Article Text

other Versions

PDF
Case series
Use of flow-diverting stents as salvage treatment following failed stent-assisted embolization of intracranial aneurysms
  1. Daniel M Heiferman1,
  2. Joshua T Billingsley2,
  3. Manish K Kasliwal3,
  4. Andrew K Johnson3,
  5. Kiffon M Keigher3,
  6. Michel E Frudit4,
  7. Roham Moftakhar3,
  8. Demetrius K Lopes3
  1. 1Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
  2. 2Department of Neurosurgery, University of Florida—Orlando Health, Orlando, Florida, USA
  3. 3Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
  4. 4Division of Neurosurgery, University of São Paulo School of Medicine, São Paulo, Brazil
  1. Correspondence to Dr Demetrius K Lopes, Department of Neurological Surgery, Rush University Medical Center, 1725 W Harrison St, Suite 855, Chicago, IL 60612, USA; brainaneurysm{at}mac.com

Abstract

Flow-diverting stents, including the Pipeline embolization device (PED) and Silk, have been beneficial in the treatment of aneurysms previously unable to be approached via endovascular techniques. Recurrent aneurysms for which stent-assisted embolization has failed are a therapeutic challenge, given the existing intraluminal construct with continued blood flow into the aneurysm. We report our experience using flow-diverting stents in the repair of 25 aneurysms for which stent-assisted embolization had failed. Nineteen (76%) of these aneurysms at the 12-month follow-up showed improved Raymond class occlusion, with 38% being completely occluded, and all aneurysms demonstrated decreased filling. One patient developed a moderate permanent neurologic deficit. Appropriate stent sizing, proximal and distal construct coverage, and preventing flow diverter deployment between the previously deployed stent struts are important considerations to ensure wall apposition and prevention of endoleak. Flow diverters are shown to be a reasonable option for treating previously stented recurrent cerebral aneurysms.

  • Aneurysm
  • Angiography
  • Flow Diverter
  • Intervention

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.