Stent placement in the endovascular treatment of intracranial aneurysms

Swiss Med Wkly. 2008 Nov 1;138(43-44):646-54.

Abstract

Objective: To analyze the immediate and midterm angiographic and clinical results of stent placement in the endovascular treatment of intracranial cerebral aneurysms.

Methods: Out of 330 cerebral aneurysms treated by endovascular approach in our neurovascular centre, stents have been used in 18 patients. Twelve aneurysms (66.7%) were acutely ruptured, four (22.2%) were unruptured, two (11.1%) were recanalized after initial coiling. In three patients (16.7%) stent placement was used for revascularization of acute vessel thrombosis during coiling. Angiographic follow-up was obtained in 13 (72.2%) patients (mean 1.8 years, range 0.4-6.6) and clinical follow-up in 13 (72.2%) patients (mean 2.0 years, range 0.2-6.6).

Results: Complete occlusion was achieved in eight (44.4%) patients, a neck-remnant remained in four (22.2%) and an incomplete occlusion in four (22.2%). In the two cases of previously treated aneurysms a neck-remnant remained after secondary stent-assisted coiling. In four cases thromboembolic events resulted in a transient procedure related morbidity. No permanent procedure related morbidity or mortality was observed. One case of an asymptomatic late in-stent stenosis occurred. On clinical followup modified Ranking Score was 0 in 3 patients (23.1%), 1 in 3 patients (23.1%) and 2-3 in 7 patients (53.9%). On angiographic follow-up recanalisation was observed in 5 (38.5% = 5/13) aneurysms.

Conclusion: Even in acutely ruptured aneurysms, stent assisted coiling can be a relatively effective and safe treatment for cerebral aneurysms. One asymptomatic in-stent stenosis occurred indicating that the risk rate of restenosis seems to be lower compared to stent deployment in atherosclerotic lesions, where restenosis rates up to 30% are described.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Vessel Prosthesis
  • Cerebral Angiography
  • Cerebral Arteries / pathology*
  • Female
  • Humans
  • Intracranial Aneurysm / physiopathology
  • Intracranial Aneurysm / surgery*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stents*
  • Time Factors
  • Treatment Outcome