Stent-assisted reconstructive endovascular repair of cranial fusiform atherosclerotic and dissecting aneurysms: Long-term clinical and angiographic follow-up

Ajay K. Wakhloo, Jake Mandell, Matthew J. Gounis, Christopher Brooks, Italo Linfante, Jesse Winer, John P. Weaver

Research output: Contribution to journalArticlepeer-review

131 Scopus citations

Abstract

Background and Purpose: The purpose of this study was to investigate the periprocedural morbidity, mortality, and long-term clinical and angiographic follow-up using stent-assisted coiling and stenting alone for treatment of cranial fusiform dissecting and atherosclerotic aneurysms. Methods: The Institutional Review Board approved the study. A retrospective analysis was performed of 30 fusiform dissecting and atherosclerotic aneurysms treated in 28 patients (20 females; mean age, 52.6 years). Eleven aneurysms (37%) were located in the posterior circulation. Twenty-one (70%) originated from arterial dissection and 4 aneurysms (13%) presented with subarachnoid bleeding. Twenty-four (80%) aneurysms were treated with stents and coils, whereas 6 (20%) were treated with stents alone. Results: Immediate postprocedural angiograms in 24 aneurysms treated with stent-assisted coiling showed complete occlusion in 12 and subtotal occlusion in 11 aneurysms, whereas no occlusion was seen in one aneurysm and in all 6 aneurysms treated with stents alone. A clinical improvement or stable outcome was achieved in 25 patients (89%). The 2 cases of permanent morbidity included a patient with a finger dysesthesia associated with a perforator stroke and another patient with hemiparesis and aphasia due to a delayed in-stent thrombosis. One patient died after treatment of a giant vertebrobasilar junction aneurysm. Angiographic follow-up was available in 23 of the 27 surviving patients (85%) at a mean of 16.2 months (range, 1 to 108 months). Recanalization in 4 patients (17%) at 3, 5, 24, and 36 months required retreatment in 3. In-stent stenosis of ≤50% was found in 3 patients. Conclusion: Stent-assisted coil embolization is an attractive option for ruptured and nonruptured fusiform aneurysms with stable long-term outcome. However, recanalization observed up to 3 years after the initial obliteration emphasizes the need for long-term follow-up angiography.

Original languageEnglish (US)
Pages (from-to)3288-3296
Number of pages9
JournalStroke
Volume39
Issue number12
DOIs
StatePublished - Dec 1 2008
Externally publishedYes

Keywords

  • Dissecting aneurysm
  • Fusiform aneurysms
  • Intracranial aneurysms
  • New endovascular techniques
  • Pseudoaneurysms
  • Stent-assisted coiling
  • Stents

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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