Willis Covered Stent for Treating Intracranial Pseudoaneurysms of the Internal Carotid Artery: A Multi-Institutional Study

Lu, Dan; Ma, Tao; Zhu, Ge-Min; Zhang, Tao; Wang, Naibing; Lei, Hui; Sui, Jing; Wang, Zhiguo; He, Shiming; Chen, Lei; Deng, Jianping

doi:10.2147/ndt.s345163

Cited by 10 publications

(8 citation statements)

References 38 publications

(40 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 21 Lu et al found that the incidence of in-stent stenosis in the cavernous and clinoid segment of the ICA was relatively higher. 22 The possible reason is that this segment of the vessel was too tortuous to restrict the expansion and apposition of the stent. In this study, only 1 patient (2.8%) had mild asymptomatic in-stent stenosis, and the others had good parent artery patency.…”

Section: Discussionmentioning

confidence: 99%

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

Wu,

Wang,

Cui

et al. 2023

TCRM

View full text Add to dashboard Cite

Objective To retrospectively evaluate the efficacy and security of Willis covered stent (WCS) deployment for complex vascular diseases of the internal carotid (ICA) and vertebral (VA) arteries. Methods Retrospective analysis was performed on complex vascular disease patients (n=36) treated with WCSs at our center between March 2017 and December 2022, with a 3–36-months follow-up surveillance and digital subtraction angiography (DSA) examination. Results The WCSs were successfully deployed in all the patients. The 36 included lesions were carotid-cavernous sinus fistulas (CCFs; n=10) (27.8%), complex saccular aneurysms (n=10) (27.8%), traumatic pseudoaneurysms (n=7) (19.4%), blood blister-like aneurysms (BBAs; n=5) (13.9%), and iatrogenic carotid or vertebral artery ruptures (n=4) (11.1%). The WCS was released at the communicating segment (n=2) (5.6%), the ophthalmic segment (n=3) (8.3%), the clinoid and cavernous segment (n=28) (77.8%), the petrous segment (n=2) (5.6%) of ICA and the V3 segment (n=1) (2.8%) of VA. Postoperative DSA showed complete lesion occlusion in 26 patients (72.2%) who were immediately treated with WCSs, and endoleaks occurred in 3 patients (8.3%) (endoleaks resolved postadjustment in 7 patients (19.4%)). In patients (n=3) (8.3%) treated with double stents at the break of the ICA, the endoleak remained in 1 CCF patient (2.8%) during the 3-month follow-up, and the residual shunt disappeared after the second stent system was placed 3 months later. No aneurysm, bleeding or infarct recurrence reported, and only 1 patient (2.8%) had mild asymptomatic in-stent stenosis. Deaths and procedural complications did not occur during follow-up. Conclusion Treatment with a WCS for intracranial complex vascular diseases resulted in satisfactory clinical outcomes and appeared effective and safe. Controlled, multicenter, large sample sizes and longer follow-up periods studies are necessary.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Wu,

Wang,

Cui

et al. 2023

TCRM

View full text Add to dashboard Cite

show abstract

“…In cases with medial or full-thickness erosion involvement of the arterial wall, termed as impending CBS, we recommend covered stents insertion to achieve complete isolation of the diseased arterial wall ( 11 ). Protection of the wall is theoretically immediate and permanent by covered stents, because it provides an immediate barrier between blood flow and the diseased arterial wall.…”

Section: Discussionmentioning

confidence: 99%

“…Covered stent protection, in contrast, can provide direct and complete diseased arterial wall coverage, and is especially suitable for impending (type 2) CBS, where there is existing arterial wall invasion. However, the stiffness of covered stents designed for the application in the peripheral vessels, such as the Viabahn or Fluence covered stents, may have contributed to the failed delivery of stents to the distal-ICA reported in previous studies ( 11 ). The Willis covered stent (MicroPort, Shanghai, China), which was initially designed for cerebrovascular application ( 12 ), is safer and more efficient for distal-ICA application due to its greater flexibility and maneuverability ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

“…However, the stiffness of covered stents designed for the application in the peripheral vessels, such as the Viabahn or Fluence covered stents, may have contributed to the failed delivery of stents to the distal-ICA reported in previous studies ( 11 ). The Willis covered stent (MicroPort, Shanghai, China), which was initially designed for cerebrovascular application ( 12 ), is safer and more efficient for distal-ICA application due to its greater flexibility and maneuverability ( 11 ). However, its maximum length is only 16 mm, which is often not long enough to cover the diseased arterial segment.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Safety and efficacy of protective stent insertion to prevent carotid blowout syndrome at the distal internal carotid artery in nasopharyngeal carcinoma patients: a comparison with endovascular occlusion

Tang,

Liu,

Mao

et al. 2024

Quant Imaging Med Surg

View full text Add to dashboard Cite

Background Carotid blowout syndrome (CBS) frequently occurs at the distal internal carotid artery (distal-ICA) in patients with nasopharyngeal carcinoma (NPC), and remedial treatments run a high risk for neurologic complications. A case-control study was conducted to evaluate the safety and efficacy of protective stent insertion at the distal-ICA to prevent CBS in NPC patients, with a comparison to endovascular coil occlusion. Methods A total of 28 consecutive NPC patients at high risk of CBS from June 2019 to December 2021 in Shanghai Sixth People’s Hospital (a tertiary institution) were retrospectively included and divided into a stent protection group and occlusion group. Technique feasibility, treatment outcomes and neurological deficiency were compared between the two groups by two-sample test. Kaplan-Meier analysis compared patients’ survival rates at mid-term follow-up. Results Stent insertion was performed in 15 patients and ICA occlusion in 13 patients. The technical success rate was 100% in both groups. Procedure-related ischemic stroke was identified in 2 patients (15.4%) in the occlusion group, compared with none in the stent protection group. Bleeding was encountered in one patient in the stent protection group and one patient in the occlusion group, each. During a median follow-up of 10.5 (range, 2–31) months, 3 patients (20%) showed asymptomatic in-stent occlusion in the stent protection group. Notably, the median survival time was significantly longer in the stent protection group than in the occlusion group (23.3 vs. 15.8 months, P=0.04). Conclusions Protective stenting the distal-ICA was similarly effective in preventing CBS in NPC patients but was safer than endovascular occlusion of ICA.

show abstract

“…The Willis balloon-expandable covered stent (MicroPort, Shanghai) and a house-made self-expandable covered stent (MicroPort, Shanghai) were used to treat the experimentally-induced lesions. The Willis stent is composed of three parts: expandable PTFE (ePTFE) membrane, a bare cobalt-chrome stent, and a balloon catheter 6 , 9 , 21 . The self-expandable covered stent was made from ePTFE membrane, a bare nitinol stent, and a microcatheter for delivery.…”

Section: Methodsmentioning

confidence: 99%

Endothelialization of PTFE-covered stents for aneurysms and arteriovenous fistulas created in canine carotid arteries

Yang,

Hao,

Gao

et al. 2024

Sci Rep

View full text Add to dashboard Cite

To investigate the endothelialization of covered and bare stents deployed in the canine carotid arteries and subclavian arteries for treating experimental aneurysms and arteriovenous fistulas, twenty aneurysms were created in 10 dogs, and 20 fistulas in another 10 dogs. The Willis balloon-expandable covered stent and a self-expandable covered stent were used to treat these lesions, and a self-expandable bare stent was deployed in the subclavian artery for comparison. Followed up for up to 12 months, the gross observation, pathological staining, and scanning electronic microscopic data were analyzed. Two weeks after creation of animal model, thirty self-expandable covered stents and ten balloon-expandable covered stents were deployed. Fifteen bare stents were deployed within the left subclavian arteries. Twenty days after stenting, the aneurysm significantly shrank. At 6 months, the thrombi within the aneurysm cavity were organized. Three to 12 months later, most covered and bare stents were covered by a thin transparent or white layer of endothelial intima. Layers of intima or pseudomembrane were formed on the stent 20–40 days after stent deployment. Over three months, the pseudomembrane became organized, thinner, and merged into the vascular wall. Under scanning electronic microscopy, the surface of covered and bare stents had only deposition of collagen fibers and rare endothelial cells 20–40 days after stenting. From three to ten months, the endothelial cells on the internal surface of stent became mature, with spindle, stripe-like or quasi round morphology along the blood flow direction. Over time, the endothelial cells became mature. In conclusion, three months after deployment in canines’ arteries, the self-expandable bare and covered stents have mostly been covered by endothelial cells which become maturer over time, whereas the balloon-expandable covered stents do not have complete coverage of endothelial cells at three months, especially for protruding stent struts and areas. Over time, the endothelialization will become mature.

show abstract

Willis Covered Stent for Treating Intracranial Pseudoaneurysms of the Internal Carotid Artery: A Multi-Institutional Study

Cited by 10 publications

References 38 publications

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

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

Safety and efficacy of protective stent insertion to prevent carotid blowout syndrome at the distal internal carotid artery in nasopharyngeal carcinoma patients: a comparison with endovascular occlusion

Endothelialization of PTFE-covered stents for aneurysms and arteriovenous fistulas created in canine carotid arteries

Contact Info

Product

Resources

About