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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- "Balloons or coils slow the flow patterns in the cavernous sinus, serve as a scaffold for polymerization of the liquid adhesive, and form a physical barrier preventing further movement of the liquid adhesive. Covered stents have recently been considered a promising treatment choice of TCCFs, particularly for recurrent, residual, and multiple fistulas, and fistulas combined with pseudoaneurysms or dissections.11,16,17 However, the treatment limitations when using a covered stent in TCCF patients include the stiffness of the stent, the difficulty of navigation, and the absence of unified perioperative medication. "
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. DOI:10.3988/jcn.2013.9.2.83 · 1.70 Impact Factor
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ABSTRACT: Asymptotic optimal (AO) algorithms for detection of signals in additive autoregressive noise of order m (m-dependent Markov noise) are synthesized. The algorithms require the storage of m past data samples to achieve optimum performance. It is an AO memory discrete-time detector of a deterministic or quasideterministic signal in autoregressive noise. To assure the change of the detector's parameters as a result of learning the AO algorithm was modified to an adaptive one. Combining the AO algorithm with adaptation it is a powerful approach to overcome a priori uncertainty in information systems. The investigations are carried out by a common approach with many simulation resultsSignals, Systems, and Electronics, 1995. ISSSE '95, Proceedings., 1995 URSI International Symposium on; 11/1995
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ABSTRACT: We report our single-center experience using detachable balloons (DB), coils and Willis covered stents (MicroPort, Shanghai, China) to treat post-traumatic direct carotid-cavernous fistulas (DCCFs), focusing on preservation of the internal carotid artery (ICA). We retrospectively reviewed the records of 51 patients who received endovascular treatment (EVT). EVT with DBs was chosen as the first-line therapeutic strategy, and Willis covered stent placement and coiling was the alternative. The patency and stability of all DCCFs was evaluated by angiographic and clinical follow-up for between 3 and 48 months. A total of 54 DCCFs in 51 patients were treated as follows: DB alone (n=40); combined DB and Willis covered stent (n=8); Willis covered stent alone (n=2); combined DB and coils (n=2); coils alone (n=1); and DB in combination with both coils and a Willis covered stent (n=1). Overall, 98% of DCCFs were successfully treated with the occlusion of the fistula and preservation of the ICA; the ICA was sacrificed in only one patient. Approximately 85% of DCCFs were successfully treated with DBs alone. Second and third administrations of EVT were required in 12 DCCFs. DCCF-related symptoms improved gradually between 1 day and 6 months after treatment. EVT using DB to occlude fistulas and preserve the ICA is the preferential treatment for DCCFs. When standard treatment has failed, coils and/or Willis covered stents can be used as a safe alternative or remedial tool with ICA preservation and reconstruction.Journal of Clinical Neuroscience 09/2010; 18(1):24-8. DOI:10.1016/j.jocn.2010.06.008 · 1.38 Impact Factor