Stent-Assisted Coiling In Endovascular Treatment Of 500 Consecutive Cerebral Aneurysms With Long-Term Follow-Up

BACKGROUND AND PURPOSE: Stent-assisted coil embolization has become one of the most preferred techniques in the treatment of wide-neck intracranial aneurysms; however, long-term patency and safety of the self-expanding neurostents and their role in durability of the endovascular treatment has remained ambiguous. We sought to retrospectively examine the long-term results of self-expanding stent usage in conjunction with coil embolization in treatment of wide-neck cerebral aneurysms. MATERIALS AND METHODS: We coiled 500 wide-neck cerebral aneurysms with different types of self-expanding neurostent assistance in 468 patients. Patient and aneurysm characteristics, pharmacologic therapy protocol, complications, and initial occlusion grades were analyzed. Patients underwent angiographic follow-up at 6 months to 7 years after treatment. DSA or MRA images of all patients were analyzed to assess the occlusion rate of aneurysms and patency of the parent artery. RESULTS: Enterprise (n = 340), Solitaire (n = 98), Wingspan (n = 41), LEO (n = 16), and Neuroform (n = 5) stent systems were used in this series. Stent-related thromboembolic events occurred in 21 patients and intraoperative rupture occurred in 4 patients. Initially, complete occlusion was achieved in 42.2% of the aneurysms, and, according to the last follow-up data, the rate had progressed to 90.8%. Recanalization rate at 6 months was 8%, whereas the late recanalization rate was 2%. CONCLUSIONS: The use of stents in endovascular treatment provides high rates of complete occlusion and low rates of recurrence at a long-term follow-up study.WoSScopu

Treatment Of Intracranial Aneurysms Using The Pipeline Flow-Diverter Embolization Device: A Single-Center Experience With Long-Term Follow-Up Results

BACKGROUND AND PURPOSE: Flow-diverting devices now offer a new treatment alternative for cerebral aneurysms. We present the results of a large single-center series of patients treated with the PED, including long-term follow-up. MATERIALS AND METHODS: Between November 2008 and September 2011, sidewall aneurysms with a wide neck (>= 4 mm) or unfavorable dome-neck ratio (= 10 mm). In 34/251 (13.5%), PEDs were used for retreatment. Adjunctive coiling was performed in 11 aneurysms (2.1%). The mean number of devices per aneurysm was 1.3. One aneurysm ruptured in the fourth month posttreatment (0.5%), and symptomatic in-construct stenosis was detected in 1 patient (0.5%) treated with percutaneous transarterial angioplasty. Any event rate was 27/191 (14.1%), with a permanent morbidity of 1% and mortality of 0.5%. Control angiography was available in 182 (95.3%) patients with 239 (95.2%) aneurysms. In 121 aneurysms (48.2%), 1- to 2-year control angiography was available. The aneurysm occlusion rate was 91.2% in 6 months, increasing to 94.6%. CONCLUSIONS: Use of the FED is safe, efficacious, and durable in cerebral aneurysm treatment, with low morbidity-mortality and high occlusion rates as confirmed with mid- to long-term control angiography.WoSScopu