The use of intracranial stents in stent-assisted coil embolization is now a current neurosurgical practice worldwide. The clinical utility of these stents in the sole stenting (SS) technique, however, has not been thoroughly described, and the published reports of this experience are scarce. This study was designed to evaluate SS treatment of dissecting and nondissecting aneurysms of the posterior circulation.
This prospective and descriptive study was conducted in 20 consecutive patients who harbored single aneurysms of the posterior circulation and who were treated using the SS approach in the last 3 years. The clinical and radiological assessment and follow-up of the patients were evaluated using the modified Rankin scale as well as with computed tomography angiography and digital subtraction angiography at discharge and at 1, 3, 6, and 12 months.
Eleven of the 20 patients had subarachnoid hemorrhages, 3 presented with ischemia, 1 presented with brainstem compression, and the remaining 5 patients had incidentally discovered, asymptomatic lesions. Only 1 patient had a complication (occipital infarction) attributable to the SS procedure. One patient died of rebleeding 2 weeks after the procedure. At 1 month, 40% of the patients had a subtotal or total occlusion, which increased to 55% at 3 months and 85% at 6 months, with a final subtotal or total occlusion rate of 80% at 1 year. The SS procedure in 1 case was considered a failure at 6 months because no change had been noted since the 1-month follow-up. One case showed partial occlusion and 1 case showed recanalization.
Use of SS for aneurysms in the posterior circulation complex is a safe and effective technique, demonstrating an occlusion rate of 80% at the 1-year follow up.
Aenis M, , Stancampiano AP, , Wakhloo AK, & Lieber BB: Modeling of flow in a straight stented and nonstented side wall aneurysm model. J Biomech Eng 11:206–212, 1997
Ahn JY, , Han IB, , Kim TG, , Yoon PH, , Lee YJ, & Lee BH, et al.: Endovascular treatment of intracranial vertebral artery dissections with stent placement or stent-assisted coiling. AJNR Am J Neuroradiol 27:1514–1520, 2006
Albuquerque FC, , Fiorella DJ, , Han PP, , Deshmukh VR, , Kim LJ, & McDougall CG: Endovascular management of intracranial vertebral artery dissecting aneurysms. Neurosurg Focus 18:2 E3, 2005
Aletich VA, , Debrum GM, , Misra M, , Charbel F, & Ausman JI: The remodeling technique of balloon-assisted Guglielmi detachable coil placement in wide-necked aneurysms: experience at the University of Illinois at Chicago. J Neurosurg 93:388–396, 2000
Allcock J, Aneurysms. Newton TH, & Potts DG: Radiology of the Skull and the Brain St. Louis, Mosby, 1974. 2445–2486
Amagasaki K, , Yagishita T, , Yagi S, , Kuroda K, , Nishigaya K, & Nukui H: Serial angiography and endovascular treatment of dissecting aneurysms of the anterior cerebral and vertebral arteries. Case report. J Neurosurg 91:682–686, 1999
Benndorf G, , Herbon U, , Sollmann WP, & Campi A: Treatment of a ruptured dissecting vertebral artery aneurysm with double stent placement: case report. AJNR Am J Neuroradiol 22:1844–1848, 2001
Brisman JL, , Song JK, & Newell DW: Cerebral aneurysms. N Engl J Med 355:928–939, 2006
Canton G, , Levy DI, & Lasheras JC: Hemodynamic changes due to stent placement in bifurcating intracranial aneurysms. J Neurosurg 103:146–155, 2005
Chiaradio JC, , Guzman L, , Padilla L, & Chiaradio MP: Intravascular graft stent treatment of a ruptured fusiform dissecting aneurysm of the intracranial vertebral artery: technical case report. Neurosurgery 50:213–217, 2002
Chiche L, , Praquin B, , Koskas F, & Kieffer E: Spontaneous dissection of the extracranial vertebral artery: indications and long-term outcome of surgical treatment. Ann Vasc Surg 19:5–10, 2005
Cohen JE, , Gomori JM, & Umansky F: Endovascular management of spontaneous bilateral symptomatic vertebral artery dissections. AJNR Am J Neuroradiol 24:2052–2056, 2003
Coley SC, & Clifton A: Dissecting vertebral artery aneurysm: diagnosis and coil embolization. Br J Radiol 72:408–411, 1999
Conforto AB, , Yamamoto F, , Evaristo EF, , Puglia P Jr, , Caldas JG, & Scaff M: Intracranial vertebral artery dissection presenting as subarachnoid hemorrhage: successful endovascular treatment. Acta Neurol Scand 103:64–68, 2001
de Bray JM, , Penisson-Besnier I, , Dubas F, & Emile J: Extracranial and intracranial vertebrobasilar dissections: diagnosis and prognosis. J Neurol Neurosurg Psychiatry 63:46–51, 1997
Doerfler A, , Wanke I, , Egelhof T, , Stolke D, & Forsting M: Double-stent method: therapeutic alternative for small wide-necked aneurysms. Technical note. J Neurosurg 100:150–154, 2004
Fiorella D, , Albuquerque FC, , Deshmukh VR, & McDougall CG: Usefulness of the Neuroform stent for the treatment of cerebral aneurysms: results at initial (3–6-mo) follow-up. Neurosurgery 56:1191–1192, 2005
Fiorella D, , Albuquerque FC, , Deshmukh VR, , Woo HH, , Rasmussen PA, & Masaryk TJ, et al.: Endovascular reconstruction with the Neuroform stent as monotherapy for the treatment of uncoilable intradural pseudoaneurysms. Neurosurgery 59:291–300, 2006
Fiorella D, , Albuquerque FC, , Han P, & McDougall CG: Preliminary experience using the Neuroform stent for the treatment of cerebral aneurysms. Neurosurgery 54:6–17, 2004
Fiorella D, , Albuquerque FC, , Woo HH, , Rasmussen PA, , Masaryk TJ, & McDougall CG: Neuroform in-stent stenosis: incidence, natural history, and treatment strategies. Neurosurgery 59:34–42, 2006
Fisher CM, , Kistler JP, & Davis JM: Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:1–9, 1980
Flemming KD, , Wiebers DO, , Brown RD Jr, , Link MJ, , Nakatomi H, & Huston J III, et al.: Prospective risk of hemorrhage in patients with vertebrobasilar nonsaccular intracranial aneurysm. J Neurosurg 101:82–87, 2004
Fratkin JD, & Zubkov A: Part 2: A pathological spectrum: basilar dolichoectasia and vertebral dissection, each with fatal subarachnoid hemorrhage. Semin Cerebrovasc Dis Stroke 4:69–75, 2004
Friedman AH, & Drake CG: Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60:325–334, 1984
Geremia G, , Brack T, , Brennecke L, , Haklin M, & Falter R: Occlusion of experimentally created fusiform aneurysms with porous metallic stents. AJNR Am J Neuroradiol 21:739–745, 2000
Geremia G, , Haklin M, & Brennecke L: Embolization of experimentally created aneurysms with intravascular stent devices. AJNR Am J Neuroradiol 15:1223–1231, 1994
Guglielmi G, , Viñuela F, , Duckwiler G, , Dion J, , Lylyk P, & Berenstein A, et al.: Endovascular treatment of posterior circulation aneurysms by electrothrombosis using electrically detachable coils. J Neurosurg 77:515–524, 1992
Halbach VV, , Higashida RT, , Down CF, , Fraser KW, , Smith TP, & Teitelbaum GP, et al.: Endovascular treatment of vertebral artery dissections and pseudoaneurysms. J Neurosurg 79:183–191, 1993
Hamada J, , Kai Y, , Morioka M, , Yano S, , Todaka T, & Ushio Y: Multimodal treatment of ruptured dissecting aneurysms of the vertebral artery during the acute stage. J Neurosurg 99:960–966, 2003
Han PP, , Albuquerque FC, , Ponce FA, , MacKay CI, , Zabranski JM, & Spetzler RF, et al.: Percutaneous intracranial stent placement for aneurysms. J Neurosurg 99:23–30, 2003
Hanel RA, , Boulos AS, , Savageau EG, , Levy EI, , Guterman LR, & Hopkins NL: Stent placement for the treatment of nonsaccular aneurysms of the vertebrobasilar system. Neurosurg Focus 18:2 E8, 2005
Higashida RT, , Smith W, , Gress D, , Urwin R, , Dowd CF, & Balousek PA, et al.: Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. Case report and review of the literature. J Neurosurg 87:944–949, 1997
Hunt WE, & Kosnik EJ: Timing and perioperative care in intracranial aneurysm surgery. Clin Neurosurg 21:79–89, 1974
Iihara K, , Sakai N, , Murao K, , Sakai H, , Higashi T, & Kogure S, et al.: Dissecting aneurysms of the vertebral artery: a management strategy. J Neurosurg 97:259–267, 2002
Inamasu J, , Nakamura Y, , Saito R, , Kuroshima Y, , Mayanagi K, & Ichikizaki et al.: Endovascular treatment of ruptured vertebral artery dissection in the acute stage. Cerebrovasc Dis 16:306–308, 2003
Islak C, , Kocer N, , Albayram S, , Kizilkilic O, , Uzma O, & Cokyuksel O: Bare stent-graft technique: a new method of endoluminal vascular reconstruction for the treatment of giant and fusiform aneurysms. AJNR Am J Neuroradiol 23:1589–1595, 2002
Jabbour P, , Koebbe C, , Veznedaroglu , Benitez RP, & Rosenwasser R: Stent-assisted coil placement for unruptured cerebral aneurysms. Neurosurg Focus 17:5 E10, 2004
Jamous MA, , Satoh K, , Matsubara S, , Satomi J, , Nakajima N, & Uno M, et al.: Ischemic basilar artery dissecting aneurysm treated by stenting only–case report. Neurol Med Chir (Tokyo) 44:77–81, 2004
Joo JY, , Ahn JY, , Chung YS, , Han IB, , Chung SS, & Yoon PH, et al.: Treatment of intra- and extracranial arterial dissections using stents and embolization. Cardiovasc Intervent Radiol 28:595–602, 2005
Kaku Y, , Yoshimura S, , Yamakawa H, & Sakai N: Failure of stent-assisted endovascular treatment for ruptured dissecting aneurysms of the basilar artery. Neuroradiology 45:22–26, 2003
Kurata A, , Ohmomo T, , Misayaka Y, , Fujii K, , Kan S, & Kitahara T: Coil Embolization for the treatment of ruptured dissecting vertebral aneurysms. AJNR Am J Neuroradiol 22:11–18, 2001
Lanzino G, , Wakhloo AK, , Fessler RD, , Hartney ML, , Guterman LR, & Hopkins N: Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms. J Neurosurg 91:538–546, 1999
Lavine SD, , Larsen DW, , Giannota SL, & Teitelbaum GP: Parent vessel Guglielmi detachable coil herniation during wide-necked aneurysm embolization: treatment with intracranial stent placement: two technical case reports. Neurosurgery 46:1013–1017, 2000
Leibowitz R, , Marcellus ML, , Chang SD, , Steinberg GK, & Marks MP: Parent vessel occlusion for vertebrobasilar fusiform and dissecting aneurysms. AJNR Am J Neuroradiol 24:902–907, 2003
Levy EI, , Boulos AS, , Bendok BR, , Kim SH, , Qureshi AI, & Guterman LR, et al.: Brainstem infarction after delayed thrombosis of a stented vertebral artery fusiform aneurysm: case report. Neurosurgery 51:1280–1285, 2002
Lieber BB, , Stancampiano AP, & Wakhloo AK: Alteration of hemodynamics in aneurysm models by stenting: influence of stent porosity. Ann Biomed Eng 25:460–469, 1997
Locksley HB: Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the cooperative study. J Neurosurg 25:219–239, 1966
Lylyk P, , Ceratto R, , Hurvitz D, & Basso A: Treatment of a vertebral dissecting aneurysm with stents and coils: technical case report. Neurosurgery 43:385–388, 1998
Lylyk P, , Cohen JE, , Ceratto R, , Ferrario A, & Miranda C: Combined endovascular treatment of dissecting vertebral artery aneurysms by using stents and coils. J Neurosurg 94:427–432, 2001
Lylyk P, , Ferrario A, , Pasbon B, , Miranda C, & Doroszuk G: Buenos Aires experience with the Neuroform self-expanding stent for the treatment of intracranial aneurysms. J Neurosurg 102:235–241, 2005
MacKay CI, , Han PP, , Albuquerque FC, & McDougall CG: Recurrence of a vertebral artery dissecting pseudoaneurysm after successful stent-supported coil embolization: case report. Neurosurgery 53:754–761, 2003
Mangrum WI, , Huston J III, , Link MJ, , Wiebers DO, , McClelland RL, & Christianson TJ, et al.: Enlarging vertebrobasilar nonsaccular intracranial aneurysms: frequency, predictors, and clinical outcome of growth. J Neurosurg 102:72–79, 2005
Mawad ME, , Cekirge S, , Ciceri E, & Saatci A: Endovascular treatment of giant and large intracranial aneurysms by using a combination of stent placement and liquid polymer injection. J Neurosurg 96:474–482, 2002
Mehta B, , Burke T, , Kole M, , Bydon A, , Seyfried D, & Malik G: Stent-within-a-stent technique for the treatment of dissecting vertebral artery aneurysms. AJNR Am J Neuroradiol 24:1814–1818, 2003
Mizutani T, , Kojima H, , Asamoto S, & Miki Y: Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36:905–913, 1995
Moret J, , Cognard C, , Weill A, , Castaings L, & Rey A: [Reconstruction technic in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases.]. J Neuroradiol 24:30–44, 1997. (Fr)
Nichols DA, , Brown RD Jr, , Thielen KR, , Meyer FB, , Atkinson JL, & Piepgras DG: Endovascular treatment of ruptured posterior circulation aneurysms using electrolytically detachable coils. J Neurosurg 87:374–380, 1997
O'Shaughnessy BA, , Getch CC, , Bendok BR, & Batjer HH: Late morphological progression of a dissecting basilar artery aneurysm after staged bilateral vertebral artery occlusion: case report. Surg Neurol 63:236–243, 2005
Ogilvy CS, , Hoh BL, , Singer RJ, & Putman CM: Clinical and radiographic outcome in the management of posterior circulation aneurysms by use of direct surgical or endovascular techniques. Neurosurgery 51:14–22, 2002
Pierot L, , Boulin A, , Castaings L, , Rey A, & Moret J: Selective occlusion of basilar artery aneurysms using controlled detachable coils: report of 35 cases. Neurosurgery 38:948–954, 1996
Price RF, , Sellar R, , Leung C, & O'Sullivan MJ: Traumatic vertebral arterial dissection and vertebrobasilar arterial thrombosis successfully treated with endovascular thrombolysis and stenting. AJNR Am J Neuroradiol 19:1677–1680, 1998
Rabinov JD, , Hellinger FR, , Morris PP, , Ogilvy CS, & Putman CM: Endovascular management of vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 24:1421–1428, 2003
Ramgren B, , Cronqvist M, , Romner B, , Brandt L, , Holtås S, & Larson EM: Vertebrobasilar dissection with subarachnoid hemorrhage: a retrospective study of 29 patients. Neuroradiology 47:97–104, 2005
Rankin J: Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 2:200–215, 1957
Sadasivan C, , Leber BB, , Guonis MJ, , Lopes DK, & Hopkins LN: Angiographic quantification of contrast medium washout from cerebral aneurysms after stent placement. AJNR Am J Neuroradiol 23:1214–1221, 2002
Saeed AB, , Shuaib A, , Al-Sulaiti G, & Emery D: Vertebral artery dissection: warning symptoms, clinical features and prognosis in 26 patients. Can J Neurol Sci 27:292–296, 2000
Sani S, , Jobe KW, & Lopes DK: Treatment of wide-necked cerebral aneurysms with the Neuroform2 Treo stent. A prospective 6-month study. Neurosurg Focus 18:2 E4, 2005
Sasaki O, , Hiroshi O, , Koike T, , Koitzumi T, & Tanaya R: A clinico-pathological study of dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 75:874–882, 1991
Sawada M, , Kaku Y, , Yoshimura S, , Kawaguchi M, , Matsuhisa T, & Hirata T, et al.: Antegrade recanalization of a completely embolized vertebral artery after endovascular treatment of a ruptured intracranial dissecting aneurysm. Report of two cases. J Neurosurg 102:161–166, 2005
Schievink WI: Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 344:898–906, 2001
Sekhon LHS, , Morgan MK, , Sorby W, & Grinnell V: Combined endovascular stent implantation and endosaccular coil placement for the treatment of a wide-necked vertebral artery aneurysm: technical case report. Neurosurgery 43:380–384, 1998
Thanvi B, , Munshi SK, , Dawson SL, & Robinson TG: Carotid and vertebral artery dissection syndromes. Postgrad Med J 81:383–388, 2005
Turjman F, , Massoud TF, , Ji C, , Guglielmi C, , Viñuela F, & Robert J: Combined stent implantation and endosaccular coil placement for treatment of experimental wide-necked aneurysms: a feasibility study in swine. AJNR Am J Neuroradiol 15:1087–1090, 1994
Vanninen R, , Manninen H, & Ronkainen A: Broad-based intracranial aneurysms: thrombosis induced by stent placement. AJNR Am J Neuroradiol 24:263–266, 2003
Wakhloo AK, , Lanzino G, , Lieber BB, & Hopkins LN: Stents for intracranial aneurysms: the beginning of a new endovascular era?. Neurosurgery 43:377–379, 1998
Wakhloo AK, , Schellhammer F, , de Vries J, , Haberstroh J, & Schumacher M: Self-expanding and balloon-expandable stents in the treatment of carotid aneurysms: an experimental study in a canine model. AJNR Am J Neuroradiol 15:493–502, 1994
Wakhloo AK, , Tio FO, , Lieber BB, , Schellhammer F, , Graf M, & Hopkins LN: Self-expanding nitinol stents in canine vertebral arteries: hemodynamics and tissue response. AJNR Am J Neuroradiol 16:1043–1051, 1995
Wells-Roth D, , Biondi A, , Janardhan V, , Chapple K, , Gobin YP, & Riina HA: Endovascular procedures for treating wide-necked aneurysms. Neurosurg Focus 18:2 E7, 2005
Willing SJ, , Skidmore F, , Donaldson J, , Nobo UL, & Chernukha K: Treatment of acute intracranial vertebrobasilar dissection with angioplasty and stent placement: report of two cases. AJNR Am J Neuroradiol 24:985–989, 2003
Yamaura I, , Tani E, , Yokota M, , Nakano A, , Fukami M, & Kaba K, et al.: Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils. J Neurosurg 90:853–856, 1999
Yaşargil MG Sr, , Young PH, & Teddy PJ, Clinical considerations, surgery of the intracranial aneurysm and results. Yaşargil MG: Microneurosurgery Vol II:Stuttgart, Thieme Medical Publishers, 1984. 260–269
Yasui N, , Hadeishi H, , Nishimura H, & Uemura K: Tohoku Ruptured Vertebrobasilar Aneurysm Study Group: Cooperative study of ruptured vertebrobasilar artery aneurysms in the Tohoku district in Japan. Neurol Med Chir (Tokyo) 43:219–227, 2003
Yasui T, , Komiyama M, , Nishikawa M, & Nakajima H: Subarachnoid hemorrhage from vertebral artery dissecting aneurysms involving the origin of the posteroinferior cerebellar artery: report of two cases and review of the literature. Neurosurgery 46:196–201, 2000
Yasui T, , Komiyama M, , Nishikawa M, , Nakajima H, , Kobayashi Y, & Inoue T: Fusiform vertebral artery aneurysms as a cause of dissecting aneurysms. Report of two autopsy cases and a review of the literature. J Neurosurg 91:139–144, 1999
Zenteno M, , Modenesi Freitas JM, , Aburto-Murrieta Y, , Koppe G, , Machado E, & Lee A: Balloon-expandable stenting with and without coiling for wide-neck and complex aneurysms. Surg Neurol 66:603–610, 2006
Zenteno M, , Santos-Franco J, , Aburto-Murrieta Y, , Modenesi-Freitas JM, , Ramírez-Guzmán G, & Gómez-Llata S, et al.: Superior cerebellar artery aneurysms treated using the sole stenting approach. J Neurosurg 107:860–864, 2007
Zenteno MA, , Murillo-Bonilla LM, , Guinto G, , Gomez CR, , Martinez SR, & Higuera-Calleja J, et al.: Sole stenting bypass for the treatment of vertebral artery aneurysms: technical case report. Neurosurgery 57:1 Suppl E208, 2005
All Time | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 900 | 184 | 79 |
Full Text Views | 218 | 3 | 0 |
PDF Downloads | 132 | 5 | 1 |
EPUB Downloads | 0 | 0 | 0 |