Immediate and midterm follow-up results of using an electrodetachable, fully retrievable SOLO stent system in the endovascular coil occlusion of wide-necked cerebral aneurysms

OBJECT: Stent-assisted embolization is an alternative endovascular treatment method for wide-necked intracranial aneurysms. Currently available stents have the limitations of poor radial force, difficult delivery systems, and lack of full retrievability. The authors report on their preliminary experience with the use of a new, fully retrievable, self-expanding neurovascular stent, which has a high radial force and easy delivery system, combined with coil or Onyx embolization for the treatment of wide-necked aneurysms, including 6-month follow-up data. METHODS: Fifteen patients with 18 wide-necked intracranial aneurysms were treated using the SOLO stent system and detachable platinum coils. Aneurysms were located at the posterior communicating artery (seven lesions), midbasilar artery (one lesion), internal carotid artery (ICA) bifurcation (one lesion), ICA-ophthalmic artery segment (eight lesions), and posterior cerebral artery (one lesion). Eleven aneurysms were small, six were large, and one was giant. Only one of these aneurysms was in the acute stage of subarachnoid hemorrhage; balloon remodeling alone failed to keep the coils in the aneurysm sac. RESULTS: Only one stent required retrieving and repositioning after it had been fully deployed, and retrieval was easy and successful. No thromboembolic complication, dissection/rupture, or vasospasm occured during stent placement. Follow-up angiograms obtained at 6 months posttreatment in the 18 aneurysms demonstrated that all stents were patent with no evidence of intimal hyperplasia or stenosis. In all cases but one, 100% lesion occlusion was observed at the 6-month control angiography examination. Only one aneurysm had recanalized. CONCLUSIONS: The fully retrievable self-expandible SOLO stent is a feasible, secure, and effective system with a high radial force and ease of delivery in treating wide-necked intracranial aneurysms in combination with coil embolization.     

Combined endovascular treatment of dissecting vertebral artery aneurysms by using stents and coils

OBJECT: With the recent development and refinement of endovascular stents, the significant potential for these devices in the treatment of wide-necked dissecting and fusiform aneurysms has become apparent. In this article the authors report on the use of stents and coils to treat dissecting and fusiform vertebral artery (VA) aneurysms. METHODS: Eight consecutive patients harboring eight dissecting aneurysms and one fusiform aneurysm of the VA were succesfully treated using a procedure in which the authors inserted an intravascular stent and secondary endosaccular coils when needed. In all but one patient complete aneurysm occlusion was achieved, and in all cases there was no neurological complication. Follow-up angiography examinations were performed in all patients (mean duration of follow-up angiography review 13.1 months, range 3-42 months). The patients remained stable throughout the clinical follow-up period (mean 14.1 months, range 4-42 months). No rebleeding was recorded. CONCLUSIONS: At present this combined approach represents a reliable and safe alternative for the treatment of VA dissecting aneurysms, especially in patients who cannot tolerate occlusion tests.     

Intrasaccular combination of metallic coils and onyx liquid embolic agent for the endovascular treatment of cerebral aneurysms

OBJECT: The aim of this study was to report on a novel technique in which metallic embolization coils were combined with the Onyx liquid embolic agent in the aneurysm sac to achieve a more durable result after endovascular treatment. This therapeutic procedure was performed in selected cases in which, based on the authors' experiences, either coil embolization or Onyx alone would likely have failed. The authors report long-term clinical and angiographic follow-up results in 20 consecutive intracranial aneurysms treated using this combination for defined indications. METHODS: Twenty aneurysms in 20 patients were treated with a combination of embolic coils and Onyx. Four aneurysms were giant; 13, large; and three, small. This new technique was used when standard Onyx or coil treatment with balloon assistance was determined to involve a higher possibility of recanalization, because either an adjunctive stent insertion could not be performed or the Onyx technique could not be used due to an unsuccessful seal test or intraaneurysm balloon prolapse. In one case, an adjunctive stent was placed before coil placement and Onyx deposition to control the material in the sac of the aneurysm, which had a fusiform neck. All aneurysms were completely occluded after using this technique. No clinical or technical adverse events occurred in any of the cases. Follow-up angiography was performed in all patients: 3-year studies in six patients, 2-year studies in five, and 1-year studies in nine. None of these studies demonstrated aneurysm regrowth or parent artery occlusion. CONCLUSIONS: The combination of the embolic coils and the Onyx liquid embolic agent provides very durable aneurysm occlusion for defined indications.     

Double-stent method: therapeutic alternative for small wide-necked aneurysms. Technical note

The authors present two cases of patients with small, acutely ruptured, wide-necked aneurysms of the distal vertebral artery that were not amenable to conventional coil embolization and were instead treated by means of a double-stent method in which one stent was placed inside another. Angiography performed immediately after the procedure revealed a significant reduction in aneurysm filling; total occlusion of the lesion was observed after 7 days and confirmed 6 months later in both aneurysms. By placing one stent inside the other, stent permeability can be reduced, which may result in significant hemodynamic changes with accelerated aneurysm thrombosis. This double-stent method may represent a therapeutic alternative, especially in cases of small, wide-necked aneurysms in which conventional endovascular techniques or stent-supported coil embolization is not considered feasible or is believed to be too dangerous, and surgical treatment is contra-indicated.     

Treatment of complex intracranial aneurysms with a telescoping stent technique

Background and Object Complex intracranial aneurysms present a treatment challenge for both open and endovascular modalities of treatment. This report seeks to illustrate a series of patients with aneurysms treated with telescoping stents as a method of flow diversion for small and fusiform intracranial aneurysms.Material and Methods A retrospective evaluation of six patients treated with a telescoping stent technique utilizing available stents (at that time before the pipeline era) for complex cerebral aneurysms between January 2009 and January 2010 was performed. Five patients had dissecting aneurysms and one patient had a small superior hypophyseal artery aneurysm. One of the patients was treated in the setting of a Hunt and Hess grade IV subarachnoid hemorrhage. Follow-up cerebral angiography was performed postprocedure at 6 months.Results At a mean follow-up period of 9 months, all the patients experienced complete or near-complete occlusion (>95%). No periprocedural complications were noted in this series. No episodes of hemorrhage or thromboembolic complications occurred.Conclusions Overlapping Neuroform and Enterprise stents may induce complete thrombosis of intracranial aneurysms and facilitate parent artery remodeling. The use of self-expanding stents is still an adequate treatment modality, especially if there is a need for vessel wall stabilization rather than flow diversion. The technique is also a sufficient alternative in small intracranial aneurysms not readily amenable to open surgical treatment or traditional endovascular coil embolization.     

Clinical and angiographic outcome of intracranial aneurysms treated with Matrix detachable coils in Chinese patients

BACKGROUND: Aneurysm recurrence is an innate problem in endovascular treatment of aneurysms with coils. A coated coil system named Matrix (Boston Scientific Neurovascular, Fremont, CA), covered with a bioabsorbable polymeric material (polyglycolide/lactide copolymer [PGLA]), was developed to accelerate intraaneurysmal clot organization and fibrosis. The purpose of this study was to evaluate the efficacy and safety of the Matrix detachable coils in patients with intracranial aneurysms and aneurysmal recurrence rate. METHODS: In a regional neurosurgical center in Hong Kong, data of patients undergoing endovascular embolization of intracranial aneurysm was collected. In a 20-month period, 42 patients with 44 aneurysms were treated by endovascular embolization using matrix coils alone or mixed with bare platinum coils. Thirty-four patients presented with ruptured aneurysms, and 8 patients presented with unruptured aneurysms. RESULTS: Twenty-five patients (60%) had 6-month follow-up DSA, and 10 patients (24%) had 18-month follow-up DSA. Seven aneurysm recurrences were identified, amounting to 16% for all aneurysms and 14% for ruptured aneurysms. Four patients were treated by repeated embolization, and 2 patients were treated by microsurgical clipping. Two adverse events due to thromboembolism were noted. One 78-year-old lady with poor-grade subarachnoid hemorrhage treated by partial embolization died from rebleed at day 4. Another patient with partial embolization and spontaneous thrombosis of dorsal wall ICA aneurysm died at 2 months with aneurysm recanalization with rerupture. Twenty-six patients achieved favorable outcome (GOS score 4 or 5) at last follow-up. The aneurysm recurrence rate using bare platinum coils of the same center was 11% and 7% for all aneurysms and ruptured aneurysms, respectively. CONCLUSION: Matrix coil embolization was safe, but there was no reduction in aneurysm recurrence using matrix coils alone or mixed with GDCs, compared with GDCs alone.     

Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils

OBJECTIVE: The long-term durability of the endovascular occlusion of cerebral aneurysms is one of the major factors limiting the more widespread use of this technique. Long-term occlusion of wide-necked aneurysms has improved with new assistive devices that seem to improve aneurysm occlusion while protecting the parent vessel. We report the use of a new intracranial stent--the Neuroform microstent--in the treatment of patients with wide-necked cerebral aneurysms. METHODS: Patients identified as harboring wide-necked intracranial aneurysms were evaluated for stent-assisted coiling. After appropriate anticoagulation was performed, depending on whether the aneurysm was ruptured or unruptured, the Neuroform stent was delivered across the neck of the aneurysm and deployed with a coil pusher. After stent placement, standard coil occlusion of the aneurysm was achieved in the majority of cases. RESULTS: Fifty-six patients were identified as having wide-necked intracranial aneurysms suitable for stent-assisted coiling. A total of 49 aneurysms in 48 patients were treated with this procedure. In eight cases, stent deployment failed. Forty-one of the aneurysms were initially stented, followed by coil placement. Six aneurysms were stented only, and one aneurysm was initially coiled, followed by stent placement. There were five deaths (8.9%), one of which occurred secondary to a stroke after the procedure (1.8%). Four patients (7%) experienced thromboembolic events, three of which were considered to have been secondary to the procedure (5.3%). In addition, there were two femoral pseudoaneurysms. The overall complication rate was 10.7%. Five patients were available for follow-up angiographic evaluation, and their cases are discussed. CONCLUSION: Intracranial stenting may overcome important technical limitations in current endovascular therapy by improving the occlusion of wide-necked aneurysms while protecting the parent vessel.     

Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms.

OBJECT: Results of previous in vitro and in vivo experimental studies have suggested that placement of a porous stent within the parent artery across the aneurysm neck may hemodynamically uncouple the aneurysm from the parent vessel, leading to thrombosis of the aneurysm. For complex wide-necked aneurysms, a stent may also aid packing of the aneurysm with Guglielmi detachable coils (GDCs) by acting as a rigid scaffold that prevents coil herniation into the parent vessel. Recently, improved stent system delivery technology has allowed access to the tortuous vascular segments of the intracranial system. The authors report here on the use of intracranial stents to treat aneurysms involving different segments of the internal carotid artery (ICA), the vertebral artery (VA), and the basilar artery (BA). METHODS: Ten patients with intracranial aneurysms located at ICA segments (one petrous, two cavernous, and three paraclinoid aneurysms), the VA proximal to the posterior inferior cerebellar artery origin (one aneurysm), or the BA trunk (three aneurysms) were treated since January 1998. In eight patients, stent placement across the aneurysm neck was followed (immediately in four patients and at a separate procedure in the remaining four) by coil placement in the aneurysm, accomplished via a microcatheter through the stent mesh. In two patients, wide-necked aneurysms (one partially thrombosed BA trunk aneurysm and one paraclinoid segment aneurysm) were treated solely by stent placement; coil placement may follow later if necessary. No permanent periprocedural complications occurred and, at follow-up examination, no patient was found to have suffered symptoms referable to aneurysm growth or thromboembolic complications. Greater than 90% aneurysm occlusion was achieved in the eight patients treated by stent and coil placement as demonstrated on immediate postprocedural angiograms. Follow-up angiographic studies performed in six patients at least 3 months later (range 3-14 months) revealed only one incident of in-stent stenosis. In the four patients originally treated solely by stent placement, no evidence of aneurysm thrombosis was observed either immediately postprocedure or on follow-up angiographic studies performed 24 hours (two patients), 48 hours, and 3 months later, respectively. CONCLUSIONS: A new generation of flexible stents can be used to treat complex aneurysms in difficult-to-access areas such as the proximal intracranial segments of the ICA, the VA, or the BA trunk. The stent allows tight coil packing even in the presence of a wide-necked, irregularly shaped aneurysm and may provide an endoluminal matrix for endothelial growth. Although convincing experimental evidence suggests that stent placement across the aneurysm neck may by itself promote intraluminal thrombosis, the role of this phenomenon in clinical practice may be limited at present by the high porosity of currently available stents.     

Review of endovascular stent‐assisted embolization for management of intracranial aneurysms

Objective: This was a retrospective review of the results using stent‐assisted coil embolization for management of intracranial aneurysms. Methods: The records of seven patients treated with stent‐assisted Gugliemi detachable coil (GDC) embolization were retrieved from the authors’ prospectively maintained database. The clinical presentation, site and type of aneurysms, treatment procedure and complications, and outcome of these identified cases were reviewed. Results: Between January 2002 and May 2004, seven patients with intracranial aneurysms, four of which were ruptured, were treated by stent‐assisted GDC embolization. Four aneurysms were located at the anterior circulation and three were at the posterior circulation. The indications for stent use were: giant aneurysm (>2.5 cm), dissecting pseudo‐aneurysm, broad‐necked aneurysm and the need for preservation of important parent arteries or branches. Concerning the technical aspect, all except one had successful stent deployment. One stent dislodged after apparent successful deployment. GDC embolization was continued and the aneurysm was partially occluded. More than 90% occlusion of aneurysm sac was achieved in six aneurysms. Intraoperative complications included over‐coagulation, failure in stent deployment, displacement of stent, coil entrapment and thromboembolism. One patient had added focal neurological deficit after the procedure, and one became vegetative due to an unrelated cause. The patient in whom the stent was dislodged suffered another subarachnoid haemorrhage 4 months later and died. Conclusion: Percutaneous intracranial stent is a new and useful device to assist embolization of cerebral aneurysms that were previously not amenable to endovascular therapy. These preliminary results suggest that this procedure could achieve satisfactory outcomes without significant complications.     

支架结合电解可脱弹簧圈治疗宽颈后交通动脉瘤的初步体会

目的 总结血管内支架结合电解可脱弹簧圈(Guglielmi detachable coil,GDC)治疗宽颈后交通动脉瘤的临床体会。方法 32例宽颈后交通动脉瘤,均先植入冠脉支架覆盖动脉瘤颈,再将微导管通过支架网孔超选进入动脉瘤腔,填塞GDC。结果 32例患者,动脉瘤完全填塞26例,90％以上填塞4例,60～70％填塞2例。所有载瘤动脉通畅,临床效果优良。结论 血管内支架结合GDC是治疗宽颈后交通动脉瘤的有效方法,长期疗效有待进一步随访。     

Endovascular treatment of very small intracranial aneurysms

BACKGROUND: The treatment of very small cerebral aneurysms with maximal diameter less than 3 mm remains a challenge for endovascular and surgical treatment. Endovascular treatment of these lesions may be difficult and associated with high risk of complications because of their small size. Our purpose was to assess the feasibility and results of endovascular treatment of these lesions. METHODS: We conducted a retrospective review of our experience and results of endovascular treatments for a series of 11 consecutive patients with 11 very small aneurysms. Of 11 aneurysms, 10 were acutely ruptured, and 1 was unruptured with a previous subarachnoid hemorrhage from another aneurysm. Aneurysms were located at the internal carotid artery (n = 4), the anterior communicating artery (n = 6), and the vertebral artery (n = 1). Seven patients were treated with coil embolization, and remodeling technique was used in 1 case. Three cases underwent intravascular stent implantation. Coil packing was done after in 2 of 3 aneurysms, and stent implantation alone was used in the remaining aneurysm. RESULTS: Coil embolization and stent deployment were carried out without difficulty in all cases. Coil packing was not available after stent implantation in 1 case for unsuccessful navigation of microcatheter into the aneurysm sac. Immediate angiography demonstrated complete occlusion in 10 cases and nearly complete occlusion in 1 case with stent implantation alone. No stent thrombosis and aneurysmal rupture was encountered during treatment. With the exception of 1 patient (Hunt and Hess grade 4) who died of pneumonia 4 weeks after treatment, no clinical evidence of neurologic deterioration and hemorrhagic complication was seen during the follow-up period in the remaining 10 patients. Follow-up angiography for 3 to 12 months (mean, 5.3 months) was available in 6 (60%) of 10 surviving patients, and no aneurysm recanalization was found. CONCLUSIONS: Endovascular treatment may be a feasible and effective therapeutic alternative for very small aneurysms. The long-term efficacy and durability of endovascular treatment for these lesions remains to be determined in a large series.     

Transluminal stent-assisted coil embolization of a vertebral confluence aneurysm: technique report

BACKGROUND: Recent advances in stent technology have allowed for negotiation of often tortuous posterior circulation intracranial vasculature. Stent-assisted coil embolization is a novel treatment for complex wide-necked aneurysms, as stents provide a buttress that allows for coil deposition while preventing coil herniation into the parent vessel lumen. We describe a case of stent-assisted coil embolization of a complex wide-necked vertebral confluence aneurysm. CASE DESCRIPTION: A 61-year-old woman presented with a Hunt-Hess III, Fisher Grade III subarachnoid hemorrhage secondary to a ruptured vertebral confluence aneurysm demonstrated on angiography. The patient underwent emergent angiography and attempted coiling of a vertebral confluence aneurysm. Because of the aneurysm's complex wide neck and the presence of subclavian steal syndrome, the coils repeatedly herniated into the left vertebral and basilar artery lumina. A flexible coronary stent was deployed across the aneurysm neck, preventing coil herniation and allowing for greater coil deposition. The patient tolerated the procedure and underwent repeat coiling 2 months postoperatively because of mild coil compaction. This resulted in 100% occlusion and the patient is neurologically normal except for a sixth nerve palsy which had been present after the hemorrhage. CONCLUSION: Recent advances in stent technology allow negotiation of the tortuous posterior circulation vasculature. Stent-assisted coil embolization of complex, wide-necked vertebral confluence aneurysms may be an alternative intervention for these surgically challenging lesions.     

Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils

OBJECT: Surgical or endovascular occlusion of the parent artery proximal to an aneurysm has been recommended for treatment of dissecting aneurysms of the intracranial posterior circulation. However, dissecting aneurysms may rupture even after proximal occlusion because distal progression of thrombus is necessary to occlude the dissecting aneurysm completely, and this may be delayed by the presence of retrograde flow. In this article the authors present their experience in treating six patients with ruptured dissecting aneurysms. METHODS: The authors report on six patients with a ruptured dissecting aneurysm in the posterior fossa who were successfully treated by endovascular occlusion of the aneurysm by using Guglielmi detachable coils. The procedure was particularly aimed at occluding the dissected site. CONCLUSIONS: At the present time, endovascular occlusion of the dissected site is a safe, minimally invasive, and reliable treatment for dissecting aneurysms when a test occlusion is tolerated and adequate collateral circulation is present.     

Complementary management of partially occluded aneurysms by using surgical or endovascular therapy

OBJECT: The authors present a series of patients in whom partially occluded aneurysms were retreated using complementary surgical or endovascular therapy. METHODS: During a period of 18 months, 301 patients with intracranial aneurysms were treated using either clip application (171 patients) or endovascular embolization with Guglielmi Detachable Coils ([GDCs] 130 patients). Routine posttreatment angiography studies revealed residual aneurysms in 21 of these patients, nine of whom were retreated using an endovascular or surgical method, with a mean treatment latency of 1.2 months. Four patients underwent primary surgical clip application, whereas five patients experienced GDC packing first. Among patients in the surgical group, the residual aneurysm neck was small and total elimination of the aneurysm was achieved by packing in GDCs. In patients in the endovascular group the authors incompletely packed the aneurysm because of its wide neck or fusiform component in two patients, perforation of a very small aneurysm in one patient, and coil dislocation in another patient. Typical coil compaction occurred in one case. Complete clip application was achieved in all patients. There was no complication in any patient due to the second treatment modality. Final outcome was excellent or good in six and fair in three. CONCLUSIONS: Following clip application or endovascular embolization of intracranial aneurysms, the use of complementary surgical or endovascular management is successful and associated with low morbidity.     

Parent vessel Guglielmi detachable coil herniation during wide-necked aneurysm embolization: treatment with intracranial stent placement: two technical case reports

OBJECTIVE AND IMPORTANCE: Despite recent advances in technology, parent vessel coil herniation occasionally complicates successful Guglielmi detachable coil embolization, particularly in wide-necked aneurysms. We report endovascular stent deployment performed in two patients specifically to treat this complication. CLINICAL PRESENTATION: Two patients underwent Guglielmi detachable coil embolization of cavernous segment aneurysms. Both developed coil herniation into the internal carotid artery. In one patient, the herniation occurred during the initial procedure; in the other, it was discovered in a delayed fashion during a follow-up examination for ocular symptoms. INTERVENTION: In both patients, endovascular stent deployment was performed to isolate the herniated portion of the coil from the internal carotid lumen. Follow-up angiography at 6 months demonstrated no aneurysm recanalization and no stenosis of the parent internal carotid artery in the stented region in either patient. CONCLUSION: The use of intraluminal stents has been reported to be a helpful technical adjunct to the conventional endovascular treatment of aneurysms and balloon angioplasty. One additional indication for the use of this technology is sequestering herniated coils from the lumen of the parent artery to reduce potential embolic or occlusive sequelae.     

支架植入术联合弹簧圈栓塞治疗颅内复杂动脉瘤

目的探讨应用新型颅内支架植入联合弹簧圈栓塞术治疗颅内复杂动脉瘤的疗效。方法对26例30个颅内复杂动脉瘤行支架植入术弹簧圈栓塞术,术后6～24个月进行随访。结果术后即刻疗效：24个复杂动脉瘤完全栓塞,4个次全栓塞（栓塞95%以上）,2个不完全栓塞;所有支架位置满意,载瘤动脉通畅。随访2例动脉瘤复发,未见支架移位、塌陷、狭窄,载瘤动脉通畅、光滑。结论颅内支架植入联合弹簧圈栓塞术治疗颅内复杂动脉瘤安全有效;应根据动脉瘤的具体情况来选择具体技术。     

血管内介入治疗大脑后动脉夹层动脉瘤

目的观察血管内介入治疗大脑后动脉夹层动脉瘤的效果。方法回顾性分析12例接受血管内介入治疗的大脑后动脉夹层动脉瘤患者,评价治疗效果。结果12例大脑后动脉夹层动脉瘤中,P1段2例,P1-P2段2例,P2段6例,P3段2例,均成功实施栓塞治疗;对其中2例单纯以弹簧圈栓塞动脉瘤,8例以弹簧圈闭塞载瘤动脉,2例植入支架。术后即刻行复查造影显示Raymond分级1级10例,2级2例。术后4例诉头痛,经对症治疗后2周内好转;未见动脉瘤破裂出血及脑梗死。随访期间影像学检查均未见动脉瘤复发,无新发神经功能障碍及颅内再次出血;末次随访时改良Rankin量表0分10例,1分1例,2分1例。结论血管内介入治疗大脑后动脉夹层动脉瘤效果较好,且安全性较高。     

Buenos Aires experience with the Neuroform self-expanding stent for the treatment of intracranial aneurysms

OBJECT: The authors report their experience with the use of the Neuroform Microdelivery System for intravascular reconstruction. They assess the technical feasibility of the system, the efficacy of the combined application of stent and detachable coils, and the follow-up findings. METHODS: Fifty patients found to harbor a complex wide-necked intracranial aneurysm were selected for the study. Different strategies were chosen and the performance and technical success of the device were evaluated. Stent placement was recorded as optimal or suboptimal with respect to the stent position. Clinical and angiographic follow-up examinations were obtained. Forty-six patients with 48 intracranial aneurysms were treated, leading to a technical success rate of 92%. Forty-two lesions were located in the anterior circulation. In every case the dome/neck ratio was less than 2 and the mean aneurysm size in these patients was 8.8 mm. The most frequent clinical presentation was subarachnoid hemorrhage in 48% of cases. Stent placement was optimal in 81.2% of cases and suboptimal in 18.8%. In 31% of cases, the investigators encountered difficulties in placing the Neuroform stent. Clinical follow up was recorded in all patients and angiographic follow up was obtained in 63%. There were no cases of repeated hemorrhage. In a single case in which only the stent was implanted progressive thrombosis was identified during the follow-up period. The procedure-related morbidity and mortality rates were 8.6 and 2.1%, respectively. CONCLUSIONS: On the basis of the results, the authors conclude that the Neuroform self-expanding stent is a flexible and useful device that can be readily and safely maneuvered through tortuous intracranial vessels, enabling the endovascular treatment of complex wide-necked aneurysms. Early in the authors' experience, stent delivery presented difficulties; however, a second generation of devices has resolved this limitation. Although the early results are promising, the long-term benefit of this technique has to be proved by angiographic and clinical follow-up examinations.     

Endovascular reconstruction of intracranial arteries by stent placement and combined techniques

OBJECT: The authors investigated the feasibility, safety, and short-term outcome of stent treatment for intracranial aneurysms, stenoses, and dissections. METHODS: One hundred twenty-three consecutive patients with intracranial saccular, dissecting, and fusiform aneurysms, atherosclerotic lesions, and dissections were selected for intracranial stent implantation with or without adjunctive coil placement. One hundred eleven patients (mean age 47 years, range 3-73 years) underwent stent treatment; 12 patients (9.8%) were not treated. These 111 patients were divided into four groups: in Group 1 there were 62 patients with saccular aneurysms; Group 2 included nine patients (10 lesions) with dissecting or fusiform aneurysms; in Group 3 there were 36 patients with symptomatic intracranial atheromatous stenoses of more than 50%; and Group 4 included four patients with symptomatic intracranial dissections. All patients underwent computerized tomography scanning and/or magnetic resonance imaging and cerebral digital subtraction angiography preoperatively. Of the 72 aneurysms in Groups 1 and 2, 59 (82%) were treated with combined endovascular stent implantation and endosaccular coil placement. In 67 aneurysms (93%) we achieved complete or nearly complete obliteration. All patients with arterial narrowing achieved residual stenoses of less than 30% postangioplasty. One patient required repeated angioplasty. The morbidity rate in the series was 10.9% and the mortality rate was 6.3%. CONCLUSIONS: These findings indicate that stent treatment is feasible and seems to be an effective modality for arterial reconstruction. This versatile tool allows the treatment of a wide variety of challenging intracranial lesions.