Double-stent method: therapeutic alternative for small wide-necked aneurysms

Technical note

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✓ The authors present two cases of patients with small, acutely ruptured, wide-necked aneurysms of the distal vertebral artery that were not amenable to conventional coil embolization and were instead treated by means of a double-stent method in which one stent was placed inside another. Angiography performed immediately after the procedure revealed a significant reduction in aneurysm filling; total occlusion of the lesion was observed after 7 days and confirmed 6 months later in both aneurysms. By placing one stent inside the other, stent permeability can be reduced, which may result in significant hemodynamic changes with accelerated aneurysm thrombosis. This double-stent method may represent a therapeutic alternative, especially in cases of small, wide-necked aneurysms in which conventional endovascular techniques or stent-supported coil embolization is not considered feasible or is believed to be too dangerous, and surgical treatment is contraindicated.

Article Information

Address reprint requests to: Arnd Doerfler, M.D., Department of Neuroradiology, Institute of Diagnostic and Interventional Radiology, University of Essen Medical School, Hufelandstrasse 55, D–45122 Essen, Germany. email: arnd.doerfler@uni-essen.de.

© AANS, except where prohibited by US copyright law.

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    Case 1. Angiograms (A, B, D, E, and F) and radiograph (C) depicting double-stent placement. A: Right VA injection revealing a small wide-necked aneurysm at the V4 segment. B: Right VA injection demonstrating the stent over the wire across the aneurysm. C: Plain radiograph obtained after double-stent placement (arrow). D: Lateral view obtained immediately after stent placement demonstrating a slight residual filling of the aneurysm. E: Angiogram obtained 7 days after the stents were placed confirming total occlusion of inflow into the aneurysm. F: Control angiogram obtained at the 6-month follow-up examination demonstrating disappearance of the aneurysm.

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    Case 2. Angiograms (A, B, D, E, and F) and radiograph (C) demonstrating double-stent placement. A: Anteroposterior arteriogram obtained with a left VA injection revealing a small wide-necked aneurysm in the distal segment of the VA (V4 segment). B: Rotational subtracted angiogram with 3D reconstruction. C: Plain radiograph obtained after double-stent placement (arrows). D: Left VA injection revealing the stent over the wire across the aneurysm. E: Rotational angiogram obtained 8 days after the stents were placed confirming total aneurysm occlusion. F: Control angiogram obtained at the 6-month follow-up examination demonstrating complete aneurysm occlusion. Note the nonstenotic narrowing at the proximal portion of the stent, which is consistent with mild intimal hyperplasia (arrow).

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