Intravascular Occlusion of Cerebral Aneurysms with Self-Expanding Stents

Kandiba D., Svistov D., Savello .

Medicomilitary Academy, Saint Petersburg, Russia

 

The research goal was to study use of self-expanding stents in treatment of cases with cerebral aneurysms.

Material and Methods. Operations were performed in 12 cases with saccular (9) and fusiform (3) cerebral aneurysms. Stents were used in all of them. Big and giant aneurysms were revealed in 10 patients. They were small in 2 cases. Multiple aneurysms were watched in 2 patients. There were 7 cases, who had sustained subarachnoid hemorrhages; the rest had unruptured aneurysms. A wide neck of aneurysm (a diameter of more than 5 mm, a cupula/neck ratio of less than 2.0) was an indication for stent implantation. Leo nitinol (n=11, 15 pieces) and Neuroform (n=1, one piece) stents were used.

Results. Stent implantation was performed in a non-acute period and a satisfactory state. It was successful in 11 cases. One-stage occlusion of saccular aneurysm with DCS, GDC, Matrix microcoils was made in 4 cases. It was delayed in 4 patients. Total and subtotal embolization was achieved in 6 and 2 cases respectively. We failed to occlude aneurysm in 1 patient. As for fusiform aneurysms, 1-2 stents were implanted into an area of artery dilation. Control examinations did not reveal recanalization and a growth of saccular aneurysms. Fusiform aneurysms were characterized by stabilization or reduction. Transient neurological complications were present in 3 cases. Thromboembolism, aneurysm rupture and stent dislocation, watched in 2 patients, were caused by technical difficulties. Favorable outcomes were observed in 11 cases (mRS<2). There were no fatal outcomes.

Conclusion. Self-expanding stents and tactics of multi-stage interventions permit to overcome limitations of intravascular methods of treatment, used in wide-neck aneurysms, and to ensure a favorable outcome in the majority of cases.