Stent-assisted reconstructive endovascular repair of cranial fusiform atherosclerotic and dissecting aneurysms: long-term clinical and angiographic follow-up

Stroke. 2008 Dec;39(12):3288-96. doi: 10.1161/STROKEAHA.107.512996. Epub 2008 Sep 4.

Abstract

Background and purpose: The purpose of this study was to investigate the periprocedural morbidity, mortality, and long-term clinical and angiographic follow-up using stent-assisted coiling and stenting alone for treatment of cranial fusiform dissecting and atherosclerotic aneurysms.

Methods: The Institutional Review Board approved the study. A retrospective analysis was performed of 30 fusiform dissecting and atherosclerotic aneurysms treated in 28 patients (20 females; mean age, 52.6 years). Eleven aneurysms (37%) were located in the posterior circulation. Twenty-one (70%) originated from arterial dissection and 4 aneurysms (13%) presented with subarachnoid bleeding. Twenty-four (80%) aneurysms were treated with stents and coils, whereas 6 (20%) were treated with stents alone.

Results: Immediate postprocedural angiograms in 24 aneurysms treated with stent-assisted coiling showed complete occlusion in 12 and subtotal occlusion in 11 aneurysms, whereas no occlusion was seen in one aneurysm and in all 6 aneurysms treated with stents alone. A clinical improvement or stable outcome was achieved in 25 patients (89%). The 2 cases of permanent morbidity included a patient with a finger dysesthesia associated with a perforator stroke and another patient with hemiparesis and aphasia due to a delayed in-stent thrombosis. One patient died after treatment of a giant vertebrobasilar junction aneurysm. Angiographic follow-up was available in 23 of the 27 surviving patients (85%) at a mean of 16.2 months (range, 1 to 108 months). Recanalization in 4 patients (17%) at 3, 5, 24, and 36 months required retreatment in 3. In-stent stenosis of <or=50% was found in 3 patients.

Conclusions: Stent-assisted coil embolization is an attractive option for ruptured and nonruptured fusiform aneurysms with stable long-term outcome. However, recanalization observed up to 3 years after the initial obliteration emphasizes the need for long-term follow-up angiography.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aneurysm, Dissecting / complications
  • Aneurysm, Dissecting / diagnostic imaging
  • Aneurysm, Dissecting / surgery
  • Aneurysm, Dissecting / therapy*
  • Aneurysm, Ruptured / complications
  • Aneurysm, Ruptured / diagnostic imaging
  • Aneurysm, Ruptured / surgery
  • Aneurysm, Ruptured / therapy
  • Cerebral Angiography
  • Embolization, Therapeutic / instrumentation
  • Embolization, Therapeutic / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Intracranial Aneurysm / complications
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / surgery
  • Intracranial Aneurysm / therapy*
  • Intracranial Arteriosclerosis / complications*
  • Male
  • Middle Aged
  • Reperfusion / instrumentation
  • Reperfusion / methods*
  • Retrospective Studies
  • Stents*
  • Subarachnoid Hemorrhage / etiology
  • Treatment Outcome