TJWY’s Stent-assisted Perdenser® 19 Coil Systems for Embolism in the Treatment of Large Aneurysm in the Communicating Segment of the Intracranial Artery

The recurrence of aneurysms is one of the major challenges in treating intracranial aneurysms through endovascular embolization. ^[1-2] Large/giant intracranial aneurysms feature a large volume, thrombus and generally wide aneurysm neck. Only embolization with a spring coil easily causes falling of the spring coil and has difficulty in dense embolization, resulting in a high recurrence rate. Stent-assisted embolization in the treatment of aneurysms obtains a good result and applied in more and more cases. The stent technology may reshape the aneurysm neck and prevent the spring coil from falling into the parent artery, so as to reach a denser embolization rate; in addition, it can promote intimal regeneration, so that the aneurysm can be cured the recurrent rate can be lowered^[3-5]. Studies report that the immediate dense embolization rate for large/giant intracranial aneurysms with the simple spring coils is 39.5% and the recurrence rate is 57.9%, while that for large/giant intracranial aneurysms with stent-assisted spring coil is 47.1% and the recurrence rate is 23.5%^[6].

Patient Information

• Male, 60Y.

Pre-operative imaging

• The size of the aneurysm measured under 3D imaging is about 1.31cm*1.31cm, which is a large aneurysm in the communicating segment of the intracranial artery, and the aneurysm neck is wide. It is planned to embolize the aneurysm with stent-assisted coil.

Procedure

• Under general anesthesia, the right femoral artery puncture approach was used to establish the access. Under the guidance of the roadmap, the stent microcatheter was super-selected at the lesion site. After the embolic microcatheter entered the aneurysm, it was attached to the wall of the aneurysm cavity in a semi-pigtail shape, and the head end was placed at the center of the aneurysm cavity. In order to reduce the kick-microcatheter effect, this position is convenient to observe the mark point at the proximal end of the microcatheter, and it is more conducive to the centripetal packing of the coil.

• TJWY’s Perdenser® Coil System for Embolism 16mm×30cm-3D was used to form a basket to liberate half the stent to cover the aneurysm neck.

• After liberating the stent half, continue to perform basketing operations. After basketing, the Perdenser® Coil System for Embolism is well attached to the wall with stable basketing status.

• Then along the embolic microcatheter, sequentially pack 3 Perdenser® coil systems for embolism 11mm×30cm-3D, 3 Perdenser® coil systems for embolism 12mm×30cm-3D, 3 Perdenser® coil systems for embolism 14mm×30cm-3D, 2 Perdenser® coil systems for embolism 16mm×30cm-2D, 1 Perdenser® Coil System for Embolism 10mm×30cm-3D, 4 Perdenser® coil systems for embolism 13mm×30cm-3D and 1 Perdenser® Coil System for Embolism 7mm×30cm-3D, at last, use 1 Perdenser® Coil System for Embolism 8mm×30cm-3D to close up. A total of 19 spring coils were used during this operation.

Later, liberate the stent completely and press the stent with guiding wire arch to make it well attach to the wall. In order to achieve better prognosis and reduce the recurrence, implant another stent to superpose in the first stent.

After Operation

• After operation, it showed through radiography that the aneurysm was densely embolized, there was no contrast agent residue in the cavity and the blood flowed smooth in the stent.

Product Introduction

Lepu Medical-TJWY’s independetly developed Perdenser® Coil System for Embolism is divided into complex type and spiral type. The complex type can be used to make basket with its 360° Ω-shaped design with freely turning point to effectively protect the aneurysm wall and avoid its rupture. An excellent basket performance is not only helpful for aneurysm wall protection, but also provides a good foundation for subsequent packing. The head end of the coil system is designed with a polymer ball cap, which can ensure no damage to the aneurysm wall and avoid rupturing the aneurysm during the operation.

Excellent gap detection and packing ability effectively ensures that dense embolism can be achieved during surgery. Hundreds of models are available for basket formation to packing and close-up.

According to the different diameters of the coils, the system can meet the packing requirements of aneurysms of different sizes and support the whole process operation from basket forming to packing and close-up. Taijie Weiye’s ultrasoft coil system for embolism has good flexibility, which can be used for basket forming and packing in the micoaneurysms treatment, but also can be used as close-up coil in the treatment of large-and medium-sized aneurysms, providing safe and reliable performance.

References:

[1] Murayama Y, Nien YL, Duckwiler G, et al. Guglielmi detachable coil embolization of cerebral aneurysms: 11 years' experience [J]. J Neurosurg, 2003, 98: 959-966.

[2] Crobeddu E, Lanzino G, Kallmes DF, et al. Review of 2 decades of aneurysm-recurrence literature, part 1: reducing recurrence after endovascular coiling [J]. AJNRAm J Neuroradiol, 2013,  34: 266-270.

[3] Canton G, Levy DI, Lasheras JC. Hemodynamic changes due to stent placement in bifurcating intracranial aneurysms [J]. J Neurosurg, 2005, 103:146-155.

[4] Wanke I, Forsting M. Stents for intracranial wide-necked aneurysms: more than mechanical protection [J]. Neuroradiology, 2008, 50: 991-998.

[5] Ba HJ, Cai JY, Lu C, et al. Stent-assisted coil embolization or treatment of intracranial wide-necked aneurysms: long-term follow-up analysis [J]. Journal of Interventional Radiology, 2015, 24: 5-9.

[6] Wang B, Gao BL, Xu GP, et al. Endovascular embolization is applicable for large and giant intracranial aneurysms: experience in one center with long- term angiographic follow-up [J]. Acta Radiol, 2015, 56: 105-113.