Endovascular treatment of complex intracranial aneurysms using intra/extra-aneurysmal stent

Acta Neurochir (Wien). 2011 Apr;153(4):923-30. doi: 10.1007/s00701-010-0934-9. Epub 2011 Jan 12.

Abstract

Background: Intra/extra-aneurysmal stent placement for treatment of complex and wide-necked bifurcation aneurysms has been previously described. However, this technique has been rarely reported in the treatment of dissecting aneurysms with incorporated vessels. We assess the feasibility and effectiveness of intra/extra-aneurysmal stent-assisted coil embolization in the treatment of those complex intracranial aneurysms.

Methods: Between January 2009 and April 2010, nine consecutive patients with wide-necked or dissecting aneurysms with incorporated vessels underwent endovascular treatment using intra/extra-aneurysmal stent-assisted coiling at our institution. We assessed the clinical history, morphologic features of the aneurysms, treatment results, and follow-up.

Results: All Neuroform stents were successfully deployed in this series. Of the nine aneurysms treated with stent-assisted embolization, complete occlusion was achieved in seven aneurysms, nearly complete in one, and incomplete was present in one. There was no procedure-related complication in this series. Angiographic follow-up results of eight patients (mean, 8.6 months) showed continued obliteration of the aneurysms in six patients, incomplete occlusion in two patients, and the two patients received second treatment. On the modified Rankin Scale applied in follow-up, all patients were assessed as functionally improved or of stable clinical status.

Conclusions: Intra/extra-aneurysmal stent placement and subsequent coil embolization may be effective for the treatment of selected patients with complex intracranial aneurysms. Short-term follow-up data indicate good durability of stent-assisted aneurysm occlusion. However, further study with longer follow-up and larger case series is necessary for validation of the efficacy of this treatment modality.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Aneurysm, Dissecting / diagnostic imaging
  • Aneurysm, Dissecting / therapy*
  • Aneurysm, Ruptured / diagnostic imaging
  • Aneurysm, Ruptured / therapy
  • Cerebral Angiography
  • Embolization, Therapeutic / methods*
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Image Processing, Computer-Assisted
  • Imaging, Three-Dimensional
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / therapy*
  • Male
  • Middle Aged
  • Retreatment
  • Stents*
  • Subarachnoid Hemorrhage / diagnostic imaging
  • Subarachnoid Hemorrhage / therapy
  • Tomography, X-Ray Computed
  • Treatment Outcome