Abstract
Introduction
Our purpose was to analyze the long-term evolution of wide neck cerebral aneurysms treated with stent assistance.
Methods
Data of consecutive patients treated with the Neuroform stent over 9 years were retrospectively analyzed with emphasis on periprocedural complications, aneurysm occlusion grade evolution, and in-stent stenosis rates.
Results
Altogether, 113 patients with 117 unruptured and ruptured aneurysms were subject of analysis. Mean aneurysm size was 9.4 mm, and mean neck size was 4.7 mm. Procedural thromboembolic and hemorrhagic complications affected eight (6.8 %) and four cases (3.4 %), respectively. Immediate complete occlusion and occlusion with residual neck was achieved in 85 % of cases, which at the first follow-up of 6 months, changed to 77 and 76 % at 36 months. Aneurysms ≥10 mm showed a higher tendency of recurrence. During the overall follow-up time ranging from 1 to 9 years, an in-stent stenosis of ≥50 % was observed only in three cases, all of them being asymptomatic.
Conclusions
Stent-assisted coiling of wide neck aneurysms provided stable occlusion over the long-term follow-up, with very low and silent in-stent stenosis rates. Some incompletely occluded aneurysms showed a tendency of progressive occlusion; however, this was counterbalanced by the regrowth of others.
Similar content being viewed by others
Abbreviations
- AComA:
-
Anterior communicating artery
- ACA:
-
Anterior cerebral artery
- DSA:
-
Digital subtraction angiography
- DWI:
-
Diffusion-weighted imaging
- ICA:
-
Internal carotid artery
- MCA:
-
Middle cerebral artery
- MR:
-
Magnetic resonance
- MRA:
-
MR angiography
- SAC:
-
Stent-assisted coiling
- PCA:
-
Posterior cerebral artery
- TOF:
-
Time of flight
References
Yahia AM, Latorre JG, Gordon V et al (2011) Progressive occlusion of aneurysms in Neuroform stent-assisted treatment of intracranial aneurysms. J Neurol Neurosurg Psychiatry 82:278–282
Piotin M, Blanc R, Spelle L et al (2010) Stent-assisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms. Stroke 41:110–115
Lawson MF, Newman WC, Chi YY et al (2011) Stent-associated flow remodeling causes further occlusion of incompletely coiled aneurysms. Neurosurgery 69(3):598–603
Roy D, Milot G, Raymond J (2001) Endovascular treatment of unruptured aneurysms. Stroke 32:1998–2004
Bendszus M, Stoll G (2006) Silent cerebral ischaemia: hidden fingerprints of invasive medical procedures. Lancet Neurol 5:364–372
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, discussion 291–300
Maldonado IL, Machi P, Costalat V et al (2011) Neuroform stent-assisted coiling of unruptured intracranial aneurysms: short- and midterm results from a single-center experience with 68 patients. AJNR Am J Neuroradiol 32:131–136
Szikora I, Berentei Z, Kulcsar Z et al (2006) Endovascular treatment of intracranial aneurysms with parent vessel reconstruction using balloon and self expandable stents. Acta Neurochir (Wien) 148:711–723, discussion 723
Wanke I, Doerfler A, Schoch B et al (2003) Treatment of wide-necked intracranial aneurysms with a self-expanding stent system: initial clinical experience. AJNR Am J Neuroradiol 24:1192–1199
Wanke I, Forsting M (2008) Stents for intracranial wide-necked aneurysms: more than mechanical protection. Neuroradiology 50:991–998
Baráth K, Cassot F, Fasel JH et al (2005) Influence of stent properties on the alteration of cerebral intra-aneurysmal haemodynamics: flow quantification in elastic sidewall aneurysm models. Neurol Res 27(Suppl 1):S120–S128
Fiorella D, Albuquerque FC, Deshmukh VR et al (2005) Usefulness of the Neuroform stent for the treatment of cerebral aneurysms: results at initial (3-6-mo) follow-up. Neurosurgery 56:1191–1201, discussion 1201–2
Biondi A, Janardhan V, Katz JM et al (2007) Neuroform stent-assisted coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and midterm follow-up. Neurosurgery 61:460–468, discussion 468–9
Bodily KD, Cloft HJ, Lanzino G et al (2011) Stent-assisted coiling in acutely ruptured intracranial aneurysms: a qualitative, systematic review of the literature. AJNR Am J Neuroradiol 32(7):1232–1236
Lylyk P, Ferrario A, Pasbón B et al (2005) Buenos Aires experience with the Neuroform self-expanding stent for the treatment of intracranial aneurysms. J Neurosurg 102:235–241
Vendrell JF, Costalat V, Brunel H et al (2011) Stent-assisted coiling of complex middle cerebral artery aneurysms: initial and midterm results. AJNR Am J Neuroradiol 32:259–263
Akpek S, Arat A, Morsi H et al (2005) Self-expandable stent-assisted coiling of wide-necked intracranial aneurysms: a single-center experience. AJNR Am J Neuroradiol 26:1223–1231
Benitez RP, Silva MT et al (2004) Endovascular occlusion of wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils. Neurosurgery 54:1359–1367, discussion 1368
Yahia AM, Gordon V, Whapham J et al (2008) Complications of Neuroform stent in endovascular treatment of intracranial aneurysms. Neurocrit Care 8:19–30
Tähtinen OI, Vanninen RL, Manninen HI et al (2009) Wide-necked intracranial aneurysms: treatment with stent-assisted coil embolization during acute (<72 h) subarachnoid hemorrhage–experience in 61 consecutive patients. Radiology 253:199–208
Aviv RI, O’Neill R, Patel MC, Colquhoun IR (2005) Abciximab in patients with ruptured intracranial aneurysms. AJNR Am J Neuroradiol 26(7):1744–1750
Ries T, Siemonsen S, Grzyska U et al (2009) Abciximab is a safe rescue therapy in thromboembolic events complicating cerebral aneurysm coil embolization: single center experience in 42 cases and review of the literature. Stroke 40(5):1750–1757
Fiorella D, Albuquerque FC, Woo H et al (2006) Neuroform in-stent stenosis: incidence, natural history, and treatment strategies. Neurosurgery 59:34–42, discussion 34–42
Conflict of interest
The Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital of Essen, Germany, acknowledges financial support for furthering research and education in Interventional Neuroradiology through an institutional grant support from Boston Scientific/Stryker.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kulcsár, Z., Göricke, S.L., Gizewski, E.R. et al. Neuroform stent-assisted treatment of intracranial aneurysms: long-term follow-up study of aneurysm recurrence and in-stent stenosis rates. Neuroradiology 55, 459–465 (2013). https://doi.org/10.1007/s00234-013-1143-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-013-1143-z