Clinical Study Of Neuroform-stents For Treatment Of Wide—necked Cerebral Aneurysms

Objective Coiling associated with placement of self-expandable intracranial stents has amplified the treatment of intracranial wide-necked aneurysms, The purpose of this report is to present our experience with the Neuroform Stent associated with coiling and to evaluate complications, effectiveness, and results of this technique。Methods Twenty patients with wide-necked intracranial aneurysms were treated by endovascular embolization with stent-assisted coils.The aneurysms located at the anterior communicating artery(n=4),the posterior communicating artery(n=11),the vertebral artery(n=2),the superior segment of basilar artery(n=1), the C2 segment of internal carotid artery(n=1), the crotch of middle cerebral artery(n=1) .All these aneurysms are wide-necked or no-necked.The stent size was determined according to the aneurysmal neck size and the largest diameter of the parent artery. the stent delivery system was introduced over the microguidewire. At the appropriate location for sufficient coverage of the aneurysmal neck, the stent was gently deployed。12 aneurysms were primarily stented, followed by coil placement。In the other cases, the microcatheter was introduced into the aneurysm first with or without coil embolzation,then the stent implanted was carried and the coil embolzation was continued until total occlusionResults In all patients but one , we were capable of navigating the microdelivery systems through the tortuous vessels without difficulty. The stent was able to be deployed at the aimed location without stent displacement or dislodgement. In one case , the first stent did not reach the desired location due to severe tortuosity of the cervical internal carotid artery ,fortunately,we successfully deployed the second stend on the desired location. Microcatheter selection of the aneurismal sac failed in one patient , who had a small aneurysm on the C2 segment of the internal carotid artery with an acute angle with the parent artery. For this patient, endovascular treatment was terminated without any further attempt.。Thromboembolic events were observed in one case of ACA aneurysm during the procedure , in whom the stent was deployed to reduce coil loop protrusion. However, after thrombolysis with intra-arterial urokinase\, the patency of the parent artery was preserved. The patient had no complication related to the thrmobolytic . In one case ,stenting for the aneurysms was performed as a rescue procedure to confine the migration of previously placed coils witch prolapsed in the parent artery. There was no devastating event such as aneurysmal perforation or vessel rupture during endovascular treatment in all patients. In the final DSAs of the patients who underwent coiling either before or after stent deployment, Complete occlusion was obtained in 12 aneurysms, nearly complete occlusion (95% or more occluded) in 5 aneurysms, and partial occlusion (less than 95% occluded) in 3 aneurysm. Clinical and angiographic follow-up was available in 12 patients during the time ranged from 3 to 6 months。No delayed recanalization or regrowth was observed in complete occlusion cases of 8 patients. During the follow-up period, there were no hemorrhagic events, no delayed thrombosis, and no stent displacement.Conclusion In conclusion, deploying a stent in the intracranial vessels may cause technical and prognostic problems. However, it plays an undeniably important role in dealing with wide-necked aneurysms. To overcome the technical limitations in the coiling of wide-necked aneurysms, stent-assisted coil embolization may be a technically feasible and relatively safe method, but the durability of this treatment and the existence of delayed recurrence are not yet well known. though longer periods of follow-up are required.。...