The Use of Flow-Diverting Stents in the Treatment of Giant Cerebral Aneurysms: Preliminary Results

Abstract

The treatment of giant cerebral aneurysms has always been a challenge for neurosurgeons and neuroradiologists. Flow-diverting stents (Silk; Pipeline Embolization Device) are new endovascular devices introduced for the treatment of intracranial aneurysms without release of intrasaccular coils. They are tubular bimetallic endoluminal devices with low porosity. We have employed these stents in the Neuroradiology Unit of Bellaria Hospital (Bologna, Italy) since the end of 2008, treating nine patients with giant carotid cerebral aneurysms using nine Silk stents as soon as the device obtained the CE mark. All patients were pretreated with dual antiplatelet medications before surgery. The Silk stents were deployed through a 4F Balt introducer, which ensured an uneventful and very quick procedure. Control CT angiography or MR angiography was typically performed at discharge and one, three, six and 12 months after treatment. Post-treatment results were: four complete occlusions, three near complete occlusions (residual neck flow) with reduced volume of the aneurysm and two more than 50% reduction of intra-aneurysmal flow. A fatal hemorrhagic complication occurred in one patient, probably due to the antiplatelet treatment. The Silk stent seems a very interesting curative device to treat giant aneurysms with preservation of the parent artery and small adjacent branches. Technical improvements will certainly reduce the thrombogenic effect with the related risks.

International Retrospective Study of the Pipeline Embolization Device: A Multicenter Aneurysm Treatment Study

“…[1][2][3][4] High rates of complete aneurysm occlusion have been reported, even in large and giant aneurysms, with the use of endoluminal flow diverters. [1][2][3][4][5][6][7] The Pipeline Embolization Device (PED; Covidien, Irvine, California) received CE mark approval in 2008 for the embolization of cerebral aneurysms and received US FDA approval in 2011 (PMA P100018) for the treatment of large and giant wideneck aneurysms in the internal carotid artery, from the petrous to the superior hypophyseal segments. While numerous previous studies have reported overall rates of adverse events similar to those in other endovascular procedures, case reports and small case series documenting severe and "unexpected" complications have raised questions about the safety of these devices.…”

Complications in the Treatment of Intracranial Aneurysms with Silk Stents: An Analysis of 30 Consecutive Patients

“…our cohort has already been described in detail 6,18 . Briefly, between december 2007 and december 2010 we treated 29 unruptured aneurysms and one blister-like aneurysm 30 days after SAH deploying a Silk stent to cover the aneurysm neck.…”

“…We always managed to reach the position for stent deployment without encountering differences in the stability of the system or vessel wall injury between the vASCO 21 microcatheter (calibre 0.0021") and the vASCO 25 (calibre 0.0025") 6,18 .…”

“…The first literature reports on single and multiple centre trials on the use of fd stents to treat wide-neck (large and giant) and/or fusiform aneurysms are promising 4,6,8,9,11,12,[18][19][20][21]29 . good results have also been published recently on the use of fd stents to treat very small aneurysms (<5 mm) 17 .…”

Ocular Thrombosis after Stent-Assisted Coiling of a C7 (Paraclinoid) Internal Carotid Artery Aneurysm

“…Occlusion of large side branches by stent placement has not been reported to the best of our knowledge. Furthermore, immediate or delayed occlusion of the ophthalmic artery or important side branches is rarely reported even when using a high surface coverage flow diverter stent in the paraclinoid carotid artery 6,7 . Although this mechanism seems unlikely, we could not deny the possibility of branch occlusion because of lack of angiographic study at the occurrence of the symptom.…”