Sole stenting of large and giant intracranial aneurysms with self-expanding intracranial stents-Limits and complications

Clinical Institute of Diagnostic and Interventional Radiology, University Hospital Center Zagreb, Kispaticeva 12, Zagreb, Croatia.
Acta Neurochirurgica (Impact Factor: 1.77). 05/2010; 152(5):763-9. DOI: 10.1007/s00701-009-0592-y
Source: PubMed


Intracranial aneurysms may be difficult for endovascular treatment due to size, fusiform shape, or wide neck. In such patients, intracranial stents are used to support the coils in the aneurysm sac, or they may be used as a sole stenting technique to divert the blood flow without coils. The aim of this paper is to contribute to the existing data by reviewing the risks of sole stenting of large and giant aneurysms.
We treated seven patients with nine aneurysms by self-expanding intracranial stents, either by a single or multiple stents in a stent-in-stent configuration. The follow-up was performed by digital subtraction angiography with a mean follow-up time of 6 months.
A positive response to stenting occurred in five out of seven patients (71%) and six out of nine aneurysms (67%). The aneurysms were occluded in two patients, and incomplete results were noted in three patients. The symptoms due to the compression of cranial nerves resolved in four patients (57%). Procedure-related subarachnoid hemorrhage occurred in two out of seven patients (29%), with death of one patient as a result of hemorrhage (14%).
Sole stenting of large and giant aneurysms with self-expanding intracranial stents may be associated with a higher risk than previously reported. The effect of stenting on intra-aneurysmal flow in such aneurysms, even after the placement of multiple overlapping stents, seems to be unpredictable.

Download full-text


Available from: Goran Pavlisa, May 02, 2014
  • Source
    • "In the case of fibromuscular dysplasia, the patient was successfully treated with a Symbiot-type self-expanding stent, without any significant postinterventionnal neurological event.2 As a consequence, endovascular treatment is effective and less invasive,3 although the complication rate of these self-expanding stents can reach up to 10% and the bleeding rate 29%.16 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Carotid pseudoaneurysms of petrous localization are rare. They are mostly due to trauma, tumoral or infectious diseases, or a result of iatrogenic complications after skull base surgery. Symptoms such as facial paralysis are exceptional and have rarely been described in the literature until now. We report the case of a 64-year-old woman, who developed left peripheral facial paralysis induced by two carotid pseudoaneurysms in their intrapetrous section. The treatment is endovascular, despite the high morbidity rate. She was first put on antiplatelet medications, before the left carotid aneurysm was bypassed thanks to a self-expanding pipeline-type stent with flow diversion. The left peripheral facial paralysis was due to the compression exerted by the left carotid aneurysm, probably a congenital malformation. The progressive palsy recovery was fist due to the aneurysmal thrombosis, then to the secondary fibrosis.
    11/2011; 1(2):133-8. DOI:10.1055/s-0031-1284209
  • Source
    • "The main issues of stent grafts are their stiffness and the unavoidable occlusion of all covered side branches. The technique of telescoping porous stents may work, but efficiency mostly remains unpredictable [6]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to evaluate the safety and efficacy of the recently available flow diverter "pipeline embolization device" (PED) for the treatment of intracranial aneurysms and dissections. Eighty-eight consecutive patients underwent an endovascular treatment of 101 intracranial aneurysms or dissections using the PED between September 2009 and January 2011. The targeted vessels include 79 (78%) in the anterior circulation and 22 (22%) in the posterior circulation. We treated 96 aneurysms and 5 vessel dissections. Multiple devices were implanted in 67 lesions (66%). One technical failure of the procedure was encountered. Immediate exclusion of the target lesion was not observed. Angiographic follow-up examinations were carried out in 80 patients (91%) with 90 lesions and revealed complete cure of the target lesion(s) in 47 (52%), morphological improvement in 32 lesions (36%), and no improvement in 11 lesions (12%). Six major complications were encountered: one fatal aneurysm rupture, one acute and one delayed PED thrombosis, and three hemorrhages in the dependent brain parenchyma. Our experience reveals that the PED procedure is technically straightforward for the treatment of selected wide-necked saccular aneurysms, fusiform aneurysms, remnants of aneurysms, aneurysms with a high likelihood of failure with conventional endovascular techniques, and dissected vessels. While vessel reconstruction, performed after dissection, is achieved within days, remodeling of aneurysmal dilatations may take several months. Dual platelet inhibition is obligatory. Parenchymal bleeding into brain areas dependent on the target vessel is uncommon.
    Neuroradiology 09/2011; 54(4):369-82. DOI:10.1007/s00234-011-0948-x · 2.49 Impact Factor
  • Source
    • "Current endovascular techniques are regarded as having lower risks for the patient [28]. Despite the fact that these techniques are being constantly developed, in GIAs, these still seem to be unsatisfactory in terms of durability of aneurysm occlusion [24, 28]. Parkinson [23] suggests that the results of surgical techniques should be the “gold standard” with which other techniques, including endovascular treatment, are compared. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Internal carotid artery (ICA) is predominant localization of giant intracranial aneurysms (GIAs). The rupture of GIA is supposed to be related to higher risk of poor clinical outcome. Although endovascular techniques are still being developed, they seem to be unsatisfactory in the mean of GIAs. Included in the retrospective analysis were 78 giant and 250 smaller surgically treated ICA aneurysms. Exclusion criteria were multiple and blood blister-like aneurysms. Neurological deficit on admission, clinical and radiological presentation, gender, age, segment of ICA, surgical methods, accessory techniques and complications were analyzed. Death rate and short- and long-term outcome of giant aneurysms were compared with smaller aneurysms and risk factors for mortality, unfavorable short- and long-term outcome were determined. There was no difference in general and surgical complications between ICA aneurysm size groups, as well as in occurrence of newly diagnosed neurological deficit after the operation. There were similar mortality rates, proportion of unfavorable outcome, and low health related quality of life for giant and smaller aneurysms. A 12.2% death rate for all ICA aneurysms was achieved. Trapping method as well as Fisher grades 3 and 4 increased mortality risk in the smaller aneurysm group. No significant factors were related to an unfavorable outcome in the ruptured giant aneurysm group. Patients older than 65, Hunt-Hess grades 4 and 5, Fisher grade 4, and newly diagnosed deficit after operation were connected with unfavorable outcome in the ruptured smaller aneurysm group. Newly diagnosed neurological deficit was also an unfavorable outcome risk factor in both giant and smaller ICA unruptured aneurysms. No difference was noted in long-term health-related quality of life between the giant and smaller ICA groups. Higher age and presence of concomitant disease were independent factors affecting quality of life, although obtained data were incomplete. The study breaks the stereotype of unfavorable giant ICA aneurysms treatment results. Mortality rate, short- and long-term outcome after the operation of giant and smaller ICA aneurysms are similar. Higher age, patients' condition at admission, and the amount of extravasated blood and trapping method are poor prognostic factors in patients with smaller ICA aneurysm.
    Acta Neurochirurgica 05/2011; 153(8):1611-9; discussion 1619. DOI:10.1007/s00701-011-1021-6 · 1.77 Impact Factor
Show more