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Patrick P. Han, Felipe C. Albuquerque, Francisco A. Ponce, Christopher I. Mackay, Joseph M. Zabramski, Robert F. Spetzler, and Cameron G. McDougall

. 26 Thus, angiographic verification of the stability of large or giant aneurysms with GDCs alone appears poor. In this paper we report the results of our experience in the use of intracranial stents for the treatment of complex intracranial aneurysms. Clinical Material and Methods From a prospectively maintained database, 13 patients (10 women and three men with a mean age of 56 years [range 29–77 years]) harboring intracranial aneurysms that were treated with intracranial stents were identified. Indications for the procedure, the anatomical location and type

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Elad I. Levy, Alan S. Boulos, Ricardo A. Hanel, Fermin O. Tio, Ronald A. Alberico, Mary Duffy Fronckowiak, Balazs Nemes, Ann Marie Paciorek, Lee R. Guterman, and L. Nelson Hopkins

when endovascular devices are used to improve vessel patency. More importantly, the caliber and accessibility of canine vessels permit the replication of conditions similar to those encountered during intracranial stent implantation in humans. The diameter of the BA in the canine model approximates that of distal intracranial vessels in humans (∼ 1.5–1.8 mm). The catheters and devices used in humans can be used in dogs. The arteries are easily accessible and can be easily removed and processed for histological analysis. 45 Randomization Scheme A predetermined

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Matthew F. Sanford, Aquilla S. Turk, David B. Niemann, Kari A. Pulfer, and Beverly A. Aagaard-Kienitz

✓ The authors describe the novel use of cerebral perfusion computerized tomography studies to evaluate the effectiveness of internal carotid artery stent placement in a man with symptomatic transient ischemic attacks caused by tandem stenoses of the internal carotid and middle cerebral arteries.

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Bradley A. Gross, Ashutosh P. Jadhav, Brian T. Jankowitz, and Tudor G. Jovin

TO THE EDITOR: We read with great interest the article from Kang et al. 3 ( Kang DH, Yoon W, Kim SK, et al: Endovascular treatment for emergent large vessel occlusion due to severe intracranial atherosclerotic stenosis. J Neurosurg [epub ahead of print June 22, 2018. DOI: 10.3171/2018.1.JNS172350] ). As an institution with significant interest and more than a decade of experience with intracranial stenting in the setting of acute large vessel occlusion (LVO), we found the results of this study quite remarkable. In the spirit of advancing the care of acute stroke

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Pedro Lylyk, José E. Cohen, Rosana Ceratto, Angel Ferrario, and Carlos Miranda

secondary treatment and as part of a unique or a combined strategy in different vascular conditions. Clinical Material and Methods Patient Population Between June 1996 and June 2001, 123 consecutive patients with intracranial saccular, dissecting, and fusiform aneurysms, atherosclerotic stenotic lesions, and arterial dissections were selected for intracranial stent placement with or without adjunctive GDCs. In 12 patients (9.8%) the stent did not reach the target and these patients were excluded from further analysis. The patient population was composed of 52

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Stanley H. Kim, Adnan I. Qureshi, Alan S. Boulos, Bernard R. Bendok, Elad I. Levy, Abutaher M. Yahia, Lee R. Guterman, and L. Nelson Hopkins

, 4, 10, 12, 13 Although there have been reports on the feasibility and safety of intracranial angioplasty, procedure-related complications such as acute arterial dissection have prompted the adjunctive use of intracranial stent placement. 1, 6 We describe a case in which iatrogenic CCF occurred after angioplasty for symptomatic cavernous ICA stenosis. A coronary stent was used to treat the fistula. Our case report adds to the list of complications of intracranial angioplasty and underscores the technological limitations of angioplasty in which a coronary balloon

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Giuseppe Lanzino, Ajay K. Wakhloo, Richard D. Fessler, Mary L. Hartney, Lee R. Guterman, and L. Nelson Hopkins

aneurysms. Conclusions We report our preliminary experience with intracranial stents used alone or in combination with GDC placement for the treatment of aneurysms originating from different ICA segments, the VA adjacent to the PICA origin, and the BA trunk. Our account demonstrates that this novel approach is both feasible and safe with the use of flexible intravascular stents. Thus far, we have been able satisfactorily to place coils in complex aneurysms that we would have been unable to treat without stent placement. Although the long-term effects of intracranially

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Pascal Jabbour, Christopher Koebbe, Erol Veznedaroglu, Ronald P. Benitez, and Robert Rosenwasser

Object

The treatment of wide-necked cerebral aneurysms represents a challenging problem for neurosurgeons. The recent development of stents has provided clinicians with the ability to treat these aneurysms while keeping the parent vessel patent. The long-term occlusion rate of aneurysms treated with stent-assisted coil placement has yet to be investigated. The authors report the use of a new intracranial stent—the Neuroform microstent—in the treatment of unruptured wide-necked cerebral aneurysms.

Methods

Thirty-two patients harboring unruptured wide-necked intracranial aneurysms underwent a stent-assisted coil placement procedure. Patients were pretreated with antiplatelet agents, and a stent was positioned across the neck of the aneurysm. The next step was the insertion of coils into the aneurysm cavity. Patients received anticoagulation therapy for 24 hours after the procedure.

All 32 patients with unruptured wide-necked cerebral aneurysms were suitable candidates for this procedure. Occlusion of at least 90% of the aneurysm was achieved in 24 patients (75%) and 0% occlusion was observed in five patients (15%). Two patients experienced thromboembolic events, one of which was directly related to the stent. The overall complication rate was 6.3%.

Conclusions

Intracranial stents will be used more frequently in the new era of endovascular management of wide-necked cerebral aneurysms. With some technical improvements and more data on long-term occlusion rates, this new modality should improve the occlusion of wide-necked cerebral aneurysms while protecting the parent vessel.

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David Wells-Roth, Alessandra Biondi, Vallabh Janardhan, Kyle Chapple, Y. Pierre Gobin, and Howard A. Riina

Wide-necked aneurysms remain difficult to treat by either open microneurosurgical or endovascular procedures. Recent advances in the latter technology, including intracranial stents and bioactive coils, now allow an endovascular treatment option for cases in which this was not previously available. In this report the authors describe the new developments in endovascular technologies that make the treatment of wide-necked aneurysms possible. This includes discussion of intracranial stents and bioactive coils designed to promote obliteration of the aneurysm lumen. In addition, methods for coil insertion in wide-necked aneurysms are described, including balloon remodeling and various stent placement procedures. Wide-necked aneurysms previously thought to be untreatable by endovascular means can now be obliterated, thanks to new devices specifically designed for intracranial use.

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Giuseppe Lanzino, Ajay K. Wakhloo, Richard D. Fessler, Robert A. Mericle, Lee R. Guterman, and L. Nelson Hopkins

Results of previous in vitro and in vivo experimental studies have suggested that the placement of a porous stent within the parent artery across the aneurysm neck may hemodynamically uncouple the aneurysm from the parent vessel, leading to thrombosis of the aneurysm. For complex wide-necked aneurysms, a stent may also aid the packing of the aneurysm with Guglielmi detachable coils (GDCs) by acting as a rigid scaffold that prevents coil herniation into the parent vessel. Recently, improved stent system delivery technology has allowed access to the tortuous vascular segments of the intracranial system. The authors report here the intracranial stenting of aneurysms involving different segments of the internal carotid artery (ICA) and the vertebral artery (VA).

Four patients with intracranial aneurysms located at the petrous, cavernous, and paraclinoid segments of the ICA and at the VA proximal to the origin of the posterior inferior cerebellar artery, respectively, were treated since January 1998. In three of these patients, stent placement across the aneurysm neck was followed by GDC placement, accomplished via a microcatheter through stent mesh. In one patient, the aneurysm was treated solely by stenting.

No periprocedural complications were observed, and at follow up, no patient was found to have suffered symptoms referable to aneurysm growth or thromboembolic complications. More than 90% occlusion of the aneurysm was achieved in the three cases treated by stenting and GDC placement. One of these patients underwent 6-month follow-up angiography that did not reveal any in-stent stenosis. In the case treated solely by stent placement, no evidence of aneurysm thrombosis was observed either immediately postprocedure or on follow-up angiography performed 24 hours later.

A new generation of flexible stents can be used to treat intracranial aneurysms in difficult-to-access areas such as the proximal intracranial segments of the ICA or the VA. The stent allows tight coil packing even in the presence of a wide-necked, irregularly shaped aneurysm and may provide an endoluminal matrix for endothelial growth. Although convincing experimental evidence suggests that stent placement across the aneurysm neck may by itself promote intraluminal thrombosis, the role of this phenomenon in clinical practice may be limited at present by the high porosity of currently available stents.