Evaluation of Enterprise Stent-Assisted Coiling and Telescoping Stent Technique as Treatment of Supraclinoid Blister Aneurysms of the Internal Carotid Artery

Background: Supraclinoid blister aneurysms (BAs) of the internal carotid artery are uncommon and deadly, and appropriate treatment is controversial. Endovascular reconstruction may allow treatment through aneurysm isolation. We report a single-institution experience in the use of Enterprise stent-assisted coiling (ESAC) for treating BAs to appraise the safety and efficacy of this technique. Methods: Patients treated with ESAC for a BA at our institution between 2013 and 2016 were retrospectively included in this study. Patients’ aneurysm characteristics, progression status, aneurysm occlusion on follow-up angiography, and modified Rankin Scale (mRS) score were recorded and analyzed. Occlusion rates and neurologic outcomes were compared between patients treated with a single stent and those treated with multiple telescoping stents. Results: Forty-four patients were included (17 males; average age, 47.3 years), and ESAC was successfully performed in all patients. Immediate postprocedure angiography revealed complete occlusion in 23 patients (52.3%), residual neck in 15 (34.1%), and residual aneurysm in 6 (13.6%). Twenty patients (45.5%) suffered perioperative cerebral vasospasm, and 3 (6.8%) died of secondary ischemic stroke. The duration of follow-up ranged from 2.5 to 27 months (mean, 11.59 ± 5.76 months). One patient with recurrence was treated with additional coiling, and another patient was treated with a covered stent. The use of telescoping stents was associated with a better complete aneurysm occlusion rate compared with the use of single stents (84.4% [27 of 34] vs. 44.4% [4 of 9]; P = 0.04). Follow-up mRS score was ≤1 for 32 of 41 patients (78.4%). Conclusions: ESAC to treat BAs is safe, effective, and provides good clinical outcomes. ESAC with telescoping stents has a higher follow-up complete occlusion rate compared with ESAC with single stents.