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Circumferential and fusiform intracranial aneurysms: reconstructive endovascular treatment with self-expandable stents

  • Interventional Neuroradiology
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Abstract

Introduction

We report our experience with endovascular treatment (EVT) of circumferential and fusiform intracranial aneurysms by a reconstructive approach with self-expandable stents.

Methods

A retrospective review of our prospectively maintained database identified all circumferential and fusiform aneurysms treated by a reconstructive endovascular approach over a 3-year period. Clinical charts, procedural data, and angiographic results were reviewed.

Results

From April 2004 to May 2007, 13 patients were identified, of whom 12 were asymptomatic and 1 presented with a subarachnoid hemorrhage. Two patients with an aneurysm ≤2 mm were treated by stent-within-stent placement without coiling (group 1). In 11 patients with a larger aneurysm, stenting with subsequent coiling was performed (group 2). In this latter approach, a balloon was temporarily inflated within the stent to ensure safe coil delivery. All patients showed an excellent clinical outcome. Asymptomatic procedural complications occurred in three patients, two with cervical internal carotid artery dissection and one with retroperitoneal hematoma. In patients of group 1, the aneurysm had completely disappeared at 6 months. In patients of group 2, aneurysm occlusion was complete in three and incomplete in eight. Follow-up angiography in 12 patients showed four with further thrombosis, six with stable results, and two with minor recanalization.

Conclusion

Circumferential and fusiform intracranial aneurysms may be treated by a reconstructive endovascular approach with self-expandable stents. In small aneurysms, a stent-within-stent technique is effective, whereas stenting and subsequent coiling is indicated in larger aneurysms. This therapeutic protocol is associated with good clinical and anatomical results.

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References

  1. Anson JA, Lawton MT, Spetzler RF (1996) Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg 84:185–193

    PubMed  CAS  Google Scholar 

  2. Mizutani T, Miki Y, Kojima H, Suzuki H (1999) Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery 45:253–259

    Article  PubMed  CAS  Google Scholar 

  3. Biondi A (2006) Trunkal intracranial aneurysms: dissecting and fusiform aneurysms. Neuroimaging Clin N Am 16:453–465

    Article  PubMed  Google Scholar 

  4. Graff-Radford NR, Adams HP Jr, Smoker WRK, Biller J, Boarini DJ (1985) Unruptured fusiform aneurysms of the posterior circulation with thalamic infarction. Neurosurgery 17:495–499

    Article  PubMed  CAS  Google Scholar 

  5. 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 57:1218–1227

    Article  PubMed  Google Scholar 

  6. Debrun G, Fox AJ, Drake CG, Peerless S, Girvin J, Ferguson G (1981) Giant unclippable aneurysms: treatment with detachable balloons. AJNR Am J Neuroradiol 2:167–173

    PubMed  CAS  Google Scholar 

  7. Drake C, Peerless S (1997) Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965–1992. J Neurosurg 87:141–162

    PubMed  CAS  Google Scholar 

  8. Gobin PY, Vinuela F, Gurian JH et al (1996) Treatment of large and giant fusiform intracranial aneurysms with Guglielmi detachable coils. J Neurosurg 84:55–62

    PubMed  CAS  Google Scholar 

  9. Anson JA (1998) Treatment strategies for intracranial fusiform aneurysms. Neurosurg Clin N Am 9:743

    PubMed  CAS  Google Scholar 

  10. Deshmukh VR, Kakarla UK, Figuereido EG, Zabramsky JM, Spetzler RF (2006) Long-term clinical and angiographic follow-up of unclippable wrapped intracranial aneurysms. Neurosurgery 58:434–442

    PubMed  Google Scholar 

  11. Lawton MT, Quinones-Hinojosa A, Sanai N, Malek JY, Dowd CF (2003) Combined microsurgical and endovascular management of complex intracranial aneurysms. Neurosurgery 52:263–274

    Article  PubMed  Google Scholar 

  12. Hoh BL, Putman CM, Budzik RF, Carter BS, Ogilvy CS (2001) Combined surgical and endovascular techniques of flow alteration to treat fusiform and complex wide-necked intracranial aneurysms that are unsuitable for clipping or coil embolization. J Neurosurg 95:24–35

    PubMed  CAS  Google Scholar 

  13. Chen L, Kato Y, Sano H et al (2007) Management of complex, surgically intractable intracranial aneurysms: the option for intentional reconstruction of aneurysm neck followed by endovascular coiling. Cerebrovasc Dis 23:381–387

    Article  PubMed  Google Scholar 

  14. Phatouros CC, Sasaki TY, Higashida RT et al (2000) Stent-supported coil embolization: the treatment of fusiform and wide-neck aneurysms and pseudoaneurysms. Neurosurgery 47:107–113

    Article  PubMed  CAS  Google Scholar 

  15. Lylyk P, Cohen JE, Ceratto R, Ferrario A, Miranda C (2002) Endovascular reconstruction of intracranial arteries by stent placement and combined techniques. J Neurosurg 97:1306–1313

    PubMed  Google Scholar 

  16. Kessler I, Mounayer C, Piotin M, Spelle L, Vanzin JR, Moret J (2005) The use of balloon-expandable stents in the management of intracranial arterial diseases: a 5-year single-center experience. AJNR Am J of Neuroradiol 26:2342–2348

    Google Scholar 

  17. Wanke I, Doerfler A, Schoch B, Stolke D, Forsting M (2003) Treatment of wide-necked intracranial aneurysms with a self-expanding stent system: initial clinical experience. AJNR Am J Neuroradiol 24:1192–1199

    PubMed  Google Scholar 

  18. Alfke K, Straube T, Dörner L, Mehdorn HM, Jansen O (2004) Treatment of intracranial broad-neck aneurysms with a new self-expanding stent and coil embolization. AJNR Am J Neuroradiol 25:584–591

    PubMed  Google Scholar 

  19. 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 54:1359–1367

    Article  PubMed  Google Scholar 

  20. Fiorella D, Albuquerque F, Han P, MacDougall C (2004) Preliminary experience using the Neuroform stent for the treatment of cerebral aneurysms. J Neurosurg 54:6–16

    Article  Google Scholar 

  21. Lylyk P, Ferrario A, Pasbon B, Miranda C, Doroszuk G (2005) Buenos Aires experience with the Neuroform self-expanding stent for the treatment of intracranial aneurysms. J Neurosurg 102:235–241

    PubMed  Google Scholar 

  22. Higashida RT, Halbach VV, Dowd CF, Juravsky L, Meagher S (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 26:1751–1756

    PubMed  Google Scholar 

  23. Kis B, Weber W, Berlit P, Kuhne D (2006) Elective treatment of saccular and broad-necked intracranial aneurysms using a closed-cell nitinol stent (Leo). Neurosurgery 58:443–450

    PubMed  Google Scholar 

  24. Lubicz B, Leclerc X, Levivier M et al (2006) Retractable self-expandable stent for endovascular treatment of wide-necked intracranial aneurysms: preliminary experience. Neurosurgery 58:451–457

    PubMed  Google Scholar 

  25. Lubicz B, François 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 (in press)

  26. Fiorella D, Albuquerque FC, Deshmukh VR et al (2006) Endovascular reconstruction with the Neuroform stent as monotherapy for the treatment of uncoilable intradural pseudoaneurysms. Neurosurgery 59:291–300

    Article  PubMed  Google Scholar 

  27. Hunt W, Hess R (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20

    PubMed  CAS  Google Scholar 

  28. Guglielmi G, Vinuela F, Dion J, Duckwiler G (1991) Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg 75:8–14

    Article  PubMed  CAS  Google Scholar 

  29. Guglielmi G, Vinuela F, Duckwiler G et al (1992) Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 77:515–524

    PubMed  CAS  Google Scholar 

  30. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484

    Article  PubMed  CAS  Google Scholar 

  31. Turjman F, Massoud TF, Ji C, Guglielmi G, Vinuela F, Robert J (1994) Combined stent implantation and endosaccular coil placement for treatment of experimental wide-necked aneurysms: a feasibility study in swine. AJNR Am J Neuroradiol 15:1087–1090

    PubMed  CAS  Google Scholar 

  32. Szikora I, Guterman LR, Wells KM, Hopkins LN (1994) Combined use of stents and coils to treat experimental wide-necked carotid aneurysms: preliminary results. AJNR Am J Neuroradiol 15:1091–1102

    PubMed  CAS  Google Scholar 

  33. Massoud TF, Turjman F, Ji C et al (1995) Endovascular treatment of fusiform aneurysms with stents and coils: technical feasibility in a swine model. AJNR Am J Neuroradiol 16:1953–1963

    PubMed  CAS  Google Scholar 

  34. 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 22:1844–1848

    PubMed  CAS  Google Scholar 

  35. Vanninen R, Mannine H, Ronkainen A (2003) Broad-based intracranial aneurysms: thrombosis induced by stent placement. AJNR Am J Neuroradiol 24:263–266

    PubMed  Google Scholar 

  36. 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 100:150–154

    PubMed  Google Scholar 

  37. Zenteno M, 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 66:603–610

    Article  PubMed  Google Scholar 

  38. Ansari SA, Lassig JP, Nicol E, Thompson BG, Gemmete JJ, Ghandhi D (2007) Thrombosis of a fusiform intracranial aneurysm induced by overlapping neuroform stents: case report. Neurosurgery 60:E950–E951

    Article  PubMed  Google Scholar 

  39. Wakhloo AK, Schellhammer F, de Vries J, Haberstroh J, Schumacher M (1994) Self-expanding and balloon-expandable stents in the treatment of carotid aneurysms: an experimental study in a canine model. AJNR Am J Neuroradiol 15:493–502

    PubMed  CAS  Google Scholar 

  40. Lieber BB, Stancampiano AP, Wakhloo AK (1997) Alteration of hemodynamics in aneurysm models by stenting: influence of stent porosity. Ann Biomed Eng 25:460–469

    Article  PubMed  CAS  Google Scholar 

  41. Hirabayashi M, Ohta M, Rüfenacht DA, Chopard B (2003) Characterization of flow reduction properties in an aneurysm due to a stent. Phys Rev E Stat Nonlin Soft Matter Phys 68:021918

    PubMed  Google Scholar 

  42. Ahlhelm F, Roth C, Kaufmann R, Schulte-Altedorneburg G, Romeike BF, Reith W (2007) Treatment of wide-necked intracranial aneurysms with a novel self-expanding two-zonal endovascular stent device. Neuroradiology 49:1023–1028

    Article  PubMed  Google Scholar 

  43. Molyneux AJ, Cekirge S, 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 25:39–51

    PubMed  Google Scholar 

  44. Akpek S, Arat A, Morsi H, Klucznick RP, Strother CM, Mawad ME (2005) Self-expandable stent-assisted coiling of wide-necked intracranial aneurysms: a single-center experience. AJNR Am J Neuroradiol 26:1223–1231

    PubMed  Google Scholar 

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Correspondence to Boris Lubicz.

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Lubicz, B., Collignon, L., Lefranc, F. et al. Circumferential and fusiform intracranial aneurysms: reconstructive endovascular treatment with self-expandable stents. Neuroradiology 50, 499–507 (2008). https://doi.org/10.1007/s00234-008-0366-x

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  • DOI: https://doi.org/10.1007/s00234-008-0366-x

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