, Volume 50, Issue 12, pp 991–998 | Cite as

Stents for intracranial wide-necked aneurysms: more than mechanical protection

Invited Review


Treatment of wide-necked aneurysms by endovascular coil embolization usually requires mechanical aids in order to protect the parent artery from occlusion due to extension of coils or thrombosis. Endovascular stents are one tool that can be deployed to solve this essentially mechanical problem. The effect of a stent placed in the situation may also act as a hemodynamically active flow diverter. Endovascular stents used in other circumstances are prone to the unwanted side effect of neoinitmal proliferation, but this phenomenon should be seen as a potential asset for “aneurysmal stents” because it may lead to a reaction that contributes to vessel wall healing.


Stent Intracranial aneurysm Stent-assisted coiling Hemodynamics 


Conflict of interest statement

The authors are both consultants for Boston Scientific; additionally, I. Wanke consults for Microvention and ev3.


  1. 1.
    Britz GW (2005) Clipping or coiling of cerebral aneurysms. Neurosurg Clin N Am 16(3):475–485 v. doi: 10.1016/ PubMedCrossRefGoogle Scholar
  2. 2.
    Molyneux AJ, Kerr RS, Yu LM et al (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366(9488):809–817. doi: 10.1016/S0140-6736(05)67214-5 PubMedCrossRefGoogle Scholar
  3. 3.
    Fiorella D, Albuquerque FC, Deshmukh VR et al (2005) Usefulness of the Neuroform stent for the treatment of cerebral aneurysms: results at initial (3–6-mo) follow-up. Neurosurgery 56(6):1191–1201 discussion 1201–2. doi: 10.1227/01.NEU.0000159645.86823.AF PubMedCrossRefGoogle Scholar
  4. 4.
    Kis B, Weber W, Berlit P et al (2006) Elective treatment of saccular and broadnecked intracranial aneurysms using a closed-cell nitinol stent (Leo). Neurosurgery 58(3):443–450 discussion 443–50PubMedGoogle Scholar
  5. 5.
    Lubicz B, Francois O, Levivier M et al (2008) Preliminary experience with the enterprise stent for endovascular treatment of complex intracranial aneurysms: potential advantages and limiting characteristics. Neurosurgery 62:1063–1069PubMedGoogle Scholar
  6. 6.
    Weber W, Bendszus M, Kis B et al (2007) A new self-expanding nitinol stent (Enterprise) for the treatment of wide-necked intracranial aneurysms: initial clinical and angiographic results in 31 aneurysms. Neuroradiology 49(7):555–561. doi: 10.1007/s00234-007-0232-2 PubMedCrossRefGoogle Scholar
  7. 7.
    Wanke I, Gizewski E, Dorfler A et al (2005) Stenting plus coiling: dangerous or helpful? Rofo 177(9):1255–1259PubMedGoogle Scholar
  8. 8.
    Wanke I, Doerfler A, Schoch B et al (2003) Treatment of wide-necked intracranial aneurysms with a self-expanding stent system: initial clinical experience. AJNR Am J Neuroradiol 24(6):1192–1199PubMedGoogle Scholar
  9. 9.
    Wanke I, Gizewski E, Forsting M (2006) Horizontal stent placement plus coiling in a broad-based basilar-tip aneurysm: an alternative to the Y-stent technique. Neuroradiology 48:817–820PubMedCrossRefGoogle Scholar
  10. 10.
    Hauck EF, Welch BG, White JA, et al (2008) Stent/coil treatment of very large and giant unruptured ophthalmic and cavernous aneurysms. Surg Neurol, doi: 10.1016/j.surneu.2008.01.025
  11. 11.
    Biondi A, Janardhan V, Katz JM et al (2007) Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and midterm follow-up. Neurosurgery 61(3):460–468 discussion 468, 469PubMedCrossRefGoogle Scholar
  12. 12.
    Kelly ME, Turner R, Gonugunta V et al (2007) Stent reconstruction of wide-necked aneurysms across the circle of Willis. Neurosurgery 61(5):249–254 (Suppl 2)discussion 254, 255PubMedGoogle Scholar
  13. 13.
    Lubicz B, Lefranc F, Levivier M et al (2006) Endovascular treatment of intracranial aneurysms with a branch arising from the sac. AJNR Am J Neuroradiol 27(1):142–147PubMedGoogle Scholar
  14. 14.
    Pumar JM, Blanco M, Vazquez F et al (2005) Preliminary experience with Leo selfexpanding stent for the treatment of intracranial aneurysms. AJNR Am J Neuroradiol 26(10):2573–2577PubMedGoogle Scholar
  15. 15.
    Turk AS, Niemann DB, Ahmed A et al (2007) Use of self-expanding stents in distal small cerebral vessels. AJNR Am J Neuroradiol 28(3):533–536PubMedGoogle Scholar
  16. 16.
    Zaidat OO, Szeder V, Alexander MJ (2007) Transbrachial stent-assisted coil embolization of right posterior inferior cerebellar artery aneurysm: technical case report. J Neuroimaging 17(4):344–347PubMedGoogle Scholar
  17. 17.
    Higashida RT, Halbach VV, Dowd CF et al (2005) Initial clinical experience with a new self-expanding nitinol stent for the treatment of intracranial cerebral aneurysms: the Cordis Enterprise stent. AJNR Am J Neuroradiol 26(7):1751–1756PubMedGoogle Scholar
  18. 18.
    Peluso JP, van Rooij WJ, Sluzewski M et al (2008) A new self-expandable nitinol stent for the treatment of wide-neck aneurysms: initial clinical experience. AJNR Am J Neuroradiol 29:1405–1408PubMedCrossRefGoogle Scholar
  19. 19.
    Lieber BB, Livescu V, Hopkins LN et al (2002) Particle image velocimetry assessment of stent design influence on intra-aneurysmal flow. Ann Biomed Eng 30(6):768–777. doi: 10.1114/1.1495867 PubMedCrossRefGoogle Scholar
  20. 20.
    Barath K, Cassot F, Fasel JH et al (2005) Influence of stent properties on the alteration of cerebral intra-aneurysmal haemodynamics: flow quantification in elastic sidewall aneurysm models. Neurol Res 27(Suppl 1):S120–S128. doi: 10.1179/016164105X35477 PubMedCrossRefGoogle Scholar
  21. 21.
    Rhee K, Han MH, Cha SH (2002) Changes of flow characteristics by stenting in aneurysm models: influence of aneurysm geometry and stent porosity. Ann Biomed Eng 30(7):894–904. doi: 10.1114/1.1500406 PubMedCrossRefGoogle Scholar
  22. 22.
    Geremia G, Haklin M, Brennecke L (1994) Embolization of experimentally created aneurysms with intravascular stent devices. AJNR Am J Neuroradiol 15(7):1223–1231PubMedGoogle Scholar
  23. 23.
    Lanzino G, Wakhloo AK, Fessler RD et al (1999) Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms. J Neurosurg 91(4):538–546PubMedGoogle Scholar
  24. 24.
    Ohta M, Wetzel SG, Dantan P et al (2005) Rheological changes after stenting of a cerebral aneurysm: a finite element modeling approach. Cardiovasc Intervent Radiol 28(6):768–772. doi: 10.1007/s00270-004-7148-6 PubMedCrossRefGoogle Scholar
  25. 25.
    Lylyk P, Cohen JE, Ceratto R et al (2001) Combined endovascular treatment of dissecting vertebral artery aneurysms by using stents and coils. J Neurosurg 94(3):427–432PubMedGoogle Scholar
  26. 26.
    Wakhloo AK, Tio FO, Lieber BB et al (1995) Self-expanding nitinol stents in canine vertebral arteries: hemodynamics and tissue response. AJNR Am J Neuroradiol 16(5):1043–1051PubMedGoogle Scholar
  27. 27.
    Sadasivan C, Lieber BB, Gounis MJ et al (2002) Angiographic quantification of contrast medium washout from cerebral aneurysms after stent placement. AJNR Am J Neuroradiol 23(7):1214–1221PubMedGoogle Scholar
  28. 28.
    Vanninen R, Manninen H, Ronkainen A (2003) Broad-based intracranial aneurysms: thrombosis induced by stent placement. AJNR Am J Neuroradiol 24(2):263–266PubMedGoogle Scholar
  29. 29.
    Doerfler A, Wanke I, Egelhof T et al (2004) Double-stent method: therapeutic alternative for small wide-necked aneurysms. Technical note. J Neurosurg 100(1):150–154PubMedGoogle Scholar
  30. 30.
    Foutrakis GN, Yonas H, Sclabassi RJ (1997) Finite element methods in the simulation and analysis of intracranial blood flow. Neurol Res 19(2):174–186PubMedGoogle Scholar
  31. 31.
    Burleson AC, Strother CM, Turitto VT (1995) Computer modeling of intracranial saccular and lateral aneurysms for the study of their hemodynamics. Neurosurgery 37(4):774–782 discussion 782–4. doi: 10.1097/00006123-199510000-00023 PubMedCrossRefGoogle Scholar
  32. 32.
    Aenis M, Stancampiano AP, Wakhloo AK et al (1997) Modeling of flow in a straight stented and nonstented side wall aneurysm model. J Biomech Eng 119(2):206–212. doi: 10.1115/1.2796081 PubMedCrossRefGoogle Scholar
  33. 33.
    Steinman DA, Milner JS, Norley CJ et al (2003) Image-based computational simulation of flow dynamics in a giant intracranial aneurysm. AJNR Am J Neuroradiol 24(4):559–566PubMedGoogle Scholar
  34. 34.
    Tamatani S, Ozawa T, Minakawa T et al (1997) Histological interaction of cultured endothelial cells and endovascular embolic materials coated with extracellular matrix. J Neurosurg 86(1):109–112PubMedGoogle Scholar
  35. 35.
    Bavinzski G, Talazoglu V, Killer M et al (1999) Gross and microscopic histopathological findings in aneurysms of the human brain treated with Guglielmi detachable coils. J Neurosurg 91(2):284–293PubMedGoogle Scholar
  36. 36.
    Castro E, Fortea F, Villoria F et al (1999) Long-term histopathologic findings in two cerebral aneurysms embolized with Guglielmi detachable coils. AJNR Am J Neuroradiol 20(4):549–552PubMedGoogle Scholar
  37. 37.
    Horowitz MB, Purdy PD, Burns D et al (1997) Scanning electron microscopic findings in a basilar tip aneurysm embolized with Guglielmi detachable coils. AJNR Am J Neuroradiol 18(4):688–690 13PubMedGoogle Scholar
  38. 38.
    Koizumi T, Kawano T, Kazekawa K et al (1997) Histological findings in aneurysm treated with IDC: scanning electron microscopical study. No Shinkei Geka 25(11):1027–1031PubMedGoogle Scholar
  39. 39.
    Mawad ME, Mawad JK, Cartwright J Jr et al (1995) Long-term histopathologic changes in canine aneurysms embolized with Guglielmi detachable coils. AJNR Am J Neuroradiol 16(1):7–13PubMedGoogle Scholar
  40. 40.
    Mizoi K, Yoshimoto T, Takahashi A et al (1996) A pitfall in the surgery of a recurrent aneurysm after coil embolization and its histological observation: technical case report. Neurosurgery 39(1):165–168 discussion 168, 169. doi: 10.1097/00006123-199607000-00035 PubMedCrossRefGoogle Scholar
  41. 41.
    Molyneux AJ, Ellison DW, Morris J et al (1995) Histological findings in giant aneurysms treated with Guglielmi detachable coils. Report of two cases with autopsy correlation. J Neurosurg 83(1):129–132Google Scholar
  42. 42.
    Spetzger U, Reul J, Weis J et al (1996) Microsurgically produced bifurcation aneurysms in a rabbit model for endovascular coil embolization. J Neurosurg 85(3):488–495PubMedCrossRefGoogle Scholar
  43. 43.
    Stiver SI, Porter PJ, Willinsky RA et al (1998) Acute human histopathology of an intracranial aneurysm treated using Guglielmi detachable coils: case report and review of the literature. Neurosurgery 43(5):1203–1208. doi: 10.1097/00006123-199811000-00106 PubMedCrossRefGoogle Scholar
  44. 44.
    Tenjin H, Fushiki S, Nakahara Y et al (1995) Effect of Guglielmi detachable coils on experimental carotid artery aneurysms in primates. Stroke 26(11):2075–2080PubMedGoogle Scholar
  45. 45.
    de Gast AN, Altes TA, Marx WF et al (2001) Transforming growth factor betacoated platinum coils for endovascular treatment of aneurysms: an animal study. Neurosurgery 49(3):690–694 discussion 694–6. doi: 10.1097/00006123-200109000-00030 PubMedCrossRefGoogle Scholar
  46. 46.
    Freed LE, Vunjak-Novakovic G, Biron RJ et al (1994) Biodegradable polymer scaffolds for tissue engineering. Biotechnology (N Y) 12(7):689–693. doi: 10.1038/nbt0794-689 CrossRefGoogle Scholar
  47. 47.
    Alexander MJ, Smith TP, Tucci DL (2002) Treatment of an iatrogenic petrous carotid artery pseudoaneurysm with a Symbiot covered stent: technical case report. Neurosurgery 50(3):658–662. doi: 10.1097/00006123-200203000-00047 PubMedCrossRefGoogle Scholar
  48. 48.
    Redekop G, Marotta T, Weill A (2001) Treatment of traumatic aneurysms and arteriovenous fistulas of the skull base by using endovascular stents. J Neurosurg 95(3):412–419PubMedCrossRefGoogle Scholar
  49. 49.
    Forbus WD (1930) On the origin of miliary aneurysms of the superficial cerebral arteries, in Johns Hopkins Hospital. Bull, Editor. p. 239.Google Scholar
  50. 50.
    Barnett HJM (1998) Pathophysiology, Diagnosis and Management, in Stroke, C. Livingstone, Editor. Philadelphia.Google Scholar
  51. 51.
    Rossitti S (1998) Shear stress in cerebral arteries carrying saccular aneurysms. A preliminary study. Acta Radiol 39(6):711–717PubMedCrossRefGoogle Scholar
  52. 52.
    Groden C, Hagel C, Delling G et al (2003) Histological findings in ruptured aneurysms treated with GDCs: six examples at varying times after treatment. AJNR Am J Neuroradiol 24(4):579–584PubMedGoogle Scholar
  53. 53.
    Murayama Y, Tateshima S, Gonzalez NR et al (2003) Matrix and bioabsorbable polymeric coils accelerate healing of intracranial aneurysms: long-term experimental study. Stroke 34(8):2031–2037. doi: 10.1161/01.STR.0000083394.33633.C2 PubMedCrossRefGoogle Scholar
  54. 54.
    Mitra D, Herwadkar A, Soh C et al (2007) Follow-up of intracranial aneurysms treated with matrix detachable coils: a single-center experience. AJNR Am J Neuroradiol 28(2):362–367PubMedGoogle Scholar
  55. 55.
    Pierot L, Leclerc X, Bonafe A et al (2008) Endovascular treatment of intracranial aneurysms with matrix detachable coils: midterm anatomic follow-up from a prospective multicenter registry. AJNR Am J Neuroradiol 29(1):57–61. doi: 10.3174/ajnr.A0738 PubMedCrossRefGoogle Scholar
  56. 56.
    Rossitti S (2007) Endovascular coiling of intracranial aneurysms using bioactive coils: a single-center study. Acta Radiol 48(5):565–576. doi: 10.1080/02841850701308360 PubMedCrossRefGoogle Scholar
  57. 57.
    Szikora I, Seifert P, Hanzely Z et al (2006) Histopathologic evaluation of aneurysms treated with Guglielmi detachable coils or matrix detachable microcoils. AJNR Am J Neuroradiol. 27(2):283–288 14PubMedGoogle Scholar
  58. 58.
    Ding YH, Dai D, Lewis DA et al (2005) Angiographic and histologic analysis of experimental aneurysms embolized with platinum coils, Matrix, and HydroCoil. AJNR Am J Neuroradiol 26(7):1757–1763PubMedGoogle Scholar
  59. 59.
    Chaloupka JC J.M., Ugurel MS, Lee S, Tejada J, Hsu SW. First year single center experience with the Matrix detachable coils for treatment of 139 consecutive intracranial aneurysm cases: Technical and clinical outcomes including 6-month angiographic follow-up. in 42nd Annual Ammerican Society of Neuroradiology. 2004. Seattle.Google Scholar
  60. 60.
    Geyik S, Yavuz K, Ergun O et al (2008) Endovascular treatment of intracranial aneurysms with bioactive Cerecyte coils: effects on treatment stability. Neuroradiology 50(9):787–793PubMedCrossRefGoogle Scholar
  61. 61.
    Bendszus M, Bartsch AJ, Solymosi L (2007) Endovascular occlusion of aneurysms using a new bioactive coil: a matched pair analysis with bare platinum coils. Stroke 38(10):2855–2857. doi: 10.1161/STROKEAHA.107.489088 PubMedCrossRefGoogle Scholar
  62. 62.
    Lowe HC, Oesterle SN, Khachigian LM (2002) Coronary in-stent restenosis: current status and future strategies. J Am Coll Cardiol 39(2):183–193. doi: 10.1016/S0735-1097(01)01742-9 PubMedCrossRefGoogle Scholar
  63. 63.
    Kearney M, Pieczek A, Haley L et al (1997) Histopathology of in-stent restenosis in patients with peripheral artery disease. Circulation 95(8):1998–2002PubMedGoogle Scholar
  64. 64.
    Hoffmann R, Mintz GS, Dussaillant GR et al (1996) Patterns and mechanisms of in-stent restenosis. A serial intravascular ultrasound study. Circulation 94(6):1247–1254PubMedGoogle Scholar
  65. 65.
    Broadbent LP, Moran CJ, Cross DT 3rd et al (2003) Management of neuroform stent dislodgement and misplacement. AJNR Am J Neuroradiol 24(9):1819–1822PubMedGoogle Scholar
  66. 66.
    Tanaka N, Martin JB, Tokunaga K et al (2004) Conformity of carotid stents with vascular anatomy: evaluation in carotid models. AJNR Am J Neuroradiol 25(4):604–607PubMedGoogle Scholar
  67. 67.
    Mukherjee D, Kalahasti V, Roffi M et al (2001) Self-expanding stents for carotid interventions: comparison of nitinol versus stainless-steel stents. J Invasive Cardiol 13(11):732–735PubMedGoogle Scholar
  68. 68.
    Hoit DA, Malek AM (2005) Three-dimensional rotational angiographic detection of in-stent stenosis in wide-necked aneurysms treated with a self-expanding intracranial stent. Neurosurgery 57(6):1228–1236 discussion 1228–36. doi: 10.1227/01.NEU.0000186026.12709.BC PubMedCrossRefGoogle Scholar
  69. 69.
    Schwartz RS, Huber KC, Murphy JG et al (1992) Restenosis and the proportional neointimal response to coronary artery injury: results in a porcine model. J Am Coll Cardiol 19(2):267–274PubMedCrossRefGoogle Scholar
  70. 70.
    Wakhloo AK, Schellhammer F, de Vries J et al (1994) Self-expanding and balloonexpandable stents in the treatment of carotid aneurysms: an experimental study in a canine model. AJNR Am J Neuroradiol 15(3):493–502PubMedGoogle Scholar
  71. 71.
    Edelman ER, Rogers C (1998) Pathobiologic responses to stenting. Am J Cardiol 81(7A):4E–6E. doi: 10.1016/S0002-9149(98)00189-1 PubMedCrossRefGoogle Scholar
  72. 72.
    Holmes DR Jr, Schwartz RS, Webster MW (1991) Coronary restenosis: what have we learned from angiography? J Am Coll Cardiol 17(6):14B–22B (Suppl B)PubMedGoogle Scholar
  73. 73.
    LaDisa JF Jr, Olson LE, Guler I et al (2004) Stent design properties and deployment ratio influence indexes of wall shear stress: a three-dimensional computational fluid dynamics investigation within a normal artery. J Appl Physiol 97(1):424–430 discussion 416. doi: 10.1152/japplphysiol.01329.2003 PubMedCrossRefGoogle Scholar
  74. 74.
    Lopes D, Sani S (2005) Histological postmortem study of an internal carotid artery aneurysm treated with the Neuroform stent. Neurosurgery 56(2):E416 discussion E416. doi: 10.1227/01.NEU.0000147977.07736.66 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Department of Diagnostic and Interventional, Radiology and NeuroradiologyUniversity Hospital of EssenEssenGermany

Personalised recommendations