Acta Neurochirurgica

, Volume 152, Issue 5, pp 763–769

Sole stenting of large and giant intracranial aneurysms with self-expanding intracranial stents—limits and complications

  • Goran Pavlisa
  • David Ozretic
  • Tamara Murselovic
  • Gordana Pavlisa
  • Marko Rados
Clinical Article

Abstract

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 ocurred 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 intraaneurysmal flow in such aneurysms, even after the placement of multiple overlapping stents, seems to be unpredictable.

Keywords

Intracranial aneurysm Sole stenting Self-expanding stent Large and giant aneurysms 

References

  1. 1.
    Ahn JY, Han IB, Kim TG, Yoon PH, Lee YJ, Lee BH, Seo SH, Kim DI, Hong CK, Joo JY (2006) Endovascular treatment of intracranial vertebral artery dissections with stent placement or stent-assisted coiling. AJNR Am J Neuroradiol 27:1514–1152PubMedGoogle Scholar
  2. 2.
    Fiorella D, Albuquerque FC, Masaryk TJ, Rasmussen PA, McDougall CG (2005) Balloon-in-stent technique for the constructive endovascular treatment of “ultra-wide necked” circumferential aneurysms. Neurosurgery 57:1218–1227CrossRefPubMedGoogle Scholar
  3. 3.
    Mehta B, Burke T, Kole M, Bydon A, Seyfried D, Malik G (2003) Stent-within-a-stent technique for the treatment of dissecting vertebral artery aneurysms. AJNR Am J Neuroradiol 24:1814–1818PubMedGoogle Scholar
  4. 4.
    Molyneux AJ, Cekirge SH, Saatci I, Gal G (2004) Cerebral aneurysm multicenter European Onyx (CAMEO) trial: results of a prospective observational study in 20 European centers. AJNR Am J Neuroradiol 25:39–51PubMedGoogle Scholar
  5. 5.
    Benitez RP, Silva MT, Klem J, Veznedaroglu E, Rosenwasser RH (2004) Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils. Neurosurgery 54:1359–1368CrossRefPubMedGoogle Scholar
  6. 6.
    Lubicz B, Collignon L, Lefranc F, Bruneau M, Brotchi J, Balériaux D, De Witte O (2008) Circumferential and fusiform intracranial aneurysms: reconstructive endovascular treatment with self-expandable stents. Neuroradiology 50:499–507CrossRefPubMedGoogle Scholar
  7. 7.
    Szikora I, Berentei Z, Kulcsar Z, Barath K, Berez A, Bose A, Nyary I (2006) Endovascular treatment of intracranial aneurysms with parent vessel reconstruction using balloon and self expandable stents. Acta Neurochir (Wien) 148:711–723CrossRefGoogle Scholar
  8. 8.
    Vanninen R, Manninen H, Ronkainen A (2003) Broad-based intracranial aneurysms: thrombosis induced by stent placement. AJNR Am J Neuroradiol 24:263–266PubMedGoogle Scholar
  9. 9.
    Wakhloo AK, Mandell J, Gounis MJ, Brooks C, Linfante I, Winer J, Weaver JP (2008) Stent-assisted reconstructive endovascular repair of cranial fusiform atherosclerotic and dissecting aneurysms: long-term clinical and angiographic follow-up. Stroke 39:3288–3296CrossRefPubMedGoogle Scholar
  10. 10.
    Zenteno MA, Modenesi Freitas JM, Aburto-Murrieta Y, Koppe G, Machado E, Lee A (2006) Balloon-expandable stenting with and without coiling for wide-neck and complex aneurysms. Surg Neurol 66:603–610CrossRefPubMedGoogle Scholar
  11. 11.
    Zenteno MA, Murillo-Bonilla LM, Guinto G, Gomez CR, Martinez SR, Higuera-Calleja J, Lee A, Gomez-Llata S (2005) Sole stenting bypass for the treatment of vertebral artery aneurysms: technical case report. Neurosurgery 57:E208CrossRefPubMedGoogle Scholar
  12. 12.
    Zenteno MA, Santos-Franco JA, Freitas-Modenesi JM, Gómez C, Murillo-Bonilla L, Aburto-Murrieta Y, Díaz-Romero R, Nathal E, Gómez-Llata S, Lee A (2008) Use of the sole stenting technique for the management of aneurysms in the posterior circulation in a prospective series of 20 patients. J Neurosurg 108:1104–1118CrossRefPubMedGoogle Scholar
  13. 13.
    Kaku Y, Yoshimura S, Yamakawa H, Sakai N (2003) Failure of stent-assisted endovascular treatment for ruptured dissecting aneurysms of the basilar artery. Neuroradiology 45:22–26PubMedGoogle Scholar
  14. 14.
    Fiorella D, Woo HH, Albuquerque FC, Nelson PK (2008) Definitive reconstruction of circumferential, fusiform intracranial aneurysms with the pipeline embolization device. Neurosurgery 62:1115–1121CrossRefPubMedGoogle Scholar
  15. 15.
    Lylyk P, Miranda C, Ceratto R, Ferrario A, Scrivano E, Luna HR, Berez AL, Tran Q, Nelson PK, Fiorella D (2009) Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience. Neurosurgery 64:632–643CrossRefPubMedGoogle Scholar
  16. 16.
    Diaz FG, Ohaegbulam S, Dujovny M, Ausman JI (1998) Surgical management of aneurysms in the cavernous sinus. Acta Neurochir (Wien) 91:25–28CrossRefGoogle Scholar
  17. 17.
    Raaymakers TW, Rinkel GJ, Limburg M, Algra A (1998) Mortality and morbidity of surgery for unruptured intracranial aneurysms: a meta-analysis. Stroke 29:1531–1538PubMedGoogle Scholar
  18. 18.
    Higashida RT, Smith W, Gress D, Urwin R, Dowd CF, Balousek PA, Halbach VV (1997) Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. Case report and review of the literature. J Neurosurg 87:944–949CrossRefPubMedGoogle Scholar
  19. 19.
    Lylyk P, Ceratto R, Hurvitz D, Basso A (1998) Treatment of a vertebral dissecting aneurysm with stents and coils: technical case report. Neurosurgery 43:385–388CrossRefPubMedGoogle Scholar
  20. 20.
    Brooks NP, Turk AS, Niemann DB, Aagaard-Kienitz B, Pulfer K, Cook T (2008) Frequency of thromboembolic events associated with endovascular aneurysm treatment: retrospective case series. J Neurosurg 108:1095–1100CrossRefPubMedGoogle Scholar
  21. 21.
    Crowley RW, Evans AJ, Kassell NF, Jensen ME, Dumont AS (2009) Endovascular treatment of a fusiform basilar artery aneurysm using multiple “in-stent stents”. J Neurosurg Pediatr 3:496–500CrossRefPubMedGoogle Scholar
  22. 22.
    Aziz-Sultan A, Heros RC (2008) Sole stenting. J Neurosurg 108:1101–1103CrossRefPubMedGoogle Scholar
  23. 23.
    Cebral JR, Castro MA, Burgess JE, Pergolizzi RS, Sheridan MJ, Putman CM (2005) Characterization of cerebral aneurysms for assessing risk of rupture by using patient-specific computational hemodynamics models. AJNR Am J Neuroradiol 26:2550–2559PubMedGoogle Scholar
  24. 24.
    Doerfler A, Wanke I, Egelhof T, Stolke D, Forsting M (2004) Double-stent method: therapeutic alternative for small wide-necked aneurysms. Technical note. J Neurosurg 100:150–154CrossRefPubMedGoogle Scholar
  25. 25.
    Fiorella D, Albuquerque FC, Deshmukh VR, Woo HH, Rasmussen PA, Masaryk TJ, McDougall CG (2006) Endovascular reconstruction with the Neuroform stent as monotherapy for the treatment of uncoilable intradural pseudoaneurysms. Neurosurgery 59:291–300CrossRefPubMedGoogle Scholar
  26. 26.
    Manabe H (2008) Ruptured cerebral aneurysms treated by stent-assisted GDC embolization—two case reports with long-term follow-up. Acta Neurochir Suppl 103:5–8CrossRefPubMedGoogle Scholar
  27. 27.
    Park SI, Kim BM, Kim DI, Shin YS, Suh SH, Chung EC, Kim SY, Kim SH, Won YS (2009) Clinical and angiographic follow-up of stent-only therapy for acute intracranial vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 30:1351–1356CrossRefPubMedGoogle Scholar
  28. 28.
    Santos-Franco JA, Zenteno M, Lee A (2008) Dissecting aneurysms of the vertebrobasilar system. A comprehensive review on natural history and treatment options. Neurosurg Rev 31:131–140CrossRefPubMedGoogle Scholar
  29. 29.
    Benndorf G, Herbon U, Sollmann WP, Campi A (2001) Treatment of a ruptured dissecting vertebral artery aneurysm with double stent placement: case report. AJNR Am J Neuroradiol 22:1844–1848PubMedGoogle Scholar
  30. 30.
    Kim M, Levy EI, Meng H, Hopkins LN (2007) Quantification of hemodynamic changes induced by virtual placement of multiple stents across a wide-necked basilar trunk aneurysm. Neurosurgery 61:1305–1313CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Goran Pavlisa
    • 1
  • David Ozretic
    • 1
  • Tamara Murselovic
    • 2
  • Gordana Pavlisa
    • 3
  • Marko Rados
    • 1
  1. 1.Clinical Institute of Diagnostic and Interventional RadiologyUniversity Hospital Center ZagrebZagrebCroatia
  2. 2.Clinic of Anesthesiology, Reanimatology and Intensive CareUniversity Hospital Center ZagrebZagrebCroatia
  3. 3.Special Hospital for Pulmonary DiseasesZagrebCroatia

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