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1. Patient Preparation
To lower their risk of thromboembolism, patients have antiplatelet therapy (aspirin and clopidogrel) for a few days before to the surgery. Usually, general anesthesia is used.
Stent assisted coiling
Stent assisted coiling
procedure steps
2. Access to Vascular
The femoral or radial arteries are typically used to get access. In the parent artery that supplies the aneurysm, a guiding catheter is inserted.
3. Navigation of Microcatheters
One microcatheter is used to send coils into the aneurysm sac, while the other is used to deliver the stent across the aneurysm neck.
4. Deployment of Stents
In order to prevent coil protrusion and preserve arterial patency, the stent is carefully positioned and deployed across the aneurysm neck inside the parent artery.
5. Embolization of Coils
After that, coils are consecutively deployed for dense packing after being placed into the aneurysm sac via the second microcatheter.
6. Inflation of Balloons
Balloon remodeling may occasionally be performed in addition to the stent to achieve the best coil placement.
7. Confirmation
Throughout, angiographic imaging is used to verify parent vascular patency, coil stability, and stent insertion.
8. Hemostasis and Catheter Removal
All catheters are removed once effective embolization has been confirmed, and vascular access site hemostasis is attained.
9. After-Procedure Care
In order to avoid in-stent thrombosis, patients continue antiplatelet medication and are closely watched for any problems
disease treated
Spinal Vascular Malformation
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Brain Aneurysm
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suitable for
Anatomical characteristics that increase the risk of coil prolapse
into the parent artery include wide-necked cerebral aneurysms, where the neck diameter is typically ≥4 mm or the dome-to-neck ratio is less than 2:1.
Aneurysms that are complex, fusiform, dissecting, or broad-based
Aneurysms that are complex, fusiform, dissecting, or broad-based and for which simple coiling is not a safe or effective treatment.
Stent placement provides scaffolding for coil stability
Stent placement provides scaffolding for coil stability in aneurysms situated in complex or challenging arterial architecture.
Circumstances where improved coil retention is necessary
Circumstances where improved coil retention is necessary to avoid herniation into the parent vessel.
Situations when it is anticipated that the stent's flow diversion
Situations when it is anticipated that the stent’s flow diversion effects will encourage aneurysm thrombosis.
Both ruptured and unruptured aneurysms
if the patient is properly prepared for the dual antiplatelet therapy that is required.
Antiplatelet therapy is necessary for stent patency
Antiplatelet therapy is necessary for stent patency and should be administered to patients who may safely tolerate it after the procedure.
benefits
Improved Coil Stability
In wide-neck aneurysms in particular, the stent serves as a scaffold to prevent coil prolapse or herniation into the parent artery.
Treatment of Complex Aneurysms
Makes it possible to safely embolize fusiform, wide-neck, or complex aneurysms that are inappropriate for straightforward coiling.
Better Occlusion Rates
Compared to coiling alone, there are greater rates of total aneurysm occlusion and durability.
Preservation of Parent Vessel
While stabilizing the aneurysm, it keeps the parent artery open and protects nearby branch vessels.
Decreased Requirement for Balloon Assistance
This could reduce flow disturbance throughout the process by doing away with the necessity for temporary balloon inflation.
Flow Diversion Effect
In addition to coil packing, the stent’s mesh may decrease blood flow into the aneurysm, encouraging thrombosis.
Applicable to Both Ruptured and Unruptured Aneurysms
Offers patients who need stabilization without open surgery treatment alternatives for ruptured aneurysms.
Minimally Invasive
The endovascular method minimizes recovery time and procedural morbidity when compared to surgical clipping.
Feasible in Tortuous Anatomy
Flexible stents make it easier to navigate difficult vascular anatomy.
Possibility of Temporary Stents
Some methods enable stent extraction after coiling, lowering the risk of bleeding and long-term antiplatelet medication.
post-treatment recovery
Hospitalization and Observation
Following the procedure, patients typically remain in the hospital for one to two days in order to closely monitor hemodynamic parameters, vascular access sites, and neurological condition.
First Recuperation
Mild headaches, exhaustion, or discomfort at the catheter insertion site are frequently experienced by patients; these symptoms usually go away in a few days.
Regular neurological evaluations are carried out to find any early issues.
Engagement and Attention
It is advised to gradually resume daily activities over a period of one to three weeks, avoiding intense exercise at first to promote vascular recovery.
Antiplatelet Treatment
Depending on the kind of stent and the clinical situation, post-procedure dual antiplatelet medication (aspirin and clopidogrel) is usually continued for weeks to months in order to prevent stent thrombosis.
Follow-up
Angiography or MRI imaging follow-up is often carried out in a matter of weeks to months to evaluate stent patency and aneurysm occlusion stability.
Extended Recuperation
In two to four weeks, patients usually resume their regular activities.
Unless there are peri-procedural issues, rehabilitation is rarely required.
Possible Difficulties
