دورية أكاديمية
Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms.
| العنوان: | Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms. |
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| المؤلفون: | Lanzino G; Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, USA., Wakhloo AK, Fessler RD, Hartney ML, Guterman LR, Hopkins LN |
| المصدر: | Journal of neurosurgery [J Neurosurg] 1999 Oct; Vol. 91 (4), pp. 538-46. |
| نوع المنشور: | Case Reports; Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Association of Neurological Surgeons Country of Publication: United States NLM ID: 0253357 Publication Model: Print Cited Medium: Print ISSN: 0022-3085 (Print) Linking ISSN: 00223085 NLM ISO Abbreviation: J Neurosurg Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Charlottesville, VA : American Association of Neurological Surgeons Original Publication: Chicago [etc.] |
| مواضيع طبية MeSH: | Basilar Artery/*surgery , Carotid Artery, Internal/*surgery , Intracranial Aneurysm/*surgery , Stents/*standards , Vertebral Artery/*surgery, Adult ; Angiography, Digital Subtraction ; Basilar Artery/diagnostic imaging ; Carotid Artery, Internal/diagnostic imaging ; Female ; Humans ; Intracranial Aneurysm/diagnostic imaging ; Male ; Middle Aged ; Postoperative Period ; Treatment Outcome ; Vertebral Artery/diagnostic imaging |
| مستخلص: | Object: Results of previous in vitro and in vivo experimental studies have suggested that placement of a porous stent within the parent artery across the aneurysm neck may hemodynamically uncouple the aneurysm from the parent vessel, leading to thrombosis of the aneurysm. For complex wide-necked aneurysms, a stent may also aid packing of the aneurysm with Guglielmi detachable coils (GDCs) by acting as a rigid scaffold that prevents coil herniation into the parent vessel. Recently, improved stent system delivery technology has allowed access to the tortuous vascular segments of the intracranial system. The authors report here on the use of intracranial stents to treat aneurysms involving different segments of the internal carotid artery (ICA), the vertebral artery (VA), and the basilar artery (BA). Methods: Ten patients with intracranial aneurysms located at ICA segments (one petrous, two cavernous, and three paraclinoid aneurysms), the VA proximal to the posterior inferior cerebellar artery origin (one aneurysm), or the BA trunk (three aneurysms) were treated since January 1998. In eight patients, stent placement across the aneurysm neck was followed (immediately in four patients and at a separate procedure in the remaining four) by coil placement in the aneurysm, accomplished via a microcatheter through the stent mesh. In two patients, wide-necked aneurysms (one partially thrombosed BA trunk aneurysm and one paraclinoid segment aneurysm) were treated solely by stent placement; coil placement may follow later if necessary. No permanent periprocedural complications occurred and, at follow-up examination, no patient was found to have suffered symptoms referable to aneurysm growth or thromboembolic complications. Greater than 90% aneurysm occlusion was achieved in the eight patients treated by stent and coil placement as demonstrated on immediate postprocedural angiograms. Follow-up angiographic studies performed in six patients at least 3 months later (range 3-14 months) revealed only one incident of in-stent stenosis. In the four patients originally treated solely by stent placement, no evidence of aneurysm thrombosis was observed either immediately postprocedure or on follow-up angiographic studies performed 24 hours (two patients), 48 hours, and 3 months later, respectively. Conclusions: A new generation of flexible stents can be used to treat complex aneurysms in difficult-to-access areas such as the proximal intracranial segments of the ICA, the VA, or the BA trunk. The stent allows tight coil packing even in the presence of a wide-necked, irregularly shaped aneurysm and may provide an endoluminal matrix for endothelial growth. Although convincing experimental evidence suggests that stent placement across the aneurysm neck may by itself promote intraluminal thrombosis, the role of this phenomenon in clinical practice may be limited at present by the high porosity of currently available stents. |
| تواريخ الأحداث: | Date Created: 19991003 Date Completed: 19991014 Latest Revision: 20220410 |
| رمز التحديث: | 20240627 |
| DOI: | 10.3171/jns.1999.91.4.0538 |
| PMID: | 10507372 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 0022-3085 |
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| DOI: | 10.3171/jns.1999.91.4.0538 |