Delayed thrombosis or stenosis following enterprise-assisted stent-coiling: Is it safe? Midterm results of the interstate collaboration of enterprise stent coiling

J. Mocco, Kyle M. Fargen, Felipe C. Albuquerque, Bernard Bendok, Alan S. Boulos, Jeffrey S. Carpenter, David J. Fiorella, Brian L. Hoh, Jay U. Howington, Kenneth M. Liebman, Sabareesh K. Natarajan, Ansaar T. Rai, Rafael Rodriguez-Mercado, Adnan H. Siddiqui, Kenneth V. Snyder, Erol Veznedaroglu, L. Nelson Hopkins, Elad I. Levy

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Background: Stent-assisted coiling of intracranial aneurysms with self-expanding stents has widened the applicability of neuroendovascular therapies to those aneurysms previously considered "uncoilable" because of poor morphology. The Enterprise Vascular Reconstruction Device and Delivery System (Cordis) has demonstrated promising initial short-term results. However, the rates of delayed in-stent stenosis or thrombosis are not known. Objective: To report midterm results of the Enterprise stent system. Methods: A 10-center registry was created to provide a large volume of data on the safety and efficacy of the Enterprise stent system. Pooled data were compiled for consecutive patients undergoing Enterprise stent-assisted coiling at each institution. Available follow-up data were evaluated for the incidence of in-stent stenosis, thrombosis, and aneurysm occlusion. Results: In total, 213 patients (176 females) with 219 aneurysms were treated with the Enterprise stent. One hundred ten patients had undergone delayed angiography (≥30 days from stent placement, mean follow-up 174.6 days). Forty percent of patients demonstrated total occlusion with 88% having ≥90% aneurysm occlusion. Six percent of patients had delayed (>30 days) angiographic findings, of which 3% demonstrated significant (≥50%) in-stent stenosis or occlusion. Seven delayed thrombotic events occurred (3%), along with 2 additional immediate periprocedural events. All 7 delayed events were concomitant to cessation of double-antiplatelet therapy. Conclusion: Midterm occlusion rates are excellent, and stenosis and thrombosis rates are comparable to other available neurovascular stents. Interruption of antiplatelet therapy appears to be a factor in those developing delayed stenosis or thrombosis.

Original languageEnglish (US)
Pages (from-to)908-913
Number of pages6
JournalNeurosurgery
Volume69
Issue number4
DOIs
StatePublished - Oct 2011
Externally publishedYes

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Stents
Pathologic Constriction
Thrombosis
Aneurysm
antineoplaston A10
Intracranial Aneurysm
Blood Vessels
Registries
Angiography
Therapeutics
Safety
Equipment and Supplies
Incidence

Keywords

  • Cerebral aneurysm
  • Coil embolization
  • Endovascular
  • Enterprise Vascular Reconstruction Device and Delivery System
  • Stent-assisted coiling

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Delayed thrombosis or stenosis following enterprise-assisted stent-coiling : Is it safe? Midterm results of the interstate collaboration of enterprise stent coiling. / Mocco, J.; Fargen, Kyle M.; Albuquerque, Felipe C.; Bendok, Bernard; Boulos, Alan S.; Carpenter, Jeffrey S.; Fiorella, David J.; Hoh, Brian L.; Howington, Jay U.; Liebman, Kenneth M.; Natarajan, Sabareesh K.; Rai, Ansaar T.; Rodriguez-Mercado, Rafael; Siddiqui, Adnan H.; Snyder, Kenneth V.; Veznedaroglu, Erol; Hopkins, L. Nelson; Levy, Elad I.

In: Neurosurgery, Vol. 69, No. 4, 10.2011, p. 908-913.

Research output: Contribution to journalArticle

Mocco, J, Fargen, KM, Albuquerque, FC, Bendok, B, Boulos, AS, Carpenter, JS, Fiorella, DJ, Hoh, BL, Howington, JU, Liebman, KM, Natarajan, SK, Rai, AT, Rodriguez-Mercado, R, Siddiqui, AH, Snyder, KV, Veznedaroglu, E, Hopkins, LN & Levy, EI 2011, 'Delayed thrombosis or stenosis following enterprise-assisted stent-coiling: Is it safe? Midterm results of the interstate collaboration of enterprise stent coiling', Neurosurgery, vol. 69, no. 4, pp. 908-913. https://doi.org/10.1227/NEU.0b013e318228490c
Mocco, J. ; Fargen, Kyle M. ; Albuquerque, Felipe C. ; Bendok, Bernard ; Boulos, Alan S. ; Carpenter, Jeffrey S. ; Fiorella, David J. ; Hoh, Brian L. ; Howington, Jay U. ; Liebman, Kenneth M. ; Natarajan, Sabareesh K. ; Rai, Ansaar T. ; Rodriguez-Mercado, Rafael ; Siddiqui, Adnan H. ; Snyder, Kenneth V. ; Veznedaroglu, Erol ; Hopkins, L. Nelson ; Levy, Elad I. / Delayed thrombosis or stenosis following enterprise-assisted stent-coiling : Is it safe? Midterm results of the interstate collaboration of enterprise stent coiling. In: Neurosurgery. 2011 ; Vol. 69, No. 4. pp. 908-913.
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T1 - Delayed thrombosis or stenosis following enterprise-assisted stent-coiling

T2 - Is it safe? Midterm results of the interstate collaboration of enterprise stent coiling

AU - Mocco, J.

AU - Fargen, Kyle M.

AU - Albuquerque, Felipe C.

AU - Bendok, Bernard

AU - Boulos, Alan S.

AU - Carpenter, Jeffrey S.

AU - Fiorella, David J.

AU - Hoh, Brian L.

AU - Howington, Jay U.

AU - Liebman, Kenneth M.

AU - Natarajan, Sabareesh K.

AU - Rai, Ansaar T.

AU - Rodriguez-Mercado, Rafael

AU - Siddiqui, Adnan H.

AU - Snyder, Kenneth V.

AU - Veznedaroglu, Erol

AU - Hopkins, L. Nelson

AU - Levy, Elad I.

PY - 2011/10

Y1 - 2011/10

N2 - Background: Stent-assisted coiling of intracranial aneurysms with self-expanding stents has widened the applicability of neuroendovascular therapies to those aneurysms previously considered "uncoilable" because of poor morphology. The Enterprise Vascular Reconstruction Device and Delivery System (Cordis) has demonstrated promising initial short-term results. However, the rates of delayed in-stent stenosis or thrombosis are not known. Objective: To report midterm results of the Enterprise stent system. Methods: A 10-center registry was created to provide a large volume of data on the safety and efficacy of the Enterprise stent system. Pooled data were compiled for consecutive patients undergoing Enterprise stent-assisted coiling at each institution. Available follow-up data were evaluated for the incidence of in-stent stenosis, thrombosis, and aneurysm occlusion. Results: In total, 213 patients (176 females) with 219 aneurysms were treated with the Enterprise stent. One hundred ten patients had undergone delayed angiography (≥30 days from stent placement, mean follow-up 174.6 days). Forty percent of patients demonstrated total occlusion with 88% having ≥90% aneurysm occlusion. Six percent of patients had delayed (>30 days) angiographic findings, of which 3% demonstrated significant (≥50%) in-stent stenosis or occlusion. Seven delayed thrombotic events occurred (3%), along with 2 additional immediate periprocedural events. All 7 delayed events were concomitant to cessation of double-antiplatelet therapy. Conclusion: Midterm occlusion rates are excellent, and stenosis and thrombosis rates are comparable to other available neurovascular stents. Interruption of antiplatelet therapy appears to be a factor in those developing delayed stenosis or thrombosis.

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KW - Coil embolization

KW - Endovascular

KW - Enterprise Vascular Reconstruction Device and Delivery System

KW - Stent-assisted coiling

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