Initial experience of Enterprise VRD-assisted coil embolization for wide-necked aneurysms

Abstract

Object: This report describes our initial experience using a new self-expanding nitinol stent, Enterprise VRD (Cordis, Miami, FL, USA), designed for the treatment of wide-necked intracranial aneurysms. Method: Stent-assisted coiling was performed in 33 wide-necked saccular aneurysms between July 2011 and December 2012 in this institution. Six aneurysms were recanalized after prior endovascular treatment. The aneurysms were located in the following arteries: 15 internal carotid artery (ICA; 45.5%), 2 middle cerebral artery (MCA; 6.1%), 3 anterior communicating artery (AcomA; 9.1%), 12 basilar artery (BA; 36.7%), 1 posterior cerebral artery (PCA; 3.0%). The mean aneurysm dome size was 11.6 mm (7-25 mm), the mean aneurysm neck size was 6.54 mm (4-13.8 mm). Patients were given 81 mg of aspirin and 75 mg of clopidogrel daily starting at least 7 days before stent deployment. All stents were deployed using the standard jailing technique. Result: The stent was accurately placed in all patients. Difficulty in navigating the Prowler Select Plus microcatheter (Cordis, Miami, FL, USA) beyond the aneurysm neck was experienced in 5 patients (15.2%). Therefore, catheter exchange was performed in these patients. Slip drop of the Prowler Plus during the stent deployment occurred in 1 patient. Additional coil embolization immediately after stent deployment was achieved in all patients, and occlusion was complete in 25 patients (75.8%). However, it was necessary to switch from the jailed technique to the trans-cell technique in 8 patients (24.2%). Procedural adverse events included two thrombo-embolisms and one subarachnoid hemorrhage. There was a 3% morbidity rate and no mortality. Follow-up angiography was achieved in 10 patients. Asymptomatic stent occlusion occurred in 1 patient. Conclusion: The Enterprise VRD is valuable in the treatment of wide-necked aneurysms. However, its safety and efficacy should be further evaluated in a larger series with longer follow-up. © 2012, The Japanese Society for Neuroendovascular Therapy. All rights reserved.