Artikel
Endovascular treatment of intracranial aneurysms using a self-expanding stent (LEO®)
Die endovaskuläre Behandlung intrakranieller Aneurysmen durch Einsatz eines selbstexpandierenden Stents (LEO®)
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Autoren
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B. Kis
- Klinik für Psychiatrie, Universität Duisburg-Essen
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W. Weber
- Abteilung für Radiologie und Neuroradiologie, Alfried-Krupp-Krankenhaus, Essen
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F. Götz
- Abteilung für Neuroradiologie, Medizinische Hochschule Hannover
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H. Becker
- Abteilung für Neuroradiologie, Medizinische Hochschule Hannover
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D. Kühne
- Abteilung für Radiologie und Neuroradiologie, Alfried-Krupp-Krankenhaus, Essen
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
Text
Objective: Endovascular coil embolization of broad based saccular and fusiform intracranial aneurysms is challenging and long-term results are dissatisfying. Reconstructive treatments using stents improve occlusion rate and protect parent vessels. We evaluate safety and efficacy of a new self-expanding stent manufactured with braided nitinol wires (Leo®, Balt, Montmorency, France).
Methods: 60 saccular (sc) broad-necked intracranial aneurysms, and 13 fusiform (fu) lesions in 66 patients were treated. They were located on the internal carotid artery (24 sc, 2 fu), basilar trunk (5 sc, 5 fu), middle cerebral artery (9 sc), cavernous carotid artery (6 sc, 2 fu), basilar tip (8 sc), intracranial vertebral artery (1 sc, 4 fu), anterior cerebral artery (3 sc), anterior communicating artery (2 sc), posterior communicating artery (1 sc), and PICA (1 sc). 27 aneurysms showed recurrence after primary endovascular treatment (24) or surgery (3).
Results: Stent deployment was successful in 72 lesions, and additional coil embolization was performed in 54. Immediate complete or partial occlusion was achieved in 46 aneurysms. Follow-up (available in 52 patients and 55 aneurysms; obtained at 3-16 months; average, 5 months) revealed one asymptomatic parent vessel occlusion and one in-stent stenosis, but patent stents in the remaining cases. Minor angiographic recurrences occurred in four lesions which were easily re-treated. A permanent neurological deficit following an endovascular procedure was encountered in one case after periprocedural in-stent thrombosis. Five deaths occurred after the endovascular procedure caused by brain stem compression of the coil packet (2 sc), pneumonia (1 fu), or sequelae of acute SAH (2 fu).
Conclusions: The primary and recurrence treatment of broad-necked saccular intracranial aneurysms using the Leo® stent is feasible and effective. Short-term follow-up proved intact parent arteries and stable occlusion rates in the majority of cases. Complex and so far untreatable fusiform lesions have a treatment option by this method, but this implieds a higher periprocedural risk.
