Intra-arterial vein bypass using a vein-loaded stent system to occlude wide-necked aneurysms: an experimental study...

We treated 13 experimental wide-necked aneurysms of lateral type produced in dog carotid arteries with a vein-loaded stent system consisting of an autologous vein graft, a vein-carrier stent, and two other self-expanding Z-shaped stents. The vein-loaded stent, made by connecting the autologous vein graft to the vein-carrier stent, was implanted in the common carotid artery to seal the aneurysm's orifice, after which two booster stents were deployed. The distal stent was placed to fix the distal end of the vein graft, and the proximal stent was placed at the proximal venous portion of the vein-loaded stent to reinforce its proximal end. In this manner an intra-arterial bypass was established across the aneurysm. Of 13 aneurysms seven were completely occluded, preserving the parent artery. The remaining six procedures resulted in parent artery occlusion because of failures in stent deployment. Angiograms performed in within 1 week six successfully treated dogs revealed the parent artery to be patent in four but thrombosed in two. Histological study of successful cases showed as smooth intima with slight endothelial hypertrophy and partially organised thrombus. The intraluminal features were also observed with a vascular endoscope at the time of treatment in four dogs and at the time of follow-up angiography in two. The appearances corresponded well to the macroscopic findings in the specimens. Our vein-loaded stent system offers complete closure of the orifice, which does not occur with conventional stent placement. The method is believed to show clinical promise for treating wide-necked aneurysms not curable by embolisation of the sac.