Sole Stenting Technique for Treatment of Complex Aneurysms

Abstract

Objective : Complex aneurysms such as fusiform and very small aneurysms (< 3 mm) are challenging in neurovascular and endovascular surgery. Author reports follow-up results of 9 cases treated by sole stent technique with pertinent literature review. Methods : A retrospective study was made of 9 patients who were treated by sole stenting technique for cerebral aneurysm between January 2003 and January 2009. Two of them had fusiform aneurysm, 5 had very small aneurysm, and 2 had small saccular aneurysm. Five patients had ruptured aneurysms and four had unruptured aneurysms. Seven aneurysms were located in the internal carotid artery (ICA), 1 in the middle cerebral artery (MCA) and 1 in the basilar artery. Follow-up cerebral angiography was performed at post-procedure 3 months, 6 months, and 12 months. Mean follow-up period is 30 months (ranged from 3 days to 30 months). Results : Aneurysm size was decreased in 6 of 9 cases on follow-up images and was not changed in 3 cases. Although total occlusion was not seen, patients had stable neurological condition and angiographic result. The procedural complication occurred in 2 cases. One was coil migration and the other was suboptimal deployment of stent, and both were asymptomatic. Re-bleeding and thromboembolic complication had not been occurred. Conclusion : Sole stenting technique is relatively effective and safe as an alternative treatment for fusiform and very small aneurysms.

Early surgical removal of migrated coil/stent after failed embolization of intracranial aneurysm

“…Kim 12 reported on the successful conservative treatment of a patient with suboptimal stent deployment; however, the individual presented with normal blood flow on postoperative angiography. Based on an analysis of 9 cases, Fiorella et al 6 concluded that symptomatic patients with delayed in-stent stenosis should undergo endovascular angioplasty or bypass surgery, whereas a "strategy of watchful waiting may be effective" in the case of asymptomatic subjects.…”

Endovascular Treatment of Middle Cerebral Artery Aneurysms with Flow Modification with the Use of the Pipeline Embolization Device

“…[1][2][3][4][5] A few case series with the use of the sole stent placement technique in the treatment of complex fusiform MCA aneurysms also exist in the literature. 6,7 Additionally, Y-stent flow diversion by use of self-expandable stents with a closed-cell design without endosaccular coiling has also been reported to be effective in a small, selected case series, including 5 MCA bifurcation aneurysms with complete occlusion in the follow-up. 8 The introduction of the Pipeline Embolization Device (PED) (Covidien/ev3, Irvine, California) as a dedicated flow diverter added a new dimension to this treatment strategy, with its being porous enough to preserve the patency of the branch vessels covered by the construct.…”

Treatment of Complex Intracranial Aneurysms with a Telescoping Stent Technique

“…45 Sole stenting is a reconstructive method that has been described as an alternative treatment for complex aneurysms. 9,15,46 Utilizing flow diversion in the treatment of complex intracranial aneurysms in the United States is challenging secondary to the current regulatory environment regarding the use of stents specifically designed for flow diversion.…”