Stent-assisted parent artery occlusion of giant cerebrovascular aneurysms to avoid mass effect.
BACKGROUND
Endovascular treatment of giant cerebrovascular aneurysms (GCA) may be challenging due to risk of worsening mass effect, thromboembolism, rupture, and recurrence. The purpose of this study was to provide a preliminary evaluation of GCA therapy using stent-assisted coil parent artery occlusion (PAO) to reduce the likelihood of mass effect, aneurysm recurrence, and vessel recanalization.


METHODS
Five patients with GCAs were treated by PAO by deploying detachable coils within a Neuroform-3 stent across the aneurysm neck. Patients were monitored clinically to note any changes after treatment. Magnetic resonance angiography was performed 3 to 12 months after stent placement, and incomplete PAO and aneurysm recurrence were noted.


RESULTS
Stent-assisted PAO was technically successful in all GCAs with no residual aneurysm filling and without any coil herniation into the aneurysm sac. None of the patients had recanalization of the vessel or GCA or clinical worsening over a follow-up period of 3-17 months. Symptomatic mass effect improved in 2 and resolved in 2 patients.


CONCLUSIONS
Based on our preliminary experience, stent-assisted PAO in GCAs is technically feasible and may be a valid option in patients who tolerate balloon test occlusion to minimize the likelihood of increased mass effect from coil embolization.
Hussain
Syed I
SI
Neurointerventional Section, Department of Neurology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Lynch
John R
JR
Wolfe
Thomas
T
Fitzsimmons
Brian-Fred
BF
Zaidat
Osama O
OO
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D021721:Balloon Occlusion; D001921:Brain / Q000098:blood supply* / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000601:surgery*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D019635:Neurosurgical Procedures; D015607:Stents; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome