Article
Treatment of intracranial aneurysms by flow-modifying stents and stent-assisted coil-embolisation: a single center's retrospective 10-year analysis
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Published: | May 13, 2014 |
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Objective: Presentation of our experience in the treatment of intracranial aneurysms by stent implantation and stent-assisted coil embolisation.
Method: Retrospective analysis of intracranial aneurysm patients, endovascularly treated between 2003 and 2013 by flow modification (stents, flow diverting stents and stent-assisted coil embolization). Configuration, size, location of the aneurysm and clinical data were collected. The follow-up analysis of the occlusion rates was evaluated by angiography, CTA, MRA according to the Raymond classification. The clinical neurological outcome was assessed using the modified Rankin Scale.
Results: Between May 2003 and July 2013, a total of 156 endovascular stent treatments of 147 patients (111 women, 36 men) with a mean age of 53.4 years (range 24–82 J), were performed at our department. 72,1% (n=116) of all aneurysms were located in the anterior, 27,9% (n=43) in the posterior circulation. Incidental aneurysms represented 69% (n=108), multiple (≥2) aneurysms 25% (n=40) of all cases. A bleeding history (rupture or St.p. SAH) was documented in 24,5% (n=6). Stent-assisted coiling was performed in 96 cases, of which 51 procedures happened two-staged. 23 flow diverters were implanted. 16 stent-alone procedures were documented. Raymond I+II occlusion rates were achieved in 86,2% of cases.
2 serious complications (mRS 6, rebleeding after stent implantation) were documented, a third patient died of pulmonary embolism. 135 patients had satisfactory neurological outcomes of mRS ≤2
Conclusions: The long-term follow-up data of our series show satisfactory progressive thrombosis and occlusion rates of stent and stent-assisted treatment of complex intracranial aneurysms. This endovascular treatment has been established as a low morbidity treatment option of complex, wide-necked aneurysms and is increasingly performed in proximal and difficult to reach aneurysms (ACI, A. vertebral, Basilar A.).
Indication, treatment success, long-term follow-up as well as pitfalls (complications) of the past 10 years are presented.