Use of covered stents to treat complex cerebrovascular diseases: Expert consensus

Abstract

The treatment of complex cerebrovascular diseases (CCVDs) at the skull base, such as complex intracranial aneurysms, carotid-cavernous sinus fistulas, and intracranial artery traumatic injuries, is a difficult clinical problem despite advances in endovascular and surgical therapies. Covered stents or stent graft insertion is a new concept for endovascular treatment that focuses on arterial wall defect reconstruction, differing from endovascular lesion embolization or flow diverter therapies. In recent years, covered stents specifically designed for cerebrovascular treatment have been applied in the clinical setting, allowing thousands of patients with CCVDs to undergo intraluminal reconstruction treatment and achieving positive results, even in the era of flow diverters. Since there is no unified reference standard for the application of covered stents for treating CCVDs, it is necessary to further standardize and guide the clinical application of this technique. Thus, we organized authoritative experts in the field of neurointervention in China to write an expert consensus, which aims to summarize the results of covered stent insertion in the treatment of CCVDs and propose suitable standards for its application in the clinical setting. Based on the contents of this consensus, clinicians can use individualized intraluminal reconstruction treatment techniques for patients with CCVDs.

Application of the Willis Covered Stent in the Treatment of Complex Vascular Diseases of the Internal Carotid Artery and Vertebral Artery: A Retrospective Single-Center Experience

“… 5 However, they have some serious drawbacks, including a high relapse rate and an obvious mass impact. 2 , 6 The WCS implantation was first reported by Li et al 7 and has been considered one of the most promising methods since 2006. The WCS implantation is the perfect treatment for aneurysms or carotid arteriovenous fistulas.…”

“…As a balloon-expandable stent comprising bare metal stent, balloon catheter and expandable polytetrafluoroethylene (ePTFE) membrane, the WCS instantly isolates the aneurysm from the intracranial circulation, restores the artery wall and reduces the mass effect while maintaining the patency of the parent artery. 2 Despite these advantages, currently available data are based on small-sized case reports and single-center experiences, as such cases are extremely scarce. In this study, we report our experience and the efficacy and safety of WCS implantation by retrospectively analyzing 36 patients with ICA and VA lesions treated with this stent at our institution.…”

Deep learning-based 3D cerebrovascular segmentation workflow on bright and black blood sequences magnetic resonance angiography

“…3D reconstructions complement the interpretations of radiologists, and segmentation allows automated image analysis pipelines to be used. This enables doctors to directly observe lesions and vascular conditions and has numerous clinical applications such as identifying blood flow behavior, detecting tumors [8], aiding neurosurgical navigation [9], and designing and implementing cerebral vascular scaffolds [10]. Vascular diseases, particularly in the middle cerebral artery (MCA) and LSA, play a significant role in dementia, being major causes of Alzheimer's disease [11].…”

Electrospun Polycaprolactone/Polyvinylidene Fluoride Composite Nanofibers for Fabricating Artificial Conduits for Ureteral Stricture Treatment

“…Though the bare metal stent, which consists of a metal mesh structure, is the most basic structure, it is a structure in which foreign substances easily accumulate, and a restenosis problem may occur in which tissue in contact grows into the inside. − For this reason, stent products are mainly coated stents. Silicone or e-PTFE is mainly used as the stent coating material, while polymer stents or drug-coated stents are also available. , However, each type of covered stent has its own problems. − …”

“…Silicone or e-PTFE is mainly used as the stent coating material, while polymer stents or drug-coated stents are also available. 6,7 However, each type of covered stent has its own problems. 8−11 Electrospinning is a technique that uses an electric field to produce fibers from a polymer solution.…”