parent vessels.
- Fig 2.
A 58-year-old man with an MCA bifurcation aneurysm treated with the jailing technique. A, Angiogram shows a small wide-neck MCA bifurcation aneurysm mainly involving the inferior branch. B, Two microcatheters (the Echelon-10 [eV3 Neurovascular, Irvine, California] for introducing coils and the Prowler Select Plus for delivering the Enterprise stent) are in position. C, The framing coil is first introduced and then a stent is deployed to compact the coil mass into the aneurysm sac. D, Postembolization angiogram shows complete occlusion of the aneurysm with patency of the parent vessels.
- Fig 3.
A 53-year-old man with multiple aneurysms. A, Angiogram shows a small wide-neck MCA bifurcation aneurysm equally involving 2 branches. B, First, the Neuroform stent is implanted to secure the superior branch. Coils, which endanger the inferior branch, are introduced. C, Second, a Neuroform stent is implanted to preserve the inferior branch, but difficulty is encountered while delivering the stent system through the interstices of the first stent, so the stent is pushed out of the microcatheter to barely secure the inferior branch. D, Postembolization angiogram shows complete occlusion of the aneurysm with patency of both branches.
- Fig 4.
A 59-year-old woman with a tiny MCA bifurcation aneurysm treated with stent alone. A and B, Conventional and 3D angiograms show the aneurysm. C, Follow-up angiogram at 9 months after stent placement shows disappearance of the aneurysm (white arrows show the stent). D, 3D angiogram at 9 months shows significantly altered angles between M1 and the inferior branch compared with Image B. (Note: On image B, the numbers indicate the measurement of the vessel diameter which is not shown here.)
Tables
Angiographic and clinical results and follow-up in 16 patients with 16 wide-neck MCA aneurysms treated with stentsa
Patient No. Presentation HH Location Size Stent Stenting Strategy Initial Results mRS at Discharge Angiographic FU Clinical FU Interval Results Interval mRS 1 Ruptured 2 L-Bifur S NF 3.0/20 Jailing Class I 1 9 m, MRA Stable 67 m 0 2 Ruptured 2 R-Bifur S NF 3.5/15 Mesh Class I 1 6 m, DSA Class I 52 m 1 3 Unruptured 0 R-Bifur S NF 2.5/20 Jailing Class III 0 7 m, DSA Class I 49 m 0 4 Ruptured 1 L-Bifur S NF 3.5/15 Mesh Class I 1 6 m, DSA Class I 32 m 0 5 Ruptured 2 R-Bifur S NF 3.0/15 Mesh Class I 1 6 m, MRA Stable 30 m 0 6 Ruptured 4 L-Bifur L LEO 4.5/25 Waffle cone Class III 6 NA NA NA NA 7 Recurrence 0 R-Bifur T NF 3.0/20 Stenting alone NA 0 4 m, MRA Stable 18 m 0 8 Unruptured 0 R-Bifur T NF 2.5/15 Stenting alone NA 0 9 m, DSA Class I 11 m 0 9 Unruptured 0 R-M1 T NF 3.5/20 Stenting alone NA 0 4 m, MRA Stable 9 m 0 10 Ruptured 1 L-Bifur S NF 2.5/15 Y-Configuration Class I 1 7 m, DSA Class I 7 m 0 11 Unruptured 0 R-Bifur S EP 4.5/22 Jailing Class I 0 3 m, MRA Stable 6 m 0 12 Ruptured 1 L-Bifur S NF 3.0/20 Coil plus stent Class III 1 6 m, DSA Class I 6 m 0 13 Unruptured 0 L-M1 L LEO 3.5/18 Mesh Class I 0 5 m, DSA Class I 5 m 1 14 Ruptured 2 L-Bifur L NF 3.5/20 Mesh Class I 4 1 m, MRA Stable 1 m 4 15 Ruptured 2 L-Bifur S LEO 3.5/18 Mesh Class II 1 NA NA 5 m 1 16 Ruptured 1 L-Bifur S LEO 3.5/18 Mesh Class I 1 NA NA 4 m 1 a Embolization results were classified using the Raymond classification system: class I, complete occlusion; class II, residual neck; class III, residual sac.
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