Aims and objectives
Traditional endovascular treatment of aneurysms (coiling,
stent-assisted coiling,
balloon remodeling) has become the treatment of choice in most saccular aneurysms with results comparable to surgical clipping and a lower complication rate.
Nevertheless,
large/giant or wide-necked saccular aneurysms and fusiform aneurysms remain a challenge for the interventional neuroradiologist and endovascular technique.
In the ‘90s,
some studies [1,
2] suggested that the deployment of a stent in the parent artery,
with the aim of assisting the coiling in the aneurysm’s sac,
could determine a “diversion” of the...
Methods and materials
PATIENTS
We retrospectively reviewed patients with unruptured intracranial aneurysms who underwent endovascular treatment with flow diverters between April 2013 and August 2015 at our institution.
We identified 25 patients (16 asymptomatic and 9 symptomatic).
Nine patients (mean age 55 ± 10 years; 6 females,
3 males) with specific neurologic symptoms and unruptured aneurysms (mean size 21 ± 7 mm) were treated; 3 patients referred progressive visual loss,
4 symptoms related to compression of cranial nerves (III-IV-VI deficit),
2 suffered of multiple TIA episodes,
followed by...
Results
All devices could be navigated to the target area and could be deployed across the aneurysm neck.
In all except one case a single device was implanted.
In one case the control MRI study showed a suspected displacement of the stent,
and therefore an angiographic examination was performed to confirm the finding; a few days later,
because of the neck was uncompletely covered,
a second flow diverter stent was placed with “telescoping technique” within the first device.
Considering the retreatment,
complete aneurysm neck coverage and...
Conclusion
Our preliminary results showed that the treatment of symptomatic aneurysms with flow diversions may be a safe and effective therapeutic option in reducing symptomatic disorders of patients with large/giant or wide-neck aneurysms that are difficult to treat with standard neurointerventional techniques.
However,
more studies and randomized trials are needed in order to precisely define the indications of this technique.
References
1.
Mericle RA,
Lanzino G,
Wakhloo AK,
Guterman LR,
Hopkins LN.
Stenting and secondary coiling of intracranial internal carotid artery aneurysm: technical case report.
Neurosurgery.
1998;43(5):1229-34.
2.
Sekhon LH,
Morgan MK,
Sorby W,
Grinnell V.
Combined endovascular stent implantation and endosaccular coil placement for the treatment of a wide-necked vertebral artery aneurysm: technical case report.
Neurosurgery.
1998;43(2):380-3; discussion 4.
3.
Ionita CN,
Natarajan SK,
Wang W,
Hopkins LN,
Levy EI,
Siddiqui AH,
et al.
Evaluation of a second-generation self-expanding variable-porosity flow diverter in a rabbit...