Frequency and predictors of endoleaks and long-term patency after covered stent placement for the treatment of intracranial aneurysms: a prospective, non-randomised multicentre experience

Objective

We investigated immediate/late endoleaks and long-term patency following stent-graft placement for treatment of intracranial aneurysms located within the distal internal carotid artery (ICA) or vertebral artery (VA).

Methods

Forty-five aneurysms in 41 patients receiving covered stents in three centres were followed. Outcome measures included aneurysm occlusion rate, endoleaks, late in-stent stenosis rate, clinical improvement, neurological deficiencies and death.

Results

Total aneurysm exclusion was achieved in 69.2% (n?=?27), with 30.8% (n?=?12) experiencing immediate residual endoleaks. Angiographic follow-up (mean 43.5?±?14.3 months) revealed that 87.2% (n?=?34) were completely occluded with only 12.8% (n?=?5) showing residual endoleaks. Predictors of immediate endoleaks in our patient group were stent number (P?=?0.023) and stent diameter (P?=?0.022), while predictors of late endoleaks in our patient group were stent diameter (P?=?0.035) and stent angulation (P?=?0.021). Late in-stent stenosis rates were 18.0?±?13.3 and 29.0?±?18.5% compared with the period immediately following implantation at 2- and 6-year follow-ups respectively. Smoking (P?=?0.017) and stent angulation (P?=?0.020) were predictors of late in-stent stenosis.

Conclusion

Treating intracranial aneurysms with Willis stent-grafts has an acceptable immediate and late occlusion rate and long-term stented artery patency rate.

Key Points

? Covered stents can be a treatment option for intracranial aneurysms. ? Technical success for treating distal ICA and VA aneurysms can reach 97.6%. ? However immediate and late endoleaks occur in 30.8 and 12.8% respectively. ? The number, diameter and angulation of stents are possible predictors of endoleaks. ? Smoking and stent angulation seem to predict late in-stent stenosis.