Intracranial aneurysm stent-assisted coiling [Neurosurgery Wiki]

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====== Intracranial aneurysm stent-assisted coiling ======

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[[Stent-assisted coiling]] is a minimally invasive endovascular technique commonly used to treat [[wide-necked intracranial aneurysm]]s, where traditional coiling may not be sufficient to prevent coil prolapse into the parent artery. Here's an outline of the procedure and its implications:

1. **Preparation and Access**: The procedure begins with the insertion of a catheter, typically through the femoral or radial artery, and guides it up to the cerebral circulation. Imaging, often fluoroscopy or digital subtraction angiography, is used to navigate and visualize the aneurysm.

2. **Stent Placement**: A self-expanding stent is deployed across the neck of the aneurysm in the parent artery. This stent serves as a scaffold, providing structural support that prevents the coils from protruding out of the aneurysm sac and into the parent artery. 

3. **Coiling**: Once the stent is in place, a microcatheter is guided through the stent and into the aneurysm sac. Detachable coils are then deployed into the aneurysm to promote thrombosis, effectively "sealing" it off from blood flow. These coils induce clotting within the aneurysm, leading to its occlusion.

4. **Benefits of Stent-Assisted Coiling**: 
   - **Aneurysm Exclusion**: This technique enables effective treatment of complex aneurysms with wide necks that cannot be treated with coiling alone.
   - **Reduced Recurrence**: The stent decreases the likelihood of recurrence by stabilizing the aneurysm and reinforcing the parent vessel.
   - **Minimally Invasive**: It’s an endovascular approach, avoiding the need for open surgery and reducing recovery times.

5. **Risks and Considerations**:
   - **Dual Antiplatelet Therapy**: Patients require dual antiplatelet therapy (aspirin and clopidogrel) before and after the procedure to prevent in-stent thrombosis, which can be a challenge in patients with a history of bleeding disorders.
   - **Ischemic Complications**: Despite antiplatelet therapy, there’s a risk of thromboembolic events.
   - **Recanalization**: While effective, there's still a chance that the aneurysm may recanalize over time, requiring follow-up imaging and possible retreatment.

Stent-assisted coiling has become a reliable option for treating complex aneurysms, particularly those unsuitable for traditional clipping or coiling alone.
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[[Wide-neck aneurysm]]s represent a challenge for treatment in the setting of acute [[subarachnoid hemorrhage]]. [[Stent]]-assisted [[coiling]] (SAC) and [[balloon-assisted coiling]] (BAC) are well-known techniques for treating wide-necked aneurysms. [[Comaneci-assisted coiling]] (CAC) is a newer technique involving temporary stent deployment to assist an aneurysm [[coiling]].
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see [[Stent-Assisted Coiling for Unruptured Intracranial Aneurysm]]