With the recent development and refinement of endovascular stents, the significant potential for ... more With the recent development and refinement of endovascular stents, the significant potential for these devices in the treatment of wide-necked dissecting and fusiform aneurysms has become apparent. In this article the authors report on the use of stents and coils to treat dissecting and fusiform vertebral artery (VA) aneurysms. Eight consecutive patients harboring eight dissecting aneurysms and one fusiform aneurysm of the VA were succesfully treated using a procedure in which the authors inserted an intravascular stent and secondary endosaccular coils when needed. In all but one patient complete aneurysm occlusion was achieved, and in all cases there was no neurological complication. Follow-up angiography examinations were performed in all patients (mean duration of follow-up angiography review 13.1 months, range 3-42 months). The patients remained stable throughout the clinical follow-up period (mean 14.1 months, range 4-42 months). No rebleeding was recorded. At present this combined approach represents a reliable and safe alternative for the treatment of VA dissecting aneurysms, especially in patients who cannot tolerate occlusion tests.
The authors report their experience with the use of the Neuroform Microdelivery System for intrav... more The authors report their experience with the use of the Neuroform Microdelivery System for intravascular reconstruction. They assess the technical feasibility of the system, the efficacy of the combined application of stent and detachable coils, and the follow-up findings. Fifty patients found to harbor a complex wide-necked intracranial aneurysm were selected for the study. Different strategies were chosen and the performance and technical success of the device were evaluated. Stent placement was recorded as optimal or suboptimal with respect to the stent position. Clinical and angiographic follow-up examinations were obtained. Forty-six patients with 48 intracranial aneurysms were treated, leading to a technical success rate of 92%. Forty-two lesions were located in the anterior circulation. In every case the dome/neck ratio was less than 2 and the mean aneurysm size in these patients was 8.8 mm. The most frequent clinical presentation was subarachnoid hemorrhage in 48% of cases. Stent placement was optimal in 81.2% of cases and suboptimal in 18.8%. In 31% of cases, the investigators encountered difficulties in placing the Neuroform stent. Clinical follow up was recorded in all patients and angiographic follow up was obtained in 63%. There were no cases of repeated hemorrhage. In a single case in which only the stent was implanted progressive thrombosis was identified during the follow-up period. The procedure-related morbidity and mortality rates were 8.6 and 2.1%, respectively. On the basis of the results, the authors conclude that the Neuroform self-expanding stent is a flexible and useful device that can be readily and safely maneuvered through tortuous intracranial vessels, enabling the endovascular treatment of complex wide-necked aneurysms. Early in the authors' experience, stent delivery presented difficulties; however, a second generation of devices has resolved this limitation. Although the early results are promising, the long-term benefit of this technique has to be proved by angiographic and clinical follow-up examinations.
With the recent development and refinement of endovascular stents, the significant potential for ... more With the recent development and refinement of endovascular stents, the significant potential for these devices in the treatment of wide-necked dissecting and fusiform aneurysms has become apparent. In this article the authors report on the use of stents and coils to treat dissecting and fusiform vertebral artery (VA) aneurysms. Eight consecutive patients harboring eight dissecting aneurysms and one fusiform aneurysm of the VA were succesfully treated using a procedure in which the authors inserted an intravascular stent and secondary endosaccular coils when needed. In all but one patient complete aneurysm occlusion was achieved, and in all cases there was no neurological complication. Follow-up angiography examinations were performed in all patients (mean duration of follow-up angiography review 13.1 months, range 3-42 months). The patients remained stable throughout the clinical follow-up period (mean 14.1 months, range 4-42 months). No rebleeding was recorded. At present this combined approach represents a reliable and safe alternative for the treatment of VA dissecting aneurysms, especially in patients who cannot tolerate occlusion tests.
The authors report their experience with the use of the Neuroform Microdelivery System for intrav... more The authors report their experience with the use of the Neuroform Microdelivery System for intravascular reconstruction. They assess the technical feasibility of the system, the efficacy of the combined application of stent and detachable coils, and the follow-up findings. Fifty patients found to harbor a complex wide-necked intracranial aneurysm were selected for the study. Different strategies were chosen and the performance and technical success of the device were evaluated. Stent placement was recorded as optimal or suboptimal with respect to the stent position. Clinical and angiographic follow-up examinations were obtained. Forty-six patients with 48 intracranial aneurysms were treated, leading to a technical success rate of 92%. Forty-two lesions were located in the anterior circulation. In every case the dome/neck ratio was less than 2 and the mean aneurysm size in these patients was 8.8 mm. The most frequent clinical presentation was subarachnoid hemorrhage in 48% of cases. Stent placement was optimal in 81.2% of cases and suboptimal in 18.8%. In 31% of cases, the investigators encountered difficulties in placing the Neuroform stent. Clinical follow up was recorded in all patients and angiographic follow up was obtained in 63%. There were no cases of repeated hemorrhage. In a single case in which only the stent was implanted progressive thrombosis was identified during the follow-up period. The procedure-related morbidity and mortality rates were 8.6 and 2.1%, respectively. On the basis of the results, the authors conclude that the Neuroform self-expanding stent is a flexible and useful device that can be readily and safely maneuvered through tortuous intracranial vessels, enabling the endovascular treatment of complex wide-necked aneurysms. Early in the authors' experience, stent delivery presented difficulties; however, a second generation of devices has resolved this limitation. Although the early results are promising, the long-term benefit of this technique has to be proved by angiographic and clinical follow-up examinations.
Uploads