RESUMEN
BACKGROUND: Wide-necked bifurcation aneurysms (WNBA) of the middle cerebral artery (MCA) present significant therapeutic challenges. Flow-diverter stents have been increasingly adopted for their management, though they may give rise to adverse outcomes such as in-stent stenosis (ISS). This study explores the association between stent oversizing and the incidence of ISS following flow-diverter stent placement in MCA bifurcation aneurysms. METHODS: A retrospective study included 34 patients who underwent flow-diverter stent placement for MCA bifurcation aneurysms between 2020 and 2023. Data on patient demographics, aneurysm morphology, and stent sizing were collected. ISS was evaluated through follow-up imaging at 6-month post-procedure. Stent oversizing was determined by calculating the difference between the stent diameter and the proximal and distal parent vessel diameters. Statistical analyses included Pearson correlation and chi-square tests, with significance established at p < 0.05. RESULTS: The studied group had a mean age of 57.8 years, with 81.6% female patients. The average aneurysm neck size was 3.6 mm, with a mean dome-to-neck ratio of 1.6. ISS was detected in 64.7% of cases proximally and 88.2% distally. A statistically significant negative correlation (r = -0.496, p = 0.003) was observed between stent oversizing and ISS, indicating that increased stent oversizing was associated with a higher incidence of ISS, particularly in the distal vessel segments. CONCLUSION: The findings indicate that stent oversizing is significantly associated with the development of ISS in MCA bifurcation aneurysms treated with flow-diverter stents. Careful consideration of stent sizing, particularly minimizing oversizing in distal segments, may mitigate the risk of ISS and improve clinical outcomes. These results underscore the importance of meticulous stent selection and procedural planning in neurointerventional practice.
RESUMEN
Flow diverter stents are increasingly used as the sole endovascular treatment method for complex or wide-necked intracranial aneurysms.1 Technical complications related to stent deployment are infrequently reported in the literature. During treatment, implant misbehaviors may occur, including incomplete tubular expansion with insufficient aneurysmal coverage and wall apposition, proximal or distal narrowing, and twisting along the axis.2- 4 Little is known about this phenomenon, especially if it relates to the operator experience, deployment techniques, different devices, and implant properties. The management of these complications requires technical precision and is often remediated by "massaging" the stent with the delivery system, balloon angioplasty, or placement of additional self-expandable stents. Lastly, if critically damaged, the stent could be taken out of the vessel with a combination of maneuvers called "stentectomy."5 These techniques often necessitate multiple navigations and the utilization of a larger microcatheter. We aim to highlight the feasibility of Comaneci 17 stent-angioplasty as an effective bailout strategy for inadequately deployed flow diverter stents. The suggested approach's technical aspects, including pros and cons, have been discussed.
RESUMEN
Cerebral developmental venous anomalies are asymptomatic benign cerebrovascular malformations that are commonly found accidentally on brain magnetic resonance imaging. It is not uncommon for cerebrospinal fluid flow to be obstructed at the level of the aqueduct of Sylvius, causing an obstructive non-communicating hydrocephalus. Most notable reasons for such an obstruction at that level are tumors, congenital etiology, or post-inflammatory gliotic atresia.
