ABSTRACT
PURPOSE: In the treatment of wide-necked aneurysms, stenting may be required after balloon-assisted coiling (BAC) for reconstructing the lumen/flow of the parent artery in cases of coil herniation. The potential benefits and complications of both techniques remain unclear when used together. Our aim was to assess the safety and long-term angiographic outcomes of stenting after BAC. METHODS: Retrospective review of 87 unruptured wide necked aneurysms (in 80 patients) treated with BAC and requiring stent placement at the final stage of the procedure due to coil prolapse. Aneurysm characteristics, technical issues, clinical records, and MR results were assessed. Post-treatment and follow-up angiograms were evaluated by two independent reviewers and categorized as "stable," "further thrombosis," or "recanalization." RESULTS: The mean maximum diameter was 9.1 ± 4.7 mm and aspect ratio 1.20 ± 0.47. Complete and near-complete initial occlusion were observed in 53 (60.9%) and 28 (32.2%) of all treated aneurysms, respectively. Angiographic follow-up (80 aneurysms; mean, 34.68 ± 25.26 months) revealed stability and further thrombosis in 92.4% (74/80). Recanalization was observed in six cases (7.5%, 6/83), four of which were retreated. No significantly different outcomes were found in terms of aneurysm size (p = 0.641). Transient and reversible procedure-related complications occurred in eight (9.2%), minor permanent deficits in 2.3%, and major deficits, including death, in four cases (4.6%). CONCLUSION: Our results suggest that treatment of wide-necked aneuryms with stent placement after BAC yields low recanalization rates and enhanced angiographic outcomes in long-term follow-up.
Subject(s)
Embolization, Therapeutic/methods , Intracranial Aneurysm/therapy , Stents , Adult , Aged , Aged, 80 and over , Angiography, Digital Subtraction , Cerebral Angiography , Contrast Media , Female , Humans , Intracranial Aneurysm/diagnostic imaging , Magnetic Resonance Imaging , Male , Middle Aged , Recurrence , Retreatment , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Standard therapy for acute ischaemic stroke is the intravenous thrombolysis with rtPA. A combined therapy with intravenous bridging and consecutive intraarterial thrombolysis and mechanical thrombectomy is a relatively new option in patients with proximal vessel occlusion. PATIENTS AND METHODS: 10 Patients with a CTA proven proximal vessel occlusion in the anterior circulation (ACI, carotis bifurcation, MCA) in CTA were treated with a combined therapy with i. v. and i. a. thrombolysis and thrombectomy with a Solitaire FR stent device. RESULTS: All Patients were recanalized, the NIHSS changed from 15.6 to 3.3. 8 out of 10 patients had nearly no symptoms when dismissed. There were no direct therapeutic complications. CONCLUSION: Combined therapy with i. v. and i. a. thrombolysis and thombectomy with the Solitaire FR stent device is a promising option in patients with acute proximal vessel occlusion in the anterior circulation.
Subject(s)
Brain Ischemia/therapy , Fibrinolytic Agents/administration & dosage , Fibrinolytic Agents/therapeutic use , Stroke/therapy , Thrombectomy , Thrombolytic Therapy/methods , Acute Disease , Adult , Aged , Aspirin/therapeutic use , Brain Ischemia/complications , Carotid Artery Diseases/drug therapy , Carotid Artery Diseases/therapy , Cerebral Angiography , Female , Humans , Infarction, Middle Cerebral Artery/drug therapy , Infarction, Middle Cerebral Artery/therapy , Injections, Intra-Arterial , Injections, Intravenous , Magnetic Resonance Angiography , Male , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Stents , Stroke/etiology , Tissue Plasminogen Activator/administration & dosage , Tissue Plasminogen Activator/therapeutic useSubject(s)
Device Removal/instrumentation , Device Removal/methods , Embolization, Therapeutic/adverse effects , Embolization, Therapeutic/instrumentation , Foreign-Body Migration/etiology , Foreign-Body Migration/surgery , Stents , Blood Vessel Prosthesis , Female , Humans , Middle Aged , Treatment OutcomeABSTRACT
Basilar artery "fenestration" is the result of a failed fusion of the bilateral longitudinal neural arteries and can be associated with a saccular aneurysm, which typically arises at the proximal juncture of the unfused segment. "Kissing" aneurysms at this site, i.e. two aneurysms arising from the proximal junction of the unfused segment of the basilar artery pointing anteriorly and posteriorly are reported to be exceedingly rare. We present three patients with this rare condition, all of them being treated by endovascular techniques.