WingSpan Stent System in the endovascular treatment of intracranial aneurysms: clinical experience with midterm follow-up results

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Object

The WingSpan stent is a new self-expandable neurovascular stent designed for endovascular treatment of intracranial atheromatous lesions. The authors report their experience with the use of this stent for the endovascular treatment of intracranial aneurysms.

Methods

Thirty-seven patients with 40 wide-necked intracranial aneurysms were treated using the WingSpan stent. Twenty-two aneurysms (55%) were small and 18 (45%) were large or giant. In all but 4 aneurysms, embolization was completed by packing the aneurysm sac with platinum coils. In 4 dissecting aneurysms that were fusiform or too small and wide necked to be catheterized, the stent was used alone. In these cases, the stent bridged the aneurysm neck to allow for flow redirection and the potential stent-induced endothelization effect.

Results

Follow-up angiograms obtained in 3 of 4 aneurysms, treated with only stent placement, demonstrated aneurysmal thrombosis and parent artery remodeling in 2 patients and moderate decrease in size in 1. Follow-up angiography obtained at 6 months to 1 year in 31 aneurysms after stent-supported coil embolization demonstrated complete occlusion in 23 aneurysms (74.2%) with a progressive thrombosis rate of 66.7% (10 of 15 aneurysms), and a recanalization rate of 16.1%.

Conclusions

In treating wide-necked intracranial aneurysms, the WingSpan Stent System is very flexible, secure, and effective. Its delivery system is very easy and exact in that it exerts higher outward radial force, thus providing an excellent conformability and a strong scaffold to hold the coils in place. It may offer an effective treatment when used alone in some fusiform or very wide-necked, small dissecting aneurysms in which other surgical or endovascular treatment strategies are not deemed feasible.

Abbreviations used in this paper: ACoA = anterior communicating artery; BA = basilar artery; ICA = internal carotid artery; MCA = middle cerebral artery; PCoA = posterior communicating artery; SAH = subarachnoid hemorrhage; VA = vertebral artery.

Article Information

Address correspondence to: H. Saruhan Cekirge, M.D., Hacettepe University Hospitals, Department of Radiology, 06100 Sihhiye Ankara, Turkey. email: cekirgesaatci@superonline.com.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Photograph depicting the WingSpan Stent System when deployed.

  • View in gallery

    Angiograms. A: Initial diagnostic image showing a dissecting fusiform BA aneurysm. B: Nonsubtracted image demonstrating the single WingSpan stent deployed within the BA across the dissecting aneurysmal segment. C and D: Images obtained at 3-month (C) and 1-year (D) follow-ups, showing spontaneous thrombosis of the aneurysm with parent artery remodeling.

  • View in gallery

    A: Pretreatment coronal T2-weighted MR image showing partially thrombosed giant left ICA aneurysm. B: Initial diagnostic angiogram showing a wide-necked ICA aneurysm. C: Posttreatment angiogram obtained after stent-assisted coil embolization, demonstrating complete occlusion of the aneurysm. D: Six-month follow-up angiogram displaying hemodynamically significant in-stent stenosis of the left ICA. It is notable that the left A1 segment is preferably filling from contralateral ICA via the ACoA. E: One-year follow-up angiogram revealing spontaneous partial resolution of the stenosis. The left A1 segment is filling from the ipsilateral ICA.

  • View in gallery

    Angiograms. A: Initial 3D reconstruction showing a wide-necked left M2 segment (inferior trunk) aneurysm. B and C: Nonsubtracted images demonstrating the WingSpan stent deployed across the neck of the aneurysm (B) and complete occlusion of the aneurysm after stent-assisted coil embolization (C). D and E: Six-month (D) and 1-year (E) follow-up images showing stable aneurysm occlusion.

  • View in gallery

    Angiograms. A: Pretreatment image, oblique view, showing a broad-necked right P1 segment aneurysm. B: Posttreatment image, Towne projection, demonstrating > 95% (Raymond Class 2) occlusion of the aneurysm. C and D: Six-month follow-up angiograms, oblique (C) and Towne (D) projections, showing further thrombosis of the aneurysm sac resulting in complete obliteration.

  • View in gallery

    Angiograms. A: Initial diagnostic image showing a wide-necked giant left ICA bifurcation aneurysm. B: Nonsubtracted image demonstrating the WingSpan stent deployed across the neck of the aneurysm. C: Posttreatment image demonstrating complete occlusion of the aneurysm after stent-assisted coil embolization. D: Six-month follow-up angiogram displaying regrowth of the aneurysm at the neck.

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