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: 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. · 1.89 Impact Factor
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ABSTRACT: Treatment of posttraumatic direct carotid-cavernous fistula (DCCF) with detachable balloons (DB) is associated with relatively low complete occlusion rates. We aimed to compare the angiographic and clinical results of treatment with covered stents with the results of treatment with DB. Thirty-four patients with posttraumatic DCCF were selected for treatment with DB (n=19, group A) or covered stents (n=15, group B). Data on the technical success, duration of initial procedure and hospital stay, initial and final angiographic results, mortality, morbidity and final clinical outcomes were collected and analyzed within 12months. DB deployment and covered stent placement were technically successful in all patients, except one patient in group B in whom the covered stent failed to navigate to the target DCCF. The initial angiographic results for the 33 patients with successful procedures showed complete occlusion in 16 patients in group A (84.2%; 95% confidence interval [CI]: 66%, 102%) and 11 patients in group B (78.6%; 95% CI: 54%, 103%; p>0.05). The 12-month angiographic results indicated complete occlusion in 12 patients in group A (63.2%; 95% CI: 39%, 87%) and 14 patients in group B (100%; p=0.013). The average initial procedure time was 120.0±17.76minutes in group A and 93.15±8.12minutes in group B (p<0.001). No significant differences were seen between the two groups in technical success, mortality, morbidity or final clinical outcomes. In this nonrandomized, prospective study of posttraumatic DCCF treatment, the 12-month angiographic results of treatment with covered stents was superior to that of BD.Journal of Clinical Neuroscience 12/2012; · 1.25 Impact Factor
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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; · 3.36 Impact Factor