Treatment of extracranial and intracranial aneurysms and arteriovenous fistulae using stent grafts

Neurosurgery. 2004 Sep;55(3):631-8; discussion 638-9. doi: 10.1227/01.neu.0000134455.02947.1f.

Abstract

Objective: Treatment of 11 patients with aneurysms or arteriovenous fistulae of the craniocervical arteries with stent grafts.

Methods: Peripheral stent grafts were deployed in two extracranial internal carotid arteries. Coronary stent grafts were used to treat two giant aneurysms, five direct carotid-cavernous fistulae, one vertebrojugular fistula, and two dissecting aneurysms of the vertebral artery (V2 and V4).

Results: Stent grafts were used successfully in two extracranial internal carotid and two extracranial vertebral arteries, one dissecting aneurysm of the intracranial vertebral artery, one giant aneurysm and one pseudoaneurysm of the cavernous internal carotid artery, and five direct carotid-cavernous sinus fistulae. Angiographic follow-up examinations (available in nine patients; obtained at 3 mo to 5 yr; average, 24 mo) revealed normal vessel caliber, and the stent grafts in all 9 of 11 initial patients were patent. There was a recurrent saccular aneurysm adjacent to the stent graft in the patient with the intracranial vertebral artery aneurysm. The following five complications were encountered: transient hemiparesis (n = 2), increased hemiparesis, postprocedural management-related fatality, and ICA dissection. In six patients, stent graft deployment was accomplished without any technical or clinical complication. There were no permanent neurological deficits consequent to stent graft placement.

Conclusion: Stent grafts are a useful tool for the endovascular treatment of head and neck aneurysms and direct arteriovenous fistulae in selected patients. The major disadvantage of the currently available stent grafts is their lack of mechanical flexibility. Maneuvering stent grafts in the intracranial arteries carries the risk of iatrogenic vessel dissection and may require supportive measures and protection of the target site by conventional stents.

MeSH terms

  • Adult
  • Aged
  • Aneurysm, Dissecting / diagnostic imaging
  • Aneurysm, Dissecting / therapy*
  • Angiography, Digital Subtraction
  • Angioplasty, Balloon*
  • Arteriovenous Fistula / diagnostic imaging
  • Arteriovenous Fistula / therapy*
  • Blood Vessel Prosthesis*
  • Brain / blood supply
  • Carotid Artery, Internal / diagnostic imaging
  • Carotid-Cavernous Sinus Fistula / diagnostic imaging
  • Carotid-Cavernous Sinus Fistula / therapy
  • Cerebral Angiography
  • Child
  • Female
  • Follow-Up Studies
  • Humans
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / therapy*
  • Male
  • Middle Aged
  • Neurologic Examination
  • Outcome and Process Assessment, Health Care
  • Risk Factors
  • Stents*
  • Vertebral Artery Dissection / diagnostic imaging
  • Vertebral Artery Dissection / therapy