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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2013 December;20(4):213-9
Stent-assisted reconstructive endovascular therapy for broad-based cerebral aneurysms
Peng T., Liu A., Jia J., Li Y., Jiang C., Wu Z., Yang X. ✉
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital Capital Medical University, Beijing, China
Aim: The aim of the study was to present the results of the first prospective analysis of stent-assisted coiling of broad-based cerebral aneurysms.
Methods: Patients with cerebral aneurysms that were broad-based (>4 mm) or had unfavorable dome/neck ratios (<1.5) were enrolled in this study between February 2010 and March 2011 at our center. Aneurysms were treated with the self-expanding neurovascular stents with or without adjunctive coil embolization. All patients underwent clinical evaluation and conventional angiography more than 3 months after treatment. Angiographic results were adjudicated by an experienced neuroradiologist at a nonparticipating site.
Results: One hundred and forty-two patients with 176 intracranial aneurysms (30 men; 19-78 years of age; mean age, 51.3 years) were treated during the study period. A clinical improvement or stable outcome was achieved in 136 patients (95.8%). The 4 cases of permanent morbidity included 2 patients with a paralysis, one patient with hemiparesis due to an acute in-stent thrombosis and another one with aphasia due to an acute in-stent thrombosis too. Two patients died of rehemorrhage after treatment. Angiographic follow-up was available in 114 of the 140 surviving patients (81.4%) at a mean of 8.25 months (range, 3 to 18 months). Recanalization in 10 patients (8.8%) ranging from 3 to 12 months required retreatment in all. No significant in-construct stenosis (≥50%) was identified at follow-up angiography.
Conclusion: Stent-assisted coil embolization is an attractive option for broad-based cerebral aneurysms with a low morbidity and mortality rates. Recanalization observed 3 months after the initial obliteration emphasizes the need for follow-up angiography.