Treatment of distal internal carotid artery aneurysm with the willis covered stent: a prospective pilot study.
ABSTRACT To evaluate the flexibility and efficacy of the Willis covered stent in the treatment of distal internal carotid artery (DICA) aneurysms.
The study was approved by the authors' institutional review board, and the research was conducted by the authors' institution and the MicroPort Medical Company (Shanghai, China). Thirty-one patients with 33 DICA aneurysms were considered for treatment with a Willis covered stent. The angiographic assessments were categorized as complete or incomplete occlusion. The data on technical success, initial and final angiographic results, mortality, morbidity, and final clinical outcome were collected, and follow-up was performed at 1, 3, 6, and 12 months and yearly after the procedures.
Navigation and deployment of the covered stents were successful in 97.6% (41 of 42; 95% confidence interval [CI]: 93%, 102%) of the attempted stent placement procedures. The initial angiographic results showed a complete occlusion in 23 patients with 25 aneurysms (of 32 aneurysms, 78.1% [95% CI: 63%, 93%]) and an incomplete occlusion in seven patients with seven aneurysms (21.9%). The angiographic follow-up (mean, 14 months [95% CI: 12, 15 months]) findings exhibited a complete occlusion in 27 patients with 29 aneurysms (of 31 aneurysms, 93.5% [95% CI: 84%, 103%]) and an incomplete occlusion in two aneurysms (6.5%), with a mild in-stent stenosis in two patients. The clinical follow-up (mean, 27 months [95% CI: 23, 30 months]) demonstrated that 15 patients experienced a full recovery and 14 patients improved.
The preliminary results demonstrate good flexibility and efficacy of the Willis covered stent in the treatment of DICA aneurysms in selected patients; longer follow-up and expanded clinical trials are needed.
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ABSTRACT: OBJECTIVE: The treatment of posttraumatic direct carotid-cavernous fistulas (TCCFs) with detachable balloons (DBs) is associated with relatively high recanalization rate. The aim of this study was to evaluate the feasibility of using covered stents in patients with posttraumatic carotid-cavernous fistulas (CCFs) and pseudoaneurysms. METHODS: Twelve patients with posttraumatic CCFs and 3 with pseudoaneurysms following detachable balloon deployment referred for treatment with covered stents were enrolled into this prospective study. Data on technical success, initial and final angiography results, mortality, morbidity, and the final clinical outcome, were retrospectively collected and analyzed at 1-, 3-, 6-, 12-months, and then annually. RESULTS: The navigation and deployment of the covered stents to the target CCF were technically successful in 14 of the 15 attempted stents, giving a successful technical rate of 93.3%. Angiography poststent placement showed complete occlusion in 11 patients with 11 CCFs, and incomplete occlusion in 3. Follow-up angiography revealed complete occlusion and no obvious in-stent stenosis in any patient. Clinical follow-up demonstrated full recovery in 13 patients, and an unchanged status in 1. CONCLUSION: These preliminary results indicate that the use of a covered stent is a feasible procedure for the treatment CCFs and pseudoaneurysms.Journal of neuroimaging: official journal of the American Society of Neuroimaging 04/2013; · 1.82 Impact Factor
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ABSTRACT: This study evaluated the clinical value of detachable-balloon embolization for traumatic carotid-cavernous fistula (TCCF), focusing on the frequency, risk factors, and retreatment of recurrence. Fifty-eight patients with TCCF underwent transarterial detachable-balloon embolization between October 2004 and March 2011. The clinical follow-up was performed every 3 months until up to 3 years postprocedure. Each patient was placed in either the recurrence group or the nonrecurrence group according to whether a recurrence developed after the first procedure. The relevant factors including gender, fistula location, interval between trauma and the interventional procedure, blood flow in the carotid-cavernous fistula, number of balloons, and whether the internal carotid artery (ICA) was sacrificed were evaluated. All 58 TCCFs were successfully treated with transarterial balloon embolization, including 7 patients with ICA sacrifice. Recurrent fistulas occurred in seven patients during the follow-up period. Univariate analysis indicated that the interval between trauma and the interventional procedure (p=0.006) might be the main factor related to the recurrence of TCCF. The second treatments involved ICA sacrifice in two patients, fistula embolization with balloons in four patients, and placement of a covered stent in one patient. Detachable balloons can still serve as the first-line treatment for TCCFs and recurrent TCCFs despite having a nonnegligible recurrence rate. Shortening the interval between trauma and the interventional procedure may reduce the risk of recurrence.Journal of Clinical Neurology 04/2013; 9(2):83-90. · 1.81 Impact Factor
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ABSTRACT: IntroductionFlow diversion is a new approach to the endovascular treatment of intracranial aneurysms which uses a high density mesh stent to induce sac thrombosis. These devices have been designed for the treatment of complex shaped and large size aneurysms. So far published safety and efficacy data on this approach is sparse.Material and Methods Over 8 months, standardized clinical and angiographic data were collected on 70 patients treated with a flow diverter device (SILK flow diverter (SFD)) in 18 centres worldwide. Treatment and early follow up details were audited centrally. SFDs were deployed alone in 57 (81%) or with endosaccular coils in 10 (14%) aneurysms, which included: 44 (63%) saccular, 26 (37%) fusiform shapes and 18 (26%) small, 37 (53%) large, 15 (21%) giant sizes. Treatment outcome data up to 30 days were reported for all patients, with clinical (50 patients) and imaging (49 patients) follow up (median 119 days) data available.ResultsDifficulties in SFD deployment were reported in 15 (21%) and parent artery thrombosis in 8 (11%) procedures. Procedural complications caused stroke in 1 and serious extracranial bleeding in 3 patients; 2 of whom developed fatal pneumonias. Delayed worsening of symptoms occurred in 5 patients (3 transient, 1 permanent neurological deficit, and 1 death) and fatal aneurysm bleeding in 1 patient. Overall permanent morbidity rates were 2 (4%) and mortality 4 (8%). Statistical analysis revealed no significant association between complications and variables related to treated aneurysm morphology or rupture status.Conclusion This series is the largest reporting outcome of the new treatment approach and provides data for future study design. Procedural difficulties in SFD deployment were frequent and anti-thrombosis prophylaxis appears to reduce the resulting clinical sequelae, but at the cost of morbidity due to extracranial bleeding. Delayed morbidity appears to be a consequence of the new approach and warrants care in selecting patients for treatment and future larger studies.PLoS ONE 09/2010; 5(9). · 3.53 Impact Factor