Treatment of wide-necked intracranial aneurysms with a self-expanding stent system: initial clinical experience.
OBJECTIVE
Currently available stents for intracranial use usually are balloon-expandable coronary stents that carry the risk of damaging a dysplastic segment of the artery, with potential vessel rupture. We assessed the technical feasibility and efficacy of the combined application of a flexible, self-expanding neurovascular stent and detachable coils in the management of wide-necked intracranial aneurysms in humans.


METHODS
Four consecutive patients with a wide-necked intracranial aneurysm were treated with a combined approach that consisted of delivery of a flexible self-expanding neurovascular stent through a microcather to cover the neck of the aneurysm and subsequent filling of the aneurysm with coils through the stent interstices. The aneurysms were located at the internal carotid artery (n=2) and the basilar tip encroaching the P1 segment (n=2). Previous attempts with conventional endosaccular coil packing alone failed in all cases.


RESULTS
Stent placement in the desired position with complete or nearly complete occlusion of the aneurysms was feasible in all patients. In one patient, aneurysm perforation with the microcatheter occurred and necessitated ventricular drainage, which led to a large parenchymal and intraventricular hemorrhage because of the strong anticoagulation regimen. Six-month follow-up demonstrated no focal neurologic sequelae in any of the patients, except slight memory dysfunction in the patient with bleeding.


CONCLUSIONS
Preliminary data demonstrate that this extremely flexible stent is technically easy to deploy and can be easily and safely maneuvered through severely tortuous vessels, enabling the treatment of intracranial wide-necked aneurysms. The combination of endovascular reconstruction of the parent vessel with use of a self-expanding stent followed by coil embolization offers a promising therapeutic alternative for wide-necked aneurysms not amenable to coil embolization alone. Although immediate angiographic results are promising, long-term angiographic and clinical follow-up is essential to determine permanent vessel patency and aneurysm occlusion rate.
Wanke
Isabel
I
Department of Neuroradiology, University Hospital of Essen, Hufelandstrasse 55, D-45122 Essen, Germany.
Doerfler
Arnd
A
Schoch
Beate
B
Stolke
Dietmar
D
Forsting
Michael
M
D015901:Angiography, Digital Subtraction; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000628:therapy; D002343:Carotid Artery, Internal / Q000473:pathology; D002426:Cavernous Sinus / Q000473:pathology; D002533:Cerebral Angiography; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D012008:Recurrence; D019233:Retreatment; D015607:Stents; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000628:therapy