| Objective1. To compare the clinical outcomes and procedural related complications of Enterprise and Solitaire stent-assisted coiling in wide-neked cerebral aneurysms.2. To evaluate the safety and efficacy of endovascular therapy in a series of posterior communicating artery aneurysms (PcomA) with oculomotor nerve palsy (ONP), and analyze the influence factors on the recovery of oculomotor nerve palsy.Materials and methods1. We retrospectively investigated 138 patients with wide-neck intracranial aneurysms treated with stent-assisted coiling (Enterprise stent or Solitaire stent) in our department during January 2010 to July 2014. Patients’characteristics, angiography results and procedure outcomes, peri-procedure complications and follow-up outcomes were evaluated. Patients with in-stent stenosis or thrombosis were also analyzed. We also attempted to clarify the risk factor of in-stent stenosis or thrombosis complication after stent-assisted coiling.2. From January 2011 to December 2015,216 patients with PComA aneurysms underwent endovascular coiling in our hospital. Of them,39 patients (18.1%) presented with oculomotor nerve palsy attributable to PcomA. We collected clinical data of the 39 patients and retrospectively evaluated the efficacy and safety of endovascular treatment for PComA aneurysm-induced ONP. Univariate analysis was used to explore the possible influencing factors of recovery from the following aspects:sex, age, size of aneurysm, degree of ONP before treatment, rupture, duration of symptoms and so on.Results1. One hundred and fifty-four intracranial aneurysms were confirmed in a total of 138 patients by angiography, of them,151 were treated with stent-assisted coiling. One hundred and fifteen patients with 127 aneurysms were treated with Enterprise stent-assisted coiling, and 23 patients with 24 aneurysms with Solitaire. The overall technique success rate was 99.3% (137/138). Imaging follow-up was available in 121 patients (87.7%,121/138), and the mean follow-up time was 13.3 ±6.9 months. One hundred and seventeen patients with at least 1 angiographic follow-up,3 patients were followed up with CTA, and 1 patient with MRA. The immediate occlusion rate (Raymond rank I and II) was 72.8%(110/151). There was no significant difference between Enterprise group and Solitaire group (P=0.81). Procedure related complications included 5 cases of vascular spasm,3 cases of coil escape and 13 cases of acute thrombosis. There were no significant difference in the incidence of the above complications between the two stents, the P values were 0.59,0.41,0.44, respectively. Five patient with ruptured aneurysms died during perioperative period (Enterprise, n=5; Solitaire, n=0, P=0.59). There was no significant difference between the Enterprise group and the Solitaire group in terms of Glasgow Outcome Scale (P =0.99). There were 66 patients whose aneurysms were located in bifurcation or curve, and 72 patients whose aneurysms were located in straight parent artery. The incidence of in-stent stenosis or thrombosis complication of aneurysms located in bifurcation or curve was significantly higher than that of non bifurcation or curve (P=0.01).2. The 39 patients with ONP attributable to PcomA included 18 cases of complete ONP and 21 cases of partial ONP. Twelve patients received stent-assisted coiling and 27 patients received conventional coiling. The average follow-up time was 21.4 months. At the last available clinical follow-up, recovery of ONP was complete in 23 (60.0%) patients, partial in 11 (28.2%) and 5 (12.8%) patients remained unchanged. Stent associated thrombosis occurred in 1 patients, and the blood flow recovered to TICI(thrombolysis in cerebral infarction) 2b after arterial thrombolysis. The patient resulted in partial ONP and incomplete hemiplegia. Before procedure 18 patients presented with complete ONP and 21 with partial ONP. Complete recovery was achieved in 7 patients (38.9%) of 18 patients with complete paralysis. Complete recovery was achieved in 16 (76.2%) of 21 patients with incomplete paralysis.The complete recovery rate of patients with complete ONP was significantly lower than that of patients with partial ONP (P=0.025). Of the 39 patients, the preoperative ONP time ranged from 1 to 25 days (23 patients less than 4 days,16 patients more than 4 days). Complete recovery was achieved in 18 (78.3%) of 23 patients with shorter preoperative ONP time. Complete recovery was achieved in 5 (31.2%) of 16 patients with longer preoperative ONP time. The complete recovery rate of patients with longer preoperative ONP time was significantly lower than that of patients with shorter preoperative ONP time (P=0.007).Conclusion1. Both stents in wide-neck aneurysms were safe, and exhibited similar immediate and follow-up results. The incidence of in-stent stenosis or thrombosis complication in patients whose aneurysms located in bifurcation or curve was significantly higher.2. Endovascular therapy was a safe and effective way to treat posterior communicating artery aneurysms with oculomotor nerve palsy. The complete ONP and longer preoperative ONP time were risk factors affecting the recovery of ONP. |
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