Does a Low-wall Coverage Stent Have a Flow Diverting Effect in Small Aneurysms?

Abstract

Backbround and PurposeThe flow diverting effect of a low-wall coverage stent remains controversial. We evaluted patients who underwent stenting for small aneurysms with a low but potential risk of growth and reviewed related literature.Materials and MethodsWe evaluated 9 small aneurysms among 19 unruptured intracranial aneurysms from eight patients who underwent stenting. The patients had unexplainable severe headache (n = 8), aneurysm originating from the anterior choroidal artery (n = 3), potential growth or rupture risks including hypertension (n = 5), and multiple aneurysms (n = 6). Stents with a relatively low-wall coverage ratio (8-10%) were used. Clinical and angiographic outcomes were assessed.ResultsOne (n = 8) or two stents (n = 1) were used without any procedural difficulties or complications. Although no immediate changes of aneurysm morphology were observed, aneurysms decreased in size (n = 8) when examined by DSA (n = 8) or MRA (n = 1) during a median 28.9-month follow-up. There were no adverse events, including thromboembolism, aneurysm rupture, or stent movement during a median 31.9-month clinical follow-up (range: 17-69 months).ConclusionAlthough a variable degree of aneurysm size decrease may not prevent further growth or rupture of small aneurysms, stenting with a low-wall coverage ratio may have some advantageous hemodynamic effect. Flow modification of stent architecture vs. aneurysm characteristics, including size and location, on long-term outcome, requires further clarification.

Microguidewire Looping to Traverse Stented Parent Arteries of Intracranial Aneurysms

“…The actual course of a parent artery may be altered as well6). Even stent devices with low wall coverage divert flow in small aneurysms15), so enhanced wall coverage through smaller cell size may augment this effect, promoting a very high rate of occlusion. These effects favorably impact hemodynamic conditions near an aneurysm and help reduce recanalization rates.…”

Emergent carotid artery stenting for cervical internal carotid artery injury during carotid endarterectomy: A case report

“…reported that the Neuroform (Boston Scientific Corp., Fremont, CA) or Enterprise stent (Codman Neurovascular, Miami, FL) was placed in the neck of a small unruptured aneurysm, and the aneurysm size decreased due to the flow diverting effect. [ 13 ] Regarding the flow diverting effect of a carotid artery stent, Kuramoto et al . reported a case of complete occlusion 12 months after the placement of the WALLSTENT for an aneurysm in the narrow neck of the common carotid artery.…”