Endovascular Reconstruction With the Neuroform Stent as Monotherapy for the Treatment of Uncoilable Intradural Pseudoaneurysms

Neurosurgery. 2006 Aug;59(2):291-300; discussion 291-300. doi: 10.1227/01.NEU.0000223650.11954.6C.

Abstract

Objective: Intradural pseudoaneurysms have a malignant natural history and can be difficult to treat if parent vessel deconstruction is not feasible. These lesions often involve a long arterial segment and lack a defined saccular component that would safely accommodate the introduction of embolization coils. The current report describes the successful endovascular treatment of these lesions using a strategy of Neuroform stent reconstruction.

Methods: A retrospective review of the prospectively maintained Neuroform databases from our two institutions identified all intracranial aneurysms treated with the Neuroform stent alone, without embolization coils. The clinical charts, procedural data, and angiographic results were reviewed.

Results: Over a 38-month study period (10/02-2/06), 266 aneurysms were treated with the Neuroform stent. Of these, 10 were small "uncoilable" intradural pseudoaneurysms associated with subarachnoid hemorrhage. These lesions were treated using a strategy of endovascular stent reconstruction of the diseased vascular segment with one or more Neuroform stents (without concomitant coil embolization). Seven pseudoaneurysms were treated in the context of acute or subacute subarachnoid hemorrhage, and three were associated with a remote history of subarachnoid hemorrhage. Periprocedural complications occurred in two patients (clinically silent, intraprocedural thromboembolic event successfully treated with intra-arterial abciximab, symptomatic postprocedural stent thrombosis with successful thrombolysis, and excellent neurological recovery). Both complications occurred in patients with ruptured aneurysms and could be attributed to inadequate platelet inhibition at the time of the initial procedure. Follow-up conventional angiographic examinations were available for all 10 patients with pseudoaneurysms (1-18.5 mo; average, 9.0 mo). In nine cases, the aneurysms improved at follow-up, with either complete (n = 5) or near complete (n = 4) resolution. In one case, short-term follow-up (1 mo) demonstrated no significant change. No patient has rehemorrhaged after treatment.

Conclusion: Endovascular Neuroform stent reconstruction represents an optimal strategy for the management of intradural pseudoaneurysms that require a constructive treatment strategy and are too small to accommodate the introduction of embolization coils. Nine out of 10 patients in the current series treated with this strategy demonstrated some degree of endovascular remodeling with either complete (n = 5) or partial (n = 4) angiographic resolution at follow-up. No rehemorrhages were encountered. Adequate antiplatelet therapy, even in the setting of acute subarachnoid hemorrhage, is prerequisite for the avoidance of thromboembolic complications.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aneurysm, False / diagnostic imaging
  • Aneurysm, False / physiopathology
  • Aneurysm, False / surgery*
  • Carotid Artery, Internal, Dissection / diagnostic imaging
  • Carotid Artery, Internal, Dissection / physiopathology
  • Carotid Artery, Internal, Dissection / surgery
  • Cerebral Angiography
  • Child
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / physiopathology
  • Intracranial Aneurysm / surgery*
  • Male
  • Middle Aged
  • Neurosurgical Procedures / instrumentation*
  • Neurosurgical Procedures / methods
  • Postoperative Complications / drug therapy
  • Postoperative Complications / physiopathology
  • Postoperative Complications / prevention & control
  • Reconstructive Surgical Procedures / instrumentation*
  • Reconstructive Surgical Procedures / methods
  • Retrospective Studies
  • Stents* / standards
  • Stents* / statistics & numerical data
  • Subarachnoid Hemorrhage / etiology
  • Subarachnoid Hemorrhage / physiopathology
  • Subarachnoid Hemorrhage / prevention & control
  • Subarachnoid Space / diagnostic imaging
  • Subarachnoid Space / pathology
  • Subarachnoid Space / surgery
  • Thromboembolism / drug therapy
  • Thromboembolism / prevention & control
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Vascular Surgical Procedures / instrumentation*
  • Vascular Surgical Procedures / methods

Substances

  • Fibrinolytic Agents