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

• Published in: Acta neurochirurgica 2010-05, Vol.152 (5), p.763-769
• Main Authors: Pavlisa, Goran, Ozretic, David, Murselovic, Tamara, Pavlisa, Gordana, Rados, Marko
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Angiography, Digital Subtraction; Brain Ischemia - epidemiology; Brain Ischemia - physiopathology; Brain Ischemia - prevention & control; Cerebral Arteries - diagnostic imaging; Cerebral Arteries - pathology; Clinical Article; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - instrumentation; Embolization, Therapeutic - methods; Fatal Outcome; Female; Humans; Interventional Radiology; Intracranial Aneurysm - complications; Intracranial Aneurysm - pathology; Intracranial Aneurysm - therapy; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Mortality; Neurology; Neuronavigation; Neuroradiology; Neurosurgery; Postoperative Complications - epidemiology; Postoperative Complications - physiopathology; Postoperative Complications - prevention & control; Prosthesis Implantation - adverse effects; Prosthesis Implantation - instrumentation; Prosthesis Implantation - methods; Reoperation; Retrospective Studies; Risk Assessment; Stents - adverse effects; Stents - statistics & numerical data; Stents - trends; Subarachnoid Hemorrhage - epidemiology; Subarachnoid Hemorrhage - physiopathology; Subarachnoid Hemorrhage - prevention & control; Surgical Orthopedics; Treatment Outcome
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-009-0592-y

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.