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Endovascular treatment of intracranial aneurysms with flow-diverter stents: preliminary single-centre experience

Trattamento endovascolare degli aneurismi intracranici con stent a diversione di flusso: esperienza preliminare monocentrica

  • Vascular and Interventional Radiology / Radiologia Vascolare E Interventistica
  • Published:
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Abstract

Purpose

This paper reports our preliminary experience with the endovascular treatment of intracranial aneurysms using flow-diverter stents (FDs) and compares it with the literature data.

Materials and methods

From May 2009 to April 2012, 28 patients (6 men and 22 women; mean age, 54 years) with a total of 35 aneurysms were treated with FDs. We evaluated postprocedural technical success and long-term efficacy, with follow-up examinations performed at 3–7 days [computed tomography (CT)/magnetic resonance (MR) angiography] and at 3, 6 and 12 months (digital subtraction angiography, DSA). A total of 43 FDs were placed, 36 Pipeline and 7 Silk.

Results

A total of 30 procedures were performed (two patients were treated twice). Technical success was 96.6%, with one case of postprocedural death; the aneurysm exclusion rate at 3, 6 and 12 months was 60%, 73% and 89%, respectively. There was no case of acute stent thrombosis, and only two cases of nonsignificant stenosis. All covered side branches were patent, except one case of steno-occlusion of the ophthalmic artery.

Conclusions

Our results are consistent with the literature and demonstrate the effectiveness and safety of FDs in selected cases of cerebral aneurysm (wide neck, fusiform, blister-like).

Riassunto

Obiettivo

Scopo del presente lavoro è riportare la nostra esperienza nel trattamento endovascolare degli aneurismi cerebrali mediante stent a diversione di flusso (FD), confrontandola con i dati della letteratura.

Materiali e metodi

Da maggio 2009 ad aprile 2012 sono stati trattati mediante FD 28 pazienti (6 maschi e 22 femmine; età media 54 anni) portatori di 35 aneurismi cerebrali. Abbiamo valutato il successo tecnico procedurale e l’efficacia a distanza mediante angiotomografia computerizzata (TC) o angio-risonanza magnetica (RM) a 3–7 giorni, quindi angiografia digitale a sottrazione (DSA) a 3, 6 e 12 mesi. Sono stati posizionati complessivamente 43 FD, 36 Pipeline e 7 Silk.

Risultati

Complessivamente sono stati eseguiti 30 interventi (due ritrattamenti a 3 mesi per copertura parziale del colletto aneurismatico). Abbiamo ottenuto il successo tecnico nel 96,6% dei casi, con un caso (3,4%) di insuccesso esitato in decesso post-operatorio. L’esclusione dal circolo dell’aneurisma è stata a 3, 6 e 12 mesi rispettivamente del 60%, 73% ed 89%. Non abbiamo osservato nessun caso di trombosi intra-stent, solo due casi di stenosi lieve intra-stent, risoltesi poi al followup; in tutti i casi i vasi collaterali ricoperti dagli stent sono risultati pervi, eccetto un caso di steno-occlusione dell’arteria oftalmica.

Conclusioni

I risultati da noi ottenuti, in linea con i dati della letteratura, documentano che il trattamento degli aneurismi cerebrali mediante FD rappresenta un’opzione sicura ed efficace in casi selezionati (aneurismi a largo colletto, fusiformi, blister-like), con buoni risultati nel tempo.

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Authors and Affiliations

  1. Radiodiagnostic and Interventional Radiology Institute, Amedeo Avogadro University of Eastern Piedmont, AOU Maggiore della Carità, Novara, Italy

    Emanuele Malatesta, Ignazio Divenuto, Rita Fossaceca, Mariangela Lombardi, Paolo Cerini, Giuseppe Guzzardi, Alessandro Stecco & Alessandro Carriero

  2. Neuroradiology Department, E.O. Ospedali Galliera, Genova, Italy

    Nunzio Paolo Nuzzi

  3. Neuroradiology and Radiology, Anthea Hospital Bari, Gruppo Villa Maria, Bari, Italy

    Cosma Andreula

  4. Corso Mazzini 18, 28100, Novara (NO), Italy

    Emanuele Malatesta

Authors
  1. Emanuele Malatesta
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  2. Nunzio Paolo Nuzzi
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  3. Ignazio Divenuto
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  4. Rita Fossaceca
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  5. Mariangela Lombardi
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  6. Paolo Cerini
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  7. Giuseppe Guzzardi
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  8. Alessandro Stecco
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  9. Cosma Andreula
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  10. Alessandro Carriero
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Corresponding author

Correspondence to Emanuele Malatesta.

Additional information

Preliminar results of this study were presented at the 26th National Congress AINR, 19–22 October 2011, Padua, Italy and at the 45th National Congress SIRM, 1–5 June 2012, Turin, Italy.

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Malatesta, E., Nuzzi, N.P., Divenuto, I. et al. Endovascular treatment of intracranial aneurysms with flow-diverter stents: preliminary single-centre experience. Radiol med 118, 971–983 (2013). https://doi.org/10.1007/s11547-013-0944-9

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  • DOI: https://doi.org/10.1007/s11547-013-0944-9

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