title: Treatment of internal carotid artery aneurysms with a covered stent: experience in 24 patients with mid-term follow-up results.
abstract: OBJECTIVE
  We present our preliminary experience, including mid-term angiographic and clinical follow-up results, with an alternative technique for the endovascular treatment of intracranial aneurysms in a series of patients. This new method, previously described in anecdotal case reports, consists of endovascular deployment of an artificial vessel graft (stent graft or covered stent) in the parent vessel to exclude the intracranial aneurysm sac from circulation.
  
  
  METHODS
  Twenty-five internal carotid artery (ICA) aneurysms in 24 patients were successfully treated by using a Jostent coronary stent graft deployed in the parent artery across the aneurysm neck. All except four aneurysms were extradural, located in the petrous or cavernous portion of the ICA. The four intradural aneurysms were located in the carotico-ophthalmic region. Seventeen aneurysms in 16 patients occurred posttraumatically, secondary to motor vehicle accidents or surgical injury.
  
  
  RESULTS
  Twenty-three aneurysms were immediately excluded from circulation after stent graft placement. In two aneurysms, a slow contrast material filling (endoleak) into the aneurysm cavity was observed immediately after treatment. One was thrombosed, as shown by late control angiography; in the other one, a second larger bare stent was used to appose the stent graft's distal end to the ICA wall, thus sealing the endoleak into the distal graft. No technical adverse event, including vessel dissection, vessel perforation, or thromboembolism, occurred with or without clinical consequence. No mortality or morbidity developed during or after the procedure, including the follow-up period. Two-year control angiography in one patient, 1.5-year control angiography in two patients, 1-year control angiography in six patients, and 6-month control angiography in 12 patients were performed, revealing reconstruction of the ICA with no aneurysm recanalization. All symptoms resolved after treatment in the patients who had initially presented with mass effect.
  
  
  CONCLUSIONS
  Initial anatomic, clinical and mid-term follow-up results in this small series of patients are encouraging. This technique has been proved to have potential in the reconstructive treatment of intracranial aneurysms. Further research and development are needed to optimize the stent graft technology for the cerebrovascular system.
authors.affiliation: Hacettepe University Hospital, Department of Radiology, Sihhiye 06100, Ankara, Turkey.
authors.forename: Isil
authors.initials: I
authors.lastname: Saatci
authors.forename: H Saruhan
authors.initials: HS
authors.lastname: Cekirge
authors.forename: M Halil
authors.initials: MH
authors.lastname: Ozturk
authors.forename: Anil
authors.initials: A
authors.lastname: Arat
authors.forename: Fikret
authors.initials: F
authors.lastname: Ergungor
authors.forename: Zeki
authors.initials: Z
authors.lastname: Sekerci
authors.forename: Engin
authors.initials: E
authors.lastname: Senveli
authors.forename: Uygur
authors.initials: U
authors.lastname: Er
authors.forename: Sami
authors.initials: S
authors.lastname: Turkoglu
authors.forename: Osman E
authors.initials: OE
authors.lastname: Ozcan
authors.forename: Tuncalp
authors.initials: T
authors.lastname: Ozgen
mesh_terms: D000293:Adolescent; D000328:Adult; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D020099:Coated Materials, Biocompatible; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
chemical_list: D020099:Coated Materials, Biocompatible