Combined use of stents and coils to treat experimental wide-necked carotid aneurysms: preliminary results.
ABSTRACT To develop a new technique to treat wide-necked side-wall aneurysms, combining the implantation of intraarterial stents with the endosaccular placement of coils.
Bilateral side-wall aneurysms were surgically created on the carotid arteries of four dogs. In each animal, Guglielmi detachable coils were introduced into one of the aneurysms after implantation of a balloon-expandable Strecker stent within the parent artery, adjacent to the aneurysm orifice. The contralateral aneurysms were treated with coils alone.
In two dogs, one of the stented and both nonstented aneurysms remained partially open for 4 weeks after subtotal packing with coils. In another two dogs, tight aneurysm packing with coils resulted in complete occlusion of all four aneurysms. Bulging of the coil mass resulted in 30% to 75% narrowing of the nonstented parent arteries. At 4 and 5 weeks, significant stenosis resulting from reactive hyperplasia was observed in all stented carotid arteries.
Based on these preliminary results, we conclude that Guglielmi detachable coils can be introduced into an aneurysm cavity through Strecker stents. The stents allow tighter packing of wide-necked aneurysms by preventing coils from migrating or bulging into the parent arteries.
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ABSTRACT: To determine the efficacy of porous metallic stents in the treatment of experimentally created carotid-jugular fistulas. Carotid-jugular fistulas were constructed surgically in five mongrel dogs. Porous metallic stents were placed endovascularly across the fistula holes within the carotid artery; carotid angiography was performed before, immediately after, and 1 and 2 months after stent placement. The fistula specimens were resected 2 months after stent placement; gross and light microscopic analyses were performed. Angiography revealed complete closure of three of the five fistulas 1 month after stent placement; two of the five fistulas remained patent but demonstrated diminished flow rate. All carotid arteries were widely patent throughout the study. Gross pathology of the carotid-jugular specimens revealed fibrous connective tissue and collagen within the fistula hole. A thin layer of endothelium covered the stent wires and the fibrous connective tissue overlying the fistula hole. The stents were effective in closing three of the five fistulas and reducing flow through the fistulas in the remaining animals. With further refinements and variations in technique, porous metallic stents may prove a viable alternative to current endovascular devices for treatment of certain arteriovenous fistulas.American Journal of Neuroradiology 16(10):1965-73. · 3.68 Impact Factor
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ABSTRACT: To assess the biomechanical feasibility of treating experimental fusiform aneurysms endovascularly with a combination of stents and coils. An experimental model was surgically constructed in the necks of nine swine to simulate intracranial fusiform aneurysms possessing important "perforators" or side branches. Balloon-expandable metal stents were positioned across the aneurysms in eight swine. In five of these, additional treatment was intraaneurysmal placement of detachable microcoils. Attempts were made to deposit these coils strategically away from the origin of the side branch. Stent placement was successful in seven swine but failed in one swine because of stent-aneurysm size mismatch. Two swine treated with only stents showed no significant alterations in blood filling of the aneurysm or side branch. Satisfactory coil placement (outside the stent, within the aneurysm sac, and away from the orifice of the side branch) was achieved in four of the five swine treated with stents and coils. Careful fluoroscopic monitoring and controlled coil delivery were necessary to avoid covering the sidebranch origin. These aneurysms could not be packed densely after detachment of the first coil because of the resultant radiographic overlap of multiple coil loops on the stent and its lumen in all projections. In one swine there was inadvertent untoward reentry of the coil tip into the expanded stent lumen during its delivery. Endovascular treatment of experimental fusiforms aneurysms using stents and coils is technically feasible. The stent maintains patency of the parent artery while allowing strategic coil placement in the aneurysm sac away from the origin of side branches. This technique may prove useful in the future treatment of intracranial fusiform aneurysms. However, potential sources of technical difficulties have been identified, and further longterm studies using an appropriate intracranial stent will be necessary before human application.American Journal of Neuroradiology 16(10):1953-63. · 3.68 Impact Factor
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ABSTRACT: Kurzfassung: Mit der endovaskulären Coil- Embolisation steht eine hocheffiziente Technik für den minimalinvasiven Verschluss zerebraler Aneurysmen zur Verfügung. In Abhängigkeit von Aneurysmagröße und -morphologie ist bei Ein- satz moderner endovaskulärer Techniken mit stabilen Aneurysmaverschlüssen in > 85 % der Fälle zu rechnen. Auch ursprünglich als endovas- kulär unbehandelbar eingestufte Läsionen kön- nen durch den Einsatz verschiedener Hilfsmittel wie Protektionsballons, intrakraniellen Stents oder modernen semipermeablen Stents, soge- nannten "Flow diverter", häufig therapiert wer- den. Behandlungspflichtige Aneurysmarezidive können durch endovaskuläre Verfahren, chirurgi- sche Techniken oder auch durch kombiniert mul- timodale Behandlungen wie den therapeuti- schen Gefäßverschluss unter Bypassschutz the- rapiert werden. An unserem Zentrum wird die Mehrzahl behandlungspflichtiger Aneurysma- rezidive nach initialer Coil-Embolisation neuer- lich durch endovaskuläre Techniken versorgt. In einigen Fällen, wie nicht embolisierbaren Aneu- rysmarezidiven, Nachblutungen oder akuten in- terventionellen Komplikationen, kann das chirur- gische Management endovaskulär vorbehandel- ter Aneurysmen erforderlich werden. Der vorlie- gende Bericht gibt einen kurzen Überblick über die häufigsten Behandlungsszenarien. Abstract: Treatment Strategies for Cerebral Aneurysms Following Insufficient Endo- vascular Therapy. Neurosurgical Manage- ment of Aneurysmal Recurrences, Re- bleedings, and Endovascular Complica- tions. Endovascular treatment of intracranial aneurysms has become an established tech- nique that can provide stable permanent occlu- sion in > 85 % of cases. Even those aneurysms considered untreatable by endovascular means can now often be managed using adjunctive