Use of self-expanding stents in distal small cerebral vessels

Previously, endovascular treatment of wide-necked aneurysms and stenosis involving small vessels measuring <2 mm in diameter was limited. There are no reports in the literature addressing stent placement in small distal cerebral vessels. Recent experience with the Neuroform stent has shown that this device can be safely and effectively used to treat aneurysms in vessels of this caliber.

We report 8 cases of Neuroform stent placement into cerebral vessels measuring <2 mm in diameter (range, 1.1-1.8 mm). All stents were placed for aneurysm treatment in conjunction with coiling. Lesion locations and number were as follows: anterior communicating artery region (n = 5), pericallosal artery A2-A3 (n = 1), middle cerebral artery (MCA) M1-M2 (n = 1), and MCA M3-M4 (n = 1). Clinical follow-up ranged from 4.5 to 18 months. Imaging follow-up was performed with MR imaging/MR angiography.

All procedures were successfully performed without immediate or delayed device-related complications. Intraprocedural thrombus developed within the stent in 2 patients and immediately resolved with 10 mg of intra-arterial abciximab. Follow-up at 18 months demonstrated durable results. There were no clinical neurologic symptoms related to the treated vessel territory at follow-up.

Development of newer low-profile endovascular devices allows access and ability to treat lesions farther out in the smaller cerebral vessels. We have safely and successfully treated 8 vessels smaller than 2 mm in diameter with newer self-expanding stents with good short- and intermediate-term results. Further follow-up and more experience are necessary to determine long-term results.