Sole stenting of large and giant intracranial aneurysms with self-expanding intracranial stents-limits and complications.
BACKGROUND
Intracranial aneurysms may be difficult for endovascular treatment due to size, fusiform shape, or wide neck. In such patients, intracranial stents are used to support the coils in the aneurysm sac, or they may be used as a sole stenting technique to divert the blood flow without coils. The aim of this paper is to contribute to the existing data by reviewing the risks of sole stenting of large and giant aneurysms.


METHODS
We treated seven patients with nine aneurysms by self-expanding intracranial stents, either by a single or multiple stents in a stent-in-stent configuration. The follow-up was performed by digital subtraction angiography with a mean follow-up time of 6 months.


RESULTS
A positive response to stenting occurred in five out of seven patients (71%) and six out of nine aneurysms (67%). The aneurysms were occluded in two patients, and incomplete results were noted in three patients. The symptoms due to the compression of cranial nerves resolved in four patients (57%). Procedure-related subarachnoid hemorrhage occurred in two out of seven patients (29%), with death of one patient as a result of hemorrhage (14%).


CONCLUSIONS
Sole stenting of large and giant aneurysms with self-expanding intracranial stents may be associated with a higher risk than previously reported. The effect of stenting on intra-aneurysmal flow in such aneurysms, even after the placement of multiple overlapping stents, seems to be unpredictable.
Pavlisa
Goran
G
Clinical Institute of Diagnostic and Interventional Radiology, University Hospital Center Zagreb, Kispaticeva 12, Zagreb, Croatia. gpavlisa@net.amis.hr
Ozretic
David
D
Murselovic
Tamara
T
Pavlisa
Gordana
G
Rados
Marko
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D002545:Brain Ischemia / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D038361:Neuronavigation; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents / Q000009:adverse effects / Q000706:statistics & numerical data / Q000639:trends*; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D016896:Treatment Outcome