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DOI: 10.1055/s-2005-836921
© Georg Thieme Verlag Stuttgart · New York
Treatment of Wide-Necked Intracranial Aneurysms with a Self-Expanding Stent: Mid-Term Results
Behandlung intrakranieller Aneurysmen mit einem selbst-expandierenden Stent: mittelfristige ErgebnissePublication History
Publication Date:
29 November 2005 (online)
![](https://www.thieme-connect.de/media/zblneurochir/200504/lookinside/thumbnails/10.1055-s-2005-836921-1.jpg)
Abstract
Purpose: To evaluate mid-term clinical and angiographic results after using a self-expanding neurovascular stent and coils for the management of broad-based intracranial aneurysms. Methods: During the period from August 2001 to October 2004 we treated a total of 42 patients with 44 aneurysms using a self-expandable stent. To date we have data on more than 6 months of follow-up in 25 patients with 26 aneurysms. Aneurysm occlusion was divided into the following categories: 100 % (complete), 95-99 % (subtotal), and < 95 % (incomplete). Results: In 15 aneurysms complete occlusion, in 11 aneurysms subtotal occlusion was initially achieved. Control DSA showed progressive thrombosis in seven aneurysms leading to total occlusion in another 4 aneurysms. Three recanalisations were observed in one large and two giant ICA aneurysms. No vessel occlusion occurred. One vessel stenosis of the stented segment was noted, but it was not clinically relevant. One patient experienced a small embolic infarction after stopping antiplatelet medication. No persistent deterioration of the clinical status occurred. Conclusion: Combining a stent with coils seems to be an acceptable treatment option for broad-based intracranial aneurysms. As this special subgroup of treated aneurysms includes only those with an unfavourable geometry, the results are extremely promising.
Zusammenfassung
Einleitung: Evaluation der mittelfristigen klinischen und angiographischen Ergebnisse nach Behandlung breitbasiger intrakranieller Aneurysmen mit der Kombination eines selbst-expandierbaren Stents und Platinspiralen. Patienten/Material und Methoden: Zwischen August 2001 und Oktober 2004 wurden insgesamt 42 Patienten mit 44 Aneurysmen mit Hilfe eines selbst-expandierbaren Stents behandelt. 25 Patienten mit 26 Aneurysmen konnten bisher über einen Zeitraum von mehr als 6 Monaten nachuntersucht werden. Die Okklusionsrate der Aneurysmen wurde unterteilt in drei Gruppen: 100 % (komplett), 95-99 % (subtotal) und < 95 % (inkomplett). Ergebnisse: Unmittelbar nach der Intervention waren 15 Aneurysmen komplett und 11 subtotal verschlossen. Bei sieben Aneurysmen wurde in der Kontrollangiographie eine zunehmende Thrombosierung gesehen, die bei 4 Aneurysmen zum kompletten Verschluss geführt hat. Drei Rekanalisierungen wurden in zwei Riesenaneurysmen und einem großen Aneurysma der A. carotis interna festgestellt. Gefäßverschlüsse durch den Stent wurden nicht beobachtet, ein Patient hatte im Verlauf eine klinisch nicht relevante Gefäßeinengung. Als Spätkomplikation wurde ein embolischer Infarkt nach Absetzen der Plättchenhemmer gesehen. Bei keinem Patienten kam es zu einer klinischen Verschlechterung. Schlussfolgerung: Die Behandlung breitbasiger intrakranieller Aneurysmen mit einem selbst-expandierenden Stent und Coils ist eine Alternative, um gute mittelfristige Ergebnisse zu erzielen. Insbesondere unter dem Aspekt der höheren Rekanalisierungsraten bei breitbasigen Aneurysmen sind die Ergebnisse extrem vielversprechend.
Key words
intracranial aneurysm - wide-necked aneurysm - self-expanding microstent - coil embolisation - mid-term results
Schlüsselwörter
intrakranielles breitbasiges Aneurysma - selbst-expandierbarer Stent - endovaskuläre Therapie - mittelfristige Ergebnisse
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I. WankeMD
Department of Neuroradiology · University of Essen
Hufelandstraße 55
45122 Essen
Germany
Phone: 49/2 01/7 23 15 39
Fax: 49/2 01/7 23 59 59
Email: isabel.wanke@uni-essen.de